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1.
Trials ; 23(1):784, 2022.
Article in English | PubMed | ID: covidwho-2029733

ABSTRACT

BACKGROUND: Corticosteroids are one of the few drugs that have shown a reduction in mortality in coronavirus disease 2019 (COVID-19). In the RECOVERY trial, the use of dexamethasone reduced 28-day mortality compared to standard care in hospitalized patients with suspected or confirmed COVID-19 requiring supplemental oxygen or invasive mechanical ventilation. Evidence has shown that 30% of COVID-19 patients with mild symptoms at presentation will progress to acute respiratory distress syndrome (ARDS), particularly patients in whom laboratory inflammatory biomarkers associated with COVID-19 disease progression are detected. We postulated that dexamethasone treatment in hospitalized patients with COVID-19 pneumonia without additional oxygen requirements and at risk of progressing to severe disease might lead to a decrease in the development of ARDS and thereby reduce death. METHODS/DESIGN: This is a multicenter, randomized, controlled, parallel, open-label trial testing dexamethasone in 252 adult patients with COVID-19 pneumonia who do not require supplementary oxygen on admission but are at risk factors for the development of ARDS. Risk for the development of ARDS is defined as levels of lactate dehydrogenase > 245 U/L, C-reactive protein > 100 mg/L, and lymphocyte count of < 0.80 × 10(9)/L. Eligible patients will be randomly assigned to receive either dexamethasone or standard of care. Patients in the dexamethasone group will receive a dose of 6 mg once daily during 7 days. The primary outcome is a composite of the development of moderate or more severe ARDS and all-cause mortality during the 30-day period following enrolment. DISCUSSION: If our hypothesis is correct, the results of this study will provide additional insights into the management and progression of this specific subpopulation of patients with COVID-19 pneumonia without additional oxygen requirements and at risk of progressing to severe disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT04836780. Registered on 8 April 2021 as EARLY-DEX COVID-19.

2.
Curr Med Chem ; 2022 Apr 30.
Article in English | MEDLINE | ID: covidwho-2022256

ABSTRACT

The incidence rate of opportunistic secondary infections through invasive fungi has been observed to be 14.5% to 27% in the SARS CoV pandemic during the year 2003. But, the incidence of SARS CoV-2 is accompanied by the substantial rise in secondary opportunistic infections like mucormycosis (black fungus) mainly in the immunocompromised individuals, and diabetic patients taking steroids. Substantial rates of COVID-19 cases with mucormycosis were reported in India and other parts of the world. Previous research reports delineated the ability of Mucorales in invading the various tissues like lungs, brain, sinus through the GRP78 and subsequently this infection could invoke crusting, edema, and necrosis of brain parenchyma, ptosis, proptosis, and vision loss due to intraorbital & intracranial complications. Similarities of these pathophysiological complications with already existing diseases are causing clinicians to face several challenges in order to diagnose and treat this disease effectively at the early stage. This minireview depicts the mucormycosis-induced immune, and pathophysiological alterations in COVID-19 patients comorbid with diabetes, immunosuppression, and also reported the various clinical manifestations, and the therapeutic modalities and the failures of anti-fungal vaccines. Therefore, the emerging mucormycosis in COVID-19 patients need a rapid investigation and selective optimization of the effective therapeutic modalities including antifungal vaccines to minimize mortality rate.

