A narrative literature review on traditional medicine options for treatment of corona virus disease 2019 (COVID-19)

Molecular modeling of some commercially available antiviral drugs and their derivatives against SARS-CoV-2 infection

Numerous prior studies have identified therapeutic targets that could effectively combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, including the angiotensin-converting enzyme 2 (ACE2) receptor, RNA-dependent RNA polymerase (RdRp), and Main protease (Mpro). In parallel, antiviral compounds like abacavir, acyclovir, adefovir, amantadine, amprenavir, darunavir, didanosine, oseltamivir, penciclovir, and tenofovir are under investigation for their potential in drug repurposing to address this infection. The aim of the study was to determine the effect of modifying the functional groups of the aforementioned antivirals in silico. Using the genetic optimization for ligand docking algorithm on software Maestro (version 11.1), the modified antivirals were docked onto ACE2 receptor, RdRp, and Mpro. Using QuickProp (Maestro v11.1), PASS (prediction of activity spectra for the substances), and altogether with SwissADME, the ADMET (absorption, distribution, metabolism, excretion, and toxicity) of the modified antivirals, as well as their bioavailability and the predicted activity spectra, were determined. Discovery studio software was used to undertake post-docking analysis. Among the 10 antivirals, N(CH3)2 derivative of darunavir, N(CH3)2 derivative of amprenavir and NCH3 derivative of darunavir exhibited best binding affinities with ACE2 receptor (docking scores: -10.333, -9.527 and -9.695 kJ/mol, respectively). Moreover, NCH3 derivative of abacavir (-6.506 kJ/mol), NO2 derivative of didanosine (-6.877 kJ/mol), NCH3 derivative of darunavir (-7.618 kJ/mol) exerted promising affinity to Mpro. In conclusion, the results of the in silico screenings can serve as a useful information for future experimental works.

COVID-19 home remedy consumption and perceived effectiveness among adult population in Brunei Darussalam: a PLS-SEM approach

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 affects the respiratory system and causes severe acute respiratory infections. Several cultures have influenced the use of home remedies to ease mild symptoms of COVID-19 sometimes alongside conventional medicine. The aim of this study was to investigate the usage of COVID-19 home remedies among the adult population in Brunei.

METHODS

The study design was a cross-sectional study using an online survey and distributed nationwide. The statistical analysis of the data included descriptive statistics describing the sociodemographic characteristics of the respondents, their experience with COVID-19 infection, consumption of general home remedies and COVID-19 home remedy, their practice of COVID-19 home remedy use, and their attitude towards the general use of home remedy. Sub-group analysis including Pearson's chi-square test and Fisher's exact test was computed for the variables in relation to the COVID-19 home remedy use and the perceived effectiveness of the types of home remedy. Multivariate analysis including Partial Least Squares Structural Equation Modelling (PLS-SEM) was applied to determine the correlations between the factors and outcomes measured. P-value less than 0.05 is considered statistically significant.

RESULTS

There was a total of 864 eligible responses included in the study. The primary findings showed COVID-19 home remedy was used by 72.2% of the study participants. Most frequently used types of COVID-19 home remedy were cloves (37%), lemon (37%), and honey (23%). There was an infrequent usage of coconut (4.6%), eucalyptus oil (3.7%), habbatussauda (3.5%), traditional/ herbal cough syrup (2.4%), and turmeric (2.2%). The PLS-SEM demonstrated that 'Experience' appears to be a central endogenous variable that affects the decision on the use of COVID-19 home remedy. This relationship is mediated by 'Safety', 'Source', and 'Opinion' which have significant contributions to the outcome, accounting for 98.2% of the variance explained (R-square = 0.982).

CONCLUSIONS

The outcome of this study establishes the baseline prevalence of COVID-19 home remedy consumption among Bruneian residents and compared the previous study on Brunei's general use of traditional medicine. The present findings could help nurses and other healthcare professionals in Brunei understand the practice of Bruneian adults on the consumption of home remedies for COVID-19.

Whole-genome sequencing in medicinal plants: current progress and prospect

Advancements in genomics have dramatically accelerated the research on medicinal plants, and the development of herbgenomics has promoted the "Project of 1K Medicinal Plant Genome" to decipher their genetic code. However, it is difficult to obtain their high-quality whole genomes because of the prevalence of polyploidy and/or high genomic heterozygosity. Whole genomes of 123 medicinal plants were published until September 2022. These published genome sequences were investigated in this review, covering their classification, research teams, ploidy, medicinal functions, and sequencing strategies. More than 1,000 institutes or universities around the world and 50 countries are conducting research on medicinal plant genomes. Diploid species account for a majority of sequenced medicinal plants. The whole genomes of plants in the Poaceae family are the most studied. Almost 40% of the published papers studied species with tonifying, replenishing, and heat-cleaning medicinal effects. Medicinal plants are still in the process of domestication as compared with crops, thereby resulting in unclear genetic backgrounds and the lack of pure lines, thus making their genomes more difficult to complete. In addition, there is still no clear routine framework for a medicinal plant to obtain a high-quality whole genome. Herein, a clear and complete strategy has been originally proposed for creating a high-quality whole genome of medicinal plants. Moreover, whole genome-based biological studies of medicinal plants, including breeding and biosynthesis, were reviewed. We also advocate that a research platform of model medicinal plants should be established to promote the genomics research of medicinal plants.

Endophytic Pseudomonas fluorescens promotes changes in the phenotype and secondary metabolite profile of Houttuynia cordata Thunb

The interactions between microbes and plants are governed by complex chemical signals, which can forcefully affect plant growth and development. Here, to understand how microbes influence Houttuynia cordata Thunb. plant growth and its secondary metabolite through chemical signals, we established the interaction between single bacteria and a plant. We inoculated H. cordata seedlings with bacteria isolated from their roots. The results showed that the total fresh weight, the total dry weight, and the number of lateral roots per seedling in the P. fluorescens-inoculated seedlings were 174%, 172% and 227% higher than in the control seedlings. Pseudomonas fluorescens had a significant promotional effect of the volatile contents compared to control, with β-myrcene increasing by 192%, 2-undecanone by 203%, decanol by 304%, β-caryophyllene by 197%, α-pinene by 281%, bornyl acetate by 157%, γ-terpinene by 239% and 3-tetradecane by 328% in P. fluorescens-inoculated H. cordata seedlings. the contents of chlorogenic acid, rutin, quercitin, and afzelin were 284%, 154%, 137%, and 213% higher than in control seedlings, respectively. Our study provided basic data to assess the linkages between endophytic bacteria, plant phenotype and metabolites of H. cordata to provide an insight into P. fluorescens use as biological fertilizer, promoting the synthesis of medicinal plant compounds.

Emergency Protective Measures and Strategies of COVID-19: From Lifestyle to Traditional Chinese Medicine

This article reviews various aspects of COVID-19, including its current status, its side-effects, emergency protective measures and strategies from lifestyle to traditional Chinese medicine (TCM) for fighting against the SARS-CoV-2, and its major variants (Delta and Omicron), with the ongoing global COVID-19 pandemic, which include "Carassius auratus lifestyle" for high effective isolation, social and high-tech medical strategies, traditional Chinese herbs "Bark-Flower-Fruit-Grass-Leaf-Nucleolus(seed)-Root (BFFGLNR)", and the combination of Chinese and western medicine. As a choice, little is known whether the Chinese acupuncture is an effective method for confirming and suspecting COVID-19 patients, which include imported and asymptomatic cases. Definitely, acupuncture has been proven effective treatment for the recovery of COVID-19 cases. However, further animal experiments and clinical trials are required to confirm its effects and disclose underlying mechanisms. In conclusion, these emergency protective measures and strategies for COVID-19 will help to effectively combat the SARS-CoV-2 and its variants during the pandemic and post-COVID-19 era.

Identification of potential targets against SARS-CoV-2 of antiviral drugs based on photoaffinity probes

Facing the sudden outbreak of coronavirus disease 2019 (COVID-19), it is extremely urgent to develop effective antiviral drugs against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Drug repurposing is a promising strategy for the treatment of COVID-19. To identify the precise target protein of marketed medicines, we initiate a chemical biological program to identify precise target of potential antivirus drugs. In this study, two types of recombinant human coronavirus SARS-CoV-2 RdRp protein capturing probes with various photoaffinity labeling units were designed and synthesized based on the structure of FDA-approved drugs stavudine, remdesivir, acyclovir, and aladenosine. Fortunately, it was found that one novel photoaffinity probe, RD-1, could diaplayed good affinity with SARS-CoV-2 RdRp around the residue ARG_553. In addition, RD-1 probe also exhibited potent inhibitory activity against 3CLpro protease. Taken together, our findings will elucidate the structural basis for the efficacy of marketed drugs, and explore a rapid and efficient strategy of drug repurposing based on the identification of new targets. Moreover, these results could also provide a scientific basis for the clinical application of marketed drugs.

