Medical Specialties Commons^™

A Bayesian Pharmacokinetics Integrated Phase I-Ii Design To Optimize Dose-Schedule Regimes, Mengyi Lu, Ying Yuan, Suyu Liu

Faculty, Staff and Student Publications

The schedule of administering a drug has profound impact on the toxicity and efficacy profiles of the drug through changing its pharmacokinetics (PK). PK is an innate and indispensable component of the dose-schedule optimization. Motivated by this, we propose a Bayesian PK integrated dose-schedule finding (PKIDS) design to identify the optimal dose-schedule regime by integrating PK, toxicity, and efficacy data. Based on the causal pathway that dose and schedule affect PK, which in turn affects efficacy and toxicity, we jointly model the three endpoints by first specifying a Bayesian hierarchical model for the marginal distribution of the longitudinal dose-concentration process. …

Neurofilament Light Chain In Serum Of Cancer Patients With Acute Neurological Complications, Amulya Gottiparthy, Keng Lam, Suprateek Kundu, Zixi Yang, Ivo Tremont-Lukats, Sudhakar Tummala

Faculty, Staff and Student Publications

Aim: Neurofilament light chain (NfL) is a nonspecific sensitive biomarker of axonal damage.

Methods: This case series identified cancer patients with neurological complications who had serum NfL measurements and paired these results to outcomes.

Results: NfL serum levels were available in 15 patients with hematological malignancies or solid tumors. The neurological complications studied were immune effector cell-associated neurotoxicity syndrome, immune checkpoint inhibitor-related encephalopathy, anoxic brain injury, Guillain-Barre syndrome, hemophagocytic lymphohistiocytosis, transverse myelitis, paraneoplastic syndrome, central nervous system demyelinating disorder and chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. All patients but one with serum NfL >900 pg/ml died …

Predicting Kidney Graft Function And Failure Among Kidney Transplant Recipients, Yi Yao, Brad C Astor, Wei Yang, Tom Greene, Liang Li

Faculty, Staff and Student Publications

Background: Graft loss is a major health concern for kidney transplant (KTx) recipients. It is of clinical interest to develop a prognostic model for both graft function, quantified by estimated glomerular filtration rate (eGFR), and the risk of graft failure. Additionally, the model should be dynamic in the sense that it adapts to accumulating longitudinal information, including time-varying at-risk population, predictor-outcome association, and clinical history. Finally, the model should also properly account for the competing risk by death with a functioning graft. A model with the features above is not yet available in the literature and is the focus of …

Implications Of Myocardial Strain In Primary Mitral Regurgitation-A Cardiovascular Magnetic Resonance Study, Simone Romano, Danai Kitkungvan, Duc T Nguyen, Carlos El-Tallawi, Edward A Graviss, Afshin Farzaneh-Far, Dipan J Shah

Faculty, Staff and Student Publications

Aims: Chronic primary mitral regurgitation (MR) results in progressive left ventricular (LV) remodelling. Abnormal myocardial deformation (strain) can be present despite preserved ejection fraction (EF). Cardiovascular magnetic resonance (CMR) feature-tracking techniques allow assessment of global longitudinal strain (GLS) from routine cine images. The aim of this study is to evaluate the prognostic value of CMR feature tracking-derived GLS in patients with primary MR.

Methods and results: Consecutive patients undergoing CMR for chronic MR from January 2012 to June 2018 were enrolled. Patients with LVEF < 50% were excluded. The composite primary outcome aiming to detect decompensation related to MR comprised (i) referral for mitral surgery owing to symptoms or LV systolic dysfunction or (ii) cardiovascular death. The secondary outcome was all-cause death. A total of 422 patients were followed for a median of 2.7 years, and the primary endpoint was met in 93 patients (34 patients reported symptoms at baseline). At multivariable analysis, GLS≥ -16.6% was associated with primary outcome [hazard ratio (HR) 1.90, P = 0.01]. In moderate MR cohort, patients with GLS≥ -16.6% had worse event-free survival, whereas there was no significant difference in mild or severe MR groups. GLS≥ -16.0% remained associated with all-cause death after adjusting for other covariates including the MR severity (HR 2.24, P = 0.02).

