Melatonin, vitamins and minerals supplements for the treatment of Covid-19 and Covid-like illness: A prospective, randomized, double-blind multicenter study.

BACKGROUND: Melatonin, zinc, and multivitamins are among most recommended supplements in the fight against coronavirus disease 2019 (COVID-19). We aimed to examine the efficacy and safety of this association in the treatment of COVID-19 and COVID-like illnesses. METHODS: We conducted a multicenter prospective, randomized, double-blind, controlled trial. Patients with no medical history consulting the emergency department for covid and covid-like illness and who were not hospitalized were included. Patients were assigned in a 1:1 ratio to the treatment or the placebo group. The primary outcome was studying the effectiveness of zinc multivitamin supplement and melatonin in the treatment of COVID and -like illnesses symptoms' according to the time from randomization to clinical improvement. The pre-specified secondary outcomes were date of disappearance of symptoms present on admission, appearance of an adverse effect due to the administration of the treatment, number of patients developing complications, requiring hospitalization, requiring respiratory support. RESULTS: One hundred sixty four patients were eligible for the study and were randomized to either the treatment group or the placebo group. Overall, 128 of the 164 patients had a PCR for SARS-CoV-2, yielding a positive PCR result in 49.1% of them. Regarding the disappearance of all initial presenting symptoms: on the 5th day of the follow-up, there was a significant difference between the two groups with a p value 0.04;On the 10th day, there was a significant difference too with p value of 0.038. There were no significant differences between the two groups in recovery during the 15th day of follow-up p>0.5. Finally, 100% of patients fully recovered in the treatment group vs 98.8% in the placebo group. No severe adverse events were reported throughout the trial. CONCLUSIONS: Our results showed that daily doses of Melatonin, zinc and vitamins did significantly reduce the duration of symptoms accelerating its disappearance among patients consulting with COVID-19 or COVID-19 like illness.

Bedside lung ultrasonography by emergency department residents as an aid for identifying heart failure in patients with acute dyspnea after a 2-h training course.

BACKGROUND: Ultrasonographic B-lines have recently emerged as a bedside imaging tool for the differential diagnosis of acute dyspnea in the Emergency Department (ED). However, despite its simplicity, LUS has not fully penetrated emergency department. This study aimed to assess the accuracy and reproducibility of ultrasonographic B-lines performed by emergency medicine (EM) residents for the diagnosis of congestive heart failure (CHF) in patients admitted to ED for acute dyspnea. PATIENTS AND METHODS: This is a cross-sectional prospective study conducted between January 2016 and October 2017 including patients aged over 18 years admitted to ED for acute dyspnea. At admission, two consecutive bedside LUS study were performed by a pair of EM residents who received a 2-h course for recognition of sonographic B-lines to determine independently B-lines score and B-profile pattern. All participating sonographers were blinded to patients' clinical data. B-lines score ≥ 15 or a B-profile pattern was considered as suggestive of CHF. The final leading diagnosis was assessed by two expert sonographers, who were blinded to the residents' interpretations, based on clinical findings, chest X-ray, brain natriuretic peptide, cardiac and lung ultrasound testing. Accuracy and agreement of B-lines score and B-profile pattern were calculated. RESULTS: We included 700 patients with a mean age of 68 ± 12.6 years and a sex ratio (M/F) of 1.43. The diagnosis of CHF was recorded in 371 patients (53%). The diagnostic performance of B-lines score at a cut-off 15 and B-profile pattern was, respectively, 88% and 82.5% for sensitivity, 75% and 84% for specificity, 80% and 85% for positive predictive value, 84% and 81% for negative predictive value. The area under receiver operating characteristic curve was 0.86 [0.83-0.89] and 0.83 [0.80-0.86], respectively, for B-lines score and B-profile pattern. There was an excellent agreement between residents for the diagnosis of CHF using both scores (kappa = 0.81 and 0.85, respectively, for ordinal scale B-lines score and B-profile pattern). CONCLUSION: Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry: clinicaltrials.gov; Trial registration number: NCT03717779; Date of registration: October 24, 2018 'Retrospectively registered'; URL of trial registry record: clinicaltrials.gov.

Ketoprofen versus Diclofenac sodium in the treatment of renal colic.

INTRODUCTION: Adult renal colic is a frequent lombo-abdominal painful syndrome in emergencies. Treatment is based on nonsteroidal anti-inflammatory drug (NSAID) but the choice between different NSAIDs remains a subject of controversy. Our aim was to compare the efficacy and the safety of two intramuscularly NSAIDs in renal colic. METHODS: We conducted a 32-week, randomized, double-blind, single-center study . Patients who had renal colic with a visual analogue scale (VAS) ≥ 5 were randomly assigned to receive, by intramuscularly injection, 100 mg of Ketoprofen (GK) or 75 mg of diclofenac (GD). If VAS > 3 after 40 minute, 1 g of paracetamol was administered as rescue analgesia. Primary endpoint was successful treatment. Secondary outcome was the occurrence of side effects. RESULTS: We have included 80 patients. the average age was 39 ± 13 years for GK versus 43 ± 14 years for GD. The mean VAS on admission was also similar in both arms. We objectified a therapeutic success rate of 92% in both groups. This success was similar in both arms. The use of rescue medication was 32.5% in the GK versus 47.5% in the GD (P=0.17). We have observed in 46% (n =37) of the study population side effects. These effects were only minor and no major intolerance expression was registered. CONCLUSION: the efficacy and tolerance of NSAIDs in the treatment of renal colic was the same for diclofenac and ketoprofen.

Inhaled nitrous oxide during the make stitches : Randomized double blind prospective study.

INTRODUCTION: Inhaled nitrous oxide (MEOPA) ensures short-term analgesia of a patient in spontaneous ventilation through a mask. It ensures analgesic coverage during the painful gesture while saving to the patient the phenomena of memorization. AIM: To study the efficacy and safety of the use of MEOPA during the make stitches. METHODS: Randomized double blind prospective study including any patient aged > 16 years admitted to the emergency for make stitches during a period of 3 months. After consent, patients were randomized to 2 groups (MEOPA versus placebo). When the stitches were made, if the patient has a VAS (visual analog scale) > 30%, an emergency analgesia with 2% subcutaneous xylocaine is performed. The primary endpoint was the degree of analgesia according to VAS. The secondary endpoints were the occurrence of side effects, patient and operator satisfaction. RESULTS: We collected 115 patients comparable in age, sex and pain at baseline. The mean of the VAS during suturing was 11.1±5.8% (MEOPA) versus 47.8±13.9% (placebo); and the mean at the end of the procedure was 5.2±5% (MEOPA) versus 27.6±12.8% (placebo) with p=0.000. Only minor adverse events (22% versus 16%) were observed with P = 0.306. CONCLUSION: We affirm the interest of this non-invasive, safe, innocuous analgesic technique that satisfies caregivers, patients and caregivers in suturing.