Health risk communication and infodemic management in Iran: development and validation of a conceptual framework

OBJECTIVE

The COVID-19 pandemic exposed significant gaps in Iran's and other health systems' risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health recommendations among the Iranian population. This study aimed to develop a conceptual framework for health risk communication and infodemic management (RCIM) during epidemics and health emergencies in Iran that could have potential applications in other contexts.

DESIGN

This study was designed in two phases. Phase 1 involved semistructured qualitative interviews with key informants to explore effective RCIM strategies across public health settings in Iran and to develop a conceptual framework. Phase 2 involved revising the framework based on feedback from an online expert panel regarding its comprehensiveness and validity.

SETTING

Provincial/national public health settings in Iran.

PARTICIPANTS

Twenty key informants from provincial and national public health authorities who contributed to COVID-19 response programmes participated in interviews. Nine experts from diverse academic disciplines, provincial and national settings, and geographical locations participated in an online expert panel.

RESULTS

The conceptual model was created based on qualitative interviews and expert panel discussions and was structured according to six pillars of the WHO health system framework: leadership and governance, information, health workforce and financial resources, along with media and community. Leadership and governance, including trustworthy leaders, were recommended as the foundation for developing RCIM in Iran. Developing an official strategy with information infrastructures, including high-quality surveillance systems, identified personnel and training for specialists among the health workforce, financial resources, communication channels and community engagement were recognised as other dimensions for developing health risk communication in Iran.

CONCLUSION

The proposed framework represents a step toward establishing a national RCIM strategy in Iran. Further validation of the conceptual framework and experiments on how it could potentially influence policy and practice is recommended. This model has the potential to be applied in other contexts in its current form or as the foundation for customised local versions.

Can egg yolk antibodies terminate the CSBV infection in apiculture?

Chinese sacbrood virus (CSBV) is the most severe pathogen of Apis cerana, which leads to serious fatal diseases in bee colonies and eventual catastrophe for the Chinese beekeeping industry. Additionally, CSBV can potentially infect Apis mellifera by bridging the species barrier and significantly affect the productivity of the honey industry. Although several approaches, such as feeding royal jelly, traditional Chinese medicine, and double-stranded RNA treatments, have been employed to suppress CSBV infection, their practical applicabilities are constrained due to their poor effectiveness. In recent years, specific egg yolk antibodies (EYA) have been increasingly utilized in passive immunotherapy for infectious diseases without any side effects. According to both laboratory research and practical use, EYA have demonstrated superior protection for bees against CSBV infection. This review provided an in-depth analysis of the issues and drawbacks in this field in addition to provide a thorough summary of current advancements in CSBV studies. Some promising strategies for the synergistic study of EYA against CSBV, including the exploitation of novel antibody drugs, novel TCM monomer/formula determination, and development of nucleotide drugs, are also proposed in this review. Furthermore, the prospects for the future perspectives of EYA research and applications are presented. Collectively, EYA would terminate CSBV infection soon, as well as will provide scientific guidance and references to control and manage other viral infections in apiculture.

The Conflict between the Beliefs of the Health Care Providers and Family Caregivers in the Use of Traditional Medicine in Pediatric Oncology: An Ethnographic Study

Introduction: Traditional medicine are popular treatments among families of children with cancer. This study was designed to identify the behaviors, beliefs, and values of families and health care providers for the use of traditional medicine in pediatric oncology. Methods: This study was conducted with a focus on ethnography approach in the oncology department of a pediatric subspecialty hospital in northeastern of Iran from September 2021 to June 2022. A total of 20 key informants were observed and interviewed formally and informally. The Miles and Huberman (1994) approach was used for data analysis. Results: Finally, two main cultural themes were emerged, including the blame of traditional herbal medicine and the synergy of rituals with modern therapies. Families use traditional medicine based on values passed down from generation to generation, while health care providers make evidence-based decisions. Conclusion: The results of the present study represent the conflict between health care providers and families in the use of medicinal herbs. The findings allow care providers to be aware of the beliefs and values of children caregivers to make the right decision about traditional medicine use.

Plant-Derived Antioxidants for Management of COVID-19: A Comprehensive Review of Molecular Mechanisms

We aimed to review the literature to introduce some effective plant-derived antioxidants to prevent and treat COVID-19. Natural products from plants are excellent sources to be used for such discoveries. Among different plant-derived bioactive substances, components including luteolin, quercetin, glycyrrhizin, andrographolide, patchouli alcohol, baicalin, and baicalein were investigated for several viral infections as well as SARS-COV-2. The mechanisms of effects detected for these agents were related to their antiviral activity through inhibition of viral entry and/or suppuration of virus function. Also, the majority of components exert anti-inflammatory effects and reduce the cytokine storm induced by virus infection. The data from different studies confirmed that these agents may play a critical role against SARS-COVID-2 via direct (antiviral activity) and indirect (antioxidant and anti-inflammatory) mechanisms, suggesting that natural products are a potential option for management of patients with COVID-19 due to the lower side effects and high efficiency.

An Industrial Approach to Production of Tofacitinib Citrate (TFC) as an Anti-COVID-19 Agent: A Joint Experimental and Theoretical Study

In this report, we have presented our experience about a facile method for synthesis of tofacitinib citrate (TFC). The developed analytical methods for identification and qualifications are also included. As TFC seems to be effective in treatment of the symptoms of COVID-19 (SARS family), manufacturing of this active pharmaceutical ingredient (API) could be helpful. The API of TFC was prepared from the diamine intermediate in an ambient and solvent-free condition. Elimination of the reaction solvent resulted in decreasing the cost and preventing the rejection of the organic volatile impurity (OVI) test. The final citrate addition step was carried out using water as a solvent (the citrate content was 37.5% by potentiometry). Moreover, the results of the Karl-Fischer (KF) titration analysis was about 0.24%, which showed that the use of water does not increase the water content of the crystal structure.

Small-molecule metabolites in SARS-CoV-2 treatment: a comprehensive review

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has quickly spread all over the world. In this respect, traditional medicinal chemistry, repurposing, and computational approaches have been exploited to develop novel medicines for treating this condition. The effectiveness of chemicals and testing methods in the identification of new promising therapies, and the extent of preparedness for future pandemics, have been further highly advantaged by recent breakthroughs in introducing noble small compounds for clinical testing purposes. Currently, numerous studies are developing small-molecule (SM) therapeutic products for inhibiting SARS-CoV-2 infection and replication, as well as managing the disease-related outcomes. Transmembrane serine protease (TMPRSS2)-inhibiting medicinal products can thus prevent the entry of the SARS-CoV-2 into the cells, and constrain its spreading along with the morbidity and mortality due to the coronavirus disease 2019 (COVID-19), particularly when co-administered with inhibitors such as chloroquine (CQ) and dihydroorotate dehydrogenase (DHODH). The present review demonstrates that the clinical-stage therapeutic agents, targeting additional viral proteins, might improve the effectiveness of COVID-19 treatment if applied as an adjuvant therapy side-by-side with RNA-dependent RNA polymerase (RdRp) inhibitors.

A comprehensive review on pharmacologic agents, immunotherapies and supportive therapeutics for COVID-19

The emergence of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected many countries throughout the world. As urgency is a necessity, most efforts have focused on identifying small molecule drugs that can be repurposed for use as anti-SARS-CoV-2 agents. Although several drug candidates have been identified using in silico method and in vitro studies, most of these drugs require the support of in vivo data before they can be considered for clinical trials. Several drugs are considered promising therapeutic agents for COVID-19. In addition to the direct-acting antiviral drugs, supportive therapies including traditional Chinese medicine, immunotherapies, immunomodulators, and nutritional therapy could contribute a major role in treating COVID-19 patients. Some of these drugs have already been included in the treatment guidelines, recommendations, and standard operating procedures. In this article, we comprehensively review the approved and potential therapeutic drugs, immune cells-based therapies, immunomodulatory agents/drugs, herbs and plant metabolites, nutritional and dietary for COVID-19.

