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Zare M, Mirahmadizadeh A, Khosravi M, Karimi M, Dehghani SL. Comparison of Time to Report the Side Effects after AstraZeneca and Sinopharm Vaccinations in Users of the COVID-19 Symptom Study App: A Survey in South Iran. Med J Islam Repub Iran 2023; 37:99. [PMID: 38021386 PMCID: PMC10657253 DOI: 10.47176/mjiri.37.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Concerns about the side effects of SARS-CoV-2 vaccines have been raised nationwide. We aimed to compare the time to report the side effects of the Oxford-AstraZeneca and Sinopharm COVID-19 vaccines. Methods Information on side effects of AstraZeneca and Sinopharm COVID-19 vaccines was obtained from the COVID-19 Symptom Study App affiliated with Shiraz University of Medical Science during 2021. A COX regression model with an adjusted Hazard Ratio and 95% Confidence Interval; HR (95% C.I) was reported at the significance level of < 0.05. Results 4478 and 5555 participants received the AstraZeneca and Sinopharm vaccines, respectively; more age, history of SARS-CoV-2 infection, first vaccine dose, hypertension, and hypertension with cardiovascular disease were seen in the AstraZeneca group (P < 0.05 for all). However, the AstraZeneca group had lower immune deficiency and time to report the side effects (P < 0.05 for both). There was significantly less time to pain HR(95% C.I.); 0.50 (0.47-0.52), vertigo 0.65 (0.61-0.69), weakness 0.41 (0.38-0.44), headache 0.43 (0.39-0.74), anorexia 0.31 (0.28-0.34), nausea 0.56 (0.51-0.62), severer allergy 0.71 (0.63-0.81), general inflammation 0.27 (0.23-0.31), fever > 38oC 0.12 (0.1-0.15), eye inflammation 0.45 (0.39-0.52), diarrhea 0.85 (0.73-0.99), blurred vision 0.73 (0.61-0.86), injection site redness 0.32 (0.26-0.39), fatigue/paleness 0.53 (0.50-0.57), joint pain 0.55 (0.41-0.73), auxiliary gland inflation 0.59 (0.43-0.80), convulsions 0.30 (0.17-0.52), and severe side effects 0.3 (0.27-0.33) in the AstraZeneca group; However, skin rash 0.77 (0.57-1.05) and hospitalization 0.72 (0.21-2.55) were the same. Conclusion Sinopharm COVID-19 vaccine recipients reported longer times to report vaccine-related side effects than AstraZeneca; due to the lack of adverse effects like hospitalization, vaccination should continue to control the pandemic; more real-population studies are needed on the long-term effects of vaccination against COVID-19.
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Affiliation(s)
- Marjan Zare
- Non-communicable Diseases Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-communicable Diseases Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran
| | - Masoumeh Khosravi
- Deputy of Statistics Bureau, Department of Statistics and Information
Technology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Karimi
- Technical deputy of Vice-Chancellery for Health, Department of Health Affairs,
Shiraz University of Medical Sciences, Shiraz, Iran
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Maity S, Santra A, Vardhan Hebbani A, Pulakuntla S, Chatterjee A, Rao Badri K, Damodara Reddy V. Targeting cytokine storm as the potential anti-viral therapy: Implications in regulating SARS-CoV-2 pathogenicity. Gene 2023:147612. [PMID: 37423400 DOI: 10.1016/j.gene.2023.147612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/18/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
The latest global pandemic corona virus disease - 2019 (COVID-19) caused by the virus SARS-CoV-2 is still a matter of worrying concern both for the scientific communities and health care organizations. COVID-19 disease is proved to be a highly contagious disease transmitted through respiratory droplets and even close contact with affected individuals. COVID-19 disease is also understood to exhibit diverse symptoms of ranging severities i.e., from mild fatigue to death. Affected individuals' susceptibility to induce immunologic dysregulation phenomena termed 'cytokine storm' seems to be playing the damaging role of escalating the disease manifestation from mild to severe. Cytokine storm in patients with severe symptoms is understood to be characterized by enhanced serum levels of many cytokines including interleukin-1β, interleukin-6, IL-10, TNF, interferon-γ, MIP-1α, MIP-1β and VEGF. Since cytokine production in general is the most important antiviral defense response, understanding the COVID-19 associated cytokine storm in particular and differentiating it from the regular cytokine production response becomes crucial in developing an effective therapeutic strategy.This review focuses on the potential targeting of COVID-19 associated cytokine storm and its challenges.
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Affiliation(s)
- Subashish Maity
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India
| | - Ayantika Santra
- Department of Biochemistry, Indian Academy Degree College, Bengaluru, 560 043, India
| | | | - Swetha Pulakuntla
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India
| | - Ankita Chatterjee
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India
| | - Kameswara Rao Badri
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Morehouse School of Medicine, GA, Atlanta-30310, USA; Clinical Analytical Chemistry Laboratory, COVID-19 Testing Laboratory, Morehouse School of Medicine, GA, Atlanta-30310, USA.
| | - Vaddi Damodara Reddy
- Department of Biotechnology, REVA University, Bengaluru-560064, Karnataka, India.
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Abd El-Hadi HR, Eltanany BM, Zaazaa HE, Eissa MS. Chromatographic impurity profile assessment of dual action binary combination: Ecological analysis with comparative statistics. SUSTAINABLE CHEMISTRY AND PHARMACY 2023; 33:101075. [DOI: 10.1016/j.scp.2023.101075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Nainu F, Mamada SS, Emran TB. Prospective role of NSAIDs with antiviral properties for pharmacological management of postsurgical procedures during COVID-19. Int J Surg 2023; 109:109-111. [PMID: 36799818 PMCID: PMC10389334 DOI: 10.1097/js9.0000000000000101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Sukamto S. Mamada
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Talha B. Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
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Abdel Rahman MA, Elghobashy MR, Zaazaa HE, Atty SA, El-Mosallamy SS. Validated HPLC-PDA methodology utilized for simultaneous determination of Etoricoxib and Paracetamol in the presence of Paracetamol toxic impurities. BMC Chem 2022; 16:108. [PMID: 36461095 PMCID: PMC9717564 DOI: 10.1186/s13065-022-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
Etoricoxib (ETO), Paracetamol (PCM), and two toxic impurities for Paracetamol impurity K (4-aminophenol (PAP)) and impurity E (para-hydroxy acetophenone (PHA)) were separated using a simple and selective HPLC method that was tested for the first time. PCM is a commonly used analgesic and antipyretic medication that has recently been incorporated into COVID-19 supportive treatment. Pharmaceuticals containing PCM in combination with other analgesic-antipyretic drugs like ETO help to improve patient compliance. The studied drugs and impurities were separated on a GL Sciences Inertsil ODS-3 (250 × 4.6) mm, 5.0 µm column, and linear gradient elution was performed using 50 mM potassium dihydrogen phosphate adjusted to pH 4.0 with ortho-phosphoric acid and acetonitrile as mobile phase at 2.0 mL/min flow rate at 25 °C and UV detection at 220 nm. The linearity range was 1.5-30.0 µg/mL for ETO and PCM while 0.5-10.0 µg/mL for PAP and PHA, with correlation coefficients (r) for ETO, PCM, PAP, and PHA of 0.9999, 0.9993, 0.9996, and 0.9998, respectively. The proposed method could be used well for routine analysis in quality control laboratory.
