Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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On Sep 2018

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Saraswati Dental College
On Sep 2018

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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : UC01 - UC04 Full Version

A Retrospective Evaluation of Combination Therapy of Methylprednisolone and Remdesivir for Severe COVID-19 Patients

Published: July 1, 2021 | DOI:
Shruti Jain, Madhu Bala, Harish C Sachdeva, Vandana Talwar, Usha Ganapathy

1. Associate Professor, Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, Delhi, India. 2. Associate Professor, Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, Delhi, India. 3. Professor, Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, Delhi, India. 4. Professor, Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, Delhi, India. 5. Professor, Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, Delhi, India.

Correspondence Address :
Dr. Shruti Jain,
Associate Professor, Department of Anaesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjang Hospital, Delhi, India.


Introduction: Severe and threatening complications of Corona Virus Disease-2019 (COVID-19) are caused by direct viral injury as well as excessive and aberrant host immune response induced by the virus. In this context, use of Methylprednisolone (MP) to prevent cytokine storm and Remdesivir to prevent viral replication seems prudent.

Aim: To assess the clinical outcome of combination therapy of Remdesivir and MP pulse therapy in patients with severe COVID-19 in Intensive Care Unit (ICU).

Materials and Methods: The retrospective study was conducted in the COVID-19 ICU, dealing exclusively with 21 severe illness severe illness cases at Safdurjung Hospital, New Delhi, India from June to July 2020. They were given MP pulse therapy (500 mg/day for three days, followed by 1 mg/kg orally once daily, tapered by 10 or 20 mg/day and finishing with 10 mg) along with intravenous Remdesivir. Pre and post-therapy examination of the patients included clinical features, inflammatory markers (Interleukin-6, ferritin and D-dimer), gas parameters like ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and changes in chest radiograph. Values of PaO2/FiO2, inflammatory markers on day 1 and day 3 were expressed as mean±SD and their difference compared using student t-test. Statistical significance was defined as p<0.05.

Results: This treatment regimen was associated with significant improvement in PaO2/FiO2 (p<0.001), significant decrease in inflammatory markers (p<0.001) and reversal of radiological changes. Ten patients were discharged within two weeks of treatment while six patients were shifted to high dependency unit for further oxygen requirement. They were all successfully discharged from hospital without oxygen requirement within next two weeks. Five patients developed opportunistic infections and succumbed to death. Side-effects of therapy included hyperglycaemia in nine patients, which was managed by insulin infusion.

Conclusion: Combination therapy of MP pulse and Remdesivir in patients with severe COVID-19 resulted in significant clinical improvement. Given the high efficacy, it could be one of the promising approaches to the management of patients with severe COVID-19.


Coronavirus disease-2019, Cytokine storm, Inflammatory markers

The world is in grip of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The immune response induced by SARS-CoV-2 infection is two phased. During the incubation and early symptomatic stages, viral replication occurs and adaptive immune response is generated that tries to eliminate the virus and prevents disease progression to pulmonary stages. The pulmonary phase is characterised by the development of an organising pneumonia, severe pro-inflammatory state and activation of clotting with macro and microvascular thrombosis and hypoxemia (1). It has been shown that the severe and threatening complications of COVID-19 are caused by excessive and aberrant host immune response induced by the virus (2),(3),(4). Studies have shown that any intervention which can prevent this catastrophe can also prevent the lung damage and pulmonary thromboembolism (1),(5).

In this context, use of immunosuppressive drugs like glucocorticoids, intravenous(iv) immunoglobulin and anticytokine agents (anakinra, tocilizumab) seems prudent for patients with severe COVID-19 to prevent the induction of Cytokine Release Syndrome (CRS) in COVID-19 patients (6),(7),(8). Drugs like tocilizumab and immunoglobulin are expensive and their use in wide-scale epidemics or in less prosperous healthcare systems is not possible. World Health Organisation has recommended systemic corticosteroids for the treatment of patients with severe and critical COVID-19 to dampen the cytokine storm and associated tissue injury (9). MP is the preferred corticosteroid, in the treatment of COVID-19 as it is a better immunosuppressive agent and helps in improvement of respiratory complications (10). But, systemic use of corticosteroids has been associated with delayed viral clearance (11). Therefore, MP should be supplemented with antiviral agent.

Remdesivir inhibits the viral Ribonucleic Acid (RNA) synthesis and has been associated with lesser oxygen requirement and respiratory infection in adults who were hospitalised with COVID-19 infection (12). Infectious Diseases Society of America (IDSA) has recommended remdesivir in hospitalised COVID-19 patients who require supplemental oxygen. It reduces clinical signs within 12 hours post inoculation, reduces viral replication and severity of lung lesions (13).

