{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:32:46Z","timestamp":1762432366683,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T00:00:00Z","timestamp":1688342400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Nasal irrigation is thought to decrease the viral load present in the nasal cavity. Our aim was to assess the effect of a hypertonic seawater solution [with algal and herbal natural ingredients (Sinomarin\u00ae)] on the viral load of nasopharynx in patients hospitalized with severe COVID-19 pneumonia. We conducted a prospective, randomized, controlled trial from June 2022 to December 2022. We allocated 56 patients with COVID-19 pneumonia into two groups (28 in each group)\u2014the hypertonic seawater group [nasal irrigations with a hypertonic seawater solution (Sinomarin\u00ae) every 4 h for 16 h per day, for two consecutive days] and the control group (no nasal irrigations). A second nasopharyngeal swab was collected 48 h after the baseline nasopharyngeal swab (8 h after the last wash in the hypertonic seawater group) to estimate the SARS-CoV-2 viral load as determined by cycle threshold (Ct) values. In the hypertonic seawater group, the mean Ct values significantly increased two days after the initial measurement [\u0394Ct 48\u22120 h = 3.86 \u00b1 3.03 cycles, p &lt; 0.001 (95%CI: 2.69 to 5.04)]. No significant differences in the Ct values were observed in the control group [\u0394Ct 48\u22120 h = \u22120.14 \u00b1 4.29, p = 0.866 (95%CI: \u22121.80 to \u22121.52)]. At follow-up, 17 patients from the hypertonic seawater group had negative test results compared to only 9 patients from the control group (p = 0.03). Nasal irrigations with a hypertonic seawater solution containing algal and herbal natural ingredients significantly decreased nasopharyngeal viral load and the detection time of SARS-CoV-2 in the nasal cavity.<\/jats:p>","DOI":"10.3390\/jpm13071093","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T01:32:18Z","timestamp":1688434338000},"page":"1093","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients Reduces Viral Load and SARS-CoV-2 Detection Time in the Nasal Cavity"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8846-519X","authenticated-orcid":false,"given":"Ioannis","family":"Pantazopoulos","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"},{"name":"Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7634-4665","authenticated-orcid":false,"given":"Athanasios","family":"Chalkias","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"},{"name":"Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA"},{"name":"Outcomes Research Consortium, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angeliki","family":"Miziou","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michalis","family":"Spanos","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efrosyni","family":"Gerovasileiou","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2885-4510","authenticated-orcid":false,"given":"Erasmia","family":"Rouka","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, University of Thessaly, 45550 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9541-1010","authenticated-orcid":false,"given":"Konstantinos","family":"Gourgoulianis","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.1002\/jmv.27643","article-title":"The Emergence and Epidemic Characteristics of the Highly Mutated SARS-CoV-2 Omicron Variant","volume":"94","author":"Tian","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e126","DOI":"10.1002\/mco2.126","article-title":"SARS-CoV-2 Omicron Variant: Immune Escape and Vaccine Development","volume":"3","author":"Ao","year":"2022","journal-title":"MedComm"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1038\/s41591-020-0868-6","article-title":"SARS-CoV-2 Entry Factors Are Highly Expressed in Nasal Epithelial Cells Together with Innate Immune Genes","volume":"26","author":"Sungnak","year":"2020","journal-title":"Nat. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1002\/eji.202249805","article-title":"Differential Susceptibility to SARS-CoV-2 in the Normal Nasal Mucosa and in Chronic Sinusitis","volume":"52","author":"Zhang","year":"2022","journal-title":"Eur. J. Immunol."},{"key":"ref_5","first-page":"147","article-title":"SARS-CoV-2 Viral Load and Shedding Kinetics","volume":"21","author":"Puhach","year":"2023","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8794127","DOI":"10.1155\/2022\/8794127","article-title":"Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial","volume":"2022","author":"Pantazopoulos","year":"2022","journal-title":"Can. Respir. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1177\/1945892418773566","article-title":"Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-Analysis","volume":"32","author":"Kanjanawasee","year":"2018","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41421-020-00192-8","article-title":"Sulfated Polysaccharides Effectively Inhibit SARS-CoV-2 in Vitro","volume":"6","author":"Kwon","year":"2020","journal-title":"Cell Discov."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"119551","DOI":"10.1016\/j.carbpol.2022.119551","article-title":"A State-of-the-Art Review on Fucoidan as an Antiviral Agent to Combat Viral Infections","volume":"291","author":"Pradhan","year":"2022","journal-title":"Carbohydr. Polym."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"(2013). World Medical Association World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_11","unstructured":"(2023, June 22). Clinical Spectrum, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov\/overview\/clinical-spectrum\/."},{"key":"ref_12","unstructured":"(2023, June 22). Hospitalized Adults: Therapeutic Management, Available online: https:\/\/www.covid19treatmentguidelines.nih.gov\/management\/clinical-management-of-adults\/hospitalized-adults--therapeutic-management\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"c869","DOI":"10.1136\/bmj.c869","article-title":"CONSORT 2010 Explanation and Elaboration: Updated Guidelines for Reporting Parallel Group Randomised Trials","volume":"340","author":"Moher","year":"2010","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1943274","DOI":"10.1080\/21688370.2021.1943274","article-title":"Virus-Associated Disruption of Mucosal Epithelial Tight Junctions and Its Role in Viral Transmission and Spread","volume":"9","author":"Tugizov","year":"2021","journal-title":"Tissue Barriers"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1159\/000528969","article-title":"Epithelial Barrier in the Nasal Mucosa, Related Risk Factors and Diseases","volume":"184","author":"Zhang","year":"2023","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"594495","DOI":"10.3389\/fmed.2020.594495","article-title":"Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2","volume":"7","author":"Salamanna","year":"2020","journal-title":"Front. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"13185","DOI":"10.1021\/bi035268s","article-title":"Angiotensin-Converting Enzyme-2 (ACE2): Comparative Modeling of the Active Site, Specificity Requirements, and Chloride Dependence","volume":"42","author":"Guy","year":"2003","journal-title":"Biochemistry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1021\/acsptsci.1c00080","article-title":"Inhibition of Severe Acute Respiratory Syndrome Coronavirus 2 Replication by Hypertonic Saline Solution in Lung and Kidney Epithelial Cells","volume":"4","author":"Machado","year":"2021","journal-title":"ACS Pharmacol. Transl. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s00228-021-03102-3","article-title":"Essentials in Saline Pharmacology for Nasal or Respiratory Hygiene in Times of COVID-19","volume":"77","author":"Huijghebaert","year":"2021","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1080\/07391102.2020.1754293","article-title":"A Review on the Cleavage Priming of the Spike Protein on Coronavirus by Angiotensin-Converting Enzyme-2 and Furin","volume":"39","author":"Hasan","year":"2021","journal-title":"J. Biomol. Struct. Dyn."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.abb.2009.05.013","article-title":"A Study of Human Furin Specificity Using Synthetic Peptides Derived from Natural Substrates, and Effects of Potassium Ions","volume":"487","author":"Izidoro","year":"2009","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"13630","DOI":"10.1038\/s41598-018-31936-y","article-title":"Antiviral Innate Immune Response in Non-Myeloid Cells Is Augmented by Chloride Ions via an Increase in Intracellular Hypochlorous Acid Levels","volume":"8","author":"Ramalingam","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2058738420941757","DOI":"10.1177\/2058738420941757","article-title":"Could Nasal Irrigation and Oral Rinse Reduce the Risk for COVID-19 Infection?","volume":"34","author":"Casale","year":"2020","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1038\/s41598-018-37703-3","article-title":"A Pilot, Open Labelled, Randomised Controlled Trial of Hypertonic Saline Nasal Irrigation and Gargling for the Common Cold","volume":"9","author":"Ramalingam","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"010332","DOI":"10.7189\/jogh.10.010332","article-title":"Hypertonic Saline Nasal Irrigation and Gargling Should Be Considered as a Treatment Option for COVID-19","volume":"10","author":"Ramalingam","year":"2020","journal-title":"J. Glob. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1001\/archoto.2007.19","article-title":"Efficacy of Isotonic Nasal Wash (Seawater) in the Treatment and Prevention of Rhinitis in Children","volume":"134","author":"Slapak","year":"2008","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3022","DOI":"10.1007\/s12070-021-02749-9","article-title":"Comparison of the Healing Effect of Nasal Saline Irrigation with Triamcinolone Acetonide Versus Nasal Saline Irrigation Alone in COVID-19 Related Olfactory Dysfunction: A Randomized Controlled Study","volume":"74","author":"Yildiz","year":"2022","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_28","first-page":"112","article-title":"Efficacy and Safety of a Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients in Patients with COVID-19","volume":"26","author":"Gangadi","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cegolon, L., Mastrangelo, G., Emanuelli, E., Camerotto, R., Spinato, G., and Frezza, D. (2022). Early Negativization of SARS-CoV-2 Infection by Nasal Spray of Seawater plus Additives: The RENAISSANCE Open-Label Controlled Clinical Trial. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14112502"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1046112","DOI":"10.3389\/fpubh.2022.1046112","article-title":"Effect of Nasal Irrigation in Adults Infected with Omicron Variant of COVID-19: A Quasi-Experimental Study","volume":"10","author":"Liu","year":"2022","journal-title":"Front. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"447","DOI":"10.5582\/bst.2022.01495","article-title":"Can Nasal Irrigation with Chlorine Dioxide Be Considered as a Potential Alternative Therapy for Respiratory Infectious Diseases? The Example of COVID-19","volume":"16","author":"Cao","year":"2022","journal-title":"Biosci. Trends"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1002\/lio2.686","article-title":"Effects of Hypertonic Alkaline Nasal Irrigation on COVID-19","volume":"6","author":"Yilmaz","year":"2021","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Baxter, A.L., Schwartz, K.R., Johnson, R.W., Kuchinski, A.-M., Swartout, K.M., Srinivasa Rao, A.S.R., Gibson, R.W., Cherian, E., Giller, T., and Boomer, H. (2022). Rapid Initiation of Nasal Saline Irrigation to Reduce Severity in High-Risk COVID+ Outpatients. Ear. Nose. Throat J.","DOI":"10.1177\/01455613221123737"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1145669","DOI":"10.3389\/fpubh.2023.1145669","article-title":"Efficacy of Nasal Irrigation and Oral Rinse with Sodium Bicarbonate Solution on Virus Clearance for COVID-19 Patients","volume":"11","author":"Wang","year":"2023","journal-title":"Front. Public Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3283","DOI":"10.1007\/s12070-022-03106-0","article-title":"Virucidal Effect of Povidone Iodine on SARS-CoV-2 in Nasopharynx: An Open-Label Randomized Clinical Trial","volume":"74","author":"Banu","year":"2022","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e0165622","DOI":"10.1128\/spectrum.01656-22","article-title":"Selection of Ideal Reference Genes for Gene Expression Analysis in COVID-19 and Mucormycosis","volume":"10","author":"Kumar","year":"2022","journal-title":"Microbiol. Spectr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"847407","DOI":"10.3389\/fmed.2022.847407","article-title":"False-Positive Results of SARS-CoV-2 RT-PCR in Oropharyngeal Swabs From Vaccinators","volume":"9","author":"Kong","year":"2022","journal-title":"Front. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1093\/cid\/ciab684","article-title":"False Coronavirus Disease 2019 Cases Due to Contamination by Inactivated Virus Vaccine","volume":"74","author":"To","year":"2022","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e0147722","DOI":"10.1128\/spectrum.01477-22","article-title":"SARS-CoV-2: Challenges in Reconverting Diagnostic Laboratories to Combat the Pandemic","volume":"10","year":"2022","journal-title":"Microbiol. Spectr."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/7\/1093\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:05:06Z","timestamp":1760126706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/7\/1093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,3]]},"references-count":39,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jpm13071093"],"URL":"https:\/\/doi.org\/10.3390\/jpm13071093","relation":{},"ISSN":["2075-4426"],"issn-type":[{"type":"electronic","value":"2075-4426"}],"subject":[],"published":{"date-parts":[[2023,7,3]]}}}