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ABSTRACT Background In this phase 2 randomised placebo-controlled clinical trial, we hypothesised that blocking mineralocorticoid receptors with spironolactone in patients with COVID-19 is safe and may reduce illness severity. Methods Hospitalised patients with confirmed COVID-19 were randomly allocated to low dose oral spironolactone (50mg day 1, then 25mg once daily for 21 days) or standard care in a 2:1 ratio. Both groups received dexamethasone 6mg for 10 days. Group allocation was blinded to the patient and research team. Primary outcomes were time to recovery, defined as the number of days until patients achieved WHO Ordinal Scale (OS) category ≤ 3, and the effect of spironolactone on aldosterone, D-dimer, angiotensin II and Von Willebrand Factor (VWF). Results 120 patients were recruited in Delhi from 01 February to 30 April 2021. 74 were randomly assigned to spironolactone and dexamethasone (SpiroDex), and 46 to dexamethasone alone (Dex). There was no significant difference in the time to recovery between SpiroDex and Dex groups (SpiroDex median 4.5 days, Dex median 5.5 days, p = 0.055). SpiroDex patients had lower aldosterone levels on day 7 and lower D-dimer levels on days 4 and 7 (day 7 D-dimer mean SpiroDex 1.15µg/mL, Dex 3.15 µg/mL, p = 0.0004). There was no increase in adverse events in patients receiving SpiroDex. Post hoc analysis demonstrated reduced clinical deterioration (pre specified as escalating to WHO OS category >4) in the SpiroDex group vs Dex group (5.4% vs 19.6%). Conclusion Low dose oral spironolactone in addition to dexamethasone was safe and reduced D-Dimer and aldosterone. Although time to recovery was not significantly reduced, fewer patients progressed to severe disease. Phase 3 randomised controlled trials with spironolactone should be considered.
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COVID-19ABSTRACT
BACKGROUND: Traditionally medical education involves classroom teaching, small group discussions and bed-side clinics. These have become difficult to conduct in times of the COVID-19 pandemic. Video-conferencing software and apps provide pragmatic alternatives for medical education in this scenario. However, the apps are not designed specifically for medical education. In this background, we aimed to review available video-conferencing freeware (platforms/apps) for their suitability in imparting post-graduate medical education. METHODOLOGY: Software and apps were searched on Android and iOS platforms. Freeware were selected based on pre-defined criteria. They were evaluated for features supporting post-graduate medical education like participant numbers, time limit, user comfort and security features. RESULTS: Our search yielded 118 video conferencing software and apps. Of these, 07 free apps met the initial inclusion and exclusion criteria. 'Say Namaste' was included post-hoc. Most apps allowed adequate numbers of participants and were comfortable for users. Only two apps had end-to-end encryption. CONCLUSION: Video-conferencing freeware can serve as a viable alternative for some aspects of medical teaching. Provision of certain additional features would make these apps more effective for post-graduate medical education.