There are paucities of studies on safety and efficacy of combination therapy of corticosteroids and remdesivir for the treatment of severe COVID-19 illness. Hence, the study was conducted to analyse the clinical outcome of severe COVID-19 patients admitted in ICU of a tertiary care hospital, who were treated using combination of MP pulse therapy and remdesivir.

Material and Methods

The retrospective study was conducted in the COVID-19 ICU, dealing exclusively with severe illness cases, of Safdarjung Hospital, New Delhi from June to July, 2020. Permission for same was taken from ICU incharge and Head of Department of Anaesthesia and Critical care.

Inclusion criteria: Patients ≥18 years of age, with severe COVID-19 illness admitted in ICU were included in the study. Patients were considered to have severe illness if they had respiratory rate of ≥30/min, blood oxygen saturation of ≤93%, a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2:FiO2) of less than 300 mm Hg and/or infiltrates in more than 50% of the lung field (14).

Exclusion criteria: Patients who were allergic to any therapeutic agents, pregnant or lactating females, prior uncontrolled Hypertension (HTN), uncontrolled Diabetes Mellitus (DM), history of gastrointestinal bleeding, heart failure and active malignancies were excluded from the study.

Study Procedure

Twenty-two patients with severe COVID-19 illness were admitted in the ICU during the study period. One patient was excluded as she was 28 weeks pregnant.

All patients were started on i.v MP pulse 500 mg/day for three days, followed by 1 mg/kg orally once daily, tapered by 10 or 20 mg/day and finishing with 10 mg (15). MP was administered as single dosage in morning. 200 mg of injection remdesivir was given iv on first day followed by 100 mg for next 4 days. Patients were also given unfractionated heparin, iv piperacillin/tazobactam along with azithromycin for seven days, vitamin C, B complex and zinc.

Demographical details {age, sex and Body Mass Index (BMI)}, co-morbidities, respiratory variables, X-ray changes, inflammatory markers, mode of ventilation, details of treatment and clinical outcome were recorded.

Statistical Analysis

The data was entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 23.0. Age, BMI, number of days from onset of symptoms to ICU, duration of Non invasive Ventilation (NIV), MP intake and total ICU stay was presented as mean±SD. Values of PaO2:FiO2, inflammatory markers on day 1 and day 3 were expressed as mean±SD and their difference compared using student t-test. Statistical significance was defined as p<0.05.


In the study group, there were 21 patients with 14 males and seven females. Mean age was 58±8.5 years with mean BMI of 26.85±2.3. All patients presented with fever, cough, sore throat and breathlessness, with respiratory rate of 30-32 per minute. Mean time between onset of symptoms and admission in ICU was 7.85±1.45 days. Five patients had Diabetes Mellitus (DM), four had Hypertension (HTN), five patients had both the co-morbidites and two had asthma (Table/Fig 1).

Lung infiltrates occupied more than 50% of lung field on chest radiograph (Table/Fig 2)a, (Table/Fig 3)a. Mean PaO2/FiO2 ratio at time of ICU admission was 128.15±10.77. Mean values of inflammatory markers i.e., Interleukin-6 (IL-6), serum ferritin, D-Dimer were 290.2±150.82, 627.4±488.43, 892.83±146.3, respectively (Table/Fig 1). Patients were ventilated with NIV/High Flow Nasal Canula (HFNC) to maintain saturation ≥92%. Patients were intubated if NIV/HFNC failed to maintain saturation.

After three days of treatment, mean PaO2/FiO2 significantly improved to 214.17±21.86 (p<0.001). Mean values of IL-6, ferritin and D-dimer improved significantly to 171.21±118.9, 363.83±350.94 and 461.57±63.42 respectively (p<0.001). Infiltrates on chest radiograph were significantly reduced (Table/Fig 2)b, (Table/Fig 3)b.

Fourteen patients required NIV and seven were ventilated with HFNC. Later, five patients developed opportunistic infections (two had pseudomonas, one had acinetobacter and two had fungal infections), were started on appropriate treatment and subsequently required intubation but finally succumbed to death. Side-effects included hyperglycaemia, ranging from 200-450 mg/dL, in nine patients which was managed by insulin infusion.

Mean duration of NIV was 5.57±3.59 days. Thereafter, they were shifted on non rebreathing mask, venturi face mask, nasal prongs and then on room air. The mean steroid intake and ICU stay was 11.4±2.44 days and 13.2±2.61 days, respectively. Ten patients were discharged and six patients were shifted to high dependency unit for further oxygen requirement. They were all finally discharged from hospital without oxygen requirement within two-week (Table/Fig 3).


