Determinants of COVID-19 vaccine acceptance and encountered side-effects among the vaccinated in Bangladesh

Objective:To identify the acceptance of the vaccine based on factors influencing the vaccination program and the side effects from vaccinated people.Methods:A cross-sectional online survey of 1529 Bangladeshi adults(≥18 years)was conducted between 17 April,2021 and 26 April,2021.Statistical analysis of the data included Chi-square test and multinomial logistic regression analysis.Results:In total,67.04%of the participants were willing to accept a COVID-19 vaccine,and 45.00%of them in our study had already received.Overall Bangladeshi people were more likely to accept COVID-19 vaccine if the vaccine reduces risk of infectious disease and has no associated health risk after receiving it.Among the respondents,religions,education level,living area(urban),belif that vaccines protect against infectious diseases and vaccines do not have health-related risk and vaccination was significantly associated with the acceptance of COVID-19 vaccines.Conversely,people’s perception on development of natural immunity rather than receiving vaccines was also positively reflected.More than half(57.41%)reported minor side effects such as fever,muscle pain and headache after getting vaccine shots.Conclusions:This study revealed that the acceptance rate was influenced by socio-demographic and health-related characteristics and people are not afraid of this vaccine if they faced minor side effects after receiving it.These findings might help the government and policymakers of Bangladesh to implement necessary steps to accomplish this vaccination program effectively.

Clinical study of Shenqi Fuzheng injection decreasing side-effects of chemotherapy for patients with ovarian epithelial cancer

Objective: The aim of the study was to observe the clinical effects of Shenqi Fuzheng injection decreasing sideeffects of chemotherapy for patients with ovarian epithelial cancer. Methods: The 36 cases of ovarian epithelial cancer in The Third Affiliated Hospital of SUN Yat-sen University(Guangzhou, China) from June 2010 to June 2013, were randomly divided into the study group and the control group. The study group contained 18 cases using Shenqi Fuzheng injection combined with TP(Taxol + Carboplatin/cisplatin) chemotherapy, and the control group contained 18 cases only using TP chemotherapy without Shenqi Fuzheng injection. During and after chemotherapy, the side-effects and therapy effects were observed. Results: The grade II of nausea and vomit were less in the study group than that in the control group, which was significantly different(P < 0.05). But there were no significantly differences in grade I of nausea and vomit between the two groups(P > 0.05). There was less degree of decrease of lymphocyte in the study group than that in the control group, which was significantly different(P < 0.05). But between two groups, there were no significant differences in the drop of white blood cells and red blood cells, the incidence of allergic reaction, liver and renal functions, nerve lesion and phalacrosis(P > 0.05). There was no significant difference in chemotherapy effect between the two groups(P > 0.05). Conclusion: Shenqi Fuzheng injection can in some degree relieve the side effects of TP chemotherapy for the patients with ovarian epithelial cancer, including relieving nausea and vomiting, protecting lymphocytes, and has no conflict effect on chemotherapy efficacy.

Randomized Multi-center Study of Baofuxin for Treatment of Bleeding Side-effect Induced by IUD

To observe the efficacy of Baofuxin for treatment of bleeding side effect induced by IUD. Method The study is a multi-center trial. The subjects were randomly allocated into two groups, Baofuxin group (90 cases) and Indomethacin group (90 cases). In the Baofuxin group, the subjects took the medicine on the first day of menses, once a bag, twice a day for 10 days. In the Indomethacin group,only one capsule was taken once a time, twice a day for 7 days. The treatment was given for three menstrual cycles. The subjects were asked to record their bleeding/spotting by using menstrual diary card not only during the treatment cycles but also during the three months previous and after the treatment cycles. The menstrual profile was analyzed by using MDSv2. 3 program that was provided by WHO. Results Within each 90-day reference period of treatment and post-treatment cycles, the number of bleeding/spotting days decreased obviously and bleeding/spotting free days were greatly increased. Both medicines have little effect on number of episode of bleeding/spotting. The subjects who thought the treatment were highly effective were 81. 1% in the Baofuxin group and 56.2% in the Indomethacin group respectively (P <0.01). Conclusion Both Bat,fuxin and indomethacin are highly effective on treatment of bleeding side effect induced by IUD, but Baofuxin had longer effects and was more acceptable.

