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BioImpacts : BI 2023Medications used to treat oral ulcers include corticosteroids, anesthetics, and antihistamines. These can be used as gels, mouthwashes, pastes, ointments, etc....
INTRODUCTION
Medications used to treat oral ulcers include corticosteroids, anesthetics, and antihistamines. These can be used as gels, mouthwashes, pastes, ointments, etc. Diphenhydramine hydrochloride (DPH) has local anesthetic properties that can help treat the aphthae. One of the drawbacks of the delivery to the transmucosal is the quick turnaround time of the gel, a mucous form that is located on the epithelial film surface.
METHODS
Therefore, it seems that the preparation of a carrier that has the characteristics of adhesive mucus can increase the duration of drug retention on the mucous surface. To solve this problem, mesoporous silica nanoparticles (MSNPs) were synthesized and functionalized with amino and thiol groups and suggested as a system of drug delivery. The properties and structure of MSNPs were investigated by dynamic light scattering (DLS), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS), thermal gravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), and nitrogen adsorption-desorption isotherms (BET).
RESULTS
Our outcomes indicated that the average sizes of bare MSNPs (MSN), amino modified MSNPs (MSN-NH2), and thiol modified MSNPs (MSN-SH) were obtained to be 611, 655, and 655 nm respectively and the average pore size of MSN, MSN-NH2, and MSN-SH were about 2.42 nm, 2.42 nm, and 2.44 nm, respectively, according to the BJH (Barrett-Joyner-Halenda) pore size distribution. The release kinetics and release of DPH from mesoporous silica carriers were evaluated.
CONCLUSION
Eventually, the mucoadhesive study and DPH-loaded particles were investigated. Also, the MSN-SH exhibited a high mucoadhesive capacity for buccal mucosa compared with MSN-NH2 and MSN.
PubMed: 38022378
DOI: 10.34172/bi.2023.27548 -
Journal of Pharmaceutical Policy and... Nov 2023A comprehensive guideline named "Diagnostic Therapeutic Flow Chart for Covid-19″ (DTFC) was released by the Scientific Committee of Covid-19 of Iran's Ministry of...
BACKGROUND
A comprehensive guideline named "Diagnostic Therapeutic Flow Chart for Covid-19″ (DTFC) was released by the Scientific Committee of Covid-19 of Iran's Ministry of Health and Medical Education and regularly was updated. The aim of this study was to compare the prescription pattern of drug treatment in outpatient Covid-19 patients with the DTFC.
METHODS
A cross-sectional study was conducted on the prescription pattern of drugs given to outpatients with a diagnosis of Covid-19, in Isfahan City from June to September 2021 (concurrent with the fifth peak of Covid-19 in Iran) taking into account the recommendations of the 9th version of DTFC (December 2020). A total of 8250 prescriptions were retrieved from the Public Health Department of Isfahan City.
RESULTS
Famotidine 20, 40 mg tablets (N = 936 patients) was the most prescribed drug followed by dexamethasone ampule (N = 588), prednisolone 5, 50 mg tablets (N = 478), azithromycin 250, 500 mg capsules (N = 452), diphenhydramine syrup (N = 362), vitamin D3 soft gel 50,000 Iu (N = 526), naproxen 250, 500 mg tablets (N = 266) and favipiravir 200 mg tablet (N = 191). The following drugs were administered against the recommendation of the DTFC-9: azithromycin, favipiravir, remdesivir, cetirizine, corticosteroids, vitamin C, vitamin B12, multivitamins, proton pump inhibitors (e.g., omperazole, anticoagulants (rivaroxaban,….), aspirin and ivermectin. Administration of analgesics, famotidine, hydroxychloroquine, vitamin D3, diphenhydramine and statins were in concordance with the DTFC-9.
