Assessment of palliative approach in the pain management in endodontic emergencies during Covid-19 outbreak: Retrospective cohort study

Aim: During the coronavirus disease, a palliative approach was recommended for the management of endodontic emergencies. This retrospective cohort study was conducted to investigate the effectiveness of dexamethasone or ibuprofen-acetaminophen combination for pain management in endodontic emergencies. Material(s) and Method(s): One hundred and eight records of patients who presented to the emergency department with dental pain were evaluated retrospectively. Since interventional procedures were not performed during the pandemic period, Specific analgesics/antibiotics for the management of pain were preferred. A follow-up protocol with a questionnaire was developed to observe the effectiveness of palliative treatment and make changes if necessary. All participants received a questionnaire to rate the pain levels 6, 12, 18, 24, 48, and 72 hours after taking the drug. All data were collected from the patient file and assessed. After inclusion and exclusion criteria, 32 patients were included (n = 19, ibuprofen + acetaminophen;n = 13, dexamethasone). Data were analyzed using the chi-square test (P = 0.05). Result(s): In both groups, a significant decrease in pain was experienced immediately after medication and at 6, 12, and 18 hours, with no significant difference (P >.05). However, dexamethasone (Group II) resulted in lower pain levels than ibuprofen\acetaminophen (Group I) at 24 and 48 hours (P <.05) Discussion: Both dexamethasone and ibuprofen-acetaminophen can be good palliative choices in endodontic emergencies in pandemic conditions. However, at 24 and 48 hours, dexamethasone resulted in lower pain levels.Copyright © 2022, Derman Medical Publishing. All rights reserved.

A descriptive study of older medical cannabis users in medical cannabis clinics

Introduction: There is a dearth of information on older users (65+ years) of medical cannabis, who may face unique challenges due to altered metabolism with aging, concurrent medication use, and risk of adverse effects. This observational study aimed to describe a large cohort of older medical cannabis users in Canada. Method(s): From Oct 2014 to Oct 2020, a commercial medical cannabis provider based in Canada collected anonymized data for research purposes from patient volunteers. Data included demographic, social, and health details (at intake) and cannabis products, self-perceived changes in symptoms and change in medications (at follow-up, variable duration). Cannabis products were categorized as cannabidiol (CBD) only, tetrahydocannabinol (THC) only or mixed CBD/THC. Of the mixed, formulations could be in 1:1 ratios (CBD+/THC+), predominantly CBD (CBD+/THC-) or predominantly THC (CBD-/THC+). Result(s): In total, 9766 subjects in the older cohort (65+ years old) completed the entire questionnaire (mean age (SD) = 73.6 (6.8) y, 60% female). They represented 23.1% of the total dataset (N = 42,267, mean (SD) =51.5 (16.8) y). The proportion of adults in the older cohort tended to increase over time (pre-2018: 17.6%;2018: 26.7%;2019: 31.2%;2020: 22.7%, when the overall intake decreased from 8869 to 5644). Among the older cohort, 15.5% were previous cannabis users and 67.7% were referred for chronic pain (mainly arthritis, chronic pain, lower back pain). Concomitant analgesic use was common (over-the-counter analgesics: 44.5%;opioids: 28.3%;NSAIDs: 24.5%). 7.9% of the sample (compared to 19.9% in the whole sample) were referred for psychiatric disorders, though 21.4% indicated antidepressant use and 12.3% indicated benzodiazepine use. Another 7% were referred for neurological disorders. Follow-up data were captured in visits (11,992) from 4698 older patients, averaging 2.5 visits per patient. The type of medical cannabis used changed over time, with increasing use of cannabis oil compared to herbal cannabis. In 2020, of 2478 visits, 78.9% use was cannabis oil and 6.7% was herbal forms (pre-2018: 57.6% vs 36.2%). The composition of cannabis oil demonstrated a preference for cannabinoid oil (CBD+) over tetrahydrocannabinol (THC+) in 6043 visits: 45.2% were using CBD+ preparations, only 3.2% were using THC+ preparations, and for CBD/THC combinations, CBD predominated (CBD+/THC-: 30.5%;CBD+/THC+: 16.8%;CBD-/THC+: 4.3%). Adverse-effects (7062 visits) included dry mouth (15.8%), drowsiness (8.6%), dizziness (4%) and hallucinations (0.6%). Patients reported improved pain, sleep and mood over time, though 15-20% reported no improvement or worsening. Medication use was mostly unchanged, though 40% of opioid users reported requiring reduced dosages. Conclusion(s): These data were drawn from a large convenience sample. The data suggest an increasing proportion of older users of medical cannabis, though COVID-19 may have affected recent use. Female users comprised a higher proportion, and cannabis oil containing CBD was preferred. Systematic studies of effectiveness and safety in older users of cannabinoids are needed given its increasing use. Funding(s): No funding was received for this work.Copyright © 2021

