3- Wednesday Research News – 11th August

1 – Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxia: an international, randomized, blinded trial

• Dexamethasone 6 mg daily is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease.
• This study aims to assess the effects of dexamethasone 12 mg versus 6 mg daily in patients with COVID-19 and severe hypoxia.
• Among patients with COVID-19 and severe hypoxia, dexamethasone 12 mg did not result in statistically significantly more days alive without life support at 28 days than dexamethasone 6 mg.
• However, the confidence interval around the point estimate should be considered when interpreting the results of this trial. 

Source: MedRxiv

2- Right Ventricular Dysfunction in Ventilated Patients with COVID-19 (COVID-RV)

• COVID-19 is associated with cardiovascular complications, with right ventricular dysfunction (RVD) commonly reported.
• The combination of acute respiratory distress syndrome (ARDS), injurious invasive ventilation, micro/macro thrombi and the potential for direct myocardial injury create conditions where RVD is likely to occur.
• No study has prospectively explored the prevalence of RVD, and its association with mortality, in a cohort requiring mechanical ventilation.
• COVID-RV demonstrates a prevalence of RVD in ventilated patients with COVID-19 of 6.2% and is associated with a mortality of 85.7%.
• Association is observed between RVD and each of the aetiological domains of; ARDS, ventilation, micro/macro thrombi and myocardial injury.

Source: MedRxiv

3- Protocol for a multicentre randomized controlled trial of normobaric versus hyperbaric oxygen therapy for hypoxemic COVID-19 patients

• At least 1 in 6 COVID-19 patients admitted to hospital and receiving supplemental oxygen will die of complications.
• More than 50% of patients with COVID-19 that receive invasive treatment such as mechanical ventilation will die in hospital.
• Such impacts overwhelm the limited intensive care unit resources and may lead to further deaths given inadequate access to care.
• This study aims to determine the effectiveness of HBOT for improving oxygenation, morbidity, and mortality among hypoxemic COVID-19 patients.

Source: MedRxiv

4- Impact of B.1.351 (beta) SARS-CoV-2 variant on BNT162b2 mRNA vaccine effectiveness in long-term care facilities of eastern France: a retrospective cohort study

• This study aimed to assess the effectiveness of the BNT162b2 mRNA vaccine against B.1.351 (beta) variant among residents of long-term care facilities (LCTFs) in eastern France.
• They used routinely collected surveillance and COVID-19 vaccination data to conduct a retrospective cohort study of SARS-CoV-2 B.1.351 infection incidence and vaccine effectiveness among LCTFs residents in eastern France between 15 January and 19 May 2021.
• They observed reduced vaccine effectiveness associated with B.1.351, as well as B.1.351 outbreaks in two LTCFs among individuals who had received two doses of vaccine.
• The findings highlight the need to maintain SARS-CoV-2 surveillance in these high-risk settings beyond the current COVID-19 mass vaccination campaign, and advocate for a booster vaccine dose prior to the next winter season.

Source: MedRxiv

5- Clinical Determinants and Predictors for Prognosis of SARS-CoV-2 Infected Pediatric Patients in Saudi Arabia

• The significant variations in clinical characteristics and outcomes of COVID-19 that range from asymptomatic to severe fatal illness entail searching for potential prognostic determinants to help predict the disease course and early detection of patients at risk of developing life-threatening complications.
• Although children are less commonly infected by SARS-CoV-2 than their adult counterparts, and their symptoms are generally milder, a severe type of COVID-19 cannot be precluded.
• It can be concluded that COVID-19 pediatric patients with underlying comorbidities, being cardiovascular, respiratory, or obesity, are at high risk of developing severe illness, and young age has a protective role against the disease severity.

Source: MedRxiv

6- SARS-CoV-2 variant Delta rapidly displaced variant Alpha in the United States and led to higher viral loads

• This study reports on the displacement of Alpha (B.1.1.7) by Delta (B.1.617.2 and its substrains AY.1, AY.2, and AY.3) in the United States.
• By analyzing RT-qPCR testing results and viral sequencing results of samples collected across the United States, they show that the percentage of SARS-CoV-2 positive cases caused by Alpha dropped from 67% in May 2021 to less than 3.0% in just 10 weeks.
• They also show that the Delta variant has outcompeted the Iota (B.1.526) variant of interest and Gamma (P.1) variant of concern.
• The results are consistent with the hypothesis that the Delta variant is more transmissible than the Alpha variant, and that this could be due to the Delta variant’s ability to establish a higher viral load earlier in the infection compared to the Alpha variant.

Source: MedRxiv

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