CENTRAL ASIAN JOURNAL OF MEDICAL AND NATURAL SCIENCES

Volume: 05 Issue: 01 | Jan-Feb 2024 ISSN: 2660-4159

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THE EFFECTS OF PROBIOTIC LACTOBACILLUS

ACIDOPHILUS AND COLCHICINE ON THE CONTROL OF
SYMPTOMS, DURATION, AND DISEASE PROGRESSION
OF MILD AND MODERATE CASES OF COVID-19: A
RANDOMIZED CONTROLLED CLINICAL TRIAL

1. Mrs. Wedad Mohammad Abstract: Background: Coronavirus disease 2019

(COVID-19) is a newly emerging human disease caused by
a novel coronavirus, causing a global pandemic crisis.
Received 20th Nov 2023,
Accepted 28th Dec 2023, Probiotics and/or colchicine may be considered as options
Online 11st Jan 2023 for treatment since they have anti-viral, anti-inflammatory,
and immunomodulatory effects. Objective: To assess the
1 effectiveness of probiotic supplements (Lactobacillus
Internal Medicine department, Faculty
acidophilus) and colchicine on symptoms, duration, and
of Medicine, Mohamed bin ali
progression of mild and moderate cases of COVID-19
alsanosy, Algeria
infection. Methods: A three-arm randomized controlled
Email. [email protected]
clinical trial was carried out in the triage clinic of the family
medicine department at Ain Shams University Hospitals on
150 participants who had been diagnosed as COVID-19
patients with mild and moderate severity. Patients aged
below 18 years or above 65 years with any co-morbidities,
pregnant or lactating females, and severe COVID-19
confirmed cases were excluded. Randomization was done
by using sealed envelopes containing codes for intervention
or control. Patients are followed up for improvement of their
symptoms with no development of new symptoms over the
course of two weeks. Results: A total of 150 patients with
mild and moderate severity of COVID-19 were enrolled in
the study, 50 patients in each arm; around one third (34.7%)
of the participants were aged between 29 and 39 years; one-

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
quarter (24.7%) were aged between 18 and 28 years and
40.6% were aged 40 years and above. The mean duration of
symptoms improvement was 12, 11 and 12 in the colchicine,
probiotic, and control groups, respectively. Improvement of
inflammatory markers over time occurred in each of the
three groups, with no statistically significant difference
between them. Conclusion: Probiotic Lactobacillus
acidophilus and colchicine shows no significant effect on
the symptoms, duration, and progression of mild and
moderate cases of COVID-19.
Trial registration: The study was registered at Protocol
Registration and Results System (No. NCT05911022)
registered on 20/06/2023.
https://classic.clinicaltrials.gov/ct2/show/NCT05911022

Key words: Probiotics, Colchicine, COVID-19, RCT, Ain

Shams University, Cairo.

benefits to the host when given in sufficient

INTRODUCTION doses” (4).

A novel coronavirus was discovered to be Early reports from Wuhan indicate that 2%
the source of a cluster of pneumonia cases in to 10% of COVID-19 patients exhibited
Wuhan (China), which led to an outbreak gastrointestinal symptoms, including diarrhea,
throughout China and then to a global pandemic. vomiting, and abdominal pain. 10% of patients
In February of 2020, the World Health experienced one to two days of nausea and
Organization officially recognized COVID-19 diarrhea prior to the onset of fever and respiratory
(coronavirus disease 2019 (1). symptoms (5).

COVID-19 disease frequently manifests as The severity of COVID-19 disease was

a fever, dry cough, shortness of breath, and correlated with the diversity of the gut
breathing difficulties. Some of the less frequent microbiota, and alterations in the gut microbiota
symptoms include anosmia, sore throat, runny persisted even after the virus eliminated,
nose, vomiting, and diarrhea (2). suggesting that the virus may have a long-lasting
negative impact on the homoeostasis of the
Dysbiosis of the gut microbiome,
human microbiome (6).
immunological dysregulation,
hyperinflammation, and a cytokine storm are As an intestinal microbe regulator,
hallmarks of COVID-19 illness (3). Probiotics probiotics help to improve the immune system,
are defined as” live bacteria that provide health lessen allergic reactions, and play a crucial part in
antiviral immunomodulation. They also increase

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
the gastrointestinal microbiota's capacity to
modulate immunological activity (7).
The aim of the current study is to assess the
Infection with SARS-CoV-2 significantly effectiveness of probiotic supplements
altered the fecal microbiomes of all 15 patients, (Lactobacillus acidophilus) and colchicine on
according to a study of confirmed COVID-19 symptoms, duration, and progression of mild and
patients in Hong Kong. This imbalance of moderate cases of COVID-19 infection.
intestinal microbiota persisted even after SARS-
CoV-2 clearance (8).