Analgosedation of patients with severe COVID-19 associated respiratory failure supported with extracorporeal membrane oxygenation: A retrospective, single-center analysis

Objectives: Analgosedation of patients with severe respiratory failure due to coronavirus disease 2019 (COVID-19) proved to be challenging. Patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO) seemed to require analgosedative drugs in high doses. This study reviews analgosedation practices in patients with COVID-19 associated severe respiratory failure supported with VV ECMO. Method(s): This is a retrospective, single-center registry study including all patients with COVID-19 associated severe respiratory failure that were supported with VV ECMO at our center. All sedative and analgetic drugs administered intravenously or via inhalation to patients for at least two hours were recorded and analyzed. Result(s): Between March 2020 and January 2022, 88 patients with COVID-19 associated severe respiratory failure were supported with VV ECMO at our center. Propofol and sufentanil were used most frequently for analgosedation in this cohort. Both drugs were co-administered following treatment standards established prior to the emergence of COVID-19 at our center. Sedative and analgetic drugs were switched to alternative regimens after a median time of 3 and 12.5 days. Alternative regimens included Isofluran, alpha-2- agonists (clonidine or dextomidine) or esketamine. Alpha-2- agonists were initiated at a median time of 2 days after starting VV ECMO support. Benzodiazepines were used primarily as last resort treatment option for sedation at our center. During the four waves of the pandemic experienced at our center, we experienced an increased average number of drugs needed for analgosedation. Conclusion(s): Analgosedation in critically ill COVID-19 patients supported with ECMO is challenging. It remains unclear, whether the standard analgosedation regimen with sufentanil and propofol established at our center prior to the COVID-19 pandemic is optimal for this patient cohort. Further studies are needed to determine optimal and long term safe analgosedation regimens in critically ill patients supported by VV ECMO. Furthermore, changes experienced during the course of the pandemic need to be scrutinized in comparison to other cohorts. (Table Presented).

Post-Covid Myocarditis Simulating Acute Coronary Syndrome

Background: Acute myocarditis corresponds to an acute inflammation of the myocardium whose origin is most often viral. Several viruses can be incriminated to note the parvovirus B19, the virus herpes of the group 6 and to a lesser degree the virus of the hepatitis C (VHC) [18,19]. Since 2019 and with the discovery of SARS COV2 some cases of myocarditis associated with covid have been noted, this last association is rare and is present in only 5% of cases [8]. The diagnosis of myocarditis is sometimes difficult and can lead to confusion with acute coronary syndrome, especially in cases of ST-segment elevation on the EKG, hence the interest of magnetic resonance imaging, which has made it possible in recent years to reduce the rate of unnecessary coronary angiography, especially in the case of young subjects with no cardiovascular risk factors. in this context we report the case of a 33 year old patient with no cardiovascular risk factors and no medical or surgical antecedents who was admitted to the emergency department for the management of acute chest pain related to acute post-covid myocarditis, the patient was initially admitted to the cardiology intensive care unit where he was put in condition and under analgesic treatment and under therapeutic protocal of covid 19 and under anticoagulation based on low molecular weight heparin at preventive dose with a good clinical evolution he was transferred thereafter to the clinical cardiology then declared outgoing under treatment of covid 19 with an appointment of control in 1 month.

Sustaining Life versus Altering Life-Saving Drugs: Insights to Explain the Paradoxical Effect of Extracorporeal Membrane Oxygenation on Drugs.

There has been a substantial increase in the use of extracorporeal membrane oxygenation (ECMO) support in critically ill adults. Understanding the complex changes that could affect drugs' pharmacokinetics (PK) and pharmacodynamics (PD) is of suitable need. Therefore, critically ill patients on ECMO represent a challenging clinical situation to manage pharmacotherapy. Thus, clinicians' ability to predict PK and PD alterations within this complex clinical context is fundamental to ensure further optimal and, sometimes, individualized therapeutic plans that balance clinical outcomes with the minimum drug adverse events. Although ECMO remains an irreplaceable extracorporeal technology, and despite the resurgence in its use for respiratory and cardiac failures, especially in the era of the COVID-19 pandemic, scarce data exist on both its effect on the most commonly used drugs and their relative management to achieve the best therapeutic outcomes. The goal of this review is to provide key information about some evidence-based PK alterations of the drugs used in an ECMO setting and their monitoring.

