Rate of Recovery and Symptomatic Efficacy of a Polyherbal AYUSH Formulation in the Treatment of SARS-CoV-2 Disease: A Single-arm Trial.

Background: The COVID-19 pandemic, caused by the human coronavirus, SARS-CoV-2, has led to the death of millions across the globe. The SARS-CoV-2 virus is highly infectious, and mutates rapidly. This creates additional challenges for the development of robust therapeutic solutions. Along with modern healthcare, there is a need to explore natural, plant-based antiviral compounds that can be used in the treatment of COVID-19. Objective: The present feasibility study investigates the efficacy of a 13-ingredient Ayurvedic polyherbal formulation, NOQ19, in the management of COVID-19. Methodology: A single-arm, open-label study design was adopted for this feasibility study. 161 RT-PCR-positive COVID-19 patients were enrolled. The enrolled participants were provided with the Ayurvedic intervention - two tablets of NOQ19 thrice daily along with the standard of care treatment. Follow-up COVID-19 RT-PCR tests were conducted on days 5, 10, and 14 or until the patient tested negative. The time taken to turn RT-PCR negative or become asymptomatic was noted. Setting: The study was conducted at Sri Sri Institute for Advanced Research from April 2021 to June 2021. Participants: A total of 161 COVID-19 patients isolating at home were assessed. Intervention: The NOQ19 preparation is a combination of 13 Ayurvedic herbs. Outcomes Measured: RT-PCR tests, the turnaround time to becoming asymptomatic, and regular symptoms assessment. Results: The analysis demonstrated that 74% of the patients tested negative on the RT-PCR within five days of taking NOQ19. Additionally, 98% of the subjects tested negative on the RT-PCR on day 10 after taking NOQ19 and standard of care treatment (as necessary). None of the participants reported any adverse events or side-effects due to NOQ19 medication. Conclusion: The NOQ19 Ayurvedic polyherbal formulation can be an effective and safe option for the symptomatic management of COVID-19.

Outcome of tracheostomy among COVID-19 patients in a tertiary hospital setting: Our experience.

INTRODUCTION: The COVID-19 pandemic is unprecedented. Amongst those who contracted COVID-19, a number required intubation and prolonged ventilation. This increased the number of ventilated patients in the hospital and increased the requirement for tracheostomy of severe COVID-19 patients. Our objective is to study the outcome of patients with COVID-19 who underwent tracheostomy. MATERIALS AND METHODS: This study is a novel retrospective study in a tertiary centre in Malaysia. Case notes of COVID- 19 patients who underwent tracheostomy in Hospital Ampang were collected using the electronic Hospital Information System. Data were analysed using the SPSS system. RESULTS: From a total of 30 patients, 15 patients survived. All patients underwent either open or percutaneous tracheostomy. The median age is 53 (range: 28-69) with a significant p-value of 0.02. Amongst comorbidities, it was noted that diabetes mellitus was significant with a p-value of 0.014. The median time from the onset of COVID-19 to tracheostomy is 30 days. The median duration of intensive care unit (ICU) stay is 30.5 days, with the median duration of hospital length of stay of 44 days (p = 0.009 and <0.001, respectively). No complications that contributed to patient death were found. Survivors had a median of 29.5 days from tracheostomy to oxygen liberation. CONCLUSION: Tracheostomy in COVID-19 patients that requires prolonged ventilation is unavoidable. It is a safe procedure and mortality is not related to the procedure. Mortality is primarily associated with COVID-19.

An In-vitro evaluation of a polyherbal formulation, against SARS-Cov-2.

