Assessing Attitudes and Understanding After Ovarian Tissue Cryopreservation: A Follow-Up Telephone Interview Survey

Purpose: Assessing patient and guardian experiences regarding their history of ovarian tissue cryopreservation (OTC) years after initial procedure. Methods: Cross-sectional follow-up telephone survey. A questionnaire developed by The Pediatric Initiative Network of the Oncofertility Consortium, modified to assess intent and attitudes regarding OTC, tissue access knowledge, financial burden of tissue storage, and intent to use tissue, was utilized. Interviews were conducted for those who underwent OTC at a metropolitan children's hospital between 2013 and 2022. Results: Of 60 eligible patients, 39 interviews were completed. Contacted patients were 3-28 years old, with minors accompanied by guardians. Average age at OTC was 8.5 years old, and 5.1% (2/39) were deceased at the time of contact. All interviewees underwent OTC for fertility preservation before gonadotoxic treatment. Seventy percent of patients (7/10) and 48.1% (13/27) of guardians stated they would use frozen tissue for pregnancy, with 50% (5/10) of patients and 59.3% (16/27) of guardians not understanding tissue access. Regret occurred in 10% (1/10) of patients and 3.4% (1/29) of guardians. It was associated with 10.8% (4/37) of tissue discard due to failed storage payments. Financial concerns occurred in 29.7% (11/37) of interviewees. Overall, 92.3% (36/39) would recommend OTC, and 94.9% (37/39) would repeat their choice to undergo OTC. Conclusion: Follow-up after OTC is essential to patient understanding of tissue status, access, and payments. Most do not regret OTC, except in cases of financial burden leading to tissue discard. Follow-up should be sequentially scheduled and include counseling on financial assistance programs.

Norgestrel (Opill) Is the First Over-the-Counter Oral Contraceptive Pill Approved in the United States

Just less than half of the pregnancies in the United States are unintended. Unintended pregnancy rates are greatest among women younger than 24 years, women of color, and those who have incomes less than 200% of the federal poverty level. Additionally, options to terminate a pregnancy are restricted or limited in some states. In July 2023, the U.S. Food and Drug Administration approved norgestrel (Opill) as the first over-the-counter oral contraceptive pill available in the United States. Norgestrel is indicated specifically for the prevention of pregnancy, contains only progesterone, and is indicated for daily oral use. This article provides an overview of over-the-counter norgestrel, including administration, adverse effects, contraindications, and practice implications for women's health nurses.

Value of pharmacy services for common illness symptoms covered by universal coverage at drugstore compared to outpatient services at a hospital in Thailand

Background

Drug stores is an option that people can receive health care services for their common illnesses. This is the first study aims to estimate cost savings for 16 common illness symptoms to the Thailand's health system.

Method

This study gathered retrospective secondary data from several studies and surveyed the median cost of medicines. Cost savings of care provided by pharmacists at drug stores in comparison to out-patient department (OPD) services at hospitals were quantified using cost of illness approach.

Results

The average number of hospital visits for treatment for 16 common illness symptoms was 2,356 visits per month. The estimation of the cost savings per visit from three perspectives, including government, patient, and societal, at tertiary care hospitals were 12.7-19.4, 12.7-25.6, and 18.9-25.6 USD, and at secondary care hospitals were 6.0-12.7, 6.0-18.9, and 12.2-18.9 USD. Every $1 reimbursed at drug stores will save additional costs in Thailand's health system, ranging from $0.04 to $0.24 and $0.02 to $0.16 at tertiary care hospitals and secondary hospitals, respectively.

Conclusion

Pharmacy services for 16 common illness symptoms can clearly save costs.

Twenty-five years of Open-Top Chambers in tropical environments: where, how, and what are we looking at regarding flora response to climate change?

MAIN CONCLUSION

Open-Top Chambers should be more used in tropical ecosystems to study climate change effects in plants as they are still insufficient to extract plant response patterns in these ecosystems. Understanding flora response to climate change (CC) is critical for predicting future ecosystem dynamics. Open-Top Chambers (OTCs) have been widely used to study the effects of CC on plants and are very popular in temperate ecosystems but are still underused in tropical regions. In this systematic review, we aimed to discuss the use of OTCs in the study of the effects of different agents of climate change on tropical flora by presenting scientometric data, discussing the technical aspects of its use and enumerating some observations on plant response patterns to climatic alterations in the tropics. Our analysis indicated that the bottleneck in choosing an OTC shape is not strictly related to its purpose or the type of parameter modulated; instead, passive or active approaches seem to be a more sensitive point. The common critical point in using this technique in warmer regions is overheating and decoupling, but it can be overcome with simple adaptations and extra features. The most frequently parameter modulated was CO2, followed by O3 and temperature. The plant families with more representatives in the studies analyzed were Fabaceae, Myrtaceae, and Poaceae, and the most represented biome was tropical and subtropical moist broadleaf forests. In conclusion, OTCs are a valuable and feasible tool to study CC effects on various tropical ecosystems, regardless of structure, active/passive approach, or other technical features. One of the primary advantages of this methodology is its applicability for in situ use, eliminating the need for plant transplantation. We encourage studies using OTC experimental design for plant conservation in the tropics.

Construction of surface-rich MoS2 nanoflowers decorated on 2D layered MXene nanohybrid heterostructure for highly efficient and rapid degradation of oxytetracycline

In this study, we successfully developed a hybrid architecture referred to as MoS2@MX, involving the integration of MoS2 layered onto MXene using a straightforward co-precipitation method. This innovative hybrid photocatalyst exhibited remarkable efficiency in removing oxytetracycline (OTC) molecules from aqueous solutions under visible-light irradiation. During the photocatalytic process, both MoS2 and MX played distinct yet complementary roles. MoS2 facilitated efficient electron transfer, while MX contributed to the generation of radicals. This unique collaboration resulted in a noteworthy 99 % oxidation efficiency for OTC degradation within a brief 60 min of visible light exposure in an aqueous environment. The radicals 1O2 and •OH were identified as the principal drivers behind OTC degradation, underscoring the vital role of the hybrid material. Mechanistically, the degradation of OTC involved several key steps, including C-H bond cleavage, de-carboxylation, C-N bond oxidation, and de-chlorination. Importantly, the MoS2@MX hybrid composite demonstrated remarkable stability, maintaining a noteworthy photocatalytic efficiency of 89 % for targeted OTC removal after undergoing five consecutive cycles. In conclusion, this study emphasizes the potential of the MoS2@MX hybrid material as an effective agent for degrading organic OTC compounds within aquatic environments. The hybrid's multifaceted roles and exceptional performance suggest promising applications in sustainable water treatment.

The cadmium tolerance enhancement through regulating glutathione conferred by vacuolar compartmentalization in Aspergillus sydowii

Aspergillus was found to be a vital hyperaccumulation species for heavy metal removal with admirable tolerance capacity. But the potential tolerance mechanism has not been completely studied. This study quantified the amounts of total cadmium (Cd), Cd2+, glutathione (GSH), and reactive oxygen species (ROS) in the protoplasts and vacuoles of mycelium. We modulated GSH synthesis using buthionine sulfoximine (BSO) and 2-oxothiazolidine-4-carboxylic acid (OTC) to investigate the subcellular regulatory mechanisms of GSH in the accumulation of Cd. The results confirmed that GSH plays a crucial role in vacuolar compartmentalization under Cd stress. GSH and GSSG as a redox buffer to keep the cellular redox state in balance and GSH as a metal chelating agent to reduce toxicity. When regulating the decreased GSH content with BSO, and increased GSH content with OTC, the system of Cd-GSH-ROS can change accordingly, this also supported that vacuolar compartmentalization is a detoxification strategy that can modulate the transport and storage of substances inside and outside the vacuole reasonably. Interestingly, GSH tended to be distributed in the cytoplasm, the battleground of redox takes place in the cytoplasm but not in the vacuole. These finding potentially has implications for the understanding of tolerance behavior and detoxification mechanisms of cells. In the future bioremediation of Cd in soil, the efficiency of soil remediation can be improved by developing organisms with high GSH production capacity.

Real-world Data and Evidence to support a switch in status from Prescription drug to Over the Counter drug as applied by the EMA, the US FDA, the MHRA, and the BfArM

PURPOSE

We studied under which circumstances and to what extent Real-World Data (RWD) and Real-World Evidence (RWE) were used in regulatory decisions when switching products from Prescription-only (Rx) to Over-the-Counter (OTC) status with the aim of extracting learnings that could be applied in future switches.

