Treatment Of COVID-19 Infection Research Articles

Investigating the Significances of Thiol Functionalities in SARS-CoV-2 Using Carbon Dots for Viral Inhibition.

While the World Health Organization has declared the end of the SARS-CoV-2 public health emergency, studies related to corona viruses are still under course. As of 2024, the severity of COVID-19 has diminished with current treatments and vaccinations. However, individuals can still face severe complications, highlighting the importance of ongoing research into innovative treatments for current and future coronavirus-related diseases. This study approaches the mechanism of viral entrance into the host cells and the current evidence on the use of sulfhydryl groups for the COVID-19 treatment. Certain thiol drugs, a key contributor to inflammatory processes, exhibit both viral inhibition properties and the potential to regulate cellular oxidative stress by scavenging free radicals. Herein, we developed biocompatible thiol-functionalized carbon dots (CDs) and investigated the correlation between the number of thiols and pseudo-SARS-CoV-2 inhibition, reactive oxygen species (ROS) scavenging, and anti-inflammatory response. The free-radical scavenging experiment and the ROS cellular assay indicate that thiolated CDs serve as effective reducing agents and potential regulators of cellular oxidative stress. The CDs also demonstrated good cell viability alongside significant antiviral capabilities, with inhibition levels up to 60.4%. Furthermore, the flow cytometry results suggest that in an inflammatory environment, the presence of thiolated CDs promotes an anti-inflammatory response. Overall, the results demonstrate a strong correlation between the number of thiols and the increased efficacy observed across experiments, presenting thiolated CDs as promising candidates to prevent and treat COVID-19 infection.

Reviewing Ivermectin’s Efficacy in Treating COVID-19 Infection

Background: The use of antiviral therapies in addressing COVID-19 infection has been subject to varying approaches across different jurisdictions during the initial two years of the pandemic, with ivermectin being permitted in some regions, while banned in others. Objective: This study aimed to comprehensively review the evidence surrounding the efficacy of ivermectin, specifically in combating COVID-19 infection. Method: The efficacy of ivermectin has been assessed through an extensive review of scientific literature. Additionally, a comparative analysis has been conducted, evaluating cases and fatalities in states and countries that either have embraced or rejected ivermectin and other antiviral treatments. Results: A thorough examination of the scientific literature has revealed a predominantly positive trend supporting the utilization of ivermectin, evident in works published up to October 2021 and continuing in subsequent publications. Insights drawn from 217 studies have indicated improvements of 85%, 62%, and 41% for prophylaxis, early treatment, and late treatment, respectively. This positive effect, particularly in prophylaxis, has been further substantiated by analyzing cases and fatalities during the mid-2021 Indian outbreak. The success of the ivermectin-based Uttar Pradesh kit has been highlighted by the notably expedited reduction in cases and fatalities compared to other Indian states employing alternative approaches. Moreover, when contrasting countries that have prohibited ivermectin and other antivirals (e.g., the United States and the United Kingdom) with nations endorsing various antiviral strategies, including ivermectin, or with historical use of ivermectin (e.g., Africa, India, Saudi Arabia, or the United Arab Emirates), the advantages of endorsing rather than discouraging antiviral therapies have become evident. Conclusion: The majority of scientific literature has been found to support the use of ivermectin against COVID-19 infection, consistent with the lesser impact of COVID-19 infections observed in Indian states that have either utilized or abstained from ivermectin, as well as in countries that have either adopted or rejected antiviral treatments.

Status and hotspot analysis of Qingfei Paidu Decoction for the prevention and treatment of COVID-19 based on bibliometric analysis.