Therapeutic Applications of Fucoidans and their Potential to Act Against COVID-19

In this review article, we present the updated evidence of therapeutic applications of fucoidan (a seaweed polysaccharide) and its novel potential to treat infectious diseases such as coronavirus disease (COVID-19). Because of their many biological activities, seaweeds have been identified as a rich and useful source of bioactive chemicals. Sulfated polysaccharides from the sea are considered a source of physiologically active chemicals that might be used in medication development. Antitumor, antiviral, antioxidant, antibacterial, anticoagulant, and immune-inflammatory properties have all been described for these compounds. By interfering at various phases of viral infection, marine sulfated polysaccharide has a virucidal effect. As a result, it opens the door to the development of antiviral treatments. Virus entry into host cells is an initial process, avoiding this type of entry makes any precautionary measure effective. The inhibitory action of certain marine sulfated polysaccharides against coronavirus was tested, and fucoidan, iota-carrageenan, and sea cucumber sulfated polysaccharides all showed a substantial antiviral impact. Fucoidan is one of the useful sulfated polysaccharides that has been widely studied and explored in various research. There are different sources of fucoidans, which have been used in the treatment of viral infection. Additionally, we highlight the mechanism of action of fuocidan against COVID-19. Hence, we could suggest that COVID-19 might be prevented and treated using these sulfated polysaccharides. This review thus highlights ample evidence to support the hypothesis that a large number of drugs have been developed from powerful compounds isolated from marine seaweeds.

Phytochemicals in the Prevention and Treatment of SARS-CoV-2-Clinical Evidence

The first case of SARS-CoV-2 infection was reported in December 2019. Due to the rapid spread of the disease and the lack of adequate therapy, the use of plants that have a long history in the treatment of viral infections has often been considered. The aim of this paper is to provide a brief review of the literature on the use of phytochemicals during the new pandemic. An extensive search of published works was performed through platforms Google Scholar, PubMed, Science Direct, Web of Science and Clinicaltrials.gov. Numerous preclinical studies on the use of phytochemicals (quercetin, curcumin, baicalin, kaempferol, resveratrol, glycyrrhizin, lycorine, colchicine) against SARS-CoV-2 have shown that these components can be effective in the prevention and treatment of this infection. Clinical research has proven that the use of black cumin and green propolis as well as quercetin has positive effects. As for other phytochemicals, in addition to preclinical testing which has already been carried out, it would be necessary to conduct clinical tests in order to assert their effectiveness. For those phytochemicals whose clinical efficacy has been proven, it would be necessary to conduct research on a larger number of patients, so that the conclusions are more representative.

Role of Dantabija, Haridra, and Zingiber (DHZ) combination to restore health and immunity in mild to moderate COVID-19 patients

Background

COVID-19 (SARS-CoV-2) has caused various clinical manifestations ranging from asymptomatic, minor flu-like symptoms to acute respiratory distress syndrome (ARDS), pneumonia, and even death. Early restriction of viruses is of utmost importance in controlling the spread of COVID-19. The present study aimed to evaluate the role of a common herbal extract combination of pomegranate (dantabija), turmeric (haridra), and zinger (DHZ) in mild to moderate covid cases.

Methods

A hundred covid-positive subjects of mild to moderate severity have been randomized to control and study groups. The study population has been given the fixed-dose combination of DHZ as an adjuvant to standard treatment. Data have been analyzed using standard statistical tools.

Finding

DHZ as an adjuvant helped in turning 83.33% of patients negative in the home quarantine group whereas 40% of patients in the hospitalized group turned negative with the addition of DHZ in the standard management. The percent negativity was lower in patients who received only standard management. Out of all patients, who did not receive DHZ, only 38% of patients in home quarantine and 32% in hospitalized patients became negative for COVID-19. Patients who received DHZ also showed improvement in blood pressure levels, oxygen levels as well as improvement in all symptoms associated with COVID-19 infections.

Interpretation

DHZ has shown a promising effect in mild to moderate cases of COVID-19 as an adjuvant to the standard therapy. The study results indicated that the combination probably produces its effect by its immunomodulatory action.

Altı Tıbbi Bitkinin Sitotoksik Etkileri ve SARS-CoV-2'ye Karşı Antiviral Etkinliğinin Araştırılması

Aim: Today, the COVID-19 pandemic, which causes deaths in 224 countries around the world, continues to show its effect all over the world. However, unfortunately, there are few studies that determine the effect of natural products derived from plants on COVID-19. However, as it is known, the source of most drugs is plants and medicinal aromatic plants have been used frequently for therapeutic purposes since the existence of humanity. The aim of this study is to investigate the cytotoxic effects of six medicinal plants such as Licorice (Glycyrrhiza glabra), Saffron (Crocus sativus L.), Black Cumin (Nigella sativa L.), Laurel (Lauris nobilis), Buckwheat (Lavandula stoechas) and Zahter (Thymbra spicata L. var. spicata) and their antiviral activities against SARS-CoV-2 in vitro conditions. Material and Method: This study was carried out in two stages. In the first stage, plants were collected and extracts were obtained. At the beginning of the second stage, cytotoxic effects on vero cells at non-cytotoxic broad-spectrum concentrations against SARS-CoV-2 in cell culture of six medicinal plants were investigated. In this step, the concentration of six ethnobotanically important medicinal plants that were not cytotoxic to SARS-CoV-2 was determined. In the continuation of the second stage, the plants were evaluated for the determination of viral replication inhibition and their antiviral effectiveness against SARS-CoV-2. In this step, in vitro antiviral effects of plants against SARS-CoV-2 were determined at a concentration that did not show cytotoxic effects.. Results: The concentration of six plants used in the study without cytotoxic effects was determined.. Among the plants examined, it was determined that the only plant that was effective against SARS-CoV-2 in vitro conditions was the licorice plant (Glycyrrhiza glabra). The licorice plant was found to inhibit SARS-CoV-2 in vitro at the 2nd dilution (1:4) after the initial concentration. Conclusion: According to the findings obtained from our study, it was determined that the licorice plant was effective against the SARS-CoV-2 in vitro conditions. Supported by further studies, it can be thought that our findings may contribute to the fight against the COVID-19 pandemic. Keywords: SARS-CoV-2, Antiviral Efficacy, Plant Extract, Licorice (Glycyrrhiza glabra), Saffron (Crocus sativus L.), Black Cumin (Nigella sativa L.), Laurel (Lauris nobilis), Buckwheat (Lavandula stoechas), Zahter (Thymbra spicata L. var. spicata).

The SARS-CoV-2 main protease (Mpro): Structure, function, and emerging therapies for COVID-19

The main proteases (Mpro), also termed 3-chymotrypsin-like proteases (3CLpro), are a class of highly conserved cysteine hydrolases in β-coronaviruses. Increasing evidence has demonstrated that 3CLpros play an indispensable role in viral replication and have been recognized as key targets for preventing and treating coronavirus-caused infectious diseases, including COVID-19. This review is focused on the structural features and biological function of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main protease Mpro (also known as 3CLpro), as well as recent advances in discovering and developing SARS-CoV-2 3CLpro inhibitors. To better understand the characteristics of SARS-CoV-2 3CLpro inhibitors, the inhibition activities, inhibitory mechanisms, and key structural features of various 3CLpro inhibitors (including marketed drugs, peptidomimetic, and non-peptidomimetic synthetic compounds, as well as natural compounds and their derivatives) are summarized comprehensively. Meanwhile, the challenges in this field are highlighted, while future directions for designing and developing efficacious 3CLpro inhibitors as novel anti-coronavirus therapies are also proposed. Collectively, all information and knowledge presented here are very helpful for understanding the structural features and inhibitory mechanisms of SARS-CoV-2 3CLpro inhibitors, which offers new insights or inspiration to medicinal chemists for designing and developing more efficacious 3CLpro inhibitors as novel anti-coronavirus agents.

Indicators of Mental Health Disorder, COVID-19 Prevention Compliance and Vaccination Intentions among Refugees in Kenya

Background and Objectives: COVID-19 remains a major development challenge in many developing countries. This study analysed the effect of mental health disorder and indicators of COVID-19 preventive practices on vaccination intentions among refugees in Kenya. Materials and Methods: The data were the fourth and fifth waves of the High Frequency Phone Surveys on the impacts of COVID-19 that were collected by the Kenyan National Bureau of Statistics (KNBS) between May 2020 and June 2021. The data were collected from Kakuma, Kalobeyei, Dadaab and Shona camps using the stratified random sampling method. The data were analysed with random effects instrumental variable Probit regression model. Results: The results showed that 69.32% and 93.16% of the refugees were willing to be vaccinated during the 4th and 5th waves, respectively. The fear of dying was reported by 85.89% and 74.19% during the 4th and 5th waves, respectively. COVID-19 contact prevention and immune boosting indicators were differently influenced by some demographic and anxiety index variables, while being endogenous influenced vaccine hesitancy along with urban residence, age, knowing infected persons, days of depression, days of anxiety, days of physical reactions, members losing job, searching for jobs, accepting job offers and being employed. Conclusions: It was concluded that efforts to promote COVID-19 vaccination should address mental health disorder and compliance with existing COVID-19 contact and immune boosting behaviour with a focus on urban residents and youths.

