Clinical Characteristics and Remedy Profiles of Patients with COVID-19: A Retrospective Cohort Study

OBJECTIVE

The aim of the study was to identify indicated homeopathic remedies based on the clinical characteristics of coronavirus disease 2019 (COVID-19) patients in India.

METHODS

In this retrospective, cohort study, confirmed COVID-19 patients admitted at a COVID Health Centre in New Delhi between April 29 and June 17, 2020 were given conventional and homeopathic treatment. Patients were grouped into mild, moderate or severe categories of disease. Their symptomatologic profiles were analyzed to identify indicated homeopathic medicines.

RESULTS

A total of 196 COVID-19 patients were admitted. One hundred and seventy-eight patients had mild symptoms; eighteen patients had moderate symptoms; no patients with severe symptoms were included as they were referred to tertiary care centers with ventilatory support. The mean age of patients with mild symptoms was significantly lower (38.6 years; standard deviation or SD ± 15.8) compared with patients in the moderate category (66.0 years; SD ± 9.09). The most important symptoms identified were fever (43.4%), cough (47.4%), sore throat (29.6%), headache (18.4%), myalgia (17.9%), fatigue (16.8%), chest discomfort (13.8%), chills (12.6%), shortness of breath (11.2%) and loss of taste (10.2%). Twenty-eight homeopathic medicines were prescribed, the most frequently indicated being Bryonia alba (33.3%), Arsenicum album (18.1%), Pulsatilla nigricans (13.8%), Nux vomica (8%), Rhus toxicodendron (7.2%) and Gelsemium sempervirens (5.8%), in 30C potency.

CONCLUSION

Data from the current study reveal that Arsenicum album, Bryonia alba, Pulsatilla nigricans, Nux vomica, Rhus toxicodendron and Gelsemium sempervirens are the most frequently indicated homeopathic medicines. A randomized controlled clinical trial based on this finding is the next step.

Use of insulin glargine during pregnancy: A review

BACKGOUND AND AIMS

Hyperglycemia during pregnancy is increasing globally. Insulin therapy is considered the standard of care for its optimum management. Insulin glargine, in spite of widespread use in non-pregnant adults, lacks randomized controlled trial evidence as safe basal insulin during pregnancy. Aim of this review is to discuss major available evidences and recommendations on the use of insulin glargine during pregnancy.

METHODS

Evidences related to use of insulin glargine during pregnancy, including animal studies, placental transfer studies, case reports as well as observational studies were retrieved using PUBMED & Google scholar. Recommendations regarding use of insulin glargine during pregnancy by international and Indian organizations were reviewed.

RESULTS

Trans-placental transfer studies show that insulin glargine does not cross placenta when used at therapeutic concentrations. Although there are no randomized controlled trials on insulin glargine in pregnancy, it's use during pregnancy is not associated with any adverse maternal or neonatal outcomes as shown in many case reports and observational studies (both prospective and retrospective). It's use during pregnancy is hence considered safe by many organizations across the globe.

CONCLUSIONS

Insulin glargine can be continued safely during pregnancy in women who are already taking it prior to pregnancy and have achieved good glycemic control with it. However we require preferably randomized controlled trials or large prospective observational studies to establish it as first line or preferred basal insulin for management of hyperglycemia during pregnancy.

A practical approach to diseases affecting dentate nuclei

A wide variety of diseases affect the dentate nuclei. When faced with the radiological demonstration of signal changes in the dentate nuclei, radiologists and clinical neurologists have to sieve through the many possibilities, which they do not encounter on a regular basis. This task can be challenging, and therefore, developing a clinical, radiological, and laboratory approach is important. Information on the topic is scattered and the subject has not yet been reviewed. In this review, a combined clinicoradiological approach is presented. The signal changes in T1, T2, fluid-attenuated inversion recovery (FLAIR), diffusion, susceptibility weighted, and gadolinium-enhanced images can give specific or highly suggestive patterns, which are illustrated. The role of computed tomography (CT) in the diagnostic process is discussed. Specific radiological patterns do not exist in a significant proportion of patients where the clinical and laboratory analysis becomes important. In this review, we group the clinical constellations to narrow down the differential diagnosis and highlight the diagnostic clinical signs, such as tendon xanthomas and Kayser-Fleischer rings. As will be seen, a number of these conditions are potentially reversible, and hence, their early diagnosis is desirable. Finally, key diagnostic tests and available therapies are outlined. The practical approach thus begins with the radiologist and winds its way through the clinician, towards carefully selected diagnostic tests defining the therapy options.

