As is standard in meta-analyses, patients were compared only with other patients randomized in the same trial. Therefore, observed associations support a causal relationship between the administration of corticosteroids, compared with usual care or placebo, and reduced mortality.
This study has several limitations. First, the prospective nature of this meta-analysis implies that there is little risk of selective reporting or of publication bias, 6 but it is possible that lack of participation by some investigators of ongoing trials was based on their knowledge of their trial results.
Nonetheless, the number of patients randomized in eligible trials who did not participate is likely to be smaller than the number of patients included in this meta-analysis. It was the only trial that assessed the effect of methylprednisolone. Third, there were only limited missing outcome data, but in many trials, follow-up was censored when participants were discharged from the hospital.
We are aware of no reason that the effect of corticosteroids on postdischarge day mortality would differ from that on predischarge mortality, but it will be important to report on longer-term mortality, including postdischarge mortality, in future analyses. Fourth, the definitions and reporting of serious adverse events were not consistent across the trials and therefore a meta-analysis for this secondary end point was not conducted.
Fifth, the trials only recruited adults, and the effect of corticosteroids on children remains unclear. Similarly, the trials were mainly conducted in high-income settings. Sixth, 1 trial reported mortality at 21 days and 1 trial reported mortality at 30 days after randomization, potentially leading to inconsistency between trial results. In this prospective meta-analysis of clinical trials of critically ill patients with COVID, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower day all-cause mortality.
Corresponding Author: Jonathan A. Published Online: September 2, Diaz, MD; Arthur S. Marshall, MD. Author Contributions: Dr Sterne had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Slutsky reported being a co-primary investigator of one of the trials that is included in the meta-analysis.
Dr Angus reported receiving personal fees from Ferring Pharmaceuticals Inc, Bristol-Myers Squibb, Bayer AG, and Alung Technologies Inc; and having patents pending for Selepressin compounds, compositions, and methods for treating sepsis and for proteomic biomarkers of sepsis in elderly patients. Dr Emberson reported receiving grants from Boehringer Ingelheim.
Dr Lim reported receiving grants from Pfizer. No other disclosures were reported. This group assembled information on ongoing trials and invited trial investigators to participate in this prospective meta-analysis. The WHO chief scientist invited trial investigators to participate and provided a secure portal for submission of data.
Other than the contributions of Dr Diaz as a coauthor, the WHO had no role in the preparation, review, or approval of the manuscript. The WHO had no role in the decision to submit the manuscript for publication. Dr Angus is Associate Editor, JAMA , but was not involved in any of the decisions regarding review of the manuscript or its acceptance.
Additional Contributions: We gratefully acknowledge the efforts of all trial investigators the lists of names appear in the Supplement and the patients who provided consent for participation.
We thank Agnes Sagfors, PhD, and other staff at the W 2 O Group for searches of trial registries and for administrative and communications support.
None of these persons received compensation beyond their usual salaries. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Download PDF Comment. Figure 1. View Large Download. Figure 2. Figure 3. Figure 4. Table 1. Characteristics of Included Trials. Table 2. Characteristics of Patients Included in the Prospective Meta-analysis. Conversations with Dr Bauchner Subscribe to Podcast.
Lists of investigators and steering committee eTable 1. Summary of assessments of the risk of bias in the estimated effect of corticosteroids on mortality and serious adverse events in each trial, with brief explanation of judgements eTable 2. Effects of corticosteroids on day mortality according to whether patients received invasive mechanical ventilation IMV at the time of randomization eFigure 2. Effects of corticosteroids on day mortality according to whether patients received vasoactive medication at the time of randomization eFigure 3.
Corticosteroids and infectious diseases. PubMed Google Scholar Crossref. Corticosteroids in the treatment of severe sepsis and septic shock in adults. Corticosteroids for treating sepsis in children and adults.
PubMed Google Scholar. Clinical evidence does not support corticosteroid treatment for nCoV lung injury. Rationale for prolonged corticosteroid treatment in the acute respiratory distress syndrome caused by coronavirus disease Chapter prospective approaches to accumulating evidence. Accessed August 24, Dexamethasone in hospitalized patients with Covid—preliminary report.
Published online July 17, Published online August 24, Acute respiratory distress syndrome: the Berlin definition. Effect of hydrocortisone on day mortality or respiratory support among critically ill patients with COVID a randomized clinical trial.
Published online September 2, RoB 2: a revised tool for assessing risk of bias in randomised trials. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency CIRCI in critically ill patients part I.