Conclusion: In patients with primary MR with preserved systolic function, GLS was associated with our composite …

Iatrogenic Ventricular Septal Defect After Transcatheter Aortic Valve Implantation: A Rare Complication, Muhammad Sabri, Hussam Al Hennawi, Shayan Qadir, Lucy Checchio, Chaitra Janga, Hamza Muhammadzai, Donald C. Haas

Abington Jefferson Health Papers

Iatrogenic ventricular septal defect (VSD) is a rare complication following transcatheter aortic valve implantation (TAVI). An 83-year-old male underwent TAVI for severe aortic stenosis (AS) and was diagnosed with a peri-membranous VSD on echocardiography, which was not evident on pre-procedural imaging. This case highlights the risk factors, symptoms, diagnosis, and management of iatrogenic VSD following TAVI.

Acute Myocarditis Secondary To Human Metapneumovirus: A Case Series And Mini-Review, Hussam Al Hennawi, Aamna Khan, Alexander Shpilman, Jennifer A. Mazzoni

Abington Jefferson Health Papers

Among viral myocarditis, human metapneumovirus (hMPV) is a rare causative agent with associated cardiac complications. This report provides insight into the disease progression and sheds light on reported cases from the literature. We present the clinical courses of two patients, aged 68 and 58, who developed myocarditis secondary to hMPV infection. Despite the typical severity associated with viral myocarditis in older populations, both patients experienced significant improvement in their condition and ultimately survived. This report highlights the necessity of recognizing hMPV as a potential cause of myocarditis, particularly in older adults presenting with simultaneous respiratory and cardiac symptoms. The recovery …

Addressing Unprofessional Behaviors In The Clinical Learning Environment: Lessons From A Multi-Year Virtual, Intergenerational, Interdisciplinary Workshop, Stacey Rose, Anita Kusnoor, Phuong Huynh, Jocelyn Greely, Yesenia Rojas-Khalil, Doris Kung, Anne Gill, Nadia Ismail, Nital Appelbaum

Faculty, Staff and Students Publications

INTRODUCTION: Optimizing the clinical learning environment (CLE) is a medical education priority nationwide.

MATERIALS AND METHODS: We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions.

RESULTS: Over two sessions (2021-2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants' ability to recognize and respond to challenges in the CLE.

DISCUSSION: Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants' knowledge and commitment to improve …

Approved Car-T Therapies Have Reproducible Efficacy And Safety In Clinical Practice, Daniel Goyco Vera, Hiral Waghela, Mohamed Nuh, Jonathan Pan, Premal Lulla

Faculty, Staff and Students Publications

CAR-T cell therapy has established itself as a highly effective treatment for hematological malignancies. There are currently six commercial CAR-T products that have been FDA approved for diseases such as B-ALL, LBCL, MCL, FL, MM, and CLL/SLL. "Real-world" studies allow us to evaluate outcomes from the general population to determine their efficacy and safety compared to those who were included in the original trials. Based on several well conducted "Real-world" studies that represent diverse populations, we report that outcomes from the original trials that led to the approval of these therapies are comparable to those in practice.

Birth Related Neonatal Conditions, Jotishna Sharma, Gangaram Akangire

Neonatology Review: Isolette to Crib Podcast

Dr Akangire will discuss birth related conditions that occur in the newborn. He will define birth injuries, briefly go over risk factors, describe common birth injuries and discuss emergencies with bleeding, nerve injuries and fracture.

Click here to stream the podcast episode.

Navigating Wound Closure Strategies: Primary Closure Vs. Delayed Primary Closure In Digestive Surgery—A Systematic Review And Meta-Analysis On Surgical Site Infections, Lam Sihardo, Arnetta Nl Lalisang, Afid B. Putra, Bagus A. Suryawiditya

The New Ropanasuri Journal of Surgery

Introduction. Surgical site infection (SSI) is a significant concern following digestive surgery, with varying incidence rates based on wound contamination levels. The choice between Primary Closure (PC) and Delayed Primary Closure (DPC) impacts SSI occurrence, making it essential to evaluate their comparative effectiveness. DPC is hypothesized superior to PC to prevent SSI or wound infection after a contaminated abdominal surgery.