Headaches in patients with new coronavirus infection

Objective. To study clinical features of migraine in patients with coronavirus infection, as well as headache associated with Covid-19. Material and methods. The study design was cross-sectional. We used free open online source <<Google, Forms>>. Participants were recruited by publishing a survey in social networks of the South Ural State Medical University among students who recovered from mild coronavirus infection in December 2020. The questionnaire assessed the features of migraine and headache ac-companying Covid-19. Results. There were 98 respondents;63 people had Covid-19 associated headaches. Previous migraine was observed in 25 patients, 32 people had no previous headache. According to patient self-assessment, cephalalgia was the most unpleasant symptom of coronavirus infection in 15% of respondents. Headache associated with infection corresponded to migraine phenotype in patients with previous migraine much more often than in those who had not previous migraine. Most patients required analgesics to relieve headache regardless previous migraine. Effectiveness of therapy was low. Respondents without previous cephalalgia rated Covid-19 headache as the most unpleasant symptom due to its intensity, high frequency and poor pain relief effectiveness. Covid-19 headache intensity was significantly higher in 52% of patients with previous migraine compared to baseline cephalalgia. Higher incidence by 2 or more times was observed in 72% of patients. In 28% of respondents, there was aggravation of course of migraine with higher intensity, incidence and poor pain relief after infection. Conclusion. Headache is a typical and maladaptive symptom of mild coronavirus infection. A quarter of respondents with previous migraine experienced aggravation of course of primary cephalalgia after Covid-19.Copyright © 2021, Media Sphera Publishing Group. All rights reserved.

Acute Pancreatitis Following a Lower Extremity Angioplasty

Introduction: Acute pancreatitis affects a significant population globally. Usual etiologies are gallstones, alcohol, hypertriglyceridemia, medications;less frequent are trauma, hypercalcemia, infections, toxins, ischemia, anatomic anomalies, vasculitis, and idiopathic. Pancreatitis post coronary intervention is an uncommon cause with only 19 published cases in the last two decades. Being cognizant of this etiology is important given the increasing number of patients undergoing angiography. Case Description/Methods: An 81-year-old female with hypertension, diabetes, peripheral arterial disease, prior cholecystectomy underwent left lower extremity angioplasty at an outside center. Within a few hours, she started having severe epigastric pain radiating to her back, nausea, vomiting and loose bloody stool. She presented to the emergency department 24 hours after symptom onset. Epigastric tenderness was present on exam. Labs revealed leukocytosis (24,450/muL), elevated lipase (1410 U/L), elevated creatinine (1.3 mg/dL), lactate (3.1 mmol/L), calcium 9.4 mg/dL and triglycerides 161 mg/dL. Incidentally, found to be positive for COVID-19. Normal common bile duct diameter seen on sonogram. CT angiogram of the abdomen/pelvis showed acute pancreatitis, duodenal and central small bowel enteritis (Figure). She was not on any medications known to cause pancreatitis and denied alcohol use. Patient improved with analgesics and intravenous fluids. She had no recurrence of bloody stools and hemoglobin remained stable. On day 4, she was able to tolerate a regular diet, and leukocyte count and creatinine normalized. Patient did not have any COVID respiratory symptoms, and was discharged. Discussion(s): Given the temporal association to angioplasty and no other identifiable cause, acute pancreatitis was presumed to be due to the contrast used during angioplasty. Other possibilities included cholesterol embolism but no peripheral signs of cholesterol embolism were seen. Patient was an asymptomatic COVID-19 case. Although, there are case series of pancreatitis due to COVID, those were found in very sick symptomatic patients. On review of literature, cholesterol embolism was identified as a definite cause only on autopsy or laparotomy (Table). Other possible mechanisms are: high viscosity of the contrast media leading to ischemia and necrosis, contrast causing NF-kB activation followed by epithelial damage, and vasospasm. Pancreatitis after coronary angiography is rare, nonetheless, an important differential especially if there is a temporal relationship.