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Affiliation(s)
- Mona A. Abdel Rahman
- grid.412319.c0000 0004 1765 2101Analytical Chemistry Department, Faculty of Pharmacy, October 6 University, 6 October City, PO Box 12858, Giza, Egypt
| | - Mohamed R. Elghobashy
- grid.412319.c0000 0004 1765 2101Analytical Chemistry Department, Faculty of Pharmacy, October 6 University, 6 October City, PO Box 12858, Giza, Egypt ,grid.7776.10000 0004 0639 9286Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562 PO Egypt
| | - Hala E. Zaazaa
- grid.7776.10000 0004 0639 9286Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562 PO Egypt
| | - Shimaa A. Atty
- Pharmaceutical Chemistry Department, Egyptian Drug Authority, 51 Wezaret El-Zeraa St, Cairo, Egypt
| | - Sally S. El-Mosallamy
- grid.7776.10000 0004 0639 9286Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, 11562 PO Egypt
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6
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Amponsah SK, Tagoe B, Adams I, Bugyei KA. Efficacy and safety profile of corticosteroids and non-steroidal anti-inflammatory drugs in COVID-19 management: A narrative review. Front Pharmacol 2022; 13:1063246. [DOI: 10.3389/fphar.2022.1063246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
Due to the fact that coronavirus disease 2019 (COVID-19) is still prevalent, and current reports show that some parts of the world have seen increase in incidence, it is relevant that health professionals and scientists know about recent or novel trends, especially drug treatments. Additionally, the safety profiles of these drug treatments need to be documented and shared with the public. Some studies have demonstrated the clinical benefits of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in COVID-19 treatment. On the contrary, others have also reported that NSAIDs and corticosteroids may worsen symptoms associated with COVID-19. While some researchers have suggested that corticosteroids may be helpful if used in the early stages of COVID-19, there are still some conflicting findings regarding the use of corticosteroids in certain viral infections. Our review suggests that methylprednisolone, dexamethasone, and ibuprofen have therapeutic potential in reducing mortality due to COVID-19 among hospitalized patients. This review also highlights the fact that the use of NSAIDs is not associated with adverse outcomes of COVID-19. In reality, evidence suggests that NSAIDs do not increase the risk of COVID-19 infections. Also, the literature reviewed suggests that corticosteroid treatment in COVID-19 was linked with a decrease in all-cause mortality and disease progression, without increase in adverse events when compared to no corticosteroid treatment.
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Rani M, Uniyal A, Akhilesh, Tiwari V. Decrypting the cellular and molecular intricacies associated with COVID-19-induced chronic pain. Metab Brain Dis 2022; 37:2629-2642. [PMID: 35849300 PMCID: PMC9289353 DOI: 10.1007/s11011-022-01048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/23/2022] [Indexed: 10/25/2022]
Abstract
Pain is one of the clinical manifestations that can vary from mild to severe symptoms in COVID-19 patients. Pain symptoms can be initiated by direct viral damage to the tissue or by indirect tissue injury followed by nociceptor sensitization. The most common types of pain that are reported to occur in COVID-19 patients are headache, myalgia, and chest pain. With more and more cases coming in the hospitals, many new and unique symptoms of pain are being reported. Testicular and abdominal pain are rare cases of pain that are also being reported and are associated with COVID-19. The SARS-CoV-2 virus has a high affinity for angiotensin-converting enzyme-2 receptor (ACE-2) which acts as an entry point for the virus. ACE-2/ Ang II/AT 1 receptor also participates directly in the transmission of pain signals from the dorsal horn of the spinal cord. It induces a series of complicated responses in the human body. Among which the cytokinetic storm and hypercoagulation are the most prominent pathways that mediate the sensitization of sensory neurons facilitating pain. The elevated immune response is also responsible for the activation of inflammatory lipid mediators such as COX-1 and COX-2 enzymes for the synthesis of prostaglandins (PGs). PG molecules especially PGE2 and PGD2 are involved in the pain transmission and are found to be elevated in COVID-19 patients. Though arachidonic acid pathway is one of the lesser discussed topics in COVID-19 pathophysiology, still it can be useful for explaining the unique and rarer symptoms of pain seen in COVID-19 patients. Understanding different pain pathways is very crucial for the management of pain and can help healthcare systems to end the current pandemic situation. We herein review the role of various molecules involved in the pain pathology of COVID-19.
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Affiliation(s)
- Mousmi Rani
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India
| | - Ankit Uniyal
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India
| | - Akhilesh
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India
| | - Vinod Tiwari
- Neuroscience and Pain Research Laboratory, Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, 221005, Uttar Pradesh, India.
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Grando M, Balbi M, Zeppieri M. COVID-19-induced liver injury in adult patients: A brief overview. World J Virol 2022; 11:443-452. [PMID: 36483102 PMCID: PMC9724208 DOI: 10.5501/wjv.v11.i6.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/07/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease has spread worldwide since 2019, causing important pandemic issues and various social health problems to date. Little is known about the origin of this virus and the effects it has on extra-pulmonary organs. The different mechanisms of the virus and the influence it has on humans are still being studied, with hopes of finding a cure for the disease and the pathologies associated with the infection. Liver damage caused by coronavirus disease 2019 (COVID-19) is sometimes underestimated and has been of important clinical interest in the past few years. Hepatic dysfunctions can manifest in different forms which can sometimes be mild and without specific signs and symptoms or be severe with important clinical implications. There are several studies that have tried to explain the mechanism of entry (hepatotropism) of the virus into hepatocytes and the effects the virus has on this important organ. What clearly emerges from the current literature is that hepatic injury represents an important clinical aspect in the management of patients infected with COVID-19, especially in frail patients and those with comorbidities. The aim of our brief overview is to summarize the current literature regarding the forms of hepatic damage, complications, mechanisms of pathology, clinical features of liver injury, influence of comorbidities and clinical management in patients with COVID-19 infection.
