A case that high doses of Vitamin C as a potential therapy for COVID-19

Aromatase inhibitors (AI's) are the most effective adjuvant anti-hormonal therapy for estrogen receptor positive (ER+) post-menopausal breast cancer patients, with superior disease free survival over tamoxifen. However, approximately half of the women who take this drug will develop significant joint pains, termed Aromatase Inhibitor-Induced Arthralgia (AIA). Though this medicine should be taken for 5 years, the joint pain can be so troublesome that 13-20% may prematurely discontinue it because of the arthralgia, thus sacrificing their best chance of disease free survival. Furthermore, daily quality of life is significantly affected by this chronic pain while taking AI therapy. Nonetheless, neither the etiology nor the treatment of AIA is well-understood within the medical community. It is known that low estrogen levels, as seen on AI therapy, decrease the amount of available, active vitamin D. Low Vitamin D is implicated in non-specific musculoskeletal pain in non-cancer patients, possibly mediated by higher levels of inflammatory cytokines IL-6 and TNF-alpha in a low vitamin D state. Vitamin D replacement has been shown to be helpful for AIA in some small clinical trials. We therefore propose to test the hypothesis that AIA can be effectively prevented by high dose Vitamin D supplementation, and that effective prophylaxis of the problem will lead to improved compliance with AI therapy. In this clinical trial, we will enroll 184 women who are beginning adjuvant AI therapy and randomize half of them to receive high dose vitamin D (50,000 IU Vitamin D3 per week for 12 weeks, followed by 2000 IU Vitamin D3 daily for 40 weeks), and the other half to receive standard dose vitamin D (800 IU Vitamin D3 daily for 52 weeks). We will assess each woman's baseline joint pains via a questionnaire (Health Assessment Questionnaire-II). We hypothesize that AIA can be effectively prevented with high dose vitamin D, and this will correlate to increased compliance in the high dose vitamin D arm.. The primary endpoint is development of AIA as measured by a defined change in HAQ-II score between baseline and 12 wks. This randomized Phase 2 study is powered to detect an improvement from an expected 33% incidence of AIA in the standard dose group to 18% or less in the high-dose group (alpha=10%, one-tailed). Finally, as an exploratory objective, we will determine whether those in the standard dose vitamin D arm have a correlation between higher levels of inflammatory cytokines and development of AIA. This study targets a very common cause of pain among breast cancer survivors and aims to offer an effective treatment strategy to alleviate pain and improve quality of life as well as medication compliance. Citation Format: Polly A. Niravath, Sue Hilsenbeck, Tao Wang, Mothaffar Rimawi. A randomized, controlled trial of high dose vs. standard dose vitamin D for aromatase inhibitor-induced arthralgia in breast cancer survivors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr CT319. doi:10.1158/1538-7445.AM2014-CT319

Policymakers and relevant public health authorities can analyze people’s attitudes towards public health policies and events using sentiment analysis. Sentiment analysis focuses on classifying and analyzing text sentiments. A Twitter sentiment analysis has the potential to monitor people’s attitudes towards public health policies and events. Here, we explore the feasibility of using Twitter data to build a surveillance system for monitoring people’s attitudes towards public health policies and events since the beginning of the COVID-19 pandemic. In this study, we conducted a sentiment analysis of Twitter data. We analyzed the relationship between the sentiment changes in COVID-19-related tweets and public health policies and events. Furthermore, to improve the performance of the early trained model, we developed a data preprocessing approach by using the pre-trained model and early Twitter data, which were available at the beginning of the pandemic. Our study identified a strong correlation between the sentiment changes in COVID-19-related Twitter data and public health policies and events. Additionally, the experimental results suggested that the data preprocessing approach improved the performance of the early trained model. This study verified the feasibility of developing a fast and low-human-effort surveillance system for monitoring people’s attitudes towards public health policies and events during a pandemic by analyzing Twitter data. Based on the pre-trained model and early Twitter data, we can quickly build a model for the surveillance system.