Effect Evaluation of Echocardiography on Right Ventricular Function in Patients after the Recovering from Coronavirus Disease 2019

This research was aimed at exploring the changes in right ventricular function in patients after the recovery of coronavirus disease 2019 (COVID-19) under echocardiography and providing a reference for the rehabilitation and treatment of COVID-19 patients. Three echocardiographic follow-up examinations were performed on 40 recovered COVID-19 patients and 40 healthy people. Right ventricular function between patients after COVID-19 rehabilitation and healthy people was compared. The mean values of right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), right ventricular ejection fraction (RVEF), right myocardial performance index (RMPI), and tricuspid annular plane systolic speed (S') were compared between patients after COVID-19 rehabilitation and healthy subjects. The technical parameters of two-dimensional speckle tracking were compared. The results showed that the differences in RVFAC, TAPSE, RVEF, and RMPI between COVID-19 patients and healthy controls were not significant during the three follow-up periods (P > 0.05). At the first follow-up, the S' was 12.78 cm/s in COVID-19 patients and 13.18 cm/s in healthy subjects. At the second follow-up, the S' was 11.98 cm/s in COVID-19 patients and 12.77 cm/s in healthy subjects. At the third follow-up, the S' was 12.79 cm/s in COVID-19 patients and 13.12 cm/s in healthy subjects. There was no significant difference between the two groups (P > 0.05). In addition, there was no significant difference in right ventricular function between COVID-19 patients and healthy controls, and there was no significant difference in cardiovascular symptoms (P > 0.05). In summary, COVID-19 had no substantial effect on right ventricular function and better recovery in patients.

Social Marketing Strategy to Promote Traditional Thai Medicines during COVID-19: KAP and DoI Two-Step Theory Application Process

Introduction: Recently, the Thai government has been promoting the innovation of finished forms of traditional Thai medicine (TTM) products (e.g., tablets and capsules). According to the existing literature, most consumers are unaware of the finished forms of TTMs because of conflicting knowledge, information, and communication. Therefore, the consumers have poor perceptions about TTMs and their benefits. Purpose: This qualitative study explores the current perceptions about TTMs and the modes of promotion that are being utilized to develop a strategic communication plan for the finished forms of TTMs. Design/methodology/approach: Utilising thematic analysis, focus groups were conducted with thirty experienced consumers. Findings: Using KAP and DoI theory, the following three themes emerged in this study: (i) the current KAP of Thai consumers toward the finished forms of TTM; (ii) factors influencing the use of finished forms of TTM; and (iii) integrated marketing communication as a promotion strategy to rapidly disseminate knowledge. Research limitations/implications: Given Thailand's large population, the findings of this study are substantially limited and cannot be generalized. Therefore, the findings herein may not reflect the experiences and opinions of the Thai consumers residing in other regions or the opinions of the entire country. Originality/value: This study utilises interdisciplinary methods and two-step theory application to explain the current knowledge and perceptions about the finished forms of TTM and develop proper communication and media strategies that can promote the finished forms of traditional Thai medicines, helping to widen their usage significantly.

Development and Validation of a Tool to Improve Community Pharmacists’ Surveillance Role in the Safe Dispensing of Herbal Supplements

Background: There has been an appreciable increase in the use of herbal supplements, including immune boosters, during the current COVID-19 pandemic. However, there are concerns with falsified herbal supplements.

Objectives: Developed a new questionnaire that can potentially help community pharmacists identify the extent of falsified herbal supplements.

Methods: A 9-month cross sectional study was conducted among 500 community pharmacies across United Arab Emirates. A new 5-factor, 24-itmes scale was developed based on current labelling requirements across countries and piloted. This included seven items on identified uses and contraindication, seven items on hazard identification, four items on product identity, three items on packaging and product insert and three items on product handling and storage. The face and content validity of the scale was assessed via the content validity index (CVI). Its construct validity was tested using an exploratory factor analysis (EFA) via principally component analysis (PCA). The model was subsequently confirmed through partial confirmatory factor analysis (PCFA). Its reliability was assessed via test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs).

Results: The CVI of the finalized questionnaire was 0.843. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.891, and Bartlett’s test of sphericity indicated significance (p-value < 0.001). Confirmation of the subsequent 5-domains was achieved through PCFA using maximum likelihood analysis with oblimin rotation. The PCFA obtained values was 0.962 for NFI, 0.977 for CFI, and 0.987 for the Tucker Lewis Index. All values were greater than 0.95, and the RMSEA value was 0.03 (i.e., less than 0.06). Consequently, the model had a good fit. All domains demonstrated Cronbach’s alpha coefficients above 0.70, with 0.940 for the full instrument. Meanwhile, all items met the IIC correlation standard of ≥0.40. The instrument presented good ICC statistics of 0.940 (0.928–0.950) as well as statistical significance (p < 0.001). Community pharmacists with more than 10 experience years were more likely to identify falsified herbal supplements compared to those with 1–10 years experience (p < 0.001).

Conclusion: This study developed and validated a new instrument to identify safe herbal supplements, which should enhance the role of the community pharmacists in the safe and effective treatment of suitable patients with herbal supplements.

A comprehensive review on facemask manufacturing, testing, and its environmental impacts

The coronavirus pandemic (COVID-19) is currently the biggest threat to human lives due to its rapid transmission rate causing severe damage to human health and economy. The transmission of viral diseases can be minimized at its early stages with proper planning and preventive practices. The use of facemask has proved to be most effective measure to curb the spread of virus along with social distancing and good hygiene practices. This necessitates more research on facemask technology to increase its filtration efficiencies and proper disposal, which can be accelerated with knowledge of the current manufacturing process and recent research in this field. This review article provides an overview of the importance of facemask, fundamentals of nonwoven fabrics, and its manufacturing process. It also covers topics related to recent research reported for improved facemask efficiencies and testing methods to evaluate the performance of facemask. The plastic waste associated with the facemask and measures to minimize its effect are also briefly described. A systematic understanding is given in order to trigger future research in this field to ensure that we are well equipped for any future pandemic.

Investigation on anti-Corona viral potential of Yarrow tea

Achillea millefolium (Yarrow) is a herbaceous plant of Greek origin noted to treat pneumonia, common cold, cough, and other respiratory disorders. The flowers and leaves are the core part used to prepare herbal tea that gains the world's recognition as medicinal tea. Coronavirus disease is spreading across the globe, and numerous approaches are lodged to treat virus-induced lung inflammation. Here, we used the network pharmacology, metabolite analysis, docking and molecular simulation and MM-PBSA analysis to comprehend the biochemical basis of the health-boosting impact of Yarrow tea. Next, we performed the microscopic and dynamic light scattering (DLS) analysis of yarrow-treated ChAdOx1 nCoV-19 to evaluate the virucidal activity of the Yarrow. The present study investigates the druggability, metabolites and potential interaction of the title tea with genes associated with Covid-19-induced pathogenesis. Towards this, 1022 gene hits were obtained, 30 are mutually shared. Network Pharmacology and microarray gene expression analysis find the connection of PTGS2 in relieving the virus-induced inflammation. Yarrow constituents Luteolin may inhibit or down-regulate the Cyclooxygenase II (PTGS2), a plausible mechanism underlying the Yarrow's anti-inflammatory actions. Further, the Yarrow's virucidal activity was assessed towards Transmission Electron Microscopic (TEM). The Yarrow treated SARS-nCoV-2 cell exhibits the disintegration of the virus membrane. This work provides a scientific basis for further elucidating the mechanism underlying Achillea millefolium's antiviral and anti-inflammatory properties.

