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Megha KB, Arathi A, Shikha S, Alka R, Ramya P, Mohanan PV. Significance of Melatonin in the Regulation of Circadian Rhythms and Disease Management. Mol Neurobiol 2024; 61:5541-5571. [PMID: 38206471 DOI: 10.1007/s12035-024-03915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
Melatonin, the 'hormone of darkness' is a neuronal hormone secreted by the pineal gland and other extra pineal sites. Responsible for the circadian rhythm and seasonal behaviour of vertebrates and mammals, melatonin is responsible for regulating various physiological conditions and the maintenance of sleep, body weight and the neuronal activities of the ocular sites. With its unique amphiphilic structure, melatonin can cross the cellular barriers and elucidate its activities in the subcellular components, including mitochondria. Melatonin is a potential scavenger of oxygen and nitrogen-reactive species and can directly obliterate the ROS and RNS by a receptor-independent mechanism. It can also regulate the pro- and anti-inflammatory cytokines in various pathological conditions and exhibit therapeutic activities against neurodegenerative, psychiatric disorders and cancer. Melatonin is also found to show its effects on major organs, particularly the brain, liver and heart, and also imparts a role in the modulation of the immune system. Thus, melatonin is a multifaceted candidate with immense therapeutic potential and is still considered an effective supplement on various therapies. This is primarily due to rectification of aberrant circadian rhythm by improvement of sleep quality associated with risk development of neurodegenerative, cognitive, cardiovascular and other metabolic disorders, thereby enhancing the quality of life.
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Affiliation(s)
- K B Megha
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum, 695 012, Kerala, India
| | - A Arathi
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum, 695 012, Kerala, India
| | - Saini Shikha
- CSIR-Institute of Microbial Technology, Sector 39-A, Chandigarh, 160036, India
| | - Rao Alka
- CSIR-Institute of Microbial Technology, Sector 39-A, Chandigarh, 160036, India
- Academy of Scientific and Innovation Research (AcSIR), Ghaziabad, 201002, India
| | - Prabhu Ramya
- P.G. Department of Biotechnology, Government Arts College, Trivandrum, 695 014, India
| | - P V Mohanan
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum, 695 012, Kerala, India.
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Singh G, Nguyen C, Kuschner W. Pharmacologic Sleep Aids in the Intensive Care Unit: A Systematic Review. J Intensive Care Med 2024:8850666241255345. [PMID: 38881385 DOI: 10.1177/08850666241255345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background: Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve sleep, although their benefits in the ICU remain uncertain. This review aims to provide a comprehensive assessment of the objective and subjective effects of medications used for sleep in the ICU, as well as their adverse effects. Methods: PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from their inception until June 2023 for comparative studies assessing the effects of pharmacologic sleep aids on objective and subjective metrics of sleep. Results: Thirty-four studies with 3498 participants were included. Medications evaluated were melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine. The majority of studies were randomized controlled trials. Melatonin and dexmedetomidine were the best studied agents. Objective sleep metrics included polysomnography (PSG), electroencephalography (EEG), bispectral index, and actigraphy. Subjective outcome measures included patient questionnaires and nursing observations. Evidence for melatonin as a sleep aid in the ICU was mixed but largely not supportive for improving sleep. Evidence for ramelteon, suvorexant, and propofol was too limited to offer definitive recommendations. Both objective and subjective data supported dexmedetomidine as an effective sleep aid in the ICU, with PSG/EEG in 303 ICU patients demonstrating increased sleep duration and efficiency, decreased arousal index, decreased percentage of stage N1 sleep, and increased absolute and percentage of stage N2 sleep. Mild bradycardia and hypotension were reported as side effects of dexmedetomidine, whereas the other medications were reported to be safe. Several ongoing studies have not yet been published, mostly on melatonin and dexmedetomidine. Conclusions: While definitive conclusions cannot be made for most medications, dexmedetomidine improved sleep quantity and quality in the ICU. These benefits need to be balanced with possible hemodynamic side effects.
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Affiliation(s)
- Gaurav Singh
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher Nguyen
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Ware Kuschner
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
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Clark AD, Cumpstey AF, Santolini J, Jackson AA, Feelisch M. Uncoupled redox stress: how a temporal misalignment of redox-regulated processes and circadian rhythmicity exacerbates the stressed state. Open Biol 2023; 13:230151. [PMID: 37669692 PMCID: PMC10480010 DOI: 10.1098/rsob.230151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Diurnal and seasonal rhythmicity, entrained by environmental and nutritional cues, is a vital part of all life on Earth operating at every level of organization; from individual cells, to multicellular organisms, whole ecosystems and societies. Redox processes are intrinsic to physiological function and circadian regulation, but how they are integrated with other regulatory processes at the whole-body level is poorly understood. Circadian misalignment triggered by a major stressor (e.g. viral infection with SARS-CoV-2) or recurring stressors of lesser magnitude such as shift work elicit a complex stress response that leads to desynchronization of metabolic processes. This in turn challenges the system's ability to achieve redox balance due to alterations in metabolic fluxes (redox rewiring). We infer that the emerging 'alternative redox states' do not always revert readily to their evolved natural states; 'Long COVID' and other complex disorders of unknown aetiology are the clinical manifestations of such rearrangements. To better support and successfully manage bodily resilience to major stress and other redox challenges needs a clear perspective on the pattern of the hysteretic response for the interaction between the redox system and the circadian clock. Characterization of this system requires repeated (ideally continuous) recording of relevant clinical measures of the stress responses and whole-body redox state (temporal redox phenotyping). The human/animal body is a complex 'system of systems' with multi-level buffering capabilities, and it requires consideration of the wider dynamic context to identify a limited number of stress-markers suitable for routine clinical decision making. Systematically mapping the patterns and dynamics of redox biomarkers along the stressor/disease trajectory will provide an operational model of whole-body redox regulation/balance that can serve as basis for the identification of effective interventions which promote health by enhancing resilience.
