Timeline of changes in spike conformational dynamics in emergent SARS-CoV-2 variants reveal progressive stabilization of trimer stalk with altered NTD dynamics.

SARS-CoV-2 emergent variants are characterized by increased viral fitness and each shows multiple mutations predominantly localized to the spike (S) protein. Here, amide hydrogen/deuterium exchange mass spectrometry has been applied to track changes in S dynamics from multiple SARS-CoV-2 variants. Our results highlight large differences across variants at two loci with impacts on S dynamics and stability. A significant enhancement in stabilization first occurred with the emergence of D614G S followed by smaller, progressive stabilization in subsequent variants. Stabilization preceded altered dynamics in the N-terminal domain, wherein Omicron BA.1 S showed the largest magnitude increases relative to other preceding variants. Changes in stabilization and dynamics resulting from S mutations detail the evolutionary trajectory of S in emerging variants. These carry major implications for SARS-CoV-2 viral fitness and offer new insights into variant-specific therapeutic development.

SARS-CoV-2 spike protein as a bacterial lipopolysaccharide delivery system in an overzealous inflammatory cascade.

Accumulating evidence indicates a potential role for bacterial lipopolysaccharide (LPS) in the overactivation of the immune response during SARS-CoV-2 infection. LPS is recognised by Toll-like receptor 4 (TLR4), mediating proinflammatory effects. We previously reported that LPS directly interacts with SARS-CoV-2 spike (S) protein and enhances proinflammatory activities. Using native gel electrophoresis and hydrogen-deuterium exchange mass spectrometry, we showed that LPS binds to multiple hydrophobic pockets spanning both the S1 and S2 subunits of the S protein. Molecular simulations validated by a microscale thermophoresis binding assay revealed that LPS binds to the S2 pocket with a lower affinity compared to S1, suggesting a role as an intermediate in LPS transfer. ໿Congruently, nuclear factor-kappa B (NF-κB) activation in monocytic THP-1 cells is strongly boosted by S2. Using NF-κB reporter mice followed by bioimaging, a boosting effect was observed for both S1 and S2, with the former potentially facilitated by proteolysis. The Omicron S variant binds to LPS, but with reduced affinity and LPS boosting in vitro and in vivo. Taken together, the data provide a molecular mechanism by which S protein augments LPS-mediated hyperinflammation.

COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome.

PURPOSE: The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). METHODS: A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. RESULTS: Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. CONCLUSION: Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.

Retrospective time to event analysis of integrated medicine treatment effect on mild symptomatic COVID19 patients in facility quarantine at Kallakurichi, Tamil Nadu

Background: This study has been conducted on confirmed COVID 19 positive patients (n = 55), who had come to Kallakurichi District of Tamilnadu state from one of the containment zones in Indian State of Maharashtra. Out of the 55, 8 (14.55%) patients were symptomatic and remaining 47 (85.45%) were asymptomatic patients. 47 patients who reached in their home land on 24th May and rest on 25th may 2020. All of them have been treated with integrated medicine treatment method. Materials and Methods: Everybody was quarantined from 27th may to 7th June 2020 at Mahabharathi Engineering College, Vasudevanur, Chinna salem Taluk, Kallakurichi District. Integrative Intervention Consisting of Vitamin C Tablet, Zinc tablet for 5 days, and Kabasura Kudineer 60 ml BD Before food for all days was the treatment given for all patients. Result: Among them, three of them had co -morbid conditions like diabetes and hypertension. 27.3% were female and 72.7% are male patients. Average age was 32.33 among the range of 14 to 65years. Conclusion: All patients including who has co-morbidity were completely relieved from the disease on the day of discharge. All symptomatic patients were asymptomatic with median time of 4 days IP admission.

