Neurosteroids and their Therapeutic Potential: Remembering the Contribution of Dr. Sabina Luchetti, Netherlands Institute for Neuroscience, Amsterdam, Netherlands.

This article traces the career of Dr. Sabina Luchetti (1969-2021), a noted physician (medical doctor, specialized in Neurology at Tor Vergata University of Rome, Italy), a dedicated neuroscientist (Ph.D. in Neuroscience at Tor Vergata University and IRCCS Santa Lucia of Rome), and a member of a renowned Netherlands group (senior researcher at Professor Swaab Laboratory of the Netherlands Institute for Neuroscience, Amsterdam, Netherlands), working in the field of brain function and diseases. She is particularly involved in the study of natural compounds, such as neurosteroids and their biosynthetic pathways in neurodegenerative and neuroinflammation- related disorders, working on post-mortem human brains. This editorial outlines Dr. Luchetti's wide range of interests, discloses her superior fund of knowledge, and recollects her humanitarian spirit, all of which contribute to creating a great sense of belonging to any group of researchers whom she worked with. The impact of Dr. Luchetti's work will continue to be felt for many years. From the bench to the bedside, her work has indirectly contributed to shedding light on the neurosteroids' potential therapeutic effects, considering that neurosteroids and their analogues (some of which are over-the-counter) are now used to treat depression, epilepsy, and substance abuse disorders. Moreover, the potential therapeutic effects of allopregnanolone with respect to its capability to promote neuroregeneration and neuroprotection are a promising basis for future treatment of neurodegenerative diseases.

Provider Practice Patterns Regarding Over-The-Counter Continence Devices.

INTRODUCTION AND HYPOTHESIS: Vaginal inserts and continence devices are recommended as a conservative treatment option for the management of stress urinary incontinence (SUI); however, practice patterns for recommendation and use of such devices are currently unknown. Our objectives were to better understand counseling patterns relating to over-the-counter (OTC) continence devices, to assess perceived barriers to recommending these devices, and to estimate clinician familiarity with three such devices currently available in the USA. METHODS: In this cross-sectional study, an anonymous electronic survey was distributed to all Accreditation Council for Graduate Medical Education-accredited OB/GYN and Urology residency and Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowship programs. A total of 326 survey responses were collected. Multivariate logistic regression was used to assess respondent characteristics associated with recommending OTC continence devices to patients. RESULTS: Sixty-four percent of respondents expressed familiarity with any OTC continence device. Of respondents who reported regular evaluation and treatment of women with SUI (n = 269), 60% reported ever recommending OTC devices for SUI. On multivariate regression, being a trainee and general OB/GYN provider were associated with being less likely to recommend OTC devices for SUI. Of respondents who did not regularly recommend OTC continence devices, reported barriers to doing so included a lack of training with these devices, leading to clinician discomfort (70%) and not remembering OTC devices as an option (15%). CONCLUSIONS: Given the low risk associated with patient use of these easily accessible devices, our study highlights barriers to clinician recommendation with the goal of increasing clinician awareness and consideration of OTC continence devices.

Effect of At-Home Versus Over-the-Counter Bleaching Agents on Enamel Color, Roughness, and Color Stability.

Background This study was designed to evaluate the efficacy of standard at-home bleaching agents in comparison to new over-the-counter (OTC) products on human enamel regarding color change, color stability, and surface roughness. Methodology A total of 80 extracted adult human maxillary central incisors were prepared and arbitrarily divided into the following four equal groups (N =20): group A: at-home opalescence boost containing 15% carbamide peroxide (CP); group B: crest whitening strips containing 6% hydrogen peroxide (HP); group C: light-emitted diode (LED) home tray with 20% CP + 4% HP; and group D: white and black toothpaste containing active charcoal components. Tooth color was measured using a spectrophotometer. Enamel surface roughness using a three-dimensional optical profilometer was measured before and after the bleaching procedure. To assess color stability, each bleached group was further subdivided into two equal subgroups (n = 10) according to the immersion media of either coffee or tea. Finally, the color was measured after 24 hours of immersion. Results All groups showed improvement in color from the baseline. The crest whitening strips group showed the lowest color improvement in comparison to all other groups. After staining, group C showed the lowest mean color change value ∆E2. No statistically significant difference was noted in surface roughness among all groups. Conclusions All OTC bleaching products as well as at-home bleaching improve teeth color and increase roughness on the enamel surface. Staining media has an adverse effect on the teeth after bleaching. The LED home tray showed a better whitening effect and color stability after bleaching.

