Background: we have observed the effect of insomnia treatment in clinical and prognostic differences of patients admitted for COVID-19 pneumonia in respiratory sub-intensive units that were administered a prolonged-release melatonin 2 mg (PRM 2 mg) therapy versus a group of patients out of therapy. Materials and Methods: We evaluated 40 patients on prolonged-release melatonin 2 mg (PRM 2 mg) therapy versus a control group of 40 patients out of therapy. Results: patients in the PRM 2 mg group had a shorter duration of therapy with non-invasive ventilation (5.2 ± 3.0 vs. 12.5 ± 4.2; p < 0.001), with a shorter stay in sub-intensive care (12.3 ± 3.2 vs. 20.1 ± 6.1; p < 0.001), and, therefore, a shorter overall duration of hospitalization (31.3 ± 6.8 vs. 34.3 ± 6.9 p = 0.03). In addition, a lower incidence of delirium was found (2.2 ± 1.1 vs. 3.3 ± 1.3; p < 0.001). Conclusions: A significant increase in sleep hours and a reduction in delirium episodes occurs in hospitalized insomniac patients treated with PRM 2 mg, compared to untreated patients. Based on these preliminary results, we can assume that there are benefits of prolonged-release melatonin 2 mg in COVID-19 therapy.
In order to evaluate the efficacy of oral supplementation with 3 g of arginine per day associated with creatine, L-carnitine, aspartic acid, magnesium, selenium and vitamins C and E (Argivit© Aesculapius Farmaceutici) in the prevention and treatment of sarcopenia in patients with COVID-19-related pneumonia, we conducted a parallel randomized study comparing it with standard therapy alone. Forty patients on standard therapy plus supplementation were compared with a control group of 40 patients, all hospitalized at the sub-intensive care unit of the Del Mare Hospital in Naples, with a clinical diagnosis of SARS-CoV-2 infection and COVID-19 pneumonia. Muscle strength was assessed with the handgrip test and muscle ultrasound. Arginine-supplemented patients had an average grip strength of 23.5 at the end of hospitalization compared with 22.5 in the untreated group with less reduction, showing statistical significance (p < 0.001). In the same way, the thickness of the vastus lateralis quadriceps femoris muscle measured at the end of hospitalization showed less reduction on ultrasound, with a higher average value in the group receiving treatment than in the group of patients without supplementation (p < 0.001). Upon discharge there was a 58.40% reduction in ventilation days in patients with arginine supplementation compared with the control group.
Lung failure has been the most common cause of hospitalization for COVID-19. Yet, bilateral interstitial pneumonia has not been the only cause of lung failure of these inpatients, and frequently they develop other illnesses associated with COVID-19. Pulmonary embolism has been the most looked for in the world, but rarely other pneumological diseases, such as pneumothorax and pneumomediastinum, have been described and associated with a worsening prognosis. We here report our clinical experience associated with the occurrence of pneumothorax and pneumomediastinum in a cohort of inpatients hospitalized in our division of medicine in a regular ward or in a sub-intensive ward.
Background. Since the European Society of Cardiology (ESC) published guidelines to stratify the risk of pulmonary embolism (PE), the main goal of several physicians has been to find a biomarker able to identify patients with venous thromboembolism at high risk to die. Increased levels of pro-B-type natriuretic peptide (BNP) were suggested as useful biomarkers in the guidelines of ESC (i.e., 2014) to identify patients with PE at high risk of death, but its role was not confirmed in other guidelines. Lung Ultrasound Scan (LUS) has been suggested as a diagnostic and prognostic test to identify patients with a high risk of mortality for lung failure. The aim of this study is to evaluate the prognostic role of pro- BNP together with the LUS evaluation in patients with COVID-19 and PE in particular regarding mortality for pulmonary embolism and overall death. Patients and Methods. We retrospectively analyzed records from 178 patients with confirmed COVID-19, admitted to our ward (i.e., COVID Medicine Unit at Ospedale del Mare in the town of Napoli) between March 2020 and May 2021. For this study, we analyzed the LUS data of all 178 patients and the available data on the pro-BNP of 120 patients. For all selected patients, mortality for PE and overall deaths were recorded. Results. The Propensity Score Matching was used to minimize and erase confounding factors. Data showed that an association between serum levels of pro-BNP and pulmonary thrombotic events was neither present before nor after matching an association with adverse outcomes and was found for increased values of LUS. Discussion. During the first waves of the pandemic, patients with confirmed COVID-19 with severe lung failure frequently showed pulmonary embolism as a clinical acute complication inducing life-threatening evolution. Conclusions. An association between LUS score and severe PE and/or overall mortality in hospitalized patients with COVID-19 was found while a similar association was not confirmed for pro-BNP.
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