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Background: Acetaminophen and ibuprofen are the only antipyretics drugs approved in children, and are considered safe and well tolerated. However, data regarding the adverse drug reaction (ADR) profile of these drugs in children are scattered. Aim: The aim of our study is to evaluate the ADRs of acetaminophen and ibuprofen through an observational study over a period of 15 years (January 2005-April 2020). Reports of suspected ADRs to the active substances ‘acetaminophen’ and ‘ibuprofen’ are listed and accessible through the Italian spontaneous reporting database (RAM system) by AIFA (Pharmacovigilance of the Italian Drug Agency). Methods: Acetaminophen ADRs in paediatric populations were 15% of cases, with more frequent involvement of skin and soft tissue (54.36%) and gastrointestinal apparatus (44.09%); liver dysfunction accounts for 5.67%. Results: Ibuprofen paediatric ADRs were 26%: skin and soft tissues in 63.16% of cases, gastrointestinal tract in 47.75%, hematemesis and melena in 6.38%; kidney injury in 2.25% of cases. Conclusion: Children aged 2 to 11 are more frequently affected by ADRs than infants and adolescents. The risk of gastrointestinal and renal side effects is significantly higher with ibuprofen. Hepatobiliary side effects are more frequently linked to acetaminophen. Potentially fatal ADRs have been reported sporadically for both drugs.

The article considers the practical issues of providing emergency care to children with febrile conditions from the mo-dern point of view. The main data reflecting the pathogenesis of fever are presented. Recommendations for the selection of groups of patients at high risk of threatening bacterial infections and approaches to their examination and treatment are provided. A review of modern pharmacological possibilities of antipyretics is also given., У статті з сучасних позицій розглядаються практичні питання надання невідкладної допомоги дітям із фебрильними станами. Наведено основні дані, що відбивають патогенез лихоманки. Надано рекомендації щодо виділення груп пацієнтів з високим ризиком загрозливих бактеріальних інфекцій та тактики їх обстеження і лікування. Запропоновано огляд сучасних фармакологічних можливостей жарознижуючих засобів.

The usage of medications like aspirin, ibuprofen and acetaminophen is well-accepted as pain relieving agents worldwide. Aspirin is a medication that is used not only for relieving pain but also for decreasing the risk of heart attack. Acetaminophen and ibuprofen have a significant role in decreasing chronic pain and inflammation. There is a deep connection between the dental procedures and the patients medicine intake. These effects can be known as side effects and damage the natural structure of the tooth or can be any disturbance in dental procedures especially in surgery and tooth extractions. Recognition of common medications and their effects is an important aspect not only for physicians but also for dentists and oral surgeons. The database of this article was derived from valid sources such as PubMed, Google scholar and Web of Science. The search method included the primary keywords like “aspirin”, “ibuprofen” and “acetaminophen” combined with “teeth”, “tooth extraction”, “oral cavity”, “dental procedures'', and/or “bleeding time”. Our results illustrated that a long-term application of aspirin favorably affects the patients who are suffering from angina, stroke or myocardial infarctions. Other findings confirmed that ibuprofen has antipyretic, analgesic and anti – inflammatory features. Effective characteristics of paracetamol as the medicine of choice for the treatment of post-exodontia pain was demonstrated according to several studies. In this review article we provide details about the effects of the three aforementioned medications, their usage in the dental field and any adverse effects on healthy tooth structures.

Background/Aims: This study aimed to assess the association between local and systemic reactogenicity and humoral immunogenicity after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination.Methods: Adverse events were prospectively evaluated using an electronic diary in 135 healthy adults who received a SARS-CoV-2 vaccine (AZD1222, AstraZeneca/Oxford, n = 42; or BNT162b2, Pfizer/BioNTech, n = 93). We semi-quantitatively measured anti-S1 immunoglobulin G (IgG) using an enzyme-linked immunosorbent assay at baseline, 3 weeks after the first dose of AZD1222 or BNT162b2, and 2 weeks after the second dose of BNT162b2. We evaluated the association between the maximum grade of local or systemic adverse events and the anti-S1 IgG optical density using multivariate linear regression with adjustment for age, sex, and use of antipyretics.Results: The median age of the 135 vaccinees was 30 years (36 years in the AZD1222 group and 29 years in the BNT162b2 group) and 25.9% were male (9.5% in the AZD1222 group and 33.3% in the BNT162b2 group). Local and systemic adverse events were generally comparable after the first dose of AZD1222 and the second dose of BNT162b2. The grades of local and systemic adverse events were not significantly associated with anti-S1 IgG levels in the AZD1222 or BNT162b2 group.Conclusions: Local and systemic reactogenicity may not be associated with humoral immunogenicity after SARS-CoV-2 vaccination.

Introduction: The COVID-19 pandemic in Ecuador was declared in March 2020. Since that date, there has been an exponential increase in the disease. But cases in pediatric age worldwide are reported as less frequent, without being Ecuador the exception. Until March 2021, 5,4% of cases correspond to children. Methods: A transversal analysis was applied in this research. Data was collected from the clinical records of the GEMA system. The study variables were: demographics, clinics, diagnosis tests, hospitalization length, and treatment. The descriptive analysis used percentage and median. To identify significant differences, the Chi-square test was applied. It was considered a significative result p

У статті подано огляд літератури та дані власного дослідження щодо ефективності ібупрофену та його переносимості при фебрильній лихоманці в дітей, хворих на гострі респіраторні інфекції. Отримані дані свідчать, що ібупрофен є швидко та тривало діючим жарознижувальним препаратом із високим ступенем переносимості, рекомендованим до застосування в дітей.

Background. Fever in children is one of the most common causes for parents to see a doctor. The purpose was to analyze the state of awareness of doctors about the fever treatment principles in children, the methods of optimal dosage of antipyretic drugs and features of the antipyretic therapy use in certain categories of patients by means of specially designed questionnaires. Materials and methods. One hundred eight doctors took part in the survey. The questionnaire consisted of 20 questions. Results. Doctors note that only 66.0 % of parents use the means recommended by the doctor to reduce the body temperature in their children, the rest rely on personal experience and recommendations of pharmacists. 64.2 % of respondents indicated ibuprofen as a first-line antipyretic drug. 90.6 % of doctors believed an increase in body temperature to 38.5 °C or more to be an indication for the use of antipyretic drugs. However, 26.4 % of doctors use this group of drugs after vaccination; 17.0 % of respondents admit the use of antipyretic drugs at a child’s body temperature less than 38.5 °C, especially with a history of febrile convulsions, as well as pain syndrome and poor health. 50.9 % of respondents combine the use of ace­taminophen and ibuprofen if one of them is ineffective, using the second drug in the intervals between taking the first one. The most difficult questions for doctors were the peculiarities of the use of antipyretic drugs in children with comorbidities. Conclusions. Given the findings of the survey, we consider it necessary to conduct further work among physicians on awareness of the principles and indications for the use of antipyretic therapy in children.

Quinine and its D-isomer quinidine have been used medically in Europe since the 1600s. They were originally found within the bark of the cinchona tree in the jungle of the Andes. They were recognized to have multiple beneficial medical properties, ranging from a combined antipyretic and analgesic effect to the first effective treatment for malaria and later atrial fibrillation. With the development of other medications and the recognition of the potential life-threatening toxic reactions to these drugs, their medical use declined. Quinine is available without a prescription in many countries and is present in tonic water. Quinine has an extensive following of users who believe it is salutary and harmless, considering it a food supplement. In the past, dermatologists were frequently the first to recognize disease caused by these drugs owing to early findings of dermatitis or petechiae. Even though the medical use of these drugs has markedly decreased, drug eruptions may still be due to quinine, and patients may even be unaware they are taking this medication.

