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Frontiers in Medicine 2021SARS-CoV-2 has resulted in a global pandemic since its outbreak in Wuhan, 2019. Virus transmission primarily occurs through close contact, respiratory droplets, and...
SARS-CoV-2 has resulted in a global pandemic since its outbreak in Wuhan, 2019. Virus transmission primarily occurs through close contact, respiratory droplets, and aerosol particles. However, since SARS-CoV-2 has been detected in fecal and rectal samples from infected individuals, the fecal-oral route has been suggested as another potential route of transmission. This study aimed to investigate the prevalence and clinical implications of rectal SARS-CoV-2 shedding in Danish COVID-19 patients. Hospitalized and non-hospitalized adults and children who were recently tested with a pharyngeal COVID-19 test, were included in the study. A rectal swab was collected from all participants. Hospitalized adults and COVID-19 positive children were followed with both pharyngeal and rectal swabs until two consecutive negative results were obtained. RT-qPCR targeting the envelope gene was used to detect SARS-CoV-2 in the samples. Demographic, medical, and biochemical information was obtained through questionnaires and medical records. Twenty-eight of 52 (53.8%) COVID-19 positive adults and children were positive for SARS-CoV-2 in rectal swabs. Seven of the rectal positive participants were followed for more than 6 days. Two of these (28.6%) continued to test positive in their rectal swabs for up to 29 days after the pharyngeal swabs had turned negative. Hospitalized rectal positive and rectal negative adults were comparable regarding demographic, medical, and biochemical information. Furthermore, no difference was observed in the severity of the disease among the two groups. We provided evidence of rectal SARS-CoV-2 shedding in Danish COVID-19 patients. The clinical importance of rectal SARS-CoV-2 shedding appears to be minimal.
PubMed: 35096894
DOI: 10.3389/fmed.2021.804804 -
Expert Opinion on Drug Discovery Jan 2021, the deadliest malaria parasite, kills hundreds of thousands of people per year, mainly young children in Sub-Saharan Africa. Artesunate suppositories are recommended... (Review)
Review
INTRODUCTION
, the deadliest malaria parasite, kills hundreds of thousands of people per year, mainly young children in Sub-Saharan Africa. Artesunate suppositories are recommended as pre-referral malaria treatment in remote endemic areas for severely ill children to prevent progression of the disease and to provide extra time for patients until the definitive severe malaria treatment can be administered.
AREAS COVERED
The authors provide an overview of the discovery of artesunate and its different formulations focusing on rectal administration, summarizing key studies concerning the pharmacokinetic, pharmacodynamic, safety, tolerability and efficacy of rectal artesunate leading to WHO recommendation and market authorization in Africa. In addition, studies on acceptance and adherence to rectal artesunate administration and the post-launch status are also covered.
EXPERT OPINION
Efforts by ministries of health in malaria endemic countries together with international health organizations should establish and enforce guidelines to ensure the correct use of artesunate suppositories only as pre-referral medication in presumed severe malaria cases to minimize the risk of abuse as a monotherapy for treatment of uncomplicated malaria. The priority is to not jeopardize the efficacy of artesunate and to prevent resistance development against this valuable drug class in Africa.
Topics: Administration, Rectal; Age Factors; Animals; Antimalarials; Artesunate; Child; Child, Preschool; Drug Development; Drug Evaluation, Preclinical; Humans; Malaria, Falciparum; Plasmodium falciparum; Severity of Illness Index; Suppositories
PubMed: 32921162
DOI: 10.1080/17460441.2020.1804357 -
American Journal of Translational... 2022This study was designed to evaluate the efficacy of rectal administration of different doses of Panax notoginseng and Colla Corii Asini (CCA) suppositories in the...
OBJECTIVE
This study was designed to evaluate the efficacy of rectal administration of different doses of Panax notoginseng and Colla Corii Asini (CCA) suppositories in the treatment of ulcerative colitis (UC) and the effect on immune function and recurrence.