3.
Journal of Pharmacy Technology ; 2022.
Article in English | Web of Science | ID: covidwho-2021145

ABSTRACT

Relevance to Patient Care and Clinical Practice: Corticosteroids are among the most prescribed medications, particularly during the COVID-19 era. The literature has clearly highlighted the dangers of prolonged, high-dose corticosteroid use, which is important for clinicians to consider before treating patients in their clinical practices. Objective: The objective of this article is to review the literature on complications of corticosteroid use, review corticosteroid pharmacokinetics, and provide an updated reference on risks associated with corticosteroid therapy, especially at higher doses. Data Sources: A conventional literature search of PubMed was conducted without restrictions on publication date. Search terms included "corticosteroids," "avascular necrosis," "gastrointestinal bleeding," and "complications." Study Selection and Data Extraction: Pertinent systematic review/meta-analyses and randomized controlled trials were reviewed for study inclusion. Data Synthesis: Corticosteroids were associated with complications including avascular necrosis, gastrointestinal bleeding, myocardial infarction, heart failure, cerebrovascular events, diabetes mellitus, psychiatric syndromes, ophthalmic complications, tuberculosis reactivation, and bacterial sepsis. Increased daily and cumulative doses were associated with increased excess risk of complications. Cumulative doses greater than 430 mg prednisone equivalent were shown to increase the excess risk of avascular necrosis, with progressively higher rates with higher doses. Risk of gastrointestinal bleeding was significantly increased with corticosteroid usage in the in-patient but not out-patient setting. Conclusion: Since corticosteroids have been associated with the aforementioned severe complications and frequent medicolegal malpractice claims, counseling and informed consent should be performed when prescribing moderate-high dosages of corticosteroids. Further research is needed to characterize the long-term effects of corticosteroid usage in COVID-19 patients.

4.
Gut ; 71(Suppl 2):A148, 2022.
Article in English | ProQuest Central | ID: covidwho-2020135

ABSTRACT

BackgroundCoronavirus disease 2019 (COVID-19), which was first reported in Wuhan City, China, is a major public health burden worldwide. Systemic corticosteroid therapy is an effective treatment for severe COVID-19 with ARDS. It ameliorates COVID-19-induced cytokine storm and improves patient outcomes;however, it can trigger immunosuppression, which causes a myriad of secondary infections.MethodsFifteen patients suffering from gastrointestinal complaints during COVID-19 related illness underwent gastroscopic/colonoscopic examination.ResultsWe report 15 cases of gastrointestinal (GI) Cytomegalovirus (CMV) infection diagnosed on biopsy. The mean age at diagnosis was 57 years;13 were males and 2 were females. The most common presentation was bleeding per rectum in 12 patients, dysphagia in 2 patients and abdominal pain in 1 patient. The most common site was the colon seen in 10 patients, 1 patient had Ileo-caecal valve involvement, and 2 each had gastric and esophageal involvement. Among colonic involvement, 2 patients had pan-colonic involvement. Out of 15 patients, 9 patients had either past history of steroid intake or ongoing intake for COVID-19 associated lung injury. Nine patients were diabetic, and 2 were suffering from chronic liver disease.ConclusionsImmunosuppressive state inhibits the activity of crucial transcriptional regulators of proinflammatory genes and reducing lymphocyte levels. Therefore, exposure to systemic corticosteroids can be a risk factor for CMV infection in patients with severe COVID-19.

5.
Archives of Disease in Childhood ; 107(Suppl 2):A330, 2022.
Article in English | ProQuest Central | ID: covidwho-2019891

ABSTRACT

912 Table 1Association of demographic and clinical features with serology status of SARS-CoV-2Results88 pediatric patients up to the age of 18 years attending the pediatric department at AIIMS Patna were enrolled for the study. Only two patients had history of positive RT-PCR test for COVID-19 infection in the past. 63.6% (56 out of 88) had seropositive status against SARS-Cov-2. Various demographic and clinical variables described in table 1 were analysed and none of the demographic features had statistically significant association with serology status of SARS-CoV-2. Out of 88 children, 57 (64.8%) were males and 31(35.2%) were females. 58% of the children were from urban areas and 42% were from rural areas. The majority of the patients i.e 58 (65.9%) belonged to lower socioeconomic class and 30 (34.0%) belonged to upper class according to modified Kuppuswamy scale 2021. The corticosteroid therapy was received by 13 patients for various clinical indications among which 5 (38%) had seropositive status and 8(61.5%) had seronegative status against SARS-CoV-2 and the association was statistically significant with p-value of 0.041and Odd’s ratio ( 95% CI) of 0.29 (0.087-0.994) suggesting that patients who received corticosteroid therapy had 29% lesser chances of getting seropositive status compared to those who did not receive the therapy.ConclusionAmong the participants, 63.6% were seropositive against SARS-CoV-2 while only 2.2% had history of COVID 19 RTPCR positivity in past. The patients who received corticosteroids had lesser chances of getting positive antibody status against SARS-CoV-2 infection compared to those who did not receive the same.

