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Timing of of corticosteroids administration is very important in COVID19 cases for the recovery and decrease the mortality.
The sickest patients with COVID-19 suffer a hyperinflammatory state-a cytokine storm-that has features in common with a rare haematological condition called haemophagocytic lymphohistiocytosis. Immune suppression should help such patients. By contrast, immune suppression during the early phase of the viral infection might allow increased viral replication and aggravate the disease.
The 3C-like proteinase on SARS-CoV-2 (nsp5) inhibits HDAC2 transport into the nucleus, and so impairs the way in which it mediates inflammation and cytokine responses, so activation of histone deacetylase by dexamethasone may directly oppose the action of SARS-CoV-2.
Timing of of corticosteroids administration is very important in COVID19 cases for the recovery and decrease the mortality.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Early CS | Experimental | early use of dexamethasone as early as the laboratory confirmation of inflammation. |
|
| Late CS | No Intervention | Dexamethasone is to be used lately upon the deterioration of cases i.e. sPO2 < 92% |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Early-Corticosteroids | Drug | early use of dexamethasone/Methylprednisolone as early as laboratory evidence of high inflammatory markers |
|
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of cases that will need hospitalization | Deterioration in the clinical picture of cases that necessitate hospitalization | 10 days |
| Percentage of cases that will need oxygen supplementation | Percentage of cases whose clinical status deteriorate that their sPO2 become less than 92% | 10 days |
| 28-days mortality | Percentage of cases who died within 28 days of presentation | 28 days |
| Measure | Description | Time Frame |
|---|---|---|
| Percentages of COVID-19 Severity according to CDC 2020 | Percentages of COVID-19 severity according to CDC 2020 | 10 days |
| Time to return to daily activity | Time to return to daily activity level |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Emad R Issak | Assalam Clinics | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Asalam | Maadi | Cairo Governorate | 11433 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24400953 | Background | Spoorenberg SM, Deneer VH, Grutters JC, Pulles AE, Voorn GP, Rijkers GT, Bos WJ, van de Garde EM. Pharmacokinetics of oral vs. intravenous dexamethasone in patients hospitalized with community-acquired pneumonia. Br J Clin Pharmacol. 2014 Jul;78(1):78-83. doi: 10.1111/bcp.12295. |
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| ID | Term |
|---|---|
| D000086382 | COVID-19 |
| ID | Term |
|---|---|
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
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| ID | Term |
|---|---|
| D003907 | Dexamethasone |
| D008775 | Methylprednisolone |
| ID | Term |
|---|---|
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
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| 60 days |
| Percentage of cases with increased d-dimer | Percentage of cases with increased d-dimer from baseline | 10 days |
| Percentage reduction in CRP | Percentage reduction in CRP from baseline | 10 days |
| Percentage reduction in LDH | Percentage reduction in LDH from baseline | 10 days |
| Percentage reduction in Ferritin | Percentage reduction in Ferritin from baseline | 10 days |
| D014777 |
| Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D000072473 |
| Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
| D011239 | Prednisolone |