Background: In the last two years, COVID-19 pandemic caused by SARS-CoV-2 has created a mass destruction among humanity causing a major health crisis around the world. With the emergence of new strains of the virus, lack of targeted drugs and antimicrobial resistance, there is a dire need to discover specific antiviral with minimum side effects targeted against COVID-19. Objective: The present study evaluates the antiviral efficacy of a novel Ayurvedic polyherbal formulation, NOQ19, composed of a 13 well known herbs, in a cell-based setting. Methodology: Vero E6 (CL1008), the African green monkey kidney epithelial cell, were infected with SARS-CoV-2 virus (isolate USA-WA1/2020) in a 96 well-plate. NOQ19 test material was diluted at different concentration: 0.05 mg/ml, 0.1 mg/ml, 0.2 mg/ml, 0.3 mg/ml, 0.4 mg/ml, 0.5 mg/ml, 0.6 mg/ml, 0.7 mg/ml, 0.8 mg/ml and 0.9 mg/ml. These different concentrations of NOQ19 were added to infected cells respectively and incubated for 3 days in 5% CO2 incubator. Remdesivir was used as a positive control. The cells were finally fixed with formaldehyde, stained with crystal violet and plaques were visualized. The number of plaques were counted to determine the PFU(plaque forming units)/ml. Results: The results of the present study demonstrated an excellent an antiviral efficacy of NOQ19 at 0.9 mg/ml concentration, eliminating 100% virus. The IC50 of the drug was found to be 0.2 mg/ml. Conclusion: There is limited data around pre-clinical efficacy of polyherbal Ayurvedic drugs. Ayurvedic and herbal formations need to be tested in a preclinical setting to support the human data. The results of the present study demonstrated viral load reduction using NOQ19 in Vero E6 cell lines infected with SARS-CoV-2 virus. These result along with other preclinical and clinical trials could further evaluate the efficacy of NOQ19 as a potential therapeutic option in the fighting the COVID-19 challenge.

Telemedicine: An Effective Tool for Patient-Physician Communication.

The purpose of this study was to evaluate the effectiveness of telemedicine appointments in a tertiary orthopedic hip clinic during the COVID-19 pandemic, as a substitute for traditional in-person visits. One hundred sixty-three patients had a telemedicine visit from March to September 2020. Patients were divided into two cohorts. The presurgical group included all patients who had not undergone any prior surgical hip procedures. The pre-surgical group was further subdivided into two groups based on the purpose of the visit: conservative treatment and imaging review. Patients who were indicated for surgical treatment from these two groups were identified to assess their compliance with the surgical indication. The effectiveness was measured by assessing whether patients required an in-person visit before the scheduled follow-up after the telemedicine visit for further medical assessment. Fifty (30.7%) men and 113 (69.3%) women had a telemedicine visit during the 6-month period. The mean age was 43.68 (±16.95) years. There were 92 (56.4%) patients in the presurgical group, of whom 41% followed up after indication for conservative treatment and 59% visited to review imaging. From these groups, 27% were indicated for surgical treatment. The postsurgical group contained 71 (43.6%) patients, divided into three groups based on their surgery date: 0 to 3 months (27%), 4 to 12 months (59%), and more than 12 months (14%). All patients were compliant with the scheduled follow-up after their telemedicine visit. This study showed that telemedicine can be an effective tool for patient-physician communication, obviating the need for subsequent follow-up beyond regularly scheduled visits. [Orthopedics. 2023;46(3):e173-e178.].

Rate of Recovery and Symptomatic Efficacy of a Polyherbal AYUSH Formulation in the Treatment of SARS-CoV-2 Disease: A Single-arm Trial.

