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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">UJGH</journal-id>
      <journal-title-group>
        <journal-title>Universal Journal of Gastroenterology and Hepatology</journal-title>
      </journal-title-group>
      <issn pub-type="epub"></issn>
      <issn pub-type="ppub"></issn>
      <publisher>
        <publisher-name>Science Publications</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.31586/ujgh.2023.772</article-id>
      <article-id pub-id-type="publisher-id">UJGH-772</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Brief Review</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>
          Role of Probiotics and Colchicine in COVID-19 Management?
        </article-title>
      </title-group>
      <contrib-group>
<contrib contrib-type="author">
<name>
<surname>Hassan</surname>
<given-names>Samar Osama Ahmed</given-names>
</name>
<xref rid="af1" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hassan</surname>
<given-names>Ahmed Nour El-Din</given-names>
</name>
<xref rid="af2" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mohamed</surname>
<given-names>Manal Sabry</given-names>
</name>
<xref rid="af3" ref-type="aff">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nessim</surname>
<given-names>Mina Mikhail</given-names>
</name>
<xref rid="af3" ref-type="aff">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ashram</surname>
<given-names>Mohamed Nabil Badawy Al</given-names>
</name>
<xref rid="af3" ref-type="aff">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Allam</surname>
<given-names>Mohamed Farouk</given-names>
</name>
<xref rid="af1" ref-type="aff">1</xref>
<xref rid="af4" ref-type="aff">4</xref>
<xref rid="cr1" ref-type="corresp">*</xref>
</contrib>
      </contrib-group>
<aff id="af1"><label>1</label> Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt</aff>
<aff id="af2"><label>2</label> Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt</aff>
<aff id="af3"><label>3</label> Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt</aff>
<aff id="af4"><label>4</label> Department of Community Medicine, Faculty of Medicine, October 6 University, Cairo, Egypt</aff>
<author-notes>
<corresp id="c1">
<label>*</label>Corresponding author at: Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
</corresp>
</author-notes>
      <pub-date pub-type="epub">
        <day>31</day>
        <month>10</month>
        <year>2023</year>
      </pub-date>
      <volume>1</volume>
      <issue>1</issue>
      <history>
        <date date-type="received">
          <day>08</day>
          <month>09</month>
          <year>2023</year>
        </date>
        <date date-type="rev-recd">
          <day>16</day>
          <month>10</month>
          <year>2023</year>
        </date>
        <date date-type="accepted">
          <day>28</day>
          <month>10</month>
          <year>2023</year>
        </date>
        <date date-type="pub">
          <day>31</day>
          <month>10</month>
          <year>2023</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>&#xa9; Copyright 2023 by authors and Trend Research Publishing Inc. </copyright-statement>
        <copyright-year>2023</copyright-year>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
          <license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p>
        </license>
      </permissions>
      <abstract>
        <bold>Background</bold>: Coronavirus disease 2019 (COVID-19) is a newly emerging human disease caused by a novel coronavirus, causing a global pandemic crisis<bold>.</bold> Probiotics and/or colchicine may be considered as options for treatment since they have anti-viral, anti-inflammatory, and immunomodulatory effects. The aim of the current review was to assess the effectiveness of probiotic supplements and colchicine on symptoms, duration, and progression of mild and moderate cases of COVID-19 infection<bold>.</bold> <bold>Re</bold><bold>view</bold><bold>:</bold> A randomized, double-blind, placebo-controlled trial in the United States with 182 participants who were randomly assigned to receive daily oral probiotic (Lactobacillus rhamnosus) LGG or placebo for 28 days. The study indicated that LGG is well-tolerated and is associated with a delay in the onset of COVID-19 infection, a reduction in the incidence of symptoms, and alterations in the structure of the gut microbiome when administered as post-exposure prophylaxis within seven days of exposure. Colchicine may lessen mortality and the need for mechanical ventilation in mild-to-moderate COVID-19 patients, according to a systematic review and meta-analysis. <bold>Conclusion: </bold>Probiotics and/or colchicine may be viable treatment options for COVID-19 patients. To examine the efficacy of probiotics and colchicine in the treatment of COVID-19, it is necessary to conduct additional clinical trials and provide clinicians with evidence, as there are currently insufficient studies to support this conclusion.