The ABCs of OTCs: A Video-Based Curriculum Regarding Over-the-Counter Pediatric Products.

Introduction: Over-the-counter (OTC) products are widely used by families with young children. To educate future pediatricians on OTC product counseling and support the health and safety of children under their care, modern, accessible, and engaging curricula are needed. Methods: We developed an OTC product curriculum consisting of seven videos and one facilitated group discussion using a flipped classroom pedagogy to educate students on counseling parents about OTC product use. Fourth-year medical students pursuing pediatric training from four institutions participated in the curriculum during their end-of-year transition-to-residency course. We measured effectiveness via a pre/post comparison using a student self-assessment with multiple-choice questions. A simulated parent call OSCE provided participants with an opportunity to apply their knowledge and receive directed formative feedback. Data were analyzed using descriptive and inferential statistics. Results: A total of 41 students participated in the curriculum and completed all assessments. The majority (93%) watched all the videos. All participants (100%) agreed the videos were useful. Knowledge improved significantly (pretest mean score = 70%, posttest mean score = 87%, p < .001). No significant differences were found when comparing institution, gender, prior experience, or electives. Discussion: We developed a feasible and effective video-based curriculum to teach OTC product guidance. Given the importance of discussing OTC medications with families and the need for convenient educational tools, this curriculum may have widespread application to medical students during clinical rotations as well as pediatric and family medicine trainees.

Eficácia e segurança do enxaguatório clareador sobre o esmalte dental: estudo clínico controlado randomizado e estudo in vitro / Efficacy and safety of whitening mouthrinse on enamel: randomized clinical trial and in vitro study

Enxaguatórios clareadores tornaram-se muito populares devido ao seu fácil uso e disponibilidade. Contudo, não há evidência dos efeitos e segurança desses produtos sobre o esmalte sadio e desmineralizado. Esta proposta foi dividida em duas partes. A primeira foi um estudo clínico randomizado que avaliou a eficácia e segurança do enxaguatório clareador. Participantes (n=45) foram alocados aleatoriamente em três grupos de tratamento: LWE (Listerine Whitening Extreme­peróxido de hidrogênio a 2,5%); PL (Enxaguatório placebo); e OPF (Opalescence PF­peróxido de carbamida a 10%). O tratamento foi realizado 1x/dia por 14 dias durante 2h para OPF, e 2x/dia por 90 dias durante 30s para LWE e PL. A cor dos dentes foi avaliada com escalas de cor (DUEC) e por espectrofotometria. Foram avaliados sensibilidade dental, condição gengival, potencial de desmineralização do esmalte, e a satisfação do participante. As avaliações foram realizadas em diferentes tempos. Para as escalas de cor, KruskalWallis mostrou diferença significante entre os tratamentos nos tempos avaliados (p<0,05). LWE apresentou maiores valores de DUEC comparado ao PL a partir de 60 dias. PL e OPF exibiram valores constantes, sendo significativamente maiores para OPF. Para o espectrofotômetro, RM-ANOVA mostrou diferença significante para os grupos e interação (p<0,05). LWE apresentou maiores valores de alteração de cor do que PL a partir de T14. OPF exibiu os maiores valores de alteração de cor durante todo o período de estudo. Após 2 anos, houve manutenção da cor dos dentes para todos os grupos. Houve baixa intensidade de sensibilidade para LWE e OPF. Nenhum participante apresentou inflamação gengival. LWE e OPF promoveram uma diminuição significativa na concentração de cálcio, mas após 1 semana, os valores foram intermediários. A concentração de fosforo não apresentou alteração nos tempos avaliados. Todos os participantes ficaram satisfeitos com o tratamento com OPF e 67% dos participantes do grupo LWE apresentaram satisfação. A segunda parte consistiu em um estudo in vitro que comparou o efeito do enxaguatório clareador na desmineralização do esmalte e em lesões incipientes de cárie durante ciclagem de pH. Espécimes de esmalte/dentina bovino (n=120) com a superfície dividida em três áreas [esmalte sadio controle, esmalte tratado (ET); e lesão incipiente de carie tratada (LICT)] foram distribuídos aleatoriamente nos grupos experimentais: LWE; PL; OPF e água deionizada (AD). Os tratamentos (2min para LWE, PL e AD; e 2h para OPF) foram realizados durante uma ciclagem de pH de 28 dias (6´60min desmineralização). Intensidade de reflexão superficial (rSRI), perda mineral e concentração de flúor (espécimes adicionais) foram avaliados. Para ET, foi observado maior valor de rSRI em LWE (89,99%±6,94) e maior diminuição de rSRI foi observada para OPF e AD. Não houve perda mineral nos grupos (p>0,05). Para LICT, rSRI diminuiu significativamente após a ciclagem para todos os grupos sem diferença entre eles (p>0,05). Maior concentração de flúor foi encontrada em OPF. LWE e OPF exibiram efeitos semelhantes na perda mineral com valores intermediários. Houve eficácia clareadora tanto para LWE quanto para OPF e manutenção da cor após 2 anos. Houve efeito protetor do enxaguatório durante a ciclagem. (AU)