Qingfei Paidu Decoction (QFPDD) has played an important role in the prevention and treatment of COVID-19 infection in China. The present study aims to perform an econometric analysis and visualization of the literature on the treatment of COVID-19 with QFPDD in the Chinese databases and English databases. Six databases including such as Chinese databases CNKI, VIP, CBM, WANFANG as well as English databases PubMed, Web of Science were searched for publications related to the prevention and treatment of COVID-19 with QFPDD. The institutions, authors, keywords of each publication were cisualized using the software of CiteSpace. A total of 187 literature on the prevention and treatment of novel coronavirus infection with QFPDD were included, of which 145 (77.5%) were in Chinese and 42 (22.5%) were in English. Those publications were written by 926 authors from 383 institutions. There were 78 theoretical studies (41.7%), 63 clinical studies (33.7%), and 46 basic studies (24.6%). The cooperative institutions with the core of "Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences" and "Shanghai University of Chinese Medicine Cross Academy of Science" have been formed, and two core teams with "Wang Yanping" and "Zhang Weidong" have been formed. The keyword analysis showed that the research mainly focuses on pathologic pathogenesis, clinical efficacy, adverse reactions, integrated Chinese and western medicine therapy, network pharmacology research. QFPDD has attracted worldwide attention, mechanism research and clinical research may become a future development trend. Therefore, in-depth basic research and clinical studies with large samples and multi-center cooperation should be carried out to provide high-level evidence-based evidence for the prevention and treatment of COVID-19 with QFPDD.

Unveiling the detrimental vicious cycle linking skeletal muscle and COVID-19: A systematic review and meta-analysis.

Skeletal muscle catabolism supports multiple organs and systems during severe trauma and infection, but its role in COVID-19 remains unclear. This study investigates the interactions between skeletal muscle and COVID-19. The PubMed, EMbase, and The Cochrane Library databases were systematically searched from January 2020 to August 2023 for cohort studies focusing on the impact of skeletal muscle on COVID-19 prevalence and outcomes, and longitudinal studies examining skeletal muscle changes caused by COVID-19. Skeletal muscle quantity (SMQN) and quality (SMQL) were assessed separately. The random-effect model was predominantly utilized for statistical analysis. Seventy studies with moderate to high quality were included. Low SMQN/SMQL was associated with an increased risk of COVID-19 infection (OR=1.62, p<0.001). Both the low SMQN and SMQL predicted COVID-19-related mortality (OR=1.53, p=0.016; OR=2.18, p=0.001, respectively). Mortality risk decreased with increasing SMQN (OR=0.979, p=0.009) and SMQL (OR=0.972, p=0.034). Low SMQN and SMQL were also linked to the need for intensive care unit/mechanical ventilation, increased COVID-19 severity, and longer hospital stays. Significant skeletal muscle wasting, characterized by reduced volume and strength, was observed during COVID-19 infection and the pandemic. This study reveals a detrimental vicious circle between skeletal muscle and COVID-19. Effective management of skeletal muscle could be beneficial for treating COVID-19 infections and addressing the broader pandemic. These findings have important implications for the management of future virus pandemics. PROSPERO CRD42023395476.

Synthesis, molecular docking analysis, molecular dynamic simulation, ADMET, DFT, and drug likeness studies: Novel Indeno[1,2-b]pyrrol-4(1H)-one as SARS-CoV-2 main protease inhibitors.

The COVID-19 pandemic began in 2019 as a result of the advent of a novel coronavirus, SARS-CoV-2. At present, there are a limited number of approved antiviral agents for the treatment of COVID-19. Remdesivir, Molnupiravir, and Paxlovid have been approved by the FDA to treat COVID-19 infections. Research has shown that the main protease enzyme (Mpro) of SARS-CoV-2 plays a crucial role in the enzymatic processing of viral polyproteins. This makes Mpro an interesting therapeutic target for combating infections caused by emerging coronaviruses. The pharmacological effects of pyrroles and their derivatives have a wide range of applications. In our study, we focused on synthesizing nine novel derivatives of 2-arylamino-dihydro-indeno[1,2-b] pyrrol-4(1H)-one, with a particular emphasis on their antiviral properties. Using in silico studies involving molecular docking and DFT analyses in the gas phase using the B3LYP/6-31++G(d,p) basis set, we studied these compounds with respect to their interactions with the Mpro of SARS-CoV-2. The results of the docking analysis revealed that the synthesized compounds exhibited favorable inhibitory effects. Notably, compound 5f demonstrated the highest effectiveness against the target protein. Furthermore, the pharmacokinetic and drug-like properties of the synthesized derivatives of 2-arylamino-dihydroindeno[1,2-b] pyrrol-4(1H)-one indicated their potential as promising candidates for further development as inhibitors targeting SARS-CoV-2. However, it is imperative to determine the in vitro efficacy of these compounds through comprehensive biochemical and structural analyses.