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Affiliation(s)
- Anna D. Clark
- Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Andrew F. Cumpstey
- Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Sud, Universite Paris-Saclay, F-91198, Gif-sur-Yvette Cedex, France
| | - Alan A. Jackson
- Human Nutrition, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Martin Feelisch
- Perioperative and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
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Mukundarajan R, Soni KD, Trikha A. Prophylactic Melatonin for Delirium in Intensive Care Unit: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2023; 27:675-685. [PMID: 37719343 PMCID: PMC10504656 DOI: 10.5005/jp-journals-10071-24529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Delirium, being a common disorder among critically ill patients, has a reported incidence ranging 45-83% in the intensive care unit (ICU) population. The prophylactic use of melatonin and melatonergics has been shown to have a positive effect in reducing the incidence of delirium in many clinical trials. Our study was thus proposed to find out the role of melatonin on the incidence and severity of ICU delirium, ICU and hospital length of stay (LOS), requirement, duration of mechanical ventilation, and ICU mortality. Methodology A systematic search of various databases was performed to find out the trials which compare melatonin with a placebo or standard therapy for delirium prevention with the results conveyed as mean differences (MDs) or risk ratios. The statistical software, Review Manager (RevMan, version 5.4), was used for data synthesis. Results Twelve studies were included in the meta-analysis. Prophylactic administration of melatonin or ramelteon was not associated with a statistically significant reduction in the incidence of delirium (odds ratio [OR] 0.63; confidence interval [CI]: 0.60, 1.32; p = 0.22), the severity of delirium (MD: 0.22; 95% CI: From -1.36 to 1.81; p = 0.78), ICU LOS (MD: 0.05; 95% CI: From -0.65 to 0.75; p = 0.89), hospital LOS (MD: -1.46; 95% CI: From -4.50 to -1.59; p = 0.35), need for mechanical ventilation (OR: 0.74, 95% CI: 0.38-1.44; p = 0.37), and ICU mortality (MD: 0.78; 95% CI: 0.56; 1.11; p = 0.62). However, a significant reduction in the duration of mechanical ventilation (MD: -0.85; 95% CI: From -1.64 to -0.06; p = 0.03) was found. Conclusion Our meta-analysis suggests that melatonin when given prophylactically has no significant role in reducing the incidence and severity of delirium, ICU and hospital LOS, need for mechanical ventilation, duration of mechanical ventilation, and ICU mortality. Further studies are warranted. How to cite this article Mukundarajan R, Soni KD, Trikha A. Prophylactic Melatonin for Delirium in Intensive Care Unit: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2023;27(9):675-685.
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Affiliation(s)
- Ramkumar Mukundarajan
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anesthesia and Perioperative Care, School of Medicine, University of California, San Francisco, California, United States of America
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Jacobson JL, Tylka J, Glazer S, Zhang Y, Cosme R, Silvestri JM, Patwari PP. Melatonin Use in Pediatric Intensive Care Units: A Single-Center Experience. Med Sci (Basel) 2023; 11:55. [PMID: 37755159 PMCID: PMC10534299 DOI: 10.3390/medsci11030055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
Growing evidence indicates that altered melatonin secretion during critical illness may influence the quality and quantity of sleep, delirium, and overall recovery. However, limited data exist regarding the use of melatonin in pediatric critical illness. Data were reviewed over a 5-year period at a tertiary pediatric intensive care unit for pediatric patients (ages 0-18 years) who were prescribed melatonin with the aim of identifying the frequency of and indications for use. Data collection included the hospital day of initiation, the dose, the frequency, the duration of use, and the length of stay. The results demonstrate that melatonin was infrequently prescribed (6.0% of patients admitted; n = 182) and that the majority of patients received melatonin as continuation of home medication (46%; n = 83 of 182). This group had significantly earlier melatonin use (0.9 ± 2.3 day of hospitalization; p < 0.0001) and significantly reduced lengths of stay compared to the other groups (mean LOS 7.2 ± 9.3 days; p < 0.0001). Frequently, clear documentation of indication for melatonin use was absent (20%; n = 37). In conclusion, given that melatonin is infrequently used within a tertiary PICU with the most common indication as the continuation of home medication, and often without clear documentation for indication, this presents an opportunity to emphasize a more attentive and strategic approach regarding melatonin use in the PICU population.
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Affiliation(s)
- Jessica L. Jacobson
- Department of Pharmacy, Rush University Medical Center (RUMC), Chicago, IL 60612, USA;
| | - Joanna Tylka
- Department of Pediatrics, RUMC, Rush University Children’s Hospital, Chicago, IL 60612, USA; (J.T.)
| | - Savannah Glazer
- Department of Pediatrics, RUMC, Rush University Children’s Hospital, Chicago, IL 60612, USA; (J.T.)
| | - Yanyu Zhang
- Bioinformatics and Biostatistics Core, RUMC, Chicago, IL 60612, USA
| | - Rosario Cosme
- Department of Psychiatry, RUMC, Chicago, IL 60612, USA
| | - Jean M. Silvestri
- Department of Pediatrics, RUMC, Rush University Children’s Hospital, Chicago, IL 60612, USA; (J.T.)
| | - Pallavi P. Patwari
- Department of Pediatrics, RUMC, Rush University Children’s Hospital, Chicago, IL 60612, USA; (J.T.)
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Kim RE, Mabunga DF, Kim HJ, Han SH, Kim HY, Shin CY, Kwon KJ. Novel Therapeutics for Treating Sleep Disorders: New Perspectives on Maydis stigma. Int J Mol Sci 2022; 23:ijms232314612. [PMID: 36498940 PMCID: PMC9740493 DOI: 10.3390/ijms232314612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
Sleep is a restorative period that plays a crucial role in the physiological functioning of the body, including that of the immune system, memory processing, and cognition. Sleep disturbances can be caused by various physical, mental, and social problems. Recently, there has been growing interest in sleep. Maydis stigma (MS, corn silk) is a female maize flower that is traditionally used as a medicinal plant to treat many diseases, including hypertension, edema, and diabetes. It is also used as a functional food in tea and other supplements. β-Sitosterol (BS) is a phytosterol and a natural micronutrient in higher plants, and it has a similar structure to cholesterol. It is a major component of MS and has anti-inflammatory, antidepressive, and sedative effects. However, the potential effects of MS on sleep regulation remain unclear. Here, we investigated the effects of MS on sleep in mice. The effects of MS on sleep induction were determined using pentobarbital-induced sleep and caffeine-induced sleep disruption mouse models. MS extracts decreased sleep latency and increased sleep duration in both the pentobarbital-induced sleep induction and caffeine-induced sleep disruption models compared to the positive control, valerian root extract. The butanol fraction of MS extracts decreased sleep latency time and increased sleep duration. In addition, β-sitosterol enhances sleep latency and sleep duration. Both MS extract and β-sitosterol increased alpha activity in the EEG analysis. We measured the mRNA expression of melatonin receptors 1 and 2 (MT1/2) using qRT-PCR. The mRNA expression of melatonin receptors 1 and 2 was increased by MS extract and β-sitosterol treatment in rat primary cultured neurons and the brain. In addition, MS extract increased the expression of clock genes including per1/2, cry1/2, and Bmal1 in the brain. MS extract and β-sitosterol increased the phosphorylation of ERK1/2 and αCaMKII. Our results demonstrate for the first time that MS has a sleep-promoting effect via melatonin receptor expression, which may provide new scientific evidence for its use as a potential therapeutic agent for the treatment and prevention of sleep disturbance.