Colchicine is an anti-inflammatory drug PATIENTS AND METHODS

frequently prescribed for the treatment and Study design and setting: A three-arm
prevention of crystals induced arthritis, such as randomised controlled clinical trial was done as
gout, systemic auto-inflammatory illnesses such part of the investigation over the course of a year
Bechet’s disease and familial Mediterranean at the Triage Clinic of the Family Medicine
fever (9). Inhibiting neutrophil chemotaxis and Department at Ain Shams University Hospitals.
activity in response to vascular damage is its Inclusion criteria: Patients with mild and
mode of action (10). moderate COVID-19 severity, aged 18 to 64.
Exclusion criteria Patients with COVID-
One of the clinical trials called
19 who are under 18 or over 65, have co-morbid
COLCORONA 2020 was directed by the conditions, are pregnant or lactating mother, or
Montreal Heart Institute and conducted in Brazil, have severe confirmed COVID-19 were excluded
Canada, Greece, South Africa, Spain, and the from the trial.
United States conducted by Tardif. et al. in 2021.
Participants in the research and
The trial revealed that the effect of colchicine on
sampling: A total of 150 individuals who
clinical symptoms of COVID-19- community-
satisfied the inclusion criteria had their data
treated individuals was not statistically
gathered between the beginning of July 2021 and
significant difference between the colchicine
the end of August 2022.
group and controls (11).
Patients were chosen from the
Colchicine may lessen mortality and the Triage/COVID-19 Outpatient Clinic, and each
need for mechanical ventilation in mild-to- one had the following procedures:
moderate COVID-19 patients, according to a Sociodemographic information was gathered for
systematic review and meta-analysis conducted the clinical history, including age, gender, marital
by Siemieniuk et al. in 2020 (12). status, place of residence, smoking history, etc.
Medical information included weight, current
Consequently, probiotics and/or colchicine medications, symptoms (onset, course, and
may be viable treatment options for COVID-19 duration), and the presence of co-morbidities.
patients. To examine the efficacy of probiotics The temperature, heart rate, blood pressure,
and colchicine in the treatment of COVID-19, it respiratory rate, and oxygen saturation are all
is necessary to conduct additional clinical trials measured during a thorough general examination.
and provide clinicians with evidence, as there are Patients who met the CDC's criteria for
currently insufficient studies to support this suspicion had radiographic and laboratory
conclusion. confirmation using the tests PCR-COVID-19,

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
Complete Blood Count, CRP, Ferritin and D- ventilation, and improvement in inflammatory
Dimer, as well as High-resolution CT chest. markers level (CBC, CRP, ferritin, and D-dimer).
Patients were categorised as mild and Final assessment: Release from isolation
moderate based on laboratory and radiographic 10 days after start of symptoms or 10 days after
results once the diagnosis was confirmed. the patient's first positive swab (14).
The participants were divided into 3 14 days after the initiation of therapy,
groups: individuals were polled about whether their
Group A (Colchicine group) consisted of symptoms had improved or remained the same,
COVID-19 patients with mild to moderate and Complete Blood Count, CRP, Ferritin, and
disease who received the recommended course of D-Dimer were retested.
care in accordance with the protocol established End point: The trial lasted until the sample
by the Egyptian Supreme Council of University size was reached, the patient's symptoms had
Hospitals, as well as Colchicine tablets (0.5 mg) improved, and no new symptoms had appeared. It
three times per day for three days and also continued until there was no longer a
subsequently twice per day for four days (13). requirement for hospitalisation or ICU
Patients in Group B (Probiotic group) admissions or the occurrence of adverse events
with mild and moderate COVID-19 severity got (AES) or severe adverse events (SAEs) during
probiotics in the form of oral sachets once daily the course of the study.
for two weeks in addition to protocol prescribed Sample Size: By using G power program
by the Egyptian Supreme Council of University for sample size calculation, setting power at 80%,
Hospitals. alpha error at 5%, and assuming medium effect
Group C (Control group) consists of size difference (0.3) in symptoms improvement in
COVID-19 patients with mild and moderate patients with COVID-19 infection taking
severity who received the recommended course probiotic supplement (Lactobacillus Acidophilus)
of care in accordance with the protocol and patients taking Colchicine and patients taking
established by the Egyptian Supreme Council of standard protocol treatment as there is no
University Hospitals (Vitamin C 500 mg twice previous studies in the same topic to calculate the
daily, Vitamin D3 2000-4000 IU/day, Zinc 75 mg sample size on its results, and taking into
once daily for two weeks, and necessary protocol consideration 10% for drop out; based on that, a
of management based on case assessment and sample size of at least 150 patients with
severity). COVID-19 infection (50 patients in each
Randomization: To distribute intervention group) will be sufficient to achieve study
or control codes, the researcher utilised sealed objective.
envelopes. Data Analysis:
Follow-up: Participants were contacted
The collected data were introduced and
twice a week by phone to assess their symptoms
statistically analyzed by utilizing the Statistical
(increase or decrease, duration, and development
Package for Social Sciences (SPSS) version 20
of new symptoms), compliance with treatment,
for windows. Qualitative data were defined as
daily temperature, oxygen saturation, need for
numbers and percentages. Chi-Square test,
oxygen inhalation, need for hospital admission,
Fisher’s exact test were used for comparison
need for ICU admission, need for mechanical
between categorical variables as appropriate.
Quantitative data were tested for normality by