Background: The COVID-19 pandemic, caused by the human coronavirus, SARS-CoV-2, has led to the death of millions across the globe. The SARS-CoV-2 virus is highly infectious, and mutates rapidly. This creates additional challenges for the development of robust therapeutic solutions. Along with modern healthcare, there is a need to explore natural, plant-based antiviral compounds that can be used in the treatment of COVID-19. Objective: The present feasibility study investigates the efficacy of a 13-ingredient Ayurvedic polyherbal formulation, NOQ19, in the management of COVID-19. Methodology: A single-arm, open-label study design was adopted for this feasibility study. 161 RT-PCR-positive COVID-19 patients were enrolled. The enrolled participants were provided with the Ayurvedic intervention - two tablets of NOQ19 thrice daily along with the standard of care treatment. Follow-up COVID-19 RT-PCR tests were conducted on days 5, 10, and 14 or until the patient tested negative. The time taken to turn RT-PCR negative or become asymptomatic was noted. Setting: The study was conducted at Sri Sri Institute for Advanced Research from April 2021 to June 2021. Participants: A total of 161 COVID-19 patients isolating at home were assessed. Intervention: The NOQ19 preparation is a combination of 13 Ayurvedic herbs. Outcomes Measured: RT-PCR tests, the turnaround time to becoming asymptomatic, and regular symptoms assessment. Results: The analysis demonstrated that 74% of the patients tested negative on the RT-PCR within five days of taking NOQ19. Additionally, 98% of the subjects tested negative on the RT-PCR on day 10 after taking NOQ19 and standard of care treatment (as necessary). None of the participants reported any adverse events or side-effects due to NOQ19 medication. Conclusion: The NOQ19 Ayurvedic polyherbal formulation can be an effective and safe option for the symptomatic management of COVID-19.

SARS-CoV-2: The Virus

The following sections are included: Key Message Introduction Virology Clinical Features of Disease, Physiological Implications, and Prognosis Modes of Transmission The Rise of Variants and Related Public Health Concerns Conclusion References. © 2022 World Scientific Publishing Company.

Nutraceuticals in HIV and COVID-19-Related Neurological Complications: Opportunity to Use Extracellular Vesicles as Drug Delivery Modality.

People living with HIV/AIDS (PLWHA) are at an increased risk of severe and critical COVID-19 infection. There is a steady increase in neurological complications associated with COVID-19 infection, exacerbating HIV-associated neurocognitive disorders (HAND) in PLWHA. Nutraceuticals, such as phytochemicals from medicinal plants and dietary supplements, have been used as adjunct therapies for many disease conditions, including viral infections. Appropriate use of these adjunct therapies with antiviral proprieties may be beneficial in treating and/or prophylaxis of neurological complications associated with these co-infections. However, most of these nutraceuticals have poor bioavailability and cannot cross the blood-brain barrier (BBB). To overcome this challenge, extracellular vesicles (EVs), biological nanovesicles, can be used. Due to their intrinsic features of biocompatibility, stability, and their ability to cross BBB, as well as inherent homing capabilities, EVs hold immense promise for therapeutic drug delivery to the brain. Therefore, in this review, we summarize the potential role of different nutraceuticals in reducing HIV- and COVID-19-associated neurological complications and the use of EVs as nutraceutical/drug delivery vehicles to treat HIV, COVID-19, and other brain disorders.

The efficacy of an Ayurvedic polyherbal formulation in the symptomatic management of mild COVID-19 cases: A double blind, randomized controlled trial (preprint)

Purpose: The COVID-19 pandemic, caused by the SARS-CoV-2 virus has infected millions of people globally, overwhelming the pharmaceutical industry and health care systems. The resulting crisis has highlighted the need for modern and traditional medicine systems to work together to find effective solutions quickly. Modern systems of medicine are primarily oriented towards symptomatic treatment, whereas the traditional systems of medicine such as Ayurveda emphasize prevention as well as treatment. Patients and methods NF2 is polyherbal Ayurvedic formulation consisting of 19 ingredients from 13 herbs. 50 patients with confirmed symptomatic or asymptomatic case of COVID-19, reporting to the study site were invited to participate in a double blinded, randomized placebo-controlled clinical trial. The study duration was around 3 months, and the intervention period for an individual patient was 10 days. Results: Significant improvements were observed in the NF2 arm in comparison to the placebo arm. On Day 5, the population in the NF2 arm showed a complete recovery from sputum formation, sore throat, headache and fever. By Day 10, 90-100% of the population in the NF2 arm showed a complete recovery from all symptoms, unlike the control arm. Conclusion: NF2 facilitated a complete recovery from all clinical features of COVID-19 faster, when compared to the control. No side effects were observed during the entire study duration.