Whitening mouthrinses have become very popular because they are easy to use and are accessible. However, there is no evidence of the effects and safety of this product on sound and demineralized enamel. The proposal comprised in two parts. The first one was a randomized clinical trial that evaluated the efficacy and safety of the whitening mouthrinse. Participants (n=45) were randomly allocated to three treatment groups: LWE (Listerine Whitening Extreme­2.5% hydrogen peroxide); PL (placebo mouthrinse); and OPF (Opalescence PF­10% carbamide peroxide). The treatment was performed 1x/day for 14 days during 2h for OPF, and 2x/day for 90 days during 30s for LWE and PL. Tooth color was measured using shade guides (DUEC) and spectrophotometer. Tooth sensitivity, gingival condition, enamel demineralization potential, and participant satisfaction were analyzed. The analyses were performed in different times. For shade guides, Kruskal-Wallis showed a significant difference between treatments in the evaluated times (p<0.05). LWE showed higher DUEC values compared to PL after 60 days. PL and OPF exhibit constant values, being significantly higher for OPF. For spectrophotometer, RM-ANOVA showed significance for the groups and interaction (p<0.05). LWE showed higher color difference values than PL from T14. OPF exhibited the highest values throughout the study. After 2 years, there was maintenance of tooth color for all groups. There was lower intensity of sensitivity for LWE and OPF. No participant exhibited gingival inflammation. LWE and OPF promote a significant decrease in calcium concentration, but after 1 week the values were intermediate. Phosphorus concentration did not alter over time. All participants of OPF group were satisfied with the treatment and 67% of the participants of LWE group showed satisfaction. The second part of the study consisted of an in vitro study that compared the effect of whitening mouthrinse on enamel demineralization and on initial caries lesions. Bovine enamel/dentin specimens (n=120) had their surface divided into three areas [control sound enamel, enamel treated (ET); and initial caries lesion treated (ICLT)] and were randomly assigned to the experimental groups: LWE; PL; OPF; and deionized water (DW). The treatments (2min for LWE, PL and DW; and 2h for OPF) were performed during a 28-day pH cycle (6x60min demineralization). Surface reflection intensity (rSRI), mineral loss, and fluoride concentration (additional specimens) were performed. For ET, a higher value of rSRI was observed in LWE (89.99%±6.94) and a greater decrease in rSRI was observed for OPF and DW. There was no mineral loss in the groups (p>0.05). For ICLT, rSRI was significantly significant after cycling for all groups with no difference between them (p>0.05). Higher fluoride concentration was found in OPF. LWE and OPF exhibited similar effects on the mineral loss with intermediate values. There was whitening efficacy for both LWE and OPF and color maintenance after 2 years. There was a protective effect of the mouthrinse during cycling (AU)

Community Pharmacists' Knowledge, Attitude, and Practice in Providing Self-Care Recommendations for the Management of Premenstrual Syndrome.