Clinical Trial to Evaluate Safety and Efficacy of Thinqure20 (A Herbal Composition) in the Treatment and Prophylaxis of Novel Coronavirus and Testing its In vitro- Potential against MS2 Bacteriophagae, Corona Virus, Influenza Virus and Mucor racemosus

Background and Objective: Thinqure20 is a polyherbal, reverse-pharmacology-based formulation that contains Piper longum, Piper nigrum, Zingiber officinale, and rock salt as active ingredients. It is designed to work as an effective antiviral agent and also as a preventive measure against SARS-CoV-2. Clinical and non-clinical studies have established significant safety efficacy and tolerability of Thinqure20 formulation in the treatment of COVID-19 infection. Methods: In vivo human study was conducted on COVID-19 patients for 5 days. A total of 30 Covid-19 patients (n = 30) were enrolled. In vitro, cell line studies were also carried out to evaluate the potential effectiveness of Thinqure20 polyherbal formulation as an antiviral, antifungal, and Angiotensin- Converting Enzyme 2 (ACE2) inhibition. Results: Human studies have demonstrated a mean percentage of reduction in viral load from baseline to end of the study visit which was found to be 75.4%. The minimum and maximum reduction in viral load was found to be 59.3% and 100%, respectively. Viral load testing was carried out by Reverse Transcriptase-quantitative Polymerase Chain Reaction (RT-qPCR) test. In vitro studies of Thinqure, 20 extracts showed potential antiviral activity against MS2 bacteriophage, influenza, and human coronavirus, antifungal activity against Mucor racemosus, and significant ACE2 receptor inhibition. Conclusion: Thinqure20, a polyherbal formulation, is a potentially effective antiviral agent against non-enveloped viruses (MS2 bacteriophage), enveloped viruses (influenza and human coronavirus), and antifungal agent against mucor strains. It is also proven to be effective in the treatment of COVID-19 and can be attributed to an early recovery by the reduction in viral load. Clinical Trail Registration Number: CTRI/2021/03/032471.

A Comprehensive Review on Potentially Therapeutic Agents against COVID-19 from Natural Sources

Abstract: Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the recent pandemic and worldwide outbreak of respiratory disease. Since there are no known specific drugs for fighting this virus and the process for new drug development is lengthy, scientists have been trying to develop drugs against this viral infection. The potent antiviral activity of natural products has been confirmed in several previous studies. Viral and host proteins contributing to COVID-19 infections can be targeted by natural compounds derived from plants, marine organisms, and microorganisms. The most important of these compounds are polyphenols (e.g., anthraquinone polyphenol, hinokinin, curcumin, and epigallocatechin gallate), alkaloids (e.g., isoquinoline, 10- hydroxyusambarensine, anisotine, and adhatodine), and terpenoids (salvinorin A, thymoquinone, bilobalide, ginkgolide A, and celastrol) from plants, sulphated polysaccharides (carrageenans, chondroitin sulfate C, and fucoidan) from marine organisms, and glycocin F and lactococcin G phycocyanin, and lipopeptide from microorganisms. This study reviews these compounds and their mechanism of action for treating COVID-19 infection and guides researchers in developing effective and safe therapeutic agents against this disease from naturally derived compounds.

Emerging Therapeutic Potential of Polyphenols from Geranium sanguineum L. in Viral Infections, Including SARS-CoV-2.

