Sleep Promotion in a Busy Inner City High Dependency Unit

Introduction: Critical care patients commonly have disrupted sleep patterns, with reduction of REM sleep, duration of sleep, increased fragmentation and loss of circadian rhythm.1 Causes include the patients' pathophysiology, medications administered and the busy critical care environment. Data collection showed that our patients were sleeping, on average, for a single block of sleep of 3.5 hours. Delirium rates and its known deleterious effects are highly associated with poor sleep, as well as an impairment of psychomotor performance and neurocognitive dysfunction. Sleep deprivation in the healthy population impairs lymphocyte action, cytokine production and pro-inflammatory balance, as well as a reduction in respiratory function and prolongation of respiratory support.2 Objectives: To firstly measure the sleep quality and explore the reasons behind poor sleep from the patients themselves and to gauge the MDT knowledge and interest in sleep, as a fundamental component of patient management. Then using the results we aimed to improve the duration and quality of the patients sleep on high dependency unit. Method(s): The Adapted Richard Campbell Sleep Questionnaire was given to all patients in the HDU over a 4 week period. Results were analysed, then stored for post intervention comparison. The duration of sleep was documented for all patients and a staff questionnaire was done to assess knowledge and concern of staff. Interventions included a staff sleep awareness week with education and prompts attached to the charting tables promoting sleep. Face masks and ear plugs were freely available to be distributed at the evening ward round. The critical care pharmacist identified medications that could alter the patients ability to achieve REM sleep - e.g. evening administered PPIs, and melatonin was commenced early when sleep was troublesome. Estates fixed soft close doors and soft closed bins supplied for clinical areas. After interventions, there was a further 4 week study period where the above factors were repeated. The need for natural light was highlighted and thus this was optimized in the ward environment and those physiologically able were offered trips outdoors to facilitate normal day night wake cycle. With the COVID pandemic ongoing we also endeavored to limit movement overnight of venerable patients. Result(s): The original data collection was of 45 patients with multiple data points, and the second of 27 patients with multiple data points. Results from the Adapted Richard Campbell Sleep Questionnaire were compared using a one tailed students t test. There were significant increases in the subjective quality of sleep (p=0.046) and quantity of sleep (p=0.00018). Reasons given as to improvement of sleep were reduction in discomfort from monitoring and the bed (p=0.026), reduced ambient light (p=0.031) and reduced impact from the presence of other patients (p=0.002). Conclusion(s): There was marked improvement in the awareness of the importance of sleep within the critical care team after education promoting a change in attitude and culture towards sleep. We are planning a second iteration targeting sedation, noise from monitors and staff and overnight interventions. Although this has been done with level 2 patients, extension to level 3 areas would be beneficial.

What a difference a year makes: Objective rest/activity patterns, circadian phase markers, and sleep quality before and during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic led to numerous changes in sleep duration, quality, and timing. The goal of this study was to examine objective and self-reported changes in sleep and circadian timing before and during the pandemic. METHODS: Data were utilized from an ongoing longitudinal study of sleep and circadian timing with assessments at baseline and 1-year follow-up. Participants had baseline assessment between 2019 and March 2020 (before pandemic) and 12-month follow-up between September 2020 and March 2021 (during pandemic). Participants completed 7 days of wrist actigraphy, self-report questionnaires, and laboratory-collected circadian phase assessment (dim light melatonin onset). RESULTS: Actigraphy and questionnaire data were available for 18 participants (11 women and 7 men, Mean = 38.8 years, SD = 11.8). Dim light melatonin onset was available for 11 participants. Participants demonstrated statistically significant decreases in sleep efficiency (Mean = -4.11%, SD = 3.22, P = .001), worse scores on Patient-Reported Outcome Measurement Information System sleep disturbance scale (Mean increase = 4.48, SD = 6.87, P = .017), and sleep end time delay (Mean = 22.4 mins, SD = 44.4 mins, P = .046). Chronotype was significantly correlated with change in dim light melatonin onset (r = 0.649, P = .031). This suggests that a later chronotype is associated with a greater delay in dim light melatonin onset. There were also non-significant increases in total sleep time (Mean = 12.4 mins, SD = 44.4 mins, P = .255), later dim light melatonin onset (Mean = 25.2 mins, SD = 1.15 hrs, P = .295), and earlier sleep start time (Mean = 11.4 mins, SD = 48 mins, P = .322). CONCLUSION: Our data demonstrate objective and self-reported changes to sleep during the COVID-19 pandemic. Future studies should look at whether some individuals will require intervention to phase advance sleep when returning to previous routines such as returning to office and school settings.