      </abstract>
      <kwd-group>
        <kwd-group><kwd>Probiotics</kwd>
<kwd>Colchicine</kwd>
<kwd>COVID-19</kwd>
<kwd>Management</kwd>
<kwd>Clinical trials</kwd>
<kwd>Review</kwd>
</kwd-group>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec1">
<title>Review</title><p>A novel coronavirus was discovered to be the source of a cluster of pneumonia cases in Wuhan (China), which led to an outbreak throughout China and then to a global pandemic. In February of 2020, the World Health Organization (WHO) officially recognized COVID-19 (coronavirus disease 2019) [
<xref ref-type="bibr" rid="R1">1</xref>].</p>
<p>COVID-19 disease frequently manifests as a fever, dry cough, shortness of breath, and breathing difficulties. Some of the less frequent symptoms include anosmia, sore throat, runny nose, vomiting, and diarrhoea [
<xref ref-type="bibr" rid="R2">2</xref>].</p>
<p>The aim of the current review was to assess the effectiveness of probiotic supplements and colchicine on symptoms, duration, and progression of mild and moderate cases of COVID-19 infection<bold>.</bold></p>
<p>Early reports from Wuhan indicate that 2% to 10% of COVID-19 patients exhibited gastrointestinal symptoms, including diarrhoea, vomiting, and abdominal pain. 10% of patients experienced one to two days of nausea and diarrhoea prior to the onset of fever and respiratory symptoms [
<xref ref-type="bibr" rid="R3">3</xref>].</p>
<p>The severity of COVID-19 disease was correlated with the diversity of the gut microbiota, and alterations in the gut microbiota persisted even after the virus eliminated, suggesting that the virus may have a long-lasting negative impact on the homoeostasis of the human microbiome [
<xref ref-type="bibr" rid="R4">4</xref>]<bold>.</bold> </p>
<p>Infection with SARS-CoV-2 significantly altered the faecal microbiomes of all 15 patients, according to a study of confirmed COVID-19 patients in Hong Kong. This imbalance of intestinal microbiota persisted even after SARS-CoV-2 clearance [
<xref ref-type="bibr" rid="R5">5</xref>].</p>
<p>Dysbiosis of the gut microbiome, immunological dysregulation, hyperinflammation, and a cytokine storm are hallmarks of COVID-19 illness [
<xref ref-type="bibr" rid="R6">6</xref>]. Probiotics are defined as&#x26;#x0201d; live bacteria that provide health benefits to the host when given in sufficient doses&#x26;#x0201d; [
<xref ref-type="bibr" rid="R7">7</xref>].</p>
<p>As an intestinal microbe regulator, probiotics help to improve the immune system, lessen allergic reactions, and play a crucial part in antiviral immunomodulation. They also increase the gastrointestinal microbiota's capacity to modulate immunological activity [
<xref ref-type="bibr" rid="R8">8</xref>]. </p>
<p>Wischmeyer et al. [
<xref ref-type="bibr" rid="R9">9</xref>] conducted a randomized, double-blind, placebo-controlled trial in the United States with 182 participants who were randomly assigned to receive daily oral probiotic (Lactobacillus rhamnosus) LGG or placebo for 28 days. The study indicated that LGG is well-tolerated and is associated with a delay in the onset of COVID-19 infection, a reduction in the incidence of symptoms, and alterations in the structure of the gut microbiome when administered as post-exposure prophylaxis within seven days of exposure.</p>
<p>Colchicine is an anti-inflammatory drug frequently prescribed for the treatment and prevention of crystals induced arthritis, such as gout, systemic auto-inflammatory illnesses such Bechet&#x26;#x02019;s disease and familial Mediterranean fever [
<xref ref-type="bibr" rid="R10">10</xref>].</p>
<p>Colchicine inhibits neutrophil activation and release of IL1, IL8, and superoxide, D. In addition to promotion of maturation of dendritic cells to act as antigen presenting cells, Colchicine inhibits vascular endothelial growth factor (VEGF) and endothelial proliferation [
<xref ref-type="bibr" rid="R11">11</xref>]. </p>
<p>One of the clinical trials called COLCORONA 2020 was directed by the Montreal Heart Institute and conducted in Brazil, Canada, Greece, South Africa, Spain, and the United States conducted by Tardif.<italic> </italic><italic>et</italic><italic> al.</italic> in 2021. The trial revealed that the effect of colchicine on clinical symptoms of COVID-19- community-treated individuals was not statistically significant difference between the colchicine group and controls [
<xref ref-type="bibr" rid="R12">12</xref>].</p>
<p>Colchicine may lessen mortality and the need for mechanical ventilation in mild-to-moderate COVID-19 patients, according to a systematic review and meta-analysis conducted by <italic>Siemieniuk</italic><italic> et al.</italic> in 2020 [
<xref ref-type="bibr" rid="R13">13</xref>].</p>
</sec><sec id="sec2">
<title>Conclusion</title><p>Probiotics and/or colchicine may be viable treatment options for COVID-19 patients. To examine the efficacy of probiotics and colchicine in the treatment of COVID-19, it is necessary to conduct additional clinical trials and provide clinicians with evidence, as there are currently insufficient studies to support this conclusion. </p>
<p>Further randomised controlled trials with a larger sample size could be conducted to confirm these results.</p>
<p></p>
</sec>
  </body>
  <back>
    <ref-list>
      <title>References</title>
      
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</mixed-citation>
</ref>
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<label>[7]</label>
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<label>[8]</label>
<mixed-citation publication-type="other">Zhang H, Yeh C, Jin Z, Ding L, Liu BY, Zhang L, Dannelly HK. Prospective study of probiotic supplementation results in immune stimulation and improvement of upper respiratory infection rate. Synth Syst Biotechnol 2018;3(2):113-20. doi: 10.1016/j.synbio.2018.03.001.
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<ref id="R9">
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<mixed-citation publication-type="other">Wischmeyer PE, Tang H, Ren Y, Bohannon L, Ramirez ZE, Andermann T M, Sung AD. Daily Lactobacillus probiotic versus placebo in COVID-19-exposed household contacts (PROTECT-EHC): a randomized clinical trial. MedRxiv, 2022-01. doi: 10.1101/2022.01.04.21268275
</mixed-citation>
</ref>
<ref id="R10">
<label>[10]</label>
<mixed-citation publication-type="other">Lopes MI, Bonjorno LP, Giannini MC, Amaral NB, Menezes PI, Dib SM, et al. Beneficial effects of colchicine for moderate to severe COVID-19: a randomised, double-blinded, placebo-controlled clinical trial. RMD Open 2021;7(1):e001455. doi: 10.1136/rmdopen-2020-001455.
</mixed-citation>
</ref>
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<label>[11]</label>
<mixed-citation publication-type="other">Leung YY, Yao Hui LL, Kraus VB. Colchicine-Update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum 2015;45(3):341-50. doi: 10.1016/j.semarthrit.2015.06.013.
</mixed-citation>
</ref>
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