The existing literature supports the anti-inflammatory, antioxidant, and antiviral capacities of the polyphenol extracts derived from Geranium sanguineum L. These extracts exhibit potential in hindering viral replication by inhibiting enzymes like DNA polymerase and reverse transcriptase. The antiviral properties of G. sanguineum L. seem to complement its immunomodulatory effects, contributing to infection resolution. While preclinical studies on G. sanguineum L. suggest its potential effectiveness against COVID-19, there is still a lack of clinical evidence. Therefore, the polyphenols extracted from this herb warrant further investigation as a potential alternative for preventing and treating COVID-19 infections.

Ethnobotanical study of medicinal plants used in the prevention and treatment of COVID-19 infection in the Tiaret region (Algeria)

The Corona Virus disease has spread widely over the world with a high mortality rate. This spread has prompted people to look for other ways to treator minimize the negative impact of this out break. During the pandemic, the Algerian population used medicinal plants for the prevention and treatment of COVID-19. The present work was carried out to identify the medicinal plants used during COVID-19 by the population of Tiaret region (Algeria). An ethnobotanical survey was conducted to collect data on the medicinal plants used, including the socio demographic parameters of the users and floristic characteristics of the plants. Information was obtained from 428 participants, of which 67.05% were women, aged between 16 and 88 years old. Most plant users were between 41 and 64 years old. The majority of participants have a high level of education (55.14% university and 20.32% secondary). Quantitative indices, namely, Frequency of Citation (FC), Relative Frequency of Citation (RFC) and Family Importance Value (FIV) were used to analyze the data. 27 species of medicinal plants belonging to 15 botanical families used during the COVID - 19 pandemic in our region. The most used species were Syzygium aromaticum, Zingiber officinale, Citrus limon and Aloysia citriodora.

Predictors of an unfavorable outcome in patients with severe pneumonia against the background of COVID-19 infection

Objective. To determine the predictors of an unfavorable outcome in patients with severe pneumonia against the background of COVID-19 infection.Materials and methods. A retrospective analysis of the case histories of deceased patients (control group, n = 40) for January 2021 (a continuous sample — 15.01.21–31.01.21) and surviving patients for the same period (n = 40) with a confirmed PCR diagnosis of coronavirus infection, who were on inpatient treatment at the state healthcare institution “Gomel City Clinical Hospital No. 3” (SHI “GCCH №3”) in Gomel. The Ethical Committee of SHI “GCCH №3” found no violations contradicting ethics and morality in conducting the study. Treatment of patients, assessment of the severity of the condition were carried out according to modern protocols for the diagnosis and treatment of COVID-19 infection, approved by the Ministry of Health of the Republic of Belarus (No. 1195 of 11.11.2020). The group of surviving patients was represented by 11 men and 29 women versus 24 men and 16 women in the control group (p &lt; 0.05).According to computed tomography of chest organs (CT CO), all 80 patients had signs of bilateral viral pneumonia characteristic of COVID-19. When processing and describing CT data, a semi-quantitative scale was used to estimate the volume of infiltration and consolidation zones of the lungs, recommended by temporary protocols. The total volume of lung damage in COVID-19 infection (“frosted glasses”, “cobblestone pavement”, “consolidation sites”) was &gt; 55% in both groups, p &gt; 0.05. CT CO was performed on Somatom Emotion 6 (Siemens) with a spiral type of scanning.Patients of both groups were comparable in age, concomitant comorbid pathology: coronary heart disease (CHD), arterial hypertension (AH), diabetes mellitus (DM), etc., however, they had differences in gender (the proportion of males prevailed in the group of deceased). A feature of the study was a solid sample among deceased patients. Taking into account the group differences by gender, in this study, an additional comparison of the results by gender was carried out. Results. The course of COVID-19 infection at the stationary stage is characterized by large-scale negative clinical dynamics, fever, “explosion” of acute phase indicators, thrombosis, distress syndrome with a drop in saturation and unfavorable outcomes. The indicators obtained using the NEWS-2, SHOCK-COVID scales (scales for predicting the severity of the clinical course of coronavirus infection) in severe patients, although they indicate a worsening of the patient’s clinical condition, but rather late, when the “cytokine storm”, powerful inflammation, thrombosis, significant damage to lung tissue already dominate among clinical syndromes, the decrease in saturation and the effectiveness of drug therapy is significantly limited.Conclusion. According to the results of the study, it is recommended to divide patients into groups of moderate and high risk of adverse outcome based on clinical, instrumental, laboratory data in dynamics. In patients with moderate risk, protocol therapy in most cases is sufficient to stabilize the general condition. In patients with an unfavorable outcome, this therapy does not restrain the growth of lung tissue damage with negative clinical, laboratory dynamics, which requires additional decisions, changes in the doses of drug therapy to prevent fatal outcomes.

