Introduction: The novel Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2), has been considered a major life-threatening danger to the human population worldwide. The traditional Indian medicines also play an important role as possible novel therapeutic approaches, exclusively targeting SARS-CoV-2 and its pathways. Among the Siddha medicines, Kabasura kudineer is a formulation composed of 15 ingredients used against fever caused by respiratory infections. Aim: To determine the outcome of Kabasura kudineer, among SARS CoV-2 patients admitted in a tertiary care hospital of Tamil Nadu with mild to moderate symptoms or asymptomatic patients. Methods: A prospective observational study was carried out in Covid care Hospital, Tirunelveli Medical College Hospital, Tirunelveli after the approval of Institutional Ethics Committee. Written informed consent forms were obtained from the patients. A total of 100 patients with positive Real Time Polymerase Chain Reaction (RT-PCR) for SARS-nCov-2 with asymptomatic and mild to moderate symptoms were included in this study. Among them, 50 patients were included in the control group and the other 50 patients were provided with 60 mL Kabasura kudineer for 5 days. Again on the sixth day, RT-PCR was repeated. Results: Among 50 participants in each group, by the sixth day, RT-PCR converted into negative for 27 patients in group B, by 10th day 25 in group A and 22 in group B, by 14th day 25 in group A and remaining 1 in group B became negative. Conclusion: The present study showed Kabasura kudineer was effective when compared with the control group against SARS-nCoV-2 patients with no symptoms and mild symptoms and also the conversion of RT-PCR.
Introduction: The ever-growing number of COVID-19 patients stresses upon the need to identify effective yet readily available predictors of disease severity to ensure better clinical outcomes. D-dimer is a fibrin specific degradation product derived by enzymatic action of plasmin on factor XIIIa cross-linked fibrin. It serves as an ideal marker for activation of coagulation and fibrinolytic pathways. Identification of coagulopathy as an important complication in COVID-19 patients has brought to focus D-dimer as a possible predictor of clinical severity in patients. Aim: In this study, we analysed the role of D-dimer levels in assessing the clinical severity of the COVID-19 patients. Materials and Methods: We enrolled 217 in-patients of Tirunelveli Medical College in this single centre observational study and classified them into asymptomatic, mild, moderate and severe according to “Clinical Management Protocol: COVID 19”, by the Ministry of Health and Family Welfare and Director General of Health Services. D-dimer was estimated in the separated plasma, using latex based assay using semi-automated coagulation analyser. Data were presented as percentages for categorical variables and median±Inter Quartile Range (IQR) for continuous variables. Chi-square test was used to compare the D-dimer values between symptomatic and asymptomatic groups. A value of p<0.05 was considered statistically significant. Results: Among the 217 cases, 88.9% were asymptomatic cases, 8.8% presented with mild clinical severity and 2.3% had moderate clinical presentation. In our study population, the Mean±SD and Median±IQR of D-dimer values (in ng/mL) were 223.4±230.6 and 157.0±187.7, respectively. The mean D-dimer value was found to increase as the category of our study group ascended from asymptomatic patients to mild and moderate clinical cases. It was noted that 91.1% of the cases who had D-dimer values <500 ng/mL were asymptomatic. Also, the odds of patients with high levels of D-dimer being clinically symptomatic was 5.5 times more than the odds of patients with D-dimer levels <500 ng/mL. Conclusion: Elevation of D-dimer levels associated with the severity of clinical course of patients infected with SARS CoV-2 when compared to patients with mild or asymptomatic clinical presentations.
Introduction: Early identification of severe disease in Coronavirus Disease-2019 (COVID-19) infection is important to reduce mortality and for the efficient allocation of medical resources. Several studies have established that severe cases of COVID-19 infections tend to have a higher Neutrophil Lymphocyte Ratio (NLR) and is an independent predictor of mortality. Aim: This study aimed to determine whether NLR can serve as a predictor of the prognosis of COVID-19 infections in Indian patients. Materials and Methods: This study was an ambispective observational single centre study conducted in Tirunelveli Medical College from March 2020 to July 2020. Clinical and laboratory data of 1100 laboratory-confirmed COVID-19 infected patients were reviewed in this study. The patients were categorised as, asymptomatic, mild, moderate, and severe cases based on their clinical presentation. The demographic, clinical characteristics and laboratory data on the day of admission were analysed and compared by tertiles of the NLR. The receiver operating curve was applied to determine the threshold of NLR and the prognostic value was assessed via the Kaplan-Meier curve and regression models. Results: A total of 1100 cases were included in the study and were subdivided based on the clinical presentation into mild (n=226), moderate (n=27), severe (n=67), and asymptomatic (n=780) cases. The overall mortality rate was 4.9%. The ROC curve indicated that NLR is a better predictor of severe disease than other haematological parameters, with 89.3% Area Under the Curve (AUC) at the cut-off value of 2.81 with 80.6% sensitivity and 87.1% specificity. Multivariate analysis established that patients with NLR >2.8 had higher odds (OR=19.809, 95% CI-10.159-38.622) of severe infection and mortality (HR=1.110, 95% CI-1.088-1.113). Kaplan-Meier curve showed a significant difference (p-value<0.001) in the duration of hospital stay between patients with NLR <2.8 (Mean=10.4 days) and NLR >2.8 (13.1 days). Conclusion: Early identification of COVID-19 patients with severe disease is important to reduce mortality. Elevated NLR is associated with severe disease in Severe Acute Resiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. NLR >2.8 in Indian population, may aid in identification of severe illness necessitating early access to intensive care unit and requirement of respiratory support.
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