Discover and read the best of Twitter Threads about #dexaméthasone

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Updated WHO severe COVID treatment guidelines

🟢Steroid (#Dexamethasone)
🟢IL6 blocker (#Toci) or 🟢JAKi (#Baricitinib)
🟠±mAb in seronegative people

NOT recommended

Lots to discuss, a🧵
Remdesivir (RDV) is in the “We suggest no remdesivir” category.
At some level, this isn’t too surprising & is old news.
Despite initial hype, RDV never moved the needle much on patient centered outcomes (risk of mortality or requiring IMV) & many of us had stopped using it.
In #ACTT1 RDV did improve outcomes on an ordinal scale, but the effect was modest. It shortened time to clinical improvement but not hospital LOS (patients stayed in the hospital longer to receive it).
RDV did NOT improve mortality or risk of IMV.
Read 19 tweets
01/ Vous voulez savoir :
- comment se protéger d’une #COVID sévère sans médicaments sur ordonnance ?
- pourquoi elle touche certaines personnes et pas d'autres ?
- ce qui cause les #EffetsSecondaires des #vaccins ?

#COVID_19 #covid19 #covid #coronavirus #vaccination

02/ Jean-Marc Sabatier (@SabatierJeanMa1), Directeur de Recherche au CNRS depuis 32 ans, PhD/HDR en Biochimie et Microbiologie, nous explique tout cela dans une vidéo ( dont je résume les 42 premières minutes dans ce #thread.
03/ Le virus #SARS-CoV-2 s’attaque au #SRA (le système rénine-angiotensine), un de nos systèmes de régulation les plus importants, responsable des fonctions autonomes rénales, pulmonaires, cardiovasculaires, de l’#immunité innée et du #microbiote intestinal.
Read 48 tweets
A metal ion orients SARS-CoV-2 mRNA to ensure accurate 2′-O methylation of its first nucleotide
The #SARSCoV2 #coronavirus is able to utilize the changes in metal ion concentrations to disguise itself in the human host body thus evading immune responses. Image
Efficacy of #clarithromycin on #COVID19 pneumonia without oxygen administration; protocol for multicenter, open-label, randomized-controlled, 3-armed parallel group comparison, exploratory trial #CAMECOVID
Japan Registry of Clinical Trials jRCTs071210011 Image
The influence of #HLA genotype on the severity of #COVID19 infection
A genetic link has been discovered explaining why some people catch #Covid but don't get sick. The gene is found three times as often in people who are #asymptomatic. Image
Read 199 tweets
🔝5 Concerns about #SARSCoV2 #Biology: A Call to Pause, Deliberate, and Revise Policy─This review is intended both as a basic resource and to initiate an open and critical dialog about SARS-CoV-2 biology for an independent and public call to action.…
Structural basis of ribosomal #frameshifting during translation of the #SARSCoV2 #RNA #genome
A unique feature of the SARS-CoV-2 genome controls protein synthesis and presents an "Achilles heel" of the virus. Image
Brainstem neuropathology in two cases of #COVID19: #SARSCoV2 trafficking between #brain and #lung
Neuropathologic evidence strongly suggests that the pathophysiology of COVID-19 related respiratory failure includes a neurogenic component. Image
Read 213 tweets
📡Live Now 📡

So you become #COVID Positive, What's Next?

For answers, watch our webinar and post if you have any other questions/doubts on #COVID19 here👉
I think there is a greater responsibility on patients too.

Doctors say, 80% effort has to be from patients. If a patient does not follow #COVID19 protocols/instructions given by Doctor, panics then it will be more difficult

- Prof. Raghuram, BITS Goa
#StayHome, do not go outside unless absolutely necessary, do not challenge the administration - it is one of the social service which we can do during this time

- Prof. Raghuram, BITS Goa

Live Now :
Read 36 tweets
IMPORTANT THREAD on #COVIDTreatments - What Works & What Does not. Will be an ongoing threat.

Start with Dr Zarir Udwadia of Mumbai.
Link to Dr Udwadia's Video

1st Point: 90000+ Medical papers on Covid. UNFORTUNATELY, big divergence in Observational Studies impact and Real World impact of a rigorous RCT
RCT is Randomized controlled trial.
A Good website is

2) What Works ?
(A) Steroids are essential. #DEXAMETHASONE 6mg/day for Critically ill Covid Patients. Reduces Death by 33/20% for Patients on Ventilators & Oxygen. ImageImageImage
Read 19 tweets
Following @remap_cap & #RECOVERY #Tocilizumab results, @NIHCOVIDTxGuide has updated guidelines:
-#Toci + #Dexamethasone now recommended for all ICU pts on IMV, NIPPV, or HFNC
-Toci + Dex recommended for non-ICU pts w/ rapidly increasing O2 needs & elevated inflammatory markers
You can read the updated NIH COVID19 treatment guidelines here:…

