A Meta-Analysis of Association between Remdesivir and Mortality among Critically-Ill COVID-19 Patients.

BACKGROUND: The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. MATERIALS AND METHODS: A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and non-ventilated patients. RESULTS: The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74; P <0.0001). CONCLUSION: Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.

Impact of Intravenous Vitamin C Administration in Reducing Severity of Symptoms in Breast Cancer Patients During Treatment.

Introduction Alternative medicine during treatment is often used to make the quality of life (QoL) better. Women with early-stage breast cancer, particularly the ones who possess lower QoL, are more prone to opt for complementary medicine. This study aims to explore the effects exerted by intravenous vitamin C (IVC) on symptoms and adverse events associated with breast cancer treatment. Methods This single-center, parallel-group, single-blind interventional study was conducted in the oncology ward of a tertiary care hospital in Pakistan. For this study, after informed consent was taken, breast cancer patients with Union for International Cancer Control stages IIA to IIIb were included in the study. Three hundred and fifty (n = 350) patients were randomized into two groups at a ratio of 1:1. Study group was randomized to receive 25 grams per week of IVC at a rate of 15 grams per hour for four weeks in addition to their current standard treatment, and the control group received placebo (normal saline drip with label removed) in addition to their current standard treatment. Results In patients who had received IVC, there was a significant decrease in the mean severity score after 28 days for the following symptoms: nausea (2.65 ± 0.62 vs. 2.59 ± 0.68; p-value: 0.0003), loss of appetite (2.26 ± 0.51 vs. 2.11 ± 0.52; p-value: 0.007), tumor pain (2.22 ± 0.45 vs. 1.99 ± 0.40, p-value: <0.0001), fatigue (3.11 ± 0.32 vs. 2.87 ± 0.29; p-value: <0.0001), and insomnia (2.59 ± 0.35 vs. 2.32 ± 0.36, p-value: <0.0001). Conclusion Our study showed improvement in the mean severity score of nausea, fatigue, tumor pain, loss of appetite, and fatigue. More studies are also needed to assess the long-term effects of IVC in the cancer management. This shall help incorporate the use of IVC in standard practice to make the journey of cancer management comfortable for the patients.

Corrigendum: Prevalence of Common Mental Disorders in South Asia: A Systematic Review and Meta-Regression Analysis.

[This corrects the article DOI: 10.3389/fpsyt.2020.573150.].

Prevalence of Common Mental Disorders in South Asia: A Systematic Review and Meta-Regression Analysis.

South Asian countries report the highest prevalence of common mental disorders (CMDs) globally. This systematic review and meta-analysis report the pooled prevalence of CMDs among the South Asian countries. Database searches were conducted in eight electronic databases. Titles, abstracts, full-text screening, and extraction of data on the event rate of 17 indicators of CMDs were performed by two independent reviewers. A total of 160 studies were included and data analysis was done using the Comprehensive Meta-analysis Software (v.3). A prevalence of depressive symptoms was 26.4% among 173,449 participants, alcohol abuse was 12.9% (n = 107,893); anxiety 25.8% (n = 70,058); tobacco smoking 18.6% (n = 84,965); PTSD 17.2% (n = 42,298); mixed anxiety and depression 28.4% (n = 11,102); suicidal behaviors 6.4% (n = 25,043); misuse of opiates 0.8% (n = 37,304); tobacco chewing 21.0% (n = 10,586); use of cannabis 3% (n = 10,977); GAD 2.9% (n = 70,058); bipolar disorder 0.6% (n = 7,197); IV drug abuse 2.5% (n = 15,049); panic disorder 0.01% (n = 28,087); stimulant use 0.9% (n = 1,414); OCD 1.6% (n = 8,784) and phobic disorders 1.8% (n = 27,754). This study reported a high prevalence of CMDs in South Asian countries; necessitating further research on psychiatric epidemiology in those contexts. It informs the need for effective policymaking and implementation of culturally appropriate multilevel interventions.

Comparison of the Efficacy of Duloxetine and Pregabalin in Pain Relief Associated with Diabetic Neuropathy.

