Phytomedicines for Covid-19: Opportunities and Obstacles

COVID-19 is a disease caused by SARS-CoV-2 that can trigger respiratory tract infection. Due to its tendency to affect the upper respiratory tract (sinuses, nose and throat) or lower respiratory tract (windpipe and lungs), this disease is life-threatening and affects a large number of populations. This virus's unique and complex nature enhances the scope to look into the direction of herbal plants and their constituents for its prevention and treatment. The herbal remedies can have preventive as well as therapeutic actions. This review focuses on various aspects of using herbal medicines for COVID-19, as herbal constituents may also have adverse effects. Various studies revealed that some medicinal plants show life-threatening adverse effects, so selecting plants, and their related studies should be appropriate and strategic. This article includes various factors that should be considered before herbal drug use in COVID-19 patients. These are clinical trials, safety, molecular mechanism, and self-medication, which have been elaborated. This article also discusses the targets of covid-19 and different coronavirus strains. As before, treatment diagnosis of the disease is very important. Various patents have been filed and granted for its proper diagnosis so that its treatment can be easy.Copyright © 2022 Society of Pharmaceutical Sciences and Research. All rights reserved.

An Ethnobotanical Survey of COVID-19 Therapeutic Plants

After the emergence of COVID-19, the global usage of herbal medicine has expanded considerably. Exploring the scientific and clinical potential of medicinal plants, the World Health Organization (WHO) promotes projects to create COVID-19 medicines via traditional medicine. The purpose of our research was to compile a list of plants used in the outpatient treatment of COVID-19 by herbalists, including the plants, the sections utilized, and the method of preparation and administration. an ethnobotanical survey was done in order to determine the plants prescribed by herbalists to their COVID-19 patients/clients. In our investigation, we discovered 14 plant species, with Eucalyptus globulus, Lavandula angustifolia, Artemisia herbacea alba, Syzygium aromaticum, and Thymus vulgaris being the most often suggested.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Thymus vulgaris, a natural pharmacy against COVID-19: A molecular review.

Introduction: A worldwide pandemic infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a deadly disease called COVID-19. Interaction of the virus and the Angiotensin converting-enzyme 2 (ACE2) receptor leads to an inflammatory-induced tissue damage. Thymus vulgaris L. (TvL) is a plant with a long history in traditional medicine that has antimicrobial, antiseptic, and antiviral properties. Thymol and Carvacrol are two important biological components in Thyme that have anti-inflammatory, antioxidant, and immunomodulatory properties. This study is a molecular review on the potential effects of TvL and its active compounds on SARS-COV2 infection. Method: This is a narrative review in which using PubMed, Scopus, ISI, Cochrane, ScienceDirect, Google scholar, and Arxiv preprint databases, the molecular mechanisms of therapeutic and protective effects of TvL and its active compounds have been discussed regarding the molecular pathogenesis in COVID-19. Results: Thyme could suppress TNF-alpha, IL-6, and other inflammatory cytokines. It also enhances the anti-inflammatory cytokines like TGF-beta and IL-10. Thyme extract acts also as an inhibitor of cytokines IL-1-beta and IL-8, at both mRNA and protein levels. Thymol may also control the progression of neuro-inflammation toward neurological disease by reducing some factors. Thyme and its active ingredients, especially Thymol and Carvacrol, have also positive effects on the renin-angiotensin system (RAS) and intestinal microbiota. Conclusions: Accordingly, TvL and its bioactive components may prevent COVID-19 complications and has a potential protective role against the deleterious consequences of the disease.

Identification of herbal teas and their compounds eliciting antiviral activity against SARS-CoV-2 in vitro.

