The long term anticoagulation with warfarin is associated with various bleeding risks which led to the need for newer drugs. With the developments in the anticoagulation therapy the newer agents like dabigatran, rivaroxaba, apixaban and edoxaban have gained popularity with their more predictable pharmacological properties and reduced need for drug monitoring.The United States of America has approved both rivaroxaban and dabigatran to be used in the treatment of VTE (Venous Thrombo Embolism). In Europe and Canada dabigatran is prescribed after elective hip or knee arthroplasty to prevent VTE. For a VTE prophylaxis after an orthopediac surgery and to prevent stroke in AF patient, Rivaroxaban is recommended according to RECORD study. Edoxaban is highly effective in treatment of VTE and acts as a preventive measure of stroke in NVAF (Nonvalvular Atrial Fibrillation). Through this article various pharmacological aspects, dosing regimens, bleeding associated risk will be illustrated.

Objectives: The present study was aimed to overcome the problems associated with the drug such as bioavailability, to reduce the dosage regimen, half-life, and to determine the appropriateness of niosomal formulation as a drug carrier. Methods:The niosomal suspension was prepared by thin film technique, by varying ratios of span 60 and cholesterol and varying the concentration of span 60. The prepared four formulations were evaluated for various parameters. Results:The optimized formulation had a vesicular size of 250-400 nm. Varying the concentration of span 60, the entrapment efficiency demonstrated that it had a considerable task. The highest entrapment efficiency was 95.3%. The kinetics study confirmed that the liberation of drug from the niosomal suspension is in a restricted manner. The statistical optimization showed that NS2 is the optimized formulation. The gastrointestinal enzymes showed no significant change in the release of drug from the formulation. The zone of inhibition showed that optimized formulation has a better activity than the marketed formulation. The MIC was found to be 0.05 mg, hence can be used as an efficient carrier for delivery of cefixime. Conclusion:The present study concludes that the prepared niosomal suspension is a convenient and efficiency carrier for the delivery of antibacterial drug. Besides this, it provided controlled delivery of drug.

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Osler Weber Rendu syndrome, synonymously Hereditary hemorrhagic telangiectasia, is a rare systemic disease with multiple-organ involvement. This genetic disorder inherits in an autosomal dominant fashion, with the incidence found closer to 1 in every 5,000 people. The condition can be diagnosed at any age and has an equal chance of affecting both males and females. A 74-year-old male, having a history of left hemiplegia, was admitted with a recent history of recurrent melena. An upper enteroscopy revealed bleeding telangiectasia in the proximal jejunum managed with hemoclips. The possibility of Osler Weber Rendu syndrome was considered as he developed bleeding recurrently. According to Curacao Criteria, a minimum of two out of four symptoms should be present to ratify the disease, and the presence of three symptoms makes a definite diagnosis. Since there is no cure for the syndrome to date, therapy's mainstay entails meticulous supportive care (focused on managing the manifestations). The disease is a type of arteriovenous malformation associated with the mutation in either endoglin (ENG) or activin A receptor-like kinase-1 (ACVRL1) genes. He was given an intraarticular injection of methotrexate in the left wrist hand because of small joint polyarthritis. The patient was symptomatically and clinically better on discharge. Novel treatment strategy includes bevacizumab and thalidomide though their use has not been clinically approved.

Psychotropic medications are used in the treatment of chronic psychotic disorders like anxiety, depression, insomnia, bipolar disorders, cognitive impairment, seizure, loss of consciousness, altered sensorium, delirium etc. The objective of this study is to describe the pattern of use of psychotropic medications in patients presenting to geriatrics department, to compare the pattern of usage of psychotropic medication at the time of admission versus at the time of discharge and to find out the dose optimization pattern in elderly patients. Observational retrospective study, conducted in the department of geriatrics. The sample size calculated for the study was 35. The study was carried out through AHIS and by reviewing case files. The data were collected on specially designed data collection forms. Consumption of the psychotropic drugs was the highest within 71-80 years of age group, of which 49.15% of patients fall in this age group. All of the patients prescribed with psychotropic medications had insomnia (26.70%), followed by anxiety (20.30%), seizure (20.30%) and depression (16.90%). Among the 2nd generation anti psychotropics, quetiapine was the most frequently prescribed drug (54.24%). Benzodiazepines were the preferred antidepressants (36%) followed by SSRIs. Sixty two percent of the patients continued the same dose prescribed from the outside hospital and a dose increment was done for 37.5% of the patients. The incidence of usage of psychotropic medications were found to be more with females. Atypical antipsychotic drugs were the most commonly used ones. Current evidence shows no superiority for atypical antipsychotics over haloperidol.