Lichen planus after COVID-19 infection and vaccination

Background: Lichen planus (LP) is an inflammatory disorder believed to result from CD8+ cytotoxic T-cell (CTL) mediated autoimmune reactions against basal keratinocytes. We present a review of LP following COVID-19 infection and vaccination. Method(s): Literature searches were conducted on PubMed and Google Scholar from 2019 to 7/2022. 35 articles were selected based on subject relevance, and references within articles were also screened. Result(s): 39 cases of post-vaccination LP and 6 cases of post-infection LP were found among case reports and case series. 150 cases of postvaccination LP and 12 cases of post-infection LP were found in retrospective and prospective studies. Conclusion(s): LP is a rare complication of COVID-19 infection and vaccination that may be mediated by overstimulation of T-cell responses and proinflammatory cytokine production. However, it does not represent a limitation against COVID-19 vaccination, and the benefits of vaccination considerably outweigh the risks.

Umifenovir in COVID-19 therapy: a systematic review and meta-analysis.

SARS-CoV-2 has infected more than 600 million people worldwide over the last 2.5 years. So far, there efficacy of many antiviral drugs against COVID-19 has been evaluated only in small studies conducted in different countries. Objective. To assess the efficacy of umifenovir in patients with COVID-19. Materials and methods. We performed systematic search of publications in the PubMed and Google Scholar databases. Sixteen studies with a total of 1,843 patients were included in the analysis. The following endpoints were evaluated: frequencies of negative PCR test on days 7 and 14;mortality in patients with mild, moderate, and severe disease;and frequency of fever resolution on day 7. Results. We found that patients receiving umifenovir demonstrated a significantly higher frequency of negative PCR test on day 7 than patients who received no causal therapy or other antiviral drugs (odds ratio (OR) 1.69, 95% confidence interval (CI): 1.09-2.62, p = 0.02, I2 = 13%). This difference was even more significant among patients with mild to moderate COVID-19 (OR: 2.03, 95% CI: 1.24-3.32, p = 0.005, I2 = 0%), as well as on day 14 (OR: 2.02, 95% CI: 1.35-3.94, p = 0.0007, I2 = 50%). We also observed a reduced risk of death in the studies that included only patients with mild and moderate disease (JR: 0.53, 95% CI: 0.33-0.83, p = 0.006, I2 = 0). Umifenovir therapy did not affect the frequency of fever resolution by day 7 (OR: 0.87, 95% CI: 0.49-1.56, p = 0.64, I2 = 0%). Conclusion. Umifenovir significantly accelerated virus elimination by days 7 and 14 among patients with mild to moderate COVID-19. Umifenovir also reduced the risk of death compared to other antiviral drugs.Copyright © 2022, Dynasty Publishing House. All rights reserved.

Financial Crisis and its Effect on Psychological Well-Being, Health, Satisfaction, and Financial Incapability, A Systematic Review

Background and Objectives: The decline in GDP caused by the global economic recession of 2008 and that caused by the COVID-19 pandemic has resulted in the poor economy of countries around the globe with increased rates of unemployment and adverse job conditions. This systematic review aims to identify the impact of a Financial crisis on Psychological well-being, Life satisfaction, Health Satisfaction, and Financial Incapability. Methodology: The literature included in the review was searched from Feb 1, 2023, to March 26, 2023, by using the PUBMED database as the search engine. Studies discussing the impact of the financial or economic crisis on psychological well-being, Health, Life satisfaction, and Financial Incapabilities published in the English Language were included in this review whereas systematic reviews and metanalysis, case reports, articles published in languages other than English and articles with limited access were excluded. Result(s): Of the 26 articles found eligible for the study, there were 22 Quantitative studies, 2 qualitative studies, and 2 Mixed Method Studies. Most of the articles included in this study discussed the Global Economic crisis caused by COVID-19 and the Global Financial Crisis of 2008. Almost 80% of the studies included in this review discussed psychological well-being and the prevalence of psychological disorders including Depression, Anxiety, Stress, Fear, Loneliness, Burnout, and Suicide whereas the rest of the articles discussed mortality regarding mental disorders. Conclusion(s): Financial crisis or economic recession results in an increased prevalence of common mental disorders affecting psychological well-being by increasing rates of unemployment and adverse job conditions. Policymakers with competitive financial behavior and knowledge are essential elements for psychological well-being and life satisfaction.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Possibilities of low-dose radiation therapy in the treatment of intrapulmonary injuries caused by COVID-19 infection.

