Awareness and possible treatment options toward COVID-19 among selected healthcare professionals in National Capital Region

Background@#Since December 2019, SARS-CoV-2, otherwise known as coronavirus disease 2019 (COVID-19), has caused worldwide panic and is now a serious problem. As the situation worsens, the need for an official cure becomes more crucial and different methods are being considered for treating infected COVID-19 patients. @*Objectives@#This study aimed to emphasize and further elaborate on the existing and possible treatment methods against COVID-19 and assess the awareness of healthcare professionals (doctors, medical technologists, and nurses) on the treatments for COVID-19. @*Methodology@#The study utilized an exploratory sequential mixed methods design following the treatment and misinformation theories models. The respondents were selected based on inclusion and exclusion criteria and recruited through the snowball sampling technique. The study used an adapted survey questionnaire on the pathophysiology of COVID-19 and possible treatment options. Descriptive statistical analysis for quantitative data and open thematic coding is used in an online qualitative deductive data analysis. @*Results@#Based on the data, webinars, lectures, and discussions were the primary source of information among healthcare professionals. Most of the respondents showed proficiency with remdesivir among investigational selective medicines. Chloroquine was the top choice among selected repurposed drugs. They were aware of the convalescent plasma therapy that uses antibodies from the blood plasma of recovered COVID-19 patients. They were not aware of the different herbal treatments used to treat COVID-19. @*Conclusion@#Hence, chloroquine (repurposed drug), remdesivir (investigational drug), and convalescent plasma (adjunctive therapy) are the most well-known treatments for COVID-19. Most of the respondents were aware of the action and side effects of chloroquine, remdesevir, and convalescent plasma therapy.

Intravenous whole blood transfusion results in faster recovery of vascular integrity and increased survival in experimental cerebral malaria

BACKGROUND Cerebral malaria is a lethal complication of Plasmodium falciparum infections in need of better therapies. Previous work in murine experimental cerebral malaria (ECM) indicated that the combination of artemether plus intraperitoneal whole blood improved vascular integrity and increased survival compared to artemether alone. However, the effects of blood or plasma transfusion administered via the intravenous route have not previously been evaluated in ECM. OBJECTIVES To evaluate the effects of intravenous whole blood compared to intravenous plasma on hematological parameters, vascular integrity, and survival in artemether-treated ECM. METHODS Mice with late-stage ECM received artemether alone or in combination with whole blood or plasma administered via the jugular vein. The outcome measures were hematocrit and platelets; plasma angiopoietin 1, angiopoietin 2, and haptoglobin; blood-brain barrier permeability; and survival. FINDINGS Survival increased from 54% with artemether alone to 90% with the combination of artemether and intravenous whole blood. Intravenous plasma lowered survival to 18%. Intravenous transfusion provided fast and pronounced recoveries of hematocrit, platelets, angiopoietins levels and blood brain barrier integrity. MAIN CONCLUSIONS The outcome of artemether-treated ECM was improved by intravenous whole blood but worsened by intravenous plasma. Compared to prior studies of transfusion via the intraperitoneal route, intravenous administration was more efficacious.

Omega-3 fatty acid supplementation as an adjunctive therapy in the treatment of chronic kidney disease: a meta-analysis

The aim of this study was to evaluate the benefits and risks of omega-3 fatty acid supplementation in patients with chronic kidney disease. A systematic search of articles in PubMed, Embase, the Cochrane Library, and reference lists was performed to find relevant literature. All eligible studies assessed proteinuria, the serum creatinine clearance rate, the estimated glomerular filtration rate, or the occurrence of end-stage renal disease. Standard mean differences with 95% confidence intervals for continuous data were used to estimate the effects of omega-3 fatty acid supplementation on renal function, as reflected by the serum creatinine clearance rate, proteinuria, the estimated glomerular filtration rate, and relative risk. Additionally, a random-effects model was used to estimate the effect of omega-3 fatty acid supplementation on the risk of end-stage renal disease. Nine randomized controlled trials evaluating 444 patients with chronic kidney disease were included in the study. The follow-up duration ranged from 2 to 76.8 months. Compared with no or low-dose omega-3 fatty acid supplementation, any or high-dose omega-3 fatty acid supplementation, respectively, was associated with a lower risk of proteinuria (SMD: -0.31; 95% CI: -0.53 to -0.10; p=0.004) but had little or no effect on the serum creatinine clearance rate (SMD: 0.22; 95% CI: -0.40 to 0.84; p=0.482) or the estimated glomerular filtration rate (SMD: 0.14; 95% CI: -0.13 to 0.42; p=0.296). However, this supplementation was associated with a reduced risk of end-stage renal disease (RR: 0.49; 95% CI: 0.24 to 0.99; p=0.047). In sum, omega-3 fatty acid supplementation is associated with a significantly reduced risk of end-stage renal disease and delays the progression of this disease.

