Efficacy and safety of glucocorticoids in treatment of COVID-19: a retrospective study.

BACKGROUND: Novel coronavirus pneumonia is a novel kind of highly contagious disease without any specific drugs. Considering the successful experience of antiviral therapy combined with glucocorticoids (GCs) in severe acute respiratory syndrome, this study was designed to evaluate the clinical efficacy of GCs in treating patients with coronavirus disease 2019 (COVID-19). METHODS: A cohort of 42 patients with COVID-19 admitted to The First Hospital of Jiaxing from January 4, 2020, to February 16, 2020, were included and grouped into a test group (n=20) and control group (n=22) based on their therapeutic regimens. There were no significant differences in baseline characteristics between patients in the two groups. Conventional treatment (antiviral therapy) was given to patients in both groups, while an additional hormone drug (GCs) was used in patients in the test group. Indices including body temperature, blood routine indices [white blood cell (WBC), lymphocyte, monocyte, and C-reactive protein (CRP)], blood biochemical indices [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)], and complications were recorded during the treatment. Time to achieve negative virus nucleic acid (nCoV-RNA) testing, and hospital stays were also observed and compared between the two groups. RESULTS: All included patients completed the trial. After treatment, superior therapeutic efficacy was achieved in patients in the test group, with body temperature dropping more significantly with a much shorter recovery time compared to the control group (P=0.0412). Simultaneously, the percentage of patients with abnormal blood routine indices (WBC), monocyte, and (CRP) in the test group was reduced more sharply, while no noticeable difference was observed in the number of patients who developed abnormal blood biochemical indices during treatment between the two groups. Additionally, a shorter duration of hospital stays was found in the test group relative to the control group (14.84±8.76 vs. 18.25±7.42 days, P>0.05). Patients who received GCs had a shorter recovery time for body temperature and inflammation. CONCLUSIONS: Hormonotherapy with GCs can accelerate the recovery time for body temperature as well as inflammation in patients with COVID-19. It deserves promotion and application in the clinical treatment of coronavirus disease as a form of adjuvant medicine. The ongoing focus of research is on long-term adverse events in GCs.

Simultaneous degradation of glucocorticoids and sterilization using bubbling corona discharge plasma based systems: A promising terminal water treatment facility for hospital wastewater.

Glucocorticoids (GCs) have drawn great concern due to their widespread contamination in the environment and application in treating patients with COVID-19. Due to the lack of data about GC removal using advanced treatment processes, a novel Paralleling and bubbling corona discharge reactor (PBCD) combined with iron-loaded activated-carbon fibre (Fe-ACF) was addressed in this study to degrade GCs represented by Hydrocortisone (HC) and Betamethasone (BT). The results showed that the PBCD-based system can degrade GCs effectively and can achieve effective sterilization. The removal rates of GCs were ranked as PBCD/Fe-ACF > PBCD/ACF > PBCD. The concentration of E. coli was reduced from 109 to 102 CFU/mL after 60 min of PBCD-based system treatment. The abundance of bacteria in actual Hospital wastewater (HWW) was significantly reduced. Plasma changed the physical and chemical properties of ACF and Fe-ACF by etching axial grooves and enhancing stretching vibrations of surface functional groups, thus promoting adsorption and catalytic degradation. For GC degradation, the functional reactive species were identified as •OH, 1O2, and •O2 radicals. Possible degradation pathways for HC and BT were proposed, which mainly included defluorination, keto acid decarboxylation, demethylation, intramolecular cyclization, cleavage and ester hydrolysis, indicating a reduction in GC toxicity. Since GCs are widely used in patients with COVID-19 and their wastewater needs to be sterilized simultaneously, the intensive and electrically driven PBCD-based system is promising in GC pollution control and sterilization in terminal water treatment facilities.

Enhanced degradation of glucocorticoids, a potential COVID-19 remedy, by co-fermentation of waste activated sludge and animal manure: The role of manure type and degradation mechanism.

Waste activated sludge (WAS) and animal manure are two significant reservoirs of glucocorticoids (GCs) in the environment. However, GC degradation during anaerobic digestion (AD) of WAS or animal manure has rarely been investigated. In this study, co-fermentation of WAS and animal manure was conducted to investigate the performance of AD in controlling GC dissemination. Effects of manure type on GC degradation and sludge acidification were investigated. The results showed that co-fermentation of WAS and chicken manure (CM) significantly enhanced the degradation of hydrocortisone (HC) to 99%, betamethasone (BT) to 99%, fluocinolone acetonide (FA) to 98%, and clobetasol propionate (CP) to 82% in 5 days with a mixing ratio of 1:1 (g TS sludge/g dw manure) at 55 °C and initial pH of 7. Simultaneously, sludge reduction was increased by 30% and value-added volatile fatty acid (VFA) production was improved by 40%. Even a high GC content of biomass (3.6 mg/g TS) did not impact both sludge hydrolysis and acidification. The amendment of WAS with CM increased soluble organic carbon, Ca2+, and relative abundance of anaerobes (Eubacterium) associated with organic compound degradation. Furthermore, 44 transformation products of HC, BT, FA, and CP with lower lipophilicity and toxicity were identified, indicating possible degradation pathways including hydroxylation, ketonization, ring cleavage, defluorination, hydrogenation, methylation, and de-esterification. Overall, this study provides a practical way to control GC pollution and simultaneously promote waste reduction and VFA production. Animal manure type as an overlooked factor for influencing co-fermentation performance and pollutant degradation was also highlighted.