This paper examines the relevance of the use of a single irradiation of lungs in treatment of pneumonia caused by a new coronavirus infection. Clinical observations are presented that demonstrate perspectives in the treatment of this disease. Patients with severe pneumonia who were prescribed LD-RT (low-dose radiation therapy) at a dose of 0.5-1.5 Gy showed shorter recovery times and no complications. This method of treatment has shown its effectiveness in a number of studies from different countries, predicting success and economic benefits in its further use and study. A literature search containing information on relevant studies was carried out in PubMed, EMBASE, Web of Science and Google Scholar systems. Attention was focused on full-text articles given their general availability in a pandemic.Copyright © 2021 VIDAR Publishing House. All right reserved.

Long-COVID and its Physical and Neurological Symptoms in Adults: A Systematic Review

This review was carried out with the objective to study patterns of neurological, psychological and other physical consequences of COVID-19 in the long term. The guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) had been followed;22 articles, published during January 2020 to September 2021, were selected. Original research, review articles, editorial and viewpoints were included. Google Scholar, Medline, and PubMed were searched through 2020 till 2021.Data collection in selected studies was performed mainly through the online survey, telephone survey, use of medical records, and patient interviews. This systematic review contains the studies conducted in the American, Asian and European countries. The major outcomes identified were the neurological, psychological, and other long-term chronic manifestations of COVID- 19. This review demonstrates that long-COVID has started to bring a huge wave of patients, the count of them being millions now, who can enter a phase of disability due to neurological damages if not treated during the early course of illness. Though more disabling than lethal, long-COVID patients with a neurological deficit is expected to overburden the healthcare system globally which is already been struggling to handle acute COVID-19 patients in this once-in-a-lifetime pandemic.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Metformin in COVID-19: Is There a Role Beyond Glycemic Control?

Context: The coronavirus disease 2019 (COVID-19) pandemic is still a cause of worldwide health concern. Diabetes and its associated comorbidities are risk factors for mortality and morbidity in COVID-19. Selecting the right antidiabetic drug to achieve optimal glycemic control might mitigate some of the negative impacts of diabetes. Metformin continues to be the most widely administered antidiabetic agent. There is evidence of its beneficial outcome in COVID-19 independent of its glucose-lowering effect. Evidence Acquisition: A thorough literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science to identify studies investigating metformin in COVID-19. Result(s): Several overlapping mechanisms have been proposed to explain its antiviral properties. It could bring about conformational changes in the angiotensin-converting enzyme-2 receptor and decrease viral entry. The effects on the mammalian target of the rapamycin pathway and cellular pH have been proposed to reduce viral protein synthesis and replication. The immunomodulatory effects of metformin might counter the detrimental effects of hyperinflammation associated with COVID-19. Conclusion(s): These findings call for broader metformin usage to manage hyperglycemia in COVID-19.Copyright © 2023, International Journal of Endocrinology and Metabolism.

- Mass gatherings and vaccines usefulness.

Introduction: Mass gatherings (MGs) are usually pre-planned large events that are known to amplify the risk of infectious disease (1). Although, the risk and pattern of diseases at mass gatherings vary depending on the features of the event such as crowding, shared accommodation, possibilities of the participants to prolonged exposure and close contact with infectious individuals, type of activities, and also the characteristics of the participants including their age & immunity to infectious agents, many of these can be prevented by appropriate vaccinations (2, 3). The aim of this article is to present a summary of the risk of vaccine-preventable diseases in MGs. Method(s): The method used to develop this article weas based on a litterature review. A summaryzing process of the documented risk of vaccine-preventable diseases in MGs was conducted to extract the most useful knowledge on this topic. It explored also available evidence on the effectiveness of vaccination policies for reducing disease transmission associated with these events and also the outstanding questions that need to be addressed for future consideration of some new and promising vaccines. Pubmed- Medline, Scopus, web of science and google Scholar were used to search over the published litterature. Result(s): The current Hajj vaccination policy includes mandatory vaccination for all pilgrims against meningococcal disease. This is in addition to mandatory vaccination against yellow fever, polio and Sarscov2 for pilgrims coming from endemic region. The Saudi Ministry of Health also strongly recommends seasonal influenza vaccination for all pilgrims, particularly those at high risk of infection complications. Data on the vaccination requirements for other mass gathering events such as Kumbh Mela and other religious, sports and entertainment events are still clearly lacking. Travelers to the FIFA 2022, Qatar, were advised to remain up-to-date with routine vaccines. Apart from the hajj settings, no data are available on the possible impact of the current vaccination policy on the control of infectious disease transmission in mass gatherings. The available data demonstrate that the current vaccination policy and health requirement for hajj is effectively contributing towards controlling the transmission of infectious diseases associated with Hajj pilgrimage (37), however evidence on effectiveness is clearly lacking. Moreover, there is no vaccination policy as part of health requirements for attendance in Kumbh Melain India. Conclusion(s): While taking into account local immunization policies of countries of origin and countries of travel, for diseases with known effective prequalified vaccines, WHO recommends that travelers at risk of developing complications, or at increased risk of acquiring and spreading infection such as those attending mass events, should consider vaccination as a preventive measure. Such policies are effective when these are driven by evidence and its effectiveness are measured through large scale studies. Mots cles: Mass Gatherings, Vaccines, Vaccination, Prevention Declaration de liens d'interets: Les auteurs n'ont pas precise leurs eventuels liens d'interets.Copyright © 2023

