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Gaboreau Y, Milovančev A, Rolland C, Eychenne C, Alcaraz JP, Ihl C, Mazet R, Boucher F, Vermorel C, Ostojic SM, Borel JC, Cinquin P, Bosson JL. Molecular Hydrogen for Outpatients with COVID-19 (Hydro-COVID): A Phase 3 Randomised, Triple-Blinded, Pragmatic, Placebo-Controlled, Multicentre Trial. J Clin Med 2024; 13:4308. [PMID: 39124575 PMCID: PMC11313273 DOI: 10.3390/jcm13154308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/03/2024] [Accepted: 07/14/2024] [Indexed: 08/12/2024] Open
Abstract
Background. Due to its antioxidant, anti-inflammatory, anti-apoptosis, and anti-fatigue properties, molecular hydrogen (H2) is potentially a novel therapeutic nutrient for patients with coronavirus acute disease 2019 (COVID-19). We determined the efficacy and safety profile of hydrogen-rich water (HRW) to reduce the risk of COVID-19 progression. Methods: We also conducted a phase 3, triple-blind, randomised, placebo-controlled trial to evaluate treatment with HRW initiated within 5 days after the onset of signs or symptoms in primary care patients with mild-to-moderate, laboratory-confirmed COVID-19. Participants were randomised to receive HRW or placebo twice daily for 21 days. The incidence of clinical worsening and adverse events were the primary endpoints. Results: A total of 675 participants were followed up to day 30. HRW was not superior to placebo in preventing clinical worsening at day 14: in H2 group, 46.1% in the H2 group, 43.5% in the placebo group, hazard ratio 1.09, 90% confidence interval [0.90-1.31]. One death was reported at day 30 in the H2 group and two in the placebo group at day 30. Adverse events were reported in 91 (27%) and 89 (26.2%) participants, respectively. Conclusions: HRW taken twice daily from the onset of COVID-19 symptoms for 21 days did not reduce clinical worsening.
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Affiliation(s)
- Yoann Gaboreau
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
| | - Aleksandra Milovančev
- Institute of Sremska Kamenica, Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Carole Rolland
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
| | - Claire Eychenne
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
| | - Jean-Pierre Alcaraz
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
| | - Cordelia Ihl
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
- CHU Grenoble Alpes, Department of Pharmacy, University Grenoble Alpes, 38700 Grenoble, France;
| | - Roseline Mazet
- CHU Grenoble Alpes, Department of Pharmacy, University Grenoble Alpes, 38700 Grenoble, France;
| | - François Boucher
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
| | - Celine Vermorel
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
| | - Sergej M. Ostojic
- FSPE Applied Bioenergetics Lab, University of Novi Sad, 21000 Novi Sad, Serbia;
| | | | - Philippe Cinquin
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
- CHU Grenoble Alpes, CIC1406, University Grenoble Alpes, Inserm, 38700 Grenoble, France
| | - Jean-Luc Bosson
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, University Grenoble Alpes, 38700 Grenoble, France; (C.R.); (C.E.); (J.-P.A.); (C.I.); (F.B.); (C.V.); (J.-L.B.)
