Adverse Effects Of Prolonged Use Research Articles

Adverse effects of prolonged use of mask among employees at selected departments in Nedumkandam, Idukki, Kerala

Introduction: “The surgical face mask has become a symbol of our times”. In March 17, 2020 this was headline of an article in the New York Times on the role of face mask during the COVID-19 outbreak. This study was undertaken to assess the effects of prolonged use of mask on physical well-being of employees in selected departments of Nedumkandam, Idukki, Kerala Method: The present study was an explorative study of 110 employees working in different sectors in Nedumkandam. Data were collected by using self-structured questionnaire. . There were total 20 questions related to physical effects of prolonged mask usage.. All participants wore either surgical mask or N95 respirators for a minimum of 6 hours per day. Result: Majority of the participants were male (56.3%) and between the age group of 36-45 years. The result indicated that 80.9% (N=89) were uncomfortable with mask usage. Reported side effects include head ache, breathing difficulty, nasal discomfort, skin related problems, Mask related infection. The majority of the respondents (N=89, 80.9%) report one or more of these adverse effect while 19% (N=21) report none of these side effects. Conclusion: The study was concluded that majority of the employees suffering with various physical discomforts including head ache, nose related problem, breathlessness, skin related problems. Employees who wear masks for extended periods reported increased fatigue and a sense of breathlessness.

Aging and Mesenchymal Stem Cells: Basic Concepts, Challenges and Strategies.

Aging and frailty are complex processes implicating multifactorial mechanisms, such as replicative senescence, oxidative stress, mitochondrial dysfunction, or autophagy disorder. All of these mechanisms drive dramatic changes in the tissue environment, such as senescence-associated secretory phenotype factors and inflamm-aging. Thus, there is a demand for new therapeutic strategies against the devastating effects of the aging and associated diseases. Mesenchymal stem cells (MSC) participate in a "galaxy" of tissue signals (proliferative, anti-inflammatory, and antioxidative stress, and proangiogenic, antitumor, antifibrotic, and antimicrobial effects) contributing to tissue homeostasis. However, MSC are also not immune to aging. Three strategies based on MSC have been proposed: remove, rejuvenate, or replace the senescent MSC. These strategies include the use of senolytic drugs, antioxidant agents and genetic engineering, or transplantation of younger MSC. Nevertheless, these strategies may have the drawback of the adverse effects of prolonged use of the different drugs used or, where appropriate, those of cell therapy. In this review, we propose the new strategy of "Exogenous Restitution of Intercellular Signalling of Stem Cells" (ERISSC). This concept is based on the potential use of secretome from MSC, which are composed of molecules such as growth factors, cytokines, and extracellular vesicles and have the same biological effects as their parent cells. To face this cell-free regenerative therapy challenge, we have to clarify key strategy aspects, such as establishing tools that allow us a more precise diagnosis of aging frailty in order to identify the therapeutic requirements adapted to each case, identify the ideal type of MSC in the context of the functional heterogeneity of these cellular populations, to optimize the mass production and standardization of the primary materials (cells) and their secretome-derived products, to establish the appropriate methods to validate the anti-aging effects and to determine the most appropriate route of administration for each case.

Levamisole in steroid-dependent nephrotic syndrome in children: A case series

Nephrotic syndrome (NS) is a common clinical entity encountered in children and adults. Steriod Dependent Nephrotic Syndrome(SDNS) is one of the most common pediatric glomerular diseases. However, a significant chunk of cases follows a relapsing and remitting course. Various modalities such as cyclophosphamide, cyclosporine, tacrolimus, mycophenolate mofetil (MMF), levamisole, and rituximab have been tried in patients with steroid-dependent or frequently relapsing NS (FRNS). We describe our experience of using levamisole in nine patients with steroid-dependent NS. We used the regimen of levamisole dosing at 2.5 mg/kg on alternate days, along with alternate dosing of steroids at the lowest possible doses to achieve remission. During follow-up, two of the patients were switched over to a calcineurin inhibitor (tacrolimus). All the remaining seven patients responded to levamisole and attained remission. At 18 months follow-up, four patients were on a minimal dose of steroids (prednisolone 0.25 mg/kg alternate day) with levamisole 2.5 mg/kg, whereas three patients were on prednisolone 0.5 mg/kg/alternate day with levamisole 2.5 mg/kg alternate day. Among the patients with steroid-sensitive NS, 30%–60% are frequently relapsing or steroid-dependent forms of NS. Corticosteroids have well recognized and potentially serious adverse effects. A lot of steroid-sparing agents such as MMF, rituximab, alkylating agents like cyclophosphamide, and calcineurin inhibitors have been used in clinical medicine, to mitigate the above mentioned adverse effects of prolonged use of corticosteroids, with varying success. But these medications have significant side effects and toxicity profiles of their own. Our case series reiterates the role of levamisole in FRNS and SDNS patients without much risk of adverse events in patients and hence being a relatively less expensive treatment option.

