The use of integrative therapy based on Yoga and Ayurveda in the treatment of a high-risk case of COVID-19/SARS-CoV-2 with multiple comorbidities: a case report

Background We report a high-risk case of a coronavirus disease 19 (COVID-19)-positive patient with comorbidities including diabetes mellitus (DM), hypertension (HTN), hypothyroidism and chronic kidney disease (CKD), treated successfully using an integrative therapy plan based on Ayurveda and Yoga, along with government-mandated compulsory modern western medicine (MWM) treatment. Recently, some evidence has been emerging on the use of Ayurveda for treatment of COVID-19. The classical texts of Ayurvedic medicine such as Charaka Samhita and Sushruta Samhita contain descriptions of pandemics of similar proportions and describe them as Janapadoddhvansa, meaning the destruction of communities, along with their causes and treatment. Case presentation The case reported herein is a 55-year-old man from Delhi, India, with confirmed (tested) COVID-19, who first took MWM for 7 days before seeking integrative therapy. The patient has comorbidities including DM, HTN, hypothyroidism and CKD and had developed symptoms including fever (which was resolved by the time integrative therapy was started), sore throat, dry cough, body aches, weakness, bad taste and smell, and heaviness in the abdomen. Based on the patient’s symptoms and comorbidities, a treatment plan including Ayurvedic medicines, Yoga protocol, dietary recommendations and lifestyle modifications was prescribed by a registered Ayurveda doctor and a Yoga consultant. The patient started experiencing improvement in all the symptoms within 2 days after starting the treatment; he reported approximately $$75\%$$ 75 % relief from the symptoms after 5 days, and almost complete relief within 9 days. Also, the blood sugar levels (both fasting blood sugar [FBS] and postprandial blood sugar [PPBS]) exhibited significant improvement after 5 days, and decreased to within the normal range within 12 days. Besides relief in symptoms, the patient’s real-time reverse transcription polymerase chain reaction (RT-PCR) test done on the 19th day returned negative results. Conclusions Integrative therapy was found to be effective in mitigating the symptoms of COVID-19 in this patient with multiple comorbidities. Moreover, a significant improvement in blood sugar levels (not under control with modern medicine) was also achieved. Integrative therapy based on the classical texts of Ayurveda and Yoga may offer a promising and scalable treatment option for COVID-19 patients. A case series or a suitably designed randomized controlled trial is needed to assess its efficacy.

A Successful Treatment Regimen for the Prevention of Sinusitis after Maxillary Sinus Floor Elevation Surgery in a High-Risk Case

Maxillary sinus floor elevation (sinus lift) is a widely recognized dental-surgical approach for dental implant placement. However, for an otorhinolaryngological high-risk patient with severe anatomic-structural impairments of the maxillary sinus drainage pathway, surgical intervention is recommended before sinus lift to avoid postsinus lift maxillary sinusitis. Here, we show a case that postsinus lift maxillary sinusitis in such a high-risk patient was noninvasively prevented by the collaboration of otorhinolaryngologist and dentist. A 48-year-old Japanese male intended to undergo a sinus lift for dental implant placement by periodontist. Otorhinolaryngologist found septal deviation, concha bullosa, the presence of Haller cell, and nasal mucosal swelling by the nasal allergy, while no sinusitis and diagnosed him as a “high-risk case” for postsinus lift maxillary sinusitis. The patient was administered preoperative topical steroid and leukotriene receptor antagonist in addition to perioperative antibiotic prophylaxis so that his complication was noninvasively prevented. Thus, this case suggested that consultation from dentist to otorhinolaryngologist provides benefit to the patients who have been diagnosed as “high-risk case” for postsinus lift maxillary sinusitis.

Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic

Objective To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic. Methods This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a “high-risk case protocol” was utilized to maximize available resources. As information and technology evolved, a “universal point-of-care protocol” was implemented. Results Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure ( P = .92). Discussion Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on “COVID-19 clinics” or other community testing facilities. Implications for Practice Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.

SUN-431 Case Finding Versus Routine Screening of Thyroid Dysfunction in Pregnancy

Background: Thyroid dysfunction in pregnancy is associated several adverse outcomes. This has triggered a debate about whether universal screening should be implemented. Despite recommendations against universal screening, the clinical practice of many caregivers may differ. We aimed to assess the sensitivity of using targeted high-risk case finding for diagnosing thyroid dysfunction in pregnancy compared to routine screening in pregnant Saudi women, and to evaluate if gestational diabetes (GDM) specifically affected the risk. Methods: A cross-sectional study in two hospitals under the Ministry of National Guards Health affairs of Saudi Arabia; King Abdulaziz Hospital, Al-Ahsa, and Imam Abdulrahman bin Faisal Hospital, Dammam. Pregnant ladies attending the Family medicine, Obstetrics and Gynecology, and Endocrinology clinics in both hospitals were assessed by the caring physician based on a check list for risk stratification for thyroid dysfunction as per the 2012 Endocrine society clinical practice guidelines for management of thyroid dysfunction in pregnancy. Presence of one risk factor defined high risk. All patients had a routine serum TSH measured as universal screening is commonly practiced in both institutions, the physician doing the risk stratification was not aware of the TSH result. Sensitivity and specificity for the case finding approach was calculated using and abnormal TSH value as the gold standard for presence of thyroid dysfunction. The institutions lab reference TSH 0.35 – 4.94 mIU/L was used as cutoff. Results: 1571 pregnant women were included in the study; mean age 29.3± 6.2 years, 396 (23.5%) were primigravida. The mean TSH value was 1.898 ± 1.459 mlU/L. 1178 (75%) pregnant women had an indication for screening based on presence of at least one risk factor, of which 95 (8.1%) tested abnormal for TSH. 393 women had no risk factors, of which 379 (96.4%) had normal TSH, (Chi square 9.3, p-value 0.002). [Sensitivity 87.2%, (95%CI 79.4% – 92.8%), Specificity 25.9%, (95%CI 23.7% – 28.3%)]. Total abnormal TSH values was 109 (6.9%), 43 were abnormal high (i.e. hypothyroid); of which 40 screened positive by case finding approach [Sensitivity 93.02%, (95%CI 80.9% – 98.5%), Specificity 25.52%, (95%CI 23.4% – 27.8%)]. Moreover, 178 (11.3%) women screened positive for GDM at some stage in pregnancy out of which only 5 (2.8%) had an abnormal TSH value, while of the 1393 pregnant women who screened negative for GDM 1289 (92.5%) had a normal TSH value, (Chi square 5.3, p-value 0.02). [Sensitivity 4.6%, (95%CI 1.5% – 10.4%), Specificity 88.2%, (95%CI 86.4% – 89.8%)]. Conclusion: Targeted high-risk case finding predicts thyroid dysfunction in pregnant Saudi women with high sensitivity supporting its utility in screening our pregnant population. Gestational diabetes is highly prevalent in Saudi women, but does not increase risk of thyroid dysfunction in pregnancy.

Ewing's sarcoma with distant metastasis: A brief note on management and emerging therapies

Ewing’s sarcoma is an aggressive fatal malignancy of bones and soft-tissue. It predominantly affects the young population, with a worldwide incidence of three cases per million. The pelvis, extremities, and ribs are the most common sites. We present a case of massive Ewing’s sarcoma of the right femur with metastasis to bones and lungs. The patient was treated with chemotherapy. However, he succumbed to his illness before completion of therapy. In conclusion, Ewing’s sarcoma with distant metastasis is a high risk case with poor prognosis. Integrating novel molecular targets with conventional chemotherapeutic agents holds a promise for high-risk Ewing’s sarcoma patients.