BACKGROUND: The SARS-CoV-2/COVID-19 pandemic has inflicted medical and socioeconomic havoc, and despite the current availability of vaccines and broad implementation of vaccination programs, more easily accessible and cost-effective acute treatment options preventing morbidity and mortality are urgently needed. Herbal teas have historically and recurrently been applied as self-medication for prophylaxis, therapy, and symptom alleviation in diverse diseases, including those caused by respiratory viruses, and have provided sources of natural products as basis for the development of therapeutic agents. To identify affordable, ubiquitously available, and effective treatments, we tested herbs consumed worldwide as herbal teas regarding their antiviral activity against SARS-CoV-2. RESULTS: Aqueous infusions prepared by boiling leaves of the Lamiaceae perilla and sage elicit potent and sustained antiviral activity against SARS-CoV-2 when applied after infection as well as prior to infection of cells. The herbal infusions exerted in vitro antiviral effects comparable to interferon-ß and remdesivir but outperformed convalescent sera and interferon-α2 upon short-term treatment early after infection. Based on protein fractionation analyses, we identified caffeic acid, perilla aldehyde, and perillyl alcohol as antiviral compounds. Global mass spectrometry (MS) analyses performed comparatively in two different cell culture infection models revealed changes of the proteome upon treatment with herbal infusions and provided insights into the mode of action. As inferred by the MS data, induction of heme oxygenase 1 (HMOX-1) was confirmed as effector mechanism by the antiviral activity of the HMOX-1-inducing compounds sulforaphane and fraxetin. CONCLUSIONS: In conclusion, herbal teas based on perilla and sage exhibit antiviral activity against SARS-CoV-2 including variants of concern such as Alpha, Beta, Delta, and Omicron, and we identified HMOX-1 as potential therapeutic target. Given that perilla and sage have been suggested as treatment options for various diseases, our dataset may constitute a valuable resource also for future research beyond virology.

Evaluation of the inhibitory activities of thyme compounds against coronavirus disease-19 (COVID-19) by molecular docking and molecular dynamic simulation

We have explored the inhibitory capability of Thymus vulgaris compounds against ACE2 protein -the host receptor for SARS-CoV-2, papain-like and main protease of the SARS-CoV-2 through molecular simulations. The docking results showed that the compounds had a greater capability to inhibit ACE2 and papain-like protease in comparison to the main protease. The majority of compounds (61.7%) bind to the S2 active pocket of ACE2. The most powerful anticoronavirus activity is expressed in the order: Terpinolene > Thymol > Bicyclogermacrene. Pi interactions play key roles in the binding of three compounds to the active sites of ACE2 enzyme. 34 out of these 60 compounds were fitted in the PLpro active site. α-humulene followed by (+)-Spathulenol, and (-)-β-Bourbonene showed strong capacity to inhibit PLpro binding site. Except for (+)-Spathulenol which also formed H-bond with Asp165 and Tyr274 amino acids, α-humulene and (-)-β-Bourbonene conjugate with PLpro were stabilized mainly through alkyl and pi interactions. According to the Mpro docking results, 58.3% of thyme compounds could block the active site. The binding energy order was (-)-Spathulenol at highest, then Bicyclogermacrene, (+)-δ-cadinene, (+)-Spathulenol, and Viridiflorol, followed by (-)-β-Caryophyllene oxide. Cys145, His41, Met49, and Met165 are key residues in the interaction of these ligands with the enzyme binding site. The weakest interaction with all three enzymes was observed for (R)-(-)-1-Octen-3-ol and (3S)-Oct-1-en-3-ol. Based on the molecular dynamics simulation lowest conformational change was detected for ACE2 in the present of Terpinolene. (-)-Spathulenol and α-Humulene had the least and most displacement compared to its initial positions, respectively.

A Focused Insight into Thyme: Biological, Chemical, and Therapeutic Properties of an Indigenous Mediterranean Herb.

