Background Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored including corticosteroids (CS); preliminary results of CS in coronavirus disease 2019 (COVID-19) are encouraging, however, the role of CS is still controversial. Research Question What is the impact of CS in mortality, ICU admission, mechanical ventilation and viral shedding in COVID-19 cases? Study Design and Methods We conducted a systematic review of literature on CS and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature until July 22, 2020, that report outcomes of interest in COVID-19 patients receiving CS with a comparative group. Results A total of 73 studies with 21,350 COVID-19 cases were identified. CS use was widely reported in mechanically ventilated (35.3%), ICU (51.3%) and severe COVID-19 cases (40%). CS showed mortality benefit in severelly ill COVID-19 cases (OR 0.65, 95%CI 0.51-0.83, P=0.0006), however, no beneficial or harmful effects were noted amongst high- or low-dose CS regimens. Emerging evidence shows that low-dose CS do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high- and low-dose CS regimens. Interpretation Our results show evidence of mortality benefit in severely-ill COVID-19 treated with CS. CS are widely used in COVID-19 cases worldwide and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for CS.

The use of electronic cigarettes, known as vaping, has become increasingly popular over the past decade, particularly in the adolescent and young adult population, often exposing users to harmful chemicals. Vaping has been associated with a heterogeneous group of pulmonary disease. Recently, a multistate epidemic has emerged surrounding vaping-related acute lung injury, prompting the Centers for Disease Control and Prevention to list an official health advisory. In this review, we describe the current literature on the epidemiology, clinical significance, as well as recommended evaluation and treatment of vaping-related lung injury.

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