PREVENTIVE CARE IN OPHTHALMOLOGY – A REVIEW ARTICLE

Shalakya Tantra is an important branch in Ayurveda which deals with the diseases of the supraclavicular region. Eyecare is described under "Shalakya Tantra”. The eye is the most important and sensitive of five sense organs in the human body. Ayurveda also gives prime importance to the eye and primarily aim at the prevention of disease and promotion of positive health. Some of the faulty lifestyle exposures like sedentary habits, smoking, alcohol consumption, fat, sugar-rich diet, junk food, high carbohydrate food etc are notably associated with the risk of developing eye diseases. Association of eye diseases with Dinacharya, Ritucharya, Aahara-Vihara, Mind, Occu- pation, and Aging process are also important. Factors like continuous hours spent reading, watching TV, using mobile and working on computers take their toll on eye health. Ayurveda possesses vivid information about the lifestyle leading to healthy living and also the preventive strategies in general. For eye diseases, a few daily regi- mens like Aschyotana (eye drops), Anjana (Collyrium), Nasya (nasal application of drugs), Abhyanga (oil massage) are promoted as high-end measures for the maintenance of eye health, Various Netra vyayama (eye exercis- es), Yoga, Pranayama and Satkriya (Neti, Trataka etc) are also an effective therapy for healing of eye disorders. Keywords: Dincharya, Ritucharya, Aschyotana, Anjana, Padabhyanga

Direct Delivery of ANA-TA9, a Peptide Capable of Aβ Hydrolysis, to the Brain by Intranasal Administration

We have recently reported Catalytides (Catalytic peptides) JAL-TA9 (YKGSGFRMI) and ANA-TA9 (SKGQAYRMI), which are the first Catalytides found to cleave Aβ42. Although the Catalytides must be delivered to the brain parenchyma to treat Alzheimer’s disease, the blood–brain barrier (BBB) limits their entry into the brain from the systemic circulation. To avoid the BBB, the direct route from the nasal cavity to the brain was used in this study. The animal studies using rats and mice clarified that the plasma clearance of ANA-TA9 was more rapid than in vitro degradation in the plasma, whole blood, and the cerebrospinal fluid (CSF). The brain concentrations of ANA-TA9 were higher after nasal administration than those after intraperitoneal administration, despite a much lower plasma concentration after nasal administration, suggesting the direct delivery of ANA-TA9 to the brain from the nasal cavity. Similar findings were observed for its transport to CSF after nasal and intravenous administration. The concentration of ANA-TA9 in the olfactory bulb reached the peak at 5 min, whereas those in the frontal and occipital brains was 30 min, suggesting the sequential backward translocation of ANA-TA9 in the brain. In conclusion, ANA-TA9 was efficiently delivered to the brain by nasal application, as compared to other routes.

Versatile Nasal Application of Cyclodextrins: Excipients and/or Actives?

Cyclodextrins (CDs) are oligosaccharides widely used in the pharmaceutical field. In this review, a detailed examination of the literature of the last two decades has been made to understand the role of CDs in nasal drug delivery systems. In nasal formulations, CDs are used as pharmaceutical excipients, as solubilizers and absorption promoters, and as active ingredients due to their several biological activities (antiviral, antiparasitic, anti-atherosclerotic, and neuroprotective). The use of CDs in nasal formulations allowed obtaining versatile drug delivery systems intended for local and systemic effects, as well as for nose-to-brain transport of drugs. In vitro and in vivo models currently employed are suitable to analyze the effects of CDs in nasal formulations. Therefore, CDs are versatile pharmaceutical materials, and due to the continual synthesis of new CDs derivatives, the research on the new nasal applications is an interesting field evolving in the coming years, to which Italian research will still contribute.

VAMANAKARMA: AN ANCIENT AYURVEDIC CLEANSING THERAPY

‘Charaka Samhita’ an ancient text of Ayurveda emphasizes the cleansing of the body through Panchakarma. Today’s generation is out of touch with nature. Poor dietary habits, fast foods, no proper exercise regimen, stress and strain of daily life to compete and survive- these patterns have led to a lot of hormonal changes, and the agents that regulate the body’s mechanism have become poor leading to the spread of toxins throughout the body causing various diseases. As per Ayurveda, these toxins are called “ama”. This foul-smelling, sticky, harmful fluid needs to be completely removed from the body. This is done through Panchkarma, which is advised quarterly, half-yearly, or yearly to get rid of the toxins from the body and also to provide protection from different diseases. This process has twofold benefits – cleansing of the body and also rejuvenation, thus giving a youthful appearance to the body. Panchakarma includes five methods through which the body is detoxified –Procedure of Vamana (induced vomiting), Procedure of Virechana (induced purgation), Basti (enema), Nasya (nasal application), Rakthamokshanana (bloodletting). The three Doshas (vital physiological factors according to Ayurveda) in the human body that is - Vata, Pita, and Kapha are balanced, leading to good physical health and mental balance. Vamanaprocedure means induction of emesis. Through this procedure, the toxins are removed from the body especially through the upper body parts. Vamanaisthe best remedy for Kapha-related diseases. Most of the diseases today are due to improper digestion and metabolism (Agni). The cause is the changing lifestyle full of stress and anxiety. Irregular dietary habits add further to these issues. Diseases need to be uprooted from the base. Therapies like Panchkarma or particular therapy as VamanaKarma for particular Doshas like Kapha can be thought of on a regular basis as a remedy.