A perennial wild shrub from the Lamiaceae family and native to the Mediterranean region, thyme is considered an important wild edible plant studied for centuries for its unique importance in the food, pharmaceutical, and cosmetic industry. Thyme is loaded with phytonutrients, minerals and vitamins. It is pungent in taste, yet rich in moisture, proteins, crude fiber, minerals and vitamins. Its chemical composition may vary with geographical location but is mainly composed of flavonoids and antioxidants. Previous studies have illustrated the therapeutic effects of thyme and its essential oils, especially thymol and carvacrol, against various diseases. This is attributed to its multi-pharmacological properties that include, but are not limited to, antioxidant, anti-inflammatory, and antineoplastic actions. Moreover, thyme has long been known for its antiviral, antibacterial, antifungal, and antiseptic activities, in addition to remarkable disruption of microbial biofilms. In the COVID-19 era, some thyme constituents were investigated for their potential in viral binding. As such, thyme presents a wide range of functional possibilities in food, drugs, and other fields and prominent interest as a nutraceutical. The aims of the current review are to present botanical and nutritive values of this herb, elaborate its major constituents, and review available literature on its dietetic and biological activities.

The effect Phenthymol (Thyme, Anethum graveolens, Ajwain and Honey) in the Treatment of Corona Virus Disease (Covid 19)

Introduction: Coronavirus is one of the main pathogens and since common coronary therapies such as hydroxychloroquine are often symptomatic, the use of traditional medicine herbs is one of the ways to obtain new drugs. The aim of this study was to evaluate the effect of Thyme, Anethum graveolens, Ajwain and Honey in the treatment of corona virus disease (Covid 19) Methods: Double-blind randomized clinical trial, with a control group with a sample size of 60 people in patients with a diagnosis of Quid-19 referred to the Tehran Punak Health Center from the beginning of January 2016, patients in the placebo group received treatment in addition to standard treatment (5 g every 6 hours). The results were assessed using SPSS software. Findings: There was no significant difference in the baseline data of sex, age, height, weight, past medical history, initial symptoms, disease diagnosis, and medication between the patients diagnosed with and suspected to have COVID-19 among the three treatment groups (P > 0.05). Fever, diarrhea, shortness of breath and body aches and fatigue in people who used the herbal composition (Thyme, Anethum graveolens, Ajwain and Honey) had a significant reduction on 14th day. Conclusion: Since the nature of the herbal composition used is hot and dry, is combined with honey and it can be effective in reducing the cold of cold organs. Also, Thyme, Anethum graveolens, Ajwain and honey have antioxidant and anti-inflammatory, analgesic and effective effects. They are used to treat infections. It is evident in patients with coronavirus because of the high levels of white blood cells and chemokines.

Changes in Multiple Myeloma Treatment Patterns during the Early COVID-19 Pandemic Period

