ABSTRACT
Intro The RECOVERY trial showed evidence that dexamethasone given at moderate doses for a short period of time reduced mortality in comparison to standard of care in hospitalised COVID-19 patients. However, there is no evidence to demonstrate whether higher doses of steroid may improve or worsen the outcomes. This study compares the effectiveness of low-dose- methylprednisolone to pulse-methylprednisolone among the critically-ill COVID- 19 patients. Methods This is a retrospective observational study among critically-ill COVID- 19 patients whom were admitted to intensive care unit Hospital Pulau Pinang from August 2020 until February 2021. We collected the data of patients that received either methylprednisolone dose more than 2mg/kg/day or methylprednisolone dose equal or less than 2mg/kg/day. Both groups received standard of care. The primary outcome is all-cause mortality within 30 days from symptoms onset. The secondary outcomes are duration of mechanical ventilation, length of ICU stays and rate of complications such as acute kidney injury, sepsis, bleeding tendency and diabetic ketoacidosis. Findings A total of 100 patients were included in the analysis, whom 64% were male, mean age of 56.6 (SD 13.4) and 53% have at least one comorbidity. The survival analysis revealed that 30 days survival rate were 91.2% in the low-dose- methylprednisolone group and 81.8% in the pulse-methylprednisolone group (p = 0.226) and showed no significant differences after adjustment for covariates such as the doses of methylprednisolone, gender, requirement of mechanical ventilation and absence or presence of comorbidity. However, age more than 60 years old does increase the risk of mortality (p value 0.018). Comparing the low- dose-methylprednisolone to pulse-methylprednisolone, the duration of mechanical ventilation were 15.7 days vs 13.8 days (p 0.572), length of ICU stay were 14.9 days vs 15 days (p 0.875) and rate of complications were not significantly differences. Conclusion The use of pulse-methylprednisolone in critically-ill COVID-19 patients does not improve the survival rate.
ABSTRACT
Objectives: The COVID-19 pandemic has been declared a public health emergency of international concern. Singapore was one of the first countries to identify imported cases and also experience a second wave of outbreaks. A slew of measures enacted by the government to ‘flatten the curve’ has directly impacted upon the way we practice. Study design/Methods: This article describes steps enacted by our department to ensure sustainability of our ophthalmic practice. Results: We share considerations at various time points and policies implemented in a stepwise approach in response to the worsening community situation. We further discuss our phased approach towards reinstating our services safely and effectively for patients and staff in a markedly different practice climate. Conclusions: The COVID-19 pandemic has markedly upended the way we practice medicine. Reflecting on the ideal measures required for such occurrences in the future will empower practices with the ability to respond effectively to future outbreaks. © Asian Journal of Ophthalmology.