- CHU Grenoble Alpes, CIC1406, University Grenoble Alpes, Inserm, 38700 Grenoble, France
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Pozdnyakova DD, Bakhareva TА, Baranova IA, Selemir VD, Chuchalin AG. [Rehabilitation program of post-COVID-19 syndrome with the use of nitric oxide and molecular hydrogen]. TERAPEVT ARKH 2024; 96:260-265. [PMID: 38713041 DOI: 10.26442/00403660.2024.03.202639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/30/2024] [Indexed: 05/08/2024]
Abstract
Рost-COVID-19 syndrome (PS) is one of the medical and social problem. According to WHO, 10-20% of COVID-19 patients suffer from PS. The use of medical gases - inhaled nitric oxide (iNO) and molecular hydrogen (iH2) - may influence on the mechanisms of development PC. AIM To evaluate the safety and efficacy of the combined inhalation of NO and H2 (iNO/iH2) in patients with respiratory manifestations of PS. MATERIALS AND METHODS 34 patients with PS (11 men/23 women, 60.0±11.7 years) were included in the prospective open-label controlled study in parallel groups: the main group (n=17) received iNO/iH2 for 90 minutes once a day for 10 days (concentration of NO 60 ppm, H2<4% in the gas mixture), the control group (n=17) didn't receive inhalations. The period from the confirmation of COVID-19 to the start of the study was 641.8±230.5 days. The groups did not differ in the baseline parameters. The clinical symptoms (from the self-observation diary and mMRC questionnaires, "dyspnea language"), FAS, HADS, SF-36 scores, 6-minute walk test, the blood serum parameters of oxidative stress, the dynamics of the microcirculation in the eye bulbar conjunctiva were evaluated. The individual dose of iNO has chosen during a 15-minute test (the positive dynamics of the microcirculation have indicated that the dose was selected correctly). RESULTS The decrease the symptoms severity, such as dyspnea, cough, fatigue and palpitations (p<0.005), the increase in SF-36 questionnaire scores (p=0.006) and a reducing of FAS score (p=0.001), as well as the anxiety component of HADS (p=0.02) were revealed at the end of treatment in the main group compared to the control group. We observed an improvement in distance walked (p=0.01) and the values SpO2 (p=0.04) in 6-minute walk test, the increase in the volumetric blood flow velocity in venules (p<0.001), and the date in oxidative damage (p<0.001) and antioxidant activity (p=0.03) parameters in the blood serum. CONCLUSION The results of the study demonstrate clinical efficacy iNO/iH2 on clinical indicators, parameters of oxidative stress and microcirculation in patients with PS.
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Affiliation(s)
| | - T А Bakhareva
- Pirogov Russian National Research Medical University
| | - I A Baranova
- Pirogov Russian National Research Medical University
| | - V D Selemir
- Russian Federal Nuclear Center - All-Russian Research Institute of Experimental Physics
| | - A G Chuchalin
- Pirogov Russian National Research Medical University
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Dillen H, Bekkering G, Gijsbers S, Vande Weygaerde Y, Van Herck M, Haesevoets S, Bos DAG, Li A, Janssens W, Gosselink R, Troosters T, Verbakel JY. Clinical effectiveness of rehabilitation in ambulatory care for patients with persisting symptoms after COVID-19: a systematic review. BMC Infect Dis 2023; 23:419. [PMID: 37344767 DOI: 10.1186/s12879-023-08374-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Lingering symptoms after acute COVID-19 present a major challenge to ambulatory care services. Since there are reservations regarding their optimal management, we aimed to collate all available evidence on the effects of rehabilitation treatments applicable in ambulatory care for these patients. METHODS On 9 May 2022, we systematically searched articles in COVID-19 collections, Embase, MEDLINE, Cochrane Library, Web of Science, CINAHL, PsycArticles, PEDro, and EuropePMC. References were eligible if they reported on the clinical effectiveness of a rehabilitation therapy applicable in ambulatory care for adult patients with persisting symptoms continuing 4 weeks after the onset of COVID-19. The quality of the studies was evaluated using the CASP cohort study checklist and the Cochrane Risk of Bias Assessment Tool. Summary of Findings tables were constructed and the certainty of evidence was assessed using the GRADE framework. RESULTS We included 38 studies comprising 2,790 participants. Physical training and breathing exercises may reduce fatigue, dyspnoea, and chest pain and may improve physical capacity and quality of life, but the evidence is very weak (based on 6 RCTs and 12 cohort studies). The evidence underpinning the effect of nutritional supplements on fatigue, dyspnoea, muscle pain, sensory function, psychological well-being, quality of life, and functional capacity is very poor (based on 4 RCTs). Also, the evidence-base is very weak about the effect of olfactory training on sensory function and quality of life (based on 4 RCTs and 3 cohort studies). Multidisciplinary treatment may have beneficial effects on fatigue, dyspnoea, physical capacity, pulmonary function, quality of life, return to daily life activities, and functional capacity, but the evidence is very weak (based on 5 cohort studies). The certainty of evidence is very low due to study limitations, inconsistency, indirectness, and imprecision. CONCLUSIONS Physical training, breathing exercises, olfactory training and multidisciplinary treatment can be effective rehabilitation therapies for patients with persisting symptoms after COVID-19, still with high uncertainty regarding these effects. These findings can guide ambulatory care practitioners to treat these patients and should be incorporated in clinical practice guidelines. High-quality studies are needed to confirm our hypotheses and should report on adverse events.
