Neuro-inflammatory pathways in COVID-19-induced central nervous system injury: Implications for prevention and treatment strategies.

This review explores the neuroinflammatory pathways underlying COVID-19-induced central nervous system (CNS) injury, with a focus on mechanisms of brain damage and strategies for prevention. A comprehensive literature review was conducted to summarize current knowledge on the pathways by which SARS-CoV-2 reaches the brain, the neuroinflammatory responses triggered by viral infection, neurological symptoms and long COVID. Results: We discuss the mechanisms of neuroinflammation in COVID-19, including blood-brain barrier disruption, cytokine storm, microglial activation, and peripheral immune cell infiltration. Additionally, we highlight potential strategies for preventing CNS injury, including pharmacological interventions, immunomodulatory therapies, and lifestyle modifications. Conclusively, Understanding the neuroinflammatory pathways in COVID-19-induced CNS injury is crucial for developing effective prevention and treatment strategies to protect brain health during and after viral infection.

Coffee and brain health: An introductory overview.

Introduction to the "Impact of Coffee on Brain Health" explores the multifaceted relationship between coffee consumption and brain function. The chapter begins by highlighting coffee's global popularity and cultural significance, setting the stage for an in-depth exploration of its effects on brain health. It describes the intricate components of coffee, including caffeine, antioxidants, and polyphenols, elucidating their physiological and medicinal roles in promoting cognitive function and neuroprotection. While moderate coffee consumption offers potential benefits such as enhanced cognitive performance and mood regulation, excessive intake can pose risks such as insomnia and medication interactions. Research studies provide robust evidence supporting coffee's neuroprotective effects, while practical implications offer recommendations for optimizing consumption and minimizing risks. By embracing a personalized approach to coffee consumption and staying informed about its potential impacts, individuals can harness its benefits for brain health and overall well-being.

Coffee and stress management: How does coffee affect the stress response?

This chapter explores the complex relationship between coffee drinking and stress management, highlighting the advantages and disadvantages of this widely consumed beverage. The chapter explores the physiological, psychological, and social effects of coffee on stress response and resilience through a thorough analysis of recent studies. It highlights the negative consequences of excessive intake on cardiovascular, gastrointestinal, and mental health while also discussing how moderate coffee consumption may lower stress levels, improve coping skills, and promote relaxation. Considerations for vulnerable populations, interactions with medications and supplements, and sustainability concerns in coffee production and consumption are also addressed. By identifying missing gaps in our understanding of coffee and stress management, the chapter underscores the need for future research to elucidate underlying mechanisms and promote mindful consumption practices. Ultimately, by embracing a holistic approach that considers individual health, environmental sustainability, and social responsibility, we can harness the potential of coffee to support resilience, well-being, and sustainability for individuals and communities worldwide.

Behavioral and psychological aspects of coffee consumption.

The chapter "Behavioral and Psychological Aspects of Coffee Consumption" delves into the complex interplay between coffee drinking and cognitive functions, human behavior, and health-related effects. It starts by looking at coffee's physiological impacts, such as how it affects the body's neurotransmitter systems, metabolism, cardiovascular health, liver health, mental health, and bone health. The larger framework of behavioral and psychological variables impacting patterns of coffee drinking provides further context for these effects. The chapter explores a range of behavior change interventions designed to encourage moderate coffee use. It also covers the role that technology, customized methods, and environmental alterations might play in supporting healthier choices. The statement underscores the significance of attending to the requirements of heterogeneous populations, surmounting obstacles to behavior modification, and guaranteeing the enduring viability of intervention results. The chapter also outlines new directions in neuroscience and behavioral science research, including developments in neuroimaging methods and the application of digital health technology to the delivery of interventions. Additionally, it emphasizes how coffee use affects public health and policy, arguing in favor of evidence-based guidelines and treatments that encourage sensible coffee consumption habits and enhance population health outcomes. Ultimately, the chapter offers a thorough summary of the behavioral and psychological effects of coffee drinking, highlighting the significance of multidisciplinary studies and cooperative efforts to deepen our comprehension of this intricate phenomenon.

Coffee and amyotrophic lateral sclerosis (ALS).

