High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America.

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan-Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.

Herniación Cervical: Factor desencadenante inusual en el Síndrome de Brown-Sequard o de Hemisección medular / Cervical Herniation: an Unusual Trigger Brown-sequard Syndrome or Spinal cord Hemisection

The Brown-Sequard syndrome involves a hemisection of the spinal cord. Usually occurs as a result of penetrating trauma, with an incidence of 2-4% in traumatic injuries of the spinal cord, being more common in men. We report the case of a male patient, 40 years of age; attended the "University Hospital School," located in the city of Tegucigalpa, Honduras, for referring pain in the interscapular thoracic spine, mild episode that improves with the use of common analgesics. Four days before admission to the emergency area, the pain intensifies, becomes continuous, disabling, no improvement even with use of oral analgesics and even with intravenous medication. Brown Sequard syndrome is not diagnosed by a herniation, the rule states detect spinal trauma, but determining other etiologies have added clinical importance to avoid misdiagnosis.