In-Silico Evaluation of Deoxyvasicinone and Semi Synthetic derivatives of Justicia adhatoda against Coronavirus

Novel coronavirus disease (COVID-19) is the major health crisis in the world. World Health Organization has declared COVID-19 as a global pandemic. There are no effective drugs to treat COVID-19 infection. Some drugs include remdesivir, umifenovir, favipiravir, lopinavir/ ritonavir, ribavirin, hydroxychloroquine, etc are used to treat this disease. There is an urgent need for public health measures to implement preventive approaches to control severe COVID-19 disease. Justica adhatoda is a well-known plant drug in Ayurvedic and Unani medicines. Various phytochemical constituents have been isolated from J. adhatoda which possesses activities like antitussive, abortifacient, antimicrobial, cardiovascular protection, anticholinesterase, anti-inflammatory and other important activities. The alkaloids from leaf extracts of J. adhatoda possess anti-viral activity. Molecular docking interaction study against 6W63 showed that molecule 4d showed maximum docking interaction with dock score of (-) 8.1 kcal/mol. MD simulation data reflected the stable ligand-receptor interaction. Maximum and minimum energy gap were showed by 7 and 4d, respectively. The order of stability of the synthesized molecules were 4d&gt;2&gt;3&gt;5&gt;4c&gt;4a&gt;4b&gt;1&gt;6&gt;7. The order of ionization potential and electron affinity of the synthesized molecules were 3&gt;4c&gt;4b&gt;4a&gt;1&gt;6&gt;7&gt;4d&gt;5&gt;2. These data confirmed that molecule 4d would be a boon for society.

Medicinal Plant Extracts and Herbal Formulations: Plant Solutions for the Prevention and Treatment of COVID-19 Infection

Medicinal Plant Extracts and Herbal Formulations: Plant Solutions for the Prevention and Treatment of COVID-19 Infection

Mesenchymal stem cell therapy for COVID-19 infection.

COVID-19 emerged in December 2019 in Wuhan, China, spread worldwide rapidly, and caused millions of deaths in a short time. Many preclinical and clinical studies were performed to discover the most efficient therapy to reduce the mortality of COVID-19 patients. Among various approaches for preventing and treating COVID-19, mesenchymal stem cell (MSC) therapy can be regarded as a novel and efficient treatment for managing COVID-19 patients. In this review, we explain the pathogenesis of COVID-19 infection in humans and discuss the role of MSCs in suppressing the inflammation and cytokine storm produced by COVID-19. Then, we reviewed the clinical trial and systematic review studies that investigated the safety and efficacy of MSC therapy in the treatment of COVID-19 infection.