6.
Archives of Disease in Childhood ; 107(Suppl 2):A127-A128, 2022.
Article in English | ProQuest Central | ID: covidwho-2019855

ABSTRACT

AimsWe aimed to improve the management of bronchiolitis in a tertiary Paediatrics centre according to NICE and Trust guidance, to reduce unnecessary investigation [NK1] and inappropriate use of oxygen and antibiotic therapies.[NK1] Could cut out CXR part to save words and would put oxygen in as that was a key elementMethodsData was collected over two ‘Plan, Do, Study, Act’ cycles from cases admitted under the General Paediatrics team at the Evelina London Children’s Hospital with a diagnosis of bronchiolitis. For cycle one, cases were admitted between October and November 2019, and for cycle two between September and October 2021. Electronic care records were consulted to compare the management against Trust guidance on bronchiolitis, as well as NICE guideline NG9 in the domains of investigation, oxygen therapy and respiratory support, and medications.The findings of cycle one were presented to the General Paediatrics team and a series of improvement bundles were produced based on identified areas for improvement. Cycle two began at the start of the first true bronchiolitis season following the disruption of viral transmission by public health measures during the COVID-19 pandemic. Considering the findings of cycle two, the bundles were amended and re-presented to the team. The Trust guideline was also amended to reflect the recommendations.ResultsAt baseline (n=28), 29% of patients had a capillary blood gas performed, of which only 37% were indicated, and 61% had a chest x-ray, of which 50% were indicated. Where oxygen therapy was indicated, it was given in 100% of cases, but oxygen was unnecessarily given in 50% of cases according to NICE guidance and 57% according to Trust policy. Hypertonic saline and nebulised adrenaline were correctly not given in any cases. However, 53% were given antibiotics, 18% salbutamol, 21% ipratropium bromide and 7% systemic or inhaled corticosteroids, all of which are not indicated in either NICE or Trust guidance.In cycle two (n=11), the proportion of patients who had blood gas analysis had increased to 55%, with only 17% being indicated, however the rate of chest x-rays improved to 27%, with 33% being indicated. Again 100% of children received oxygen when indicated by oxygen saturations being persistently less than 90%, and a reduction of 12% in the inappropriate use of oxygen was seen (from 57% to 45%). As in cycle one, neither hypertonic saline nor nebulised adrenaline were used. There were improvements in the use of inappropriate antibiotics from 53% to 18%, and ipratropium bromide from 21% to 9%. However, Salbutamol use increased from 18% to 27% and corticosteroids from 7% to 9%.In both cycles, where high-flow nasal oxygen was used this was clinically indicated in 100% of cases. In cycle one, 61% required high-flow nasal oxygen compared with 36% in cycle two.ConclusionBy implementing improvement bundles and drawing clinician’s attention to areas where unnecessary actions have been taken, inappropriate radiation exposure was reduced and antimicrobial stewardship improved. While oxygen therapy is routinely given when indicated, further work will aim to reduce its use where it is not needed.

7.
Intern Med J ; 2022.
Article in English | Web of Science | ID: covidwho-2019328

ABSTRACT

BACKGROUND: Suspected organising pneumonia (OP) is a common finding in patients with severe coronavirus disease 2019 (COVID-19), but the impact on outcomes of the radiological patterns of diffuse parenchymal lung disease on outcome of these patients is still uncertain. AIMS: Investigate the presence of radiological images compatible with OP and its association with clinical outcomes in patients with COVID-19 submitted to invasive mechanical ventilation (IMV). METHODS: Retrospective, unicentric cohort study composed of patients who required IMV and underwent chest computerized tomography to investigate secondary complications of COVID-19. We compared patients with radiological findings characteristic of suspected OP with those without this condition. The main outcome was hospital mortality. RESULTS: Two hundred and ten patients were included, and 65 had signals compatible with OP. All patients with suspected OP were treated with corticosteroids. There was no difference in IVM-free days until day 28 between the groups (median, 0 days;interquartile range [IQR], 0-14.8) in the group with suspected OP vs 0 days (IQR, 0-11) in the group without suspected OP (P = 0.14). In univariate analysis, the presence of suspected OP was associated with lower hospital mortality;however, after correction for potential confounding variables, it was not associated with the outcome, even after matching by propensity score in patients without this condition. CONCLUSION: OP radiologic pattern in patients with severe COVID-19 is not associated with worse outcomes.

