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

PurposeThe 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 methodsNF2 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.ResultsSignificant 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.ConclusionNF2 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.

High D-dimer Level in Fracture Patient with Asymptomatic Covid-19: Dilemmatic Surgery Decision - A Serial Case Report

Introduction: SARS-CoV-2 is highly transmittable virus. D-dimer associated with high fatality rate in COVID-19 with pneumonia and fractures. COVID-19 make surgical decision more challenging. Thrombosis plays an important mechanism in severity of COVID-19 and could be measured through D-dimer level. Case illustrations: We report 4 fracture cases with asymptomatic COVID-19. 1st case diagnosed close fracture in right 1/3 distal cruris without pneumonia, D-dimer 2420 ng/dl. Surgery 20 days after trauma with decreased D-dimer level. 2nd case, was diagnosed with close fracture in the left cruris and right 1/3 middle of clavicle with pneumonia, D-dimer level 6670 ng/dl, decision obtained in 27 days after hospitalization with decreased D-dimer. 3rd case diagnosed open fracture in left 1/3 distal humerus with pneumonia, D-dimer level 1020 ng/dl. Surgery 32 days after trauma with decreased D-dimer. 4th case diagnosed open fracture in left 1/3 proximal humeral and left medial phalanx index finger with pneumonia. The D-dimer level 2830 ng/dl. Surgery was obtained 17 days after trauma with decreased D-dimer. Discussion: Pandemic creates gray zone in orthopedic surgery. D-dimer found increased in COVID-19 and fracture patients. Asymptomatic case can be operated on 10th day post positive result as long as the general condition is optimal. D-dimer also important in making the decision to perform surgery. D-dimer over 2500 ng/mL have greater risk for being VTE in fracture patients. Conclusion: The pandemic has creates a large gray zone. The strategies for decision making includes general condition and severity COVID-19 also D-dimer level. Keywords: D-dimer, COVID-19, Fracture, Surgery.

Exploring secondary SARS-CoV-2 transmission from asymptomatic cases using contact tracing data

Background Individuals with asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can propagate the virus unknowingly and thus have been a focus of public health attentions since the early stages of the pandemic. Understanding viral transmissibility among asymptomatic individuals is critical for successful control of coronavirus disease 2019 (COVID-19). The present study aimed to understand SARS-CoV-2 transmissibility among young asymptomatic individuals and to assess whether symptomatology was associated with transmission of symptomatic vs. asymptomatic infections. Methods We analyzed one of the first-identified clusters of SARS-CoV-2 infections with multiple chains of transmission that occurred among university students in March 2020 in Kyoto prefecture, Japan, using discrete and two-type branching process models. Assuming that the number of secondary cases resulting from either primary symptomatic or asymptomatic cases independently followed negative binomial distributions, we estimated the relative reproduction numbers of an asymptomatic case compared with a symptomatic case. To explore the potential association between symptomatology and transmission of symptomatic vs. asymptomatic incident infections, we also estimated the proportion of secondary symptomatic cases produced by primary symptomatic and asymptomatic cases. Results The reproduction number for a symptomatic primary case was estimated at 1.14 (95% confidence interval [CI]: 0.61–2.09). The relative reproduction number for asymptomatic cases was estimated at 0.19 (95% CI: 0.03–0.66), indicating that asymptomatic primary cases did not result in sufficient numbers of secondary infections to maintain chains of transmission. There was no apparent tendency for symptomatic primary cases to preferentially produce symptomatic secondary cases. Conclusions Using data from a transmission network during the early epidemic in Japan, we successfully estimated the relative transmissibility of asymptomatic cases of SARS-CoV-2 infection at 0.22. These results suggest that contract tracing focusing on symptomatic index cases may be justified given limited testing capacity.

Seroprevalence of Anti-SARS-CoV-2 Antibodies in Blood Donors from Nuevo Leon State, Mexico, during 2020: A Retrospective Cross-Sectional Evaluation

The progression and distribution of the SARS-CoV-2 pandemic are continuously changing over time and can be traced by blood donors’ serological survey. Here, we investigated the seroprevalence of anti-SARS-CoV-2 antibodies in blood donors in Nuevo Leon, Mexico during 2020 as a strategy for the rapid evaluation of the spread of SARS-CoV-2 and asymptomatic case detection. We collected residual plasma samples from blood donors who attended two regional donation centers from January to December of 2020 to identify changes in anti-SARS-CoV-2 IgG prevalence. Plasma samples were analyzed on the Abbott Architect instrument using the commercial Abbott SARS-CoV-2 IgG chemiluminescent assay. We found a total of 99 reactive samples from 2068 analyzed plasma samples, resulting in a raw prevalence of 4.87%. Donors aged 18–49 years were more likely to be seropositive compared to those aged >50 years (p < 0.001). Weekly seroprevalence increased from 1.8% during the early pandemic stage to 27.59% by the end of the year. Prevalence was 1.46-fold higher in females compared to males. Case geographical mapping showed that Monterrey city recorded the majority of SARS-CoV-2 cases. These results show that there is a growing trend of seroprevalence over time associated with asymptomatic infection that is unnoticed under the current epidemiological surveillance protocols.

