Fuelling the Immune System for the 21st Century

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

Assessment of pre-eclampsia and eclampsia health commodities' supply chains in selected hospitals of Lagos State during COVID-19 pandemic

Purpose: Pre-eclampsia and eclampsia (PE/E) are rising in Sub-Saharan Africa, including Nigeria. This study aims to evaluate the availability and logistics management of sixteen items from the Nigerian essential medicine list required for managing these conditions. Design/Methodology/approach: A cross-sectional study in 50 health-care facilities in Lagos State, Nigeria, at the beginning of the COVID-19 pandemic by interviewing the facility's main person in charge of health commodities. Data were recorded during the visit and in the previous six months using the adapted Logistics Indicators Assessment Tool (LIAT). In addition, descriptive analysis was conducted based on the World Health Organization availability index. Findings: The availability of 13 (81%) of the commodities were high, and 3 (19%) were relatively high in the facilities, stock out rate during the visitation and previous six months varied with the commodities: urinalysis strip (22%) and (40%), hydralazine (20%) and (20%), labetalol injection (8%) and (20%), labetalol tablet (24%) and (24%) and sphygmomanometer (8%) and (8%). No stock out was recorded for 11 (69%) commodities. All the facilities observed 9 (75%) out of the 12 storage guidelines, and 36 (72%) had a perfect storage condition score. Limitations/Implications: Current state of PE/E health commodities in the selected facilities is highlighted, and the strengths and weaknesses of the supply chain in these health facilities were identified and discussed. Originality/value: These commodities' availability ranged from reasonably high to very high. Regular supportive supervision is germane to strengthening the logistics management system for these commodities to prevent the negative impact on the health and well-being of the people during the COVID-19 pandemic and post-pandemic. © 2023, Adesola Olalekan, Victor Igweike, Oloruntoba Ekun, Abosede Adegbite and Olayinka Ogunleye.

Oncological emergencies

The incidence of cancer continues to rise, with an estimated 1 in 2 of the UK population born after 1960 diagnosed with malignancy at some point during their lifetime. This is in the context of an ageing population with increasing multimorbidity and polypharmacy. Cancer patients are frequent users of emergency care services and have a high rate of ambulance conveyance and hospital admission after review in emergency departments. Presentations can be a consequence of the cancer, its treatment or coexistent morbidity. Given the expanding armamentarium of cancer therapies, acute and general physicians are faced with a myriad of complex issues and require a knowledge of the broad principles of initial assessment, initial management and timely access to the wider multi-professional cancer team. © 2022

Assessment of Knowledge and Perception of Pharmacy Students Regarding Herbal Drugs: a Cross-Sectional Analysis from Pakistan

Herbal drug therapy is a beneficial and easily accessible modality of treatment.Pharmacist can play a pivotal role in rationalizing its use. This study was aimed to assess the knowledge and perception ofpharmacy students regarding herbal drugs.We conducted a cross-sectional survey using avalidated study instrument. The survey included pharmacy students from various universities across Pakistan.There were 342 (54.3%) 4(t)h yearand 288 (45.7%) 5(th) year students. We found statistically significant variations (p < 0.05) in the knowledge of male and female respondentsregarding;'the carminative use of Hyoscyamus niger' and 'effectiveness of Citrus aurantifolia in vomiting and chest burning'. Similarly, significant variations were found in perception of students regarding the 'inclusion of herbal drugs in every medical degree course', 'evidence-based herbal drugs use', and 'necessity of specific portion of herbal drugs in every pharmacy'. More than 40% of students agreed that it was fine to use Senna alexandrina during COVID-19 pandemic-era without evidence-based studies.The knowledge of pharmacy students about herbal drugs is not satisfactory and evidence-based drug use is to be improved to enhance their skills in the rational therapy of herbal drugs, which will be fruitful in managing the community's disease conditions.

