Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report (RECOVERY) trial is a randomized, controlled, open-label, comparison of dexamethasone 6 mg given once daily for up to ten days vs. usual care alone. 2104 patients randomly allocated to receive dexamethasone were compared with 4321 patients concurrently allocated to usual care. The primary outcome was 28-day mortality (21.6%) patients allocated dexamethasone vs (24.6%) patients in usual care died within 28 days (age-adjusted rate ratio [RR] 0.83; 95% confidence interval [CI] 0.74 to 0.92; P<0.001). No oxygen then dexamethasone did not reduce mortality at 28 17.0% vs. 13.2%, RR 1.22 [95% CI 0.93 to 1.61]; p=0.14). patients receiving oxygen without invasive mechanical ventilation dexamethasone did reduce mortality at 28days (21.5% vs. 25.0%,-- a number needed to treat around 30. And if you were intubated then dex 6mg for for to 10 days really was a show stopper with a nnt of 9 for mortality at 28days. Last case bias. but things I dont like about this open label- obviously not ideal but I do believe doctors are better than open label enrolled if confirmed or clinically expected covid-- not quite the same thing -the good news is almost every vented pt. had criteria for acute resp destress syndrome or ARDS and would have met criteria for every ARDS trial performed to date. and this is similar to numbers we saw with what is now standard of care- like the 8% benefit we saw low title volume and 16% benefit we saw with proning. It is totally possible these results are real. and if they arent then who cares!! examethasone has little mineralocorticoid activity, which is potentially beneficial for a few reasons. Mineralocorticoid stimulation may promote fluid retention and hypernatremia (which are especially undesirable in patients with ARDS). 6mg oral or IV once a day! now Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension JAMA Intern Med. 2020;180(4):542-551. doi:10.1001/jamainternmed.2019.7454 To compare the effectiveness and safety of chlorthalidone and hydrochlorothiazide for first time antihypertensive drug users 730 225 individuals retrospective, observational, comparative cohort design- 2001-2018 large cohort and had to have taken the medication for a year prior to having any event occur. The primary outcomes were acute myocardial infarction, hospitalization for heart failure, ischemic or hemorrhagic stroke, and a composite cardiovascular disease outcome including the first 3 outcomes and sudden cardiac death. Fifty-one safety outcomes were measured. That’s a total of 55 outcomes “To address multiplicity concerns, we indicate which estimates remain statistically significant after a Bonferroni correction for 55 hypotheses” “ IN THE END No significant difference was found in the associated risk of myocardial infarction, hospitalized heart failure, or stroke Chlorthalidone was associated with a significantly higher risk of hypokalemia (hazard ratio [HR], 2.72; 95% CI, 2.38-3.12), hyponatremia (HR, 1.31; 95% CI, 1.16-1.47), acute renal failure (HR, 1.37; 95% CI, 1.15-1.63), chronic kidney disease (HR, 1.24; 95% CI, 1.09-1.42), and type 2 diabetes mellitus (HR, 1.21; 95% CI, 1.12-1.30). No difference in cardiovascular diseaes- but these are first time hypertesnive patients. They are not honda—did we expect sick??? Chlorthalidone was associated with a significantly higher risk of hypokalemia (hazard ratio [HR], 2.72; 95% CI, 2.38-3.12), hyponatremia (HR, 1.31; 95% CI, 1.16-1.47), acute renal failure (HR, 1.37; 95% CI, 1.15-1.63), chronic kidney disease (HR, 1.24; 95% CI, 1.09-1.42), and type 2 diabetes mellitus (HR, 1.21; 95% CI, 1.12-1.30). chlorthalidone was associated with an increased risk of hypomagnesemia, hyperkalemia, vomiting, syncope, gout, impotence, and anaphylactoid react(continued)