新冠肺炎的可怕後遺症：腦霧與慢性疲勞，你該怎麼辦？

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COVID-19肆虐全球，全球已超過600萬人死亡，而台灣經歷去年短暫疫情洗禮，現在正面對著每日新增破萬病例的高峰期！目前最主要的變種Omicron的幾項主要症狀，前五名為流鼻水、頭痛、疲勞、打噴嚏、喉嚨痛等，但統計指出，有高達24％的人會發生「腦霧」（Brain Fog）的症狀，是因為腦部某些部位受損所造成。

腦霧的主要症狀

腦霧的主要症狀包括病人感到記憶力減退、常感到一時之間想不起某些之前可以記得的事情、要花點時間才能找到精準的詞彙語句、注意力降低、沒辦法清晰的思考事情、過去能輕易完成的簡單任務變得沒辦法很明快完成，這些感到「自己好像變笨了」的時間染疫後數週開始出現。除此之外，也可能同時有新的睡眠障礙、憂鬱或焦慮情緒和不明的疼痛感等等。

與老化或失智的區別

上了年紀也有可能會有類似的狀況，但老化或失智通常比較常見於中老年人，尤其是整個過程是漸進緩慢產生的。而腦霧發生在COVID-19罹病後數週即開始產生，除了明確與罹病有前後時序關係，通常患者都能明確指出自己的腦力在短時間內與過去有明顯的不同。尤其如果您的年紀還未到中老年，在這波台灣疫情大流行後，若發生上述症狀，那麼很有可能便是腦霧。

兒童也會有後遺症嗎

兒童由於不太能明確表達，尤其是幼兒，後遺症常常會被忽略。而由於相關研究數目不夠大但因為國外已有許多研究顯示兒童染疫後即使是輕症也可能產生新冠長期症狀（Long COVID-19，長新冠），國外統計從10%到27%都有。包含哮喘、頭痛、腹痛等不明疼痛、專注力下降、疲累、甚至聽力降低，這些長新冠症狀除了影響孩子的生長發育，也影響學齡期間的學習能力，對孩子的影響甚大。而台灣這波大流行發生時，12歲以下的兒童尚未施打疫苗，若孩子染疫，後續孩子們的整體狀況需要更加小心追蹤，家長們得要多費心了。

為什麼會有腦霧？

大家會覺得很奇怪，COVID-19明明主要攻擊的是呼吸系統，主要初期症狀也是呼吸道相關，為什麼最後會產生腦霧和慢性疲勞？實際上明確的完美解釋還未能提出，因為大部分的家屬並不願意提供腦部解剖，疫情期間要對大量染疫過世者進行解剖也是困難的，但仍然有些有力的研究可做為解釋：

於2022年3月發表在著名科學期刊Nature的論文，以英國生物醫學資料庫（UK Biobank），對最近3年在COVID-19疫情前後各做一次大腦斷層的785人進行分析，其中有401人於2020年3月至2021年4月期間感染，和沒有染疫的384人對照組比起來，即使罹病者多屬輕症、無需住院，他們的大腦灰質都比罹病前流失了一些！大腦灰質主管著記憶與情緒，影響語言、思考與溝通。在自然老化的過程中，大腦每年平均會損失0.2%至0.3%的灰質，而這項研究發現，即使最輕症的染疫者，也在多個大腦區域損失了0.2%到2%的灰質，相當於最嚴重的狀況下，大腦硬生生的老了十年！

史丹佛大學神經科學家威斯-柯拉伊（Tony Wyss-Coray）表示，即使病毒沒有直接侵入和感染大腦，但病毒可能徘徊在大腦外圍導致神經系統發炎。史丹佛大學的研究指出，過世染疫者的大腦被許多包含「巨噬細胞」的免疫細胞滲透，可能是因為免疫細胞為了找出病毒而大量出現在大腦組織，一般非染疫者的大腦中，免疫細胞的數量則少很多。

而美國國家衛生研究院（National Institutes of Health）也發現染疫者腦血管變薄受損，日本則有研究指出染疫者的腦較為腫脹。由於已經有大量不是針對腦部的COVID-19研究都指出染疫可能會引起免疫系統錯亂、自體攻擊、自體免疫風暴，因此搭配這些腦部相關的證據可以推論，腦霧的產生很有可能是因為免疫細胞企圖清除腦部組織或周邊的病毒，但在這樣激烈的戰爭過程中造成了腦組織的損傷，引起了後遺症。