Generation of APN-chimeric gene-edited pigs by CRISPR/Cas9-mediated knock-in strategy

The prevalence of porcine enteric coronaviruses (PECs), including transmissible gastroenteritis virus (TGEV), swine acute diarrhea syndrome coronavirus (SADS-CoV), porcine delta coronavirus (PDCoV), and porcine epidemic diarrhea virus (PEDV), poses a serious threat to animal and public health. Here, we aimed to further optimize the porcine aminopeptidase N (pAPN) gene editing strategy to explore the balance between individual antiviral properties and the biological functions of pAPN in pigs. Finally, APN-chimeric gene-edited pigs were produced through a CRISPR/Cas9-mediated knock-in strategy. Further reproductive tests indicated that these gene-edited pigs exhibited normal pregnancy rates and viability. Notably, in vitro viral challenge assays further demonstrated that porcine kidney epithelial cells isolated from F1-generation gene-edited pigs could effectively inhibit TGEV infection. This study is the first to report the generation of APN-chimeric pigs, which may provide a natural host animal for characterizing PEC infection with APN and help in the development of better antiviral solutions. © 2022 Elsevier B.V.

Progress of the development of anti-COVID-19 drugs

Since the outbreak of the novel coronavirus (SARS-CoV-2) disease COVID-19 (also known as 2019-nCoV) caused by SARS-CoV-2 in the end of 2019, it has spread rapidly in worldwide. Besides developing effective vaccines, it is urgent to develop safe and effective anti-SARS-CoV-2 drugs to fight this disease. Paxlovid, molnupiravir, sotrovimab and bebtelovimab are urgently authorized by FDA have been proved to be effective against Omicron. This manuscript mainly reviews the recent progress of effective inhibitors against the virus in the world, including receptor inhibitors, antibodies, natural product inhibitors, synthetic inhibitors and broad-spectrum antiviral drugs that are effective against other RNA viruses.

Progress of the development of anti-COVID-19 drugs

Since the outbreak of the novel coronavirus (SARS-CoV-2) disease COVID-19 (also known as 2019-nCoV) caused by SARS-CoV-2 in the end of 2019, it has spread rapidly in worldwide. Besides developing effective vaccines, it is urgent to develop safe and effective anti-SARS-CoV-2 drugs to fight this disease. Paxlovid, molnupiravir, sotrovimab and bebtelovimab are urgently authorized by FDA have been proved to be effective against Omicron. This manuscript mainly reviews the recent progress of effective inhibitors against the virus in the world, including receptor inhibitors, antibodies, natural product inhibitors, synthetic inhibitors and broad-spectrum antiviral drugs that are effective against other RNA viruses. © 2023, Chinese Pharmaceutical Association. All rights reserved.

Research progress on mechanism and clinic application of traditional Chinese medicine against coronavirus

Coronaviruses (CoVs) are the largest positive-strand RNA viruses discovered, with high variability and high infectivity. There are seven kinds of CoVs that can infect humans so far. Among them, severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003, middle east respiratory syndrome coronavirus (MERS-CoV) in 2012 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 have caused global outbreaks, posing a serious threat to global public health security. Research on CoVs infection has never stopped, and the current treatment methods mainly focus on improving symptoms. Traditional Chinese medicine (TCM) has a long history and rich experience in preventing and treating various diseases. In terms of anti-CoVs, TCM has attracted much attention because of its multi-CoVs and multi-targets, significant antiviral effect and few side effect. TCM extracts or their compounds can exert anti-CoVs effects by directly or indirectly inhibiting the invasion, replication, assembly of CoVs, regulating immunity and inhibiting inflammation. This article systematically reviews the mechanism and clinical application of TCM in anti-CoVs and alleviating virus-induced symptoms, in order to provide theoretical reference for the research and development of anti-coronavirus drugs. © 2023 Editorial Office of Chinese Traditional and Herbal Drugs. All rights reserved.

Exercise precision medicine for type 2 diabetics: Targeted benefit or risk?