Role of Diet and Nutrients in SARS-CoV-2 Infection: Incidence on Oxidative Stress, Inflammatory Status and Viral Production

Coronavirus illness (COVID-19) is an infectious pathology generated by intense severe respiratory syndrome coronavirus 2 (SARS-CoV-2). This infectious disease has emerged in 2019. The COVID-19-associated pandemic has considerably affected the way of life and the economy in the world. It is consequently crucial to find solutions allowing remedying or alleviating the effects of this infectious disease. Natural products have been in perpetual application from immemorial time given that they are attested to be efficient towards several illnesses without major side effects. Various studies have shown that plant extracts or purified molecules have a promising inhibiting impact towards coronavirus. In addition, it is substantial to understand the characteristics, susceptibility and impact of diet on patients infected with COVID-19. In this review, we recapitulate the influence of extracts or pure molecules from medicinal plants on COVID-19. We approach the possibilities of plant treatment/co-treatment and feeding applied to COVID-19. We also show coronavirus susceptibility and complications associated with nutrient deficiencies and then discuss the major food groups efficient on COVID-19 pathogenesis. Then, we covered emerging technologies using plant-based SARS-CoV-2 vaccine. We conclude by giving nutrient and plants curative therapy recommendations which are of potential interest in the COVID-19 infection and could pave the way for pharmacological treatments or co-treatments of COVID-19.

Prospective Medicinal Plants and Their Phytochemicals Shielding Autoimmune and Cancer Patients Against the SARS-CoV-2 Pandemic: A Special Focus on Matcha

Background

Being "positive" has been one of the most frustrating words anyone could hear since the end of 2019. This word had been overused globally due to the high infectious nature of SARS-CoV-2. All citizens are at risk of being infected with SARS-CoV-2, but a red warning sign has been directed towards cancer and immune-compromised patients in particular. These groups of patients are not only more prone to catch the virus but also more predisposed to its deadly consequences, something that urged the research community to seek other effective and safe solutions that could be used as a protective measurement for cancer and autoimmune patients during the pandemic.

Aim

The authors aimed to turn the spotlight on specific herbal remedies that showed potential anticancer activity, immuno-modulatory roles, and promising anti-SARS-CoV-2 actions.

Methodology

To attain the purpose of the review, the research was conducted at the States National Library of Medicine (PubMed). To search databases, the descriptors used were as follows: "COVID-19"/"SARS-CoV-2", "Herbal Drugs", "Autoimmune diseases", "Rheumatoid Arthritis", "Asthma", "Multiple Sclerosis", "Systemic Lupus Erythematosus" "Nutraceuticals", "Matcha", "EGCG", "Quercetin", "Cancer", and key molecular pathways.

Results

This manuscript reviewed most of the herbal drugs that showed a triple action concerning anticancer, immunomodulation, and anti-SARS-CoV-2 activities. Special attention was directed towards "matcha" as a novel potential protective and therapeutic agent for cancer and immunocompromised patients during the SARS-CoV-2 pandemic.

Conclusion

This review sheds light on the pivotal role of "matcha" as a tri-acting herbal tea having a potent antitumorigenic effect, immunomodulatory role, and proven anti-SARS-CoV-2 activity, thus providing a powerful shield for high-risk patients such as cancer and autoimmune patients during the pandemic.

Adults' State of Using Complementary and Alternative Medicine During the COVID-19 Pandemic: Complementary and Alternative Medicine During the COVID-19 Pandemic

This study aimed to explore the attitudes of adults living in Turkey toward complementary and alternative medicine in the period of the coronavirus disease-2019 (COVID-19) pandemic and identify whether Turkish adults used complementary and alternative medicine during the pandemic. The cross-sectional study covered 3242 adults across Turkey. The data were collected via a Personal Information Form and the Holistic Complementary and Alternative Medicine Questionnaire. The participants had positive attitudes toward complementary and alternative medicine (33.8 ± 4.7). The results indicated that the Turkish adults widely used complementary and alternative treatment methods (70.5%) during the COVID-19 pandemic, and they were more oriented toward the use of herbal treatment (35.5%). It was identified that the primary reasons for using complementary and alternative medicine were to be protected from COVID-19, and if infected with COVID-19, to recover from it quickly with only mild symptoms.

Vitamin K: A Simple and Efficient Add-on to the Current Treatment Regime of COVID-19

Background:

: Intravascular thrombosis and pulmonary fibrosis in COVID-19 patients with pneumonia is significantly associated with the severity of disease. Vitamin K is known to balance the coagulation mechanisms and also prevents calcification and fibrosis of the extrahepatic soft tissues. This narrative review focuses on the role of Vitamin K as a linking factor for thrombotic as well as pulmonary complications of COVID-19.

Methods and Results:

Article search was performed in databases of WHO, PubMed, Scopus and Clinical Trial Registry using appropriate key words. Original articles included very few observational studies which showed a reduced level of Vitamin K as well as activated extrahepatic Vitamin K Dependent Proteins (VKDP) in COVID-19 patients when compared to healthy controls. Chronic treatment with Vitamin K Antagonists did not reduce the risk of in-hospital death. Docking study was performed using Swiss dock and it gave a significant interaction between menaquinone and SARS-CoV-2 main Protease (SARS-CoV-2 Mpro).

Discussion:

Deficiency of Vitamin K in COVID-19 can be due to excess use of antagonists or defective ingestion or absorption. This triggers an imbalance in the normal coagulation-anticoagulation mechanism by channelling the available Vitamin K to the liver and thereby causing a deficiency of the same in extrahepatic tissues and finally leading to thrombosis. This also prevents carboxylation and activation of extrahepatic VKDP required to prevent the calcification of soft tissues and thus leading to lung fibrosis.

Conclutions:

Supplementation of Vitamin K should be considered as a potentially modifiable risk factor in severe COVID-19. Randomized control trials are highly recommended to give clearer evidence on the same.

A Comprehensive Investigation Regarding the Differentiation of the Procurable COVID-19 Vaccines

COVID-19 caused by coronavirus SARS-CoV-2 became a serious threat to humankind for the past couple of years. The development of vaccine and its immediate application might be the only to escape from the grasp of this demoniac pandemic. Approximately 343 clinical trials on COVID-19 vaccines are ongoing currently, and almost all countries are motivating ongoing researches at warp speed for the development of vaccines against COVID-19. This review explores the progress in the development of the vaccines, their current status of ongoing clinical research, mechanisms, and regulatory approvals. Many pharmaceutical companies are already in the endgame for manufacturing various vaccines of which some are already being marketed across the globe, while others are yet to get approval for marketing. The primary aim of this review is to compare regulatory accepted vaccines in terms of their composition, doses, regulatory status, and efficacy. The study is conducted by grouping into approved and unapproved vaccines for marketing. Different routes of administration of vaccines along with the efficacy of the routes are also presented in the review. A wide range of database and clinical trial data is reviewed for sorting out the information on different vaccines. Unfortunately, many mutations (alpha, beta, gamma, delta, kappa, omicron etc.) of SARS-CoV-2 have attacked people in very short time, which is the great challenge for investigational vaccines. Moreover, some vaccines like Pfizer's BNT162, Oxford's ChAdOx1, Moderna's mRNA-1273, and Bharat Biotech's Covaxin have got regulatory approval in some countries for its distribution which may prove to stand tall against the pandemic.

Natural products can be used in therapeutic management of COVID-19: Probable mechanistic insights

The unexpected emergence of the new Coronavirus disease (COVID-19) has affected more than three hundred million individuals and resulted in more than five million deaths worldwide. The ongoing pandemic has underscored the urgent need for effective preventive and therapeutic measures to develop anti-viral therapy. The natural compounds possess various pharmaceutical properties and are reported as effective anti-virals. The interest to develop an anti-viral drug against the novel severe acute respiratory syndrome Coronavirus (SARS-CoV-2) from natural compounds has increased globally. Here, we investigated the anti-viral potential of selected promising natural products. Sources of data for this paper are current literature published in the context of therapeutic uses of phytoconstituents and their mechanism of action published in various reputed peer-reviewed journals. An extensive literature survey was done and data were critically analyzed to get deeper insights into the mechanism of action of a few important phytoconstituents. The consumption of natural products such as thymoquinone, quercetin, caffeic acid, ursolic acid, ellagic acid, vanillin, thymol, and rosmarinic acid could improve our immune response and thus possesses excellent therapeutic potential. This review focuses on the anti-viral functions of various phytoconstituent and alkaloids and their potential therapeutic implications against SARS-CoV-2. Our comprehensive analysis provides mechanistic insights into phytoconstituents to restrain viral infection and provide a better solution through natural, therapeutically active agents.