Introduction Painful diabetic peripheral neuropathy (PDPN) complicates 25% of type II diabetes mellitus. It has a profound impact on diabetes-related morbidity and worsens the quality of life. Both pregabalin and duloxetine may be indicated for PDPN. In this study, the efficacy of duloxetine and pregabalin was compared in patients with PDPN. Methods It was a single-centre open-label study conducted with patients of diabetes mellitus type II diagnosed with PDPN. Patients were randomized to receive 60 mg/daily duloxetine or 300 mg/daily pregabalin. Pain scores were recorded using visual analogue scale (VAS) on day 0, week 4, and week 12. Data was entered and analysed using SPSS version 22.0 (IBM Corp., Armonk, NY). Results In the duloxetine group, the mean VAS score decreased from 6.81 ± 0.91 to 4.01 ± 1.12 with 12 weeks of therapy (p <0.0001). In the pregabalin group, the mean VAS score decreased from 6.99 ± 1.12 to 4.91 ± 0.82 with 12 weeks of therapy (p <0.0001). At 12 weeks, duloxetine showed lower VAS scores than pregabalin (p <0.0001). In the duloxetine group, the mean change in VAS score over time was - 2.80 and in the pregabalin group, the mean change was - 2.80. Adverse events were reported in 17.9% of the participants. Lethargy/somnolence (8.1%) and peripheral edema (3.4%) were commonly reported in the pregabalin group and constipation (6.9%) and orthostatic hypotension (4.6%) were commonly reported in the duloxetine group. Conclusions Duloxetine at a daily fixed dose of 60 mg is efficacious in the relief of neuropathic pain. Pregabalin also showed a comparable outcome. Both duloxetine and pregabalin have a promising safety profile and are well-tolerated.

Reasons for Refusing Laser-Assisted in Situ Keratomileusis in a Pakistani Population.

PURPOSE: To study and analyze the reasons for not performing laser-assisted in-situ keratomileusis (LASIK) surgery in Pakistan. METHODS: This is a retrospective observational review of the patients who presented for LASIK surgery during January 2014 to September 2016 at the Hashmanis Hospital refractive surgery facility in Karachi, Pakistan. RESULTS: A total of 6005 eyes in 3512 patients presented for LASIK surgery. Out of these, a total of 1795 eyes (29.9%) of 899 patients (25.6%) were rejected. The most common cause for not performing LASIK surgery was found to be increased risk of postoperative ectasia seen in 534 (29.75%) eyes. In 275 (15.32%) eyes, the surgery could not be performed because of affordability of procedure or unscientific apprehensions of the patient. Keratoconus was seen in 268 (14.93%) eyes. CONCLUSION: The patients presenting for LASIK surgery need extensive screening as the large proportion of patients may have corneal structural for not performing this procedure. The cost of the procedure plays its role as does the unscientific beliefs amongst the patients.

Hazardous impact and translocation of vanadium (V) species from soil to different vegetables and grasses grown in the vicinity of thermal power plant.

The distribution of vanadium (V) species in soil (test soil), vegetables and grasses, collected from the vicinity of a thermal power plant has been studied. For comparison purpose soil (control soil), same vegetable and grass samples were collected from agricultural land devoid of any industrial area. A simple and efficient ultrasonic assisted extraction method has been developed for the extraction of V(5+) species from soil, vegetable and grass samples using Na(2)CO(3) in the range of 0.1-0.5 mol/L. For comparison purpose same sub samples were also extracted by conventional heating method. The total and V species were determined by electrothermal atomic absorption spectrometry using different modifiers. The validity of V(5+) and V(4+) determination had been confirmed by the spike recovery and total amount of V by the analysis of CRM 1570 (spinach leave) and sub samples of agricultural soil. The concentration of total V was found in the range of 90-215 and 11.4-42.3 µg/g in test and control soil samples, respectively. The contents of V(5+) and total V in vegetables and grasses grown around the thermal power plant were found in the range of 2.9-5.25 and 8.74-14.9 µg/g, respectively, which were significantly higher than those values obtained from vegetables and fodders grown in non exposed agricultural site (P<0.01). Statistical evaluations indicate that the sum of concentrations of V(5+) and V(4+) species was not significantly different from total concentration of V in same sub samples of vegetable, grass and soil of both origins, at 95% level of confidence.

Microwave-assisted acid extraction of selenium from medicinal plants followed by electrothermal atomic absorption spectrometric determination.

A simple and rapid microwave-assisted extraction (MAE) of selenium (Se) from medicinal plants was investigated using different concentrations of nitric acid and hydrochloric acid, sample mass, heating time, microwave energy, and plant particle size. The optimization strategy was carried out using multivariate methodologies. Electrothermal atomic absorption spectrometry was used to determine Se. The accuracy of the optimized procedure was evaluated by using certified reference materials with certified values for Se and a microwave-assisted acid digestion (MD) method for comparative purpose. No significant difference was observed (P > 0.05) when comparing the values obtained by the proposed MAE and MD methods (paired t-test). Under the optimum operating conditions, the LOD obtained from the standard calibration curve was 0.012 microg/L for Se. The average RSD of the MAE method varied between 4.05 and 7.53% (n = 6). The proposed method was successfully applied for the determination of Se in medicinal plants used as remedies for cancerous and infection diseases.