A prospective study of acute sinusitis, clinical features and modalities of management in adults, Sudan

Background: Acute sinusitis is not an uncommon disease that manifests with inflammation of the mucosal lining of the paranasal sinuses. It has varied etiologies including viral, bacterial, fungal, and allergic. Anatomical variations, trauma, auto-immunity, diabetes mellitus, and dental procedures are predisposing factors. With the wide variation in the etiological factors, the management could be tricky. This study is quite relevant with the advent of the relentlessly persisting COVID-19 pandemic which affects the upper respiratory tract as well. Method(s): This is a descriptive hospital-based prospective study conducted at the Khartoum ENT Teaching Hospital, Ibnsina Teaching Hospital, Omdurman Military Hospital, and Omdurman Teaching Hospital in Khartoum State in the period from March 2020 to February 2021. The study included all patients 18 years and older diagnosed with acute sinusitis. The data was collected by a well-structured questionnaire designed to meet the objectives of the study and analyzed using SPSS 20. Any COVID-19 suspect is excluded from the study. Result(s): The total number of patients was 109;of them, 59 (54.1%) were females and 50 (45.9%) were males, and the female to male ratio was 1.18:1. One hundred seven (98.2%) patients received medical treatment and two patients (1.8%) did take the medications. Eighty-one patients (74.3%) were cured with medical treatment and only 28 patients (25.7%) needed surgical intervention. The age group from 25 to 40 years old was the most affected, accounting for 68 patients (62.4%), and the above 60 years old (3.7%) was the least affected group. Conclusion(s): Acute sinusitis is not an uncommon disease, if addressed properly and timely is medically treatable in most cases apart from complicated cases. This study shows that the active working ages (25-40) were the most affected. Few patients needed surgery (FESS). Negligence could result in complications. Diseases like COVID-19 affect the upper respiratory tract, and there is a similarity in symptoms, and in the advent of the COVID-19 pandemic nowadays, differentiation is of paramount importance.Copyright © 2022, The Author(s).

Sedation in the ICU: association between dexmedetomidine and 28-day mortality in patients with COVID-19

Introduction: The aim of our study is to evaluate the relationship between dexmedetomidine (DEX) use as a sedative agent in mechanical ventilated ICU patients and 28-day mortality. DEX, a selective alfa-2 adrenergic receptor agonist, widely used for its sedative and analgesic properties, has been linked to increasing parasympathetic tone, reducing the inflammatory response and oxidative stress [1]. Since severe COVID-19 is associated with an hyperinflammatory state, it is hypothesized that DEX might improve outcomes in these patients. Method(s): This is a retrospective observational study of mechanically ventilated patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Logistic regression analysis was performed to evaluate the association of DEX use and 28-day mortality from time of intubation. Result(s): A total of 277 patients were analyzed, 151 in the DEX group and 126 in the no DEX group. Patients in the DEX group were younger (53.3 vs. 63.3 years, p < 0.001), had less comorbidities (2.8 vs. 3.5, p = 0.01), lower SOFA at admission (6.2 vs. 7.1, p = 0.01) but had a prolonged ICU stay (21.4 vs. 15.9, p < 0.001). Male gender (65.6 vs. 69.0, p = 0.54), incidence of obesity (56.3 vs. 46.8, p = 0.12), coronary artery disease (4.0 vs. 7.9, p = 0.16) and atrial fibrillation (4.0 vs. 7.1, p = 0.25) were similar between groups. PaO2/ FiO2 ratio at admission (111.1 vs. 108.1, p = 0.61), days spent in RASS < 3 (13.7 vs. 12.4, p = 0.31) and opioid use (14.8 vs. 13.1, p = 0.16) were also similar. From time of intubation, 28-day mortality in the cohort receiving DEX was 14.7% compared to 59.5% in the no DEX group (OR 0.12;95% CI 0.07-0.21;p = 0.01). Conclusion(s): Use of DEX was associated with lower 28-day mortality in COVID-19 critically ill patients requiring invasive mechanical ventilation in our study analysis. Considering the limitations of a retrospective observational study, RCTs are needed to confirm the results.

Effective removal of selected pharmaceuticals from sewerage treatment plant effluent using natural clay (Na-montmorillonite).

