Magnesium Sulfate: A Potential Adjuvant Treatment on COVID-19

COVID-19 has currently become a major global health problem. Due to novelty and high morbidity and mortality, there are some important medical challenges to achieve proper management and treatment of the disease. Different pharmaceutical categories have been candidate for viral or cytokine phase control, and in this regard many clinical trials are underway to obtain evidences and acceptable results. One of these compounds is magnesium (Mg) sulfate which may have potential therapeutic effect on the cytokine phase of COVID-19. Mg compounds have long been used in practice under various indications and purposes as supplemental compounds, electrolyte regulation and also prevention of drugs side effects. In addition, the effectiveness of Mg sulfate in controlling asthma attacks, gynecological cases and pre-natalogical problems has also been proven. Herein we briefly reviewed immunomodulatory and respiratory effects of Mg and its potential benefits in COVID-19 treatment. Mg sulfate can be used both systemically and by inhalation, but nebulizer route has potential effect on rapid onset of action on respiratory system and reduced incidence of systemic side effects. To the best of our knowledge, in COVID-19 patients, as other viral infections, airway hyper-reactiveness can be overrepresented. In this regard ventilation improvement and reducing of airway resistance should be considered. Some bronchodilators, such as β2-agonists and anti-muscarinic agents used to relieve these symptoms. Another option has provided for hospitalized patients, is nebulized Mg sulfate. It has been suggested in the literature that Mg sulfate can cause bronchodilation in asthmatic patients by various mechanisms, including by inhibition of calcium influx into the cytosol, prevention of acetylcholine secretion, inhibition of histamine release; and finally, by β2-receptor affinity enhancement, increases bronchodilator effect of β2-agonists. On the other hand, according to some researches, low Mg level is associated with increased inflammatory response.  in vitro studies showed that short-term exposure to Mg sulfate without affecting on viability and function of phagocytes, diminished cytokine gene and protein expression, and consequently could reduce production of TNF-α and IL-6 from neonatal monocytes. Moreover, Mg sulfate can reduce the level of interleukin 1β, that is a potent pro-inflammatory cytokine. Another study of the anti-inflammatory effect of Mg compounds showed that neutralized Mg ions can convert THP-1-derived macrophages to the M2 phenotype (anti-inflammatory macrophages), thereby reduce the production of inflammatory cytokines and enhance the secretion of anti-inflammatory cytokines. As well as, according to in vitro and in vivo studies, Mg sulfate significantly reduces baseline level along with LPS-stimulated cytokine production. Altogether, given that the cytokine phase of COVID-19 plays a very significant role in patient morbidity and mortality, therefore proper management and control of this stage of the disease is important on rescuing patients. It seems that, administration of Mg compounds as an adjuvant treatment may improve this condition of disease. Our preliminary experiences indicated the potential positive effects of Mg sulfate on the improvement process in covid-19. However, in order to achieve more accurate and reliable results, adequate randomized clinical trials are needed. It should be considered that intravenous administration of this drug can be performed only in the intensive care unit (ICU) and or under close observation, but the Inhaler form does not require close monitoring. Moreover, oral Mg supplementation in outpatients may also reduce the inflammatory response in COVID-1

The effectiveness of relaxation training in the quality of life and anxiety of patients with asthma

Introduction: With a 5–10% global prevalence, asthma, as a chronic condition which can strongly affect the quality of life of patients and care givers, needs comprehensive approach, including medications and psychological techniques, to get the optimal control. This is why the current study aimed to assess the effectiveness of the Papworth method relaxation training among patients with asthma, considering reduced anxiety and improved quality of life.Material and methods: Through a randomized controlled trial, 30 patients with asthma 20–45 years of age referring to a tertiary university hospital in Tehran enrolled two study groups, including disease cases and controls. The Papworth method of relaxation was used and was finally assessed for its effectiveness by two questionnaires, namely STAI for anxiety and SF-36 for the quality of life. Pre-test and post-test were done for both groups.Results: The scores of the anxiety questionnaire (STAI) before and after the intervention were significantly different, and the mean scores obviously reduced after relaxation training among cases from 102.6 to 79.5. The scores of the QOL grew clearly after relaxation training in the case group from 308.07 to 546.6.Conclusions: As an accessory helpful treatment, relaxation training Papworth method sounds to be perfectly able to control stressful conditions in patients with asthma to prevent disease attacks and improve the quality of life. So, psychological teams can be advised to referral centers for asthma in the relevant clinics to help people get training in this regard

