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Toxicity due to heavy metals (HM), specifically mercury (Hg), arsenic (As), lead (Pb), and cadmium (Cd) remains a challenge to scientists till date. This review gives insights into natural antidotes for the management and prevention of HM toxicity. Various databases such as PubMed, Embase, and Science Direct were searched for available facts on natural antidotes and their commercial products against HM toxicity till date. Toxicity owing to such metals needs prevention rather than therapy. Natural antidotes, fruits and vegetables, rich in antioxidant are the answers to such toxicities. Synthetic chelators impart a major drawback of removing essential metals required for normal body function, along with the toxic one. Natural antioxidants are bestowed with scavenging and chelation properties and can be alternative for synthetic chelating agents. Natural compounds are abundantly available, economic, and have minimal side effects when compared with classical chelators. Prevention is better than cure and thus adding plentiful vegetables and fruits to our diet can combat HM toxicity-related illness. Graphical abstract.

The pandemic of coronavirus infection 2019 (COVID-19) due to the serious respiratory condition created by the coronavirus 2 (SARS-CoV-2) presents a challenge to recognize effective strategies for management and treatment. In general, COVID-19 is an acute disease that can also be fatal, with an ongoing 10.2% case morbidity rate. Extreme illness may bring about death because of enormous alveolar damage and hemorrhage along with progressive respiratory failure. The rapidly expanding information with respect to SARS-CoV-2 research suggests a substantial number of potential drug targets. The most encouraging treatment to date is suggested to be with the help of remdesivir, hydroxychloroquine, and many such repurposed drugs. Remdesivir has a strong in vitro activity for SARS-CoV-2, yet it is not the drug of choice as affirmed by the US Food and Drug Administration and presently is being tried in progressing randomized preliminaries. The COVID-19 pandemic has been the worst worldwide general health emergency of this age and, possibly, since the pandemic influenza outbreak of 1918. The speed and volume of clinical preliminaries propelled to examine potential treatments for COVID-19 feature both the need and capacity to create abundant evidence even in the center of a pandemic. No treatments have been demonstrated as accurate and dependable to date. This review presents a concise precise of the targets and broad treatment strategies for the benefit of researchers.

The present investigation deals with solubility enhancement of Etodolac (ETD) through co-crystals technique utilizing various co-formers and to evaluate their therapeutic efficacy against carrageenan-induced inflammation. Co-formers citric acid anhydrous and tartaric acid were selected to formulate ETD co-crystals to improve solubility and dissolution employing neat grinding technique. The prepared co-crystals were characterized for solubility enhancement, Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), in vitro dissolution and stability studies. The co-crystals were further investigated for in vivo studies to assess their potential to cure paw edema in mice. The outcome of the study illustrated significantly improved solubility and dissolution of ETD up to 6.15 folds using citric acid. Approximately a two-fold reduction in nitric oxide and cytokines levels was observed with optimized formulation. Also, substantial inhibition of inflammation was observed in paw edema induced animals. In sight of the above results the co-crystal approach could be an alternative for enhanced therapeutic potential.

Graphical abstract, Highlights • Biogenic synthesized gold nanoparticles (AuNPs) falls in the range of 4−10 nm of spherical in shape. • AuNPs exhibited anticancer potential against the various studied breast cancer cell lines. • Flow cytometry analysis revealed that increasing dosage of AuNPs can induce apoptosis in cancer cells but PBMC remains unaffected. • Also, Biogenic synthesized gold nanoparticles inhibit colony formation units as the dose increases., With the advancement of nanotechnology, the nano-sized particles make an imprint on our daily lives.The present investigation revealed that biomolecules present in seed exudates of Vigna radiata are responsible for the synthesis of AuNPs, confirmed by the routine characterization techniques. Anticancer efficacy showed by AuNPs might be due to the release of phytochemicals in the exudate which is being adsorbed on the surface of AuNPs referencing their anticancer efficacy against the tested breast cancer cell lines. Inhibition of clonogenicity and cell cycle arrest at G2/M phase then apoptosis of AuNPs was also observed, but found nontoxic to the human PBMC cells which further confirms its biocompatible property Among the various physicochemical study, present AuNPs shows unique information, they show photoluminescent property which may be used for bioimaging purposes. However, further molecular analysis needs to be explored to understand the underlying mechanism for therapeutic and biomedical application.

Nanoparticles (NPs) as nanocarriers have emerged as novel and promising theranostic agents. The term theranostics revealed the properties of NPs capable of diagnosing the disease at an early stage and/or treating the disease. Such NPs are usually developed employing a surface engineering approach. The theranostic agents comprise NPs loaded with a drug/diagnostic agent that delivers it precisely to the target site. Theranostics is a field with promising results in enhancing therapeutic efficacy facilitated through higher payload at the targeted tissue, reduced dose, and dose-dependent side effects. However, controversies in terms of toxicity and size-dependent properties have often surfaced for NPs. Thus, a stringent in-vitro and in-vivo evaluation is required to develop safe and non-toxic NPs as theranostic agents. The review also focuses on the various entry points of NPs in the human system and their outcomes, including toxicity. It elaborates the evaluation criteria to ensure the safe use of NPs for diagnostic and therapeutic purposes.