BACKGROUND: The purpose of the study was to investigate the effects of cefuroxime axetil combined with Xingpi Yanger granules on the treatment of upper respiratory tract infection accompanied by diarrhea and on serum gastrin (GAS), motilin (MOT), and somatostatin (SS) levels in children. METHODS: In total, 124 children with upper respiratory tract infection accompanied by diarrhea admitted to the department of pediatrics in our hospital from May 2019 to May 2020 were selected and divided into a study group (n=62) and a reference group (n=62), according to admission number. The reference group children received routine treatment, while the children in the study group were treated with cefuroxime axetil combined with Xingpi Yanger granules. After treatment, each clinical index of the children in both groups was detected to evaluate the clinical efficacy of the different treatment methods. RESULTS: There were no significant differences in gender ratio, average age, mean body temperature, mean duration of diarrhea, average weight, or place of residence between the 2 groups (P>0.05); the total clinical effective rate after treatment in the study group was significantly higher than that in the reference group (P

Objective: Fever is one of the frequent reasons for admission to the emergency department. Studies comparing oral forms of non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol with intravenous (IV) forms for fever are common in the literature. Our study is the first emergency department study comparing IV forms of ibuprofen and paracetamol in the treatment of febrile patients. Methods: A randomized, double-blind study was conducted in a tertiary university emergency department for a six-month period. Patients aged 18-65 years who had a fever of >= 38.0 degrees C were included. Patients were administered 400 mg of IV ibuprofen and 1000 mg of IV paracetamol. The primary aim of the study was to determine whether there was a difference in the effect of the two drugs on fever. The secondary aim was to investigate whether there was a difference in terms of numeric rating scale (NRS) measurements and the need for additional antipyretic therapy. Results: A total of 200 people, 100 of whom were female, were included in the study. The mean age was 30.77 +/- 10.61 years. The mean initial temperature for ibuprofen and paracetamol was 38.79 +/- 0.470 degrees C and 38.70 +/- 0.520 degrees C, respectively, with no difference noted between the groups (p = 0.380). It was found that both drugs significantly provided fever control in the first 30 min (p < 0.001), with no difference between them in terms of fever reduction (p = 0.980). Both drugs significantly improved in accompanying symptoms, although both drugs did not show superiority to each other (p = 0.0226). When evaluated in terms of a need for rescue medication, no significant difference was found between the two drugs (p = 0.404). No side effects were encountered during the study. Conclusion: In adult age group patients admitted to the emergency department with high fever, the IV forms of 1000 mg paracetamol and 400 mg ibuprofen effectively and equally reduce complaints, such as fever and accompanying pain. They can be effectively used as each other's rescue medicine and as an alternative to each other in patients with comorbid diseases. (c) 2021 Elsevier Inc. All rights reserved., Ege University Scientific Research Projects Coordination, This article was supported by Ege University Scientific Research Projects Coordination.

Background COVID19 is a high burden for medicine and society as still no specific therapy exists. Most patients depend on symptomatic treatment, comparable to the symptomatic treatment in common respiratory infection e.g., Acetaminophen or Ibuprofen. Many cases of COVID19 show mild forms without need of hospitalization. In this randomized, open-label, multicentre, comparative trial we analysed the efficacy, safety, and tolerability of the herbal medicinal product BNO 1030 in mild cases of COVID-19 to offer an additional symptomatic relive. Methods The study was designed as an open label randomized, prospective, multicentred clinical trial. Out of 133 screened outpatients aged 18 to 70 with mild COVID-19 symptoms 120 patients were randomised (1:1) in 2 parallel groups. The main group received BNO 1030 in addition to symptomatic therapy (acetaminophen or ibuprofen). The control group got a symptomatic therapy only. The patients with laboratory proven COVID 19 were included for the final analyses: 47 – in the main group and 46 – in the control one. The evaluation criteria were dynamics of the symptoms: hyperthermia, myalgia, nasal congestion, nasal discharge, coughing, anosmia, rhinolalia, sore throat, duration of the use of antipyretics (clinically significant fever). These symptoms were assessed during the physician’s visit on a 4-point scale (0 — absent, 1 — insignificant, 2 — moderate, 3 — strong/pronounced) and self- assessed via ten-point visual analogue scale (VAS) daily in a patient’s diary. The primary endpoint was the decrease of the average score compared to the baseline defined as “therapeutic benefit” from the usage of BNO 1030. Results In the comparison of both groups over the treatment time, the main group (n = 47) showed a greater decrease in the severity of symptoms of fever, myalgia, nasal congestion, coughing, anosmia and rhinolalia, assessed by the doctor on a 4-point scale on V2 (4th day) and V3 (14th day) compared to those on V1, as well as a reduction of the antipyretics intake duration (p p Conclusions BNO 1030 (Imupret®) offers a safe and effective treatment benefit in patients with mild forms of diagnosed COVID-19 aged 18–70 in addition to symptomatic treatment with acetaminophen or NSAIDs. COVID 19 positive patients treated with Imupret showed an earlier relive of symptoms when being treated with BNO 1030. Trial registration This trial was registered in ClinicalTrial.gov: NCT04797936.

The article presents the results of the analysis of clinical features of gastroenterological manifestations of a new coronavirus infection (COVID-19) caused by the pathogen SARS-CoV-2. Taking into account the stage-by-stage system assessment of the experience of treating 1,180 patients in a multi-specialty hospital transformed into an infectious hospital, the most characteristic clinical manifestations of digestive damage by SARS-CoV-2 coronavirus are described. The article focuses on verification of changes in the digestive system, both at the stage of primary examination, and during etiotropic (in combination with hydroxychloroquine and azithromycin, interferon-alpha drugs), pathogenetic (in combination with corticosteroids, heparin drugs, according to indications - an interleukin-6 inhibitor) and symptomatic (antipyretics, antiemetics and antitussive drugs) therapy, carried out in accordance with Temporary guidelines of the Ministry of health of the Russian Federation “Prevention, diagnosis and treatment of new coronavirus infection Covid-19”. Directions for the development of algorithms for clinical and laboratory, instrumental and radiological diagnostics of changes in the digestive system in patients with COVID-19 are justified.

With mortality rising from the COVID-19 pandemic, we may be overlooking a key aspect of the immunological response. Fever is a cardinal sign of this rampant infection; however, little attention has been paid towards how a fever may work in our favor in overcoming this disease. Three key aspects of patient care - fever, fluid, and food - can be harmonized to overcome COVID-19 infection. Both animal and human studies have demonstrated that fever suppression during viral infections, either through low ambient temperatures or antipyretic use, may increase morbidity and prolong the illness. As fever rises, so do antidiuretic hormone levels, leading to solute-free water retention - making conservative fluid management essential. Finally, fever inhibits gastrointestinal function as energy is reallocated to the immunological response, underscoring the need to work in concert with these physiological changes. An opportunity awaits to investigate this natural barrier to infection, let us not pass it by.

In children, fever is a symptom of a wide spectrum of diseases, ranging from common self-limiting viral upper respiratory tract infections to serious life-threatening diseases. The aim of the diagnostic procedure is to identify the cause of fever, determine indications for outpatient treatment, plan the appropriate pharmacological therapy or reveal the need for hospitalisation. Paracetamol and ibuprofen are antipyretics recommended for symptomatic treatment of children; however, the medications should not be used in combination or alternately, except in specific clinical situations. The drugs may be applied to treat fever and topical reactions after vaccination, but not prophylactically in order to reduce the incidence of fever or local discomfort after vaccination. Both medications can be used in patients with asthma, with the exception of intolerant children. Children with confirmed or suspected COVID-19 may be treated with paracetamol and ibuprofen in accordance with clinical indications and dosage recommendations.

