Bromhexine for Post-exposure COVID-19 Prophylaxis: A Randomized, Double-blind, Placebo-controlled Trial

Background: Limited medications are available for post-exposure prophylaxis of coronavirus disease 2019 (COVID-19) infection. Whether bromhexine can prevent or mitigate symptomatic infection after virus exposure is undetermined. Objective(s): We aimed to evaluate bromhexine's effect on preventing COVID-19 after close contact exposure. Method(s): A multi-center randomized, double-blind, placebo-controlled clinical trial was conducted on 372 adults (>= 18 years) who had close contact within four days with a household member with confirmed COVID-19. They were randomly assigned to receive bromhexine 8 mg (n = 187) or placebo (n = 185) three times a day for two weeks. The primary outcome was the incidence of symptomatic COVID-19. Secondary outcomes included hospitalization or death, confirmed COVID-19 by Polymerase Chain Reaction (PCR) in symptomatic patients, and adverse drug reactions. Result(s): The incidence of symptomatic COVID-19 was significantly lower in individuals who received bromhexine than in those who received the placebo (16 [8.6%] vs. 34 [18.4%], relative risk = 0.47, P = 0.005). PCR confirmation was reported in 13 (7.0%) and 26 (14.1%) individuals in the bromhexine and placebo groups, respectively (P = 0.025), with a relative risk reduction of 50%. The hospitalization rate, death, and medication side effects did not vary significantly between the bromhexine and placebo arms. Conclusion(s): Bromhexine is an effective, non-invasive, affordable agent with a low side-effect profile to prevent symptomatic COVID-19. Early use of bromhexine potentially provides another layer of protection;hence, it can play a role in controlling the pan-demic. Copyright © 2022, Author(s).

Efficacy and Safety of Novel Herbal Tablets in COVID-19 Patients in Hospital Stay Days, ICU Admission and Mortality Rate Thereof: An Ppen-Label, Single-Blind Randomized Clinical Trial

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the super-spreading virus, has claimed hundreds of thousands of lives worldwide. Objectives: This study aimed to evaluate the effectiveness of the novel suggested herbal compound, formulated as compressed tablets, in reducing the length of hospital stay(LoS), intensive care unit (ICU) admission, and mortality in confirmed COVID-19 cases. Methods: Following an open-label, single-blind randomized clinical trial design, a total of 200 patients aged 18 65 admitted to Imam Reza hospital in Tabriz, northwest of Iran, were randomized to intervention and control groups in a1:1 ratio, i.e.,100 subjects in each group. The former received standard treatment along with the compressed herbal tablets, and the latter only received the standard treatment. Adverse reactions incidence within 180 days after the beginning of the intervention was set as the primary safety endpoint. The most important and active ingredients of the tablets were Terminalia chebula, Glycyrrhiza glabra, Anacyclus pyrethrum, Senna alexandrina, Ferrula asafoetida, Pistacia lentiscus, Zizyphus jujuba, Crocus sativus, Echinacea angustifolia, and Hyssopus officinalis. This trial is registered at the Iranian Registry of Clinical Trials (code: IRCT20200522047545N1). Results: Those in the intervention arm had significantly lower rates of LoS (7.38 vs. 9.45, P = 0.030), ICU admission (6 out of 100 vs. 32 out of 100, P= 0.000), and mortality (1 vs. 19 out of 100, P= 0.000). Conclusions: Our observations suggest that adequate improvement is provided by the prepared herbal compound along with substantial savings in hospitalization hoteling costs. While further multi-center studies with a larger sample size are needed to extend our knowledge regarding the effect of this new option, these novel clinical data may well provide a new alternative for the management of COVID-19 disease.

Quantitative analysis of taste disorder in COVID-19 patients, the hypersensitivity to salty quality.