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder characterized by progressive loss of motor neurons. The effective treatments for ALS remain elusive, necessitating exploration into novel preventive strategies. ALS pathogenesis is triggered by oxidative stress which results in neuroinflammation, exicitotoxicity and neuronal cell death. Nutritional mechanism for halting progression of neurodegeneration is through dietary compounds with antioxidants, anti-inflammatory or neuromodulating activity. Coffee is a widely consumed beverage made up of polyphenols, caffeine and other compounds with possible antioxidants and neuro-protective roles. It is important to say that various epidemiological studies have documented association between coffee intake and ALS. This chapter is aimed to present a comprehensive review of existing literature on coffee consumption and ALS, involving epidemiological studies, preclinical research, and its mechanism of actions in animal model of ALS. It highlights key findings regarding the potential neuroprotective properties of coffee constituents such as caffeine, polyphenols, and other bioactive compounds. Furthermore, it discusses possible pathways through which coffee may modulate ALS pathogenesis, including suppressing oxidative stress and neuroinflammation while boosting adenosine function via the adenosine receptor two on the motor neuron cells membrane in the spinal cord to enhance motor function via the corticospinal tract. Overall, this chapter underscores the significance of further research to unravel the specific mechanisms by which coffee exerts its neuroprotective effects in ALS, with the ultimate goal of identifying dietary strategies for ALS prevention and management.

Synaptic modulation by coffee compounds: Insights into neural plasticity.

The physiological structure and functioning of the brain are determined by activity-dependent processes and affected by "synapse plasticity." Because chemical transmitters target and regulate synapses, exogenous chemical stimulants and transmitters can alter their physiological functions by interacting with synaptic surface receptors or chemical modulators. Caffeine, a commonly used pharmacologic substance, can target and alter synapses. It impact various biological, chemical, and metabolic processes related to synaptic function. This chapter investigates how caffeine affects fluctuations in structure and function in the hippocampus formation and neocortical structure, regions known for their high synaptic plasticity profile. Specifically, caffeine modulates various synaptic receptors and channel activities by mobilizing intracellular calcium, inhibiting phosphodiesterase, and blocking adenosine and GABA cellular receptors. These caffeine-induced pathways and functions allow neurons to generate plastic modulations in synaptic actions such as efficient and morphological transmission. Moreover, at a network level, caffeine can stimulate neural oscillators in the cortex, resulting in repetitive signals that strengthen long-range communication between cortical areas reliant on N-methyl-d-aspartate receptors. This suggests that caffeine could facilitate the reorganization of cortical network functions through its effects on synaptic mobilization.

Addressing comprehensive complexities a striking familial hypercholesterolemia case study.

BACKGROUND: Premature aortic involvement and comprehensive management strategies in familial hypercholesterolemia familial hypercholesterolemia (FH), a rare autosomal dominant genetic disorder, poses significant challenges due to its propensity for elevated low-density lipoprotein cholesterol, premature coronary heart disease, and vascular atherosclerosis. CASE PRESENTATION: Unraveling Cardiovascular Complexities: A Striking Familial Hypercholesterolemia. This case study delves into a remarkable instance of FH in a 16-year-old female who presented with chest pain and worsening dyspnea. Diagnostic evaluation revealed distinct electrocardiographic changes, elevated troponin levels, and profound dyslipidemia. Remarkable findings on transthoracic echocardiography, computed tomography angiography, and catheterization prompted multidisciplinary interventions and demonstrated remarkable enhancements in ventricular function, mitral regurgitation, and aortic stenosis. CONCLUSION: The case study underscores the urgency of comprehensive management strategies in confronting the myriad challenges of FH, emphasizing the value of early intervention, innovative therapies, and rigorous imaging modalities for unraveling the intricate cardiovascular manifestations of this condition.

Exploring the reported adverse effects of COVID-19 vaccines among vaccinated Arab populations: a multi-national survey study.

