Safety and Efficacy of Siddha Medicine preparation in the management of COVID-19: A Prospective Randomised Open Label Study

Background

The use of complementary and alternative medicine (CAM) therapies has surged since the spread of COVID-19 pandemic. However, the efficacy and safety of these CAM therapies remains majorly unexplored. Objective of the current study is to understand the efficacy and safety of one such traditional CAM therapy of South India, known as 'Siddha' system of medicine, in the management for the COVID-19 patients.

Methods

We conducted a randomised, controlled, open label trial in patients hospitalized with SARS-CoV-2 infection who had an oxygen saturation of 90% or more while breathing ambient air. Patients were randomized into two groups in a 1:1 ratio to either intervention group, receiving seven days of siddha medicine (Intervention group; n=50) or standard care (control group; n=50). The primary end point was clinical markers and patient recovery status on day 8.

Results

A total of 100 patients with confirmed COVID-19 with average age of 37 yrs (interquartile range, 28-49) participated in the study. There was no statsistically difference between groups at baseline (P>0.05). After intervention, patients in the intervention group had statistically (P<0.05) significant reduction in the symptoms when compared to standard care. By end of the intervention period, 6 patients (12%) were hospitalized in the control group and none of them were reported for intervention group.

Conclusion

Among patients with mild to moderate COVID-19, 7 days of siddha medicine showed a significant reduction in the clinical sysmptoms and requirement of hospitalisation, with no adverse events. Therefore, the particular siddha medicine preparation could be used safely and effectively for the management of COVID-19 patients.

Clinical Trial Registration

CTRI/2020/08/026999.

Survival analysis to assess the length of stay of novel coronavirus (COVID-19) patients under Integrated Medicine - Zinc, Vitamin C & Kabasura Kudineer (ZVcKK)

Objective:

COVID19 pandemic out of all odds has created an opportunity to offer treatment in an integrative manner. This study measures the Length of stay (LS) of patients in an integrative way, as done earlier in China and Vietnam. Length of stay, Clinical presentations, and Comorbidities were analyzed among COVID19 patients in ESI Hospital, Coimbatore, Tamil Nadu, India.

Method:

Retrospective cross-sectional data on 251 Positive COVID19 patients of both sexes irrespective of age admitted from 27 March 2020 and 26 April 2020 cases were included in the study. The final discharge date is taken as 5th May 2020. Kaplan Meier survival analysis was adopted.

Results:

Male, female ratio were 141(56.2%): 83(33.1%), 12 (4.8%) Male Child and 15 (6.0%) were Female child. 5.2% of the patients were in the age group greater than 60, 75.3% were in the age group 20-60, and the remaining 19.5% were 0- 20 age group. 84.9% of patients were Asymptomatic, while fever and cough were the main symptoms recorded in the remaining cases. CT scan was done for 7 patients. No mortality and no serious adverse events were reported. Comorbidity is 15% and does not influence hospital length of stay. The overall median length of stay is 12 days for those who were under ZVcKK (Median ST CI- 11.59-12.41).

Conclusion:

This study recorded a median of 12 days in the Length of stay and 13.5 days in the Length of stay average. Comparing earlier studies, patients taking ZVcKK have savings of 7 days. i.e., the relief speed is higher while using ZVcKK.

Concurrent T790M and L858R mutations in treatment-naïve metastatic non-small-cell lung cancer: A therapeutic challenge – Current treatment strategies and promising therapies of the future in a nutshell

De novo (pretreatment) epidermal growth factor receptor T790M mutation in non-small-cell lung cancer (NSCLC) is rare when detected by standard genotyping methods. We present a case of concurrent de novo T790M and L858R mutations detected by direct sequencing in treatment-naïve metastatic NSCLC. This case is worthy of mention as the presence of this mutation has a bearing on the choice of treatment. This article aims to evaluate the clinical outcome for metastatic NSCLC with de novo T790M mutation and formulate an optimum treatment plan in this clinical scenario. The novel targeted therapy agents have also been reviewed.