METHODS
Totally 120 UC patients admitted to our hospital from February 2019 to February 2020 were enrolled and randomized into experimental group (n=60) and control group (n=60). The experimental group received rectal administration of a high dose of Panax notoginseng and CCA suppositories, while the control group received a low dose. After three months of treatment, clinical symptom scores, inflammatory factor levels, scores of rectal mucosa, immune function, recurrence rates, adverse reaction rates, and clinical efficacy were compared between the two groups.
RESULTS
After treatment, the experimental group obtained significantly lower clinical symptom scores, inflammatory factors, and scores of rectal mucosa than the control group (all P<0.001). The immune function of the observation group was significantly better than that of the control group (P<0.001). At 6, 8, and 12 months after treatment, the recurrence rates in the experimental group were all significantly lower than those in the control group (all P<0.001). The two groups showed no significant difference in the incidence of adverse reaction (P>0.05), and the experimental group obtained a higher clinical efficacy than the control group (P<0.001).
CONCLUSION
For patients with UC, the rectal administration of Panax notoginseng and CCA suppositories can exert positive effects on their inflammatory factors, immune functions, UC severity, clinical symptoms, and recovery. In addition, higher doses were associated with better effects without increased adverse events.
PubMed: 35173878
DOI: No ID Found -
Gut Jul 2021
Review
Topics: Administration, Oral; Administration, Rectal; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Drug Development; Endpoint Determination; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Mesalamine; Proctitis; Randomized Controlled Trials as Topic; Sigmoidoscopy; Tacrolimus; Treatment Outcome
PubMed: 33789968
DOI: 10.1136/gutjnl-2021-324108 -
Epilepsy & Behavior : E&B Dec 2019Benzodiazepines, including diazepam and midazolam, are the mainstay of treatment for seizure emergencies, including acute repetitive seizures. Nonparenteral dosage forms... (Review)
Review
Benzodiazepines, including diazepam and midazolam, are the mainstay of treatment for seizure emergencies, including acute repetitive seizures. Nonparenteral dosage forms are used when parenteral (intravenous or intramuscular) dosing is not feasible. Currently available nonparenteral dosage forms have limitations in terms of usability, patient and caregiver acceptance, speed of action, and portability. Diazepam buccal film (DBF) is a compact, easily administered diazepam formulation. When placed onto the buccal mucosa inside the cheek, DBF adheres firmly and then rapidly dissolves, delivering diazepam transbucally and via the gastric route. In fasted healthy male volunteers, plasma levels were achieved rapidly after DBF placement in a linear dose-proportional fashion. Bioavailability in adult patients with epilepsy was not significantly different when DBF was applied interictally or periictally (within 5 min of a seizure). Diazepam buccal film was successfully placed and generally used without difficulty, even without patient cooperation immediately after a seizure. In a crossover comparative study with diazepam rectal gel (Diastat®) in adult patients with epilepsy, DBF performed equivalently to the rectal gel, but peak exposures were less variable. Diazepam buccal film is a convenient alternative for out-of-hospital treatment of seizure exacerbations. Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.
Topics: Acute Disease; Administration, Buccal; Anticonvulsants; Diazepam; Humans; Seizures
PubMed: 31699662
DOI: 10.1016/j.yebeh.2019.106537 -
Current Opinion in Oncology Jul 2020The value of adjuvant chemotherapy in rectal cancer is controversial with opinions varying from 'not be used' since randomized trials have not shown significant gains to... (Review)
Review
PURPOSE OF REVIEW
The value of adjuvant chemotherapy in rectal cancer is controversial with opinions varying from 'not be used' since randomized trials have not shown significant gains to 'be used as in colon cancer' as the need is the same and colon and rectal cancers are quite similar. This review will look upon data critically and with open eyes.