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Affiliation(s)
- Ryeong-Eun Kim
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Darine Froy Mabunga
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Hee Jin Kim
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 01795, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Chan Young Shin
- Department of Pharmacology, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Kyoung Ja Kwon
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
- Correspondence: ; Tel.: +82-2-454-5630; Fax: +82-2030-7899
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LaBuzetta JN, Malhotra A, Zee PC, Maas MB. Optimizing Sleep and Circadian Health in the NeuroICU. Curr Treat Options Neurol 2022; 24:309-325. [PMID: 35855215 PMCID: PMC9283559 DOI: 10.1007/s11940-022-00724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review This article introduces fundamental concepts in circadian biology and the neuroscience of sleep, reviews recent studies characterizing circadian rhythm and sleep disruption among critically ill patients and potentially links to functional outcomes, and draws upon existing literature to propose therapeutic strategies to mitigate those harms. Particular attention is given to patients with critical neurologic conditions and the unique environment of the neuro-intensive care unit. Recent Findings Circadian rhythm disruption is widespread among critically ill patients and sleep time is reduced and abnormally fragmented. There is a strong association between the degree of arousal suppression observed at the bedside and the extent of circadian disruption at the system (e.g., melatonin concentration rhythms) and cellular levels (e.g., core clock gene transcription rhythms). There is a paucity of electrographically normal sleep, and rest-activity rhythms are severely disturbed. Common care interventions such as neurochecks introduce unique disruptions in neurologic patients. There are no pharmacologic interventions proven to normalize circadian rhythms or restore physiologically normal sleep. Instead, interventions are focused on reducing pharmacologic and environmental factors that perpetuate disruption. Summary The intensive care environment introduces numerous potent disruptors to sleep and circadian rhythms. Direct neurologic injury and neuro-monitoring practices likely compound those factors to further derange circadian and sleep functions. In the absence of direct interventions to induce normalized rhythms and sleep, current therapy depends upon normalizing external stimuli.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Department of Neurosciences, Division of Neurocritical Care, University of California, San Diego, San Diego, USA
| | - Atul Malhotra
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, San Diego, USA
| | - Phyllis C. Zee
- Department of Neurology, Division of Sleep Medicine, Northwestern University, Chicago, USA
| | - Matthew B. Maas
- Department of Neurology, Division of Neurocritical Care, Northwestern University, 626 N Michigan Ave, Chicago, IL 60611 USA
- Department of Anesthesiology, Section of Critical Care Medicine, Northwestern University, 626 N Michigan Ave, Chicago, IL 60611 USA
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Li H, Sun P. Insight of Melatonin: The Potential of Melatonin to Treat Bacteria-Induced Mastitis. Antioxidants (Basel) 2022; 11:antiox11061107. [PMID: 35740004 PMCID: PMC9219804 DOI: 10.3390/antiox11061107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Bovine mastitis is a common inflammatory disease, mainly induced by bacterial pathogens, such as Staphylococcus aureus, Escherichia coli, and Streptococcus agalactiae. Mastitis has negative effects on the production and quality of milk, resulting in huge economic losses. Melatonin, which is synthesized and secreted by the pineal gland and other organs, is ubiquitous throughout nature and has different effects on different tissues. Melatonin is crucial in modulating oxidative stress, immune responses, and cell autophagy and apoptosis, via receptor-mediated or receptor-independent signaling pathways. The potent antioxidative and anti-inflammatory activities of melatonin and its metabolites suggest that melatonin can be used to treat various infections. This article reviews the potential for melatonin to alleviate bovine mastitis through its pleiotropic effect on reducing oxidative stress, inhibiting pro-inflammatory cytokines, and regulating the activation of NF-κB, STATs, and their cascade reactions. Therefore, it is promising that melatonin supplementation may be an alternative to antibiotics for the treatment of bovine mastitis.
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Lan S, Lee H, Chao C, Chang S, Lu L, Lai C. Efficacy of melatonin in the treatment of patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials. J Med Virol 2022; 94:2102-2107. [PMID: 35032042 PMCID: PMC9015545 DOI: 10.1002/jmv.27595] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/19/2022]
Abstract
This study investigated the effect of melatonin on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). We searched PubMed, the Web of Science, the Cochrane Library, Ovid MEDLINE, and Clinicaltrials.gov for randomized controlled trials (RCTs) published before September 11, 2021. Only RCTs that compared the clinical efficacy of melatonin with a placebo in the treatment of patients with COVID-19 were included. The primary outcome measure was the clinical recovery rate. We included three RCTs in this meta-analysis. Melatonin 3 mg three times daily was administered in one RCT, and 3 or 6 mg daily before bedtime in the other two trials. Treatment duration was 14 days in two RCTs and 7 days in one trial. The clinical recovery rates were 94.2% (81/86) and 82.4% (70/85) in the melatonin and control groups, respectively. Overall, patients receiving melatonin had a higher clinical recovery rate than did the controls (odds ratio [OR]: 3.67; 95% CI: 1.21-11.12; I2 = 0%, p = 0.02). The risk of intensive care unit admission was numerically lower in the melatonin group than in the control group (8.3% [6/72] vs. 17.6% [12/68], OR: 0.45; 95% CI: 0.16-1.25; I2 = 0%, p = 0.13), and the risk of mortality was numerically lower in the melatonin group than in the control group (1.4% [1/72] vs. 4.4% [3/68], OR: 0.32; 95% CI: 0.03-3.18; I2 = 0%, p = 0.33). In conclusion, melatonin may help improve the clinical outcomes of patients with COVID-19.
