Case study on the effect of T-AYU-HM Premium with modern medicine in severe Covid-19 Patient

 

Atul M. Desai¹*, Hemshree A. Desai², Rutvij A. Desai³, Chirag Desai⁴

¹Ayurveda Physician, Dhanvantari Clinic, Ayurveda Health Care and Research Centre, Vyara, Gujarat, India.

²Modern Medicine Practitioner; Dhanvantari Clinic, Ayurveda Health Care and Research Centre,

Vyara, Gujarat, India.

³Student of Master of Science, Manila Central University, Philippines.

⁴Associate Professor: Department of Pharmacology, ROFEL Shri G.M. Bilakhia College of Pharmacy, Vapi.

 

ABSTRACT:

Indian traditional system of medicine has a definite role in the treatment of Covid-19. This case report presents the outcome of Ayurvedic interventions along with modern medicines in a severe covid-19 infected patient with breathlessness. A patient with a history of cough, breathing difficulty and generalized weakness tested positive for the rapid antigen test and prescribed the standard treatment of care with 14 days of strict home quarantine. During follow-up, there was no clinical improvement and oxygen saturation was fluctuating and required oxygen support. Therefore, the patient sought ayurvedic intervention at the covid-19 healthcare center with supportive oxygen therapy. The patient was managed with ayurvedic intervention along with modern medicines. On the date of admission to the covid-19 care center, the patient's SpO2 72% on room air, HRCT 80-90%, and ESR, CRP, and LDH were 40(mm/hour), 11.47(mg/L), and 306(Units/L) respectively. By adhering to the integrated therapy patient’s oxygen saturation and clinical profile were improved with time. On the 11^th day of treatment patient, SpO2 was sustained at 95% and HRCT report was 70-80%, and clinical profile improved remarkably.  The patient’s HRCT after one month was50-60% compared to the previous report suggestive of remarkable improvement. The effect on inflammatory markers and oxygen saturation suggests that integration of modern medicines along with ayurvedic medicine in the patient was significant and deserves further studies. Integrating ayurvedic treatment along with modern medicine might be considered as an effective approach in the management of severe covid-19 patients.

 

 

INTRODUCTION:

How coronavirus has impacted many countries in the last 2 years requires no further piece of information. Despite the vaccine, the impact of coronavirus is still brutal in many countries. India has already faced the second wave of coronavirus infection. During the second wave, India has witnessed extraordinary support in the form of oxygen supply, covid-19 help centers, medications, and machines like oxygen oxygen concentrators and ventilators for the patients.

 

The number of cases increased in the second wave was faster but what is more important is children and younger ones are being mainly infected during this with variable clinical presentation and fluctuating oxygen saturation^1-2. This critical situation demands prevention and adherence to safety measures for controlling the number of infections. During this critical situation, integrating Ayurvedic medicines with modern medicine in covid-19 might become useful in preventing further complications and might support speedy recovery.T-AYU-HM Premium is a herbo-mineral formulation with established preclinical and clinical studies in sickle cell anemia. The formulation was studied for phase-II safety and efficacy clinical trial in covid-19 patients. The case report studies on the effect of T-AYU-HM Premium along with onion steam vaporization in reactivation/re-infection of covid-19 and comorbidities like sickle cell anemia with Covid-19 have already been reported ^3-4. Acupen is Polyherbal formulation with anti-inflammatory activity.

 

Case Report:

Site information:

We are presenting a clinical outcome of integrated treatment approach of ayurvedic medicine and modern medicine in a severe covid-19 patient admitted at the Covid-19 healthcare center managed by Dhanvantari Clinic – Ayurvedic Health Care and Research Centre -Vyara, Gujarat. Continuous monitoring of a patient’s clinical profile is done by both modern medicine practitioners and Ayurvedic physicians throughout the period of treatment.  

 

Patient demographic information:

Mr. X is a 35-year-old married male resident of Tapi district, Gujarat.

 

Informed consent:

With the prior discussion with family and willingness, the patient had come to the covid-19 healthcare center and gave his consent for the integrated treatment approach to the doctors. The patient had provided consent to share information like vitals, laboratory parameters and imaging studiesto be utilized for publication to improvise evidence-based practice in the current pandemic situation.

 

Patient medication history:

Mr. X was tested positive with a rapid antigen test on date 17/04/2021. He had been prescribed standard of care as per guideline for covid-19 and advised strict home quarantine. Despite13 days of treatment patient’s condition was not improved. Therefore he visited the nearby covid-19 healthcare center. The observation is mentioned in the following table-1. Based on observation and clinical condition the patient was referred to the hospital for further management. Patient prescribed medications were as mentioned in table-1.