8.
Respirol Case Rep ; 10(9): e01010, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2013740

ABSTRACT

Disseminated primary varicella infection can carry risks of significant morbidity and mortality particularly in immunocompromised populations. Routine, funded childhood vaccination against varicella has significantly reduced associated hospitalization and deaths, however, uptake and efficacy among adults is unknown. We present a case of disseminated primary varicella infection (including rash, pneumonitis, hepatitis and thrombocytopenia) in an immunocompetent patient on long term inhaled corticosteroids for asthma. This case highlights potential risk factors for severe varicella which require further study in adults and raises the need to discuss vaccination in at risk groups including appropriate counselling in those who may be at higher risk.

9.
Open Life Sciences ; 17(1):917-937, 2022.
Article in English | Web of Science | ID: covidwho-2005772

ABSTRACT

Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.

10.
Journal of Infection and Chemotherapy ; 2022.
Article in English | ScienceDirect | ID: covidwho-2004230

ABSTRACT

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first broke out in Wuhan in December 2019, and has since caused a global pandemic. The efficacy of several drugs has been evaluated, and it is now evident that tocilizumab has a beneficial effect, especially combined with corticosteroids, in patients with Coronavirus Disease 2019 (COVID-19). However, the optimal timing of tocilizumab administration has not yet been established. The goal of the present study was to determine the optimal timing of tocilizumab administration after starting corticosteroid therapy in patients with COVID-19. Methods We retrospectively analyzed the clinical characteristics of patients who were hospitalized for COVID-19 and treated with tocilizumab and corticosteroids in our hospital. The patients were divided into concurrent and sequential groups. The concurrent group received tocilizumab ≤ 24 hours after corticosteroids, and the sequential group received tocilizumab > 24 hours after corticosteroid administration. Results The baseline clinical characteristics of tocilizumab administration were similar between the two groups. White blood cell counts were significantly lower and C-reactive protein levels were significantly higher in the concurrent group than the sequential group. In the concurrent group, tocilizumab administration led to a significant decrease in maximum body temperature. In addition, there were significantly more oxygen-free days in the concurrent group than in the sequential group. However, survival rate was not significantly different between the concurrent and the sequential groups. Conclusions In the combination therapy with tocilizumab and corticosteroids, early administration of tocilizumab after starting corticosteroid treatment is effective when treating COVID-19.

11.
RADS Journal of Biological Research & Applied Sciences ; 13(1):83-122, 2022.
Article in English | CAB Abstracts | ID: covidwho-2002888

ABSTRACT

Background: COVID-19 is a global pandemic initiated in January 2020 that caused 79 million cases and more than 1.7 million deaths worldwide. The causative agent of COVID-19 is Severe Acute Respiratory Syndrome Coronavirus-2, a member of Betacoronvirus. COVID-19 patients are classified into asymptomatic, mild symptomatic, and severe symptomatic cases. Objectives: To review the prevalence, therapeutic interventions for the treatment, vaccination, and containment of COVID-19 in four quarters of 2020, emphasizing the advancements in biological studies, and the social, economic, and environmental impact of the pandemic. Methodology: Data of COVID-19 spread, identification, prevention, and control measures was analyzed. The impacts of pandemic on society, economy, and the environment were assessed.