Background: Early during the COVID-19 pandemic patient and provider anxiety concerning in-person visits and travel restrictions may have delayed cancer diagnosis and altered treatment. We evaluated changes in clinical presentation and treatment patterns in multiple myeloma (MM) during the early COVID-19 period compared to historical pre-COVID periods. Methods: Using the nationwide Flatiron Health EHR-derived de-identified database, we compared clinical presentation and treatment patterns in the immediate post-COVID period (2020) to a comparable pre-COVID period (2018 and 2019). We focused on two separate clinical settings: 1) patients newly diagnosed with MM during February-June in the years of interest (NEWPT) with evidence of management within 90 days and follow-up for 7 months;and 2) patients diagnosed with MM during 2014-2019 receiving active treatment as of February (2018, 2019, 2020, ACTIVE) and follow-up for 11 months. Delayed clinical presentation was assessed using baseline (90 days before diagnosis/index date) measures of ISS stage, ECOG performance status, anemia, and kidney function. We examined treatment patterns (choice of regimen) of both cohorts in the two time periods. We compared clinical features of initial presentation in pre-COVID and COVID period using Pearson's χ 2 test. For NEWPT, we also utilized Kaplan-Meier curves and log-rank test to compare time to treatment initiation between the two periods. Multivariable Cox proportional hazards regression model with death as a competing risk was used to determine impact of COVID on treatment initiation by adjusting sex, age at diagnosis, race, insurance, stage, baseline ECOG, and hospital setting. All analyses were conducted in SAS (Version 9.4, SAS Institute, Cary, North Carolina) with 2 sided tests and a type I error of 5%. Results: Our study included 1319 NEWPT (964 pre-COVID and 355 COVID) and 2206 ACTIVE (1014 pre-COVID and 1192 COVID) patients. In the NEWPT cohort, we observed no differences between the pre-COVID and COVID periods in terms of baseline characteristics, including clinical features like stage, ECOG performance status, anemia or kidney function (Table A). Patients in the pre-COVID period were more likely to initiate any treatment (91.1% vs 86.2%, p<.01). Median time to treatment initiation was 30 days pre-Covid and 32 days during the Covid period (log-rank test p=0.04, Figure A). After adjusting for patient demographic, clinical features (extent of anemia, hypercalcemia, kidney dysfunction), and hospital variables (US region, practice type academic vs community), the difference between the two periods was not significant (COVID vs pre-COVID hazard ratio=0.88, 95% confidence interval 0.78-1.10, p=0.07). In NEWPT cohort, compared with their pre-COVID counterparts, patients in COVID period were more likely to receive monoclonal antibody (mAb) (14.4% vs 4.8%, p<.01, Figure B) and used IMID-based regimen as their first line of therapy (80.4% vs 74.3%, p<.01). In ACTIVE cohort, more patients in the pre-COVID period were anemic (Hemoglobin <10 