 

Table-1 Patients History of Covid-19 treatment

Date	Clinical parameters	Medications
30/ 04/ 2021	Symptoms were coughing, generalized weakness, and  difficulty in breathing   Observations; SpO2 85% on room air, Pulse rate 137/min, RR 36/min, BP 122/80 mmHg	Tablet Paracetamol SOS; Tablet Azithromycin  0-1-0, Tablet Ivermectin 1-0-1 Tablet Doxycycline 1-0-1 Tablet Cefixime 1-0-1 Tablet Rantac D 1-0-1 Tablet Vitamin C 500mg 1-0-1 x 5 days

 

Patient’s clinical examination:

The patient presented at the Covid-19 healthcare center managed by Dhanvantari Clinic – Ayurvedic Health Care and Research Centre on 1st May 2021 with difficulty breathing, fever, general weakness, and coughing. On physical examination, the patient’s oxygen saturation was 72% which suggests that he has progressed to severe covid-19 infection. Such patients are prone to critical conditions and may require ventilator support.

 

Patient’s treatment record:

The patient was started on oxygen at 5 liters/ minute for 2 hours along with an integrated treatment approach with continuous clinical profile monitoring. The treatment chart is mentioned with the date in the following table-2.

 

Table-2 Patient integrated treatment observation

Date	Supportive measures	Parental	Ayurvedic medicines	Modern medicines
01/05/2021	Oxygen 5 lit/minute per 2 hour   Duolin 3ml and Budecort2ml Nebulisation	Inj. LMWH 40mg SC OD Inj. Dexa 4mg IM OD	Tab.T-AYU-HMPremium 600mg PO TDS x 5 days Tab. Acupen 600mg PO TDS x 5 days	Tab. levocet M PO BD x 5 days Tab. Eupod 200mg PO BD x 5 days Cap. Rabinate DSRPO BD x 5 days Tab. WysolonePO OD x 5 days
03/05/2021	Oxygen 5 lit/minute per 2 hour	Inj. LMWH 40 mg SC x OD Inj. Dexa 4mg IM x OD
04/05/2021	Oxygen 5 lit/minute per 2 hour	Inj. LMWH 40 mg SC x OD
05/05/2021	Oxygen 5 lit/minute per 2 hour	Inj. LMWH 40 mg SC x OD	Tab. T-AYU-HM Premium 600mg PO TDS x 5 days Tab. Acupen 600mg PO TDS x 5 days	Tab. Wysolone PO OD x 5 days Cap. Rabinate DSR PO BD x 5 Days Cap. Clopilet A 75mg PO OD x 5 days Tab. Azithral PO OD x 5 Days Tab. Vitchew CZ PO BD x 5 Days
11/05/2021			Tab. T-AYU-HM Premium 600mg PO TDS x 5 days Tab. Acupen 600mg PO TDS x 5 days
18/05/2021			Tab. T-AYU-HM Premium 600mg PO BD x 15 days Tab. Acupen 600mg PO BD x 15 days	Tab. Ecosprin AV 75 OD x 15 days Tab. Rivaban 10 OD x 15 days Cap . Folvite MB PO OD x 15 Days Tab. Tribet 1 PO OD x 15 Days
02/06/2021	Good improvement and discharge

Note: DuolinRespule 3ml (Ipratropium bromide 500mcg + levosalbutamol 1.25mg), Budecortrespule 2ml (Budesonide 0.5mg), LMWH 40mg (Enoxaparin), Dexa 4mg (dexamethasone), Levocet M (Levocetirizine 5mg + Montelukast 10mg ), Eupod 200 (cefpodoxime 200mg), Rabinate DSR (Domperidone 30mg + Rabeprazole 20mg), Wysolone 10 (predinisolone 10mg), Clopilet A 75( aspirin 75mg + clopidogrel 75mg), Azithral 500 ( azithromycin 500mg ), Vitchew CZ (Multivitamin), Ecosprin AV 75 ( atorvastatin 10mg + aspirin 75mg), Rivaban 10 (Rivaroxaban 10mg ), Folvite MB ( Folic acid+ Methylcobalamin + Pyridoxine hydrochloride), Tribet 1 ( Glimepride 1mg + Metformin 500mg + Pioglitazone 15mg)

 

 