Dense Deposit Disease Involving C3 and C4d Deposits

Dense deposit disease (DDD), earlier called Type II membranoproliferative glomerulonephritis is distinct disease having frequent relapses reaching end-stage kidney disease by 10-year in up to 50%-60% of cases and high recurrence rate in the allograft. The term DDD is derived from its distinctive ribbon-like osmiophilic deposits in the lamina densa of glomerular basement membrane by electron microscopy. Pathogenetically, alternate pathway dysfunction leads to this disease, which is diagnosed by ultrastructure. Herein, we describe our observation of C4d positivity in an adolescent boy with DDD.

Towards the Total Synthesis of Schisandrene: Stereoselective Synthesis of the Dibenzocyclooctadiene Lignan Core

A stereoselective synthesis of the dibenzocyclooctadiene ­lignan core of the natural product schisandrene is described. Starting from readily available gallic acid, the synthetic strategy involves Suzuki–Miyaura cross-coupling, Stille reaction, and ring-closing metathesis (RCM) in the reaction sequence. The required asymmetric center at C-7′ was established by an asymmetric reduction of a keto compound using the Corey–Bakshi–Shibata (CBS) catalyst. In our approach, the eight-membered ring was achieved by RCM for the first time.

Spectrum of renal involvement in hematolymphoid neoplasms: Renal biopsy findings of 12 cases

Spectrum of causes for renal dysfunction in patients with hematolymphoid malignancy (excluding plasma cell dyscrasia) is varied. A retrospective evaluation of “native” renal biopsies referred to our institute during the period from January 2010 to December 2013 revealed 12 cases. Age ranged between 7 and 69 (median 54.5) years. All patients were males. The neoplasms included non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute lymphoblastic leukemia, Burkitt's lymphoma, intravascular lymphoma, Hodgkin lymphoma and chronic myeloid leukemia. Proteinuria was noted in 66% of the patients (nephrotic range in 5, subnephrotic range in 3). Renal insufficiency was noted in 100% patients. Malignancy-related kidney injury was noted in 75% of the cases. Renal histology showed lymphomatous infiltration (8), membranoproliferative glomerulonephritis (MPGN) (3), intracapillary monoclonal deposit disease (1) and intravascular lymphoma (1). Distribution of lymphomatous infiltration was diffuse in 50% and focal in 50%. We observed that renal dysfunction was predominantly a direct effect, that is, lymphomatous invasion. Paraneoplastic glomerulopathic changes occur in the form of MPGN. Proteinuria of >2 g/day correlated with glomerular disease.

Primary hyperparathyroidism in a child

Primary hyperparathyroidism is rare in children. We report a 12-year-old girl who presented with recurrent renal calculi, muscular weakness and inability to walk; was diagnosed to have parathyroid adenoma and underwent parathyroidectomy.

Cystic lymphangioma of pericardium presenting as isolated chylopericardium – A case report

Isolated chylopericardium due to cystic lymphangioma of pericardium is a rare entity. We report a case of asymptomatic chylopericardium in a young male who presented with cardiomegaly. Echocardiography revealed massive pericardial effusion without tamponade. Pericardiocentesis yielded 1.25 L of tea-colored fluid which showed triglyceride level of 1723 mg/dL and cholesterol of 1021 mg/dL with a cholesterol to triglyceride ratio of <1, characteristic of chylous fluid. Lymphoscintigraphy using 99Tc demonstrated lymphatic leak around the heart region. Fusion of MRI images with lymphoscintigraphy was taken with a view of localizing the leak site; it demonstrated enhancement in the pericardial space. Surgery was done via right lateral thoracotomy. Thoracic duct was ligated above diaphragm and pericardial window created by anterior pericardiectomy. The patient had an uneventful recovery and was well after 6 months of follow up. Pericardial biopsy showed cystic lymphangioma of pericardium.