同樣的推論也可以解釋COVID-19染疫後慢性疲勞的產生。由於COVID-19所引發的免疫路徑既多又複雜，大戰所產生的各種自體抗體、細胞因子，都可能像是雙面刃一般，雖然是我們身體產生為了對抗病毒的，卻在大戰中以及大戰結束後，對身體的正常運作造成了傷害，甚至這樣的傷害是持續性的。而由於每個人的免疫系統和細微生化路徑都有所不同，因此雖然大部分的人可以康復回歸正常生活，有的人卻引發嚴重或困擾的後遺症。

發生腦霧和慢性疲勞怎麼辦？

目前健保並沒有可以直接改善這樣問題的解法。但以過去針對慢性疲勞與各種發炎相關病症所設計出的功能醫學，按照「避免發炎」、「及早控制發炎」、「消除發炎」的方針去應對，以及「改善粒線體」的重要功能醫學核心價值之一，已成功幫助許多人，因此應該同樣對COVID-19引發的後遺症有幫助。以下便給予簡單的說明：

高劑量維他命C注射療法

維他命C具強力抗氧化、抗發炎、內皮修復和免疫調節作用，高劑量維他命C注射早已被大量文獻證實有效改善許多發炎相關併發症，甚至是抗癌的重要方式。相關文章參考：高劑量維他命C（高濃度維他命C）注射療法：抗癌、解毒、消除發炎、逆轉氧化

在這兩年多來，也已在國外進行不少研究。在與對照組相比之下，有接受高劑量靜脈注射維生素C組的腦霧評分顯著降低，如睡眠障礙、注意力不集中、憂鬱和不明疼痛也獲得緩解。有研究指出，加護病房中COVID-19 患者使用高劑量靜脈注射維生素C顯著改善了血氧濃度，減少了免疫風暴，進而降低重症患者死亡率。

由於前述腦霧與慢性疲勞形成的原因，因此站在「及早打破發炎路徑」「及早穩定免疫風暴」的理論上，未染疫者即可提早施打作為預防，而一旦染疫，在解除居家隔離和自主觀察期後，更該盡早施打，趕緊將這期間的發炎因子消除、同時讓整體免疫系統的紊亂穩定下來。越早施打的效果會更為優良。

功能醫學點滴

COVID- 19所引起的免疫風暴和發炎反應，會大量消耗身體內的許多生化路徑輔酶，除了維生素C以外，維生素B家族包括B1、B2、 B6、B12 等等，以及許多胺基酸與其前驅物質，都會在罹患COVID- 19期間被巨量耗損，口服因為還要透過腸胃系統吸收，常常無法補足，導致身體的多個系統來不及修復。同時這些營養素還與血清素、多巴胺和腎上腺素等人體賀爾蒙的合成有關，這也可以說明為何許多染疫者康復後仍持續有憂鬱或焦慮情緒。建議一旦染疫，在能正常出門後，可以與高劑量維他命C注射療法作為交替施打。

粒線體功能提升

相關文章閱讀：

靜脈雷射：激活血液中血球與多種酶、提振人體免疫力與修復活化神經

粒線體是人體細胞的發電廠，除了平時可以經由粒線體飲食(多攝取抗氧化物、多色蔬果、避開油炸物、避開反式脂肪)以及刻意攝取粒線體補充劑(Q10、NMN等等)，但如果粒線體本身受到傷害，除了給予原料之外，也需要修復粒線體才能從源頭改善。在免疫風暴過程中，粒線體功能多半降低(像是癌症化療也會造成粒線體受損，產生癌症慢性疲勞)，這時便可利用靜脈雷射，以特殊波段的紅光治療去進行粒線體的功能提升。

結論

COVID-19染疫引起免疫混亂和嚴重發炎反應，導致腦霧、慢性疲勞、認知障礙、憂鬱等各種後遺症。除了基本的飲食均衡、好好優化作息之外，在染疫初期早點以高劑量維他命C降低發炎反應，以及後續持續透過高劑量維他命C注射、功能醫學點滴、粒線體功能提升(粒線體補充劑與靜脈雷射)等方法，由醫師依據病患的年齡、既有疾病、整體狀況做最佳建議與搭配，會是大幅降低與改善COVID-19後遺症的少數安全沒有副作用的可行療法。至於難以使用針劑治療的兒童，除了從飲食與作息調養外，建議從尚未染疫期間便可以每天攝取日常年齡建議劑量的兩倍維他命D和維他命C作為保養。若有疑問，也可以與您的家庭醫師或至以下門診時間與醫師討論。

