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2.
Respir Res ; 23(1): 105, 2022 Apr 29.
Article in English | MEDLINE | ID: covidwho-1875011

ABSTRACT

BACKGROUND: Quantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19. METHODS: Between February 7 and February 17, 2020, 72 patients with severe COVID-19 were retrospectively enrolled. All 300 chest CT scans from these patients were collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3-7 days); Stage 3 (8-14 days); Stage 4 (15-21 days); and Stage 5 (22-31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, - 500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders. RESULTS: Of 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (- 3.27% [95% CI, - 5.86 to - 0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group. CONCLUSIONS: Steroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247.


Subject(s)
COVID-19 , COVID-19/drug therapy , Humans , Lung/diagnostic imaging , Lung Volume Measurements/methods , Retrospective Studies , Steroids/therapeutic use
3.
Perm J ; 26(1): 106-118, 2022 04 05.
Article in English | MEDLINE | ID: covidwho-1863293

ABSTRACT

Pulse steroids therapy is widely used to treat flare-ups of autoimmune diseases, such as systemic lupus erythematosus. The main assumption is that severe inflammation caused by an autoimmune disease must be aggressively quelled before it causes further damage. We present a series of 9 cases that explore the use of high-dose pulse steroids in hypoxemic respiratory failure. We used high-dose steroids to alter the outcome of some patients, using commonly accepted protocols such as 6 mg of dexamethasone via IV, baricitinib, and tocilizumab. The outcome of each case is discussed. The patients were treated with 500 mg of high-dose methylprednisolone via IV for 3 days, followed by 250 mg via IV for 3 days; followed by 12 or 6 mg of dexamethasone was administered daily by mouth or IV. A retrospective review of patients who received a computerized tomography pulmonary angiogram showed that these patients had organizing pneumonia features. Eight out of nine cases had a favorable outcome.


Subject(s)
COVID-19 , Pneumonia , Respiratory Insufficiency , COVID-19/complications , COVID-19/drug therapy , Dexamethasone/therapeutic use , Humans , Respiratory Insufficiency/drug therapy , Respiratory Insufficiency/etiology , SARS-CoV-2 , Steroids
5.
Eur J Neurol ; 29(3): 947-949, 2022 03.
Article in English | MEDLINE | ID: covidwho-1853743

ABSTRACT

BACKGROUND: Spontaneous intracranial hypotension (SIH) is a syndrome characterized by low cerebrospinal fluid (CSF) pressure and postural headaches, and affects 1 per 20,000 individuals every year. CASE REPORT: We report an otherwise healthy 38-year-old man admitted to the hospital with orthostatic headache that developed 48 h after a short-haul flight during which he sustained a neck injury due to turbulence. Neurological examination, blood analysis and computed tomography scan performed at the emergency service were normal. Brain and spine magnetic resonance imaging (MRI) showed diffuse pachymeningeal enhancement and contrast medium egress from the subarachnoid space into the epidural space at the level of C2. The patient was treated with bed rest, hydration and 1 mg/kg/day oral prednisone for 5 days, with a gradual withdrawal in the following 7 days. Complete symptomatic relief was observed after 16 days, with resolution of the pathological findings on brain and spinal MRI after 1 month, except for localized pachymeningeal enhancement. Clinical relief was maintained over time until last follow-up visit 9 months later. CONCLUSION: Successful conservative treatment barely exceeds one quarter of cases of SIH. The clinical benefits of steroids may result from several mechanisms of action, for example, improving brain oedema and inflammation, determining fluid retention, and facilitating reabsorption of the CSF from extradural space. Notwithstanding that epidural blood patch remains the most successful treatment for SIH, future studies should explore the effectiveness of steroids as first-line therapy in addition to the most commonly suggested measures of bed rest and hydration.