Leaching of pesticides in tea brew

A cup of tea that cheers can also be an important route of human exposure to pesticide residues. It is important to evaluate the percent transfer of pesticide residue from dried (made) tea to tea infusion, as tea is subjected to an infusion process prior to human consumption. To investigate the pesticide translocation, 13 pesticides commonly used on tea were studied by subjection of fortified teas to infusion. Analytes of interest were quantified by gas-liquid chromatography with nitrogen-phosphorus and electron capture detectors. Interestingly, water solubility of pesticides did not necessarily indicate a shift of residues toward their preferential accumulation in infusion. The pesticides with larger partition coefficient (K(ow)) values remained nonextractable in infusing water. Further, boiling for longer periods (extended brewing time) resulted in higher transfer of pesticides to tea brew.

Incorporating spatial variation in density enhances the stability of simple population dynamics models

Simple discrete time models of population growth admit a wide variety of dynamic behaviors, including population cycles and chaos. Yet studies of natural and laboratory populations typically reveal their dynamics to be relatively stable. Many explanations for the apparent rarity of unstable or chaotic behavior in real populations have been developed, including the possible stabilizing roles of migration, refugia, abrupt density-dependence, and genetic variation in sensitivity to density. We develop a theoretical framework for incorporating random spatial variation in density into simple models of population growth, and apply this approach to two commonly used models in ecology: the Ricker and Hassell maps. We show that the incorporation of spatial density variation into both these models has a strong stabilizing influence on their dynamic behavior, and leads to their exhibiting stable point equilibria or stable limit cycles over a relatively much larger range of parameter values. We suggest that one reason why chaotic population dynamics are less common than the simple models indicate is, these models typically neglect the potentially stabilizing role of spatial variation in density.

Estimation of dynamically evolving ellipsoids with applications to medical imaging

The estimation of dynamically evolving ellipsoids from noisy lower-dimensional projections is examined. In particular, this work describes a model-based approach using geometric reconstruction and recursive estimation techniques to obtain a dynamic estimate of left-ventricular ejection fraction from a gated set of planar myocardial perfusion images. The proposed approach differs from current ejection fraction estimation techniques both in the imaging modality used and in the subsequent processing which yields a dynamic ejection fraction estimate. For this work, the left ventricle is modeled as a dynamically evolving three-dimensional (3-D) ellipsoid. The left-ventricular outline observed in the myocardial perfusion images is then modeled as a dynamic, two-dimensional (2-D) ellipsoid, obtained as the projection of the former 3-D ellipsoid. This data is processed in two ways: first, as a 3-D dynamic ellipsoid reconstruction problem; second, each view is considered as a 2-D dynamic ellipse estimation problem and then the 3-D ejection fraction is obtained by combining the effective 2-D ejection fractions of each view. The approximating ellipsoids are reconstructed using a Rauch-Tung-Striebel smoothing filter, which produces an ejection fraction estimate that is more robust to noise since it is based on the entire data set; in contrast, traditional ejection fraction estimates are based only on true frames of data. Further, numerical studies of the sensitivity of this approach to unknown dynamics and projection geometry are presented, providing a rational basis for specifying system parameters. This investigation includes estimation of ejection fraction from both simulated and real data.

The solution of an integral equation with its application to human joints

The fundamental fluid transport mechanisms in a cavity of a joint and the deformation of the bearing surfaces are important for the understanding of the bio-mechanical process involved in the physiology of normal and pathological synovial joints. We present here a study of elasto-rheodynamic lubrication of a self-acting dynamically loaded bearing which employs a porous, elastic material (articular cartilage) and a visco-elastic non-linear lubricant (synovial fluid). The tangible solution of the model is, finally, subjected to the resolution of a non-linear integral equation. Important conclusion is drawn from the results obtained for bearing characteristics which show the self-adjusting nature of human joints.