Background and objectives: Premenstrual syndrome (PMS) comprises a variety of physical and emotional symptoms that affect women of reproductive age. The distress caused by PMS often leads to self-medication, and many over-the-counter or non-prescription products are available for relieving PMS symptoms. The choice of a suitable product should be based on advice from a health professional, such as a community pharmacist. Hence, we assessed the knowledge, attitude, and practice of Malaysian community pharmacists in providing self-care recommendations for the management of PMS. Materials and Methods: A cross-sectional survey was carried out in Kuala Lumpur, Malaysia from September to November 2018 using a self-administered questionnaire. The respondents were community pharmacists working in Kuala Lumpur and were chosen from a list of Type A license holders in the city. Results: We achieved a response rate of 79% and included 181 questionnaires in the final analysis. Of the 181 respondents, most of them (76.8%; n = 139) had medium to good levels of knowledge of PMS. Likewise, most of the respondents (78.5%; n = 142) had positive attitudes toward their role in PMS management. Having taken courses on managing minor illnesses in women substantially enhanced their levels of knowledge of (p = 0.002), but not their attitude towards, PMS management. Among the PMS-relieving products, the most commonly recommended products were ibuprofen (79%; n = 143), mefenamic acid (74.5%; n = 135), and naproxen (66.9%; n = 121), which are well known for their anti-inflammatory effect. This suggests that the respondents based their product choice on sound evidence. Conclusions: Community pharmacists can play an important role in the management of PMS. In future work, a larger sample can be assembled to obtain more insight into the readiness of community pharmacists to help women in self-managing PMS and establish a specialized service to this end.

O que é bom para tosse? Uma perspectiva médico-sociológica sobre os remédios para tratar tosse e resfriado em pediatria / What is good for cough? A medical-sociological perspective on medicines to treat coughs and colds in pediatrics

As medicações para tosse e resfriados são amplamente conhecidos e utilizados pela população brasileira. O objetivo dessa dissertação é entender por que essas medicações são tão populares apesar das preocupações médicas a respeito do seu uso em crianças. A metodologia utilizada foi a busca de evidências científicas sobre o padrão de segurança e eficácia dessas substâncias, além do fichamento e análise de uma reunião ocorrida em 2008 pelo Food and Drugs Admnistration. Também foram utilizados autores da filosofia e sociologia para analisar os resultados encontrados como Van der Geest, Fernando Lefèvre, Philipe Pignarre e Georges Canguilhem. Os resultados obtidos indicam que essas substâncias são utilizadas pelo seu potencial sedativo em diversos casos; o estudo não encontrou evidências médicas que sustentem o uso das medicações no ponto de vista biomédico baseado em eficácia e padrão de segurança. No entanto, a análise sociológica permitiu a elaboração de que esses medicamentos assumem o papel de cuidado médico, atribuindo valores simbólicos para os processos que envolvem os quadros de resfriado e gripe. A conclusão do estudo permite afirmar que um olhar exclusivamente bioquímico sobre a substância é insuficiente se quisermos compreender o lugar social desses medicamentos, suas formas de uso e os sentidos a eles atribuídos. Os xaropes, como essa pesquisa optou por nomear genericamente essas medicações apesar do seu efeito bioquímico questionável, são capazes de exercer grande impacto nas atribuições simbólicas de doença e cura. (AU)

The medications for cough and cold are widely known and used by brazilian population. The purpose of this dissertation is to understand why these medications are so popular despite medical concerns about their use in children. The methodology used was the search for scientific evidence on safety and efficacy of these substances, in addition to the record and analysis of a meeting that took place in 2008 by the Food and Drugs Admnistration. Philosophy and sociology authors were also used to analyze the results found, such as Van der Geest, Fernando Lefèvre, Philipe Pignarre and Georges Canguilhem. The results obtained were that these substances are used due their sedative potential in several cases; the study found no medical evidence to support the use of medications in the biomedical point of view based on efficacy and safety concerns. However, the sociological analysis allowed the elaboration that these drugs assume the role of medical care, attributing symbolic values to cold and flu processes. The conclusion of the study allows us to affirm that the exclusive biochemical view of the substance is insufficient to understand the social place of these medications, their kinds of use and their meanings. Syrups, as this research chose to name these medications generically, even though they have a questionable biochemical effect, are capable of having a great impact on the symbolic attributions of disease and cure. (AU)

Chemical pneumonitis from aspiration of rash protector spray.

Within hours of accidental instillation of a popular diaper rash protector spray, a 23 day old male developed severe chemical pneumonitis, acute respiratory failure and pneumomediastinum. Despite optimal ventilatory management, the unconventional use of frequent bronchial saline lavages was necessary to maintain oxygenation and ventilation. The only listed active ingredient, 10% dimethicone was a non-toxic inhalant, but the undisclosed inactive ingredients included mineral oil and balsam of peru which may cause chemical pneumonitis and allergic reactions. This case serves as a warning on OTC product designs and formulations, and cautions us to search beyond the listed active ingredients for potential toxicity.