Effectiveness of masks in the suppression of COVID-19 cases during the ongoing pandemic in India

Perhaps the worst predicament faced by humanity in the twenty-first century is the COVID-19 pandemic, which is caused by the SARS-CoV-2 virus. Most parts of the world, including India, went into lockdowns for some period because of the massive increase in cases throughout 2020. Face masks became an important counter-measure for protecting the populace, health professionals, and medics, particularly during the period prior to the mass availability of vaccines. This study intends to evaluate the effectiveness of face masks in limiting the spread of the virus. The data for the number of COVID-19 cases was analyzed from January 1, 2022 to May 31, 2022, using Python programming. This timeframe involved face mask mandates and no mask requirement, and hence was considered to be ideal for analyzing the usefulness of face masks. A decline in cases during the mandate was observed, while the opposite occurred without the mandate. The outcome of the research showed that face masks are effective additional measures against the spread of SARS-CoV-2. This study elevates the value of personal protective equipment (PPE), such as face masks, made with nonwovens and other fabrics, as lifesavers in the case of airborne diseases such as COVID-19 and other pulmonary disorders. Application: This study shows that extra precautions like wearing face masks helped stop the spread of SARS-CoV-2 along, with vaccinations. © TAPPI Press 2022.

Safety and efficacy of siddha medicine preparation in the management of COVID-19: A prospective randomised open label study.

Background: The use of complementary and alternative medicine (CAM) therapies has surged since the spread of COVID-19 pandemic. However, the efficacy and safety of these CAM therapies remains majorly unexplored. Objective: To understand the efficacy and safety of Nochi Kudineer Chooranam (5 gm), Mahasudarsan Chooranam (3 gm) , Adathodai Manapagu (10 ml), Omatheeneer (10 ml), Maldevi chenduram (100 mg) with honey in management of COVID 19 patients. Methods: We conducted a randomised, controlled, open label trial in patients hospitalized with SARS-CoV-2 infection who had an oxygen saturation of 90% or more while breathing ambient air. Patients were randomized into two groups in a 1:1 ratio to either intervention group, receiving seven days of siddha medicine (Intervention group; n = 50) or standard care (control group; n = 50). The primary end point was clinical markers and patient recovery status on day 8. Results: A total of 100 patients with confirmed COVID-19 with average age of 37 yrs (interquartile range, 28-49) participated in the study. There was no statistically difference between groups at baseline (P > 0.05). After intervention, patients in the intervention group had statistically (P < 0.05) significant reduction in the symptoms when compared to standard care. By end of the intervention period, 6 patients (12%) were hospitalized in the control group and none of them were reported for intervention group. Conclusion: Among patients with mild to moderate COVID-19, 7 days of siddha medicine showed a significant reduction in the clinical symptoms and requirement of hospitalisation, with no adverse events. Therefore, the particular siddha medicine preparation could be used safely and effectively for the management of COVID-19 patients.

Uncovering cryptic pockets in the SARS-CoV-2 spike glycoprotein.

The COVID-19 pandemic has prompted a rapid response in vaccine and drug development. Herein, we modeled a complete membrane-embedded SARS-CoV-2 spike glycoprotein and used molecular dynamics simulations with benzene probes designed to enhance discovery of cryptic pockets. This approach recapitulated lipid and host metabolite binding sites previously characterized by cryo-electron microscopy, revealing likely ligand entry routes, and uncovered a novel cryptic pocket with promising druggable properties located underneath the 617-628 loop. A full representation of glycan moieties was essential to accurately describe pocket dynamics. A multi-conformational behavior of the 617-628 loop in simulations was validated using hydrogen-deuterium exchange mass spectrometry experiments, supportive of opening and closing dynamics. The pocket is the site of multiple mutations associated with increased transmissibility found in SARS-CoV-2 variants of concern including Omicron. Collectively, this work highlights the utility of the benzene mapping approach in uncovering potential druggable sites on the surface of SARS-CoV-2 targets.