Prolonged Detection of SARS-CoV-2 RNA in An Asymptomatic Individual in Thailand: A Case Study

Clinical characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) have been reported in Thailand, but there is still no asymptomatic case with prolonged persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA has been described. Here, we report, for the first time, the detection of SARS-CoV-2 RNA from nasopharyngeal and throat swab specimens for at least 110 days in a 30-year-old Thai female with no clinical symptoms. The COVID-19 IgG antibody was also observed in her blood sample. However, her husband was negative for both SARS-CoV-2 RNA and IgM/IgG antibody, implying no transmission of SARS-CoV-2 to her husband throughout the 110 days. As far as we know, this is the very first asymptomatic case to show the longest prolonged persistence of SARS-CoV-2 RNA from nasopharyngeal and throat swab specimens in Thailand. In most cases of COVID-19 infection, molecular monitoring for SARS-CoV-2 may be discontinued, and asymptomatic cases may be underestimated. Thus, the information in this report could be combined with additional data sources to raise public health awareness with regard to clinical management. Keywords: Asymptomatic individual, COVID-19, Prolonged detection, SARS-CoV-2

Transmission roles of symptomatic and asymptomatic COVID-19 cases: a modeling study

Objective Age-dependent asymptomatic and symptomatic transmission dynamics of COVID-19 have not been well quantified due to limited data. Methods Through a population-based surveillance network, we collected data on 1342 confirmed cases with a 90-days follow-up for all asymptomatic cases. Results The difference in transmissibility of a symptomatic and asymptomatic case depended on age and was most distinct for the middle-age groups. The asymptomatic cases had a 66.72% lower transmissibility rate than symptomatic cases, and 74.10% (95%CI: 65.85% - 80.72%) of all asymptomatic cases were missed in detection. The average proportion of asymptomatic cases was 28.22% (95%CI: 22.97% - 34.56%). Simulation showed that the burden of asymptomatic transmission increased as the epidemic continued and could potentially dominate the spreading. Conclusion Asymptomatic COVID-19 cases play a significant role in transmission. Vaccine Strategies prioritizing the population between 30-60 years old are likely to have the most population-level benefits.

Approach to Asymptomatic Case of Bicuspid Aortic Valve with Coarctation and Massive Aortic Arteriopathy: a Ticking Time Bomb

The combination of aortic coarctation (CoA) and bicuspid aortic valve (BAV) is associated with high risk of ascending aortic dilatation and type A aortic dissection. Most of the patients having combined lesions remain asymptomatic until adulthood and are incidentally diagnosed. Several questions regarding their treatment strategies remain unanswered. Both single-and two-stage surgical procedures have been described in medical literature, to treat CoA and BAV. Lately, combined endovascular therapy (Balloon angioplasty or Stent implantation) and surgery, has become a good alternative in selected cases. Here, we describe such a asymptomatic case of BAV with massive aneurysmal root dilatation and CoA, which was managed with endovascular stenting and surgery.

Perioperative Evaluation of Heart Echinococcus Cyst in a 14-Year-Old Child

BACKGROUND: Echinococcosis of the heart has a rate 0.02–2% of all hydatid diseases. Clinical presentation is depending of the location of hydatid cyst in the heart. Patients can be an asymptomatic case or lethal stroke, arrhythmias, valvular dysfunction, pulmonary edema, cardiac tamponade, cardiac failure, shock, and even death. CASE REPORT: We present a case report, a 14-year-old child with 2 weeks of sore throat, whooping cough, subfebrile condition, sweating, fatigue and physical weakness, nausea, abdominal pain, and decreased appetite. He came to emergency room with cardiogenic shock and pulmonary edema. He was diagnosed with intramyocardial hydatid cyst. CONCLUSION: Echinococcus cyst lesion in the LV in lateral wall, not communicating with the LV cavity, has been removed successfully with on-pump technique in a 14-year-oldchild. Median sternotomy was preferred and cardiopulmonary bypass has been considered the safest method. Supplemental medical therapy with albendazole is recommended to reduce the risk of recurrence.

How much does a medical and healthcare products regulatory agency medical device alert for metal-on-metal hip arthroplasty patients really cost?

Background: Many worldwide regulatory authorities recommend regular surveillance of metal-on-metal hip arthroplasty patients given high failure rates. However, concerns have been raised about whether such regular surveillance, which includes asymptomatic patients, is evidence-based and cost-effective. We determined: (1) the cost of implementing the 2015 MHRA surveillance in “at-risk” Birmingham Hip Resurfacing (BHR) patients; and (2) how many asymptomatic hips with adverse reactions to metal debris (ARMD) would have been missed without patient recall. Methods: All BHR patients eligible for the 2015 MHRA recall (all females, and males with head sizes ⩽46 mm, regardless of symptoms) at one centre were invited for review (hips = 707; patients = 593). All patients were investigated (Oxford Hip Score, radiographs, blood metal ions, and targeted cross-sectional imaging) and managed accordingly. Surveillance costs were calculated using finance department data. Results: The surveillance cost £105,921.79 (range £147.76–£257.50/patient). Radiographs (£39,598) and nurse practitioner time/assistance (£23,618) accounted for 60% of overall costs. 31 hips had ARMD on imaging (12 revised; 19 under surveillance). All revisions were symptomatic. 7 hips with ARMD under surveillance were asymptomatic and remain under regular review. The number needed to treat to avoid missing one asymptomatic ARMD case was 101 patients, representing a cost of £18,041 to avoid one asymptomatic case. Conclusions: Implementing MHRA surveillance for “at-risk” BHR patients was extremely costly. The risk of asymptomatic ARMD was low with the BHR (1%), suggesting recommended follow-up in asymptomatic patients is not cost efficient. This raises concerns about the increasingly intensive surveillance recommended in the 2017 MHRA guidance for metal-on-metal hip patients.