Use of dexamethasone in COVID-19 patients: systematic review and meta-analysis

COVID-19 is associated with disseminated lung damage in patients, Dexamethasone can reduce lung injury caused by inflammation and there reduce the progression to respiratory failure and prevent death. This systematic review aimed to determine the benefits and safety of Dexamethasone in COVID-19 treatment. The study was performed by a comprehensive literature search which were published in several databases i.e., PubMed, Science Direct, VHL Regional Portal, and ClinicalTrials.gov within the search time of 28 November 2020. Inclusion criteria were articles on the study on COVID-19 patients who received Dexamethasone, observational and experimental studies on the outcomes use evaluation of Dexamethasone. Exclusion criteria are the articles that do not provide control in controlled studies and do not show clear research results on the use of Dexamethasone. An initial search from four databases by entering keywords resulted in 1,046 articles. After screening articles duplication we obtained 835 studies. Finally, 6 articles were obtained after we screened for the article that it can be obtained its full text and 5 articles joined in articles included in the meta-analysis. The analysis showed that Dexamethasone in Covid-19 patients could reduce the incidence of death within 28 days with RR of 0.78 (95% CI 0.57-0.97 P=0.13) compared with Methylprednisolone, Dexamethasone was compared without corticosteroids with RR 0.89 (95% CI 0.82-0.97 P=0.01). Dexamethasone also reduced mechanical ventilator use during treatment with RR 0.95 (95% CI = 0.86-1.05 P = 0.28) compared without corticosteroids. The conclusion from these results: the use of Dexamethasone can reduce the number of deaths in COVID-19 patients, especially severe and critically ill category patients.

A case report of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 in Maha Sarakham, Thailand

We report a case of a 19-year-old female with multisystemic inflammatory syndrome that was associated with the novel coronavirs disease 2019 (COVID-19), which manifested as serious illness that occurred four weeks after COVID-19 infection. Her clinical manifestations involved multiple organ systems including high-grade fever with shock syndrome, pulmonary edema, myopericarditis with pericardial effusion, hepatitis, generalized maculopapular rash, and several elevated inflammatory markers. She was treated with human immunoglobulin, methylprednisolone, acetylsalicylic acid, enoxaparin, and empirical antibiotics. She required a 2-week hospitalization and was discharged after improvement of clinical symptoms and normalization of inflammatory markers. A day prior to discharge, an echocardiography was done and it showed normal ventricular function and no coronary aneurysmal dilation.

Clinical outcomes of patients treated with dexamethasone vs. methylprednisolone for severe COVID-19 pneumonia

BACKGROUND: Coronavirus Disease 19 (COVID-19) damages the lungs and may potentially culminate in acute respiratory distress syndrome (ARDS). Several therapy strategies, including corticosteroids, have been attempted across the world with favorable results. However, the most suitable corticosteroid type and dose for COVID-19 treatment remain undefined. Therefore, we performed a study to retrospectively compare the efficacy of two popular corticosteroid therapies: dexamethasone and methylprednisolone, in treating severe COVID-19 pneumonia. METHODS: This observational retrospective cohort analysis comprised 1001 patients diagnosed with an established diagnosis of severe COVID-19 pneumonia who were hospitalized to a tertiary care hospital, Dr. Ziauddin Hospital North Nazimabad, Karachi, Pakistan, from April 2020 through February 2021. RESULTS: Between the two study groups, no significant difference was reported in patient mortality. A significantly higher percentage of MTP patients required admission to the ICU (194 (33.0%) vs. 89 (21.5%);P- < 0.001). Patients in the DXM group had significantly lower chances of being admitted to the ICU (OR: 0.419, 95% CI: 0.273-0.642;P- < 0.001), supported by a significantly lower risk of the need of ICU admission (HR 0.538, 95% CI: 0.383-0.755;P- < 0.001). Additionally, on Kaplan-Meier analysis, the DXM group patients received discharge from the hospital significantly earlier (6.83 vs. 8.20 days;Log Rank P-0.003) and required ICU admission much later (5.01 vs. 2.40 days;Log Rank P- < 0.001). CONCLUSION: Dexamethasone was found to have a significant reduction in the need for intensive care unit admission as well as early hospital discharge.

Comparison of clinical outcome between dexamethasone and methyl prednisolone in treatment of moderate to severe COVID-19: a systematic review and meta-analysis

Objective: Though systemic corticosteroid is used for treatment of COVID 19, questions regarding the appropriate dose, duration and type of corticosteroid use still remain unanswered. This study aimed to address, whether choice of systemic corticosteroid significantly influences the clinical outcome of COVID 19 patients. Materials and Methods: Studies reporting the comparison between clinical outcome of dexamethasone and methylprednisolone in treatment of COVID 19 were searched from inception till April, 2021. Random-effect model was used. Odd's ratio (OR) and 95% confidence interval was expressed. I2 statistics used for test of heterogeneity. Result: Three studies with 373 patients (160 in dexamethasone group and 213 in methyl prednisolone group) were included. Though, statistically significant reduction in all-cause mortality with methyl prednisolone group in comparison to dexamethasone group (OR=1.80, 95%CI: 1.08 to 3.01, P=0.02) estimated, sub group analysis of observational studies did not support the finding (OR=1.60, 95% CI: 0.88 to 2.92, P=0.12). No significant difference in terms of need for invasive ventilator or intensive care unit (ICU) between the 2 groups. The grade of evidence was very low for both the outcomes. Conclusion and Relevance: In the present context, both dexamethasone and methyl prednisolone are equally effective in the management of COVID 19.