Objective: To explore the role of the Centers for Disease Control and Prevention (CDC) in public health emergencies. Methods: The details of 12 public health events that occurred between January 2021 to December 2022 were analyzed to explore the roles of the CDC. Results: There were 160 patients involved in 10 public health events in 2021 and 48 patients involved in 2 public health events in 2022. Besides, the proportion of school public health events in 2022 was 0%, which was lower than in 2021, which was 80% (P < 0.05). 99.38% of patients during public health events were sent to the hospital promptly in 2022, which was higher than that in 2021, which was 81.25% (P < 0.05). Furthermore, the average time taken for the CDC to control public health events in 2022 was 20.11 ± 1.62 hours, and the average time taken to send inspection reports was shorter than that in 2021. The public satisfaction score was also higher in 2022 compared to 2021 (P < 0.05). Conclusion: The role of the CDC is to control infectious diseases. Therefore, it is important to pinpoint the existing problems in the strategies implemented by the CDC so that more improvements can be made to better prevent infectious diseases.

BACKGROUND AND AIMSDuring the time of the COVID-19 pandemic, multiple treatment options have been investigated, even though their efficacy and secondary effects remain insufficiently known.We report the case of a vitamin C induced oxalate nephropathy in a COVID-19 patient with preexisting chronic kidney disease (CKD) resulting in irreversible acute renal failure.Vitamin C, also known as ascorbic acid, has been used as an anti-inflammatory therapy for COVID-19, but review of the literature shows similar cases of acute kidney injury (AKI), raising concern.METHODWe report the case of a 73-year-old Caucasian woman admitted for hyperthermia and digestive disorders. She had recently started a first-line chemotherapy for multiple myeloma with partial response. She also displayed preexisting stage 4 CKD (eGFR 18.50 mL/min/1.73 m² using CKD-EPI) of unknown aetiology.She was tested positive for SARS-CoV2 by nasopharyngeal swab and soon transferred to the intensive care unit. She received intravenous corticosteroids using dexamethasone 6 g/24 h for 10 days and a piperacillin + tazobactam probabilistic antibiotherapy. She also received high doses (15 g/24 h) of vitamin C for three consecutive days. No monoclonal antibodies were prescribed due to a previous vaccination with a positive serology upon admission.Although the patient recovered from respiratory tract infection, her kidney function progressively deteriorated with serum creatinine levels rising up to 8.06 g/dL, leading to her admission in our nephrology department. The patient was initially treated with high doses of diuretics for anasarca and an abdominal CT excluded urinary tract obstruction with normal kidney size and aspect. Urinary analysis showed protein to creatinine (p/c) ratio of 1348 g/g, and presence of urinary light chains. Her monoclonal spike was measured at 2.3 g/L and her kappa/lambda fraction was 1.74.Intermittent haemodialysis was initiated, and a kidney biopsy was performed.RESULTSHistology revealed hundreds of intratubular calcium oxalate crystals, with severe and diffuse acute tubular necrosis and interstitial edema. There was no amyloidosis, no sign of active glomerular disease and no interstitial fibrosis. Immunofluorescence (IgA, IgG, IgM, C1Q, C3, kappa and lambda) was negative. We concluded to oxalate nephropathy.After a 2-month follow-up, the patient remains dialysis dependent.Vitamin C is a precursor of oxalate and has been shown to cause secondary oxaluria, particularly with high-dose regimens in patients with altered renal function. Given the histological findings evocative of acute oxalate nephropathy, the accountability of high doses of vitamin C should be considered.No other cause of hyperoxaluria was identified in our patient beside broad spectrum antibiotic use, which could decrease intestinal bacterial oxalate degradation. In particular, there was no malabsorptionThe limitation of our report is the unknown cause of preexisting CKD; therefore, we cannot rule out preexisting hyperoxaluria. Also, no dosage of serum vitamin C and oxalate levels were performed during follow-up. Finally, our patient had other possible causes AKI, such as recent SARS-CoV2 infection, or linked to multiple myeloma, but these were considered unlikely given the proper haematological response to treatment and non-evocative biopsy.The rationale for vitamin C use in COVID-19 is based on in vitro studies showing its antioxidant, anti-inflammatory, anticoagulant and immune modulatory properties. There lack large clinical studies, and the literature shows conflicting results. Multiple cases of acute oxalate nephropathy were described.CONCLUSIONVitamin C is an anti-inflammatory treatment used in COVID-19 that can lead to secondary hyperoxaluria with significant and irreversible AKI. Due to the severity of AKI in patients with preexisting CKD, we believe renal function should be considered before using high doses of vitamin C.Larger controlled trials are needed both to establish the clinical benefit of vitamin C and further describe its potential nephrotoxicity.

