ABSTRACT
Background: In past 2 years, COVID-19 pandemic has affected the health care system adversely. World statistics showed a huge rise in the incidence of this highly infectious disease. Abnormal and unregulated immune response was found to be the key deciding factor for the outcome of this disease. A lot of studies showed a promising role of corticosteroids as immunosuppressant agents. They reduce morbidity and mortality in patients with moderate-to-severe COVID-19 disease. However, steroid therapy comes with a huge concern in form of their adverse effects, especially on prolonged use. Optimum duration of steroid therapy is not standardized. Aim and Objectives: The present study was carried out to determine days of oxygen requirement and duration of hospital stay in patients receiving short course steroid vis-à-vis long course steroid therapy. Materials and Methods: A retrospective observational study was conducted in tertiary care teaching hospital after prior permission of the Institutional Ethics Committee. All patients diagnosed as having moderate COVID-19 illness with age group of 18–80 years with minimum 03 days of 6 mg dexamethasone or other equivalent steroid administration were included in the study. Patients who were living with HIV/AIDS, cancer, hepatic and renal illness, ischemic and other valvular diseases, and chronic pulmonary diseases affecting oxygenation status were excluded from the study. A total of 203 study participants were enrolled during study period (68 in short course while 135 in long course steroid group). Data were enrolled in predesigned structured and validated case record form. Results: Short course steroid therapy was found more frequent in <60 years of age. Mean and SD of days of oxygen administration were (4.36 vs. 8.88) and (2.15 vs. 3.43) in short course and long course steroid therapy, respectively. Oxygen requirement for ?7 days was in (10, 7.41%) patients and (45, 66.18%) patients in short course steroid group and long course steroid group, respectively. Mean and standard deviation of duration of hospital stay were (6.64, 2.87) and (11.9, 4.03) in short course and long course steroid group, respectively. Hospital stay for more than 9 days was (20, 14.81%) and (47, 69.12%) in short course and long course steroid group, respectively. Conclusion: A positive association was found between duration of hospital stay and long course steroid therapy and was statistically significant. Similarly, a positive association between days of oxygen requirement and long course steroid therapy was found and again it was statistically significant. The study findings indicated that short course steroid therapy was found to be more effective in treatment outcome of COVID-19 illness as far as the duration of hospital stay and oxygen administration parameters are concerned.
ABSTRACT
Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in China, in December 2019, and was declared a pandemic by WHO on March 11, 2020. The treatment is evolving and is mostly supportive in nature. Material and methods: This was a single-center retrospective study that included confirmed COVID-19 cases treated at our institute (a tertiary care hospital in Jammu and Kashmir, India), between March 2020 and December 2020. Patients with age more than 18 years were included in the study. Results: On evaluating the effect of various drug therapies used in management of COVID-19 patients of all severity, use of remdesivir and famotidine was associated with significantly higher odds of survival. In subgroup of patients with severe disease, use of systemic steroids was associated with significantly higher odds of survival in addition to remdesivir and famotidine. In patients with severe COVID-19 illness, likelihood of survival was significantly higher in those who received combination of systemic steroids plus remdesivir compared to steroids and remdesivir alone. Conclusion: Steroids were effective in severe COVID-19 illness and the combination of steroids and remdesivir was more effective in severe illness. There is a need to undertake more large scale prospective randomized trials to determine the most effective drug therapies to treat the sick patients and prevent worsening of mild cases.
ABSTRACT
Objective To detail clinical profle and outcome in children infected with SARS-CoV-2. Methods This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (<18 y) with COVID-19 illness from April 2020–October 2020 were reviewed and analyzed. Results A total of 2919 children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness were tested for novel COVID-19 virus in the fu emergency (n=1744), severe acute respiratory infection (SARI) ward (n=825), and non-COVID area (n=350) of the hospital. 8.73% (255/2919) children tested positive for SARS-CoV-2 infection. Of the 255 positive cases, 144 (56.47%) were managed on an outpatient basis and 100 (59 boys) required admission in COVID ward. The mortality rate of patients with SARS-CoV-2 was 11.4% (29/255). Majority of children admitted with COVID-19 had severe to critical illness due to the presence of malnutrition and underlying comorbidities. Conclusions Children of all age groups were susceptible to COVID-19 illness with a slight male preponderance. Amongst infected, two-third were asymptomatic or had mild symptoms that required outpatient management and home isolation. The adverse outcomes were more commonly seen in infants and children>10 y of age with malnutrition and comorbid illness.