Making CABG Less Invasive: Endoscopic Vessel Harvesting in Scotland

Background: We present our early experience of introducing state-of-the-art endoscopic vessel harvesting (EVH) into a hospital in Scotland. Coronary arteries bypass grafting (CABG) is the most frequently performed adult cardiac surgical operation and circa. 1200 cases were performed across Scotland in 2019/20, prior to the COVID-19 pandemic. Although internal thoracic artery (ITA) is the preferred conduit, most CABG operations require long saphenous vein (LSV) to be harvested from one or both legs. The radial artery (RA) is also used less frequently. Conduits are currently harvested by open technique, representing one of the longest incisions in surgery. Even when expertly performed, this is a major source of morbidity and delayed hospital discharge. Known risk factors for wound complications include age > 75 years, female sex, BMI > 28, history of smoking, diabetes mellitus and peripheral vascular disease. Both LSV and RA can be successfully harvested endoscopically via 2 cm incision with expected reduction in post-operative morbidity. In our quest to make CABG less invasive, we decided to embark upon a programme of EVH and hereby present our early clinical experience and vision for future roll-out across centres routinely performing cardiac surgery in Scotland. Methods: Consecutive patients undergoing isolated elective CABG surgery at one institution were consented for endoscopic vessel harvesting (EVH). We used a novel on-screen imaging (CoreVista, CardioPrecision), along with latest EVH harvesting tools (HemoPro 2, Getinge) and standard imaging/CO2 insufflation (Stryker). Data on risk factors, wound complications, patient satisfaction and length of stay were collected. Results: A short video will be used to demonstrate key steps of the procedure. Nine patients were recruited into the study. The mean age was 61 years [95% CI 53-69 years]. Six out of 9 (66%) patients had one or more risk factors for post-operative wound complications. LSV was harvested endoscopically in 6 patients (66%) and RA in 3 (33%) patients. The median number of grafts was 3 [range 2-5]. There were no immediate wound complications. All patients expressed a high level of satisfaction with the surgical result. Median post-operative length of stay was 5 days [range 5-6 days]. At a median follow-up of 2 months there were no late wound complication or adverse events reported. Conclusions: EVH was successfully delivered without complications in our series with high degree of patient satisfaction and consistently short length of stay. The combination of devices was easy to use and integrate into the standard CABG theatre footprint and procedure. Plans are now being made to implement EVH more widely across Scotland.

The role of precautions: Organising a medical conference during COVID-19 pandemic—Lessons from IADVL MIDDERMACON 2021

Background The use of virtual platforms for clinical meetings has become the default approach during this pandemic era. Organising an offline conference during a pandemic is a challenge and is possible if the participating crowd is vaccinated and is willing to follow appropriate pandemic protocols. Objective To determine the feasibility of conducting a conference among mostly vaccinated delegates using standard precautionary protocols. Methods This study was conducted at IADVL MIDDERMACON 2021, held in Mangalore, India, in late October 2021, during the phase of decline of the Delta variant of SARS-CoV-2. The study population included all conference attendees, including support staff. Details were collected about their vaccination status, comorbidities, and mode of travel to the conference venue. An reverse-transcription polymerase chain reaction (RT-PCR) test was done randomly among the attendees for COVID-19 infection. A post-conference assessment and RT-PCR tests were done at the end of 2 weeks to assess the occurrence of infections among study participants. Results A total of 1744 people were present at the venue, of which 576 (33.03%) participated in the study. The percentage of fully vaccinated was 88.88% (512/576). The majority had taken the vaccine Covishield (manufactured by AstraZeneca), that is, 85.06% (490/576). Infection post the conference was reported in 0.195% (1/576). Conclusions Holding large gatherings like medical conferences pose a challenge during a pandemic. However, to increase the benefits of the conference, it is advisable to hold them offline with vaccinated delegates, follow the advice of the conference organising committee, and practise safe precautionary measures.

Safety and Efficacy of Siddha Medicine preparation in the management of COVID-19: A Prospective Randomised Open Label Study

Background The use of complementary and alternative medicine (CAM) therapies has surged since the spread of COVID-19 pandemic. However, the efficacy and safety of these CAM therapies remains majorly unexplored. Objective of the current study is to understand the efficacy and safety of one such traditional CAM therapy of South India, known as ‘Siddha’ system of medicine, in the management for the COVID-19 patients. Methods We conducted a randomised, controlled, open label trial in patients hospitalized with SARS-CoV-2 infection who had an oxygen saturation of 90% or more while breathing ambient air. Patients were randomized into two groups in a 1:1 ratio to either intervention group, receiving seven days of siddha medicine (Intervention group;n=50) or standard care (control group;n=50). The primary end point was clinical markers and patient recovery status on day 8. Results A total of 100 patients with confirmed COVID-19 with average age of 37 yrs (interquartile range, 28-49) participated in the study. There was no statsistically difference between groups at baseline (P>0.05). After intervention, patients in the intervention group had statistically (P<0.05) significant reduction in the symptoms when compared to standard care. By end of the intervention period, 6 patients (12%) were hospitalized in the control group and none of them were reported for intervention group. Conclusion Among patients with mild to moderate COVID-19, 7 days of siddha medicine showed a significant reduction in the clinical sysmptoms and requirement of hospitalisation, with no adverse events. Therefore, the particular siddha medicine preparation could be used safely and effectively for the management of COVID-19 patients. Clinical Trial Registration CTRI/2020/08/026999.