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Affiliation(s)
- Martina Grando
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento 33078, Italy
| | - Massimiliano Balbi
- Department of Internal Medicine, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento 33078, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Kanapeckaitė A, Mažeikienė A, Geris L, Burokienė N, Cottrell GS, Widera D. Computational pharmacology: New avenues for COVID-19 therapeutics search and better preparedness for future pandemic crises. Biophys Chem 2022; 290:106891. [PMID: 36137310 PMCID: PMC9464258 DOI: 10.1016/j.bpc.2022.106891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic created an unprecedented global healthcare emergency prompting the exploration of new therapeutic avenues, including drug repurposing. A large number of ongoing studies revealed pervasive issues in clinical research, such as the lack of accessible and organised data. Moreover, current shortcomings in clinical studies highlighted the need for a multi-faceted approach to tackle this health crisis. Thus, we set out to explore and develop new strategies for drug repositioning by employing computational pharmacology, data mining, systems biology, and computational chemistry to advance shared efforts in identifying key targets, affected networks, and potential pharmaceutical intervention options. Our study revealed that formulating pharmacological strategies should rely on both therapeutic targets and their networks. We showed how data mining can reveal regulatory patterns, capture novel targets, alert about side-effects, and help identify new therapeutic avenues. We also highlighted the importance of the miRNA regulatory layer and how this information could be used to monitor disease progression or devise treatment strategies. Importantly, our work bridged the interactome with the chemical compound space to better understand the complex landscape of COVID-19 drugs. Machine and deep learning allowed us to showcase limitations in current chemical libraries for COVID-19 suggesting that both in silico and experimental analyses should be combined to retrieve therapeutically valuable compounds. Based on the gathered data, we strongly advocate for taking this opportunity to establish robust practices for treating today's and future infectious diseases by preparing solid analytical frameworks.
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Affiliation(s)
- Austė Kanapeckaitė
- AK Consulting, Laisvės g. 7, LT 12007 Vilnius, Lithuania,Corresponding author
| | - Asta Mažeikienė
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, LT-03101 Vilnius, Lithuania
| | - Liesbet Geris
- Biomechanics Research Unit, GIGA In Silico Medicine, University of Liège, Quartier Hôpital, Avenue de l'Hôpital 11 (B34), Liège 4000, Belgium,Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C (2419), Leuven 3001, Belgium,Skeletel Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Herestraat 49 (813), Leuven 3000, Belgium
| | - Neringa Burokienė
- Clinics of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio str. 21/27, LT-03101 Vilnius, Lithuania
| | - Graeme S. Cottrell
- University of Reading, School of Pharmacy, Hopkins Building, Reading RG6 6UB, United Kingdom
| | - Darius Widera
- University of Reading, School of Pharmacy, Hopkins Building, Reading RG6 6UB, United Kingdom
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Mohamed SK, El Bakri Y, Abdul DA, Ahmad S, Albayati MR, Lai CH, Mague JT, Tolba MS. Synthesis, crystal structure, and a molecular modeling approach to identify effective antiviral hydrazide derivative against the main protease of SARS-CoV-2. J Mol Struct 2022; 1265:133391. [PMID: 35663190 PMCID: PMC9142792 DOI: 10.1016/j.molstruc.2022.133391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 01/25/2023]
Abstract
In the fall of 2019, a new type of coronavirus took place in Wuhan city, China, and rapidly spread across the world and urges the scientific community to develop antiviral therapeutic agents. In our effort we have synthesized a new hydrazide derivative, (E)-N'-(1-(4-bromophenyl)ethylidene)-2-(6-methoxynaphthalen-2-yl)propanehydrazide for this purpose because of its potential inhibitory proprieties. The asymmetric unit of the title molecule consists of two independent molecules differing noticeably in conformation. In the crystal, the independent molecules are linked by N-H···O and C-H···O hydrogen bonds and C-H···π(ring) interactions into helical chains extending along the b-axis direction. The chains are further joined by additional C-H···π(ring) interactions into the full 3-D structure. To obtain a structure-activity relationship, the DFT-NBO analysis is performed to study the intrinsic electronic properties of the title compound. Molecular modeling studies were also conducted to examine the binding affinity of the compound for the SARS-CoV-2 main protease enzyme and to determine intermolecular binding interactions. The compound revealed a stable binding mode at the enzyme active pocket with a binding energy value of -8.1 kcal/mol. Further, stable dynamics were revealed for the enzyme-compound complex and reported highly favorable binding energies. The net MMGBSA binding energy of the complex is -37.41 kcal/mol while the net MMPBSA binding energy is -40.5 kcal/mol. Overall, the compound disclosed the strongest bond of ing the main protease enzyme and might be a good lead for further structural optimization.
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Affiliation(s)
- Shaaban K Mohamed
- Chemistry and Environmental Division, Manchester Metropolitan University, Manchester M1 5GD, United Kingdom
- Chemistry Department, Faculty of Science, Minia University, 61519 El-Minia, Egypt
| | - Youness El Bakri
- Department of Theoretical and Applied Chemistry, South Ural State University, Lenin prospect 76, Chelyabinsk 454080, Russia
| | - Dalia A Abdul
- Department of Chemistry, College of Science, university of Sulaimani, Sulaimania, Iraq
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar 25000, Pakistan
| | - Mustafa R Albayati
- Kirkuk University, College of Science, Department of Chemistry, Kirkuk, Iraq
| | - Chin-Hung Lai
- Department of Medical Applied Chemistry, Chung Shan Medical University, Taichung 40241, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, 402 Taichung, Taiwan
| | - Joel T Mague
- Department of Chemistry, Tulane University, New Orleans, LA 70118, United States
| | - Mahmoud S Tolba
- Chemistry Department, Faculty of Science, New Valley University, El-Kharja 72511, Egypt
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Wojcieszyńska D, Guzik H, Guzik U. Non-steroidal anti-inflammatory drugs in the era of the Covid-19 pandemic in the context of the human and the environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155317. [PMID: 35452725 PMCID: PMC9015952 DOI: 10.1016/j.scitotenv.2022.155317] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 05/23/2023]
Abstract
From 2019, life in the world has mainly been determined by successive waves of the COVID-19 epidemic. During this time, the virus structure, action, short- and long-term effects of the infection were discovered, and treatments were developed. This epidemic undoubtedly affected people's lives, but increasing attention is also being paid to the effects of the epidemic on the environment. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a global scoping review of peer-reviewed information has been conducted on the use of over-the-counter non-steroidal anti-inflammatory drugs in the treatment of symptoms of SARS-CoV-2 infections and their positive and negative effects on the human body, the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on aquatic organisms, and their adverse effects on non-target organisms. The literature from 1998 to 2021 was analysed using the Scopus®, Web of Science™ (WoS) and Google Scholar databases. As non-steroidal anti-inflammatory drugs place a heavy burden on the environment, all reports of the presence of these drugs in the environment during the pandemic period have been thoroughly analysed. Of the 70 peer-reviewed records within the scope, only 14% (n = 10) focussed on the analysis of non-steroidal anti-inflammatory drugs concentrations in wastewater and surface waters during the pandemic period. The percentage of these works indicates that it is still an open topic, and this issue should be supplemented with further reports in which the results obtained during the pandemic, which has been going on for several years, will be published. The authors hope this review will inspire scientists to investigate the problem of non-steroidal anti-inflammatory drugs in the environment to protect them for the next generation.