Angiotensin converting enzyme 2 gene expression and markers of oxidative stress are correlated with disease severity in patients with COVID-19.

BACKGROUND: Oxidative stress is thought to play a significant role in the pathogenesis and severity of COVID-19. Additionally, angiotensin converting enzyme 2 (ACE2) expression may predict the severity and clinical course of COVID-19. Accordingly, the aim of the present study was to evaluate the association of oxidative stress and ACE2 expression with the clinical severity in patients with COVID-19. METHODS AND RESULTS: The present study comprised 40 patients with COVID-19 and 40 matched healthy controls, recruited between September 2021 and March 2022. ACE 2 expression levels were measured using Hera plus SYBR Green qPCR kits with GAPDH used as an internal control. Serum melatonin (MLT) levels, serum malondialdehyde (MDA) levels, and total antioxidant capacity (TAC) were estimated using ELISA. The correlations between the levels of the studied markers and clinical indicators of disease severity were evaluated. Significantly, lower expression of ACE2 was observed in COVID-19 patients compared to controls. Patients with COVID-19 had lower serum levels of TAC and MLT but higher serum levels of MDA compared to normal controls. Serum MDA levels were correlated with diastolic blood pressure (DBP), Glasgow coma scale (GCS) scores, and serum potassium levels. Serum MLT levels were positively correlated with DBP, mean arterial pressure (MAP), respiratory rate, and serum potassium levels. TAC was correlated with GCS, mean platelet volume, and serum creatinine levels. Serum MLT levels were significantly lower in patients treated with remdesivir and inotropes. Receiver operating characteristic curve analysis demonstrates that all markers had utility in discriminating COVID-19 patients from healthy controls. CONCLUSIONS: Increased oxidative stress and increased ACE2 expression were correlated with disease severity and poor outcomes in hospitalized patients with COVID-19 in the present study. Melatonin supplementation may provide a utility as an adjuvant therapy in decreasing disease severity and death in COVID-19 patients.

The inhibitory and inactivating effects of visible light on SARS-CoV-2: A narrative update.

Prior to the coronavirus disease-19 (COVID-19) pandemic, the germicidal effects of visible light (λ = 400 - 700 nm) were well known. This review provides an overview of new findings that suggest there are direct inactivating effects of visible light - particularly blue wavelengths (λ = 400 - 500 nm) - on exposed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virions, and inhibitory effects on viral replication in infected cells. These findings complement emerging evidence that there may be clinical benefits of orally administered blue light for limiting the severity of COVID-19. Possible mechanisms of action of blue light (e.g., regulation of reactive oxygen species) and important mediators (e.g., melatonin) are discussed.

Randomized Clinical Trial of Antioxidant Therapy Patients with Septic Shock and Organ Dysfunction in the ICU: SOFA Score Reduction by Improvement of the Enzymatic and Non-Enzymatic Antioxidant System.

