Early Stage Combination Treatment with Methylprednisolone Pulse and Remdesivir for Severe COVID-19 Pneumonia

BACKGROUND

This study evaluated the clinical outcomes of patients with severe COVID-19 pneumonia treated with remdesivir plus standard corticosteroid treatment (SCT) or with remdesivir plus high-dose corticosteroid pulse therapy (HDCPT).

METHODS

One hundred and two patients with severe COVID-19 pneumonia and respiratory failure were included. The patients were divided into two cohorts. The first comprised patients who received remdesivir and SCT, consisting of 6 mg dexamethasone daily for up to 10 days or until hospital discharge. The second included patients who received remdesivir and HDCPT, composed of 250 mg iv of methylprednisolone for three days, followed by a slow reduction in the dose of steroids. The severity of hypoxemia was assessed using the SaO2/FiO2 peripheral oxygen saturation index.

RESULTS

55 received remdesivir plus HDCPT, and 47 received remdesivir plus SCT. Mortality at 30 days was significantly lower among patients who received remdesivir plus HDCPT (4/55) than among those who did not (15/47). In patients who received remdesivir plus HDCPT, 7.3% required invasive mechanical ventilation and admission to the ICU and 36.4% non-invasive ventilation versus 29.8% and 61.7%, respectively, among those treated with remdesivir plus SCT. Remdesivir plus HDCPT induced a significantly faster improvement in the SaO2/FiO2 index.

CONCLUSION

Early combination treatment with remdesivir plus HDCPT reduced in-hospital mortality and the need for admission to the ICU. Furthermore, it improved the SaO2/FiO2 index faster in patients with severe COVID-19 pneumonia.

Can ultrasonographic findings of perihepatic lymphadenopathy promote investigations to detect possible presence of virus C infection in non-symptomatic subjects?

PURPOSE: Only early detection of non-symptomatic patients is able to arrest the diffusion of the non-symptomatic HCV infection and lead to prompt treatment. Our aim was to attempt to correlate the presence of perihepatic lymph nodes and hepatitis C infection and to assess whether ultrasonography can have a role to promote specific investigations for pre-clinical diagnosis of virus C infection. METHOD: We performed a controlled study on a cohort of 7974 subjects from a town of 27000 inhabitants on the eastern coast of Sicily. Serologic hepatitis A, B and C markers, alanine aminotransferase levels and abdominal ultrasound examination according to size and number of peri-hepatic lymph nodes were performed on blind basis. RESULTS: One or more pathological lymph nodes were present in 684/7974 subjects. Haematochemical tests revealed the presence of anti-HCV positivity in 528/684 subjects with pathological lymph nodes and in 8/7290 subjects without pathological lymph nodes, there being a significant difference (P<0.0001) between the two groups. CONCLUSION: Our results confirm the association between perihepatic lymph nodes and virus C infection. Correct diagnostic assessment of this datum could lead not only to early diagnosis by specific blood test for HCV and consequent prompt aimed treatment, but could pave the way for efficacious territorial prevention and detection of an elevated percentage of likely non-symptomatic carriers.

[A rare case of drug-induced hepatitis]

This paper describes a case of drug-induced hepatitis that onset in a patient who was hospitalised in our department after administration of calcium heparin. The rarity of the case was shown not only by the very short time elapsed between cause (drug administration) and effect (bio-humoral changes detected), but also by the histology results of the liver biopsy. This latter confirmed that mechanisms of idiosyncrasy, which may cause liver cell necrosis, can occur after administration of any drug.

Developing the sociology of health in nurse education: towards a more critical curriculum--Part 2: Linking methodology and epistemology

In Part Two of the paper a model for curriculum development is proposed which derives from the teaching experience of the authors. This is intended to provide a methodological and conceptual framework for studying the problem of human consciousness and action in relation to health in a way that is consistent with both the values and purposes of student-centered learning and the claims of critical theory. It is suggested that such a critical curriculum of health is needed in order to ensure that the 'knowledgeable doer' Project 2000 aims to produce is indeed a qualitatively different kind of professional nurse practitioner.

Developing the sociology of health in nurse education: towards a more critical curriculum--part I: andragogy and sociology in Project 2000

This paper examines the potential for developing a more critical and reflexive curriculum around the sociology of health in nurse education. In Part One a review of the literature on Project 2000 to date suggests that insufficient attention has been paid to the scope for linking methodological and epistemological issues. it is argued that the status of 'andragogy' as a strategy of teaching and learning is ill-defined and that the nature of sociological theory in nurse education remains too crude and dichotomous to produce the 'knowledgeable doer', a qualitatively different kind of professional nurse practitioner.