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Affiliation(s)
- Danuta Wojcieszyńska
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural Science, University of Silesia in Katowice, Jagiellońska 28, 40-032 Katowice, Poland
| | - Henryk Guzik
- Department of Orthopaedics and Traumatology, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Urszula Guzik
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural Science, University of Silesia in Katowice, Jagiellońska 28, 40-032 Katowice, Poland.
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Khirfan F, Jarrar Y, Al-Qirim T, Goh KW, Jarrar Q, Ardianto C, Awad M, Al-Ameer HJ, Al-Awaida W, Moshawih S, Ming LC. Analgesics Induce Alterations in the Expression of SARS-CoV-2 Entry and Arachidonic-Acid-Metabolizing Genes in the Mouse Lungs. Pharmaceuticals (Basel) 2022; 15:696. [PMID: 35745615 PMCID: PMC9227818 DOI: 10.3390/ph15060696] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/22/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
Paracetamol and nonsteroidal anti-inflammatory drugs are widely used in the management of respiratory viral infections. This study aimed to determine the effects of the most commonly used analgesics (paracetamol, ibuprofen, and diclofenac) on the mRNA expression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry and arachidonic-acid-metabolizing genes in mouse lungs. A total of twenty eight Balb/c mice were divided into four groups and treated separately with vehicle, paracetamol, ibuprofen, and diclofenac in clinically equivalent doses for 14 days. Then, the expressions of SARS-CoV-2 entry, ACE2, TMPRSS2, and Ctsl genes, in addition to the arachidonic-acid-metabolizing cyp450, cox, and alox genes, were analyzed using real-time PCR. Paracetamol increased the expressions of TMPRSS2 and Ctsl genes by 8.5 and 5.6 folds, respectively, while ibuprofen and diclofenac significantly decreased the expression of the ACE2 gene by more than 2.5 folds. In addition, all tested drugs downregulated (p < 0.05) cox2 gene expression, and paracetamol reduced the mRNA levels of cyp4a12 and 2j5. These molecular alterations in diclofenac and ibuprofen were associated with pathohistological alterations, where both analgesics induced the infiltration of inflammatory cells and airway wall thickening. It is concluded that analgesics such as paracetamol, ibuprofen, and diclofenac alter the expression of SARS-CoV-2 entry and arachidonic-acid-metabolizing genes in mouse lungs.
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Affiliation(s)
- Fatima Khirfan
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11731, Jordan; (F.K.); (T.A.-Q.); (M.A.)
| | - Yazun Jarrar
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11731, Jordan; (F.K.); (T.A.-Q.); (M.A.)
| | - Tariq Al-Qirim
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11731, Jordan; (F.K.); (T.A.-Q.); (M.A.)
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Malaysia;
| | - Qais Jarrar
- Department of Applied Pharmaceutical Sciences, Faculty of Pharmacy, Al-Isra University, Amman 11622, Jordan;
| | - Chrismawan Ardianto
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Mohammad Awad
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11731, Jordan; (F.K.); (T.A.-Q.); (M.A.)
| | - Hamzeh J. Al-Ameer
- Department of Biology and Biotechnology, American University of Madaba, Madaba 17110, Jordan; (H.J.A.-A.); (W.A.-A.)
| | - Wajdy Al-Awaida
- Department of Biology and Biotechnology, American University of Madaba, Madaba 17110, Jordan; (H.J.A.-A.); (W.A.-A.)
| | - Said Moshawih
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei Darussalam;
| | - Long Chiau Ming
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya 60115, Indonesia
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei Darussalam;
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Guerrero M, Castroman P, Quiroga O, Berenguel Cook M, Narvaez Tamayo MA, Venturoni L, Pergolizzi Jr J, Rekatsina M, Varrassi G. Pain Management and COVID-19: A Latin American Perspective. Cureus 2022; 14:e23100. [PMID: 35464506 PMCID: PMC9001811 DOI: 10.7759/cureus.23100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/12/2022] [Indexed: 11/25/2022] Open
Abstract
Vaccinations and therapeutics have been developed for COVID-19, but vaccine uptake varies markedly among countries. Public health responses have also varied, in particular, with lockdown efforts and school closing. All over the world, the pandemic exposed healthcare and economic weaknesses. COVID-19 exacerbated mental health issues by exposing the population to prolonged periods of fear, anxiety, financial stress, psychological uncertainties, and sometimes isolation from even family and friends. Chronic pain patients have been disproportionately affected. The pandemic-associated stresses may have exacerbated their already painful symptoms while at the same time interrupting their access to care. The ramifications of the COVID-19 post-viral syndrome (“long COVID-19”) are not yet known. COVID-19 viral infection has been associated with neuropathic pain symptoms. Tele-triage and telehealth applications can help manage chronic pain patients in the COVID-19 era, but many interventional procedures, injections, or other treatments have been delayed. The role of palliative care for patients with terminal cases of infection must be re-examined. Palliative care is a relatively new medical specialty and allows terminally ill patients to die in as much comfort and peace as can be afforded to them. More training in palliative care for all clinicians is urgently needed. COVID-19 exposed much that is wrong or weak or inadequate in our healthcare systems, but it also allowed us to embrace new technologies and develop better systems to manage the challenge of a pandemic.
