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SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: The science continues to develop in terms of the epidemiology of persistent, or long COVID, especially in the pediatric population. The impact of persistent COVID-19 on cardiorespiratory fitness in the form of physical activity and athletic performance among children/adolescents is not well described, especially among vulnerable populations. METHODS: A retrospective electronic health record review identified children/adolescents with previously diagnosed COVID (N=312, 52.9% male, mean age at diagnosis 6.6 [SD 5.9] years, 20.5% non-Hispanic White [NHW], 19.2% non-Hispanic Black [NHB], and 54.5% Hispanic, 85.26% hospitalized due to COVID-19 illness) from one pediatric healthcare system that serves predominantly Medicaid-dependent families. Patients or caregivers completed a follow-up telephone survey from March 2021- February 2022 to estimate the prevalence of persistent COVID symptoms, defined as the presence of symptoms lasting ≥ 30 days. Multiple logistic regression models explored the association between physical activity and the presence of long COVID. RESULTS: 71 (22.8%) patients reported long COVID and the most prevalent symptoms included tiredness (21 [6.7%]), shortness of breath (18 [5.8%]), cough (16 [5.1%]), headache (14 [4.5%]), difficulty with thinking/concentration (14 [4.5%]), disrupted sleep (14 [4.5%]), other symptoms (12 [3.8%]), anxiety (11 [3.5%]), body aches (11 [3.5%]), joint pain (10 [3.2%]) chest pain (9 [2.9%]), intermittent fever (6 [1.9%]), and loss taste/smell (5 [1.6%]). Almost a third (32%, N = 24) of patients who participated in any athletics or physical activity in or outside of school reported a negative impact on physical or athletic performance, and 66.7% reported it was directly related to COVID-19 illness. Specific complaints when returning to physical activity post-COVID illness included tiredness (7 [36.8%]) and shortness of breath (2 [10.5%]). The odds of a decline in physical activity performance was over twice that (OR 2.17, 95% CI 0.54-8.71, p = 0.28) among children with long COVID versus those reporting no long COVID after adjusting for demographics. There was no difference by age (mean 9.8 vs. 9.7 years, p = 0.93), sex (50% girls vs. 50% boys, p =0.71), or race/ethnicity (25% NHW vs. 25% NHB vs. 37.5% Hispanic, p = 0.25) in terms of decline in physical activity performance. Two children were recommended to delay re-entry into physical activity. CONCLUSIONS: A substantial proportion of ethnically diverse children from low resource backgrounds who had severe COVID illness are reporting long-term impacts on physical activity and cardiorespiratory fitness. Findings can inform pediatricians about this vulnerable population in post-COVID-19 recovery efforts. CLINICAL IMPLICATIONS: Pediatric pulmonologists and other sub-specialists should screen and monitor patients who have had previous severe COVID-19 illness for persistent cardiorespiratory impacts. DISCLOSURES: No relevant relationships by Kubra Melike Bozkanat No relevant relationships by Jackson Francis No relevant relationships by Weiheng He No relevant relationships by Alejandra Lozano No relevant relationships by Matthew Mathew No relevant relationships by Sarah Messiah No relevant relationships by Angela Rabl No relevant relationships by Sumbul shaikH No relevant relationships by Nimisha Srikanth No relevant relationships by Apurva Veeraswamy No relevant relationships by Sitara Weerakoon No relevant relationships by Luyu Xie
ABSTRACT
An Ayurvedic polyherbal formulation (Ayush-64) was repurposed for use in mild to moderate COVID-19 cases based on the supportive evidence obtained from a pilot study on its effect on Influenza like illness (ILI) and molecular docking study which revealed that several compounds isolated from Ayush-64 demonstrated antiviral activity. The study aims at evaluating the effect of an Ayurvedic intervention (Ayush-64) in mild to moderate COVID-19 patients. A prospective single arm, pilot study in mild to moderate COVID-19 patients. The study was conducted at Chaudhary Brahm Prakash Ayurved Charak Sansthan (CBPACS), New Delhi, India. A total of 37 COVID-19 participants confirmed through RT-PCR were included in the study. The proportion of participants with negative SARS-CoV-2 on nasal or throat swab in a 2-day consecutive real-time RT-PCR test was evaluated as the secondary outcome. In the study, 86.1% of participants demonstrated clinical recovery with 14 days of use of Ayush-64 as stand-alone treatment without any other conventional medicines, out of which 75% clinically recovered within 8 days. Further, 69.4% of participants turned negative by the 15th day, out of which 50% became COVID-19 negative on the 8th day. No AE/ ADR was observed during the study. Ayush-64 may significantly facilitate clinical improvement in terms of duration for clinical recovery and attaining negative conversion in mild to moderate COVID-19 cases.