Utility of nasal application of lignocaine gel using cotton tip swab versus squirting with slip-tip syringe for transnasal fibreoptic bronchoscopy: a pilot randomised controlled trial

BackgroundDuring flexible fibreoptic bronchoscopy through the nasal route, anaesthesia of the nasal passage is achieved by lignocaine gel application by a slip-tip syringe or with the help of a cotton tip swab. No studies in existing literature have compared the two techniques in terms of efficacy.Methods137 consecutive patients undergoing bronchoalveolar lavage (BAL) were recruited over a 2-year period. The patients underwent BAL after nasal anaesthesia—either by slip-tip syringe or by cotton tip swab smeared with 2% lignocaine gel. Patients were monitored for intraprocedural epistaxis, discomfort and improvement in operator visibility of nasal passage.Results67 patients were randomised to cotton swab and 70 patients to the gel instillation group. There were no significant differences in terms of epistaxis, 29.9% in the cotton tip swab (95% CI 19.3% to 42.3%) versus 24.3% in the gel instillation group (95% CI 14.8% to 36%) or detection of nasal blocks, 7.5% in the cotton tip swab (95% CI 2.5% to 16.6%) versus 10% in the gel instillation group (95% CI 4.1% to 19.5%) in the two groups, although a significant difference was there in terms of visibility, 73.1% in the cotton tip swab (95% CI 60.9% to 83.2%) versus 42.9% in the gel instillation group (95% CI 31.1% to 55.3%). There was no difference in the mean pain score across the two groups either during the procedure or 1 hour after it. A short systematic review of existing literature on the topic has been provided for comparison.ConclusionApplication of 2% lignocaine gel by slip-tip syringe and cotton tip swab are equivalent in terms of observed and narrated pain experienced by patients, frequency of epistaxis and nasal blocks. Vision was better preserved in the cotton tip swab group.

MULTIDISCIPLINARY APPROACH IN THE PREVENTION AND MANAGEMENT OF OCULAR HEALTH

In today’s era of globalization, prevention plays an important role in the field of health science. Excess us-age of gadgets like use of computers, ipads and smart phones is leading to over functioning of eyes. Eyes are the windows to the mind. among the five sense organs Ayurveda gives prime importance to eyes. Now-a-days changed work expectations requiring prolonged working hours in front of computers, nutritional deficiency, pollution, stress, indiscriminate use of topical ocular drugs and increased incidence of allergic disorders, etc. lead to eye diseases. Suffering from ocular disorders with uncorrected refractive error in children result into adverse effect on quality of life and significantly affect their vision, education and psy-chosocial development. Working in artificial light either dim light or bright light is another culprit for dete-rioration of ocular health so emphasis should be laid on the prevention of these, as eyes are the most im-portant and sensitive of five sense organs in human body. Ayurveda is one of the greatest gifts to mankind. In Ayurveda, selected classical daily regimes like Netraprakshalana (eye wash), Anjana (collyrium), Snana(bath), Padabhyanga (foot massage with oil), Nasya (nasal application of drugs), wholesome and unwholesome dietetics are promoted as high-end measures for the maintenance of eye-health. Various Netravyayamas (eye exercises), Yogasanas, Pranayamas, Neti and Trataka are said to be beneficial for the same cause. The main aim of this review is to promote and spread the awareness about maintenance of oc-ular health and prevention from the earlier causation of ocular diseases.

Topical intranasal lidocaine is not a sphenopalatine ganglion block

There is renewed interest in the central role of the sphenopalatine ganglion (SPG) in cerebrovascular autonomic physiology and the pathophysiology of different primary and secondary headache disorders. There are diverse neural structures (parasympathetic, sympathetic and trigeminal sensory) that convene into the SPG which is located within the pterygopalatine fossa (PPF). This makes the PPF an attractive target to neuromodulatory interventions of these different neural structures. Some experts advocate for the nasal application of local anesthetics as an effective route for SPG block with the belief that the local anesthetic can freely access the PPF. It is time to challenge this historical concept from the early 1900s. In this daring discourse, I will review anatomical studies, CT and MRI reports to debunk this old myth. Will provide anatomical evidence to explain that all these assumptions are untrue and the local anesthetic has to magically ‘travel’ a distance of 4–12 mm of adipose and connective tissue to reach the SPG in sufficient concentration and volume to effectively induce SPG blockade. Future research should focus on assessing a clinical biomarker to confirm SPG blockade. It could be regional cerebral blood flow or lacrimal gland secretion.

Nafamostat Mesylate in lipid carrier for nasal SARS-CoV2 titer reduction in a hamster model

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) has been responsible for the largest pandemic in recent decades. After seemingly being in control due to consequent lock-downs and social distancing, the majority of countries faces currently a second wave of exponentially increasing infections, hospital referrals and deaths due to SARS-CoV-2-mediated disease (COVID-19). To date, no effective vaccination has been found, and wearing masks and social distancing are the only effective approaches to reduce further spreading.However, unwillingness in the societies to distance again and consequently wear masks might be reasons for the second SARS-CoV-2 infection wave. User-friendly chemicals interfering at the host site with viral entry might be an approach to contain the pandemic. In addition, such an approach would work synergistic with vaccinations that miss new virus mutants.Nafamostat (NM) has been shown in vitro to interfere with cellular virus entry by inhibition of the host transmembrane protease serine 2 (TMPRSS2), an enzyme required for SARS-CoV-2 spike protein cleavage, a prerequisite for cell entry.We hypothesized that nasal application of NM in a liposomal layer (as additional mechanical barrier) could lower the nasal viral load and subsequently reduce the severity of COVID-19. We found, indeed, that nasal viral load one day post single NM application, was lowered in a hamster SARS-CoV-2 infection model. However, severity of subsequent local tissue destruction and weight loss due to pneumonitis was not favorably altered.In conclusion, a single NM application reduced nasal viral load, but did not favorably improve the outcome of COVID-19, likely due to the short half-time of NM. Improvement of NM stability or repetitive application (which was not permitted in this animal model according to Dutch law) might circumvent these challenges.