Evaluating effects of allo-vedic preparation Raj Nirwan Bati on symptomatic cases of COVID-19 at a tertiary level health care facility in rural setting of northern India

Background: The present pandemic of COVID-19 has created a huge pressure on the current health system of the world as the burden is increasing exponentially day by day. Study evaluated the effect of the novel allo-vedic formulation named Raj Nirwan Bati (RNB) on the clinical symptoms, microbiological, bio-chemical, haematological and radiological profile of patients of COVID-19.Methods: Prospective single arm, non- randomized clinical trial was conducted which enrolled 40 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed patients of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2). Each patient was given one dosage of RNB twice a day for 10 days. Patients were evaluated on the clinical symptoms, microbiological, bio-chemical, haematological and radiological profile of patients of COVID-19. Cochran’s Q tests was used to assess statistical significance.Results: The study revealed that 31 (77.5%) of the COVID-19 cases were having mild, 6 (15%) moderate and 3 (7.5%) having severe form of illness. The association between absence of clinical symptom (fever, cough, breathlessness, sore throat, fatigue and myalgia) and the day of evaluation (first, fifth and tenth day) after start of RNB intervention was found to be statistically significant (p<0.001, p<0.001, p=0.002, p<0.001, p<0.001 and p<0.001) respectively. Thirty (75.0%) of the cases on RNB intervention became negative for SARS-CoV-2 after day 5 on naso-pharyngeal and oro-pharyngeal RT-PCR testing (p<0.001). Statistically significant association was observed only for changes in proportion of cases with elevated lactate dehydrogenase (LDH) values and C-reactive protein (CRP) positive from day 1 to day 10 of RNB intervention (p<0.001).Conclusions: RNB may be considered a drug to fight against COVID-19.

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Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran

Archives of Iranian Medicine ◽

10.34172/aim.2020.102 ◽

2020 ◽

Vol 23 (11) ◽

pp. 766-775

Author(s):

Seyed Farshad Allameh ◽

Saeed Nemati ◽

Reza Ghalehtaki ◽

Esmaeil Mohammadnejad ◽

Seyed Mojtaba Aghili ◽

...

Keyword(s):

Clinical Characteristics ◽

Clinical Symptoms ◽

Risk Groups ◽

Severe Form ◽

Capital City ◽

Rt Pcr ◽

C Reactive Protein ◽

Reactive Protein ◽

History Of ◽

Elevated Lactate

Background: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. Methods: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters. Results: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63–38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06–10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00–8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64–3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07–2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study. Conclusion: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups.

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COVID-19 in an Asymptomatic Renal Transplant Recipient Employed in the Health Care Setting: A Case Report

International Journal of Angiology ◽

10.1055/s-0041-1725183 ◽

2021 ◽

Author(s):

Harsha Adnani ◽

Akshay Khatri ◽

Nirav Agrawal ◽

Ernesto Molmenti ◽

Madhu Bhaskaran

Keyword(s):

Health Care ◽

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Clinical Symptoms ◽

Severe Disease ◽

Care Facility ◽

Health Care Facility ◽

Asymptomatic Patients

AbstractDuring the ongoing pandemic, there have been varying presentations of coronavirus disease 2019 (COVID-19) infection, with the concern that patients who are immunosuppressed (due to underlying medical conditions and/or therapies) are at higher risk of severe disease. We report the case of an elderly renal transplant recipient working in a long-term health care facility who was being monitored by weekly surveillance testing and tested positive for COVID-19 by polymerase chain reaction (PCR) testing, despite having no clinical symptoms. He recovered with supportive care, despite being on multiple long-term immunosuppressant drugs and having multiple comorbidities. Additionally, it was found that he did not mount an antibody response, when he tested negative by serologic testing. Through this case, we wish to highlight the unique clinical scenario of asymptomatic patients who may have an underwhelming immune response to COVID-19, but may nevertheless be an important source of dissemination. We further discuss the probable mechanism of such asymptomatic presentations in immunosuppressed patients, while reinforcing the importance of self-isolation of COVID-19 patients (particularly in asymptomatic health care workers).