Acute diarrhea is diarrhea that lasts less than 14 days. Regarding its severity, acute diarrhea is classified as mild, moderate or severe. Mild when signs of dehydration are not observed, moderate when there are mild or moderate signs of dehydration and rehydration can be done orally and severely when it results in more intense dehydration with or without electrolyte disturbances, and requires intravenous therapy. Diarrhea disease in the Inpatient Installation Bandar Lampung Adventist Hospital is the 10 biggest diseases and has never been evaluated on the use of drugs in pediatric patients. This study aims to evaluate the use of drugs in patients with acute diarrhea inpatients installation at the Bandar Lampung Adventist Hospital calculated from July to December 2019 data. This research is a descriptive study with retrospective data collection. The data collection process begins by tracing medical records of acute diarrhea patients. The population of acute diarrhea cases was 152 patients and then the number of samples obtained was then selected according to the inclusion criteria as a sample of 60 patients. From the research results it is known that the use of drugs in patients with acute diarrhea in pediatric patients includes antibiotics, electrolyte solutions, analgesic/antipyretics, antidiarrheals and other drugs (antihistamines, supplements and probiotics). The validation of drug use on the right indicators, the right patient and the right dose has reached 100%, the right indicator is 37% and the drug is 63% incorrect, this is due to the use of antibiotics without laboratory results that show acute diarrhea due to infection. Keywords: acute diarrhea, evaluation of drug use, pediatric

The use of antibiotic drugs (ABDs) has significantly reduced the number of severe bacterial infectious diseases and mortality in children, especially in infants. But the widespread and unnecessary use of ABDs, including reserve antibiotics (the use of carbapenems increased by 45%, polymyxins – by 13%), to treat uncomplicated acute respiratory infections is open to many hazards, such as increased antibiotic resistance of pathogens. Antibiotic-associated diarrhea is one of the common complications of antibiotic therapy. According to various authors, the incidence of antibiotic-associated diarrhea is 6–80% among patients treated with antibiotics, on average 35% of patients (approximately every third patient) receiving antibiotics report symptoms of antibiotic-associated diarrhea. Disruptive changes in the qualitative and quantitative composition of the intestinal microbiota are accompanied by a decrease in the protective functions of the intestinal mucosa and contribute to the growth of pathogenic and opportunistic microorganisms (Clostridium spp., Candida spp., Salmonella spp., Staphyloccus aureus). The findings of most studies obtained on a large sample of paediatric population, as well as the clinical guidelines of the World Association of Gastroenterologists recommend the use of L. rhamnosus GGprobiotic strain (level of evidence 1) to prevent antibiotic-associated diarrhea in children. L. rhamnosus GGpresents chromosomal resistance to a range of antibiotics, which varies with species and strain. They do not contain plasmid DNA, which is dangerous for the spread of antibiotic resistance among other bacteria, which enables their wide therapeutic and prophylactic use. Clinical case studies of the course of antibiotic-associated diarrhea in children are presented to demonstrate the variability of clinical symptoms. Fever in children with ARI, particularly in tender-age infants, requires special attention from parents and doctors, as its main risk lies with a dehydration due to significant water loss during breathing, and especially increased sweating (including sweating induced by antipyretics). Therefore, oral rehydration therapy is an important method for treating infectious diseases in children. Complications that develop in patients, especially in children, after administration of antibiotics, diseases that can lead to water and electrolyte imbalance are life-threatening conditions that require immediate medical attention. Correction of water and electrolyte balance, timely restoration of intestinal microflora improve prognosis in such patients and promote faster recovery.

COVID-19 has affected negatively day to day life and global economy. Considering need for search of immunity modulator drugs for fighting this virus, Ayurvedic treatment was planned. 30 year old female patient, having history of the hypertension was diagnosed as a case of COVID-19 through RT-PCR. AYUSH Kwath (20 ml OD for 7 days), Sanshamani vati(2BD for 7 days), Sudarshan churn (3gm for14 days), Vit –C and Azithromycin given orally for 5 days. RT-PCR sample result was found COVID negative on 7th day of treatment. Antipyretic, anti-inflammatory, immune-modulatory activities were documented earlier of used medications which have shown beneficial result in present case also. Orally administered, add on Ayurvedic formulation exerted symptomatic relief in symptomatic COVID-19 case with pitta-kapha prakriti having co-morbidity of Hypertension. RCT needs to be conducted to validate result in larger sample which will generate evidence for support.

Nesteroidiniai vaistai nuo uždegimo (NVNU) yra vieni labiausiai paplitusių vaistų, jie ne tik malšina skausmą, tačiau pasižymi priešuždegiminiu ir antipiretiniu poveikiu. Juos kasdien visame pasaulyje vartoja daugelis žmonių, nepriklausomai nuo jų indikacijų ir šalutinio poveikio, neatsižvelgiant į jų vartojimo savitumus. Metodai ir tyrimo dalyviai. Tyrime dalyvavo 423 asmenys, kurie vartoja nesteroidinius vaistus nuo uždegimo. Tiriamieji buvo apklausti anoniminiu anketavimo būdu. Duomenys analizuoti vartojant „Microsoft Excel 2019“ ir „IBM SPSS 22.0“ programas. Pateikti rezultatai statistiškai reikšmingi, jei p

Aim: Prevention and treatment of upper respiratory tract infections are given the highest priority because of the tremendous health and economic impact of these diseases. Development of novel effective and safe options for treatment can contribute considerably to decrease the burden of disease. Materials and methods: We designed a multicenter, randomized, double-blind, placebo-controlled study in ambulatory-treated adult patients with a clinical diagnosis of acute upper respiratory tract viral infection. The patients (18-60 years old) were randomized into two groups and followed-up for 5 days. Group 1 received the standard symptomatic therapy + Aviron Rapid®, and Group 2 received the standard symptomatic therapy + placebo. The primary endpoint of the study was defined as the duration of disease measured by the percentages of disease-free patients for every 12-hour period of the study. Results: Treating clinically relevant patients with the natural product Aviron Rapid® for 5 days decreases the duration of disease, the intake of antipyretics and the severity of symptoms. Significant difference between the tested groups for most of studied parameters was found as soon as 12 or 24 hours after initiation of administration in favour of active arm and was the most prominent on days 3 and 4. Significant decrease in the total score of symptoms severity was achieved on day 4 and extended to the end of study. There were no dif-ferences in the adverse events between the groups and the tested product demonstrated excellent safety profile. Conclusions: This study is a clinical confirmation of well documented antiviral activity of the product targeting multiple points in viral replication and covering broad spectrum viral pathogens.

A 55-year-old man was treated at the village hospital with six months medical history of recurrent chills and fever. Due to the lack of imaging examination, antipyretic and anti-infective medications were given. Although symptomatic treatment can relieve fever symptoms, symptoms easily flare up again two to three days after taking the drug. Later, the patient suffered from fever again during the COVID-19 epidemic and was sent to our hospital for isolation and treatment. During this hospitalization, chest CT examination is mandatory for all patients in order to meet the requirements of epidemic prevention and control. This led to the inadvertent discovery of a large cystic solid mass in the right thoracic cavity communicating with the esophageal lumen. The patient was preliminarily diagnosed as giant midesophageal diverticulum after three-dimensional CT image reconstruction of the chest was reviewed. Considering the patient’s persistent fever with poor nutritional status, we decided to temporarily place two gastric tubes (diverticulum decompression and gastrointestinal nutrition), and antibiotics were used at the same time as another main treatment. However, after the symptoms eased and nutritional status improved, he refused all further treatment. We believe that this patient’s diverticulum is very classic, and the treatment plan is highly integrated with the needs of epidemic prevention and control and achieves a satisfactory therapeutic effect, so we hope to provide colleagues with new diagnosis and treatment enlightenment through this case.