This study retrospectively analysed 21 patients with severe COVID-19 illness, who were administered MP pulse therapy along with remdesivir, and found the combination resulted in significant clinical improvement. Lung injury in COVID-19 is associated with direct viral injury as well as CRS (1). MP, a synthetic glucocorticoid is the best choice for the pulmonary phase of COVID-19 because it has better lung penetration (16) and genomic data specific for SARS-CoV-2 (17). Administration of MP in pulses (500-1000 mg/day), induces apoptotic effects, gives very rapid immunosuppressive and anti-inflammatory effects and completely reverses the cytokine storm (18),(19),(20),(21). Studies have shown that pulse therapy of MP is associated with successful outcomes and decreased risk of death (6),(15),(21),(22).

Sheianov MV et al., had described three cases of severe COVID-19 successfully treated with a combination of MP pulse therapy (1,000 mg/day iv for three consecutive days) and iv immunoglobulin (20 g/day) (6), So C et al., reported a case series of seven mechanically ventilated patients with acute respiratory distress syndrome caused by COVID-19 who received early treatment 1000 or 500 mg/day for three days of MP followed by 1 mg/kg and tapered off. All the patients were extubated within seven days (15). Saune PM et al., described two cases of severe COVID-19 that were successfully managed with MP pulse therapy (500 mg/day) for three days (21). Edalatifard M et al., conducted a single-blind, randomised controlled clinical trial involving hospitalised patients with severe COVID-19 at the early pulmonary phase of the illness in Iran. Thirty-four patients received MP pulse therapy (250 mg/day) for three days. The percentage of improved patients was higher and the mortality rate was significantly lower in the MP group (p<0.001) (22).

But use of corticosteroids has also been associated with delayed viral clearance, higher mortality rate, longer length of stay, higher rate of bacterial infection and hypokalemia (23). Therefore, MP pulse should be reserved for patients with severe COVID-19 illness with high inflammatory markers and should be supplemented with antiviral agent to reduce viral replication.

Remdesivir, is a nucleotide analogue and has been reported to inhibit the viral RNA synthesis by a specific mechanism of delayed chain termination for all three coronaviruses (MERS-CoV, SARS-CoV and SARS-CoV-2) and shows promising results (24). Treatment with remdesivir in COVID-19 is associated with clinical improvement, length of stay, and reduction in serious adverse events. IDSA as well as National Institutes of Health (NIH) guidelines recommend use of remdesivir in hospitalised COVID-19 patients requiring supplemental oxygen. NIH also recommends use of corticosteroid along with Remdesivir for patients who require oxygen through a high flow device or NIV (25).

There is a case report where successful treatment of severe COVID-19 pneumonia patient was done by combination therapy of MP in dose of 1 mg/kg and remdesivir (26). In the index study, initiation of MP pulse and remdesivir resulted in significant clinical improvement, reduced levels of inflammatory markers, improvement in PaO2/FiO2, reversal of radiological changes and led to early weaning of patients. These findings were similar to those reported by other studies (6),(15),(21),(22).

The treatment was found to be generally safe, well tolerated and without any serious side-effects. There was fluctuation of blood sugar levels, which was effectively managed in ICU setting. Other studies also reported changes in blood sugar levels which were managed successfully (6),(15),(22). There was no episode of heart rhythm disturbances, uncontrolled HTN and gastrointestinal bleeding. So C et al., reported two cases of delirium while Edalatifard M et al., reported one adverse event (15),(22).

In this study, five patients developed opportunistic infections. They failed to maintain oxygen saturation, were intubated and finally succumbed to death. Edalatifard M et al., reported one case of oppurtunistic infection (22). Stuck et al have shown that higher doses of corticosteroid could probably be associated with concomitant infections (27). While few previous case reports who have used MP with other drugs have reported zero mortality, study by Edalatifard M et al., reported mortality in two out of 34 patients (6),(15),(21),(22).


The limitation of the study is absence of comparative group for this protocol. The study group was not homogenous in terms of age, sex and related co-morbidities. There was no long-term follow-up for the side-effects of corticosteroids. The effectiveness and safety of these components, either separately or in combination, require further evaluation.


Methylprednisolone pulse therapy, along with remdesivir resulted in significant clinical improvement with good outcome in patients with severe COVID-19 illness. This line of therapy could be one of the promising approaches to the management of patients with severe COVID-19 illness.


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DOI and Others


Date of Submission: Jan 20, 2021
Date of Peer Review: Apr 05, 2021
Date of Acceptance: May 04, 2021
Date of Publishing: Jul 01, 2021

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Jan 21, 2021
• Manual Googling: May 03, 2021
• iThenticate Software: May 25, 2021 (20%)

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