Call interview for early detection and appropriate treatment to decrease COVID-19 pandemic burden

One of the most important concerns during the covid-19 pandemic is an imbalance in health services. Considering significant mortality among hospital staff and the general population, a great apprehension was raised in society. Consequently, many patients with symptoms were rushed to hospitals. In this regard, to keeping clinics away from overcrowding, call interview with patients plays a crucial role in not only patients screening but also treatment approach. &nbsp

Eosinophilic Mucin Rhinosinusitis in Iranian Patients Undergoing Endoscopic Sinus Surgery

Introduction:  Eosinophilic mucin rhinosinusitis is a type of chronic rhinosinusitis (CRS). Diagnosis and treatment of this condition play a significant role in reducing the patients’ clinical symptoms. This type of rhinosinusitis has a higher relapse rate, compared to the other types. This disease is more resistant to treatment and more dependent on corticosteroid therapy, compared to the other types of rhinosinusitis. Regarding this, the present study was designed to evaluate the frequency of eosinophilic mucin rhinosinusitis in patients undergoing sinus surgery in a tertiary referral center and examine some clinical and laboratory characteristics regarding this type of rhinosinusitis.   Materials and Methods: This cross-sectional observational study was performed on patients over the age of 16 years, who were diagnosed with CRS in the otolaryngology clinic of a referral tertiary-level hospital, and were candidates for endoscopic sinus surgery. Based on the detection of eosinophilic mucin, the subjects were divided into two groups of eosinophilic mucin and non-eosinophilic mucin rhinosinusitis (controls). The groups were compared in terms of sino-nasal outcome test (SNOT-22) scores, Lund-Mackay staging scores, osteitis status, immunoglobulin E (IgE) level, and eosinophilia.   Results: In this study, 46 subjects participated, 29 (63%) cases of whom had eosinophilic mucin. The SNOT-22 score and serum IgE level were significantly higher in the eosinophilic mucin group, compared to those in the control group. Osteitis and Lund-Mackay scores were also higher in the eosinophilic mucin group than those in the control group; however, this difference was not statistically significant.    Conclusion: Patients with eosinophilic mucin rhinosinusitis showed a more severe clinical involvement. Seemingly, the Iranian patients have a lower and higher frequency of eosinophilic mucin rhinosinusitis, compared to the patients from the Western countries and East Asia, respectively

Pulmonary manifestations in a cohort of patients with inborn errors of immunity : an 8-year follow-up study

Background: Inborn errors of immunity (IEIs) are a group of congenital diseases caused by genetic defects in the development and function of the immune system. The involvement of the respiratory tract is one of the most common presentations in IEIs. Methods: Overall, 117 patients with diagnosed IEIs were followed-up within 8 years at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD). Demographic, clinical, and laboratory data were collected in a questionnaire. Pulmonary function test (PFT), chest X-ray (CXR), and high-resolution computed tomography (HRCT) scans were obtained where applicable. Results: Our study population consisted of 48 (41%) patients with predominantly antibody deficiencies (PADs), 39 (32%) patients with congenital defects of phagocytes, 14 (11.9%) patients with combined immunodeficiency (CID), and 16 (14%) patients with Mendelian susceptibility to mycobacterial diseases (MSMD).. Recurrent pneumonia was the most common manifestation, while productive cough appeared to be the most common symptom in almost all diseases. PFT showed an obstructive pattern in patients with PAD, a restrictive pattern in patients with CID, and a mixed pattern in patients with CGD. HRCT findings were consistent with bronchiectasis in most PAD patients, whereas consolidation and mediastinal lesions were more common in the other groups. Conclusions: Pulmonary manifestations vary among different groups of IEIs. The screening for lung complications should be performed regularly to reveal respiratory pathologies in early stages and follow-up on already existing abnormalities. (C) 2022 Codon Publications. Published by Codon Publications.Peer reviewe