Umifenovir in COVID-19 therapy: a systematic review and meta-analysis.

SARS-CoV-2 has infected more than 600 million people worldwide over the last 2.5 years. So far, there efficacy of many antiviral drugs against COVID-19 has been evaluated only in small studies conducted in different countries. Objective. To assess the efficacy of umifenovir in patients with COVID-19. Materials and methods. We performed systematic search of publications in the PubMed and Google Scholar databases. Sixteen studies with a total of 1,843 patients were included in the analysis. The following endpoints were evaluated: frequencies of negative PCR test on days 7 and 14;mortality in patients with mild, moderate, and severe disease;and frequency of fever resolution on day 7. Results. We found that patients receiving umifenovir demonstrated a significantly higher frequency of negative PCR test on day 7 than patients who received no causal therapy or other antiviral drugs (odds ratio (OR) 1.69, 95% confidence interval (CI): 1.09-2.62, p = 0.02, I2 = 13%). This difference was even more significant among patients with mild to moderate COVID-19 (OR: 2.03, 95% CI: 1.24-3.32, p = 0.005, I2 = 0%), as well as on day 14 (OR: 2.02, 95% CI: 1.35-3.94, p = 0.0007, I2 = 50%). We also observed a reduced risk of death in the studies that included only patients with mild and moderate disease (JR: 0.53, 95% CI: 0.33-0.83, p = 0.006, I2 = 0). Umifenovir therapy did not affect the frequency of fever resolution by day 7 (OR: 0.87, 95% CI: 0.49-1.56, p = 0.64, I2 = 0%). Conclusion. Umifenovir significantly accelerated virus elimination by days 7 and 14 among patients with mild to moderate COVID-19. Umifenovir also reduced the risk of death compared to other antiviral drugs.Copyright © 2022, Dynasty Publishing House. All rights reserved.

Racial and Ethnic Disparities in the Use of Live Video Telemedicine

Purpose of Study As a result of the coronavirus disease 2019 (COVID-19) pandemic and physical distancing, telehealth has been scaled up as a key strategy to address the need for virtual access to medical services. Previous studies have examined use of web-portals for accessing health information, but data on the use of live video telemedicine for disease management across different ethnicities is limited. The objective of this study is to determine if disparities exist among different ethnic groups in accessing live video telemedicine services. Methods Used A literature review was conducted using databases such as PubMed and Google Scholar. Key search terms included: telehealth, telemedicine, ethnicity, and disparities. Studies were included if a) they were conducted in the United States, b) patients used a live video telehealth service with a provider, c) focused on telemedicine use across different racial and ethnic groups, and d) investigated completed access to live video telemedicine at the individual level, and not potential access at the aggregate level. Summary of Results Of 25 articles found, 5 met our inclusion criteria. Overall, white patients had higher rates of telehealth visit completion and video telehealth use than non-white patients. Studies that used telehealth visits for diabetes education and glycemic control showed that self-care improved in all ethnic groups, but despite tailored intervention, minority groups never achieved the same level of self-care as whites. Conclusions Our review suggests that overall white patients have better access to live video telemedicine, and use the services at higher rates compared to non-white patients. However, since this trend was not seen in every study, it is likely that other factors beyond race and ethnicity play a role in access to telemedicine. Effective strategies are needed to mitigate disparities to ensure equitable telemedicine access.

