Two Lactobacilli strains as adjuvant therapy in the management of irritable bowel syndrome: a randomized control trial

Alleviating the symptoms of irritable bowel syndrome (IBS) through the addition of probiotics to the treatment of IBS patients appears to be promising. The present randomized clinical trial seeks to assess the efficacy of a multi-strain probiotic product combining two Lactobacillus (L.) strains: L. acidophilus and L. plantarum, in diarrhea-predominant IBS (IBS-D) patients. A randomized, single-blinded clinical trial design was adopted to randomly assign 100 patients into two groups. Patients in group A received standard IBS treatment, whereas Group B patients were treated with probiotics besides the standard treatment. Both groups were treated for up to 12 weeks. The patients were assessed clinically by using IBS - Symptom Severity Scale (IBS-SSS) before starting the treatment and then at the end of the treatment period to evaluate the actual effect of probiotic intervention in treating IBS-D. Both treatments resulted in significant reductions in the total IBS-SSS score, but the reduction in Group B was significantly higher than in Group A. The reduction was significant in the number of days with pain, the severity of abdominal distension, satisfaction with bowel symptoms, and the effect of IBS on patients' life. The standard treatment showed a reduction of 241 points in the overall IBS-SSS score, while adding the probiotic resulted in 307 points reduction. Before treatment, all patients had severe IBS symptoms, but after treatment, 100% of patients in group B either achieved complete remission or had mild symptoms, while 14.3% of patients in group A still had moderate IBS. The patients on probiotics exhibited higher reductions in IBS-SSS overall scores as well as scores of individual sections. The probiotics also improved the severity of the disease and its symptoms when added to standard treatment. The results of this trial could support the addition of probiotics to the guidelines for managing IBS.

Two Lactobacilli strains as adjuvant therapy in the management of irritable bowel syndrome: a randomized control trial

Alleviating the symptoms of irritable bowel syndrome (IBS) through the addition of probiotics to the treatment of IBS patients appears to be promising. The present randomized clinical trial seeks to assess the efficacy of a multi-strain probiotic product combining two Lactobacillus (L.) strains: L. acidophilus and L. plantarum, in diarrhea-predominant IBS (IBS-D) patients. A randomized, single-blinded clinical trial design was adopted to randomly assign 100 patients into two groups. Patients in group A received standard IBS treatment, whereas Group B patients were treated with probiotics besides the standard treatment. Both groups were treated for up to 12 weeks. The patients were assessed clinically by using IBS - Symptom Severity Scale (IBS-SSS) before starting the treatment and then at the end of the treatment period to evaluate the actual effect of probiotic intervention in treating IBS-D. Both treatments resulted in significant reductions in the total IBS-SSS score, but the reduction in Group B was significantly higher than in Group A. The reduction was significant in the number of days with pain, the severity of abdominal distension, satisfaction with bowel symptoms, and the effect of IBS on patients' life. The standard treatment showed a reduction of 241 points in the overall IBS-SSS score, while adding the probiotic resulted in 307 points reduction. Before treatment, all patients had severe IBS symptoms, but after treatment, 100% of patients in group B either achieved complete remission or had mild symptoms, while 14.3% of patients in group A still had moderate IBS. The patients on probiotics exhibited higher reductions in IBS-SSS overall scores as well as scores of individual sections. The probiotics also improved the severity of the disease and its symptoms when added to standard treatment. The results of this trial could support the addition of probiotics to the guidelines for managing IBS.

