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Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus, started in livestock within the markets of Wuhan, China and was consequently spread around the world. The virus has been rapidly spread worldwide due to the outbreak. COVID-19 is the third serious coronavirus outbreak in less than 20 years after Severe Acute Respiratory Syndrome (SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in 2012. The novel virus has a nucleotide identity closer to that of the SARS coronavirus than that of the MERS coronavirus. Since there is still no vaccine, the main ways to improve personal immunity against this disease are prophylactic care and self-resistance including an increased personal hygiene, a healthy lifestyle, an adequate nutritional intake, a sufficient rest, and wearing medical masks and increasing time spent in well ventilated areas. There is a need for novel antivirals that are highly efficient and economical for the management and control of viral infections when vaccines and standard therapies are absent. Herbal medicines and purified natural products have the potential to offer some measure of resistance as the development of novel antiviral drugs continues. In this review, we evaluated 41 articles related to herbal products which seemed to be effective in the prevention or treatment of COVID-19.Copyright © 2021 The Author(s).
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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.
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Outcomes: 1. Describe unique barriers that Chinese North American patients with advanced cancer face in expressing emotions and discussing future planning. 2. Identify empathic opportunities (ie, topics associated with emotional expression) during care planning discussions with Chinese North American patients. Introduction: Recognizing emotions in intercultural contexts represents a core competency in palliative care. Yet, a paucity of literature describes the types, patterns, and contexts of patient-expressed emotions during high-stakes conversations with patients from linguistically marginalized communities. We sought to address this gap by analyzing the emotional content during care planning conversations with Chinese patients with advanced cancer and their caregivers. Method(s): We conducted a secondary analysis of 22 semistructured interviews of Chinese patients (n=20) with metastatic cancer and their caregivers (n=8) recruited at one American comprehensive cancer centre. Informed by the Empathic Communication Coding System and existing literature, we conducted template analysis to code the transcripts for patients' and caregivers' expressed emotions. We also thematically analyzed the patterns and contexts in which emotions arose. Result(s): Participants were middle-aged (55.6+/-13.5 years), born in China (89.3%), 60.7% female, 85.7% partnered/married, and 89.3% college educated. Most of the interviews were conducted with patients alone (72.7%). Happiness was the most prevalent emotion (62%) followed by gratitude (43%), fear (43%), sadness (38%), anger (14%), surprise (14%), and humour (5%). When a caregiver was present, the interviews trended toward lower frequency of emotional expression. Regarding intensity, only one instance (anger) was categorized as most severe. Regarding context, emotions were only expressed in discussions about the past or present. Specifically, participants expressed positive emotions when discussing clinician attributes, symptom relief, and immigration to North America. Participants expressed negative emotions when discussing burdensome symptoms, diagnostic journey, the COVID-19 pandemic, and experiences with linguistic or cultural discordance. Discussion(s): Emotional expression during high-stakes care planning conversations with Chinese patients and caregivers may be infrequent and grounded in social, topical, and temporal context. Future work is necessary to understand how clinicians could best respond to distressing emotions during naturally occurring palliative care conversations with Chinese patients and their caregivers.Copyright © 2023
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SARS-CoV-2 can naturally grow and spread from bats or rodents. There are different ways to protect oneself from such viruses. Firstly, a thorough diagnosis by different methods of testing, isolating the infected, and phased interaction with people are advanced, societal-level mitigative efforts that could be implemented. Another method of protection is to eat healthy food. Spices contain flavonoids, acetaminophen, and pseudoephedrine;these ingredients are natural and non-steroidal anti-inflammatory agents and cause no harm. Meat that is mildly spiced, and eggs are also good to boost the immune system. Thirdly, herd immunity is a way to protect people from the virus. Around 50,000 infections in a 250-mile radius could help to develop herd immunity, but this is only a prediction. One should visit his physician if he has a high temperature or cough. SARS-CoV-2, which causes COVID-19, is a new viral strain containing genetic sequences from HIV and malaria in addition to the SARS virus. COVID-19 also targets the ACE2 receptor, which is present in the lungs, heart, and kidneys. Remdesivir seems to be lowering the viral growth in some clinical studies, and in some conditions, it is still understudied and ineffective to eradicate the virus. Recent reports predicted that around 15 COVID-19 mutants have arisen in the last 5 months. The new mutants could be more active or less active, or even drug-resistant. And lastly, new vaccines or drugs must be discovered or invented in BSL3 labs. COVID-19 can be overcome by following mitigation, prophylaxis, and treatment.Copyright © 2021 Bentham Science Publishers.