門診時間

以下是各種維他命C療法輔助治療COVID-19的文章連結：

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36.	Vitamins, supplements and COVID-19: a review of currently available evidence. Speakman LL, Michienzi SM, Badowski ME. Drugs Context. 2021 Oct 6;10:2021-6-2. doi: 10.7573/dic.2021-6-2. eCollection 2021. PMID: 34659426 Free PMC article. Review.
37.	Feasibility of Vitamin C in the Treatment of Post Viral Fatigue with Focus on Long COVID, Based on a Systematic Review of IV Vitamin C on Fatigue. Vollbracht C, Kraft K. Nutrients. 2021 Mar 31;13(4):1154. doi: 10.3390/nu13041154. PMID: 33807280 Free PMC article.
38.	What is the role of supplementation with ascorbic acid, zinc, vitamin D, or N-acetylcysteine for prevention or treatment of COVID-19? Bauer SR, Kapoor A, Rath M, Thomas SA. Cleve Clin J Med. 2020 Jun 8. doi: 10.3949/ccjm.87a.ccc046. Online ahead of print. PMID: 32513807
39.	The efficacy of Siddha Medicine, Kabasura Kudineer (KSK) compared to Vitamin C & Zinc (CZ) supplementation in the management of asymptomatic COVID-19 cases: A structured summary of a study protocol for a randomised controlled trial. Natarajan S, Anbarasi C, Sathiyarajeswaran P, Manickam P, Geetha S, Kathiravan R, Prathiba P, Pitchiahkumar M, Parthiban P, Kanakavalli K, Balaji P. Trials. 2020 Oct 27;21(1):892. doi: 10.1186/s13063-020-04823-z. PMID: 33109252 Free PMC article.
40.	Devilishly radical NETwork in COVID-19: Oxidative stress, neutrophil extracellular traps (NETs), and T cell suppression. Schönrich G, Raftery MJ, Samstag Y. Adv Biol Regul. 2020 Aug;77:100741. doi: 10.1016/j.jbior.2020.100741. Epub 2020 Jul 4. PMID: 32773102 Free PMC article. Review.
41.	How Nutrition can help to fight against COVID-19 Pandemic. Aman F, Masood S. Pak J Med Sci. 2020 May;36(COVID19-S4):S121-S123. doi: 10.12669/pjms.36.COVID19-S4.2776. PMID: 32582329 Free PMC article.
42.	The efficiency and safety of high-dose vitamin C in patients with COVID-19: a retrospective cohort study. Gao D, Xu M, Wang G, Lv J, Ma X, Guo Y, Zhang D, Yang H, Jiang W, Deng F, Xia G, Lu Z, Lv L, Gong S. Aging (Albany NY). 2021 Feb 26;13(5):7020-7034. doi: 10.18632/aging.202557. Epub 2021 Feb 26. PMID: 33638944 Free PMC article.
43.	Role of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control study. Behera P, Patro BK, Singh AK, Chandanshive PD, S R R, Pradhan SK, Pentapati SSK, Batmanabane G, Mohapatra PR, Padhy BM, Bal SK, Singh SR, Mohanty RR. PLoS One. 2021 Feb 16;16(2):e0247163. doi: 10.1371/journal.pone.0247163. eCollection 2021. PMID: 33592050 Free PMC article.
44.	A secondary approach with conventional medicines and supplements to recuperate current COVID-19 status. Chowdhury A, Sajid M, Jahan N, Adelusi TI, Maitra P, Yin G, Wu X, Gao Y, Wang S. Biomed Pharmacother. 2021 Oct;142:111956. doi: 10.1016/j.biopha.2021.111956. Epub 2021 Jul 27. PMID: 34332377 Free PMC article. Review.
45.	Application of methylene blue -vitamin C -N-acetyl cysteine for treatment of critically ill COVID-19 patients, report of a phase-I clinical trial. Alamdari DH, Moghaddam AB, Amini S, Keramati MR, Zarmehri AM, Alamdari AH, Damsaz M, Banpour H, Yarahmadi A, Koliakos G. Eur J Pharmacol. 2020 Oct 15;885:173494. doi: 10.1016/j.ejphar.2020.173494. Epub 2020 Aug 20. PMID: 32828741 Free PMC article.