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Fazio S, Affuso F, Bellavite P. A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Management of Mild-to-Moderate Symptomatic COVID-19. Med Sci Monit 2022; 28:e936292. [PMID: 35256581 PMCID: PMC8917781 DOI: 10.12659/msm.936292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 01/11/2023] Open
Abstract
In the past 2 years, the coronavirus disease 2019 (COVID-19) pandemic has driven investigational studies and controlled clinical trials on antiviral treatments and vaccines that have undergone regulatory approval. Now that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants may become endemic over time, there remains a need to identify drugs that treat the symptoms of COVID-19 and prevent progression toward severe cases, hospitalization, and death. Understanding the molecular mechanisms of SARS-CoV-2 infection is extremely important for the development of effective therapies against COVID-19. This review outlines the key pathways involved in the host response to SARS-CoV-2 infection and discusses the potential role of antioxidant and anti-inflammatory pharmacological approaches for the management of early mild-to-moderate COVID-19, using the examples of combined indomethacin, low-dose aspirin, omeprazole, hesperidin, quercetin, and vitamin C. The pharmacological targets of these substances are described here for their possible synergism in counteracting SARS-CoV-2 replication and progression of the infection from the upper respiratory airways to the blood, avoiding vascular complications and cytokine and bradykinin storms.
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Affiliation(s)
- Serafino Fazio
- Department of Internal Medicine (retired professor), Medical School University Federico II, Naples, Italy
| | | | - Paolo Bellavite
- Physiopathology Chair, Homeopathic Medical School of Verona, Verona, Italy
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15
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Supportive Home Remedies for Orofacial Pain during the Coronavirus Disease 2019 Pandemic: Their Value and Limitations. Int J Dent 2022; 2022:2005935. [PMID: 35069740 PMCID: PMC8771145 DOI: 10.1155/2022/2005935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impeded access to timely dental care, and there is an urgent need for adjuvant therapies that can reduce orofacial pain in emergencies. Aims To provide information on the benefits and limitations of eight representative home remedies as palliative care for orofacial pain during the coronavirus disease 2019 (COVID-19) pandemic. Methods PubMed and Medline were electronically searched for eight home remedies for orofacial pain that can be used in COVID-19. Papers published in English in the past 30 years were considered. Among the published studies suitable for the research purpose, those in which the abstract and body text were confirmed were targeted, and duplicate studies were excluded. Finally, 86 studies were included. Results There is extensive and high-level scientific evidence for the application of tooth brushing and flossing, mouth rinsing with chlorhexidine, use of over-the-counter pain medication, and application of cryotherapy in emergencies. Gargling with salt water, brushing with bamboo salt, gargling with garlic juice, and oil pulling are traditional methods used for centuries. The use of natural products for orofacial pain has a significant empirical effect but has weak scientific evidence. Conclusions Knowing the correct application method, effects, and side effects is desirable to use these methods appropriately in emergencies. However, scientific evidence is unclear and generally lacking for home remedies to be the main treatment strategy, and there are clear limitations to their use as a single main treatment.
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16
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Updates on Palliative Medicine in the COVID-19 Era. J Clin Med 2022; 11:jcm11020315. [PMID: 35054011 PMCID: PMC8779552 DOI: 10.3390/jcm11020315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 12/25/2022] Open
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Soliman RM, Mostafa NM, Fayez YM, Monir HH, Rostom Y. OUP accepted manuscript. J AOAC Int 2022; 105:1268-1279. [PMID: 35916665 PMCID: PMC9383530 DOI: 10.1093/jaoacint/qsac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022]
Abstract
Background Common cold and cough preparations represent a huge segment of the global pharmaceutical market. Recently, cold/cough formulations containing paracetamol (PAR) have attracted significant attention as PAR has been implemented into the supportive treatment of mild cases of COVID-19 as the first-line antipyretic. From a literature review, no method has been reported yet for simultaneous estimation of PAR, pseudoephedrine hydrochloride (PSE) and carbinoxamine maleate (CRX) in any matrix. Thus, there is an urgent need for smart and green methods that would enable quantification of the cited components in their challenging ratio. Objectives The aim of this work is to develop and validate the first UV spectrophotometric methods for simultaneous determination of the selected drugs taking into consideration the list of challenges including the highly overlapping features and spectral interferences in the cited mixture. Methods Namely, the proposed methods are: direct spectrophotometry, dual wavelength, first derivative, derivative ratio, ratio difference, constant center coupled with spectrum subtraction, and the constant multiplication method paired with spectrum subtraction. Results These methods were linear over the concentration range of 2.5–35 μg/mL, 1.5–20 μg/mL, and 4.5–35 μg/mL for PAR, PSE and CRX, respectively. These methods fulfill the validity parameters according to International Conference on Harmonization (ICH) guidelines. The results obtained were statistically benchmarked to the official ones where no significant difference was noticed. Conclusion The developed methods are successfully applied for concurrent quantification of the studied components in the marketed dosage form without interference from matrix excipients. The impact on the environment was assessed by five green metrics, namely a recent Analytical greenness (AGREE) metric algorithm based on the green analytical chemistry framework, Green Analytical Procedure Index (GAPI), Eco-Scale, Assessment of Green Profile (AGP), and National Environmental Methods Index (NEMI). Highlights Eco-friendly and successive spectrophotometric methods were firstly developed in this work, for the simultaneous quantification of PAR, PSE and CRX. These approaches incorporate a simple enrichment-aided technique to augment their spectrophotometric signals, facilitating the accurate quantitation of the minor component in the cited mixture.
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Affiliation(s)
- Rabab M Soliman
- Ministry of Health and Population, Directorate of Health Affairs, Ismailia Health Administration, Ismailia, Egypt
| | - Nadia M Mostafa
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Kasr El-Aini Street, Cairo 11562, Egypt
| | - Yasmin M Fayez
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Kasr El-Aini Street, Cairo 11562, Egypt
| | - Hany H Monir
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Kasr El-Aini Street, Cairo 11562, Egypt
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18
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Poggiali E, De Iaco F. The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pain is a frequent reason for referral to the Emergency Department (ED). Adequate management of pain is a moral and ethical imperative. If not correctly treated, acute pain can cause physical and psychological complications, and become chronic with severe consequences such as anxiety, depression, and social isolation. As consequence, emergency clinicians should treat pain as soon as possible, avoiding delays even in case of acute abdominal pain. Pain management is particularly complex in the elderly and emergency clinicians should always consider AGS Beers criteria ® to avoid inappropriate medications, severe side-effects, and drug-drug interactions. Pain is also a common cause of delirium in older patients. The SARS CoV-2 infection not only can cause acute pain, but also exacerbate chronic pain, particularly in the elderly, who are at high risk to be infected. Looking at all this evidence, emergency clinicians should treat pain with different strategies according to their experience and cultural background, making the right choice for each patient. This work is a critical review of the pain management in the ED, with a particular attention on the effects of COVID-19 in the EDs. We conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline from 2000 to 2020, using the keywords of “pain”, “emergency”, “COVID19”, “elderly”, “palliative care”, “ketamine”, “dexmedetomidine”, and “post-traumatic stress disorder”. The aim of this review is to help emergency clinicians to correctly manage pain in the ED with a new point of view regarding the pain management in COVID-19 patients.
