When is a rash not ‘just’ a rash? A guide to recognition and treatment of paediatric dermatological emergencies

Paediatricians are often asked to review patients with a rash. We all know the potential sinister causes of the non-blanching rash and can recognize the ‘viral rash’ which is a staple paediatric presentation. However, there are a myriad of other paediatric rashes of varying aetiology occurring alone and in association with systemic diseases. Paediatric dermatological emergencies are thankfully rare, but there are a few serious acute presentations that paediatricians should be aware of. This article will cover how to recognize and manage the most serious emergency presentations.     

Melatonin restores neutrophil functions and prevents apoptosis amid dysfunctional glutathione redox system

Melatonin is a chronobiotic hormone, which can regulate human diseases like cancer, atherosclerosis, respiratory disorders, and microbial infections by regulating redox system. Melatonin exhibits innate immunomodulation by communicating with immune system and influencing neutrophils to fight infections and inflammation. However, sustaining redox homeostasis and reactive oxygen species (ROS) generation in neutrophils are critical during chemotaxis, oxidative burst, phagocytosis, and neutrophil extracellular trap (NET) formation. Therefore, endogenous antioxidant glutathione (GSH) redox cycle is highly vital in regulating neutrophil functions. Reduced intracellular GSH levels and glutathione reductase (GR) activity in the neutrophils during clinical conditions like autoimmune disorders, neurological disorders, diabetes, and microbial infections lead to dysfunctional neutrophils. Therefore, we hypothesized that redox modulators like melatonin can protect neutrophil health and functions under GSH and GR activity–deficient conditions. We demonstrate the dual role of melatonin, wherein it protects neutrophils from oxidative stress-induced apoptosis by reducing ROS generation; in contrast, it restores neutrophil functions like phagocytosis, degranulation, and NETosis in GSH and GR activity–deficient neutrophils by regulating ROS levels both in vitro and in vivo. Melatonin mitigates LPS-induced neutrophil dysfunctions by rejuvenating GSH redox system, specifically GR activity by acting as a parallel redox system. Our results indicate that melatonin could be a potential auxiliary therapy to treat immune dysfunction and microbial infections, including virus, under chronic disease conditions by restoring neutrophil functions. Further, melatonin could be a promising immune system booster to fight unprecedented pandemics like the current COVID-19. However, further studies are indispensable to address the clinical usage of melatonin.     

Improved treatment efficacy of risedronate functionalized chitosan nanoparticles in osteoporosis: formulation development,in vivo,and molecular modelling studies

Abstract

Delivery of bisphosphonates-like risedronate has been a major challenge till date due to its poor bioavailability and gastrointestinal tract adverse effects. In this study, we explored the prospective use of risedronate functionalised chitosan nanoparticle (RISCN) for management and treatment of osteoporosis. The prepared nanoparticle was characterised by using scanning electron microscopy, atomic force microscopy, and dynamic light scattering technique. Osteoporosis was induced on quarantined female Wistar rats and treated with RISCN. Docking studies were performed to establish the molecular mechanism of RISCN in improving the bone microarchitecture. Results indicated that there was a significant improvement in bone mineral density and healing of trabecular microarchitecture with less cortical porosity on the bone surfaces of the treatment groups. Docking studies indicated a high affinity and binding of chitosan and RISCN towards the human farnesyl diphosphate synthase (FDPS). Thus, a novel risedronate-loaded chitosan nanoparticle revealed promising results in an effective bone bridging process and osteoporosis treatment.     

Synthesis of novel gefitinib‐based derivatives and their anticancer activity

Drug latentiation is a process of modifying a drug molecule structurally to improve its binding affinity as well as increasing the drug–receptor interactions and potentiate its therapeutic potential. In the quest for discovering more potent epidermal growth factor receptor (EGFR) inhibitors, gefitinib‐based derivatives were designed by simple structural modification at the secondary amine of gefitinib by N‐alkylation. Three gefitinib derivatives (gefitinib‐NB, ‐NP, and ‐NIP) were synthesized by N‐alkylation and phase transfer catalysis. Structural characterization, physicochemical parameters such as solubility, log P, and p K _a were determined. Molecular docking studies were carried out to investigate the binding interactions at the active site. Further drug‐bovine serum albumin (BSA) protein and drug‐calf thymus (CT) DNA interactions were performed to understand the pharmacokinetics of the synthesized derivatives. All the compounds were screened for preliminary in vitro cytotoxic activity against A549, A431 lung, and MDA‐MB‐231 breast cancer cell lines by MTT assay. The gefitinib‐NP and gefitinib‐NB derivatives exhibited strong cytotoxic activity compared with gefitinib. They also showed higher drug‐BSA and drug‐DNA interactions. Molecular docking studies showed the orientation and binding interactions with the EGFR as well as with BSA and CT DNA. The results establish a strong correlation between the experimental and molecular docking studies. EGFR inhibition studies were also carried out for the derivatives and we identified the NP derivative of gefitinib as a potential lead compound. The gefitinib‐based derivatives reported herein are cytotoxic agents and can be tested for further pharmacokinetic profiles and toxicity studies which might be helpful for designing more potent gefitinib‐based derivatives in the future.     

Inclusion Complexes of Nateglinide with HP–β–CD and L-Arginine for Solubility and Dissolution Enhancement: Preparation,Characterization, and Molecular Docking Study

Purpose

The objective of present study was to increase solubility and dissolution performance of a poorly water soluble antidiabetic drug, Nateglinide (NAT), through formation of inclusion complexes with hydroxypropyl-beta-cyclodextrin (HP–β–CD). The effect of L-arginine (ARG), an amino acid, on the complexation efficiency and solubility enhancing power of HP–β–CD was investigated by preparing ternary inclusion complexes.

Methods

The binary and ternary inclusion complexes were prepared by physical mixing, kneading, co-evaporation, and spray drying methods containing NAT, HP–β–CD, and ARG. The complexes were characterized by FTIR, DSC, PXRD, and ¹H–NMR. Molecular modeling study revealed that introduction of ternary agent ARG have improved the interactions of NAT and HP–β–CD.

Results

The complex prepared by spray drying method showed the highest increase in solubility and dissolution rate compared to other methods. Molecular docking study revealed that ARG interactions plays an essential role in increasing the stability and solubility of the complex.

Conclusions

The present study demonstrated increase in solubility and dissolution of NAT. Hence, ternary complexes of NAT can be used as an efficient tool for the delivery of insoluble drug, NAT.

     

Variations in Placental Attachment of Umbilical Cord

The purpose of this study was to evaluate the variations in the placental attachment of umbilical cord by dissection method. The Placental attachment of Umbilical Cord was examined after careful dissection of membranes in 110 specimens. Various types of Umbilical Cord insertions were noticed and measured its distance from placental margin. Details were recorded and analyzed. A total of 110 specimens were observed, of which 83(75.45%) showed normal, 18(16.36%) were marginal, 8(7.27%) showed furcate and only 1(0.9%) specimen was velamentous insertion. As other congenital anomalies are often associated with umbilical cord insertion anomalies, early diagnosis of the latter would give an insight into the former.