Knowledge & Usage of Personal Protective Equipment for Prevention of Infection Among Frontline Health Care Workers During Covid – 19 Pandemic

Background: The risk of transmission of novel SARS CoronaVirus-2 among health care workers can be reduced using personal protective equipment. It is critical to follow guidelines for appropriate use of protective gear to avoid its wastage. This study aimed to evaluate frontline healthcare workers’ understanding of effective donning and doffing of protective equipment in the wake of recent emergence of corona virus disease.Physical impacts due to its prolonged usage were also identified. Material and Methods: A cross sectional survey was conducted targeting frontline health care workers from June till July 2021. Data was analyzed using SPSS version 24. Descriptive analysis was performed for qualitative variables.Chi-square test was utilized to determine association between qualitative variables and p <0.05 was considered to be statistically significant. Results: A total of 204 responses were received. Surgical masks (53.9%), gloves (51.5%), gowns (46.1%) and N95 respirator (40.7%) were most frequently used. Physicians had better knowledge on correct utilization of protective equipment as compared to non-physicians, p<0.001.Only 55.9% and 47.1% participants knew correct donning and doffing sequence respectively.The most prevalent mistakes while doffingwere touching front of mask and potentially contaminated surfaces followed by incorrect doffing sequence.Mostrespondentsmentioned scarcity of protective gear. Around 53% participants did not attend any training session on utilization of personal protective equipment. Prolonged exposure to masks and gloves led to acne, facial marks and itching. Frequent practice of hand hygiene was linked with skin dryness and cracking, p<0.001. Conclusion: We observed lack of expertise in donning and doffing technique. Mostly mistakes occurred during doffing, so interactive workshops are required to train health care workers.Most common dermatological manifestationsdue to use of masks and gloves included acne, facial markings, and itching. Adverse effects of prolonged use of PPE can be avoided by having shorter duration of working hours and giving rest during the shifts. Keywords: COVID-19; personal protective equipment; skin manifestation; pandemics.

Association between diffuse idiopathic skeletal hyperostosis and long-term use of isotretinoin: case report

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a systemic condition that affects mainly the anterolateral spine, with abundant bone growth and formation of bridges between the vertebral bodies, but ossification in peripheral entheses may also occur. Its prevalence increases with age and is higher in males. Diagnosis at ages under 40 years are extremely rare. Hence, this report aims to describe a rare case of DISH in a young woman probably due to the long-term use of isotretinoin and discuss its presentation, bone involvement and differential diagnosis. A 37-year-old female patient was admitted to the Rheumatology service with progressive limitation of neck rotation and back flexion during the past 3 years, associated with great loss of function and impairment in daily activities. She had a previous diagnosis of congenital ichthyosiform erythroderma, managed with low doses of isotretinoin for 12 years. The current weekly isotretinoin dosage was 180mg. Prior image exams showed axial spondylopathy with diffuse peripheric enthesopathy since she was 33 years old and sacroiliitis with asymmetric syndesmophytes in the lumbar spine that resembled a psoriatic arthritis. Other diseases were denied. Family history included a case of rheumatoid arthritis but no history of psoriasis. Physical exam included erythema and diffuse skin peeling in the upper and lower limbs. Her hands were deformed with ulnar deviation but had no signs of arthritis. Cervical rotation was stiff and ranged 30o to the left and 35o to the right. Schober test distanced 1cm and Patrick’s Faber test was negative. Laboratory tests showed no alteration except for a serum 25-OH vitamin D of 7.25ng/mL (reference value: >30ng/mL). Biochemical and bone turnover markers were normal, including serum total calcium, magnesium, phosphorus, parathyroid hormone and alkaline phosphatase. Inflammatory markers C-reactive protein and erythrocyte sedimentation rate were within normal ranges. Human leukocyte antigen B27 was negative. Conventional radiographies were performed and showed increased bone texture with calcification of anterior and lateral ligaments of the cervical, thoracic and lumbar spine. Bone mineral density, evaluated by dual-energy X-ray absorptiometry (DXA), showed a Z-score of +3.2 SD at lumbar spine. Trabecular bone score by DXA was normal and vertebral fracture assessment showed no fracture and confirmed the formation of bridges between vertebral bodies. Clinical presentation was not compatible with ankylosing spondylitis nor psoriatic arthritis as there was no typical inflammatory pain, no elevated inflammatory markers, no typical skin lesions and no family history of psoriasis. However, the hyperostosis affecting the spine and the diffuse enthesopathy were very exuberant for DISH, but the female sex, young age and bilateral spine involvement were uncommon finds. As this patient was on long-term isotretinoin therapy, DISH development is more likely an adverse effect of retinoids on bone metabolism. Thus, clinicians and dermatologists should be always alert to the adverse effects of prolonged use of isotretinoin and, in cases of movement restriction, possible bone involvement must be further evaluated, as DISH may be a differential diagnosis. Since there is no specific treatment, early diagnosis can be crucial to avoid extensive bone damage and irreversible morbidity.