46.	Impact of vitamins A, B, C, D, and E supplementation on improvement and mortality rate in ICU patients with coronavirus-19: a structured summary of a study protocol for a randomized controlled trial. Beigmohammadi MT, Bitarafan S, Hoseindokht A, Abdollahi A, Amoozadeh L, Mahmoodi Ali Abadi M, Foroumandi M. Trials. 2020 Jul 6;21(1):614. doi: 10.1186/s13063-020-04547-0. PMID: 32631405 Free PMC article.
47.	Diet Supplementation, Probiotics, and Nutraceuticals in SARS-CoV-2 Infection: A Scoping Review. Infusino F, Marazzato M, Mancone M, Fedele F, Mastroianni CM, Severino P, Ceccarelli G, Santinelli L, Cavarretta E, Marullo AGM, Miraldi F, Carnevale R, Nocella C, Biondi-Zoccai G, Pagnini C, Schiavon S, Pugliese F, Frati G, d'Ettorre G. Nutrients. 2020 Jun 8;12(6):1718. doi: 10.3390/nu12061718. PMID: 32521760 Free PMC article. Review.
48.	A comparative analysis for anti-viral drugs: Their efficiency against SARS-CoV-2. Kivrak A, Ulaş B, Kivrak H. Int Immunopharmacol. 2021 Jan;90:107232. doi: 10.1016/j.intimp.2020.107232. Epub 2020 Nov 30. PMID: 33290969 Free PMC article. Review.
49.	Single-cell transcriptomic atlas of primate cardiopulmonary aging. Ma S, Sun S, Li J, Fan Y, Qu J, Sun L, Wang S, Zhang Y, Yang S, Liu Z, Wu Z, Zhang S, Wang Q, Zheng A, Duo S, Yu Y, Belmonte JCI, Chan P, Zhou Q, Song M, Zhang W, Liu GH. Cell Res. 2021 Apr;31(4):415-432. doi: 10.1038/s41422-020-00412-6. Epub 2020 Sep 10. PMID: 32913304 Free PMC article.
50.	Vitamin C and zinc lozenges for COVID-19? Hemilä H, Chalker E. J Am Pharm Assoc (2003). 2021 Sep-Oct;61(5):e39. doi: 10.1016/j.japh.2021.05.018. Epub 2021 May 29. PMID: 34120854 Free PMC article. No abstract available.
51.	Vitamin C and coronavirus. Simonson W. Geriatr Nurs. 2020 May-Jun;41(3):331-332. doi: 10.1016/j.gerinurse.2020.05.002. Epub 2020 May 8. PMID: 32439200 Free PMC article. Review. No abstract available.
52.	Re: Vitamin C and zinc lozenges for COVID-19? Marwitz KK. J Am Pharm Assoc (2003). 2021 Sep-Oct;61(5):e39-e40. doi: 10.1016/j.japh.2021.05.019. Epub 2021 May 29. PMID: 34112616 Free PMC article. No abstract available.
53.	COVID-19: Up to 82% critically ill patients had low Vitamin C values. Tomasa-Irriguible TM, Bielsa-Berrocal L. Nutr J. 2021 Jul 9;20(1):66. doi: 10.1186/s12937-021-00727-z. PMID: 34243781 Free PMC article.
54.	Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial. Thomas S, Patel D, Bittel B, Wolski K, Wang Q, Kumar A, Il'Giovine ZJ, Mehra R, McWilliams C, Nissen SE, Desai MY. JAMA Netw Open. 2021 Feb 1;4(2):e210369. doi: 10.1001/jamanetworkopen.2021.0369. PMID: 33576820 Free PMC article. Clinical Trial.
55.	Vitamin C and Cardiovascular Disease: An Update. Morelli MB, Gambardella J, Castellanos V, Trimarco V, Santulli G. Antioxidants (Basel). 2020 Dec 3;9(12):1227. doi: 10.3390/antiox9121227. PMID: 33287462 Free PMC article. Review.
56.	The influence of vitamin-C intake on blood glucose measurements in COVID-19 pandemic. Al-Obaidi ZMJ, Hussain YA, Ali AA, Al-Rekabi MD. J Infect Dev Ctries. 2021 Mar 7;15(2):209-213. doi: 10.3855/jidc.13960. PMID: 33690202
57.	Vitamin C May Increase the Recovery Rate of Outpatient Cases of SARS-CoV-2 Infection by 70%: Reanalysis of the COVID A to Z Randomized Clinical Trial. Hemilä H, Carr A, Chalker E. Front Immunol. 2021 May 10;12:674681. doi: 10.3389/fimmu.2021.674681. eCollection 2021. PMID: 34040614 Free PMC article. No abstract available.