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Affiliation(s)
- Hannelore Dillen
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium.
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium.
| | - Geertruida Bekkering
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Centre for Evidence-Based Medicine, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Cochrane Belgium, 7 Kapucijnenvoer, 3000, Leuven, Belgium
| | | | - Yannick Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, 10 Corneel Heymanslaan, 9000, Ghent, Belgium
| | - Maarten Van Herck
- REVAL-Rehabilitation Research Center, Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research and Development, Ciro, 1 Hornerheide, Horn, 6085 NM, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 25 P. Debyelaan, Maastricht, 6229 HX, The Netherlands
| | - Sarah Haesevoets
- REVAL-Rehabilitation Research Center, Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - David A G Bos
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
| | - Ann Li
- , post-COVID community, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven University Hospitals Leuven, 49 Herestraat, 3000, Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 101 Tervuursevest, 3001, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 101 Tervuursevest, 3001, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
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Chuchalin AG, Bobkov EV. [Heart Diseases by Professor Dmitry D. Pletnev (for the reprint of D.D. Pletnev's monograph "Heart Diseases", 1936)]. TERAPEVT ARKH 2023; 95:279-284. [PMID: 37167151 DOI: 10.26442/00403660.2023.03.202153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
The article presents a brief review of Heart Diseases (1936), the monograph by one of the founders of domestic and world cardiology Dmitry Dmitrievich Pletnev. In the monograph, he summarized his clinical and experimental approach to the issues of heart diseases, addressed several fundamental problems of modern physiology and healthcare, introduced the concept of "functional unit" and "functional unity of the whole body", the concept of the extracardiac genesis of the chest frog, differential diagnosis of left and right ventricle myocardial infarction, semiotics and treatment of chronic heart failure, functional diagnosis of heart arrhythmias. All these approaches and concepts have long been included in the classics of world cardiology.
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Affiliation(s)
- A G Chuchalin
- Pirogov Russian National Research Medical University
| | - E V Bobkov
- Pirogov Russian National Research Medical University
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Chuchalin AG. Pulmonary fibrosis in patients with COVID-19: A review. TERAPEVT ARKH 2022; 94:1333-1339. [PMID: 37167174 DOI: 10.26442/00403660.2022.11.201943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 12/27/2022]
Abstract
The viral infectious disease pandemic caused by SARS-CoV-2 has affected over 500 million people and killed over 6 million. This is the official data provided by the WHO as of the end of May 2022. Among people who have recovered from COVID-19, post-COVID syndrome is quite common. Scattered epidemiological studies on post-COVID syndrome, however, indicate its high relevance. One of the manifestations of post-COVID syndrome is the development of pulmonary fibrosis (PF). This article is devoted to the analysis of literature data on epidemiology, immunomorphology, as well as X-ray morphological and functional characteristics of PF in patients with post-COVID syndrome. Attention is drawn to the various phenotypes of the post-COVID syndrome and the incidence of PF, which, as clinical practice shows, is most common in people who have had severe COVID-19. This article discusses in detail the molecular biological and immunological mechanisms of PF development. The fibrotic process of the lung parenchyma is not an early manifestation of the disease; as a rule, radiomorphological signs of this pathological process develop after four weeks from the onset of acute manifestations of a viral infection. The characteristic signs of PF include those that indicate the process of remodulation of the lung tissue: volumetric decrease in the lungs, cellular degeneration of the lung parenchyma, bronchiectasis and traction bronchiolectasis. The process of remodulating the lung tissue, in the process of fibrosis, is accompanied by a violation of the lung function; a particularly sensitive test of functional disorders is a decrease in the diffusion capacity of the lung tissue. Therefore, in the process of monitoring patients with post-COVID syndrome, a dynamic study of the ventilation function of the lungs is recommended. The main clinical manifestation of PF is dyspnea that occurs with minimal exertion. Shortness of breath also reflects another important aspect of fibrous remodulation of the lung parenchyma oxygen dissociation is disturbed, which reflects a violation of the gas exchange function of the lungs. There are no generally accepted treatments for PF in post-COVID syndrome. The literature considers such approaches as the possibility of prescribing antifibrotic therapy, hyaluronidase, and medical gases: thermal helium, nitric oxide, and atomic hydrogen. The article draws attention to the unresolved issues of post-covid PF in people who have had COVID-19.