CONCLUSION
In this study, we showed frequent use of drugs with unproven efficacy in outpatient cases of Covid-19 mostly attributed to corticosteroids and antibiotics use. Our research highlights the discrepancy between recommendations for care and clinical practice and the need for strategy to bridge gaps in evidence-based informed decision-making.
PubMed: 38012696
DOI: 10.1186/s40545-023-00672-8 -
PloS One 2023On July 1st, 2021, the University of Colorado Hospital (UCH) implemented new sedation protocols in the luminal gastrointestinal (GI) suite. GI proceduralist supervised,...
BACKGROUND
On July 1st, 2021, the University of Colorado Hospital (UCH) implemented new sedation protocols in the luminal gastrointestinal (GI) suite. GI proceduralist supervised, Nurse Administered Sedation with fentanyl, midazolam, and diphenhydramine (NAS) sedation was transitioned to Monitored Anesthesia Care with propofol under physician anesthesiologist supervision (MAC).
OBJECTIVE
To determine if there are statistically significant reductions in Sedation-Start to Scope-In time (SSSI) when using Monitored Anesthesia Care with propofol (MAC) versus Nurse Administered Sedation with fentanyl, midazolam, and diphenhydramine (NAS). Secondary objectives were to determine if statistically significant improvements to other operational times, quality measures, and satisfaction metrics were present.
METHOD
This study was a retrospective analysis of a natural experiment resultant of a change from NAS to MAC sedation protocols. Outcomes for NAS protocols from 1/1/21-6/30/21 were compared to outcomes of MAC protocols from the dates 8/1/21-10/31/21. Results were analyzed using Quasi-Poisson regression analysis and stratified based on upper GI, lower GI, and combined procedures. Patient demographic data including age, biological sex, comorbidities, and BMI, were adjusted for in the analysis. ASA matching was not performed as nursing sedation does not use ASA classifications. Pre-anesthesia co-morbidities were assessed via evaluation of a strict set of comorbidities abstracted from the electronic medical record. Perioperative operational outcomes include Sedation Start to Scope-In (SSSI), In-Room to Scope-In Time (IRSI), Scope Out to Out of Room (SOOR), Total Case Length (TCL), and Post Anesthesia Care Unit Length of Stay (PACU LOS). Quality outcomes include PACU Administered Medications (PAM), and Clinician Satisfaction Scores (CSS).
RESULTS
A total of 5,582 gastrointestinal (GI) endoscopic cases (upper, lower, and combined endoscopies) were observed. Statistically significant decreases in SSSI of 2.5, 2.1, and 2.2 minutes for upper, lower, and dual GI procedures were observed when using MAC protocols. A statistically significant increase in satisfaction scores of 47.0 and 19.6 points were observed for nurses and proceduralists, respectively, when using MAC.
CONCLUSION
MAC protocols for endoscopic GI procedures at UCH led to statistically significant decreases in the time required to complete procedures thus increasing operational efficiency.
Topics: Humans; Midazolam; Propofol; Fentanyl; Hypnotics and Sedatives; Diphenhydramine; Retrospective Studies; Colonoscopy; Academic Medical Centers; Anesthesia; Conscious Sedation
PubMed: 38011117
DOI: 10.1371/journal.pone.0294418 -
International Journal of Molecular... Oct 2023The emergence of lethal coronaviruses follows a periodic pattern which suggests a recurring cycle of outbreaks. It remains uncertain as to when the next lethal...