g/L, 14.9% vs 9.7%, p<.01) at baseline than those in the COVID period. As in NEWPT cohort, ACTIVE patients in the COVID period used mAb-based regimen more commonly (28.9% vs 16.9%, p<.01) (Figure C). In addition, fewer ACTIVE treatment patients in the COVID period received cyclophosphamide regimens (7.9% vs 15.1% p<.01). Conclusions: During early COVID-19 pandemic we did not observe evidence of delayed diagnosis or more advanced stage, anemia or kidney disease for NEWPT with MM. MM treatment patterns were notable for higher utilization of mAb, IMID-based therapies and decreased use of cyclophosphamide regimens, without significant change in time to treatment initiation. Reassuringly, changes in treatment-patterns during COVID pandemic were modest, some likely reflecting changes in MM treatment landscape (advances in mAb regimens) rather than direct impact of COVID. Further studies are needed to understand how these changes evolve and affect clinical outcomes over time beyond 2020. [Formula presen ed] Disclosures: Neparidze: GlaxoSmithKline: Research Funding;Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees;Janssen: Research Funding. Zeidan: Jasper: Consultancy;AstraZeneca: Consultancy;Aprea: Consultancy, Research Funding;Gilead: Consultancy, Other: Clinical Trial Committees;Loxo Oncology: Consultancy, Other: Clinical Trial Committees;Astellas: Consultancy;Agios: Consultancy;Kura: Consultancy, Other: Clinical Trial Committees;Jazz: Consultancy;Pfizer: Other: Travel support, Research Funding;Genentech: Consultancy;Geron: Other: Clinical Trial Committees;BMS: Consultancy, Other: Clinical Trial Committees, Research Funding;ADC Therapeutics: Research Funding;Novartis: Consultancy, Other: Clinical Trial Committees, Travel support, Research Funding;Boehringer Ingelheim: Consultancy, Research Funding;Astex: Research Funding;BeyondSpring: Consultancy;Incyte: Consultancy, Research Funding;Daiichi Sankyo: Consultancy;Epizyme: Consultancy;BioCryst: Other: Clinical Trial Committees;Cardiff Oncology: Consultancy, Other: Travel support, Research Funding;Janssen: Consultancy;Ionis: Consultancy;Amgen: Consultancy, Research Funding;Acceleron: Consultancy, Research Funding;AbbVie: Consultancy, Other: Clinical Trial Committees, Research Funding. Podoltsev: Pfizer: Honoraria;PharmaEssentia: Honoraria;Blueprint Medicines: Honoraria;Incyte: Honoraria;Novartis: Honoraria;CTI BioPharma: Honoraria;Bristol-Myers Squib: Honoraria;Celgene: Honoraria. Shallis: Curis: Divested equity in a private or publicly-traded company in the past 24 months. Ma: Celgene/Bristol Myers Squibb: Consultancy, Research Funding. Davidoff: Amgen: Consultancy;AbbVie: Other: Family member consultancy. Huntington: AstraZeneca: Consultancy, Honoraria;TG Therapeutics: Research Funding;Thyme Inc: Consultancy;Flatiron Health Inc.: Consultancy;Genentech: Consultancy;SeaGen: Consultancy;Novartis: Consultancy;Pharmacyclics: Consultancy, Honoraria;Servier: Consultancy;Bayer: Honoraria;DTRM Biopharm: Research Funding;AbbVie: Consultancy;Celgene: Consultancy, Research Funding.