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Awareness and Myths Related to COVID-19 among Medical Students at a Tertiary Health Care Facility in Northern India.

Journal of Medical Education Development ◽

10.52547/edcj.14.41.1 ◽

2021 ◽

Vol 14 (41) ◽

pp. 1-10

Author(s):

NILIMA Takhelchangbam ◽

◽

Naresh Pal Singh ◽

Anamika Singh ◽

Deepanshi Saxena ◽

...

Keyword(s):

Health Care ◽

Medical Students ◽

Care Facility ◽

Health Care Facility ◽

Northern India

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Clinical manifestations and treatment outcomes of scrub typhus in a rural health care facility on the Thailand-Myanmar border

The Journal of Infection in Developing Countries ◽

10.3855/jidc.8912 ◽

2017 ◽

Vol 11 (05) ◽

pp. 407-413 ◽

Cited By ~ 2

Author(s):

Tobias Brummaier ◽

Chatporn Kittitrakul ◽

Vorada Choovichian ◽

Saranath Lawpoolsri ◽

Chayadol Namaik-larp ◽

...

Keyword(s):

Scrub Typhus ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Care Facility ◽

Health Care Facility ◽

Kidney Injury ◽

Rapid Test ◽

Common Symptom ◽

Positive Serology ◽

Adults And Children

Introduction: Scrub typhus is endemic in rural Southeast Asia. The district of Umphang in northwestern Thailand is a prototype environment for this disease. We report the clinical manifestations and outcomes of patients diagnosed with scrub typhus in this area. Methodology: Patients diagnosed with scrub typhus between 2011 and 2014 were analyzed. Diagnosis was based on clinical symptoms in conjunction with a positive rapid test or a pathognomonic eschar lesion. Results: A total of 857 patients were included, of which 488 were adults and 369 were children. Most patients (728; 84.9%) were included via a positive serology on rapid test, 86 patients (10.0%) had eschar only, and 43 patients (5.0%) had both sero-confirmation and presence of eschar. The most common symptom was fever (93.8%), followed by headache (48.1%) and cough (33.1%). Eschars were reported in 129 patients, with a significantly higher percentage in children (p < 0.001), and a different anatomical distribution was found when adults and children were compared. Common complications were elevated transaminases, acute kidney injury, and pneumonia. Most patients recovered from the disease. Conclusions: Scrub typhus in Umphang district is common. Patients can present with a variety of clinical symptoms, regardless of the presence of fever. Standard treatment led to a favorable outcome in most patients.

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Molecular and Virological Investigation of a Focal Chikungunya Outbreak in Northern India

The Scientific World JOURNAL ◽

10.1155/2013/367382 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Manisha Soni ◽

Anil Kumar Singh ◽

Shashi Sharma ◽

Ankita Agarwal ◽

Natarajan Gopalan ◽

...

Keyword(s):