Entry Screening Device for Public Transport During Pandemic Period

Social distancing is the one of the preferred ways to get out of the current situation and it has become difficult to follow it. Most people use public transport as a medium to travel. It becomes very difficult to maintain an effective social distance in public transports. So, we have planned to give a solution to address this problem by ensuring safeness in buses. Here, we kept a fixed limit for persons entering into the bus and before that they had to pass the temperature check and mask detection checks. The device consists of a Raspberry pi Module which acts as a system, a Camera module, PIR Sensors, Infrared Temperature Sensors, LCD Monitor. LCD Monitor shows the details of the number of persons that can be accommodated in a particular bus and the number of people present inside the bus. Temperature sensors, such as infrared temperature sensors, are used to detect the temperature of people entering the bus. It is captured and determined whether or not the person is wearing their mask in the entrance by the Camera Module. PIR Sensors are used to monitor the count of the persons entering or exiting the bus which is displayed in the LCD monitor. So, these work together and make the entry screening while entering a transport system. © 2022 IEEE.

Review on Herbal Remedies for Covid-19 (Corona Virus)

The unknown coronavirus has been unfold all over within the world. The primary case was declared in Dec 2019, and this coronavirus malady has become a virulent disease. Infection of this virus is directly attacked on the system of the flesh or animals. Nowdays there's a deficiency of correct management or vaccinum out there to stop this malady that principally attacks the system of body. Hindrance is healthier than cure. This term is extremely renowned to any or all people. Thus currently this time has come back to used for our savings of lives. Ayurveda is the ancient system of drugs which is originated in India. During this covid -19 amount boosting of our system is that the excellent thanks to fight against this corona virus. Many seasoning plants unit accessible in our shut that unit used for immunity boosting throughout Covid 19. Some seasoning plants like Tinospora cordifolia, Withania somnifera, Nyctanthes arbortristis that unit commonly used for immunity boosting. This herb contains compounds like glycosides, steroids, diterpenoid lactones, alkaloids, steroidal lactone,etc. vary of research unit accessible on Tinospora cordifolia, Ashwagandha, and Nyctanthes arbortristis to prove its immunomodulatory activity, anti-oxidant activity, anti- inflammatory activity, anti-pyretic activity. Throughout this general review we've a bent to targated on the role, drugs activities of Tinospora cordifolia, Withania somnifera, Nyctanthes arbortristis to prevention and treatment of COVID 19 or CORANA VIRUS infection.

The ongoing Pharmacotherapy for ministration of Covid 19 disease: A Review

A completely unique coronavirus (2019-n Cov) formally reffered to as severe acute respiratory syndromes [SARS Cov 2] appeared in wuhan, china. The coronavirus infectious disease 2019 (covid 19) has speechless like a shock in fully unprepared world. Covid 19 caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS Cov 2). Covid 19 first emerged in December 2019 all in cluster of patients with the pneumonia of unknown cause was recognized in Wuhan, China. In july 2020, SARS Cov2 was affected more than 200 countries. The coronavirus fevered 79% and 50% genomic similarities with severe acute respiratory syndromes coronavirus 2 [SARS Cov 2] and middle east respiratory syndromes coronavirus [MN1 -https://media.proquest.com/media/hms/PFT/1/3XbxM?_a=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%3D%3D&_s=70BTI4WE5mLgKRxd9Spf1sZLpKY%3D ERS Cov 2] respectively. Several drugs have been investigated for their efficacy and safety in the treatment of covid 19 disease like antiviral, antimalerials, antibiotics immunomodulators, anticoagulants.