Sunitinib induced nephrotic syndrome and thrombotic microangiopathy

Sunitinib is an oral, multitargeted receptor tyrosine kinase inhibitor of targets such as vascular endothelial growth factor and platelet derived growth factor receptor. It is used for the treatment of metastatic renal cell carcinoma (RCC). Use of sunitinib has been associated with renal dysfunction and nephrotic syndrome. However, simultaneous occurrence of nephrotic syndrome and renal dysfunction in a patient treated with sunitinib is rare. We report a case of metastatic RCC treated with sunitinib for 22 months who presented with nephrotic syndrome and renal dysfunction. Renal biopsy was diagnostic of thrombotic microangiopathy with diffuse effacement of podocytic foot process.

Postrenal transplant laryngeal and visceral leishmaniasis - A case report and review of the literature

Visceral leishmaniasis (kala-azar) is a disease caused by protozoa of genus Leishmania. It is currently regarded as the second most dreaded parasitic disease, next to malaria. There have been very few case reports of visceral leishmaniasis among the renal transplant recipients. We present a renal allograft recipient with symptoms of fever, sore throat, hoarseness of voice, lymphadenopathy, splenomegaly, and pancytopenia after 7 years post-transplant period. On investigating, he was diagnosed to have extensive visceral leishmaniasis with laryngeal involvement. Despite extensive PubMed literature search, we could not find any case report of postrenal transplant visceral and laryngeal leishmaniasis and to the best of our knowledge this is the first case report of this kind.

Diffuse mesangial sclerosis - Report of two cases

Diffuse mesangial sclerosis (DMS) is a rare cause of nephrotic syndrome in the infantile and childhood period. DMS is a phenotypic expression of syndromic entities such as WAGR syndrome (Wilms’ tumor, aniridia, genitourinary anomalies and mental retardation), Denys Drash syndrome, Pierson syndrome, Frasier syndrome, or Galloway–Mowat syndrome. We report two cases of DMS, one presenting in first year of life and another in second decade of life. Both of them had fatal outcome. Recognition of the disease is very important in modifying the management of patient and active surveillance of family members.

Solanum trilobatum in the management of atopy: Through inhibition of mast cell degranulation and moderation of release of interleukins

Solanum trilobatum is a widely used plant in the Indian indigenous systems of medicine. It is mainly used in the treatment of respiratory diseases like bronchial asthma. In our present study, we report that the aqueous and alcoholic extracts of S. trilobatum exhibited inhibition of mast cell degranulation. Further, aqueous and alcoholic extracts of S. trilobatum significantly decreased the release of IL1α and increased the release of IL8 from the cultured keratinocytes. Oral administration of the aqueous and alcoholic extracts of S. trilobatum stabilized mast cells in experimental rats.

Clinico-pathologic pattern of gastrointestinal stromal tumors (GIST) in southern India: A single-institution experience

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Background: There have been major advances in understanding the behavioral pattern, pharmacological intervention, and clinical response of GIST; yet Indian data in this regard is sparse. This study analyses the clinico-pathologic features in 36 patients (21 male, 15 female) of GIST seen at our institution. Methods: GIST was defined as a mesenchymal spindle or epithelioid cell lesion arising in the GI tract with CD117 immuno-reactivity. Retrospective data from January 03 to March 06 was analyzed for age, tumor site, morphology, immuno- reactivity, prognostic factors, response to treatment (by RECIST), and recurrence or metastasis. All patients had surgery; those with residual, recurrent, or metastatic disease got imatinib till tumor progression. Results: GIST presented at a mean age of 48.2 yrs (SD 6.4, range 34–65). The mean tumor size was 13.9 cm (range 2–42). The most common site was the small intestine (ileum 8, jejunum 7, duodenum 4). 24 patients (66.7%) had localized disease at baseline. Of these, 14 had local recurrence after surgery, and were given imatinib. 5 of them are in complete remission, 4 had partial response (PR), 3 patients died, and 2 had stable disease. Most patients with recurrent GIST had a mitotic rate of >10/50hpf. 8 patients developed metastasis, and received imatinib. Of these, 2 got a PR, 3 had progressive disease and died, and 3 had stable disease. 12 patients (33.3%) had metastasis at baseline (to liver and abdominal cavity), and underwent debulking. Of these, 6 patients with stable disease are on treatment with imatinib, 3 died and 3 were lost to follow-up. Conclusions: Average age of presentation was less than in Western reports. The commonest site was the small intestine as opposed to stomach in western literature. Mitotic rate was a better prognostic factor than gross tumor size. GIST with a mixed cell morphology showed aggressive behavior. Imatinib mesylate is useful in the post-operative management of GIST.

