ABSTRACT
Novel coronavirus commonly known as coronavirus disease 19 (COVID-19) has rapidly spread worldwide and triggered the current global health crisis. It mostly affects humans through the zoonotic transmission of coronavirus 2 (SARS-CoV-2). This chapter focuses on the various epidemics and pandemics (plague, cholera, Spanish flu, etc.) in the history of human civilization, principal component analysis (PCA) for the interpretation of COVID-19 spreading kinetics during the first wave (in the year 2020), the potential use of herbal medicines, dietary remedies, and allopathic therapy to fight COVID-19, and various preventive measures undertaken to combat the pandemic during the first wave. The numbers of confirmed, recovered, active, and deceased cases is considered for the mapping of PCA within different countries. This study can be used as an informative approach for anticipating and strategy-making against COVID-19 or some other pandemics in the ensuing times. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Aims & Objectives: In this study we analysed the utility of serial measurements of IL6 levels in patients with SARS-CoV-2 to intervene with Tocilizumab in SARS CoV2 severe ARDS, and to assess the role of tocilizumab and predictability of Interleukin 6 levels for use of Tocilizumab by which invasive Mechanical ventilation can be avoided in patients with severe ARDS. Patients/Materials & Methods: This retrospective observational study includes 39 adult patients with SARS CoV2 severe ARDS who were admitted to tertiary care centre, Breach Candy Hospital Mumbai between 17th of May and 8th of August 2020. All 39 patients were treated with the standard of care out of which 26 patients who were given Tocilizumab constituted study group and 13 patients who didn't receive Tocilizumab constituted control group. For study group serial levels of IL6 were done before giving tocilizumab and after it. Tocilizumab was given intravenously at 8 mg/kg bodyweight (up to a maximum of 800 mg) in two infusions, 12 h apart, The primary endpoint was a composite of invasive mechanical ventilation or death. Results: The mean age of the patients in tocilizumab group was 64.12 ± 10.75 whereas in control it was 68.15 ± 15.67. 5 deaths were observed in tocilizumab group versus 5 deaths in control group (p = 0.19). In study group, out of 12 patients who required ventilation support, 9 survived versus 1 in control group (p = 0.01) and was statistically significant. In tocilizumab group all the patient who were on BPAP or HFNC recovered well. No difference was found in IL-6 levels pre-treatment versus post-treatment (p = 2.17) in study group. Discussion & Conclusion: Our study concluded that though IL6 is a good marker of cytokine storm but its predictivity to determine tocilizumab usage was not found significant. Tocilizumab when given early in severe acute respiratory distress patients improves the outcome when compared with control group irrespective of IL6 levels.
ABSTRACT
Aims & Objectives: In this study we analysed the predictability of Neutrophil/Lymphocyteratio in patient with severe SARS-CoV-2 Acute Respiratory Distress Syndrome and role of steroid (Dexamethasone and Methylprednisolone) in controlling transition of inflammatory phase of pneumonia to hyper inflammatory phase ofARDS. Patients/Materials & Methods: This retrospective observational study includes>250 patients admitted in BKCCOVID Centre Mumbaifrom 1st September onwards (ongoing) who are RT-PCR positive for SARSCoV2 and presented with pneumonicpatchin Xray and breathlessness. All these patients were treated with standard of care treatment special with steroids (Dexamethasone 6 mg/day or Methylprednisolone 80 mg BD) and LMWH. Patients with high N/L Ratio>5 with GGOs in Xray were put on steroidsplus LMWH and amoxicillineplusclavulanic acid.While those who on admission with N/L>7 with distress were considered for MPSpulse therapy. Results: Patient who were having N/L ratio>7 without any coverofsteroids and LMWH had poor disease outcome as compared to patients who are on steroids and LMWH. While those who were N/L>5 but were on Steroids and LMWH had better outcome even after increase in N/L ratio. Discussion &Conclusion: Patients with N/L>5 should be started with steroids with LMWH with broad spectrum antibiotics, while those with N/L>7 with respiratory distress should be considered for MPS pulsetherapy.
ABSTRACT
Novel Coronavirus Disease 2019 or Covid-19 Pandemic has become a globally recognized public-health phenomenon. As of September 2020, over 30 million people have been affected worldwide, and more than 1 million deaths have been registered. Healthcare professionals & researchers around the world are working hand in hand to find a vaccine or an efficient cure for this dis-ease. Till then, a large part of the globe remains under lock down, and people are advised to follow certain guidelines like social distancing, practicing hand hygiene, etc. Pharmacists are one of the key healthcare workers who are working to fight this Pandemic. This commentary is an effort to describe their role in combating this Pandemic in a developing nation India. They are responsi-ble for manufacturing/ supplying/dispensing of drugs to the ailing patients in the hospitals and community. In rural areas, pharmacists are expected to provide medical guidance. They play a vital role in medical information services within the hospital, along with providing Pharmacovigilance activities related to Covid-19 drugs. The essentiality of the presence of clinical pharmacists is being felt increasingly in India, where the healthcare workforce is limited. The safety of these caregivers during this Pandemic should be a pri-ority so that this healthcare force can be efficiently utilized in managing the Pandemic in the country in the coming days.