Leveraging knowledge of Asian herbal medicine and its active compounds as COVID-19 treatment and prevention

The outbreak of COVID-19 disease has led to a search for effective vaccines or drugs. However, insufficient vaccine supplies to meet global demand and no effective approved prescribed drugs for COVID-19 have led some people to consider the use of alternative or complementary medicines, such as traditional herbal medicine. Medicinal plants have various therapeutic properties that depend on the active compounds they contain. Obviously, herbal medicine has had an essential role in treatment and prevention during COVID-19 outbreak, especially in Asian cultures. Hence, we reviewed the uses of herbal medicine in Asian cultures and described the prominent families and species that are sources of antiviral agents against COVID-19 on the basis of case reports, community surveys, and guidelines available in the literature databases. Antiviral efficacy as determined in laboratory testing was assessed, and several promising active compounds with their molecular targets in cell models against SARS-CoV-2 viral infection will be discussed. Our review findings revealed the highly frequent use of Lamiaceae family members, Zingiber officinale, and Glycyrrhiza spp. as medicinal sources for treatment of COVID-19. In addition, several plant bioactive compounds derived from traditional herbal medicine, including andrographolide, panduratin A, baicalein, digoxin, and digitoxin, have shown potent SARS-CoV-2 antiviral activity as compared with some repurposed FDA-approved drugs. These commonly used plants and promising compounds are recommended for further exploration of their safety and efficacy against COVID-19.

Role of herbal medicines in the management of patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIM

The management of the worldwide spreading COVID-19 consists of amelioration of its symptoms but no cure is yet available. Herbal medicines supplemented with the Western medicine have been applied for COVID-19 treatment in India, China, Iran, and other countries. This systematic review and meta-analysis of RCTs evaluates the effect and safety of herbal intervention in the management of COVID-19.

EXPERIMENTAL PROCEDURE

RCTs from databases like PubMed, Cochrane Library, ScienceDirect, Google Scholar, Science Direct, CTRI, AYUSH Research Portal, India, were reviewed and the data were extracted for study sample demographics, intervention details, clinical effect, inflammatory markers and safety monitoring. Outcomes were expressed as Risk-ratio (RR) with 95% CI for dichotomous data, and Mean-Difference (MD) with 95% CI for continuous data.

RESULT AND CONCLUSION

From the 32 eligible studies, a total of 3177 COVID-19 patients were included in the review. Herbal intervention as an adjuvant to Western medicine causes significantly higher improvement compared to Western medicine alone [Fever (RR = 1.09 CI 1.03, 1.15), Cough (Risk-Ratio = 1.22 CI 1.08, 1.37), Fatigue (Risk-Ratio = 1.27 CI 1.11, 1.44), Chest CT Improvement (Risk-Ratio = 1.15 CI 1.08, 1.23)]. The laboratory parameters were also better in the herbal medicine group compared to standard care group only WBC (MD = 0.36 CI 0.16, 0.55), Lymphocyte percentage (MD = 5.48 CI 3.05, 7.92), Absolute lymphocyte count (MD = 0.23 CI 0.07, 0.39), CRP (MD = -5.66 CI -7.96, -3.37). However, duration of hospital stays (MD = -1.82 CI -3.84, 0.21); IL-6 (MD = -3.67 CI -8.76, 1.43), ESR Level (MD = -10.38 CI -25.96, 5.21) were statistically insignificant. No significant adverse events for herbal medications were noted in the included RCTs, during the time of the studies. (n = 665, RR 0.93; 95% CI 0.76, 1.14).

Impact of Nutrition in the Management of Nutritional Status of Covid-19 Patients

Abstract:

The second outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV-2) is of great concern due to its awful mortality and morbidity rate with decreasing nutritional status and poor lifestyle as well as noteworthy food crisis and affected economy of the world. Increasing food prices, food crisis, global hunger and decreasing availability and feasibility of food are the foremost causes of decreasing nutritional status, which increases the risk of susceptibility to infection and, in turn, leads to unfavorable outcomes of the diseases. Although, in times of the Covid- 19 pandemic, nutrition is of potential attention, and there is a requirement for more exploration in the field of nutrition for the prevention of diseases arising from coronavirus infection. Elderly and individuals with co-morbidity, such as respiratory diseases, cardiovascular diseases, diabetes mellitus and metabolic diseases, are more prone towards getting infected with the coronavirus. Good nutrition is mandatory for healthy immune responses, which can be improved by the inclusion of vitamin A, B6, B12, C, D, E, zinc, selenium, iron, copper and an antioxidant-rich diet.

Clinical features and mechanistic insights into drug repurposing for combating COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged from Wuhan in China before it spread to the entire globe. It causes coronavirus disease of 2019 (COVID-19) where mostly individuals present mild symptoms, some remain asymptomatic and some show severe lung inflammation and pneumonia in the host through the induction of a marked inflammatory 'cytokine storm'. New and efficacious vaccines have been developed and put into clinical practice in record time, however, there is a still a need for effective treatments for those who are not vaccinated or remain susceptible to emerging SARS-CoV-2 variant strains. Despite this, effective therapeutic interventions against COVID-19 remain elusive. Here, we have reviewed potential drugs for COVID-19 classified on the basis of their mode of action. The mechanisms of action of each are discussed in detail to highlight the therapeutic targets that may help in reducing the global pandemic. The review was done up to July 2021 and the data was assessed through the official websites of WHO and CDC for collecting the information on the clinical trials. Moreover, the recent research papers were also assessed for the relevant data. The search was mainly based on keywords like Coronavirus, SARS-CoV-2, drugs (specific name of the drugs), COVID-19, clinical efficiency, safety profile, side-effects etc.This review outlines potential areas for future research into COVID-19 treatment strategies.

In Silico Evaluation of Different Flavonoids from Medicinal Plants for Their Potency against SARS-CoV-2

The ongoing pandemic situation of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a global threat to both the world economy and public health. Therefore, there is an urgent need to discover effective vaccines or drugs to fight against this virus. The flavonoids and their medicinal plant sources have already exhibited various biological effects, including antiviral, anti-inflammatory, antioxidant, etc. This study was designed to evaluate different flavonoids from medicinal plants as potential inhibitors against the spike protein (Sp) and main protease (Mpro) of SARS-CoV-2 using various computational approaches such as molecular docking, molecular dynamics. The binding affinity and inhibitory effects of all studied flavonoids were discussed and compared with some antiviral drugs that are currently being used in COVID-19 treatment namely favipiravir, lopinavir, and hydroxychloroquine, respectively. Among all studies flavonoids and proposed antiviral drugs, luteolin and mundulinol exhibited the highest binding affinity toward Mpro and Sp. Drug-likeness and ADMET studies revealed that the chosen flavonoids are safe and non-toxic. One hundred ns-MD simulations were implemented for luteolin-Mpro, mundulinol-Mpro, luteolin-Sp, and mundulinol-Sp complexes and the results revealed strong stability of these flavonoid-protein complexes. Furthermore, MM/PBSA confirms the stability of luteolin and mundulinol interactions within the active sites of this protein. In conclusion, our findings reveal that the promising activity of luteolin and mundulinol as inhibitors against COVID-19 via inhibiting the spike protein and major protease of SARS CoV-2, and we urge further research to achieve the clinical significance of our proposed molecular-based efficacy.

Advancing the Regulation of Traditional and Complementary Medicine Products: A Comparison of Five Regulatory Systems on Traditional Medicines with a Long History of Use

Background

An appropriate regulatory system to ensure and promote the quality, safety, and efficacy of the products of traditional medicine (TM) and complementary medicine (CM) is critical to not only public health but also economic growth. The regulatory approach and evaluation standards for TM/CM products featured with a long history of use are yet to be developed. This study aims to investigate and compare the existing regulatory approaches for TM/CM products with a long history of use.

Method

A mixed approach of documentary analysis involving official and legal documents from official websites, as well as a scoping review of scholarly work in scientific databases about regulatory systems of TM/CM products in China, Hong Kong, Taiwan, Japan, and Korea, was employed in this study and used for comparison.

Results

For registration purposes, all five regulatory systems recognized the history of use as part of the totality of evidence when evaluating the safety and efficacy of TM/CM products with a long history of use. Generally, the list of classic formulas is predefined and bound to the formulas recommended in the prescribed list of ancient medical textbooks. Expedited pathways are usually in place and scientific data of nonclinical and clinical studies may be exempted. At the same time, additional restrictions with the scope of products constitute a comprehensive approach in the regulation. Quality assurance and postmarketing safety surveillance were found to be the major focus across the regulatory schemes investigated in this study.

Conclusion

The regulatory systems investigated in this study allow less stringent registration requirements for TM/CM products featured with a long history of use, assuming safety and efficacy to be plausible based on historic use. Considering the safety and efficacy of these products, regulatory standards should emphasize the technical requirements for quality control and postmarket surveillance.

Prevention and Treatment of COVID-19 Using Traditional and Folk Medicine: A Content Analysis Study

Background

Coronavirus 2019 (COVID-19) is a respiratory disease with no specific and definitive drug treatment. With the COVID-19 outbreak, traditional and folk methods were used for its treatment. This study was conducted to explore people's experiences of using traditional and folk medicine for the prevention and treatment of COVID-19 in Iran.