Longitudinal Follow-up of Pulmonary Function in Patients Hospitalized with Pulmonary Covid-19

Purpose of Study: The post-acute sequelae of COVID-19, as a multisystemic disease have been described in adults. Although some studies have described the pulmonary complications up to 3 months post-COVID infection, longitudinal data on pulmonary sequalae are sparse. The objective of this review was to summarize the findings of studies that included a longitudinal follow-up of patients with moderate to severe pulmonary COVID-19 infection. Methods Used: We performed a literature search using Pubmed, Google Scholar and Medline using key words: "pulmonary function test", PFT?, "long-COVID", longitudinal? and sequalae?. We included studies of adult patients (>18 years of age) who had been hospitalized with acute COVID-19 infection and had at least two follow-ups with PFT measurements, including one follow-up at least 6 months post-infection. Studies that did not account for co-morbidities and other lung diseases or those which only included one-time follow-up were excluded. Summary of Results: Five studies satisfied our inclusion criteria (See Table). The studies showed persistent lung injury for at least 3 months after discharge, with decreased forced expiratory volume (FEV1), total lung capacity (TLC), forced vital capacity (FVC), diffusion vital capacity of the lungs for carbon monoxide (DCLO) and carbon monoxide transfer coefficient (KCO). Although these values improved at 6 and 12 months of follow-up, those with more severe disease continued to have decreased DLCO suggestive of restrictive lung damage. Studies that included symptomatic assessment revealed that a minority of patients continued with fatigue and dyspnea uf to 12 months after the infection. The limitations of the studies include availability of data from a single center, small sample size and the variability in controlling for different co-morbidities. In addition, baseline PFT measurement before COVID-19 infection was not available for most patients. Most of the studies were done at the time that the Delta variant was dominant, therefore the data may not be applicable to other variants. Conclusion(s): Our literature review shows that some adult patients hospitalized with acute covid pulmonary infection continue to have abnormal PFTs for up to 12 months after infection. Although PFTs improve overtime, a minority of patients with more severe disease on admission continue with abnormal functional abnormalities, specifically restrictive ventilatory pattern with impaired DLCO at 12 months of follow-up. It is important that patients hospitalized with moderate to severe pulmonary COVID-19 infection be followed up and managed for at least 12 months after the initial infection. Larger prospective studies including different variants of COVID-19 that take into account various co-morbidities and different management strategies are warranted.

Online Content About Prenatal Tdap Vaccination Using Reddit

Purpose of Study The Centers for Disease Control and Prevention (CDC) reported in 2017 that only 50.4% of pregnant women received the Tdap vaccination to protect their newborns from pertussis;21.7% were unaware they needed it and 18.3% were concerned about adverse effects on their baby. This study investigated common concerns women expressed online regarding Tdap in pregnancy and assessed accuracy of online content using Reddit, a popular discussion website. Methods Used We used Reddit's built-in search engine to find user-generated posts by searching key words related to Tdap vaccination in pregnancy. Using the same keywords, we also searched commonly appearing subreddits, which are online communities within Reddit dedicated to topics. Working backwards from February 29, 2020 (to avoid COVID issues), we evaluated posts and comments that met the following inclusion criteria: posts from U.S. users with at least 10 comments;posts and comments focused on Tdap in pregnancy. Comments from automated bots or users outside the U.S. were excluded. Using the idea of saturation, Reddit posts with over 50 comments were analyzed until the 50th comment or until 4 subthemes were found. The CDC guidelines were used to judge accuracy. Summary of Results 100 Reddit posts with 2872 comments between February 2020 to October 2018 were included in the study. 74 Reddit posts sought advice on Tdap vaccination, safety/side effects, and who need Tdap. Out of the 2872 comments, 115 contained inaccurate content;96% of those related to the recommended frequency of the pertussis vaccination. Common themes within the comments included: cocooning (a strategy to protect infants by vaccinating close contacts);why and when pregnant women should get Tdap;and side effects. The most prevalent subtheme pertained to visitation rules for those who declined Tdap. Few comments reflected more extreme opinions, such as 'only illegal immigrants have pertussis.' Conclusions Although most pregnant women on Reddit support the recommendation for Tdap in pregnancy, some users report inconsistent information received from their clinicians. Confusion still remains about who should receive Tdap. There is potential for improved patient education provided by clinicians to ensure their pregnant patients have accurate and complete information about Tdap.