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19
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Pandolfi S, Chirumbolo S, Ricevuti G, Valdenassi L, Bjørklund G, Lysiuk R, Doşa MD, Lenchyk L, Fazio S. Home pharmacological therapy in early COVID-19 to prevent hospitalization and reduce mortality: Time for a suitable proposal. Basic Clin Pharmacol Toxicol 2021; 130:225-239. [PMID: 34811895 PMCID: PMC9011697 DOI: 10.1111/bcpt.13690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023]
Abstract
The COVID‐19 pandemic is a highly dramatic concern for mankind. In Italy, the pandemic exerted its major impact throughout the period of February to June 2020. To date, the awkward amount of more than 134,000 deaths has been reported. Yet, post‐mortem autopsy was performed on a very modest number of patients who died from COVID‐19 infection, leading to a first confirmation of an immune‐thrombosis of the lungs as the major COVID‐19 pathogenesis, likewise for SARS. Since then (June–August 2020), no targeted early therapy considering this pathogenetic issue was approached. The patients treated with early anti‐inflammatory, anti‐platelet, anticoagulant and antibiotic therapy confirmed that COVID‐19 was an endothelial inflammation with immuno‐thrombosis. Patients not treated or scarcely treated with the most proper and appropriate therapy and in the earliest, increased the hospitalization rate in the intensive care units and also mortality, due to immune‐thrombosis from the pulmonary capillary district and alveoli. The disease causes widespread endothelial inflammation, which can induce damage to various organs and systems. Therapy must be targeted in this consideration, and in this review, we demonstrate how early anti‐inflammatory therapy may treat endothelia inflammation and immune‐thrombosis caused by COVID‐19, by using drugs we are going to recommend in this paper.
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Affiliation(s)
- Sergio Pandolfi
- High School of Oxygen Ozone Therapy, University of Pavia, Pavia, Italy.,Unit of Neurosurgery, Villa Mafalda Health Clinics, Rome, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | | | - Luigi Valdenassi
- High School of Oxygen Ozone Therapy, University of Pavia, Pavia, Italy
| | - Geir Bjørklund
- Department of Direction Board, Council for Nutritional an Environmental Medicine (CONEM), Mo i Rana, Norway
| | - Roman Lysiuk
- CONEM Ukraine Life Science Research Group, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Monica Daniela Doşa
- Department of Pharmacology, Faculty of Medicine, Ovidius University, Constanta, Romania
| | - Larysa Lenchyk
- CONEM Ukraine Pharmacognosy and Natural Product Chemistry Research Group, National University of Pharmacy, Kharkiv, Ukraine
| | - Serafino Fazio
- Department of Internal Medicine, University of Naples Federico II, Naples, Italy
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Ibrahim H, Hamdy AM, Merey HA, Saad AS. Dual-Mode Gradient HPLC and TLC Densitometry Methods for the Simultaneous Determination of Paracetamol and Methionine in the Presence of Paracetamol Impurities. J AOAC Int 2021; 104:975-982. [PMID: 33560299 PMCID: PMC7928902 DOI: 10.1093/jaoacint/qsab021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 01/22/2021] [Indexed: 01/06/2023]
Abstract
Background Paracetamol is one of the most widely analgesic and antipyretic drugs recently integrated into the supportive therapy of COVID-19. The pharmaceuticals containing methionine with paracetamol may contribute to avoid hepatotoxicity and eventual paracetamol overdose-dependent death. Objective The current work purposes to develop and validate two chromatographic methods for the simultaneous determination of methionine and paracetamol in presence of two paracetamol impurities (4-nitrophenol and 4-aminophenol). Methods Two chromatographic methods were established and validated according to the International Conference on Harmonization guidelines. The first one was a RP-HPLC/UV method based on applying a “dual-mode” gradient elution. The separation was realized via varying both the composition of the ternary mobile phase (acetonitrile–methanol–water) and its flow rate. This strategy enabled a relatively rapid analysis with a satisfactory resolution, although the investigated compounds exhibit a significant difference in lipophilicity. The second one relied on TLC- densitometry, where the optimum separation was realized using a quaternary mobile phase system composed of butanol–dioxane–toluene–methanol (8: 2.5: 3.5: 0.3, by volume). Both methods were monitored at 220 nm. Results The developed methods were proven to be robust, accurate, specific, and appropriate for the routine analysis of paracetamol in its pure form or in pharmaceutical formulations with methionine in quality control laboratories. Conclusions The corresponding methods are suitable to determine methionine and paracetamol in the presence of paracetamol impurities. Highlights The study achieves the analysis of methionine and paracetamol in the presence of paracetamol impurities via the application of HPLC and TLC- densitometry methods.
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Affiliation(s)
- Hany Ibrahim
- Egyptian Russian University, Faculty of Pharmacy, Analytical Chemistry Department, Badr City, Cairo, Egypt
| | - Abdallah M Hamdy
- Egyptian Russian University, Faculty of Pharmacy, Analytical Chemistry Department, Badr City, Cairo, Egypt
| | - Hanan A Merey
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Kasr El-Aini St, Cairo, Egypt.,October 6 University, Faculty of Pharmacy, Analytical Chemistry Department, Giza, Egypt
| | - Ahmed S Saad
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Kasr El-Aini St, Cairo, Egypt.,Badr University in Cairo (BUC), School of Pharmacy and Pharmaceutical Industries, Pharmaceutical Chemistry Department, Cairo, Egypt
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21
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Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) have been discouraged for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, fearing that they could increase the risk of infection or the severity of SARS-CoV-2. Methods Original studies providing information on exposure to NSAIDs and coronavirus disease 2019 (COVID-19) outcomes were retrieved and were included in a descriptive analysis and a meta-analysis with Cochrane Revue Manager (REVMAN 5.4), using inverse variance odds ratio (OR) with random- or fixed-effects models. Results Of 92,853 papers mentioning COVID-19, 266 mentioned NSAIDs and 61 mentioned ibuprofen; 19 papers had analysable data. Three papers described NSAID exposure and the risk of SARS-CoV-2 positivity, five papers described the risk of hospital admission in positive patients, 10 papers described death, and six papers described severe composite outcomes. Five papers studied exposure to ibuprofen and death. Using random-effects models, there was no excess risk of SARS-CoV-2 positivity (OR 0.86, 95% confidence interval [CI] 0.71–1.05). In SARS-CoV-2-positive patients, exposure to NSAIDs was not associated with excess risk of hospital admission (OR 0.90, 95% CI 0.80–1.17), death (OR 0.88, 95% CI 0.80–0.98), or severe outcomes (OR 1.14, 95% CI 0.90–1.44). With ibuprofen, there was no increased risk of death (OR 0.94, 95% CI 0.78–1.13). Using a fixed-effect model did not modify the results, nor did the sensitivity analyses. Conclusion The theoretical risks of NSAIDs or ibuprofen in SARS-CoV-2 infection are not confirmed by observational data. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01089-5.