Methods. This systematic review study was carried out through PubMed, Scopus, and Cochrane (CENTRAL). Quality was assessed using Risk of Bias (ROB-2) tool. All results were summarized, and quantitative analysis was performed using a random-effect model. This study …

Bacillus Calmette-Guerin (Bcg) As An Intralesional Therapy For Cutaneous Metastatic Malignant Melanoma: A Literature Review, Farisa B. Dina, Ahmad Kurnia

The New Ropanasuri Journal of Surgery

Introduction. Malignant melanoma is the most lethal form of skin cancer and is the third most common cause of death of all malignancies in the world. Cutaneous metastatic lesions are the earliest and the most frequently encountered metastatic lesions in malignant melanoma. The use of Bacillus Calmette-Guerin (BCG) as an intradermal therapy agent has been long debated due to its effectiveness and adverse effects. This literature review aims to provide a comprehensive explanation regarding the use of intralesional BCG in establishing local control and preventing recurrence in cutaneous metastatic malignant melanoma.

Method. A literature search was conducted on various …

Infrarenal Abdominal Aortic Pseudoaneurysm With Suspected Behcet Disease: A Unique Case Report, Harsya D. Gunardi, Danny Pratama, Andrio W. Prabowo, Nanang W. Hidayat, M Aprizal Putera, Grady Krisandi

The New Ropanasuri Journal of Surgery

Introduction. Abdominal aortic pseudoaneurysm caused by autoimmune vasculitis is a rare complication. Clinical presentation of patients is often late with life–threatening complications.

Case Illustration: A 62–year–old male patient with infrarenal abdominal aortic pseudoaneurysm presenting with a 2–week worsening severe abdominal and lumbar pain with a history of uncontrolled hypertension and a history of oral ulcer. He was successfully treated with tube grafting through open surgical repair.

Conclusion: The pseudoaneurysm was successfully removed and replaced with a polyester tube graft with no perioperative complications and was discharged 5 days later

C-Reactive Protein As An Early Predictor Of Anastomosis Leakage After Colorectal Surgery: A Literature Review, Lucky Permana, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. Anastomosis leakage is a defect in the intestinal wall at the anastomosis site after surgery. This condition is a serious complication causing increased morbidity and mortality. CRP is commonly used as an acute postoperative indicator after abdominal surgery. The use of CRP as an early predictor of anastomosis leakage after colorectal surgery is supported by several studies showing its good diagnostic value. However, using CRP as a biomarker is not standard at Cipto Mangunkusumo National Hospital. Therefore, this literature review aims to support the evidence for CRP in the early detection of anastomosis leakage after colorectal surgery.

Method. …

The Role Of Active Surveillance Of Papillary Thyroid Microcarcinoma: A Literature Review, Prasojo Prasojo, I Gusti Ngurah Gunawan Gunawan Wibisana

The New Ropanasuri Journal of Surgery

Introduction: Thyroid cancer is one of the most common cancers in the world, with incidence 144,7: 100.000 population. The incidence has risen up to 211% within the last 30 years, and one–third of thyroid cancer is papillary thyroid microcarcinoma. There are still controversies regarding whether immediate surgery or active surveillance is the better option for treating this condition. This review aims to evaluate the safety and efficacy of active papillary thyroid microcarcinoma surveillance.

Methods: Cochrane, PubMed, EBSCOHost, and ProQuest were searched for relevant studies of active surveillance of papillary thyroid microcarcinoma.

Results: Six publications were selected after a literature search …

Transformation Of Accreditation Of Higher Education In Health In Indonesia: Qualitative Assessment, Yefta Moenadjat, Insan Sosiawan A. Tunru, Sutrisno Soemardjo

The New Ropanasuri Journal of Surgery

Accreditation of higher education in health in Indonesia shifts to the qualitative assessment driven to ensure quality improvement. The method replaces the former quantitative assessment method that has been applied since 2012; it will be effective in January 2025. The driving factors and rationale of transformation are outlined in this article. The rationale of the qualitative assessment that applies principle–based accreditation and the quantitative assessment that applies rule–based accreditation is reviewed here. Information on the accreditation procedure and the goal is presented, aiming for institutions to prepare for this new version of accreditation.