IMO, this change makes sense based on the published & pre-published data, which I discussed last month:
There are some caveats:
-Toci must be combined with dexamethasone (not given alone; ? harm signal)
-It should be given early (w/i 3 days)
-Toci should NOT be given to people who are already immunosuppressed or who have “an uncontrolled” infxn (e.g. getting worse despite Abx)
Read 5 tweets
Reducing #COVID19 #Airborne #Transmission Risks on #PublicTransportation Buses
Wearing of #facemasks reduced the overall particle count released into the bus by an average of 50%, the dispersion distance by several feet and #aerosol particles by 84.36%. Image
🔝#SARSCoV2 Infects Human Engineered Heart Tissues and Models COVID-19 Myocarditis
#COVID19 can kill heart muscle cells, interfere with contraction. Details of how #coronavirus infects #heart: models of tissue damage may help develop potential therapies. Image
High-content screening of coronavirus genes for innate immune suppression reveals enhanced potency of SARS-CoV-2 proteins
196 protein products of seven coronaviruses: the genes encoded by #SARSCoV2 are generally more potent immune suppressors than others Image
Read 236 tweets
⚠️#Ocular #MRI Findings in Patients with Severe #COVID19: A Retrospective Multicenter Observational Study
All patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region. Screening needed. Image
⚠️🔝New-Onset #IgG #Autoantibodies in Hospitalized Patients with #COVID19
An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues. Image
⚠️🔝Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance
Damage to the heart found in more than half of #COVID19 patients discharged from hospital who show raised levels of troponin. Image
Read 235 tweets
🚨Exciting results from the #RECOVERY trial #preprint of #Tocalizumab (Toci) in hospitalized people w/ #COVID19
-reduced 28-day mortality (29 vs 33%; NNT)
-decreased likelihood of requiring MV (33% vs 38%)
-shorter hospital stay (median 20 vs >28 days)…
They randomized 4116 pts to weight-based Toci vs usual care (UC):
-groups were balanced: mostly male (>65%), older (>60 yo), & w/ comorbidities (>55%)
-most patients (82%) also received dexamethasone
-they received Toci early in hospitalization but were 7-14 days after onset
Notably, only 83% of patients in the Toci group actually received Toci (plus 2.6% randomized to the UC group got Toci); this would decrease the effect size and bias the towards null.

This means their ITT analysis is probably *underestimating* the true effect size somewhat.

Read 13 tweets
"This week marks the one-year anniversary since WHO learned of cases of ‘pneumonia with unknown cause’ via a bulletin issued by the health authorities in Wuhan and ProMed.

We immediately set up an incident management structure to follow this development"-@DrTedros #COVID19
"This is a moment for all of us to reflect on the toll the #COVID19 pandemic has taken, the progress we have made, the lessons we have learned, and what we need to do in the year ahead to end this pandemic"-@DrTedros
Read 35 tweets
It took a while to digest the details of over 600 pages, but here is my review and comparative analysis of the #ACTT2 trial that compared #baricitinib vs. #placebo among patients receiving #remdesivir for #COVID19!

Some very interesting insights, I think!

Sit briefly and enjoy!
Will be mainly comparing #ACTT2 to #ACTT1, but also will get some insights and questions that come up when comparing #ACTT2 to the #dexamethasone #RecoveryTrial
The idea of using #baricitinib (aka Bari) for #COVID19 is in this commentary in .@TheLancet from Feb. when Peter Richardson & Co working .@benevolent_ai .@ucl searched drugs and noted that #bari could block inflammation & viral endocytosis.

Read 25 tweets
With the .@NIAIDNews #ACCT1 trial final report published on 05 Nov 2020 and the .@WHO's #SolidarityTrial Preliminary report published on 02 December 2020, thought it would be good to take another look at both trials and find ways forward for the patients we are dealing with today
Motivated by a patient I am dealing with who will survive very severe #COVID19 in the setting of transplant, but her father, who was hospitalized earlier than her with moderate COVID, was left to progress and died before her discharge, given #remdesivir only after going on #BiPAP
Here is the link to the prior analysis and I think the new publications give some interesting details which will follow

Read 39 tweets
"This week, I was pleased to see that the @MHRAgovuk gave an emergency authorization for the Pfizer/BioNTech #COVID19 vaccine for rollout"-@DrTedros #ACTogether

"Just like with the 🇬🇧’s findings on #dexamethasone in the summer, this is an important scientific step for the world as vaccines will be critical in the battle against #COVID19"-@DrTedros #ACTogether
Read 29 tweets
"75 years ago, as the 🌍 lay smouldering from the 2nd global conflict in 30 years, a new project was conceived – a project born of suffering, death & loss, but also of hope, & the blinding realization that there is no future but a common future"-@DrTedros #UNGASS #UN75
"That project, of course, was the United Nations 🇺🇳"-@DrTedros #UNGASS #UN75

Read 60 tweets
"With the latest positive news from vaccine trials, the light at the end of this long, dark tunnel is growing brighter.

