Booster Dose of COVID 19 and Ethical Issues

COVID 19 is a recent and global pandemic. Preventive medicine is not very popular in Pakistan. With the limited resources, an average Pakistani would spend on a medical treatment rather than on a preventive drug. In Pakistan, booster shots are recently made available only to those who can pay for the cost of the vaccine. A Utilitarian approach has been adopted at various levels since the pandemic emerged by health care organizations and the government. The purpose was to maximize the benefits and minimize the risk of harm. It is the need of the hour to think about health equity and justice in a pluralistic way and refrain from initiating booster shots for elite of a resource-poor country. This pandemic will never end if a maximum number of people are not vaccinated in each country. This is only possible if there is an equitable distribution of vaccines.

USE OF FLUNARIZINE AS A PREVENTIVE FOR VESTIBULAR MIGRAINE CRISES IN COMPARISON WITH OTHER DRUGS: SYSTEMATIC LITERATURE REVIEW

INTRODUCTION: Vestibular migraine is the main cause of episodic vertigo and the second most common cause of dizziness in adults. Treatment for vestibular migraine encompasses the prevention of crises and the control of acute symptoms. Flunarizine works by preventing the contraction of labyrinthine vessels and altering blood flow, thus preventing symptoms. Due to the high prevalence of the disease, its negative impacts on individual health and increased expenditure on public health, preventive pharmacological and non-pharmacological treatment must be implemented early. PURPOSE: To evaluate the efficacy of Flunarizine as a preventive for migraine and vestibular crises compared to other preventive drugs. MATERIAL AND METHODS: Scientific articles were searched in the databases using the terms (vestibular migraine OR migrainous vertigo) AND (flunarizine) AND (prophylaxis). Subsequently, a systematic literature review and meta-analysis was performed, including 3 randomized clinical trials comparing flunarizine and other preventive drugs in terms of efficacy and safety for preventing migraine vertigo attacks. The studies were analyzed using a ROB table, analysis using the GRADE method and meta-analysis. RESULTS: Qualitatively, the analysis showed that flunariniza was positive for decreasing the frequency of vertigo in cases of vestibular migraine, with a moderate degree of evidence, a relative risk of 0.34 and a confidence interval of 0.15 to 0.76. CONCLUSIONS: There are few studies available in the scientific literature on the use of flunarizine in vestibular migraine, many of which are heterogeneous among themselves, mainly in the way of evaluating and monitoring patients, carried out mainly through subjective methods. The meta-analysis showed a positive result for flunarizine as a preventive drug for the studied population. Furthermore, in all the studies analyzed, no serious side effects resulting from the use of the medication were reported, which makes it safe for patients to use. Flunarizine is a good drug for the prevention of vestibular migraine, especially in reducing the number of attacks, with a good level of evidence.

THE SAFETY OF PHOTOSENSITIZERS AS A PREVENTIVE DRUG FOR INDUSTRIAL POULTRY FARMING

The aim of the work was to determine the safety of the use of photosensitizers as a preventive drug for industrial animals. In the theoretical part, the definition of photosensitizers was given with a description of the reactions in which they enter into biological systems, the purpose of the work and the tasks were formulated. In the practical part, the effectiveness of the Photoditazine photosensitizer was determined in order to maintain the well-being of the livestock of industrial birds and to obtain high-quality and safe poultry products. In vivo experiments were conducted to determine the effectiveness of photosensitizers as a preventive drug for production animals. Studies were also conducted to determine the safety of products obtained from experimental animals by feeding their meat to laboratory rats with further determination of their pancreatic elastase concentration by ELISA. For the experiments, non-linear white female rats were selected as the most adequate test object for rapid analysis of the safety of raw materials obtained after the use of photosensitizers.

InterMiG: international differences in the therapeutic approach to migraine patients in specialized headache centers