Magnesium Sulfate: A Potential Adjuvant Treatment on COVID-19

COVID-19 has currently become a major global health problem. Due to novelty and high morbidity and mortality, there are some important medical challenges to achieve proper management and treatment of the disease. Different pharmaceutical categories have been candidate for viral or cytokine phase control, and in this regard many clinical trials are underway to obtain evidences and acceptable results. One of these compounds is magnesium (Mg) sulfate which may have potential therapeutic effect on the cytokine phase of COVID-19. Mg compounds have long been used in practice under various indications and purposes as supplemental compounds, electrolyte regulation and also prevention of drugs side effects. In addition, the effectiveness of Mg sulfate in controlling asthma attacks, gynecological cases and pre-natalogical problems has also been proven. Herein we briefly reviewed immunomodulatory and respiratory effects of Mg and its potential benefits in COVID-19 treatment. Mg sulfate can be used both systemically and by inhalation, but nebulizer route has potential effect on rapid onset of action on respiratory system and reduced incidence of systemic side effects. To the best of our knowledge, in COVID-19 patients, as other viral infections, airway hyper-reactiveness can be overrepresented. In this regard ventilation improvement and reducing of airway resistance should be considered. Some bronchodilators, such as β2-agonists and anti-muscarinic agents used to relieve these symptoms. Another option has provided for hospitalized patients, is nebulized Mg sulfate. It has been suggested in the literature that Mg sulfate can cause bronchodilation in asthmatic patients by various mechanisms, including by inhibition of calcium influx into the cytosol, prevention of acetylcholine secretion, inhibition of histamine release; and finally, by β2-receptor affinity enhancement, increases bronchodilator effect of β2-agonists. On the other hand, according to some researches, low Mg level is associated with increased inflammatory response.  in vitro studies showed that short-term exposure to Mg sulfate without affecting on viability and function of phagocytes, diminished cytokine gene and protein expression, and consequently could reduce production of TNF-α and IL-6 from neonatal monocytes. Moreover, Mg sulfate can reduce the level of interleukin 1β, that is a potent pro-inflammatory cytokine. Another study of the anti-inflammatory effect of Mg compounds showed that neutralized Mg ions can convert THP-1-derived macrophages to the M2 phenotype (anti-inflammatory macrophages), thereby reduce the production of inflammatory cytokines and enhance the secretion of anti-inflammatory cytokines. As well as, according to in vitro and in vivo studies, Mg sulfate significantly reduces baseline level along with LPS-stimulated cytokine production. Altogether, given that the cytokine phase of COVID-19 plays a very significant role in patient morbidity and mortality, therefore proper management and control of this stage of the disease is important on rescuing patients. It seems that, administration of Mg compounds as an adjuvant treatment may improve this condition of disease. Our preliminary experiences indicated the potential positive effects of Mg sulfate on the improvement process in covid-19. However, in order to achieve more accurate and reliable results, adequate randomized clinical trials are needed. It should be considered that intravenous administration of this drug can be performed only in the intensive care unit (ICU) and or under close observation, but the Inhaler form does not require close monitoring. Moreover, oral Mg supplementation in outpatients may also reduce the inflammatory response in COVID-1

The Effectiveness of Relaxation Training in the Quality of Life and Anxiety of Patients with Asthma