Interaction of copper with iron, iodine, and thyroid hormone status in goitrous patients.

In many developing countries, men and women are at high risk of goiter and iron deficiency. The aim of the recent study is to assess the interaction of (Cu), with iron (Fe), iodine/iodide (I), and thyroid hormones in goitrous patients. Sixty goitrous male (GMPs) and 72 female patients (GFPs) were evaluated for the Cu, Fe, I, and thyroid hormones status in biological samples (serum and urine), and compared to non-goitrous subjects of both genders (M = 106, F = 120). The biological samples were analyzed for Cu and Fe concentration using atomic absorption spectrometer, while I was measured by the potentiometric method, prior to microwave-assisted acid digestion (MD). Quality control for the method was established with certified samples. Significantly higher mean values of Cu in serum, and urine samples of GMPs and GFPs, while lower value of Fe and I were observed as compared to control subjects (p < 0.015), respectively. The mean values of free triiodothyronine (FT3) and free thyroxin (FT4) were found to be lower in goitrous patients of both genders than in the age-matched healthy controls (p < 0.006 and 0.002), respectively, in contrast high mean values of thyroid-stimulating hormone (TSH) were detected in patients (p < 0.009), as compared to non-goitrous subjects. It was observed that the deficiencies of Fe, I, and thyroid hormone in goitrous patients could be influenced by efficiency of Cu.

Separation and preconcentration of trace amounts of aluminum ions in surface water samples using different analytical techniques.

A separation/preconcentration of aluminum (III) (Al(3+)) has been developed to overcome the problem of high matrix species, which may interfere with the determination of trace quantity of Al(3+) in natural water samples. The separation of Al(3+) in water samples was carried out from interfering cations by complexing them with 2-methyle 8-hyroxyquinoline (quinaldine) on activated silica. Whereas the separated trace amounts of Al(3+) was preconcentrated by cloud point extraction (CPE), as prior step to its determination by spectrofluorimetry (SPF) and flame atomic absorption spectrometry (FAAS). The Al(3+) react with 8-hydroxyquinoline (oxine) and then entrapped in non-ionic surfactant Triton X-114. The main factors affecting CPE efficiency, such as pH of sample solution, concentration of oxine and Triton X-114, equilibration temperature and time period for shaking were investigated in detail. The validity of separation/preconcentration of Al(3+) was checked by certified reference material of water (SRM-1643e). After optimization of the complexation and extraction conditions, a preconcentration factor of 20 was obtained for Al(3+) in 10 mL of natural water samples. The relative standard deviation for 6 replicates containing 100 microg L(-1) of Al(3+) was 5.41 and 4.53% for SPF and FAAS, respectively. The proposed method has been applied for determination of trace amount of Al(3+) in natural water samples with satisfactory results.

Separation and preconcentration of aluminum in parenteral solutions and bottled mineral water using different analytical techniques.

A new method is reported for the separation of aluminum ions [Al(III)] from interfering elements in parenteral and pharmaceutical solutions (PS) and bottled mineral water (BMW) samples, through solid-phase extraction with 2-methyl-8-hydroxyquinoline (quinaldine) adsorbed onto activated silica gel. While the enrichment step of separated Al(III) was carried out by cloud point extraction (CPE) using 8-hydroxyquinoline as complexing reagent, the resulted complex was entrapped in a non-ionic surfactant octylphenoxypolyethoxyethanol (Triton X-114). The enriched Al(III) in sample solutions were determined by spectrofluorometry (SPF) at lambda(excitation) 370 nm and lambda(emission) 510 nm, and flame atomic absorption spectrometry (FAAS) for comparative purpose. The variables affecting the complexation and extraction steps were studied and optimized. The validity of methodology was checked with certified reference material of water and standard addition method. The enrichment factor and detection limit of Al(III) for the preconcentration of 50 ml of PS and BMW were found to be 100 and 0.25 microg/L, respectively. The proposed method has been applied for the determination of trace amount of Al(III) in PS and BMW samples with satisfactory results. In PS the levels of Al(III) are above than permissible limit (25 microg/L).