Pentoxifylline as Adjunctive Therapy in Children with Acute Bacterial Meningitis

Introduction. Pentoxifylline, an inhibitor of tumor necrosis factor, has been shown in animal models of acute bacterial meningitis that reduce the host inflammatory response. Objective. To evaluate the effect of pentoxifylline administrated as adjunctive therapy in the treatment of acute bacterial meningitis in children. Material and methods. Prospective and open study that included children, between 3 months to 15 years old hospitalized in the Institute of Tropical Medicine, of Asunción, Paraguay, with the diagnosis of acute bacterial meningitis. Patients were randomly assigned, to receive in addition to antibiotic therapy (cefotaxime or ceftriaxone) pentoxifylline, dexamethasone, or neither. The presenting status was recorded and the course of disease monitored with preset criteria. The primary endpoints comprised death and severe neurological sequelae. Results. Eighty seven children received as adjunctive drug pentoxifylline (n=35), dexamethasone (n=30) and neither (n=22). At admission, the demographic, clinical and laboratory characteristics of the patients were comparable. There were no significant differences among the three groups regarding to the duration of fever and meningeal symptoms after admission. The mortality were comparable (11% in pentoxifylline, 13% in dexamethasone and 9% in control group) (p>0.6). Among the survivor patients, unfavorable outcome (severe sequelae) was observed in 13%, 20% and 15% for pentoxifylline-, dexamethasone- and control-group, respectively (p>0.5). Conclution. The data of the present study do not support the routine use of pentoxifylline as adjunctive therapy for bacterial meningitis in children.

Resumen Introducción. La pentoxifilina, un inhibidor del factor de necrosis tumoral, se ha demostrado en modelos animales de la meningitis bacteriana aguda que reducen la respuesta inflamatoria del huésped. Objetivo. Para evaluar el efecto de la pentoxifilina se administra como terapia auxiliar en el tratamiento de la meningitis bacteriana aguda en niños. Material y métodos. Estudio prospectivo y abierto que incluyó a los niños, entre 3 meses a 15 años de edad hospitalizado en el Instituto de Medicina Tropical, de Asunción, Paraguay, con el diagnóstico de la meningitis bacteriana aguda. Los pacientes fueron asignados al azar para recibir, además de la terapia con antibióticos (cefotaxima o ceftriaxona) pentoxifilina, dexametasona, o ninguno. El estado de presentación se registró y el curso de la enfermedad monitorizó con criterios preestablecidos. Los criterios de valoración primarios comprenden la muerte y secuelas neurológicas graves. Resultados: Ochenta y siete niños recibieron pentoxifilina drogas como adyuvante (n = 35), dexametasona (n = 30) y no (n = 22). Al ingreso, las características demográficas, clínicas y analíticas de los pacientes eran comparables. No hubo diferencias significativas entre los tres grupos en cuanto a la duración de la fiebre y los síntomas meníngeos después de la admisión. La mortalidad fue comparable (11% en pentoxifilina, 13% en dexametasona y 9% en el grupo control) (p > 0,6). Entre los pacientes sobrevivientes, se observó un resultado desfavorable (secuelas graves) en el 13%, 20% y 15% para pentoxifylline-, dexamethasone- y el control de grupos, respectivamente (p> 0,5). Conclución. Los datos del presente estudio no apoyan el uso rutinario de la pentoxifilina como tratamiento adyuvante para la meningitis bacteriana en niños.