Introduction: With a 5–10% global prevalence, asthma, as a chronic condition which can strongly affect the quality of life of patients and care givers, needs comprehensive approach, including medications and psychological techniques, to get the optimal control. This is why the current study aimed to assess the effectiveness of the Papworth method relaxation training among patients with asthma, considering reduced anxiety and improved quality of life. Material and methods: Through a randomized controlled trial, 30 patients with asthma 20–45 years of age referring to a tertiary university hospital in Tehran enrolled two study groups, including disease cases and controls. The Papworth method of relaxation was used and was finally assessed for its effectiveness by two questionnaires, namely STAI for anxiety and SF-36 for the quality of life. Pre-test and post-test were done for both groups. Results: The scores of the anxiety questionnaire (STAI) before and after the intervention were significantly different, and the mean scores obviously reduced after relaxation training among cases from 102.6 to 79.5. The scores of the QOL grew clearly after relaxation training in the case group from 308.07 to 546.6. Conclusions: As an accessory helpful treatment, relaxation training Papworth method sounds to be perfectly able to control stressful conditions in patients with asthma to prevent disease attacks and improve the quality of life. So, psychological teams can be advised to referral centers for asthma in the relevant clinics to help people get training in this regard

Prophylactic Recommendation for Healthcare Workers in COVID-19 Pandemic

During COVID-19 pandemic, it seems that healthcare workers (HWs) are more prone to the infection than general population. Indeed, a high viral load atmosphere and infected medical equipment are sources for spreading the disease. Many HWs should care for patients in the intensive care units (ICUs) which are one of the most contaminated areas. However, despite the adequate protections, HWs are still exposed to the coronavirus. Moreover, some procedures such as tracheal intubation increase the risk of infection. Overall, the probability of contamination in HWs is three times more than that of other people. According to Keshavan et al., about 3300 Chinese HWs have been infected by COVID-19, with a mortality rate of 0.4%. In Iran, we have a large number of affected HWs, with 69 registered deaths until late March 2020. Most of them were young with no previous medical history. So we have to improve protection and plan additional arrangements against COVID-19. There are several mechanisms for the antiviral activity of hydroxychloroquine. This drug is a weak base that concentrates on the intracellular sections including endosome and lysosome; so, viral replication in the phase of fusion and uncoating will be stopped.  Also, hydroxychloroquine can change the ACE2 glycosylation and inhibits both S-protein binding and phagocytosis. The last mechanism would be the suppressing effect on cytokine production and the immunomodulatory effect of the drug. Based on in-vitro studies of chloroquine on SARS-CoV-1, its effective role as a prophylactic agent and a post-infection treatment has been raised. According to another cell-culture study, the preventive effect of the drug is estimated to be 24 hours before and 5 hours after the contamination. The weekly dose of 500 mg chloroquine, which is used for malaria prophylaxis, will result in a concentration below the EC50, which is not enough for inhibition of the novel coronavirus. But the minimum dosage, which is used for rheumatoid arthritis treatment (250mg daily) will result in plasma concentrations higher than EC50, which may be sufficient in this regard. Regarding this pharmacokinetics and in-vitro investigations a double-blind, randomized, placebo-controlled trial using chloroquine as a prophylactic agent for SARS-CoV-2 infection is ongoing. The recommended dose is a loading dose of 10 mg/kg from base drug followed by 150 mg daily (250 mg chloroquine phosphate salt). Subsequently, the number of infected patients will be assessed after 3 months. Another running clinical trial is a phase III triple blinded one employing hydroxychloroquine with 200mg daily dose for 60 days and the outcome as well as the rate of symptomatic infected patients will be evaluated. There is also another ongoing study on hydroxychloroquine as a COVID-19 post-exposure prophylactic agent prescribed within 3 days of either a HWs or household contact. The recommended dose is 800mg once, followed by 600 mg during 6 to 8 hours, then 600mg once a day for 4 consecutive days. Finally, the rate and severity of COVID-19 infections are compared. The study could probably show that 200-400mg of hydroxychloroquine per day is a reasonable prophylactic regimen for the exposed HWs. To be more precise, our experience on the rheumatologic patients who tool 200 mg per day hydroxychloroquine, as well as the medical workers who received the same dose for prophylaxis against the novel coronavirus showed that hydroxychloroquine with a 200 mg/day dose can have a relative prophylactic effect on COVID-19. According to our data, the few cases who received 200mg of hydroxychloroquine per day, showed mild to moderate symptoms with no severe manifestations. However, the prophylactic dose of 400mg per day may be accompanied by some drug interactions and adverse effects in the long term; so 200mg of hydroxychloroquine is a rational prophylactic dose for practitioners who are exposed to the high viral load environment

