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0 0.5 1 1.5 2+ Mortality -135% unadjusted Improvement Relative Risk N-acetylcysteine  Ramadhan et al.  LATE TREATMENT Is late treatment with N-acetylcysteine beneficial for COVID-19? Prospective study of 91 patients in Indonesia (Jun 2020 - Jul 2021) Study underpowered to detect differences Ramadhan et al., Indonesian J. Tropica.., Dec 2021 Favors N-acetylcysteine Favors control

The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In COVID-19 Patients

Ramadhan et al., Indonesian Journal of Tropical and Infectious Disease, 9:3
Dec 2021  
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14th treatment shown to reduce risk in February 2021
*, now known with p = 0.000034 from 24 studies, recognized in 3 countries.
Lower risk for mortality, hospitalization, and cases.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Prospective study with 75 NAC patients and 16 control patients, showing no significant difference in mortality.
This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups.
risk of death, 134.7% higher, RR 2.35, p = 0.68, treatment 11 of 75 (14.7%), control 1 of 16 (6.2%), unadjusted.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ramadhan et al., 27 Dec 2021, prospective, Indonesia, peer-reviewed, 6 authors, study period June 2020 - July 2021.
This PaperN-acetylcys..All
The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Α Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In COVID-19 Patients
Fitratul Ramadhan, Ngakan Putu, Parsama Putra, Ungky Agus Setyawan, Susanthy Djajalaksana, Aditya Sri, Harun Al Rasyid
Tumor Necrosis Factor Alpha (TNF-α) is a pro-inflammatory cytokine that plays a crucial role in COVID-19 disease
ACKNOWLEDGEMENT This research received grant from COVID Research and Innovation Consortium by LPDP-RistekBrin. CONFLIC OF INTEREST The authors declare that they have no conflict of interest. REFERENCE 1. Tang Y, Liu J, Zhang D, Xu Z, Ji J, Wen C. this study prove that there is the involvement of TNF-α in the mechanism of action of NAC. NAC interferes with the NLRP3 inflammasome pathway by suppressing the expression of NLRP3 and caspase-1 activation mRNA. NAC decreased IL1β, IL18, IL6 and TNF-ɑ in vitro. NAC inhibits downstream activity post-TNF-α receptor activation, and under oxidative stress, NAC inhibits World Health CONCLUSION This finding is by the previous studies, in which Changes in TNF-α levels and alterations in SpO2/FiO2 ratio of COVID-19 patients in the group without adjuvant NAC therapy showed a positive correlation. On the other hand, in the group that did not receive adjuvant NAC therapy, the correlation coe cient was negative and not significant. it was found that the administration of NAC can increase the SpO2/FiO2 ratio. The conclusions of TNF-α and IL-6 gene expression. 9. De Flora S, Balansky R, La Maestra S. Rationale for using changes in TNF-ɑlevels and diferences in the SpO2/FiO2 ratio in COVID-19 patients who did not receive adjuvant NAC therapy. There was a significant decrease in TNF-ɑ levels a fter NA C a dministration a s a djuvants. I n addition, there was also a substantial increase in the SpO2FiO2 ratio after administration of adjuvant..
Alamdari, Moghaddam, Amini, Keramati, Zarmehri et al., Application of methylene blue-vitamin C-N-acetyl cysteine for treatment of critically ill COVID-19 patients, report of a phase-I clinical trial, European journal of pharmacology
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Shi, Yang, Zhou, Xi, Sun et al., Activated carbon N-acetylcysteine microcapsule protects against nonalcoholic fatty liver disease in young rats via activating telomerase and inhibiting apoptosis, PLoS One
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Wong, Lee, Kua, N-Acetylcysteine as Adjuvant Therapy for COVID-19-A Perspective on the Current State of the Evidence, Journal of inflammation research
Zhang, Ju, Ma, Wang, N-acetylcysteine improves oxidative stress, and inflammatory response in patients with community-acquired pneumonia: A randomized controlled trial, Medicine
Šalamon, Kramar, Pirc Marolt, Poljšak, Milisav, Medical and Dietary Uses of N-Acetylcysteine, Antioxidants
Late treatment
is less effective
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