The present study is aimed at formulating Genipin crossed curcumin loaded sericin NPs (Cur-SNPs) for the biomedical application in terms of anti-inflammatory and antioxidant potential. Cur-SNPs were prepared by employing modified desolvation method and crosslinking using genipin (Gn) and optimization for particle size, drug entrapment and loading. The optimized curcumin loaded sericin NPs (Opt-Cur-SNPs) exhibited particle size (263±3.5 nm), entrapment efficiency (85.7 ± 1.20%), drug loading (47.0 ± 1.23%) and zeta potential (-25.65 mV). The in-vitro drug release data revealed that 72.0 ± 2.3% and 83.1 ± 1.0% curcumin release over a span of 60 h in simulated gastric fluid and colonic pH. In-vivo antioxidant activity and anti-inflammatory activity showed significant results (p

Breast cancer is one of the epidemic threats among different cancers in women and technologically advanced approaches have been attempted to overcome breast cancer. Despite conventional therapies being effective, there are several shortcomings, such as undesirable side effects, problems in the bioavailability of some drugs, due to which several advancements have been endeavored for curing breast cancer. Nano-based advanced drug delivery systems possess tumor targeting ability, reduced side effects, high bioavailability, and controlled release of a drug, and thus, became a research hotspot for breast cancer too. Apart from the nano-based delivery system, micro-based delivery system, transdermal patches, microneedles have similarly been well-thought-out strategies. To enhance targeting, some tactics such as surface ligand attachment and use of stimuli-responsive materials have shown promises. This chapter discusses various such advanced delivery systems and briefs about various strategies to deliver anti-breast cancer drugs specifically to breast cancer.

Context: Gout is a painful disorder which does not have an efficient delivery system for its treatment. Objective: Development and in vitro, in vivo evaluation of allopurinol-loaded nonionic surfactant-based niosomes was envisaged. Materials and methods: Niosomes were prepared with Span 20 and Tween 20 (1:1 molar ratio) using ether injection method. The formulations were screened for entrapment efficiency, particle size analysis, zeta potential, release kinetics, in vivo activity, and stability studies. Result: Stable, spherical vesicles of average particle size 304 nm with zeta-potential and entrapment efficiency of 22.2 mV and 79.44 ± 0.02%, respectively, were produced. In vitro release study revealed 82.16 ± 0.04% release of allopurinol within 24 h. The niosomal formulation was further evaluated for its antigout potential in monosodium urate (MSU) crystal induced gout animal model. The formulation demonstrated significant uric acid level reduction and enhanced antigout activity when compared with the pure allopurinol. Discussion: The better antigout activity displayed by niosomal formulation could be attributed to sustained release of drug, higher drug solubility within biological fluids, better membrane interaction, smaller size, and presence of cholesterol and surfactant. Conclusions: This study reveals that niosomes can be an efficient delivery system for the treatment of gout.

OBJECTIVE:We examined the incremental cost-effectiveness between two mHealth programs, implemented from 2011 to 2015 in rural Bangladesh: (1) Comprehensive mCARE package as an intervention group and (2) Basic mCARE package as a control group. METHODS:Both programs included a core package of census enumeration and pregnancy surveillance provided by an established cadre of digitally enabled community health workers (CHWs). In the comprehensive mCARE package, short message service (SMS) and home visit reminders were additionally sent to pregnant women (n = 610) and CHWs (n = 70) to promote the pregnant women's care-seeking of essential maternal and newborn care services. Economic costs were assessed from a program perspective inclusive of development, start-up, and implementation phases. Effects were calculated as disability adjusted life years (DALYs) and the number of newborn deaths averted. For comparative purposes, we normalized our evaluation to estimate total costs and total newborn deaths averted per 1 million people in a community for both groups. Uncertainty was assessed using probabilistic sensitivity analyses with Monte Carlo simulation. RESULTS:The addition of SMS and home visit reminders based on a mobile phone-facilitated pregnancy surveillance system was highly cost effective at a cost per DALY averted of $31 (95% uncertainty range: $19-81). The comprehensive mCARE program had at least 88% probability of being highly cost-effective as compared to the basic mCARE program based on the threshold of Bangladesh's GDP per capita. CONCLUSION:mHealth strategies such as SMS and home visit reminders on a well-established pregnancy surveillance system may improve service utilization and program cost-effectiveness in low-resource settings.