An Automatic Real-Time Face Mask Detection using CNN

Coronavirus (Covid-19) is continuously spreading all over the world now with different variances like alpha, beta, gamma, Epsilon, and Zeta. There are numerous careful steps are taken to minimize the spread of corona virus. Wearing face mask is one among the important measures that people should follow but unfortunately the majority of individuals are not following this safety measure in public spaces. In this paper, we have proposed a novel face mask detection model by cascading three CNN models such as YOLO V3, Facenet and Mobilenet. Here, YOLO V3 model is used for detecting people in a surveillance video data which helps to reduce the search space for face detection techniques. Second CNN model namely Facenet is incorporated to detect the face which is then fed to Mobilenet for mask detection. In the proposed work, mask detection is considered as a binary class problem where a people without mask are discriminated from the people with face mask. A transfer learning is adopted for YOLO V3 and Facenet models. The output layer of Mobilenet is modified for the binary classification. Mobilenet is trained with 3833 instances belonging to both the classes were collected from a realtime data acquired in the laboratory environment during offline classes and from sources like Kaggle and Google images. The trained model has achieved 99.2% accuracy for unseen data. © 2021 IEEE.

Role of Statins in the Primary Prevention of Atherosclerotic Cardiovascular Disease and Mortality in the Population with Mean Cholesterol in the Near-Optimal to Borderline High Range: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of this meta-analysis was to analyze the benefits and harms of treating the population with statins in those having mean low-density lipoprotein cholesterol (LDL-C) in the near-optimal (100 to 129 mg/dl) to borderline high (130 to 159 mg/dl) range and free of cardiovascular disease (CVD). METHODS: We searched PubMed, PubMed Central, Cochrane Library, and Google Scholar databases for randomized controlled trials (RCTs) published between 1994 and July 2020. We included RCTs with greater than 90% of participants free of CVD. Two reviewers independently screened the articles using the Covidence software, assessed the methodological quality using the risk of bias 2 tool, and analyzed the data using the RevMan 5.4 software. RESULTS: Eleven trials were included. Statin therapy was associated with a decreased risk of myocardial infarction (RR = 0.56, 95% CI: 0.47 to 0.67), major cerebrovascular events (RR = 0.78, 95% CI: 0.63 to 0.96), major coronary events (RR = 0.67, 95% CI: 0.57 to 0.80), composite cardiovascular outcome (RR = 0.71, 95% CI: 0.62 to 0.82), revascularizations (RR = 0.65, 95% CI: 0.57 to 0.74), angina (RR = 0.76, 95% CI: 0.63 to 0.92), and hospitalization for cardiovascular causes (RR = 0.74, 95% CI: 0.64 to 0.86). There was no benefit associated with statin therapy for cardiovascular mortality and coronary heart disease mortality. All-cause mortality benefit with statin therapy was seen in the population with diabetes and increased risk of CVD. Statin therapy was associated with no significant increased risk of myalgia, creatine kinase elevation, rhabdomyolysis, myopathy, incidence of any cancer, incidence of diabetes, withdrawal of the drug due to adverse events, serious adverse events, fatal cancer, and liver enzyme abnormalities. CONCLUSION: Statin therapy was associated with a reduced risk of cardiovascular disease and procedures without increased risk of harm in populations with mean LDL-C in the near-optimal to the borderline high range and without prior atherosclerotic cardiovascular disease.

Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations.

The Sendai Framework for Disaster Risk Reduction 2015-2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.

Severe COVID-19 Is Characterized by an Impaired Type I Interferon Response and Elevated Levels of Arginase Producing Granulocytic Myeloid Derived Suppressor Cells.

