ABSTRACT
BACKGROUND: efficacy of therapeutic cholecalciferol supplementation for severe COVID-19 is sparingly studied. OBJECTIVE: effect of single high-dose cholecalciferol supplementation on sequential organ failure assessment (SOFA) score in moderate-to-severe COVID-19. METHODS: participants with moderate to severe COVID-19 with PaO2/FiO2 ratio < 200 were randomized to 0.6 million IU cholecalciferol oral (intervention) or placebo. OUTCOMES: primary outcome was change in Day 7 SOFA score and pre-specified secondary outcomes were SOFA and 28-day all-cause mortality. RESULTS: in all, 90 patients (45 each group) were included for intention-to-treat analysis. 25(OH)D3 levels were 12 (10-16) and 13 (12-18) ng/ml (P = 0.06) at baseline; and 60 (55-65) ng/ml and 4 (1-7) ng/ml by Day 7 in vitamin D and placebo groups, respectively. The SOFA score on Day 7 was better in the vitamin D group [3 (95% CI, 2-5) versus 5 (95% CI, 3-7), P = 0.01, intergroup difference - 2 (95% CI, -4 to -0.01); r = 0.4]. A lower all-cause 28-day mortality [24% compared to 44% (P = 0.046)] was observed with vitamin D. CONCLUSIONS: single high-dose oral cholecalciferol supplementation on ICU admission can improve SOFA score at Day 7 and reduce in-hospital mortality in vitamin D-deficient COVID-19. ClinicalTrials.gov id: NCT04952857 registered dated 7 July 2021. What is already known on this topic-vitamin D has immunomodulatory role. Observational and isolated intervention studies show some benefit in COVID-19. Targeted therapeutic vitamin D supplementation improve outcomes in severe COVID-19 is not studied in RCTs. What this study adds-high-dose vitamin D supplementation (0.6 Million IU) to increase 25(OH)D > 50 ng/ml is safe and reduces sequential organ failure assessment score, in-hospital mortality in moderate to severe COVID-19. How this study might affect research, practice or policy-vitamin D supplementation in vitamin D-deficient patients with severe COVID-19 is useful may be practiced.
Subject(s)
COVID-19 , Cholecalciferol , SARS-CoV-2 , Vitamin D Deficiency , Humans , Male , Female , Double-Blind Method , Middle Aged , COVID-19/mortality , COVID-19/complications , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/complications , Cholecalciferol/administration & dosage , Cholecalciferol/therapeutic use , Aged , Vitamin D/blood , Vitamins/therapeutic use , Vitamins/administration & dosage , Organ Dysfunction Scores , Dietary Supplements , Coronavirus Infections/drug therapy , Coronavirus Infections/mortality , COVID-19 Drug Treatment , Pandemics , Adult , Treatment Outcome , Pneumonia, Viral/drug therapy , Pneumonia, Viral/mortality , Severity of Illness Index , BetacoronavirusABSTRACT
Nanocrystalline metal-ion (M = Fe, Ni, Ag, and Pd) doped and undoped anatase-TiO2 powders were prepared using a solution combustion method. The photocatalytic degradation of different dyes such as methylene blue (MB), rhodamine B (RB), rhodamine B base (RBB), and thionine acetate (TA) was investigated under UV exposure. The degradation rate of the dyes were found to be better in the case of Ag+ and Pd2+ doped TiO2, whereas Fe3+ and Ni2+ doped TiO2 showed lower photocatalytic activity compared to undoped TiO2 nanoparticles. Combustion synthesized catalysts exhibited much better activity compared to the commercial Degussa P25 (75% anatase + 25% rutile) TiO2 photocatalyst. The intermediate states created in the band gap of the TiO2 photocatalyst due to doping of first row transition metal ions (such as Fe3+ and Ni2+) into the TiO2 lattice act as recombination centres and the electrons present in the d-orbital quench the photogenerated holes by indirect recombination, hence increasing e--h+ recombination rates. As a result, a decrease in the photocatalytic activity of TiO2 doped with first row transition metal ions is observed. However, in the case of noble metal ions (such as Ag+ and Pd2+) in TiO2, photoreduction of Ag+ and Pd2+ ions occurs upon UV irradiation, hence the noble metal-ions act as electron scavengers. Consequently, the lifetime of the holes (h+) increases and hence higher photocatalytic oxidation activity of the dyes is observed. A novel strategy of electron scavenging is envisaged here to develop Ag+ and Pd2+ doped TiO2 to increase the photocatalytic oxidation of organic dyes for the development of better water pollution abatement catalysts. Redox-pair stabilization in the TiO2 lattice similar to photo-chromic glasses play a defining role in enhancing the photocatalytic activity of the catalyst and is a key finding for the development of superior photocatalysts. With the help of UV-vis and fluorescence spectroscopy, the mechanisms of the superior oxidation activity of Pd2+ and Ag+ doped TiO2 nanoparticles are explained.