BACKGROUND AND AIM: Here, we assess the effect of adjuvant antioxidant therapies in septic shock patients with organ dysfunction and their effect on the enzymatic and non-enzymatic antioxidant systems. METHODS: Randomized clinical trial run between 2018 and 2022. One hundred and thirty-one patients with septic shock were included in five groups with 25, 27, 24, 26 and 29 patients each. Group 1 received vitamin C (Vit C), Group 2 vitamin E (Vit E), Group 3 n-acetylcysteine (NAC), Group 4 melatonin (MT) and group 5 no treatment. All antioxidants were administered orally or through a nasogastric tube for 5 days as an adjuvant to standard therapy. RESULTS: All patients had multiple organ failure (MOF) and low Vit C levels. Vit C therapy decreased CRP, PCT and NO3-/NO2- but increased Vit C levels. The SOFA score decreased with MT in 75%, Vit C 63% and NAC 50% vs. controls 33% (p = 0.0001, p = 0.03 and p = 0.001 respectively). MT diminished lipid peroxidation (LPO) (p = 0.01) and improved total antioxidant capacity (TAC) (p = 0.04). Vit E increased thiol levels (p = 0.02) and tended to decrease LPO (p = 0.06). Selenium levels were decreased in the control group (p = 0.04). CONCLUSIONS: Antioxidants used as an adjuvant therapy in the standard treatment of septic shock decrease MOF and oxidative stress markers. They increase the TAC and thiols, and maintain selenium levels.

The clinical efficacy of melatonin in the treatment of patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials.

Background: The COVID-19 pandemic has resulted in significant morbidity and mortality worldwide, with cytokine storm leading to exaggerating immune response, multi-organ dysfunction and death. Melatonin has been shown to have anti-inflammatory and immunomodulatory effects and its effect on COVID-19 clinical outcomes is controversial. This study aimed to conduct a meta-analysis to evaluate the impact of melatonin on COVID-19 patients. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched without any language or publication year limitations from inception to 15 Nov 2022. Randomized controlled trials (RCTs) using melatonin as therapy in COVID-19 patients were included. The primary outcome was mortality, and the secondary outcomes included were the recovery rate of clinical symptoms, changes in the inflammatory markers like C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR). A random-effects model was applied for meta-analyses, and further subgroup and sensitivity analyses were also conducted. Results: A total of nine RCTs with 718 subjects were included. Five studies using melatonin with the primary outcome were analyzed, and the pooled results showed no significant difference in mortality between melatonin and control groups with high heterogeneity across studies identified (risk ratio [RR] 0.72, 95% confidence interval [CI] 0.47-1.11, p = 0.14, I2 = 82%). However, subgroup analyses revealed statistically significant effects in patients aged under 55 years (RR 0.71, 95% CI 0.62-0.82, p < 0.01) and in patients treated for more than 10 days (RR 0.07, 95% CI 0.01-0.53, p = 0.01). The recovery rate of clinical symptoms and changes in CRP, ESR, and NLR were not statistically significant. No serious adverse effects were reported from melatonin use. Conclusion: In conclusion, based on low certainty of evidence, the study concluded that melatonin therapy does not significantly reduce mortality in COVID-19 patients, but there are possible benefits in patients under 55 years or treated for more than 10 days. With a very low certainty of evidence, we found no significant difference in the recovery rate of COVID-19 related symptoms or inflammatory markers in current studies. Further studies with larger sample sizes are warranted to determine the possible efficacy of melatonin on COVID-19 patients. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022351424.

Effect of Exogenous Application of Tryptophan and Methyl Jasmonate on Some Metabolites and Antioxidant Activities of Feverfew

Tanacetum parthenium (L.) Schultz-Bip (feverfew) is among the important medicinal and aromatic plants due to its tryptophan (TRP), serotonin (SER), melatonin (MEL), and parthenolide (PRT) content. In recent studies, have reported TRP, MEL, and (PRT) are effective in the treatment of COVID-19, thus increasing the popularity of feverfew, which is rich in these valuable molecules. This study investigated the possible effects of exogenous foliar applications of methyl jasmonate (MeJA 0.5 mM) and TRP (20 mM) on plant TRP, SER, MEL, and PRT levels. During the pre-flowering period, endogenous TRP was measured as 128.9 mu g/mL and endogenous PRT as 1.53% mg/g in the leaves of the control group. During the flowering period, the MEL level was measured as 1.38 mu g/mL in the leaves of the TRP application group. In addition, in the pre-flowering period, MeJA-induced increases of 94.51% were determined in DPPH antioxidant activity and the total flavonoid content was 38.76 mg QE/g, whereas the highest total phenolic content of 51.63 mg GAE/g was found in flower samples of the control group. However, neither the developmental periods nor the treatments significantly affected the total phenolic content in the leaves.