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BACKGROUND: Outbreak of Corona Virus Disease in late 2019 (COVID-19) has become a pandemic global Public health emergency. Since there is no approved anti-viral drug or vaccine declared for the disease and investigating existing drugs against the COVID-19. OBJECTIVE: AYUSH-64 is an Ayurvedic formulation, developed and patented by Central Council of Research in Ayurvedic Sciences, India, has been in clinical use as anti-malarial, anti-inflammatory, anti-pyretic drug for few decades. Thus, the present study was undertaken to evaluate AYUSH-64 compounds available in this drug against Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2) Main Protease (Mpro; PDB ID: 6LU7) via in silico techniques. MATERIALS AND METHODS: Different molecular docking software's of Discovery studio and Auto Dock Vina were used for drugs from selected AYUSH-64 compounds against SARS-CoV-2. We also conducted 100 ns period of molecular dynamics simulations with Desmond and further MM/GBSA for the best complex of AYUSH-64 with Mpro of SARS-CoV-2. RESULTS: Among 36 compounds of four ingredients of AYUSH-64 screened, 35 observed to exhibits good binding energies than the published positive co-crystal compound of N3 pepetide. The best affinity and interactions of Akuammicine N-Oxide (from Alstonia scholaris) towards the Mpro with binding energy (AutoDock Vina) of -8.4 kcal/mol and Discovery studio of Libdock score of 147.92 kcal/mol. Further, molecular dynamics simulations with MM-GBSA were also performed for Mpro- Akuammicine N-Oxide docked complex to identify the stability, specific interaction between the enzyme and the ligand. Akuammicine N-Oxide is strongly formed h-bonds with crucial Mpro residues, Cys145, and His164. CONCLUSION: The results provide lead that, the presence of Mpro- Akuammicine N-Oxide with highest Mpro binding energy along with other 34 chemical compounds having similar activity as part of AYUSH-64 make it a suitable candidate for repurposing to management of COVID-19 by further validating through experimental, clinical studies.
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BACKGROUND: Influenza-like Illness (ILI) refers to a wide range of viral infections with an important cause of morbidity and mortality worldwide. The global incidence of ILI is estimated at 5-10% in adults and 20-30% in children. In India influenza accounts for 20-42% of monthly acute medical illness hospitalizations during the peak rainy season. AYUSH-64, a poly-herbal drug, is in practice for 40 years for various clinical conditions like fevers, microfilaremia, and inflammatory conditions. OBJECTIVE: A pilot study was conducted to evaluate the safety and efficacy of Ayurvedic formulation, AYUSH-64 in clinically diagnosed ILI for accelerating the recovery. MATERIAL AND METHODS: A prospective, open-label, nonrandomized, single group, single-center pilot clinical study with pre-test and post-test design was conducted at Raja Ramdeo Anandilal Podar Central Ayurveda Research Institute for Cancer, Mumbai, an institute of Central Council for Research in Ayurvedic Sciences (CCRAS) between June 2018 and July 2019. A total of 38 participants of clinically diagnosed ILI (18-65 years) were studied with an one-week intervention of 'AYUSH 64' in a dose of 3 gm/day and three weeks post-treatment observation period. Assessment of parameters viz. improvement in the symptoms of ILI, frequency of usage of acetaminophen, antihistaminic and cough syrup, hematology, liver function and kidney function tests along with incidence of secondary complications, and time to return to a normal routine was done. RESULTS: One-week intervention of AYUSH 64 helped to recover from ILI symptoms with reduced frequency of usage of acetaminophen and antihistaminic. The intervention was safe on hematology and biochemical parameters. No serious adverse effects were observed during the study. CONCLUSION: AYUSH 64 along-with standard care in ILI is safe and efficacious and this may be used in other viral infections with pyrexia as add-on to standard care for early recovery and better outcome.
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Prevalence of pulmonary thromboembolism (PTE) is very high when we compare the coronavirus disease 2019 positive patients with the other patients who are admitted in intensive care unit for other different infection. Thorough evaluation of the different causative factors for PTE should be better evaluated and prevention can be tried accordingly. Incidence of subclinical PTE that can give rise to future cardiac disease needs to be studied and plan of action can be done accordingly. Newer modalities of detecting PTE using non-invasive or simple invasive techniques need to be investigated to cope up in pandemic situation.
