scholarly journals In search of an ideal drug for safer treatment of obesity: The false promise of pseudoephedrine

2021 ◽  
Author(s):  
Antonio Munafò ◽  
Stefano Frara ◽  
Norberto Perico ◽  
Rosaria Di Mauro ◽  
Monica Cortinovis ◽  
...  
Keyword(s):  
Adverse Events ◽  
Treatment Options ◽  
Public Health Problem ◽  
Cardiovascular Death ◽  
Regulation Of Transcription ◽  
Major Public Health Problem ◽  
Obese Patients ◽  
Ephedra Sinica ◽  
The Central Nervous System ◽  
Treatment Of Obesity

AbstractObesity is a major public health problem worldwide. Only relatively few treatment options are, at present, available for the management of obese patients. Furthermore, treatment of obesity is affected by the widespread misuse of drugs and food supplements. Ephedra sinica is an old medicinal herb, commonly used in the treatment of respiratory tract diseases. Ephedra species contain several alkaloids, including pseudoephedrine, notably endowed with indirect sympathomimetic pharmacodynamic properties. The anorexigenic effect of pseudoephedrine is attributable primarily to the inhibition of neurons located in the hypothalamic paraventricular nucleus (PVN), mediating satiety stimuli. Pseudoephedrine influences lipolysis and thermogenesis through interaction with β3 adrenergic receptors and reduces fat accumulation through down-regulation of transcription factors related to lipogenesis. However, its use is associated with adverse events that involve to a large extent the cardiovascular and the central nervous system. Adverse events of pseudoephedrine also affect the eye, the intestine, and the skin, and, of relevance, sudden cardiovascular death related to dietary supplements containing Ephedra alkaloids has also been reported. In light of the limited availability of clinical data on pseudoephedrine in obesity, along with its significantly unbalanced risk/benefit profile, as well as of the psychophysical susceptibility of obese patients, it appears reasonable to preclude the prescription of pseudoephedrine in obese patients of any order and degree.

An Insight Into Unani Hypoglycemic Drugs And Their Mechanism of Action

2019 ◽  
Vol 05 ◽  
Author(s):  
Sadia Nikhat ◽  
Mohd. Fazil
Keyword(s):  
Adverse Events ◽  
Scientific Evidence ◽  
Public Health Problem ◽  
Convincing Evidence ◽  
Major Public Health Problem ◽  
Significant Activity ◽  
Preparation Methods ◽  
Diabetes Mellitus Type Ii ◽  
Unani Medicine ◽  
Action Mechanisms

Background: Diabetes mellitus type-II is a major public health problem characterized by hypo-insulinemia and insulin resistance leading to hyperglycemia and its complications. In Unani medicine, it is known as ziyābetus. Several drugs are prescribed in Unani medicine as single and compound formulations for various abnormalities caused by the disease. Most of these drugs have been studied on scientific parameters and have shown significant activity in reducing the symptoms and complications of diabetes. Objectives: The literature research was planned with the objective to find out the action mechanisms of certain selected herbal drugs of Unani medicine, with evidence of their efficacy. Methods: Unani literature was first reviewed extensively and the most frequently-prescribed and easily available drugs for diabetes were selected, followed by a search on major internet search engines for scientific evidence of their efficacy alongwith information of their active ingredient and dosage. Ten drugs were selected for the present review. Results and Conclusion: There is convincing evidence to suggest that the selected drugs have a promising action against diabetes and its complications. Also, there are largely no adverse events reported and some of the preparation methods described in Unani medicine have been proven to reduce or eliminate the adverse events, if any.

OP116 Cost-Effectiveness Of Sacubitril/Valsartan In Heart Failure

2017 ◽  
Vol 33 (S1) ◽  
pp. 52-53
Author(s):  
Liang Lin ◽  
Mohamed Ismail Abdul Aziz ◽  
David Bin-Chia Wu ◽  
Kwong Ng
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Public Health Problem ◽  
Cardiovascular Death ◽  
Sensitivity Analyses ◽  
Major Public Health Problem ◽  
Old Patients ◽  
Asian Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
The Cost

