Treatment of COVID-19 Pneumonia and Acute Respiratory Distress With Ramatroban, a Thromboxane A2 and Prostaglandin D2 Receptor Antagonist: A Four-Patient Case Series Report.

Hypoxemia in COVID-19 pneumonia is associated with hospitalization, mechanical ventilation, and mortality. COVID-19 patients exhibit marked increases in fatty acid levels and inflammatory lipid mediators, predominantly arachidonic acid metabolites, notably thromboxane B2 >> prostaglandin E2 > prostaglandin D2. Thromboxane A2 increases pulmonary capillary pressure and microvascular permeability, leading to pulmonary edema, and causes bronchoconstriction contributing to ventilation/perfusion mismatch. Prostaglandin D2-stimulated IL-13 production is associated with respiratory failure, possibly due to hyaluronan accumulation in the lungs. Ramatroban is an orally bioavailable, dual thromboxane A2/TP and prostaglandin D2/DP2 receptor antagonist used in Japan for allergic rhinitis. Four consecutive outpatients with COVID-19 pneumonia treated with ramatroban exhibited rapid relief of dyspnea and hypoxemia within 12-36 h and complete resolution over 5 days, thereby avoiding hospitalization. Therefore, ramatroban as an antivasospastic, broncho-relaxant, antithrombotic, and immunomodulatory agent merits study in randomized clinical trials that might offer hope for a cost-effective pandemic treatment.

The effect of water activity and storage temperature on the growth of Aspergillus flavus in medicinal herbs.

The quality control of medicinal herbs post harvesting or after collection becomes very critical because of susceptibility to fungal invasion during storage depending on the temperature and humidity of the storage area. The information on moisture equilibrium is important on the process and storage of foods which can be extended to medicinal herbs. In the present study, the growth of Aspergillus flavus was observed on selected ten medicinal herbs with water activity aw above 0.81 when stored at 25 +/- 2 degrees C, 30 +/- 2 degrees C and 40 +/- 2 degrees C except for Picrorhiza kurrooa and Alpinia galanga which were found to have anti-fungal properties. Aspergillus flavus did not grow in any samples of medicinal herbs with water activity aw below 0.81 at temperatures of 25 +/- 2 degrees C, 30 +/- 2 degrees C and 40 +/- 2 degrees C. Also Aspergillus flavus did not grow in any samples of medicinal herbs with water activity aw above 0.81 when stored below 10 +/- 2 degrees C. Therefore it can be concluded that the contamination of medicinal herbs with aflatoxins can be minimized by controlling water activity and storage temperature. Sorption isotherms (desorption) can be interpreted to determine the optimum drying which can lower the water activity to the level required for preventing growth of Aspergillus flavus and also for ensuring quality of medicinal herbs which may get destroyed upon over drying. Furthermore, it also saves incremental cost in prolonged drying over the optimum drying.