12.
J Asthma Allergy ; 15: 811-825, 2022.
Article in English | MEDLINE | ID: covidwho-1997372

ABSTRACT

Purpose: There has been concern that asthma and chronic obstructive pulmonary disease [COPD] increase the risk of developing and exacerbating COVID-19. The effect of medications such as inhaled corticosteroids (ICS) and biologics on COVID-19 is unclear. This systematic literature review analyzed the published evidence on epidemiology and the burden of illness of asthma and COPD, and the use of baseline medicines among COVID-19 populations. Patients and Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE® and Cochrane were searched (January 2019-August 2021). The prevalence of asthma or COPD among COVID-19 populations was compared to the country-specific populations. Odds ratios (ORs) were estimated to compare healthcare resource utilization (HCRU) rates, and meta-analyses of outcomes were estimated from age-adjusted ORs (aORs) or hazard ratios (aHRs). Meta-analyses of COVID-19 outcomes were conducted using random effects models for binary outcomes. Results: Given the number and heterogeneity of studies, only 183 high-quality studies were analyzed, which reported hospitalization, intensive care unit (ICU) admissions, ventilation/intubation, or mortality. Asthma patients were not at increased risk for COVID-19-related hospitalization (OR = 1.05, 95% CI: 0.92 to 1.20), ICU admission (OR = 1.21, 95% CI: 0.99 to 1.1.48), ventilation/intubation (OR = 1.24, 95% CI: 0.95 to 1.62), or mortality (OR = 0.85, 95% CI: 0.75 to 0.96). Accounting for confounding variables, COPD patients were at higher risk of hospitalization (aOR = 1.45, 95% CI: 1.30 to 1.61), ICU admission (aOR = 1.28, 95% CI: 1.08 to 1.51), and mortality (aOR = 1.41, 95% CI: 1.37 to 1.65). Sixty-five studies reported outcomes associated with ICS or biologic use. There was limited evidence that ICS or biologics significantly impacted the risk of SARS-CoV-2 infection, HCRU, or mortality in asthma or COPD patients. Conclusion: In high-quality studies included, patients with asthma were not at significantly higher odds for adverse COVID-19-related outcomes, while patients with COPD were at higher odds. There was no clear evidence that baseline medication affected outcomes. Registration: PROSPERO (CRD42021233963).

13.
Steroids ; : 109102, 2022.
Article in English | ScienceDirect | ID: covidwho-1996573

ABSTRACT

Several drugs and antibodies have been repurposed to treat COVID-19. Since the outcome of the drugs and antibodies clinical studies have been mostly inconclusive or with lesser effects, therefore the need for alternative treatments has become unavoidable. However, corticosteroids, which have a history of therapeutic efficacy against coronaviruses (SARS and MERS), might emerge into one of the pandemic's heroic characters. Corticosteroids serve an immunomodulatory function in the post-viral hyper-inflammatory condition (the cytokine storm, or release syndrome), suppressing the excessive immunological response and preventing multi-organ failure and death. Therefore, corticosteroids have been used to treat COVID-19 patients for more than last two year. According to recent clinical trials and the results of observational studies, corticosteroids can be administered to patients with severe and critical COVID-19 symptoms with a favorable risk-benefit ratio. Corticosteroids like Hydrocortisone, dexamethasone, Prednisolone and Methylprednisolone has been reported to be effective against SARS-CoV-2 virus in comparison to that of non-steroid drugs, by using non-genomic and genomic effects to prevent and reduce inflammation in tissues and the circulation. Clinical trials also show that inhaled budesonide (a synthetic corticosteroid) increases time to recovery and has the potential to reduce hospitalizations or fatalities in persons with COVID-19. There is also a brief overview of the industrial preparation of common glucocorticoids.

14.
J Postgrad Med ; 2022 Aug 16.
Article in English | MEDLINE | ID: covidwho-1994306

ABSTRACT

Transverse myelitis (TM) has been reported in association with various vaccinations. Herein we describe a case of longitudinally extensive transverse myelitis (LETM) associated with vaccination with ChAdOx1 nCoV-19 (COVISHIELD) vaccine. A 59-year-old woman with no prior co-morbidities presented with lower extremity numbness, weakness, acute urinary retention, and constipation. Numbness gradually extended up to the lower costal margin with band like sensation. She had received the vaccine 5 days prior to the onset of the symptoms. Extensive diagnostic evaluation effectively ruled out causes other than vaccination-associated transverse myelitis. Following treatment with intravenous methylprednisolone, the patient made a significant recovery. TM may be associated with vaccination against the novel ChAdOx1 nCoV-19 vaccine and we believe this to be the first report from India of LETM associated with this vaccine.