Ethnobotanical study of medicinal plants used in the prevention and treatment of COVID-19 infection in the Tiaret region (Algeria)

The Corona Virus disease has spread widely over the world with a high mortality rate. This spread has prompted people to look for other ways to treator minimize the negative impact of this out break. During the pandemic, the Algerian population used medicinal plants for the prevention and treatment of COVID-19. The present work was carried out to identify the medicinal plants used during COVID-19 by the population of Tiaret region (Algeria). An ethnobotanical survey was conducted to collect data on the medicinal plants used, including the socio demographic parameters of the users and floristic characteristics of the plants. Information was obtained from 428 participants, of which 67.05% were women, aged between 16 and 88 years old. Most plant users were between 41 and 64 years old. The majority of participants have a high level of education (55.14% university and 20.32% secondary). Quantitative indices, namely, Frequency of Citation (FC), Relative Frequency of Citation (RFC) and Family Importance Value (FIV) were used to analyze the data. 27 species of medicinal plants belonging to 15 botanical families used during the COVID - 19 pandemic in our region. The most used species were Syzygium aromaticum, Zingiber officinale, Citrus limon and Aloysia citriodora.

Molecular Docking Analysis of SARS-CoV-2 Inhibitor N3 (6LU7) against Selected Flavonoids and Vitamins

&lt;p&gt;Background: Coronavirus is a zoonotic disease and transmits between animals and humans. The disease known as COVID-19 (SARS-CoV-2) has become a pandemic since its outbreak. In addition to vaccines, a combination of antiretroviral agents, chloroquine derivatives, and vitamins are being used to treat SARS-CoV-2. &lt;p&gt; Method: We performed molecular docking analysis of SARS-CoV-2 inhibitor N3 (6LU7) using a series of flavonoid derivatives and vitamins. The X-ray crystallographic 3D structures of COVID-19 main protease in complex with an inhibitor N3 (PDB code: 6LU7, resolution 2.16 Å complexed with a selective substance) were downloaded from the online Protein Data Bank. The structures of the ligands and protein were constructed using ChemDrawUltra 8.0. The docking process, interactions, and binding of ligands were visualized using the software Molegro Virtual Dockings (MVD). The physicochemical and toxicity characteristics of tested flavonoid derivatives and vitamins were determined using Swiss-ADME and pkCSM online software. We found that molecular docking scores were between -64.42 and –172.00 Kcal/mol. The H-bonding and steric interactions were compared with other flavonoid derivatives. The ADMET parameters suggested that compounds 4, 68, 90, 92, and 94 have a higher GI rate. &lt;p&gt; Results: Our results also indicated that compound 78 was more potent and had higher skin permeation than other flavonoid derivatives. The study showed that the compounds 5, 28, 74, 78, and folic acid fitted well in the active site of COVID-19 inhibitor N3 (6LU7) and interacted with the residues in the active site, which are essential for their biological activity. &lt;p&gt; Conclusion: Therefore, compounds 5, 28, 74, and 78 and folic acid can be a COVID-19 inhibitor N3 (6LU7) and might be used in the treatment of COVID-19 infection.&lt;/p&gt;

Impact of COVID-19 Medication (Favipiravir and Hydroxychloroquine) on High Frequency Hearing.

During the initial phase of the COVID-19 pandemic, there was ongoing investigation into potentially effective treatments. Antiviral medications such as Favipiravir and Hydroxychloroquine were employed to treat COVID-19 infections. However, limited studies have examined the adverse effects of these medications on hearing, particularly at extended high frequencies. This study included 10 subjects who had received medications like Azithromycin, a combination of Favipiravir and Hydroxychloroquine, and Hydroxychloroquine alone as part of their COVID-19 treatment. These subjects had previously undergone extended high-frequency audiometry testing (from 8 to 20kHz) as part of another project conducted by the same department before contracting COVID-19. Post-COVID-19 extended high-frequency audiometry was performed 1 month after the patients received a negative RT-PCR report. The results were then compared using a Paired t-test. A significant shift in the thresholds of high frequencies above 8-20kHz is found in subjects who had received Favipiravir and Hydroxychloroquine medications. We observed a significant impact of COVID-19 medications on high-frequency hearing, which tends to go unnoticed in regular pure-tone audiometry evaluations. Therefore, our study emphasizes the need for regular follow-ups, including detailed audiological assessments that incorporate extended high-frequency testing, at least once every 3 months for patients who have taken medications for COVID-19 treatment.