Evaluation of the Pharmacologic Treatment of COVID-19 Pandemic in Iraq

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, or COVID-19) has been detrimental to human health, economy, and wellbeing. Little information is known on the epidemiology and outcome of the disease in a localized community within Iraq. We carried out an audit of confirmed cases of COVID-19 in the Kirkuk General Hospital. Data from the 20th of June to the 31st of July, 2020, were collected and analyzed. Suspected COVID-19 cases were confirmed by real-time polymerase chain reaction (RT-PCR). Data on clinical symptoms, age, and treatment protocols were analyzed concerning the outcome. Our study included a total of 200 individual confirmed COVID-19 patients. The majority of cases 55% (n = 110) displayed severe symptoms, while 32.5% (65 cases) and 12.5% (25 cases) of patients displayed moderate to mild symptoms, respectively. The rate of death in the referred patients was 5%. Most patients admitted to the hospital for treatment recovered and were discharged from the hospital within 5 to 30 days post-diagnosis. Statistical analysis revealed that patients treated with oseltamivir, hydroxychloroquine, and azithromycin in combination with vitamins C and D have shorter hospital stay compared to patients receiving the same therapeutic protocol in combination with steroids. Moreover, a higher mortality rate (4.5%) was observed in patients treated with oseltamivir, hydroxychloroquine, ceftriaxone, and steroids. This study highlights a significant relationship between age, secondary ailments, and the choice of medications as simple predictors of the outcome of COVID-19.

Indomethacin: Can It Counteract Bradykinin Effects in COVID-19 Patients?

COVID-19 represents the biggest health challenge. Although the mortality rate of COVID-19 is low, the high numbers of infected people and those with post-COVID-19 symptoms represent a real problem for the health system. A high number of patients with COVID-19 or people recovered from COVID-19 suffer from a dry cough and/or myalgia. Interestingly, an imbalance in bradykinin was observed in COVID-19 patients, which might be due to the accumulation of bradykinin as a result of a reduction in the degradation of bradykinin. This finding inspired the idea of possible similitude between the dry cough that is induced by angiotensin-converting enzyme inhibitors and the COVID-19-induced dry cough. Both of these types of cough are mediated, at least partially, by bradykinin. They both manifested as a persistent dry cough that is not responded to traditional dry cough remedies. However, several drugs were previously investigated for the treatment of angiotensin-converting enzyme inhibitor–induced dry cough. Here, we hypothesized that such treatment might be useful in COVID-19-induced dry cough and other bradykinin-related symptoms such as generalized pain and myalgia. In this article, evidence was presented to support the use of indomethacin as a potential treatment of COVID-19-induced dry cough. The choice of indomethacin was based on its ability to suppress the cyclooxygenase enzyme while also lowering the level of the inflammatory mediator bradykinin. Furthermore, indomethacin has been shown to be effective in treating angiotensin-converting enzyme inhibitor–induced dry cough. Moreover, indomethacin is a long-established, low-cost, effective, and readily available medication.

High-Throughput Screening Platforms in the Discovery of Novel Drugs for Neurodegenerative Diseases

Neurodegenerative diseases (NDDs) are incurable and debilitating conditions that result in progressive degeneration and/or death of nerve cells in the central nervous system (CNS). Identification of viable therapeutic targets and new treatments for CNS disorders and in particular, for NDDs is a major challenge in the field of drug discovery. These difficulties can be attributed to the diversity of cells involved, extreme complexity of the neural circuits, the limited capacity for tissue regeneration, and our incomplete understanding of the underlying pathological processes. Drug discovery is a complex and multidisciplinary process. The screening attrition rate in current drug discovery protocols mean that only one viable drug may arise from millions of screened compounds resulting in the need to improve discovery technologies and protocols to address the multiple causes of attrition. This has identified the need to screen larger libraries where the use of efficient high-throughput screening (HTS) becomes key in the discovery process. HTS can investigate hundreds of thousands of compounds per day. However, if fewer compounds could be screened without compromising the probability of success, the cost and time would be largely reduced. To that end, recent advances in computer-aided design, in silico libraries, and molecular docking software combined with the upscaling of cell-based platforms have evolved to improve screening efficiency with higher predictability and clinical applicability. We review, here, the increasing role of HTS in contemporary drug discovery processes, in particular for NDDs, and evaluate the criteria underlying its successful application. We also discuss the requirement of HTS for novel NDD therapies and examine the major current challenges in validating new drug targets and developing new treatments for NDDs.