A case report of hearing loss post use of hydroxychloroquine in a HIV-infected patient

The Republic of Ireland, like many other countries is trying to diversify energy sources to counteract environmental, political and social concerns. Bioethanol from domestically grown agricultural crops is an indigenously produced alternative fuel that can potentially go towards meeting the goal of diversified energy supply. The Republic of Ireland’s distribution of existing soils and agricultural land-uses limit arable crop land to around 10% of total agricultural area. Demand for land to produce arable crops is expected to decrease, which could open the opportunity for bioethanol production. Bioethanol production plants are required to be of a sufficient scale in order to compete economically with other fuel sources, it is important therefore to determine if enough land exists around potential ethanol plant locations to meet the potential demands for feedstock. This study determines, through the use of a developed GIS based model, the potential quantities of feedstock that is available in the hinterlands of nine locations in the Republic of Ireland. The results indicate that three locations can meet all its feedstock demands using indigenously grown sugarbeet, while only one location can meet its demands using a combination of indigenous wheat and straw as the two locally sourced feedstocks.Department of Agriculture, Fisheries and Food Research Stimulus Fun

Evaluating the Effects of Umifenovir Compared to Lopinavir/Ritonavir in the Management of Patients with COVID-19: A Randomized Controlled Trial

Background. Due to the lack of specific safe medications for the treatment of COVID-19, medications used for other similar conditions are being tested to alleviate the condition of COVID-19 patients, resulting in acceptable outcomes in some cases. Umifenovir (Arbidol®) is used to treat influenza viruses by inhibiting the fusion of the virus with the host cell. According to previous findings, umifenovir may inhibit SARS-CoV-2 infection by interfering with the release of SARS-CoV-2 from inside the cell. This study aimed to determine the effects of umifenovir, a fusion inhibitor, versus lopinavir/ritonavir in treating patients with COVID-19. Methods. This study was a randomized controlled trial consisting of 90 confirmed COVID-19 patients divided into the lopinavir/ritonavir group and the umifenovir group. The lopinavir/ritonavir group received 100/25 mg twice, while the umifenovir group was given 200 mg thrice a day, in both groups, for seven days. Outcomes included mortality rate and the need for mechanical ventilation or intensive care unit admission. Length of stay in the hospital and ICU and the lab tests trend were also assessed. Results. The mortality rate and the need for admission to the ICU were significantly lower in the umifenovir group (8% vs. 27.5%; P-value = 0.02). Moreover, The levels of white blood cells were also lower in the umifenovir group than in the control group by day 10 (6.2 (5.3-7.4) vs. 10.8 (9.9-13); P-value <0.001). Conclusions. Umifenovir may reduce the need for admission to the ICU and mortality rate in patients with COVID-19 compared with lopinavir/ritonavir. The lab test trends were also in favor of umifenovir use.

Potential effect of coenzyme Q10 (Ubiquinone) on serum NGAL biomarker and kidney function following Coronary Artery Bypass Grafting surgery

Background: Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) surgery, and is associated with major adverse outcomes. Effect of preoperative administration of coenzyme Q10 was evaluated in order to realize that whether it could prevent the occurrence of AKI following elective CABG surgery. Materials and Methods: Two hundred and fifty patients who were candidate for elective CABG surgery between September 2017 and August 2018 were randomly assigned to intervention group (receiving coenzyme Q10, 300 mg BID for 2 days before surgery) and control group. Serum NGAL (neutrophil gelatinase-associated lipocalin) was measured at baseline, 6 and 24 hours after surgery. Serum creatinine (sCr) and urine output (UO) were also measured at baseline and after surgery. Results: Fifty patients completed the study. The total incidence of acute kidney injury was 32%. There were no significant differences in the incidence of AKI (p=0.07) between the two groups. Serum NGAL was shown no significant difference at 6 (p=0.13) and 24 (p=0.22) hours after surgery compared to the baseline level between the two groups, whereas, the significant difference in the hospitalization duration was shown between them (p=0.02). Conclusion: CoQ10 supplementation did not significantly decrease the incidence of AKI in patients undergoing elective CABG

Effect of L-Carnitine on Troponin, IL6 and HS– CRP levels after Coronary Artery Bypass Graft Surgery