Aedes Aegypti ◽

Chikungunya Virus ◽

Viral Rna ◽

Clinical Samples ◽

Nucleotide Sequencing ◽

The Novel ◽

Rt Pcr ◽

Northern India ◽

Genotype Identification ◽

Mosquito Pool

Chikungunya (CHIK) fever is one of the most important arboviral infections of medical significance. The objective of the present study is to identify and characterize the etiology of a focal febrile arthritis outbreak from Gwalior, northern India, during October-November 2010. A detailed virological (isolation) and molecular (end-point RT-PCR, quantitative RT-PCR, and nucleotide sequencing) investigation of this outbreak was carried out by collecting and studying 52 clinical samples and 15 mosquito pools from the affected region. The investigation revealed the presence of CHIK viral RNA in 29% of clinical samples and 13% mosquito pool by RT-PCR. The quantification of CHIK viral RNA in samples varied from 102.50to 106.67 copies/mL, as demonstrated through quantitative RT-PCR. In addition, six CHIK viruses were isolated from RT-PCR positive samples. The nucleotide sequences of partial E1 gene of five representative CHIK viruses were deciphered, which revealed that all the viral strains from this outbreak belong to the recently emerging ECS African genotype. Identification of Chikungunya virus ECSA African genotype as the etiology of the present outbreak confirms the continued circulation of the novel genotype, since 2006, in India. The identification of CHIK virus inAedes aegyptialso confirmed it as the major vector in northern India.

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Congenital Malaria in newborns delivered to Malaria-Infected mothers in hilly region of northern India: Is it really deadly?

Current Pediatric Reviews ◽

10.2174/1573396317666211102093324 ◽

2021 ◽

Vol 17 ◽

Author(s):

Avinish Singh ◽

Balram Ji Omar ◽

Swathi Chacham ◽

Jaya Chaturvedi ◽

Sriparna Basu ◽

...

Keyword(s):

Cord Blood ◽

Point Of Care ◽

Multivariate Logistic Regression Analysis ◽

Care Facility ◽

Health Care Facility ◽

Causative Factor ◽

Serological Tests ◽

Northern India ◽

Hilly Region ◽

Congenital Malaria

Background: Malaria is endemic in many states of India. Though there are reports of maternal and congenital malaria from endemic areas, however there remains paucity of data from hilly terrains. The present study evaluated the prevalence, clinical and microbiological spectrum of maternal and congenital malaria at a tertiary health care facility in Northern India over a period of 18 months. Methods: In this observational study, mothers along with their new borns were evaluated for malaria by maternal, placental and cord blood smear examination and rapid point-of-care diagnostic serological tests. Positive cases were confirmed by polymerase chain reaction. Mother-newborn duos were followed up till discharge from hospital. Results : A total of 843 mothers delivered during the study period and were screened along with their newborns and placentae. A total of Ten (1.18%) mothers had evidence of malarial parasitemia (Plasmodium vivax, n=7 and Pl. falciparum, n=3), however none of the placental and cord blood samples were positive for malaria. Overall, 127 (15.1%) neonates required admission in neonatal intensive care unit for various morbidities. Incidence of small for gestational age (SGA) was high (n=210; 24.9%). Multivariate logistic regression analysis demonstrated maternal malaria to be an independent contributor for SGA [Odds Ratio (95% Confidence Interval), 10.7 (2.06 - 49.72)]. However, only 2% variance of SGA could be explained by maternal malaria alone. Conclusions: We report an encouragingly lower incidence of maternal malaria in mothers attending for delivery and a ‘Zero’ incidence for placental and congenital malaria during the study period as compared to national data (upto 7.4% in non-immune mothers), although maternal malaria could be a causative factor for SGA.

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Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease

Infection ◽

10.1007/s15010-021-01597-7 ◽

2021 ◽

Author(s):

Lisa Pilgram ◽

◽

Lukas Eberwein ◽

Kai Wille ◽

Felix C. Koehler ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Fatal Outcome ◽

