Post-COVID-19 cardio-pulmonary manifestations after 1-year of SARS-CoV-2 infection among Indian population: A single centre, case-control study (OneCoV2 study).

BACKGROUND: The evolving challenge of persistent symptoms post-Coronavirus disease-2019 (COVID-19), particularly debilitating cardio-pulmonary manifestations, necessitates further exploration. Our study aimed to assess the cardio-pulmonary complications in patients a year after hospital discharge from severe COVID-19, contrasting these with findings from a non-COVID group. METHODS: The OneCoV2 study, a prospective, case-control study, was conducted at a tertiary care teaching hospital in northern India. We enrolled 43 subjects, with a mean age of 25.57 ± 7.94 years (COVID group) and 27.30 ± 8.17 years (non-COVID group). Comprehensive tests included pulmonary function tests, cardiac function tests, 6-min walk tests, and laboratory investigations. RESULTS: Significant differences were found in the pulmonary function [forced vital capacity (FVC) (p = 0.037), forced expiratory flow (FEF) 25-75 % (p = 0.013)], and cardiac function [left ventricular ejection fraction (LVEF) (p = 0.032), heart rate (HR) (p = 0.047)], along with the six-minute walk test results between the two groups. In the COVID group, Pearson's correlation showed a negative correlation between FVC and C-reactive protein (CRP) [r = -0.488, p = 0.007] and a positive correlation between the six-minute walk test [r = 0.431, p = 0.003] and HR [r = 0.503, p = 0.013]. CONCLUSIONS: Our data suggest that pulmonary abnormalities are prevalent in COVID patients even after 1-year of hospital discharge. Cardiac biomarkers also show an inclination towards the COVID group. While we found significant correlations involving some parameters like FVC, CRP, HR, and results from the six-minute walk test, we did not find any significant correlations with the other tested parameters in our study.

Albuminuria, glycemic variability and effect of flash glucose monitoring based decision making on short term glycemic variability in Indian type 2 diabetes patients: Indi-GlyVar study.

Aim and scope: Glycemic variability (GV) denotes the fluctuations in the glucose values around the baseline. High glycemic variability is associated with a higher risk of diabetes-associated complications. In this study, we sought to determine the impact of therapeutic interventions based on flash glucose monitoring on rapid, short-term glycemic variability. We also studied the prevalent albuminuria in diabetic kidney disease and its effect on glycemic variability. Methods: In a 14-day, single-center, prospective intervention study, we measured the GV indices at baseline (days 1-4) and ten days after ambulatory glucose profile-based intervention using flash glucose monitoring (Abbott Libre Pro, Abbott Diabetes Care, Alameda, California, USA) in patients with type 2 diabetes. An EasyGV calculator was used to estimate the flash glucose monitoring (FGM)-derived measures of GV. The primary outcome was to assess the impact of FGMS-based therapeutic interventions on glycemic variability markers: SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD], M value, and coefficient of variance [%CV], AUC below 70 mg/dl, low blood glucose index, AUC above 180 mg/dl [AUC >180], high blood glucose index [HBGI], and J index. Time-related matrices (time in range (%), time above range (%), and time below range (%) were also calculated from the ambulatory glucose profile. Renal function parameters (serum creatinine, estimated glomerular filtration rate, urine albumin excretion) were calculated. The GV with regard to albumin excretion rate was compared. Results: Fifty-eight T2DM patients (63.8%, males) with a mean age of 51.5 ± 11.9 years were studied. When compared with baseline (days 1-4), on day 14, there was a significant improvement in mean sensor glucose (mg/dl) median (IQR) [155 (116-247) vs 131 (103-163) (p ≤0.001)], JINDEX [15,878 (7,706-28,298) vs 8,812 (5,545-14,130) (p ≤0.001)], HBGI [361 (304-492) vs 334 (280-379) (p ≤0.001)], MAGE (mg/dl) [112 (8-146) vs 82 (59-109) (p ≤0.001)], M-value [2,477 (1,883-3,848) vs 2,156 (1,667-2,656) (p ≤ 0.001)], MAG (mg/dl) [111 (88-132) vs 88 (69-102) (p ≤ 0.001)]. Patients with albuminuria at baseline had high mean sensor glucose (mg/dl) median (IQR) [190 (131-200) vs 131 (112-156) (p = 0.001)], CONGA (mg/dl) median (IQR) [155 (101-165) vs 108 (83-120) (p = 0.001)], JINDEX, HBGI, MAGE (mg/dl), and M-value are, median (IQR) [20,715 (10,970-26,217 vs 91,118 (6,504-15,445)) (p ≤ 0.01)], [415 (338-423) vs 328 (292-354) (p = 0.001)], [125 (102-196) vs 103 (74-143) (p ≤ 0.01)], [3,014 (2,233-3,080) vs 2,132 (1,788-2,402) (p ≤0.01)], respectively. Conclusion: In type 2 diabetes, flash glucose monitoring-guided therapeutic interventions can reduce glycemic variability in a brief span (10 days) of time. Also, albuminuria in type 2 diabetes is associated with high glycemic variability. Reduced diabetes complications may ultimately result from this reduced glycemic variability.