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Kim OT, Drapkina OM, Rodionova YV. Russian-language publication activity of medical researchers in during the COVID-19 pandemic: “post-COVID-19 syndrome”. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To study the dynamics and pattern of publications in Russian on post-COVID-19 syndrome (PCS) in order to assess the completeness of information and identify medical specialties with its most active investigation in Russia.Material and methods. The search for publications was carried out in the database of the largest digital scientific library in Russia Elibrary.ru from February 1, 2021 to February 1, 2022. The study included publicly available medical publications on the consequences of coronavirus disease 2019 (COVID-19) in Russian. Publications were classified according to subject matter, study design, and evidence hierarchy. The data obtained is reflected using integers, percentages and graphs.Results. The study included 478 publications, of which 196 (41%) presented data from original studies, while 269 (56,3%) reflected the results of existing sources. Expert community documents accounted for 2,7%. In terms of study design, most of original studies described case series (37,2%) and individual case reports (22,4%). Casecontrol studies accounted for 20,4%, cross-sectional studies — 8,7%, prospective cohort studies — 3,6%, randomized clinical trials — 1,5%, and systematic reviews — 1%. In addition, 5,1% of publications were devoted to preclinical studies, mathematical models and various methodological aspects. By topic, the largest number of publications noted cardiovascular (12,2%) and neurological manifestations of PCS (12,2%). Furthermore, 23,5% of publications described the course of PCS in specific groups of patients, particular issues of COVID-19 consequences, and healthcare management problems. We also revealed that 11,7% of publications were devoted to general rehabilitation, 71% — to imaging diagnostics, 5,6% — to herd immunity to the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARSCoV-2), and 5,6% — to PCS features in children. The smallest number of publications considered mental (5,1%), gastroenterological (4,6%), pharmacological (4,6%), rheumatological (4%) and pulmonological aspects of PCS.Conclusion. The dynamics and pattern of publications on COVID-19 in Russian are generally consistent with global trends and reflect the natural consequences of the pandemic. This analysis of publications on PCS showed that the most in-demand specializations in this filed are cardiology, neurology, and rehabilitation.
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Affiliation(s)
- O. T. Kim
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - Yu. V. Rodionova
- National Medical Research Center for Therapy and Preventive Medicine
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Araja D, Berkis U, Murovska M. COVID-19 Pandemic-Revealed Consistencies and Inconsistencies in Healthcare: A Medical and Organizational View. Healthcare (Basel) 2022; 10:healthcare10061018. [PMID: 35742069 PMCID: PMC9223168 DOI: 10.3390/healthcare10061018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 12/17/2022] Open
Abstract
The circumstances of the Coronavirus disease caused by the SARS-CoV-2 virus (COVID-19) pandemic have had a significant impact on global and national developments, affecting the existence of society in all its expressions, as well as the lives of people themselves. In the context of the pandemic, increased attention has been focused on acute measures, but the ending of the pandemic is expected as a resolution of the related healthcare problems. However, there are several indicators that the COVID-19 pandemic might induce long-term consequences for individual and public health. Some of the consequences are inferred and predictable, but there are also areas of medicine that have been indirectly affected by the pandemic, and these consequences have not yet been sufficiently explored. This study is focused on drawing attention to some of the COVID-19 pandemic consistencies and the pandemic-revealed inconsistencies in healthcare. Content analysis and statistical analysis were applied to achieve the aim of the study. The main findings of the study address chronic disease burden (particularly, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)), healthcare governance and organizational issues, and the synergy between health policy perspectives and innovative solutions in practice. The study provides insight into the particular healthcare issues affected by the COVID-19 pandemic, such as the increase in mortality in some diagnoses besides COVID-19 and the possible emergence of a new type of resistance—vaccine-resistance—contemporaneously supporting the identification of the tendencies and currently unnoticed indirect consistencies and inconsistencies revealed by the pandemic.
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