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
Kolmogorov-Smirnov test. Normal distribution
of variables was described as mean and standard
deviation (SD), and independent sample t-test RESULTS
was used for comparison between groups. For
Of the participants in the present clinical
comparison of Lab investigation before and after
trial, around one-third (34.7%) were between the
the treatment Mc Nemar test was used for
ages of 29 and 39, one-quarter (24.7%) were
qualitative binary variables, While Marginal
between the ages of 18 and 28, and 40.6% were
Homogeneity test was used for nominal
older than 40. 68% of people live in cities, 57%
variables. P value ≤0.05 was statistically
in rural regions, and 25% in urban slum. 23
significant.
percent of them smoked, 92% were married, 49%
had graduate degrees, and 71% were housewives.
Regarding demographic information, there was
no statistically significant difference between the
three groups (Table 1).

Table 1: Comparisons between the three treatment groups regarding the sociodemographic
characteristics.
Treatment groups
Total Control Colchicin Probiotic P-value
Variable group e group group
N % N % N % N %
18-28 Y 37 24.7% 9 18.0% 15 30.0% 13 26.0%
29-39 Y 52 34.7% 19 38.0% 16 32.0% 17 34.0% 0.870
Age
40-50 Y 30 20.0% 10 20.0% 9 18.0% 11 22.0%
51-60 Y 31 20.7% 12 24.0% 10 20.0% 9 18.0%
Male 66 44.0% 20 40.0% 23 46.0% 23 46.0%
Sex 0.780
Female 84 56.0% 30 60.0% 27 54.0% 27 54.0%
No 115 76.7% 41 82.0% 38 76.0% 36 72.0%
Smoking 0.490
Yes 35 23.3% 9 18.0% 12 24.0% 14 28.0%
Single 36 24.0% 8 16.0% 14 28.0% 14 28.0%
Marital Married 92 61.3% 33 66.0% 29 58.0% 30 60.0%
0.740
status Divorced 5 3.3% 2 4.0% 1 2.0% 2 4.0%
Widow 17 11.3% 7 14.0% 6 12.0% 4 8.0%
Illiterate 22 14.7% 8 16.0% 8 16.0% 6 12.0%
Read and write 10 6.7% 5 10.0% 3 6.0% 2 4.0%
Primary 9 6.0% 1 2.0% 5 10.0% 3 6.0%
Preparatory 7 4.7% 3 6.0% 3 6.0% 1 2.0%
Education 0.760
Secondary 12 8.0% 4 8.0% 4 8.0% 4 8.0%
Intermediate institute 40 26.7% 15 30.0% 12 24.0% 13 26.0%
University graduate 49 32.7% 14 28.0% 14 28.0% 21 42.0%
Postgraduate 1 0.7% 0 0.0% 1 2.0% 0 0.0%