Background There is currently a wide therapeutic arsenal for migraine patients, without a single first-line preventive drug and we choose the different available alternatives taking into account comorbidities, national guidelines, previous treatments and personal experiences. Our objective was to evaluate the differences in the use of migraine treatments between neurologists from different countries. Methods This is a multi-centre observational study carried out by neurologists from specialized headache units in seven countries, retrospective with consecutive inclusion of all patients presenting with a migraine diagnosis, over a period of three months. Results A total of 734 patients were recruited but only 600 were considered in the analysis in order to homogenize the patient cohorts from countries: 200 Spain (ES), 100 Italy (IT), 85 Russia (RUS), 80 Germany (DE), 60 Portugal (PT), 45 Poland (PL) and 30 Australia (AU). 85.4 % of patients were women with a mean age of 42.6 ± 11.8 years. Considering previous and current preventive treatment, the order of use was: antidepressants (69.3 %), antiepileptic drugs (54.7 %), beta-blockers and antihypertensive drugs (49.7 %), OnabotulinumtoxinA (44.0 %) and others (36.2 %). Statistically significant differences were found between all pharmacological classes: antidepressants were commonly used in all countries, with the exception of Poland (AU: 76.7 %, IT: 71.0 %, DE: 60.0 %, PL: 31.1 %, PT: 71.7 %, RUS: 70.6 %, ES: 78.5 %; p < 0.0001); antiepileptic drugs were more frequently prescribed in Portugal, Australia and Spain (AU: 73.3 %, IT: 40.0 %, DE: 37.5 %, PL: 48.9 %, PT: 85.0 %, RUS: 29.4 % and ES: 69.0 %; p < 0.0001); beta-blockers and antihypertensive drugs were frequently used in all countries except Italy (AU: 60.0 %, IT: 14.0 %, DE: 53.8 %, PL: 48.9 %, PT: 68.3 %, RUS: 49.4 % and ES: 59.0 %; p < 0.0001); BTX-A were predominately used in Spain, Italy and Australia (AU:56.7 %, IT:58.0 %, DE:20.0 %, PL: 42.2 %, PT: 26.7 %, RUS: 24.7 % and ES: 58.5 %; p < 0.0001) and others were most frequently used in Poland (AU: 0.0 %, IT: 19.0 %, DE: 42.5 %, PL: 95.6 %, PT: 31.7 %, RUS: 3.5 % and ES: 49.5 %; p < 0.0001). If only patients without comorbidities are considered (200/600), statistically differences between countries persist in all preventive treatments. Conclusions There is heterogeneity in the choice of preventive treatment between different countries. Prospective comparative studies of the different oral and subcutaneous alternatives would help to create a global therapeutic algorithm that would guarantee the best option for our patients.

Commentary The Elderly in the pandemic era

Highlighted manuscriptDapsone has been the treatment and preventive drug for mild cognitive impairment, Alzheimer's disease, Parkinson's disease, Seizure, Stroke and Covid-19 ARDS.B.K.'s team at Hunt Regional Hospital reported a study that drastically reduced mortality by administering Dapsone to patients with Covid-19 ARDS in the intensive care unit.If Dapsone were used for early symptoms of cognitive impairment or stroke, the increase in deaths would have been prevented.J.H. also recommends it to the elderly living in this pandemic era. However, we must consult our doctor before taking it.

Histone deacetylase inhibitors suppress ACE2 and ABO simultaneously, suggesting a preventive potential against COVID-19

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide as a pandemic throughout 2020. Since the virus uses angiotensin-converting enzyme 2 (ACE2) as a receptor for cellular entry, increment of ACE2 would lead to an increased risk of SARS-CoV-2 infection. At the same time, an association of the ABO blood group system with COVID-19 has also been highlighted: there is increasing evidence to suggest that non-O individuals are at higher risk of severe COVID-19 than O individuals. These findings imply that simultaneous suppression of ACE2 and ABO would be a promising approach for prevention or treatment of COVID-19. Notably, we have previously clarified that histone deacetylase inhibitors (HDACIs) are able to suppress ABO expression in vitro. Against this background, we further evaluated the effect of HDACIs on cultured epithelial cell lines, and found that HDACIs suppress both ACE2 and ABO expression simultaneously. Furthermore, the amount of ACE2 protein was shown to be decreased by one of the clinically-used HDACIs, panobinostat, which has been reported to reduce B-antigens on cell surfaces. On the basis of these findings, we conclude that panobinostat could have the potential to serve as a preventive drug against COVID-19.

Enzyme Producing Activity of Probiotics and Preparation of Compound Enzyme

Probiotics are a group of active microorganisms, which benefit the host by colonizing and changing the composition of host flora. It is of great significance to promote the development of human gastrointestinal nutrition and health by regulating the host mucosal and systemic immune function or regulating the balance of intestinal flora. The purpose of this study is to analyze the production activity of the enzyme, evaluate its biological characteristics and safety as a preventive drug, and provide reference for the research of enzyme production and compound enzyme preparation by probiotics. In this study, four groups of probiotics were set up: Clostridium butyricum experimental group, Lactobacillus plantarum experimental group, drinking water control group, and Bacillus licheniformis experimental group. In addition, a variety of complex enzyme experiments were set up to study the influence on the digestive tract and single factor experiment. The results showed that probiotics and compound enzyme preparations could significantly promote the intestinal digestibility. Under the effect of probiotics, the weight of the chicken was almost 1 Jin heavier than that of the control group, and the average digestibility was increased by 4.3%. The effect of the enzyme on digestibility is stronger than that of probiotics, but the final effect tends to be stable.

