Objectives To determine whether preoperative dexamethasone reduces postoperative vomiting in patients undergoing elective bowel surgery and whether it is associated with other measurable benefits during recovery from surgery, including quicker return to oral diet and reduced length of stay. Design Pragmatic two arm parallel group randomised trial with blinded postoperative care and outcome assessment. Setting 45 UK hospitals. Participants 1350 patients aged 18 or over undergoing elective open or laparoscopic bowel surgery for malignant or benign pathology. Interventions Addition of a single dose of 8 mg intravenous dexamethasone at induction of anaesthesia compared with standard care. Main outcome measures Primary outcome: reported vomiting within 24 hours reported by patient or clinician. Secondary outcomes: vomiting with 72 and 120 hours reported by patient or clinician; use of antiemetics and postoperative nausea and vomiting at 24, 72, and 120 hours rated by patient; fatigue and quality of life at 120 hours or discharge and at 30 days; time to return to fluid and food intake; length of hospital stay; adverse events. Results 1350 participants were recruited and randomly allocated to additional dexamethasone (n=674) or standard care (n=676) at induction of anaesthesia. Vomiting within 24 hours of surgery occurred in 172 (25.5%) participants in the dexamethasone arm and 223 (33.0%) allocated standard care (number needed to treat (NNT) 13, 95% confidence interval 5 to 22; P=0.003). Additional postoperative antiemetics were given (on demand) to 265 (39.3%) participants allocated dexamethasone and 351 (51.9%) allocated standard care (NNT 8, 5 to 11; P<0.001). Reduction in on demand antiemetics remained up to 72 hours. There was no increase in complications. Conclusions Addition of a single dose of 8 mg intravenous dexamethasone at induction of anaesthesia significantly reduces both the incidence of postoperative nausea and vomiting at 24 hours and the need for rescue antiemetics for up to 72 hours in patients undergoing large and small bowel surgery, with no increase in adverse events. Trial registration EudraCT (2010-022894-32) and ISRCTN (ISRCTN21973627).

BACKGROUND: Remdesivir has proved its antiviral efcacy on COVID-19 virus in-vitro, but its role in infected patients is still obscure. OBJECTIVE:To evaluate the efcacy and safety of Remdesivir in COVID-19 patients with signicant pulmonary involvement. STUDYDESIGN AND METHOD:We conducted a single center, two-arm, prospective, open-label, phase II study from June 2020 to December 2020 on COVID-19 patients (≥18 years), admitted at Jagjivan Ram Railway Hospital, Mumbai. The primary outcome was to evaluate the all-cause mortality up to 28 days in COVID-19 patients; secondary outcome was to assess the length of hospital stay (LOHS) and duration of respiratory supports, using PASS v11.0 software (19). RESULTS:Overallmortality status at 28 dayswas notsignicant(62 (31.2%)in the remdesivir group vs 65 (32.5%)in the control group), and themean LOHS was less in remdesivir arm which was statistically signicant in the female subgroup although the remdesivir group had delay in hospital admission from the onset of the symptoms and statistically higher index IL6 values. Duration of invasive mechanical ventilation showed signicant statistical difference among the study groups(4.7±1.18 daysin control vs 2.8±1.88 daysin remdesivir), and across both the genders. Hypertension and diabetesmellitusfoundtobe themost commoncomorbiditiesinCOVID-19.Nosafetyconcernswere reportedinRemdesivirgroup. CONCLUSION: Remdesivir was well tolerated without any adverse events, but did not show any signicant effect on COVID-19 survival rate, however it decreases the length of hospital stay and duration of invasive ventilator support. More studies are needed to understand the effects of Remdesivir in larger populations.