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Affiliation(s)
- Shao‐Huan Lan
- School of Pharmaceutical Sciences and Medical TechnologyPutian UniversityPutianChina
| | - Hong‐Zin Lee
- School of PharmacyChina Medical UniversityTaichungTaiwan
| | - Chien‐Ming Chao
- Department of Intensive Care MedicineChi Mei Medical CenterLiouyingTaiwan
| | | | - Li‐Chin Lu
- School of ManagementPutian UniversityPutianChina
| | - Chih‐Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General HospitalTainan BranchTainanTaiwan
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Tian Y, Qin Z, Han Y. Suvorexant with or without ramelteon to prevent delirium: a systematic review and meta-analysis. Psychogeriatrics 2022; 22:259-268. [PMID: 34881812 DOI: 10.1111/psyg.12792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
Delirium is a common and serious neurobehavioral syndrome, associated with prolonged hospital stays, and increased morbidity and mortality. As it remains unclear whether suvorexant with or without ramelteon prevents delirium in elderly hospitalized patients, we conducted a systematic review and meta-analysis to evaluate, searching the PubMed, Cochrane Library, Web of Science, EMBASE, and EBSCOhost databases for all randomized controlled trials (RCTs), case-control studies, and cohort studies that investigated the effects of suvorexant with or without ramelteon on delirium in adult hospitalized patients. The primary outcome was the incidence of delirium. Two randomized controlled trials, 7 cohort studies and 2 case-control studies involving 2594 patients were included in this meta-analysis. The results showed that both suvorexant alone (odds ratio (OR) = 0.30, 95% confidence interval (CI): 0.14-0.65, P = 0.002) and suvorexant with ramelteon (OR = 0.39, 95% CI 0.23-0.65, P = 0.0003) reduced the incidence of delirium in adult hospitalized patients. Six studies involved the use of benzodiazepines; subgroup analysis performed separately in the suvorexant alone and suvorexant with ramelteon groups indicated that when benzodiazepine was administered, suvorexant with ramelteon was effective at reducing the incidence of delirium (OR = 0.53, 95% CI 0.37-0.74, P = 0.0002), but no significant difference was observed for suvorexant alone (OR = 0.40, 95% CI 0.11-1.53, P = 0.18). The current literature thus supports the effectiveness of suvorexant with or without ramelteon for delirium prevention, although suvorexant alone failed to significantly reduce the incidence of delirium when benzodiazepine was administered. The present study was limited by the significant heterogeneity among the included studies, and caution should be exercised when interpreting the results. This study was registered in the PROSPERO database (CRD4202017964).
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Affiliation(s)
- Yu Tian
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zaisheng Qin
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yunyang Han
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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11
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Pohanka M. New uses of Melatonin as a Drug, a Review. Curr Med Chem 2022; 29:3622-3637. [PMID: 34986763 DOI: 10.2174/0929867329666220105115755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022]
Abstract
Melatonin is a simple compound with a proper chemical name N-acetyl-5-methoxy tryptamine and known as a hormone controlling circadian rhythm. Humans produce melatonin at night which is the reason for sleeping in the night and awakening over the day. Melatonin interacts with melatonin receptors MT1 and MT2 but it was also revealed that melatonin is a strong antioxidant and it also has a role in regulation of cell cycle. Currently, melatonin is used as a drug for some types of sleep disorder but the recent research points to the fact that melatonin can also serve for the other purposes including prophylaxis or therapy of lifestyle diseases, cancer, neurodegenerative disorders and exposure to chemicals. This review summarizes basic facts and direction of the current research on melatonin. The actual literature was scrutinized for the purpose of this review.
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Affiliation(s)
- Miroslav Pohanka
- Faculty of Military Health Sciences, University of Defense, Trebesska 1575, Hradec Kralove CZ-50001, Czech Republic
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12
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Mtewa AG, Amanjot A, Lampiao F, Okella H, Weisheit A, Tolo CU, Ogwang P. SARS-CoV-2 vaccine development. CORONAVIRUS DRUG DISCOVERY 2022. [PMCID: PMC9217717 DOI: 10.1016/b978-0-323-85156-5.00046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
SARS-CoV-2 is a well-known viral strain that causes COVID-19. The disease became a pandemic in early 2020 and infected millions of people and killed hundreds of thousands of people worldwide. Vaccine development against the disease was accelerated with multiple collaborations among research institutions in order to shorten the duration that vaccine development normally takes. Prior coronavirus vaccines present a basis on which vaccines against the current strain can be developed with much speed and relative ease. Among the patented coronavirus vaccines, DNA-based vaccine had the most patents registered which must have clues to guide the efforts in the current works. This work presents some progress on COVID-19 vaccine development and also possible animal venom protein sources that can potentially be used in the pipeline. The future of COVID-19 vaccine is bright with the heightened collaborative efforts and data sharing opportunities that the pandemic has brought among researchers.
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Krupa S, Dorota O, Friganovic A, Mędrzycka-Dąbrowska W, Jurek K. The Polish Version of the Nursing Delirium Screening Scale (NuDESC PL)-Experience of Using in Nursing Practice in Cardiac Surgery Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910108. [PMID: 34639408 PMCID: PMC8507661 DOI: 10.3390/ijerph181910108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Abstract
Introduction: Delirium is a common complication of patients hospitalized in Intensive care units (ICU). The risk of delirium is estimated at approximately 80% in intensive care units. In the case of cardiac surgery ICU, the risk of delirium increases due to the type of procedures performed with the use of extracorporeal circulation. The aim of this study was to provide an official translation and evaluation of Nursing Delirium Screening Scale (NuDESC) into Polish. The NuDESC scale is a scale used by nurses around the world to detect delirium at an early stage in treatment. Methods: The method used in the study was the NuDESC tool, which was translated into Polish. The study was conducted by Cardiac ICU nurses during day shift (at 8 a.m.), night shift (at 8 p.m.) and in other situations where the patients showed delirium-like symptoms. Results: Statistically significant differences were observed between the first and second day in the studied group of patients in the case of illusions/hallucinations. Delirium occurred more frequently during the night, but statistical significance was demonstrated for both daytime and nighttime shifts. It was not demonstrated in relation to the NuDESC scale in the case of insomnia disorders. The diagnosis of delirium and disorientation was the most common diagnosis observed in patients on the first day of their stay in the ICU, followed by problems with communication. Delirium occurred on the first day, mainly at night. On the second day, delirium was much less frequent during the night; the biggest problem was disorientation and problems with communication. Conclusion: This study contributed to the development of the Polish version of the scale (NuDESC PL) which is now used as the Polish screening tool for delirium detection. The availability of an easy-to-use nurse-based delirium instrument is a prerequisite for widespread implementation.
