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.

Psychological Impact of the COVID-19 Pandemic on Healthcare Professionals in Tunisia: Risk and Protective Factors.

Background: Our study aimed to evaluate the magnitude of different psychological outcomes among Tunisian healthcare professionals (HCPs) during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, and to identify the associated factors. Methods: Healthcare professionals completed a cross-sectional questionnaire during a 3-week period in the first wave of the COVID-19 pandemic in Tunisia. The survey collected demographic information, factors that may interfere with the psychological outcomes, behavioral changes, and mental health measures. Mental health was assessed using three scales: the Seven-Item Insomnia Severity Index, the Two-Item Patient Health Questionnaire, and the Two-Item Generalized Anxiety Disorder instrument. Multivariable logistic regression was conducted to identify factors associated with psychological outcomes. Results: A total of 503 HCPs successfully completed the survey, and 493 agreed to enroll in the study: 411 (83.4%) physicians, 323 (64.2%) women, and 271 (55%) with a second-line work position. A significant proportion of HCPs had anxiety (35.7%), depression (35.1%), and insomnia (23.7%). Women, those with a psychiatric history, and those using public transportation had higher proportions for overall symptoms compared with other groups, for example, depression in 44.9% of female participants vs. 18.2% of male participants (p = 0.00). Those with a previous medical history and nurses had more anxiety and insomnia compared with other groups, for example, anxiety in 45.1% of nurses, 36.1% of interns/residents, and 27.5% of attending physicians (p = 0.04). Multivariable logistic regression showed that female gender was a risk factor for all psychological outcomes, whereas psychiatric history was a risk factor for both anxiety and insomnia [odds ratio (OR) = 2.86, 95% CI 1.78-4.60, p = 0.00 for insomnia]. Using protective equipment was associated with a lower risk for depression (OR = 0.41, 95% CI 0.27-0.62, p = 0.00) and anxiety. Physical activity was also protective against depression and anxiety (OR = 0.41, 95% CI 0.25-0.67, p = 0.00). Conclusion: Psychological symptoms are usually overlooked or dismissed by HCPs, although the COVID-19 pandemic played a major role in exacerbating this burden. Prompt psychological support should be endorsed and simple measures, such as physical activity and ensuring the availability of personal protective equipment, are paramount to improve mental health outcomes and the quality of care provided to patients.