Cholesterol and Melatonin Exert Opposite Effects on the Interaction of Model DMPC Membranes with the SARS-CoV-2 S-Protein: A SANS Study

An effect of receptor-binding domain (RBD) of SARS-CoV-2 S-protein on structural parameters of model lipid membranes presented by dimyristoylphosphatidylcholine (DMPC) systems with cholesterol and melatonin impurities is studied by small angle neutron scattering (SANS). It is shown that an increase in melatonin concentration in the lipid membrane leads to a decrease in the thickness of the lipid bilayer, while an increase in the concentration of cholesterol leads to an increase in its thickness. It is suggested that increasing the concentration of melatonin in a membrane prevents the interaction of coronaviral S-protein with a lipid membrane of a cell. In the presence of cholesterol in the system, the interaction of a lipid membrane with an active part of S-protein occurs depending on a phase state of the lipid: in the case of a gel phase, there is no changes in structural parameters, but at higher temperatures in the case of a liquid crystal phase, an addition of RBD SARS-CoV-2 to the system causes a reduce in the membrane thickness. © 2023 Wiley-VCH GmbH.

Protocol for Preparing for Competitions in Different Time Zones

The pandemic affected all branches of the country's economy, all categories of services, but also performance sports. With it, competitions appeared postponed without a precise date or even totally canceled. In performance sports, a major role was played by the uncertainty of the biggest competition in an athlete's life, the Tokyo competition. It was a great challenge for the coach to organize his training periods, so as to bring the athletes in the best shape, but also for the doctors and the medical staff to work on an adequate recovery, to support the physical effort through the most well-rated supplements, always adapting to changes and not least for athletes to resist physically and mentally and to find the motivation to continue the routine to achieve their goal, that of reaching Tokyo.Copyright © 2022 Andreea-Elena Siminiceanu, published by Sciendo.

Assessment of Sleep Quality among Medical Students During the Covid- 19 Pandemic

Objective: To assess the sleep quality among medical students, comparing their sleep cycles during physical and online studies along with other factors associated with sleep patterns. Study Design: Cross-sectional Questionnaire based survey Place and Duration of Study: Department of Community Medicine, HITEC Institute of Medical Sciences Taxila from 1st January 2020 to 31st March 2020 Methodology: One hundred and forty seven students were surveyed in a time period of 1 month. The questionnaire included PSQI Pittsburgh Sleep Quality Index and other clinically validated questions. Students with known sleeping disorders were excluded from this survey. Result(s): There were 81 (55.1%) females and 65 (44.2%) males with mean age 20+/-1.4 years. Out of these 94(63.9%) were classified as "Poor Sleepers" and only 53 (36.1%) were "Good Sleepers". Poor sleep quality was associated with female gender (p<0.05), day-scholar residence status (p<0.054), excessive time required to sleep (p<0.00), excessive screen time usage (p<0.007), increased hours of study (p<0.089), experiencing trouble while driving, eating and socializing (p<0.002), lack of enthusiasm (p<0.000), unsatisfactory daily activities (p<0.000) and poor daytime alertness levels (p<0.360). 104 (70.7%) were aware of the effects of melatonin on sleep, only 51 (34.7%) admitted to have used coffee to stay awake at night. 98 (66.7%) subjects were pre-exam workers, 95 (64.6%) admitted not being able to wake up easily in the morning. Conclusion(s): The students and hostelites that used less screen time slept better. Excessive daytime tiredness was also a result of poor sleeping habits. Students who studied for longer periods of time and had difficulty waking up in the morning slept poorly. Poor sleepers also find it difficult to interact and are often unambitious about performing their daily menial tasks, as well as displeased with their daily activities. As a matter of fact, we deduce that sleep quality has unanticipated consequences for medical students' social and mental health.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