RECENT FINDINGS
With the exception of one randomized phase II trial (ADORE) revealing a significant gain in disease-free survival using one more effective regimen (mFOLFOX) than bolus 5-fluorouracil leucovorin, no new data have been presented. However, bringing up aspects in previous trials, either considered irrelevant for the present situation or overall negative, of what adjuvant treatment can achieve, a small reduction (hazard ratio about 0.8) in the risk of recurrence is present. This reduction is not fundamentally different from that in colon cancer considering that adjuvant treatment for rectal cancer cannot be initiated as rapidly as it can after a colon cancer diagnosis.
SUMMARY
Adjuvant chemotherapy after rectal cancer surgery reduces recurrence risks but the benefit is limited and for most patients not clinically relevant. Neoadjuvant therapy can be more effective but results from randomized trials are not yet available.
Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Clinical Trials, Phase II as Topic; Fluorouracil; Humans; Leucovorin; Organoplatinum Compounds; Oxaliplatin; Randomized Controlled Trials as Topic; Rectal Neoplasms
PubMed: 32541328
DOI: 10.1097/CCO.0000000000000641 -
Journal of Inflammation Research 2021The effective colon drug delivery remains to be an international frontier research in inflammatory bowel disease (IBD) therapy. The exploration and research of... (Review)
Review
The effective colon drug delivery remains to be an international frontier research in inflammatory bowel disease (IBD) therapy. The exploration and research of nanocarrier-based nanomedicine with great potential brings new opportunities for IBD therapy and diagnoses. Functional nanocarriers with varying morphology and characteristics can not only effectively avoid the destruction of the complex gastrointestinal (GI) tract microenvironment but also endow drugs with target therapy and improved bioavailability, thus elevating therapeutic efficacy. In this review, we illustrated several challenges in IBD therapy, then emphasis on some latest research progress of nanoparticles based therapy of oral administration, rectal administration and parenteral administration, as well as IBD diagnoses. Finally, we described the future perspective of nanocarriers in the treatment and diagnoses of IBD.
PubMed: 33953597
DOI: 10.2147/JIR.S304101 -
Parasite Immunology Nov 2020The possibility of manipulating the immune response in lambs to the gastrointestinal nematode Trichostrongylus colubriformis to reduce production losses associated with...
BACKGROUND AND OBJECTIVES
The possibility of manipulating the immune response in lambs to the gastrointestinal nematode Trichostrongylus colubriformis to reduce production losses associated with infection was investigated. In a series of four experiments, attempts to immunize sheep via the mucosal route to modify the immune response and induce mucosal tolerance are outlined. Initially, a proof of concept study was conducted with lambs being injected with multiple doses of a somatic T colubriformis antigen without an adjuvant in the rectal submucosa and subsequently challenged with T colubriformis L3 larvae. This was followed by a dose-response study comparing different antigen doses to identify the optimum dose of the nematode antigen for successful induction of mucosal tolerance. The final two studies were conducted to determine the larval stage specificity of the parasite antigen and the most suitable site of delivery required to stimulate mucosal tolerance.
METHODS
In the proof of concept study, lambs either received repeated injections in the rectal submucosa at 3 × weekly intervals with 15 µg of L3, 11 µg of L4 and 21 µg of immature adult (L5) somatic T colubriformis antigens (ANT) or not (INF) prior to infection with T colubriformis. In the dose-rate study, antigen dose rates of 100%, 50%, 10%, 1% or 0% of the antigen concentration used in the proof of concept study were compared while the larval stage study compared antigen from either L3, L4, L5 stages or combination of all (COMB) and the route of administration study compared antigen delivery into either the rectal submucosa (RE) or sub-cutaneous injection (SC).
