Objectives: The primary objectives of the study are to determine the effectiveness of the Kaba Sura Kudineer (KSK) & Nilavembu Kudineer (NVK) along with standard Allopathy Treatment to compared with Placebo (Decaffeinated Tea) with standard Allopathy Treatment in the management of Symptomatic COVID 19 patients and also in reduction of Hospital Stay Time & Changes in Immunological (IL6) and Bio Chemical Markers (Ferritin, CRP, D-Dimer and LDH). The secondary objectives are to evaluate the safety of the trial medicines and their effects in the reduce the risks of the disease. In addition, to document the profile of Symptomatic COVID 19 patients as per Siddha Principles. Trial Design: A Double Blinded, Three arm, Single Centre, Placebo Controlled, Exploratory and comparative Randomized Controlled Trial Participants: Patients who were admitted to the COVID Care Centre at Govt. Institute of Medical Sciences. Noida in India will be recruited. These will be patients with Mild and Moderate symptoms with laboratory confirmed COVID 19 (RT – PCR Tested Positive) aged 18-65, willing and consenting to participate. Intervention and comparator: Arm I: Decaffeinated Tea (Placebo – similar in taste and appearance to the other Two Decoctions), 60 Ml Morning and Night after Food, along with standard Allopathy Treatment for 10 days. Arm II: Nilavembu Kudineer (The Siddha Medicines which is used as a standard Anti-Viral drug for the past Pandemics by Siddha Physicians) 60 Ml Morning and Night after Food, along with standard Allopathy Treatment for 10 days. Arm III: Kaba Sura Kudineer (The Siddha Medicine which is proposed to be used as a Treatment for COVID 19 based on Siddha Literature) 60 Ml Morning and Night after Food, along with standard Allopathy Treatment for 10 days. The investigational drugs are registered products under the Govt.of India and bought from GMP Certified Manufacturing Units. Main Outcomes: Primary outcomes: Reduction in Viral load of SARS-CoV-2 at the end of treatment (10 days). 2. Time taken to convert Patient from symptomatic to Asymptomatic based on Reduction in clinical symptoms (10 days). 3. Effect of drugs inflammatory markers (IL6,) at the end of treatment (10 days). 4. Reduction in hospital stay time (20 days follow up). (Based on RT PCR CT Value 3^rd, 6^th if needed 10^th day). (Based on IL 6 Value needed 10^th day or IL6 value on turning negative. (entry level/exit level). Secondary outcomes (10 days): Reduction in use of Intensive Supportive Care. 2. Reduction in incidence of complications (Acute Respiratory Distress Syndrome, other systemic complications). 3. MuLBSTA score for viral pneumonia (multinodular infiltration, hypo-lymphocytosis, bacterial co infection, Total Leucocyte Count (TLC ≤ 0.8 x 10⁹/L), smoking history, hyper-tension and age) score. 4. Laboratory markers (Haematological & Biochemical Markers). 5. Adverse events/effects Siddha-based measurements. 6. Siddha Udaliyal assessment by using Yakkai Ilakkanam (YI) Tool to diagnose body condition for covid-19 patients. Randomisation: The assignment of the participants into 3 Groups will be allocated in 1:1:1 Ratio through randomization Blocks in Microsoft Excel by a Statistician who is not involved in the study. The allocation scheme will be made by another statistician by using a closed envelope after the assessment of eligibility and Informed consent procedures. The groups will be balanced for age and sex with 3:1 Ratio in each group for mild: severe COVID-19 symptoms. Blinding: The Study is Double Blinded. Participants and Investigators were blinded. Numbers to be randomized (Sample size): Sample size could not be calculated, Since there are no prior trials on KSK and NVK as a comparative trial. In addition, there are no prior trials on KSK and NVK in this region. A total Number of 120 Patients, 40 each in 3 groups will be recruited in 1:1:1 Ratio. Trial Status: Protocol Number : SCRUND GIMS Noida Study 1,Version: 2.0 Protocol Date : 20.08.2020 The recruitment period is completed for the trial. The Trial started its recruitment on 22.8.2020. We anticipate study including data analysis will finish in January 2021. This is to state that it was a late submission from authors for publication of the protocol to the BMC, after enrolment in the study was over. Trial Registration: The trial protocol was registered with CTRI (Clinical Trial Registry of India) and number is CTRI/2020/08/027286 on 21.08.2020 Full Protocol: The full Protocol is attached as an additional file, Accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated. This letter serves as a summary of the key elements of the full protocol. The Study protocol has been reported in accordance with the SPIRIT guidelines.