Favipiravir induced nephrotoxicity in two patients of COVID-19

This paper reports two cases of AKI with favipiravir induced nephrotoxicity. Patient 1: 38-year male, confirmed reverse transcriptase polymerase chain reaction positive (RT-PCR) positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) and moderate pneumonia was given hydroxy-chloroquinine (HCQ) 400 mg BID followed by 200 mg BID for 10 days and favipiravir at 1600 mg BID followed by 600 mg BID for 5 days. Patient 2: 51-year male RT-PCR positive, severe COVID-19 was started on HCQ and favipiravir at same dose as in patient one along with methylprednisolone 40 mg BID for days and enoxaparin 40 mg subcutaneous once daily. In conclusion, the authors believe as many repurposed drugs are being used for COVID-19 on experimental and compassionate basis without well conducted research, the clinicians need to be very careful of any new adverse event. The AKI like in any other patient needs comprehensive review for all possible etiology before linking it to COVID-19.

Special Issue: COVID-19 part III. (Special Issue: COVID-19 part III.)

This special issue contains 22 articles that discuss COVID-19 in the Europe. The topics include profiles of current COVID-19 vaccines, hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients, effect of early oseltamivir on outpatients without hypoxia with suspected COVID-19, relationship between serum osteopontin levels and the severity of COVID-19 infection, methylprednisolone in adults hospitalized with COVID-19 pneumonia, personal protective equipment in the COVID-19 pandemic and the use of cooling-wear as alleviator of thermal stress, influence of age and gender on the epidemic of COVID-19;forehead temperature measurements during cold outdoor temperatures, impact of lockdown during the COVID-19 pandemic on number of patients and patterns of injuries at a level I trauma center, establishing a telerehabilitation program for patients with Duchenne muscular dystrophy in the COVID-19 pandemic, 6-month SARS-CoV-2 antibody persistency in a Tyrolian COVID-19 cohort, evaluating the longitudinal effectiveness of preventive measures against COVID-19 and seroprevalence of IgG antibodies to SARS-CoV-2 in cancer outpatients and healthcare workers, The first 8 weeks of the Austrian SARS-CoV-2 epidemic, clinical manifestations of COVID-19 in the general population, sex and age differences in COVID-19 mortality in Europe, among others.

COVID-19 outcome in kidney allograft recipients, a report of a referral center

Introduction. The pandemic of SARS Cov-19 (COVID-19) has affected millions of individuals and resulted in 3 percent mortality worldwide. Kidney allograft recipients are at increased risk of mortality and morbidity in COVID-19, due to their immunosuppressed and cardiovascular conditions. Methods. This study evaluated the outcome of renal allograft recipients with COVID-19 in a single referral center. Seven thousands, seven hundred and forty one patients with COVID-19 admitted in Firoozgar Hospital from March 2019 to September 2021. Among them 59 were kidney allograft recipients with the age range of 18-76. We reported our outcome as the mortality during hospital stay. Acute kidney injury and severity score were defined based on KDIGO and WHO classification, respectively. Our Therapeutic management included low dose CNI and antimetabolites withdrawal. The selection of steroid dose was related to severity score. Critical and severe patients received methylprednisolone pulse for three consecutive days. Results. Fifty nine renal allograft recipients were included in this study, 38 (64.5%) were male and 21(35.6%) were female. The most frequent comorbidities were diabetes mellitus (52.5%) and hypertension (30%). The mortality rate was 22% (13 out of 59). Forty six (78%) patients were discharged from the hospital with good condition. According to defined WHO classification severity score, 15 (25.4%) had mild, 14 (23.7%) moderate, 17 (28.8%) severe, and 13 (22%) were in a critical situation on admission. Acute kidney injury developed in 13.6% of patients. Univariate analysis showed that Severity score, age, transplant duration, CRP and lymph/neutrophil ratio, LDH, and need for intubation were the major predictive risk factors of mortality (P < 0.05). Conclusion. The mortality rate in hospitalized kidney allograft recipients was 1.5 to 3 fold higher than general population. Those with acute kidney injury need long term follow up for the detection of permanent sequel. As the COVID-19 infection in renal allograft recipients considerably increases the risk of morbidity and mortality, these patients should be monitored closely to prevent poor outcomes.