Impact of the COVID-19 Pandemic on in-Person Visit Rates Among Patients with Hematologic Malignancies in the United States

Background/objectives: The COVID-19 pandemic led to a dramatic reduction of in-person medical care in the general population;however, impacts have not been well-characterized for patients with hematologic malignancies. This study assessed the impact of COVID-19 on healthcare delivery for patients with hematologic malignancies with documented active treatment. Methods: Patients from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database with confirmed diagnosis of AML, DLBCL, FL, MCL, CLL or MM, and age ≥ 18 years at initial diagnosis were included. To be included in the study, documented receipt of at least one systemic, non-maintenance line of therapy between March 1, 2016 - February 28, 2021 was required. Patients were categorized into treatment types within lines of therapy: Oral therapy (OralTx);outpatient infusions (OutPtTx);and inpatient infusions, including hematopoietic transplants and CAR-T cell therapy (InPtTx). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month. Only visits occurring within a line of therapy were included (i.e. during active therapy, excluding surveillance). Telemedicine was only available for ion during the pandemic period. We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual visit rates between March 2020 - February 2021 (expected in-person visit rates if the pandemic had not occurred) for all diseases combined, each disease, and each treatment type. Differences between projected and actual monthly visit rates during the pandemic period were considered statistically significant and related to the pandemic if the actual visit rate was outside of the 95% prediction interval (PI) surrounding the projected estimate. Results: A total of 22,559 patients were included in this analysis (6,241 OralTx, 14,501 OutPtTx, 7,675 InPtTx): 4,069 AML, 3,641 DLBCL, 2,004 FL, 1,899 MCL, 4,574 CLL and 6,701 MM. There was a gradual downward trend in in-person visit rates across all diseases over the study period (March 2016 - February 2021, Figure) and general visit frequencies were lower for OralTx and higher for OutPtTx and InPtTx overall. For all diseases combined, early pandemic months (March - May 2020) saw an 18% (95% PI 8.9% - 25%) reduction in in-person visit rates averaged across OralTx and OutPtTx, with the projected rate being 1.5 (95% PI 1.3 - 1.6) visits per patient per month, compared to an actual rate of 1.2. Reductions in the in-person visit rates were significant for all 3 treatment types for MM, for OralTx for CLL, and for OutPtTx for MCL and CLL. Telemedicine visit rates were greatest for patients who received OralTx, followed by OutPtTx, then InPtTx, with greater use in the early pandemic months and subsequent decrease in later months. All in-person visit rates increased close to predicted rates in the later half of the pandemic period. Conclusions: In treatment of hematologic malignancies, overall documented in-person visit rates for patients on OralTx and OutPtTx significantly decreased during early pandemic months, but returned close to the projected rates later in the pandemic. There were no significant reductions in the overall in-person visit rate for patients on InPtTx. Variability in these trends by disease type was observed, with significant reductions in in-person visits impacting MM, CLL, and MCL. Figure. Visit rates over time according to treatment category [Formula presented] Disclosures: Lau: Roche: Current equity holder in publicly-traded company;Flatiron Health Inc: Current Employment. Wang: Roche: Current equity holder in publicly-traded company;Flatiron Health: Current Employment. Davidoff: AbbVie: Other: Family member consultancy;Amgen: Consultancy. Huntington: Bayer: Honoraria;Thyme Inc: Consultancy;Novartis: Consultancy;Flatiron Health Inc.: Consultancy;Genentech: Consultancy;eaGen: Consultancy;Servier: Consultancy;AstraZeneca: Consultancy, Honoraria;TG Therapeutics: Research Funding;DTRM Biopharm: Research Funding;AbbVie: Consultancy;Pharmacyclics: Consultancy, Honoraria;Celgene: Consultancy, Research Funding. Calip: Pfizer: Research Funding;Roche: Current equity holder in publicly-traded company;Flatiron Health Inc: Current Employment. Shah: AstraZeneca: Research Funding;Seattle Genetics: Research Funding;Epizyme: Research Funding. Stephens: CSL Behring: Consultancy;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees;AstraZeneca: Consultancy;Celgene: Consultancy;JUNO: Research Funding;Mingsight: Research Funding;Abbvie: Consultancy;Arqule: Research Funding;Adaptive: Membership on an entity's Board of Directors or advisory committees;Novartis: Research Funding;Epizyme: Membership on an entity's Board of Directors or advisory committees;Beigene: Membership on an entity's Board of Directors or advisory committees;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding. Miksad: Flatiron Health Inc: Current Employment, Current holder of individual stocks in a privately-held company;Roche: Current equity holder in publicly-traded company. Parikh: GNS Healthcare: Current holder of individual stocks in a privately-held company;Onc.AI: Current holder of individual stocks in a privately-held company;Humana: Honoraria, Research Funding;Nanology: Honoraria;Thyme Care: Honoraria;Flatiron Health Inc: Honoraria. Takvorian: Pfizer: Research Funding;Genentech: Consultancy. Neparidze: GlaxoSmithKline: Research Funding;Janssen: Research Funding;Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees. Seymour: Flatiron Health Inc: Current Employment;Janssen: Membership on an entity's Board of Directors or advisory committees;Roche: Current equity holder in publicly-traded company;Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees;Pharmacyclics: Membership on an entity's Board of Directors or advisory committees.