Meta-analysis on the efficacy and tolerability of the augmentation of antidepressants with atypical antipsychotics in patients with major depressive disorder

We assessed the efficacy and tolerability of the augmentation of antidepressants (ATDs) with atypical antipsychotics (AAPs) to treat patients with major depressive disorder. A retrograde study to identify relevant patient data included databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Database of Abstracts of Reviews of Effects. Data from 17 trials, involving 3807 participants, were identified. The remission rate (RR) and overall response rate (ORR) of adjunctive treatment with AAPs were significantly higher than placebo treatment: RR=1.90 (95%CI=1.61-2.23, z=7.74, P<0.00001) and ORR=1.68 (95%CI=1.45-1.94, z=7.07, P<0.00001). We found that the short-term (4 weeks) treatment [ORR=1.70 (95%CI=0.98-2.95, Z=1.89, P=0.06)] was significantly different from the long-term (6-12 weeks) treatment [ORR=1.68 (95%CI=1.45-1.94, z=7.07, P<0.00001)]. No significant difference in ORR was observed between groups with or without sedative drugs. The discontinuation rate due to adverse effects was higher for adjunctive treatment with AAPs: ORR=3.32 (95%CI=2.35-4.70, z=6.78, P<0.00001). These results demonstrate that the augmentation of ATDs with AAPs (olanzapine, quetiapine, aripiprazole, and risperidone) was more effective than a placebo in improving response and remission rates, although associated with a higher discontinuation rate due to adverse effects.

Curative Effect Observation of Transfer Factor Oral Solutions as Adjunctive Therapy in Elderly Patients with Recurrent Respiratory Tract Infection (RRTI) / 中国药师

Objective:To observe the curative effect of transfer factor oral solutions as the adjunctive therapy in ederly patients with recurrent respiratory tract infection ( RRTI) . Methods:Totally 74 ederly patients with RRTI were selected and divided into the observation group and the control group randomly. The patients in the two groups were given anti-infection and symptomatic treatment during the acute stage of attack. The patients in the observation group were additionally given transfer factor oral solutions 10ml, po, tid for 3 months. The changes in serum immunoglobulin IgG, IgA and IgM levels in the two groups before and after the medical treat-ment were compared, and the clinical curative effect and adverse drug reactions ( ADR) were observed as well. Results: After the medical treatment, the serum IgG, IgA and IgM levels in the observation group were obviously increased than before (P0. 05). The total clinical efficiency in the observation group was much higher than that in the control group (P0. 05). Conclusion:Transfer factor oral solutions as the adjunctive therapy in ederly patients with RRTI has the favorable clinical curative effect and safety, and the underlying mechanisms may be concerned with the effect of enhancing serum immunoglobulin IgG, IgA and IgM levels, as well as humoral immune function.

Clinical observation of Xuebijing Injection on adjunctive therapy for stroke-associated pneumonia / 中草药

Objective: To observe the clinical therapeutic effect of Xuebijing Injection on stroke-associated pneumonia (SAP). Methods: A total of 42 patients with SAP were randomly divided into two groups. The patients in the two groups were all given regular treatment. Besides the regular treatment, the patients in the Xuebijing group received iv drip of 50 mL Xuebijing Injection twice a day. The course of the treatment was 7 d. Results: The total effective rate in Xuebijing group (90.5%) was significantly higher than that in the control group (66.7%) (P < 0.05). Compared with the control group, the body temperature, respiration, heart rate, white blood cell count, and C-reactive protein of Xuebijing group were obviously improved (P < 0.05). Compared with the control group,the time of defervescence and cough relief in Xuebijing group reduced obviously (P < 0.05). There were no obvious adverse reactions in all patients. Conclusion: Xuebijing Injection has the anti-inflammatory effect and it is a positive adjunctive therapy for the treatment of SAP without obvious adverse reactions.

The Effects of Adjuvant Therapy of Atypical Antipsychotics on the Change of Clinical Symptoms in Patients with Major Depressive Disorder in a University Hospital: 1 Year Follow-Up Study / 신경정신의학

OBJECTIVES: This study is to assess the effects of adjuvant therapy of atypical antipsychotics on the change clinical symptoms in patients with major depressive disorder. METHODS: We conducted a chart review of patients, who visited a university hospital. Ninety seven patients were divided into two groups : patients with adjuvant use of antipsychotics with antidepressants (AD+AAP ; n=32) and patients with only antidepressants (AD ; n=65). We compared and analyzed three clinical domains including depressive symptoms, anxiety symptoms and sleep qualities between two groups. Depressive symptoms, Anxiety symptoms, and sleep pattern were evaluated by Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) at baseline (first day of admission) and 1 year later. RESULTS: During 1 year, the BDI scores of AD+AAP group has been greatly decreased, compared to AD group (F=5.87, p=0.02). In the comparison of patients with severe symptoms of major depressive disorder (BDI score >21), there was significant difference in the change of BDI score between AD+AAP and AD (F=4.14, p=0.04). After 1 year, there were no significant differences in BAI score change (F=0.51, p=0.47), PSQI score change (F=0.89, p=0.35) between two group. However, the duration of adjunctive therapy and the type of atypical antipsychotics would not impact the results. CONCLUSION: Current study suggested that adjuvant therapy of atypical antipsychotics would be effective on depressive symptoms in patients with severe major depressive disorder, compared to the treatment with antidepressants alone.