There is now real hope that vaccines – in combination with other tried and tested public health measures – will help to end the #COVID19 pandemic"-@DrTedros
"The significance of this scientific achievement cannot be overstated.
No vaccines in history have been developed as rapidly as these. The scientific community has set a new standard for vaccine development"-@DrTedros #COVID19 #ACTogether

Read 23 tweets
"We published the first global report on the burden of #sepsis, and a charter on health worker safety"-@DrTedros #HealthForAll #WHA73

"We’ve drawn new & much-needed attention to #mentalhealth, with new guidelines on stress management & adolescent & mental health, & we hosted the Big Event for Mental Health, a global advocacy event seen by more than 600,000 people"-@DrTedros #WHA73

"On maternal & child health, we’ve published new standards for improving the quality of care for small & sick newborns & provided intensive support for 20 countries to address the indirect impact of #COVID19 on mothers & children"-@DrTedros #HealthForAll
Read 91 tweets
Opening of the resumed #WHA73 with @DrTedros…
Ms Keva Bain, Permanent Representative of the #Bahamas🇧🇸 to the UN in Geneva is the President of the 73rd World Health Assembly #WHA73

Watch live ▶️
Five Vice-Presidents of the 73rd World Health Assembly #WHA73:
San Marino🇸🇲

Watch live ▶️
Read 52 tweets
"6 months ago, WHO launched the Solidarity Trial to evaluate the effectiveness of 4 drugs for the #COVID19 treatment.
The Solidarity Trial is the 🌍’s largest randomized controlled trial of COVID-19 therapeutics, involving almost 13K patients in 500 🏥 in 30 countries"-@DrTedros
"In June, we announced that we were discontinuing the hydroxychloroquine arm of the study, and in July we announced that we would no longer enrol patients to receive the combination of lopinavir and ritonavir"-
@DrTedros #COVID19
Read 30 tweets
Consider Trump Paranoia?

His longest-serving political advisor Stephen Miller: Covid
His longest-serving business associate Hope Hicks: Covid
His longest-serving legal advisor Giuliani: so sick, likely Covid
His longest-serving fake wife #Flotits: Covid

#ScreamHere #WayTooEarly Image
Trump Paranoia 2/5

Trump longest-serving accountant: Allen Weisselberg: Flipped
Trump longest-serving lawyer: Michael Cohen: Flipped
Trump longest-serving friend: David Pecker: Flipped
Trump longest-serving sex playboy buddy: Epstein: epsteined in prison

#TrumpIsNotAmerica Image
Trump Paranoia 3/5

Trump most trusted child, Ivanka: Covid (in reality is plotting her get-away behind locked door)
Trump Idiot Son number 1: Don Jr: Called dad crazy
Trump Idiot son number 2: Eric* Testified in NY for 8 hours Monday

*obviously Gary Busey's son
#TrumpIsNotWell Image
Read 5 tweets
1. Something I'm watching with Trump: The literature I saw didn't recommend #Dexamethasone early in the disease course. There were concerns that it would suppress the immune system's initial response, but his physicians had no problem with it. I don't presume
2. professionals are incompetent. So how could their use be justified? If Trump was infected by the debate that would put him on Dexamethasone about four days in. It's obvious Commander Conley doesn't want to tell the American people that POTUS was already infected on Tuesday.
3. He doesn't want to go back in time. But once Trump threatened the peaceful transfer of power, no polite courtesy can be afforded him. He wants to threaten us as a domestic enemy then he doesn't get any slack.
Read 5 tweets
1. #Dexamethasone Psychiatric Side Effects from

A wide range of psychiatric reactions including affective disorders (e.g., irritable, euphoric, depressed, labile mood, and suicidal ideation) psychotic reactions (e.g., mania, delusions, hallucinations,
2. aggravation of schizophrenia), behavioral disturbances, irritability, anxiety, sleep disturbances and cognitive dysfunction (e.g., confusion, amnesia) have been reported. These reactions have been reported in adults and children. In adults, the occurrence of severe reactions
3. has been estimated to be about 5% to 6%.[Ref]

This is not a drill. The way Trump's treatment is being handled is a threat to national security. Doctors under the @DeptofDefense control are engaging in enemy level propaganda to influence a US election.
Read 4 tweets
Live: @DrTedros' opening remarks at the #EBSpecial on #COVID19…
"It seems incredible to think that when the #EB146 met in Feb, there were just 151 cases & 1 death outside 🇨🇳 of what we now call #COVID19.

Today, almost 35M cases of COVID-19 have now been reported to WHO, & 1M+ people are reported to have lost their lives"-@DrTedros #EBSpecial
"Numbers can blind us to the reality that every single life lost is someone who loved & was loved by others – someone’s mother, father, someone’s sister, someone’s brother, daughter or son.

They are the reason we’re here"-@DrTedros #EBSpecial

Read 41 tweets
Dear @realDonaldTrump
You act like a child. You just potentially sacrificed the lives of two secret service members for a joyride. #TrumpCovid

I had #COVID19. I would have done anything to get outside my house for a ride. But that would have been bad for others.
I sweated through my clothes.
I coughed so hard that I pulled a muscle.
I was lucky enough to get a test.

But mine was a false negative. So, I couldn't get investigational therapies. Image
I too was on #dexamethasone . But unlike you, I was on it in March. It happened to be the only steroid I can handle.

I was irritable, and as tired as I was, I couldn't sleep. I didn't have my family here
Read 7 tweets

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