Prevalence of Symptoms in Patients Discharged from COVID Care Facility of NIMS Hospital: Is RT PCR Negativity Truly Reflecting Recovery? A Single-Centre Observational Study.

PURPOSE: To assess the prevalence of post-COVID symptoms in patients with recovered COVID-19 (nasopharyngeal RT PCR negative) who were discharged from an acute COVID care facility at a tertiary care teaching hospital in North India. METHODS: This study was an observational study with retrospective data collection, conducted in the COVID follow-up clinic, a combined clinic of medicine and endocrinology. Patients discharged from the acute COVID care facility were recruited after 14 days of discharge if they fulfilled inclusion and exclusion criteria. The retrospective data was collected from the hospital records/EMR and analysed by the SPSSv23. RESULTS: Fifty patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The Mean age of patients was 53.4±13.8 years (range 28-77). Seventy six percent were male, and 38% had type 2 diabetes. Fever (94%), cough (78%) and breathlessness (68%), were the most common symptoms at presentation to acute care facility. Oxygen saturation at presentation had a negative correlation with D-Dimer, age, and C reactive protein. When patients were evaluated clinically, after 14 days (range 15 to 50 days) of the discharge, 82% of patients had at least one persistent symptom. Fatigue (74%) was the most common symptoms in follow-up followed by breathlessness (44%), and muscle weakness (36%). Two patients had persistent fever, even after negative RT PCR status. CONCLUSION: Patients discharged from the acute COVID care facility had a high prevalence of post-COVID symptoms even after 14 days.

Randomized placebo-controlled pilot clinical trial on the efficacy of ayurvedic treatment regime on COVID-19 positive patients.

BACKGROUND: Specific treatment for COVID-19 is still an unmet need. Outcomes of clinical trials on repurposed drugs have not been yielding success. Therefore, it is necessary to include complementary approaches of medicine against COVID-19. PURPOSE: This study was designed to evaluate the impact of traditional Indian Ayurvedic treatment regime on asymptomatic patients with COVID-19 infection. STUDY DESIGN: It is a placebo controlled randomized double-blind pilot clinical trial. METHODS: The study was registered with Clinical Trial Registry-India (vide Registration No. CTRI/2020/05/025273) and conducted at the Department of Medicine in National Institute of Medical Sciences and Research, Jaipur, India. 1 g of Giloy Ghanvati (Tinospora cordifolia) and 2 g of Swasari Ras (traditional herbo-mineral formulation) and 0.5 g each of Ashwagandha (Withania somnifera) and Tulsi Ghanvati (Ocimum sanctum) were given orally to the patients in treatment group twice per day for 7 days. Medicines were given in the form of tablets and each tablet weighed 500 mg. While, Swasari Ras was administered in powdered form, 30 min before breakfasts and dinners, rest were scheduled for 30 min post-meals. Patients in the treatment group also received 4 drops of Anu taila (traditional nasal drop) in each nostril every day 1 h before breakfast. Patients in the placebo group received identical-looking tablets and drops, post randomization and double blinded assortments. RT-qPCR test was used for the detection of viral load in the nasopharyngeal and oropharyngeal swab samples of study participants during the study. Chemiluminescent immunometric assay was used to quantify serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) and high sensitivity C-reactive protein (hs-CRP) on day 1 and day 7 of the study. RESULTS: By day 3, 71.1 % and 50.0 % patients recovered in the treatment and placebo groups, respectively. Treatment group witnessed 100 % recovery by day 7, while it was 60.0 % in the placebo group. Average fold changes in serum levels of hs-CRP, IL-6 and TNF-α in treatment group were respectively, 12.4, 2.5 and 20 times lesser than those in the placebo group at day 7. There was 40 % absolute reduction in the risk of delayed recovery from infection in the treatment group. CONCLUSIONS: Ayurvedic treatment can expedite virological clearance, help in faster recovery and concomitantly reduce the risk of viral dissemination. Reduced inflammation markers suggested less severity of SARS-CoV-2 infection in the treatment group. Moreover, there was no adverse effect observed to be associated with this treatment.

Lactose intolerance and other disaccharidase deficiency.

Intolerance to foods which contain lactose can cause a range of intestinal and systemic symptoms. These symptoms are caused by Lactase deficiency which is encoded by a single gene (LCT) of ≈ 50 kb located on chromosome 2q21. In some food items, lactose has been missed because of "hidden" lactose due to inadequately labeled, confusing diagnosis of lactose intolerance based on dietary restriction of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. The key in the management of lactose intolerance is the dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of "risk" foods, inadequately labeled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the types, symptoms and management of lactose intolerance and also highlights differences from milk allergy which closely mimics the symptoms of lactose intolerance.