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
Non-
71 47.3% 26 52.0% 25 50.0% 20 40.0%
working/housewife
unskilled manual
4 2.7% 1 2.0% 3 6.0% 0 0.0%
worker
Occupation skilled manual 0.610
14 9.3% 4 8.0% 4 8.0% 6 12.0%
worker/farmer
Trades/business 9 6.0% 4 8.0% 3 6.0% 2 4.0%
semi-professional 30 20.0% 10 20.0% 8 16.0% 12 24.0%
Professional 22 14.7% 5 10.0% 7 14.0% 10 20.0%
Urban slum 25 16.7% 7 14.0% 6 12.0% 12 24.0%
Residence Rural 57 38.0% 20 40.0% 20 40.0% 17 34.0% 0.550
Urban 68 45.3% 23 46.0% 24 48.0% 21 42.0%
Test of Sig, Chi-square test. differences. After two weeks, the majority of
patients (54%, 46% and 56%) had residual
symptoms with no difference between the three
Table 2 summarizes clinical information,
groups. Hospitalization rate was 14%, 2% and
such as the number of new symptoms, their
10% in the colchicine, probiotic, and control
duration, and their persistence after two weeks. In
groups respectively, with no statistically
the colchicine, probiotic, and control groups, the
significant differences.
mean symptom duration was 12, 11 and 12,
respectively, with no statistically significant
Table 2: Comparisons between the three treatment groups regarding the clinical data.
Control Colchicine Probiotic
Variable Total P-value
group group group
Duration of Mean (SD) 12 (4) 12 (3) 12 (4) 11 (4)
symptoms
0.837**
improvement Min-Max (5-30) (5-21) (7-30) (5-25)
(post)
residual NO 72 48% 22 44% 23 46% 27 54%
0.57
symptoms (post) Yes 78 52% 28 56% 27 54% 23 46%
Hospitalization NO 137 91.3% 45 90% 43 86% 49 98%
0.09
(post) Yes 13 8.7% 5 10% 7 14% 1 2%
Test of Sig: ANOVA**: *Sig P value < 0.05.

The proportion of adverse effects in the

colchicine group is shown in Figure 1. In the
present trial, 44% of the patients in the colchicine
group had gastrointestinal side effects.

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
Figure 1 shows the percentage of
gastrointestinal side effects in the Colchicine
44% group
56% Yes
NO In terms of laboratory results, all the
parameters before and after the intervention were
statistically significantly (Table 3).

Table 3: Comparison between the treatment groups regarding the laboratory data before and
after intervention.

Pre Post
Variable P-value
N % N %
Normal 96 64% 120 80%
Neutrophil Neutropenia 36 24% 11 7.3% 0.05*#
Neutrophilia 18 12% 19 12.7%
Normal 80 53.3% 104 69.3%
Lymphocytes Lymphopenia 55 36.7% 29 19.3% 0.02*#
Lymphocytosis 15 10% 17 11.3%
Normal 39 26% 91 60.7%
CRP <0.001*$
Increase 111 74% 59 39.3%
Normal 64 42.7% 114 76%
D-dimer <0.0001*$
Increase 86 57.3% 36 24%
Normal 52 34.7% 111 74%
S. ferritin <0.001*$
Increase 98 65.3% 39 26%
*Sig P value; # test of Sig Marginal Homogeneity Test; $ test of sig McNamar Test.

significant differences between them except

Table 4 and Table 5 show that each of the lymphocyte count post intervention and D-Dimer
three groups had improvements in inflammatory level pre intervention.
markers over time (CBC parameters, CRP,
Ferritin and D-Dimer), with no statistically

Table 4: Comparison between the three treatment groups regarding laboratory data (CBC
parameters) before and after the intervention.

Grouping
Variable Total Control Colchicine Probiotic P-value
group group group

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N % N % N % N %

Normal 96 64% 33 66% 33 66% 30 60%

Neutrophil
Neutropenia 36 24% 12 24% 11 22% 13 26%
(pre) 0.950
Neutrophilia 18 12% 5 10% 6 12% 7 14%

Normal 80 53.3% 26 52% 31 62% 23 46%

Lymphocytes
Lymphopenia 55 36.7% 16 32% 16 32% 23 46% 0.210
(pre)
Lymphocytosis 15 10% 8 16% 3 6% 4 8%

Normal 120 80% 39 78% 41 82% 40 80%

Neutrophil
Neutropenia 11 7.3% 3 6% 3 6% 5 10%
(post) 0.820
Neutrophilia 19 12.7% 8 16% 6 12% 5 10%

Normal 104 69.3% 34 68% 38 76% 32 64%

Lymphocytes
Lymphopenia 29 19.3% 10 20% 12 24% 7 14% 0.01*
(post)
Lymphocytosis 17 11.3% 6 12% 0 0.0% 11 22%

Test of Sig Chi-square test; *Sig P value <0.05.