Racial Disparities in Telemedicine Uptake during the COVID-19 Pandemic Among Patients with Hematologic Malignancies in the United States

Background/objectives: The COVID-19 pandemic impacted healthcare visit trends, propelling healthcare systems to reduce in-person visits and hospital admissions and increasingly rely on telemedicine;whether there are differences in these trends across racial groups is unknown. This study investigated potential racial disparities in visits during the pandemic for patients with documented active treatment for hematologic malignancies. Methods: We used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database to select patients with confirmed diagnosis of AML, DLBCL, FL, MCL, CLL or MM, at least 18 years old at initial diagnosis, and documented race in the EHR as Black/African American or White were included. Patients were categorized into treatment types within lines of therapy: Orals (orals + outpatient infusions with orals) vs. Inpatient treatments (chemotherapy, hematopoietic transplants & CAR-T cell therapy). Monthly visit rates were calculated as the number of visits (telemedicine or in-person [in-clinic treatment administration, vitals, and/or labs]) per active patient per 30-day standardized month, except for months in which the patient was considered not active (e.g. no documented therapy, surveillance). We used time-series forecasting methods on pre-pandemic monthly visit rate data (March 2016 - February 2020) to estimate projected counterfactual monthly visit rates (expected rates if the pandemic did not occur) between March 2020 - February 2021 for all diseases combined, for each disease, each treatment type, and each race. Differences between projected and actual monthly visit rates during the pandemic period were considered significant and related due to the pandemic if the actual visit rate was outside of the 95% prediction interval (PI) surrounding the projected estimate. We used cross-correlation analysis to test for significant differences in visit rates between Black and White patients. Results: The analysis included 17,621 patients (2,225 Black, 15,396 White): 3,041 AML, 2,715 DLBCL, 1,558 FL, 1,511 MCL, 3,813 CLL and 5,244 MM (1,166 Black, 4078 White). Across all diseases and treatment categories, Black patients had no significant reductions in in-person visit rates throughout the pandemic period compared to the projected rates. There was, however, an 18% statistically significant reduction (95% PI 9.9% - 25%) in in-person visit rates for White patients on orals during early pandemic months (March - May 2020) from a projected visit rate of 2.0 (95% PI 1.8 - 2.2) visits per patient per month to an actual visit rate of 1.61. There was no significant reduction in in-person visit rates for White patients on inpatient treatments. Telemedicine uptake was significantly higher for White patients compared with Black patients for all diseases combined across all treatment categories (Figure A & B) (t = 9.5, p < 0.01), AML inpatient treatments (t = 2.4, p = 0.04), MM orals (Figure C) (t = 6.0, p < 0.01) and MM inpatient treatments (Figure D) (t = 2.3, p = 0.04). Conclusions: A tradeoff in reductions in in-person visits and uptake of telemedicine use was observed overall. White patients had significantly higher telemedicine uptake compared with Black patients for both oral and inpatient treatments. In-person visit rates for Black patients were unchanged regardless of treatment category. These in-person visit rates reflect documented telemedicine use disparities, which requires further study into possible compound causes, including economic and societal factors. Figure. Trends over time in telemedicine visit rates for White patients (blue line) and Black patients (black line) [Formula presented] Disclosures: Neparidze: Eidos Therapeutics: Membership on an entity's Board of Directors or advisory committees;GlaxoSmithKline: Research Funding;Janssen: Research Funding. Lau: Flatiron Health Inc: Current Employment;Roche: Current equity holder in publicly-traded company. Wang: Flatiron Health: Current Employment;Roche: Current equity holder in publicly-traded company. Davidoff: Amgen: Consultancy;AbbVie: Other: Family member consultancy. Huntington: Bayer: Honoraria;Servier: Consultancy;Pharmacyclics: Consultancy, Honoraria;Thyme Inc: Consultancy;Genentech: Consultancy;AbbVie: Consultancy;SeaGen: Consultancy;Celgene: Consultancy, Research Funding;Flatiron Health Inc.: Consultancy;DTRM Biopharm: Research Funding;TG Therapeutics: Research Funding;AstraZeneca: Consultancy, Honoraria;Novartis: Consultancy. Calip: Flatiron Health Inc: Current Employment;Roche: Current equity holder in publicly-traded company;Pfizer: Research Funding. Shah: AstraZeneca: Research Funding;Seattle Genetics: Research Funding;Epizyme: Research Funding. Stephens: Adaptive: Membership on an entity's Board of Directors or advisory committees;Celgene: Consultancy;Abbvie: Consultancy;CSL Behring: Consultancy;Novartis: Research Funding;Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding;JUNO: Research Funding;Mingsight: Research Funding;AstraZeneca: Consultancy;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Beigene: Membership on an entity's Board of Directors or advisory committees;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees;Epizyme: Membership on an entity's Board of Directors or advisory committees;Arqule: Research Funding. Miksad: Flatiron Health Inc: Current Employment, Current holder of individual stocks in a privately-held company;Roche: Current equity holder in publicly-traded company. Parikh: Onc.AI: Current holder of individual stocks in a privately-held company;Humana: Honoraria, Research Funding;Flatiron Health Inc: Honoraria;Thyme Care: Honoraria;Nanology: Honoraria;GNS Healthcare: Current holder of individual stocks in a privately-held company. Takvorian: Genentech: Consultancy;Pfizer: Research Funding. Seymour: Janssen: Membership on an entity's Board of Directors or advisory committees;Roche: Current equity holder in publicly-traded company;Pharmacyclics: Membership on an entity's Board of Directors or advisory committees;Flatiron Health Inc: Current Employment;Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Prevalence of Complementary and Integrative Health Use in Patients Afflicted with COVID-19

