scholarly journals Effectiveness of the Use of Dexamethasone in Treatment of Coronavirus Infections: A Systematic Review

2020 ◽  
Vol 8 (T1) ◽  
pp. 518-521
Author(s):  
Muhammad Ardi Munir ◽  
Sarifuddin Sarifuddin ◽  
Amirah Basry ◽  
Christin Rony Nayoan ◽  
Astri Hardiyanti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Oxygen Therapy ◽  
Standard Treatment ◽  
Antiviral Treatment ◽  
Oxford University ◽  
Randomized Controlled ◽  
Review Systematic ◽  
Coronavirus Infection

BACKGROUND: WHO declared the coronavirus disease (COVID)-19 outbreaks as a worldwide pandemic in March 2020. More than 1,500,000 confirmed cases have been diagnosed in more than 130 countries and regions, estimated to cause 93,000 deaths so far recorded on April 10, 2020. There is no vaccine or antiviral treatment for coronavirus. METHODS: The literature sources from the research were obtained by searching for national and international journals. The journal is indexed in Google Scholar, PubMed, Science Direct, e-books, and others. Five journals were obtained, including a literature review, systematic review, and randomized controlled trials (RCT) discussing the use of dexamethasone in COVID-19 therapy, Middle East respiratory syndrome, and severe acute respiratory syndrome. RESULTS: A study from Oxford University compared 2100 COVID-19 patients who received low and moderate potential dexamethasone at a dose of 6 mg/day for 10 days with 4300 COVID-19 patients who only received standard treatment for coronavirus infection. The results obtained in patients using ventilator mortality decreased from 40% to 28%, and patients using oxygen, the mortality rate decreased from 40% to 20%. The dexamethasone RCT study can reduce the death rate of 1 in 3 COVID-19 patients who received mechanical ventilation therapy and 1 in 5 patients who received oxygen therapy without mechanical ventilation but did not reduce patients’ mortality rate who did not receive therapy oxygen. CONCLUSION: The use of dexamethasone with oxygen therapy and mechanical ventilation can reduce mortality patients with COVID-19.

scholarly journals Hydroxychloroquine Efficacy for the Treatment of Patients with COVID-19: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Nayara Izabel Viana ◽  
Ruan Pimenta ◽  
Guilherme Lopes Gonçalves ◽  
Thaynara Faria Gomes ◽  
Vanessa Ribeiro Guimarães ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Standard Treatment ◽  
Meta Analysis ◽  
Antiviral Treatment ◽  
Public Health Emergency ◽  
Quality Information ◽  
Transmission Rates ◽  
Randomized Controlled

Abstract Background and Purpose: COVID-19 (Coronavirus Disease - 2019) represents a public health emergency because of the elevated transmission rates and associated mortality. There is an urgent need to limit the spread of the virus and to develop an effective antiviral treatment for the patients harboring such disease. This meta-analysis aimed to evaluate the results of the existing randomized clinical trials assessing the use of Hydroxychloroquine (HCQ) to treat COVID-19.Methods: A systematic review was performed on PubMed and Google Scholar according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) recommendations. Information from randomized controlled trials (RCT) was retrieved and included in a meta-analysis.Results: Among 214 studies that were found, 3 were included for in the meta‐ analysis. Patients treated with HCQ had a faster clearance of virus or pneumonia improvement than those that received standard treatment (OR = 7.08, 95% CI 2.79 to 4.12; P = 0.001). Only minor side effects were reported.Conclusions: Although this meta-analysis has found favorable evidence for the use of HCQ in the treatment of COVID-19, the literature does not yet present well-designed clinical studies that demonstrate the effectiveness of this medication. We believe that clinical trials coordinated by standardized guidelines, with complete and quality information, must be carried out worldwide and are urgently needed.

scholarly journals Outcome of Using Intravenous Immunoglobulin (IVIG) in Critically Ill COVID-19 Patients’: A ‎Retrospective, ‏Multi-Centric Cohort Study

2021 ◽  
Author(s):  
Mohammadreza Salehi ◽  
Mahdi Barkhori Mehni ◽  
Mohammadmehdi Akbarian ◽  
Samrand Fattah Ghazi ◽  
Nasim Khajavi Rad ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Treatment Group ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Standard Treatment ◽  
Ivig Treatment ◽  
Icu Length Of Stay ◽  
Duration Of Hospitalization ◽  
Standard Treatment Group