Subject(s)
Intracranial Hypotension , Adult , Blood Patch, Epidural/methods , Headache/therapy , Humans , Intracranial Hypotension/diagnostic imaging , Intracranial Hypotension/drug therapy , Magnetic Resonance Imaging , Male , Steroids
7.
Acta Biomed ; 93(2): e2022156, 2022 05 11.
Article in English | MEDLINE | ID: covidwho-1848005

ABSTRACT

Background and aim Recurrent wheezing is often triggered by viral respiratory infections. The aims of our study were: i) to evaluate whether the addition of a nutraceutical (Leucodif®), could improve the efficacy of montelukast or inhaled steroids (ICS) compared to the single treatment; ii) to verify whether a treatment is more effective than another. Our study was biased by the COVID-19 pandemic, which resulted in a lockdown of almost two months in Italy. Methods The multicenter, open-label study enrolled 84 children aged 2-6 years diagnosed with recurrent wheezing and randomized them into four treatment arms for three months: ICS treatment; ii) montelukast; iii) montelukast + Leucodif; iv) ICS + Leucodif. Children were assessed at baseline and after one, two, and three months of treatment using the TRACK score for both the caregiver and the physician. Results Out of the 84 patients, 18 patients received ICS therapy, 22 patients ICS + Leucodif, 24 patients montelukast, and 20 patients montelukast + Leucodif. All four treatments resulted in a significant reduction in symptoms with no differences among the various groups. Conclusions Our study demonstrates that montelukast therapy appears to be equally effective as ICS therapy and that the addition of the nutraceutical Leucodif does not appear to improve the treatment outcome. However, in our opinion our study was strongly influenced and biased by the lockdown due to the COVID-19 pandemic, which inherently resulted in reduced exposure to the viruses that commonly cause respiratory infections in children.


Subject(s)
Anti-Asthmatic Agents , Asthma , COVID-19 , Acetates , Administration, Inhalation , Anti-Asthmatic Agents/adverse effects , Asthma/drug therapy , Child , Communicable Disease Control , Cyclopropanes , Dietary Supplements , Humans , Pandemics , Quinolines , Respiratory Sounds , Steroids/therapeutic use , Sulfides
8.
Rev Esp Quimioter ; 35 Suppl 1: 54-58, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1836619

ABSTRACT

Critically ill patients with COVID-19 face a higher risk of disease progression and complications. The current standard of care includes supportive care measures and fluid management. The Recovery trial observed a reduction in all-cause, 28-day mortality (p<0.001) when patients with COVID-19 requiring oxygen therapy received 6 mg of dexamethasone per day for 10 days. In contrast, in patients not requiring oxygen, no benefit was observed: 28-day mortality rates for the dexamethasone and routine care groups were 17.8% and 14%, respectively. To corroborate these results, the World Health Organization (WHO) performed a meta-analysis. The study showed that the use of systemic corticosteroids compared with routine care placebo was associated with a decrease in all-cause, 28-day mortality. With respect to the effectiveness of remdesivir, the ACTT-1 trial found that the drug conferred a benefit on time to clinical improvement. The subgroup analysis in the clinical trial also showed a benefit per mortality in patients requiring supplemental oxygen, albeit not those in need of mechanical ventilation.


Subject(s)
COVID-19 , Pneumonia , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Dexamethasone/therapeutic use , Humans , Oxygen/therapeutic use , Pneumonia/drug therapy , SARS-CoV-2 , Steroids/therapeutic use
9.
Probl Endokrinol (Mosk) ; 68(2): 56-65, 2022 02 22.
Article in Russian | MEDLINE | ID: covidwho-1835984