ObjectiveAs an integral part of emergency medical rescue teams during public health events, understanding the core competencies that nursing personnel should possess—including theoretical knowledge, practical skills, comprehensive abilities and personal...

IN NEW YORK CITY, several public health events over the past five years—West Nile virus, the World Trade Center attacks and the air quality issues that ensued from these attacks, the anthrax attacks, the 2003 smallpox vaccination campaign, and the international SARS epidemic—have challenged and sharpened the communication skills of the people in the city health department who are charged with communicating with the public. Each situation made us profoundly aware of how integral good communication is to disease control work. When a public health threat descends on a city that hosts a dozen local television stations and several cable stations, three television networks, six daily newspapers and scores of community weeklies, and numerous radio stations, expect a big production and a great deal of fanfare for a new pathogen. Add to this mixture the fact that New York is an international city of 8 million people where more than 130 languages are spoken and that it has a powerful mayor’s office with more than 50 mayoral agencies (including our own); several layers of local government including a 51-member city council, a borough president in each of five boroughs, and 59 community boards; and hundreds of advocacy and special interest groups, and what results is complicated terrain that poses a potent challenge for effective communication in the best of times, much less during a crisis. It is not surprising that in New York City we regularly deal with public health issues and events that attract a constant stream of media, community, and political interest. We are, after all, hosts for a large proportion of the nation’s tuberculosis, AIDS, and other sexually transmitted disease cases, and we have our share of outbreaks and unusual illnesses—like the case of bubonic plague diagnosed in a traveler in early 2003. Our 20,000-plus restaurants are often the targets of investigative media reports, and, just recently, the ban on smoking in bars and all workplaces set off an international media storm. Clearly, we are no strangers to media attention and controversy. Although we were accustomed to a fast-paced media operation, the media storm that accompanied the introduction of West Nile virus in 1999 was, up until then, unprecedented for our department. In retrospect, the media frenzy, community controversy, and political interest surrounding West Nile virus primed us for larger communication challenges to come. In this article, I focus mainly on media communications and describe what we did well and what we did not do so well, recounting briefly some of the anecdotes and personal experiences that help illustrate this. It is my hope that these lessons, along with a growing literature on crisis and risk communication, will provide useful advice to health communications colleagues elsewhere. Among the most important lessons learned from some of our crises in New York City, ten things stand out. These are the areas that our agency strives to improve on in each time of crisis. Others here or elsewhere may come up with a different list that might be just as worthwhile. As the adage goes, the more we know, the more we know how much we don’t know and the more we realize how much we can improve. Some of the points that follow are drawn from risk and crisis communication theory translated into experience. These theories are well articulated by Peter Sandman, Vincent Covello, and others. My colleagues and I in New York City continue to learn as we tackle each challenge that comes along and prepare for the next one.

ObjectivesDisruptive public health risks and events, including infectious disease outbreaks, are inevitable, but their effects can be mitigated by investing in prevention and preparedness. We assessed the epidemic preparedness and response capacities of health systems in 186 countries from 2018 to 2022.MethodsWe utilized data from the International Health Regulations (IHR) State Party Self-Assessment Annual Reporting (SPAR) submissions to assess health systems’ IHR capacities to (1) prevent, (2) detect, (3) respond, (4) enable resources and coordinate, and (5) ensure operational readiness from 2018 to 2022. We categorized the IHR capacities into five levels, with level 1 denoting the lowest level of national capacity and level 5 the highest. We calculated each index’s capacity level as the arithmetic mean of its related indicators and analyzed changes over time using the Mann–Kendall nonparametric trend test.ResultsSPAR reporting marginally improved from 92.9% (182 of 196 countries) in 2018 to 94.9% (186 of 196 countries) in 2022, with considerable improvement in all five capacity domains over this period: prevention (58.4 in 2018 to 66.5 in 2022), detection (74.7 to 78.3), response (56.5 to 67.8), enabling resources and coordination (63.0 to 68.3), and ensuring operational readiness (62.8 to 69.9). From the 2022 submissions, 116 (62%) countries reported functional (Level 4 or 5) prevention capacity, 162 (87%) had functional detection capacity, 118 (63%) had functional response capacity, 121 (65%) had functional enabling resources and coordination capacity, and 133 (72%) had functional operational readiness against public health events. Across all the indexes, the WHO African Region reported the fewest countries with functional capacity in these domains.ConclusionsThere was an overall increase in functional capacity across all five domains at both global and regional levels; and a high percentage of countries achieved functional capacity across all domains in 2022. However, a significant number of countries, particularly in the Global South, have yet to achieve functional competence in these capacities, leaving the world vulnerable to the persistent risk of epidemics and infectious biohazards. Strengthening IHR competencies through local, national, and global engagements must be urgently prioritized to achieve global health security against infectious diseases.