Methods

This qualitative study was conducted on 37 people in Arak (Iran) from May to November 2020 using a conventional content analysis approach. The participants were selected using cluster sampling and interviewed using semistructured telephone interviews. After transcribing the interviews, they were analyzed using content analysis. Accordingly, semantic units were identified, related codes were extracted and placed in subcategories and categories based on similarities, and themes were formed. The interviews continued until data saturation.

Results

After analyzing the collected data, 116 different codes were extracted and classified into two subcategories of pharmacological and non-pharmacological methods. Then, each of the subcategories was classified into two categories: conventional medicine and traditional medicine. Finally, two main themes were obtained, including prevention methods and self-treatment methods for COVID-19.

Conclusion

People use various traditional and folk methods for COVID-19 prevention and treatment. Such methods can be either useful or lack the necessary effectiveness and have side effects. Thus, necessary training should be provided to the public about using these methods and avoiding unapproved treatments.

The COVID-19 Pandemic: A Health Crisis Managed or a Panic Response with Disastrous Future Consequences?

In 1 year, COVID-19 spread rapidly worldwide affecting all societies and most age-groups. It has taken not only a toll of human lives (approaching 220 million people infected with 4.55 million reported deaths at time of writing) but also decimated every economy as countries struggle to control infection rates by introducing draconian lockdown and social distancing measures, bringing great suffering well beyond medical effects of the disease. A parallel pandemic has resulted in a deluge of information emanating from both scientific as well as international news media including social media platforms. Fact and fiction, reality, and perception have become entangled; the only realistic solution, both medically as well as politically, is concerted global vaccination (which is currently underway) to reduce further infection by introducing universal immunity. However, public controversy rages due to widespread apprehension regarding necessity, immediate risks, and long-term safety of what is perceived as "fast-tracked" medication. While some concerns may be justified, much is due to misconception and misunderstanding. This review highlights some of the issues concerning the handling of the COVID-19 crisis by governments worldwide, the medical and scientific communities, and the media and how this may have laid the foundations for a far greater medical, social, and economic burden in the coming years. We present comparative data to challenge current conceptions of this disease in the more general context of human health to provide a perspective that seems to have been lost in the general panic. We need more rational approaches to the handling of a disease which is unlikely to disappear from our spectrum of afflictions even after the magnifying glass has been removed.

Study on the Mechanism of treating COVID-19 with Shenqi Wan based on Network Pharmacology

PURPOSE

Through the method of network pharmacology, the active components and targets of Shenqi wan (SQW) were excavated, the relationship with COVID-19 was discussed, and the possible mechanism of SQW in the treatment of COVID-19 was revealed from the aspects of multi-components, multi-targets, and multi-pathways.

METHODS

Firstly, the active components of SQW were screened from TCMSP and the 2020 edition of Chinese Pharmacopoeia, and the related targets of the components were obtained. Then the disease targets related to COVID-19 were screened from GeneCards and OMIM. Venny was used to map the relationship between component-target and disease-target, and String was used to analyzing the interaction of common targets. The network was constructed and analyzed by Cytoscape, the function of GO and KEGG genes was enriched by Metascape, and the molecular docking was verified by CB-Dock.

RESULTS

Finally, 45 active components of SQW were obtained, and 72 potential targets were related to COVID-19, ACE2, IL6, NOS3, and CRP may be the key targets. GO enrichment of 1715 projects, such as lipopolysaccharide stress response, active oxygen metabolism, positive regulation of cell migration, and other GO enrichment. 136 KEGG pathways were obtained, TNF signaling pathway, IL-17 signaling pathway, HIF-1 signaling pathway. Molecular docking showed that kaempferol, quercetin, luteolin, astragaloside, calyx isoflavone glucoside, matrine, and other COVID-19-related targets such as ACE2, 3CLpro, PLpro, PTGS2 have good binding ability.

CONCLUSION

According to the above results, it is suggested that SQW may play a role in the treatment of COVID-19 by directly or indirectly combining kaempferol, quercetin, and luteolin with ACE2, 3CLpro, PLpro, and PTGS2 to regulate multiple biological functions and signaling pathways.

Nanotechnology based solutions to combat zoonotic viruses with special attention to SARS, MERS, and COVID 19: Detection, protection and medication

Zoonotic viruses originate from birds or animal sources and responsible for disease transmission from animals to people through zoonotic spill over and presents a significant global health concern due to lack of rapid diagnostics and therapeutics. The Corona viruses (CoV) were known to be transmitted in mammals. Early this year, SARS-CoV-2, a novel strain of corona virus, was identified as the causative pathogen of an outbreak of viral pneumonia in Wuhan, China. The disease later named corona virus disease 2019 (COVID-19), subsequently spread across the globe rapidly. Nano-particles and viruses are comparable in size, which serves to be a major advantage of using nano-material in clinical strategy to combat viruses. Nanotechnology provides novel solutions against zoonotic viruses by providing cheap and efficient detection methods, novel, and new effective rapid diagnostics and therapeutics. The prospective of nanotechnology in COVID 19 is exceptionally high due to their small size, large surface-to-volume ratio, susceptibility to modification, intrinsic viricidal activity. The nano-based strategies address the COVID 19 by extending their role in i) designing nano-materials for drug/vaccine delivery, ii) developing nano-based diagnostic approaches like nano-sensors iii) novel nano-based personal protection equipment to be used in prevention strategies.This review aims to bring attention to the significant contribution of nanotechnology to mitigate against zoonotic viral pandemics by prevention, faster diagnosis and medication point of view.

Epidemiology of COVID-19: An updated review

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a zoonotic infection, is responsible for COVID-19 pandemic and also is known as a public health concern. However, so far, the origin of the causative virus and its intermediate hosts is yet to be fully determined. SARS-CoV-2 contains nearly 30,000 letters of RNA that allows the virus to infect cells and hijack them to make new viruses. On the other hand, among 14 detected mutations in the SARS-CoV-2 S protein that provide advantages to virus for transmission and evasion form treatment, the D614G mutation (substitution of aspartic acid [D] with glycine [G] in codon 614 was particular which could provide the facilitation of the transmission of the virus and virulence. To date, in contrary to the global effort to come up with various aspects of SARS-CoV-2, there are still great pitfalls in the knowledge of this disease and many angles remain unclear. That's why, the monitoring and periodical investigation of this emerging infection in an epidemiological study seems to be essential. The present study characterizes the current epidemiological status (i.e., possible transmission route, mortality and morbidity risk, emerging SARS-CoV-2 variants, and clinical feature) of the SARS-CoV-2 in the world during these pandemic.

COVID-19 and environment: a poignant reminder of sustainability in the new normal

The nexus of COVID-19 and environment is conspicuously deep-rooted. The roles of environmental factors in the origin, transmission and spread of COVID-19 and the mutual impact of the pandemic on the global environment have been the two perspectives to view this nexus. The present paper attempts to systematically review the existing literature to understand and explore the linkages of COVID-19 with environment and proposes conceptual frameworks to underline this nexus. Our study indicates a critical role of meteorological factors, ambient air pollutants and wastewater in severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) transmission-spread dynamics. The study also focuses on the direct and indirect impacts of COVID-19 on the regional and global environment. Most of the indirect environmental effects of COVID-19 were attributed to global human confinement that resulted from the implementation of the pandemic containment measures. This worldwide anthropogenic 'pause' sent ripples to all environmental compartments and presented a unique test bed to identify anthropogenic impacts on the earth's natural systems. The review further addresses emerging sustainability challenges in the new normal and their potential solutions. The situation warrants critical attention to the environment-COVID-19 nexus and innovative sustainable practices to address the ramifications of short- and long-term environmental impacts of the COVID-19 pandemic.

Graphical abstract

A case-based systematic review on the SARS-COVID-2-associated cerebrovascular diseases and the possible virus routes of entry

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sparked a global pandemic that continues to affect various facets of human existence. Many sources reported virus-induced acute cerebrovascular disorders. Systematically, this paper reviews the case studies of COVID-19-related acute cerebrovascular diseases such as ischaemic stroke, intracerebral hemorrhage, and cerebral sinus thrombosis. We also spoke about how SARS-CoV-2 can infect the brain and trigger the aforementioned disorders. We stated that SARS-CoV-2 neuroinvasion and BBB dysfunction could cause the observed disorders; however, further research is required to specify the mechanisms and pathogenesis of the virus.