Surgical Treatment For Hepatocellular Carcinoma With Right Atrium Tumor Thrombus: A Literature Review, Mohammad Z. Hazmi, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. The prognosis of patients with hepatocellular carcinoma (HCC) with right atrial tumor thrombus (RATT) is poor, with a mortality rate of 60 to 90%. Along with the development of multimodality management and surgical techniques in cases of HCC, surgery is still an option for curative purposes. This study aims to review the indications, appropriate surgical techniques, and postoperative survival outcomes in HCC with RATT.

Methods. This literature review conducted using online databases, including Cochrane Library, PubMed, ScienceDirect, EBSCOhost, and ProQuest.

Results. Six case reports and four retrospective studies were reviewed. Surgery for HCC with RATT has one, three, and …

The Significance Of Aldehyde Dehydrogenase 1 In Cancers, Anh L. Nguyen, Caroline O. B. Facey, Bruce M. Boman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

The goal of this paper is to discuss the role of ALDH isozymes in different cancers, review advances in ALDH1-targeting cancer therapies, and explore a mechanism that explains how ALDH expression becomes elevated during cancer development. ALDH is often overexpressed in cancer, and each isoform has a unique expression pattern and a distinct role in different cancers. The abnormal expression of ALDHs in different cancer types (breast, colorectal, lung, gastric, cervical, melanoma, prostate, and renal) is presented and correlated with patient prognosis. ALDH plays a significant role in various cellular functions, such as metabolism, oxidative stress response, detoxification, and cellular …

Navigating Rarity: A Case Report On Primary Splenic Lymphoma, Santosh Pv Rai, Skand Rastogi, Anshuman Senapati, Jyoti Kini, Salama Yasmeen

Manipal Journal of Medical Sciences

Primary Splenic Lymphoma (PSL) is a rare condition, which complicates its understanding and definition. The rarity of PSL has led to varied definitions: some consider it primary only if splenomegaly is predominant, while others include spleen involvement with hilar lymph nodes. Documentation on PSL is sparse in Indian literature. This case report of a 48-year-old woman, presenting with fever, weight loss, and left hypochondrium pain, and diagnosed with PSL through CECT abdomen and USG-guided biopsy, contributes to better understanding of the condition.

Unravelling An Unusual Blastoma In An Infant With Confusing Radiological Diagnosis, Arun Viswanathan Dr, Santosh Rai, Harsha Prasad Lashkari, Jayateertha Joshi

Manipal Journal of Medical Sciences

We report an unusual case of an 8-month-old child, who presented to us with a mass per abdomen with confusing imaging characteristics reported as a germ cell tumour / Neuroblastoma.

Patient presented with a large mass per abdomen which had both retroperitoneal and intraperitoneal components and was compressing the adjacent structures and was appearing heterogenous with calcifications within. The more favoured diagnosis on imaging was a peritoneal or retroperitoneal germ cell tumor / Neuroblastoma. Repeated imaging revealed that the mass was abutting / compressing the left lobe of the liver and high AFP beta HCG and LDH values were noted. …

Benefits Of Neurodevelopment Treatment And Trunk Mobilization In Spastic Diplegi Cerebral Palsy: Case Study, Enggal -. Andayani, Nitaya Putri Nur Hidayati, Sugiono -. -

Jurnal Fisioterapi Terapan Indonesia

ABSTRACT: Background: Spastic diplegia cerebral palsy is a movement disorder with the lower limbs being heavier than the upper limbs which occurs due to brain damage. This disorder makes it difficult for children to carry out functional activities. Neurodevelopmental treatment (NDT) and trunk mobilization are approaches to treating cerebral palsy cases. Objective: To find out the management of neurodevelopmental treatment (NDT) physiotherapy and trunk mobilization in cases of diplegic spastic cerebral palsy. Results: Shortly after the therapy, the results showed a decrease in spasticity, but during subsequent therapy the muscle spasticity returned to normal. For the results of therapy carried …

Effectiveness Of Using Soft Exosuit In Stroke Case To Improve Walking Speed And Endurance, Aditya Denny Pratama, Rakha Shidqi Widyadhana