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Dejaco C, Alunno A, Bijlsma JW, Boonen A, Combe B, Finckh A, Machado PM, Padjen I, Sivera F, Stamm TA, Buttgereit F. Influence of COVID-19 pandemic on decisions for the management of people with inflammatory rheumatic and musculoskeletal diseases: a survey among EULAR countries. Ann Rheum Dis 2021; 80:518-526. [PMID: 33158877 PMCID: PMC7650208 DOI: 10.1136/annrheumdis-2020-218697] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/10/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate how the first wave of COVID-19 pandemic influenced decisions of rheumatologists and health professionals in rheumatology regarding the management of patients with inflammatory rheumatic and musculoskeletal diseases (RMDs). METHODS An English-language questionnaire was developed by a EULAR working group and distributed via national rheumatology societies of EULAR countries, EMEUNET and individual working group members. Responses were collected using an online survey tool. Descriptive statistics were calculated. RESULTS We analysed 1286 responses from 35/45 EULAR countries. Due to containment measures, 82% of respondents indicated cancellation/postponement of face-to-face visits of new patients (84% of them offering remote consultation) and 91% of follow-up visits (96% with remote consultation). The majority of respondents (58%) perceived that the interval between symptom onset and first rheumatological consultations was longer during containment restrictions than before. Treatment decisions were frequently postponed (34%), and the majority (74%) of respondents stated that it was less likely to start a biological disease modifying anti-rheumatic drug (DMARD)/targeted synthetic DMARD during the pandemic, mainly because of patients' fear, limited availability of screening procedures and decreased availability of rheumatological services. Use of (hydroxy)chloroquine (HCQ) and tocilizumab (TCZ) for the COVID-19 indication was reported by 47% and 42% of respondents, respectively, leading to a shortage of these drugs for RMDs indications according to 49% and 14% of respondents, respectively. CONCLUSION Measures related to containment of COVID-19 pandemic led to a perceived delay between symptom onset and a first rheumatological visit, postponement of treatment decisions, and shortage of HCQ and TCZ, thereby negatively impacting early treatment and treat-to-target strategies.
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Affiliation(s)
- Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria
- Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy
| | - Alessia Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | | | - Annelies Boonen
- Internal Medicine, Division of Rheumatology, and School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bernard Combe
- Department of Rheumatology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Axel Finckh
- Department of Medicine, Division of Rheumatology, University Hospital of Geneva, Geneve, Switzerland
| | - Pedro M Machado
- Department of Rheumatology, University College London & University College London Hospitals & Northwick Park Hospital, London, UK
| | - Ivan Padjen
- Division of Clinical Immunology and Rheumatology, University Hospital Centre Zagreb and University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Francisca Sivera
- Medicine, Miguel Hernandez University of Elche Faculty of Medicine, Sant Joan D'Alacant, Spain
- Rheumatology, Hospital General de Elda, Elda, Spain
| | - Tanja A Stamm
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Frank Buttgereit
- Rheumatology and Immunology, Charite Medical Faculty Berlin, Berlin, Germany
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Analgesic Drugs and COVID-19. J Clin Med 2021; 10:jcm10030545. [PMID: 33540701 PMCID: PMC7867250 DOI: 10.3390/jcm10030545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
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Lariccia V, Magi S, Serfilippi T, Toujani M, Gratteri S, Amoroso S. Challenges and Opportunities from Targeting Inflammatory Responses to SARS-CoV-2 Infection: A Narrative Review. J Clin Med 2020; 9:E4021. [PMID: 33322733 PMCID: PMC7763517 DOI: 10.3390/jcm9124021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is a global pandemic that continues to sweep across the world, posing an urgent need for effective therapies and prevention of the spread of the severe acute respiratory syndrome related to coronavirus-2 (SARS-CoV-2). A major hypothesis that is currently guiding research and clinical care posits that an excessive and uncontrolled surge of pro-inflammatory cytokines (the so-called "cytokine storm") drives morbidity and mortality in the most severe cases. In the overall efforts made to develop effective and safe therapies (including vaccines) for COVID-19, clinicians are thus repurposing ready-to-use drugs with direct or indirect anti-inflammatory and immunomodulatory activities. Speculatively, there are many opportunities and challenges in targeting immune/inflammatory processes in the evolving settings of COVID-19 disease because of the need to safely balance the fight against virus and aggressive inflammation versus the suppression of host immune defenses and the risk of additional harms in already compromised patients. To this end, many studies are globally underway to weigh the pros and cons of tailoring drugs used for inflammatory-driven conditions to COVID-19 patient care, and the next step will be to summarize the growing clinical trial experience into clean clinical practice. Based on the current evidence, anti-inflammatory drugs should be considered as complementary approaches to anti-viral drugs that need to be timely introduced in the management of COVID-19 according to disease severity. While drugs that target SARS-CoV-2 entry or replication are expected to confer the greatest benefits at the early stage of the infection, anti-inflammatory drugs would be more effective in limiting the inflammatory processes that drive the worsening of the disease.
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Affiliation(s)
- Vincenzo Lariccia
- Department of Biomedical Sciences and Public Health, School of Medicine, University “Politecnica delle Marche”, Via Tronto 10/A, 60126 Ancona, Italy; (S.M.); (T.S.); (M.T.)
| | - Simona Magi
- Department of Biomedical Sciences and Public Health, School of Medicine, University “Politecnica delle Marche”, Via Tronto 10/A, 60126 Ancona, Italy; (S.M.); (T.S.); (M.T.)
| | - Tiziano Serfilippi
- Department of Biomedical Sciences and Public Health, School of Medicine, University “Politecnica delle Marche”, Via Tronto 10/A, 60126 Ancona, Italy; (S.M.); (T.S.); (M.T.)
| | - Marwa Toujani
- Department of Biomedical Sciences and Public Health, School of Medicine, University “Politecnica delle Marche”, Via Tronto 10/A, 60126 Ancona, Italy; (S.M.); (T.S.); (M.T.)
| | - Santo Gratteri
- Institute of Legal Medicine, University “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Salvatore Amoroso
- Department of Biomedical Sciences and Public Health, School of Medicine, University “Politecnica delle Marche”, Via Tronto 10/A, 60126 Ancona, Italy; (S.M.); (T.S.); (M.T.)