The coronavirus disease 2019 (COVID-19) pandemic has been a major challenge worldwide for the past years with high morbidity and mortality rates. While vaccination was the cornerstone to control the pandemic and disease spread, concerns regarding safety and adverse events (AEs) have been raised lately. A cross-sectional study was conducted between January 1st and January 22nd, 2022, in six Arabic countries namely Saudi Arabia, Egypt, Syria, Libya, Iraq, and Algeria. We utilized a self-administered questionnaire validated in Arabic which encompassed two main parts. The first was regarding sociodemographic data while the second was about COVID-19 vaccination history, types, doses, and experienced AEs. A multistage sampling was employed in each country, involving the random selection of three governorates from each country, followed by the selection of one urban area and one rural area from each governorate. We included the responses of 1564 participants. The most common AEs after the first and second doses were local AEs (67.9% and 46.6%, respectively) followed by bone pain and myalgia (37.6% and 31.8%, respectively). After the third dose, the most common AEs were local AEs (45.7%) and fever (32.4%). Johnson and Johnson, Sputnik Light, and Moderna vaccines showed the highest frequency of AEs. Factors associated with AEs after the first dose included an increase in age (aOR of 61-75 years compared to the 12-18 years group: 2.60, 95% CI: 1.59-4.25, p = 0.001) and male gender (OR: 0.72, 95% CI: 0.63-0.82, p < 0.001). The cumulative post-vaccination COVID-19 disease was reported with Sinovac (16.1%), Sinopharm (15.8%), and Johnson and Johnson (14.9) vaccines. History of pre-vaccination SARS-CoV-2 infection significantly increases the risk of post-vaccination COVID-19 after the first, second, and booster doses (OR: 3.09, CI: 1.9-5.07, p < 0.0001; OR: 2.56, CI: 1.89-3.47, p < 0.0001; and OR: 2.94, CI: 1.6-5.39, p = 0.0005 respectively). In conclusion, AEs were common among our participants, especially local AEs. Further extensive studies are needed to generate more generalizable data regarding the safety of different vaccines.

Neurofibroma: Case Series with Clinical Features and Recommendations.

Neurofibroma is an autosomal benign disorder. It can be localized, diffuse or invasive like plexiform neurofibroma that involves the nerves, muscle, tissues, skeleton. It represents itself as a destructive variant of neurofibroma, mostly present as orbital or periorbital neurofibroma or may be associated with autosomal dominant disease. Clinical diagnosis of neurofibromatosis (NF) according to National Institutes of Health (NIH) criteria should have more than two of the seven features including lisch nodules, cafe'- au-lait spots, plexiform neurofibroma, optic glioma, freckling, first degree relative with NF or dysplasia of cortical bones. However, proper early diagnosis is still crucial due to its various presentation such as cheek mass, painless swelling on skin, chalazion, intratracheal tumor, genital swelling or ptosis. It is reported that neurofibroma often represents as ocular or facial swelling. Here we are presenting features of neurofibroma of eight cases of patients from Civil Hospital, Karachi. These cases had main complain of overhanging skin mass mainly on orbital or periorbital region that damage the area and with poor daily activities. Multiple nodules on face and body along with them Cafe'-au-lait spots and lisch nodules were main signs. While, other signs i.e. ptosis, pterygium, telecanthus and muddy discoloration of conjunctiva need further evaluation for correlation with neurofibromatosis. Debulking surgery was planned for most of the cases but the huge disfigurement caused by overhanging skin mass and nodules made it a challenge for plastic surgeons to provide good outcomes with minimum damage. Keywords: neurofibroma; lisch nodules; ptosis; Cafe'-au-lait spot; periorbital; overhanging skin.

A comparative study of the common complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicines.

Osteoarthritis is the most common form of arthritis worldwide and progression of arthritis may lead to secondary complications. Osteoarthritis is the degradation of joint tissues from the effects of injury, grinding sensation and inflammation. There are three main systems of medicine including allopathic, homeopathic and herbal system for the treatment of osteoarthritis. Plants are the basis for traditional medicine which is still widely practiced today. The objective of the present study is to find out the complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicine. This study was conducted in Karachi from January 2019 to January 2020. Allopathic, Homeopathic and Herbal practitioners were consulted in the study (n=600, with= 200 in each study group). Data was analyzed by SPSS 22 version. Finding of the study suggest that after the treatment with allopathic medicines orthopaedician, family physician or rheumatologist / internal medicine specialist, there was no significant difference in complaints (Chi-square =0.598, p=0.742). Moreover, there was no significant difference in complications (Chi-square = 0.039, p=0.981). While treatment with homeopathic medicines either by orthologist or family physician significant difference in complaints were observed (Chi-square =4.86, p=0.027). The patient visiting family physicians have higher number of complications than orthologists. While treatment with herbal medicines either by orthologists or family physician there was significant difference in complaints. (Chi-square =5.404, p=0.020). The study reveals that there is no significant difference of complaints and complications in allopathic systems of medicine when treating osteoarthritis, while it is significant for homeopathic and herbal medicine.