15.
Ann Otol Rhinol Laryngol ; : 34894221118186, 2022 Aug 12.
Article in English | MEDLINE | ID: covidwho-1993186

ABSTRACT

BACKGROUND: Anosmia and hyposmia significantly affect patients' quality of life and have many etiologies, including trauma, inflammatory conditions including chronic rhinosinusitis, neoplasm, and viral infections, such as rhinovirus and SARS-CoV-2. OBJECTIVE: Our purpose was to establish whether a consensus exists regarding optimal management of olfactory dysfunction and to provide insight into the treatment of anosmia in the current climate of increased prevalence secondary to COVID-19. Thus, we aimed to systematically review the literature on the management of non-Chronic-rhinosinusitis- related anosmia/hyposmia. METHODS: PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990 using terms combined with Medical Subject Headings (MeSH). We included articles evaluating management of anosmia and hyposmia written in the English language, with original data, a minimum of 3 months of follow-up except for COVID-related studies, at least 2 patients, and well-defined and measurable outcomes. RESULTS: A total of 3013 unique titles were returned upon the initial search. Of these, 297 abstracts were examined, yielding 19 full texts meeting inclusion criteria (8 with level 1 evidence, 3 with level 2, 1 with level 3, and 7 with level 4). The studies included a total of 1522 subjects, with follow up ranging from 3 to 72 months, with an exception for COVID related studies. Endpoints were based on clinically significant improvements of olfactory functions as measured through validated smell tests. Treatments with the most robust data were intranasal corticosteroids and olfactory training. CONCLUSION: The literature on the treatment of anosmia and hyposmia includes randomized trials showing the efficacy of a few modalities. While further research is needed to expand therapeutic options for this debilitating condition, the current literature supports the use of olfactory training and topical corticosteroids.

16.
Rev Med Virol ; : e2386, 2022 Aug 15.
Article in English | MEDLINE | ID: covidwho-1990539

ABSTRACT

The effect of corticosteroid therapy is still controversial on prevention of mortality in coronavirus disease-2019 (COVID-19). The objective of this study is to investigate the effect of corticosteroids on mortality. This systematic review was performed as per preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was performed at different databases namely Medline/PubMed, Cochrane and Google scholar on 10 February 2022. A pooled estimate for effect of corticosteroid therapy on mortality was calculated as outcome of study. Risk bias analysis and Newcastle Ottawa Scale were used to assess the quality of randomized control trial (RCT) and cohort studies, respectively. Cochran's Q test and the I2 statistic were conducted for heterogeneity and accordingly study model was applied. A total 43 studies were included, having sample size of 96,852 patients. Amongst them, 19,426 and 77,426 patients received corticosteroid therapy (intervention group) or standard treatment without corticosteroid (control group), respectively. Mortality observed in the intervention and control group was 14.2% (2749) and 7.1% (5459), respectively. The pooled estimate 2.173 (95% CI: 2.0690-2.2820) showed significantly increased mortality in intervention as compared to control. The pooled estimate of methyprednisolone 1.206 (95% CI: 1.0770-1.3500) showed significantly increased mortality while the pooled estimate of dexamethasone 1.040 (95% CI: 0.9459-1.1440) showed insignificantly increased mortality as compared to control. 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 infections due to corticosteroids initiated at high dose in the early stage of infection.