The emergence of lethal coronaviruses follows a periodic pattern which suggests a recurring cycle of outbreaks. It remains uncertain as to when the next lethal coronavirus will emerge, though its eventual emergence appears to be inevitable. New mutations in evolving SARS-CoV-2 variants have provided resistance to current antiviral drugs, monoclonal antibodies, and vaccines, reducing their therapeutic efficacy. This underscores the urgent need to investigate alternative therapeutic approaches. Sigma receptors have been unexpectedly linked to the SARS-CoV-2 life cycle due to the direct antiviral effect of their ligands. Coronavirus-induced cell stress facilitates the formation of an ER-derived complex conducive to its replication. Sigma receptor ligands are believed to prevent the formation of this complex. Repurposing FDA-approved drugs for COVID-19 offers a timely and cost-efficient strategy to find treatments with established safety profiles. Notably, diphenhydramine, a sigma receptor ligand, is thought to counteract the virus by inhibiting the creation of ER-derived replication vesicles. Furthermore, lactoferrin, a well-characterized immunomodulatory protein, has shown antiviral efficacy against SARS-CoV-2 both in laboratory settings and in living organisms. In the present study, we aimed to explore the impact of sigma receptor ligands on SARS-CoV-2-induced mortality in ACE2-transgenic mice. We assessed the effects of an investigational antiviral drug combination comprising a sigma receptor ligand and an immunomodulatory protein. Mice treated with sigma-2 receptor ligands or diphenhydramine and lactoferrin exhibited improved survival rates and rapid rebound in mass following the SARS-CoV-2 challenge compared to mock-treated animals. Clinical translation of these findings may support the discovery of new treatment and research strategies for SARS-CoV-2.
Topics: Animals; Mice; SARS-CoV-2; COVID-19; Receptors, sigma; Antiviral Agents; Lactoferrin; Ligands; Diphenhydramine
PubMed: 37958703
DOI: 10.3390/ijms242115718 -
Cureus Sep 2023Anaphylaxis due to magnesium sulfate is uncommon with very few reported cases. We report a case of a 28-year-old female who had low serum magnesium and was given...
Anaphylaxis due to magnesium sulfate is uncommon with very few reported cases. We report a case of a 28-year-old female who had low serum magnesium and was given magnesium sulfate. She developed pruritic urticarial rash, hypoxemia, and stridor. Anaphylaxis was diagnosed, and she received epinephrine, diphenhydramine, and oxygen therapy causing resolution. The study also discusses similar published cases and their presentation and treatment. We have briefly overviewed the clinical criteria for the diagnosis of anaphylaxis. The study also intends to make the clinician consider anaphylaxis while administering magnesium sulfate for any reason.
PubMed: 37900406
DOI: 10.7759/cureus.46071 -
Advances in Therapy Jan 2024Sleep deficit or poor sleep leads to ill-health, whereas sleep deprivation for longer periods of time increases the risk of developing adverse conditions associated with... (Randomized Controlled Trial)
Randomized Controlled Trial
Standardized Extract of Valeriana officinalis Improves Overall Sleep Quality in Human Subjects with Sleep Complaints: A Randomized, Double-Blind, Placebo-Controlled, Clinical Study.
INTRODUCTION
Sleep deficit or poor sleep leads to ill-health, whereas sleep deprivation for longer periods of time increases the risk of developing adverse conditions associated with poor quality of life, and high socioeconomic impact. The treatments for sleep disturbances include melatonin and over-the-counter medicines like diphenhydramine and doxylamine, all of which have negative side effects. Valerian (Valeriana officinalis L.) is a traditional herb and the most preferred alternate sleep solution to manage sleep complaints.
METHODS
Eighty adult subjects with sleep complaints were randomized in 1:1 ratio to receive either V. officinalis extract (VE) or placebo for 8 weeks in a double-blind, placebo-controlled, parallel, clinical study. Primary efficacy endpoints included the Pittsburgh Sleep Quality Index (PSQI) and sleep latency using wrist actigraphy (WA), as well as a number of secondary endpoints, including sleep parameters such as actual sleep time and sleep efficiency using WA, the Epworth Sleepiness Scale (ESS), the Beck Anxiety Inventory (BAI), the Visual Analogue Scale (VAS) for the feeling of waking up refreshed, and a tertiary endpoint of sleep parameters using polysomnography (PSG) in a subset of 20 subjects per group. Safety parameters included physical examination, vital sign measurements, hematology, and clinical chemistry tests. Adverse events and serious adverse events were monitored throughout the study period.
