International Medical University

Possible risk of leukopenia is one of the drug-induced adverse effects of the atypical antipsychotic agent olanzapine (OLZ). Hence, to prevent the peripheral exposure and related side effects of the agent, the present research was aimed to prepare and investigate safety and efficacy of OLZ-loaded lipid nanocarriers in the therapy of CNS disorders via intranasal (i.n.) delivery. The OLZ-loaded nanostructured lipid carriers (NLC) and microemulsion (ME) were prepared by melt emulsification and aqueous titration methods, respectively. Optimized formulation was evaluated for the particle size, zeta potential and entrapment efficiency were found to be 88.95 ± 0.8 and 24.80 ± 0.5 nm, -22.21 ± 1.9 and − 20.84 ± 1.3 mV, and 88.94 ± 1.6 and 98.40 ± 0.95%, respectively for the two nanocarriers (NLC and ME). Alternatively, ex vivo permeation of OLZ mucoadhesive NLC (OLZ-MNLC) and OLZ mucoadhesive ME (OLZ-MME) was observed 820 ± 7.2 and 940 ± 8.9 µg/cm 2 , respectively. Finally, C max values calculated for OLZ in brain through administration of 99M Tc-OLZ-MNLC (i.n.), 99M Tc-OLZ-MME (i.n.) and 99M Tc-OLZ-NLC (i.v.) and it was found to 9.33 ± 0.65% radioactivity/gram (RA/g), 1.06 ± 0.26% RA/g and 0.082 ± 0.004% RA/g, respectively. Therefore, 99M Tc-OLZ-MNLC formulation through i.n. delivery showed superior brain uptake than OLZ-MME formulation. Simultaneously, the nanoformulations didn’t reflect any gross changes in biomarkers and hematological toxicity when compared with control. Hence, it can be inferred that the nose-to-brain delivery of OLZ-MNLC can be considered as effective and safe delivery for brain therapy.

OBJECTIVE:This consensus statement provides evidence-based visual guidance in graphic algorithms and a summary of evidence and considerations to assist health care professionals with the diagnosis and management of adults with prediabetes and diabetes mellitus in shared decision making to improve care. METHODS:The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts to update the 2023 AACE Comprehensive Type 2 Diabetes Management Algorithm and align this algorithm update with related AACE clinical guidance. RESULTS:This algorithm for management of adults with type 2 diabetes (T2D) includes 11 sections: (1) Principles for the Management of Adults With T2D; (2) Prediabetes Algorithm (3) Diabetes Classification Algorithm (new); (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Comorbidities- and Complications-Centric Glycemic Control Algorithm; (7) Glucose-Centric Glycemic Control Algorithm; (8) Initiating and Titrating Insulin Algorithm; (9) Profiles of Pharmacotherapy for T2D; (10) Profiles of Pharmacotherapy for Obesity; and (11) Vaccine Recommendations for Adults With T2D. CONCLUSIONS:This 2026 update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and T2D. It also provides guidance on the management of atherosclerotic risk factors of dyslipidemia and hypertension. A new algorithm was added to ensure that other causes and classes of diabetes are considered beyond T2D. There continues to be an emphasis on a complications- and comorbidities-centric approach, beyond glucose levels, to frame decisions regarding first-line and subsequent pharmacological choices for treating adults with T2D.

Autoimmune diseases are chronic, debilitating conditions caused by the immune system mistakenly attacking healthy tissues. Conventional treatments mainly involve broad immunosuppression, which is associated with significant side effects, limited specificity, and suboptimal long-term outcomes. For instance, continuing to take corticosteroids can result in a number of serious dose-linked toxicities, such as osteoporosis, hypertension, and a markedly increased susceptibility to infection, whereas methotrexate, even at therapeutic doses, can still cause liver damage and bone marrow suppression. This review aims to explore recent advances in nanotechnology-based therapies for autoimmune diseases, focusing on their mechanisms, therapeutic applications, and potential for clinical translation. A comprehensive review of peer-reviewed literature was conducted to examine various nanotechnology platforms, including drug-loaded nanoparticles, antigen-specific nanomedicines, RNA interference (siRNA), CRISPR-enabled systems, and stimuli-responsive nanocarriers. For instance, methotrexate-loaded polymeric nanoparticles dramatically decreased arthritis severity in preclinical rheumatoid arthritis rodents, whereas PLGA nanoparticles containing gluten protein induced immunological tolerance in a clinical study for celiac disease. Nanomedicine offers several advantages over traditional therapies, including targeted drug delivery, enhanced bioavailability, reduced systemic toxicity, and the potential to induce immune tolerance. Notable innovations include biodegradable polymeric nanoparticles, liposomes, micelles, exosome-mimetic nanoparticles, and magnetic nanomaterials. Emerging technologies, such as CRISPR-Cas9 and RNAi, delivered via nanoparticles, are advancing immune modulation in autoimmune models. Despite promising outcomes, several barriers remain, including concerns about toxicity, scale-up manufacturing issues, and regulatory challenges. Nanotechnology is redefining autoimmune disease therapy by shifting from non-specific immunosuppression to precision-targeted approaches. Future progress lies in integrating nanomedicine with personalized medicine to tailor treatments based on individual immune profiles. Continued interdisciplinary collaboration and regulatory alignment are essential to translating these innovations into clinical practice.

Diabetic retinopathy (DR) is a complication of diabetes mellitus which causes retinal damage which when left untreated will cause visual problems. As the prevalence of DR increases over the years, there is a need to optimise the currently available treatments as well as developing novel drugs to improve the therapy provided for the patients in the clinical practice. Several pharmacological therapies like, anti-vascular endothelial growth factor and anti-inflammatory therapies which include intravitreal, and implant of corticosteroids are significant in the management to decrease the risk of DR-related vision impairment. Clinical trials for novel drug therapies are still ongoing till this day to enhance the efficacy of DR treatment. Even though there are also modern treatments such as laser therapy for the patients, prevention should be done to lower the number of individuals affected by DR. Due to the complexity of DR, there are numerous obstacles to develop new medications for DR which include the increasing healthcare cost of DR treatment. New insights such as utilisation of artificial intelligence will be implemented into the management of DR as it has proved its potential in aiding the screening process. In parallel with the increase in DR prevalence and the number of treatments developed, extensive understanding of the mechanism of action of DR should be further improved to prevent more complications in the future. This review summarises the epidemiological trend, prevention strategies, challenges in treatment, current novel therapeutics (including drugs under clinical trials), future therapeutic trends and possibilities for implementing AI in the early diagnosis and management of DR.

Objective To assess the effects of acupuncture on perceived stress, Cortisol levels, and qualitative outcomes in healthy adults. Methods A pre-post interventional study was conducted according to the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines. A total of 32 participants underwent 12 acupuncture sessions over 4 weeks. Perceived stress was assessed using the perceived stress scale, while biological stress was measured using hair cortisol levels. Focus group discussions and additional narrative analysis were conducted to collect qualitative data. Results Of the 34 initial participants, 32 completed the 12-session treatment regimen over 4 weeks, resulting in a high compliance rate of 93.8%. Significant differences in perceived stress scale scores were observed between pre-treatment and post-treatment at weeks 2, 3, and 4 (P<0.05). However, no significant difference was found in hair cortisol levels between pre-treatment and post-treatment (P>0.05). Qualitative analysis identified five key themes: "manageable stress", "relaxation and calm", "improved sleep", "unpleasant experiences", and "relief from body tension". Conclusion Acupuncture is a feasible intervention for reducing perceived stress and enhancing stress-coping abilities in healthy adults, although it does not appear to have a biological effect.