METHODS

Sanofi commissioned Clarivate Analytics to identify switches from Rx to OTC in the European Union (centrally by the European Medicines Agency [EMA] and in Germany by the Bundesinstitut für Arzneimittel und Medizinprodukte [BfArM]), in the United States by the Food and Drug Administration (FDA), and in the United Kingdom by the Medicines and Healthcare products Regulatory Agency (MHRA) as far back as data were available in the public domain, mainly Health Authority webpages. They covered the period from and including 2022 and went as far back as they could find data in their proprietary database or in the public domain; for the EMA back to 2008, the US FDA back to 2001, the UK MHRA back to 1991, and the German BfArM for the period 2013-2022. We also asked Clarivate to investigate the nature of acceptance of RWD and RWE, and to what extent they are accepted by the different regulators in their decision-making and approval processes.

FINDINGS

We found that the number of drugs available in the OTC segment is higher in regulatory jurisdictions where OTC policies are clear and supplemented by guidelines and transparent decision-making processes at the regulator level. A wide range of different data sources, many of which can be regarded as RWD/RWE in their broadest definitions, have been used to support switches. The data required by regulators to support a switch from Rx-only to OTC availability primarily centers on drug safety-both the drug's intrinsic safety and the safety associated with consumer usage.

IMPLICATIONS

Clear and transparent regulatory switch frameworks are conducive to growing the number of medicines available to consumers willing to self-manage their conditions. Transparent disclosure of the RWD and RWE data sets that regulators have found acceptable in historic switch applications is desirable because it would help sponsors to facilitate and increase prospective switches, thereby benefiting patients and society.

Exploring rat corpus cavernosum alterations induced by finasteride treatment and withdrawal

Despite its efficacy for treating androgenetic alopecia, finasteride, an inhibitor of 5α-reductase (i.e., the enzyme converting testosterone, T, into dihydrotestosterone, DHT), is associated with several side effects including sexual dysfunction (e.g., erectile dysfunction). These side effects may persist after drug suspension, inducing the so-called post-finasteride syndrome (PFS). The effects of subchronic treatment with finasteride (i.e., 20 days) and its withdrawal (i.e., 1 month) in rat corpus cavernosum have been explored here. Data obtained show that the treatment was able to decrease the levels of the enzyme 5α-reductase type II in the rat corpus cavernosum with increased T and decreased DHT levels. This local change in T metabolism was linked to mechanisms associated with erectile dysfunction. Indeed, by targeted metabolomics, we reported a decrease in the nitric oxide synthase (NOS) activity, measured by the citrulline/arginine ratio and confirmed by the decrease in NO2 levels, and a decrease in ornithine transcarbamylase (OTC) activity, measured by citrulline/ornithine ratio. Interestingly, the T levels are negatively correlated with NOS activity, while those of DHT are positively correlated with OTC activity. Finasteride treatment also induced alterations in the levels of other molecules involved in the control of penile erection, such as norepinephrine and its metabolite, epinephrine. Indeed, plasma levels of norepinephrine and epinephrine were significantly increased and decreased, respectively, suggesting an impairment of these mediators. Interestingly, these modifications were restored by suspension of the drug. Altogether, the results reported here indicate that finasteride treatment, but not its withdrawal, affects T metabolism in the rat corpus cavernosum, and this alteration was linked to mechanisms associated with erectile dysfunction. Data here reported could also suggest that the PFS sexual side effects are more related to dysfunction in a sexual central control rather than peripheral compromised condition.

Physiological cost of Ulva lactuca under combined pressure of nutrient-oxytetracycline: One potential formation and maintenance mechanism of Ulva sp. green tide

Environmental pollution is considered to lead to Ulva sp. green tides. Nevertheless, nutrients with high concentrations inhibit algae which may be damaged by antibiotics, such as OTC (oxytetracycline). Thus, Ulva sp. algae might pay a physiological cost under nutrient-OTC combined pressures. If this hypothesis is confirmed, Ulva sp. algae cannot easily form green tides, or green tides are difficult to maintain. To test this hypothesis, an uniform design experiment during which OTC, ammonia (NH4-N) and phosphate (PO4-P) were factors was set to simulate nutrient-OTC combined pressures, and Ulva lactuca was exposed to the pressures for 96 h. The TN (total nitrogen, CTN) or TP (total phosphorus, CTP) content in U. lactuca increased with increasing nutrient concentrations, as CTN = 21.206±1.000+ 1.227±0.418NH4-N × PO4-P (R2 = 0.282, p < 0.05) and CTP = 1.886±0.266+ 0.877±0.126PO4-P (R2 = 0.689, p < 0.05), respectively. The increase in dry weight of U. lactuca (Wdry) had a relationship with combined pressures, Wdry = 0.011±0.029 - 0.036±0.014PO4-P (R2 = 0.243, p < 0.05), i.e., the algal growth was inhibited by increasing PO4-P concentration. The SOD (Superoxide dismutase) activity (ASOD) was stimulated by OTC, as ASOD = 127.868±8.741+9.587±4.179 OTC (R2 = 0.193, p < 0.05). The contents of Chl a and b (Ca and Cb) were negatively affected by OTC or PO4-P with high concentration, as Ca = 0.566±0.042 - 0.024±0.022 OTC × PO4-P (R2 = 0.179, p < 0.05) and Cb = 0.512±0.043-0.044±0.020PO4-P (R2 = 0.180, p < 0.05). Thus, too high concentrations of PO4-P or OTC may hinder the formation and maintenance of Ulva sp. green tides.

Assessment of Reader Technologies for Over-the-Counter Diagnostic Testing

Background: Over-the-counter (OTC) diagnostic testing is on the rise with many in vitro diagnostic tests being lateral flow assays (LFAs). A growing number of these are adopting reader technologies, which provides an alternative to visual readouts for results interpretation, allowing for improved accessibility of OTC diagnostics. As the reader technology market develops, there are many technologies entering the market, but no clear, single solution has yet been identified. The purpose of this research is to identify and discuss important parameters for the assessment of LFA reader technologies for consideration by manufacturers or researchers. Methods: As part of The National Institute of Biomedical Imaging and Bioengineering's Rapid Acceleration of Diagnostics (RADx) Tech program, reader manufacturers were interviewed to investigate the current state of reader technology development through several parameters identified as important industry standards. Readers were categorized by technology type and parameters including cost, detection method, multiplex capabilities, assay type, maturity, and use case were all assessed. Results: Fifteen reader manufacturers were identified and interviewed, and information on a total of 19 technologies was assessed. Reader technology type was found to be predictive of other attributes, whether the reader is smart technology only, a standalone reader, a reader with smart technology required, or a reader with smart technology optional. Conclusions: Pairing reader technology with OTC diagnostic tests is important for improving existing COVID-19 tests and can be utilized in other diagnostics as the OTC use case grows in popularity. Reader technology type, which is predictive of core reader attributes, should be considered when selecting a reader technology for a specific LFA test within the context of regulatory guidance. As diagnostics increase in complexity, readers provide solutions to accessibility challenges, facilitate public health reporting, and ease the transition to multiplex testing, therefore increasing market availability.

Hemorrhagic stroke caused by xylometazoline poisoning

An increase in the use of over-the-counter medications has been observed in recent years. This also concerns xylometazoline, approved for the treatment of allergic rhinitis or upper respiratory tract infections. We present the fatal case of a 40 year-old-woman with a massive hemorrhagic stroke. Initial toxicology tests of biological material collected during autopsy revealed the presence of xylometazoline. No other significant toxicology findings were noted. LC-MS/MS method has been developed to determine xylometazoline concentration, which was 18.6 ng/mL in blood and 498.9 ng/mL in urine. The macroscopically detected hemorrhagic focus was confirmed by histopathological which confirmed hemorrhagic infarcts in the brain tissue, especially in the subarachnoid area. No other pathological changes were found. Based on findings from autopsy and toxicological analyses, the direct cause of death was concluded to be hemorrhagic stroke resulting from xylometazoline intoxication. Although xylometazoline products are regarded as relatively safe and are available over the counter, the risk of adverse effects, in particular stroke leading to death, should be considered. If adverse effects are observed, it is reasonable to measure the concentration of the drug in blood and urine. With such data, it will be possible to assess the actual exposure to this xenobiotic and draw firmer conclusions.