The Novel ◽

Reactive Protein ◽

Medical Evaluation ◽

Chi Squared ◽

Predictive Risk ◽

Respiratory Coronavirus ◽

Elevated Lactate

Abstract Purpose The ongoing pandemic caused by the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) has stressed health systems worldwide. Patients with chronic kidney disease (CKD) seem to be more prone to a severe course of coronavirus disease (COVID-19) due to comorbidities and an altered immune system. The study’s aim was to identify factors predicting mortality among SARS-CoV-2-infected patients with CKD. Methods We analyzed 2817 SARS-CoV-2-infected patients enrolled in the Lean European Open Survey on SARS-CoV-2-infected patients and identified 426 patients with pre-existing CKD. Group comparisons were performed via Chi-squared test. Using univariate and multivariable logistic regression, predictive factors for mortality were identified. Results Comparative analyses to patients without CKD revealed a higher mortality (140/426, 32.9% versus 354/2391, 14.8%). Higher age could be confirmed as a demographic predictor for mortality in CKD patients (> 85 years compared to 15–65 years, adjusted odds ratio (aOR) 6.49, 95% CI 1.27–33.20, p = 0.025). We further identified markedly elevated lactate dehydrogenase (> 2 × upper limit of normal, aOR 23.21, 95% CI 3.66–147.11, p < 0.001), thrombocytopenia (< 120,000/µl, aOR 11.66, 95% CI 2.49–54.70, p = 0.002), anemia (Hb < 10 g/dl, aOR 3.21, 95% CI 1.17–8.82, p = 0.024), and C-reactive protein (≥ 30 mg/l, aOR 3.44, 95% CI 1.13–10.45, p = 0.029) as predictors, while renal replacement therapy was not related to mortality (aOR 1.15, 95% CI 0.68–1.93, p = 0.611). Conclusion The identified predictors include routinely measured and universally available parameters. Their assessment might facilitate risk stratification in this highly vulnerable cohort as early as at initial medical evaluation for SARS-CoV-2.

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Risk Factors and Clinical Outcomes of Cancer Patients with Clostridium difficile Associated Diarrhea Co-infected with a Second Enteropathogen

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.881 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S362-S363

Author(s):

Harika Yalamanchili ◽

Andrew Chao ◽

Eduardo Yepez Guevara ◽

Samuel L Aitken ◽

Micah Bhatti ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Cancer Patients ◽

Clinical Symptoms ◽

Care Facility ◽

Health Care Facility ◽

Exact Test ◽

Increased Risk ◽

Clostridium Difficile Associated Diarrhea ◽

The Impact

Abstract Background Cancer patients are at an increased risk for C. difficile infection (CDI) which is often identified along with other enteropathogens. The impact of co-infections on outcomes has not been established in this population. We compared the risk factors and clinical characteristics of patients with CDI monoinfection (CDIM) and patients coinfected with bacterial (CDIB) or viral (CDIV) enteropathogens. Methods Adult patients presenting with primary or recurrent CDI (n = 88) identified on a two-step GI multiplex assay (Biofire) followed by toxin A/B EIA, were classified into CDIM (n = 66), CDIB (n = 12), and CDIV (n = 10) groups. Demographic and clinical data were collected and risk factors and outcomes compared by Fisher’s exact test, ANOVA, and the Kruskal–Wallis test. CDI severity was determined using Zar’s criteria, presence of bacteremia, and ICU stay. Results During the study period, 2,017 diarrheal samples were submitted to the microbiology laboratory. An enteric pathogen was identified in 311 (15%) patients. CDI was identified in 88 cases of which 22 (25%) had a second pathogen. CDIM was found in 66 (21%), CDIB in 12 (4%), and CDIV in 10 (3%) subjects. The most common co-pathogens identified were diarrheagenic E. coli in the CDIB group (9/12, 75%) and norovirus in the CDIV group (8/10, 80%). Groups were similar in terms of demographics, number of recurrences, health care acquisition, co-morbidities, disease severity, serum creatinine at presentation, presence of toxin by EIA, and mortality. Patients with CDIM were more likely to have a recent hospitalization than the CDIB group (44/66 67% vs.. 3/12 25%, P = 0.01). Clinical symptoms at presentation were similar for the three groups except for nausea which was more common in the CDIV group when compared with CDIM (8/10, 80% vs. 25/66, 38%; P = 0.02). The use of proton pump inhibitors was similar in the three groups. There was however, a higher proportion of patients taking GABA-like drugs within 90 days among the CDIB patients (10/12, 83%) than the group with CDIM (26/66, 40%) P = 0.01. Conclusion In CDI cancer patients, co-infection with other enteropathogens is common. Patients with CDIB were less likely to have a recent admission to a health care facility. The use of GABA-like drugs was associated with a higher risk of bacterial co-infection. Disclosures All authors: No reported disclosures.