Reattachment of Partially Amputated Ear Based On 7 mm-wide Small Skin Pedicle without Vascular Anastomosis

PURPOSE: It has been reported that the ear perfusion can maintain by a very small pedicle because the ear has good vascularized system. Replantation of an amputated ear with vascular anastmosis, has been reported before and offers the succeessful reconstructive results. But, in this paper we report a case of complete nonmicrosurgical salvage of a nearly amputated ear based on 7 mm-wide small skin pedicle with adjunctive therapies. METHODS: A 49-year-old man was referred with a nearly complete detachment of left ear. The blood supply to the ear was maintained exclusively on 7 mm-wide small skin pedicle in the lobule. After we identified the fresh bleeding at the distal margin of the detached ear, we performed the primary repair. At the end of the procedure, the areas of the concha bowl and helical root appeared to be congested. So the immediate postoperative treatment for improving the tissue survival was done with Lipo-Prostaglandin E1 (Eglandin(R)) injection, leech apply and antibiotics medications. RESULTS: Assessment of the replanted ear on postoperative day 14 revealed a nearly viable auricle including the helical root. The ear appeared to be entirely healed, with excellent projection and fully restored normal elasticity. CONCLUSION: We found the complete salvage of a nearly amputated ear based on 7 mm-wide small skin pedicle with adjunctive therapies including Lipo-Prostaglandin E1 (Eglandin(R)) injection, leech apply and antibiotics without microsurgery.

Increased EEG Current-Source Density in the High Beta Frequency Band Induced by Levetiracetam Adjunctive Therapy in Refractory Partial Epilepsy

BACKGROUND AND PURPOSE: Levetiracetam (LEV) is an antiepileptic drug (AED) that has favorable effects on cognition. Although neuropsychological studies have demonstrated these favorable outcomes on cognition, there are few electrophysiologic data describing the functional changes exerted by LEV. The purpose of this study was to determine the effects of LEV adjunctive therapy on the current-source density (CSD) in the high beta frequency band (22-30 Hz) of EEG background activity in refractory partial epilepsy (RPE). METHODS: We conducted a 24-week, open-label, prospective study in 24 patients with RPE. Scalp electroencephalography and neuropsychological tests (NPTs) were conducted twice, once before the LEV trial and then again after 24 weeks of medication. RESULTS: The CSD in the 22-30 Hz band of EEG background activity increased in the bilateral anterior cingulate gyri, left parahippocampal gyrus, and a small area of the right anterior parahippocampal gyrus after the LEV trial. Neither seizure freedom nor the dosage increment of LEV elicited meaningful CSD changes. Verbal memory and executive function were improved after the 24-week LEV trial. CONCLUSIONS: To our knowledge, this is the first study to examine the changes in CSD induced by LEV adjunctive therapy in RPE patients. The CSD changes and NPT results suggest that LEV enhances the activities of the neuronal networks in the prefrontal cortex and left hippocampus.

Short-term effect of COX-2 selective inhibitor as an adjunct for the treatment of periodontal disease: a clinical double-blind study in humans

Adjunctive therapeutic strategies that modulate the inflammatory mediators can play a significant role in periodontal therapy. In this double-blind, placebo-controlled study, 60 subjects diagnosed as periodontitis patients were evaluated for 28 days after periodontal treatment combined with selective cyclooxygenase-2 (COX-2) inhibitor. The experimental group received scaling and root planning (SRP) combined with the Loxoprofen antiinflammatory drug (SRP+Loxoprofen). The control group received SRP combined with placebo (SRP+placebo). Plaque index (PI), probing pocket depth (PD) and bleeding on probing (BOP) were monitored with an electronic probe at baseline and after 14 and 28 days. Both groups displayed clinical improvement in PD, PI and BOP. They also showed statistically similar values (p>0.05) of PD reduction on day 14 (0.4 mm) and on day 28 (0.6 mm). At the baseline, few deeper sites (>7 mm) from SRP+Loxoprofen group were responsible and most PD reduction was observed after 14 days (p<0.05). The percentage of remaining deep pockets (>7 mm) after 14 days in the SRP+Loxoprofen group was significantly lower (p<0.05) than in the SRP+placebo group. Loxoprofen presents potential effect as an adjunct of periodontal disease treatment, but long-term clinical trials are necessary to confirm its efficacy.

