Reduction of SARS-CoV-2 viral load in exhaled air by antiseptic chewing gum: a pilot trial.

PURPOSE: The dominant route of transmission of SARS-CoV-2 is airborne, through respiratory transmission by aerosols or droplets which can be measured by viral load in exhaled air. Several natural substances have shown antiviral activity. The aim of this pilot study was to investigate the effect of a chewing gum containing natural antiseptic ingredients (cinnamon-, peppermint- and lemon-oil, quercetin, spermidine, ginger and ginseng) on viral load in exhalative air in patients infected with SARS-CoV-2. METHODS: Nine patients infected with SARS-CoV-2 were enrolled and exhaled forcefully into a special mouthpiece at different time points before and after chewing the antiseptic gum. The mouthpiece contained a filter paper serving for extraction of coronaviruses following real-time PCR to quantify the viral load. RESULTS AND CONCLUSION: Cycle threshold (Ct) values of all patients increased after chewing the gum. The mean difference between the Ct values at baseline (before chewing the antiseptic gum) and time point 30 min (15 min after chewing) was 3.8 ± 2.6; (93% viral load reduction; p = 0.002). Time point 15 min (2.7 ± 1.7 (83% viral load reduction; p = 0.003)), 60 min (3.0 ± 3.4 (88% viral load reduction; p = 0.028)), 90 min (3.7 ± 1.8 (92% viral load reduction; p = 0.004)) and 120 min (3.0 ± 3.7 (91% viral load reduction; p = 0.05)) showed similar results. The antiseptic chewing gum demonstrated a significant potential to reduce SARS-CoV-2 viral load in exhalative air and, in this way, reduce further spread and infection risk. Larger placebo-controlled clinical trials are required to confirm these findings further.

[No improved survival rate in severely injured patients by prehospital intubation : A retrospective data analysis and matched-pair analysis]. / Kein verbessertes Überleben bei schwerstverletzten Patienten durch die präklinische Intubation : Eine retrospektive Datenanalyse mit Matched-pair-Analyse.

BACKGROUND: Training programs for the treatment of trauma patients generally recommend establishing a secure airway if the patient presents with a Glasgow coma scale (GCS) score of less than 9; however, the evidence for its effectiveness is rather sparse. This study analyzed the effect of preclinical intubation on mortality of patients with a GCS <9 in an emergency medical situation. METHODS: This retrospective analysis included patients who were primarily admitted to a German level 1 trauma center between 2002 and 2012 with an injury severity score (ISS) ≥ 16, a GCS < 9 and primary transport from the site of the accident. Data were collected from the trauma registry of the German Society for Trauma Surgery and from hospital records. A total of 455 patients were included and a matched-pair analysis of 62 patients was conducted. RESULTS: Both analytical methods showed no significant reduction in mortality rate after prehospital intubation. In the retrospective analysis intubated patients presented with a significantly lower systolic blood pressure on admission, received a higher amount of fluid volume at all phases of treatment and arrived at the hospital after a prolonged rescue time. In the matched-pair analysis, intubated patients also received a higher amount of fluid volume and showed better peripheral oxygen saturation on admission. No further differences between the groups could be found. CONCLUSION: It appears that preclinical intubation in trauma patients with a GCS < 9 does not result in a better outcome. The preclinical intubation resulted in a reduced systolic blood pressure on arrival at hospital, a prolonged preclinical rescue time and a greater amount of infused fluid volume.

Improved virological and immunological efficacy of resistance-guided switch in antiretroviral therapy: a Frankfurt HIV cohort analysis.

To evaluate the treatment outcome of antiretroviral therapy, depending on the use and utility of a concept of resistance-guided switch, patients from the Frankfurt HIV cohort have been followed for 24 weeks. If available, prior resistance data have been evaluated and patients were grouped into their expected viral response. The data of 354 patients were thus analysed, taking into account the genotypic sensitivity score of the administered medication (> or ≤2). When looking at the proportion of patients who achieved a viral load of <50/ml, the response rates differed significantly better for patients with a favourable resistance scoring as compared to an unfavourable one (71.9 % as compared to 56.0 %, p = 0.008). Interestingly, patients with a favourable resistance score also showed a better immunological response, as measured by median CD4 cell count of 391/µl [interquartal range (IQR) 250-530/µl] against 287/µl (IQR 174-449/µl) and a larger total increase of 141/µl against 38/µl. A significant virological and immunological benefit could be demonstrated for patients of a cohort with resistance-guided antiretroviral therapy adjustments.