In this study, 150 patients were referred to the Dibaj health care service center. All of them were included in the study after their positive PCR result for COVID-19. The patients were classified into two groups using a four-block randomized method. Seventy-five patients received NAC while the other 75 patients were treated by bromhexine. Considering the sex of the subjects, 80 (53.3%) of them were women and the remaining 70 (46.7%) patients were men. The mean age of the patients was 15.029 ± 44.65 years with respective the minimum and maximum age of 18 and 80 years (Table 1).
Table 1. Age distribution of patients with COVID_19 participating in study 2022
age
|
Number of patients
|
Percentage of patients
|
20>age
|
6
|
4%
|
21-30
|
25
|
16.6%
|
31-40
|
33
|
22%
|
41-50
|
35
|
23.3%
|
51-60
|
24
|
16%
|
61-70
|
24
|
16%
|
70<age
|
3
|
2%
|
Out of 150 patients investigated in this study, 7 (4.7%), 37 (24.7%), 56 (37.3%), 37 (24.7%), 12 (8.0%), and 1 (0.7%) case referred the clinic 1, 2, 3, 4, 5, and 6 days after the emergence of the symptoms, respectively.
The average time passed from the emergence of symptoms to the first visit to Dibaj Clinic was 3.2 ± 1.025 days. Out of 150 studied patients, 17 (11.33%) cases were hospitalized while the remaining 133 (88.6%) cases had no history of hospitalization within one month. Among the 75 patients in the NAC group, 11 (14.66%) were hospitalized and 64 (85.33%) recovered at home without referring to the hospital. In the bromhexine group, 6 (8%) were hospitalized while the remaining 69 (92%) were treated at home and did not need to be hospitalized. The average hospitalization period of patients in both groups A and B was 5.29 days. The average hospitalization time of NAC and bromhexine groups was 5.8 and 5 days, respectively (Figure 1)
In general, the average recovery time of the patients (standard deviation) from the symptom appearance to the end of the symptoms was 10.75 (5.165) days, with respective minimum and the maximum recovery periods of 3 and 25 days after the emergence of symptoms. The mean duration of complete recovery of symptoms in NAC and bromhexine groups was 12.65 ± 0.90 and 10.76±0.64 (P=0.0935), respectively, showing no statistically significant difference.
The average oxygen saturation of both groups was 94.68 ± 1.833% on the first day of the visit. On the seventh and fourteenth day of the disease, it was 94.87±2.524% and 95.75±1.925%, respectively. In the NAC group, the average oxygen saturation was 94.47%, 95.43% and 95.73% in the first, second, and third visit, respectively. While in the bromhexine group, the average oxygen saturation on the first, second and third visits was 94.80%, 95.43%, and 95.93%, respectively.
The average oxygen saturation in the first visit in the NAC and Bromhexine groups was respectively 94.47% and 94.80% (P=0.31); showing no significant difference.
On the second visit, oxygen saturation in the NAC and Bromhexine groups was 94.65% and 95.43%, respectively (P=0.070). exhibiting no statistically significant difference.
On the third visit, the oxygen saturation in the NAC (95.73%) and Bromhexine (95.93%) group was not significantly different (P=0.54).
The oxygen saturation of the first visit increased compared to the second visit showed a 0.19% increment in the NAC group but this enhancement was 0.66% in the bromhexine group. On the third visit this increase was 1.33% and 1.19% in the NAC and Bromhexine groups (p=0.001), respectively showing a statistically significant difference (Figure 2).
No mortality was observed in the two groups. Out of 150 patients studied, 117 patients (78%) reported no complications after taking the drugs, while 33 complained about mild complications that did not require drug discontinuation or intervention. Among the patients who received NAC, 7 cases (4.6%) reported a decrease in blood pressure after taking the drug, and 8 patients (5.3%) reported stomach pain, which was resolved by changing the time of taking the drug. Of the 75 patients in the bromhexine group, 18 (12%) reported drowsiness.
In this study, 7 out of 17 hospitalized patients (1 from the Bromhexine group and 6 from the N-acetylcysteine group) were excluded from the study due to being hospitalized before the end of the intended treatment period, they were, however, followed up for one month.