Attitudes of women and pharmacists on the opportunity to obtain a progestogen-only pill over the counter - Italian outcomes

PURPOSE

Scrutinizing, among potential providers and users, the perceived claim and interest for over the counter (OTC) accessibility of a progestogen-only pill (POP).

METHODS

Cross-sectional, descriptive study based on an online survey of 1000 women and 100 pharmacists in Italy, part of a larger sample including Germany and Spain.

RESULTS

Hormonal contraceptive methods are used by 35%; 5% of women reported currently not using contraception, 40% using a barrier method, and 20% a method considered less effective than male condoms (including 16% withdrawal and 4% natural methods and fertility/contraceptive applications). Almost 80% of women felt knowledgeable about the different contraceptive method, but about 1/3 had experienced difficulty accessing their oral contraceptive (OC) in the past two years. Women reacted positively to the proposition of an OTC-POP and 85% agreed that they would discuss the decision to buy it with their doctor; 75% reported they would continue to see their doctor for other reproductive health issues, including screening. The most frequent barrier is cost (reported by 25-33% of women) followed by long waiting times for doctor appointments and lack of personal time to schedule an appointment.Pharmacists (66%) would be likely/fairly likely to recommend the POP after appropriate training, agreeing that the benefits of an OTC-POP included improved access for women, saving them time and giving them more independence.

CONCLUSIONS

Potential users of contraception in Italy have a positive attitude toward OTC-POP, with doctors continuing to have a relevant role. Following training, pharmacists are also positive.

Stable photodegradation of antibiotics by the functionalized 3D-Bi2MoO6@MoO3/PU composite sponge: High efficiency pathways, optical properties and Z-scheme heterojunction mechanism

The designation and fabrication of heterogeneous photocatalyst with superior redox capability is an important technique for emerging pollutants treatment. In this study, we designed the Z-scheme heterojunction of stable 3D-Bi₂MoO₆@MoO₃/PU, which could not only accelerate the migration and separation in photogenerated carriers, but also stabilize the separation rate of photo-generation carriers. In the Bi₂MoO₆@MoO₃/PU photocatalytic system, 88.89% of oxytetracycline (OTC, 10 mg L^-1) and 78.25%-84.59% of multiple antibiotics (SDZ, NOR, AMX and CFX, 10 mg L^-1) could be decomposed within 20 min under the optimized reaction condition, revealing the superior performance and potential application value. Specifically, the morphology, chemical structure and optical properties detection of Bi₂MoO₆@MoO₃/PU greatly affected the direct Z-scheme electron transferring mode in the p-n type heterojunction. Besides, the ·OH, h⁺, ·O₂^- dominated the photoactivation process through ring-opening, dihydroxylation, deamination, decarbonization and demethylation in OTC decomposition. Expectantly, the stability and universality of Bi₂MoO₆@MoO₃/PU composite photocatalyst would further broaden the practical application and demonstrated that the potential of photocatalytic technique in antibiotics pollutants for wastewater remediation.

The remarkable journey of one female individual with ornithine transcarbamylase deficiency diagnosed post-mortem

Urea cycle disorders (UCDs) comprise a group of inborn errors of metabolism with impaired ammonia clearance and an incidence of ~1:35 000 individuals. First described in the 1970s, the diagnosis and management of these disorders has evolved dramatically. We report on a 59-year-old woman with a UCD who contributed to advances in the understanding and treatment of this group of disorders. This individual was diagnosed with carbamoyl phosphate synthetase 1 deficiency based on a biochemical assay under a research context predating genetic sequencing, treated longitudinally as having this metabolic disorder, and was among the first participants to trial UCD pharmaceutical therapies. She ultimately succumbed to a SARS-CoV-2 infection while maintaining unexpectedly normal ammonium levels. Postmortem genetic testing revealed ornithine transcarbamylase deficiency. This individual's contributions to the field of UCDs is discussed herein.

Enhanced activity of Fe/Mn nanoparticles using a response surface methodology and mechanism for removing oxytetracycline and copper ion

As feed additives, oxytetracycline (OTC) and copper ion (Cu(II)) are often detected in livestock and poultry farming wastewater. To address this issue, firstly, the synthesis conditions of Fe/Mn nanoparticles (Fe/Mn NPs) were initially optimized using a response surface methodology (RSM) to yield highly active Fe/Mn NPs, where the application of RSM significantly increased the Fe/Mn NPs' efficiency in removing co-contamination OTC and Cu(II),respectively, from 45.8 to 86.2% and 14.9-67.2%. Secondly, scanning electron microscope and Nitrogen adsorption-desorption isotherms results showed that Fe/Mn NPs were composed of elliptic particles between 20 and 40 nm, a specific surface area of 59.5 m² g^-1, and a mean pore diameter of 5.27 nm. Fourier infrared spectrometer and X-ray photoelectron spectroscopy analysis revealed that amino, carboxyl and hydroxyl functional groups existed on the surface. Zeta potential indicated that Fe/Mn NPs maintained a high negative charge density between pH 1 and 11. These surface properties possessed by the green synthesized Fe/Mn NPs resulted in high adsorption efficiency for co-contamination OTC and Cu(II). Based on this, a removal mechanism based on a combination of complex-bridging effect, pore-filling, hydrogen bonding, surface complexation, ion exchange and electrostatic attraction was proposed. Finally, the assessment of Fe/Mn NPs used in swine wastewater demonstrated that both 99.9% OTC and 55.6% Cu(II) were removed.

Sensitive fluorescent detection and micromechanism of Mn-doped CuS probe for oxytetracycline hydrochloride

The novel CuMnS nanoflower fluorescent probe based on Mn-doped CuS was developed to achieve the fluorescence detection of oxytetracycline hydrochloride (OTC), the fluorescent sensor has good selectivity and stability. The doping of Mn significantly increased the fluorescence intensity of CuS, which was above 10 times that of CuS. When the predominant species of OTC molecule was zwitterionic OTC^+/-at the solution pH of about 5.00, the fluorescence quenching efficiency of CuMnS by OTC reached the highest. Through fluorescence lifetime and UV absorption, the sensing mechanism between CuMnS and OTC was found to be static quenching. Moreover, Multiwfn wavefunction analysis program based on density function theory (DFT) calculation was applied to compare the interactions between different OTC species and CuMnS at different pH, to reveal the micromechanism of fluorescence quenching of CuMnS by OTC from the views of atoms. The molecular surface quantitative analysis and basin analysis of different OTC species demonstrated that the N atom and O atoms of tricarbonylamide moiety of zwitterionic OTC^+/- can provide lone pair electrons to form a non-fluorescent ground state complex with CuMnS. Meanwhile, the electrostatic attraction of OTC^+/- with negatively charged CuMnS was also beneficial to the interaction, resulting in the effective fluorescence quenching of CuMnS. This work offers a convenient method for sensitively detecting OTC and broadens the application of CuMnS in the field of fluorescence detection.

Knowledge and Use of Over-the-counter Drugs in Italy: An Exploratory Survey-based Study in the General Population

BACKGROUND

During the past decade, the misuse of over-the-counter (OTC) medicines has become a global public health concern, especially among young people. In this study, we aimed to explore the OTC consumption and related misuse in Italy and identify the demographic characteristics of people/individuals involved in this phenomenon, understanding eventual risk factors.

METHODS

The study consisted of an anonymous online survey distributed by direct contact and via the Internet between June-November 2021 to the general population living in Italy. Descriptive statistics were reported, and binary regression analyses were performed to identify risk factors for lifetime misuse of OTC. The University of Hertfordshire approved the study (aLMS/SF/UH/02951).

RESULTS

The final sample size was composed of 717 respondents. The sample was mainly represented by female (69.3%) students (39.9%) in the 20-25 years age group (30.0%). Based on the survey responses, study participants were divided into two groups according to the presence/absence of OTC abuse/misuse (127 versus 590), which were compared for possible predictors of OTC diversion. Multivariate regression showed that OTC abuse/misuse was associated with the knowledge of the effects of OTC [odds ratio/OR = 2.711, 95%Confidence Interval/CI 1.794-4.097, p <0.001]. On the contrary, the educational level appeared to be a protective factor [OR = 0.695, 95%CI 0.58-0.94, p = 0.016].