Table 5: Comparison between the three treatment groups regarding laboratory data (CRP, D-
Dimer and Ferritin parameters) before and after the intervention.

Grouping
Total Colchicine Probiotic P-value
Variable Control group
group group

N % N % N % N %

CRP Normal 39 26% 13 26% 15 30% 11 22%

(pre) increase 111 74% 37 74% 35 70% 39 78% 0.660

D- Normal 64 42.7% 15 30% 20 40% 29 58%

dimer
increase 86 57.3% 35 70% 30 60% 21 42% 0.016*
(pre)

S. Normal 52 34.7% 16 32% 17 34% 19 38%

ferritin
increase 98 65.3% 34 68% 33 66% 31 62% 0.814
(pre)

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CRP Normal 91 60.7% 34 68% 26 52% 31 62%

(post) increase 59 39.3% 16 32% 24 48% 19 38% 0.254

D- Normal 114 76% 40 80% 33 66% 41 82%

dimer
increase 36 24% 10 20% 17 34% 9 18% 0.125
(Post)

S. Normal 111 74% 40 80% 35 70% 36 72%

ferritin
(post) increase 39 26% 10 20% 15 30% 14 28% 0.483

Test of Sig Chi-square test; *Sig P value <0.05.

(40.6%) are over the age of 40 years. Of the 150
DISCUSSION participants, 84% were female and 66% were
Coronavirus disease 2019 (COVID-19) is male, which is consistent with Doerre and
an extremely contagious viral infection caused by Doblhammer (15) finding that infection rates are
the SARS-CoV-2 virus, which results in severe highest among the young and Sex ratios show
acute respiratory syndrome. It has had a that women at working ages have greater
catastrophic effect on the demography of the infection risks than males.
globe. It is now the most crucial aspect of global In addition, the smoking rate among study
health. In late December 2019, the first cases of participants was 23% which is comparable to that
this predominantly respiratory viral illness were of Farsalinos et al. (16), who discovered that
reported in Wuhan, Hubei Province, China. hospitalized COVID-19 patients had a smoking
SARS-CoV-2 rapidly spread across the globe. On prevalence that was roughly one-fourth of what
March 11, 2020, the World Health Organization was predicted.
(WHO) had to declare it as a global pandemic. Notably, there is no statistically significant
The 150 COVID-19 non-hospitalized difference in the sociodemographic features of
patients in the current trial, which is a three-arm the three groups, suggesting good matching.
randomized interventional study, ranged in In line with Hakki et al. (17) who found
severity from mild to moderate. The study was that peak RNA viral load and peak infectious
registered at Protocol Registration and Results viral load occurred a median of 3 days after
System (No. NCT05911022) registered on symptom onset, the current study revealed that
19/06/2023. the average duration of symptom onset is the
The participants were randomly assigned to fourth day. As a result, the majority of the study
receive the standard treatment protocol alone, the participants sought medical attention at the peak
standard treatment protocol plus colchicine, or of symptom onset.
the standard treatment protocol plus probiotics. Further subgroup analysis revealed that the
The study's findings regarding the mean duration of symptoms improvement after
sociodemographic characteristics of the intervention is 9.8 days in mild cases and 13 days
participants show that approximately one third in moderate cases, with a statistically significant
(34.7%) of them are between the ages of 29 and difference between them, which is consistent
39 years, one-quarter (24.7%) are between the with Faiq et al. (18) who found the median
ages of 18 and 28 years, and forty percent survival time was 12 days in moderate

