Research Roundup

In this regular feature, aesthetic nurse Claudia McGloin presents a brief synopsis of a range of recently published articles on medical aesthetics. Research roundup aims to provide an overview, rather than a detailed summary and critique, of the papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided at the end of each study summary

Changes in recreational cannabis use during home confinement in the COVID-19 pandemic

The aim of this article was to analyse the influence of population confinement on the experience of cannabis use and to identify the factors that modulate the pattern of cannabis use in a group of drug users living in the autonomous community of Aragón (Spain). For this purpose, a qualitative study was carried out based on sixteen semi-structured personal interviews with cannabis users according to a non-random snowball sampling. After analysing their discourse, changes were observed both in terms of an increase and a decrease in the experience of consumption, as well as a possible relationship between the changes in the consumption pattern of these users and the restrictions decreed by the government of this country. Thus, it was concluded that the population confinement generated changes in the consumption pattern of drug users, with an increase in consumption occurring in users with an increase in available free time and who had collected cannabis prior to asylum. Meanwhile, the reduction was related to the decrease in opportunities to consume cannabis, lack of knowledge of suppliers and longer working hours, mainly. © 2022 Asociacion Espanola de Estudio en Drogodependencias. All rights reserved.

bioTCIs: Middle-to-Macro Biomolecular Targeted Covalent Inhibitors Possessing Both Semi-Permanent Drug Action and Stringent Target Specificity as Potential Antibody Replacements.

Monoclonal antibody therapies targeting immuno-modulatory targets such as checkpoint proteins, chemokines, and cytokines have made significant impact in several areas, including cancer, inflammatory disease, and infection. However, antibodies are complex biologics with well-known limitations, including high cost for development and production, immunogenicity, a limited shelf-life because of aggregation, denaturation, and fragmentation of the large protein. Drug modalities such as peptides and nucleic acid aptamers showing high-affinity and highly selective interaction with the target protein have been proposed alternatives to therapeutic antibodies. The fundamental limitation of short in vivo half-life has prevented the wide acceptance of these alternatives. Covalent drugs, also known as targeted covalent inhibitors (TCIs), form permanent bonds to target proteins and, in theory, eternally exert the drug action, circumventing the pharmacokinetic limitation of other antibody alternatives. The TCI drug platform, too, has been slow in gaining acceptance because of its potential prolonged side-effect from off-target covalent binding. To avoid the potential risks of irreversible adverse drug effects from off-target conjugation, the TCI modality is broadening from the conventional small molecules to larger biomolecules possessing desirable properties (e.g., hydrolysis resistance, drug-action reversal, unique pharmacokinetics, stringent target specificity, and inhibition of protein-protein interactions). Here, we review the historical development of the TCI made of bio-oligomers/polymers (i.e., peptide-, protein-, or nucleic-acid-type) obtained by rational design and combinatorial screening. The structural optimization of the reactive warheads and incorporation into the targeted biomolecules enabling a highly selective covalent interaction between the TCI and the target protein is discussed. Through this review, we hope to highlight the middle to macro-molecular TCI platform as a realistic replacement for the antibody.

Fuelling the Immune System for the 21st Century

The article presents a reprint of the article Fuelling the Immune System for the 21st Century by Michael Passwater which appeared in the February 2023 issue of immune function. Topics discussed include global occurrences of emerging and re-emerging infectious diseases, the importance of nutrition in supporting the immune system, the value of the vitamins C and D, and the status of proton pump inhibitors (PPI). Also noted are suggested adult doses of nutrients.

Parental Preferences And Beliefs Regarding The Use Of Over The Counter (Otc) Medications In Children - A Cross Sectional Study

Introduction: Over the Counter (OTC) Medicines usage for common ailments like fever, cough cold or gastro intestinal complaints have been common in Indian setting and also increasing in other countries as well. Although these medications can be effective, can cause adverse effects especially in paediatric age group if administered in improper dosage or method. This study is an attempt to identify the parental beliefs and methods regarding usage of OTC drugs in their children. Aim(s): To identify parental perceptions, knowledge, applications and practice of using OTC drugs in their children. Material(s) and Method(s): This cross-sectional questionnaire-based study was conducted at Saveetha Medical College Hospital, Chennai, Tamil Nadu, India (tertiary care centre) from May 2022 to September 2022. Parents of children aged up to 14 years were subjected to a validated questionnaire;respondents mostly being mothers. The questionnaire had 3 parts with questions pertaining to socio - demographic details (part 1), knowledge application and practice of using OTC drugs and impact of the covid - 19 pandemic on parents seeking healthcare for their children. The data was tabulated onto excel sheets and analysed using SPSS software for windows. Result(s): A total of 83 children participated in the study. Majority of the study population was greater than 1 year. Upon analysing the responses, 74 (89%) of the respondents had OTC drugs at home with most common being drugs for fever (51.4%) followed by cough and cold (33.8%), with the major source of OTC drugs being the nearby pharmacy (97.3%) which was statistically significant amongst educated mothers purchasing OTC medications with a p value of 0.05. Parents did not have much knowledge about the side effects or how the drugs work. With the outlook of visiting a hospital, 50% of the parents still felt it is necessary to visit a hospital for their children's illness. Among those who were apprehensive to visit a hospital, the primary concern was fear of infection in case they visited a hospital which was statistically significant with a p value of 0.001. Overall, parents felt that despite OTC drugs, it is the treatment of a doctor that plays a role in the overall recovery of their child. Conclusion(s): This study showed majority of the parents have OTC drugs in their home and use self-medication to treat illness in their children. However, knowledge and awareness in regarding drug dosage, adverse effects and drug actions was found to be less even amongst educated parents. Parental education during hospital visits by treating doctors and information on the drug labels will help the parents to use these medications as a temporary measure until their child meets the doctor and also help to avoid any possible adverse effects due to improper OTC drug administration. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Understanding COVID-19 News Coverage using Medical NLP