ABSTRACT

BACKGROUND: There is a lack of data on the features of dysglycemia in hospitalized patients with COVID-19 and concomitant diabetes mellitus (DM) confirmed by continuous glucose monitoring (CGM). AIM: to study the glycemic profile in hospitalized patients with COVID-19 and type 2 diabetes mellitus by continuous glucose monitoring and the role of steroid therapy in dysglycemiadevelopment. MATERIALS AND METHODS: We examined 21 patients with COVID-19 and DM 2 and 21 patients with DM 2 without COVID-19 (control group) using a professional 4-7-day CGM. We also compared two subgroups of patients with COVID-19 and DM 2: 1) patients received systemic glucocorticosteroids (GCS) during CGM and 2) patients in whomCGMwas performed after discontinuation of GCS. RESULTS: Compared with controls, patients with COVID-19 and DM2 had lesser values of glycemic «time in range¼ (32.7 ± 20.40 vs 48.0 ± 15.60%, p = 0.026) andhigher parameters of mean glycemia (p <0.05) but similar proportion of patients with episodes of hypoglycemia (33.3% vs 38.1%, p = 0.75). Patients who received dexamethasone during CGM were characterized by higher hyperglycemia and the absence of episodes of hypoglycemia. In patients who hadCGM after dexamethasone discontinuation, hyperglycemia was less pronounced, but 60% of them had episodes of hypoglycemia, often nocturnal, clinically significant and not detected by routine methods. CONCLUSION: Patients with COVID-19 and DM 2had severe and persistent hyperglycemia but a third of them hadalso episodes of hypoglycemia. During therapy with dexamethasone, they had the most pronounced hyperglycemia without episodes of hypoglycemia. In patients who underwent CGM after discontinuation of dexamethasone, hyperglycemia was less pronounced but 60% of them have episodes of hypoglycemia, often nocturnal, clinically significant and not diagnosed by routine methods. It would be advisable to recommend at least a 5-6-fold study of the blood glucose level (with its obligatory assessment at night) even for stable patients with COVID-19 and DM 2after the end of GCS treatment.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Hyperglycemia , Hypoglycemia , Blood Glucose , Blood Glucose Self-Monitoring , COVID-19/complications , COVID-19/drug therapy , Dexamethasone/adverse effects , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Humans , Hyperglycemia/drug therapy , Hypoglycemia/chemically induced , Steroids
10.
Indian J Ophthalmol ; 70(5): 1815-1816, 2022 05.
Article in English | MEDLINE | ID: covidwho-1835159

ABSTRACT

We present a rare case of COVID-19 associated conjunctivitis where patient presented with redness, foreign body sensation, watering, and pain. Symptoms started while patient was COVID-19 positive. On examination, severe conjunctival congestion was present along with follicles. Visual acuity was 6/6 in both eyes. The patient was started on topical antibiotics and showed improvement but again presented with aggravated symptoms. Conjunctival swab was sent for culture and sensitivity, which was negative for any organisms. The patient was then started on oral and topical steroid, which showed improvement. Even though COVID-19 associated conjunctivitis is self-limiting, here it showed a progressive course and resolved only after steroid.


Subject(s)
COVID-19 , Conjunctivitis , Anti-Bacterial Agents/therapeutic use , Conjunctivitis/diagnosis , Conjunctivitis/drug therapy , Conjunctivitis/etiology , Humans , Steroids , Visual Acuity
11.
Indian J Ophthalmol ; 70(5): 1817-1818, 2022 05.
Article in English | MEDLINE | ID: covidwho-1835133

ABSTRACT

A 28-year-old female who underwent an uneventful femtosecond laser enabled keratoplasty (FLEK) in her left eye presented with pain, redness, and blurring of vision in the operated eye two weeks after getting immunized with COVID-19 vector vaccine (ChAdOx1 nCoV19 Vaccine Recombinant COVISHIELD, AstraZeneca). Slit-lamp examination showed donor stromal edema with Descemet's membrane folds and Khodadoust line (KP's on endothelium) with anterior chamber cells and flare. The patient was diagnosed with acute corneal graft rejection and advised hourly topical steroids with cycloplegics and oral steroids. The patient responded to treatment and there was progressive reversal of graft rejection with the patient achieving best spectacle-corrected visual acuity (BSCVA) of 20/30 after five weeks of treatment. Our case highlights possible immune corneal graft rejection after COVID19 vaccination and the need to step up topical steroids before vaccination.