58.	Strengthening the immunity of the Swiss population with micronutrients: A narrative review and call for action. Berger MM, Herter-Aeberli I, Zimmermann MB, Spieldenner J, Eggersdorfer M. Clin Nutr ESPEN. 2021 Jun;43:39-48. doi: 10.1016/j.clnesp.2021.03.012. Epub 2021 Mar 24. PMID: 34024545 Free PMC article. Review.
59.	Vitamin C supplementation is necessary for patients with coronavirus disease: An ultra-high-performance liquid chromatography-tandem mass spectrometry finding. Xing Y, Zhao B, Yin L, Guo M, Shi H, Zhu Z, Zhang L, He J, Ling Y, Gao M, Lu H, Mao E, Zhang L. J Pharm Biomed Anal. 2021 Mar 20;196:113927. doi: 10.1016/j.jpba.2021.113927. Epub 2021 Jan 27. PMID: 33549875 Free PMC article. Clinical Trial.
60.	Hydroxychloroquine as Postexposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 Infection : A Randomized Trial. Barnabas RV, Brown ER, Bershteyn A, Stankiewicz Karita HC, Johnston C, Thorpe LE, Kottkamp A, Neuzil KM, Laufer MK, Deming M, Paasche-Orlow MK, Kissinger PJ, Luk A, Paolino K, Landovitz RJ, Hoffman R, Schaafsma TT, Krows ML, Thomas KK, Morrison S, Haugen HS, Kidoguchi L, Wener M, Greninger AL, Huang ML, Jerome KR, Wald A, Celum C, Chu HY, Baeten JM; Hydroxychloroquine COVID-19 PEP Study Team. Ann Intern Med. 2021 Mar;174(3):344-352. doi: 10.7326/M20-6519. Epub 2020 Dec 8. PMID: 33284679 Free PMC article. Clinical Trial.
61.	Efficacy of hydroxychloroquine for post-exposure prophylaxis to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among adults exposed to coronavirus disease (COVID-19): a structured summary of a study protocol for a randomised controlled trial. Barnabas RV, Brown E, Bershteyn A, Miller RS, Wener M, Celum C, Wald A, Chu H, Wesche D, Baeten JM; Hydroxychloroquine COVID-19 PEP Study Team. Trials. 2020 Jun 3;21(1):475. doi: 10.1186/s13063-020-04446-4. PMID: 32493478 Free PMC article.
62.	The Effects of Vitamin C on the Multiple Pathophysiological Stages of COVID-19. Miranda-Massari JR, Toro AP, Loh D, Rodriguez JR, Borges RM, Marcial-Vega V, Olalde J, Berdiel MJ, Riordan NH, Martinez JM, Gil A, Gonzalez MJ. Life (Basel). 2021 Dec 3;11(12):1341. doi: 10.3390/life11121341. PMID: 34947872 Free PMC article. Review.
63.	Therapeutic targets and signaling mechanisms of vitamin C activity against sepsis: a bioinformatics study. Li R, Guo C, Li Y, Qin Z, Huang W. Brief Bioinform. 2021 May 20;22(3):bbaa079. doi: 10.1093/bib/bbaa079. PMID: 32393985 Free PMC article.
64.	Hesperidin and SARS-CoV-2: New Light on the Healthy Function of Citrus Fruits. Bellavite P, Donzelli A. Antioxidants (Basel). 2020 Aug 13;9(8):742. doi: 10.3390/antiox9080742. PMID: 32823497 Free PMC article. Review.
65.	Repositioning Vitamin C as a Promising Option to Alleviate Complications associated with COVID-19. Farjana M, Moni A, Sohag AAM, Hasan A, Hannan MA, Hossain MG, Uddin MJ. Infect Chemother. 2020 Dec;52(4):461-477. doi: 10.3947/ic.2020.52.4.461. Epub 2020 Nov 24. PMID: 33263242 Free PMC article. Review.
66.	Two known therapies could be useful as adjuvant therapy in critical patients infected by COVID-19. Hernández A, Papadakos PJ, Torres A, González DA, Vives M, Ferrando C, Baeza J. Rev Esp Anestesiol Reanim (Engl Ed). 2020 May;67(5):245-252. doi: 10.1016/j.redar.2020.03.004. Epub 2020 Apr 14. PMID: 32303365 Free PMC article. English, Spanish.