CONCLUSION

Although, according to our data, the phenomenon of OTC abuse appeared to be limited, increasing attention is needed because of possible underestimation and high-risk outcomes. Preventive strategies, including simplified access to information, may play a key role in limiting OTC misuse.

Pain management recommendations during the progression of SARS-CoV-2 infection

COVID-19, an infection caused by SARS-CoV-2, had a devastating impact on people's lives. The pandemic placed a heavy burden on healthcare systems and impacted the care of patients, including those with pain. This narrative review aims to highlight the challenges in managing pain and fever resulting from COVID-19 and pre-existing conditions, and to discuss the role of over the counter analgesics as a key part of the COVID-19 treatment regimen. As most patients with COVID-19 are being managed in the outpatient setting, lifestyle interventions and over the counter analgesics are readily available options to effectively treat pain and fever, which can help to decrease the burden on the healthcare system during the COVID-19 pandemic.

Electrochemical-enhanced Fe3O4/biochar activates peroxymonosulfate (E/nano-Fe3O4/BC/PMS) for degradation of oxytetracycline

To find cost-effective and environmentally friendly free radical activators to stimulate peroxymonosulfate (PMS) oxidative degradation of organic pollutants, nano-Fe₃O₄/biochar (BC) composites were prepared and characterized in this work to examine their effectiveness in stimulating PMS oxidative degradation of Oxytetracycline (OTC) in water enhanced with electrochemical degradation. When the mass ratio of nano-Fe₃O₄ to BC is 1:1, the catalyst nano-Fe₃O₄/BC exhibits the most obvious degradation effect on OTC. After 4 h of degradation, the OTC concentrations were reduced from 20 to 2.65 mg L^-1, while treated with a single nano-Fe₃O₄ and a single BC are reduced by only 67.7% and 61.8%. Anions HCO₃^- and H₂PO₄^- significantly inhibit OTC degradation, and HCO₃^- has a stronger inhibitory effect than H₂PO₄^-, while Cl^- and NO₃^- can promote OTC degradation. Quenching test and electron spin paramagnetic resonance (EPR) detection showed that singlet oxygen (¹O₂) was the main active species in the degradation process, followed by hydroxyl radical (·OH). When reused for the third time, the removal rate of OTC by nano-Fe₃O₄/BC composites with mass ratios of 1:4, 1:2 and 1:1 was still more than 70%. Therefore, the nano-Fe₃O₄/BC composite is a promising PMS activator, which can realize the rapid oxidative degradation of OTC.

Factors Contributing to Self-Medication and Consumption of Non-Prescribed Drugs in Portugal

Objectives: This work sets out to find the relationship between taking non-prescribed drugs and predisposing, enabling and need factors. Specifically, our main aim is to find the relationship between taking non-prescribed drugs and the lack of health care. Methods: We used data from the last 2019 National Health Survey and estimate logistic regressions for the whole sample and stratified by sex. Results: The most striking finding is that people self-medicating with non-prescribed drugs seem to be replacing health care when this is not used because of financial constraints or distance from provider. This suggests that non-prescribed drugs are a fast, affordable, alternative to health care. Other findings show that income and the financial resources to cope with unexpected expenditure are considerations in taking these drugs. Health and needs are other factors triggering their consumption. Conclusion: Policy measures need to be aimed at improving access to medical care, providing responses to health needs such as those arising from chronic pain, and improving health literacy.

Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study

BACKGROUND

Self-medication has become a common phenomenon. Economic factors are important factors that affect the self-medication of residents. This study aimed to investigate the current status of self-medication behaviors in China and explored the related factors affecting considerations associated with medical insurance reimbursement or drug price in self-medication.

METHODS

A national cross-sectional investigation was conducted among Chinese people over 18 years old under a multi-stage sampling method through a questionnaire, which includes demographic sociological characteristics, self-medication behaviors and scales. The Chi-square test was used to analyze whether the respondents consider medical insurance reimbursement or drug price as an important factor when purchasing over-the-counter (OTC) drugs. Logistic regression was used to examine the associated factors of considering medical insurance reimbursement or drug price.

RESULTS

In total, 9256 respondents were included in this study; 37.52% of the respondents regarded drug prices as an important consideration, and 28.53% of the respondents attached great importance to medical insurance reimbursement. Elderly respondents who lived in the central region, had medical insurance, and had lower levels of health literacy were more likely to consider the medical insurance reimbursement, while respondents with high monthly family income as well as students were less likely to consider the same issue (p < 0.05). Respondents settled in the central and western regions, students, those without fixed occupations, those who suffered from chronic diseases, or those with lower health literacy were more likely to consider drug prices, while the respondents with bachelor degrees, urban population and high per capita monthly income were less likely to consider the drug prices (p < 0.05).

CONCLUSION

Self-medication behaviors with OTC drugs were prevalent in China, and consideration factors of medical insurance reimbursement or drug prices were related to socio-demographic characteristics and health literacy. There is a need to take measures to reduce the economic burden of self-medication, improve the health literacy of residents and strengthen public health education.

The views of women and pharmacists on the desirability of a progestogen-only pill over the counter. Results of a survey in Germany, Italy and Spain

PURPOSE

To explore the perceived need and enthusiasm for over the counter (OTC) progestogen-only pills (POP).

MATERIALS AND METHODS

A web-based survey of 1000 sexually active women (16-45) and 100 pharmacists in Germany, Italy and Spain.

RESULTS

Despite not wanting to conceive, 5-6% of women in each country were not using contraception and 8-20% were using methods less effective than condoms. At least 74% of respondents felt knowledgeable about the different contraceptives available but at least 1/3 had experienced difficulty accessing oral contraceptive (OCs) in the past two years. The cost of contraceptives, the need to see a doctor and long waits for appointments were cited as barriers for not using OCs. The majority agreed they would discuss with their doctor the decision to buy the POP, consult about side effects and other reproductive health issues. Over 2/3 of pharmacists in each country would be very, or fairly, likely to recommend the POP, agreeing that the benefits included improved access for women, and offered them more independence.

CONCLUSIONS

Asked directly, women in Germany, Spain and Italy currently using contraception are positive about a POP OTC. Pharmacists are also positive, with the overwhelming majority in favour of providing POPs.

The Different Patterns of Over-the-Counter Nonsteroidal Anti-Inflammatory Drugs or Analgesics Use in Patients with Chronic Kidney Disease and the General Population

Nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics are the most commonly used drugs worldwide and their availability over-the-counter is increasing. The aim of this study was to examine the frequency of their use as well as the awareness of the associated risk of side effects in patients with chronic kidney disease (CKD) compared to the patients at general practice (GP) offices. We found that 88.5% of the CKD and 97.1% of the GP group used NSAIDs and/or analgesics (p < 0.0001). Paracetamol was chosen the most often by both study groups, but the proportion of patients taking paracetamol was significantly higher in the CKD group (p < 0.006). On the contrary, the proportion of patients taking ibuprofen was significantly higher in GP group (p < 0.0001). Furthermore, almost 37% of CKD and 60% of GP patients never consult with their doctor before taking NSAIDs or analgesics. The influence of advertisements on the decision to take these drugs was found to be marginal in both groups. In conclusion, the NSAIDs and/or analgesics use is very common. The differences between the studied cohorts in self-decision making and the type of drugs used between the studied cohorts warrant tailored educational approaches.

Maize Intercropping in the Traditional "Milpa" System. Physiological, Morphological, and Agronomical Parameters under Induced Warming: Evidence of related Effect of Climate Change in San Luis Potosí (Mexico)

Warmer temperatures predicted as a result of climate change will have an impact on milpa. An experiment was carried out with induced passive heat with the objective of simulating the increase in temperature on the physiological, morphological, and yield parameters of milpa from different climates of San Luis Potosí, Mexico. Two different environments, Open-top chambers (OTC) and control, and three milpas, from warm–dry, temperate, and hot and humid climates, were studied. A total of 12 experimental units of 13.13 m² were used in the random design, with a factorial arrangement of 2 × 3 and two replications. Abiotic variables (minimum, maximum, and mean daily temperatures and accumulated heat units) were determined and compared between the two environments and confirmed that the OTC increased the abiotic variables. The growth and development parameters increased under the warming effect. Furthermore, the milpa from hot and humid climate was the least affected. In contrast, the warming considerably delayed yield parameters. The squash suffered the most, while the bean benefited the most. The warming affected the chlorophyll fluorescence and gas exchange differently for each crop. However, at an early stage, the maximum photochemical efficiency (Fv/Fm) and non-photochemical quenching (qN) for bean and maize were reduced, while at a late stage, they were Fv/Fm, photochemical quenching (qP), and qN for maize; stomatal conductance and transpiration rate of the squash were improved under the warming treatments. In conclusion, the warming delayed the yield and photosynthetic parameters, while growth and development benefited. The milpa systems were differently affected by warming.