Recently, many of the studies have illustrated that the new pandemic SARS-CoV-2 can affect Central Nervous System through the olfactory bulb. In addition to investigating anosmia or hyposmia induced by this virus, a quantitative analysis was needed to clarify the taste and smell disorder of the new coronavirus. The four basic taste quality with five concentrations for sweet, sour, bitter, and salty were administered to 75 subjects divided into three groups: COVID-19 patients with taste disorder, COVID-19 patients without taste disorder, and control group. The results indicated the increment of sweet (2.68 ± 0.14), sour (3.34 ± 0.12) and bitter (3.39 ± 0.2) thresholds in COVID-19 patients with taste disorder in comparison with patients without taste disorder that the threshold were: 2 ± 0.16, 2.11 ± 0.2 and 2.55 ± 0.5 for sweet, sour, and bitter respectively. On the other hand, the patients inversely showed a significant decrease in the salty taste threshold (0.51 ± 0.03) compared to COVID-19 positive control groups (1.11 ± 0.11). Additionally, despite taste disorder in almost all of the patients with smell deficiency, only 30% of cases with taste disorder reported smell deficiency. It may be concluded that some of the taste disorders in patients with COVID-19 disorder could be associated with taste receptors dysfunction or the spread of infection to the cranial nerves responsible for the conduction of tastes sensation.

Exposure to ultrafine particles while walking or bicycling during COVID-19 closures: A repeated measures study in Copenhagen, Denmark.

Ultrafine particles (UFP; particulate matter <0.1 µm diameter) emitted from motorized traffic may be highly detrimental to health. Active mobility (walking, bicycling) is increasingly encouraged as a way to reduce traffic congestion and increase physical activity levels. However, it has raised concerns of increased exposure to UFP, due to increased breathing rates in traffic microenvironments, immediately close to their source. The recent Coronavirus Disease 2019 (COVID-19) societal closures reduced commuting needs, allowing a natural experiment to estimate contributions from motorized traffic to UFP exposure while walking or bicycling. From late-March to mid-July 2020, UFP was repeatedly measured while walking or bicycling, capturing local COVID-19 closure ('Phase 0') and subsequent phased re-opening ('Phase 1', '2', '2.1' & '3'). A DiSCmini continuously measured particle number concentration (PNC) in the walker/bicyclist's breathing zone. PNC while walking or bicycling was compared across phased re-openings, and the effect of ambient temperature, wind speed and direction was determined using regression models. Approximately 40 repeated 20-minute walking and bicycling laps were made over 4 months during societal re-opening phases related to the COVID-19 pandemic (late-March to mid-July 2020) in Copenhagen. Highest median PNC exposure of both walking (13,170 pt/cm3, standard deviation (SD): 3560 pt/cm3) and bicycling (21,477 pt/cm3, SD: 8964) was seen during societal closures (Phase 0) and decreased to 5367 pt/cm3 (SD: 2949) and 8714 pt/cm3 (SD: 4309) in Phase 3 of re-opening. These reductions in PNC were mainly explained by meteorological conditions, with most of the deviation explained by wind speed (14-22%) and temperature (10-13%). Highest PNC was observed along major roads and intersections. In conclusion, we observed decreases in UFP exposure while walking and bicycling during societal re-opening phases related to the COVID-19 pandemic, due largely to meteorological factors (e.g., wind speed and temperature) and seasonal variations in UFP levels.

COVID-19 pandemic-induced physical inactivity: the necessity of updating the Global Action Plan on Physical Activity 2018-2030.

To prevent and reduce inactivity, the World Health Organization (WHO) designed a global plan called Global Action Plan on Physical Activity 2018-2030 (GAPPA) in 2017. In this plan and according to the state of physical activity in 2016, actions and goals were set. However, the world is facing a COVID-19 pandemic, which has affected various aspects of lifestyle, including physical activity. Some studies have shown that physical activity reduced during the pandemic. For this reason, the WHO should review the GAPPA and update goals and actions according to the state of physical activity in 2020.

Physical activity during COVID-19 pandemic in the Iranian population: A brief report.

COVID-19 pandemic and restrictive public health measures due to it can have many effects on physical activity. Our study aimed to compare the levels of physical activity levels (expressed as MET-minute/week), among Qom city (Iran) adults in pre and during the COVID-19 pandemic (January 2020 and 20 to 29 May 2020, respectively). 670 adults were included in this study and grouped based on age and gender. The short-form International physical activity questionnaire (IPAQ, SF) was distributed to the participants through an online survey. The Wilcoxon signed-rank test was used for statistical analyses. The present study showed that the level of physical activity decreased significantly during COVID-19 compared to pre-COVID-19 in both sexes and age groups (p < 0.001). Also, this study found that a total of 78% of the participants did not meet the physical activity guidelines during COVID-19 in Iran. Our results indicate the necessity to consider an integrated and comprehensive approach to reduce the inactivity caused by COVID-19.