RESULTS
Seventy-two subjects (35 and 37 subjects in the placebo and VE groups, respectively) completed the study and were included in the efficacy assessments. On Days 14, 28, and 56, the PSQI Total Score in the VE group decreased significantly (p < 0.05) compared to the placebo group. Further, the VE group showed significant improvements (p < 0.05) in sleep latency and actual sleep time on Days 3, 14, 28, and 56, and sleep efficiency on Days 14, 28, and 56, as evaluated by WA. There was a decrease (p < 0.05) in anxiety (BAI) on Days 14, 28, and 56, daytime drowsiness (ESS) on Days 28 and 56, and an increased feeling of waking up refreshed (VAS) on Days 28 and 56 compared to placebo. PSG results carried out in subset of subjects revealed significant improvements (p < 0.05) in total sleep time, sleep latency, and sleep efficiency on Day 56 in the VE group compared to the placebo group. No safety concerns were observed throughout the study.
CONCLUSION
VE supplementation significantly improved various subjective and objective parameters of sleep in young subjects with mild insomnia symptoms, such as overall sleep quality, sleep latency, sleep efficiency, and total sleep time. We also observed decreased anxiety and daytime sleepiness, and improved feeling of being refreshed after waking up with VE supplementation. VE was found to be safe and well tolerated throughout the study.
TRIAL REGISTRATION
Clinical Trials Registry of India: CTRI/2022/05/042818.
Topics: Adult; Humans; Valerian; Sleep Quality; Quality of Life; Sleep; Sleep Initiation and Maintenance Disorders; Plant Extracts; Research Subjects; Double-Blind Method; Treatment Outcome
PubMed: 37899385
DOI: 10.1007/s12325-023-02708-6 -
Journal of Environmental Health Science... Dec 2023This study investigated photocatalytic degradation of pharmaceutical compound using CuO or PdO-TiO membrane. The synthesized membranes were characterized by some...
This study investigated photocatalytic degradation of pharmaceutical compound using CuO or PdO-TiO membrane. The synthesized membranes were characterized by some techniques including X-ray powder diffraction (XRD), dynamic light scattering (DLS), scanning electron microscopy (SEM), and Fourier-transform infrared spectroscopy (FT-IR). The structural properties confirmed that the photocatalytic membranes were successfully prepared on ceramic supports. The PdO-TiO and CuO-TiO membranes were employed as photocatalytic membranes to degrade metronidazole (MNZ) and diphenhydramine (DPH) in aqueous solutions, respectively. Some parameters affecting the photocatalytic reaction such as pH, initial concentration, and light source were also investigated. The maximum degradation for both pharmaceutical compounds was obtained at basic pH (pH = 10), low initial concentration (C = 10 ppm) under UV irradiation. At high transmembrane pressure (ΔP = 3 bar), the flow rate across the membrane increased up 0.0078 and 0.0082 cc/s.cm for CuO-TiO and PdO-TiO photocatalytic membrane respectively while not affected on degradation efficiency (DE). At the same condition operation (C = 10 ppm, pH = 10, ΔP = 2 bar under UV irradiation), the MNZ and DPH degradation of the PdO-TiO membrane was 94 and 95% respectively that relatively higher than the CuO-TiO membrane. It is probably due to the lower energy band gap of PdO-TiO (2.5 eV) than CuO-TiO (2.7 eV). The membrane stability tests confirmed the high performance of the prepared membranes.
PubMed: 37869601
DOI: 10.1007/s40201-023-00866-x -
The Journal of International Medical... Oct 2023Drug overdose can lead to a range of symptoms, including potentially life-threatening cardiac arrhythmias. However, identifying the specific causative drug upon...
Diphenhydramine overdose detected early by integration of toxidrome and electrocardiography and treated with venoarterial extracorporeal membrane oxygenation: a case report.
