Rapid Successful Management of Diffuse Alveolar Hemorrhage as the Primary Presentation of Chlorine Gas Inhalation: A Rare Case Report

Chlorine-containing bleach, as a common disinfectant, can cause mild to severe symptoms from nasal irritation to life-threatening conditions such as acute respiratory distress syndrome (ARDS). However, the toxicity level of chlorine gas depends on the duration and concentration of exposure. Herein, we describe the case of a 44-year-old man admitted to the emergency department with a chief complaint of severe shortness of breathing and hemoptysis following accidental, short-time exposure to chlorine-containing bleach. Because of the life-threatening condition, he was transferred to the Intensive Care Unit (ICU) and received mechanical ventilation along with a corticosteroid agent and antibiotic therapy. Despite limited data on management of the severe complications of the exposure, the patient successfully recovered after four days.

The Effect of Absorbable and Non-Absorbable Sutures on Nasal Width Following Cinch Sutures in Orthognathic Surgery

Background: Non-absorbable materials (nylon) are always used in cinch sutures to maintain nasal width and to improve harmonious facial symmetry in orthognathic surgery. However, a few drawbacks of nylon materials have been clinically reported following orthognathic surgery, such as nasal irritation and exposure of the sutures. An absorbable material (PDS) has been proposed in cinch sutures, not only to avoid the complications of nylon but also to stabilize the nasal width for a long-term follow-up. Methods: Fifty-seven patients with Angle’s malocclusion classification III receiving orthognathic surgery were enrolled in this study. A non-absorbable material (nylon) and an absorbable material (PDS) were utilized for the cinch sutures. Pre-operative (T1) and post-operative six-month (T2) craniofacial 3D images were collected for all patients to measure the alar curvature (Ac) width and the alar base (Al) width. A significance level of p < 0.05 was applied in the statistical analysis. Results: With the approval of IRB, cinch suturing was performed with nylon in 29 patients and with PDS in 28 patients. Pre-operative Ac and Al distances showed no significant difference between these two groups. There were also no significant differences between the suture materials in the peri-operative change in nasal width, including Ac (nylon: 1.999 ± 1.40; PDS: 1.484 ± 0.97; p = 0.112) and Al (nylon: 1.861 ± 1.66; PDS: 1.115 ± 0.92; p = 0.056). Conclusions: For cinch sutures in orthognathic surgery, PDS can maintain the peri-operative nasal width similarly to nylon; additionally, it can be absorbed in a timely manner without the drawbacks of non-absorbable materials.

Nanodroplet-Benzalkonium Chloride Formulation Demonstrates In Vitro and Ex- Vivo Broad-Spectrum Antiviral Activity Against SARS-CoV-2 and other Enveloped Viruses

Objective: The Covid-19 pandemic has highlighted the importance of aerosolized droplets inhaled into the nose in the transmission of respiratory viral disease. Inactivating pathogenic viruses at the nasal port of entry may reduce viral loads, thereby reducing infection, transmission and spread. In this communication, we demonstrate safe and broad anti-viral activity of oil-in-water nanoemulsion (nanodroplet) formulation containing the potent antiseptic 0.13% Benzalkonium Chloride (NE-BZK). Results: We have demonstrated that NE-BZK exhibits broad-spectrum, long-lasting antiviral activity with >99.9% in vitro killing of enveloped viruses including SARS-CoV-2, human coronavirus, RSV, and influenza B. In vitro and ex-vivo studies demonstrated continued killing of >99.99% of human coronavirus with diluted NE-BZK and persistent for 8 hours post application, respectively. The repeated application of NE-BZK, twice daily for 2 weeks into rabbit nostrils demonstrated its safety with no nasal irritation. These findings demonstrate that formulating BZK into the proprietary nanodroplets offers a safe and effective antiviral and a significant addition to strategies to combat the spread of respiratory viral infectious diseases.

VALTOCO® (Diazepam Nasal Spray) for the Acute Treatment of Intermittent Stereotypic Episodes of Frequent Seizure Activity

Valtoco® is a new FDA-approved nasal spray version of diazepam indicated for the treatment of acute, intermittent, and stereotypic episodes of frequent seizure activity in epilepsy patients six years of age and older. Although IV and rectal diazepam are already used to treat seizure clusters, Valtoco® has less variability in plasma concentration compared to rectal diazepam. Furthermore, the intranasal administration of Valtoco® is more convenient and less invasive than rectal or IV diazepam, making it ideal for self-administration outside of a hospital setting. Multiple clinical trials have taken place comparing Valtoco® to the oral, rectal, and IV forms of diazepam. Aside from mild nasal irritation and lacrimation, Valtoco® was found to have no increased safety risk in comparison to traditional forms of diazepam. This review of Valtoco® will include a history of diazepam prescribing and withdrawal treatment, Valtoco® drug information, its mechanism of action, pharmacokinetics and pharmacodynamics, and a comprehensive review of clinical studies.

