Precision and Advanced Nano-Phytopharmaceuticals for Therapeutic Applications

Phytopharmaceuticals have been widely used globally since ancient times and acknowledged by healthcare professionals and patients for their superior therapeutic value and fewer side-effects compared to modern medicines. However, phytopharmaceuticals need a scientific and methodical approach to deliver their components and thereby improve patient compliance and treatment adherence. Dose reduction, improved bioavailability, receptor selective binding, and targeted delivery of phytopharmaceuticals can be likely achieved by molding them into specific nano-formulations. In recent decades, nanotechnology-based phytopharmaceuticals have emerged as potential therapeutic candidates for the treatment of various communicable and non-communicable diseases. Nanotechnology combined with phytopharmaceuticals broadens the therapeutic perspective and overcomes problems associated with plant medicine. The current review highlights the therapeutic application of various nano-phytopharmaceuticals in neurological, cardiovascular, pulmonary, and gastro-intestinal disorders. We conclude that nano-phytopharmaceuticals emerge as promising therapeutics for many pathological conditions with good compliance and higher acceptance.

Lymphatic osteopathic manipulative treatment reduces duration of deltoid soreness after Pfizer/BioNTech COVID-19 vaccine

Pfizer-BioNTech BNT162b2 is one of the three U.S. Food and Drug Administration (FDA)-approved vaccines for the prevention of COVID-19. Its most common side effect, injection site pain, occurs because of locally recruited inflammatory mediators and is mitigated by the lymphatic system. Side effects may discourage individuals from receiving vaccines; therefore, reducing the duration of injection site pain can promote vaccination compliance. Osteopathic manipulative treatments (OMT) can directly affect the physiology underlying muscle soreness; however, there is currently no literature that supports the use of OMT in this scenario. In this case report, an otherwise healthy male presented with acute left deltoid soreness after receiving the Pfizer COVID-19 vaccine. The pain began 5 h prior to the visit. Three hours after being treated with lymphatic OMT, the severity of the pain was significantly reduced and was alleviated 8h after onset in comparison to the median duration of 24–48 h. He received his second dose 3 weeks later. This case report can provide future studies with the groundwork for further investigating the role of OMT in treating postvaccination muscle soreness, which can improve patient satisfaction and potentially promote vaccination compliance.

Choice and the Placebo Effect: A Meta-analysis

Background Choice has been proposed as a method of enhancing placebo effects. However, there have been no attempts to systematically evaluate the magnitude, reliability, and moderators of the influence of choice on the placebo effect. Purpose To estimate the effect size of choice on the placebo effect and identify any moderators of this effect. Methods Web of Science, PsycINFO, EMBASE, and PubMed were systematically searched from inception to May 2021 for studies comparing placebo treatment with any form of choice over its administration (e.g., type, timing) to placebo treatment without choice, on any health-related outcome. Random-effects meta-analysis was then used to estimate the effect size associated with the influence of choice on the placebo effect. Meta-regression was subsequently employed to determine the moderating effect of factors such as type of choice, frequency of choice, and size of the placebo effect without choice. Results Fifteen independent studies (N = 1,506) assessing a range of conditions, including pain, discomfort, sleep difficulty, and anxiety, met inclusion criteria. Meta-analysis revealed that choice did significantly enhance the placebo effect (Hedges’ g = 0.298). Size of the placebo effect without choice was the only reliable moderator of this effect, whereby a greater effect of choice was associated with smaller placebo effects without choice. Conclusions Treatment choice can effectively facilitate the placebo effect, but this effect appears more pronounced in contexts where the placebo effect without choice is weaker. Because most evidence to date is experimental, translational studies are needed to test whether providing choice in clinical scenarios where placebo effects are weaker may help boost the placebo effect and thereby improve patient outcomes.

Hematologic Involvement as a Predictor of Mortality in COVID-19 Patients in a Safety Net Hospital

Introduction. COVID-19 affects the hematologic system. We evaluate the impact of hematologic involvement of different blood cell line parameters of white blood cells including absolute neutrophil count (ANC), hemoglobin, and platelets in COVID-19 patients and their association with hospital mortality and length of stay (LOS). Methods. This is a retrospective study of 475 patients with confirmed positive COVID-19 infection and hematologic abnormalities in the metropolitan New York City area. Results. Increased (ANC) (OR:1.20; 95% CI:1.02-1.42, p<0.05) increased days to hematologic involvement (OR:4.44, 95% CI:1.42-13.90; p<0.05), and persistence of hematologic involvement at discharge (OR:2.87, 95% CI:1.20, 6.90, p<0.05) were associated with higher mortality. Higher hemoglobin at admission (OR:0.77, 95% CI:0.60-0.98, p<0.001) and platelets peak (OR:0.995, 95% CI 95%:0.992-0.997, p<0.001) were associated with decreased mortality. Patients with higher white blood cell peak (B=0.46, SE=0.07, p<0.001) and higher hemoglobin at admission (B=0.05, SE=0.01, p<0.001) were associated with higher LOS. Those with higher hemoglobin nadir (B=-0.06, SE=0.01, p<0.001), higher platelets nadir (B=-0.001, SE=<0.001, p<0.001), and hematologic involvement at discharge/death (B=-0.06, SE=0.03, p<0.05) were associated with lower LOS. Conclusions. These findings can be used by clinicians to better risk-stratify patients with hematologic involvement in COVID-19 and tailor therapies to potentially improve patient outcomes.

Tele-Audiology: Current State and Future Directions

The importance of tele-audiology has been heightened by the current COVID-19 pandemic. The present article reviews the current state of tele-audiology practice while presenting its limitations and opportunities. Specifically, this review addresses: (1) barriers to hearing healthcare, (2) tele-audiology services, and (3) tele-audiology key issues, challenges, and future directions. Accumulating evidence suggests that tele-audiology is a viable service delivery model, as remote hearing screening, diagnostic testing, intervention, and rehabilitation can each be completed reliably and effectively. The benefits of tele-audiology include improved access to care, increased follow-up rates, and reduced travel time and costs. Still, significant logistical and technical challenges remain from ensuring a secure and robust internet connection to controlling ambient noise and meeting all state and federal licensure and reimbursement regulations. Future research and development, especially advancements in artificial intelligence, will continue to increase tele-audiology acceptance, expand remote care, and ultimately improve patient satisfaction.

Endometrial sampling tests for the diagnosis of endometrial carcinoma: a protocol of a diagnostic test accuracy systematic review

Background: Endometrial cancer ranks as the most common gynecological cancer. An accurate detection can dramatically improve patient relevant outcomes.Objectives: To determine the diagnostic accuracy of different endometrial sampling methods for detecting endometrial carcinoma and its precursors.Search strategy: we will search the Cochrane library, Pubmed/MEDLINE, Web of Science, and Scopus. We will search references of relevant studies.Selection criteria: We will include diagnostic test accuracy studies if women had an endometrial sampling followed by verification with histopathology in hysterectomy specimens. The primary target is endometrial carcinoma.Data collection and analysis: Two authors will independently screen studies, extract data, and assess methodological quality. We will use bivariate diagnostic random-effects meta-analysis.Results: This is a protocol of a diagnostic test accuracy systematic review.Conclusions: Evidence will aid in making well-informed decisions for diagnosing endometrial carcinoma. Implications for research will be outlined for future studies.