Abstract Background: To access the effect of Intravenous immunoglobulin ‎‎(IVIG) in critically ill corona virus disease 2019 (COVID-19) patients.Method: In this retrospective matched cohort study, records of three tertiary centers with large number of COVID-19 admissions were evaluated and used. Based on treatment options, ‎patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of ‎low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using independent t-test and ‎One-way analysis of variance (ANOVA) to compare the ‎outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.‎Result: The duration of hospitalization in the IVIG group ‎were significantly longer than standard treatment (13.74 days vs. 11.10 days, p<0.05). There was not a significant difference between the two groups in ICU length of stay, number of intubated patients and duration of mechanical ventilation (P>0.05).‎ Also initial ‎outcomes in IVIG subgroups were compared separately with the standard ‎treatment group. The results indicated that only the duration of hospitalization ‎in the IVIG subgroup with medium dose is significantly longer than the standard ‎treatment group (P<0.01).Conclusion: Using IVIG is not beneficial for COVID-19 patients based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation and even mortality rate.

Noninvasive Oxygenation Strategies in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 35 (11) ◽  
pp. 1216-1225 ◽  
Author(s):  
Yazan Zayed ◽  
Momen Banifadel ◽  
Mahmoud Barbarawi ◽  
Babikir Kheiri ◽  
Adam Chahine ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Therapy ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Controlled Trials ◽  
Immunocompromised Patients ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Randomized Controlled

Introduction: Acute hypoxemic respiratory failure (AHRF) is a leading cause of intensive care unit (ICU) admission among immunocompromised patients. Invasive mechanical ventilation is associated with increased morbidity and mortality. Objective: To evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in immunocompromised patients with AHRF. Methods: Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to December 2018. We included all randomized controlled trials (RCTs) comparing different modalities of initial oxygenation strategies in immunocompromised patients with AHRF. Our primary outcome was the need for intubation and invasive mechanical ventilation while secondary outcomes were ICU acquired infections and short- and long-term mortality. Data were extracted separately and independently by 2 reviewers. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrIs). Results: Nine RCTs were included (1570 patients, mean age 61.1 ± 13.8 years with 64% male). Noninvasive ventilation was associated with a significantly reduced intubation rate compared with standard oxygen therapy (OR: 0.53; 95% CrI: 0.26-0.91). There were no significant reductions of intubation between NIV versus HFNC (OR: 0.83; 95% CrI: 0.35-2.11) or HFNC versus standard oxygen therapy (OR: 0.65; 95% CrI: 0.26-1.24). There were no significant differences between all groups regarding short-term (28-day or ICU) mortality or long-term (90-day or hospital) mortality or ICU-acquired infections ( P > 0.05). Conclusion: Among immunocompromised patients with AHRF, NIV was associated with a significant reduction of intubation compared with standard oxygen therapy. There were no significant differences among all oxygenation strategies regarding mortality and ICU-acquired infections.

Systemic Review: High Dose Olanzapine Treatment for Treatment Resistant Schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. s802-s803
Author(s):  
Z. Azvee ◽  
J. Lally
Keyword(s):  
Systematic Review ◽  
Standard Treatment ◽  
Systemic Review ◽  
Dose Titration ◽  
High Dose ◽  
Treatment Resistant ◽  
Open Label ◽  
Randomized Controlled ◽  
Olanzapine Treatment ◽  
Competing Interest

ObjectivesSchizophrenia is a major mental illness with a progressive course. Thirty percent of cases of patients with schizophrenia do not respond to adequate trials of at least 2 different groups of antipsychotics,are currently classified as having treatment resistant schizophrenia (TRS). Clozapine remains the gold standard, treatment of choice for TRS. However, clozapine does not come without its own challenges. Its risk profile, particularly agranulocytosis, reported in 1% of cases, has led to the necessity of weekly blood counts within the first 18 weeks of treatment and subsequently every month with slow dose titration. Clinically, sedation, weight gain and hypersalivation may further hamper the compliance of patients. Non-compliance has been reported to cause rebound psychosis. Recent studies have raised questions as to which antipsychotic is most efficacious for TRS. Thus, we conducted a systematic review of high dose olanzapine treatment for people with TRS.MethodA systematic review of prospective studies found through search of PubMed, Scopus and hand-searched key papers which included randomized controlled trials and open-label studies which looked at high dose of olanzapine treatment response for TRS.ResultsThe study is currently ongoing and preliminary results will be presented at the conference in April 2017.ConclusionsThe gravity of burden TRS brings to patients extends itself to their families, carers and clinicians. Further evidence on which antipsychotic is more efficacious for patients with TRS would have huge implications in terms of health benefits for the patients, better informed clinical decisions and also health economics in general.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