Background and Objectives: Vitamin D supplementation plays a key effect in lowering cytokine storms among COVID-19 patients by influencing the activity of the renin-angiotensin system and the production of the angiotensin-2 converting enzyme. The study was conducted to explore the effect of high-dose intramuscular vitamin D in hospitalized adults infected with moderate-to-severe SARS-CoV-2 in comparison with the standard of care in the COVID-19 protocol. Materials and Methods: Two groups of patients were compared in this prospective randomized controlled trial as the vitamin D was administered orally to group 1 (alfacalcidol 1 mcg/day) and intramuscularly to group 2 (cholecalciferol 200,000 IU). One hundred and sixteen participants were recruited in total, with fifty-eight patients in each group. Following the Egyptian Ministry of Health’s policy for COVID-19 management, all patients received the same treatment for a minimum of five days. Results: A significant difference was recorded in the length of hospital stay (8.6 versus 6.8 days), need for high oxygen or non-invasive mechanical ventilator (67% versus 33%), need for a mechanical ventilator (25% versus 75%), clinical improvement (45% versus 55%), the occurrence of sepsis (35% versus 65%), and in the monitored laboratory parameters in favor of high-dose vitamin D. Moreover, clinical improvement was significantly associated with the need for low/high oxygen, an invasive/non-invasive mechanical ventilator (MV/NIMV), and diabetes, while mortality was associated with the need for MV, ICU admission, atrial fibrillation, chronic obstructive pulmonary disease, asthma, and the occurrence of secondary infection. Conclusions: Our study showed that high-dose vitamin D was considered a promising treatment in the suppression of cytokine storms among COVID-19 patients and was associated with better clinical improvement and fewer adverse outcomes compared to low-dose vitamin D.

COVID-19 has been declared a pandemic and continues to spread, leading to health and economic problems and economic burdens worldwide. COVID-19 symptoms are similar to the flu and, in severely infected patients, emerge as an acute respiratory syndrome (ARDS), pulmonary fibrosis, edema, and even organ failure. These are due to an imbalanced immune response with a more severe effect than the virus attack. However, no specific medications and treatments are available in dealing with the COVID-19. Hence, mesenchymal stem cell (MSC) treatment is proposed as one therapeutic approach. The MSCs can produce growth factors and immune protective cytokines that could fight viral infection and are proven to help endothelial cell repair. These capabilities are expected to help resist viruses and tissue repair in a patient body. MSC is believed to prevent acute respiratory infections, the most dangerous stage of COVID-19 pathogenesis. In this study, we collect some literature, reviewing and summarizing them so that we believe that MSC could be an approach to cure COVID-19 patients and improve their responses to the virus. This article reviews the use of mesenchymal stem cells as a potential therapy for COVID-19, and this information can also be used as basic information for developing a stem-cell-based therapy, especially for treating COVID-19.

With the popularization of social media, information related to public health events has seen explosive growth online, making it essential to accurately identify informative tweets with decision-making and management value for public health emergency response and risk monitoring. However, existing methods often suffer performance degradation during cross-event transfer due to differences in data distribution, and research specifically targeting public health events remains limited. To address this, we propose the Label Confusion Domain Adversarial Network (LCDAN), which innovatively integrates label confusion with domain adaptation to enhance the detection of informative tweets across different public health events. First, LCDAN employs an adversarial domain adaptation model to learn cross-domain feature representation. Second, it dynamically evaluates the importance of different source domain samples to the target domain through label confusion to optimize the migration effect. Experiments were conducted on datasets related to COVID-19, Ebola disease, and Middle East Respiratory Syndrome public health events. The results demonstrate that LCDAN significantly outperforms existing methods across all tasks. This research provides an effective tool for information detection during public health emergencies, with substantial theoretical and practical implications.