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Background: Pediatric Infammatory Multisystem Syndrome Associated With SARS-CoV-2 (PIMS) is a new insidious disease which in several points may mimic Kawasaki disease. Patients diagnosed with one of the aforementioned conditions are initially treated with intravenous immunoglobulin (IVIG). However, up to 20% of children diagnosed with Kawasaki disease appear to be resistant to such therapy. Similarly, substantial portion of PIMS patients requires second line treatment including systemic glucocorticoids. There are several calculative models, including the Kobayashi Score, which are utilized to predict patients' response to such treatment. To our best knowledge, the scoring systems derived from Kawasaki disease have not yet been assessed whether they can fulfl similar role in PIMS patients. Objectives: There were two essential questions to be addressed in the study: (1) Can the Kobayashi Score be utilized in making clinical decisions regarding concomitant treatment in PIMS patients? (2) Is there any modifcation that may increase the accuracy of the original score? Methods: First step of the study involved 19 patients diagnosed with PIMS between July 2020 and June 2021. The statistical analysis including each parameter of the Kobayashi Score has been performed in order to determine potential alterations of the score. Then, the numerous variants of modifed score have been compared in terms of their positive and negative predictive values in order to determine new PIMS IVIG Resistance Score (PIRS). In the next phase of the study, both scores have been validated in the second cohort involving 16 patients diagnosed with PIMS between July and December 2021. The fnal assessment has been performed in the unifed study group (35 PIMS patients). Results: The Kobayashi Score (see Table 1) signifcantly differentiated PIMS patients in terms of good response or resistance to IVIG (p=0.03967). However, the score returned a few false positive (3 out of 9) and false negative (2 out of 10) results. After step-by-step verifcation of clinical and laboratory parameters, authors developed a tentative PIRS (see Table 1) including the following criteria: hyponatremia, days of fever and platelet count (derived from the Kobayashi Score but with different cut-off levels) supplemented with procalcitonin level and percentage of lymphocytes. In the validatory phase of the study, both scores had equal accuracy to predict treatment response. The analysis of receiver operating characteristic curve in the unifed study group has shown better performance of PIRS (Youden index 0,72) than the Kobayashi Score (Youden index 0,49). Conclusion: The Kobayashi Score is worth being considered to estimate the risk of resistance to IVIG in PIMS patients. Nonetheless, it is not free from false positive and false negative results. The postulated modifed score called PIRS can become a promising alternative but it requires further validation in larger cohorts of patients.
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Background: Patients with spondyloarthritis (SpA) probably have a high incidence of COVID-19. Vaccination remains one of the most effective methods of preventing infectious diseases. However, data on the safety of vaccines against COVID-19 in patients with SpA are few and relate to foreign vaccines that are not licensed in Russia. Objectives: To study the safety of COVID-19 vaccines in patients with SpA in real clinical practice. Methods: The study included 47 SpA patients (25-ankylosing spondylitis, 13-psoriatic arthritis, 9-undifferentiated SpA, 19 women, 28 men, age 42.3±11.6 years, duration of the disease 11.8±9.2 years)-the main group and 97 people without any immuno-infammatory rheumatic diseases (67 women, 30 men, age 43.7±13.1 years)-the control group. 20 patients received disease-modifying antirheumatic drugs (12-methotrexate, 8-sulfasalazine), 10-biological drugs (8-TNF-α inhibitors, 2-IL-17 inhibitors), 6-glucocorticoids, 1-tofacitinib, 12-only nonsteroidal anti-infammatory drugs, 8-did not receive therapy. In the main group, 40 patients were vaccinated with Gam-COVID-Vac (Sputnik V), 3-Covi-Vac and Sputnik Light, 1-EpiVacCorona (both components of the vaccine were received by 44 patients). In the control group 69 were vaccinated with Sputnik V, 15-CoviVac, 5-Sputnik Light and BNT162b2, 2-EpiVacCorona, 1-mRNA-1273. (91 participants received both components of the vaccine). All participants were interviewed by a research doctor with a unifed questionnaire, additional information was obtained from medical documentation. Results: The data obtained are refilected in the Table 1. Local adverse events (AEs) occurred relatively less frequently in patients with SpA than in the control group. After the introduction of the first component of the vaccine, there was a significant increase in the frequency of pain