Adverse effects of prolonged use of personal protective equipment among health care workers during COVID-19 pandemic

Background: To know adverse effects of prolonged use of (PPE) personal protective equipment among various categories of health care providers while taking care of COVID-19 patients.Methods: This study include health care workers involved in care of covid-19 positive patients admitted in COVID dedicated hospital. A preformed questionnaire based performa was distributed among health care providers. Questions were framed about various possible adverse effects of use of PPE. Duration of study was six month from first July 2020 to 31 December 2020. The data was obtained from questionnaire and thereafter analysed to determine the adverse effects of different parts of PPE among various categories of HCPs depending on their age, sex and duration of exposure.Results: A total of 150 health care workers of various categories were surveyed. Maximum numbers of health care workers were in the age group of 31-40 years. Most common side effects were itching, rash, suffocation and impaired cognition. N-95 masks, gloves and face shield when used caused maximum discomfort.Conclusions: COVID-19 is ongoing pandemic with uncertinity about its end. Health care workers are continuously exposed to COVID-19 positive patients and almost all the healthcare providers experienced discomfort while using PPE causing reduced work efficiency.

Comparison of Magnetic Auriculotherapy, Laser Auriculotherapy and Their Combination for Treatment of Insomnia in the Elderly: A Double-Blinded Randomised Trial.

Background Insomnia is common amongst the elderly. With the adverse effects of prolonged use of hypnotics, the exploration of noninvasive and nonpharmacological complementary methods for insomnia is warranted. Auriculotherapy (AT) is a therapeutic approach where specific points on the auricle are stimulated to manage various physiological disorders. The purpose of this study is to determine the desirable treatment modality using AT to improve the sleep conditions of the elderly. Methods A three-arm double-blinded randomised trial was conducted on 145 eligible subjects. This study investigated three minimally invasive procedures, namely, laser auriculotherapy (LAT), magneto-auriculotherapy (MAT), and their combination. Seven auricular points were used. Treatment was performed three times a week, for six weeks. Subjects were assessed at baseline, six weeks, and follow-up after six weeks, three months, and six months. Generalised estimating equations were used to evaluate interactions amongst the groups over time based on the Pittsburgh Sleep Quality Index (PSQI), sleep parameters using actigraphic monitoring, health-related quality of life (HRQOL) using SF-12, and PHQ-9 for depression status. Results The treatment effects of the three procedures were comparable. Significant improvements were found in all of the subjective measures (PSQI, HRQOL, and PHQ-9) for individual groups over time. Improvements in the objective sleep parameters using actigraphic monitoring were detected in subjects who received MAT procedures but not in those who received LAT. The combined MAT and LAT approach did not show any advantage over MAT. Conclusions The treatment effects of the three procedures were comparable in subjective parameters but not by objective measures using actigraphic monitoring. Longer therapeutic course and more frequent administration of LAT may be considered in future trials to achieve the optimal treatment effect. Trial Registration This trial is registered with ClinicalTrials.gov: NCT02970695, registered May 2016.

Adverse effects of prolonged use of pausinystalia yohimbe on sperm and reproductive organs in rats

Adverse effects of prolonged use of pausinystalia yohimbe on sperm and reproductive organs in rats

Update on Immunosuppression in Liver Transplantation.

