Immunomodulatory effect of Unani polyherbal formulation - Tiryaq Wabai in mild to moderate COVID-19 patients - A randomized placebo-controlled clinical trial.

BACKGROUND: The pathogenesis of COVID-19 includes an integrated immune-inflammatory response. Modulation of host immune responses against the SARS-CoV-2 virus might be effective therapeutic management. Various Unani formulations have an immunomodulatory effect. OBJECTIVE: To explore the immunomodulatory effect and safety of Unani polyherbal drug (Tiryaq Wabai) in COVID-19 patients. MATERIALS AND METHODS: The current study was a randomized placebo-controlled clinical trial that included 92 mild to moderate COVID-19 patients randomized into two groups. The Unani formulation Tiryaq Wabai (2 gm orally once a day) was used as an intervention for 45 days, while the control group received a placebo. Both groups received standard care treatment. The primary outcome was 50% increment in absolute lymphocyte count (ALC). The secondary outcome was 50% increment in mean lymphocyte percentage, CD4 cells, and CD8 cell count. The mean increase in all the above parameters has also been studied. Relevant statistical tests were used to analyze the effect. RESULTS: A statistically significant improvement in a 50% increase in ALC (p-value, 0.004), lymphocyte percentage (p-value, 0.056), CD4 (p-value, 0.005), and CD8 cell count (p-value, 0.050) was reported. Also, a significant improvement in the mean value of the lymphocyte percentage (p-value 0.0007), ALC (p-value 0.0022), CD4 cell count (p-value 0.0025), and CD8 cell count (p-value 0.0093) was observed after the treatment. One adverse event of mild grade was reported in the placebo group. The analysis of safety parameters (LFT and KFT) was normal for both groups. CONCLUSION: In mild to moderate COVID-19 patients, Tiryaq Wabai effectively showed immunomodulatory activity by improving ALC count, lymphocyte percentage, CD4, and CD8 cell count.

Colchicine in the Management of Oral Submucous Fibrosis: A Systematic Review, Meta-analysis, and GRADE-Based Assessment of Certainty of Evidence.

Purpose: To study the efficacy of Colchicine in the management of Oral Sub mucous Fibrosis (OSMF) through systematic review and meta-analysis. Methods:An extensive literature search was conducted on databases such as PubMed, Cochrane Library database, LILACS, Google Scholar, CTRI, and Google search engine. The search comprises all articles published from 2013 to 2022. A total of 10 randomized control trial studies involving colchicine as one of the interventions were included. [CRD42022377674] Results:10 randomized control comprising 456 subjects were included. 3 studies are included in the meta-analysis comprising 90 subjects. All three studies show that there are significant differences between colchicine and other intervention regarding mouth opening and burning sensation. It indicates that Colchicine is significantly more effective in the reduction of burning sensation than other interventions used as a control in OSMF. Conclusion: The evidence generated through this systemic review and meta-analysis suggest that the use of an oral form of colchicine is an effective measure in the management of OSMF, especially the subjective symptom such as burning sensation where as it is not found to be much effective in case of mouth opening. If colchicine is used as co drug along with conventional injection therapy better will the result. However there is marked diversity among the studies reviewed; therefore, the results of this review should be interpreted very carefully.

Does Tobacco Use Enhance the Risk of SARS-CoV-2 Infection: Evidence from Eastern Indian Population.

Background: Tobacco consumption causes altered immune and inflammatory responses which lead to various respiratory diseases such as asthma and chronic obstructive pulmonary disease, as well as cardiovascular and cerebrovascular disorders. Studies have only confirmed the harmful effects of tobacco consumption on the severity of COVID-19. The present study aimed to explore the association between tobacco consumption and the initiation of COVID-19. Methods: This retrospective cohort study was conducted to explore the relationship between tobacco consumption and COVID-19. A brief closed-ended, self-structured questionnaire was prepared to record participants' responses. The Participants included the individuals who visited Rajendra Institute of Medical Sciences (RIMS), Ranchi, India for the COVID-19 diagnostic test. The statistical analysis was performed using SPSS software (version 24). The chi-square test and logistic regression analysis were also used to predict the odds of getting infected with COVID-19. Findings: A total of 521 valid responses were obtained and subjected to analysis. Moreover, 256 participants (49.13%) were COVID-19 positive and 57 participants (10.94%) were tobacco users. The odds ratio of tobacco consumption was higher in COVID-19-positive patients compared to COVID-19-negatives (OR=1.78; 95% CI 1.01, 3.13). The current tobacco users had a higher risk of developing COVID-19 as compared to the former users (OR=4.8; 95% CI 1.39, 16.61). The frequency and duration of tobacco use also affected the COVID-19 infectivity rate but these were statistically insignificant. Conclusion: The COVID-19 positivity rate was significantly higher in tobacco users, especially in current tobacco users as compared to former users. Nevertheless, gender and occupation had no significant effect on COVID-19 incidence in this study.

Role of Herbal Medication in Tobacco Cessation Treatment: A Systematic Review and Meta-analysis.