Since its inception in December 2019 in Wuhan, China, the severe acute respiratory syndrome coronavirus-2, the etiological agent for coronavirus disease 2019 (COVID-19), is spreading rapidly both locally and internationally, and became certified as a pandemic by the World Health Organization (WHO) in March 2020. Working in an environment of high risk, coupled with adherence to quarantine and stressors related to the job, has been found to exacerbate the psychological health of frontline healthcare workers. To assess the perceived stressors, combat strategies, and motivating factors among health care service providers during the COVID-19 pandemic. A cross-sectional study was conducted among healthcare workers at a tertiary care hospital in the north-central region of India from May to September 2020. A convenience sample of 150 health care workers was taken. A self-reported pretested structured “COVID 19 staff questionnaire” was used as a study tool. The health care workers (HCWs) included nurses, physicians, laboratory technicians, and radiology technicians who worked in high-risk areas (isolation ward, COVID intensive care unit, emergency department, and outpatient cough outdoor walk-in clinics) during the outbreak constituted our study population. The varying levels of stress or effectiveness of measures were reported as mean and standard deviation, as appropriate. Descriptive statistics were used for data presentation. A Mann-Whitney U test was used to analyse differences between two groups of non-normally distributed data. A p-value of less than 0.05 was considered statistically significant. As compared to doctors, paramedical staffs were more stressed with frequent protocol changes (88%), emotional exhaustion (68%), and conflicts with duties (62.7%). The factors like seeing colleague getting better (78.7%) and hoping for financial compensation (49.3%) were reported as stress busters; family compensation in case of death at the workplace and disability benefits in case of disease-related disability development were more effective motivational factors for paramedical staff in case of future outbreaks (p-value <0.05). It is needful that secondarily traumatized team members should be always observed, educated, and properly handled. Certain personal coping strategies adopted by health workers should be well addressed and motivated if scientifically sustainable. We have to include psychiatric preparedness and stress monitoring also for health care teams along with emphasizing hygiene, temperature monitoring, and fever management, in planning to fight the pandemic.

A 46-year-old man receiving antiretroviral therapy since 4 months for AIDS presented to the emergency department with complaints of chest pain and breathlessness. He had a history of anti-tubercular treatment for tubercular lymphadenitis prior to the initiation of antiretroviral therapy. He was in a state of peripheral circulatory failure with tachypnoea and a raised jugular venous pressure. Skiagram of the chest demonstrated an air space parallel to the lateral and medial border of the heart suggestive of pneumopericardium as well as patchy areas of consolidation (figure 1). A CT scan of the chest confirmed pneumopericardium, without associated pericardial effusion (figures 2 and 3). The patient was treated with underwater seal drainage on an emergency basis; however, he died shortly thereafter, before the operative drainage could be completed. Besides this case, there are only few reports in the literature showing this association. 1

Diabetes mellitus (DM), a global metabolic disease, is closely associated with circadian rhythms (CRs), and the situation is quite multifaceted for clinicians. Chronobiological knowledge reveals the complex relationship between circadian cycle and DM. This review demonstrates that CRs controlled by the suprachiasmatic nucleus (SCN) play a complex role in glucose homeostasis, insulin sensitivity, and pancreatic β-cell function. Chronic disruption of CRs or chronodisruption worsens metabolic dysregulation; therefore, the timing of treatments should coincide with biological rhythms. Cycles and rhythms of diabetes incidence also emphasize the need for targeted interventions, as it is with chronotherapy and chronopharmacology. External factors such as shift work, irregular sleep, and jet lag are new contributors to chronodisruption, which further aggravate metabolic derangement in diabetes. Epidemiological data underline the necessity of interventions that are related to natural rhythms. This review maps the current state of knowledge of chronobiology in diabetes and uses clinical evidence to highlight the possibilities of chronobiological interventions. Deeper understanding of CRs may provide knowledge about the diabetes progression and point towards the development of more specific treatments. Measures such as light treatment, sleep hygiene, meal timing, and chronotherapy are potential approaches that may help to entrain CRs and enhance metabolic regulation in diabetic patients. Focusing on person-centerd strategies, healthcare providers can address specific aspects of patients’ lifestyles, thus improving glycaemic control and quality of life. Yet, more studies are needed to describe the specific processes and develop more specific approaches to treatment.

Glucagon is a hormone released from the alpha cells of the pancreas. It has a major role in carbohydrate metabolism. It has a major role in increasing blood glucose levels and is helpful in glycogenolysis, gluconeogenesis, and amino acid catabolism. Its role in lipid metabolism is in the form of lipolysis and beta-oxidation of fatty acids. It also has major implications in the pathogenesis of metabolic dysfunction-associated steatotic liver diseases or non-alcoholic fatty liver disease.