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Abstract
Chronic pain management during the coronavirus disease 2019 (COVID-19) pandemic is a challenging process, especially with growing evidence that COVID-19 infection is associated with myalgias, referred pain, and widespread hyperalgesia. In light of the limited data available for COVID-19-related impact on chronic pain patients, this review explores the changes in the healthcare delivery system due to social distancing and safety precautions to provide the appropriate management of chronic pain patients during the COVID-19 pandemic. Understanding both the general problems facing chronic pain patients as well as specific problems in the COVID-19 era including deconditioning, increased mental health concerns, financial burdens, and potential for medication-induced immune-suppression is vital in the appropriate management of patients. Telemedicine, the practice of caring for patients remotely when the provider and patient are not physically present with each other, is becoming increasingly used and recognized as a valuable tool to both health care providers and patients. This paper concentrates on the proper utilization of the available resources to help patients with the most severe conditions as well as the most vulnerable group. COVID-19 may be associated with a profound effect on both the health care system and patients with chronic pain. As a result, delaying, or stopping, treatment for chronic pain patients will have negative consequences, and strong pain evaluations must be administered to triage patients appropriately. Recent recommendations for the safe use of non-opioid analgesics, opioid analgesics, and interventional pain management procedures are vital to know and understand specifically during the pandemic era. Further researches are needed to identify the advance planning and rapid responses to reduce the impact of the pandemic.
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Bruce E, Barlow-Pay F, Short R, Vilches-Moraga A, Price A, McGovern A, Braude P, Stechman MJ, Moug S, McCarthy K, Hewitt J, Carter B, Myint PK. Prior Routine Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Important Outcomes in Hospitalised Patients with COVID-19. J Clin Med 2020; 9:jcm9082586. [PMID: 32785086 PMCID: PMC7465199 DOI: 10.3390/jcm9082586] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/14/2020] [Accepted: 08/04/2020] [Indexed: 12/30/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) infection causes acute lung injury, resulting from aggressive inflammation initiated by viral replication. There has been much speculation about the potential role of non-steroidal inflammatory drugs (NSAIDs), which increase the expression of angiotensin-converting enzyme 2 (ACE2), a binding target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to enter the host cell, which could lead to poorer outcomes in COVID-19 disease. The aim of this study was to examine the association between routine use of NSAIDs and outcomes in hospitalised patients with COVID-19. This was a multicentre, observational study, with data collected from adult patients with COVID-19 admitted to eight UK hospitals. Of 1222 patients eligible to be included, 54 (4.4%) were routinely prescribed NSAIDs prior to admission. Univariate results suggested a modest protective effect from the use of NSAIDs, but in the multivariable analysis, there was no association between prior NSAID use and time to mortality (adjusted HR (aHR) = 0.89, 95% CI 0.52–1.53, p = 0.67) or length of stay (aHR 0.89, 95% CI 0.59–1.35, p = 0.58). This study found no evidence that routine NSAID use was associated with higher COVID-19 mortality in hospitalised patients; therefore, patients should be advised to continue taking these medications until further evidence emerges. Our findings suggest that NSAID use might confer a modest benefit with regard to survival. However, as this finding was underpowered, further research is required.
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Affiliation(s)
- Eilidh Bruce
- Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, UK;
- Institute of Applied Health Science, University of Aberdeen, Aberdeen AB25 2ZN, Scotland, UK
| | - Fenella Barlow-Pay
- Royal Alexandra Hospital, Paisley PA2 9PJ, Scotland, UK; (F.B.-P.); (S.M.)
| | - Roxanna Short
- Department of Biostatistics & Health Informatics, King’s College London, London WC2R 2LS, UK; (R.S.); (B.C.)
| | | | - Angeline Price
- Salford Royal NHS Trust, Salford M6 8HD, UK; (A.V.-M.); (A.P.)
| | - Aine McGovern
- Glasgow Royal Infirmary, Glasgow G4 0SF, Scotland, UK;
| | - Philip Braude
- North Bristol NHS Trust, Bristol BS10 5NB, UK; (P.B.); (K.M.)
| | - Michael J. Stechman
- School of Medicine, Cardiff University, Cardiff CF10 3AT, Wales, UK; (M.J.S.); (J.H.)
| | - Susan Moug
- Royal Alexandra Hospital, Paisley PA2 9PJ, Scotland, UK; (F.B.-P.); (S.M.)
| | | | - Jonathan Hewitt
- School of Medicine, Cardiff University, Cardiff CF10 3AT, Wales, UK; (M.J.S.); (J.H.)
| | - Ben Carter
- Department of Biostatistics & Health Informatics, King’s College London, London WC2R 2LS, UK; (R.S.); (B.C.)
| | - Phyo Kyaw Myint
- Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, UK;
- Institute of Applied Health Science, University of Aberdeen, Aberdeen AB25 2ZN, Scotland, UK
- Correspondence: ; Tel.: +44-1224-437841
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27
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Metastasio A, Prevete E, Singh D, Grundmann O, Prozialeck WC, Veltri C, Bersani G, Corazza O. Can Kratom ( Mitragyna speciosa) Alleviate COVID-19 Pain? A Case Study. Front Psychiatry 2020; 11:594816. [PMID: 33329145 PMCID: PMC7717955 DOI: 10.3389/fpsyt.2020.594816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/27/2020] [Indexed: 01/14/2023] Open
Abstract
Among the symptoms of COVID-19 fever, general malaise, pain and aches, myalgia, fatigue, and headache can affect the quality of life of patients, even after the end of the acute phase of the infection and can be long lasting. The current treatment of these symptoms, also because COVID-19 patients have been asked not to use non-steroidal anti-inflammatory drugs (NSAIDs), in particular ibuprofen are often unsatisfactory. Among the above mentioned symptoms malaise and fatigue seem the most difficult to treat. In this case report we describe the use of kratom (Mitragyna speciosa) by a patient with confirmed COVID-19 infection. What we observed was a fast and sustained relieve of the above mentioned symptoms.
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Affiliation(s)
- Antonio Metastasio
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,NHS Camden and Islington Trust, London, United Kingdom
| | - Elisabeth Prevete
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Walter C Prozialeck
- Department of Pharmacology, Midwestern University, Downers Grove, IL, United States
| | - Charles Veltri
- Department of Pharmaceutical Sciences, Midwestern University, Glendale, AZ, United States
| | - Giuseppe Bersani
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Ornella Corazza
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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