Analysis of treatment adherence and cost among patients with epilepsy: a four-year retrospective cohort study in Pakistan.

BACKGROUND: The adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. However, adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied. Therefore, the present study aimed to analyze the cost and adherence of AEDs and its associated factors in patients followed in Pakistan. METHODS: Data from prescriptions collected from patients with epilepsy who have visited the Outpatient Department (OPD) of different tertiary care hospitals at the cosmopolitan city of Karachi, Pakistan from December 2015 to November 2019. The mean follow-up period for each participant was about 22 months. Pairwise comparisons from Cox regression/hazard ratios were used to assess the predictors of adherence. Direct costs of AEDs were calculated and presented as the annual cost of drugs. RESULTS: A total of 11,490 patients were included in this study, 51.2 % were male and 48.8 % were female with a mean age of 45.2 ± 15.8 y. Levetiracetam was found as the most prescribing AED in all study participants (32.9 %). Of them, 49.1 % of patients continued their initial recommended treatment. However, 31.3 % of patients have discontinued the therapy, while, 19.6 % were switched to other AED. Adherence with initial treatment was more profound in male (57.4 %) patients, compared to female with a mean age of 44.2 years. Lamotrigine users (60.6 %) showed a higher tendency to retain on initially prescribed drugs. The total cost of epilepsy treatment in the entire study cohort was 153280.5 PKR ($941.9). By applying the Cox regression analysis, it can be observed that the patients with increasing age (OR, 2.04), migraine (OR, 2.21), psychiatric disorders (OR, 4.28), other comorbidities (OR, 1.52) and users of other than top five prescribing AEDs (2.35) were at higher risk of treatment discontinuation. However, levetiracetam (OR, 0.69), valproic acid (OR, 0.52), carbamazepine (OR, 0.81), lamotrigine (OR, 0.80) or lacosamide (OR, 0.65) users have more chances to continue their initial therapy. CONCLUSIONS: Similar to western countries, the majority of patients with epilepsy exhibited low adherence with AEDs. Various associated factors for improving adherence were identified in this study.

Assessment of Look-Alike, Sound-Alike and Read-Alike (LASARA) Medicine - Errors in Pharmacy.

ABSTRACT  Objective: To estimate chances of potential look-alike, sound-alike and read-alike (LASARA) errors in secondary-care hospital pharmacies through prescriptions screening. DESIGN: Cross-sectional, prospective study. PLACE AND DURATION OF STUDY: Al-Khidmat Hospital Pharmacy, Karachi, Pakistan from August to October, 2016. METHODOLOGY: Dispensed medicine data was collected from three pharmacies of a secondary-care hospital in Karachi over three months. Only inpatient and outpatient prescriptions issued by the hospital were included. All outside referrals (OSRs) prescriptions without hospital stamp were excluded. LASARA medicines list, available at hospital, was considered to compare five-paired drugs, dispensed to patients; and screening alerts against these paired medicines were noted. RESULTS: Out of 1,000 monitored prescriptions, 200 prescriptions were shortlisted for 22 considered medicines. Total of 38 LASARA errors were reported in 90 days. Overall LASARA results were 38, 19% errors per 200 prescriptions. Highest dispensed error frequency was observed for injection™ lasix (14 errors, 36.8%), followed by tab. thyroxin (4 errors, 10.5%), injection avil™ (3 errors, 7.8%), Injection Calcium Gluconate (2 errors, 5.2%), and Tablet Lanoxin™ (2 errors, 5.2%). CONCLUSION: LASARA errors during medicine dispensing on prescription at hospital pharmacies can be used as a tool to improve patient safety and pharmacist efficacy. Key Words: Errors, Look Alike, Read Alike, Sound Alike, Dispensing, Drugs.

In vivo assessment of anticoagulant and antiplatelet effects of Syzygium cumini leaves extract in rabbits.