67.	High-dose vitamin C ameliorates cardiac injury in COVID-19 pandemic: a retrospective cohort study. Xia G, Qin B, Ma C, Zhu Y, Zheng Q. Aging (Albany NY). 2021 Sep 9;13(17):20906-20914. doi: 10.18632/aging.203503. Epub 2021 Sep 9. PMID: 34499050 Free PMC article.
68.	Drug repurposing for COVID-19: could vitamin C combined with glycyrrhizic acid be at play by the findings of Li et al.'s database-based network pharmacology analysis? Huang YX, Wang WX, Tang YP, Yue SJ. Brief Bioinform. 2021 Mar 22;22(2):1508-1510. doi: 10.1093/bib/bbaa330. PMID: 33253353 Free PMC article.
69.	Possible application of high-dose vitamin C in the prevention and therapy of coronavirus infection. Hoang BX, Shaw G, Fang W, Han B. J Glob Antimicrob Resist. 2020 Dec;23:256-262. doi: 10.1016/j.jgar.2020.09.025. Epub 2020 Oct 13. PMID: 33065330 Free PMC article. Review.
70.	Therapeutic Options for the Treatment of Coronavirus Disease (COVID-19). Snawerdt J, Finoli L, Bremmer DN, Cheema T, Bhanot N. Crit Care Nurs Q. 2020 Oct/Dec;43(4):349-368. doi: 10.1097/CNQ.0000000000000321. PMID: 32833772 Review.
71.	Flattening the COVID-19 Curve With Natural Killer Cell Based Immunotherapies. Market M, Angka L, Martel AB, Bastin D, Olanubi O, Tennakoon G, Boucher DM, Ng J, Ardolino M, Auer RC. Front Immunol. 2020 Jun 23;11:1512. doi: 10.3389/fimmu.2020.01512. eCollection 2020. PMID: 32655581 Free PMC article. Review.
72.	Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study. Zhao B, Ling Y, Li J, Peng Y, Huang J, Wang Y, Qu H, Gao Y, Li Y, Hu B, Lu S, Lu H, Zhang W, Mao E. Ann Palliat Med. 2021 Feb;10(2):1599-1609. doi: 10.21037/apm-20-1387. Epub 2020 Nov 17. PMID: 33222462
73.	Cytokine storm in aged people with CoV-2: possible role of vitamins as therapy or preventive strategy. Fiorino S, Gallo C, Zippi M, Sabbatani S, Manfredi R, Moretti R, Fogacci E, Maggioli C, Travasoni Loffredo F, Giampieri E, Corazza I, Dickmans C, Denitto C, Cammarosano M, Battilana M, Orlandi PE, Del Forno F, Miceli F, Visani M, Acquaviva G, De Leo A, Leandri P, Hong W, Brand T, Tallini G, Jovine E, Jovine R, de Biase D. Aging Clin Exp Res. 2020 Oct;32(10):2115-2131. doi: 10.1007/s40520-020-01669-y. Epub 2020 Aug 31. PMID: 32865757 Free PMC article. Review.
74.	Phlyctenular Keratoconjunctivitis in a Patient With COVID-19 Infection. Eleiwa TK, Elmaghrabi A, Helal HG, Abdelrahman SN, ElSheikh RH, Elhusseiny AM. Cornea. 2021 Nov 1;40(11):1502-1504. doi: 10.1097/ICO.0000000000002789. PMID: 34320598
75.	Hipótesis sobre las conexiones entre COVID-19 severo en niños y nutrición: una revisión narrativa. León-Lara X, Vargas-Castillo A, Ávila-Nava A, Guevara-Cruz M, Serralde Zúñiga AE, Medina-Vera I. Nutr Hosp. 2021 Jun 10;38(3):622-630. doi: 10.20960/nh.03452. PMID: 33829849 Review. English.
76.	Emerging pharmacological therapies for ARDS: COVID-19 and beyond. Horie S, McNicholas B, Rezoagli E, Pham T, Curley G, McAuley D, O'Kane C, Nichol A, Dos Santos C, Rocco PRM, Bellani G, Laffey JG. Intensive Care Med. 2020 Dec;46(12):2265-2283. doi: 10.1007/s00134-020-06141-z. Epub 2020 Jul 11. PMID: 32654006 Free PMC article.
77.	Value of chest imaging in the newborn with suspected COVID-19. Li HY, Zhang CM, Lv YY, Dai WQ, Xu B, Qi XM. Eur Rev Med Pharmacol Sci. 2020 Nov;24(22):11971-11976. doi: 10.26355/eurrev_202011_23859. PMID: 33275274