Jurnal Fisioterapi Terapan Indonesia

Stroke is a clinically defined syndrome of acute, focal nerve discharge caused by vascular injury (infarction, hemorrhage) of the central nervous system. Punches can cause damage to the brain and affect a person's ability to walk, balance and coordinate movements. Impaired gait is common in stroke cases, often resulting in poor recovery of mobility and inability to carry out daily activities without assistance. One of the interventions that can be used is a soft exosuit. This method can help overcome walking problems in stroke patients where soft exosuits are used to increase walking speed and walking endurance. The purpose of …

Food For Thought: A Qualitative Assessment Of Medical Trainee And Faculty Perceptions Of Nutrition Education, Olivia Kunitsky, Mahdi Taye, Karla Feeley, Hugh Johnson, Abigail Glynn, Avery Stivale, Matthew Hamers, Alexis Notarianni, Sireesha Mamillapalli, Gabi Waite, Sonia Lobo

Department of Neurology Faculty Papers

BACKGROUND: The American Society of Clinical Nutrition recommends 37 to 44 h of undergraduate medical nutrition education. The Total Health Curriculum at Geisinger Commonwealth School of Medicine (GCSOM) contains 14 h of objective-based nutritional instruction. This study aimed to examine the perceptions of key stakeholders regarding the role of nutrition in medicine and to identify barriers, opportunities for improvement, and roles/responsibilities for innovative implementation of nutrition education.

METHODS: This exploratory, qualitative study employed a phenomenological approach and inductive coding process. Purposive sampling recruited medical students, undergraduate medical education (UME) faculty, physicians, and other healthcare professionals at GCSOM and affiliated clinical …

Cultivating Compassion: A Cross-Sectional Evaluation Of Empathy Among Medical Undergraduate Students, Anchu R Nath, Ishika Jindal, Nayanabai Shabadi, Sunil Kumar D

Digital Journal of Clinical Medicine

ABSTRACT:

BACKGROUND: Empathy plays a crucial role in medical practice, profoundly affecting patient outcomes and treatment. Understanding the factors that influence empathy among medical students can help in developing strategies to enhance empathetic skills during medical training. This study aims to evaluate the correlates of empathy among medical undergraduate students using an epidemiological cross-sectional design.

MATERIALS AND METHODS:

A cross-sectional study was conducted among 270 medical undergraduate students from various academic years at JSS Medical College for four months (September 2023-December 2023). Convenient sampling was used to select study participants. Participants completed a standardized empathy questionnaire, the Jefferson Scale …

Global Standards And Protocols For Oral Care In Pediatric Cancer Patients: Systematic Review Protocol, Meghna Pandit, Baby S. Nayak, Vasudeva K. Bhat, Suneel C. Mundkur, Judith A. Noronha, Sridhar N

Manipal Journal of Nursing and Health Sciences

Introduction Childhood cancer is a global health challenge, with over 275,000 cases annually among individuals under 19 years. Cancer treatments such as chemotherapy and radiation therapy lead to significant oral complications, including mucositis, xerostomia, and infections, adversely affecting treatment adherence and quality of life. Effective oral care is essential for mitigating these complications, particularly in resource-limited settings like India.

Objectives This systematic review aims to identify, assess, and summarize global guidelines and protocols for oral care in pediatric cancer patients, focusing on the prevention and management of oral complications during treatment.

Methods The protocol adheres to PRISMA-P guidelines and is …

An Experience With A Concurrent Bilateral Tibia Interlocking Nailing: Its About Dancing With The Rhythm, Hoh Wee Liam Dr, Eyrique Goh Boay Heong, Hanif Azman

Manipal Journal of Nursing and Health Sciences

Tibial shaft fractures are the most common injuries resulting from high energy trauma such as motor vehicle accident or fall from height. Operative management options of tibia shaft fractures include intramedullary nailing, plating or external fixation or conservative by casting. Interlocking nail of tibia remains favorite among other type of surgical fixation as patient can rehabilitate post op earlier.