without restriction of movement and edema/hyperemia in the control group (p<0.001 and p=0.049, respectively), while after the introduction of the second component, a significant difference was registered only for the first indicated symptom (p<0.001). The most frequent systemic AEs were weakness, fever, arthralgia or myalgia, headache, and chills, which were significantly less common (p=0.008) in the main group after immunization with the first component. The proportion of SpA patients without any reactions was significantly higher after the introduction of the first component of the vaccine (59.6% and 29.9%, p<0.001), while after immunity with the second component there were no differences (59.1% and 44.0%, p>0.05). After complete immunization, the percentage of patients without any AEs was significantly higher in the main group than in the control (50.0% and 17.6%, p<0.001). There was no exacerbation of SpA or development of new autoimmune phenomena in the main group after full vaccination. Conclusion: According to preliminary data, the tolerability of vaccines against COVID-19 in patients with SpA is satisfactory. Further studies with an increased sample are needed to study the safety, immunogenicity and clinical efficacy of immunization against COVID-19 in patients of this cohort.
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Background: Patients with rheumatoid arthritis (RA) are at high risk of developing COVID-19. Vaccination should be an effective method of preventing this disease. However, vaccination may be unsafe in RA patients. At present, data on the safety of vaccines against COVID-19 in RA patients are few and relate to foreign vaccines that are not licensed in Russia. Objectives: To study the safety of COVID-19 vaccines in patients with RA in real clinical practice. Methods: The study included 131 RA patients (120 women, 11 men, age 53.8±13.9 years, duration of disease 11.5±9.2 years)-the main group and 121 people without any immuno-infammatory rheumatic diseases (87 women, 34 men, age 39.8±14.2 years)-the control group. 103 patients received disease-modifying antirheumatic drugs (54-methotrexate, 30-lefunomide, 10-hydroxychloroquine, 8-sulfasalazine, 1-mofetil mycophenolate), 68-biological drugs (58-rituximab, 5-TNF-α inhibitors, 4-abatacept, 1-tocilizumab), 64-glucocorticoids, 10-did not receive therapy. In the main group, 92 patients were vaccinated with Gam-COVID-Vac (Sputnik V), 21 with Sputnik Light, 16 with CoviVac, 2 with EpiVacCorona (110 patients received two components of the vaccine). In the control group, 91 were vaccinated with Sputnik V, 16 with Covi-Vac, 6 with BNT162b2, 5 with Sputnik Light, 2 with EpiVacCorona, 1 with mRNA-1273 (114 participants received two components of the vaccine). All participants were interviewed by a research doctor with a unifed questionnaire, additional information was obtained from medical documentation. Results: Local and systemic adverse events (AEs) were observed both in the main group and in the control group. After the introduction of the frst component of the vaccine, local AEs (pain/hyperemia/edema) were noted in 12.2% of RA patients and in 10.7% of the control group, after the introduction of the second component of the vaccine-in 9.1% and 11.4% of respondents, respectively (in both groups p>0.05). There was a signifcant difference between the main group and the control group in the frequency of pain at the injection site without restriction of movements both after the frst (24.4% and 40.5%, p=0.007) and after the second component (18.2% and 31.6%, p=0.021). The most frequent systemic AEs were weakness, fever, muscle or joint pain, headache, chills, which were observed in both groups after administration of both the frst and second components of the vaccine. There was a signifcant difference between the main group and the control group in the frequency of fever (16.8% and 39.7%, p<0.001), weakness (26.0% and 38.8%, p=0.029), muscle and joint pain (9.2% and 25.6%, p<0.001) after administration of the frst (but not the second) component of the vaccine. A signifcant difference was revealed between the main group and the control group in the number of patients with local and systemic AEs both after the introduction of the frst component of the vaccine (19.1% and 43%, p<0.001) and after the second (15.5% and 30.7%, p=0.007). After administration of the two components of the vaccine, a higher number of patients without any AEs were detected in the main group compared to the control group (32.7% and 18.4%, p=0.014). Exacerbation of RA and the emergence of new autoimmune phenomena in main group are not marked. Conclusion: According to preliminary data, the tolerance of vaccines against COVID-19 in RA patients is satisfactory. Further studies are needed to study the safety, immunogenicity and clinical efficacy of immunization against COVID-19 in patients of this cohort.