INTRODUCTION:Heart failure (HF) is a major public health problem worldwide and in Asia. Sacubitril/valsartan reduces cardiovascular death and hospitalizations for HF. However, decision makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of current standard of care.METHODS:Using a Markov model, we projected lifetime clinical and economic outcomes of sacubitril/valsartan versus enalapril for 66-year-old patients with HF in Singapore. Key health states included New York Heart Association (NYHA) classes; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Probabilities of events were based on the PARADIGM-HF trial. The uncertain treatment effect of sacubtril/valsartan in Asian patients was modelled using a hazard ratio (HR) of 1 as upper limit in sensitivity analyses. Utilities were obtained from published literature. Local national epidemiological and cost data were applied. Analyses were conducted from the Singapore healthcare payer's perspective. Both one-way and Probabilistic Sensitivity Analyses (PSA) based on 10,000 Monte Carlo simulations were performed.RESULTS:Compared to enalapril, sacubitril/valsartan was associated with an incremental cost-effectiveness ratio (ICER) of SGD74k (USD52k) per quality-adjusted life year (QALY) gained. The cost-effectiveness of sacubitril/valsartan was highly dependent on its effectiveness in reducing the risk of cardiovascular death. However, this was uncertain, particularly in the Asian subgroup, where results were not statistically significant. In sensitivity analyses using results from Asian patients, the ICERs ranged from SGD41k (USD30k) to SGD1.3 million (USD 0.94 million) per QALY gained. PSA showed the probability of sacubitril/valsartan being cost-effective was below 1 percent, 12 percent and 71 percent at thresholds of SGD20k (USD14k), SGD50k (USD36k) and SGD100k (USD 72k) per QALY gained, respectively.CONCLUSIONS:Given the uncertain ICER, sacubtril/valsartan may not provide good value for money compared to enalapril in reducing cardiovascular morbidity and mortality in patients with HF at the current daily cost. Our study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering HF therapy.

scholarly journals Progress in Research on SARS-CoV-2 Infection Causing Neurological Diseases and Its Infection Mechanism

2021 ◽  
Vol 11 ◽  
Author(s):  
Lintao Wang ◽  
Zhiguang Ren ◽  
Li Ma ◽  
Yanjie Han ◽  
Wenqiang Wei ◽  
...  
Keyword(s):  
Public Health ◽  
Central Nervous System ◽  
Nervous System ◽  
Neurological Diseases ◽  
Public Health Problem ◽  
Neurological Complications ◽  
Major Public Health Problem ◽  
The Central Nervous System ◽  
The Impact ◽  
Great Harm

COVID-19 has spread rapidly worldwide since its outbreak and has now become a major public health problem. More and more evidence indicates that SARS-CoV-2 may not only affect the respiratory system but also cause great harm to the central nervous system. Therefore, it is extremely important to explore in-depth the impact of SARS-CoV-2 infection on the nervous system. In this paper, the possible mechanisms of SARS-CoV-2 invading the central nervous system during COVID-19, and the neurological complications caused by SARS-CoV-2 infection were reviewed.

scholarly journals Recent advances in managing chronic HCV infection: focus on therapy in patients with severe liver disease

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 367 ◽  
Author(s):  
Raoel Maan ◽  
Adriaan J. van der Meer
Keyword(s):  
Liver Disease ◽  
Treatment Options ◽  
Public Health Problem ◽  
Hcv Infection ◽  
New Drugs ◽  
European Medicines Agency ◽  
Major Public Health Problem ◽  
Advanced Liver Disease ◽  
Specific Patient ◽  
Chronic Hcv

Chronic hepatitis C virus (HCV) infection still represents a major public health problem, as it is thought to be responsible for more than 350,000 deaths around the globe on a yearly basis. Fortunately, successful eradication of the virus has been associated with improved clinical outcome and reduced mortality rates. In the past few years, treatment has improved considerably by the implementation of direct-acting antivirals (DAAs). From 2014 onwards, sofosbuvir, simeprevir, daclatasvir, ledipasvir, paritaprevir, ombitasvir, and dasabuvir have been approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). Regimens with various combinations of these new drugs, without the use of interferon (IFN), proved to be very effective and well tolerated, even among patients with advanced liver disease. Moreover, treatment duration could be shortened to 12 weeks in the majority of patients. The high costs of these DAAs, however, limit the availability of IFN-free therapy worldwide. Even in wealthy countries, it is deemed necessary to prioritize DAA treatment in order to limit the immediate impact on the health budget. As patients with advanced liver disease are in most need of HCV clearance, many countries decided to treat those patients first. In the current review, we focus on the currently available IFN-free treatment options for patients with cirrhosis. We discuss the virological efficacy as well as the clinical relevance of these regimens among this specific patient population.

scholarly journals The Effectiveness and Safety of Favipiravir in COVID-19 Hospitalized Patients in Bali, Indonesia

2021 ◽  
Vol 16 (4) ◽  
Author(s):  
Herni Damayanti ◽  
I Gede Ketut Sajinadiyasa ◽  
Rani Sauriasari
Keyword(s):  
Public Health ◽  
Adverse Events ◽  
Public Health Problem ◽  
Hospitalized Patients ◽  
Major Public Health Problem ◽  
Serious Adverse Events ◽  
Respiratory Problems ◽  
Public Health Burden ◽  
Appropriate Treatment ◽  
Clinical Conditions