Glutathione is a potential antioxidant and its reduced form (GSH) has a good skin-whitening effect in humans through its tyrosinase inhibitory activity. Many physicians consider it as a Wonder drug for skin lightening and treatment of hyperpigmentation, especially with darker skin tones. Glutathione is available in topical, oral and injectable formulations. Topical and oral forms are considered to be safe. Intravenous form did not prove its safety and efficacy to till date. In this article, we shall review and discuss the current status of glutathione as a skin lightening agent and address the miscellaneous unanswered queries regarding the dosage, duration of use and longevity of accrued effects based on clinical evidence and recent insights into its antimelanogenic mechanism.

The present-day cosmetologists, in addition to conventional skin physicians, are also cosmetologists and minor skin surgeons in their practice. The cosmetic procedures have the risk of legal problems leaving an unsatisfied patient and troublesome law. One should have safe practice of cosmetology and possible complications and how to overcome these complications after cosmetology procedure. Doctor should know the routine precautions which help him to avoid unnecessary calls by the court.

Dermaroller is a novel therapeutic modality in dermatology. Through physical trauma from needle penetration, dermaroller induces a wound healing cascade with mild temporary damage to the epidermis. This allows for the enhancement in the absorption of topical therapies across the thick stratum corneum. Dermaroller has become increasingly utilized over the last several years as it is a relatively simple procedure that is cost effective, well tolerated and offers cosmetic and therapeutic benefits. The ability to treat localized areas of disease made it popular in acne scars, alopecia, striae, melasma, actinic keratoses. The procedure has few adverse sequelae compared to other therapies, is highly effective and a viable resurfacing option for color of skin.

Platelet rich plasma (PRP) therapies in medicine has become increasing popular during the last decade. The interest in in the application of PRP in dermatology and cosmetology has increased recently in different applications such as alopecia, skin rejuvenation, wound healing, scar revision, and tissue regeneration. PRP is an autologous blood product obtained from the blood of the patients. The detailed knowledge about PRP should help clinicians better understand this therapy. In this view, the current review was done for a better understanding of what pathologies can be corrected with PRP.

Immunocompromised patients are at more risk in developing fungal infections particularly with Candida and Aspergillus species being the mycoses most commonly identified. Previously, amphotericin-B is the drug of choice for the treatment of systemic infections caused by Candida and Aspergillus species. Due to its high incidence of toxicity, its use has been limited in many cases. Voriconazole is the newest triazole synthesized against fungal infections and was approved by FDA in 2002 for the treatment of invasive aspergillosis and refractory infections of Scedosporium apiospermum and Fusarium spp.

Nanoparticles are being used extensively and found in applications to various fields ranging from agriculture to electronic devices, diagnosis to drug delivery, and cosmetics to food packaging. Increasing usage of engineered nanomaterials (ENM) raises potential concern for human health as well as to the environment. The present study aims to explore the effects of intermittent intraperitoneal exposure of ZNP on the spleen of male Wistar rat. Animals were divided into three groups, control and ZNP-treated groups (50 mg/kg and 250 mg/kg body weight), six in each group. Experimental animals were treated with different doses of ZNP once a week for 4 weeks, whereas control groups received water. After 28 days of exposure, animals were sacrificed, spleen tissue was excised, and various parameters such as hematological, genotoxicity, antioxidants, and histopathological were studied for changes in spleen if any. Results showed that ZNP exposure manages to induce alteration in various studied hematological parameters like neutrophils, platelets, and eosinophils which are found to increase significantly after the last treatment compared with the first treatment of ZNP. However, hemoglobin content, PCV, and MCV decrease with increasing dose of ZNP significantly in last treatment, when compared with the first treatment. DNA damage was observed in rats treated with a high dose of ZNPs compared with that in the control when analyzed through comet assay. Flow cytometric study was performed for better understanding of the underlying mechanism of the ZNP-mediated toxicity. From the present investigation, an increase in ROS production, a decrease in MMP, and increased apoptosis were exhibited. Further, altered antioxidant level (SOD, CAT, LDH, CYT P450, and CYT b5 r) has been observed in the studied splenic tissue, also histopathological changes observed in the rats exposed with high doses of ZNP. Therefore, ZNP may have the potential to induce a toxic effect even when exposed intermittently.

Housing environment plays a crucial role in determining the morbid conditions of the residents. In view of this, an attempt is made to examine the housing environment factors on the morbid conditions of the elderly, making use of the data collected from 778 elderly persons from Coimbatore city, Tamil Nadu. On the whole, more than one-fourth (27%) of the elderly were suffering from one or more morbid conditions. Results based on cross- tabular analysis highlighted that housing environment has exhibited the prevalence of morbid conditions among the elderly. Logistic regression analysis based on Model I (environmental factors alone) revealed that 'the odds of elderly' morbid conditions are significantly lower among those who reside in pucca houses and using drinking water from own tap, whereas such odds are moderately higher among those residing in more dense households. In Model II (socio- economic factors also included), the net effects of the first two environmental factors on morbid conditions have reduced a little extent. Further, it is noted that while the odds of morbid conditions are lower among elderly who belonged to better family income, forward castes as well as higher educational status than their cou nterparts, the reverse pattern is noticed across their age categories under consideration.