RESULTS
During infection, lamb growth was improved by antigen treatment between days 21 and 42 in the proof of concept study (P = .009), for groups 10%, 50% and 100% in the dose-rate study (P < .05 for all) and in RE in the route of administration study with no improvement observed in the larval stage study. No differences in faecal egg counts were observed (P > .05 for all). Parasite-specific IgA and IgE showed a dose-response (the dose-rate study), were not affected by larval stage (the larval stage study) and were greater in RE than SC (the route of administration study). IL-4 production following lymphocyte stimulation was greatest in COMB (the larval stage study) and RE (the route of administration study).
CONCLUSIONS
Although antigen treatment improved performance, this was inconsistent and appeared to stimulate immunity rather than induce tolerance. Combined larval stages were more efficient than individual stages, and intra-rectal administration was more effective than sub-cutaneous.
Topics: Animals; Antibodies, Helminth; Antigens, Helminth; Desensitization, Immunologic; Feces; Female; Gastrointestinal Tract; Immunity; Immunization; Larva; Lymphocyte Activation; Male; Sheep; Sheep Diseases; Trichostrongylosis; Trichostrongylus
PubMed: 32672355
DOI: 10.1111/pim.12776 -
Seizure Feb 2021We report our experience with topiramate rectal suspensions in a single center case series of three patients <1 year of age from 2017 to 2020 who received topiramate...
We report our experience with topiramate rectal suspensions in a single center case series of three patients <1 year of age from 2017 to 2020 who received topiramate per rectum after being placed nil per os (NPO) status at a free standing children's hospital. The objective was to describe the compounding methods and clinical outcomes of three of the youngest patients to receive topiramate rectal suspensions. All three patients received topiramate per rectum for 2-4 days. No adverse effects or increase in seizure frequency were noted. For patients placed on NPO status, there is currently no alternative to oral topiramate. No studies describe per rectum topiramate use in pediatrics. Rectal administration of topiramate is not only useful in times when patients are NPO, but may also be useful when patients on topiramate experience status epilepticus. The formulation of topiramate suppositories should be explored in the future. Until further information is available, dose substitution should be done carefully with close supervision by a healthcare provider.
Topics: Anticonvulsants; Child; Fructose; Humans; Pediatrics; Suspensions; Topiramate; Treatment Outcome
PubMed: 33418165
DOI: 10.1016/j.seizure.2020.12.022 -
Drug Testing and Analysis Nov 2022The rectal administration of glucocorticoids, as well as any injectable, and oral ones, is currently prohibited by the World Anti-Doping Agency when occurs "in...
The rectal administration of glucocorticoids, as well as any injectable, and oral ones, is currently prohibited by the World Anti-Doping Agency when occurs "in competition." A reporting level of 100 ng/ml for prednisolone and 300 ng/ml for prednisone was established to discriminate the allowed and the prohibited administration. Here, the urinary excretion profiles of prednisone and prednisolone were evaluated in five volunteers in therapy with glucocorticoid-based rectal formulations containing prednisone or prednisolone caproate. The urinary levels of the excreted target compounds were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) following the procedure validated and currently in use in our laboratory to detect and quantitate glucocorticoids in urine. Predictably, the excretion trend of the analytes of interest were generally comparable with those obtained after oral administration, even if the excretion profile showed a broad interindividual variability, with the absorption rate and the systemic bioavailability after rectal administration being strongly influenced by the type of formulations (suppository or rectal cream, in our case) as well as the physiological conditions of the absorption area. Results showed that the target compounds were detectable for at least 30 h after drug administration. After suppository administration, prednisolone levels reached the maximum after 3 h from drug administration and then dropped below the reporting level after 15-21 h; prednisone reached the maximum after 3 h from drug administration, and then dropped below the reporting level after 12-15 h. After cream administration, both prednisone and prednisolone levels remained in a concentration below the reporting level throughout the entire monitored period.
Topics: Humans; Prednisolone; Prednisone; Chromatography, Liquid; Administration, Rectal; Tandem Mass Spectrometry; Glucocorticoids; Administration, Oral
PubMed: 35921255
DOI: 10.1002/dta.3352