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No significant financial relationships to disclose.

In vivo studies on the effect of Ocimum sanctum L. leaf extract in modifying the genotoxicity induced by chromium and mercury in Allium root meristems

In vivo cytogenetic assay in Allium cepa root tip cells has been carried out to detect the modifying effect of Ocimum sanctum aqueous leaf extract against chromium (Cr) and mercury (Hg) induced genotoxicity. It was observed that the roots post-treated with the leaf extract showed highly significant (p < 0.001) recovery in mitotic index (MI) and chromosomal aberrations (CA) when compared to pre-treated (Cr/Hg) samples and the lower doses of the leaf extract were found to be more effective than higher doses. The present study reveals that the Ocimum sanctum leaf extract possesses the protective effect against Cr/Hg induced genetic damage.

Ab initio quality one-electron properties of large molecules: development and testing of molecular tailoring approach

The development of a linear-scaling method, viz. "molecular tailoring approach" with an emphasis on accurate computation of one-electron properties of large molecules is reported. This method is based on fragmenting the reference macromolecule into a number of small, overlapping molecules of similar size. The density matrix (DM) of the parent molecule is synthesized from the individual fragment DMs, computed separately at the Hartree-Fock (HF) level, and is used for property evaluation. In effect, this method reduces the O(N(3)) scaling order within HF theory to an n.O(N'(3)) one, where n is the number of fragments and N', the average number of basis functions in the fragment molecules. An algorithm and a program in FORTRAN 90 have been developed for an automated fragmentation of large molecular systems. One-electron properties such as the molecular electrostatic potential, molecular electron density along with their topography, as well as the dipole moment are computed using this approach for medium and large test chemical systems of varying nature (tocopherol, a model polypeptide and a silicious zeolite). The results are compared qualitatively and quantitatively with the corresponding actual ones for some cases. This method is also extended to obtain MP2 level DMs and electronic properties of large systems and found to be equally successful.

Outcome of percutaneous endoscopic gastrostomy feeding in patients on peritoneal dialysis

Protein malnutrition is now well established as an important contributory factor to the high mortality in peritoneal dialysis (PD) patients. Low dietary protein calorie intake is one of the factors leading to protein malnutrition. If PD patients develop difficulty eating, percutaneous endoscopic gastrostomy (PEG) feeding may prove beneficial in providing adequate nutrition. Studies on the effectiveness of PEG feeding in PD patients are limited to pediatric patients. The objective of the present study was to assess the outcome of PEG feeding in adult patients with end-stage renal disease (ESRD) on PD. We retrospectively reviewed charts from May 1992 to February 2000 of 10 consecutive patients in our center who had had feeding tubes inserted. The patients' ages ranged from 37 to 81 years, with mean age of 65. Of the 10 patients, 7 were male, 5 were diabetic, and 1 was infected with the human immunodeficiency virus. Two patients had cerebrovascular accident (CVA) with dysphagia, 3 had multi-infarct dementia, 2 had anoxic encephalopathy, 2 had dementia, and 1 had calciphylaxis with anorexia. Of the 10 patients, 9 failed to eat because of neurologic disorders. Two patients who had functioning PEG feedings before starting PD had no complications. Only 2 of 8 patients already on PD continued with long-term PD after a PEG was inserted. Both patients whose PD was not interrupted at the time of PEG placement immediately developed peritonitis. Of the 6 patients who were maintained on hemodialysis (HD), 2 developed peritonitis within one week of starting PEG feedings. The other 4 had no complications from PEG feedings while being maintained on HD, but 1 developed peritonitis when PD was resumed. Of the 5 patients who developed peritonitis, 3 experienced fungal peritonitis. In PD patients, PEG feeding is associated with frequent complications. However, PEG placement prior to PD initiation appears to be safe. Maintaining patients on HD for at least 6 weeks appears to decrease the incidence of peritonitis, but does not eliminate it. Use of anti-fungal prophylaxis and maintenance of the patient on HD for longer than 6 weeks may produce better results.