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Affiliation(s)
- Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna 1A, 35-310 Rzeszow, Poland; (S.K.); (O.D.)
| | - Ozga Dorota
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna 1A, 35-310 Rzeszow, Poland; (S.K.); (O.D.)
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- Department of Nursing, University of Applied Health Sciences, Mlinarska Cesta 38, 10000 Zagreb, Croatia
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland
- Correspondence:
| | - Krzysztof Jurek
- The Institute of Sociological Sciences, The John Paul II Catholic University of Lublin, 20-950 Lublin, Poland;
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14
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Brown GM, Pandi-Perumal SR, Pupko H, Kennedy JL, Cardinali DP. Melatonin as an Add-On Treatment of COVID-19 Infection: Current Status. Diseases 2021; 9:64. [PMID: 34562971 PMCID: PMC8482145 DOI: 10.3390/diseases9030064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
This brief review was written to provide a perspective on the flurry of reports suggesting that melatonin can be an important add-on therapy for COVID-19. Despite the passage of more than 60 years since its discovery and much evidence representing the contrary, there has been great reluctance to conceive melatonin as anything other than a hormone. Many other body chemicals are known to have multiple roles. Melatonin was first shown to be a hormone derived from the pineal gland, to be actively synthesized there only at night, and to act on targets directly or via the G-protein-coupled receptors (GPCRs) superfamily. It is of note that over 40 years ago, it was also established that melatonin is present, synthesized locally, and acts within the gastrointestinal tract. A wider distribution was then found, including the retina and multiple body tissues. In addition, melatonin is now known to have non-hormonal actions, acting as a free radical scavenger, an antioxidant, and as modulating immunity, dampening down innate tissue responses to invaders while boosting the production of antibodies against them. These actions make it a potentially excellent weapon against infection by the SARS-CoV-2 virus. Early published results support that thesis. Recently, a randomized controlled study reported that low doses of melatonin significantly improved symptoms in hospitalized COVID-19 patients, leading to more rapid discharge with no side effects, while significantly decreasing levels of CRP, proinflammatory cytokines, and modulating dysregulated genes governing cellular and humoral immunity. It is now critical that these trials be repeated, with dose-response studies conducted and safety proven. Numerous randomized controlled trials are ongoing, which should complete those objectives while also allowing for a more thorough evaluation of the mechanisms of action and possible applications to other severe diseases.
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Affiliation(s)
- Gregory M. Brown
- Centre for Addiction and Mental Health, Molecular Brain Sciences, Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada;
| | - Seithikurippu R. Pandi-Perumal
- Somnogen Canada Inc., Toronto, ON M6H 1C5, Canada;
- Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospitals, Saveetha University, Chennai 600077, India
| | - Harold Pupko
- Primary Care Mental Health Physician, Bathurst St., Toronto, ON M3H 3S3, Canada;
| | - James L. Kennedy
- Centre for Addiction and Mental Health, Molecular Brain Sciences, Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada;
| | - Daniel P. Cardinali
- Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires 1007, Argentina;
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15
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Melatonin as a Potential Adjuvant Treatment for COVID-19 beyond Sleep Disorders. Int J Mol Sci 2021; 22:ijms22168623. [PMID: 34445329 PMCID: PMC8395320 DOI: 10.3390/ijms22168623] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Melatonin is registered to treat circadian rhythm sleep–wake disorders and insomnia in patients aged 55 years and over. The essential role of the circadian sleep rhythm in the deterioration of sleep quality during COVID-19 confinement and the lack of an adverse effect of melatonin on respiratory drive indicate that melatonin has the potential to be a recommended treatment for sleep disturbances related to COVID-19. This review article describes the effects of melatonin additional to its sleep-related effects, which make this drug an attractive therapeutic option for treating patients with COVID-19. The preclinical data suggest that melatonin may inhibit COVID-19 progression. It may lower the risk of the entrance of the SARS-CoV-2 virus into cells, reduce uncontrolled hyper-inflammation and the activation of immune cells, limit the damage of tissues and multiorgan failure due to the action of free radicals, and reduce ventilator-induced lung injury and the risk of disability resulting from fibrotic changes within the lungs. Melatonin may also increase the efficacy of COVID-19 vaccination. The high safety profile of melatonin and its potential anti-SARS-CoV-2 effects make this molecule a preferable drug for treating sleep disturbances in COVID-19 patients. However, randomized clinical trials are needed to verify the clinical usefulness of melatonin in the treatment of COVID-19.
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16
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Palagini L, Manni R, Aguglia E, Amore M, Brugnoli R, Bioulac S, Bourgin P, Micoulaud Franchi JA, Girardi P, Grassi L, Lopez R, Mencacci C, Plazzi G, Maruani J, Minervino A, Philip P, Royant Parola S, Poirot I, Nobili L, Biggio G, Schroder CM, Geoffroy PA. International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders. Front Psychiatry 2021; 12:688890. [PMID: 34177671 PMCID: PMC8222620 DOI: 10.3389/fpsyt.2021.688890] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders. Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method. Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders. Conclusion: The administration of prolonged release melatonin at 2-10 mg, 1-2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders.
