Drug-eluting stents (DES) became the default strategy for percutaneous revascularization due to their improved intermediate-term outcomes when compared with bare-metal stents (BMS) in the pivotal ...randomized, controlled trials. The excellent results of DES in on-label or US FDA-approved indications led to extrapolation of the results to more complex situations that were excluded from initial pivotal trials; such as off-label indications. Safety concerns began to grow after reports of increased late thrombosis and possibly associated increased death and myocardial infarction with DES, especially in the off-label situations. Recently, however, several important published registries have calmed some of those uncertainties and reassured the cardiology community of the safety and efficacy of DES compared with BMS. There is an overall poorer outcome with off-label use of any stent (BMS or DES) compared with standard or on-label use. This difference in outcome is most likely related to patient or specific coronary lesion characteristics or comorbidities that predispose an individual to adverse outcomes regardless of the stent type used. It is accepted now that DES use does result in a small increased risk of late thrombosis, but that risk is offset by a significant reduction in restenosis. Overall, the current data suggest that the use of DES in most lesion subsets is at least as safe as and clearly more efficacious than use of BMS in similar situations.
In 1968, the first clinical application of the intra-aortic balloon pump (IABP) was reported for treating patients with cardiogenic shock after acute myocardial infarction (1). Now, just over three ...decades later, the IABP is routinely used by cardiologists in the cardiac care unit and in the cardiac catheterization lab as well as by cardiac surgeons in the perioperative setting. Its role in the management of congestive heart failure as a result of ischemia, infarction, or valvular heart disease has become so established that the IABP is currently the most widely used mechanical cardiac assist device. Its use is only likely to increase, given that studies have shown that aggressive IABP use is cost-effective in selected patients because of both shorter hospital stay and complication reduction (2).
The objective of the present study was to design and develop topical nanoemulsion based Terbinafine HCl (TBH) gel to increase its permeability and efficacy using rat as an animal model. Nanoemulsions ...were prepared by two different techniques viz. high pressure homogenization and high speed homogenization, the prepared nanoemulsions were incorporated into carbomer gel to obtain nanoemulsion based gel, which designated as Gel-P and Gel-S respectively. The developed gels were evaluated for drug content, stability, spreadability, and in vitro permeation using pork skin. The in vivo antifungal efficacy of the developed gels was assessed in albino Wistar rats. The globule size obtained by high pressure homogenization was less than 2 nm in radius (r.nm) and that by high speed homogenization was less than 10 r.nm. In vitro permeation studies revealed that Gel-P (51.19 ± 0.81 %) had higher permeation when compared to Gel-S (31.72 ± 1.12 %) and marketed cream (19.78 ± 1.01 %) which is essential to treat topical fungal diseases. In vivo antifungal studies in Wistar rats infected with
Trichophyton mentagrophytes
revealed that topical application of Gel-P and Gel-S cured the infection within 3 days compared to 14 days for Marketed Cream (M.C). This study confirms that the nanoemulsion gels provided greater permeation followed by cure rates of poorly soluble TBH in animal model and hence these systems could be the preferred drug carriers for drugs intended for topical use to overcome the permeability and efficacy problems.
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