School of Medicine Students Journal
Volume:2 Issue: 3, Sep 2020

The COVID-19 pandemic is a global health emergency caused by SARS-CoV-2. Unfortunately, no effective drugs have been found to date. There is also a major need for new therapies to treat this disease. The main protease is an attractive drug target among coronaviruses due to its important role in the processing of viral RNA-translated polyproteins. Objective of This study was conducted to screen data-bases of herbal compounds for potential main protease inhibitors.

Natural products from 3 database banks were first tested and filtered by ADME / toxicity, then their molecular energy was minimized, and finally, they were docked into the SARS-CoV-2 main protease and compared with indinavir.

The binding energies of 6570 molecules from different herbal compounds comprising databases were tested and five of the molecules with the highest binding energies for SARS-CoV-2 main protease docking were selected and key interactions were studied.

In conclusion, five herbal compounds including Sodwanone B, Cyclo-mulberrin, and a glycosylated derivative of kaempferol had lower docking energy com-pared to indinavir and were suggested for further research.

Throughout the past twenty years, humankind had its fair share of challenges with viral epidemics. In late December 2019, a zoonotic member of the coronaviruses, was re-sponsible for the COVID-19 outbreak of viral pneumonia in Wuhan, China. As a world-wide crisis, meanwhile a conclusive prevention or therapy has yet to be discovered, the death toll of COVID-19 has exceeded 278000 by May 11th 2020. Alike other members of Coronavirus family such as MERS and SARS-CoV-1, SARS-CoV-2 provokes influ-enza-like syndrome which might further progress to severe state of acute respiratory disease in some patients. Comparably, in 2009 the H1N1 influenza outbreak affected countless people by manifestations of respiratory system involvement. Additionally, Ebolavirus, as a member of Filoviridae family, had also made a global catastrophe by causing hemorrhagic diseases in the past twenty years. The unknown intrinsic nature of SARS-CoV-2, as a great missing piece of this pandemic puzzle, has had physicians to empirically test the possibly efficacious agents of the former viral epidemics on the COVID-19 cases. Here, the current knowledge in SARS-CoV-2clinical features, trans-missibility, and pathogenicity are all summed up as against the other emerging viruses in the last two decades, and the data crucially required for a better management of the illness has been spotlighted.

Postoperative pain after cesarean section is one of the import-ant issues in gynecology. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are two of the drugs that are used for cesarean pain management. Considering the adverse effects of opioids in the mother and the baby, NSAIDs are preferred in the post-cesarean pain management. This study was designed to compare the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoper-ative cesarean pain.

This randomized clinical trial was conducted on patients who underwent cesarean section in Taleghani Hospital during 2019. Patients were random-ly divided into two groups based on flipping coin. The first group received 100 mg of oral diclofenac potassium every 6 hours and the second group received 100 mg of diclofenac sodium suppository every 6 hours. The pain was assessed 30 minutes, 2 hours, 6 hours, 12 hours, 18 hours and 24 hours after the intervention using visual an-alogue scale (VAS) before and after analgesics.

Eighty-four patients were included in the final analysis. The mean of VAS during the intervention in the diclofenac sodium suppository group and in the Cata-flam group was 3.42 ± 2.1 and 1.93 ± 2.4 respectively (P value = 0.011). Twenty-eight among 46 patients who received opioids due to severe pain (66.7%) were in the di-clofenac suppository group and 18 of them (42.9%) were in the Cataflam group (P value = 0.021).

Diclofenac potassium tablets and diclofenac sodium suppository can re-duce the post cesarean pain. The efficacy of diclofenac potassium tablets (Cataflam) is significantly higher than the diclofenac suppository; however, the complication rate was not significantly different.

Atrial fibrillation (AF) is the most common sustained arrhyth-mia in adults which need anti-coagulant to prevent stroke. Due to high cost of Rivar-oxaban compared to Warfarin, it is not prescribed as much as Warfarin by physicians despite its superiority in intracranial hemorrhage. This study aimed to evaluate the cost-effectiveness of Rivaroxaban versus Warfarin in preventing stroke in AF patients.