When Food is Feared: A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

BackgroundAdolescents with severe restrictive eating disorders often require enteral feeding. Nasogastric feeding is occasionally used during hospitalisation to treat medical instability as a result of malnourishment, or in a specialist setting to supplement minimal oral intake by underweight patients. There is minimal guidance for clinicians to determine when nasogastric feeding should be implemented, how it should be provided and how to complement feeding with a nasogastric tube. This systematic review sets out to determine best practice for NG feeding.MethodsA systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000-2020. Inclusion terms used were as follows: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: mental disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles.Results28 studies met the full criteria. 51.7% of studies were deemed high risk of bias due to the type of study: 37.9% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) 6-66% required NG feeding; 2) staff and young people understand its necessity but generally view it negatively; 3) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 4) high calorie feeds are not associated with increased risk of refeeding syndrome; 5) Common complications were nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 6) length of stay in hospital may be longer in patients requiring NG feeding; 7) psychiatric and medical wards differ in approach; 8) concurrent therapy reduces NG use and aids recovery.ConclusionsAll studies which reviewed the use of NG over a period of time found that it had increased significantly in recent years. Due to the possibility of patient removal of the tube, it may be beneficial in practice to deliver feeds using a bolus regime which has been tailored to the individual caloric needs of the patient. This review enables cautious recommendations to be made and highlights the lack of high-quality evidence around the use of NG feeding in eating disordered young people.

SAT-034 The Effect of Natesto on Spermatogenesis, Reproductive Hormones, and Hypogonadal Symptoms. A Phase IV Study

INTRODUCTION AND OBJECTIVE: Exogenous testosterone (T) therapy is typically long-acting and causes azoospermia in up to 65% of the men. Natesto, dosed three times a day, is a short-acting, FDA approved nasal testosterone available since 2015. We hypothesized that Natesto can preserve spermatogenesis due to its short-acting property. METHODS: We prospectively enrolled hypogonadal men aged 18-55 years with two serum T levels &lt; 300 ng/dL (drawn before 10 AM), symptoms, and 2 semen analyses (SA) with total motile sperm counts (TMSC) &gt; 5 million in a phase IV clinical trial. Eligible men received Natesto for 6 months. Serum T, luteinizing hormone (LH), follicle stimulating hormone (FSH), 17-hydroxyprogesterone (17-OHP), 2 SA, and testis volume were collected at baseline and after 3 and 6 months of therapy. Symptoms were evaluated using the international index of erectile function 6 (IIEF-6) and the short form 36 (SF-36) questionnaires. The primary endpoints were change in T, LH, FSH, sperm concentration, sperm motility, and TMSC. Secondary end points were change in symptoms, testis volume, and adverse events (AEs). Data are presented as means (SD), t-test was used to compare changes after 3 and 6 months, p&lt;0.05 was considered significant. RESULTS: In total, 102 men were screened, and 60 men (age 19-55 years) enrolled. Of the 60 men, 44 completed 3 months, 33 completed 6 months, and 17 dropped out. Mean serum T increased from hypogonadal at baseline to 3 and 6 months (p=0.005), LH and FSH decreased (p=0.03) but remained within the normal range (2-5 IU/mL). Most importantly, semen parameters remained unchanged after 3 and 6 months of T therapy. Only 3 (7.5%) men had severe oligospermia and one (2.5%) became azoospermic but recovered at 6 months after discontinuation. Testis volume and intratesticular T (serum 17-OHP) were maintained at 3 and 6 months. There was improvement across all sub-domains of the IIEF as well as improvement in questions related to energy in the SF-36. A total of 10 men dropped out due to nasal irritation. CONCLUSIONS: This phase IV clinical trial demonstrated that Natesto increased serum T, improved hypogonadal symptoms, maintained gonadotropins, testis volume, intratesticular testosterone and semen parameters. Natesto, and other short acting forms of testosterone therapy may help hypogonadal men maintain fertility.

Value and Safety of High Flow Oxygenation in the Treatment of Inpatient Asthma: A Randomized, Double-blind, Pilot Study

This study was aimed to compare the value and safety of high-flow nasal cannula (HFNC) and conventional oxygen therapy (COT) in patients with asthma exacerbation. In this randomized double-blind study, forthy patients with moderate-to-severe asthma exacerbations, aged 18 years or older were enrolled. Patients were randomly assigned to receive either HFNC or COT for 24 hours. Dyspnea scale, O2 saturation, spirometer indexes, respiratory and heart rate, and arterial blood gas (ABG) were compared within 2 and 24 hours of intervention. Dyspnea scale decreased significantly from 7.58±1.04 to 6.45±0.51 (p=0.000), and from 7.84±1.7 to 6.89±0.9 (p=0.049) within 2 hours in HFNC and COT groups, respectively. In the HFNC group, forced expiratory volume in one second (FEV1) was 1.48 ±0.94 L at the time of admission and increased to 1.61±0.66 L (p=0.19) and 1.82±0.92 L (p=0.003) after 2 and 24 hours of experience, respectively. In addition, in the COT group, FEV1 increased from 1.43±0.65 L to 1.46±0.53 L and 1.64±0.6 L in the respective time-points, (p=0.071, 0.079). PaO2 and O2 saturation increased significantly in both groups during the first 2 hours. Two patients in the HFNC group had the complaint of nasal irritation and the device-produced heat; while one patient in the COT group needed more respiratory care. HFNC could be a therapeutic option for asthma exacerbation among adult patients after considering the patient’s selection.

