There have been a variety of complications reported during and post- COVID infection. Recently, there has been an increase in sporadic cases of paranasal sinus mucormycosis in COVID- 19 patients. We report a case of COVID- 19 patient diagnosed to have orbital apex syndrome secondary to mucormycosis of nose and paranasal sinus requiring emergency endoscopic sinus surgery. Appropriate use of personal protective equipment and safety precautions taken by health care workers prevented the spread of the virus during surgery.

Background: The evidence on the efficacy and safety of Ayurveda interventions as add-on to the standard conventional care for COVID-19 is limited. This study was planned to explore the potential of AYUSH-64 as add-on to conventional care in improving the clinical recovery and negative RT-PCR conversion in asymptomatic and mild COVID-19 cases. Materials and Methods: An open-label randomized controlled study was conducted at Government Medical College, Nagpur, Maharashtra, India with a sample size of 60 participants. In this study, asymptomatic or mild COVID-19 patients were randomized and allocated into intervention and control group in 1:1 ratio. AYUSH-64 two capsules (500 mg each) were administered thrice daily, after food with water for 30 days along with standard care in the intervention group, while the control group received only standard care. The effect of the interventions was assessed in terms of negative RT-PCR for COVID-19, clinical cure rate and inflammatory cytokines.Outcome measures: Primary outcome was the time to attain negative RT-PCR for COVID-19 and proportion of participants turned RT-PCR negative for COVID-19 at 7th, 15th, 22nd and 30th day respectively in the intervention group compared to the control group. Secondary outcomes were the proportion of participants who attained clinical recovery at 7th, 15th, 22nd, and 30thday; improvement in laboratory parameters on the 30th day (as compared to baseline) and incidence of Adverse Drug Reactions/Adverse Events (ADRs/AEs). The data was compared within group using paired sample t-test/ Wilcoxon signed rank test and between group using independent sample t-test/Mann-Whitney test. Results: Statistically significant difference was not observed in the proportion of participants who turned RT-PCR negative during each of the follow-ups (p=0.134) and both groups demonstrated comparable efficacy. The clinical recovery rate in terms of time taken for complete cure of symptoms in the symptomatic participants was 60% and 37% on day 15 (p=0.098) and 100% and 85.2% on day 30 (p=0.112), in the intervention and control group respectively which is numerically a better clinical outcome in the intervention group. The improvement in the inflammatory markers such as IL-6, TNF-α and D-dimer was statistically significant in the intervention group (p<0.05). None of the participants developed any complications nor were any significant ADR/AE observed in both the groups.Conclusion: In patients with asymptomatic and mild COVID-19, AYUSH-64 as add-on to standard conventional care, contributed to improving the duration for attaining complete clinical cure and demonstrated potential in reducing the levels of pro-inflammatory markers in the body.

Background N-95 masks are in high demand during this COVID-19 pandemic but wearing an N-95 mask is a real challenge to the health workers during their duty hours. The present study aims to measure the effect of the N-95 mask on oxygen saturation level in the blood and the discomforts experienced while using it. Materials and Methods Oxygen saturation was measured in 80 health care workers before and after wearing the N-95 mask continuously for more than 6 hours. The participants were asked to fill a questionnaire regarding various discomforts of N-95 mask usage, which consisted of 14 questions. Results The most common discomfort was pain around the pinna followed by difficulty in breathing and fogging of spectacles or goggles. In addition, 71% of them had decreased oxygen saturation by 1%. Conclusion N-95 mask can alter the oxygen saturation but it does not produce significant effects in healthy individuals. It can significantly affect patients with compromised airways.

In recent period of time Novel Corona virus has become the center point of attraction, due to it pandemic effect on the entire world. This pandemic disease has taken about a million of life and still its outbreak is continued. News reports have been addressing its origin in China by consumption of bats which were af-fected by Novel Corona virus (SARS-CoV2). Its spread in the entire world was a shock and the actual fact was unrevealed. Human beings live in an environment which is filled with various bacteria, fungus, virus and different types of animals since early life. But how this new bacteria or viruses get erupted, it is noth-ing but the effect of rapid modernization and urbanization. Since modernization and change in lifestyle of an individual is related to increase in demand of products which has forced the bar towards artificial world. Nature has been deteriorated for fulfilling the needs but still it is insufficient and in result natural energy /immunity is replaced by artificial. So human beings are more depended on artificial antibodies to safe-guard themselves when they are attacked by different viruses or bacteria. China is a classic example of ar-tificial food production and consumption state, so their people immunity is severely hampered, that result in the outbreak of virus. Similarly, this virus is affecting the entire world but still we have measures to fight this disease is by raising our immunity power. This can be done properly when we understand the disease in a better manner. Ayurveda is the natural science, which helps us to understand the disease and the measure to increase immunity accordingly.

Objectives: Comparative study of Ashwagandha (Withania somnifera; WS) and hydroxychloroquine (HCQ) for chemoprophylaxis against COVID-19 in actively engaged high-risk health-care workers. Design: Randomized, multicentric, open label, active control, two arm parallel efficacy study of 16 weeks. Sample size was based on pre-set 15% non-inferiority margin to HCQ for prophylaxis against COVID-19 with 80% power and alpha < 0.05. Participants: 400 health-care workers from three sites who were asymptomatic and tested negative for a quantitative Reverse Transcription Polymerase Chain Reaction test (RT-PCR) for COVID-19 and SARS-CoV-2 antibodies (IgG) were randomized in a 1:1 ratio. Participants observed physical protection measures as per the national policy. All incident confirmed COVID-19 were withdrawn.Interventions: Two tablets of 250 mg standardized aqueous extract of WS, twice daily after meal or HCQ 800 mg loading followed by 400 mg weekly for 16 weeks as per the national guidelines. Main outcome measures: The primary efficacy measure was “failure of prophylaxis” as confirmed by RT-PCR at any time during the study. Both intention-to-treat (ITT) and per-protocol (PP) efficacy analyses were performed.Results: 95 participants in the Ashwagandha (WS) arm and 101 participants in the HCQ arm completed the study. Both groups were well matched at the baseline. 91 participants from the Ashwagandha arm and 84 from the HCQ arm were withdrawn because they received the COVID-19 vaccination. Four participants (2%; 95% CI 2.8 to 3.9%) in the Ashwagandha and 5 (2.5%; 95% CI 5.4 to 8%) in the HCQ arm developed confirmed COVID-19. This was within the prefixed non-inferiority margin and the 95% CI of the absolute risk reduction (ARR) was -2.9 to 3.8% intention to treat (ITT) and -5.9 to 7.5% per protocol (PP). The 95% CI of ARR for the total COVID-19 cases was -2.8 to 11.9% ITT and -5.7 to 20.3% PP. Several health measures, particularly anxiety and stress, improved significantly in the Ashwagandha arm. Seven out of 117 in the Ashwagandha and 59 out of 178 in the HCQ groups were reported to be possible drug-related adverse events (AE); there were significantly less gut-related AE in the Ashwagandha group. AE were mostly mild and did not cause withdrawal. All incident COVID-19 cases recovered without complications. Conclusions: Ashwagandha was non-inferior to HCQ in the chemoprophylaxis against COVID-19 in high risk health-care workers. It was significantly safer, well tolerated and improved quality of life measures. Ashwagandha as COVID-19 prophylaxis seems appropriate in high-risk populations. Trial registration: The Clinical Trials Registry India Number CTRI/2020/08/027163 dated August 14, 2020.