Vijaykumar Gawali

Background: Patients with COVID-19 infections have been shown to be under tremendous psychological stress. Chanting the has been shown to ameliorate the stress markers in other conditions. Hence, we envisaged the present study to evaluate the effect of chanting the in our patients presenting with mild-to-moderate COVID-19 infections. Materials and Methods: A multicenter, prospective open label study was carried out in adults diagnosed with mild-to-moderate COVID-19 infections confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) test. General anxiety disorder-7 (GAD-7) scale was used for evaluating the psychological well-being of study participants. Results: One-hundred and twenty patients were recruited. Most of the patients felt anxious, worried that something might happen to them at baseline and the proportion has significantly reduced post-intervention (p < 0> Conclusion: We observed a significant reduction in the anxiety levels following daily chanting of in mild to moderate COVID-19 patients. A large well designed controlled clinical trial must be done for further confirmation of the findings from the present study. Keywords: Coronavirus, Psychology, Integrative medicine, Holistic medicine, Mahamantra

Mindfulness-based programs were shown to promote relaxation, and improve work performance. We evaluated the effect of an indigenous meditation technique in the work performance of Heads of Departments (HODs) in our institute. We carried out a prospective, interventional, single centre, single blinded, randomized controlled, study to evaluate the effect of meditation technique on work performance and acceptability (among employees) of HODs working in a dedicated COVID-19 tertiary care hospital. We also recruited employees from each of the Departments for obtaining their feedback. A validated feedback evaluation questionnaire was used for assessing the outcomes at baseline, and on days 1, 8, 9, 10, 11, and 12. Twenty HODs of either gender aged between 36 to 58 Years, with atleast 5 years of experience as Heads leading the respective teams were recruited. One-hundred employees aged between 21 to 58 years reporting at least for one year reporting to those HODs were recruited. The mean (SD) feedback score of the employees in the control arm was 22.98(7.2) while in the interventional arm, it was 21.82 (6.4) and was not statistically significant (p=0.28). On all the follow-up days, the scores were significantly higher in the interventional group compared to control arm. Similarly, in the interventional group, the scores were significantly higher on all the follow-up days compared to baseline while it was not statistically significant in the control group. We observed a significant improvement in the work performance of HODs as evaluated by their respective employees through the meditation technique that consisted of breathing exercise and chanting the Studies are needed exploring the effects in different units and for long term. Keywords: Coronavirus, Holistic Medicine, Mahamantra, Dedicated covid hospital

Background: Oral anticoagulation with a vitamin K antagonist like warfarin is the standard of care for thromboprophylaxis after cardiac valve replacement. However warfarin requires strict monitoring of INR to avoid bleeding.Bleeding is a major concern with warfarin, particularly in those at high risk. Nattokinase is an enzyme obtained from natto, a cheese-like food made of soybeans fermented with Bacillus subtilis, which has been consumed as a traditional food in certain Asian countries for more than 2000 years.Recent research has demonstrated that nattokinase has potent fibrinolytic activity and antithrombotic action. Case Summary: We present a case of a 37-year-old male who had undergone aortic valve replacement using a metallic prosthetic valve for rheumatic heart disease associated severe aortic regurgitation and has been maintained on oral nattokinase therapy for prophylaxis against thromboembolic complications post cardiac wall replacement since the last 12 years. Discussion: This case highlights the role of oral nattokinase for thromboprophylaxis in valve prosthesis and other prothrombotic states. This case report presents the first documented case where oral nattokinase has been successfully used for long-term thromboprophylaxis in metallic aortic valve prosthesis. Key Messages: We present a case of a 37-year-old male who had undergone aortic valve replacement using a metallic prosthetic valve for rheumatic heart disease associated severe aortic regurgitation and has been maintained on oral nattokinase therapy for prophylaxis against thromboembolic complications post cardiac wall replacement since the last 12 years. This case highlights the role of oral nattokinase for thromboprophylaxis in valve prosthesis and other prothrombotic states. This case report presents the first documented case where oral nattokinase has been successfully used for long-term thromboprophylaxis in metallic aortic valve prosthesis. Keywords: Nattokinase, Thromboprophylaxis, Metallic aortic valve prosthesis

Background: Computed Tomography (CT) chest plays a critical role in early identification & stratification of disease burden and prognostication of COVID-19 disease. We compared in-house created CT based scoring system based on ground glass opacities (G-Score), consolidation (C- Score), and atelectasis A-score (i.e. GCA score) with contemporary CT severity scores & validated it against world health organization (WHO) COVID-19 disease severity scale. Materials and Methods: Patients confirmed with real time polymerase chain reaction confirmed COVID-19 infections that underwent CT chest investigations as a part of standard of care were recruited. A compound GCA score based on the lung involvement was developed and validated. Results: Five-hundred patients of which 249 had mild, 220 with moderate, and 31 with severe COVID-19 disease were recruited. Most involved segments were superior (65%), lateral basal (56%) and posterior basal segments (64%) of right lower lobe and anteromedial (62%) and posterior basal segments (57%) of left lower lobe. Patchy non-confluent peripheral ground-glass opacities with apicobasal gradient is the most common finding (47%) in mild cases. Bilateral lower lobes were most commonly involved (72%). In moderate cases ground-glass opacities with consolidation is the predominant finding (82%). In severe cases ground-glass opacity, consolidation as well as linear platelike atelectasis and reticular opacities may represent with apicobasal gradient (80%). Conclusion: HRCT Chest has certainly come up as a versatile aid for our war against COVID -19. Firstly it helps to diagnose the pulmonary involvement of the disease and when complimented with a good scoring system furthermore it stratifies the disease burden. Keywords: HRCT, Lung, Coronavirus, GGO, Consolidation atelectasis

Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure. Keywords: Cholelithiasis, Laparoscopic Cholecystectomy, Gall stones, Cholangiopancreatography