Taste, Nutrition, and Health

The sensation of flavour reflects the complex integration of aroma, taste, texture, and chemesthetic (oral and nasal irritation cues) from a food or food component. Flavour is a major determinant of food palatability—the extent to which a food is accepted or rejected—and can profoundly influence diet selection, nutrition, and health. Despite recent progress, there are still gaps in knowledge on how taste and flavour cues are detected at the periphery, conveyed by the brainstem to higher cortical levels and then interpreted as a conscious sensation. Taste signals are also projected to central feeding centers where they can regulate hunger and fullness. Individual differences in sensory perceptions are also well known and can arise from genetic variation, environmental causes, or a variety of metabolic diseases, such as obesity, metabolic syndrome, and cancer. Genetic taste/smell variation could predispose individuals to these same diseases. Recent findings have also opened new avenues of inquiry, suggesting that fatty acids and carbohydrates may provide nutrient-specific signals informing the gut and brain of the nature of the ingested nutrients. This special issue on “Taste, Nutrition, and Health” presents original research communications and comprehensive reviews on topics of broad interest to researchers and educators in sensory science, nutrition, physiology, public health, and health care.

ROLE OF UNANI MEDICINE IN THE PREVENTION OF CORONAVIRUS DISEASE-2019 (COVID-19): A REVIEW AND RESEARCH PERSPECTIVE

In December 2019 some patients with symptoms very much similar to SARS and MERS emerged in Wuhan city of China. In January 2020 a new type of coronavirus was isolated and name as 2019-nCoV, which later termed 'SARSCoV-2'. WHO declared the Covid-19 outbreak a Public Health Emergency of International Concern, and on March 11, the epidemic was upgraded to the pandemic. As on 02.04.2020, 827,419 confirmed cases are officially reported in more than 200 countries or territories with 40,777 deaths. The history of epidemiology typically starts with 'Hippocrates' in about 400 BC; he in his valuable book, Of the Epidemics introduced several concepts of epidemiology. In Unani Classical texts, both epidemics and pandemics have been described under a common term 'Waba'. Unani medicine have described Nazla Haar by the name of Nazla-e-Wabaiya (epidemic influenza) which is characterized by body ache, sore throat, nasal irritation, burning sensation in eyes sneezing & cough, and fever. Unexplained general weakness is an early feature of Nazla-e-Wabaiya and the disease is often complicated by pneumonia and pleurisy, therefore, Nazla-e-Wabaiya (Nazla Haar) is very much similar to that of Covid-19. In such conditions Ibn Sina advised that houses should be sanitized daily by spraying different arqiyat, he recommended the use of Bukhoor(incense) of some anti-infective drugs. Zakariya Razi has prescribed several aromatic Unani drugs for prevention of Waba. For prophylaxis of epidemic diseases, Unani scholars also prescribed several drugs to augment the immunity (Quwwat-e-Mudabbira Badan). There is a long list of drugs suggested by Unani scholars to be used in different ways to combat epidemic and pandemic situations that need to be validated on current scientific parameters.

SCOPE OF UNANI MEDICINE IN THE PROPHYLAXIS AND MANAGEMENT OF COVID-19

Coronavirus disease (COVID-19) is an acute infectious disease caused by infection with a novel coronavirus SARSCoV-2. The disease severity can range from mild to developing into critical with pneumonia and even life-threatening complications such as Acute Respiratory Distress Syndrome (ARDS), shock, or multi-organ system dysfunction. The clinical picture of Nazla-e-Wabaiya is almost similar to that of Covid-19 like body ache, sore throat, nasal irritation, burning sensation in eyes sneezing, cough, and fever. As per the Unani scholars, the prophylaxis and management include various single and compound drugs to be used orally. They also prescribed various drugs as disinfectants to be used for fumigation, incense, and spray. Ibn Sina advised that houses should be sanitized daily by spraying Arq Gulab (Rosa damascene), Arq Bed Sada (Salix caprea), or Arq Nilofer (Nymphaea alba) and recommended Bukhoor (incense) of Sa'ad Kufi (Cyperusrotundus), Habb-ul-Aas (Myrtuscommunis), Kundur (Boswelliaserrata), and Sandalwood (Santalum spp.). For the treatment of Nazla-e-Wabaiya, the decoction (Joshanda) of Unnab, Sapistan, and Behidana along with Sharbat Banafsha have been recommended by many eminent Unani scholars. They have also recommended using various types of Khamiras like Khamira Gaozaban, Khamira Abresham SheeraUnnabWala, Khamira Marwareed to improve general health and immunity.