Systematic review on the risk-benefit ratio of morphine for acute heart failure

Objective:To evaluate morphine's risk-benefit profile in the treatment of acute heart failure.Method:Different electronic databases,including PubMed,MEDLINE,Cochrane Library,and Google Scholar,as well as clinicaltrails.gov,were searched for articles published between 2012 and 2022.The risk of bias in the present study was evaluated by employing randomized controlled trials(RCTs)checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups.The two-part tool was used to address the five specific domains such as selection bias,performance bias,detection bias,attrition bias,and selective reporting bias.Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software(version 5.4),a quality assessment tool.Results:A total of 13 studies were included in the present review,in which there were 5 retrospective studies,3 randomized-control studies,2 prospective studies,1 multicenter pharmacodynamics study,1 multicenter cardiac magnetic resonance imaging study,and 1 open-label,cross-over study.The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine.Conclusions:Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine.Considering the adverse effects,including mortality associated with morphine,there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure.

Melatonin’s actions are not limited to sleep

Melatonin is widely available as a supplement,usually for sleep disorders.The consumption of melatonin supplements has increased considerably in recent years.An overlooked aspect of melatonin’s administration is the resulting increase in prolactin secretion,via its action on hypothalamic dopaminergic neurons.We believe that since the effect of melatonin on prolactin is tangible,the laboratory finding of hyperprolactinemia could be encountered more often,given the increase in melatonin’s use.This is an issue that merits further study.

Gastro-intestinal toxicity of chemotherapeutics in colorectal cancer:The role of inflammation

Chemotherapy-induced diarrhea(CID)is a common and often severe side effect experienced by colorectal cancer(CRC)patients during their treatment.As chemotherapy regimens evolve to include more efficacious agents,CID is increasingly becoming a major cause of dose limiting toxicity and merits further investigation.Inflammation is a key factor behind gastrointestinal(GI)toxicity of chemotherapy.Different chemotherapeutic agents activate a diverse range of pro-inflammatory pathways culminating in distinct histopathological changes in the small intestine and colonic mucosa.Here we review the current understanding of the mechanisms behind GI toxicity and the mucositis associated with systemic treatment of CRC.Insights into the inflammatory response activated during this process gained from various models of GI toxicity are discussed.The inflammatory processes contributing to the GI toxicity of chemotherapeutic agents are increasingly being recognised as having an important role in the development of anti-tumor immunity,thus conferring added benefit against tumor recurrence and improving patient survival.We review the basic mechanisms involved in the promotion of immunogenic cell death and its relevance in the treatment of colorectal cancer.Finally,the impact of CID on patient outcomes and therapeutic strategies to prevent or minimise the effect of GI toxicity and mucositis are discussed.

Combined sevoflurane-dexmedetomidine and nerve blockade on post-surgical serum oxidative stress biomarker levels in thyroid cancer patients

