In COPD excess expectoration secondary to tracheobronchial secretions contributes to symptoms, airflow obstruction and is diagnostic criterion. It also causes increased mortality, risk of hospitalizations and accelerated decline in FEV1. N-acetylcysteine (NAC) helps in liquefying mucus and DNA (via disruption of disulfide bonds) and has antioxidant effects. Aims: Evaluate add-on effect of NAC on clinical-physiological parameters in COPD patients treated according to GOLD guidelines. Material and Methods: Single labeled, randomized, parallel group prospective Observational study. In 120 stable COPD patients Modified medical research council (MMRC) dyspnoea score, COPD Assessment test (CAT score), number of exacerbations and hospitalizations in the last year were recorded and were randomized into 2 groups of 60 each. Group A received NAC 600mg twice daily along with standard treatment. Group B received standard treatment only. Mean and Standard Deviation was compared between groups using unpaired t-test. After 1 year, changes in above parameters were reassessed. Statistical Analysis: Unpaired t-test and chi square test were used. Statistical significance was set at <0.05 level. Results: MMRC score reduced from 3.37 study group) to 2.91, difference being -0.46, and in control from 3.37 to 1.18, difference of -0.22 and p value of p<.05. CAT score reduced more in test group (-4.4) than control group (-3.1), p=.02. Out of 40 exacerbations, 14 (35%) occurred in test and 26 (65%) in control group, reduction of 30% and p=0.01. Out of 28 hospitalizations 10 (36%) test group 18 (64%) control group. i.e. a reduction of 28% and p=0.06. Conclusions: Use of N-Acetyl Cysteine, 600mg twice daily along with standard treatment can bring clinically significant change in CAT Score and frequency of exacerbations but not in MMRC score and hospitalizations.
Aim: To determine the role of vitamin D in the management of COVID-19 patients regarding morbidity and mortality. Study Design: Prospective/Observational Place and Duration: Departments of Medicine & Pulmonology, Allama Iqbal Memorial Teaching Hospital, Sialkot and Department of Medicine, Sughra Shafi Medical Complex Narowal from 1st November 2020 to 30th April 2020. Methodology: One hundred and sixty patients of both genders diagnosed to have COVID-19, were enrolled. Patient’s ages were ranging from 17 to 70 years. The detailed demographics such as age, sex, and body mass index were recorded. 5 ml blood samples were taken from all the patients to check their vitamin D levels. Severe Vitamin D deficiency was defined as 25(OH)D <25 nmol/L (10 ng/dl). Association between mortality and morbidity was examined. Results: Ninety (56.25%) were males while 70 (43.75%) were females with mean age 40.15±17.37 years. Mean body mass index of patients was 24.16±7.26 kg/m2. Severe vitamin D deficiency was observed in 80 (50%) patients. Mortality found in 30 (18.75%) patients. Frequency of morbidity was among 66 (41.25%) patients. Patients with severe vitamin D deficiency had high rate of mortality 20 (25%) and morbidity 50 (62.5%) as compared to patients with no vitamin D deficiency had 10 (8%) mortality and 16 (20%) morbidity. A significant association was observed between severe vitamin D deficiency regarding morbidity and mortality among patients with covid-19 disease with p-value <0.05. Conclusion: The vitamin-D has strongest relationship among patients with covid-19 disease to reduce mortality and morbidity. Keywords: Morbidity, COVID-19, Vitamin D, Mortality
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