Background: The traditional healthcare systems are being avidly looked into in the quest for effective remedies to tackle the menace of COVID-19 pandemic. Objective: This was a prospective randomized, controlled open-label, blinded end point (PROBE) study to evaluate the efficacy and safety of a fixed ayurvedic regimen (FAR) as an add-on to conventional treatment/standard of care (SOC) in the management of mild-to-moderate COVID-19 infection. Methodology: A total of 68 patients were recruited who consumed either FAR + SOC (n = 35) or SOC only (n = 33) for 28 days. Primary outcomes assessed were mean time required for clinical recovery and proportion of patients showing clinical recovery between the groups. Secondary outcomes assessed included mean time required for testing SARS-CoV-2 negative, change in clinical status on World Health Organization (WHO) ordinal scale, number of days of hospitalization, change in disease progression and requirement of oxygen/intensive care unit admission/ventilator support/rescue medication, health status on WHO quality of life (QOL) BREF, and safety on the basis of occurrence of adverse event/serious adverse event (AE/SAE) and changes in laboratory parameters. Results: Patients consuming FAR as an add-on SOC showed faster clinical recovery from the day of onset of symptoms by 51.34% (P < 0.05) as compared to SOC group. A higher proportion of patients taking FAR recovered within the first 2 weeks compared to those taking only SOC. It was observed that 5 times more patients recovered within 7 days in FAR group when compared to SOC (P < 0.05) group. An earlier clinical recovery was observed in clinical symptoms such as sore throat, cough, loss of taste, and myalgia (P < 0.05). Improvement in postclinical symptoms such as appetite, digestion, stress and anxiety was also observed to be better with the use of FAR. Requirement of rescue medications such as antipyretics, analgesics, and antibiotics was also found to be reduced in the FAR group (P < 0.05). FAR showed a significant improvement in all the assessed domains of QOL. None of the AEs/SAE reported in the study were assessed to be related to the study drugs. Further, FAR did not produce any significant change in the laboratory safety parameters and was assessed to be safe. Conclusion: FAR could be an effective and safe add-on ayurvedic regimen to standard of care in the management of mild and moderate COVID-19 patients. CTRI number: CTRI/2020/09/027914.

Background: Acetaminophen is widely used as an antipyretic and analgesic. It is considered safe when administered within its therapeutic range with a maximum daily dose (MDD) of 4,000 mg/day. In cases of acute intoxication, complications such as acute liver failure can occur. This study aims to assess the knowledge and attitudes toward acetaminophen-induced hepatotoxicity among the adult population in Al-Madinah Al-Munawwarah, Saudi Arabia. Methods: This descriptive cross-sectional study was conducted among adults (above 18 years) living in Al-Madinah Al-Munawwarah, Saudi Arabia, performed via an electronically distributed questionnaire using social media in March 2020. Results: Of 405 participants, only 15.3% recognized 4,000 mg/day acetaminophen to be the MDD. Meanwhile, 84% of participants knew of liver damage being a side-effect of acetaminophen. Panadol was identified as a drug containing acetaminophen by 60% of participants. Regarding attitude, 30.1% of participants revealed that they look for acetaminophen as an ingredient before buying over-the-counter medications, while 22.7% look for it in medicines prescribed by their physicians. Only 24.7% of the participants reported receiving information about acetaminophen from health care workers, most of which were from doctors (55%). Panadol and Fevadol were the most used medications with a frequency of once-twice daily. Conclusion: According to the study results, there is a lack of awareness regarding acetaminophen’s MDD. However, awareness of acetaminophen-induced hepatotoxicity is satisfactory among the Al-Madinah Al-Munawwarah population.

Introduction: Finding non-systemic antipyretic option in cancer patients who simultaneously receive several other drugs seems be logical. This study was designed to evaluate complementary therapy with Viola odorata L. oil for fever control in febrile neutropenic children. Methods and Materials: In a randomized placebo controlled clinical trial, 41 febrile children were divided into two groups. Children in the active drug group received viola oil (20 drops) to be rubbed on the peripheral margin of the patient umbilicus. Primary outcome measure of the study was the mean axillary temperature in the 30, 60, and 240 minutes after the intervention. Results: The mean temperature reduced significantly in the viola group after 30 minutes of administration (p =0.005), while there was no significant change in the placebo group (p =1.00). The number of patients who received paracetamol as the rescue treatment was significantly lower in the viola group than that in the placebo group (5 vs. 17, p =0.001). Conclusion: The results of our study showed the safety and efficacy of complementary therapy with Viola odorata L. oil for fever control in febrile neutropenic children during hospital course.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Genetic sequencing of the virus suggests that it is a beta coronavirus closely linked to the SARS virus. While most people with COVID-19 develop the only mild or uncomplicated illness, approximately 14% develop a severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by acute respiratory distress syndrome (ARDS), sepsis and septic shock, multi organ failure, including acute kidney injury and cardiac injury. Reports of the pattern of Covid symptoms suggest that mild fever, cold and cough are the most common symptoms on an average by 5 days after exposure to the virus. Given the current SARS-CoV-2 (COVID-19) pandemic, the availability of reliable information for clinicians and patients is paramount. There have been a number of reports stating that non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids may exacerbate symptoms in COVID-19 patients. There is enough literature to prove that many molecules from plants have shown important therapeutic activity with lesser side effects as compared to conventional medicines. Therefore, the present study is aimed to evaluate Plant extracts of proven antiviral activity, which are described as antipyretics and analgesics in classical Ayurvedic texts for their analgesic & antipyretic effect in laboratory animals. Tab. Febcin formulation was selected.

Enquadramento: a automedicação envolve o uso de medicamentos para tratar distúrbios ou sintomas autodiagnosticados, ou o uso intermitente ou continuado de medicação prescrita por um médico para tratamento crónico ou doenças ou sintomas recorrentes. Objetivos: caraterizar a prática da automedicação nos estudantes do ensino superior da saúde. Metodologia: estudo quantitativo e descritivo. Amostra constituída por 301 estudantes. Recolha de dados com recurso a questionário e análise de dados efetuada através do Statistical Package for the Social Sciences (SPSS). Resultados: verifica-se automedicação em 93,4% dos estudantes do ensino superior saúde. Os sinais e sintomas mais frequentes foram as cefaleias (29,8%), dismenorreia (13,5%) e febre (9,9%). Os medicamentos mais utilizados foram os analgésicos/antipiréticos (34,6%), os anti-inflamatórios (29,2%), vitaminas e sais minerais (7,4%). Conclusão: a automedicação entre os estudantes do ensino superior é elevada, pelo que é fulcral abordar esta problemática ao longo do curso de forma a minimizar os riscos associados a este consumo.