Epidemiologic Characteristics of Multisystem Inflammatory Syndrome in Children (Mis-C) with a Focus on Outcomes

Purpose of Study Treatment outcomes of children diagnosed with MIS-C are unclear and warrant investigation. The purpose of this study is to investigate the characteristics of pediatric patients diagnosed with MIS-C and their treatment outcomes with an emphasis on fatalities associated with MISC. Methods Used A literature review using Google Scholar and Pubmed using keywords such as 'Multisystem Inflammatory Syndrome in Children', 'Pediatric Inflammatory Multisystem Syndrome', and 'Coronavirus Disease 2019' was conducted. We included studies of hospitalized MIS-C patients with a sample size of more than 15. Summary of Results Of ten studies published before August 2020, five reported hospitalized MIS-C cases in the United States and five in Europe. A total of 514 hospitalized patients were reported with a sample size of 15 to 186 in various studies. Of 514 patients, 431 (84%) tested positive for SARS-CoV-2 via RT-PCR or serology. In different studies, 50% to 100% of MIS-C patients required PICU admission, 10% to 54% were intubated, and up to 80% required vasopressors. In studies that reported echocardiogram results, coronary artery dilations or aneurysm were noted in up to 93%, and depressed cardiac function was reported in 51- 100% of MIS-C patients. Treatment of MIS-C patients included intravenous immunoglobulins (IVIG) 388/514 (75%) plus steroids 288/514 (56%), along with anticoagulants and Anakinra 26/514 (5%). In total, 23 patients were put on ECMO, and of those, 16 (70%) survived. The larger studies reported fatality rate of 2% to 3% in hospitalized MIS-C patients. A total of 10 deaths were reported. Of the fatality causes that were described, 3 were associated with cerebral infarction after ECMO, 2 had not received IVIG, systemic glucocorticoids, or immunomodulators, and another 2 had co-morbidities. Conclusions Our review suggests that children with MIS-C who are hospitalized typically have a severe disease course. The outcome in vast majority of patients is favorable but death can occur, most likely as a result of cardiac dysfunction or cerebral infarction. Larger studies are needed to identify clinical features as well as laboratory and diagnostic parameters that predict disease severity and outcome.

Antiviral Drugs Used for COVID-19 Pharmacotherapy: A Narrative Review

Background: A number of research articles has been published evaluating safety and efficacy of drugs against COVID-19. Objective(s): This study was undertaken to collate and review the information regarding common proposed antiviral drugs for easy reference. Method(s): The literature search was done using terms like severe acute respiratory syndrome or SARS-CoV-2 or 2019-nCoV or SARSCoV or COVID-19 in combination with drugs or treatment or pharmacotherapy using PubMed and google scholar to identify relevant articles. Result(s): Despite showing good early results, hydroxychloroquine and lopinavir-ritonavir has not shown clinical benefit in randomized controlled trials. However lopinavir in combination with other drugs specially interferon is being investigated. Remdesivir has shown positive effect in terms of clinical improvement and continued to being investigated alone or in combination with other drugs. Favipiravir has shown mixed results and more data from adequately powered study is needed to prove its efficacy. Conclusion(s): Many drugs which showed positive effect in initial studies could not replicate the same benefit in large randomized controlled trials. There is need to evaluate efficacy and safety of drugs based on high quality evidence before allowing it to be used in general population.

