|
Cheap, effective, and widely available: dexamethasone has transformed Covid treatment.
|
|
|
Researchers knew early that that the cytokine storm in Covid looks a lot like sepsis, and that a dysregulated immune response may prompt more harm than good. Mixed early reports hampered by the usual caveats – small trial size, lack of randomization, cohort level associations – led to on-and-off use of steroids. But with all kinds of fancy immune modulators undergoing evaluation in large RCTs, someone had the forethought to go back to basics.
|
|
RECOVERY randomized 6,425 patients hospitalized with Covid-19 at 176 British medical centers to 6 mg of dexamethasone for 10 days or usual care. Results stunned: 28-day mortality, the trial's primary endpoint, favored dex (21.6% vs. 24.6%) among all comers, but the sickest patients benefitted most. Dex reduced mortality among vent patients by a third (29% vs. 41%), and by a fifth among patients receiving oxygen (21.5% vs. 25%). Patients who did not need oxygen did not benefit and trended towards harm. All of this syncs immunologically, where many now think that a strong immune response helps contain the virus in early stages, but spirals out of whack in severe disease.
MedRXiv
|
|
|
RECOVERY results are practice-changing, even while the manuscript awaits peer-review. Give dex or substitute steroid to patients on oxygen support. Continue with supportive care for those who don't need O2.
|
|
When triple therapy crashes the med rec
|
|
Not your patient's problem. ETHOS is the latest trial to show a benefit for triple therapy (LAMA + LABA + inhaled glucocorticoid) in moderate-to-severe COPD. The 8,500-patient RCT found that triple therapy decreased exacerbation rates and improved patient reported outcomes compared to dual therapy with LAMA-LABA or steroid-LABA over 52-week follow-up. While adverse events were on the whole similar between groups, those treated with inhaled steroids had a higher rate of confirmed pneumonia.
NEJM
|
|
When you flip between Zoom and WebEx
|
|
Best to stick to one approach. A phase 1 study of a vaccine against mosquito saliva (well, peptides in mosquito saliva) found that a vaccine + adjuvant combo was safe and induced an immune response in healthy volunteers (who had to watch themselves get bitten as part of the trial). The aim of the platform is to develop a single vaccine against all mosquito-borne illness. More testing is up next.
Lancet
|
|
|
We stand in solidarity with nationwide protests against police brutality, systemic racism and economic injustice. Black Lives Matter. In healthcare we must do better for our patients, our communities, and ourselves.
|
|
|
If we're in an era of precision medicine, why do we estimate kidney function with a binary correction factor for black race? Race was introduced to the widely used eGFR equations MDRD and CKD-Epi with little rationale and flimsy-at-best underlying physiologic evidence. And while supporters argue that race correction improves GFR estimation on a population level, there is evidence that race correction leads to underdiagnosis of ESRD in black patients. See our tweetorial for more.
|
|
|
For use of race-free cystatin C to estimate GFR? A 2012 study that compared eGFR derived from cystatin C, creatinine, or both found that cystatin C better approximated true GFR than creatinine alone, though these results did not reach statistical significance, and was less subject to effects from age, sex, and reported race. Critics will point out that the combined use of cystatin C and creatinine performed better than either test alone, and cystatin C is (for now) the more expensive test.
|
|
What your public health friends are talking about
|
|
|
CDC chief Robert Redfield told reporters that Covid prevalence could be 10 times larger than reported, according to the Center's best estimate. What a summer.
|
|
Send your interns something to look forward to
|
|
|
Graduating? Make sure to sign up with with your long-term email address
|
|
|
|