Clinical evaluation of nebulized verapamil in out-patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease

Objective: Chronic obstructive pulmonary disease (COPD) is associated with many health complications, including pulmonary hypertension (PH). Although oral calcium channel blockers have shown promising results in managing COPD-induced PH, significant systemic side effects may limit their use in this population. Administering verapamil through nebulization can be an alternative approach. We aim to assess the possible therapeutic effects of verapamil inhalation in out-patients with pulmonary hypertension (PH) secondary to COPD. Methods: A double-blind, randomized placebo-controlled clinical trial was conducted. Patients with PH were randomly assigned to two groups of 15 participants. The intervention group received a short-term single dose of 10 mg nebulized verapamil (4 ampoules of 2.5 mg/ml verapamil solutions). The control group received nebulized distilled water as a placebo in addition to their standard treatment throughout the study. Results: Systolic pulmonary artery pressure (sPAP) did not improve as a primary outcome significantly in patients receiving nebulized verapamil compared with those on placebo (p = 0.89). Spirometry results showed a significant improvement in FVC in the intervention group from 1.72 ± 0.63 to 1.85 ± 0.58 L (p = 0.00), and FEV1/FVC ratio decreased significantly after verapamil administration (p = 0.027). Conclusion: Verapamil did not improve any of the pulmonary artery or RV parameters in patients with COPD-associated, but it did improve SpO2 and increase FVC, which revealed us possibility of verapamil in treating V/Q mismatch. The improved gas exchange may have been due to improvements in FVC as reflected in the improved spirometry. Higher doses of verapamil may be more efficacious and can be the subject of future trials.</p

The relevance of magnesium homeostasis in COVID-19

International audiencePurpose In less than one and a half year, the COVID-19 pandemic has nearly brought to a collapse our health care and economic systems. The scientific research community has concentrated all possible efforts to understand the pathogenesis of this complex disease, and several groups have recently emphasized recommendations for nutritional support in COVID-19 patients. In this scoping review, we aim at encouraging a deeper appreciation of magnesium in clinical nutrition, in view of the vital role of magnesium and the numerous links between the pathophysiology of SARS-CoV-2 infection and magnesium-dependent functions. Methods By searching PubMed and Google Scholar from 1990 to date, we review existing evidence from experimental and clinical studies on the role of magnesium in chronic non-communicable diseases and infectious diseases, and we focus on recent reports of alterations of magnesium homeostasis in COVID-19 patients and their association with disease outcomes. Importantly, we conduct a census on ongoing clinical trials specifically dedicated to disclosing the role of magnesium in COVID-19. Results Despite many methodological limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19, and call for further and better studies to explore the prophylactic or therapeutic potential of magnesium supplementation. Conclusion We propose to reconsider the relevance of magnesium, frequently overlooked in clinical practice. Therefore, magnesemia should be monitored and, in case of imbalanced magnesium homeostasis, an appropriate nutritional regimen or supplementation might contribute to protect against SARS-CoV-2 infection, reduce severity of COVID-19 symptoms and facilitate the recovery after the acute phase