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DKD is now recognized as the primary cause of chronic and end-stage-renal disease worldwide. The disease is characterized by changes in renal function and structure, followed by a gradual decline in kidney function, leading to ESRD. Risk factors for DKD include age, sex, race/ethnicity, family history of hyperglycemia and AKI. Recent studies have shown that certain medication classes, such as SGLT-2 inhibitors, can protect the kidneys independent of diabetes control. However, there are still gaps in our understanding of DKD, and its diagnosis is subjective due to the lack of a noninvasive biomarker. This makes it challenging to design clinical trials to identify effective treatments for the disease. Our review article aims to provide information on basic mechanisms of DKD, various treatment strategies and challenges by using personalized approaches to diagnosis and prevention.

Sodium-glucose cotransporter-2 inhibitors, often known as SGLT2Is, are a class of medications used largely for anti-diabetic activity in oral dose form that lowers blood glucose levels. In recent years, numerous trials have documented the use of medications for conditions including renal and cardiovascular illness that go beyond only decreasing blood sugar. Other benefits of SGLT2Is' glucose-lowering activities include slowing or halting the progression of chronic kidney disease, lowering estimated glomerular filtration rate, lowering albuminuria, improving renal and cardiovascular health, and reducing estimated glomerular filtration rate. Published clinical trials reported all of these SGLT2I effects. The studies that we reviewed for this article are the Canagliflozin CardioVascular Assessment Study (CANVAS), Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA - CKD) trial, Effects of SGLT2I dapagliflozin on Proteinuria in Non-Diabetic Patients with The clinical studies, SGPLT2I class of medications, and their impact on cardiovascular and renal illnesses in diabetic and non-diabetic individuals are adequately covered in this review study. Keywords: SGLT2Is, Chronic kidney disease, dapagliflozin, Canagliflozin

Background:DRESS syndrome is a distinctive, severe, and atypical drug reaction includes drug rash with eosinophilia and organ dysfunction symptoms, as well as hematological abnormalities. This disease is diagnosed using the Regis CAR (European Registry of Severe Cutaneous Adverse Reaction) scoring system. Case presentation:A 25-year-old lady presented with complaints of skin lesion over whole body since 3 days along with multiple clear fluid filled blisters over face and chin and lesions in oral cavity, multiple ill-defined areas of erythema with multiple bullae over face and chin. She also had complained about was also having cough, breathlessness and chest pain. Conclusion:DRESS syndrome is a severe hypersensitivity reaction caused by a reaction from drug, which in this case is found to be allopurinol. The treatment for the same is firstly the withdrawal of causative drug and using corticosteroids,in this patient dexamethasone was used.&nbsp

Ever since herbs were used from the ancient ages to treat various diseases in one or the other form of drugs for the betterment of mankind. Due to this usage slowly the verge cam e to a decline or over exploitation which resulted in decrease of production of natural resources. Looking in to the benefits the flora and fauna were rehabilitees in form of tissue culture, co preservation, plantation etc. for the availability in its natural form. Nature is the best chemist, which helps in combatting the aliments and provides the outcomes of it. It is impossible to find any plant, which has no medical use. Ulcer and liver diseases are at an alarming rate in the developing countries. A number of drugs, which are in the existing medications for peptic ulcer and hepatic diseases, shows a comeback region due to its adverse effects, and drug interactions. Drugs, which consists from the flora, has its importance in the treatment and shows a higher rate of acceptance. Flavonoids are the naturally occurring, low molecular weight molecules seen mostly distributed in the vegetable kingdom and holds an utmost thurst in declining the generation of reactive oxygen species. Secondary compounds like apigenin, sylimarin, genesis, quercetin, kaempherol and catechins has a significance role in these diseases.

The research aimed to produce an herbal facial scrub. The majority of times, the skin on the face is in regular contact with dirt, pollution, and other contaminants. The scrub comprises various natural components that are safe to use, have fewer adverse effects, and have antibacterial, anti-infective, antioxidant, anti-aging, and moisturizing characteristics. The primary ingredient in this scrub is coffee. Coffee contains a lot of antioxidant properties. In addition, coffee grounds have a different aroma and a coarse grain and can be used to remove dirt skin cells that have died. The scrub was made with a simple mixing procedure and a variety of materials, including coffee beans, nutmeg, masoor dal, corn starch, and coconut oil mixed in melted beeswax. Other ingredients such as glycerine, light liquid paraffin, stearic acid, tween 80, and a perfuming agent was added to this formulation with effective results.

