Efficiency of Nicotinamide-based Supportive Therapy in Lymphopenia for Patients With COVID-19: A Randomized Controlled Trial

Background: The purpose of this study was to investigate the efficiency of nicotinamide-based supportive therapy in lymphopenia for patients with coronavirus disease-2019 (COVID-19). Methods: 24 patients diagnosed with the COVID-19 were randomly divided into two groups (n=12) during hospitalization in the ratio of 1:1. Based on the conventional treatment, the treatment group was given 100mg nicotinamide, five times a day. The control group only received routine treatments. The primary endpoint was the change in absolute lymphocyte counts. The secondary endpoints included both the in-hospital death and the composite endpoint of aggravation, according to upgraded oxygen therapy, improvement of nursing level, and ward rounds of superior physicians for changes of conditions. Results: The full blood counts before and after receiving the nicotinamide were comparable in each group (all P>0.05). Before and after receiving the nicotinamide, mean absolute lymphocyte counts were similar between the two groups ([0.94±0.26]*109/L versus [0.89±0.19]*109/L, P=0.565; [1.15±0.48]*109/L versus [1.02±0.28]*109/L, P=0.445, respectively). Therefore, there was no statistically significant difference in the lymphocyte improvement rate between the two groups (23.08±46.10 versus 16.52±24.10, P=0.67). There was also no statistically significant difference for the secondary endpoints between the two groups.Conclusion: Among patients with COVID-19, there was no statistically significant difference in change of full blood counts and the absolute lymphocyte counts before and after intervention in both groups. Therefore, no new evidence was found for the effect of niacinamide on lymphopenia in patients with COVID-19.Trial registration: ClinicalTrials.gov, NCT04910230. Registered 1 June 2021-retrospectively registered.

Anlotinib Combined with Temozolomide Therapy for Recurrent Glioblastoma (IDH-wt and TERTp-mut) After Standard Treatment

Purpose IDH1-wt glioblastoma patients with TERTp-mut had the worst prognosis, and no effective management strategy was established after tumor recurrence. The median overall survival (OS) of recurrent GBM patients who only received supportive therapy was approximately 1.0 month. We reported survival outcomes of recurrent glioblastoma (rGBM) treated with anlotinib combined with temozolomide therapy (ACTT), and to explore the management strategy of rGBM. Methods The clinical data of 14 rGBM patients treated with ACTT was collected. Therapeutic efficacy and adverse effects were evaluated in every 2 months of treatment. We also included 16 patients treated with bevacizumab (Bev), 22 with TMZ, 28 with re-operation, 21 with re-irradiation, and 75 with supportive care to make comparison. Kaplan-Meier analysis was used to compare the survival of ACTT group versus other treatment groups. Results Fourteen rGBM patients treated with ACTT were enrolled. After 2-month of ACTT, the overall response and disease control rate were 50.0% and 92.9%, respectively. The 6-months PFS rate was 78.6%, and the 1-year survival rate was 50.0%. The median PFS and OS in ACTT group were 11.0 and 13.0 months, respectively. The median PFS and OS in Bev-group was 4.0 and 8.0 months. The patients treated with ACTT had better PFS than that in Bev-group. And compared to all the others treatment groups, ACTT could prolong survival. Conclusion The treatment regimen of ACTT maybe reliable, safe, and effective for rGBM. The patients can gain survival benefits from ACTT, and prolonged survival were observed compared with other treatment regimens.

​Genital Changes, Haemato-biochemical Profile and Therapeutic Management of Endometritis in Crossbred Dairy Cows

Background: Reproductive performance is one of the major determinants for the economic improvement of a dairy farm. Endometritis and other uterine complications cause decrease the pregnancy rate. In this study, the genital changes and haemato-biochemical profile of crossbred dairy cows affected with endometritis was studied to evolve a suitable treatment protocol in order to improve reproductive efficiency. Methods: Crossbred cow affected with endometritis were selected based on mucopurulent vaginal discharge at estrus and tested positive for white side test. Animals were divided randomly into 8 groups with 24 animals in each group. Different therapeutic regimens fortified with supportive treatment were opted. The therapeutic regimens were supportive therapy having bypass fat, vitamins and minerals, Lugol’s iodine, Lugol’s iodine with supportive therapy, intrauterine (IU) antibiotic, IU antibiotic with supportive therapy, E. coli. LPS, E. coli. LPS with supportive therapy and control group respectively. Efficacy of each treatment regimen was based on first service conception rate (FSCR). Result: Of all the therapeutic regimens, fortification of Lugol’s iodine with supportive therapy resulted in higher FSCR (83.33%) indicating better applicability as a treatment tool for endometritis in crossbred cows.

Markers of Alzheimer’s disease in handwriting

The aim of the research. Alzheimer’s disease is the most common form of dementia. One of the potential tools for early detection of the onset of the disease is the handwriting analysis. It can be a warning signal for a serious medical investigation. The dynamics of handwriting changes are also a good indicator of the progression of the disease and the eff ectiveness of therapy. Methods. The authors have developed two corresponding tests. The fi rst (AD-HS) allows the assessment of handwriting markers of cognitive impairment and Alzheimer’s disease from an available handwriting sample. The second (ADHC) is designed to assess dynamics by comparing two handwritten documents written at diff erent times. Results. The pilot study includes 16 patients who were found to be at diff erent stages of the disease by medical examination. They all provided old handwriting samples dated 10–20 years ago and new handwriting samples specifi cally written as part of the experiment. Evaluation of 36 handwriting characteristics showed that both tests were eff ective in identifying Alzheimer’s disease and its stage. The correlation between the handwriting analysis and the medical test result was 0.62. Conclusion. Further refi nement of the proposed tests and expansion of the research base will enable handwriting exercises to be incorporated into supportive therapy to slow the progression of the disease.