The consumption of pharmaceuticals has rapidly increased on a global scale due to the serious increase in Covid-19, influenza and respiratuar sinsityal virus, which is called "triple epidemic" in the world. The use of non-prescription analgesic and anti-inflammatory drugs (AAIDs), especially paracetamol, is higher compared to pre-pandemic. This increased the AAIDs load discharged to the aqueous media through sewerage treatment plant (STP). Therefore, simple and effective treatment options for removing AAIDs from STP effluents are needed. The aim of the study was to remove AAIDs (paracetamol, acetylsalicylic acid, codeine, diclofenac, ibuprofen, indomethacin, ketoprofen, mefenamic acid, naproxen, and phenylbutazone) from STP effluents by nearly pure natural clay Na-montmorillonite. The Na-montmorillonite taken from the Ordu region in the northern part of Turkey. Surface area of the Na-montmorillonite is 99.58 m2/g and CEC is 92.40 meq/100 g. The removal efficiencies of AAIDs using Na-montmorillonite were between 82 ± 5% (ibuprofen) and 94 ± 4% (naproxen). Paracetamol was used as a model compound in kinetic and isotherm model studies. Freundlich isotherm model and the pseudo second order kinetic model were the best-fit using the obtained experimental data. Film diffusion governed its rate mechanism. The paracetamol adsorption capacity was acquired as 244 mg/g at 120 min contact time at pH 6.5 at 25 °C. With this study, it could be shown that montmorillonite can be used effectively to eliminate paracetamol from STP effluent. Natural clay can be used as a simple, inexpensive and effective adsorbent for removing AAIDs from STP effluents. Supplementary Information: The online version contains supplementary material available at 10.1007/s13201-023-01930-5.

Mediastinal Pigtail Catheterization for Treatment of Pneumomediastinum in a COVID-19 Patient: A Case Report

Spontaneous pneumomediastinum (SPM) is a decisive complication reported to be associated with COVID-19. Here, we present a case of SPM in a COVID-19positive patient that was not caused by any iatrogenic or known reasons. At the time of admission, the patient was COVID-positive and distressed. He was immediately subjected to hematological and radiological investigations (chest X-ray, HRCT), which confirmed pneumomediastinum. The patient was hypoxic and hypotensive even after receiving ionotropic support. Considering the patient's critical condition, a mediastinal pigtail catheterization was performed instead of a thoracotomy, and the catheter was in situ for nine days. Arterial blood gas was monitored during the hospital stay, and supplementary oxygen therapy was provided accordingly. The patient subsequently recovered and was discharged. Hence, SPM in this COVID patient was treated by pigtail catheterization, and major surgical interventions were avoided.Copyright © 2023 LookUs Scientific. All rights reserved.

Patterns of Self-medication During the COVID-19 Pandemic in a Colombian population.

Introduction: Self-medication is considered one of the most relevant problems for public health, since it is described as the voluntary use of drugs by the patient. Since the beginning of the health crisis caused by the COVID-19 pandemic, it has been evident that this practice has increased considerably, especially in the adult population. Objective(s): To evaluate the different patterns that influence self-medication during the COVID-19 pandemic. Method(s): A survey was conducted among the population of two vicinities of Bogota and the statistical program SPSS was used for data analysis to identify the main practices that increase the risks derived from self-medication, the most used drugs and their adverse effects. Socioeconomic factors related to self-medication were evaluated. A comparative study was carried out to observe their behavior before and during the pandemic. Additionally, the influence of the people who are part of the family and social environment on self-medication was evaluated. Result(s): The total number of surveys carried out was 301. The average age was 44.18 years. It was found that before the pandemic there was a higher frequency of self-medication of analgesics (49.1 %) and anti-influenza drugs (19.5 %), and during the pandemic it was of non-steroidal anti-inflammatory drugs (4.43 %), home remedies (6.69 %) and antibiotics (30.38 %). In addition, it was found that those who had the greatest influence on self-medication were family members (23.9 %), friends or acquaintances (17.3 %) and the pharmaceutical chemist (5.0 %). Conclusion(s): It is evident that during the COVID-19 pandemic self-medication is higher than in the pre-pandemic era, increasing the risk of adverse events and compromised patient safety.Copyright © 2023, Editorial Ciencias Medicas. All rights reserved.