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
hospitalized patients. The mean duration of intervention which was statistically significant
symptoms improvement after intervention is 12 and indicates that CBC, CRP, ferritin, and D-
days, and there is no statistically significant dimer may be employed as prognostic and
difference between the three groups. follow-up tools for both disease severity and
Tardif et al. and Dorward et al. (19) outcomes. which agrees with Yasmin et al. meta-
trials, which were conducted on 4,488 and 4,997 analysis of five RCTs concluded that CRP and D-
non-hospitalized participants while Recovery dimer levels are crucial in determining the
(20) trial were carried out on 19,423 hospitalized severity of COVID-19 because elevated levels
participants, found no statistically significant are linked to a poor prognosis. Other studies have
difference between the colchicine and usual care also used these parameters to monitor disease
protocol for time of improvement and severity and outcomes. (24)
hospitalizations in the group treated with the Additionally, Qin et al. (25) study revealed
standard protocol and colchicine. that lymphopenia, the most well-known
The results of the current study, however, hematological abnormality in patients affected by
did not agree with a meta-analysis conducted by COVID-19 infection, is seen in up to 85% of
Hariyanto et al. (21) who sought to investigate severe cases with the severity of lymphopenia
the impact of colchicine as a treatment option for linked to outcome. Soraya et al. (26) study
COVID-19 on January 29, 2021. It was revealed revealed that leukocytes and neutrophils were
that a total of eight studies involving 5778 significantly higher in severe than in non-severe
COVID-19 patients were included in this meta- COVID-19 infected patients. Leukocyte and
analysis. Colchicine treatment was linked to neutrophil counts also increased as the COVID-
better COVID-19 results. 19 disease progressed in the severe groups, which
Abdelfattah et al. (22) conducted a is in line with the findings of our study, which
retrospective study of 100 patients hospitalized at show that there is a statistically significant
the Ain Shams University Field Hospital and difference between mild and moderate cases with
concluded that colchicine has a significant effect regard to CBC parameters (neutrophils and
on the participants in terms of duration of lymphocytes levels).
symptom improvement and hospitalization. Further subgroup analysis revealed no
However, additional clinical trials are statistically significant difference in
required to validate the findings, as they are inflammatory biomarker levels between the
based on observational studies. colchicine group and controls, and these results
The current study found that 44% of the concur with those of Deftereos et al. (27) who
colchicine group participants experienced found no significant differences in CRP level
gastrointestinal adverse events, particularly at the between the control and colchicine groups.
beginning of the regimen on dose 0.5 mg three As opposed to Sarwar et al. (28) who
times per day for three days, then twice daily for reported from a meta-analysis of six RCTs that
four days. This is consistent with Terkeltaub et Colchicine is effective in decreasing
al. (23) study, which found that 36.5% of inflammatory biomarkers seen in moderate-to-
participants who took colchicine developed severe COVID-19 patients. According to Sandhu
diarrhea. et al. (29), patients in the colchicine group also
The recent trial evaluated the alternation in had a more pronounced decline in the
hematological parameters of individuals with inflammatory markers ferritin (P=0.012), D-
mild to moderate severity before and after the dimer (P=0.037), and CRP.

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CAJMNS Volume: 05 Issue: 01 | Jan-Feb 2024
On the other hand, the group that received approved by the Institutional Review Board at the
probiotics and the standard of care of treatment Faculty of medicine, Ain Shams University
shows no statistically significant difference from (Approval ID: MD 88/2020, on 20/6/2023).
the controls regarding the time of improvement An informed consent was obtained from the
and for hospitalizations due to COVID-19. In patients which addressed all the steps of the study
addition, there is no statistically significant as well as their right to withdraw from the study
difference between the two groups with regard to at any time. Privacy and confidentiality of data
of biochemical outcomes, which opposes was also assured.
Wischmeyer et al. (30) who claimed that LGG is
well-tolerated and is associated with a longer
Consent for publication
time to COVID-19 development.
Not applicable.
The majority of clinical trials on the use of
probiotics during COVID-19 use small sample
sizes. Most of them have relied on subjective Availability of Data and Material (ADM)
conclusions. In addition, there has been The data used and/or analyzed during the
considerable variation among these studies. Most current study are available from the
of the studies and meta-analyses were limited to corresponding author on reasonable request.
healthy young adults and excluded the elderly as
this population is frequently polymedicated and Competing interests
frequently has multiple comorbidities. Additional The authors declare no competing interests.
clinical trials are required to adequately validate
this conclusion. (31).
Funding
None.

CONCLUSION Author contributions:

Probiotic Lactobacillus acidophilus and All authors worked with the same level on
colchicine shows no significant effect on the field work supervision, analysis strategy, design,
symptoms, duration, and progression of mild and data management, data analysis, interpretation of
moderate cases of COVID-19. Colchicine causes
results, decision making on content and paper
more gastrointestinal adverse effects in the write-up and revision of final draft.
participants. CBC, CRP, ferritin, and D-dimer
may be used as prognostic and follow-up tools
for both disease severity and outcomes. Further Acknowledgments:
randomised controlled trials with a larger sample None.
size could be conducted to confirm these results.
Conflict of interest:
Declaration: None.
Ethics approval and consent to
participate.
This study was conducted according to the
Code of Ethics of The World Medical
Association (Declaration of Helsinki) and was

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