PROBLEM: India has the world's largest number of maternal deaths estimated at 117 000 per year. Past efforts to provide skilled birth attendants and emergency obstetric care in rural areas have not succeeded because obstetricians are not willing to be posted in government hospitals at subdistrict level. APPROACH: We have documented an innovative public-private partnership scheme between the Government of Gujarat, in India, and private obstetricians practising in rural areas to provide delivery care to poor women. LOCAL SETTING: In April 2007, the majority of poor women delivered their babies at home without skilled care. RELEVANT CHANGES: More than 800 obstetricians joined the scheme and more than 176 000 poor women delivered in private facilities. We estimate that the coverage of deliveries among poor women under the scheme increased from 27% to 53% between April and October 2007. The programme is considered very successful and shows that these types of social health insurance programmes can be managed by the state health department without help from any insurance company or international donor. LESSONS LEARNED: At least in some areas of India, it is possible to develop large-scale partnerships with the private sector to provide skilled birth attendants and emergency obstetric care to poor women at a relatively small cost. Poor women will take up the benefit of skilled delivery care rapidly, if they do not have to pay for it.

Phthalimides functionalized with cyclic amines were synthesized, characterized and screened for their in vitro antimalarial efficacy against Plasmodium falciparum (Pf3D7). Of all the listed phthalimides evaluated, 14 and 24 were identified as potent antimalarial agents as advocated by assessment of their ability to inhibit [3H] hypoxanthine incorporation in the nucleic acid of parasites. In addition, phthalimides 14 and 24 were incubated for 60 and 90 h and an enhanced antimalarial effect was noticed with increase in time to great extent. A reduction in IC50 values was observed with increase in exposure time of the parasite to the compounds. A symmetric phthalimide, 24 possessing piperazine as linker unit was identified as the most potent antimalarial agent with IC50 values of 5.97 ± 0.78, 2.0 ± 1.09 and 1.1 ± 0.75 μM on incubation period of 42, 60 and 90 h, respectively. The abnormal morphologies such as delay in developmental stages, growth arrest and condensed nuclei of parasite were observed with the aid of microscopic studies upon exposure with 14 and 24. The evaluation of 14 and 24 against chloroquine resistant strain, (Pf7GB) of P. falciparum afforded IC50 values, 13.29 ± 1.20 and 7.21 ± 0.98 μM, respectively. The combination of 24 with artemisinin (ART) showed enhanced killing of parasite against Pf3D7. Further, all phthalimides were evaluated for their activity against falcipain-2 (FP2), a major hemoglobinase of malarial parasite. The enzymatic assay afforded 6 as most active member against FP2. To the best of our knowledge this is the initial study represents phthalimide protected amino acids functionalized with cyclic amines as potent antimalarial agents.

The number of complex associations between plant-parasitic nematodes and pathogenic bacteria in causing plant diseases has been demonstrated in last seven decades. The role of nematodes in these interactions is complex, and each disease complex is distinct from another and largely dependent on the type of nematode parasitism involved. Nematodes greatly increase development of plant disease caused by bacteria. Nematodes participate in disease complexes in different ways such as (1) predisposing agent, (2) increasing susceptibility of host by modifying physiology of host tissues, (3) breaking host resistance to bacterial pathogens, (4) acting as vectors of bacterial pathogens, and (5) changing the rhizosphere microflora. Generally, in nematode-bacterium disease complexes, the nematode becomes established more readily in the presence of bacterium, but at the later stage of infection, nematode suffers some inhibition. Moreover, prior occupancy of host tissues by nematode or bacterium has different influence on the disease severity. Sometimes, the presence of both the nematode and the bacterial pathogen is necessary for production of certain types of symptoms; for example, interaction of Aphelenchoides fragariae, or A. fragariae, and Corynebacterium fascians is necessary to produce “cauliflower” disease of strawberry while neither pathogen inoculated separately reproduced the disease. The disease complexes involving plant-parasitic nematodes and pathogenic bacteria have major economic hazards. Therefore, improved understanding of relationship between nematodes and bacteria is needed to control plant disease complexes and the damage caused by them.

Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government's inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Chiranjeevi Scheme. This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat. A household-level survey of beneficiaries (n=262) and non-users (n=394) indicated that the scheme is well-targeted to the poor but many poor people do not use the services. The beneficiaries saved more than Rs 3,000 (US$ 75) in delivery-related expenses and were generally satisfied with the scheme. The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available.