How public health events influence the adoption of alternative fuel trucks at the city level: Insights from China's 2020 COVID-19 data

Lights and shadows of SARS-CoV-2 infection risk assessment in endoscopy

This paper comprehensively discusses the profound impact of global public health events on social psychological and economic levels, and constructs the corresponding multi-social response framework. This paper analyzes in detail how public health events cause a wide range of psychological trauma, including hypochondriac psychology, panic psychology, anxiety psychology and depression psychology, and probes into the formation mechanism, manifestations and long-term effects of these psychological trauma on individuals and society. Then, the paper systematically evaluated the economic losses caused by public health events, not only analyzing the direct economic losses (such as medical treatment costs, investment in epidemic prevention and control, etc.), but also deeply exploring the complexity and breadth of indirect economic losses (such as industrial chain disruption, investment decline, consumption reduction and labor market fluctuations, etc.). In terms of constructing the framework of multi-social response, this paper puts forward the strategy system of the government, social organizations, enterprises and the public. The government should play a leading role, establish a sound public health emergency mechanism, strengthen information disclosure and science popularization education, and introduce supportive policies to relieve economic pressure. Social organizations should actively participate in psychological assistance, volunteer services and international cooperation to contribute to epidemic prevention and control and social stability. Enterprises should optimize internal management, promote scientific and technological innovation and industrial upgrading, and enhance their ability to resist risks. The public should improve self-protection awareness, pay attention to mental health, and actively participate in volunteer service activities. Finally, this paper summarizes the main findings of the current research and looks forward to the direction of future research. With the frequent and complex global public health events, how to build a more efficient and collaborative social response mechanism will become the focus of future research. At the same time, the introduction of new technologies and new methods will also provide new ideas and means for the monitoring, early warning and response of public health events. Through this study, it is expected to provide valuable reference and guidance for the government, social organizations, enterprises and the public when dealing with global public health events, and promote social harmony and stability and sustainable economic development.

In recent years, public health events have significantly impacted various aspects of human production and daily life, particularly in the domains of disease transmission and economic stability. While many scholars have primarily focused on the influence of public health events from the perspective of disease prevention and control, research examining their economic implications, especially regarding public health indices in the securities market, remains relatively scarce. Such studies are crucial for ensuring public health safety and stability. This paper employs the Bayesian Convolutional Neural Network (Bayes-CNN) model to predict financial market volatility influenced by public health events and conducts a comparative analysis. To validate the feasibility of this method, the model is used to analyze the impact of the COVID-19 pandemic on the CSI (China Securities Index) Medical Service Index. The results indicate significant differences in the volatility of the CSI Medical Service Index before and after the outbreak, particularly during the pandemic period. This study also enhances the validity and reliability of its conclusions by incorporating European data and employing the GARCH model. Relevant institutions and individual investors should adopt different regulatory and investment strategies based on the specifics of various public health events to prevent the outbreak of systemic financial risks that could affect social stability. This paper offers a new perspective and methodology for predicting financial market volatility under the influence of public health events, providing valuable insights for investors and decision-makers to better understand and respond to the potential impacts of such events on financial markets.

To evaluate the efficacy and safety of umifenovir as a potential antiviral therapy for COVID-19; specifically, to determine whether umifenovir improves clinical outcomes, reduces hospitalization duration, and enhances recovery rates in patients diagnosed with COVID-19 compared to standard care. In this multicenter, open-label, randomized controlled trial, 260 patients diagnosed with COVID-19 were randomly assigned to receive either umifenovir (200 mg every six hours for seven days) or standard care. The primary outcome was clinical improvement, assessed via the National Early Warning Score 2 system, while secondary outcomes included changes in computed tomography scan scores, length of hospital stay, intensive care unit admission rates, and mortality. Of the 260 patients enrolled, 193 completed the study. Both groups showed significant reductions in clinical symptoms, although myalgia was more prevalent in the umifenovir group. The intervention group demonstrated a significant decrease in computed tomography scan scores; however, no significant differences were observed between groups regarding in hospital stay duration, intensive care unit admissions, or mortality rates. While umifenovir exhibited some immunological benefits in COVID-19 patients, it did not significantly improve broader patient-important outcomes compared to standard care. Therefore, its routine use in clinical practice for COVID-19 treatment is currently not justified, highlighting the need for further research to explore alternative therapeutic strategies.