Effect Of Dexamethasone In Patients Research Articles

Effect of dexamethasone in patients with ARDS and COVID-19 (REMED trial)\u2014study protocol for a prospective, multi-centre, open-label, parallel-group, randomized controlled trial

BackgroundSince December 2019, SARS-CoV-2 virus has infected millions of people worldwide. In patients with COVID-19 pneumonia in need of oxygen therapy or mechanical ventilation, dexamethasone 6 mg per day is currently recommended. However, the dose of 6 mg of dexamethasone is currently being reappraised and may miss important therapeutic potential or may prevent potential deleterious effects of higher doses of corticosteroids.MethodsREMED is a prospective, open-label, randomised controlled trial testing the superiority of dexamethasone 20 mg (dexamethasone 20 mg on days 1–5, followed by dexamethasone 10 mg on days 6–10) vs 6 mg administered once daily intravenously for 10 days in adult patients with moderate or severe ARDS due to confirmed COVID-19. Three hundred participants will be enrolled and followed up for 360 days after randomization. Patients will be randomised in a 1:1 ratio into one of the two treatment arms. The following stratification factors will be applied: age, Charlson Comorbidity Index, CRP levels and trial centre. The primary endpoint is the number of ventilator-free days (VFDs) at 28 days after randomisation. The secondary endpoints are mortality from any cause at 60 days after randomisation; dynamics of the inflammatory marker, change in WHO Clinical Progression Scale at day 14; and adverse events related to corticosteroids and independence at 90 days after randomisation assessed by the Barthel Index. The long-term outcomes of this study are to assess long-term consequences on mortality and quality of life at 180 and 360 days. The study will be conducted in the intensive care units (ICUs) of ten university hospitals in the Czech Republic.DiscussionWe aim to compare two different doses of dexamethasone in patients with moderate to severe ARDS undergoing mechanical ventilation regarding efficacy and safety.Trial registrationEudraCT No. 2020-005887-70. ClinicalTrials.gov NCT04663555. Registered on December 11, 2020

Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties

Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties

Effects of dexamethasone in traumatic brain injury patients with pericontusional vasogenic edema: A prospective-observational DTI-MRI study.

Cerebral edema is a frequent and serious complication in traumatic brain injury (TBI) patients. The objective is to study the effect of dexamethasone in patients with brain contusions, and to assess its effect on the vasogenic component of the pericontusional edema.Prospective-observational study to quantify, using magnetic resonance imaging, the volume of the edema before and after 10 days of dexamethasone in patients with brain contusions. Using diffusion tensor imaging, we have examined the effect of dexamethasone on fractional anisotropy (FA) and apparent diffusion coefficient (ADC). To assess changes, the pre- and post-treatment values for each patient were compared using a paired-samples Student t test.We included 30 TBI patients, 15 in each group. The volume of the vasogenic edema in the group of patients treated with dexamethasone decreased from 22 to 19 mL and this decrease was statistically significant (P < .05). Nevertheless, in the non-steroids group the volume of the vasogenic edema increased from 11 to 15 mL. There was a significant decrease in the ADC value (from 1.78–1.59; P < .05); and a significant increase in the FA value (0.09–0.11; P < .05) in the patients treated with dexamethasone.Using diffusion tensor imaging we have shown in a selected group of TBI patients with vasogenic pericontusional edema, a reduction of edema volume, a decrease in the ADC and an increase in the FA after treatment with dexamethasone. However, we have no data if such results are beneficial in terms of improving functional outcome.

婦人科がん化学療法による嘔気・嘔吐に対するｄｅｘａｍｅｔｈａｓｏｎｅの効果

Nausea and vomiting are two of the most unpleasant adverse effects associated with the use of antineoplastic agents and many patients regard them as the most stressful aspect of their disease, more stressful than even than the prospect of dying. Cisplatin, one such agent, is well known for having an emetic potential of almost 100% when administered to patients without emesis prophylaxis. The nausea it causes is the delayed-type and is hard to suppress completely with 5-HT3 antagonists. Dexamethasone (DEX) is often an effective antiemetic for cisplatin-induced nausea and vomiting, either by itself or in combination with other antiemetics. Though patients were receiving cisplatin under our regimen it did not include DEX.We therefore investigated the effects of DEX in patients with uterine cervix cancer who were being treated with a regimen including cisplatin. DEX reduced the degree of nausea and frequency of vomiting and increased appetite. It also improved the cost-effectiveness of the regimen. Based on these results, gynecologists in our hospital decided to include DEX in the cisplatin regimen.We feel that DEX should be the antiemetic drug of choice for cisplatin-regimens and in future, drug regimens should be specifically designed for each patient depending on the cause of nausea and vomiting, and the available evidence.

