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Öğe Corticosteroid use in COVID-19 pneumonia(Turkish Assoc Tuberculosis & Thorax, 2021) Diken, Ozlem Ercen; Yildirim, Fatma; Gulhan, Pinar Yildiz; Ozkaya, Sevket; Simsek, Meltem; Yucel, Cihan; Dirican, AdemIntroduction: Coronavirus disease 2019 (COVID-19) has a 1-2% fatality rate, where no specific treatment has yet been defined. Although corticosteroids are recommended for selected COVID-19 patients without acute respiratory distress syndrome (ARDS) and septic shock, there is no consensus regarding patient subgroups, dose, and duration. In this study, it was aimed to examine the contribution of corticosteroid treatment to the management of COVID-19 pneumonia without ARDS, septic shock both in acute and recovery setting. Materials and Methods: The study population was divided into two as those who used corticosteroids during the recovery phase (who did not develop sufficient radiological or clinical improvement) and those who did so during the activation phase (non-ARDS/septic shock condition, clinical, laboratory or radiological progression). Results: We identified 47 patients, 26 of which were males, and mean age was 60.5 +/- 16.5 years. Seventeen patients were found to receive corticosteroids during the recovery phase and the rest (n- 30) during the activation period. After corticosteroid therapy, we found reduction of increased pre-treatment levels of D-dimer, ferritin, fibrinogen, CRI; increment of decreased pre-treatment lymphocyte count and saturation. Complete symptomatic improvement was detected in 6.9% and 17.6% of the patients in the activation phase and recovery phase, respectively. Complete radiological improvement was found in 11.5% and 35.3% of the patients in the activation phase and recovery phase, respectively. While corticosteroid treatment was initiated on day 4.2 +/- 2.6 and continued for a mean of 5.9 +/- 2.8 days in the activation group, it was started on day 8.1 +/- 11.3 and administered for 7.8 +/- 3.8 days in the recovery group. In both groups, methylprednisolone was given at a median dose of 40 mg/day. Conclusion: Short-term low-dose corticosteroid therapy may improve clinical, radiological, laboratory outcomes in the management of COVID-19 pneumonia during the activation period without ARDS and non-septic shock and during recovery period with no satisfactory response. Further randomized controlled studies will be useful in demonstrating its efficacy.Öğe COVID-19 related acute respiratory distress syndrome: Pathological, radiological and clinical concordance(Turkish Assoc Tuberculosis & Thorax, 2021) Yildirim, Fatma; Yildiz Gulhan, Pinar; Simsek, MeltemSevere coronavirus 2019 disease (COVID-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leading to acute respiratory distress syndrome (ARDS). However, when ARDS occurs as part of COVID-19, it has different features. The strategy of breathing support is very important in treating COVID-19 related ARDS (CARDS). Though it meets the CARDS Berlin definition, COVID-19 pneumonia is a specific disease with different phenotypes. Recently, it has been suggested that CARDS has two phenotypes, type L (Type 1 or non-ARDS) and type H (Type 2, ARDS), and these phenotypes respond differently to respiratory support treatments. In this review, after mentioning the pathophysiology and radiological relationship of CARDS, the definition and treatment approaches of two different forms of CARDS were discussed.