Therapeutic Index of Herbal Medicine in Pandemic COVID-19: A Review

The study of this review focus on effective herbal medicine against COVID-19. There have been many such plants on which a lot of research has been done earlier, and these have been very good for health as we know that the current situation of the whole world is very serious with the novel COVID-19 virus epidemic. Hence, people consume a lot of herbal medicine to increase their immunity, such as kadha (brewing), and it is also very effective against this viral infection. If we take brewing in the proper dose, research should be done from clinical trials. We have been taking many medicines since old times and have been doing research on them which is Antiviral and useful in different types of infection caused by bacteria, viruses, microbes, etc. The plant's diversity included their chemical constituents, showing the promise of their therapeutic level against the antiviral activity, without any toxicity with plasma concentration. Many plants show effectively against viral infections that are Flavonoids, Glycosides, polyphenols, alkaloids, etc.. Still, any clinical trials on humans do not prove their proper research on them, but the Chinese system of medicine claimed that Traditional Chinese medicine improves the COVID-19 patient. According to this review, we aim to collate data of plants the various large in the quantity of natural active constituents from individual medicinal plant species that may have potential therapeutic efficacy. The continuing development of novel antiviral drugs needs to isolate and synthesize more new active constituents.

No significant difference in risk of prolonged opioid use following outpatient versus inpatient total shoulder arthroplasty: A propensity matched analysis

Background The purpose of this investigation was to compare rates of filled opioid prescriptions and prolonged opioid use in opioid naïve patients undergoing total shoulder arthroplasty (TSA) in inpatient versus outpatient settings. Methods A retrospective cohort study was conducted using a national insurance claims database. Inpatient and outpatient cohorts were created by identifying continuously enrolled, opioid naïve TSA patients. A greedy nearest-neighbor algorithm was used to match baseline demographic characteristics between cohorts with a 1:1 inpatient to outpatient ratio to compare the primary outcomes of filled opioid prescriptions and prolonged opioid use following surgery between cohorts. Results A total of 11,703 opioid naïve patients (mean age 72.5 ± 8.5 years, 54.5% female, 87.6% inpatient) were included for analysis. After propensity score matching (n = 1447 inpatients; n = 1447 outpatients), outpatient TSA patients were significantly more likely to fill an opioid prescription in the perioperative window compared to inpatients (82.9% versus 71.5%, p < 0.001). No significant differences in prolonged opioid use were detected (5.74% inpatient versus 6.77% outpatient; p = 0.25). Conclusions Outpatient TSA patients were more likely to fill opioid prescriptions compared to inpatient TSA patients. The quantity of opioids prescribed and rates of prolonged opioid use were similar between the cohorts. Level of evidence Therapeutic Level III.

Traditional Interference Experiments vs. Method Comparison Interference Experiments

Two papers have appeared evaluating interferences in glucose meters. These studies are method comparisons with the added information of the medication(s) taken by the subjects. This paper contrasts a traditional interference study with the method comparison protocols. Unlike the advice in CLSI EP7, a substance that interferes should be reported even if the level of interference is clinically acceptable. The evidence of no clinically important interference in the method comparison protocol is very weak, and there is no possibility to detect statistically significant interferences. I provide an example where vitamin C at a therapeutic level was within clinical error limits, but when the concentration was at levels used to treat cancer, there was bias well above clinically acceptable limits.

Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9% and 0.98 mm versus 1.53 mm, respectively. Notching was very high (61.8%) in FBRD limbs when the anterior bowing was severe (DCA > 3°) in the contralateral (FBRE) limbs. Conclusion Notching was less when femoral component sagittal positioning was planned perpendicular to DCX, in navigated TKA. Level of evidence Therapeutic level II.

Therapeutic Drug Monitoring of Carbamazepine: A 20-Year Observational Study

Background: Carbamazepine (CBZ) is a first-generation anticonvulsant drug. Hence, in certain cases, therapeutic drug monitoring (TDM) supports pharmacotherapy. Methods: The presented research was based on a retrospective analysis including 710 ambulatory and hospitalized patients treated with CBZ between the years 1991 and 2011. The method used for the determination of the CBZ concentration was fluorescence polarization immunoassay (FPIA) performed using an Abbott GmbH TDx automatic analyzer, with the therapeutic range for carbamazepine being 4–12 µg/mL. Results: The therapeutic range was observed more often in patients between 3 and 17 years of age compared with the population ≥18 years of age (73.5% vs. 68.8%). The therapeutic level was exceeded less frequently in the population between 3 and 17 years of age despite them being given a significantly higher dose per kilogram of body weight than in the population ≥18 years of age (13.64 mg/kg vs. 10.43 mg/kg, p < 0.0001). Patients ≥18 years of age were statistically significantly more likely to be in the group with a suspected drug overdose (73.9% vs. 26.1%), and suicide attempts only occurred in elderly patients (100.0% vs. 0.0%, p = 0.003). Conclusion: The results of the TDM of CBZ showed that only 71% of all samples were at the therapeutic level. To ensure the maximum efficacy and safety of the therapy, it is necessary to monitor the concentration of CBZ regardless of sex and age.