Potential Signals of COVID-19 as an Effect Modifier of Adverse Drug Reactions

PurposeCOVID-19 infection may interact with patients’ medical conditions or medications. The objective of this study was to identify potential signals of effect modification of adverse drug reactions by statistical reporting interactions with COVID-19 infection (SRIsCOVID-19) in a large spontaneous reporting database. MethodsData from the US Food and Drug Administration Adverse Event Reporting System through the second quarter of 2020 were used. Three-dimensional disproportionality analyses were conducted to identify drug-event-event (DEE) combinations, for which 1 of the events was COVID-19 infection, that were disproportionately reported. Effect size was quantified by an interaction signal score (INTSS) when COVID-19 was coreported as an adverse event or an indication (INTSSCOVID-19). An SRICOVID-19 exists when the calculated INTSSCOVID-19 is >2. The analyses focused on pandemic-emergent SRIsCOVID-19. Screening for extreme duplication of cases was applied. To assess possible reporting artifacts during the early pandemic as an alternative explanation for pandemic-emergent SRICOVID-19, we repeated the analyses with an additional year of data to gauge temporal stability of our findings. FindingsWhen examining DEE interactions, 193 emergent SRIsCOVID-19 were identified, involving 44 drugs and 88 events, in addition to COVID-19 infection. Of the 44 drugs recorded, most were immunosuppressant or modulatory drugs, followed by antivirals. Seven drugs (eg, azithromycin) were identified in emergent SRIsCOVID-19 with preferred terms representing off-label use for prevention or treatment of COVID-19 infection. These drugs were in fact repurposed for COVID-19 treatment, supporting assay sensitivity of our procedure. Infections and infestations were the most frequently observed system organ class, followed by the general disorders and respiratory disorders. The psychiatric system organ class had only a few emergent SRIsCOVID-19 but contained the largest INTSSs. Less commonly reported manifestations of COVID-19 (e.g., skin events) were also identified. After excluding DEE combinations that were highly suggestive of extreme duplication, there remained a more robust set of emergent SRIsCOVID-19, which were supported by biological plausibility considerations. Our findings indicate a relative temporal stability, with >90% of SRIsCOVID-19 persisting after updating the analysis with an additional year of data. ImplicationsThe signals identified in the analyses could be critical in refining our understanding of the causality of spontaneously reported adverse drug events and thus informing the ongoing care of patients with COVID-19. Our findings also underscore the importance of undetected report duplication as a distorting influence on disproportionality analysis.

Management of COVID-19 Pandemic by Immunity-modulating Ayurvedic Interventions: A Bright Panacea

Abstract: COVID-19, or SARS-CoV-2 or novel coronavirus 2019 (nCoV-2019), first reported in Wuhan, China, has become a global pandemic due to human-to-human transmission with no specific treatment available. This review highlights the history of coronavirus, its diagnosis, treatment, and prevention by immunity-modulating Ayurvedic interventions to manage the disease during the early chaotic days of the COVID-19 outburst. Immunity modulation is a documented mode of action for many Ayurvedic drugs, including Tinospora cordifolia, Withania somnifera, Andrographis paniculata, Glycerrhiza glabra, Boerhaevia diffusa, Ocimum sanctum, Tribulus terrestris, Curcuma longa, Emblica officinalis, Terminalia chebula, Terminalia bellirica, etc. Several studies have been performed, and many trials have been registered to evaluate the effects of these herbal drugs to combat infectious diseases like COVID-19. Studies have also shown that Ayurvedic drugs, healthy diet, good lifestyle, and psychological aspects all have been researched over the years and found to have a significant role in increasing immunity and decreasing the number of comorbidities; hence, they should be considered in designing a module for the prevention and treatment of COVID-19 infection.