Remote risk stratification of dyspnoea in acute respiratory disorders and applications for COVID-19 and future pandemics: A systematic review of the literature

Background: Due to the highly infectious nature of the disease, a large amount of community-based triage of COVID-19 is performed by video/ telephone consultation, especially in primary care. This presented clinicians with a new challenge in risk stratification of patients with dyspnoea due to suspected COVID19. This review searched existing literature to identify existing modalities to remotely assess patients with acute respiratory distress, which can be adapted for the COVID-19 pandemic and in future similar situations. Methods: We conducted a systematic search of Medline, Embase and Medrxiv for studies of the remote assessment of dyspnoea in acute respiratory disorders in adults/children. The study was registered on PROSPERO (ID: CRD42020202292): 3014 abstracts were screened independently by two reviewers and 32 studies were progressed to full text screening. Results: Five studies were selected for review, including 1317 patients. Two studies assessed video consultation, two assessed telephone related triage tools, and one study assessed an online triage tool for dyspnoea. In one study, video consultation was found to have 83% sensitivity for diagnosing 'severe' respiratory distress in comparison to faceto-face assessment. The online triage tool was found to have 87.5% sensitivity for detecting dyspnoea requiring emergency level care. Conclusion: A range of successful remote risk stratification tools and clinical features were identified for assessing dyspnoea severity which can be adapted to COVID-19 and future pandemics to assess respiratory distress via telemedicine. These findings will influence development of comprehensive evidence-based tools to assess dyspnoea which will reduce resource strain during current/future pandemics.

SARS-CoV-2 spike protein as a bacterial lipopolysaccharide delivery system in an overzealous inflammatory cascade (preprint)

Accumulating evidence indicates a potential role for bacterial lipopolysaccharide (LPS) in the overactivation of the immune response during SARS-CoV-2 infection. LPS is recognised by Toll-like receptor 4 (TLR4) in innate immunity. Here, we showed that LPS binds to multiple hydrophobic pockets spanning both the S1 and S2 subunits of the SARS-CoV-2 spike (S) protein. LPS binds to the S2 pocket with a lower affinity compared to S1, suggesting its possible role as an intermediate in the TLR4 cascade. Congruently, nuclear factor-kappa B (NF-{kappa}B) activation in vitro is strongly boosted by S2. In vivo, however, a boosting effect is observed for both S1 and S2, with the former potentially facilitated by proteolysis. Collectively, our study suggests the S protein may act as a delivery system for LPS in host innate immune pathways. The LPS binding pockets are highly conserved across different SARS-CoV-2 variants and therefore represent potential therapeutic targets.

Role of Modern Technologies and Internet of Things in the Field of Solid Waste Management

The process of handling solid waste becomes complex and tedious due to the urbanization and industrialization of the most developing and developed countries. These solid waste issues if it is not addressed properly it affects ecosystem and environment. There is a possibility of many health-oriented issues especially during the pandemic period covid-19. Most of the human beings are struggling with respiratory pulmonary diseases, asthma caused by these solid wastes. Most of the governments are also spending huge amount of money for labors, devices and some technologies to tackle these solid waste issues. There is also an opportunity for the government to generate revenue from these solid wastes by properly sorting these waste into recyclable, non-recyclable and bio-degradable wastes. But when humans are involved in sorting these waste it will cause some diseases and hygienic problems. So,in order to address the above said issues in this work the role of modern technologies, algorithms and some Internet of things (IoT) methods are discussed. Implementing these technologies in the future will save huge amount of money spent by the government for the solid waste management activities. © 2021. by the authors. All Rights Reserved.