Introduction: Complementary and Integrative Medicine (CIH) has been a popular medical approach. This study aimed to investigate CIH use in patients afflicted with COVID-19. Methods: In this telephone- based cross-sectional study, the data of CIH usage were collected from confirmed COVID-19 patients from February till June 2020in Fars province, Iran. Besides, we asked the patients' attitudes towards using these treatments. Results: Out of 453 patients diagnosed with COVID-19, 400 (88.30%) enrolled into the study and answered our question and. In this regard, 276 (69%) patients reported using CIH to treat COVID-19. The most frequently used herbal medicine among COVID-19 patients was ginger (98.9%), thyme (95.3%), and black cumin (74.3%). Most of these patients were recommended to use herbal medicine by their families and friends (34.8%). Overall, 86.2% reported high and very high levels of satisfaction using these medications. Residents of urban areas (p=0.005), employees (p<0.001), patients with an academic education (p<0.001), as well as outpatients(p<0.001) used more CIH in comparison with the others. Ultimately, only 9 (3.3%) patients consulted with their doctors regarding using these medications. Conclusion: The results of this study showed that many patients with COVID-19used CIH, but few of them consulted with their physician consultation. Physicians should ask their patients about CIH usage and patients should also report their use of CIH therapies during their medical visits. Keywords: COVID-19, complementary and alternative medicine, medicinal plant, traditional medicine, alternative medicine, Prevalence, use

Response Surface Methodology to Optimize the Isolation of Dominant Volatile Compounds from Monofloral Greek Thyme Honey Using SPME-GC-MS.

This study aimed at an experimental design of response surface methodology (RSM) in the optimization of the dominant volatile fraction of Greek thyme honey using solid-phase microextraction (SPME) and analyzed by gas chromatography-mass spectrometry (GC-MS). For this purpose, a multiple response optimization was employed using desirability functions, which demand a search for optimal conditions for a set of responses simultaneously. A test set of eighty thyme honey samples were analyzed under the optimum conditions for validation of the proposed model. The optimized combination of isolation conditions was the temperature (60 °C), equilibration time (15 min), extraction time (30 min), magnetic stirrer speed (700 rpm), sample volume (6 mL), water: honey ratio (1:3 v/w) with total desirability over 0.50. It was found that the magnetic stirrer speed, which has not been evaluated before, had a positive effect, especially in combination with other factors. The above-developed methodology proved to be effective in the optimization of isolation of specific volatile compounds from a difficult matrix, like honey. This study could be a good basis for the development of novel RSM for other monofloral honey samples.

Physical Activity and Natural Products and Minerals in the SARS-CoV-2 Pandemic: An Update.

Coronavirus-disease 19 (COVID-19) has rapidly become a global public health issue, and there is a desperate need for strategies of prevention, reduction, and treatment to halt the epidemic. The coronavirus affects the immune system, and individuals with a compromised immune system, such as those with diabetes, hypertension, obesity, are more susceptible to this virus. Lifestyle-related variables such as physical activity and nutritional supplements can decrease inflammatory markers, increase anti-inflammatory and antioxidant status, and improve the immune system. Lifesty-lerelated variables play preventive roles against various infectious diseases including COVID-19. This review highlights the effects of physical activity and nutrients supplements on the immune system and their possible benefits in combating the harms caused by infection with the COVID-19 virus.