Peroxymonosulfate activation by Co-doped magnetic Mn3O4 for degradation of oxytetracycline in water

Co-doped magnetic Mn₃O₄ was synthesized by the solvothermal method and adopted as an effective catalyst for the degradation of oxytetracycline (OTC) in water. Synergistic interactions between Co-Mn₃O₄ and Fe₃O₄ not only resulted in the enhanced catalytic activity through the activation of peroxymonosulfate (PMS) to degrade OTC but also made Fe₃O₄/Co-Mn₃O₄ easy to be separated and recovered from aqueous solution. 94.2% of OTC could be degraded within 60 min at an initial OTC concentration of 10 mg L^-1, catalyst dosage of 0.2 g L^-1, and PMS concentration of 10 mM. The high efficiency of OTC removal was achieved in a wider pH range of 3.0-10.0. Co (II), Co (III), Fe (II), Fe (III), Mn (II), Mn (III), and Mn (IV) on Fe₃O₄/Co-Mn₃O₄ were identified as catalytic sites based on XPS analysis. The free radical quenching experiments showed that O₂^•- radicals and ¹O₂ played the main role in the degradation process and the catalytic degradation of OTC involved both free radical and non-free radical reactions. Eventually, the intermediates of OTC degradation were examined, and the possible decomposition pathways were proposed. The excellent catalytic performances of Fe₃O₄/Co-Mn₃O₄ came from the fact that the large specific surface area could provide abundant active sites for the activation of PMS and the redistribution of inter-atomic charges accelerated the redox reactions of metal ions. The high degradation efficiency and rate constant of OTC in actual water samples indicated that Fe₃O₄/Co-Mn₃O₄ had a good practical application potential.

Optical tissue clearing associated with 3D imaging: application in preclinical and clinical studies

Understanding the inner morphology of intact tissues is one of the most competitive challenges in modern biology. Since the beginning of the twentieth century, optical tissue clearing (OTC) has provided solutions for volumetric imaging, allowing the microscopic visualization of thick sections of tissue, organoids, up to whole organs and organisms (for example, mouse or rat). Recently, tissue clearing has also been introduced in clinical settings to achieve a more accurate diagnosis with the support of 3D imaging. This review aims to give an overview of the most recent developments in OTC and 3D imaging and to illustrate their role in the field of medical diagnosis, with a specific focus on clinical applications.

Attitudes and Beliefs of College Students towards Pain Management Modalities: Theory of Planned Behavior Approach

Background

Chronic pain exhibits a burdening onset and duration in young adults. It is critical to understand appropriate pain management decision-making.

Objective

To investigate the associations of attitudes and beliefs of college students with their intention and behavior toward pain management modalities using the Theory of Planned Behavior (TPB).

Methods

In this cross-sectional online survey study, we recruited college students (age≥18 years) at West Virginia University, Morgantown, West Virginia, United States. We examined four pain management modalities: Over-the-Counter (OTC) pain medications, prescription pain medications (R_X), mindfulness therapy, and yoga/exercise. Likert scales were used to assess TPB constructs (attitude, Subjective Norm [SN], Perceived Behavior Control [PBC], intention, and behavior). We analyzed the associations of the TPB constructs with both intention and behavior toward pain management modalities using multiple linear regression.

Results

Of the 364 returned surveys, 227 were completed and analyzed. Attitude was found to be significantly associated with the intention to use all pain management modalities, while PBC was significantly associated with the intentions to use R_X, mindfulness, and yoga/exercise (R_X: β = 0.38; 95%CI= 0.28, 0.84; p=<0.001, mindfulness: β=0.27; 95%CI=0.07, 0.76; p=0.019, and Yoga/exercise: β=0.35; 95%CI=0.25, 0.85; p=<0.001). Furthermore, the intention to use pain management modalities consistently predicted all behaviors (OTC: β=0.49; 95%CI=0.32, 0.76; p=<0.001, R_X: β=0.47; 95%CI=0.17, 0.58; p=<0.001, Mindfulness: β=0.62; 95%CI=0.40, 0.72; p=<0.001, Yoga/Exercise: β=0.59; 95%CI=0.42, 0.84; p=<0.001).

Conclusion

College students' attitude and PBC were the top predictors of intention to choose pain management modalities, and intention predicted behavior. Research with robust study design is needed to confirm our study findings.

Self-medication in Greece: the financial impact from expanding the OTC market

OBJECTIVES

To assess the financial impact of self-medication enhancement through a potential expansion of the over-the-counter (OTC) drug list in Greece.

METHODS

An analysis consisting of two scenarios was conducted. The first scenario estimated the financial effects of hypothetically switching 5% of the volume of the total sales of reimbursed drugs in Greece to OTC, while the second scenario estimated the effects of switching to OTC the total sales volume of a set of active substances (which are currently reimbursed), facilitated by a consensus panel meeting. The analysis was conducted from the third-party payer, individual and societal perspectives. Data and costs refer to the year 2019.

KEY FINDINGS

Switching 5% of the volume of the total sales of reimbursed drugs to OTC was estimated to lead to total annual savings of 227.57 million euros. The annual savings from the third-party payer, individual and societal perspectives were estimated at 97.06 million euros, 91.81 million euros and 38.69 million euros, respectively. Switching the total sales volume of the reimbursed drugs of the active substances which emerged from the consensus panel meeting was estimated to lead to total annual savings of 567.57 million euros. The annual savings for the third-party payer, individuals and society were estimated at 232.91 million euros, 241.01 million euros and 93.65 million euros, respectively.

CONCLUSIONS

Although the present analysis is model-based, and thus did not incorporate some potentially significant parameters, it demonstrated the financial savings which a potential expansion of the OTC drug list could produce for the third-party payer, individuals and society in Greece.

Low-Altitude Boundary of Abies faxoniana Is More Susceptible to Long-Term Open-Top Chamber Warming in the Eastern Tibetan Plateau

With global climate change, for evaluating warming effect on subalpine forest distribution, the substantial effects of long-term warming on tree growth and soil nutrients need to be explored. In this study, we focused on different responses in the boundaries of trees and soils to warming. Using the open-top chamber (OTC), a 10-year artificial warming experiment was conducted to evaluate the impacts of warming on Abies faxoniana at three different altitudes. We determined metabolites and nutrient concentrations in needles of A. faxoniana and characterized the soil chemistries. Many kinds of sugars, amino acids, and organic acids showed higher contents at high altitude (3,500 m) compared with low altitude (2,600 m), which could have been due to the temperature differences. Warming significantly decreased needle sugar and amino acid concentrations at high altitude but increased them at low altitude. These results indicated contrasting physiological and metabolic responses of A. faxoniana to long-term warming at different altitudes. Furthermore, we found that OTC warming significantly increased the concentrations of soil extractable sodium, aluminum (Al), and manganese (Mn), while decreased potassium (K) and phosphorus (P) concentrations and pH values at low altitude rather than at middle (3,000 m) or high altitude. The soil carbon and nitrogen contents were increased only at the middle altitude. In A. faxoniana at low altitudes, more mineral nutrients iron, K, and P were demand, and a mass of Al, Mn, and zinc was accumulated under warming. Soil P limitation and heavy metals accumulation are disadvantageous for trees at low altitudes with warming. Therefore, compared with high altitudes, A. faxoniana growing at low boundary in alpine regions is expected to be more susceptible to warming.