Background. Mucopolysaccharidosis type II (MPS II, Hunter syndrome) is a rare hereditary lysosomal storage disease associated with iduronate-2-sulfatase deficiency. Patients with MPS II require life-long enzyme replacement therapy (ERT) to replace the deficiency of endogenous enzyme. There are two medications — idursulfase and idursulfase beta — that are licensed and recommended for these patients in Russian Federation. However, it is well known that ERT can cause hypersensitivity reactions development.Clinical Case Description. The ERT (idursulfase in the dose of 0.5 mg/kg once per week) onset in the male patient with severe MPS II was at the age of 2.5 years. Hypersensitivity reactions (urticaria, fever) were noted incidentally, thus, the premedication with antihistamines and antipyretics was performed. The ERT side effects has aggravated at the age of 8 years despite the glucocorticosteroids admission and infusion rate reduction up to 8–16 ml/h. That is why we have changed the medication on idursulfase beta with major clinical response: we have achieved control on both disease itself and hypersensitivity reactions.Conclusion. The availability of two ERT medications for patients with MPS II expands treatment opportunities. In case of any allergic reactions due to idursulfase, the change on idursulfase beta reduces the risk of any ERT complications with sufficient control of MPS II course.

Although fever is one of the main presenting symptoms of COVID-19 infection, little public attention has been given to fever as an evolved defense. Fever, the regulated increase in the body temperature, is part of the evolved systemic reaction to infection known as the acute phase response. The heat of fever augments the performance of immune cells, induces stress on pathogens and infected cells directly, and combines with other stressors to provide a nonspecific immune defense. Observational trials in humans suggest a survival benefit from fever, and randomized trials published before COVID-19 do not support fever reduction in patients with infection. Like public health measures that seem burdensome and excessive, fevers involve costly trade-offs but they can prevent infection from getting out of control. For infections with novel SARS-CoV-2, the precautionary principle applies: unless evidence suggests otherwise, we advise that fever should be allowed to run its course. Lay summary: For COVID-19, many public health organizations have advised treating fever with medicines such as acetaminophen or ibuprofen. Even though this is a common practice, lowering body temperature has not improved survival in laboratory animals or in patients with infections. Blocking fever can be harmful because fever, along with other sickness symptoms, evolved as a defense against infection. Fever works by causing more damage to pathogens and infected cells than it does to healthy cells in the body. During pandemic COVID-19, the benefits of allowing fever to occur probably outweigh its harms, for individuals and for the public at large.

Herpes Simplex Virus (HSV) is a debilitating infectious disease, often the root cause of all oral herpetic lesions. The oral herpes virus affects the individuals aesthetically, healthwise, and psychologically as well. The aim of the study is to analyze and evaluate the various treatment modalities practiced at the Department of Oral Medicine at Saveetha Dental College and Hospital, Chennai. A total of 64 participants were involved in the study conducted between the period of July 2019 - March 2020. The patients were receiving either of the following treatment: (i) Topical antivirals (ii) Topical anti-inflammatory or analgesics (iii) Systemic antivirals (iv) Systemic antipyretics (v) Supportive therapy if any. The result of the study conducted shows the prevalence of usage of 57% of topical antivirals, 12% of systemic antivirals, 12% of topical anti-inflammatory and analgesics, 13% of systemic antipyretics and 6% of supportive therapy. In conclusion, the topical antiviral drugs prescribed were of high prevalence. However, advising necessary supportive therapy can help in faster healing of the lesions.

Objective: To evaluate the frequency of self-medication among undergraduate students of medical sciences Study design and setting: Cross-sectional Study was conducted at Al-Tibri Medical College Hospital, from October 2019 to February 2020. Methodology: Data was collected after an ethical approval of concerned institute; total of 150 students included from the 1st, 3rd and final year of MBBS. Valid questionnaire was used to evaluate the response of the participants regarding selfmedication. Verbal consent was taken from the students, and then they were asked to fill their responses. Data was evaluated in the form of frequency and percentages through SPSS version 21.0. Chi-square test was applied, and the level of significance was considered p=

Nonsteroidal anti‑inflammatory drugs (NSAIDs) is a big group of medications with different chemical structure but common mechanisms of pharmacological actions and ability to provide analgesic, anti‑inflammatory and antipyretic effects. NSAIDs is one of the therapeutically instruments to relief acute and chronic pain at a wide spectrum of diseases and pathological conditions. NSAIDs administration is an integral part of the work of physicians, rheumatologists, neurologists, anesthesiologists, surgeons, traumatologists, gynecologists and other medical specialties. NSAIDs are effective and easy to use, but they can cause serious complications and first of all, the gastrointestinal adverse events.The paper present analysis of the structure of drug‑induced injuries of upper gastrointestinal tract in patients taking NSAIDs. The risks of adverse events that develop against the background of short‑term NSAIDs use for analgesic, anti‑inflammatory, antipyretic purposes have been discussed. The data on the frequency and features of clinical, endoscopic and morphological manifestations of NSAID‑gastropathies are presented. The danger of these complications, which may be accompanied by life‑threatening conditions such as bleeding or perforation, has been demonstrated. The role of modern endoscopic methods for the diagnosis of NSAID‑gastropathies is evaluated. Based on a clinical example, the authors proposed a strategy for the prevention and treatment of NSAID‑gastropathy, which arose against the background of asymptomatic Helicobacter pylori infection. Current data on various strategies for the treatment and prevention of NSAID gastropathies are presented. Based on the analysis, it has been concluded that the use of proton pump inhibitors (PPIs) and the eradication of Helicobacter pylori infection are the best strategies. The use of double doses of PPIs makes it possible to increase the effectiveness of prevention and treatment of NSAID‑gastropathies, as well as eradication therapy.

Long unclear fever in children of different ages remains one of the difficult and topical issues in the paediatric practice. Despite up-to-date techniques of laboratory and instrumental examination, verification of prolonged fever causes remains difficult; it cannot be deciphered in 10% of cases. It is especially important to differentiate fever from hyperthermia in paediatric practice. The article provides an overview of the status update on the issue. The mechanisms of fever and hyperthermia are described, criteria for fever of unknown origin are given. It is stated that infectious diseases under the guise of fever of unknown origin develop in 60–70% of children. Systemic connective tissue disease and vasculitis are detected in 20% of cases, hemato-oncological – in 5%, auto-inflammatory – in 5%, the cause of fever remains unknown in 10% of cases. The article provides clinical observations of children with diseases debuting as fever of unknown origin with the following diagnoses: juvenile rheumatoid arthritis (JRA), a systemic variant with high activity (DAS index 28 = 5.1 at the rate of < 2.6); mucocutaneous lymphonodular syndrome (Kawasaki syndrome), damages of cardiovascular system (small coronary artery aneurysms), bacterial-viral infection; auto-inflammatory syndrome – mevalonate kinase deficiency syndrome (hyper-IgD syndrome). Diagnostic approaches to the verification of febrile condition are outlined. It is noted that treatment should not be started in a stable condition of the patient without establishing the cause of the fever, and it is advisable to use only an antipyretic agent with central and peripheral effects, pronounced antipyretic effect, analgesic and anti-inflammatory effects.