BACKGROUND The incidence of thyroid cancer is increasing annually.Clinical routine thyroid surgery can be performed under a cervical plexus block,but cannot mediate the stress response during the surgery.If thyroid surgery is performed under nerve block,an inappropriate level of blockade may occur.Similarly,the stress response caused by surgery is more serious than that caused by conventional anesthesia.Therefore,it is important to combine blockade with more effective anesthesia methods.AIM To investigate the effects of combining sevoflurane-dexmedetomidine inhalation general anesthesia with the cervical plexus nerve block on the post-surgical levels of the serum oxidative stress biomarkers levels in thyroid cancer patients.METHODS We enrolled 96 thyroid cancer patients admitted to the hospital between January 2019 and December 2020.Participants were divided into a control group(n=47)and an experimental group(n=49).The experimental group received a combination of inhaled sevoflurane-dexmedetomidine and cervical plexus block,while the control group received conventional general anesthesia.The groups were compared for serum levels of monocyte chemotactic protein-1(MCP-1)and glutathione peroxidase(GSH-Px)before and after surgery,and the adrenocorticotropic hormone(ACTH)and norepinephrine(NE)levels at 1 and 12 h postsurgery.The Bispectral index(BIS)and the incidence of anesthesia side effects were also compared.RESULTS Following surgery,MCP-1 was significantly lower in the experimental group compared to the control group,whereas GSH-Px was significantly higher than that in the control group(P<0.001).The serum ACTH and NE levels were significantly lower in the experimental group than those the control group at 1 and 12 h post-surgery(P<0.001).BIS was significantly lower in the experimental group than that in the control group at 20 minutes into the operation,but the direction of the difference was reversed at eye opening(P<0.001).The incidence of side effects was 10.20%(5/49)and 12.76%(6/47)in the experimental and control groups,respectively,the difference being non-significant.CONCLUSION Sevoflurane-dexmedetomidine inhalation general anesthesia combined with cervical plexus nerve block can reduce the postoperative stress and inflammatory responses in thyroid cancer patients,while maintaining high anesthesia effectiveness and safety.

Salient concerns in using analgesia for cancer pain among outpatients: A cluster analysis study

AIM To identify unique clusters of patients based on their concerns in using analgesia for cancer pain and predictors of the cluster membership.METHODS This was a 3-mo prospective observational study(n = 207).Patients were included if they were adults(≥ 18 years), diagnosed with solid tumors or multiple myelomas, and had at least one prescription of around the clock pain medication for cancer or cancer-treatment-related pain.Patients were recruited from two outpatient medical oncology clinics within a large health system in Philadelphia.A choice-based conjoint(CBC) analysis experiment was used to elicit analgesic treatment preferences(utilities).Patients employed trade-offs based on five analgesic attributes(percent relief from analgesics, type of analgesic, type of sideeffects, severity of side-effects, out of pocket cost).Patients were clustered based on CBC utilities using novel adaptive statistical methods.Multiple logistic regression was used to identify predictors of cluster membership.RESULTS The analyses found 4 unique clusters: Most patients made trade-offs based on the expectation of pain relief(cluster 1, 41%).For a subset, the main underlying concern was type of analgesic prescribed, i.e., opioid vs non-opioid(cluster 2, 11%) and type of analgesic side effects(cluster 4, 21%), respectively.About one in four made trade-offs based on multiple concerns simultaneously including pain relief, type of side effects, and severity of side effects(cluster 3, 27.5%).In multivariable analysis, to identify predictors of cluster membership, clinical and socioeconomic factors(education, health literacy, income, social support) rather than analgesic attitudes and beliefs were found important; only the belief, i.e., pain medications can mask changes in health or keep you from knowing what is going on in your body was found significant in predicting two of the four clusters [cluster 1(-); cluster 4(+)].CONCLUSION Most patients appear to be driven by a single salient concern in using analgesia for cancer pain.Addressing these concerns, perhaps through real time clinical assessments, may improve patients' analgesic adherence patterns and cancer pain outcomes.