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Affiliation(s)
- Laura Palagini
- Psychiatry Division, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Eugenio Aguglia
- Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital “Gaspare Rodolico”, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Stéphanie Bioulac
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France
| | - Patrice Bourgin
- Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France
- Centre des troubles du sommeil - CIRCSom, Strasbourg University Hospitals, Strasbourg, France
| | - Jean-Arthur Micoulaud Franchi
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Régis Lopez
- Service de Neurologie, Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - Claudio Mencacci
- Department of Neuroscience, Aziende Socio Sanitarie Territoriali Fatebenefratelli Sacco, Milan, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Julia Maruani
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
| | - Antonino Minervino
- Department of Psychiatry, Italian Society of Psychosomatic Medicine (SIMP), Parma, Italy
| | - Pierre Philip
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, and USR CNRS 3413 SANPSY, University Hospital Pellegrin, University of Bordeaux, Bordeaux, France
| | | | - Isabelle Poirot
- Service de psychiatrie adulte, Hôpital Fontan, CHU de Lille, Lille, France
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Child Neuropsychiatry Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, Cagliari, Italy
| | - Carmen M. Schroder
- Institut des Neurosciences Cellulaires et Intégratives, CNRS-UPR 3212, Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
| | - Pierre A. Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
- GHU Paris - Psychiatry & Neurosciences, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
- Université de Paris, NeuroDiderot, Inserm, Paris, France
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Krupa S, Paweł W, Mędrzycka-Dąbrowska W, Lintowska A, Ozga D. Sleep Disturbances in Individuals Quarantined Due to SARS-CoV-2 Pandemic in Poland: A Mixed Methods Design Study. Glob Adv Health Med 2021; 10:21649561211020707. [PMID: 34164228 PMCID: PMC8188971 DOI: 10.1177/21649561211020707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The study aimed to assess sleep disturbances in patients subjected to home quarantine due to suspected SARS-CoV-2 infection. The study used a mixed methods design study as a research methodology. METHODS A semi-structured interview and the scale for Insomnia Severity Index (ISI) were used to achieve the aim of the study. The survey was conducted from 16 to 20 April 2020 and 1 to 2 September 2020 in Poland, at the during of SARS-CoV-2 epidemic in this country. The data were coded and cross-processed. The (COREQ) checklist was followed. RESULTS Interviews with patients and a thorough analysis of recordings revealed commonly used phrases in the following categories: "anxiety", "Am I going crazy?", "Sleep problems". 10 out of 11 respondents reported sleep disorders of varying severity according to the Insomnia Severity Index scale. Patients presented a fear related to the return to society and normal functioning after quarantine. Additionally, some study participants voiced concerns related to their mental health; some cases of hallucinations were reported. CONCLUSIONS Further global population studies should be conducted to analyse this phenomenon. Acute Stress Disorder should be understood as a threat to life and health of an isolated society in quarantine. Further research in this area should be promoted and the need for global guidelines for the entire population should be developed.
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Affiliation(s)
- Sabina Krupa
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland
| | - Witt Paweł
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland
- Department of Pediatric Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland
- Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, Gdańsk, Poland
| | - Agnieszka Lintowska
- Department of Public Health, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Ozga
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
- Polish Association of Anaesthesiology and Intensive Care Nurses, Poznań, Poland
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18
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Nutraceuticals as Potential Targets for the Development of a Functional Beverage for Improving Sleep Quality. BEVERAGES 2021. [DOI: 10.3390/beverages7020033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Functional beverages can be a valuable component of the human diet with the ability to not only provide essential hydration but to deliver important bioactive compounds that can contribute to chronic disease treatment and prevention. One area of the functional beverage market that has seen an increase in demand in recent years are beverages that promote relaxation and sleep. Sleep is an essential biological process, with optimal sleep being defined as one of adequate duration, quality and timing. It is regulated by a number of neurotransmitters which are, in turn, regulated by dietary intake of essential bioactive compounds. This narrative review aimed to evaluate the latest evidence of the sleep promoting properties of a selection of bioactive compounds (such as L-theanine and L-tryptophan) for the development of a functional beverage to improve sleep quality; and the effectiveness of traditional sleep promoting beverages (such as milk and chamomile). Overall, the bioactive compounds identified in this review, play essential roles in the synthesis and regulation of important neurotransmitters involved in the sleep-wake cycle. There is also significant potential for their inclusion in a number of functional beverages as the main ingredient on their own or in combination. Future studies should consider dosage; interactions with the beverage matrix, medications and other nutraceuticals; bioavailability during storage and following ingestion; as well as the sensory profile of the developed beverages, among others, when determining their effectiveness in a functional beverage to improve sleep quality.
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The Effects of Melatonin Supplementation on Sleep Quality and Assessment of the Serum Melatonin in ICU Patients: A Randomized Controlled Trial. Crit Care Med 2021; 48:e1286-e1293. [PMID: 33048904 DOI: 10.1097/ccm.0000000000004690] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate whether the use of exogenous melatonin affects sleep, reduces the prevalence of delirium, and decreases the need for analgosedation and to assess whether serum melatonin indices correlate with exogenous administration in critically ill patients. DESIGN Double-blind, randomized, placebo-controlled study. SETTING Multicenter ICUs of two tertiary hospitals. PATIENTS A total of 203 adult patients who were admitted to the ICU and administered with analgesics and/or sedatives. INTERVENTIONS Oral melatonin (10 mg) or placebo for up to seven consecutive nights. MEASUREMENTS AND MAIN RESULTS The number of observed sleeping hours at night was assessed by the bedside nurse. Sleep quality was evaluated using the Richards Campbell Questionnaire Sleep (RCSQ). The prevalence of delirium, pain, anxiety, adverse reactions, duration of mechanical ventilation, length of ICU and hospital stays, and doses of sedative and analgesic drugs administered were recorded. The use of analgesics and sedatives was assessed daily. Melatonin levels were determined by enzyme-linked immunosorbent assay. Based on the RCSQ results, sleep quality was assessed to be better in the melatonin group than that in the placebo group with a mean (SD) of 69.7 (21.2) and 60.7 (26.3), respectively (p = 0.029). About 45.8% and 34.4% of participants in the melatonin and placebo groups had very good sleep (risk ratio, 1.33; 95% CI, 0.94-1.89), whereas 3.1% and 14.6% had very poor sleep (risk ratio, 0.21; 95% CI, 0.06-0.71), respectively. No significant difference was observed regarding the days free of analgesics or sedatives, the duration of night sleep, and the occurrence of delirium, pain, and anxiety. Melatonin serum peak levels at 2 AM were 150 pg/mL (range, 125-2,125 pg/mL) in the melatonin group and 32.5 pg/mL (range, 18.5-35 pg/mL) in the placebo group (p < 0.001). CONCLUSIONS Melatonin was associated with better sleep quality, which suggests its possible role in the routine care of critically ill patients in the future.