The dry eye syndrome (DES) belongs to the group of tear film disorders, which are caused by either lowering of tear secretion or by the tear film instability. DES lowers the working capacity, worsens the quality of life and, if its symptoms are ignored for a long time, may lead to serious vision disorders, including blindness. The influence of environmental factors may be one of the reasons for intensification of the DES caused symptoms. In addition, there is a concept of iatrogenic DES, caused by a systemic and local use of medicinal drugs, by contact lenses, and by ophthalmological surgical and non-surgical manipulations. The purpose of the research was to study the clinical-pharmacological characteristics of medicinal drugs in terms of peculiarities of their application in patients with DES who have adjoining disorders as well as to determine medicines that may contribute to DES occurrence and exacerbation causing secondary lowering of tear production and sensor glandular secretion, inflammation of Meibomian glands or direct irritation. Materials of the research included the data of the medicinal drugs’ register, the search database of medicinal drugs Compendium, prescribing information and labelling of the drugs. Methods of research: biblio-semantic, content-analysis, segmenting, graphic, system analysis. It has been determined that 194 medicinal drugs, which in accordance to the 1st level of ATC-classification system belong to 10 pharmaco-therapeutic groups, have certain treatment peculiarities in patients with dry eye syndrome. DES is mentioned in different sections of prescribing information and labelling of the drugs: «side effects» – 172 drugs, «peculiarities of use» – 21 drug, «drug-to-drug interaction» – 1 drug. Segmentation of the market by the type of medicinal form demonstrated a significant prevalence of eye drops and pills (34.02% and 33.50% respectively). Taking into consideration the prevailing share of eye drops among other medicinal forms, which cause iatrogenic DES, further research is required to study their composition and define the correlation between the content of excipients and the risk of development of side effects in the form of dry keratoconjunctivitis of local ophthalmological medicinal drugs. The results of the conducted complex research determine the groups of medicinal drugs that should be prescribed with special caution for pharmacotherapy of various organs and systems in patients with the risk of DES acquisition or exacerbation. The most numerous among them are such groups as S01E – Antiglaucoma drugs and myotics, L01X – Antineoplastic drugs and N02B – Analgesics and antipyretics, which account for 21.13%, 12.37% and 9.79%, respectively. Presence of information about the risk of DES development as a result of drug-to-drug interaction in only 1 of 194 prescribing information and labelling of the drugs signifies an extremely low level of attention to the issue of medicinal drugs’ synergy in terms of their side effects.

Vaccines are a tool for the prevention of many infectious diseases that can cause different morbidity and the cost-benefit of those administered systematically is clear. In the cost of vaccines are the adverse effects that cannot currently question the benefit of vaccines administered in vaccine schedules around the world. Fever is perhaps the most common systemic side effect of vaccines and despite being a self-limiting effect causes concern and sometimes unnecessary medical consultations and tests. It describes the physiopathology of post-vaccine fever as well as practical aspects about its detection and treatment.

Context: In endemic countries, most of dengue fever cases clinically resembles other diseases or just flu-like syndrome, it is important to detect dengue infection in patient with acute fever 1 to 4 day and which serotype of dengue virus that circulation to determine the risk of severe case of dengue to occur in primary health care. Aims: The aim of this study was to identify the incidence of dengue viral infection among children with acute fever in endemic area, and which serotype of dengue virus that circulating in community in Bandung, West Java, Indonesia. Settings and Design: Prospective cohort analysis study. Methods and Material: patients age 0 to 18 years old with acute fever from Sukajadi, Neglasari, and Padasuka Primary Health Centre form march to October 2018. These primary health centers represent three subdistricts with high dengue case every year in Bandung. Inclusion criteria: Fever at least 37.6oC, 1-4 days, with or not taking antipyretics. Name, age, and sex, nutritional status, and laboratorium examination that has been done by primary health centre was collect. Rapid NS1 antigen test is done as an additional check, multiplex real time RT-PCR assay for dengue virus (1-4) was perform from blood sample that NS1 antigen positive. Statistical analysis used: independent t-test analysis. Results: A total of 178 blood samples from patients with acute fever collected. 40 (22,5%) samples were positive with rapid NS1 antigen test, mean body temperature significantly higher in confirmed dengue virus cases (37,66 (±2,07) vs 38,33 (±0,83); p0,005) and platelet count (239.218 (±99.402) vs 164.739,13 (±98.259); p>0,005) is lower in confirmed dengue virus cases. From 40 positive NS1 antigen test, 17 (42,5%) showed all serotype (Den 1-4) of dengue can be found, with 8 (47,05%) is Den 3. Conclusions: Incidence of dengue cases in patient with acute febrile in endemic urban area is quite high, and all serotype of dengue virus can be found, so the risk of secondary dengue virus infection is imminent.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN) or drug-induced liver injury (DILI) are severe drug-induced reactions, known as idiosyncratic drug reactions. It is believed that immune response can lead to these severe adverse drug reactions. Our previous analysis of the Japanese Spontaneous Drug Reaction database suggested that the onset of SJS/TEN and DILI was strongly associated with infection. Hence, we conducted a matched, nested case-control study to elucidate the association between concurrent infection and the onset of SJS/TEN or liver injury in patients prescribed antipyretic analgesics. We extracted 4 112 055 patients who were prescribed antipyretic analgesics between January 2014 and December 2015. Amongst them, 553 (0.01%) were diagnosed with SJS/TEN and 12 606 (0.3%) with liver injury. In a matched, nested case-control study, 131 and 2847 cases matched for SJS/TEN or liver injury, respectively. For each case, 3 controls were randomly matched with the case for age at index date and sex. In the conditional logistic regression analysis, there was a significant association between the combination of infection and antipyretic analgesics and the onset of SJS/TEN or liver injury (SJS/TEN: adjusted OR, 5.59; 95%CI, 2.01-15.51; liver injury: adjusted OR, 2.79; 95%CI, 2.24-3.46). Although it was not possible to distinguish whether the associations were caused by the infection or were a direct consequence of the antibiotic agents, our findings may help to increase awareness of the possibility of the increased onset of idiosyncratic drug reactions (SJS/TEN and liver injury) in antipyretic analgesic users because of infections.

Introduction. Pediatric bronchopneumonia is one of the common respiratory diseases in pediatrics. Chinese herbal injections (CHIs) are widely used to treat pediatric bronchopneumonia. In this study, we examined the efficacy of CHIs in the treatment of pediatric bronchopneumonia using a network meta-analysis (NMA). Methods. Randomized controlled trials (RCTs) of CHIs combined western medicine (WM) versus WM were searched from electronic databases. WinBUGS 1.4.3 and Stata 13.0 were adopted to compute calculations and prepare graphs, respectively. Results. 168 RCTs with 21917 patients were included. The results revealed that Xixinnao injection (XXN) + WM had the most probability to be the best intervention in the four aspects of rate of clinical efficacy, antipyretic time, cough disappearance time, and lung shadow disappearance time. While as to lung shadow disappearance time, asthma disappearance time, and hospitalization time, Yanhuning injection (YHN) + WM could be the best intervention. The safety of CHIs needs to be further assessed. Conclusions. Based on this NMA, XXN + WM and YHN + WM were potential optimal therapies in pediatric bronchopneumonia, and their safety should be strictly monitored.

International audience; Importance: Non-steroidal anti-inflammatory drugs (NSAIDs) are known to inhibit chemotaxis, oxidative burst and phagocytosis, bacterial killing in granulocytes as well as inhibiting neutrophil aggregation or degranulation, thereby interfering with the function of lymphocytes. On the other hand, ibuprofen is widely prescribed in pediatrics for its powerful analgesic and antipyretic effects. To our knowledge, no previous publication outlines the relationship between Ibuprofen therapy and an increased risk of intracranial and/or orbital complications of acute fronto-ethmoidal sinusitis in childhood. Objective: To look for a relationship between ibuprofen and occurrence of intra-cranial and/or orbital complications of acute fronto-ethmoidal sinusitis in pediatrics. Setting and methods: The medical charts of patients younger than 18 years admitted into the E.N.T. departments of 4 academic care centers during 2 consecutive years for fronto ethmoidal sinusitis were reviewed retrospectively. The history of ibuprofen intake, the occurrence of complication (orbital or intracranial) as well as the usual demographic data were noted. A statistical analysis was performed in order to ascertain whether a relationship between taking NSAIDs and the onset of an intracranial and/or orbital complication exists. Results: Intake of ibuprofen appeared to be a risk-factor of intracranial complications or associated orbital and intracranial complications of acute fronto-ethmoidal sinusitis in children. Neither gender nor age nor initial pain intensity were statistically related to the onset of complications. Conclusion and relevance: This retrospective multicenter cohort study appears to suggest that ibuprofen increases the risk of orbital and/or intracranial complications of acute fronto-ethmoidal sinusitis in childhood. Therefore, we recommend not prescribing ibuprofen if one suspects an acute sinusitis in a child or adolescent.