COVID-19 is a major public health problem, with still questionable specific cure. Favipiravir is a COVID-19 antiviral that is included in several drugs, potentially a therapy for COVID-19. This study aimed to analyze its efficacy and safety in moderate to critical hospitalized patients. This study was a retrospective cohort in Denpasar City, Bali Province, Indonesia, from August 2020 to January 2021. There was a total of 192 patients; 96 patients in the favipiravir group and 96 patients in the non-favipiravir group (remdesivir/oseltamivir). Effectivity was measured by assessing the clinical condition at the end of the isolation period of 14 days. The favipiravir group showed better clinical conditions than the non-favipiravir group (79.2% vs. 56.3%; aRR 2.196; 95% CI = 1.084 – 4.451, p=0.029), seen from being free of fever and respiratory problems. Stratification analysis demonstrated that the clinical improvement was significantly different in the severe/critical group in favor of favipiravir (RR 1,573; 95% CI = 1.139-2.172). The most common non-serious adverse events (AE) found in the use of favipiravir were gastrointestinal disturbances (12.5%). In conclusion, favipiravir is effective in severe/critical cases, and no serious adverse events were found in its use. Appropriate treatment is expected to help in reducing the public health burden.

scholarly journals Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis

2019 ◽  
Vol 8 ◽  
pp. 216495611985803 ◽  
Author(s):  
Deanna R Befus ◽  
Sharon Hull ◽  
Justine Strand de Oliveira ◽  
Gillian Sanders Schmidler ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Qualitative Content Analysis ◽  
Treatment Options ◽  
Management Strategies ◽  
Public Health Problem ◽  
Term Treatment ◽  
World Health ◽  
Major Public Health Problem ◽  
Long Term Treatment ◽  
Health Organization

Background Migraine is a disabling neurological disorder and the sixth biggest cause of disability worldwide. The World Health Organization has declared migraine a major public health problem due to a paucity of knowledge about cause and effective treatment options. Both in incidence and severity, migraine disproportionately affects people occupying marginalized social locations (SL). Managed pharmacologically, migraine is treated with daily preventive and as-needed abortive medications. Both come with high literal and figurative costs: intolerable side effects, medication interactions, and prohibitive prices. Cost prohibitive, ineffective, and unsustainable pharmacological treatment options have contributed to high levels of interest in complementary approaches by people with migraine, but little is known about their motivations, patterns of use or access, or how these may vary by SL. Method We conducted focus groups with 30 people with migraine to explore their desires and recommendations for migraine clinicians and researchers. We used qualitative content analysis to identify themes. Outcomes: We identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication as a short-term solution; high personal and economic costs of medication; and desire for more information and access to natural approaches. Across SL, participants expressed keen interest in integrative approaches and wanted better access to complementary modalities. Participants in marginalized SL described reliance on traditional/folk remedies, including engagement with family and community healers, who they described as more affordable and culturally accessible. Conclusions Holistic and integrative approaches were preferred over medication as long-term migraine management strategies. However, people in marginalized SL, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches through currently available channels. Engaging with these communities and using a critical lens to explore barriers to access can develop options to make complementary modalities more approachable, while also attending to systemic blind spots that may unintentionally alienate socially marginalized groups.

scholarly journals Managing Sexually Transmitted Infections in Pregnant Women

2012 ◽  
Vol 8 (3) ◽  
pp. 313-321 ◽  
Author(s):  
Nadi K Gupta ◽  
Christine A Bowman
Keyword(s):  
Sexually Transmitted Infections ◽  
Treatment Options ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
National Guidelines ◽  
Sexually Transmitted ◽  
Recommended Treatment ◽  
Adverse Pregnancy ◽  
The Uk ◽  
Birth Preterm

Sexually transmitted infections (STIs) constitute a major public health problem in the UK and may result in very costly complications. Many STIs pose the risk of a number of adverse pregnancy outcomes including miscarriage, still birth, preterm delivery, low birth weight and ophthalmia neonatorum. National guidelines for the management of STIs are produced and regularly revised by the British Association of Sexual Heath and HIV. This review outlines the latest recommended treatment options during pregnancy for the commonly encountered STIs.