ABSTRACTThe standard therapy for decompensated end-stage chronic liver disease of any etiology and acute fulminant hepatic failure is liver transplantation (LT). Advances in immunosuppressive therapy decreased the rates of acute and chronic rejections. Thus, graft and patient survivals have significantly improved. However, long-term adverse effects of prolonged use of immunosuppressive agents such as malignancies, opportunistic infections, metabolic disorders, and other organ toxicities have now become a major concern. Consequently, alternative approaches are needed to deescalate the customary drugs and their side effects. Therapy must be individualized and additional preventive measures should be taken by patients with particular risk factors or predisposed to certain adverse effects. Current opinion favors a combination of agents with different mechanism of actions and toxicity profiles. Corticosteroids are employed in immediate and early postoperative period. Although they have a pronounced side effect profile, calcineurin inhibitors (CNIs) are still the backbone of early and late phase immunosuppressive regimens because of their proved efficacy. Antimetabolites are frequent choices for steroid and/or CNI-sparing strategies. Studies also have established a role for mammalian target of rapamycin (mTOR) inhibitors in specific groups of recipients. Biologic agents are a hot topic of interest and made their way into current strategies for induction. Agents extrapolated from other transplantation or immunologic experience are being evaluated.How to cite this articleTasdogan BE, Ma M, Simsek C, et al. Update on Immunosuppression in Liver Transplantation. Euroasian J Hepato-Gastroenterol 2019;9(2):96–101.

A patient case highlighting the myriad of cutaneous adverse effects of prolonged use of hydroxyurea

Hydroxyurea is an antimetabolite primarily used to treat myeloproliferative disorders, and chronic treatment is associated with many cutaneous adverse effects ranging in severity from ichthyosis to aggressive nonmelanoma skin cancer. We report a 67-year-oldman with a history of polycythemia vera who was referred for management of progressively worsening dorsal hand lesions. The patient presented withhyperpigmentation, ichthyosis, plantar keratoderma, dermatomyositis-like eruptions, two squamous cell carcinomas, and actinic keratoses. The adversereactions observed were acknowledged to be related to chronic hydroxyurea use. The patient underwent Mohs excision of the squamous cell carcinomas and thehydroxyurea was promptly discontinued; subsequent cutaneous improvement of the dermatomyositislike lesions ensued. Another clinically suspicious aggressive squamous cell carcinoma was suspected and the patient was referred to the plastic surgery department for complete excision because of the size of the lesion. The patient remains on periodic dermatology follow up. We report a case that exemplifies the cutaneous adverse effects of chronic hydroxyurea therapy. Although many cases improve after drug discontinuation, strict photoprotection and ongoing surveillance are indicated given the recently proposed premalignant potential of dermatomyositis-like eruptions and the aggressive nature of hydroxyurea-induced nonmelanoma skin cancer.

Ceftaroline as Salvage Monotherapy for Persistent MRSA Bacteremia.

To summarize published data regarding the use of ceftaroline as salvage monotherapy for persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. PubMed (January 1980-June 2016) was searched using combinations of the search terms methicillin-resistant Staphylococcus aureus, MRSA, bacteremia, ceftaroline, refractory, and persistent Supplemental references were generated through review of identified literature citations. Available English-language, full-text articles pertaining to the use of ceftaroline for persistent MRSA bacteremia (MRSAB) were included. The PubMed search yielded 23 articles for evaluation. There are no randomized controlled trials to date-only case series and reports. Four retrospective case series detailing the use of ceftaroline as monotherapy for persistent MRSAB were included. Most patients received at least 4 days of an appropriate anti-MRSA antimicrobial prior to ceftaroline and were able to clear bacteremia within 3 days. The most common rationales for ceftaroline use were progression of disease or nonresponse to current therapy. Higher off-label dosing of ceftaroline is often utilized to achieve optimal pharmacokinetic/pharmacodynamic parameters. Adverse events are not well described due to lack of follow-up; however, neutropenia has been associated with prolonged use. Treatment options for persistent MRSAB remain few and far between. Ceftaroline is an effective agent for the salvage treatment of MRSAB. Off-label doses up to 600 mg every 8 hours are often used to achieve optimal pharmacokinetic/pharmacodynamic parameters. Because of lack of follow-up in these reports, the incidence of adverse effects of prolonged use of ceftaroline is not well defined.

Chronic Cannabis Use in the Compassionate Investigational New Drug Program

The Missoula Chronic Clinical Cannabis Use Study was proposed to investigate the therapeutic bepnefits and adverse effects of prolonged use of medical marijuana in a cohort of seriously ill pa- tients. Use of cannabis was approved through the Compassionate Inves- tigational New Drug (IND) program of the Food and Drug Administra- tion (FDA). Cannabis is obtained from the National Institute on Drug