The Role of Estradiol in Modifying Circadian Rhythms, Sleep Regularity and Risk for Depression During the Pubertal Transition

Background: The pubertal transition (PT) is characterized by dramatic reproductive hormone fluctuations, a developmental circadian delay, and significant changes in sleep and wake patterns. The PT also marks an abrupt divergence between the sexes in risk for depression and sleep disorders that remains elevated for females across the reproductive lifespan, implicating ovarian hormones (i.e., estradiol (E2)) as a common pathway of risk. Notably, inconsistent schedules during the COVID-19 pandemic have contributed to greater sleep irregularity (especially for adolescents), which is associated with affective impairment and inferior clinical outcomes. The objective of this research is to characterize the pathophysiological impact of E2 on sleep disturbances, endocrine rhythm dysregulation and depressive symptoms in peripubertal females. Method(s): 44 peripubertal females (ages 11-14, within 1-year post-menarche) provided daily hormone (E1G-urinary metabolite of E2) and mood assessments for one menstrual cycle and completed an 8-day sleep assessment (actigraphy, daily sleep diaries), with cortisol and melatonin circadian measurement (over four days) starting at day 7 of the following menstrual cycle. Minute-to-minute consistency in sleep/wake state over 24-hrs was calculated to index sleep regularity (SRI). Result(s): A multiple regression model predicted depressive symptoms (CES-DC) from follicular menstrual cycle phase E1G-AUC, sleep regularity index (SRI), cortisol and melatonin AUCs (F(4,18) = 3.833, p=.020, R2=.46). E1G, cortisol-AUC (p<.05) and SRI (marginally, p=.08) contributed to the prediction. Conclusion(s): Results suggest that greater sleep irregularity, greater follicular estradiol and blunted cortisol may contribute to increased depressive symptoms in peripubertal females, providing mechanistic insight into the estradiol-related sleep and affect disruptions experienced during the pubertal transition. Funding Source: K01MH121575;Foundation of Hope for Research and Treatment of Mental Illness (NC) Keywords: Puberty, Sleep Disturbances, Estradiol, Circadian Rhythms, Depressive SymptomsCopyright © 2023

Melatonin Treatment in Kidney Diseases.

Melatonin is a neurohormone that is mainly secreted by the pineal gland. It coordinates the work of the superior biological clock and consequently affects many processes in the human body. Disorders of the waking and sleeping period result in nervous system imbalance and generate metabolic and endocrine derangements. The purpose of this review is to provide information regarding the potential benefits of melatonin use, particularly in kidney diseases. The impact on the cardiovascular system, diabetes, and homeostasis causes melatonin to be indirectly connected to kidney function and quality of life in people with chronic kidney disease. Moreover, there are numerous reports showing that melatonin plays a role as an antioxidant, free radical scavenger, and cytoprotective agent. This means that the supplementation of melatonin can be helpful in almost every type of kidney injury because inflammation, apoptosis, and oxidative stress occur, regardless of the mechanism. The administration of melatonin has a renoprotective effect and inhibits the progression of complications connected to renal failure. It is very important that exogenous melatonin supplementation is well tolerated and that the number of side effects caused by this type of treatment is low.

Beneficial Effects of Melatonin on Periodontitis Management: Far More Than Oral Cavity.

Periodontitis as a highly prevalent chronic infection/inflammatory disease can eventually lead to tooth loss and masticatory dysfunction. It also has a negative impact on general health and largely impairs quality of life. The tissue destruction during periodontitis is mainly caused by the excessive immune-inflammatory response; hence, how to modulate the host's reaction is of profound importance for effective periodontal treatment and tissue protection. Melatonin, as an endogenous hormone exhibiting multiple biological functions such as circadian rhythm regulation, antioxidant, and anti-inflammation, has been widely used in general healthcare. Notably, the past few years have witnessed increasing evidence for the application of melatonin as an adjunctive approach in the treatment of periodontitis and periodontitis-related systemic comorbidities. The detailed underlying mechanisms and more verification from clinical practice are still lacking, however, and further investigations are highly required. Importantly, it is essential to establish standard guidelines in the near future for the clinical administration of melatonin for periodontal health and general wellbeing.

