Introduction Despite several ongoing efforts in biomedicine and traditional medicine, there are no drugs or vaccines for coronavirus disease 2019 (COVID-19) as of May 2020; Kabasura Kudineer (KSK), a polyherbal formulation from India’s Siddha system of medicine, has been traditionally used for clinical presentations similar to that of COVID-19. We explored the efficacy of KSK in reducing viral load and preventing the disease progression in asymptomatic, COVID-19 cases. Methods A prospective, single-center, open-labeled, randomized, controlled trial was conducted in a COVID Care Centre in Chennai, India. We recruited reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 of 18 to 55 years of age, without clinical symptoms and co-morbidities. They were randomized (1:1 ratio) to KSK (60 mL twice daily for 7 days) or standard of care (7 days supplementation of vitamin C 60,000 IU morning daily and zinc 100 mg evening daily) groups. The primary outcomes were reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR], prevention of progression of asymptomatic to symptomatic state, and changes in the immunity markers including interleukins (IL-6, IL-10, IL-2), interferon gamma (IFNγ), and tumor necrosis factor (TNF α). Siddha clinical assessment and the occurrence of adverse effects were documented as secondary outcomes. Paired t-test was used in statistical analysis. Results Viral load in terms of the CT value (RdRp: 95% CI = 1.89 to 5.74) declined significantly on the seventh day in the KSK group and that of the control group, more pronounced in the study group. None progressed to the symptomatic state. There was no significant difference in the biochemical parameters. We did not observe any changes in the Siddha-based clinical examination and adverse events in both groups. Conclusion KSK significantly reduced SARS-CoV-2 viral load among asymptomatic COVID-19 cases and did not record any adverse effect, indicating the use of KSK in the strategy against COVID-19. Larger, multi-centric trials can strengthen the current findings. Trial registration Clinical Trial Registry of India CTRI2020/05/025215. Registered on 16 May 2020

Objectives The primary objectives of this study are to determine efficacy of Siddha medicine, Kabasura kudineer in reduction of SARS-CoV-2 viral load and reducing the onset of symptoms in asymptomatic COVID-19 when compared to Vitamin C and Zinc (CZ) supplementation. In addition, the trial will examine the changes in the immunological markers of the Siddha medicine against control. The secondary objectives of the trial are to evaluate the safety of the Siddha medicine and to document clinical profile of asymptomatic COVID-19 as per principles of Siddha system of Medicine. Trial design A single centre, open-label, parallel group (1:1 allocation ratio), exploratory randomized controlled trial. Participants Cases admitted at non-hospital settings designated as COVID Care Centre and managed by the State Government Stanley Medical College, Chennai, Tamil Nadu, India will be recruited. Eligible participants will be those tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain reaction (RT-PCR) aged 18 to 55 years without any symptoms and co-morbidities like diabetes mellitus, hypertension and bronchial asthma. Those pregnant or lactating, with severe respiratory disease, already participating in COVID trials and with severe illness like malignancy will be excluded. Intervention and comparator Adopting traditional methods, decoction of Kabasura kudineer will be prepared by boiling 5g of KSK powder in 240 ml water and reduced to one-fourth (60ml) and filtered. The KSK group will receive a dose of 60ml decoction, orally in the morning and evening after food for 14 days. The control group will receive Vitamin C (60000 IU) and Zinc tablets (100mg) orally in the morning and evening respectively for 14 days. Main outcomes The primary outcomes are the reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR] from the baseline to that of seventh day of the treatment, prevention of progression of asymptomatic to symptomatic state (clinical symptoms like fever, cough and breathlessness) and changes in the immunity markers [Interleukins (IL) 6, IL10, IL2, Interferon gamma (IFNγ) and Tumor Necrosis Factor (TNF) alpha]. Clinical assessment of COVID-19 as per standard Siddha system of medicine principles and the occurrence of adverse effects will be documented as secondary outcomes. Randomisation The assignment to the study or control group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and informed consent procedures. Blinding (masking) This study is unblinded. The investigators will be blinded to data analysis, which will be carried out by a statistician who is not involved in the trial. Numbers to be randomised (sample size) Sample size could not be calculated, as there is no prior trial on KSK. This trial will be a pilot trial. Hence, we intend to recruit 60 participants in total using a 1:1 allocation ratio, with 30 participants randomised into each arm. Trial status Protocol version 2.0 dated 16th May 2020. Recruitment is completed. The trial started recruitment on the 25th May 2020. We anticipate study including data analysis will finish on November 2020. We also stated that protocol was submitted before the end of data collection Trial registration The study protocol was registered with clinical trial registry of India (CTRI) with CTRI/2020/05/025215 on 16 May 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).

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BACKGROUND Spontaneous bacterial peritonitis is defined as infected ascitic fluid in the absence of apparent intra-abdominal source of infection. Infections with more than one organism is likely to be associated with abdominal paracentesis, colonic perforation or intraabdominal source of infection. Infections among cirrhotic patients is often overlooked when compared to the attention given to its other complications. The objective of this study is to study the prevalence of spontaneous bacterial peritonitis in patients with Alcoholic liver cirrhosis within a tertiary care centre in Northern Tamilnadu. MATERIALS AND METHODS This was a cross-sectional study conducted in the Department of General Medicine in Govt. Vellore Medical College for a period of 6 months, which included 102 patients with cirrhosis of liver with ascites. Patients were diagnosed as a case of cirrhosis of liver with ascites on basis of clinical evaluation, biochemical investigations, ultrasonography and UGI scopy. All the patients were chronic alcoholics and were not on any antibiotics. All patients with ascites due to other causes viz. renal, tuberculosis, malignant pathology, cholelithiasis, collagen vascular diseases etc. were excluded. Patients who were on antibiotics prior to or on admission were excluded. Patients with obvious causes of intra-abdominal infection were excluded from the study. RESULTS 21 out of 102 patients, i.e. 20.59% had spontaneous bacterial peritonitis. Men (80.95%) more commonly presented with cirrhotic ascites when compared to women (19.05%) in our study. Ascitic fluid culture from 9 patients yielded positive results by bedside blood culture bottle inoculation. 12 patients (57.14%) were labelled as neutrocytic bacterascites. The most common organism cultured was E. coli (66.67%). CONCLUSION SBP is the common overlooked complication of ascites with prevalence common among male alcoholics in age group between 30-50 years with abdominal pain, the most common precursor symptom of SBP.

BACKGROUND Insulin resistance represents an insensitivity of peripheral tissues to the effect of insulin. Obese individuals with insulin resistance have shown increased prevalence of abnormalities of glucose metabolism. Given that insulin resistance represents an important risk factor for development of type 2 diabetes. Identification of adults with insulin resistance has been proposed as a strategy for identifying high risk adult for targeted diabetes prevention intervention. METHODS We performed a cross sectional observational study on obese patients between 20 and 50 years of age attending the Outpatient Department of General Medicine at Government Vellore Medical College and Hospital for minor ailments during the period July 2017 to December 2017. RESULTS Of the 100 obese individuals, acanthosis nigricans was present in about 61 individuals. There is an increase in insulin resistance with an increase in the class of acanthosis nigricans. Skin tags are present in about 60 individuals. Individuals with skin tags have significantly high HOMA-IR when compared with that of individuals without skin tags. CONCLUSIONS Acanthosis nigricans and skin tags are markers of insulin resistance and insulin resistance increases quantitatively with increasing grades of acanthosis nigricans.