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Introduction: Coronavirus Disease-19 (COVID-19) infection is associated with high rates of pulmonary and extrapulmonary complications that may continue to incur morbidity, disability and delayed mortality in survivors. These include hyperglycaemia, cardiac injury, acute ischaemic or haemorrhagic stroke, neurological deficits, acute kidney injury and liver injury. Aim: To describe symptoms and complications being faced by COVID-19 recovered patients, as well their socio-demographic profile and co-morbidities. Materials and Methods: This was a cross-sectional descriptive study conducted for the period of 12 months from April 2020-March 2021. Out of nearly 10,000 recovered COVID-19 patients, 1000 (calculated sample size) patients were selected randomly. The patients were categorised gender-wise (male and female) and locality-wise (urban and rural) and an attempt was made to find if any significant difference exists in the symptoms and complications based on above categorisation. The test used for this purpose was Chi-square test and Fisher's-exact test. Results: Mean age of participants was 50.2±15.7 years and 43.8% had co-morbidities. Common complications included hyperglycaemia (n=28), acute kidney injury (n=8), acute liver injury (n=5), cardio-vascular accident and stroke (n=5), septicaemia (n=8), ischaemic heart disease (n=7), deep vein thrombosis (n=2), cytokine release syndrome (n=10) and post COVID-19 fibrosis (n=3). For septicaemia, a statistically significant difference (p<0.001) was found between urban and rural areas whereas no significant difference in post COVID-19 complications between males and females was observed. Conclusion: The most common co-morbidity was diabetes mellitus and most common complication reported was hyperglycaemia. [ABSTRACT FROM AUTHOR]

Today, we are living in the era of Coronavirus Disease-2019 (COVID-19), a pandemic that has affected almost the whole globe. It has rightly been called as the 'twenty-first-century plague' which has garnered considerable attention from researchers, pharma companies, policymakers, and media. Though vaccines are being deployed and people are eagerly receiving vaccination; the duration of conferred immunity, the possibility of re-infection of recovered/vaccinated individuals, the consequence of the new mutation in SARS-CoV-2 and its impact and challenge for the efficacy and degree of protection that a potential vaccine could provide is under question. In the absence of any definite answer, people are turning towards natural remedies and spices. India is known globally as the land of spices. Spices like ginger, garlic, black pepper, cardamom, turmeric, clove, cinnamon, etc., are known for their rich aroma, texture, and immunity boosting ingredients. These are rich sources of antioxidants such as flavonoids and alkaloids. The antioxidants present in them, neutralise the free radicals generated inside the body during viral infections and also prevent cellular damage. These exhibit anti-inflammatory activity and have the potential to combat "cytokine storm" in severe COVID-19 infection. Their potential has been realized by the public and has led to a tremendous increase in global demand and consumption. The present review enlists the active ingredients present in important spices and addresses their antioxidants, antiinflammatory, and anti-viral action. Traditional Indian spices that are not only a cardinal part of the diet but are affordable, easily available can be viewed as the light at the end of the tunnel to combat the current COVID-19 conditions as a preventive measure. [ABSTRACT FROM AUTHOR]