scholarly journals Management of severe pediatric obesity

2021 ◽  
Vol 64 (6) ◽  
pp. 416-424
Author(s):  
Lindsey Yoojin Chung ◽  
Young-Jun Rhie
Keyword(s):  
Metabolic Syndrome ◽  
Pediatric Obesity ◽  
Eating Behaviors ◽  
Severe Obesity ◽  
Lifestyle Modification ◽  
Treatment Options ◽  
Public Health Problem ◽  
Alcoholic Fatty Liver ◽  
Treatment Of Obesity ◽  
Metabolic And Bariatric Surgery

Background: Pediatric obesity has increased over the decades, and in particular, severe pediatric obesity has become a serious public health problem. A concern has arisen that the COVID-19 pandemic may exacerbate the incidence of childhood obesity.Current Concepts: The consequences of severe pediatric obesity are more devastating than those of moderate obesity. Children with severe obesity are at a greater risk for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Correct assessment and diagnosis of a child with severe obesity is key to successful therapy. A thorough history and physical examination are important in identifying monogenic obesity or metabolic syndrome. Eating behaviors and psychosocial factors should be assessed to improve weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification, pharmacotherapy, and metabolic and bariatric surgery. Even though progress has been made with regard to the treatment of obesity, safe and effective treatment of severe pediatric obesity is challenging.Discussion and Conclusion: More efforts and innovations are needed to find a solution for the huge medical and emotional burden the children with severe obesity and their families are enduring.

scholarly journals Targeting Orexin Neurons for Treatment of Obesity is It Feasible in Human Being-A Systematic Review

2019 ◽  
pp. 1-9
Author(s):  
Kulvinder Kochar Kaur ◽  
◽  
Allahbadia GN ◽  
Singh M ◽  
◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleep Problems ◽  
Public Health Problem ◽  
Type2 Diabetes ◽  
Parallel Increase ◽  
Sleep Physiology ◽  
The Central Nervous System ◽  
Treatment Of Obesity ◽  
Cell Changes

Obesity is increasing at epidemic proportions both in children and adults posing a big public health problem among children as well as adults. With parallel increase in comorbidities like type2 diabetes mellitus (T2DM), metabolic syndrome (MetS) a need arises for developing medical therapies that can maintain long term weight loss. Earlier we have tried to consider multiple options like utilization of drug combinations like Qsymia, Contravene, Liraglutide, thylakoids, probiotics, Combination of glucagon like peptides1 (GLP1) with glucagon etc but nothing has proved to be as efficacious as BS in long term maintenance of weight loss. Earlier we had reviewed the cellular changes related to orexin A and B changes that are isoforms of neuropeptides that get liberated from the lateral hypothalamus (LH). Here we further review the pathophysiology of orexin neurons with regard to their role in neuroinflammation in the central nervous system (CNS) via microglial cell changes and role in spontaneous physical activity (SPA) and sleep physiology commonly termed sleep-wake promoting neuropeptides along with role in reward circuitry and how targeting them might be of help in treating obesity. Possibility is that subtle increases in SPA have been found to improve energy expenditure (EE) and that has been utilized in some workplaces where treadmill like chairs are utilized, restless people who keep sitting and standing do burn calories thus promoting carparks at distance places, no elevators have been thought as some ways by which lethargic individuals refuse to follow exercise might get helped by modulating orexin neurons besides correcting sleep problems coexisting with obesity

scholarly journals Controlled activation of cortical astrocytes can reverse neuropathic chronic pain

2021 ◽  
Author(s):  
Ikuko Takeda ◽  
Kohei Yoshihara ◽  
Dennis Cheung ◽  
Masakazu Agetsuma ◽  
Makoto Tsuda ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Pain ◽  
Sciatic Nerve ◽  
Peripheral Nerves ◽  
Treatment Options ◽  
Public Health Problem ◽  
Afferent Input ◽  
Major Public Health Problem ◽  
Partial Sciatic Nerve Ligation ◽  
Spine Plasticity

Abstract Chronic pain is a major public health problem that currently lacks effective treatment options. Here, we report a novel combination therapy that can effectively reverse chronic pain induced by nerve injury in mice. By combing transient nerve block to inhibit noxious afferent input from injured peripheral nerves, with transient concurrent activation of astrocytes in the somatosensory cortex (S1) by either transcranial direct current stimulation (tDCS) or via the chemogenetic DREADD system, we could reverse allodynia previously established by partial sciatic nerve ligation (PSL). Activation of astrocytes initiated spine plasticity to reduce synapses formed shortly after PSL. The cure from allodynia persisted long after ceasing active treatment. Thus, our study represents the first report of a robust, readily translatable approach for treating chronic pain that capitalizes on the causative interplay between noxious afferents, sensitized central neuronal circuits and astrocytic-activation induced plasticity.

Sign in / Sign up

Export Citation Format

Share Document