BACKGROUND Zinc supplementation has been considered one of the potential therapies for coronavirus disease-19 (COVID-19). We aimed to examine zinc efficacy in adult patients with COVID-19 infection. METHODS We conducted a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Patients tested positive for COVID-19 without end organ failure were randomized to oral zinc (n = 231) or matching placebo (n = 239) for 15 days. The primary combined outcome was death due to COVID-19 or ICU admission within 30 days after randomization. Secondary outcomes included length of hospital stay for inpatients and duration of COVID-19 symptoms with COVID-19 related hospitalization for outpatients. FINDINGS One hundred ninety patients (40.4%) were ambulatory and 280 patients (59.6%) were hospitalized. Mortality at 30-day was 6.5% in Zinc group and 9.2% in Placebo group [odds ratio (OR) 0.70 (0.37-1.32)]; ICU admission rate was respectively 5.2% and 11.3% [OR 0.46 (0.23-0.88)]. Combined outcome was lower in zinc group compared to placebo group [OR 0.62 (0.38-0.99)]. Consistent results were observed in prespecified subgroups of patients with age < 65 years, those with comorbidity, and those who needed oxygen therapy at baseline. Length of hospital stay was shorter in zinc group compared to placebo group [difference 3.5 days, 95% CI (2.76-4.23)] in inpatients group; duration of COVID-19 symptoms decreased with zinc treatment compared to placebo in outpatients [difference 1.9 days, 95% CI (0.62-2.6)]. No severe adverse events were observed during the study. INTERPRETATION Our results showed that in COVID-19 patients, oral zinc can decrease 30-day death and ICU admission rate and can shorten symptoms duration.

Intravenous MgSO appears to have a synergistic effect when combined with other AV nodal blockers resulting in improved rate control. Similar efficacy was observed with 4.5 and 9 g of MgSO but a dose of 9 g was associated with more side effects.

Introductionintensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few data regarding both outcomes of admitted patients to intensive care unit (ICU) in comparison with outcomes of not admitted patients. The aim of this study was to assess reasons and factors associated to refusal of admission to ICU as well as the impact on mortality at 28 days and patients' outcomes.MethodsSingle-center, cross-sectional descriptive study conducted in 8-bed Medical ICU at a Tunisian University hospital. All consecutive adult patients referred for admission to ICU during 6 months were included. We collected demographic data, ICU admission/refusal reasons, co-morbidity and diagnosis at time of admission, mortality probability model (MPMII0) score, day and time of admission, request for admission and mortality at 28 days.Results327 patients were evaluated for ICU admission and 260 were refused to ICU (79.5%). Patients refused because of unavailability of beds represented 50% and patients considered “too sick to benefit” represented 22%. Multivariate analysis showed that the presence of acute respiratory failure and request by direct contact in the unit were independently associated to admission to ICU (OR: 0.15; 95% CI: 0.07-0.31 and OR: 0.16; 95% CI: 0.08-0.31, respectively). Higher mortality rates were shown in patients “too sick to benefit” (80.7%) and unavailable beds (26.56%).ConclusionRefusal of ICU admission was correlated with the severity of acute illness, lack of ICU beds and reasons for admission request. ICU clinicians should evaluate their triage decisions and, if possible, routinely solicit patient preferences during medical emergencies, taking steps to ensure that ICU admission decisions are in line with the goals of the patient. Ultimately, these efforts will help ensure that scarce ICU resources are used most effectively and efficiently.