Sleep-related breathing disorders could be accompanied by or caused by a variety of medical conditions. They are considered to be a significant medical and social problem. Together with excessive daytime sleepiness, patients with obstructive sleep apnea experience neuropsychological symptoms such as anxiety, attention deficits, cognitive impairment, depressive symptoms and other psychological disturbances leading to social adjustment difficulties. Patients diagnosed with obstructive sleep apnea demonstrate a decline in a wide spectrum of cognitive abilities, including memory, attention, psychomotor speed, executive, verbal and visual-spatial skills. The aim of this study is to investigate the cognitive functioning and affective disorders among patients with obstructive sleep apnea syndrome and to examine the frequency and severity of cases in comparison with a control group consisting of healthy volunteers. Our research has shown that there is a relation between sleep apnea and cognitive impairments and affective changes. This relation can be explained by the direct effect of the syndrome on the patient, where the main connecting factor is the severity and the distribution of excessive daytime sleepiness. Along with treatment of the somatic medical condition, it is extremely important that the patient's mental state is treated as well. Trial Registration: 57/2013, Medical University - Sofia, Bulgaria.

An otherwise healthy, 35-year-old man was hospitalized for the management of acute respiratory failure due to coronavirus disease 2019 (COVID-19)-related severe bilateral pneumonia and acute respiratory distress syndrome (ARDS). The patient therapeutic regimen included the widely accepted standard combination of oxygen, anticoagulation therapy; corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics. A novel combination of colchicine, hymecromone, and bromhexine inhalations was added to the therapeutic regimen as part of our unique COVID-19 management institutional protocol. COVID-19-related severe bilateral pneumonia and acute respiratory distress syndrome (ARDS). The patient therapeutic regimen included the widely accepted standard combination of oxygen, anticoagulation therapy, corticosteroids, NSAIDs, and antibiotics. A novel combination of colchicine, hymecromone, and bromhexine inhalations was added to the therapeutic regimen as part of our unique COVID-19 management institutional protocol. Rapid clinical response on day 2, with a significant improvement of radiographic pulmonary changes on day 5, and improvement of laboratory results on days 5-7 were observed. The administration of inhalatory bromhexine in combination with high-dose colchicine and hymecromone was crucial for the positive outcome of the disease. This treatment regimen resulted in a four to five-fold decrease in the mortality of hospitalized patients.

Colchicine has an excellent basis for being effective against COVID-19 due to its anti-inflammatory, immunomodulatory, and cardioprotective effects, as well as its role in preventing microvascular thrombosis. In addition, colchicine also has antiviral effects, an extremely favorable safety profile, and–since it does not exert any overt immunosuppressive activity–does not interfere with effective viral clearance, nor is it associated with the occurrence of secondary infections. However, all studies to date on the effects of low-dose colchicine for COVID-19 treatment are conflicting and rather disappointing. As colchicine has the remarkable ability to accumulate intensively in leukocytes–where the cytokine storm is generated–we initiated high but safe doses of colchicine for COVID-19 patient treatment. Our assumption was that a safe increase in colchicine dosage to reach micromolar concentrations in leukocytes would result in NLRP3 inflammasome/cytokine storm inhibition and would enhance its antiviral effect by inducing microtubule dissociation. Outpatients’ high-dose colchicine treatment practically prevents hospitalizations. Total colchicine uptake analysis demonstrates an inverse relationship with hospitalization. The duration of colchicine uptake also shows an inverse relationship with hospitalization and post-COVID-19 symptoms. Unlike the WHO-recommended antiviral preparations molnupiravir, remdesivir, and paxlovid, colchicine–in addition to its antiviral effect–prevents the cytokine storm and therefore has a strong effect not only in outpatients but also in inpatients. Unlike antivirals, colchicine significantly reduces post-COVID-19 symptoms. The side effects of colchicine are similar to those of paxlovid. The price of colchicine is incomparably lower, and it is also easily available.

The successful use of bromhexine hydrochloride (BRH) for COVID-19 prevention led us to apply the same method for flu prevention. The goal of this study is to observe whether BRH could protect people against influenza.This is non-interventional, observational, questionnaire-based survey. General practitioners informed their patients to take BRH 8 mg twice per day for at least 3 weeks if they want. The mean participant age was 58.9 years (95% CI: 57.4–60.5), with a median of 62 years, indicating that the sample predominantly consisted of individuals over 60 years of age.The average number of comorbidities was 0.98, and the mean duration of prophylactic use was 80 days (95% CI: 76.7–83.7). The reported influenza incidence within the sample was 10.6%.Influenza incidence among individuals taking BRH prophylactically was significantly lower compared to national data (36.15%). Longer use was associated with a modest reduction in risk. The number of comorbidities remained the strongest predictor of influenza occurrence. Age had no significant impact among those using BRH prophylactically. The model demonstrated good discriminative ability but limited calibration, and the results should be interpreted cautiously.