78.	Supplementation of the population during the COVID-19 pandemic with vitamins and micronutrients - how much evidence is needed? Schuetz P, Gregoriano C, Keller U. Swiss Med Wkly. 2021 May 19;151:w20522. doi: 10.4414/smw.2021.20522. eCollection 2021 May 10. PMID: 34010429 Review. No abstract available.
79.	Clinical characteristics of foreign-imported COVID-19 cases in Shanghai, China. Liu XH, Lu SH, Chen J, Xia L, Yang ZG, Charles S, Yang Y, Lin Y, Lu HZ. Emerg Microbes Infect. 2020 Dec;9(1):1230-1232. doi: 10.1080/22221751.2020.1766383. PMID: 32515651 Free PMC article. No abstract available.
80.	Antioxidants and pentoxifylline as coadjuvant measures to standard therapy to improve prognosis of patients with pneumonia by COVID-19. Chavarría AP, Vázquez RRV, Cherit JGD, Bello HH, Suastegui HC, Moreno-Castañeda L, Alanís Estrada G, Hernández F, González-Marcos O, Saucedo-Orozco H, Manzano-Pech L, Márquez-Velasco R, Guarner-Lans V, Pérez-Torres I, Soto ME. Comput Struct Biotechnol J. 2021;19:1379-1390. doi: 10.1016/j.csbj.2021.02.009. Epub 2021 Feb 27. PMID: 33680348 Free PMC article.
81.	Vitamin and mineral supplementation for β-thalassemia during COVID-19 pandemic. d'Arqom A, G Putri M, Savitri Y, Rahul Alfaidin AM. Future Sci OA. 2020 Aug 18;6(9):FSO628. doi: 10.2144/fsoa-2020-0110. PMID: 33230422 Free PMC article. Review.
82.	Is vitamin C an effective agent for the prevention of COVID-19 and treatment of severe infection in the ICU? İzol Torun AN. Int J Vitam Nutr Res. 2020 Aug 3:1-2. doi: 10.1024/0300-9831/a000670. Online ahead of print. PMID: 32744166 No abstract available.
83.	Relationship Between Plasma Vitamin C and COVID-19 Susceptibility and Severity: A Two-Sample Mendelian Randomization Study. Chen S, Zheng C, Chen T, Huang D, Pan Y, Chen S. Front Med (Lausanne). 2022 Mar 9;9:844228. doi: 10.3389/fmed.2022.844228. eCollection 2022. PMID: 35355592 Free PMC article.
84.	Unusual Early Recovery of a Critical COVID-19 Patient After Administration of Intravenous Vitamin C. Waqas Khan HM, Parikh N, Megala SM, Predeteanu GS. Am J Case Rep. 2020 Jul 25;21:e925521. doi: 10.12659/AJCR.925521. PMID: 32709838 Free PMC article.
85.	Commentary: The Long History of Vitamin C: From Prevention of the Common Cold to Potential Aid in the Treatment of COVID-19. Hemilä H, Chalker E. Front Immunol. 2021 Apr 1;12:659001. doi: 10.3389/fimmu.2021.659001. eCollection 2021. PMID: 33868305 Free PMC article. No abstract available.
86.	Supplements for the Treatment of Mild COVID-19-Challenging Health Beliefs With Science From A to Z. Michos ED, Cainzos-Achirica M. JAMA Netw Open. 2021 Feb 1;4(2):e210431. doi: 10.1001/jamanetworkopen.2021.0431. PMID: 33576814 No abstract available.
87.	COVID-19, oxidative stress, and male reproductive dysfunctions: is vitamin C a potential remedy? Sengupta P, Dutta S, Slama P, Roychoudhury S. Physiol Res. 2022 Mar 25;71(1):47-54. doi: 10.33549/physiolres.934827. Epub 2022 Jan 19. PMID: 35043653 Free PMC article. Review.
88.	The role of vitamin C in pneumonia and COVID-19 infection in adults with European ancestry: a Mendelian randomisation study. Hui LL, Nelson EAS, Lin SL, Zhao JV. Eur J Clin Nutr. 2022 Apr;76(4):588-591. doi: 10.1038/s41430-021-00993-4. Epub 2021 Aug 30. PMID: 34462559 Free PMC article.