Dexamethasone in addition to metoclopramide for chronic nausea in patients with advanced cancer: a randomized controlled trial

Chronic nausea occurs in most patients with advanced cancer. This study was done to assess the antiemetic effects of dexamethasone in patients with chronic nausea refractory to metoclopramide. Secondary outcomes included appetite, fatigue, and pain. Fifty-one patients who had nausea (≥ 3/10 on a 0-10 scale) for ≥ 2 weeks despite 48 hours of oral metoclopramide therapy (40-60 mg/day) were enrolled. Patients received 20 mg/day dexamethasone (DM) orally ( n = 25) or placebo ( n = 26) for severe nausea in addition to metoclopramide (60 mg/day orally). At baseline the mean nausea intensity ratings in the DM and placebo groups were 8.0 and 7.4. At Day 8 they were 2.1 and 2.0, respectively. At Day 3 and Day 8, the mean difference in nausea intensity for the DM and placebo groups was 4.5 and 2.9 ( P = 0.16) and 5.9 and 5.7 ( P = 0.85), respectively. Improvement in appetite and fatigue were observed on Day 3 and Day 8 in both groups as compared with the baseline. Pain, vomiting, well-being, and quality of life remained unchanged in both groups at both times. We conclude that DM was not superior to placebo in the management of chronic nausea in our patients with advanced cancer.

Catabolic effect of dexamethasone in patients with major head injuries.

In the records of our extensive metabolic studies on trauma victims, we found 16 head injured patients who had no other major injuries. Among them, nine had been given dexamethasone for at least 6 days. The other seven had not received any corticosteroids. There was no significant difference in the Glasgow Coma Scales of the treated and untreated groups. Metabolic balance studies were carried out for at least 3 days, including the periods when the treated patients were receiving dexamethasone. Mean nitrogen balance was -0.296 +/- 0.03 g/kg/day for the treated group and -0.182 +/- 0.03 g/kg/day for the untreated group. This difference was significant (p = 0.02, t-test). Our metabolic data are also consistent with those of other published studies, which used other corticosteroids and somewhat different methodologies. Thus, it is clearly established that corticosteroids cause significant degrees of catabolism in head injured patients, beyond what would "normally" be expected in such patients if they did not receive these drugs.

The Assessment of Nausea and Vomiting

Given the diversity of assessment methodologies in previous studies, and given the increasing attention being shown in studies in which nausea and vomiting are used as outcome measures, it is reasonable to expect that there are more questions on the assessment of nausea and emesis than there are answers. There is little consensus on the efficacy of various approaches used to help control chemotherapy-induced nausea and emesis. There is also little consensus on the appropriate assessment techniques for their measurement. While there is room for much controlled experimentation and study of the ways to assess nausea and emesis, a review of past studies indicates several guidelines that should be kept in mind. The first of these is that nausea is a subjective phenomenon. It exists only insofar as it is defined by the patient. The clinical reality is that patients' decisions to delay or terminate chemotherapy are based on their subjective evaluations of the side effects, not on evaluations made by a clinician or others. With this in mind, a self-report approach to the assessment of nausea appears the most reasonable at this time. On the other hand, while vomiting does have subjective aspects, it represents a behavior that may be reliably observed by others. Thus, it is appropriate that observer ratings be obtained whenever feasible. The use of such indirect measures of nausea and vomiting as time to food intake, appetite change, and other measures of patient well-being should be considered whenever feasible. As with all measures, the cost in patient time needs to be balanced against the scientific needs of any study quantifying nausea and vomiting. While direct, physiologic measures would provide an important external reference to the assessment of nausea and vomiting, at the present time, these appear useful only in animal studies. The fact that nausea and vomiting can occur independently points to the validity of their assessment as separate behaviors. It is also important to note that their frequency, severity, and duration are separable phenomena. A complete assessment of nausea and vomiting responses should include separate measures of frequency, severity, and duration. Anticipatory nausea and vomiting are clinical phenomena that appear to occur with a reasonable enough frequency so that their measurement would be important in clinical studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Resistance to inhibiting effect of dexamethasone in patients with endogenous depression.

Suppression of 11-hydroxycorticosteroids (11-OHCS) release with dexamethasone (0.5 mg) has been investigated in 52 patients with endogenous depression and also in normals and in patients with other mental diseases. The suppression was considerably less in depressives (-19 +/- 5%) than in control groups (approx. -60%). The dexamethasone test indices were normalized during remission. The elucidate mechanisms of the dexamethasone inhibiting effect, the influence of tryptophan, DOPA and benzodiazepines on the 11-OHCS level and the degree of its suppression with dexamethasone have been studied. The data indicate a dual effect of serotonin on the regulation of the adrenal function: it stimulates CRF secretion and increases the inhibiting effect of corticosteroids on CRF release. It is suggested that during depression the negative feedback is disturbed in the system - brain monoamines-glucocorticoids. The possible role of this impairment in depression pathogenesis is considered.