Natural Ingredients to Improve Immunity.

The immune system protects the body from infectious agents such as bacteria, viruses, or fungi. Once encountered with pathogens or antigens, the innate and adaptive arms of the immune system trigger a strong immune response to eliminate them from the system and protect the body. Thus, well-balanced immunity is pivotal for maintaining human health, as an insufficient level of immune defense leads to infections and tumors. In contrast, the excessive functioning of the immune system causes the development of autoimmune diseases and allergies. Strong immunity requires adequate nutrition, dietary interventions, and sufficient intake of certain vitamins (vitamin C, vitamin D, and folic acid) and minerals (magnesium, zinc, and selenium). Therefore, nutritional and micronutrient deficiencies lead to compromised immunity. Several natural ingredients have shown potent immunomodulatory properties. The immune-enhancing properties of many plants and fungi are due to containing bioactive phytoconstituents such as polyphenols, terpenoids, ß-glucans, vitamins, etc. Probiotics and prebiotics can be used as innovative tools to reduce intestinal inflammation and downregulate hypersensitivity reactions. Plant sources of melatonin, a multifunctional molecule with proven anti-inflammatory and immunomodulatory properties, have been discovered relatively recently. The bioactive compounds augment the immune response by directly increasing the cytotoxic activity of natural killer cells, macrophages, and neutrophils. Many phytoconstituents prevent cell damage due to their powerful antimicrobial, antioxidant, and anti-inflammatory properties. The present review attempts to understand the molecular mechanisms underlying the immune-enhancing properties of some bioactive compounds from plants, fungi, animals, microorganisms, and other natural sources.

Melatonin improved glucose homeostasis is associated with the reprogrammed gut microbiota and reduced fecal levels of short-chain fatty acids in db/db mice.

Accumulated evidence shows that melatonin possesses the potential to improve lipid metabolism by modifying gut microbiota and glucose metabolism via regulating the melatonin receptor signaling pathway. However, the contribution of melatonin consumption on glucose homeostasis by affecting gut microbiota has not been investigated in diabetes. In the current work, we investigated the effect of melatonin administration on gut microbiota and glucose homeostasis in db/db mice, a type 2 diabetes model with leptin receptor deficiency. Administration of melatonin through drinking water (at 0.25% and 0.50%) for 12 weeks decreased diabetic polydipsia and polyuria, increased insulin sensitivity and impeded glycemia. The accumulated fecal levels of total short-chain fatty acids (SCFAs) and acetic acid are positively correlated with diabetes-related parameters-homeostasis model assessment of insulin resistance (HOMA-IR) index and fasting blood glucose (FBG) level. The reprogramming of gut microbiota structure and abundance and the reduction of fecal levels of SCFAs, including acetic acid, butyric acid, isovaleric acid, caproic acid, and isobutyric acid, by melatonin may be beneficial for enhancing insulin sensitivity and lowering FBG, which were verified by the results of correlation analysis between acetic acid or total SCFAs and HOMA-IR and FBG. In addition, the melatonin downregulated hepatic genes, including fructose-1,6-bisphosphatase 1, forkhead box O1 alpha, thioredoxin-interacting protein, phosphoenolpyruvate carboxy-kinase (PEPCK), PEPCK1 and a glucose-6-phosphatase catalytic subunit, that responsible for gluconeogenesis support the result that melatonin improved glucose metabolism. Overall, results showed that the melatonin supplementation reduced fecal SCFAs level via reprogramming of gut microbiota, and the reduction of fecal SCFAs level is associated with improved glucose homeostasis in db/db mice.