Evaluation of Nirmatrelvir/Ritonavir Use and Effectiveness

Background and Importance Nirmatrelvir/ritonavir (PAXLOVID) is a recently approved drug to prevent progression in high-risk COVID-19-infected patients. Aim and Objectives To evaluate prescribing and dispensing of PAXLOVID and the proportion of patients with hospitalisation or death from any cause at 28 day. Material and Methods Descriptive, retrospective, observational study carried out between May and August 2022 in a secondlevel hospital. All patients with PAXLOVID prescription were selected. Sources of information were: electronic medical records and the prescription programme. The Variables analysed were: sex, age, risk factors, indications, interactions, dispensation (yes/no) and final treatment received. Risk factors were evaluated with our country's drug regulatory agency (DRA) recommendations to assesed the indication. Efficacy was assessed by the proportion of patients admitted to hospital and 28-day mortality. Results PAXLOVID was prescribed to 34 patients, 14 (41.2%) were women. The median age was 76.3 years old [RIQ 25.4]. Main indications for PAXLOVID were: to be undergoing treatment with myelotoxic chemotherapy (32.3%), corticosteroids or other immunosuppressants (29.4%);being over 80 years of age and presenting specific Risk factors (14.7%) and primary immunodeficiency (5.8%). 21 patients (61.8%) had some relevant interaction with their usual medication. The most frequent interactions were with statins (23.5%), analgesics (20.6%), oral anticoagulants (12%), antiarrhythmics (8.8%), antiplatelet drugs (5.8%), antidepressants (5.8%) and antidiarrhoeals (5.8%). After Validation by the Pharmacy Service, 11 patients (32.4%) did not receive PAXLOVID, 5 because they did not meet DRA criteria, 2 because their glomerular filtration rate was less than 30 ml/min and 4 because they had incompatible interactions. 4 patients finally received 3 days-remdesivir. Among patients who received PAXLOVID, 82.26% received full doses, with 4 patients (11.76%) requiring adjustment for renal impairment. 3 patients (13%) were hospitalised in the first month, none died. Conclusion and Relevance The main indications for which PAXLOVID was prescribed were patients undergoing chemotherapy and/or immunosuppressive treatments. Interactions with PAXLOVID were frequent and in some cases limited treatment. Validation by Pharmacy Service prevented a considerable number of patients from receiving PAXLOVID when it was no-indicated or when they had insurmountable interactions, also allowed patients to receive the dose adjusted for renal impairment. PAXLOVID was effective in avoiding hospital admission and mortality in the majority of patients.

Self-medication Practices for COVID-19 Prevention: A Study among Medical Students in Yogyakarta, Indonesia

The corona virus disease 2019 (COVID-19) pandemic has increased the interest in self-care strategies, including self-medication. Medical students, as future health practitioners, learn more about medications than other students. This study aimed to describe self-medication practices for preventing COVID-19 among medical students at Universitas Islam Indonesia. This observational study used a cross-sectional design and was undertaken in November- December 2020. The study sample included 336 undergraduate medical students determined using a consecutive sampling technique based on inclusion and exclusion criteria. Data were collected using an online questionnaire about self-medication practices in the preceding 3 months. Among a total of 336 students, 137 (41%) reported using self-medication intending to prevent COVID-19, and 126 (92%) of these 137 took preventive supplements, mainly vitamins C, D, and E, and omega-3. Seven students reported the use of zinc, mainly in combination with other vitamins. Students who practiced self-medication lived closer to people confirmed with COVID-19, washed their hands more often, and desinfected their belongings more frequently than their counterparts (p<0.05). The mean duration for consuming vitamins was 11-16 days. Forty students (29%) used herbal medicine to prevent COVID-19;ginger, turmeric, honey, black seed, cutcherry, and Curcuma were the most often consumed herbal remedies. Fourteen students (10%) reported taking over-the-counter medications to relieve symptoms related to COVID-19, including antipyretic, analgesic, antiseptic, antihistamine, decongestant, antitussive, and expectorant medications. Most respondents (82%) purchased their medications at pharmacies, and 11 (9%) obtained them from online shops. These findings show the high rate of self-medication using vitamins and herbal remedies for COVID-19 prevention among university medical students. Further studies are needed to explore students' knowledge about the risks of self-medication including the use of herbal medicines.Copyright © 2022 Marmara University Press.

Phytochemistry and Pharmacology of Indian Traditional Plant Hyssop (Hyssopus officinalis L.): A Review