Introduction: Severe and threatening complications of Corona Virus Disease-2019 (COVID-19) are caused by direct viral injury as well as excessive and aberrant host immune response induced by the virus. In this context, use of Methylprednisolone (MP) to prevent cytokine storm and Remdesivir to prevent viral replication seems prudent. Aim: To assess the clinical outcome of combination therapy of Remdesivir and MP pulse therapy in patients with severe COVID-19 in Intensive Care Unit (ICU). Materials and Methods: The retrospective study was conducted in the COVID-19 Intensive Care Unit (ICU), dealing exclusively with severe illness cases, of Safdarjung Hospital, New Delhi from June to July 2020. They were given MP pulse therapy (500 mg/day for three days, followed by 1 mg/kg orally once daily, tapered by 10 or 20 mg/day and finishing with 10 mg) along with intravenous Remdesivir. Pre and post-therapy examination of the patients included clinical features, inflammatory markers (Interleukin-6, ferritin and D-dimer), gas parameters like ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and changes in chest radiograph. Values of PaO2/FiO2, inflammatory markers on day 1 and day 3 were expressed as mean±SD and their difference compared using student t-test. Statistical significance was defined as p<0.05. Results: This treatment regimen was associated with significant improvement in PaO2/FiO2 (p<0.001), significant decrease in inflammatory markers (p<0.001) and reversal of radiological changes. Ten patients were discharged with-in two weeks of treatment while six patients were shifted to high dependency unit for further oxygen requirement. They were all successfully discharged from hospital without oxygen requirement within next two weeks. Five patients developed opportunistic infections and succumbed to death. Side-effects of therapy included hyperglycaemia in nine patients, which was managed by insulin infusion. Conclusion: Combination therapy of MP pulse and Remdesivir in patients with severe COVID-19 resulted in significant clinical improvement. Given the high efficacy, it could be one of the promising approaches to the management of patients with severe COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: The on-going Corona-Virus Disease 2019 (COVID-19) pandemic has spread rapidly across the globe. Tocilizumab is a recombinant monoclonal antibody to Interleukin-6 (IL-6) receptor. An increasing number of studies across the world is reporting the use of tocilizumab in treating COVID-19 patients or at risk of developing cytokine storm. Apart from clinical and laboratory parameters, High Resolution Computed Tomographic (HRCT) chest scan is a promising tool to identify patients very early in the course of COVID-19 disease. Aim: The purpose of this retrospective research study is to find whether high chest CT Severity Score (CTSS) on HRCT thorax scan predict the clinical requirement of tocilizumab injection in COVID-19 patients. Materials and Methods: In this retrospective study, during the period from May 2020 to July, 2020, 250 patients with confirmed Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) diagnosed of COVID-19 on first or repeat sample and who also underwent HRCT scan of the chest, were assigned chest CTSS. From data obtained, patients were categorised into two groups based on mild and severe CTSS. Patients with higher CTSS have a higher future possibility of developing the cytokine storm and hence the requirement of tocilizumab can be reliably predicted. All statistical analysis was performed in IBM SPSS version 20. Results: Out of a total of 250 patients, 72 patients were given tocilizumab injection. The average CTSS was 29.8±6.38 in the tocilizumab injection group. Only 8% of patients with mild CTSS received tocilizumab injection while 60% of patients with severe CTSS received tocilizumab injection (p<0.001). Out of 72 patients who received tocilizumab injection, 16.7% had mild CTSS while 83.3% had severe CTSS (p<0.001). Average values of inflammatory markers like CRP, D-Dimer, Ferritin, LDH, and IL-6; were significantly higher in severe CTSS and tocilizumab group (p<0.001). Conclusion: CTSS may be used as a new decisive tool in triaging in-hospital COVID-19 patients. Categorising patients in mild and severe CTSS early in the disease course, even before the marked worsening of laboratory parameters and development of cytokine storm may help initiate early treatment and thereby save many lives. [ABSTRACT FROM AUTHOR]

Pirfenidone has been approved for the treatment of Idiopathic pulmonary fibrosis due to its anti-fibrotic activity. It has been shown to have anti-inflammatory and antioxidant properties apart from being an anti-fibrotic agent. Cytokine storm, severe inflammation and oxidative stress leading to acute respiratory distress syndrome and multi organ failure are factors causing mortality in patients of COVID-19. This article reports two cases of 35 years and 60 years old male patients of COVID-19, those were diagnosed by real time Polymerase Chain Reaction (PCR) using nasopharyngeal samples. They were started on pirfenidone 400mg bd, later increased to 600mg tds along with empirical antibiotics, dexamethasone, supplemental oxygen and non-invasive ventilator support. Both the patients improved and were discharged. Both the patients were followed by telemedicine after 1 week, did not require oxygen at rest and were comfortable at rest in contrast to earlier complains. Thus, the authors conclude that pirfenidone can be a possible cure for COVID-19 patients, larger trials are required to confirm its efficacy. [ABSTRACT FROM AUTHOR]

Corona Virus Disease of 2019 (COVID-19) is spreading throughout the world and the United States with confirmed cases in all 50 states. Cytokine Release Syndrome (CRS), or cytokine storm, is being increasingly reported with severe cases of COVID-19 patients and is a common cause of death in these patients. Hereby, authors report a case of critically ill COVID-19 patient who developed cytokine storm. She had a remarkable increase in inflammatory markers and went into multiorgan failure and death in less than 48 hours. Among inflammatory markers, ferritin has a high sensitivity for CRS. This case report sheds light on the importance of following the level of inflammatory markers (especially ferritin) closely in COVID-19 patients. The goal is to diagnose CRS before the patient goes into a full cytokine storm and multiorgan failure, as it may be too late to react then. Even when the patient is clinically stable, a high ferritin level could be the calm before the storm. [ABSTRACT FROM AUTHOR]