Herbal Medicine for the Treatment of Coronavirus Disease 2019 (COVID-19): A Systematic Review

Till now Coronavirus (COVID-19) has taken ~ 0.43 million lives and infected ~ 7.6 million people and the process is continuing. Face masks and regular hand-washing are the two main ways to help prevent the transmission of Coronavirus. But wearing face masks and regular hand-washing have not sufficient to stop the transmission of Coronavirus. This leads a modification needed for the procedure of prevention from Coronavirus infection. Thus the knowledge about spreading and infecting mechanism by the Coronavirus is desired (Garai, 2020). Instead of using soap and alcohol base sanitizer NaHCO3 solution can used for hand-washing to prevent from Coronavirus infection. As NaHCO3 is very cheap and less hazardous than soap and alcohol base sanitizer so this change will be economically profitable and environmentally safer (less hazard). NaHCO3 solution can also be used as nasal drop and gargle solution for the protection of nose mucus and mouth saliva from Coronavirus infection. Thus NaHCO3 solution give extra protection from Coronavirus infection when it used with mask (Garai, 2020). Beside that considering the biological immovability of NaHCO3 (mainly in human blood plasma), it is strongly recommended to use NaHCO3 for the treatment of Coronavirus patients too.

MODIFIED MARICHAYADI TAILYA (MMT) IN THE MANAGEMENT OF PRATISHAYA (RHINITIS)- A MULTI DIMENSIONAL STUDIES

Rhinitis is a very common and complicating disease condition usually affects more than 90% of the population varying from simple sneezing to multiple complications along with frequency. Usually, it affects due to pollution further follower by bacterial infection in naso-pharyngeal track. Most often it is managed instantly with anti-allergic medications like nasal drop & tablet, syrup, etc. but due to suppression of condition for a longer period it remains dormant causing multiple complications in future. Looking to the condition a nasal drop prepared from few herbs processed with mustard oil was taken into multiple clinico – experimental trail both invivo & invitro study to access the efficacy. The nasal drop in the form of Nasya i.e., modified Marichyadi taila (MMT) in management of Pratishyaya (rhinitis) has been evaluated from different angle i.e., clinical, radiological, biochemical, biological and anti-bio gram study etc. show significant result in comparison with modern control drug Otrivin. After comparing both the results it has found that MMT was more effective than Otrivin as because of its multi-stained bactericidal & virucidal effect along with maximum relief in clinical sign & symptoms. It was also observed that the drug is effective from 48-72hrs & to be continued for one to two weeks for optimum relief. Efforts have been taken to highlight the specific findings pretraining to different study in the present paper.

The Prescribing Pattern of Medications in Ear, Nose and Throat Outpatient Department of a Public Hospital

Aim: This study aimed to describe the prescribing pattern of medications in ear, nose and throat outpatient department of a public hospital in Alkharj. Methodology: The present retrospective study included collecting data from outpatient pharmacy prescriptions from a public hospital in Alkharj. The data was processed using Microsoft Excel 2016 and the descriptive data was represented as frequencies and percentages. Results: Most of the prescriptions were written by residents (79.12%). Most of the medications were prescribed as Tablet/Capsule (39.06), Nasal Drop (20.03) and Nasal Spray (16.00%). The most prescribed medication was budesonide (16.16%) followed by xylometasoline (11.62%), paracetamol (11.45%) and amoxicillin/clavulanic Acid (9.60%) Conclusion: The study revealed that the most common classes of drug prescribed for E.N.T patients were steroids such as budesonide, antibiotics amoxicillin/clavulanic acid and decongestants such as xylometasoline. It is important to increase the awareness of healthcare providers and patients about these drugs. It is also important to monitor medications prescribing to make sure that they are prescribed and used appropriately.

Use of paediatric xylometazoline nasal drop is not a child’s play in hypertensive patients on bisoprolol: A case report

: Xylometazoline, a sympathomimetic agent, is considered safe in hypertensive patients as a relief measure for nasal congestion with intranasal application. In the present case, a 58-year old male patient, having ischemic heart disease, controlled hypertension on telmisartan and bisoprolol, experienced hypertensive urgency in a span of two hours of intranasal administration of the paediatric formulation of xylometazoline. The interaction with bisoprolol should be kept in mind while using xylometazoline.

Quality by Design Based Formulation Study of Meloxicam-Loaded Polymeric Micelles for Intranasal Administration

Our study aimed to develop an “ex tempore” reconstitutable, viscosity enhancer- and preservative-free meloxicam (MEL)-loaded polymeric micelle formulation, via Quality by Design (QbD) approach, exploiting the nose-to-brain pathway, as a suitable tool in the treatment of neuroinflammation. The anti-neuroinflammatory effect of nose-to-brain NSAID polymeric micelles was not studied previously, therefore its investigation is promising. Critical product parameters, encapsulation efficiency (89.4%), Z-average (101.22 ± 2.8 nm) and polydispersity index (0.149 ± 0.7) and zeta potential (−25.2 ± 0.4 mV) met the requirements of the intranasal drug delivery system (nanoDDS) and the targeted profile liquid formulation was transformed into a solid preservative-free product by freeze-drying. The viscosity (32.5 ± 0.28 mPas) and hypotonic osmolality (240 mOsmol/L) of the reconstituted formulation provides proper and enhanced absorption and probably guarantees the administration of the liquid dosage form (nasal drop and spray). The developed formulation resulted in more than 20 times faster MEL dissolution rate and five-fold higher nasal permeability compared to starting MEL. The prediction of IVIVC confirmed the great potential for in vivo brain distribution of MEL. The nose-to-brain delivery of NSAIDs such as MEL by means of nanoDDS as polymeric micelles offers an innovative opportunity to treat neuroinflammation more effectively.