Concurrent exercise and metformin administration may reduce the acute and chronic effects of exercise on glucose metabolism in patients with type 2 diabetes (T2D). However, several studies suggest that combing metformin and exercise treatment may have no additive effect and even cause adverse effects in T2D patients. This case report aimed to highlight the challenges associated with prescribing exercise to type 2 diabetes patients undergoing metformin treatment. A 67-years old woman was followed-up for 5 months, including assessment of the acute and chronic glucose and lactate metabolism induced by concomitant exercise and metformin. The findings were four-fold: 1) During a high-intensity interval training bout, blood glucose systematically decreased, while blood lactate concentrations fluctuated randomly;2) Basal blood lactate levels were well above 2 mmol/L on days with medication only;3) Combined exercise and metformin administration induced additive effects on the normalization of glucose and 4) high levels of physical activity had a positive impact on the continuous glucose fluctuations, while decreased levels of physical activity induced a large fluctuation of glucose due to home confinement of an infectious disease caused by the SARS-CoV-2 virus. Our findings showed that when combined with exercise and metformin treatment for T2D patients, exercise may contribute to improving glycemic control while metformin may elevate lactate levels in the long term. The observed results underline the need to prescribe exercise and monitor lactate levels for reducing possible risks associated with metformin treatment and reinforce the importance of tailoring exercise therapy.

Medicine of the future: How and who is going to treat us?

Medicine's ability to quickly respond to challenges raises questions from researchers, practitioners, and society as a whole. Our task in this study was to identify key and atypical current factors influencing the development of medicine and to predict the development of medicine in the short, medium, and long term. To implement our study, we selected 22 medical experts and applied the three-level Delphi method. The current trends caused by COVID-19 have a short-term impact, but they will launch other drivers that will transform the healthcare industry. Well-being technologies, data-informed personalization, and climate change will become key drivers for the development of medicine over the period of 1–50 years. Expert opinion is divided about the future of mass availability of advanced medical treatment and sustainable development of healthcare. © 2023 The Authors

A Pilot Survey: Retention in Pain Medicine Among Fellowship Trained Anesthesiologists

Background: We aim to explore the factors related to job satisfaction among pain physicians and identify the reasons why individuals minimize or stop practicing outpatient pain medicine.Objectives/Study Design: This is a survey-based study with the primary goal to identify factors determining job satisfaction and dissatisfaction among pain medicine fellowship graduates who continue to practice and those who are no longer practicing interventional pain. A secondary goal is to elucidate reasons for anesthesiologists trained in pain medicine to leave pain medicine, despite an additional year of training, and to work as general anesthesiologists.Methods: In this study, all 114 pain program directors listed on the Accreditation Council for Graduate Medical Education (ACGME) website, or their administrative assistants were directly contacted via email. All email addresses were obtained from the ACGME website. The survey opened in September 2021, with reminder emails sent before the closing of the survey in December 2021. A final reminder email was sent 4 weeks prior to the closing of the survey.Results: Of all the respondents, 79 (89.77%) were currently practicing pain medicine, and 9 (10.23%) were no longer practicing pain medicine.Limitations: Our study has a major limitation as we are unable to determine the response rate and are limited in the data points gathered.Conclusion: We hope this study will allow for pain medicine fellowship program directors to improve recruitment and retention of pain fellows in the field while addressing the pros and cons of future career aspirations with anesthesiology residents prior to fellowship selection. A larger, more thorough study with an exact response rate can compare the various outcomes based upon different types of settings, such as private practice, partnership, and academia, as well as geographical locations.

Integration of a hybrid scan approach and in-house high-resolution MS2 spectral database for charactering the multicomponents of Xuebijing Injection

