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Background: Breathox is a sodium chloride inhaler. Increase of the airway salinity has been proposed to reduce the symptomatic stage of a respiratory viral infection. Objective(s): to evaluate the effectiveness of nasal and inhaled sodium chloride therapy through Breathox on mild COVID-19 symptoms in patients >= 18 years-old compared to usual care. Method(s): a pilot, open, randomized clinical trial, including 100 patients with confirmed and symptomatic COVID-19 within 10 days of symptom onset. All patients received standard of care (SOC), i.e. antipyretic or analgesic. Breathox was administered as two oral inhalations and one nasal instillation in each nostril at each administration with 2mg per inhalation. Patients were randomized 1:1:1 into three groups: Group 1(G1): SOC + Breathox 10 times daily for 10 days;Group 2(G2): SOC + Breathox five times daily for 10 days;Group 3(G3): SOC. Recovery time for symptoms, such as cough was assessed. Result(s): In total 100 of 103 screened patients were included from December 1 2021 to March 03 2022. Of those, 33 from G1 and G3, and 32 from G2 completed the study. Mean age was 40.4/42.2/40.6 years old for G1, G2 and G3, (p=0.96). No patients were hospitalized or died during the study. Time to cough resolution was reduced in G1 (2.8+/-0.66 days) and G2 (2.4+/-0.66 days) compared to G3 (5.39+/-0.79 days) (p=0.001), with a hazard ratio (HR) for G2 of 2.17 (Confidence interval 1.17-4.04) and G3 of 2.01 (1.06-3.81) compared to SOC. Conclusion(s): ten days of Breathox use halved the time for resolution of COVID-19-induced cough.
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Introduction: higher value of urea/albumin (U/A) ratio is associated with higher risk of death in patients with pneumonia. It is known that infections by COVID-19 can lead to ICU admission and death, and, in this scenario, the evaluation of this marker can be useful to improve the management of these patients. Objective(s): to evaluate the U/A ratio as a predictor of mortality in patients hospitalized for COVID-19. Method(s): 252 unvacinated patients with COVID-19 hospitalized between April 2020 and February 2021 were included in this cohort and were assessed by complete blood count and laboratory analysis on the first and third day of hospitalization. Result(s): Of the total number of patients, 153 were hospitalized in a ward and, of these, 28 died. Of those who required intensive care (n=99) 72 died. The comparison of the U/A ratio was lower in survivors when compared to the dyed group on the first day of hospitalization (14.0+/-10.3 vs 22.1+/-18.8;p<0.001) and on the third day (19.1+/-16.1 vs 28.3+/-16.8;p=0.005). The absolute variation in urea on the third day from baseline was also lower in the group of survivors (1.59+/-13.8 vs 30.9+/-37.9;p<0.001). The multiple logistic regression model adjusted for age, sex, place of hospitalization and C-reactive protein showed that the U/A ratio on the first day was associated with a higher risk of mortality [OR: 1.04;95%CI: 1.02-1.07;p=0.002]. The U/A ratio on the third day was not associated with risk of death whereas the absolute variation in urea showed an association with mortality [OR: 1.03;(95%CI: 1.01-1.05);p<0.001]. Conclusion(s): the use of the U/A ratio and the urea variation can predict mortality in patients hospitalized for COVID19.
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Post COVID-19 patients have been suffering from persistent symptoms even after long periods. The physiopathology of these clinical manifestations still has a lack of knowledge. The objective was to evaluate the total expression of metabolites and spittle biological pathways in patients with 60 days post COVID-19. We included 30 post-hospital discharge patients and we compared seven non COVID-19 patients control. All COVID-19 patients were assessed by demographic characteristics, pulmonary function, exercise capacity, quality of life and body composition. The metabolomic analysis was performed in the patient's splits. From the total of post COVID-19 patients, 66% were male, 60+/-14 years. The lean body mass was 30+/-7kg and fat mass 34+/-13kg. Spirometry mean severity showed FVC of 4+/-1L, FEV1 3+/-1L. Pimax and Pemax values were 90+/-31(cmH2O) and 97+/-31(cmH2O), respectively. The quality of life evaluated by the SGRQ questionnaire showed a mean percentage of magnitude of symptoms 32+/-15, activities 41+/-25, impact 13+/-11 and total of 24+/-15. Physical capacity was measured by the distance in the 6MWT, and presented an average of 413+/-131. The metabolomic analysis showed 19 metabolites statistically significant difference between groups. We observed 3 metabolites overexpressed and 16 with lower expression in post COVID19 patients. From those metabolites, we can have attention to Sphinganine(p=0.03), Piperenol A triacetate(p=0.02) and 1-Monopalmitin(p=0.03) were lower expressed in control group. The creatin was one of the non-expressed metabolites in post hospital discharge COVID-19 patients compared to the control group. Thus, metabolomic analysis can demonstrate different metabolites in post COVID-19 patients to answer persistent symptoms.