Rifaximin therapy and hepatic encephalopathy:Pros and cons

Hepatic encephalopathy(HE) is the second most common major complication in cirrhotics and it significantly impacts quality of life.Therapeutic approaches for HE treatment and prevention mainly continue to rely on ammonia-lowering strategies and non-absorbable disaccharides are currently considered the cornerstone therapy.Non-absorbable antibiotics,such as neomycin and paramomycin,are effective in treatment of acute HE episodes but their prolonged use for recurrence prevention is hampered by possible side-effects.To overcome these limitations,rifaximin use has been proposed.Rifaximin has been shown to be not superior to non-absorbable disaccharides for either HE treatment or prevention,with a similar incidence of side-effects.Cirrhosis significantly increases rifaximin absorption and this could be a cause for concern.Following long-term rifaximin therapy,Clostridium difficile colitis has been observed and Candida albicans has been isolated from 20% of patients.In addition,selection of resistant mutants of both Gram-negative and-positive bacteria in the gastrointestinal tract cannot be definitely ruled out.Electrolyte alterations(sodium and potassium) have been reported during rifaximin therapy,a warning for its long-term use in cirrhotics.Moreover,a potential interference with vitamin K production should be considered which could further impair the already altered clotting status of these patients.The therapeutic cost of rifaximin is markedly higher than non-absorbable disaccharides.While waiting for further safety data,caution should be used to limit the use of rifaximin therapy for a very short-term period in selected HE cirrhotics not responding to nonabsorbable disaccharides.

Rebuilding trust in proton pump inhibitor therapy

Introduction of proton pump inhibitor(PPI)therapy into clinical practice has revolutionized treatment approach to acid-related diseases.With its clinical success came a widespread use of PPI therapy.Subsequently,several studies found that PPIs were oftentimes overprescribed in primary care and emergency setting,likely attributed to seemingly low side-effect profile and physicians having low threshold to initiate therapy.However,now there is a growing concern over PPI side-effect profile among both patients and providers.We would like to bring more awareness to the currently available guidelines on PPI use,discuss clinical indications for PPIs and the evidence behind the reported sideeffects.We hope that increased awareness of proper PPI use will make the initiation or continuation of therapy a well informed and an evidence-based decision between patient and physician.We also hope that discussing evidence behind the reported side-effect profile will help clarify the growing concerns over PPI therapy.

Mathematical Reasoning of Treatment Principle Based on “Yin Yang Wu Xing” Theory in Traditional Chinese Medicine (II)

By using mathematical reasoning, this paper demonstrates the treatment principle: “Do not treat a disease after it has occurred. But treat the disease before it will occur” (不治已病治未病) based on “Yin Yang Wu Xing” Theory in Traditional Chinese Medicine (TCM). We defined generalized relations and reasoning, introduced the concept of generalized steady multilateral systems, and discussed its energy properties. Later based on the treatment of TCM and treated the healthy body as a steady multilateral system, it has been proved that the treatment principle above is true. The kernel of this paper is the existence and reasoning of the non-compatibility relations in steady multilateral systems, and it accords with the oriental thinking model.

The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns

Cardio-vascular specialists have witnessed and actively participated in the revolutionary developments that have occurred in their field of specialization over the last few years. Cutting-edge technologies have led to dramatic improvements in life-expectancy and quality of life. An open-mind and pioneering attitude are necessary when exploring new frontiers to improve our patients’ health. However, naive indiscriminate acceptance of novel mainstream therapies is not always advisable and prudence is required in unearthing harmful, covert side effects. An objective review of contemporary vascular research was performed and industrial bias was sifted out for a fresh prospective on how to promote primary cardiovascular prevention with attainable lifestyle adjustments [1]. A comprehensive review of Pubmed, EM-BASE and Cochrane review databases was undertaken for articles relating to cardiovascular primary prevention and statin side effects with the aim of harmonising their roles within contemporary clinic practice. Particular attention was paid to large-scale randomised controlled trials on contemporary cardiovascular pharmacotherapies and their specific adverse effects on metabolic pathways which feature prominently in cardiovascular primary prevention and regenerative programmes. There is a categorical lack of clinical evidence to support the use of statin therapy in primary prevention. Not only is there a dearth of evidence for primary cardiovascular protection, there is ample evidence to show that statins actually augment cardiovascular risk in women, patients with Diabetes Mellitus and in the young. Furthermore statins are associated with triple the risk of coronary artery and aortic artery calcification. Cardiovascular primary prevention and regeneration programmes, through life style changes and abstaining from tobacco use have enhanced clinical efficacy and quality of life over any pharmaceutical or other conventional intervention.