Clinical Study and Assessment of Efficacy of Polyherbal Combination (KNDBHU) in COVID 19 Patients

Even three years after the COVID-19 pandemic initially appeared in December of the year 2019, it is still raging over the globe. There have been numerous attempts to use well-known medications in new ways to treat COVID-19 infection. Many nations, including India, implemented a series of lock downs in an effort to limit the pandemic. Sanitation practices, social seclusion, routine mask wearing, testing, and quarantining of suspected carriers were among the recommended methods for limiting the illness. Numerous treatment strategies have also been used to prevent and treat the illness, but no formal studies using well-known Ayurvedic formulations or any polyherbal combinations have been conducted. A clinical study was planned to test the noble polyherbal combination containing Withania somnifera, Tinospora cordifolia, Moringa oleifera, Adhatoda vasica, Piper longum, Glycyrrhiza glabra, Ocimum sanctum and Curcuma longa. The study checked the rate of symptom remission in individuals receiving the polyherbal combination in addition to standard of care (SoC) to that in patients with mild and moderate symptoms of COVID-19 infections receiving SoC alone. A prospective randomized interventional clinical study was planned comparing outcomes in 2 cohorts with mild to moderate COVID-19 as under. Cohort-1 was trialled with conventional treatment as per government advisory. Cohort-2 was trialled with polyherbal combination and with conventional treatment as per government advisory. With the current add-on Polyherbal regimen, an early clinical improvement in breathlessness was seen along with early ageusia and cough reduction when compared with conventional treatment. The polyherbal combination (KNDBHU) enhanced recovery in COVID-19 Patients. Given the lack of hospital beds in India, the median length of hospital stays was shortened; this development is significant. Keywords: Covid­19, Add on polyherbal combinationregimen for Corona virus, Early Clinical Improvement, Shortened hospital stays

THU324 Euglycemic Diabetic Ketoacidosis Coinciding With COVID-19 Infection During Pregnancy

Abstract Disclosure: M. Alkhathlan: None. A. Siddiqui: None. Background: Pregnancy is well known to be a diabetogenic and ketogenic state. When coinciding with an acute illness like COVID-19 infection, it can lead to full-blown DKA requiring intervention to reverse ketoacidosis. Complete restoration of normal glycemic status can be achieved after treatment of COVID-19 infection. Clinical case: A 34-year-old, G3 P2 woman who was at 26 weeks gestation with triplet pregnancy presented to the ED with fever, shortness of breath, nausea and vomiting for 3 days. She had gestational hypertension and impaired glucose tolerance during her previous pregnancy, but none during her current pregnancy. She had tested positive for COVID-19 infection at an outpatient evaluation for mild upper respiratory symptoms, two days prior to her presentation. Vital signs in the ER were T 35.3 °C, RR 22, HR 103, BP 121/70, and O2 sat 95% on 4 L/min nasal cannula. Initial laboratory testing showed sodium 132 (135-145), potassium 4.4 (3.5-5.5), bicarb 9 mmol/L (22-29), anion gap 18 mmol/L (5-14), BUN 3 mg/dL (6-23), creatinine 0.43, eGFR &amp;gt; 60, glucose 113 mg/dL (74-109), serum ketones 3.13 mmol/L (0.02-0.27) and lactate 1.6 mmol/L (0.5-2.5). ABG confirmed acidosis with pH of 7.29, and PCO2 was 22. She was diagnosed with euglycemic DKA after ruling out other possible etiologies of high anion gap metabolic acidosis. She received betamethasone by the Obstetrics team and fetal monitoring was initiated. DKA treatment was started with IV insulin, dextrose and close glucose monitoring. She had complete resolution of metabolic acidosis after 34 hours and did not require subcutaneous insulin treatment post-DKA resolution. She was able to tolerate oral diet with significant improvement of all her symptoms. She required only supportive treatment for COVID-19 infection and tested negative on the third day of hospitalization. Conclusion: Pregnancy is a ketogenic state and when superimposed with a significant acute illness of COVID-19, can lead to euglycemic DKA even in the absence of gestational diabetes. Early detection and treatment of ketoacidosis with COVID-19 is critical to avoid fetal and maternal complications or premature delivery. Presentation: Thursday, June 15, 2023