COVID-19 ranges from asymptomatic in 35% of cases to severe in 20% of patients. Differences in the type and degree of inflammation appear to determine the severity of the disease. Recent reports show an increase in circulating monocytic-myeloid-derived suppressor cells (M-MDSC) in severe COVID 19 that deplete arginine but are not associated with respiratory complications. Our data shows that differences in the type, function and transcriptome of granulocytic-MDSC (G-MDSC) may in part explain the severity COVID-19, in particular the association with pulmonary complications. Large infiltrates by Arginase 1+ G-MDSC (Arg+G-MDSC), expressing NOX-1 and NOX-2 (important for production of reactive oxygen species) were found in the lungs of patients who died from COVID-19 complications. Increased circulating Arg+G-MDSC depleted arginine, which impaired T cell receptor and endothelial cell function. Transcriptomic signatures of G-MDSC from patients with different stages of COVID-19, revealed that asymptomatic patients had increased expression of pathways and genes associated with type I interferon (IFN), while patients with severe COVID-19 had increased expression of genes associated with arginase production, and granulocyte degranulation and function. These results suggest that asymptomatic patients develop a protective type I IFN response, while patients with severe COVID-19 have an increased inflammatory response that depletes arginine, impairs T cell and endothelial cell function, and causes extensive pulmonary damage. Therefore, inhibition of arginase-1 and/or replenishment of arginine may be important in preventing/treating severe COVID-19.

IVACS: Intelligent Voice Assistant for Coronavirus Disease (COVID-19) Self-Assessment (preprint)

At the time of writing this paper, the world has around eleven million cases of COVID-19, scientifically known as severe acute respiratory syndrome corona-virus 2 (SARS-COV-2). One of the popular critical steps various health organizations are advocating to prevent the spread of this contagious disease is self-assessment of symptoms. Multiple organizations have already pioneered mobile and web-based applications for self-assessment of COVID-19 to reduce this global pandemic's spread. We propose an intelligent voice-based assistant for COVID-19 self-assessment (IVACS). This interactive assistant has been built to diagnose the symptoms related to COVID-19 using the guidelines provided by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). The empirical testing of the application has been performed with 22 human subjects, all volunteers, using the NASA Task Load Index (TLX), and subjects performance accuracy has been measured. The results indicate that the IVACS is beneficial to users. However, it still needs additional research and development to promote its widespread application.

Antibody Profiling and Prevalence in the US population during the SARS-CoV2 Pandemic (preprint)

ABSTRACT Background: Antibody diagnostics play an important role in disease detection and can potentially aid in monitoring of the immune responses to see if an individual has developed immunity. Developing high throughput diagnostics which does not involve handling of infectious material becomes imperative in the case of pandemics such as the recent outbreak of SARS-CoV2. Methods: A protein microarray technology was used to detect the plurality of antibody response to four novel antigens namely S1 glycoprotein, Receptor binding domain (RBD), S2 glycoprotein and Nucleoprotein of the novel coronavirus named SARS-CoV2 using serum samples. A DBS card was additionally used to compare its performance with a venipuncture-based serum separator tube (SST) draw. Results: The three main subclasses of antibodies IgM, IgA and IgG were analyzed to see the variations in immune responses in the affected population and compared to their microbial RT-PCR based NP swab results. The clinical sensitivity and specificity were determined to be 98.1% and 98.6%. In the matrix comparison study, which would enable patients to test without risk of transmitting the virus, DBS matched with higher than 98% accuracy to a venipuncture-based SST collection. Conclusion: Multiplex testing enables higher sensitivity and specificity which is essential while establishing exposure on a population scale. This flexible platform along with a discrete collection methodology would be crucial and broadly useful to scale up testing in current and future pandemics. Minimum sample volume that can be collected using DBS cards can be processed in this multiplex pillar plate format enabling the capacity to provide the reliability of high throughput analyzers while having the ease of collection similar to rapid tests. Keywords: COVID19, SARS-CoV2, Antibody, Multiplex, serology, biomarker, immune modulation, prevalence, high sensitivity, high specificity, Dried blood spot, pandemic, venipuncture