Xuebijing (XBJ) Injection is a reputable patent Chinese medicine widely used to cure sepsis, among the Chinese ″Three Medicines and Three Prescriptions″ solution to fight against COVID-19. We were aimed to achieve the comprehensive multicomponent characterization from the single drugs to traditional Chinese medicine (TCM) formula, by integrating powerful data acquisition and the in-house MS2 spectral database searching. By ultra-high performance liquid chromatography/ion mobility-quadrupole time-of-flight mass spectrometry (UHPLC/IM-QTOF-MS), a hybrid scan approach (HDMSE-HDDDA) was developed, while the HDMSE data for five component drugs and 56 reference compounds were acquired and processed to establish an in-house MS2 spectral database of XBJ. Good resolution of the XBJ components was accomplished on a Zorbax Eclipse Plus C18 column within 24 min, while a fit-for-purpose HDMSE-HDDDA approach was elaborated in two ionization modes for enhanced MS2 data acquisition. XBJ MS2 spectral library was thus established on the UNIFITM platform involving rich structure-related information for the chemicals from five component drugs. We could identify or tentatively characterize 294 components from XBJ, involving 81 flavonoids, 51 terpenoids, 42 phthalides, 40 organic acids, 13 phenylpropanoids, seven phenanthrenequinones, six alkaloids, and 54 others. In contrast to the application of conventional MS1 library, this newly established strategy could demonstrate superiority in the accuracy of identification results and the characterization of isomers, due to the more restricted filtering/matching criteria. Conclusively, the integration of the HDMSE-HDDDA hybrid scan approach and the in-house MS2 spectral database can favor the efficient and more reliable multicomponent characterization from single drugs to the TCM formula. © 2022 The Author(s)

‘An incorporeal disease': COVID-19, social trauma and health injustice in four Colombian Indigenous communities

Worldwide, medical doctors and lawyers cooperate in health justice projects. These professionals pursue the ideal that, one day, every individual on Earth will be equally protected from the hazards that impair health. The main hindrances to health justice are discrimination, poverty and segregation, but we know that beyond concrete, quantifiable barriers, symbolic elements such as beliefs and fears also play a significant role in perpetuating health injustice. So, between March 2020, when the World Health Organization declared COVID-19 a global pandemic, and June 2021, when vaccines against the virus were globally available, we collected original information about the ways in which four Colombian Indigenous communities confronted COVID-19. Knowing that Colombian Indigenous communities often face health injustices, our goal was to understand the role of symbolic elements in the situation. Our main insight is that historical genocidal processes, in which the powerful have betrayed the trust of Indigenous communities, have created a trauma in the latter, resulting in reluctance and suspicion regarding the acceptance of ‘gifts' from external sources, including potentially beneficial health treatments. © The Author(s) 2022.

Nurses' Use of Holistic, Complementary and Alternative Medicine Methods Against COVID-19 Anxiety

Context • Health professionals have been experiencing physical and mental fatigue, affective disorders, and sleep problems due to the stress experienced during the COVID-19 pandemic. As in most outbreaks and pandemics, nurses are at the forefront of the fight against the coronavirus and have experienced high anxiety levels. People can resort to many methods of coping with stressful situations, including complementary and alternative medicine (CAM). Objective • The study intended to assess nurses' anxiety levels about COVID-19 during the peak period of its second wave in Turkey and to examine the methods that they used to cope with that anxiety as well as their attitudes toward CAM. Design • The research team designed a descriptive and cross-sectional study Setting • The study was conducted in a training and research hospital in the Aegean region of Turkey between February 2021 and May 2021, during the second wave of the COVID-19 pandemic. Participants • Participants were 168 nurses working in the hospital. Outcome Measures • Data were collected with the Sociodemographic Information Form, Coronavirus Anxiety Scale (CAS), and Holistic Complementary and Alternative Health Questionnaire (HCAMQ), which has two subdimensions, CAM and Holistic Health (HH). Results • A significant relationship was found between the unit where the nurses worked and their scores on the CAM subdimension (P < .037). A significant relationship was also found between the nurses' anxiety about the COVID-19 epidemic and the scores on the holistic health (HH) subdimension (P < .001) and the HCAMQ (P < .016). To cope with anxiety, the nurses who experienced anxiety used the following complementary methods: (1) saying prayers and worshipping (56.6%), (2) taking hot and cold showers (54.6%), and (3) drinking herbal teas and infusions (49.3%). A weak correlation was found between the CAS, CAM, and HCAMQ scores (P < .05). Conclusions • The current study found that it could be beneficial for nurses to apply complementary methods to reduce their anxiety, because it's not known how long the COVID-19 pandemic will continue. In line with these results, it's extremely important to determine the psychological symptoms and to determine the priorities for solving these problems in nurses. Therefore, it's recommended that nurses should identify their anxieties about COVID-19 and that they should use complementary methods to manage their anxieties. © 2023, InnoVision Communications. All rights reserved.