The Influence of COVID-19 on Inflammatory Bowel Disease-Related Search Trends

BACKGROUND: The novel SARS-CoV-2 Coronavirus pandemic has had significant global impact on health care. The pandemic's effect on patients with inflammatory bowel disease (IBD) is unknown, and health care delivery to this largely immunocompromised population is of concern, as many patients refrained or were unable to seek in-person medical care. We noticed there was a decrease in IBD related Emergency Department (ED) visits. Thus, we aimed to explore if the pandemic influenced IBD specific search trends in the United States. We predicted more patients would search for symptoms or medications using Google in order to self-treat or self-care. METHOD(S): Using Google Trends (GT), we queried Crohn's Disease (CD) or Ulcerative Colitis (UC) in combination with IBD-related symptoms (i.e. bloating, rectal bleeding, abdominal pain and diarrhea) or medications (i.e. infliximab and prednisone) between January 1 and April 30 for the years 2018-2020 in the United States. Frequencies of the specific search terms were compared to the site's relative search volume over weekly and monthly intervals. IBD related ED visits were also collected from July 2018 to July 2020. Data was analyzed using monthly and weekly mean search scores compared across years and through 2020 using ANOVA with post-hoc Tukey adjustment for multiple comparisons. RESULT(S): There were decreased search scores for bloating and rectal bleeding with IBD terms occurring during March and April of 2020 compared to years prior but not abdominal pain or diarrhea. The bloating plus CD/UC queries saw the largest variation in 2020 (CD: F = 19.18 with (2,89) df, P < 0.0001, UC: F = 14.08 with (2,89) df, P < 0.0001). For April 2020, medication search terms for infliximab + UC were significantly decreased (F = 47.73 with (2,89) df, P < 0.0001) but not for infliximab + CD (F = 3.08 with (2,89) df, P = 0.051) Prednisone searches also significantly decreased with CD and UC during this time period. In terms of IBD related ER visits, there were 84 in 2018, 99 in 2019, and 15 in 2020. The average quarterly visits in the 30 months preceding Covid was 22.5, while there was only one visit in quarter two of 2020. From March 2020 to July 2020 there were only 4 ED visits total. CONCLUSION(S): Assuming the global pandemic was the main influence of GT during March and April 2020, it appears that some IBD-related searches were significantly reduced compared to pre-pandemic levels, while others did not change. It is possible that patients utilized other services like patient portals and telehealth to communicate with providers instead of Google searches. Interestingly, IBD related ED visits were reduced during the peak of the pandemic, which raises the question and concern of how IBD patients managed their disease during this time. Limitations include the non-specificity of querying a search engine which may not reflect the habits of confirmed diagnosed IBD patients. Further research should investigate how patients cared for themselves during the pandemic. It will be important to continue to monitor the trends of IBD patient utilization of the healthcare system as cities and IBD centers start to reopen to safely and effectively deliver care.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in COVID-19 patients: A systematic review

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening drug-induced condition presenting with skin rash, fever, lymphadenopathy, systemic involvement and hematological (eosinophilia, atypical lymphocytes) findings. Although DRESS syndrome is frequently associated with reactivation of herpesviruses, the link between DRESS and COVID-19 has not been systematically analyzed. Method(s): A systematic search using PubMed and Google Scholar was conducted following the PRISMA guidelines to identify all reported DRESS cases associated with COVID-19 published between January 2020 and January 2022 using the keywords "COVID-19" AND "DRESS syndrome" OR "drug reaction with eosinophilia and systemic symptoms" OR "drug-induced hypersensitivity syndrome" OR "eosinophilia" AND "SARS-CoV- 2" OR "coronavirus". The identified DRESS cases were evaluated using the Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) scoring system [Kardaun et al, 2007]. Result(s): We identified twelve published DRESS cases associated with COVID-19 (Table 1). Eleven patients presented with severe COVID-19 disease complicated by DRESS syndrome that developed several days after initial COVID-19 clinical presentation (ARDS n5;multiorgan failure n1;pneumonia requiring mechanical ventilation, n4), one patient was asymptomatic. The culprit drugs included piperacillin-tazobactam (n4), hydroxychloroquine (n5), vancomycin (n2), ceftriaxone (n1), midazolam (n1), sulphasalazine (n1), azithromycin (n1), esomeprazole (n1), cefepime (n1), levofloxacin (n1), and meropenem (n1). The latency between the onset of treatment with culprit drug(s) and the onset of symptoms ranged from 9 to 42 days. All patients presented with widespread maculopapular rash, affecting > 50% of body surface area;five patients also had facial edema. Systemic involvement included liver (n8), renal abnormalities (n8), and heart involvement (n4). All patients had elevated body temperature (fever > = 38.5degreeC, n6) and blood eosinophilia, five patients had lymphadenopathy. Atypical lymphocytes were a rare laboratory finding (n2). Systemic corticosteroids were used in all patients;three patients received benralizumab for DRESS syndrome. Nine patients recovered, two patients died and the outcome was not reported in one case Conclusion(s): DRESS syndrome in COVID-19 patients is associated with multiple drugs, most notably with hydroxychloroquine and a variety of antibiotics. An early recognition may improve management of DRESS syndrome in COVID-19 patients.