Sensitive Aptamer SERS and RRS Assays for Trace Oxytetracycline Based on the Catalytic Amplification of CuNCs

A new method for the determination of oxytetracycline (OTC) has been established by coupling the catalytic amplification reaction of copper nanoclusters (CuNCs) with the aptamer reaction. CuNCs prepared by a wet chemical method have the catalytic activity for the formation of gold nanoparticles (AuNPs) resulting from a HAuCl₄-ethanol (En) reaction. The experimental results showed that OTC aptamer (Apt) can be adsorbed on the surface of CuNCs in a non-specific way, thus inhibiting its catalytic activity. When OTC was added to the solution, the OTC-Apt complex was generated by a specific reaction, which made the CuNCs desorb and restore their catalytic activity. With the increase of OTC, the recovery of the catalytic activity of CuNCs is strengthened, the reaction speed is accelerated, and the number of AuNPs is increased. The generated AuNPs exhibited surface enhanced Raman scattering (SERS) signals at 1615 cm⁻¹ in the presence of Vitoria blue 4R (VB4R) molecular probes, and a resonance Rayleigh scattering (RRS) peak at 586 nm. There is a good linear relationship between the intensities of SERS, or RRS, and OTC concentration at the range of 37.5–300 ng/L or 37.5–225 ng/L, respectively. A new SERS and RRS assay for the determination of trace OTC based on the regulation of CuNCs catalysis was established.

Case report: two cases of mature oocytes found in prepubertal girls during ovarian tissue cryopreservation

Objective

To report two cases of mature oocytes found in prepubertal girls undergoing ovarian tissue cryopreservation (OTC).

Design

Case report.

Setting

Large tertiary care children’s hospital and a private fertility clinic.

Patient(s)

An 8-year-old prepubertal girl with β-thalassemia and a 2-year-old girl with sickle cell disease who both underwent OTC before bone marrow transplantations.

Intervention(s)

Laparoscopic right oophorectomy was performed in each patient. The ovarian cortical tissue was processed for slow freezing and long-term storage, and all oocytes were subsequently vitrified.

Main Outcome Measure(s)

Oocytes found at the time of OTC processing for fertility preservation.

Result(s)

After a complete right oophorectomy, one mature metaphase II oocyte was discovered on tissue processing for OTC in each patient. Neither patient has yet returned for use of tissue or oocytes.

Conclusion(s)

To our knowledge, this is the first report of mature oocytes found during prepubertal OTC processing. These findings may indicate the need for increased research regarding prepubertal oocyte development and suggest that the technique of examining the media for both mature and immature oocytes at the time of OTC should become more widespread and perhaps recommended in prepubertal patients to optimize fertility preservation methods.

Aspirin, paracetamol (acetaminophen) and caffeine for the treatment of acute migraine attacks: A systemic review and meta-analysis of randomized placebo-controlled trials

BACKGROUND AND PURPOSE

Many migraine patients rely on over-the-counter analgesics for the treatment of migraine attacks. Fixed-dose combinations of aspirin, paracetamol and caffeine (APC) have been used for treating migraine in many countries for a long time. We performed a meta-analysis for the comparison of APC versus placebo, which has not been done to date.

METHODS

Randomized, blinded, placebo-controlled, parallel-group studies using APC to treat a migraine attack were included in a meta-analysis. We calculated the rate ratio (RRs) associated with APC versus placebo.

RESULTS

Seven studies were included, with 3306 participants (2147 treated with APC and 1159 treated with placebo). For the primary efficacy outcome, being pain-free at 2 h, APC was superior to placebo (19.6% vs. 9.0%, RR 2.2, 95% confidence interval [CI] 1.4-3.3). For the co-primary efficacy outcome, pain relief at 2 h, APC was superior to placebo (54.3% vs. 31.2%, RR 1.7, 95% CI 1.6-1.9). Adverse events were more frequent in the APC than the placebo groups (10.9% vs. 7.8%, RR 1.7, 95% CI 1.3-2.2).

CONCLUSIONS

Results showed that APC is superior to placebo in the treatment of acute migraine attacks. Efficacy, measured by pain-free response and pain relief at 2 h, was clinically relevant.

A review of the effectiveness of a progestogen-only pill containing norgestrel 75 µg/day

OBJECTIVES

To review published data on the effectiveness of a progestogen-only pill containing norgestrel 75 µg/day which should be under consideration by the FDA in 2022 for sale over the counter in the US.

STUDY DESIGN

A literature search in MEDLINE, EMBASE, and COCHRANE REVIEWS using specified search terms and adding related cross-references.

RESULTS

We identified a total of thirteen relevant studies of women using norgestrel 75 µg/day. None were reported with the rigor characteristic of trial reporting today. Nevertheless, six studies provided data on 3,184 women who were not breastfeeding, followed for over of 35,000 months and reported a range of overall failure rates during typical use of norgestrel 75 µg/day from 0 to 2.4/hundred woman-years giving an aggregate Pearl Index of 2.2. Seven additional studies involved 5,445 women some of whom were breastfeeding for at least part of the period of follow-up. More than 36,000 months of use yielded 12-month life table cumulative pregnancy rates for norgestrel 75 µg/day ranging from 0 to 3.4. We were unable to calculate an aggregate Pearl Index for the breastfeeding studies because of lack of crucial data.

CONCLUSIONS

The data support that norgestrel 75 µg/day is highly effective in clinical use, with similar estimates of failure in breastfeeding and non-breastfeeding women, providing support to the case for approval without the need to see a healthcare provider.

Investigation of the effects of different beverages on the disintegration time of over-the-counter medications in Saudi Arabia

Full disintegration of Oral solid dosage forms is critically important to achieve reliable clinical performance of the drug. Tablets/capsules are supposed to be taken with a full glass of water; however, many patients do not follow this recommendation as they administer their medications with beverages other than water. This study aims to assess the impact of different commonly consumed beverages in Saudi Arabia on the disintegration times of common over-the-counter (OTC) medication tablets and capsules in the Kingdom of Saudi Arabia. Five immediate release OTC drugs were chosen: Fevadol®, Solpadeine®, Ralaxon®, Artiz ®, and Brufen®. The disintegration times of these medications were assessed using a disintegration test in five beverages: Coca-cola, arabic coffee, orange juice, buttermilk and an energy drink. Times were compared to the disintegration time in water under two temperature conditions (37 °C and 5 °C). All beverages significantly increased the disintegration times of fevadol, solpadeine, and relaxon in comparison with water. The same was found for burfen, except that arabic coffee did not significantly increase disintegration time (p > 0.05). The disintegration time of artiz tablets was also significantly influenced by all beverages, except for Coca-cola and the energy drink, which had no significant impact on the disintegration time. The tested beverages should not be used as substitutes for water when ingesting medications. Patients should be advised to avoid consuming beverages other than water with therapeutic products. Increasing public awareness of drug-beverage interactions is needed.

20-Week Study of Clinical Outcomes of Over-the-Counter COVID-19 Prophylaxis and Treatment

Objectives and Setting.

As the lethal COVID-19 pandemic enters its second year, the need for effective modalities of alleviation remains urgent. This includes modalities that can readily be used by the public to reduce disease spread and severity. Such preventive measures and early-stage treatments may temper the immediacy of demand for advanced anti-COVID measures (drugs, antibodies, vaccines) and help relieve strain also on other health system resources.

Design and Participants.

We present results of a clinical study with a multi-component OTC “core formulation” regimen used in a multiply exposed adult population. Analysis of clinical outcome data from our sample of over 100 subjects − comprised of roughly equal sized regimen-compliant (test) and non-compliant (control) groups meeting equivalent inclusion criteria − demonstrates a strong statistical significance in favor of use of the core formulations.

Results.

While both groups were moderate in size, the difference between them in outcomes over the 20-week study period was large and stark: Just under 4% of the compliant test group presented flu-like symptoms, but none of the test group was COVID-positive; whereas 20% of the non-compliant control group presented flu-like symptoms, three-quarters of whom (15% overall of the control group) were COVID-positive.

Conclusions.

Offering a low cost, readily implemented anti-viral approach, the study regimen may serve, at the least, as a stopgap modality and, perhaps, as a useful tool in combatting the pandemic.