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Corona Virus disease (COVID-19) has become a global pandemic resulting in large scale morbidity and mortality worldwide. The management of COVID-19 has been a big challenge because of multifactorial pathophysiology and no specific treatment. AYUSH-64, a poly-herbal formulation developed by CCRAS, Ministry of AYUSH, Govt. of India through extensive pharmacological, toxicological and clinical studies has proven its safety and efficacy in infective febrile conditions such as malaria and influenza. AYUSH- 64 has four ingredients having immunomodulatory, anti-inflammatory, antipyretic, antioxidant and anti-viral activities. It arrests the extreme inflammatory responses in COVID-19 that causes progression to significant morbidity. AYUSH-64 has also been incorporated in the National COVID management protocol based on Ayurveda and Yoga by Government of India for asymptomatic and mild cases of COVID-19. Further, on the basis of tangible evidence generated through robust clinical and experimental studies on AYUSH-64, the Ministry of AYUSH has launched nation-wide campaign for mass distribution of AYUSH-64 to asymptomatic, mild to moderate COVID-19 patients in home isolation to reduce the burden on the hospital. This review will highlight the specifications of AYUSH-64, its mechanism of action, its repurposing for COVID-19, various clinical and experimental studies.
ABSTRACT
Corona Virus disease (COVID-19) has become a global pandemic resulting in large scale morbidity and mortality worldwide. The causative agent SARS-CoV-2 is easily subject to repeated mutation with swift spread of infection. The management of COVID-19 has been a big challenge on account of non-availability of specific therapeutic agents. The complex and multifactorial pathophysiology of COVID-19 requires therapeutic agents with anti-viral properties against SARS-CoV-2 as well as immunomodulatory properties that have a broad-spectrum effectiveness covering the disease in totality. AYUSH-64, a poly-herbal formulation developed by CCRAS, Ministry of AYUSH, Govt. of India through extensive pharmacological, toxicological and clinical studies has proven efficacy in infective febrile conditions such as malaria, micro filaremia, chikungunya and influenza with no safety issues observed in published clinical studies. Based on the empirical evidence, it has been repurposed as an adjuvant to standard care or standalone therapy for asymptomatic and mild to moderate cases of COVID- 19 by the Ministry of AYUSH at a time when India is experiencing wave after wave of COVID-19 variants causing mass distress to the healthcare delivery systems. AYUSH- 64 has four ingredients having immune-modulator, anti-inflammatory, antipyretic, antioxidant and anti-viral activities. These effects could arrest the extreme inflammatory responses in COVID-19 that causes progression to significant morbidity. Several clinical studies on AYUSH-64 in asymptomatic and mild to moderate cases of COVID-19 have been undertaken at reputed medical institutions across the country. The evidence generated through these studies is promising. AYUSH-64 has also been incorporated in the National COVID management protocol based on Ayurveda and Yoga by Government of India for asymptomatic and mild cases of COVID-19. Further, on the basis of tangible evidence generated through robust clinical and experimental studies on AYUSH-64, the Ministry of AYUSH has launched nation-wide campaign for mass distribution of AYUSH-64 to asymptomatic, mild to moderate COVID-19 patients in home isolation to reduce the burden on the hospital-based health care delivery system. This review will highlight about the specifications of AYUSH-64, its probable mechanism of action, its repurposing for COVID-19, various clinical and experimental studies undertaken during the COVID-19 pandemic and the initiatives taken to translate the outcomes of these studies on AYUSH-64.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection initiates with viral entry in the upper respiratory tract, leading to coronavirus disease 2019 (COVID-19). Severe COVID-19 is characterized by pulmonary pathologies associated with respiratory failure. Thus, therapeutics aimed at inhibiting the entry of the virus or its internalization in the upper respiratory tract are of interest. Herein, we report the prophylactic application of two intranasal formulations provided by the National Medicinal Plant Board (NMPB), Anu oil and til tailya, in the hamster model of SARS-CoV-2 infection. Prophylactic intra-nasal instillation of these oil formulations exhibited reduced viral load in lungs and resulted in reduced body weight loss and lung-pneumonitis. In line with reduced viral load, histopathological analysis revealed a reduction in lung pathology in the Anu oil group as compared to the control infected group. However, the til tailya group did not show a significant reduction in lung pathology. Furthermore, molecular analysis using mRNA expression profiling indicated reduced expression of pro-inflammatory cytokine genes, including Th1 and Th17 cytokines for both the intranasal formulations as a result of decreased viral load. Together, the prophylactic intranasal application of Anu oil seems to be useful in limiting both viral load and severity in SARS-CoV2 infection in the hamster model.