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Impact and Adaptation of Reproductive Training During COVID-19 Pandemic in Malaysia

Malaysian Journal of Medical Sciences ◽

10.21315/mjms2021.28.5.3 ◽

2021 ◽

Vol 28 (5) ◽

pp. 34-41

Author(s):

Abdul Kadir Abdul Karim ◽

◽

Muhammad Azrai Abu ◽

Mohd Faizal Ahmad ◽

Norazilah Mat Jin ◽

...

Keyword(s):

Health Care ◽

Reproductive Medicine ◽

Health Care Services ◽

Care Facility ◽

Health Care Facility ◽

Simulator Training ◽

The Novel ◽

Care Services ◽

Novel Coronavirus

The novel coronavirus (COVID-19) pandemic has affected the community at large. It has affected almost everyone and every aspect of social, economic and educational activities. Training in reproductive medicine has not been spared, as training in this field requires a combination of clinical interaction with patients, procedural experience, constant discussions and the element of research. The changes to numbers of new infections or active cases dictate the restrictions placed on the community and health care services alike. At the beginning of the pandemic, both the patients’ fear of going to a health care facility and movement restrictions had caused a significant reduction in the number of COVID-19 cases. Furthermore, the Ministry of Health (MOH) Malaysia’s recommendation to withhold all non-essential medical services, including those related to reproductive medicine, falls under this category. Therefore, it could negatively impact the quality of training and lead to an extension of training duration in reproductive medicine. Thus, the procedural experience could be supplemented with simulator training, teleconsultation could replace standard clinic sessions and online meeting platforms could replace routine academic meetings. Any modifications must be adaptable or flexible, as similar infectious pandemics and restrictions could recur from time to time.

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Radiological and clinical characteristics of 22 suspected COVID-19 patients with multiple negative RT-PCR testing

10.21203/rs.3.rs-27135/v1 ◽

2020 ◽

Author(s):

Wenjun Wu ◽

Heshui Shi ◽

Bo Liang ◽

Feihong Wu ◽

Dongqiao Xiang ◽

...

Keyword(s):

Clinical Characteristics ◽

Clinical Symptoms ◽

Lower Lobe ◽

Ground Glass Opacity ◽

Pulmonary Involvement ◽

Active Management ◽

Rapid Progression ◽

Rt Pcr ◽

Reactive Protein ◽

Group 2

Abstract This study aims to investigate radiological and clinical characteristics of suspected COVID-19 patients with negative RT-PCR testing. 22 suspected COVID-19 patients with 2-5 negative RT-PCR testing were enrolled. The most common symptoms at onset included fever (18[81.8%] patients), fatigue (16[72.7%]) and cough (12[54.5%]). 20(90.9%) patients were with normal or decreased Leukocyte count, 17 (77.3%) with decreased Lymphocyte count, 16 (72.7%) and 18 (81.8%) with increased level of C-reactive protein and D-dimers, respectively. Ground-glass opacity (GGO) (22[100]), reticular/interlobular septal thickening (11 [50%]) and consolidation (14 [63.6%)) with predominantly bilateral and peripheral distribution were typical findings at initial CT scan. The CT score of right lower lobe was significantly higher than right upper lobe (P=0.042). The total CT scores of group 2, 3, 4 (2nd week, 3rd week, 4th week and after) were significantly higher than group 1 (1st week) (P＜0.01,for all). After rapid progression at first week, the most extensive pulmonary involvement emerged at second week after symptom onset, then the involvement gradually decreased. Given the clinical symptoms, laboratory results and typical radiological manifestations, even suspected COVID-19 patients with multiple negative RT-PCR testing deserve great concern for active management.

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