Micronutrients as immunomodulatory tools for COVID-19 management.

COVID-19 rapidly turned to a global pandemic posing lethal threats to overwhelming health care capabilities, despite its relatively low mortality rate. The clinical respiratory symptoms include dry cough, fever, anosmia, breathing difficulties, and subsequent respiratory failure. No known cure is available for COVID-19. Apart from the anti-viral strategy, the supports of immune effectors and modulation of immunosuppressive mechanisms is the rationale immunomodulation approach in COVID-19 management. Diet and nutrition are essential for healthy immunity. However, a group of micronutrients plays a dominant role in immunomodulation. The deficiency of most nutrients increases the individual susceptibility to virus infection with a tendency for severe clinical presentation. Despite a shred of evidence, the supplementation of a single nutrient is not promising in the general population. Individuals at high-risk for specific nutrient deficiencies likely benefit from supplementation. The individual dietary and nutritional status assessments are critical for determining the comprehensive actions in COVID-19.

[Effect of Chinese medicine intestine adjusting therapy on patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease and undergoing noninvasive ventilation].

OBJECTIVE: To observe the effect of Chinese medicine intestine adjusting therapy (IAT) on patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and undergoing noninvasive ventilation, their immune function, ventilation indices and incidence of complication. METHODS: Patients matched with the inclusive criteria were randomized into two groups, 30 in each group. All received bi-level positive airway pressure ventilation and conventional drug therapy, but to patients in the treatment group, IAT was applied additionally by electro-acupuncturing (EA) acupoints Zusanli (ST36), Shangjuxu (ST37), Fenglong (ST40), and Quchi (LI11), also the retention enema with Xuanbai Dachengqi Decoction. The nutritional indicators, including serum total protein (TP), serum albumin (ALB) and hemoglobin (HGB); immune indices, including immuno-globulins (IgG, IgA, IgM), complements, and T-lymphocyte subsets; and the incidence of ventilation complications in the two groups were dynamically observed and compared. RESULTS: After treatment, the nutritional indicators went down in both groups (P < 0.05, P < 0.01), but the lowering in the treatment group were lesser. Moreover, the treatment group showed a higher TP level (P < 0.05) and lower depressive amplitude of ALB (P < 0.01) than those in the control group. Immune indices, excepting IgM, increased significantly in both groups (P < 0.05 or P < 0. 01), but the increments in the treatment group were higher, so significant difference was shown between groups (P < 0.05 or P < 0.01). As for comparison in ventilation complication, the incidence of abdominal distension (which was extensively occurred in the control group), belching and error aspiration in the treatment were significantly fewer (P < 0.05, P < 0.01). Besides, the maximum PS and PEEP, and the mechanical ventilation time were significantly reduced in the treatment group (P < 0.05). CONCLUSION: IAT of Chinese medicine is facilitated to improve the nutritional status of AECOPD patients with respiratory failure undergoing noninvasive ventilation, enhance their immune function, improve the ventilatory efficiency, reduce the duration of mechanical ventilation and the occurrence of complications.

[The prevention and treatment of suppurative-inflammatory complications in the bronchopulmonary system during prolonged artificial ventilation]. / Profilaktika i lechenie gnoino-vospalitel'nykh oslozhnenii v bronkholegochnoi sistemy pri prodlennoi IVL.

The use of physical methods, namely low frequency magnetic field in critically ill patients under respiratory therapy made it possible to prevent and in case of their development to effectively treat pyoinflammatory bronchopulmonary complications that accompany prolonged controlled lung ventilation. The results obtained were due to the elimination of an unfavourable effect of controlled lung ventilation on natural resistance and immune response of the respiratory tract because of normalization of physicochemical properties of the tracheobronchial tree secretion, enhanced functional capacities of phagocytes, repaired bonds between cellular and humoral local immunity in the lungs.