Subject(s)
COVID-19 , Corneal Diseases , Corneal Transplantation , Adult , COVID-19 Vaccines/adverse effects , Corneal Diseases/surgery , Corneal Transplantation/adverse effects , Endothelium , Female , Graft Rejection/diagnosis , Humans , Immunization , Postoperative Complications , Steroids , Vaccination , Visual Acuity
12.
Turk J Ophthalmol ; 52(2): 139-141, 2022 04 28.
Article in English | MEDLINE | ID: covidwho-1818499

ABSTRACT

A 61-year-old woman presented to our clinic with complaints of decreased visual acuity, pain, and redness in her left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and counting fingers at 3 meters in the left eye. On slit-lamp examination, 1+ cells were detected in the anterior chamber. Fundus examination revealed 1+ haze in the vitreous and multiple creamy-whitish lesions in the retina and vitreous. Her history included a diagnosis of coronavirus disease 2019 (COVID-19) one month earlier, for which she was hospitalized in the intensive care unit for 20 days and received systemic corticosteroid treatment. Vitreous culture yielded Candida albicans. The patient's nasopharyngeal swab sample was positive for COVID-19 by reverse transcription polymerase chain reaction test. BCVA was improved to 20/40 after amphotericin therapy (via intravitreal injection and intravenous routes), and the vitritis and chorioretinitis lesion regressed after 2 weeks of treatment. Two weeks later, intravenous amphotericin was discontinued and oral fluconazole treatment was started at a dose of 400 mg/day. At 3-month follow-up, her BCVA was 20/25 and no inflammatory reaction was observed in the anterior chamber and vitreous.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Amphotericin B/therapeutic use , Critical Care , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Female , Humans , Middle Aged , Steroids
13.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801631

ABSTRACT

Mucormycosis (Zygomycosis) is a rare and lethal invasive fungal infection, often acute and extremely severe caused by opportunist and ubiquitous fungi belonging to the class Phygomycetes, subclass Zygomycetes, order Mucorales, family Mucoraceae. India has reported surge in cases of post COVID 19 Mucormycosis over the past few months due to the increasing frequency of risk factors like corticosteroid therapy, uncontrolled diabetes, DKA, neutropenia and iron overload. Patients with a history of COVID-19 infection are at increased risk of developing fungal infections like Mucormycosis. The emergence of COVID-19 associated mucormycosis (CAM) across several nations, particularly India, warrants a detailed study to identify potential contributing factors. MATERIAL: This cross sectional study conducted at Bowring and Lady Curzon Hospital, Bangalore, involving 75 subjects diagnosed with CAM either clinically, radiological or microbiologically. The objective was to study the clinical profile of patients with COVID associated Mucormycosis and to correlate the levels of Serum ferritin and iron profile with severity and extent of disease in COVID associated Mucormycosis patients Data was collected on demographic details, co morbidities, vaccination status, history of treatment with remedesvir, oxygen therapy or steroid use, complications of past COVID 19 infection and stage of current Mucormycosis infection. Clinical outcome of the patients measured based on Iron profile, length of hospital stay, need for ICU admission, presence of diabetic ketoacidosis and mortality. The blood investigations which included were CBC with differential leukocyte count, qCRP, FBS, PPBS, HbA1c serum iron studies and serum ferritin. OBSERVATION: The mean age of the subjects was 48.19 with 52 males, 23 females. Among 75 patients with CAM, 90.7% were unvaccinated against COVID-19, 62.7% had oxygen usage and steroid therapy, 44% had use of remedesvir. Most common co morbidity was diabetes mellitus 60% with 20% of patients having DKA. Rhino orbital-cerebral mucormycosis(Stage 4- 44.6%) was the most common clinical presentation. The mean serum iron (50.37) and TIBC (255.37) were significantly higher in Stage 4 CAM cases compared with less invasive stage 2 CAM cases. Patients with Stage 4 CAM had elevated levels of inflammatory markers LDH (292) DDimer (457) CRP(74.64). Case fatality rates of CAM was 12%. CONCLUSION: The results of this study revealed significant correlation between the clinical severity of CAM and higher mortality, increased serum iron levels and inflammatory markers in this population of patients. Therefore, patients with elevated levels of available serum iron are uniquely susceptible to mucormycosis infection, suggesting dysregulated iron metabolism in its pathogenesis.