Hyssopus officinalis is a traditional medicinal plant that belongs to the family Lamiaceae, which has been used for centuries for various purposes like carminative, expectorant, and cough reliever. It has been used for the treatment of numerous diseases in patients such as ulcers, asthma, jaundice, leprosy, dropsy, bronchitis, COPD, diabetes, AIDS, bacterial and fungal infections as an herbal remedy due to its fewer side effects and is more efficacies than other traditional medicine. Major classes of chemical compounds found in H. officinalis essential oil are bicyclic monoter-penes, monoterpenoids, acyclic monoterpenes, phenolic monoterpenoids, monocyclic monoterpenes, monocyclic sesquiterpenes, tricyclic sesquiterpenes, bicyclic sesquiterpenes, tricyclic sesquiterpe-noids, straight chain saturated hydrocarbons. Some of the major chemical constituents present in the H. officinalis are beta-pinene, alpha-pinene, 1, 8-cineole, apigenin, diosmin, caffeic acid, rosmarinic acid, cis-pinocamphone, trans-pinocamphone, iso-pinocamphone, pinocarvone, which are responsible for its various pharmacological activity. Various studies have been performed on the pharmacological activity of its extract, such as antioxidant, antimicrobial, anti-diabetic, anticancer, antiviral, anti-inflammatory, analgesic, anti-leishmanial, anthelmintic, anti-protozoal, and anti-anxiety. Recently, it is used as an anticancer agent and has been demonstrated by studying its cytotoxic and apoptotic effects on breast cancer and colon cancer cells. It is used as a potent antibacterial and antifungal agent being studied on the antibiotic-resistant bacterial and fungal strains recently, which can be further useful in developing herbal medicine against AMR. It is an excellent natural antioxidant due to the presence of polyphenolic compounds, and H. officinalis is used in various food industries as a source of natural antioxidants, which has minimum side effects as compared to artificial antioxi-dants. Furthermore, the pharmacological activity of these individual chemical constituents in H. officinalis extract still needs to be investigated for identifying the effectiveness of this plant in the natural treatment of various diseases. This review aims to collect various data regarding the traditional herbal plant hyssop (Hyssopus officinalis), including its photochemistry, chemical structures of the phyto-constituents and pharmacological profile, along with all the pharmacological models. This plant has significant importance in the health industry, so further studies are required on its effective usage against various emerging health problems, including COVID-19, cancer, diabetes, AMR.Copyright © 2023 Bentham Science Publishers.

A Case Report of Herpes Zoster of the Trigeminal Ganglion after Coronavirus 2019 Vaccination in a 22-year-Old Male

Introduction. Herpes zoster is an acute viral syndrome caused by the reactivation of latent varicella-zoster virus from a previous infection. It is characterized by a painful, unilateral vesicular rash which is distributed over the territory of a dermatome. It is a significant global burden with the incidence very common in the Asia Pacific region. The frequency is closely related with increasing age and is the most common risk factor for reactivation of varicella-zoster virus. Herpes zoster does not often appear after administration of vaccination. But in the advent of increasing vaccinations for COVID-19, there have been reports of herpes zoster following COVID-19 vaccination. Case: This is a case of a 22-year-old healthy male with a previous history of varicella-zoster virus infection during childhood who developed headache, unilateral vesicular rash over the territory of the left trigeminal nerve and left-sided facial pain and numbness. The patient had previously received the COVID-19 vaccine four days prior to the onset of symptoms. The diagnosis of herpes zoster was made on clinical grounds with no need for additional laboratory work-up to confirm the diagnosis. The patient was treated with herpes zoster antiviral therapy and analgesics where improvement of the patient's condition was noted with eventual crusting of the lesions and without development of complications. Conclusion(s): Herpes zoster is a common disease with a benign course in immunocompetent adults. There is a need for further studies to identify risk factors and explain the possible relationship between COVID-19 vaccination and the development of herpes zoster. Due to the increasing COVID-19 vaccination of the population worldwide, there is a possibility of an increase in the number of herpes zoster cases following COVID-19 vaccination.Copyright © 2022, Philippine College of Physicians. All rights reserved.

Efficacy of Breathox device inhalation on acute symptoms associated with COVID-19 (BREATH study)