Estratégias terapêuticas adjuvantes que modulam os mediadores inflamatórios podem ter função significante na terapia periodontal. Neste estudo duplo-cego controlado com placebo, 60 indivíduos diagnosticados com periodontite foram avaliados por 28 dias após tratamento periodontal combinado com inibidor seletivo de COX-2. O grupo experimental foi tratado com raspagem e alisamento radicular combinado com medicação anti-inflamatória Loxoprofeno (RAR+Loxoprofen). O grupo controle foi tratado com raspagem e alisamento radicular combinado com medicação placebo (Raspagem e alisamento radicular - RAR+placebo). Presença de placa (PI), profundidade de sondagem (PS) e sangramento à sondagem (SS) foram monitoradas com auxílio de uma sonda computadorizada no início do estudo e após 14 e 28 dias. Os dois grupos demonstraram melhora clínica em relação a PS, PI e SS. Também foi observado valores semelhantes (p>0,05) de redução da PS nos períodos de 14 dias (0,4 mm) e 28 dias (0,6 mm). No início do estudo, alguns sítios profundos (>7 mm) do grupo RAR+Loxoprofen foram os responsáveis pela maior redução da PS depois de 14 dias (p<0,05). A porcentagem de bolsas periodontais profundas >7 mm após 14 dias no grupo RAR+Loxoprofen foi significativamente inferior do que o grupo RAR+placebo (p<0.05). A medicação Loxoprofen apresenta potencial efeito adjuvante à terapia periodontal, mas estudos de longo prazo são necessários para confirmar sua eficácia.

Clinical Study of Shengui Capsule as an Adjunctive Therapy for Severe Congestive Heart Failure / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of Shengui capsule in treating severe congestive heart failure(CHF).METHODS: 68 patients with severe CHF were randomly divided into 2 groups:34 patients(control group) were treated with routine therapy(rest,oxygen inhalation,inotropic agents and diuretic agents,vasodilators and symptomatic treatment) for 4 weeks,and another 34 patients with routine therapy plus 0.9 g Shengui capsule tid for 4 weeks(trial group).HR,BP,ECG,CD(Color Doppler),ANF(atrial natriuretic peptide),electrolytes and SCr before and after treatment were compared between the two groups.RESULTS: The cardiac function was improved and ANF level was down-regulated in patients treated with Shengui capsule,showing significant difference as compared with control group(P

Effect of Astragalus Injection as an Adjunctive Therapy on the Biology in Patients with Schizophrenia and Its Clinical Efficacy / 中国药房

OBJECTIVE:To observe the effect of Astragalus injection as an adjunctive therapy on the biology in patients with schizophrenia and its clinical efficacy. METHODS: A total of 100 patients with schizophrenia were randomly assigned to trial group(n=50) or control group(n=50). The trial group received routine antipsychotic drugs plus Astragalus injection (40 mL?d-1, iv gtt) for 7 days, and the control group received antipsychotic drugs alone without addition of traditional Chinese medicine for 7 days. All the patients received for a total of 4 courses of treatment. Besides, both groups received additional benzodiazepine but not other hipnotics. RESULTS: After treatment, there were significant differences between the trial group and the control group in ECG QTc duration, sugar level, therapeutic efficacy, PANSS scores (total score and the sub-item scores) and adverse reactions etc(P

Four Cases of Keloid

Keloid is a hyperproliferative disorder of dermal connective tissues, that sometimes causes perplexy and cannot be managed with medical therapy alone, such as intralesional corticosteroids or interferon injections. In those cases, the best results can be obtained when medical therapy is combined with surgical therapy. Four cases of keloid that had been successfully treated with surgical keloidectomy and postoperative adjunctive therapy are herein reported.