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Sun T, Sun Y, Huang X, Liu J, Yang J, Zhang K, Kong G, Han F, Hao D, Wang X. Sleep and circadian rhythm disturbances in intensive care unit (ICU)-acquired delirium: a case-control study. J Int Med Res 2021; 49:300060521990502. [PMID: 33730927 PMCID: PMC7983249 DOI: 10.1177/0300060521990502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The relationships among sleep, circadian rhythm, and intensive care unit (ICU)-acquired delirium are complex and remain unclear. This study aimed to examine the pathophysiological mechanisms of sleep and circadian rhythm disturbances in patients with ICU-acquired delirium. METHODS This study included critical adult patients aged 18 to 75 years who were treated in the ICU. Twenty-four-hour polysomnography was performed and serum melatonin and cortisol levels were measured six times during polysomnography. Receiver operating characteristic curves and binomial logistic regression were used to evaluate the potential of sleep, melatonin, and cortisol as indicators of delirium in the ICU. RESULTS Patients with delirium (n = 24) showed less rapid eye movement (REM) sleep compared with patients without delirium (n = 24, controls). Melatonin levels were lower and cortisol levels were higher in the delirium group than in the control group. REM sleep, melatonin, and cortisol were significantly associated with delirium. The optimal cutoff values of REM sleep and mean melatonin and cortisol levels that predicted delirium were ≤1.05%, ≤422.09 pg/mL, and ≥212.14 ng/mL, respectively. CONCLUSIONS REM sleep, and melatonin and cortisol levels are significantly associated with the risk of ICU-acquired delirium. Improved sleep and readjustment of circadian rhythmicity may be therapeutic targets of ICU-acquired delirium.
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Affiliation(s)
- Ting Sun
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Yunliang Sun
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Xiao Huang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Jianghua Liu
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Jiabin Yang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Kai Zhang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Guiqing Kong
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Fang Han
- Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Dong Hao
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Xiaozhi Wang
- Department of Pulmonary and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
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21
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Carlson G, Curtis A. To Sleep, or Not to Sleep, that Is the Question. Crit Care Nurs Clin North Am 2021; 33:213-217. [PMID: 34023087 DOI: 10.1016/j.cnc.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep disruptions occur in the intensive care unit (ICU), and pharmacologic and nonpharmacologic interventions can help minimize the effects. A structured quality improvement plan will ensure successful implementation and sustainability of a sleep protocol in the ICU.
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Affiliation(s)
- Glenn Carlson
- Division of Critical Care and Pulmonary Medicine, Bronson Battle Creek, Battle Creek, MI 49107, USA.
| | - Alyssa Curtis
- Bronson Battle Creek, Battle Creek, MI 49107, USA. https://twitter.com/alyssacurtis33
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22
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Cordone S, Scarpelli S, Alfonsi V, De Gennaro L, Gorgoni M. Sleep-Based Interventions in Alzheimer's Disease: Promising Approaches from Prevention to Treatment along the Disease Trajectory. Pharmaceuticals (Basel) 2021; 14:ph14040383. [PMID: 33921870 PMCID: PMC8073746 DOI: 10.3390/ph14040383] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
The multifactorial nature of Alzheimer’s disease (AD) has led scientific researchers to focus on the modifiable and treatable risk factors of AD. Sleep fits into this context, given the bidirectional relationship with AD confirmed by several studies over the last years. Sleep disorders appear at an early stage of AD and continue throughout the entire course of the pathology. Specifically, sleep abnormalities, such as more fragmented sleep, increase in time of awakenings, worsening of sleep quality and primary sleep disorders raise with the severity and progression of AD. Intervening on sleep, therefore, means acting both with prevention strategies in the pre-clinical phase and with treatments during the course of the disease. This review explores sleep disturbances in the different stages of AD, starting from the pre-clinical stage. Particular attention is given to the empirical evidence investigating obstructive sleep apnea (OSA) disorder and the mechanisms overlapping and sharing with AD. Next, we discuss sleep-based intervention strategies in the healthy elderly population, mild cognitive impairment (MCI) and AD patients. We mention interventions related to behavioral strategies, combination therapies, and bright light therapy, leaving extensive space for new and raising evidence on continuous positive air pressure (CPAP) treatment effectiveness. Finally, we clarify the role of NREM sleep across the AD trajectory and consider the most recent studies based on the promising results of NREM sleep enhancement, which use innovative experimental designs and techniques.
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Affiliation(s)
- Susanna Cordone
- UniCamillus, Saint Camillus International University of Health Sciences, 00131 Rome, Italy;
| | - Serena Scarpelli
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
| | | | - Luigi De Gennaro
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy;
- Correspondence:
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome “Sapienza”, 00185 Rome, Italy; (S.S.); (M.G.)
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Krupa S, Friganovic A, Mędrzycka-Dąbrowska W. Occurrence of Delirium during ECMO Therapy in a Critical Care Unit in Poland-A Cross-Sectional Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084029. [PMID: 33921285 PMCID: PMC8069600 DOI: 10.3390/ijerph18084029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The problem of delirium during extracorporeal membrane oxygenation (ECMO) therapy, which has rarely been studied, is an important issue since it is necessary to ensure patient safety during therapy. This study aimed to show the incidence of delirium in patients after extracorporeal membrane oxygenation therapy and factors affecting the occurrence of delirium in this group of patients. DESIGN A cross-sectional study was conducted. METHOD The study involved a group of patients from an intensive cardiac care unit who received extracorporeal membrane oxygenation therapy. The study lasted for more than two years, in the period from 2018 until 2020. The Nursing Delirium Screening Scale (NuDESC) and the Delirium Observation Screening Scale (DOSS) were applied. Additionally, the patients were examined using Numeric Rating Scale (NRS), the Insomnia Severity Index (ISI), the Richmond Agitation Sedation Scale (RASS), the Ramsay Sedation Scale (RSS), and a thirst intensity scale; ultimately, relationships between these factors and delirium were examined. RESULTS In patients who underwent ExtraCorporeal Membrane Oxygenation (ECMO) therapy, delirium was confirmed by the NuDESC in 68.75% of patients in the evening hours, while it was measured by the DOSS scale in 84.38% of patients in the morning. The study found that ECMO delirium was not associated with hyperactivity, sleep disturbance, sedation, pain, or thirst. CONCLUSION Delirium in patients undergoing ECMO therapy was confirmed by both the NuDESC and DOSS. Factors such as thirst and sleep disturbance after ECMO therapy were shown to influence the occurrence of delirium. The diagnosis of delirium using standardized scales is possible provided that more tests are carried out. Research should be conducted to determine whether the NuDESC is equivalent to the DOSS.