Background: Literature reports randomized trials have examined herbal drugs and other smoking cessation therapies such as aromatherapy acupuncture but no comprehensive overview of the overall results has been provided. The present systematic review and meta-analysis aimed to describe the overall effectiveness and safety of herbal medicines. Methods: This study was conducted from December 2020 to April 2021 by searching seven databases. Herbal drugs have been shown to help people quit smoking in randomized controlled studies. Two teams of researchers independently extracted the data. Findings: A total of 12 trials with 762 smokers were included in this study. The heterogeneity I2 was 43.6% with P=0.03 (Cochrane Q test) and χ2=15.77. The overall odds ratio (OR) at 95% confidence interval (CI) was 0.91 (0.68- 1.20) which shows a protective factor of herbal preparations and very low heterogeneity. The herbal treatments such as Vernonia cinerea, St. John's Wort, and lavender essential oil were significantly related to a higher continuous abstinence rate (CAR) compared to the controls with risk ratio (RR): 2.13 (0.57-4.61) at week 8; RR: 2.72 (0.77-5.3) at week 12; and RR: 2.77 (0.37-1.13) at week 24. A 7-day point abstinence rate (PAR) at week 8 was RR: 1.24 (0.81-6.34) with 95% CI; RR: 2.09 (0.93-8.29) at week 12, and RR: 2.11 (0.3-3.08) at week 24. Black pepper and lime were better in craving reduction than the placebo group. This study found no significant difference between the treatment and control groups in adverse effects, despite some minor side effects with herbal drugs. Conclusion: The results of this study showed herbal treatments have the potential to help smokers quit the habit. Further well-designed trials comparing standardized herbal medicines with conventional therapy and placebo are recommended to reinforce this data.

Diagnostic accuracy of Vibrational spectroscopy in the diagnosis of oral potentially malignant and malignant disorders: A systematic review and meta-analysis.

Oral malignant and potentially malignant conditions affect several people worldwide each year. The early diagnoses of these conditions play an important role in prevention and recovery. Vibrational spectroscopy techniques such as Raman spectroscopy (RS) and Fourier-transform infrared (FTIR) spectroscopy are used in the early, non-invasive, label-free diagnosis of malignant and pre-malignant conditions, and are areas of active research. However, there is no conclusive evidence suggesting the translatability of these methods into clinical practice. This systematic review and meta-analysis presents pooled evidence for RS and FTIR methods in the detection of malignant and potentially malignant conditions of the oral cavity. Electronic databases were searched for published literature on RS and FTIR in the diagnosis of oral malignant and potentially malignant conditions. The pooled sensitivity, specificity, diagnostic accuracy, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), pre-test, and post-test probability were then calculated using the random-effects model. A subgroup analysis was conducted separately for RS and FTIR methods. A total of 12 studies were included (8 of RS; 4 of FTIR) as per the eligibility criteria. The pooled sensitivity and specificity of the vibrational spectroscopy methods were calculated to be 0.99 (95% confidence interval [CI]: 0.90, 1.00) and 0.94 (95% CI: 0.85, 0.98), respectively. The area under the curve (AUC) for the summary receiving operator characteristic curve was found to be 0.99 (0.98-1.00). Therefore, the results obtained in this study suggest that the RS and FTIR methods offer great potential to be used in the early diagnosis of oral malignant and pre-malignant conditions.

Comparative effectiveness of medicinal interventions for oral submucous fibrosis: A network meta-analysis.

OBJECTIVES: This network meta-analysis presents an exhaustive description and comparison of the available medical interventions for the management of oral submucous fibrosis (OSMF). MATERIALS AND METHODS: A systematic review and network meta-analysis was conducted after registration with PROSPERO. (PROSPERO ID CRD42022303441). Databases (PubMed, Cochrane, EMBASE, Web of Science, and others) were searched for randomized clinical trials (RCT) trials from inception till September 2022 for the medical interventions in OSMF. The primary outcome was the improvement in mouth opening. The secondary outcomes were improvement in burning sensation, tongue protrusion, and cheek flexibility. The interventions were ranked according to their efficacy based on the surface under the cumulative ranking. RESULTS: 47 studies including 2393 patients were assessed for quantitative analysis. For mouth opening, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective [MD, 7.05 (95%CI 1.76,12.34)], followed by the combination of oral antioxidants with injectable steroids, [MD, 3.80 (95%CI -0.44,8.03)]. Additionally, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective in reducing the burning sensation [MD, -8.62(-10.95,-6.30)], followed by aloe vera [MD, -8.45(-10.40,-6.49)] and pentoxifylline [MD -7.57(-9.46,-5.68)]. For tongue protrusion, curcumin was most effective followed by antioxidants. Most of the drugs used were reported to cause negligible or mild adverse effects. CONCLUSION: This network meta-analysis reported the efficacy of medicinal interventions in OSMF patients compared to the placebo in the improvement of mouth opening and burning sensation, and cheek flexibility. The methodological quality of included RCTs was low. Well-designed studies are recommended to obtain strong evidence.