Subject(s)
COVID-19 , Diabetic Ketoacidosis , Mucormycosis , Cross-Sectional Studies , Diabetic Ketoacidosis/complications , Female , Ferritins , Humans , India/epidemiology , Iron , Male , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Oxygen/therapeutic use , Steroids/therapeutic use
14.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801479

ABSTRACT

The progression of the severity of COVID-19 caused by the SARS-Cov-2 virus is through an exaggerated host immune response called the cytokine storm. Corticosteroids can reduce this storm through their anti-inflammatory action, thus preventing lung damage. However the efficacy and side effect profile of the two commonly used corticosteroids- dexamethasone and methylprednisolone against COVID-19 have to be compared, to enable the selection of the appropriate drug with better outcomes. Thus the objective was to compare the efficacy of adjuvant parenteral methylprednisolone and dexamethasone in reducing COVID-19 disease severity and mortality among the moderate to critical patients. MATERIAL: A retrospective comparative study was done among 162 adult patients who were COVID-19 RTPCR positive with moderate or severe illness, among whom 100 patients had received parenteral dexamethasone and 62 patients had received parenteral methylprednisolone. The radiological changes, inflammatory markers and outcomes -duration of hospital stay, rate of discharges, deaths improvement in oxygen requirement, blood glucose post steroids were compared between the two groups. The same parameters were compared for duration of either steroid of less than five days and more than five days respectively. OBSERVATION: Both corticosteroids had a significant improvement in the inflammatory markers of serum LDH, D-Dimer and CRP (p<0.001) with a significant improvement in D-Dimer levels in the methylprednisolone group compared to the dexamethasone group (p =0.04). Methylprednisolone was found to have significant improvement in the oxygen requirement (p=0.01), disease severity (p= 0.015) and radiological changes (p=0.002) compared to dexamethasone. Both corticosteroids were associated with an increase in blood glucose levels post treatment, but no significant difference in the glucose levels between the two groups (p=0.469). No significant difference was seen in the outcomes on comparing the duration of steroids of either group for less than five days with a duration of more than five days. CONCLUSION: Parenteral Methylprednisolone is associated with a better improvement in the severity of moderate and severe COVID-19 compared to dexamethasone. Both steroids cause a similar increase in blood glucose levels, indicating that either steroid holds the risk of hyperglycemia and its potential complications. A longer duration of steroids is not associated with a significant difference in outcome compared to shorter duration of steroids, it also has a hyperglycemia risk similar to the latter.


Subject(s)
COVID-19 , Hyperglycemia , Adult , Blood Glucose , COVID-19/drug therapy , Dexamethasone/therapeutic use , Humans , Methylprednisolone/therapeutic use , Oxygen , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Steroids
15.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801458

ABSTRACT

The post-Covid symptoms among patients hospitalised with covid has to be determined for elucidating the spectrum of illness which persists even after the apparent recovery. The understanding of the post-Covid symptoms will help us to better manage aftermath of the pandemic. Our aim is to determine the incidence of post-Covid symptoms in a cohort of inpatients who recovered from COVID-19 from a tertiary care centre in South India. MATERIAL: 120 survivors from patients admitted with COVID 19 were prospectively followed up for 6 weeks after their discharge from the hospital. The cohort included 50 patients requiring Intensive care unit (ICU) care and 70 ward patients. The follow-up was conducted on the second and sixth week after discharge with a structured questionnaire. The questionnaire was filled by the patient/ bystanders during their visit to the hospital for follow-up at 2 weeks and through telephone follow up at 6 weeks. OBSERVATION: Mean age of the cohort was 55 years and 55% were males. 58.3% had mild covid and 41.7% had moderate to severe covid infection. 60.8% (n=73) of patients had at least one persistent symptom at sixth week of discharge. 50 (41.7%) patients required intensive care during their inpatient stay. Presence of persistent symptoms at 6 weeks was not associated with severity of illness, age or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8% followed by weight loss (22.5%) and dyspnoea (20%). Female sex (OR 2.4, 95% CI: 1.03-5.58, p = 0.041) and steroid administration during hospital stay (OR: 4.43; 95% CI: 1.9-10.28, p = 0.001), were found to be significant risk factors for the presence of post-Covid symptoms at 6 weeks as revealed by logistic regression analysis. CONCLUSION: 60.8% of inpatients treated for covid had post-Covid symptoms at 6 weeks post- discharge from hospital. Female sex and steroid administration during hospital stay were identified as predictors of persistence of post-Covid symptoms at 6weeks.


