Objectives: This study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring intensive care. Design: This is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit (ICU) admission. Patients admitted and requiring oxygen supplementation were treated with no steroids, methylprednisolone, or dexamethasone. Setting: This study takes place in the ICU’s at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles. Patients: All eligible patients admitted to the ICU for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study. Interventions: A total of 262 patients were grouped as receiving usual care (n = 75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n = 104), or dexamethasone dosed at least at 6 mg for ≥7 days (n = 83). Measurements and Main Results: All-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient. In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days ( P < 0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, P = 0.0385). Conclusions: In COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.

OBJECTIVES: This study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring ICU care. DESIGN: This is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit admission. Patients admitted and requiring oxygen supplementation were treated with either methylprednisolone or dexamethasone. SETTING: This study takes place in the intensive care units at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles. PATIENTS: All eligible patients admitted to the intensive care unit for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study. INTERVENTIONS: A total of 262 patients were grouped as receiving usual care (n=75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n=104), or dexamethasone dosed at least at 6 mg for ≥ 7 days (n=83). MEASUREMENTS and MAIN RESULTS: All-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient. In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days (p <0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, p=0.0385). CONCLUSIONS: In COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.

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Purpose Korean-American mental health is poorly understood, and screening for sleep disturbances may be an effective means of identifying at-risk individuals. Design In partnership with a Korean-American church in Los Angeles, an online survey was administered. Setting The study was conducted at a Korean-American church in Los Angeles, California. Subjects The sample consisted of 137 Korean-Americans drawn from the church congregation. Measures Sleep disturbances were measured using a single ordinal variable, and mental health outcomes included nonspecific psychological distress, perceived stress, loneliness, suicidal ideation, hazardous drinking, treatment seeking behaviors, and perceived need for help. Analysis Multivariable logistic regression was used to estimate the associations between sleep disturbances and mental health outcomes, adjusting for age and sex. Results are presented as Odds Ratios (OR) and 95% Confidence Intervals. Results Almost a third of the sample reported moderate or severe sleep disturbances. After adjusting for age and sex, sleep disturbances were associated with greater odds of reporting probable mental illness, perceived need for treatment, and treatment-seeking behaviors. Sleep disturbances were also associated with higher levels of perceived stress and loneliness, but were not significantly associated with suicidal ideation or hazardous drinking. Conclusions Sleep disturbances are associated with mental health problems and may be an important idiom of distress for Korean-Americans. Primary care providers and informal providers in the community (specifically churches) should work together to screen for sleep problems and refer at-risk individuals to appropriate levels of care.

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