The Potential of Melatonin and N-Acetylcysteine on Remdesivir Induced Liver Injury in Covid 19 Patients

The Covid-19 pandemic has been a problem in recent years. The first FDA approved drug in the treatment of this disease was Remdesivir, which, despite its many benefits, has harmful effects on the liver. Melatonin and N-acetylcysteine, two drugs that have previously been shown to protect the liver with their antioxidant properties, may reduce the hepatic toxicity induced by Remdesivir. Given that few studies have been performed on the role of oral melatonin and N-acetylcysteine on reducing the hepatic adverse effects of Remdesivir, we decided to conduct this clinical trial study. In this double-blind, randomized clinical trial study, 70 patients with Covid-19 in Besat Hospital, Tehran, Iran, during 2022, were enrolled. Patients were randomly divided into two groups of 35 each. Both groups were administered Remdesivir with same protocol. In this period, the first group received N-acetylcysteine 600 mg tablet twice daily and melatonin 6 mg tablet at bedtime. The second group received placebos with the same appearance. Liver enzymes of all patients were serially evaluated and then demographic and lab datas were extracted. Mann-Whitney test, Chi-square test and independent t-test were used for analysis of data. P < 0.05 was considered statistically significant. No significant difference was seen between case and control groups regarding age, gender, BMI and severity of the disease at the time of hospital admission (P > 0.05), which shows a random classification of two groups. The mean AST, ALT, ALP and CBC of patients in case group decreased compared to the control group but the difference was not statistically significant (P > 0.05). In patients with COVID-19 that received Remdesivir, oral administration of melatonin and NAC did not significantly decrease either the patients liver enzymes or CBC level in 6 day of enrolment compared with placebo. Further studies with longer duration and different doses are recommended. © 2023 by the authors. Licensee ResearchersLinks Ltd, England, UK. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Differences in the diurnal variation of salivary stress biomarkers during the coronavirus (COVID-19) pandemic between telecommuters and office workers

OBJECTIVES: It is necessary to objectively assess the stress state of workers, from the standpoint of holistic palliative care, in order to determine how the rapid change in work styles in the "live with coronavirus era"-in which people will coexist and live with the coronavirus (COVID-19)-will affect their physical and mental health. The aim of this study is to assess the impact of rapid changes in work patterns during the COVID-19 pandemic on the neuroendocrine stress response of workers. DESIGN AND METHODS: A total of sixteen subjects, 9 telecommuters (2 males, 7 females;age, 37.1+/-2.6 years) and 7 office workers (3 males, 4 females;age, 37.3+/-3.0 years) who provided their informed consent were enrolled in this prospective observational study. Saliva was collected four times a day (after waking, noon, evening, and before bedtime) and three times a week (Monday, Wednesday, and Friday) during May and June 2020. The saliva samples were stored at -20degreeC until measurement. Saliva components were analyzed by ELISA for cortisol, melatonin, s-IgA, and oxytocin. RESULT(S): The diurnal variation of salivary components between telecommuting and office work groups was investigated. Cortisol showed diurnal variation with higher secretion during waking hours and lower secretion toward nighttime in both groups, and no modulation was observed. In the office work group Melatonin showed diurnal variation, with increased secretion at night. In contrast, the telecommuting group showed modulation, with higher secretion at waking and lower secretion at night. s-IgA showed diurnal variation with a high level at waking and a low level thereafter in both groups, and no modulation was observed. The telecommuting group showed higher oxytocin levels in comparison to the office work group. CONCLUSION(S): These results suggest that the absence of commuting in the telecommuting group reduces anxiety due to infection, and that the diurnal variation of melatonin may be due to the alteration of circadian rhythm caused by being at home all day.