Histone deacetylase inhibitors suppress ACE2 and ABO simultaneously, suggesting a preventive potential against COVID-19

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide as a pandemic throughout 2020. Since the virus uses angiotensin-converting enzyme 2 (ACE2) as a receptor for cellular entry, increment of ACE2 would lead to an increased risk of SARS-CoV-2 infection. At the same time, an association of the ABO blood group system with COVID-19 has also been highlighted: there is increasing evidence to suggest that non-O individuals are at higher risk of severe COVID-19 than O individuals. These findings imply that simultaneous suppression of ACE2 and ABO would be a promising approach for prevention or treatment of COVID-19. Notably, we have previously clarified that histone deacetylase inhibitors (HDACIs) are able to suppress ABO expression in vitro. Against this background, we further evaluated the effect of HDACIs on cultured epithelial cell lines, and found that HDACIs suppress both ACE2 and ABO expression simultaneously. Furthermore, the amount of ACE2 protein was shown to be decreased by one of the clinically-used HDACIs, panobinostat, which has been reported to reduce B-antigens on cell surfaces. On the basis of these findings, we conclude that panobinostat could have the potential to serve as a preventive drug against COVID-19.

Effect of platelet count on long-term prognosis of cerebral infarction

Objective: This study aimed to analyze the correlation between platelet (PLT) count and the modified Rankin scale (mRS) in patients with cerebral infarction (CI) at the later stage of rehabilitation, which can be used to guide the secondary prevention strategy of CI. Methods: A total of 180 CI patients were divided into three groups according to PLT count: low PLT group (<125×109/L), medium PLT group (126– 225×109/L) and high PLT group (>226×109/L). The mRS was evaluated after three months and one year, respectively, and the difference in long-term prognosis between groups was analyzed. The mRS is an ordered scale coded from 0 (no symptoms at all) through 5 (severe disability) 6 (death). Results: Finally, a total of 99 patients had complete data. The results of the multiple comparisons among the three groups were as follows: the analysis of variance of the mRS at three months after onset yielded F = 6.714 and P = 0.002, and the difference was statistically significant. The mRS was lowest in the medium PLT group (2.09±1.465), and neurological function recovery was the best. After one year, the mRS for the medium PLT group was the lowest (1.49±1.523), with F = 6.860 and P = 0.002. The repeated measures analysis of variance revealed that the effect of continuous rehabilitation was significant in the interval from three months to one year after onset (F = 35.528, P < 0.001). This was very significant, especially for patients taking aspirin (F = 50.908, P < 0.001). However, for patients who did not take aspirin, the effect of continuous rehabilitation was not obvious during the nine months, and the difference between the results of two mRS measurements was not statistically significant (F = 1.089, P = 0.308). Conclusions: Patients with a PLT count of 126– 225×109/L had the lowest mRS between three months and one year after onset, but had the best recovery of nerve function. Patients who persisted in taking aspirin continued to significantly recover during the 9-month period, from three months to one year after onset. Aspirin is not only a secondary preventive drug, but also an important drug to promote the rehabilitation of CI patients.

The Implemention of Preventive Drug Education Program Among Public and Private School

The program caters to public and private schools’ needs regarding implementing the preventive drug education program in curriculum and instruction, intervention program and services, learning and development activities, advocacy campaigns, evaluation, and research. The main purpose of this study was to determine the level of implementation of drug education programs among public and private secondary schools in Nasipit Agusan Del Norte. The researchers used a descriptive design comprising the survey method to collect relevant information for the study. Based on the finding, there is no significant difference in the level of implementation of preventive drug education program between public and private secondary schools in Nasipit Agusan del Norte, which were the following; curriculum and instructions, intervention program and services, learning and development activities, advocacy campaigns, and monitoring evaluation and research. The researchers would like to recommend that the public and private secondary schools continue implementing the preventive drug education program in Nasipit Agusan del Norte. Moreover, all personnel in-charge in the drug education program will attend any drug symposium and activities to have proper training: curriculum and Instruction.