Tacrolimus-induced neurotoxicity from bipolar disorder to status epilepticus under the therapeutic serum level: a case report

Background Tacrolimus is a macrolide immunosuppressant widely used to prevent rejection after solid organ transplantation. In general, adverse events of tacrolimus occur more often as the concentration of tacrolimus in the blood increases. We report the case of a 39-year-old man who developed a variety of adverse events despite in the therapeutic level of tacrolimus in the blood. Case presentation A 39-year-old man underwent liver transplantation for liver cirrhosis due to alcoholic liver disease. The postoperative immunosuppressant consisted of tacrolimus (5 mg) and mycophenolate (500 mg) twice daily. Five months after taking tacrolimus, he presented with talkativeness, which gradually worsened. Brain magnetic resonance imaging performed 10 months after tacrolimus administration revealed a hyperintense lesion affecting the middle of the pontine tegmentum on T2WI. The blood concentration of tacrolimus was 7.2 ng/mL (therapeutic range 5–20 ng/mL). After 21 months, he exhibited postural tremor in both the hands. Twenty-four months after taking tacrolimus, he showed drowsy mentality, intention tremor, and dysdiadochokinesia. Electroencephalography presented generalized high-voltage rhythmic delta waves; therefore, tacrolimus was discontinued in suspicion of tacrolimus-induced neurotoxicity, and anticonvulsive treatment was started. The level of consciousness gradually improved, and the patient was able to walk independently with mild ataxia. Conclusion This case shows that tacrolimus-induced neurotoxicity can occur even at normal concentrations. Therefore, if a patient taking tacrolimus exhibits psychiatric or neurologic symptoms, neurotoxicity should be considered even when the blood tacrolimus is within the therapeutic range.

Evaluation of Voriconazole and Posaconazole Dosing in Patients with Thermal Burn Injuries

Fungal infections are a recognized cause of increased morbidity and mortality in thermal burn patients. Adequate treatment regimens remain a challenge due to unpredictable pharmacokinetic/pharmacodynamic changes caused by a hypermetabolic state and individual patient factors. A retrospective evaluation of adult thermal burn patients from April 2014 to April 2020 was conducted to assess voriconazole and posaconazole antifungal dosing regimens. The primary outcome was the incidence of attaining a therapeutic steady-state trough level on the patient’s initial voriconazole or posaconazole regimen. Of the 35 patients analyzed, 28 (80.0%) patients achieved a therapeutic level during azole therapy. However, only 13 (46.4%) patients achieved a therapeutic level on their first azole regimen. The median time to therapeutic level was 8.0 + 21.1 days from the start of azole therapy. Optimal dosing strategies for azole therapy in patients with thermal burns remains undefined. Further assessment is needed to delineate patient-specific factors that can contribute to subtherapeutic azole levels in thermal burn patients and the overall clinical impact of population-specific dosing regimens.

Ocular Inserts – A Potential Ocular Controlled Drug Delivery Systems

Ophthalmic drug delivery is one of the most exciting and difficult areas of research for pharmaceutical scientists. The eye's anatomy, physiology, and biochemistry render it impenetrable to outside chemicals. The capacity to maintain a therapeutic level of the drug at the site of action for an extended period of time is a significant hurdle in ocular therapy. The ocular insert represents a substantial development in the treatment of eye illness by extending the duration of the therapeutic level of the medicine at the site of action. They are constructed of a polymeric matrix that may or may not contain a pharmaceutical agent. The medicine can then be introduced into the polymeric support as a dispersion or solution. They have a number of advantages, including increased ocular residence and prolonged pharmaceutical release into the eye. The insert is composed of a body component that is tailored to fit within the eyelid's lachrymal canaliculus. The inserts are classed as insoluble, soluble, or bioerodible based on their solubility. The drug is released from the insert by diffusion, osmosis, and bioerosion. This review aimed to provide a brief overview of Ocular Inserts – A Potential Ocular Controlled Drug Delivery Systems.