Anxiety in Paediatric Patients: A Summary of Routinely Recorded Data at Gosh

Aims We performed an analysis of GOSH's Electronic Patient Record (EPR) data derived insights relating to patients diagnosed with an ICD-10 anxiety code. This analysis examined trends in frequency distribution and duration of anxiety diagnoses over time, alongside the medication administrations and procedures performed on these patients. Methods Routine data for all patients diagnosed with an ICD-10 anxiety code (F41-) from July 2019 to March 2022 were extracted, de-identified, and analysed in the secure GOSH Digital Research Environment (DRE). The Python package Pandas was used to clean and analyse data. Interactive visualisations were created using Plotly. Medication drug classes for these patients (Hypnotics, Anxiolytics, and Antidepressants), and OPCS-4-classification-identified-procedures were analysed. Results Across 1573 patients in the cohort, 'Anxiety disorder, unspecified' (F419) was the most common anxiety type until 2021, gradually being replaced by 'Other specified anxiety disorders' (F418). The monthly sum of anxiety diagnoses demonstrated a seasonal variation, peaking in July 2019 and July 2021, with a trough spanning UK COVID-19 lockdowns. Chronic Kidney Disease, Autism, and other developmental disorders were the most prevalent comorbidities. Stratifying by drug class, Hypnotics & Anxiolytic administrations were more popular than Antidepressants for patients diagnosed with anxiety. Melatonin was the most administered medication. The OPCS-4 Class 'U' ('Diagnostic imaging, testing and rehabilitation') was the most common group of procedures performed on the same day as an anxiety diagnosis. Transthoracic Echocardiography and CSF Injection were most prevalent. Conclusion This analysis of EPR data found a seasonal variation in anxiety diagnosis frequency, with a gradual change in the specific type. Hypnotics & Anxiolytics are more popular than Antidepressants. Anxiety diagnoses relate mostly to imaging and testing procedures. Further work includes the same analyses and trends on earlier data.

Nutritional Supplement Use Influencing by Cyberchondria and E-Health Literacy During the COVID-19 Outbreak in Turkey

Aim: "We're not just fighting an epidemic;we're fighting an infodemic," said World Health Organization Director-General Tedros Adhanom Ghebreyesus at the Munich Security Conference. In this context, we examined vitamin-mineral use frequency as influenced by cyberchondria, or E-health literacy level, and related factors during the coronavirus disease-2019 outbreak. Method(s): In this cross-sectional study, participants who were admitted to the outpatient clinics in a tertiary hospital between March 2021 and April 2021 were asked questions on socio-demographic data, the presence of vitamin and mineral use, and knowledge. The cyberchondria scores by the cyberchondria severity scale and the E-health literacy scores by the electronic health literacy scale were assessed based on nutrition type choice. The use of vitamins and minerals was compared between regular and non-regular supplement users. Factors related to the presence of nutritional supplement use were assessed through logistic regression analysis. Result(s): A total of 417 participants, including those aged 39.3+/-12.09 years, were found to be regular nutritional supplement users at a rate of 52.99% during the outbreak. The most commonly used supplements were vitamin D (62.8%), vitamin C (54.4%), vitamin B12 (39.6%), zinc (37.9%), magnesium (35.7%), and iron (33.60%). The least used supplement was melatonin (5.30%). Iron, calcium, and vitamin A users had a higher cyberchondria score than non-users (p=0.002, p=0.044, and p=0.030, respectively). However, zinc, selenium, magnesium, calcium, vitamin B6, vitamin C, omega-3 fish oil, and probiotic users had a higher E-health literacy score than non-users (p<0.001, p=0.018, p<0.001, p=0.009, p=0.047, p=0.018, p=0.002, p=0.002, respectively). Logistic regression analyses identified higher E-health literacy [odds ratio (OR)=1.077;95% confidence interval (CI): 1.042-1.115;p<0.001], female sex (OR=1,659;95% CI: 1,005-2,737;p=0.048), graduated from university (OR=2,536;95% CI: 1,009-6,374;p=0.048), presence of health professional's advice (OR=3,716;95% CI: 2,260-6,119;p<0.001) and chronic disease presence (OR=2,755;95% CI: 1,420-5,347;p=0.003) were predictors of supplement usage during the outbreak. Conclusion(s): Higher E-health literate women with comorbidities were likely nutritional supplement users during the outbreak, regardless of cyberchondria severity or age generation differences.Copyright © 2023 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.