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

BACKGROUND AND AIM: The management of the worldwide spreading COVID-19 consists of amelioration of its symptoms but no cure is yet available. Herbal medicines supplemented with the Western medicine have been applied for COVID-19 treatment in India, China, Iran, and other countries. This systematic review and meta-analysis of RCTs evaluates the effect and safety of herbal intervention in the management of COVID-19. EXPERIMENTAL PROCEDURE: RCTs from databases like PubMed, Cochrane Library, ScienceDirect, Google Scholar, Science Direct, CTRI, AYUSH Research Portal, India, were reviewed and the data were extracted for study sample demographics, intervention details, clinical effect, inflammatory markers and safety monitoring. Outcomes were expressed as Risk-ratio (RR) with 95% CI for dichotomous data, and Mean-Difference (MD) with 95% CI for continuous data. RESULT AND CONCLUSION: From the 32 eligible studies, a total of 3177 COVID-19 patients were included in the review. Herbal intervention as an adjuvant to Western medicine causes significantly higher improvement compared to Western medicine alone [Fever (RR = 1.09 CI 1.03, 1.15), Cough (Risk-Ratio = 1.22 CI 1.08, 1.37), Fatigue (Risk-Ratio = 1.27 CI 1.11, 1.44), Chest CT Improvement (Risk-Ratio = 1.15 CI 1.08, 1.23)]. The laboratory parameters were also better in the herbal medicine group compared to standard care group only WBC (MD = 0.36 CI 0.16, 0.55), Lymphocyte percentage (MD = 5.48 CI 3.05, 7.92), Absolute lymphocyte count (MD = 0.23 CI 0.07, 0.39), CRP (MD = -5.66 CI -7.96, -3.37). However, duration of hospital stays (MD = -1.82 CI -3.84, 0.21); IL-6 (MD = -3.67 CI -8.76, 1.43), ESR Level (MD = -10.38 CI -25.96, 5.21) were statistically insignificant. No significant adverse events for herbal medications were noted in the included RCTs, during the time of the studies. (n = 665, RR 0.93; 95% CI 0.76, 1.14).

Oral Health Status, Health Behaviour and Treatment Needs of Patients Undergoing Cardiovascular Surgery.

OBJECTIVE: The aim of the present study was to assess the oral health status and treatment needs of cardiovascular surgery patients. Second, the awareness of cardiovascular surgery patients regarding the association between oral health and heart disease was considered. METHODS: Assessment of oral health status, oral hygiene practices and treatment needs of 106 hospitalized patients in preparation for cardiovascular surgery. Patients were interviewed using a structured questionnaire designed for this study and oral examination was carried out by a dentist. RESULTS: The oral hygiene practices of the study cohort were not up to the standard. Patients' awareness of infective endocarditis was poor. Approximately 68% patients experienced dental caries as decayed teeth or missing teeth due to caries and filled teeth. The mean plaque index in the study group was 1.25. In this study cohort, the mean probing depth of periodontal pockets was 5.7±1.3, whereas the mean number of teeth with periodontal pockets > 6 mm was 0.5±0.9. A total of 84 (74.2%) of the patients required dental treatment. CONCLUSION: The principal finding in this study was that patients with heart disease had poor oral health. This study also highlights the importance of better interaction among all healthcare professionals to integrate oral health as part of comprehensive inpatient healthcare.

Oral health status, health behaviour and treatment needs of patients undergoing cardiovascular surgery

Abstract Objective: The aim of the present study was to assess the oral health status and treatment needs of cardiovascular surgery patients. Second, the awareness of cardiovascular surgery patients regarding the association between oral health and heart disease was considered. Methods: Assessment of oral health status, oral hygiene practices and treatment needs of 106 hospitalized patients in preparation for cardiovascular surgery. Patients were interviewed using a structured questionnaire designed for this study and oral examination was carried out by a dentist. Results: The oral hygiene practices of the study cohort were not up to the standard. Patients' awareness of infective endocarditis was poor. Approximately 68% patients experienced dental caries as decayed teeth or missing teeth due to caries and filled teeth. The mean plaque index in the study group was 1.25. In this study cohort, the mean probing depth of periodontal pockets was 5.7±1.3, whereas the mean number of teeth with periodontal pockets > 6 mm was 0.5±0.9. A total of 84 (74.2%) of the patients required dental treatment. Conclusion: The principal finding in this study was that patients with heart disease had poor oral health. This study also highlights the importance of better interaction among all healthcare professionals to integrate oral health as part of comprehensive inpatient healthcare.

Neurofibroma of facial nerve presenting as parotid mass.

Neurogenic neoplasms presenting as parotid gland tumors are extremely uncommon. We present the case of a solitary neurofibroma of the facial nerve within the parotid gland occurring in a 36-year-old male who presented with a painless enlargement in the right-side region of the parotid gland over a period of 1 year with normal facial nerve function. Magnetic resonance imaging revealed a well-demarcated round mass within the right parotid. At surgery, a tumor was found involving the main trunk of the facial nerve, histopathologically representing a neurofibroma.