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The Chinese medicinal herb Mahuang is herbaceous stem of Ephedra sinica, E. intermedia, or E. equisetina(Family, Ephedraceae). In China, Mahuang has been used, all the way over a millennium, as a key component herb of many herbal medicines for management of epidemics of acute respiratory illness and is also used in officially recommended herbal medicines for COVID-19. Mahuang is the first-line medicinal herb for cold and wheezing and also an effective diuretic herb for edema. However, Mahuang can also exert significant adverse effects. The key to safety and effectiveness is rational and precise use of the herb. In this review article, we comprehensively summarize chemical composition of Mahuang and associated differences in pharmacognosy, pharmacodynamics and pharmacokinetics of Mahuang compounds, along with the adverse effects of Mahuang compounds and products. Based on full understanding of how Mahuang is used in Chinese traditional medicine, systematic research on Mahuang in line with contemporary standards of pharmaceutical sciences will facilitate promoting Chinese herbal medicines to become more efficient in management of epidemic illnesses, such as COVID-19. To this end, we recommend research on Mahuang of two aspects, i.e., pharmacological investigation for its multicompound-involved therapeutic effects and toxicological investigation for clinical manifestation of the adverse effects, chemicals responsible for the adverse effects, and conditions for safe use of the herb and the herb-containing medicines.
Subject(s)
COVID-19 Drug Treatment , Drugs, Chinese Herbal , Ephedra sinica , Ephedra , Drugs, Chinese Herbal/chemistry , Drugs, Chinese Herbal/pharmacology , Ephedra sinica/chemistry , Ephedrine/chemistry , Humans , PlantsABSTRACT
Background: Polyethylene glycols (PEGs), also called macrogols, are molecules that cause allergic reactions in individuals who are sensitized to them. Their relevance lies in their popularity as they are usually found in many drugs and skin products such as laxatives, cosmetics, antibiotics, corticoids, contrast dyes, vitamin complexes These compounds have recently attained certain prominence due to their presence in several vaccines developed against the global pandemic of SARS-CoV2. Allergic to these substances individuals cannot be vaccinated, as PEGs or polysorbate 80 (which cross-reacts with PEGs) may be included in the vaccine. This research presents a clinical case of a 57-year man who had had several local skin reactions with associated itching, caused by different cosmetic products and Betadine® (povidone-iodine ointment) in gel. He also developed a similar clinical picture, as well as wheezing, by means of Moviprep® (a laxative), but the same day he tolerated another laxative, Casenglicol®. Additionally, he suffered a reaction to Vincigrip® (paracetamol/pseudoephedrine hydrochloride/chlorpheniramine maleate), but tolerated paracetamol alone Method: The tests have been practised on this patient are standard patch-tests, photopatch testing with sunscreen lotions, prick-tests and intra dermo-reaction (1:100) with PEGs, and controlled exposure test with laxatives Citraflett® and Vincigrip® (both of them without PEGs). Results: All these tests cast negative results but the intra dermoreaction test. In this case, the patient developed facial and oropharynx itchiness, scattered wheals, and dyspnoea, which decreased after administrating adrenaline, corticoids, and antihistamines. The patient was diagnosed allergy to PEG and has been advised from receiving any SARS-CoV2 vaccine at all. Conclusion: It is of great relevance to diagnose allergic to PEG patients, for two main reasons. First, due to the frequent presence of PEGs in medicaments and cosmetics. Many times they may be overlooked as they are included only in some formulations or brands of a same product. Thus, in consequence, these patients cannot be administrated some vaccines against SARS-CoV2 containing PEG or polysorbate.