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Introduction: Mechanical ventilation (MV) is a known risk to impact in respiratory and functional capacity postCOVID-19 infection. Objective(s): Assess pulmonary function, muscular strength and quality of life in post-COVID-19 patients submitted or not to MV. Method(s): During March of 2020 and July 2021 we had 983 hospitalized COVID-19 patients and 527 patients were discharged and invited to be followed at the multidisciplinary assistance. From the total, 116 patients [57% male, 59(52-67) years] were evaluated 60 days after first symptoms appearance through pulmonary function testing, manovacuometry, handgrip test and Saint George's Respiratory Questionnaire (SGRQ). There were no vaccinated subjects. Result(s): 34% of the patients needed intensive care (n=39), of which, 51% needed MV (n=20). MV group showed statistically significant weaker handgrip strength [27(18-35) kgf vs 35(26-45) kgf;p=0,025] and maximum inspiratory pressure predicted percentile reduction (86+/-23,5% vs 101+/-27,6%;p=0,043) when compared to non-MV group. We did not observe SGRQ differences between the groups. However, females showed statistically significant higher impact in quality of life in all SGRQ domains compared to males. There were no differences in pulmonary function. Conclusion(s): MV submitted patients presented worsened respiratory and peripheral muscular strengths without difference in pulmonary function and quality of life. Women showed higher impact in quality of life regardless of MV use.
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Introduction: Some patients affected by COVID-19 remain hospitalized due exclusively to persistent hypoxemia. The indication of long-term home oxygen therapy (LTOT) has become a strategy adopted to reduce the length of hospital stay. The influence of the degree of severity of disease involvement on the effectiveness of the strategy is unknown. Objective(s): To evaluate the clinical characteristics of patients with LTOT indication according to the type of hospitalization in COVID-19 patients. Method(s): An exploratory cross-sectional study of associated factors in stable discharged COVID-19 patients using LTOT were consecutively included. Result(s): Between April and December 2021, a total of 62 patients with LTOT indication were evaluated 15 days after hospital discharge. Of these, 32 of them required intensive care unit (ICU) at some point during their hospitalization. When we compared the ICU and ward care groups, we observed differences in age (55.84 +/-13.5 vs 68.42 +/- 14.8, p=0.001) and time of hospitalization (31.63 +/- 21.8 v 17.65 +/-9, p=0.002). However, we did not identify statistical differences between groups on gender and degree of pulmonary involvement on tomography during hospitalization. After 15 days of discharge, there was no statistically significant difference between the two groups in terms of the number of patients who needed to maintain LTOT for more period (8 vs 11). Conclusion(s): Regardless of the severity of hospitalization, most patients did not need to maintain LTOT for more than 15 days. LTOT proved to be a temporary and effective strategy to shorten the length of stay in both groups in stable COVID-19 patients.
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BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a longer recovery time after COVID-19. However, some patients may present persistent pulmonary abnormalities.OBJECTIVE: To evaluate the prevalence of tomographic abnormalities 90 days after symptom onset in patients with COVID-19 and compare two chest high-resolution computed tomography (HRCT) analysis techniques.METHODS: A multicentre study of patients hospitalised with COVID-19 having oxygen saturation <93% on room air at hospital admission were evaluated using pulmonary function and HRCT scans 90 days after symptom onset. The images were evaluated by two thoracic radiologists, and were assessed using software that automatically quantified the extent of pulmonary abnormalities.RESULTS: Of the 91 patients included, 81% had at least one pulmonary lobe with abnormalities 90 days after discharge (84% were identified using the automated algorithm). Ground-glass opacities (76%) and parenchymal bands (65%) were the predominant abnormalities. Both chest HRCT technical assessments presented high sensitivity (95.9%) and positive predictive value (92%), with a statistically significant correlation at baseline (R = 0.80) and after 90 days (R = 0.36).CONCLUSION: The prevalence of pulmonary abnormalities on chest HRCT 90 days after symptom onset due to COVID-19 was high; both technical assessments can be used to analyse the images.