The goal of the present research work was to develop and characterize a transdermal matrix patch of Lercanidipine hydrochloride (L.H.) for controlled drug delivery using the solvent evaporation method. To achieve controlled drug release, polymers such as Psyllium and HPMC K15M were optimized. Moreover, the skin permeation effect of essential oils such as linseed oil, jojoba oil, and pumpkin seed oil was investigated on Wistar rat skin. A 32 full factorial design was applied to optimize two formulation variables: concentration of essential oil as a permeation enhancer and polymer fixed-weight ratio. To study drug-excipients incompatibility, Fourier Transform Infrared Spectroscopy (FTIR) had employed, which showed the absence of chemical interaction. All formulations were evaluated for Physico-chemical parameters, ex-vivo drug release study, an in-vivo skin-irritation study on Wistar rats, and stability study. Developed matrix patch showed optimum Physico-chemical properties with the absence of skin irritation. An Ex-vivo drug release study revealed that both formulation variables show an effect on drug release from matrix patches. The effectiveness of the oils as the permeation enhancer was found to be in the following descending order: Pumpkin seed oil > Linseed oil > Jojoba oil. Therefore, pumpkin seed oil was selected as a permeation enhancer in the final Formulation that shows the highest flux (164.09±1.49 µg/cm2/h) and desired drug release for transdermal administration. Stability study shows that the patch was stable up to 6 months at 40±2 ˚C and 75±5 % R.H. and 30±2 ˚C and 65±5 % R.H. The present investigation demonstrates that the prepared matrix patch can deliver therapeutically effective controlled release dose of lercanidipine hydrochloride (L.H.) via transdermal route using pumpkin seed oil as the permeation enhancer.

Neem (Azadirachta indica) belonging to Maliaceae family is very important medicinal plant. Neem is used different medicinal system; Ayurveda, Unani, Homeopathic medicines against various diseases. Each part of neem tree which has some medical property which act on various diseases. Keywords: Azadirachtaindica, Medicinal uses, Preparations Introduction

The new era of heterocyclic moieties which are developed in the decades plays a very important role in the treatment of various diseases. Among them are 1,3,4-oxadiazoles, a heterocyclic five-membered ring which plays an vital role in the development of newer medicinal compounds for treating various biological activities, such as proliferation of cells, tuberculosis, allergy, viral diseases, etc. The present review will summarize the various synthetic approaches which will be correlated with the biological activities so that the information in future may be used by many researches to give a path breaking lead in the field of medicinal chemistry.

Background And Aim: The percentage of elderly people with head and neck cancers (HNC) is on the rise. This makes HNC in this group of patients an important issue for healthcare providers. The present study was planned to analyze the patterns of care given to the geriatric patients and to identify the factors influencing the decision making process. Materials And Methods: Data of all the elderly patients (≥65 years) registered in the year 2012, with histologically proven HNC (all sites, stages, histopathological types, except lymphoma, sarcoma and cervical metastasis of unknown origin) receiving treatment (definitive/palliative) were collected. Results: A total of 270 patients were included in this study. The median age was 72 years (range: 65–101), with predominant male population (70%, n = 190). Oral cavity squamous cell carcinoma (SCC) was the most common cancer (57%, n = 154). Eastern Co-Operative Oncology Group performance status (PS) of 0–2 was seen in 91% of the patients. Co-morbidities were present in 139 (51.5%) patients. 50% ( n = 134) of the patients received palliative intent treatment, 45% ( n = 123) definitive treatment, whereas in 5% ( n = 13) the intent was not mentioned. Age, a clinical stage and PS significantly influenced the decision making on the intent of treatment. 208 (77%) patients completed their treatment irrespective of the intent. Age was the only factor influencing treatment completion irrespective of the intent. Conclusion: Geriatric HNC patients frequently present with advanced disease, having multiple co-morbidities. Hence, a multidisciplinary team management of these patients is essential, also taking into account of the social and financial support available to these patients.

Phytoconstituents have been used in medicine since ancient times due to their various pharmacological actions. Inspite having excellent bio-activity of plant extract and their phytoconstituents in vitro they have no in vivo actions due to their poor lipid solubility or inappropriate molecular size or both, which results in their poor absorption andlower bioavailability. Phytosomes are the novel formulation technology which helps to overcome these problems.Phytosomes are produced by a process whereby a standardized plant extract or its constituents are bound to phospholipids; mainly phosphotidylcholine, producing a lipid compatible complex. The phytosome technology has been applied over many popular herbal drugs such as Ginko biloba, hawthorn, olive oil, grape seed, green tea and ginseng. This article reviews the recent trends in phytosomes drug delivery.