Being a global pandemic, the COVID-19 outbreak received global media attention. In this study, we analyze news publications from CNN and The Guardian - two of the world's most influential media organizations. The dataset includes more than 36,000 articles, analyzed using the clinical and biomedical Natural Language Processing (NLP) models from the Spark NLP for Healthcare library, which enables a deeper analysis of medical concepts than previously achieved. The analysis covers key entities and phrases, observed biases, and change over time in news coverage by correlating mined medical symptoms, procedures, drugs, and guidance with commonly mentioned demographic and occupational groups. Another analysis is of extracted Adverse Drug Events about drug and vaccine manufacturers, which when reported by major news outlets has an impact on vaccine hesitancy. © 2021 Copyright for this paper by its authors

Pathophysiology of Takotsubo Cardiomyopathy: Reopened Debate.

Takotsubo cardiomyopathy (TTC), a persistently obscure dysfunctional condition of the left ventricle, is uniquely transient but nevertheless dangerous. It features variable ventricular patterns and is predominant in women. For 30 years, pathophysiologic investigations have progressed only slowly and with inadequate focus. It was initially proposed that sudden-onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC. Later, it was generally accepted without proof that, in the presence of pain or emotional stress, the dominant mechanism for TTC onset was a catecholamine surge that had a direct, toxic myocardial effect. We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone. In addition, after reviewing the recent medical literature and considering our own clinical observations, especially on spasm, we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm. This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men. We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor. An improved understanding of TTC is especially important because of the condition's markedly increased incidence during the ongoing COVID-19 pandemic.

Surgeon-led 7-VINCut Antibiotic Stewardship Intervention Decreases Duration of Treatment and Carbapenem Use in a General Surgery Service.

Antibiotic stewardship programs optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. In this prospective interventional study, a multidisciplinary team led by surgeons implemented a program aimed at shortening the duration of antibiotic treatment <7 days. The impact of the intervention on antibiotic consumption adjusted to bed-days and discharges, and the isolation of multiresistant bacteria (MRB) was also studied. Furthermore, the surgeons were surveyed regarding their beliefs and feelings about the program. Out of 1409 patients, 40.7% received antibiotic therapy. Treatment continued for over 7 days in 21.5% of cases, and, as can be expected, source control was achieved in only 48.8% of these cases. The recommendations were followed in 90.2% of cases, the most frequent being to withdraw the treatment (55.6%). During the first 16 months of the intervention, a sharp decrease in the percentage of extended treatments, with R2 = 0.111 was observed. The program was very well accepted by surgeons, and achieved a decrease in both the consumption of carbapenems and in the number of MRB isolations. Multidisciplinary stewardship teams led by surgeons seem to be well received and able to better manage antibiotic prescription in surgery.

Pharmacogenomics and Pharmacogenetics: In Silico Prediction of Drug Effects in Treatments for Novel Coronavirus SARS-CoV2 Disease.

The latest developments in precision medicine allow the modulation of therapeutic approaches in different pathologies on the basis of the specific molecular characterization of the patient. This review of the literature coupled with in silico analysis was to provide a selected screening of interactions between single-nucleotide polymorphisms (SNPs) and drugs (repurposed, investigational, and biological agents) showing efficacy and toxicityin counteracting Covid-19 infection. In silico analysis of genetic variants related to each drug was performed on such databases as PharmGKB, Ensembl Genome Browser, www.drugs.com, and SNPedia, with an extensive literature review of papers (to May 10, 2020) on Covid-19 treatments using Medline, Embase, International Pharmaceutical Abstracts, PharmGKB, and Google Scholar. The clinical relevance of SNPs, known as both drug targets and markers, considering genetic variations with known drug responses, and the therapeutic consequences are discussed. In the context of clinical treatment of Covid-19, including infection prevention, control measures, and supportive care, this review highlights the importance of a personalized approach in the final selection of therapy, which is probably essential in the management of the Covid-19 pandemic.

A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology.

Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.