2020 ◽  
Author(s):  
Judith van Paassen ◽  
Jeroen S. Vos ◽  
Eva M. Hoekstra ◽  
Katinka M.I. Neumann ◽  
Pauline C. Boot ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Observational Studies ◽  
Oxygen Therapy ◽  
Meta Analysis ◽  
Viral Clearance ◽  
Care Group ◽  
Short Term ◽  
Secondary Infections ◽  
Short Term Mortality

Abstract Background: In the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In the recent RECOVERY trial, evaluating the effect of dexamethasone, a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroids in COVID-19. However, the effectiveness and safety of corticosteroids still remain uncertain, and reliable data to further shed light on the benefit and harm are needed. Objectives: The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of corticosteroids in COVID-19. Methods: A systematic literature search of RCTS and observational studies on adult patients was performed across Medline/PubMed, Embase, and Web of Science from 1st of December 2019 until 1 st of October 2020, according to the PRISMA guidelines. Primary outcomes were short-term mortality and viral clearance (based on RT-PCR in respiratory specimens). Secondary outcomes were: need for mechanical ventilation, other oxygen therapy, length of hospital stay and secondary infections. Results: Forty-four studies were included, covering 20.197 patients. In twenty-two studies, the effect of corticosteroid use on mortality was quantified. The overall pooled estimate (observational studies and RCTs) showed a significant reduced mortality in the corticosteroid group (OR 0.72 (95%CI 0.57-0.87). Furthermore, viral clearance time ranged from 10-29 days in the corticosteroid group and from 8-24 days in the standard of care group. Fourteen studies reported a positive effect of corticosteroids on need for and duration of mechanical ventilation. A trend towards more infections and antibiotic use was present. Conclusions: Our findings from both observational studies and RCTs confirm a beneficial effect of corticosteroids on short-term mortality and a reduction of need for mechanical ventilation. And although data in the studies were too sparse to draw any firm conclusions, there might be a signal of delayed viral clearance and an increase in secondary infections.

scholarly journals Steroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Tarun Krishna Boppana ◽  
Saurabh Mittal ◽  
Karan Madan ◽  
Anant Mohan ◽  
Vijay Hadda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Randomized Controlled Trials ◽  
Steroid Therapy ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Treatment Modalities ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled

There is an urgent need for effective treatment modalities for coronavirus disease 2019 (COVID-19). Data for the use of steroids in COVID-19 is emerging. We conducted this systematic review and meta-analysis to estimate the effectiveness of steroid administration in mortality reduction due to COVID-19 compared to the control group. A systematic search of the Pubmed and Embase databases was performed to extract randomized controlled trials (RCTs) regarding the use of steroid therapy for COVID-19. An overall and subgroup (based upon the type of steroid) pooled mortality analysis was performed, and odds ratios were reported. Cochrane risk of bias assessment tool was used to assess the risk of bias. Heterogeneity was assessed using the I2 statistic. Six RCTs, including 7707 patients, were selected for review. Three trials reported 28-day mortality, and two trials reported 21-day mortality, and one trial reported in-hospital mortality. There were 730 deaths among 2837 participants in the steroid group while 1342 deaths among 4870 patients randomized to the control group (Odds ratio 0.76, 95% confidence interval 0.58-1.00, p=0.05). The effect was significant in patients on oxygen or mechanical ventilation. There was no difference in the various preparations and doses of the steroids. There was heterogeneity among the trials as the I2 value was 53%, with a p-value of 0.06. There was no indication of increased serious adverse events. This meta-analysis of RCTs demonstrated that the use of systemic corticosteroids is associated with a reduction in all-cause mortality in patients with COVID-19 on oxygen or mechanical ventilation.

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