Gross photography of ophthalmic pathology specimens

Removal of the entire eyeball or a portion of it is required in many ophthalmic conditions. The gross features of such specimens provide valuable information. Gross photography of an intraocular tumour, ruptured eyeball or other pathological specimens including lid lesions, orbital tumors, intraocular lens implants, intraocular and extraocular parasites, retinal pathology such as haemorrhages and peripheral degenerations, establishes a permanent documentation. We herein describe the technique of gross photography of such valuable specimens, using a dissecting microscope with a special arrangement. This technique is currently used by us with gratifying results.

Interaction with protein phosphatase 1 Is essential for bifocal function during the morphogenesis of the Drosophila compound eye

The gene bifocal (bif), required for photoreceptor morphogenesis in the Drosophila compound eye, encodes a protein that is shown to interact with protein phosphatase 1 (PP1) using the yeast two-hybrid system. Complex formation between Bif and PP1 is supported by coprecipitation of the two proteins. Residues 992 to 995 (RVQF) in the carboxy-terminal region of Bif, which conform to the consensus PP1-binding motif, are shown to be essential for the interaction of Bif with PP1. The interaction of PP1 with bacterially expressed and endogenous Bif can be disrupted by a synthetic peptide known to block interaction of other regulatory subunits with PP1. Null bif mutants exhibit a rough eye phenotype, disorganized rhabdomeres (light-gathering rhodopsin-rich microvillar membrane structures in the photoreceptor cells) and alterations in the actin cytoskeleton. Expression of wild-type bif transgenes resulted in significant rescue of these abnormalities. In contrast, expression of transgenes encoding the Bif F995A mutant, which disrupts binding to PP1, was unable to rescue any aspect of the bif phenotype. The results indicate that the PP1-Bif interaction is critical for the rescue and that a major function of Bif is to target PP1c to a specific subcellular location. The role of the PP1-Bif complex in modulating the organization of the actin cytoskeleton underlying the rhabdomeres is discussed.

Clonidine prevents insulin resistance and hypertension in obese dogs

The role that the central sympathetic nervous system plays in the development of obesity hypertension and insulin was evaluated by feeding dogs a high fat diet with or without clonidine treatment. Thirteen adult mongrel dogs were chronically instrumented and randomly assigned to receive either a high fat diet and no clonidine (n=6) or a high fat diet plus clonidine (n=7), 0.3 mg BID. Blood pressure, heart rate, plasma insulin, and electrolytes were measured daily. Insulin resistance was assessed with a multiple-dose euglycemic clamp (1, 2, and 30 mU. kg-1. min-1) before and after 1, 3, and 6 weeks of the high fat diet. Clonidine prevented the hypertension, tachycardia, and insulin resistance associated with feeding dogs the high fat diet but did not affect weight gain. The present study suggests that the central sympathetic nervous system plays a critical role in the development of both insulin resistance and hypertension associated with feeding dogs a high fat diet.

Isolation of salmonellae from dried rattlesnake preparations

Salmonella arizonae and other Salmonella serovars were isolated from four different rattlesnake preparations which were used for self-treatment of various diseases. A case of disseminated S. arizonae infection is reported in a patient who had acquired immunodeficiency syndrome and ingested dried rattlesnake.