This study is a cost-utility analysis with cost-effectiveness as-sessed by the incremental cost per quality-adjusted life-year (QALY). Two strategies were used to obtain the costs; the first was from available resources, and the next was to collect data using a questionnaire. A total number of 98 patients who met the inclusion criteria had answered the questionnaire. Utility values for obtaining ∆QALYs originated from published data. Finally the cost-effectiveness of Warfarin versus Rivar-oxaban was assessed using an incremental cost-effectiveness ratio (ICER), which was calculated as the incremental cost per QALY gained.

Mean annually physician visits were 4 times in Rivaroxaban and 14 times in Warfarin group. The patients in Warfarin Group checked their INR (international nor-malized ratio) 15 times a year, while the patients in Rivaroxaban group did not check at all. The wasting time for each physician visit and doing Lab test was approximately 3 hours. Total cost of Rivaroxaban in both private (16,699,000 IRR) and governmen-tal sector (15,755,000 IRR) were less than that for Warfarin; governmental sector 24, 233,700 & 20,345,600 IRR respectively. We analyzed the ΔQALYs of 7 different arti-cles in which the mean ΔQALY was 0.21 (Variance: 0.0072). The incremental cost per QALY per patient for Warfarin in private versus governmental sector was 18,514,762 Rial /QALY, while the ICER between Rivaroxaban versus Warfarin in both private and governmental sectors was negative (-35,879,523.8 and -21,860,000 Rial/QALY). So the calculated threshold based on the per capita gross national product (GDP), which was 702,576,000 Rials (calculated at 42,000IRR/$), showed that Rivaroxaban is more cost-effective than Warfarin.

Use of Rivaroxaban versus Warfarin in both governmental and private sectors is a cost-effective choice. So, due to its economic and potential benefits, it is recommended to prescribe Rivaroxaban rather than Warfarin.

Hepatic involvement in Wilson disease consists of isolated elevated liver enzyme, asymptomatic hepatomegaly, cirrhosis and acute liver failure. Here, we report three patients with unexplained elevated liver enzymes. By considering the level of urinary excretion of copper after penicillamine challenge test, we had some problems in the process of diagnosis. Therefore, we thought of cautiously applying the diagnostic cut-off in the mentioned challenge test.

Chronic dyspepsia is a common medical problem in patients referred to internal and gastrointestinal clinics. According to some studies, most pa-tients with dyspepsia suffer simultaneously from gastric polyps. The current study aimed to clarify the association of gastric polyp and dyspepsia in an Iranian population.

A total of 2772 dyspeptic and 1294 non-dyspeptic subjects who referred to the gastrointestinal clinical Ayatollah Taleghani Hospital in Tehran from2016 to 2018 were enrolled in this cross-sectional study. All subjects underwent upper gastrointestinal (GI) endoscopy, and patients with GI malignancy, severe GI bleeding, and history of GI surgery were excluded from the study. Participants were evaluated for age, gender, endoscopic findings, gastric polyp (GP) count, size, and lo-calization, diagnostic methods used for histology, and polyp features. The relationship between gastric polyp and dyspepsia was also evaluated.

In 4066 consecutive upper GI endoscopies in patients with and without dys-pepsia, 129 patients (3.2%) were found to have gastric polyps (GPs).The prevalence of GPs was 3.04% and 3.32% in subjects with and those without dyspepsia, respec-tively. There was no statistically significant relationship between GPs and dyspepsia (p=0.709). Hyperplasic polyp (HP) was the most common pathology in 53.5% and 34.9% of patients with and without dyspepsia, respectively. The most common location for polyps was the gastric antrum (76.7%), and the common size of the polyps was between 5-10 mm in 80.6% of patients.

In the present study, no statistically significant difference was observed in the pathologic findings of gastric polyps in terms of dyspepsia. Hyperplasic polyps (HPs) are the most common type of pathologic stomach polyps, and its prevalence maybe high due to the high frequency of Helicobacter pylori (H. pylori) infection in our country.