ABSTRACT
Background: and Purpose: Corticosteroid therapy is still controversial to use for treatment of coronavirus disease-2019 (COVID-19). The results of multiple randomized clinical trials (RCTs) and observational studies are very diverse and contradictory, which arising difficulty in the clinical decision-making. The objective of this study is to investigate the effect of corticosteroids on mortality by systematic review and meta-analysis. External Approach: A systematic search was performed on different databases namely Medline/PubMed, Cochrane and Google scholar on 10 February 2022, according to PRISMA guidelines. The 28-days mortality was considered as outcome of study. A pooled estimate was calculated with random effects and fixed effects models. Cochran’s Q test and the I2 statistic were conducted for statistical heterogeneity. Key Results: 38 studies were included, having sample size of 87,781 patients. Amongst them, 16437 patients received corticosteroid therapy (intervention group) while 71344 patients were standard (noncorticosteroids) therapy (control group). 12.68% (2084) mortality observed in the intervention group while 5.93% (4227) mortality observed in the control group. The overall pooled estimate showed a significantly (OR2.305;95%CI: 2.1810 to 2.4370) increased mortality in intervention group. A pooled fold change estimation showed significantly increased in the mortality in methylprednisolone (OR 1.206;95%CI: 1.0770 to 1.3500) and dexamethasone (OR 1.388;95% CI:1.1870 to 1.6220) therapy. Conclusion and Implication: In conclusion, corticosteroid therapy produced a negative prognosis as depicted by increased mortality among COVID-19 patients. The possible reasons might be delay in virus clearance and secondary infection due to initiation of the corticosteroids at high dose in the early stage of infection.
Subject(s)
COVID-19ABSTRACT
Since December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been spreading worldwide, triggering one of the most challenging pandemics in human population. In the light of reporting of this virus in domestic and wild animals from several parts of world, a systematic surveillance study was conceptualized to detect the SARS-CoV-2 among species of Veterinary importance. Nasal and/or rectal samples of 413 animals (Dog=195, cattle=64, horse=42, goat=41, buffalo=39, sheep=19, cat=6, camel=6 and monkey=1) were collected from different places of Gujarat state of India. RNA was extracted from samples and subjected to RT-qPCR based amplification of target sequences in viral nucleoprotein (N), spike (S) and ORF1ab genes. A total of 95 (23.79 %) animals were found positive, comprised of 67 (34.35 %) dogs, 15(23.43 %) cattle and 13(33.33 %) buffaloes. Overall, nasal samples (N=80/412, 19.41 %) gave more positive results than rectal samples (N=70/407, 17.19 %) in RT-qPCR. The whole SRAS-CoV-2 genome sequencing was done on one sample (ID-A4N; from dog) where 32 mutations, including 29 single nucleotide variation (SNV) and two deletions, were detected. Among them, 9 mutations were located in the receptor binding domain of the spike (S) protein. The consequent changes in amino acid sequence revealed that T19R, G142D, E156-, F157-, A222V, L452R, T478K, D614G, P681R mutation in S protein and D63G, R203M and D377Y in N protein. The lineage assigned to this SARS-CoV-1 sequence is B.1.617.2. Thus, the present study highlights the importance of SARS-CoV-2 surveillance in non-human host.