A CASE OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A POST-DOUBLE LUNG TRANSPLANT PATIENT WITH COVID-19

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disease characterized by an overwhelming systemic immune response and loss of natural killer cell effector functions. Triggers for the acquired form include hematologic malignancy, rheumatologic disease, or viral infection. We present a case of HLH in a patient diagnosed with COVID-19 one year after his double lung transplant. CASE PRESENTATION: A 67-year-old male with 1 year history of double lung transplant for combined pulmonary fibrosis and emphysema presented with weeklong fever, dyspnea on exertion, productive cough, and anorexia. He denied sick contacts and was compliant with prednisone, tacrolimus, and mycophenolic acid. Presenting vitals were significant for a fever 38.5C, HR 99, BP 115/71, RR 32 with oxygen saturation of 92% on 6L nasal cannula. Labs were significant for COVID-19, procalcitonin 0.06, ferritin 694, d-dimer 1,126, and negative EBV and CMV levels. Due to COVID infection, mycophenolic acid dose was decreased and he was started on remdesivir, pulse dose methylprednisolone, therapeutic heparin, and convalescent plasma. He was soon intubated, paralyzed, and proned for hypoxia. Repeat labs were significant for EBV viremia and he received ganciclovir. Due to acute hemoglobin drop, CT scan of the abdomen was obtained and revealed multiple soft tissue nodular densities in the left upper abdomen and retroperitoneum suggestive of a lymphoproliferative disorder. On day 15, he started treatment for aspergillus pneumonia with inhaled amphotericin and isavuconazole. Ganciclovir was discontinued due to transaminitis and nitric oxide started for hypoxia. New labs were significant for acutely elevated ferritin 24,050, soluble IL-2 receptor 3144, and d-dimer 1933 and hematology was consulted. Bone marrow biopsy showed increased hemophagocytosis. Due to aspergillosis, he received second line HLH therapy with tociluzimab and dexamethasone. Unfortunately, the patient ultimately passed from refractory hypoxia and septic shock from invasive aspergillosis. DISCUSSION: HLH is a diagnosis of exclusion. In solid organ transplant recipients, it is typically associated with a viral infection such as EBV or CMV. COVID-19 infection is thought to trigger HLH through a proinflammatory state or through immunosuppression predisposing a viral infection. This patient is uniquely immunosuppressed due to prior lung transplant and may have been triggered into HLH through COVID-19 and/or EBV infection. Though the patient did not initially have findings suggestive of HLH, he later developed a clinical picture consistent with it. CONCLUSIONS: Diagnosis of HLH is often delayed due to its nonspecific signs and symptoms. Due to its poor prognosis, it is important to early on consider HLH in individuals including transplant recipients who present with systemic immune activation and a concerning clinical picture. REFERENCE #1: Amir, Rawan, et al. "Epstein-Barr virus versus novel coronavirus-induced hemophagocytic lymphohistocytosis: the uncharted waters." Journal of Investigative Medicine High Impact Case Reports 8 (2020): 2324709620950107. REFERENCE #2: Diaz-Guzman E, Dong B, Hobbs SB, Kesler MV, Hayes D Jr. Hemophagocytic lymphohistiocytosis after lung transplant: report of 2 cases and a literature review. Exp Clin Transplant. 2011 Jun;9(3):217-22. PMID: 21649574. REFERENCE #3: Retamozo, Soledad, et al. "Haemophagocytic syndrome and COVID-19." Clinical rheumatology (2021): 1-12. DISCLOSURES: no disclosure on file for Mishala Bateman;No relevant relationships by Sivagini Ganesh, source=Web Response No relevant relationships by Justine Ko, source=Web Response

An Open-Label Clinical Trial to Evaluate the Safety & Efficacy of Siddha Sastric Medicines - Fixed Regimen in CONID-19 Positive Asymptomatic, Mild or Moderate cases - A Pilot Study

Background: Covid-19 is a global pandemic since 2019. SARS-CoV2 is a new virus that originated from China and is currently spread across 160 countries. Siddha medicine is one of the traditional Indian medicines, part of Ayush that tend to treat several acute and chronic diseases. Aim: The objective of this study is to observe the safety and efficacy of Siddha regimen with lab parameters like LFT, RFT, RT-PCR, LDH, FERRITIN levels, and prevention of disease complications in covid-19 positive patients on the 7th day of treatment. Experimental Procedure: A nonrandomized open-label observational retrospective study was designed. Twenty patients of either sex, of age between 18 and 60 years, were selected with proper consent. The covid patients who were confirmed by positive RT-PCR test results with or without clinical features of covid-19 were selected. They were treated with Siddha Regimen for seven days. Results: Sixteen out of 20 cases turned RT-PCR negative on their 7th day of treatment. And the Ct value of RT-PCR was statistically significant. LDH and Ferritin levels were reduced after the treatment even though the before treatment values are in the normal range. The LDH level was statistically significant on the 7th day of treatment. No Remarkable changes in the safety laboratory parameters like SGOT, SGPT, Blood urea, Serum Creatinine. Conclusion: Significant changes in efficacy laboratory parameters and no changes in safety laboratory parameters have been reported in the Siddha fixed regimen for covid-positive patients. All the 20 study participants were recovered without emergency and hospitalization.