Essential Oils: An Effective Therapeutic Strategy against SARS-CoV-2

Thousands of individuals have perished as a result of Covid-19 and it has turned into a global problem. The novel coronavirus 2019 (nCoV-2019), also known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has spread rapidly following its discovery in Wuhan patients with acute pneumonia in China. No medication or vaccine are available to treat human coronavirus infection successfully. The alternative therapies and cures are not are effective or authorised to treat Corona virus. Treatments are primarily supportive because no particular pandemic cure has been licenced. New interventions will most likely take months to years to mature. Using antiviral medicinal herbs as an auxiliary or supportive therapy seems to be a viable alternative. The essential oils of medicinal plants have antiviral and immunomodulatory effects. Being rich in antioxidants, essential oils can be used to develop new antiviral remedies. Such beneficial essential oils are being evaluated and exploited for its potent therapeutic use against many viruses. These natural compounds bestow antiviral actions by disrupting the viral life cycle during viral entry, assembly, replication, discharge and virus-specific host targets. This study highlights the essential oils derived from medicinal and aromatic plants with in vitro and in vivo antiviral effects. Essential oils having known pharmacokinetic and pharmacodynamic properties can be repurposed as a strategy against deadly SARS-CoV-2 infection. These essential oils of herbal plants can be an effective therapeutic strategy against SARS-CoV-2 when used along with conventional antiviral medicines.

Postinfectious Bronchiolitis Obliterans

Childhood bronchiolitis obliterans (BO) is an uncommon complication that is characterized clinically by persistent and continuous obstructive respiratory symptoms, and has been described secondary to various etiologic factors, including drugs, exposure to toxic fumes, allergic reactions, collagen vascular disease or infections. BO occurs most commonly in children after an episode of acute bronchiolitis and is considered a long-term sequela of viral infection.Postinfectious Bronchiolitis Obliterans (PIBO) is characterized by persistent airway obstruction with functional and radiological evidence of small airway involvement that is in general unresponsive to bronchodilator treatment.Although the condition is relatively rare, and its exact incidence is unknown, it is important to keep it in mind. PIBO is complication of lower respiratory tract epithelial injury, and is often misdiagnosed, delaying recognition and potential treatment. A PIBO diagnosis is usually based on a few factors, including a good medical history, positive clinical findings, and lung function test and imaging results, although biopsy and histopathology remain as the optimum diagnostic approach. There have to date been few studies proposing treatments for the condition, and no accepted protocol exists in literature. There is usually a fixed airway obstruction in PIBO. Various treatment approaches have been extrapolated from studies of post bone marrow transplantations and lung transplant BO. The clinical course is variable, and good supportive therapy is essential, with anti-inflammatory therapy often being employed.

Spontaneous intramural duodenal hematoma in a young woman

Summary: Non-traumatic spontaneous intramural duodenal hematoma is a rare cause of proximal gastrointestinal obstruction which may present with hemorrhage, jaundice and pancreatitis. In this case report we present a case of spontaneous duodenal hematoma in a 28-year-old female with a history of acute pancreatitis, admitted to hospital for convulsive upper abdominal pain with vomiting as suspected pancreatitis. An MRI examination of the abdomen confi rmed intraluminal bleeding into the duodenum. Following supportive therapy the clinical symptoms spontaneously subsided and laboratory parameters improved. Due to early dia gnosis and therapy the patient had a good outcome, without requiring surgery. Repeated imaging showed hematoma resorption. Key words: abdominal pain – vomitus – duodenal hematoma – hemorrhage

Gianotti-Crosti Syndrome in a Child with Recent Covid-19 Infection: A Case Report

Gianotti-Crosti Syndrome is a rare skin disease affecting children at the first years of age. The condition is clinically featured by blisters on the skin of the legs, buttocks and arms. A history of viral infection preceding the disease was reported for many cases. A 12-month-old boy, free of any medical illnesses, was presented with a history of acute-onset rash for five days prior to presentation that was preceded by a history of fever for two days then subsided. The rashes appeared initially on his buttocks, then spread to his upper and lower extremities and trunk. The child had fever, sore throat and coryza symptoms with lethargy. A polymerase chain reaction (PCR) swab was taken to test for SARS-CoV-2, which was positive two weeks before rash onset. All symptoms resolved in 1 week with supportive therapy and the current rashes appeared two weeks later in the patient. Gianotti–Crosti syndrome may follow the active phase of infection for some cases. It should not be misdiagnosed with dermatological simple eruptive disorders. The clinical features for covid-19 associated infection are typical for the well-known clinical picture of the syndrome. The case was reported to improve clinicians’ awareness and help in better understanding and reporting cutaneous manifestations of COVID-19. Keywords: Gianotti-Crosti Syndrome; Infants; Children; covid-19; Corona

Top of Basilar Artery Infarction: A Case Series from Sudan

The posterior circulation represents 20% of blood supply of the brain and its occlusion commonly by embolism cause brainstem, cerebellar and lower cerebral infarction. The clinical presentation varies from mild innocent symptoms leading to sever neurological deficit or death. Time of intervention is vital commonly with antithrombatic drugs or through intervention. Here, we report two Sudanese patients who had a complicated medical sequence over months ended as top of basilar artery occlusion received anticoagulants and supportive therapy according to their condition showed a variable recovery over weeks.