High flow nasal oxygen (HFNO) in the treatment of COVID-19 infection of adult patients from - An emergency perspective: A systematic review and meta-analysis

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2, which was first discovered in Wuhan, China. The disease has grown into a global pandemic causing mild to moderate symptoms in most people. The disease can also exhibit serious illnesses, especially for patients with other chronic diseases such as cardiovascular diseases, diabetes, chronic respiratory disease, or cancer. In such cases of severe illness, high flow nasal oxygen (HFNO) has been used to provide oxygenation to COVID-19 patients. However, the efficiency of HFNO remains uncertain, prompting the conduction of this systematic review to evaluate the effectiveness of the therapy. A thorough search for relevant and original articles was carried out on five electronic databases, including ScienceDirect, PubMed, Cochrane Library, Embase, and Google Scholar. No time limitation was placed during the search as it included all the articles related to COVID-19 from 2019 to 2022. The search strategy utilized in this systematic review yielded 504 articles, of which only 10 met the eligibility criteria and were included. Our meta-analysis reveals that HFNO success rate was higher than HFNO failure rates (0.52 (95% CI;0.47, 0.56) and 0.48 (95% CI;0.44, 0.53), respectively), however, the difference was statistically insignificant. HFNO was associated with a significant decrease in mortality and intubation rates (0.28 (95% CI;0.19, 0.39) and 0.28 (95% CI;0.18, 0.41), respectively). Our statistical analysis has shown that significantly lower ROX index (5.07 +/- 1.66, p = 0.028) and PaO2/FiO2 (100 +/- 27.51, p = 0.031) are associated with HFNO failure, while a significantly lower respiratory rate (RR) (23.17 +/- 4.167, p = 0.006) is associated with HFNO success. No statistically significant difference was observed in SpO2/FiO2 ratio between the HFNO success and failure groups (154.23 +/- 42.74 vs. 124.025 +/- 28.50, p = 0.62, respectively). Based on the results from our meta-analysis, the success or failure of HFNO in treating COVID-19 adult patients remains uncertain. However, HFNO has been shown to be an effective treatment in reducing mortality and intubation rates. Therefore, HFNO can be recommended for COVID-19 patients but with close monitoring and should be carried out by experienced healthcare workers.Copyright © 2023 The Authors

Asafetida (Ferula asafoetida) and its Potential Risks on Respiratory Disorders

Ferula asafoetida is an endemic species in Iran and is rich in oleo-gum resin with high economic value in the world. One important application of F. assafoetida is its traditional use for the management of respiratory ailments. The aim of this review was to collect papers dealing with F. asafoetida oleo-gum resin in respiratory tract's diseases in modern medicine. For preparing the manuscript the scientific databases (Google scholar, PubMed, Springer, Science Direct, Magiran), books, thesis, etc. were searched using the keywords of "Ferula asafoetida", "Ferula scorodesma", "Scorodesma foetida", "Northex asafoetida" plus "respiratory tract", "respiratory disorder" "infection", "cough", "trachea", "traditional medicine" up to Feb 2022 and the collected data were sum-marized, analyzed, and discussed. The results of the investigation confirmed the traditional belief on the efficacy of Ferula asafoetida in the treatment of respiratory viral infection (Coronavirus, influ-enza), cigarette smoking, asthma, cough and cancer, but most studies were limited to in vitro. There was only one registered randomized, blinded, placebo controlled clinical trial for 300 mg F. asafoet-ida aqueous extract capsules (three times a day for 14 days) on 40 patients with COVID-19 without any published results. Although, the studies implied the efficacy of F. asafoetida in the treatment of respiratory treatments, but design large clinical studies for evaluating its efficacy and safety is essential in future investigations.Copyright © 2023 Bentham Science Publishers.

