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0 0.5 1 1.5 2+ Hospitalization 86% Improvement Relative Risk Viral load density, day 7 62% Viral load density, day 3 43% Alkalinization  Yilmaz et al.  EARLY TREATMENT  RCT Is early treatment with alkalinization beneficial for COVID-19? RCT 60 patients in Turkey (July - September 2020) Lower hospitalization with alkalinization (not stat. sig., p=0.24) Yilmaz et al., Laryngoscope Investigat.., Nov 2021 Favors alkalinization Favors control

Effects of hypertonic alkaline nasal irrigation on COVID‐19

Yilmaz et al., Laryngoscope Investigative Otolaryngology, doi:10.1002/lio2.686
Nov 2021  
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30th treatment shown to reduce risk in December 2021
*, now known with p = 0.0000043 from 11 studies.
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.
RCT 60 outpatients with mild COVID-19 showing improved viral clearance with hypertonic alkaline (pH 9.3) nasal irrigation. All patients received HCQ. The nasal irrigation group had no hospitalizations, while 3 patients in the control group required hospitalization, associated with viral load increase at day 3.
Targeted administration to the respiratory tract provides treatment directly to the typical source of initial SARS-CoV-2 infection and replication, and allows for rapid onset of action and reduced systemic side effects.
risk of hospitalization, 85.7% lower, RR 0.14, p = 0.24, treatment 0 of 30 (0.0%), control 3 of 30 (10.0%), NNT 10.0, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
relative viral load density, 62.0% better, RR 0.38, p = 0.87, treatment median 15.0 IQR 43.0 n=30, control median 39.51 IQR 1085.1 n=30, day 7.
relative viral load density, 42.9% better, RR 0.57, p = 0.95, treatment median 1747.0 IQR 5863.5 n=30, control median 3058.0 IQR 145568.9 n=30, day 3.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Yilmaz et al., 19 Nov 2021, Single Blind Randomized Controlled Trial, Turkey, peer-reviewed, 8 authors, study period July 2020 - September 2020. Contact:
This PaperAlkalinizationAll
Effects of hypertonic alkaline nasal irrigation on COVID‐19
Yetkin Zeki Yilmaz, Begum Bahar Yilmaz, Yusuf Emre Ozdemir, Bekir Sami Kocazeybek, MD Ridvan Karaali, Doğan Çakan, Hasan Ahmet Ozdogan, Aysegul Batioglu‐karaaltin
Laryngoscope Investigative Otolaryngology, doi:10.1002/lio2.686
Objective: The causative agent of COVID-19 is a novel member of coronaviridaes, SARS-CoV-2. It has been reported that the spike (S) protein of SARS-CoV-2 is responsible of infectivity. The S protein is demonstrated to be inactivated under environmental condition, such as hypertonicity and alkaline pH. The aim of the study was to investigate the effect of hypertonic alkaline nasal irrigation (HANI) on SARS-CoV-2. Methods: Sixty patients divided into two groups. The patients in Group 1 used hydroxychloroquine (HCQ), and the patients in Group 2 used HCQ and HANI. Nasopharyngeal samples were collected at the beginning, on 3rd and 7th day of the PCR test positivity. The nasopharyngeal viral load (NVL) changes analyzed with quantitative PCR. Results: NVL decrease in weekly period was statistically significant for both groups, when the difference between NVL day 0 and 3rd in Group 1 and NVL difference between day 0 and 3rd in Group 2 were compared. The difference between Groups 1 and 2 in terms of NVL change was statistically significant (P < 0.05). Conclusion: We demonstrated a significant decrease in nasopharyngeal SARS-CoV-2 load with HANI solution and suggest that HANI may be promising modality for the COVID-19 treatment.
CONFLICT OF INTEREST Each of the authors has contributed to, read and approved this manuscript. None of the authors has any conflict of interest.
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