Objective The objective of this study was to compare statewide prehospital protocols for the management of pediatric seizures. Methods We performed a descriptive analysis comparing statewide protocols for emergency medical services management of pediatric seizures within the United States, excluding states for which no statewide protocol/model was available. We compared antiepileptic drugs (AEDs), routes and doses of administration, and differences in febrile seizure management. Results Of 50 states, 34 had either statewide protocols or models and were included. All had a protocol for the management of seizures and provided specific recommendations for the management of pediatric seizures. Twelve states (35%) preferentially recommended midazolam over other benzodiazepines. Thirty-two (94%) of 34 allowed for use of midazolam, with variable use of other AEDs. All allowed for use of intramuscular AED. Twenty-six (77%) allowed for intranasal AED. Nine (27%) allowed emergency medical services to administer a patient's own abortive AED, and 6 (18%) allowed for use of a patient's vagal nerve stimulator, when present. There was a wide variability with respect to dosing ranges for medications. Thirty-two (94%) of 34 included blood glucose measurement within the protocol. Twenty-one protocols (62%) provided recommendations for febrile seizures, including recommending active/passive cooling (8/34, 24%) and antipyretic administration (9/34, 26%). Conclusions All statewide protocols carried specific guidelines for the prehospital management of pediatric seizures; however, there was wide variability with respect to specific AEDs, routes of administration, and drug dosages. In addition to broader availability of statewide guidance, areas of potential protocol improvement and research include AED dose optimization, reprioritization of blood glucose, and greater emphasis on intranasal or intramuscular medication dosing.

Background: Fever is an extremely common sign in pediatric patients and the most common cause for a child to be taken to the doctor. There are no guidelines or consensus in India about symptomatic management of fever and hence there can be too many misconceptions and conflicting results about fever management. Aims: In this study the aim was to identify knowledge gaps of primary care doctors regarding fever in children. Methods: This cross-sectional study was conducted from August 2019 –October 2019 involving Pediatricians and family physicians (n=935). A questionnaire was administered to convenient samples of pediatricians and family physicians eliciting information about fever definition, methods of temperature measurement, and antipyretic use. Differences in responses between the doctors were evaluated. Results: The data was analyzed using the SPSS 16.0 program and descriptive statistics were used. In the present study 40% of the doctors knew that a body temperature of above 37.5°C according to an axillary measurement is defined as fever. Only 36% of the doctors took into consideration signs and symptoms other than fever to prescribe antipyretics. Almost 85% of the doctors prescribed antipyretics to control fever or prevent complications of fever especially febrile seizures. Most of the doctors (76.3%) in this study reported that the intensity of fever may be used as an indicator for severe bacterial infection. A great majority of doctors (65.3%) stated that they advised parents to alternate the use of ibuprofen and paracetamol. Conclusions: There were significant misconceptions about the management and complications of fever. There is a perceived need to improve the recognition, assessment, and management of fever with regards to underlying illnesses in children and a national consensus statement on fever and antipyresis in children.

Acute respiratory disease (ARD) is a common pathology. Untimely diagnosis and treatment, co-morbidities, old age and children under 1 year of age, pregnancy can increase the severity of the condition and lead to complications and death. According to IDSA recommendations, vaccination is an effective way to prevent complications and fatal influenza cases. Vaccination is primarily for people at risk of serious illness. In cases of suspected influenza, molecular diagnostics is recommended. At the same time, treatment of suspected influenza should be prescribed immediately, without waiting for laboratory confirmation of the diagnosis. Etiotropic treatment aimed at suppressing virus replication should be the first priority in the treatment of acute respiratory viral infections. Bacterial agents may be the primary cause of respiratory diseases or may complicate viral diseases. In the presence of a bacterial pathogen, antibacterial agents are prescribed. ARD symptoms worsen the quality of life of patients. Complex treatment of respiratory diseases includes the prescription of symptomatic therapy: antipyretics, antitussives, vasoconstrictor drugs in rhinorrhea. Cough is the most common respiratory symptom. In various diseases, cough has its own peculiarities, which allows you to carry out differential diagnosis. The American Thoracic Society has proposed schemes of differential search for acute and chronic coughs, which allow rational diagnosis of diseases. The use of antitussive drugs has its own peculiarities: when the cough is non-productive, drugs are prescribed to suppress cough, when the cough is productive - drugs are aimed at facilitating the evacuation of sputum. One of the preparations possessing expectorant, mucolytic and antispasmodic action, is Hedelix syrup on the basis of ivy.

Introduction : Anaplastic astrocytoma has a dismal prognosis with conventional treatment. Multidisciplinary treatment is needed to control the disease; however, side effects of the treatment reduce a patient's quality of life (QOL). Carmustine-impregnated wafers (Gliadel®, Eisai Co., Ltd., Tokyo, Japan), one of the treatment modalities for anaplastic astrocytoma, has been reported to have drug-induced fever as a side effect. Case Report : A 36-year-old man underwent excision for a recurrent brain tumor. Histopathological examination established a diagnosis of anaplastic astrocytoma and an intracranial carmustine implant was placed for local chemotherapy. Postoperatively, the patient developed high fever, which could not be controlled using antipyretics. The high fever ameliorated dramatically after the administration of Kampo medicines, specifically orengedokuto and shosaikoto, and the patient could continue chemotherapy. Conclusion : To the best of our knowledge, this is the first report of successful treatment of intractable carmustine implant-induced fever using Kampo medicine. In this case, Kampo medicine led to an improvement of QOL.

Background: The COVID-19 pandemic, caused by the human coronavirus SARS CoV-2, has led to millions of deaths across the globe. Not only is the SARS CoV-2 virus highly infectious, it also mutates very easily. This creates additional challenges for development of robust therapeutic solutions. Along with modern system of healthcare, there is a definite need for exploring natural plant based antiviral compounds directed against the SARS CoV-2 virus. Objective: The present observational study investigates the efficacy of an Ayurvedic polyherbal formulation of 19 ingredients, NOQ19, in the management of COVID-19. Methodology: A single arm, single centric, open label study design was adopted for this feasibility study. 161 RT-PCR positive COVID-19 patients were enrolled. The enrolled participants were provided the Ayurvedic intervention, 2 tablets of NOQ19, thrice daily along with the standard of care treatment. Follow up COVID-19 RT- PCR tests were conducted on Day 5, Day 10 and Day 14, or until the patient turned negative. The time required for testing negative on the RT-PCR test or becoming asymptomatic was noted. Results: A subjective analysis demonstrated that 74% of patients turned RT-PCR negative within 5 days of taking NOQ19. Additionally, 98% of the subjects turned RT-PCR Negative on Day 10 after taking NOQ19 in addition to the standard of care treatment of Vitamin C , Zinc and antipyretic (as necessary). None of the participants reported any adverse or side effects to the medication.Conclusion: NOQ19 Ayurvedic polyherbal formulation can be an effective and safe option for the symptomatic management of COVID-19.

