RESUMEN
BACKGROUND: The efficacy and safety of high versus medium doses of glucocorticoids for the treatment of patients with COVID-19 has shown mixed outcomes in controlled trials and observational studies. We aimed to evaluate the effectiveness of methylprednisolone 250 mg bolus versus dexamethasone 6 mg in patients with severe COVID-19. METHODS: A randomised, open-label, controlled trial was conducted between February and August 2021 at four hospitals in Spain. The trial was suspended after the first interim analysis since the investigators considered that continuing the trial would be futile. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 mg once daily for up to 10 days or methylprednisolone 250 mg once daily for 3 days. RESULTS: Of the 128 randomised patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group versus 4.8% in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; p = 0.98). None of the secondary outcomes (admission to the intensive care unit, non-invasive respiratory or high-flow oxygen support, additional immunosuppressive drugs, or length of stay), or prespecified sensitivity analyses were statistically significant. Hyperglycaemia was more frequent in the methylprednisolone group at 27.0 versus 8.1% (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; p = 0.007). CONCLUSIONS: Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation.
Asunto(s)
COVID-19 , Adulto , Masculino , Humanos , Persona de Mediana Edad , Anciano , Metilprednisolona , SARS-CoV-2 , Dexametasona , Resultado del TratamientoRESUMEN
Sarcoidosis is a chronic multisystemic disease, which can be rarely associated with autoimmune disorders, such as antiphospholipid syndrome (APS). Although amaurosis fugax is an uncommon complication, its presentation can unmask a carotid artery dissection (CAD) in these diseases. In addition, central serous chorioretinopathy (CSC) has been related to vascular disorders too. We presented a case of a Caucasian middle-aged man, who developed CAD symptoms, such as amaurosis fugax in the right eye (RE) and headache. His medical history included arterial hypertension, hypothyroidism, and Lofgren's syndrome. On examination, retinal pigment epithelium (RPE) atrophy and subretinal fluid (SRF) in the macular area of the RE were observed. These findings were confirmed by optical coherence tomography (OCT), which also revealed an increase in choroidal thickness. However, these differed significantly from the contralateral eye. These clinical symptoms and imaging findings suggested a CSC in the RE, but not all clinical processes were justified. Subsequently, a CT angiography was performed and confirmed a significant occlusion in the right internal carotid artery and progressive sharpening of the lumen with an intimal flap due to a carotid dissection. In addition, the laboratory results were compatible with antiphospholipid syndrome (APS). To the authors' knowledge, the patient returned to the ED due to an anterior uveitis and he is currently asymptomatic with Cemidon and Adalimumab treatment. We described for the first time a case of carotid dissection and central serous chorioretinopathy in the context of two autoimmune-based pathologies, such as sarcoidosis and antiphospholipid syndrome. Abbreviations: APS = Antiphospholipid syndrome, BCVA = Best-corrected visual acuity, CAD = Carotid artery dissection, CNV = Choroidal neovascular membrane, CSC = Central serous chorioretinopathy, CT = Computed tomography, ED = Emergency Department, ICAD = Internal carotid artery dissection, LE = Left eye, OCT = Optical coherence tomography, RAPD = Relative afferent pupillary defect, RPE = Retinal pigment epithelium, RE = Right eye, SRF = Subretinal fluid.
Asunto(s)
Síndrome Antifosfolípido , Coriorretinopatía Serosa Central , Sarcoidosis , Amaurosis Fugax , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Arterias Carótidas , Coriorretinopatía Serosa Central/complicaciones , Coriorretinopatía Serosa Central/diagnóstico , Angiografía con Fluoresceína/métodos , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Humanos , Infecciones por Chlamydia , Chlamydophila pneumoniae , Sistema Nervioso Central , Meningitis , BacteriasRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/complicaciones , Cateterismo Venoso Central/efectos adversos , Infecciones por Bacterias Grampositivas/etiología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Ciprofloxacina/uso terapéutico , Daptomicina/uso terapéutico , Doxiciclina/uso terapéutico , Claritromicina/uso terapéuticoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Aerococcus/aislamiento & purificación , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Endocarditis Bacteriana/tratamiento farmacológico , Antibacterianos/uso terapéuticoRESUMEN
No disponible
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Humanos , Masculino , Anciano de 80 o más Años , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Vasculitis Leucocitoclástica Cutánea/inducido químicamente , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Linfoma/diagnóstico , Vasculitis Leucocitoclástica Cutánea/complicaciones , Linfoma/complicacionesRESUMEN
No disponible
Asunto(s)
Humanos , Hipocalcemia/inducido químicamente , Cefalosporinas/efectos adversos , Tazobactam/efectos adversosAsunto(s)
Dermatosis de la Pierna/complicaciones , Leucemia Linfocítica Crónica de Células B/complicaciones , Vasculitis Leucocitoclástica Cutánea/complicaciones , Anciano de 80 o más Años , Antiinflamatorios/uso terapéutico , Humanos , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/diagnóstico , Masculino , Prednisona/uso terapéutico , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Vasculitis Leucocitoclástica Cutánea/tratamiento farmacológicoRESUMEN
No disponible