Resolutive results with oral corticosteroids for patients with COVID-19 in pulmonary inflammatory phase. Successful outpatient experience during the collapse of Belém do Pará Health System - Brazil
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Abstract
In the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belém do Pará Health System, Brazil. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of prednisolone, enoxaparin and macrolides associated and followed in outpatient facilities. Two hundred and eight patients had excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.
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SciScore for 10.1101/2021.04.19.20219949: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This applies to the early identification of the risk of an unfavorable outcome and implementing timely treatment to reduce sequelae, limitations and disabilities (19). Publications showing the benefit of corticosteroid therapy in reducing hospital stay, …
SciScore for 10.1101/2021.04.19.20219949: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This applies to the early identification of the risk of an unfavorable outcome and implementing timely treatment to reduce sequelae, limitations and disabilities (19). Publications showing the benefit of corticosteroid therapy in reducing hospital stay, intubation and deaths are crucial to corroborate the potential of this therapy in critically ill patients. Additionally, the present study highlights that good results observation of corticosteroid therapy before hypoxemia, at the beginning of phase II, may expand its indication and reinforce the hypothesis that the disease course may be changed earlier. The fear of increasing viral replication with early use of corticosteroid therapy has not been confirmed, once an inflammatory phase has been established, a time when viral replication is no longer prevalent, and everything indicates that the development of a competent immune response has already been established. Documenting the SARS-COV-2 specific cellular immunity of patients with initial lung injury is essential, as it would demonstrate the absence of clinical worsening due to the low risk of increased viral replication explaining the success of treatment appropriately. We believe that enoxaparin was decisive in controlling thrombogenesis considering the pathophysiology of the disease, as well as the modulation of immunity with the use of macrolides. However, studies are needed to confirm the magnitude of action of this drug in the management of COVID-19. Several studies a...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
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