BACKGROUND: Syzygium cumini (L.) Skeels. is one of the very popular traditionally used medicinal plants with numerous pharmacological activities including antioxidant, hypoglycemic and anti-inflammatory. However, actions of S. cumini on blood coagulation and other parameters of blood were poorly pharmacologically studied. Therefore, aim of this present investigation is to examine the effects of methanolic extract of S. cumini on blood coagulation and anticoagulation factors in healthy white albino rabbits at different doses. METHODS: Blood samples were drawn twice during this study and biochemical assays were performed to determine the effect on different parameters such as coagulation, anticoagulation, hematological, Protein C (PC) and thrombin antithrombin (TAT) complex and platelet aggregation. RESULTS: The results showed significant increase in RBCs, hemoglobin, hematocrit and platelets counts up to 1.4 × 103/cm, 2.2 g/dl, 6%, 248.2 × 103/cm respectively. While, thrombin and bleeding time were also prolonged in dose dependent manner which is highly significant (p ≤ 0.005) as compared to control. Similarly, highly significantly increased (p ≤ 0.005) in levels of protein C, thrombin antithrombin complex at dose of 500 mg/kg were observed. Whereas, levels of platelets aggregation and fibrinogen were decreased at high doses. CONCLUSION: The obtained findings of hematological and coagulation tests concludes possibly S. cumini possess anticoagulant and antiplatelet effects.

Seizure forecasting using single robust linear feature as correlation vector of seizure-like events in brain slices preparation in vitro.

OBJECTIVE: Epilepsy is a neurological disorder affecting 50 million individuals globally. Modern research has inspected the likelihood of forecasting epileptic seizures. Algorithmic investigations are giving promising results for seizure prediction. Though mostly seizure prediction algorithm uses pre-ictal (prodromal symptoms) events for prediction. On the contrary, prodromal symptoms may not necessarily be present in every patient or subject. This paper focuses on seizure forecasting regardless of the presence of pre-ictal (prodromal symptoms) using the single robust feature with maximum accuracy. Method: We evaluated datasets having 4-aminopydine induced seizure-like events rat's hippocampa slices and cortical tissue from pharmacoresistant epilepsy patients. The proposed methodology applies the Discrete Wavelet Transform (DWT) at levels 1-5 utilizing 'Daubechies-4'. Linear Discriminant classifier (LDC), Quadratic Discriminant Classifier (QDC) and Support Vector Machine (SVM) were used to classify each signal using eight discriminative features. Results: Classifier performance was assessed by parameters like true detections (TD), false detection (FD), accuracy (ACC), sensitivity (SEN), specificity (SPF), and positive predicted value (PPC), negative predicted value (NPV). Highest classification feature was selected as a seizure forecasting correlation vector and decision rule was formulated for seizure forecasting. Correlation vector served as a forecaster for current EEG activity. Proposed decision rule forecasted ongoing signal activity towards possible seizure condition true or false. The suggested framework revealed forecasting of ictal events at 10 seconds before the actual seizure. Conclusion: It is worth mentioning that the proposed study utilized a single linear feature to predict seizures precisely. Moreover, utilization of single feature encouraged in subsiding system complexity, processing delays, and system latency.

Anticonvulsant activity of DNS II fraction in the acute seizure models.

AIM OF THE STUDY: Delphinium nordhagenii belongs to family Ranunculaceae, it is widely found in tropical areas of Pakistan. Other species of Delphinium are reported as anticonvulsant and are traditionally used in the treatment of epilepsy. Delphinium nordhagenii is used by local healer in Pakistan but never used for scientific investigation as anticonvulsant. Thus, Delphinium nordhagenii was subjected to bioassay-guided fractionation and the most active fraction, i.e. DNS II acetone was chosen for further testing in the acute seizure models of epilepsy to study the antiepileptic potential in male mice. MATERIALS AND METHODS: Different doses (60, 65 and 70mg/kg, i.p.) of DNS II acetone fraction of Delphinium nordhagenii was administered 30min prior the chemoconvulsant's injection in the male mice. Convulsive doses of chemoconvulsants (pentylenetetrazole 90mg/kg, s.c. and picrotoxin 3.15mg/kg, s.c.) were used. The mice were observed 45-90min for the presence of seizures. Moreover, four different doses of DNS II (60, 65, 70 and 100mg/kg, i.p.) were tested in the MES test. RESULTS: The DNS II acetone fraction of Delphinium nordhagenii has exhibited the anticonvulsant actions by preventing the seizures against PTZ- and picrotoxin-induced seizure as well as 100% seizure protection in MES test. The results are comparable with standard AEDs (diazepam 7.5mg/kg, i.p. and phenytoin 20mg/kg, i.p.). CONCLUSIONS: These findings suggest that the Delphinium nordhagenii possesses the anticonvulsant activity. Further analysis is needed to confirm the structure and target the extended activity profile.