Background: L-carnitine seems to be able to prevent complications after heart surgery using Cardiopulmonary bypass (CPB) and the adverse effects of pump usage. This study aimed to evaluates the effects of L-carnitine on cardiac biomarkers and operation characteristics after coronary artery bypass graft (CABG) surgery.Methods and materials: In this randomized triple-blinded, sixty patients undergoing elective CABG surgery were divided into three equal groups to receive 2gr oral L-carnitine (group A), 5gr oral L-carnitine (group B) and placebo (group C) 2 hours before surgery. IL-6, creatinine, and high sensitivity C-reactive protein (HS–CRP) levels, CK-MB, cardiac troponin and inotrope administration in ICU or after CPB were recorded for all patients at baseline levels and at 8 or 24 hours postoperatively.Results: There was an evidence of a significant difference in CPK-MB level and number of red blood cell packed used in group A was lower than group C (p<0.05). The cardiac troponin level 8 hours after surgery significantly decreased in two treatment groups in comparison to group C (p<0.05). The need for inotropic support after weaning from CPB, in B group was statistically higher than C group (p=0.021).Conclusion: Although L-carnitine adjunct therapy appears not to be associated with IL-6 and HS–CRP levels, it had beneficial effects on cardiac troponin and CPK-MB levels.   Keywords: Coronary artery bypass graft surgery, IL-6, HS–CRP levels, L-carnitine, Troponi

Efficacy and safety of propolis mouthwash in management of radiotherapy induced oral mucositis; A randomized, double blind clinical trial

Aim and BackgroundPropolis has been used for the management of oral mucositis in a number of studies. Due to lack of sufficient evidence especially in radiotherapy induced oral mucositis, the present study was designed to evaluate the efficacy and safety of propolis mouthwash in oral mucositis and dysphagia in patients undergoing head and neck radiotherapy.Materials and methodsThis study was a prospective, randomised, double-blind, placebo-controlled trial. The patients randomly divided into two groups receiving either the propolis or the placebo mouthwash. Patients were advised to rinse their mouth with 15 mL three times daily for four weeks. Severity of mucositis and dysphagia were evaluated by the National Cancer Institute Common Toxicity Criteria (NCI-CTC) and Common Terminology Criteria for Adverse Events (CTCAE), respectively.ResultsThirty patients completed the study. Each group consisted of 15 patients. Although, there is not any significant difference between two groups in the first week of radiotherapy, a significant difference was seen in the second, the third and the fourth week (p = 0.03, 0.02, 0.02, respectively). Dysphagia reported as a mild score in the propolis group only in the fourth week which is significant compared with the placebo group (p = 0.01). There is not any serious adverse effect related to propolis or placebo during the study.ConclusionIt seems that propolis mouthwash is an effective and safe medication for alleviation of oral mucositis and dysphagia in patients under head and neck radiotherapy

Remdesivir associated sinus bradycardia in patients with COVID-19: A prospective longitudinal study

Background: Remdesivir is effective against SARS-Cov-2 with little evidence of its adverse effect on the cardiac system. The aim of the present study is investigating the incidence of bradycardia in COVID-19 patients treated with Remdesivir.Methods: This prospective longitudinal study was conducted in a tertiary center on COVID-19 patients for Remdesivir therapy. The objectives were to investigate the incidence of sinus bradycardia, and also the association between their demographics, underlying diseases, and the disease severity with developing bradycardia in COVID-19 patients treated with Remdesivir.Results: Of 177 patients, 44% were male. The mean (±standard deviation) age of patients was 49.79 ± 15.16 years old. Also, 33% were hospitalized due to more severe symptoms. Oxygen support was required for all hospitalized subjects. A total of 40% of the patients had comorbidities, with the most common comorbidity being hypertension. The overall incidence of bradycardia (heart rate<60 bpm) in patients receiving Remdesivir was 27%, of whom 70% had extreme bradycardia (heart rate <50 bpm). There was also a statistically significant reduction in heart rate after five doses of Remdesivir compared to the baseline heart rates. In the multivariable model, none of the covariates including age above 60 years, female sex, CRP>50 mg/L, O2 saturation<90%, underlying cardiovascular disease, hypertension and diabetes mellitus, and beta-blockers were associated with Remdesivir-induced bradycardia. No association was found between the COVID-19 severity indicators and bradycardia.Conclusion: As sinus bradycardia is a prevalent adverse cardiac effect of Remdesivir, it is recommended that all COVID-19 patients receiving Remdesivir, be evaluated for heart rate based on examination; and in the case of bradyarrhythmia, cardiac monitoring should be performed during administration to prevent adverse drug reactions