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Affiliation(s)
- Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Poland St. Warzywna1A, 35-310 Rzeszow, Poland;
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, University of Applied Health Sciences, Mlinarska cesta 38, 10000 Zagreb, Croatia;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University in Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
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Assessment and management of agitation, sleep, and mental illness in the surgical ICU. Curr Opin Crit Care 2021; 26:634-639. [PMID: 33002972 DOI: 10.1097/mcc.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Increased focus on patient-centered outcomes, mental health, and delirium prevention makes this review timely and relevant for critical care. RECENT FINDINGS This review focuses on patient-centered outcomes in the ICU, highlighting the latest research to promote brain health and psychological recovery during and after perioperative critical illness. Topics include sedation in the obese patient, delirium severity assessments, the role of the Psychiatry Consultation-Liaison in the ICU, Post-intensive care syndrome, and the importance of family engagement in the COVID era. SUMMARY Highlighting new research, such as novel implementation strategies in addition to a lack of research in certain areas like sleep in the ICU may lead to innovation and establishment of evidence-based practices in critical care. Perioperative brain health is multifaceted, and an increase in multidisciplinary interventions may help improve outcomes and decrease morbidity in ICU survivors.
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Ozga D, Krupa S, Witt P, Mędrzycka-Dąbrowska W. Nursing Interventions to Prevent Delirium in Critically Ill Patients in the Intensive Care Unit during the COVID19 Pandemic-Narrative Overview. Healthcare (Basel) 2020; 8:healthcare8040578. [PMID: 33371277 PMCID: PMC7766119 DOI: 10.3390/healthcare8040578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 01/08/2023] Open
Abstract
It has become a standard measure in recent years to utilise evidence-based practice, which is associated with a greater need to implement and use advanced, reliable methods of summarising the achievements of various scientific disciplines, including such highly specialised approaches as personalised medicine. The aim of this paper was to discuss the current state of knowledge related to improvements in "nursing" involving management of delirium in intensive care units during the SARS-CoV-2 pandemic. This narrative review summarises the current knowledge concerning the challenges associated with assessment of delirium in patients with COVID-19 by ICU nurses, and the role and tasks in the personalised approach to patients with COVID-19.
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Affiliation(s)
- Dorota Ozga
- Institute of Health Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (D.O.); (S.K.)
| | - Sabina Krupa
- Institute of Health Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland; (D.O.); (S.K.)
| | - Paweł Witt
- Department of Pediatric Anesthesiology and Intensive Care, Medical University of Warsaw, 02-091 Warszawa, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
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Cardinali DP, Brown GM, Pandi-Perumal SR. Can Melatonin Be a Potential "Silver Bullet" in Treating COVID-19 Patients? Diseases 2020; 8:E44. [PMID: 33256258 PMCID: PMC7709121 DOI: 10.3390/diseases8040044] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
The therapeutic potential of melatonin as a chronobiotic cytoprotective agent to counteract the consequences of COVID-19 infections has been advocated. Because of its wide-ranging effects as an antioxidant, anti-inflammatory, and immunomodulatory compound, melatonin could be unique in impairing the consequences of SARS-CoV-2 infection. Moreover, indirect evidence points out to a possible antiviral action of melatonin by interfering with SARS-CoV-2/angiotensin-converting enzyme 2 association. Melatonin is also an effective chronobiotic agent to reverse the circadian disruption of social isolation and to control delirium in severely affected patients. As a cytoprotector, melatonin serves to combat several comorbidities such as diabetes, metabolic syndrome, and ischemic and non-ischemic cardiovascular diseases, which aggravate COVID-19 disease. In view of evidence on the occurrence of neurological sequels in COVID-19-infected patients, another putative application of melatonin emerges based on its neuroprotective properties. Since melatonin is an effective means to control cognitive decay in minimal cognitive impairment, its therapeutic significance for the neurological sequels of SARS-CoV-2 infection should be considered. Finally, yet importantly, exogenous melatonin can be an adjuvant capable of augmenting the efficacy of anti-SARS-CoV-2 vaccines. We discuss in this review the experimental evidence suggesting that melatonin is a potential "silver bullet" in the COVID 19 pandemic.
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Affiliation(s)
- Daniel P. Cardinali
- Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires 1007, Argentina;
| | - Gregory M. Brown
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada;
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Kleszczyński K, Slominski AT, Steinbrink K, Reiter RJ. Clinical Trials for Use of Melatonin to Fight against COVID-19 Are Urgently Needed. Nutrients 2020; 12:E2561. [PMID: 32847033 PMCID: PMC7551551 DOI: 10.3390/nu12092561] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The recent pandemic of COVID-19 has already infected millions of individuals and has resulted in the death of hundreds of thousands worldwide. Based on clinical features, pathology, and the pathogenesis of respiratory disorders induced by this and other highly homogenous coronaviruses, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response contribute to COVID-19 pathology; these are caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This leads to a cytokine storm and subsequent progression triggering acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), and often death. We and others have reported melatonin to be an anti-inflammatory and anti-oxidative molecule with a high safety profile. It is effective in critical care patients by reducing their vascular permeability and anxiety, inducing sedation, and improving their quality of sleep. As melatonin shows no harmful adverse effects in humans, it is imperative to introduce this indoleamine into clinical trials where it might be beneficial for better clinical outcomes as an adjuvant treatment of COVID-19-infected patients. Herein, we strongly encourage health care professionals to test the potential of melatonin for targeting the COVID-19 pandemic. This is urgent, since there is no reliable treatment for this devastating disease.
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Affiliation(s)
- Konrad Kleszczyński
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany;
| | - Andrzej T. Slominski
- Department of Dermatology, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Pathology and Laboratory Medicine Service, VA Medical Center, Birmingham, AL 35294, USA
| | - Kerstin Steinbrink
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany;
| | - Russel J. Reiter
- Department of Cellular and Structural Biology, UT Health, San Antonio, TX 78229, USA;
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Zhang R, Wang X, Ni L, Di X, Ma B, Niu S, Liu C, Reiter RJ. COVID-19: Melatonin as a potential adjuvant treatment. Life Sci 2020; 250:117583. [PMID: 32217117 PMCID: PMC7102583 DOI: 10.1016/j.lfs.2020.117583] [Citation(s) in RCA: 396] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 12/11/2022]
Abstract
This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and often death. Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile. There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. Additional experiments and clinical studies are required to confirm this speculation.
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Affiliation(s)
- Rui Zhang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuebin Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Leng Ni
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Di
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Baitao Ma
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuai Niu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Russel J Reiter
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX 78229, USA.
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