[Zhenwu Decoction:connotation interpretation based on severe cases and modern pathophysiological mechanisms and application in treatment of heart failure in critical care unit].

Zhenwu Decoction is recorded in Treatise on Febrile Diseases by an outstanding physician ZHANG Zhong-jing in the Han dynasty. With effect of warming yang, transforming Qi, and promoting urination, Zhenwu Decoction is mainly used to treat edema due to yang deficiency. The studies of the severe and critical cases and the pathophysiological mechanisms have demonstrated that the record of Zhenwu Decoction in Treatise on Febrile Diseases describes the clinical symptoms and therapeutic regimen of acute heart failure. The syndrome treated by this formula may be related to the misdiagnosis and wrong treatment. Due to the difficult distinguishing between cardiogenic dyspnea and pulmonary dyspnea, high doses of Ephedrae Herba may be misused for inducing sweating, which may finally lead to the acute aggravation of heart failure, electrolyte disorder, and pulmonary infection. The syndrome treated by Zhenwu Decoction can illustrate the lack of experience of ancient physicians in treating acute heart failure. The description of "trembling and shivering" may be the clinical manifestation of heart failure, which is an upgraded version of "trembling and shaking" treated by Linggui Zhugan Decoction.(1)In terms of diseases, Zhenwu Decoction is suitable for the treatment of acute or chronic heart failure, cardiorenal syndrome, and diuretic resistance. The decoction is especially suitable for treating whole heart failure, acute heart failure, heart failure with reduced ejection fraction, and heart failure with the syndrome of sold and dampness. In addition, it can be used to treat both type Ⅱ and type Ⅳ cardiorenal syndrome.(2)In terms of symptoms, Zhenwu Decoction can be used for treating chest tightness, palpitations, lower limb edema, difficult urination or increased urine output, fear of cold, pale fat tongue with teeth marks, white and slippery tongue fur, and deep or slow pulse.(3)In terms of the pharmacological mechanism, Zhenwu Decoction treats heart failure following the principle of promoting urination, expanding blood vessels, and invigorating heart in modern medicine. Aconiti Lateralis Radix Praparata is the sovereign herb in the formula, with the recommended dosage of 30-60 g. However, arrhythmia may be caused by high doses of Aconiti Lateralis Radix Praparata, which should be used with concern. In addition to Zhenwu Decoction, Shenqi Pills, Renshen Decoction, Wuling Powder, and Fangji Huangqi Decoction with the effect of invigorating spleen, replenishing Qi, warming Yang, and promoting urination can be used in the recovery stage. The therapy of reinforcing Yang was the last choice for critical cases due to the lack of medical conditions, unclear clinical diagnosis in history, which should be treated objectively now.

Integrative management of critical case of Covid 19 with Ayurveda and modern medicine: A case report.

Covid 19 pandemic has placed challenges in front of medical health fraternity in terms of management, prevention and immunity building. Effectiveness of any medication has not conclusively proven; hence there is need for integrative management of Covid 19. We have managed a critical case of Covid-19 having history of thalassemia, hypothyroidism with integrative management of Ayurveda and modern medicine. A male patient (59 years of age) with history of thalassemia had complaints of cough and breathlessness since 4 days. He performed RT PCR because of his exposure to a Covid positive cases in immediate family. He was treated with Favipiravir at home for 5 days. He deteriorated on 6th day with SPO2 dropped to 75%, temp raised to 101 F and respiratory rate (RR) raised to 45/min. He was admitted in Yogeshwari Hospital Daund, Maharashtra; treated with oxygen inhalation, Remdesvir and Ayurveda medicines in intensive care unit (ICU). Ayurveda treatment protocol was advised through telemedicine. Significant improvement in clinical symptoms and normal HRCT was observed at completion of treatment. This case report provides further directions for integrative management in cases of Covid 19. Further clinical research studies in this direction are warranted.

Radical appraisal in support of archival autonomy for animal rights activism.

Working outside traditional bureaucratic structures, animal activists have a long history of creating, managing and using records in radical ways to bring the suffering of animals to society's attention. Today's online platforms enable animal activism on a networked scale, with unprecedented reach and immediacy of impact, but also with risks and challenges. This article presents findings from a critical case study of the radical recordkeeping of Direct Action Everywhere (DxE), a US-based animal liberation group. The case study explores the performative role recordkeeping plays in the group's animal activism and advocacy, and the challenge of ensuring the longevity of an archival record of its activities and their impact. It is framed by Records Continuum Theory and illustrates the benefits of applying a Records Continuum lens to researching radical recordkeeping contexts. The paper reports on the research findings of the case study, including the vital role recordkeeping plays as a form of "strategic witnessing" for the activities of DxE, as well as in developing the DxE community and communicating its mission to the public. It discusses the challenges faced by DxE in preserving their archives into the future through integrating archiving into their current radical recordkeeping processes, Continuum-style, and addressing the risks associated with using online collaborative platforms for recordkeeping and archiving. Overcoming these challenges will ensure that current recordkeeping plays its part in DxE's animal activism, and that in the future records of continuing value take their place among the multiple narratives of society in the archival multiverse.

The Neutralizing Antibody Response against Severe Acute Respiratory Syndrome Coronavirus 2 and the Cytokine/Chemokine Release in Patients with Different Levels of Coronavirus Diseases 2019 Severity: Cytokine Storm Still Persists Despite Viral Disappearance in Critical Patients.

Patients with coronavirus disease 2019 (COVID-19) exhibit a wide clinical spectrum ranging from mild respiratory symptoms to critical and fatal diseases, and older individuals are known to be more severely affected. The underlying mechanism of this phenomenon is unknown. A neutralizing antibody against viruses is known to be important to eliminate the virus. In addition, this antibody is induced at high levels in patients with severe COVID-19, followed by a termination of virus replication. Severe COVID-19 patients exhibit high levels of cytokines/chemokines, even after the disappearance of the virus. This indicates that cytokines/chemokines play significant roles in disease severity. These findings also suggest that antiviral therapy (monoclonal antibody and/or convalescent plasma therapy) should be administered early to eliminate the virus, followed by steroid treatment after viral genome disappearance, especially in patients with severe symptoms.

Symptomatic and optimal supportive care of critical COVID-19: A case report and literature review.

BACKGROUND: Coronavirus disease 2019 (COVID-19) severity is classified as asymptomatic, mild, moderate, severe, and critical. Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorable prognosis. However, a 49%-67% mortality is noted in critical cases. No COVID-19-specific drug has been reported to date, and symptomatic and optimal supportive care, including oxygenation, anti-coinfection treatments, and ventilation, represent the mainstay of treatment for this disease, especially in critical patients. CASE SUMMARY: In the above-mentioned context, we share our experience with the treatment of one critical COVID-19 case and review the relevant literature. CONCLUSION: Timely tracheal intubation, reasonable mechanical ventilation support, appropriate anti-infection treatment, and early anticoagulation and immunity support are key factors in the successful treatment of this case.

A Sever case of of SARS-CoV-2 infection in Gansu.

An outbreak infection with the novel coronavirus (SARS-CoV-2) has developed in Wuhan since December 2019.This paper describes the first critical case in Gansu China.