EFFECT OF ACUPUNCTURE ON IMMUNE FUNCTION OF PATIENTS TREATED WITH RADIOTHERAPY AND CHEMOTHERAPY

In comparison with the normal people group, values of blood CD2+ and CD4+ in pa-tients with mallgnant tumors treated with radiotherapy and chemotherapy were significantly lower andthe ratio of CD助+ and CD8+ decreased obviously （all P【0.001）; CD8+ had no apparent change （P】0.05）. Following acupunctural treatment, values of CD2+,CD4+ and the ratio of CD4+ to CD8+ increasedobviously （all P【0.001）; while those of the medicinal control group had no significant change aftertreatment（P】0. 05）. Values of IgG, IgA and IgM in patients’ serum presented an abnormal de-creasing or increasing tendency, and C3 in minority of patients were raised. Results indicated thatthere was a biphasic regulatory effect of acupuncture on the disturbance of humoral immunity andcould correct the deviation of C3 level; and its effect was better than or similar to that of the medicinecontrol group. It demonstrates that acupuncture can enhance and regulate. the immune function of pa-tients treated with radiotherapy

Precautions before starting tofacitinib in persons with rheumatoid arthritis

Tofacitinib is an immunosuppressive and disease-modifying therapy in rheumatoid arthritis.It may result in many infections flaring up.It is important to take precautions of all kinds(cardiovascular,malignancy,infections etc.)before starting tofacitinib.In this article,we have highlighted important steps where we need to take precautions before starting tofacitinib.

Human microbiome: From the bathroom to the bedside

The human gut contains trillions of bacteria, the major phylae of which include Bacteroidetes, Firmicutes, Actinobacteria and Proteobacteria. Fecal microbial transplantation(FMT) has been known of for manyyears but only recently has been subjected to rigorous examination. We review the evidence regarding FMT for recurrent Clostridium difficile infection which has resulted in it being an approved treatment. In addition there is some evidence for its use in both irritable bowel syndrome and inflammatory bowel disease. Further research is needed in order to define the indications for FMT and the most appropriate method of administration.

Effects of rapamycin in liver transplantation

BACKGROUND: Rapamycin is a potent new immunosuppressant with a mechanism of action that is distinct from that of calcineurin inhibitors, but few clinical data on rapamycin in liver transplantation are available. Hence it is necessary to evaluate the efficacy and side-effects of rapamycin-based immunosuppression in liver transplant patients. METHODS: We retrospectively analysed 39 liver transplantation patients who took rapamycin as an immunosuppressant. This series consisted of 28 patients with hepatocellular carcinoma, 9 patients with chronic fulminant hepatitis, and 2 patients with end-stage liver cirrhosis. Eight patients used rapamycin for monotherapy, and 31 used rapamycin-based immunosuppression. In the 31 patients, 7 patients used rapamycin instead of mycophenolate mofetil to treat acute rejection. RESULTS: In the 28 patients with hepatocellular carcinoma, the one-year survival rate was 67% without any tumor recurrence. The acute rejection in 7 patients was relieved in 1-2 weeks after the administration of rapamycin. All the 8 patients who received rapamycin monotherapy survived for at least 6 months and liver function tests and biopsy showed nothing abnormal. jaundice in 8 patients with chronic rejection was reduced sharply after use of rapamycin. CONCLUSIONS: Rapamycin given alone or in conjunction with calcineurin inhibitors appears to be an effective primary immunosuppressant regimen for orthotopic liver transplantation patients. Further studies are warranted to evaluate the efficacy and side-effect profile of rapamycin in liver transplant patients.