89.	Homeopathic Medicines Used as Prophylaxis in Kolkata during the COVID-19 Pandemic: A Community-Based, Cluster-Randomized Trial. Mukherjee SK, Ganguly S, Das S, Chatterjee KK, Naskar KK, Dey S, Choudhury S, Paul A, Sarkar SS, Bhattacharyya S, Sengupta S, Alam SM, Bhattacharya P, Naskar S, Mukherjee S, Shamim S, Mandal D, Sardar S, Sarkar S, Ray B, Gole R, Dey A, Bhattacharya C, Saha S. Homeopathy. 2021 Oct 29. doi: 10.1055/s-0041-1734026. Online ahead of print. PMID: 34715718
90.	Vitamin C: From Bench to Bedside. Carr AC, Lykkesfeldt J. Nutrients. 2021 Mar 27;13(4):1102. doi: 10.3390/nu13041102. PMID: 33801745 Free PMC article.
91.	COVID-19 and micronutrient deficiency symptoms - is there some overlap? Lewis SL, Chizmar LR, Liotta S. Clin Nutr ESPEN. 2022 Apr;48:275-281. doi: 10.1016/j.clnesp.2022.01.036. Epub 2022 Feb 2. PMID: 35331502 Free PMC article. Review.
92.	Keeping a Balance During the Pandemic: a Narrative Review on the Important Role of Micronutrients in Preventing Infection and Reducing Complications of COVID-19. Pinnawala NU, Thrastardottir TO, Constantinou C. Curr Nutr Rep. 2021 Sep;10(3):200-210. doi: 10.1007/s13668-021-00356-2. Epub 2021 May 5. PMID: 33948913 Free PMC article. Review.
93.	Functional Role of Dietary Intervention to Improve the Outcome of COVID-19: A Hypothesis of Work. Messina G, Polito R, Monda V, Cipolloni L, Di Nunno N, Di Mizio G, Murabito P, Carotenuto M, Messina A, Pisanelli D, Valenzano A, Cibelli G, Scarinci A, Monda M, Sessa F. Int J Mol Sci. 2020 Apr 28;21(9):3104. doi: 10.3390/ijms21093104. PMID: 32354030 Free PMC article. Review.
94.	Effects of Micronutrients or Conditional Amino Acids on COVID-19-Related Outcomes: An Evidence Analysis Center Scoping Review. Rozga M, Cheng FW, Moloney L, Handu D. J Acad Nutr Diet. 2021 Jul;121(7):1354-1363. doi: 10.1016/j.jand.2020.05.015. Epub 2020 May 20. PMID: 32565398 Free PMC article. Review.
95.	Correlation of D-xylose with severity and morbidity-related factors of COVID-19 and possible therapeutic use of D-xylose and antibiotics for COVID-19. Cheudjeu A. Life Sci. 2020 Nov 1;260:118335. doi: 10.1016/j.lfs.2020.118335. Epub 2020 Aug 23. PMID: 32846167 Free PMC article. Review.
96.	Review of Pharmacotherapy Trialed for Management of the Coronavirus Disease-19. Hall K, Mfone F, Shallcross M, Pathak V. Eurasian J Med. 2021 Jun;53(2):137-143. doi: 10.5152/eurasianjmed.2021.20384. PMID: 34177298 Free PMC article. Review.
97.	Blood nitrate and nitrite modulating nitric oxide bioavailability: Potential therapeutic functions in COVID-19. Yamasaki H. Nitric Oxide. 2020 Oct 1;103:29-30. doi: 10.1016/j.niox.2020.07.005. Epub 2020 Jul 23. PMID: 32712272 Free PMC article.
98.	Time-trend analysis of medicine sales and shortages during COVID-19 outbreak: Data from community pharmacies. Romano S, Galante H, Figueira D, Mendes Z, Rodrigues AT. Res Social Adm Pharm. 2021 Jan;17(1):1876-1881. doi: 10.1016/j.sapharm.2020.05.024. Epub 2020 May 23. PMID: 32482587 Free PMC article.
99.	Vitamin D (Cholecalciferol) with Low Dose Vitamin C as a Safe and Effective Therapeutic Modality in an Adult with COVID-19 Pneumonia. Waheed S, Zahid RO, Khan ST, Subhani F, Siddiqui E. J Coll Physicians Surg Pak. 2021 Jan;31(1):S90-S92. doi: 10.29271/jcpsp.2021.Supp3.S90. PMID: 34530542
100.	Perioperative melatonin in COVID-19 patients: benefits beyond sedation and analgesia. Nair AS. Med Gas Res. 2022 Apr-Jun;12(2):41-43. doi: 10.4103/2045-9912.325990. PMID: 34677150 Free PMC article. Review.

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