Background: Breathox is a sodium chloride inhaler. Increase of the airway salinity has been proposed to reduce the symptomatic stage of a respiratory viral infection. Objective(s): to evaluate the effectiveness of nasal and inhaled sodium chloride therapy through Breathox on mild COVID-19 symptoms in patients >= 18 years-old compared to usual care. Method(s): a pilot, open, randomized clinical trial, including 100 patients with confirmed and symptomatic COVID-19 within 10 days of symptom onset. All patients received standard of care (SOC), i.e. antipyretic or analgesic. Breathox was administered as two oral inhalations and one nasal instillation in each nostril at each administration with 2mg per inhalation. Patients were randomized 1:1:1 into three groups: Group 1(G1): SOC + Breathox 10 times daily for 10 days;Group 2(G2): SOC + Breathox five times daily for 10 days;Group 3(G3): SOC. Recovery time for symptoms, such as cough was assessed. Result(s): In total 100 of 103 screened patients were included from December 1 2021 to March 03 2022. Of those, 33 from G1 and G3, and 32 from G2 completed the study. Mean age was 40.4/42.2/40.6 years old for G1, G2 and G3, (p=0.96). No patients were hospitalized or died during the study. Time to cough resolution was reduced in G1 (2.8+/-0.66 days) and G2 (2.4+/-0.66 days) compared to G3 (5.39+/-0.79 days) (p=0.001), with a hazard ratio (HR) for G2 of 2.17 (Confidence interval 1.17-4.04) and G3 of 2.01 (1.06-3.81) compared to SOC. Conclusion(s): ten days of Breathox use halved the time for resolution of COVID-19-induced cough.

[6]-Gingerol: A narrative review of its beneficial effect on human health

Ginger rhizome, a common spice that has been traditionally used in various health aspects. The rhizome contains volatile oil and nonvolatile oil compounds, including oleoresin. Chemical constituents of ginger are numerous and vary depending on the geographic origin, harvest process, and storage conditions. [6]-Gingerol, a major bioactive constituent of ginger, has been reported to possess anti-inflammatory, antiviral, antitumor, antioxidant, and antiemetic effects. Therefore, it is a valuable food molecule with benefits for human health. This review summarized current findings on [6]-gingerol with regards to its beneficial effects on human health, encompassing the biological activities, mechanisms of action and toxicity assessment. In addition, relevant evidence in support of the application of [6]-gingerol towards the promotion health and vitality, as well as methods for extraction, identification and quantitative determination of [6]-gingerol are also provided.Copyright © 2022 The Author(s)

Prescriptions For Analgesics For The Treatment Of Osteoarthritis During The Covid-19 Pandemic: A Retrospective Analysis

Purpose: Between 2008 and 2014 approximately 32.5 million adults in the United States reported a diagnosis of osteoarthritis (OA). The 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis (OA) of the hand, hip and knee recommend treating pain due to OA with analgesic therapy as part of multi-modal treatment program. A national survey conducted by the Centers for Disease Control found that patients with OA were likely to delay care during the pandemic. Given this new barrier to healthcare, access to analgesic therapy may have become even more limited. This study aimed to evaluate changes in analgesic prescribing practices for OA as a result of the COVID-19 pandemic. Method(s): A retrospective analysis was performed to identify new prescriptions, number of doses per order and refills of 73 topical and oral analgesics from encounters for OA. OA encounters were identified using 206 ICD-10 codes for OA from July 2019 to June 2021 at UC Davis Hospital and affiliated outpatient centers. Pre-pandemic data corresponds to 2019 data and data collected after this occurred during the pandemic. Counts of new prescriptions, number of doses per order and refills by fiscal quarter were analyzed using a two-factor Poisson Regression with an interaction between quarter and year with corresponding contrasts to detect a difference between 2019 and 2020 as well as 2019 and 2021 and quarters between these years. A follow-up Sidak step-down p-value adjustment was used to correct for type I error. All statistical analyses were done with a two-sided alpha of 0.05. The Poisson Regression was performed with SAS software for Windows version 9.4 (SAS Institute Inc., Cary, NC). Result(s): A total of 31,532 encounters with a primary diagnosis of OA occurred from July 2019 to June 2021. There was an increase in the number encounters with a primary diagnosis of OA (Figure 1) but there was no statistical difference in the medications ordered from 2019 to 2020, 2019 to 2021, and the quarters between these years as well. After adjusting for Type I error, there was a significant decrease in medication refills from 2019 to 2020 (p-value 0.0031, adjusted p-value 0.0425) as well as from 2019 to 2021 (p-value <0.0001, adjusted p-value 0.003) (Figure 2), and there was a significant decrease in number of doses of analgesia from 2019 to 2020 and an increase in number of doses from 2019 to 2021 (p-value <0.0001, adjusted p-value 0.003) (Figure 3). Conclusion(s): The COVID-19 pandemic has persistent impacts on the prescribing practices of analgesics for the treatment of OA. Our data suggests that since the COVID-19 pandemic, patients with OA were overall provided with more doses of analgesics and fewer refills. It is likely that barriers imposed by COVID-19 resulted in these changes in the way analgesics are provided for the treatment of OA. [Formula presented] [Formula presented] [Formula presented]Copyright © 2023