Use of medicinal plants for COVID-19 prevention and respiratory symptom treatment during the pandemic in Cusco, Peru: A cross-sectional survey

BACKGROUND

The burden of the COVID-19 pandemic in Peru has led to people seeking alternative treatments as preventives and treatment options such as medicinal plants. This study aimed to assess factors associated with the use of medicinal plants as preventive or treatment of respiratory symptom related to COVID-19 during the pandemic in Cusco, Peru.

METHOD

A web-based cross-sectional study was conducted on general public (20- to 70-year-old) from August 31 to September 20, 2020. Data were collected using a structured questionnaire via Google Forms, it consisted of an 11-item questionnaire that was developed and validated by expert judgment using Aiken's V (Aiken's V > 0.9). Both descriptive statistics and bivariate followed by multivariable logistic regression analyses were conducted to assess factors associated with the use of medicinal plants for COVID-19 prevention and respiratory symptom treatment during the pandemic. Prevalence ratios (PR) with 95% Confidence Interval (CI), and a P-value of 0.05 was used to determine statistical significance.

RESULTS

A total of 1,747 respondents participated in the study, 80.2% reported that they used medicinal plants as preventives, while 71% reported that they used them to treat respiratory symptoms. At least, 24% of respondents used medicinal plants when presenting with two or more respiratory symptoms, while at least 11% used plants for malaise. For treatment or prevention, the multivariate analysis showed that most respondents used eucalyptus (p < 0.001 for both), ginger (p < 0.022 for both), spiked pepper (p < 0.003 for both), garlic (p = 0.023 for prevention), and chamomile (p = 0.011 for treatment). The respondents with COVID-19 (p < 0.001), at older ages (p = 0.046), and with a family member or friend who had COVID-19 (p < 0.001) used more plants for prevention. However, the respondents with technical or higher education used less plants for treatment (p < 0.001).

CONCLUSION

There was a significant use of medicinal plants for both prevention and treatment, which was associated with several population characteristics and whether respondents had COVID-19.

Current and Emerging Technologies for the Diagnosis of SARS-CoV-2

Currently, there are numerous under development or developed assays with various sensitivities and specificities for diagnosis of the Coronavirus Disease 2019 (COVID-19) caused by the SARS-CoV-2 virus. The World Health Organization (WHO) has approved several detection protocols based on real-time reverse transcription PCR (RT-qPCR) and the reliability of tests to detect the N, S, or RdRp/Hel genes of the SARS-Cov-2 virus has also investigated. Among these targets, COVID-19-RdRp/Hel targets represented the highest sensitivity. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) has also been developed to rapidly and efficiently amplify RNA under isothermal conditions. Other isothermal amplification approaches such as nucleic acid sequence-based amplification (NASBA), recombinase polymerase amplification (RPA), and rolling circle amplification (RCA) have also been reported for detecting coronaviruses but like LAMP assay. Different serological tests, including neutralization tests, immunofluorescent (IFA), enzyme-linked immunosorbent (ELISA), and western blotting assays, are available. Point-of-care tests (POCT) are emerging to detect the virus genome, IgG, or IgM antibodies against SARS-CoV-2. The advent of more sensitive, cheaper, and easier-to-perform diagnostic tests seems to be a fundamental prerequisite to improve the diagnosis of COVID-19 infection. Herein, we reviewed several commercially available diagnostic methods used in many clinical laboratories to detect COVID-19.

Incidence, characteristics, and outcome of COVID-19 in patients on liver transplant program: a retrospective study in the north of Iran

The risk of severe coronavirus disease-2019 (COVID-19) disease seems to be higher in individuals with solid organ transplantation. Therefore, the purpose of the present research is to investigate the incidence of COVID-19 and laboratory data and epidemiologic factors in liver transplant recipients and the patients on the waiting list for liver transplantation. In this study, we evaluated the records of patients on the waiting list for liver transplantation and of recipients of a liver transplant. Demographic data, underlying disease, history of drug use and participants' outcomes were collected. The diagnosis of SARS-CoV-2 infection for all patients was confirmed using a nasopharyngeal swab specimen with real-time RT-PCR. During the study period, 172 patients were enrolled, among whom 85 patients (49.4%) were on the waiting list for liver transplantation, and 87 patients (50.6%) were recipients of a liver transplant. Out of them, 10 (5.8%) had a positive result for SARS-CoV-2. Of these patients, 7.05% (6/85) and 4.6% (4/87) of patients on the waiting list and recipients of liver transplants were positive for SARS-CoV-2, respectively. Patients on the waiting list with COVID-19 infection had a higher median of albumin, ALT, AST, TBIL, DBIL, HDL and LDL value. In summary, the incidence of COVID-19 in liver transplant patients was slightly higher. The existence of underlying liver diseases should be well known as one of the poor predictive factors for worse outcomes in patients with COVID-19. So, comparative studies are recommended to identify risk factors for COVID-19 in patients with liver injury.

Endophytic fungi stimulate the concentration of medicinal secondary metabolites in houttuynia cordata thunb

Endophytic fungi usually establish a symbiotic relationship with the host plant and affect its growth. In order to evaluate the impact of endophytic fungi on the Chinese herbal medicinal plant Houttuynia cordata Thunb., three endophytes isolated from the rhizomes of H. cordata, namely Ilyonectria liriodendra (IL), unidentified fungal sp. (UF), and Penicillium citrinum (PC), were co-cultured individually with H. cordata in sterile soil for 60 days. Analysis of the results showed that the endophytes stimulated the host plant in different ways: IL increased the growth of rhizomes and the accumulation of most of the phenolics and volatiles, UF promoted the accumulation of the medicinal compounds afzelin, decanal, 2-undecanone, and borneol without influencing host plant growth, and PC increased the fresh weight, total leaf area and height of the plants, as well as the growth of the rhizomes, but had only a small effect on the concentration of major secondary metabolites. Our results proved that the endophytic fungi had potential practical value in terms of the production of Chinese herbal medicines, having the ability to improve the yield and accumulation of medicinal metabolites.

Roles of existing drug and drug targets for COVID-19 management

In December 2019, a highly transmissible, pneumonia epidemic caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), erupted in China and other countries, resulting in devastation and health crisis worldwide currently. The search and using existing drugs support to curb the current highly contagious viral infection is spirally increasing since the pandemic began. This is based on these drugs had against other related RNA-viruses such as MERS-Cov, and SARS-Cov. Moreover, researchers are scrambling to identify novel drug targets and discover novel therapeutic options to vanquish the current pandemic. Since there is no definitive treatment to control Covid-19 vaccines are remain to be a lifeline. Currently, many vaccine candidates are being developed with most of them are reported to have positive results. Therapeutic targets such as helicases, transmembrane serine protease 2, cathepsin L, cyclin G-associated kinase, adaptor-associated kinase 1, two-pore channel, viral virulence factors, 3-chymotrypsin-like protease, suppression of excessive inflammatory response, inhibition of viral membrane, nucleocapsid, envelope, and accessory proteins, and inhibition of endocytosis were identified as a potential target against COVID-19 infection. This review also summarizes plant-based medicines for the treatment of COVID-19 such as saposhnikoviae divaricata, lonicerae japonicae flos, scutellaria baicalensis, lonicera japonicae, and some others. Thus, this review aimed to focus on the most promising therapeutic targets being repurposed against COVID-19 and viral elements that are used in COVID-19 vaccine candidates.

Facile development of graphene-based air filters mounted on a 3D printed mask for COVID-19

COVID-19 belongs to a typical class of viruses that predominantly affects the human respiratory system, thereby proving to be fatal to many. The virus, along with other air pollutant particulates poses a severe threat to the human respiratory organs. Since the most common transmission mode is respiratory fomites and aerosol particulates, it is necessary to prevent their ingression through a mask. The primary use of masks is to prevent aerial particulates. This paper reveals the development of masks with air filters coated with functionalized graphene (fG) mounted on a 3D-printed facial mask replica. The fused deposition modeling (FDM) process is used for fabricating the facial mask replica. fG associated with nanosheets has an additional adsorbing capacity with a high surface area to volume ratio. fG coat is used over a polypropylene (PP) cloth through a dip coating method to enhance the antiviral and antimicrobial properties. The quality of fG was investigated through Raman spectroscopy and other characterization techniques such as SEM, XRD, and FTIR, which were used for visual interpretation of distributions of fG on a polypropylene (PP) fabric. Fabricated fG coated MB filters show 98.2% of bacterial filtration efficiency with 1.10 mbar of breathing resistance. The efficacy of the fG coated filter was tested against SARS-CoV-2 viral particles, which showed a complete arrest of viral transmission at the fG coated layer.