Background Corticosteroids have become the mainstay treatment in severe COVID-19. However its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis was conducted to assess effect of steroids in mild COVID-19 patients. Methods PubMed, EMBASE, Web of Science and Medrxiv were searched from December-31, 2019 to May-14, 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay. Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane’s ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method. Results 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (involving 2214 non–oxygen requiring COVID 19 patients) were included and analysed. Overall odds of progression to severe disease among the non-oxygen requiring COVID-19 patients receiving steroids was 5.97 (95%CI: 1.27–27.99, I 2 - 0%) and odds of death (OR: 1.35, 95%CI: 1.01–1.79; I 2–0%) as compared to the patients not receiving steroids. Mean duration of fever (7.4 days), duration to viral clearance (18.9 days), and length of hospital stay (20.8 days) were significantly higher in the steroid arm, as compared to that in no-steroid arm (6.7 days, 16.5 days, 15.2 days respectively). Conclusion Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial. Protocol registration The study was prospectively registered in PROSPERO (CRD 42021254951).
Under-representation of women in science is a global phenomenon and affects India as well. It deprives women of opportunities in science and is also a great loss to society and science itself. The scientific community can be an important pressure group for building greater focus on the issue and pushing for concrete measures to address the problem. This article reviews the discussions amongst the Indian scientific community on the subject since the early twentieth century and examines the suggestions made by it, based on research and personal experiences. There is a strong case for mandating women's presence in leadership and decision-making positions to address the issue. There is also a case for greater involvement of male colleagues in addressing this issue. Important suggestions have been put forth to make our scientific institutions women-friendly, but not many have been implemented. The resolution of the issue requires stronger will and deeper commitment from policymakers and the scientific community itself.
IntroductionFailure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.AimThe primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality.MethodsThis QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; preintervention phase (100 patients), intervention phase (100 patients) and postintervention phase (93 patients). DTAT and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hour in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis QI Team were implemented after conducting plan-do-study-act cycles.ResultsThe median DTAT reduced from 155 min in preintervention phase to 78 min in postintervention phase. Drawing of blood cultures prior to antibiotic administration improved by 67%. Application of novel screening tool at triage was found to be an independent predictor of reduced DTAT.ConclusionOur QI project identified the existing lacunae in implementation of the sepsis bundle which were dealt with in a stepwise manner. The sepsis screening tool and on-site training improved care of patients with sepsis. A similar approach can be used to deal with complex quality issues in other high-volume low-resource settings.
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