Implications for Systemic Approaches to COVID-19: Effect Sizes of Remdesivir, Tocilizumab, Melatonin, Vitamin D3, and Meditation.

INTRODUCTION: COVID-19 poses a chronic threat to inflammatory systems, reinforcing the need for efficient anti-inflammatory strategies. The purpose of this review and analysis was to determine the efficacy of various interventions upon the inflammatory markers most affected by COVID-19. The focus was on the markers associated with COVID-19, not the etiology of the virus itself. METHODS: Based on 27 reviewed papers, information was extracted on the effects of COVID-19 upon inflammatory markers, then the effects of standard treatments (Remdesivir, Tocilizumab) and adjunctive interventions (vitamin D3, melatonin, and meditation) were extracted for those markers. These data were used to approximate effect sizes for the disease or interventions via standardized mean differences (SMD). RESULTS: The data that were available indicated that adjunctive interventions affected 68.4% of the inflammatory markers impacted by COVID-19, while standard pharmaceutical medication affected 26.3%. DISCUSSION: Nonstandard adjunctive care appeared to have comparable or superior effects in comparison to Remdesivir and Tocilizumab on the inflammatory markers most impacted by COVID-19. Alongside standards of care, melatonin, vitamin D3, and meditation should be considered for treatment of SARS-COV-2 infection and COVID-19 disease.

Introduction to integrative primary care: the health-oriented clinic.

Integrative medicine is healing-oriented medicine that accounts for the whole person (body, mind, and spirit), including all aspects of lifestyle. Integrative medicine emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative. This article describes ways to bring the integrative perspective into primary care practice. Several approaches are described, including some that are routinely used in the authors' practice. Changes in practice philosophy that can (1) help inform primary care redesign, (2) facilitate the creation of patient-centered medical homes, (3) strengthen provider-patient relationships, and (4) enhance patient satisfaction are also provided.

Biofield therapies: energy medicine and primary care.

Energy medicine modalities, also known as biofield therapies, are perhaps the most mysterious and controversial complementary alternative medicine therapies. Although many of these approaches have existed for millennia, scientific investigation of these techniques is in its early stages; much remains to be learned about mechanisms of action and efficacy. These techniques are increasingly used in clinical and hospital settings and can be incorporated into an integrative primary care practice. This article describes several energy medicine and biofield therapies and outlines key elements they hold in common. Several specific approaches are described. Research findings related to the efficacy of energy medicine are summarized, and proposed mechanisms of action and safety issues are discussed. Guidelines are offered for primary care providers wishing to advise patients about energy medicine or to integrate it into their practices, and Internet and other resources for obtaining additional information are provided.

Diagnosis and management of rheumatoid arthritis.

Rheumatoid arthritis is a chronic inflammatory disease characterized by uncontrolled proliferation of synovial tissue and a wide array of multisystem comorbidities. Prevalence is estimated to be 0.8 percent worldwide, with women twice as likely to develop the disease as men. Untreated, 20 to 30 percent of persons with rheumatoid arthritis become permanently work-disabled within two to three years of diagnosis. Genetic and environmental factors play a role in pathogenesis. Although laboratory testing and imaging studies can help confirm the diagnosis and track disease progress, rheumatoid arthritis primarily is a clinical diagnosis and no single laboratory test is diagnostic. Complications of rheumatoid arthritis may begin to develop within months of presentation; therefore, early referral to or consultation with a rheumatologist for initiation of treatment with disease-modifying antirheumatic drugs is recommended. Several promising new disease-modifying drugs recently have become available, including leflunomide, tumor necrosis factor inhibitors, and anakinra. Nonsteroidal anti-inflammatory drugs, corticosteroids, and nonpharmacologic modalities also are useful. Patients who do not respond well to a single disease-modifying drug may be candidates for combination therapy. Rheumatoid arthritis is a lifelong disease, although patients can go into remission. Physicians must be aware of common comorbidities. Progression of rheumatoid arthritis is monitored according to American College of Rheumatology criteria based on changes in specific symptoms and laboratory findings. Predictors of poor outcomes in early stages of rheumatoid arthritis include low functional score early in the disease, lower socioeconomic status, early involvement of many joints, high erythrocyte sedimentation rate or C-reactive protein level at disease onset, positive rheumatoid factor, and early radiologic changes.