It might be vital to consider that complications in coronavirus patients are always associated with hypoxia. Such patients are prone to critical condition and ventilation support requirement. Hypoxia-induced complications progress faster and damage the organ. It is considered accountable for mortality and slow post-covid-19 recovery in patients. With an integrated treatment approach, oxygen requirement was improved gradually over sometime in the admitted patient. This suggests that there wasn't any burden onto the other body organs due to hypoxia. Patients with severe Covid-19 infection have more possible chances to suffer from thrombosis and associated mortality. Thrombosis due to platelet has been obvious to play a role in covid-19⁵. Therefore the therapeutic dose of low molecular weight heparin in a severe covid-19 patient was found beneficial in the previous study ⁶. A low dose of dexamethasone might be useful in lowering the mortality in severe covid-19 infections ⁷. It was also observed that low molecular weight heparin and dexamethasone showed a synergistic effect on reducing the hemolysis in PNH red blood cells⁸. Preventing the red blood cell lysis, and gradual improvement in platelets presented in table-3 indicated that thrombosis and vaso-occlusive complications in patients are prevented. White blood cell count was controlled over a period suggesting improvement in inflammatory conditions in the patient. At the time of admission, the lung was infected almost 80-90 % and therefore consideration of cefpodoxime while initiating the treatment was clear, as it is the preferential choice in pneumonia infections of the respiratory tract⁹. The patient’s modern medicine was stopped on the 11^th day of treatment and was continued only on ayurvedic medicines. On the 18^th day, to prevent post-covid-19 complications low-dose rivaroxaban along with aspirin was prescribed. Critically ill covid-19 patients are at an increased risk of thromboembolic events. Therefore, rivaroxaban has shown efficacy in preventing suchcomplications¹⁰. The patient’s elevated blood glucose level was managed through a combination of oral anti-diabetic agents to prevent further complications. As the presence of glucose in blood might provide access to viral infection as well as slow down the healing process, it is reasonable to manage the blood glucose level.

 

Table-3 Patient’s vitals and laboratory values

Particulars	01/05/21	03/05/21	05/05/21	11/05/21	18/05/21	02/06/21
SpO2 (%) on room air	72	76	89	95	96	98
Pulserate( rate/minute)	156	121	110	123	100	102
Weight(kg)	61.9	62.2	62.6	62.5	63.2	66.3
Hemoglobin (gm/dl)	15	-	13.6	14.4	13.3	12.9
RBC(millions per mm3)	5.73	-	5.31	5.6	5.38	5.46
WBC( per mm3)	15000	-	10500	11600	10400	10700
Platelets(per mm3)	641000	-	529000	365000	303000	333000
Neutrophils (% )	77	-	76	80	78	68
Lymphocytes ( % )	19	-	22	17	20	28
RBS (mg/dl)	385	-	505	396	257	143.4

 

Table-4 Patient’s inflammatory markers report

Particulars	01/05/21	05/05/21	11/05/21	18/05/21	02/06/21
ESR (mm/hour)	40	-	30	44	28
D-Dimer (ng/mL)	492	-	-	137.9	-
LDH (Units/L)	306.8	-	230.7	237.2	-
CRP(mg/dL)	11.47	4.3	3.45	15.7	6.4

 

 

The extent of damage in the lung caused by coronavirus might vary from patient to patient but laboratory markers help to understand the severity of infection and damage generated by the coronavirus. Generally, inflammatory markers like CRP, ESR, and LDH are elevated in patients with developing pneumonia in covid-19. The patient after the initiation of treatment with the integrated approach did not progress towards any further complications. Effect of treatment on inflammatory markers like CRP (<10mg/L) and ESR (<15mm/hr) indicate in table-4 that treatment has reduced the progression of the disease. Improvement in LDH indicates (<280 U/L) that the lung condition has improved and there is no progression of lung damage in the patient. The D-dimer value remained throughout the observation below the normal range upper limit (<500ng/ml).  It suggests that further recruitment of neutrophils and monocytes to cause inflammation in the patient is controlled. This might help in preventing platelet aggregation and thrombus formation in a patient^11-14.

 

HRCT is a valuable diagnostic method irrespective of days and onset of disease. It was also documented that initial follow-up HRCT images often show evidence of progression from illness onset to early stage. There was marked improvement observed in the recovery of viral pneumonitis. During the 30^th-day imaging report, no honeycombing or active fibrosis was seen. The observation suggests that a decrease in opacities was seen compared to the 1^st-day report of the patient mentioned in table-5 and figure-1. The patient’s recovery can also be monitored through improvement in CRP, ESR, D-Dimer, and HRCT reports. 

 

Table-5 Patients HRCT observations

HRCT Date	01/05/2021	11/05/2021	02/06/2021
Observation	80-90% lung involvement	70-80% lung involvement	50-60% lung involvement

 

 

HRCTDATE	01/05/2021	11/05/2021
Images
	02/06/2021

Figure -1 Comparative HRCT report of patient

 

 

CONCLUSION:

This case report study suggests integration of Ayurvedic medicine along with modern medicines do possess potential in improvising clinical outcomes in a severe covid-19 patient. This integrated treatment approach might be valuable to provide information about the possible role of ayurvedic medicines in the management of severe covid-19 patients. Sustaining oxygen requirement and preventing thrombosis and vasoocclusive complications through an integrated treatment approach might become beneficial in the future. Further studies can establish a better integrative approach in the management of covid-19.

 

ACKNOWLEDGEMENT:

The authors would like to express sincere thanks to the patient and his family member to provide consent and support for the publication of the case report.

 

CONFLICT OF INTEREST:

There is no conflict of interest regarding this investigation.

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Accepted on 08.02.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(11):4950-4954.