Nasal and Intravenous Administration of Dexmedetomidine to Prevent the Emergence Agitation After the Vascular Interventional Surgery in Children: A Randomized, Double-blind, Controlled Study

Introduction: Dexmedetomidine reduces the incidences of postanesthetic restlessness and hemodynamic fluctuations in children within acceptable ranges. Dexmedetomidine nasal drop prior to the surgery reduces the EA after anesthesia. There are several studies that compare the effects of dexmedetomidine nasal drop and intravenous injection, in which they were administered prior to the induction of anesthesia.This double-blind, randomized, controlled study was performed to compare the effects of dexmedetomidine nasal drop and intravenous injection on postoperative emergence agitation (EA), sedation, and hemodynamics in pediatric patients prior to and post surgery. METHODS: We randomly divided 120 children, who were enrolled in this study, into the control, dexmedetomidine nasal, and dexmedetomidine intravenous injection groups. The dexmedetomidine dose for nasal use was 2 µg / kg, and that for intravenous injection was 0.8 µg / kg. The nasal dose and the intravenous injection were, respectively, administered 30 and 10 min prior to the surgery being culminated. The EA was recorded within 30 min in the post-anesthesia care unit (PACU) and within 3 h in the ward. The incidence of EA, Ramsay scores, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and adverse events were recorded. RESULTS: In the PACU, the EA incidences in the nasal dose, intravenous injection, and control groups were 27.50%, 20.00%, and 52.50%, respectively. Statistical differences between the nasal and control groups (p < 0.05, OR = 0.343, 95% CI [0.135–0.871]) and the intravenous and control groups (p < 0.05, OR = 0.226, 95% CI [0.084–0.610]) were recorded. The EA incidence was not statistically different between the nasal and intravenous injection groups. The proportions of Propofol users were 52.50%, 27.50%, and 92.50% in the nasal spray, intravenous injection, and control groups, respectively. Statistically significant differences among the three groups (p < 0.05) were observed. The EA incidences in the nasal drop, intravenous injection, and control groups in the ward were 20.00%, 17.50%, and 70.00%, respectively. Statistically significant difference between the nasal drop and control groups (p < 0.05, OR = 0.107, 95% CI [0.038–0.300]) and the intravenous and control groups (p < 0.05, OR = 0.091, 95% CI [0.032–0.262]) were found. There was no significant difference in EA incidence between the nasal drop and intravenous injection groups. CONCLUSION: Dexmedetomidine nasal and intravenous administrations have similar effects in reducing the EA incidence within 30 min in the PACU and 3 h in the ward. In the PACU the sedation depth in the intravenous injection group was greater than that in the nasal drop group and within the 3 h in the ward, the depth of sedation was the same for both administration routes. The intravenous injection affects the HR more than the nasal drop within 5 min of administration. Thus, dexmedetomidine nasal drop prior to the culmination of the surgery is more suitable for PACU and ward sedation to prevent EA. Trial registration: The registration number ,ChiCTR1900021325(http://www.chictr.org.cn/index.aspx),The date of registration,02/15/2019.

Etiological Profile and Management of Epistaxis in Tertiary Care Hospital

Introduction: Epistaxis is a common otolaryngological emergency condition. It occurs due to local and systemic cause. Local cause lies within the nose bleeding either anterior or posterior. Commonest site of bleeding anterior epistaxis is kiesselbach’s plexus. In posterior epistaxis, it is difficult to locate bleeding site. Epistaxis is controlled by simply pinching of nose, decongested nasal drop and abgel packing. Some cases become more challenging required nasal packing and arterial ligation. Objectives: To study the epidemiological pattern and management of epistaxis. Methods: This was a retrospective study on pattern of epistaxis man­aged at Gandaki Medical College Teaching Hospital over a period from April 2015 to April 2016. Information regarding demographic profile, presentation and management of epistaxis was obtained from the Hospital records, ENT Outpatient clinic, Emergency Department, ENT ward and operation theatre. Results: A total of 78 cases were managed during study period. There was a significant male preponderance with male to female ratio 1.78:1. Patients’ age varied from eight to 80 years with mean age 40.7 years. The peak age of incidence was 21 - 30 years group. Idiopathic nasal bleeding 27 (34.6%) was commonest followed by nasal trauma 23 (29.5%) cases and hypertension 16 (20.5%) cases. Seventeen (21.8%) cases managed in day care basis with decongested nasal drop, chemi­cal cautery and abgel packing. Remaining cases required nasal packing and bipolar cautery and other specific form of treatment. Five (6.4%) cases required sphenopalatine artery ligation with no recurrence of bleeding. Conclusions: Epistaxis is common ENT emergency. Most common causes are idiopathic followed by nasal trauma and hypertension. Prompt management is instituted according to cases. Most of the cas­es are managed by non-surgical method.