This paper presents real-time detection of fatigue damage in mechanical structures using ultrasonic sensing methodology. The data-driven pattern identification method for anomaly detection is based on the tools derived from statistical mechanics and symbolic dynamics. The concept of escort distributions has been used to identify the behavioral patterns changes in complex systems due to gradual evolution of anomalies. The real-time information of evolving fatigue damage provides early warnings of forthcoming catastrophic failures. The anomaly detection method has been experimentally validated on poly-crystalline alloys using ultrasonic data generated from a fatigue damage testing apparatus.

e20544 Background: Despite their poor prognosis, few cancer patients have advanced care directives (ACD). Most often, ACD is discussed in an inpatient setting, when the patient is acutely ill and often nearing the end of life. Timely and thoughtful discussion would be better accomplished for both the patient and the family before such hospitalization. Methods: Interviews were done in 108 outpatients in an ambulatory chemotherapy center. A questionnaire noted whether ACD was executed or not, demographics (including education, religion and insurance status), performance status, characteristics of their cancer, and family status. All patients without ACD were counseled on the importance of ACD. The presence of an ACD was documented at each visit. Statistical comparison of patients with and without ACD at each visit was done. Results: The following variables were significantly associated with having an ACD at the first visit. Patients living alone could not be included in the logistic regression model, as none had advanced directives. However ACD execution differed significantly in patients living alone, compared with those living with family (0/33 vs 15/75; p=0.005). An additional 42 patients executed an ACD by the third visit. At the third visit, only living with family vs living alone remained significantly associated with having ACD. [OR=3.17 95% CI: 1.34, 7.50; p=0.009]. Conclusions: The following findings are noteworthy. Only 15/108 (14%) cancer outpatients had ACD. This disturbingly low rate increased to 55/108 (51%) after physician- initiated discussion. The following characteristics predicted not having ACD before intervention: younger age, absence of metastasis, better performance status, lower education status and living alone. After several physician interventions, only living alone remained a significant barrier to ACD execution by cancer outpatients. These results provide new insights and strategies to encourage improved advanced directive execution. [Table: see text] No significant financial relationships to disclose.

Medicinal plants provide good remedies for human diseases and play a vital role in our day-to-day lifes. Phyllanthus emblica Linn family- Euphorbiaceae, commonly known as amla, is an important household fruit. The anti-ascorbic agent Vitamin C is a very effective antioxidant constituent present in amla. It is considered to be the richest source of Vitamin C. The determination of ascorbic acid in this fruit was done by thin layer chromatography (TLC) and qualitative test. Thus, it was quantiÞ ed using the High Performance Thin Layer Chromatography (HPTLC) method in different varieties of fruit collected from different geographical regions. The method was carried out in TLC precoated aluminium plates with silica gel 60 GF as stationary phase. The solvent system was Ethanol: Acetic Acid (9.5:0.5 v/v) with the Rf value of 0.76± 0.03). Quantitative analysis was carried out in the absorbance at 254 nm. The linearity regression analysis for the calibration showed r= 0.992 and 0.986 with respect to peak area and height in the concentration range of 0.5-5.0 g per spot. The highest content of ascorbic acid was found in the bigger variety collected from Shirpur. The method developed can be used for a routine analysis of ascorbic acid in crude drugs as well as in herbal and pharmaceutical dosage form containing amla as an ingredient. Key words: Ascorbic acid, HPTLC, Phyllanthus emblica , Quantitative Analysis

Marine algae are one of the most important marine living resources for food, feed and medicine since ancient times in the West. However, due to lack of awareness among the people especially in India, their multifunctional properties have not yet been exploited. This paper deals with the pigment composition and its significant variation found in eighteen different species of marine macroalgae belonging to Chlorophyta, Phaeophyta and Rhodophyta, collected from the coast of Okha , Gulf of Kutch , Gujarat, India. Chlorophyll and carotenoids extraction was done with 80% acetone as solvent while phycoerythrin pigment was extracted using 50mM phosphate buffer (pH 7.0). The highest chlorophyll content was registered in Cladophora fascicularis while carotenoid content was found to be the highest in Sargassum polycustum. S imilarly phycoerythrin content was recorded greater in Scinaia farcellata followed by Porphyra necnamessis and Acanthophora delilei Lamour respectively. In terms of chlorophyll content, the maximum chlorophyll a, b as well as total chlorophyll was registered in most of the species of Chlorophyta followed by Phaeophyta and ultimately Rhodophyta. However, carotenoids were registered to be the highest in most of the species of Phaeophyta group . The group wise distribution of carotenoid showed an order: Phaeophyta>Rhodophyta>Chlorophyta. Chl b /Chl a , Car/Chl a and Car/Chl b ratios were also calculated and high ratios were recorded in Liagora erecta, S.polycustum and Padina gymnospora, respectively. Besides, phycoerythrin content showed the following trend in the species of: Rhodophyta>Phaeophyta>Chlorophyta. Emphasis was made to know the variation of different pigments of all eighteen species of marine macroalgae in this paper. Key words: Marine macroalgae, Chlorophyll a, b, Carotenoid, Phycoerythrin. DOI: 10.3126/on.v7i1.2553 Our Nature (2009) 7:48-55