Subject(s)
COVID-19 , COVID-19/complications , COVID-19/epidemiology , Cohort Studies , Female , Humans , India/epidemiology , Male , Middle Aged , Prospective Studies , Steroids , Tertiary Care Centers
16.
Sci Rep ; 12(1): 5846, 2022 04 07.
Article in English | MEDLINE | ID: covidwho-1784023

ABSTRACT

The medicinal potential of marine invertebrates' bioactive components that may act as anti-COVID-19 demonstrated promising results. Ophiocoma dentata, which is common in the Red Sea, is one such source. Therefore, this study aimed to isolate a new compound from the brittle star, Ophiocoma dentata, and evaluate its efficacy as anti-COVID-19 in-silico and in-vitro. Standard procedures were followed in order to assess the isolated compound's preliminary toxicity and anti-inflammatory properties. Computer virtual screening technology through molecular docking and ADMET studies was conducted as well as a new steroid derivative was isolated for the first time, named 5α-cholesta-4(27), 24-dien-3ß, 23 ß-diol. Investigation of the Anti-Covid-19 activity of the isolated compound using a Plaque reduction assay revealed 95% inhibition at a concentration of 5 ng/µl (12.48 µM). Moreover, this compound showed an IC50 of 11,350 ± 1500 ng/ml against the normal fibroblast cells, indicating its safety. Interestingly, this compound exhibited anti-inflammatory activity with an IC50 of 51.92 ± 0.03 µg/ml compared to a reference drug's IC50 of 53.64 ± 0.01 µg/ml, indicating that this compound is a potent anti-inflammatory. In silico data have proved that the isolated compound is a promising viral inhibitor against SARS-CoV2 and is thus recommended as a future nature preventive and curative antiviral drug.


Subject(s)
COVID-19 , Anti-Inflammatory Agents/pharmacology , COVID-19/drug therapy , Humans , Molecular Docking Simulation , RNA, Viral , SARS-CoV-2 , Steroids
17.
Asian J Psychiatr ; 72: 103099, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1773084

ABSTRACT

Acute exacerbations of psychosis have been reported with COVID-19 infection and medications used for its treatment. Terms "psychosis", "psychotic", "COVID-19″ and "coronavirus" were searched on "PubMed" and "GOOGLE SCHOLAR", yielding 84 articles. 14 case reports were selected based on pre-defined criteria and analyzed. Among selected articles,10 attributed psychosis to COVID-19 infection. In 3 articles, psychosis was diagnosed despite concurrent delirium. In 8 and 3 articles respectively, a clear temporal demarcation of psychosis and COVID-19 infection and steroid use was not described. Psychosis can occur secondary to GMC, or exposure to medication. Due process should be followed to ascertain the same. INTRODUCTION: Neurotropic coronavirus infection is associated with numerous neurological and neuropsychiatric manifestations. Such presentations before, during and after the infection have been reported. Among these presentations, acute exacerbations of psychosis have been reportedly linked with COVID-19 infection and medications used for its treatment. METHODOLOGY: Search engines "PubMed" AND "GOOGLE SCHOLAR" were searched using specific search terms during June 2021. Out of 84 articles that came up, we selected 14 articles based on pre-determined inclusion and exclusion criteria. Selected articles were analysed and discussed in the departmental journal club. RESULTS: In 10 articles, diagnosis of psychosis was attributed to COVID-19 infection. In 3 of those articles, despite reporting concurrent delirium like presentation, diagnosis was still reported as psychosis. In 8 articles, the temporal correlation between onset of psychosis, onset of COVID-19 was not clearly demarcated. In 3 articles, clear demarcation between psychosis associated with steroid use and with a general medical condition (COVID-19) was not clearly presented. Only 2 articles did mention using a structured diagnostic system. In patients (3/17) with prior history of psychiatric illness, diagnosis was reported as relapse of psychosis (2/17), without specifying the criteria used for diagnosing a relapse. CONCLUSION: Acute exacerbation of psychosis can occur secondary to a general medical condition (GMC), or after exposure to a medication. However, due process should be followed to ascertain that the psychosis is indeed secondary to a GMC, or a medication, and not a de-novo presentation, or delirium.