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BACKGROUND: India follows a pluralistic system for strategic and focused health care delivery in which traditional systems of medicine such as Ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa, and homoeopathy (AYUSH) coexist with contemporary medicine, and this system functions under the Ministry of AYUSH (MoA). The MoA developed a mobile app, called AYUSH Sanjivani, to document the trends of the use of AYUSH-based traditional and holistic measures by the public across India. Analysis of the data generated through this app can help monitor the extent of the use of AYUSH measures for maintenance of health during the COVID-19 pandemic and aid effective health promotion and communication efforts focused on targeted health care delivery during the pandemic. OBJECTIVE: The purpose of the study was to determine the extent of use of AYUSH measures by the public in India for maintenance of health during the COVID-19 pandemic as reported through the AYUSH Sanjivani mobile app. METHODS: Cross-sectional analysis of the data generated through the Ayush Sanjivani app from May 4 to July 31, 2020, was performed to study the pattern and extent of the use of AYUSH-based measures by the Indian population. The responses of the respondents in terms of demographic profile, use pattern, and benefits obtained; the association between the use of AYUSH-based measures and symptomatic status; and the association between the duration of use of AYUSH-based measures and the outcome of COVID-19 testing were evaluated based on bivariate and multivariate logistic regression analysis. RESULTS: Data from 723,459 respondents were used for the analysis, among whom 616,295 (85.2%) reported that they had been using AYUSH measures for maintenance of health during the COVID-19 pandemic. Among these 616,295 users, 553,801 (89.8%) either strongly or moderately agreed to have benefitted from AYUSH measures. Ayurveda and homeopathic measures and interventions were the most preferred by the respondents across India. Among the 359,785 AYUSH users who described their overall improvement in general health, 144,927 (40.3%) rated it as good, 30,848 (8.6%) as moderate, and 133,046 (40.3%) as slight. Respondents who had been using AYUSH measures for less than 30 days were more likely to be COVID-19-positive among those who were tested (odds ratio 1.52, 95% CI 1.44-1.60). The odds of nonusers of AYUSH measures being symptomatic if they tested positive were greater than those of AYUSH users (odds ratio 4.01, 95% CI 3.61-4.59). CONCLUSIONS: The findings of this cross-sectional analysis assert that a large proportion of the representative population practiced AYUSH measures across different geographic locations of the country during the COVID-19 pandemic and benefitted considerably in terms of general well-being, with a possible impact on their quality of life and specific domains of health.
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BACKGROUND CONTEXT: The North American Spine Society (NASS) spine fellowship directory is an established resource that provides applicants with access to important information about different fellowship programs. Additionally, some programs have created websites to provide information about their fellowship program. There has been limited research on the amount and breadth of information provided by these different resources. PURPOSE: To assess and compare the scope of information provided by the North American Spine Society (NASS) fellowship directory and individual fellowship program websites. STUDY DESIGN/SETTING: Web Content Accessibility Study. PATIENT SAMPLE: There were no patient data used in this study. All reported data were accessed from public websites and the NASS fellowship directory (August 2022 fellowships). OUTCOME MEASURES: Outcome measures were reported as the presence or lack thereof of 22 topics pertaining to the specifics of each individual spine fellowship program on both the NASS fellowship directory and individual fellowship program websites. METHODS: The NASS fellowship directory (August 2022 fellowships) and individual program websites were evaluated by two independent reviewers. Program websites were identified via Google search with a systematic protocol. Within each platform, the availability of various data were recorded. Twenty-four different data points were assessed for each program and were categorized into four main categories-general program information, fellow profiles, clinical roles, and nonclinical roles of the fellow. Chi-squared tests were used to compare differences in the availability of specific data provided by the NASS fellowship directory and individual program websites. RESULTS: Seventy-four fellowship programs were identified. The NASS fellowship directory was more likely to provide information about the application process, a description of the program, fellow salary, faculty members, case descriptions, and research requirements (p<.05). The program websites were more likely to provide information about current and previous fellows-including a list of current fellow(s), their education/training, and a list of the previous fellows and their job choice (p<.05). Program websites were also more likely to discuss rotation schedules, clinic expectations, research opportunities, journal club, institutional meetings, sponsored national meetings, and current/previous research (p<.05). However, certain information, including specific clinical responsibilities (eg, rotation schedule, call expectations, clinic expectations) and the profiles of current and previous fellows, were not well represented on either platform. CONCLUSIONS: There were significant differences in the type of information provided by the NASS fellowship directory and program websites. Furthermore, there were key pieces of information that were not well represented on either platform.