17.
Revista cientifica estudiantil ; 5(1), 2022.
Article in English | CAB Abstracts | ID: covidwho-1990011
18.
Front Public Health ; 10: 847695, 2022.
Article in English | MEDLINE | ID: covidwho-1987560

ABSTRACT

Background: During the ongoing coronavirus disease 2019 (COVID-19) pandemic, the use of corticosteroids for COVID-19 has ignited worldwide debate. Previous systematic reviews, including randomized controlled trials (RCTs) and retrospective observational studies, found that corticosteroids have beneficial effects in treating COVID-19. Aim: This systematic review and meta-analysis only included RCTs to assess the effectiveness and safety of corticosteroids in hospitalized patients with COVID-19. Methods: Comprehensive research strategies (PubMed, Embase, MEDLINE, and Coherence Library) were used to search for RCTs from December 2019 to January 2021. Results: Five RCTs were included with 7,235 patients, of which 2,508 patients were receiving corticosteroid treatments (dexamethasone or methylprednisolone), and 4,727 received standard care. The primary outcome was mortality within 28 days. The use of corticosteroids decreased the 28-day mortality of patients with COVID-19, but the findings were not statistically significant (RR, 0.91; 95% CI, 0.78-1.06, p = 0.24). The secondary outcome was the duration of hospitalization; no differences were found between the corticosteroid and standard care groups. However, corticosteroids were associated with a higher hospital discharge rate than standard treatment, but the result was not statistically significant (RR, 1.36; 95% CI, 0.95-1.96, p = 0.09). Conclusions: The results suggest that corticosteroids are comparable to standard care in terms of safety in treating COVID-19. Corticosteroids showed greater efficacy than standard care; however, the effect was minimal.


Subject(s)
COVID-19 , Adrenal Cortex Hormones/therapeutic use , COVID-19/drug therapy , Humans , Methylprednisolone/therapeutic use , Pandemics
19.
Curr Pediatr Rev ; 2022 Aug 10.
Article in English | MEDLINE | ID: covidwho-1987293

ABSTRACT

BACKGROUND: Viral bronchiolitis is a common condition and a leading cause of hospitalization in young children. OBJECTIVE: This article provides readers with an update on the evaluation, diagnosis, and treatment of viral bronchiolitis, primarily due to RSV Methods: A PubMed search was conducted in December 2021 in Clinical Queries using the key terms "acute bronchiolitis" OR "respiratory syncytial virus infection". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to children and English literature. The information retrieved from the above search was used in the compilation of this article. RESULTS: Respiratory syncytial virus (RSV) bronchiolitis is the most common viral bronchiolitis in young children. Other viruses such as human rhinovirus and coronavirus could be etiological agents. Diagnosis is based on clinical manifestation. Viral testing is useful only for cohort and quarantine purposes. Cochrane evidence-based reviews have been performed on most treatment modalities for RSV and various viral bronchiolitis. Treatment for viral bronchiolitis is mainly symptomatic support. Beta-agonists are frequently used despite the lack of evidence that they reduce hospital admissions or length of stay. Nebulized racemic epinephrine, hypertonic saline and corticosteroids are generally not effective. Passive immunoprophylaxis with a monoclonal antibody against RSV, when given intramuscularly and monthly during winter, is effective in preventing severe RSV bronchiolitis in high-risk children who are born prematurely and in children under 2 years with chronic lung disease or hemodynamically significant congenital heart disease. Vaccines for RSV bronchiolitis are being developed. Children with viral bronchiolitis in early life are at increased risk of developing asthma later in childhood Conclusions: Viral bronchiolitis is common. No current pharmacologic treatment or novel therapy has been proven to improve outcomes comparing to supportive treatment. Viral bronchiolitis in early life predisposes asthma development later in childhood.

20.
J Pers Med ; 11(11)2021 Oct 25.
Article in English | MEDLINE | ID: covidwho-1979292

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic, related to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial burden in public health due to an enormous increase in hospitalizations for pneumonia with the multiorgan disease. Treatment for individuals with COVID-19 includes best practices for supportive management of acute hypoxic respiratory failure. Emerging data indicate that dexamethasone therapy reduces 28-day mortality in patients requiring supplemental oxygen compared with usual care, and ongoing trials are testing the efficacy of antiviral therapies, immune modulators and anticoagulants in the prevention of disease progression and complications, while monoclonal antibodies and hyperimmune globulin may provide additional preventive strategies. Consensus suggestions can standardize care, thereby improving outcomes and facilitating future research. This review discusses current evidence regarding the pharmacotherapy of COVID-19.

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