Antioxidants and cisplatin nephrotoxicity; an updated review on current knowledge

Cisplatin is a first-line antitumor drug which is applied in the therapeutic field of numerous kinds of cancers. The main dose-dependent adverse effect of cisplatin is nephrotoxicity in approximately one-third of patients, who received this drug during their treatment. Oxidative stress is one of the most significant mechanisms in cisplatin nephrotoxicity. Cisplatin-induced oxidative stress stimulates apoptosis, inflammation, mitochondrial damage within cells, and endoplasmic reticulum (ER) stress. The administration of an antioxidant in this context could be a suitable approach for preventing of cisplatin nephrotoxicity. Antioxidants are categorized into four classes: dietary antioxidants, free radical scavengers, thiol-containing compounds, and iron chelators

The Effects of Oral Pentoxifylline on the Prevention of Contrast-Induced Nephropathy in Patients with Chronic Kidney Disease and Normal Renal Function: A Randomized Clinical Trial: Pentoxifylline Effects on Contrast-Induced Nephropathy

Introduction: Finding preventive methods for Contrast-Induced Nephropathy (CIN) is essential for reducing the burden of complications. In this context, anti-oxidant agents such as pentoxifylline can be viable options. This study aimed to determine the effects of oral pentoxifylline on the prevention of contrast induced nephropathy in patients undergoing angiography. Methods and Results: In this randomized clinical trial 96 patients with chronic kidney disease (CKD) and 96 subjects with normal renal function were included and randomly assigned to receive either pentoxifylline or placebo. The Incidence of CIN was determined and compared between the groups. The incidence of CIN in healthy subjects receiving pentoxifylline or placebo was 4 (8.3%) and 2 (4.16%), respectively. (P-value = 1). The incidence of CIN in patients with CKD in the pentoxifylline and placebo group was 5 (10.41%) and 12 (25%) respectively. (P-value = 0.58). Conclusion: According to the obtained results, there was no difference between patients with CKD and those with normal renal function in terms of the pentoxifylline effects on the prevention of Contrast Induced Nephropathy

Determination of Voriconazole Plasma Concentration by HPLC Technique and Evaluating Its Association with Clinical Outcome and Adverse Effects in Patients with Invasive Aspergillosis

Purpose. Invasive aspergillosis is a prevalent fungal disease, especially in Asian countries with a high mortality rate. Voriconazole (VRZ) is the first choice for invasive aspergillosis treatment. Plasma concentration of this drug is unpredictable and varies among individuals. This variability is influenced by many factors leading to clinical implication. Therapeutic drug monitoring (TDM) may have a crucial role in the patients’ treatment process. The HPLC method provides sufficient specificity and sensitivity for plasma VRZ concentration determination for TDM purposes of this drug. Methods. Patients who initiated oral or intravenous VRZ for invasive aspergillosis were enrolled in this study. Demographic characteristics and clinical data, outcome, and adverse effects were documented. For each patient, the plasma sample was collected under steady-state condition and analyzed using a validated HPLC method. Results. A total of 22 measurements were performed. Fifty percent of patients were out of the therapeutic range. From them, 27.27% and 22.73% were in subtherapeutic and supratherapeutic ranges (5.5 μg/mL), respectively. There was a significant correlation between VRZ plasma concentration and treatment outcomes (P=0.022). Treatment failure was five times higher than treatment success in those in the subtherapeutic range. Adverse effects were observed more frequently in patients with supratherapeutic concentrations compared to those with non-supratherapeutic levels. Furthermore, the mortality rate in patients experiencing treatment failure was 2.17 times higher than those with treatment success. Conclusions. TDM of VRZ plays an important role in better evaluation of efficacy and toxicity during treatment. Therefore, determination of the drug level may be of clinical significance