Circadian oscillation expression of ornithine carbamoyltransferase and its significance in sleep disturbance

Ornithine transcarbamylases (OTC), a key enzyme in urea cycle, is an important marker for some liver injury or diseases. However, whether OTC could be a sensitive indicator for liver dysfunction under sleep disturbance condition remains unknown. The present study aimed to explore the circadian oscillation expression of OTC and its significance in disturbed sleep condition. Sleep disturbance was conducted by a sleep deprivation (SD) instrument. Our results found that SD for 72h induced abnormal increasing of OTC levels in serum and liver of rats. And, serum OTC concentration and liver OTC expression could return to normal levels after recovery sleep following SD. Moreover, hepatic OTC expression showed circadian oscillation in day and night, characterized with occurrence of a peak between ZT 22 and ZT 2, and a nadir between ZT 14 and ZT 18. Further analysis suggested the existence of ROR response element (RORE) for potential RORɑ binding sites in OTC promoter region, and elevated RORɑ expression in rat livers under sleep disturbance condition. Additionally, oscillation expression of OTC induced by serum shock in HepG2 cells was characterized with a peak occurred between ZT 12 and ZT 16, and RORɑ knockdown at ZT 16 significantly lowered OTC expression. The results together indicate that OTC is closely correlated with circadian clock, and could be a sensitive indicator for sleep disturbance stress.

The Use of Over-The-Counter (OTC) Medications by University Students During Examinations in Saudi Arabia: A Cross-Sectional Study

Purpose

During examinations, many students use various over-the-counter (OTC) drugs to improve their concentration or treat exam-related medical symptoms. The purpose of this study was to scrutinize the use of OTC drugs during examinations in Saudi Arabia.

Materials and Methods

A cross-sectional study was designed, consisting of online, self-administered questionnaires comprising 27 items, including the awareness, knowledge, and attitude of students toward OTC drug use during examinations. A logistic regression model was fitted to determine factors that predict OTC drug use. The data were analyzed using Statistical Package for Social Science (SPSS).

Results

A total of 463 (92.6%) completed questionnaires were received from 500 recruited participants. Among participants, 58.5% were women, 47.9% were 22 years or older and completing their final year of study, and 44.1% of students preferred not to disclose their monthly income. The most common cause (35.6%) for OTC drug use during the examination period was headache, followed by pain (21%), fever (16.6%), and cough (8.2%). The most commonly used medication were painkillers, antipyretics, cough and cold medications, and vitamins (57.2%, 16.4%, 11%, and 7.3%, respectively). Male students showed a significant lack of awareness and knowledge regarding the safety and reasons for OTC drug use compared with their female counterparts and were less likely to read the medication leaflet before use (p < 0.001, odds ratio [OR]: 0.36, confidence interval [CI]: 0.23-0.57) and did not know which drugs require prescriptions (p < 0.001, OR: 0.41, CI: 0.27-0.63). Other significant factors that predicted OTC drug use included age, university level, and drug income.

Conclusion

The most common reported cause for OTC drug use during examinations among students was headache. Sex, age, university level, and monthly income were significant factors affecting OTC drug use during examinations.

Adsorption behaviors of the pristine and aged thermoplastic polyurethane microplastics in Cu(II)-OTC coexisting system

In this work, the hypothesis that thermoplastic polyurethane (TPU) microplastics (MPs) could form complex toxic pollution by absorbing both antibiotics and heavy metals simultaneously was proposed. The unique features of the adsorption of Cu(II) and oxytetracycline (OTC) on the pristine TPU and photo-aged (aged) TPU MPs in single and coexisting system were investigated, which included the kinetics, isothermal equilibrium and thermodynamics. The possibly synergistic or competitive effects between Cu(II) and OTC were also evaluated. The results showed that the adsorption process of Cu(II) and OTC could be described well by pseudo-second-order kinetic equation. The entire process could be divided into two stages: internal diffusion and external diffusion. The Sips model could give good fitting for the isothermal adsorption equilibrium. The thermodynamic parameters depicted the endothermic nature of adsorptions and the process was spontaneous. In the coexisting system, synergistic or competitive effects depended critically on the ratio of concentrations (Cu(II) vs OTC). When the ratio was 1:1, Cu(II) significantly enhanced the adsorption of OTC, while OTC showed a weak effect on Cu(II) adsorption. The synergies could be attributed to the formation of Cu(II)-OTC complex and the bridging effect of Cu(II). Overall, the adsorption capacity of aged TPU was higher than that of pristine TPU, which was due to the differences in morphological characteristics and functional groups. FTIR studies revealed that ester carbonyl and acylamino groups in the TPU may be involved in the adsorption of Cu(II) and OTC.

Metformin Inhibits the Urea Cycle and Reduces Putrescine Generation in Colorectal Cancer Cell Lines

The urea cycle (UC) removes the excess nitrogen and ammonia generated by nitrogen-containing compound composites or protein breakdown in the human body. Research has shown that changes in UC enzymes are not only related to tumorigenesis and tumor development but also associated with poor survival in hepatocellular, breast, and colorectal cancers (CRC), etc. Cytoplasmic ornithine, the intermediate product of the urea cycle, is a specific substrate for ornithine decarboxylase (ODC, also known as ODC1) for the production of putrescine and is required for tumor growth. Polyamines (spermidine, spermine, and their precursor putrescine) play central roles in more than half of the steps of colorectal tumorigenesis. Given the close connection between polyamines and cancer, the regulation of polyamine metabolic pathways has attracted attention regarding the mechanisms of action of chemical drugs used to prevent CRC, as the drug most widely used for treating type 2 diabetes (T2D), metformin (Met) exhibits antitumor activity against a variety of cancer cells, with a vaguely defined mechanism. In addition, the influence of metformin on the UC and putrescine generation in colorectal cancer has remained unclear. In our study, we investigated the effect of metformin on the UC and putrescine generation of CRC in vivo and in vitro and elucidated the underlying mechanisms. In nude mice bearing HCT116 tumor xenografts, the administration of metformin inhibited tumor growth without affecting body weight. In addition, metformin treatment increased the expression of monophosphate (AMP)-activated protein kinase (AMPK) and p53 in both HCT116 xenografts and colorectal cancer cell lines and decreased the expression of the urea cycle enzymes, including carbamoyl phosphate synthase 1 (CPS1), arginase 1 (ARG1), ornithine trans-carbamylase (OTC), and ODC. The putrescine levels in both HCT116 xenografts and HCT116 cells decreased after metformin treatment. These results demonstrate that metformin inhibited CRC cell proliferation via activating AMPK/p53 and that there was an association between metformin, urea cycle inhibition and a reduction in putrescine generation.

Development of Europium-Sensitized Fluorescence-Based Method for Sensitive Detection of Oxytetracycline in Citrus Tissues

Antimicrobial compounds have been successfully used to control many plant and animal diseases. Recently, oxytetracycline (OTC) and streptomycin have been approved for the treatment of Huanglongbing in citrus. Since the application of OTC is under strict regulations, several methods have been developed to determine and monitor its levels in the environment including high-performance liquid chromatography, ELISA, colorimetric, and fluorometric assays. In this study, we developed a fluorometric method for the determination of OTC in plant tissues based on its complexation with europium. Our preliminary trials showed that phenols and flavonoids interfere with the europium assay by reacting with the sensitizing reagent, cetyltrimethylammonium chloride. Consequently, we used the 60 mg hydrophilic–lipophilic balanced (HLB) cartridges to purify the OTC from the plant matrix. The recovery of OTC from spiked leaf samples was 75 ± 7.6%. Using the 500 mg HLB, we were able to detect 0.3 ppm OTC in the final sample extract, which corresponds to 3 µg g⁻¹ fresh weight (FWT). The developed method was successfully used to measure the level of OTC in leaves obtained from trunk-injected trees. The results obtained by the europium method were similar to those obtained using the ELISA assay. We also tested the cross-reactivity of OTC metabolites with the europium method. The 4-epi-OTC showed a high cross-reactivity (50.0 ± 3.6%) with europium assay, whereas α-apo-OTC and β-apo-OTC showed small cross-reactivity. We showed that the europium-sensitized fluorescence-based method can be successfully used to assess OTC in citrus plant tissues after a cleanup step. Our results showed that this method was sensitive, reproducible, and can be used to analyze many samples simultaneously.

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused. Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine. Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261). Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM (n = 54) and diphenhydramine (n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported. Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented.

Prescription and Non-Prescription Drug Classification Systems Across Countries: Lessons Learned for Thailand

Purpose

The drug classification system, as prescription or non-prescription drug category, has been utilized as a regulatory strategy to ensure patient safety. In Thailand, the same system has been used for decades, though the drug classification criteria were updated to accommodate drug re-classification in 2016. These new criteria, however, have not been applied retroactively. Inconsistency in drug classification has been observed leading to concerns regarding the drug classification system. This has prompted the need for a review of the drug classification system in Thailand. This study aims to explore Thailand and other selected countries’ regulatory management regarding the drug classification system, drug classification criteria, and drug classification itself.

