ABSTRACT
The Covid-19 pandemic has been a problem in recent years. The first FDA approved drug in the treatment of this disease was Remdesivir, which, despite its many benefits, has harmful effects on the liver. Melatonin and N-acetylcysteine, two drugs that have previously been shown to protect the liver with their antioxidant properties, may reduce the hepatic toxicity induced by Remdesivir. Given that few studies have been performed on the role of oral melatonin and N-acetylcysteine on reducing the hepatic adverse effects of Remdesivir, we decided to conduct this clinical trial study. In this double-blind, randomized clinical trial study, 70 patients with Covid-19 in Besat Hospital, Tehran, Iran, during 2022, were enrolled. Patients were randomly divided into two groups of 35 each. Both groups were administered Remdesivir with same protocol. In this period, the first group received N-acetylcysteine 600 mg tablet twice daily and melatonin 6 mg tablet at bedtime. The second group received placebos with the same appearance. Liver enzymes of all patients were serially evaluated and then demographic and lab datas were extracted. Mann-Whitney test, Chi-square test and independent t-test were used for analysis of data. P < 0.05 was considered statistically significant. No significant difference was seen between case and control groups regarding age, gender, BMI and severity of the disease at the time of hospital admission (P > 0.05), which shows a random classification of two groups. The mean AST, ALT, ALP and CBC of patients in case group decreased compared to the control group but the difference was not statistically significant (P > 0.05). In patients with COVID-19 that received Remdesivir, oral administration of melatonin and NAC did not significantly decrease either the patients liver enzymes or CBC level in 6 day of enrolment compared with placebo. Further studies with longer duration and different doses are recommended. © 2023 by the authors. Licensee ResearchersLinks Ltd, England, UK. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
ABSTRACT
Background: COVID-19 is associated with dangerous thromboembolic complications, such as stroke, heart attack, pulmonary em-bolism, and arterial and venous thromboembolism (VTE). Early diagnosis and even prediction of thromboembolic complications using biomarkers could facilitate the treatment and decrease the mortality rate. Objective(s): This study evaluated and compared the clinical and laboratory findings of COVID-19 patients with thrombotic events with other COVID-19 patients. Method(s): A total of 114 confirmed COVID-19 patients referred to Taleghani Hospital, Tehran, Iran, between February and September 2020 were included in this cross-sectional study. Those with a history of thromboembolic disease were excluded. The laboratory data, including the levels of lactate dehydrogenase (LDH), D-dimer, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and counts of lymphocyte and neutrophil, along with clinical findings (such as oxygen saturation and lung involvement percent-age), were retrospectively collected from the patients' clinical files. The incidence of thrombotic events was evaluated in patients. Result(s): The prevalence of thrombosis in the right and left main pulmonary arteries, right and left sub-segmental pulmonary ar-teries, and right and left deep veins was 2.7%, 3.5%, 7%, 7.9%, 4.4%, and 1.8% of all patients, respectively. The results showed that throm-boembolic complications were significantly associated with mortality (P < 0.001). Besides, it was found that LDH (P < 0.001) and neutrophil (P = 0.002) levels in thromboembolic COVID-19 patients were respectively higher and lower than those without throm-boembolic manifestations. Conclusion(s): High LDH and neutropenia might serve as biomarkers for thromboembolism in COVID-19 patients. Copyright © 2022, Author(s).