A Review on Therapeutic Potential of Indian Herbal Plants to Counter Viral Infection and Disease Pathogenesis

Herbal plant extracts or purified phytocomponents have been extensively used to treat several diseases since ancient times. The Indian Ayurvedic system and Chinese traditional medicines have documented the medicinal properties of important herbs. In Ayurveda, the polyherbal formulation is known to exhibit better therapeutic efficacy compared to a single herb. This review focuses on six key ayurvedic herbal plants namely, Tinospora cordifolia, Withania somnifera, Glycyrrhiza glabra/Licorice, Zingiber officinale, Emblica officinalis and Ocimum sanctum. These plants possess specific phytocomponents that aid them in fighting infections and keeping body healthy and stress-free. Plants were selected due to their reported antimicrobial and anti-inflammatory effects in several diseases and effectiveness in controlling viral pathogenesis. An ad-vanced literature search was carried out using Pubmed and google scholar. Result(s): These medicinal plants are known to exhibit several protective features against various diseases or infections. Here we have particularly emphasized on antioxidant, anti-inflammatory, anti-microbial and immunomodulatory properties which are common in these six plants. Recent literature analysis has revealed Ashwagandha to be protective for Covid-19 too. The formulation from such herbs can exhibit synergism and hence better effectiveness against infection and related dis-eases. The importance of these medicinal herbs becomes highly prominent as it maintains the har-monious balance by way of boosting the immunity in a human body. Further, greater mechanistic analyses are required to prove their efficacy in fighting infectious diseases like Covid-19. It opens the arena for in-depth research of identifying and isolating the active components from these herbs and evaluating their potency to inhibit viral infections as polyherbal formulations.Copyright © 2023 Bentham Science Publishers.

EPH117 Coinfections in COVID-19 Patients in India: A Systematic Review

Objectives: To determine the rate of coinfections and its subsequent impact on hospitalization and mortality rate in Indian COVID-19 patients. Method(s): A systematic literature search was performed on PubMed, Cochrane, WHO COVID-19 database, Google Scholar and assisted by MaiA tool at various steps. The studies were retrieved and included based on JBI's CoCoPop framework. Meta-analysis was not performed due to a limited number of studies and high heterogeneity. Descriptive statistics were summarized based on the retrieved coinfections data. The protocol was registered with PROSPERO - CRD42021275644. Result(s): A total of 2418 patients were included from eight studies. The prevalence of coinfections ranged from 4% - 46%. Pathogen-specific data showed highest prevalence of bacterial (57.3%), followed by parasitic (21.1.%), viral (14.6%), and fungal coinfections (6.9%). About 60% - 80% of the patients with coinfections required ICU admissions. Among coinfected COVID-19 patients, the average length of hospital stay was 13.67+/-3.51 days. The mortality rate of COVID-19 patients with coinfections ranged from 9%-65%. Conclusion(s): Bacterial coinfections have the highest prevalence among COVID-19 patients. A causal relationship between coinfections and mortality rate in COVID-19 patients remains unexplored. This brings up the need for comprehensive data recording practices and meticulous reporting. Further, large-scale epidemiologic studies are the need of the hour to determine the nationwide burden of coinfections in the COVID-19 pandemic.Copyright © 2022

Recent Developments and Opportunities in Fighting COVID-19

Background: COVID-19, a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), was first diagnosed in the patients from Wuhan, China, in December 2019. Within a cou-ple of months of infection, it was declared as pandemic by the World health organization. COVID-19 has become the most contagious infection with a serious threat to global health. In this review, we aimed to discuss the pathogenesis, diagnostics, current treatments and potential vaccines for COVID-19. Method(s): An extensive literature search was conducted using keywords "COVID-19";"Coron-avirus";"SARS-Cov-2";"SARS" in public domains of Google, Google scholar, PubMed, and Sci-enceDirect. Selected articles were used to construct this review. Result(s): SARS-Cov-2 uses the Spike (S) protein on its surface to recognize the receptor on an-giotensin-converting enzyme 2 (ACE2) and bind with 10-folds greater affinity than SARS-Cov-1. Molecular assays and immunoassays are the most frequently used tests, whereas computed tomog-raphy (CT) scans and artificial intelligence enabled diagnostic tools were also used in patients. In therapeutic treatment, few drugs were repurposed and about 23 therapeutic molecules, including the repurposed drugs are at different stages of the clinical trial. Similarly, the development of vaccines is also in the pipeline. Few countries have managed well to contain the spread by rapid testing and identifying the clusters. Conclusion(s): Till now, the acute complications and mortality of COVID-19 have been linked to pre-existing comorbid conditions or age. Besides the development of therapeutic strategies that include drugs and vaccine, the long term implication of COVID-19 infection in terms of the disor-der/disability in the cured/discharged patients is a new area to investigate.Copyright © 2021 Bentham Science Publishers.