Assessment on Application of Chinese Herbal Medicine in the Process of Corticosterone Reduction in Nephrotic Syndrome

Objective: To evaluate the effect of Chinese herbal medicine (CHM) in the process of corticosterone (CS) reduction in nephrotic syndrome.Methods: One hundred and twenty patients of indiopathic nephrotic syndrome sensitive to prednisone treatment were divided into two groups randomly. The dosage of prednisone used was conventionally reduced in both groups but CHM herbal treatment was added to the treated group in the period of prednisone reduction. The effect of CHM was estimated by observing the recurrence rate of disease and side-effects of prednisone.Results: The recurrence rate of disease and the occurrence rate of side-effects of prednisone in the treated group were less than those in the control group significantly (P < 0.01).Conclusion: Additional CHM in the process of CS reduction in treating CS sensitive nephrotic syndrome could markedly abate the recurrence rate of disease and the side-effect of CS reduction.

Important clinical features of atypical antipsychotics in acute bipolar depression that inform routine clinical care: a review of pivotal studies with number needed to treat

English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder＂, ＂placebo＂,and ＂trial＂.The parameters of response（≥50%improvement on MADRS,Montgomery-Asberg Depression Rating Scale total score）,remission（either ≤12 or 8 on MADRS total score at endpoint）,discontinuation due to adverse events（DAEs）,somnolence,≥7%weight gain,overall extrapyramidal side-effects（EPSs）,and akathisia,were extracted from originally published primary outcome papers.The number needed to treat to benefit（NNT） for response and remission or harm（NNH） for DAEs or other side effects relative to placebo were estimated and presented with the estimate and 95%confidence interval.Olanzapine monotherapy,olanzapine-fluoxetine combination（OFC）,quetiapine-IR monotherapy,quetiapine-XR monotherapy,lurasidone monotherapy,and lurasidone adjunctive therapy were superior to placebo with NNTs for responses of 11-12,4,7-8,4,4-5,and 7,and NNTs for remission of 11-12,4,5-11,7,6-7,and 6,respectively.There was no significant difference between OFC and lamotrigine,and between aripiprazole or ziprasidone and placebo in response and remission.Olanzapine monotherapy,quetiapine-IR,quetiapine-XR,aripiprazole,and ziprasidone 120-160 mg/day had significantly increased risk for DAEs with NNHs of 24,8-14,9,12,and 10,respectively.For somnolence,quetiapine-XR had the smallest NNH of 4.For ≥7%weight gain,olanzapine monotherapy and OFC had the smallest NNHs with both of 5.For akathisia,aripiprazole had the smallest NNH of 5.These findings suggest that among the FDA-approved agents including OFC,quetiapine-IR and-XR,lurasidone monotherapy and adjunctive therapy to a mood stabilizer,the differences in the NNTs for response and remission are small,but the differences in NNHs for DAEs and common side-effects are large.Therefore,the selection of an FDA-approved atypical antipsychotic for bipolar depression should be based upon safety and tolerability.

Drug targets beyond HMG-CoA reductase:Why venture beyond the statins?

In this review,we aim to convey a brief,select history of the development of cholesterol-lowering therapies.We focus particularly on the highly successful statins as well as setbacks that should serve as cautionary tales.We go on to preview recent developments that may complement,if not one day replace,the statins.Our focus is on pharmacological interventions,particularly those targeting the cholesterol biosynthetic pathway.Also,we examine therapies under current investigation that target the assembly of atherogenic lipoproteins(via apolipoprotein B or microsomal triglyceride transfer protein),the stability of the low-density lipoprotein-receptor(via PCSK9,proprotein convertase subtilisin kexin 9),or are designed to increase high-density lipoprotein-cholesterol(via inhibition of cholesteryl ester transfer protein).

Issues about the nocebo phenomena in clinics

During clinical work, some side-effects may occur to patients, part of which are caused by the specific pharrnacological effects of drugs and some of which are non-specific. Although these phenomena happen from time to time, burdening the anguish and expenditure of patients, their nature is still less understood. Recently, as the research of the placebo effect become deeper and deeper, clinicians and researchers have gradually realized that mind plays an important role in the occurrence of non-specific side-effects, which is called ＂nocebo effect＂ professionally, the evil side of placebo effect. This article would expatiate on nocebo effect in detail from several aspects, such as its mechanism, effect, influencing factors and discuss how to make it known and treated in clinical practice and clinical trials.