Acute respiratory infections (ARI) is an infectioan that commonly occurs in human of any age however, children and infants are the most vulnerable and most exposed to ARI. The study aims to identify the utilization of drug therapy in patients with ARI, specifically those infants and children patients at Puskesmas Kota Tengah in 2019. it employs a descriptive research design where the obtained data are secondary data that are collected retrospectively besides, the data used in this study are medical prescription documents, including the patient’s name, age, type of drug used, and drug use patternThe finding discloses that drug therapy administered to 116 infants and children patients who suffer from ARI at Puskesmas Kota Tengah in 2019 reveals that the most widely used therapy is the expectorant group(Gliceryl Guaicolate) as many as 61 (62,2%), Antihistamine group (Chlorpheniramine maleate) with a frequency of 75 times (64,1%), Vitamin B Complex with a frequency of 69 times (55,2%), Antibiotik group (Amoxicillin) with a frequency 47 times (41%), Analgesic and Antipyretic group (Paracetamol) is the most widely prescribed with a prescription frequency of 65 times (55,7%). In addition, the parameter of right drug obtains frequency of 22 times with 94 times with the percentage of (81,0%) and incorrect drug obtains a frequncy of 22 times with a percentage of (19,0%), the parameter of right dose for 83 times with a percentage of (71,6%), and incorrect dose for 33 times with a percentage of (28,4%). At the same time, the right drug use pattern parameter involves the right dose, and the right drug obtains a frequency of 94 times with a percentage 0f 8 (81,0%) while the incorrect drug use pattern obtains a frequency 0f 22 times with a percentage 0f (19,0%)

Fever is often associated with infectious, traumatic, or allergenic etiologies, a known consequence of the systemic inflammatory response. Its association with a rise in intracranial pressures (ICP) is an uncommon presentation. We herein describe two patients who developed acute hydrocephalus and presented with high-grade fever. This febrile component was resistant to conventional antipyretics and was only relieved by cerebrospinal fluid (CSF) diversion.

Introduction Lysosomal acid lipase deficiency is an autosomal recessive progressive lysosomal storage disease that mainly affects the liver, intestine growth, and causes dyslipidemia. The disease presents as two major phenotypes: the severe early-onset and late-onset forms. Sebelipase alfa is a recombinant human enzyme-replacement therapy for lysosomal acid lipase deficiency, which has been approved for long-term treatment of early-onset and late-onset patients over five years. Areas covered This review mainly focuses on the safety of sebelipase alfa based on the literature including studies, case reports, and reviews up to January 2021. The search was conducted on PubMed only by using the key word "sebelipase alfa." No restrictions were applied. Expert opinion The documented adverse events related to sebelipase alfa almost always occurred as infusion reactions. The majority of these reactions were mild to moderate and were easily managed or prevented with antihistamines, antipyretics, and steroids. Rarely, these reactions occurred in the form of anaphylaxis but were treated successfully and the infusions were started again with desensitization without a need for stopping the treatment. Based on the scientific evidence until now, sebelipase alfa appears to be a safe treatment changing the natural history of lysosomal acid lipase deficiency.

IntroductionLow back pain (LBP) is among the top three most common diseases worldwide, resulting in a life with pain-related disability. To date, no study has assessed the efficacy of metamizole (dipyrone), a non-opioid analgesic and antipyretic prodrug compared with the conventional non-steroidal anti-inflammatory drug ibuprofen, in patients with an acute LBP episode. Further, it is unclear, whether a short educational intervention is superior to usual care alone.ObjectivesThe objective of this study is to assess first, whether metamizole is non-inferior to ibuprofen in a new episode of acute or subacute LBP. Second, we aim to assess whether a short educational intervention including evidence-based patient information on the nature of LBP is superior to usual care alone.Methods and analysisAn investigator-initiated multicentre, randomised, double blind trial using a factorial design will be performed. A total of 120 participants with a new episode of LBP will be recruited from GP practices, outpatient clinics and from emergency departments, and randomised into four different treatment groups: ibuprofen alone, ibuprofen and short intervention, metamizole alone, metamizole and short intervention. The primary endpoint for the medical treatment will be change in pain assessed on an 11-point Numeric Rating Scale after 14 days. The primary outcome for the short intervention will be change in the Core Outcome Measures Index assessed after 42 days.Ethics, dissemination and fundingThis study has been approved by the responsible Ethics Board (Ethikkommission Bern/2018-01986) and the Swiss Agency for Therapeutic Products (Swissmedic/2019DR4002). Results will be published in open access policy peer-reviewed journals. The study is funded by the Swiss National Science Foundation (grant number 32 003B-179346).Trial registration numberNCT04111315

Background Accurate identification of persons at risk of suicide is challenging because suicide is a rare outcome with a multifactorial origin. The purpose of this study was to predict suicide among persons with depression using machine learning methods. Methods A case-cohort study was conducted in Denmark between January 1, 1995 and December 31, 2015. Cases were all persons who died by suicide and had an incident depression diagnosis in Denmark (n = 2,774). The comparison subcohort was a 5% random sample of all individuals in Denmark at baseline, restricted to persons with an incident depression diagnosis during the study period (n = 11,963). Classification trees and random forests were used to predict suicide. Results In men with depression, there was a high risk of suicide among those who were prescribed other analgesics and antipyretics (i.e., non-opioid analgesics such as acetaminophen), prescribed hypnotics and sedatives, and diagnosed with a poisoning (n = 96; risk = 81%). In women with depression, there was an elevated risk of suicide among those who were prescribed other analgesics and antipyretics, anxiolytics, and hypnotics and sedatives, but were not diagnosed with poisoning nor cerebrovascular diseases (n = 338; risk = 58%). Discussion Psychiatric disorders and their associated medications were strongly indicative of suicide risk. Notably, anti-inflammatory medications (e.g., acetaminophen) prescriptions, which are used to treat chronic pain and illnesses, were associated with suicide risk in persons with depression. Machine learning may advance our ability to predict suicide deaths.

ObjectivesFever is a common symptom among children. Parental lack of knowledge about fever could cause anxiety and lead to unnecessary measures to subside fever. There is little evidence about German parents’ knowledge and their fever management.DesignA cross-sectional study using a paper-based questionnaire.Setting16 kindergartens in Saarbrücken and Saarlouis regional association accepted to participate in the study. Parents from these kindergartens were requested during the pickup time to answer the questionnaire.Participants481 German parents participated in the study, 394 of them were women. Inclusion criteria were good understanding of German and being a parent of at least one child below the age of 7 years.Primary and secondary outcome measuresKnowledge and behaviour of parents on paediatric fever management and the factors influencing fever anxiety.ResultsThe older the parents were, the more anxiety they reported. Their definition of fever had a wide range of 30°C–41°C (mean 38.46, SD=0.67) and almost 90% (mean 3.05, SD=2.03) of participants reported fever as useful, whereby they felt more confident the more they found fever useful. 69% of parents felt calm when their child has fever (mean 4.47, SD=2.27). In case of fever, 55% of parents administer paracetamol, 72% ibuprofen and 32% of them would alternate between the two. Paracetamol and ibuprofen are used more by more anxious parents. In explorative factor analysis, reasons to reduce temperature were summarised in three main factors: damage prevention, illness control and well-being protection, whereby the first two were positively related to parental anxiety.ConclusionsBoth knowledge as well as level of confidence/anxiety vary largely. Taking antipyretics is related to higher level of anxiety, indicating the need for further education. Fever anxiety depends on multiple factors, which have to be further investigated.