Methods

The drug classification systems of the United States, the United Kingdom, Japan, Singapore, Malaysia, the Philippines, and Canada were selected to study alongside Thailand’s system. The regulatory review was conducted through each country’s drug regulatory agency website and available published research. Complementary interviews with drug regulatory authorities were conducted when written documentation was unclear and had limited access. Fifty-two common drugs were selected to compare their actual classifications across the different countries.

Results

All selected countries classified drugs into two major groups: prescription drugs and non-prescription drugs. The studied countries further sub-classified non-prescription drugs into 1–4 categories. Principles of drug classification criteria among countries are similar; they comprised of three themes: disease characteristics, drug safety profile, and other drug characteristics. Actual drug classification of antibiotics, dyslipidemia treatments, and hypertension treatments in Thailand are notedly different from other countries. Furthermore, 77.4% of drugs studied in Thailand fall into the behind-the-counter (dangerous) drug category, which varied from antihistamines to antibiotics, dyslipidemia treatments, and vaccines.

Conclusion

Thailand’s drug classification criteria are comparable with other nations; however, there is a need to review drug classification statuses as many drugs have been classified into improper drug categories.

Clinical and molecular characteristics of 69 Chinese patients with ornithine transcarbamylase deficiency

Background

This study aimed to describe the clinical and biochemical features of Chinese patients with ornithine transcarbamylase deficiency (OTCD), and to investigate the mutation spectrum of OTC gene and their potential correlation with phenotype.

Methods

Sixty-nine patients with OTCD were enrolled between 2004 and 2019. Clinical and laboratory data were reviewed retrospectively from medical records.

Results

Fifteen cases (13 males, 2 females) presented with early onset; 53 cases (21 males, 32 females) had late onset, and one female was asymptomatic. The median onset age was 1.5 years (range 1 day–56 years). Urine orotic acid levels were increased in all patients tested, while only 47.6% of patients showed decreased serum levels of citrulline. The peak plasma ammonia levels were higher in early-onset patients than in late-onset patients (P < 0.01). Fifty-four different mutations of OTC gene were identified and 18 of them were novel. R277W (10.6%) was the most common mutation, followed by G195R (4.6%) and A209V (3.0%). By June 2019, 41 patients had survived, 24 were deceased, and 4 were lost to follow-up. Among the survivors, 13 patients had received liver transplantation at a median age of 3 years, with a one-year survival rate of 100%. The mortality of OTCD is extremely high among patients with early onset (80.0% versus 24.5% in patients with late onset).

Conclusions

The evaluation of serum citrulline level is of limited value in diagnosis of OTCD, while urine orotic acid detection and genetic testing are more helpful.

"The unfair drive to be fair": Psychosocial aspects and implications of the use of skin lightening agents

The quest to be fair is not a concept of the new world. For centuries untold, having a lighter skin tone has been considered as a trait of beauty and supremacy. Society implicates fairness as a factor for getting a prospective life partner. Media portrays fair skin tone as a predecessor for success. These subtle influences affect young minds and drive them towards wanting fair skin. Physicians observe that it is one of the most common forms of body dysmorphic disorder. This article aims to highlight the psychosocial factors that mold this mentality and the possible ill effects it can have on a person, both psychologically as well as physically.

[Effects of high CO2 concentration, drought, and their interaction on different stay-green wheat seedlings]

In this study, a pot experiment was carried out to examine the effects of high CO₂ concentration, drought and interaction on seedling growth traits, biomass accumulation and physiological characteristics of different stay-green wheat seedlings, with a stay-green wheat variety Yannong 19 and a non stay-green wheat variety Hanxuan 3 as test materials. There were four treatments in the Open Top Chamber with factorial of CO₂ concentration (370 μmol·mol^-1 vs 550 μmol·mol^-1) and drought (45%-55% vs. 75%-85% of field water-holding capacity). Drought significantly inhibited the growth and development of wheat seedlings, while CO₂ concentration significantly increased the number of tillers and promoted the growth and development of wheat seedlings. Under drought condition, high CO₂ concentration increased the number of tillers of Hanxuan 3 and Yannong 19 by 61.0% and 42.3%, respectively. Under both water conditions, high CO₂ concentration significantly increased the biomass of wheat seedlings, and decreased the content of peroxidase and proline in leaves. Under drought condition, high CO₂ concentration showed stronger "fertilizer effect". Furthermore, different varieties had different responses to high CO₂ concentration, with higher sensitivity of Hanxuan 3 to enhancement of CO₂ concentration. Under the scenario of increasing CO₂ concentration, the amount of irrigation water applied to a field can be appropriately reduced for efficient use of water resources. Meanwhile, it is necessary to pay attention to the selection of suitable wheat varieties.

Resistance of anammox granular sludge to copper nanoparticles and oxytetracycline and restoration of performance

Nanoparticles and antibiotics, the two most frequently detected emerging pollutants from different wastewater sources, are eventually discharged into wastewater treatment plants. In this study, the widely used materials CuNPs and oxytetracycline (OTC) were selected as target pollutants to investigate their joint effects on anaerobic ammonium oxidation (anammox). The results indicated that the environmental concentration slightly inhibited the performance of the reactors, while the performance rapidly deteriorated within a week under high-level combined shocks (5.0 mg L^-1 CuNPs and 2.0 mg L^-1 OTC). After the second shock (2.5 mg L^-1 CuNPs and 2.0 mg L^-1 OTC), the resistance of anammox bacteria was enhanced, with an elevated relative abundance of Candidatus Kuenenia and absolute abundance of hzsA, nirS, and hdh. Moreover, the extracellular polymeric substance (EPS) content and specific anammox activity (SAA) showed corresponding changes. Improved sludge resistance was observed with increasing CuNP and OTC doses, which accelerated the recovery of performance.

NSAIDs and self-medication: A serious concern

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used by the patients frequently for pain which may be acute, acute-on-chronic, and chronic. For the relief of pain and inflammation, some patients may take the analgesics without consulting the family physician as they can procure the same easily, not realizing that there may be adverse effects associated with regular self-medication of NSAIDs. The NSAIDs have a risk of upper gastrointestinal bleeding or perforation, which may vary between individual NSAIDs at the doses commonly used by the patients. Thus, there is a need to create awareness in the society regarding the same to prevent self-medication associated complications.

Prevalence, associated factors and reasons for antibiotic self-medication among dwellers in Anuradhapura: a community-based study

Background Antimicrobial resistance is cited as one of the leading causes for the increased morbidity and mortality in infectious diseases globally. Antibiotic misuse can accelerate the advent and spread of resistant antimicrobial strains and antibiotic self-medication is one of the main practices of antibiotic misuse. Even though plethora of evidence is available on antibiotic self-medication among health care providers, evidence derived from community-based studies are scarce. Objective We aimed to determine the prevalence, associated factors and reasons for antibiotic self-medication among dwellers of Anuradhapura, Sri Lanka. Setting The study was conducted in Nuwaragam Palatha East, Medical Officer of Health area, Anuradhapura, Sri Lanka. Method A community-based, cross-sectional study was conducted to collect data on antibiotic self-medication during the last 3 months from all selected households using a self-administered questionnaire. Binary logistic regression was performed to determine the significant associations between variables of interest and the practice of antibiotic self-medication. Main outcome measure The prevalence of antibiotic self-medication was computed as a point estimate with 95% Confidence Interval. The reasons for antibiotic self-medication were presented as frequency and percentages. Results Of the 384 participants selected from 125 households, 211 (55%) had consumed antibiotics during the last three months and only ten were found to have self-medicated antibiotics. Hence, the prevalence was 2.6% (95% Confidence Interval = 1.0 to 4.2). The practice of antibiotic self-medication was not significantly associated with age, household size, sex, family income, employment or education level (P > 0.05). The most common symptom and reason to take antibiotics without a prescription was runny nose (80%-8/10) and convenience (70%-7/10) respectively. All have purchased the antibiotic for self-medication from a pharmacy. Information on the use of the antibiotic and the dosage were obtained from a physician's previous prescription (60%-6/10) or a pharmacist (40%-4/10). Conclusion The study revealed a very low prevalence of antibiotic self-medication. However, continuous surveillance of retail pharmacies and training of health care providers is needed to curtail errors in the use of antibiotics.