Drug overdose can lead to a range of symptoms, including potentially life-threatening cardiac arrhythmias. However, identifying the specific causative drug upon admission can be challenging in many cases. The toxidrome approach is a method that utilizes toxidromes, which are collections of findings obtained from physical examination and ancillary tests, that may be caused by a specific toxin. In this particular case, a man presented with an unknown drug overdose that caused symptoms indicative of anticholinergic effects and abnormal electrocardiogram (ECG) findings. The ECG revealed an R wave in lead aVR, S waves in leads I and aVL, and wide QRS tachycardia with a Brugada pattern. Shortly after arrival, the patient developed cardiac arrest due to a lethal arrhythmia. Prompt initiation of venoarterial extracorporeal cardiopulmonary membrane oxygenation (VA-ECMO) was performed. Fortunately, the patient achieved full neurological recovery, and the overdosed drug was identified as diphenhydramine. When diagnosing and treating drug overdose caused by an unidentified substance, diphenhydramine toxicity should be considered when an anticholinergic toxidrome is present and a Brugada pattern is observed on the ECG. VA-ECMO demonstrates potential as a viable treatment option when initial interventions prove ineffective.
Topics: Male; Humans; Extracorporeal Membrane Oxygenation; Diphenhydramine; Arrhythmias, Cardiac; Electrocardiography; Drug Overdose; Cholinergic Antagonists
PubMed: 37843498
DOI: 10.1177/03000605231205449 -
Cureus Sep 2023Kounis syndrome (KS) is an acute coronary syndrome triggered by allergic or anaphylactic reactions. It manifests as coronary artery vasospasm, acute myocardial...
Kounis syndrome (KS) is an acute coronary syndrome triggered by allergic or anaphylactic reactions. It manifests as coronary artery vasospasm, acute myocardial infarction, or coronary stent thrombosis, resulting from inflammatory cytokine release and inappropriate activation of platelets and mast cells. We present a case of an 85-year-old male with Crohn's disease who suffered anaphylaxis during infliximab infusion, culminating in non-ST myocardial infarction (NSTEMI). The patient's symptoms were effectively managed with epinephrine and diphenhydramine, and KS secondary to infliximab was diagnosed. Diagnosing KS can be challenging due to the overlapping signs of an allergic reaction and myocardial infarction. Timely recognition and appropriate management of KS are crucial to enhance patient outcomes. Therefore, healthcare providers should maintain a high index of suspicion for KS in patients with acute coronary syndromes linked to allergic reactions to optimize care and minimize potential risks. This case report underscores the significance of prompt intervention and awareness of Kounis syndrome in clinical practice.
PubMed: 37809202
DOI: 10.7759/cureus.44704 -
Radiology Case Reports Dec 2023A 28-year-old man was brought to the emergency room (ER) with a history of decrease of consciousness 30 minutes before admission. In the previous 1 hour, the patient...
A 28-year-old man was brought to the emergency room (ER) with a history of decrease of consciousness 30 minutes before admission. In the previous 1 hour, the patient felt bitten or stabbed in the left temple area. Physical examination showed signs of N VII paresis, upper extremity motoric 3/2 (right/left) and lower extremity 3/2 (right/left), positive left extremity hypesthesia. Noncontrast MRI brain examination showed increased DWI signal intensity, suggesting diffusion restriction in bilateral centrum semiovale, bilateral posterior crus internal capsule, and bilateral corpus callosum leading to suspicion of acute-hyperacute ischemia. The therapy given while in the emergency room was IVFD asering, IV dexamethasone 5 mg, IV diphenhydramine 10 mg, oral paracetamol 500 mg, oral aspirin 80 mg, oral clopidogrel 75 mg, and oral atorvastatin 40 mg. We report a case of stroke due to an anaphylactic reaction in an effort to add to the point of view if the same case occurs.
PubMed: 37789922
DOI: 10.1016/j.radcr.2023.08.110