Subject(s)
COVID-19 , Delirium , Psychotic Disorders , COVID-19/complications , Delirium/etiology , Humans , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , Recurrence , Steroids
18.
Clin Otolaryngol ; 47(4): 509-515, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1764904

ABSTRACT

OBJECTIVES: The aim of this study was to assess the effect of topical steroids on acute-onset olfactory dysfunction in patients infected with COVID-19. DESIGN AND SETTING: Systematic review and meta-analysis of cohort studies. PARTICIPANTS: Patients infected with COVID-19. MAIN OUTCOME MEASURES: PubMed, Embase, the Web of Science, SCOPUS, Cochrane database and Google Scholar were searched for articles up to September 2021. We analysed studies comparing the improvement of olfactory dysfunction between topical steroid treatment and control groups (placebo or no treatment). In addition, we performed a subgroup analysis by study type. RESULTS: The improvement of olfactory score at 2 (standardised mean difference [SMD] = 0.7272, 95% confidence interval = [0.3851, 1.0692], p < .0001, I2  = 62.1%) and 4 weeks post-treatment (SMD = 1.0440 [0.6777, 1.4102], p < .0001, I2  = 61.2%) was statistically greater in the treatment than control group. However, there was no significant difference (odds ratio [OR] = 1.4345 [0.9525, 2.1604], p = .0842, I2  = 45.4%) in the incidence of fully recovery from anosmia/hyposmia between the treatment and control groups. In subgroup analysis, there were no significant differences in the improvement of olfactory score at 4 weeks post-treatment (OR = 0.6177 [0.1309, 1.1045] vs. 0.1720 [0.8002, 1.5438], p = .0761) or the incidence of full recovery from anosmia/hyposmia (OR = 1.8478 [0.6092, 5.6053] vs. 1.3784 [0.8872, 2.1414], p = .8038) between randomised and non-randomised controlled trials. CONCLUSIONS: Although this meta-analysis found that topical steroids improved the acute-onset olfactory dysfunction caused by COVID-19, there was no difference in the rate of full olfactory recovery between treated and control patients.


Subject(s)
COVID-19 , Olfaction Disorders , Anosmia/drug therapy , Anosmia/etiology , COVID-19/complications , Humans , Olfaction Disorders/drug therapy , Olfaction Disorders/etiology , Smell , Steroids/therapeutic use
20.
Mycoses ; 65(5): 526-540, 2022 May.
Article in English | MEDLINE | ID: covidwho-1741478

ABSTRACT

BACKGROUND: The second COVID-19 wave in India has been associated with an unprecedented increase in cases of COVID-19 associated mucormycosis (CAM), mainly Rhino-orbito-cerebral mucormycosis (ROCM). METHODS: This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all-cause mortality due to CAM. RESULTS: 59 patients were diagnosed with CAM. Median duration from the first positive COVID-19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID-19. 56% patients were prescribed steroids for non-hypoxemic, mild COVID-19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID-19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. CONCLUSIONS: CAM is a rapidly progressive, angio-invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Antifungal Agents/therapeutic use , COVID-19/epidemiology , Humans , India/epidemiology , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/epidemiology , Orbital Diseases/drug therapy , Retrospective Studies , SARS-CoV-2 , Steroids/therapeutic use
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