Interlocking nail of bilateral tibia are usually performed sequentially in view of patient needing to be properly positioned to allow easy entry and reaming of interlocking nail. Hence, this will prolong operative time, thus increasing risk of general anaethesia and surgical …

A Review Of Managing Catastrophes In Robotic-Assisted Thoracic Surgery, Shamele Battan-Wraith, Kevin Wang, Ahmed Elkamel, Kameron Durante, Hope Conrad, Kayla Iannarelli, Olugbenga Okusanya, Praveen Sridhar, Stephanie G. Worrell

Department of Surgery Faculty Papers

Lung cancer is the most commonly diagnosed cancer worldwide in 2022, with over 2.5 million new cases, or 1 in 8 of all cancers diagnosed worldwide. Lung cancer is the leading cause of cancer related mortality in the United States, with non-small cell lung cancer (NSCLC) being the most prevalent type. For early-stage NSCLC, lung resection with anatomic lobectomy remains the standard of care. Robot-assisted lobectomy is gaining popularity over video-assisted thoracoscopic surgery (VATS) and open thoracotomy due to improved visualization, ergonomics, and instrumentation. Despite these advancements, intraoperative complications and a steep learning curve present significant barriers to the widespread …

Patient And Parent Knowledge, Understanding, And Concerns After A New Diagnosis Of Ehlers Danlos Syndrome., Jordan T. Jones, Lora L. Black, William R. Black

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: After diagnosis of Ehlers Danlos Syndrome (EDS), it is unclear what information patients and parents need and understand about EDS. The objective of this study is to characterize patient and parent knowledge and concerns about EDS after a diagnosis of EDS is made to determine patient and parent concerns and identify barriers that cause discomfort with the diagnosis.6 METHODS: A convenience sample of patient and parent dyads were recruited after new diagnosis of EDS. Patients and parents completed questionnaires that assessed knowledge, comfort, and barriers of EDS before and after diagnosis, EDS education materials accessed, and additional clinical needs …

Potential Of Right Ventricular Function Assessment With Echocardiography In Transcatheter Aortic Valve Replacement, Yoshihisa Morita, Taro Kariya, Michael Dougherty, Andrew Peters, Nicholas Ruggiero

Division of Cardiology Faculty Papers

BACKGROUND: Right ventricular (RV) function assessment by echocardiography can be challenging due to its complex morphology. Also, increasing use of sedation rather than general anesthesia for transfemoral approach transcatheter aortic valve replacement (TAVR) reduces the need for intraoperative transesophageal echocardiography (TEE). Recent clinical studies have demonstrated the importance of 3-dimensional (3D) echocardiography and a longitudinal strain for RV function assessment. In this study, we compared RV function echocardiographic assessment methodologies in TAVR and investigated its clinical utility.

METHODS: This was a prospective, observational study of TAVR at a large academic hospital. Inclusion criteria were adult patients undergoing TAVR requiring intraoperative …

The Win Ratio Approach In Bayesian Monitoring For Two-Arm Phase Ii Clinical Trial Designs With Multiple Time-To-Event Endpoints, Xinran Huang, Jian Wang, Jing Ning

Faculty, Staff and Student Publications

To assess the preliminary therapeutic impact of a novel treatment, futility monitoring is commonly employed in Phase II clinical trials to facilitate informed decisions regarding the early termination of trials. Given the rapid evolution in cancer treatment development, particularly with new agents like immunotherapeutic agents, the focus has often shifted from objective response to time-to-event endpoints. In trials involving multiple time-to-event endpoints, existing monitoring designs typically select one as the primary endpoint or employ a composite endpoint as the time to the first occurrence of any event. However, relying on a single efficacy endpoint may not adequately evaluate an experimental …

Double-Blind Randomised Trial Of Saline Solution For Gargling And Nasal Rinsing In Sars-Cov-2 Infection, Sebastian R Espinoza, Lexton Trauffler, Amir Shamshirsaz, Alireza Shamshirsaz, Andres Espinoza, Jimmy Espinoza, Alice O'Brien

Faculty, Staff and Student Publications

Background: Previous studies have shown that hypertonic saline nasal irrigation and gargling reduced the duration of symptoms in upper respiratory infections caused by coronavirus. This study aims to investigate the effects of two saline regimens on symptoms associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Methods: Between 2020 and 2022, individuals aged 18-65 years who tested positive for SARS-CoV-2 infection via polymerase chain reaction (PCR) were randomly assigned to either low- or high-saline regimens for 14 days. The low-saline solutions contained 2.13 g of salt dissolved in eight ounces of warm water, while the high-saline solution contained six grams of …