Consensus values and weighting factors. Comparative performance of heterogeneity variance estimators in meta-analysis. A refined method for the meta-analysis of controlled clinical trials with binary outcome.
The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. Meta-analytical methods to identify who benefits most from treatments.
Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID the CoDEX randomized clinical trial. Accessed August 11, Published online August 12, Rate of intensive care unit admission and outcomes among patients with coronavirus.
Corticosteroids as adjunctive therapy in the treatment of influenza. This randomized clinical trial compares the effect of low-dose hydrocortisone vs placebo on treatment failure death or persistent respiratory support dependency at 21 days in critically ill patients with COVID and acute respiratory failure in France.
This open label clinical trial compares the effects of dexamethasone vs usual care on the number of days alive and free of mechanical ventilation at day 28 among COVID patients in Brazil with moderate to severe acute respiratory distress syndrome ARDS. Bruno M. Tomazini, MD; Israel S. Silva; Franca P. Baldassare; Eduardo L. Moura, MD; Michele O.
Honorato, MD; Andre N. Amendola, MD; Roberta M. Roepke, MD; Daniela H. Re-printed by Penguin Classics Read an abstract adapted from the Introduction to the book. The Upanishads have rightly been described as the 'Himalayas of the Soul' and we regard this selection from them by Juan Mascaro as the finest and most accurate translations ever rendered into English.
Readers who are unfamiliar with these sublime spiritual treatises on Man, God and the Universe are advised to read our abstract adapted from the translator's introduction to the book.
Born in Majorca of Spanish parents in , Juan Mascaro's own search for Truth began at the tender age of 13 when he studied a book on occultism. This led to his discovery of an inferior English translation of the Bhagavad Gita which inspired him to learn Sanskrit by himself.
He went on to study and teach at Cambridge University, in England, where he lectured on the spiritual values in the Bible and Spanish mysticism. He died in Cambridge in at the ripe old age of 90, having left the world some of the finest translations of the sacred texts of Hinduism ever written. Rabindranath Tagore, the famous Bengali poet wrote in a letter to Mascaro that he had "caught from those great words the inner voice that goes beyond the boundaries of words.
For this is an occult book in the best and highest sense of that much misunderstood word, which contains some of the most elevated spiritual truths ever composed by the hand of man. These timeless treatises upon Truth are as far removed from the dry and dusty curiosities of religious scholarship as the Sun is removed from a guttering candle in a dark cellar filled with bemused bats.
Blavatsky tells us that upa-ni-shad is a compound word meaning "the conquest of ignorance by the revelation of secret , spiritual knowledge. They treat of and expound the secret meaning of the Vedic texts and the occult sciences. Every sincere seeker who truly longs to scale the mountain of Truth should read the Upanishads , for in few other sacred texts can we find such clear and simple instructions to guide the feet of the traveller on the path to the Light.
Various publishers and editions in hard and softcover. Most seekers after Occult Knowledge and Truth would not regard the Bible as an occult book. The same is true of most occultists too. Devout Christians, on the other hand, would be horrified to hear the Bible called an 'occult' book, given that the word is now universally associated with all that is evil.
Nonetheless, we still say that the Bible is an occult book. The word occult , as we point out on our Homepage , simply means ' hidden '. It is in this correct sense that the word is used by doctors to describe blood that is not visibly apparent.
The same definition applies to occult truth—knowledge and wisdom which is not visibly apparent. The fact of the matter us that there is more real occult knowledge and truth hidden in plain sight in the Bible than any other book we can think of.
If you doubt us, which would be an eminent attitude to adopt, for we do not expect our readers to take anything we say on trust, we suggest you read any or all of the articles about the Bible written for us by John Temple , a theologian and ex-minister of the Anglican Church.
John Temple is not alone in regarding the Bible as belonging to a special category of literature, sometimes called sacred texts. The distinguishing characteristic of this kind of writing is that, while many of its narratives have a historical basis, the language itself is largely, though not entirely, allegorical and symbolical. It is for this reason that we believe the King James Version KJV of the Bible published in should take pride of place in every occultist's library.
The answer is because it preserves more of the hidden or occult meaning of the book than any other edition, with two exceptions. These are the Greek version of the Old Testament known as the Septuagint and the Latin translation of it known as the Vulgate.
But as few people nowadays know Greek or Latin sufficiently well to utilise these editions, we have not reviewed or recommended them. Let us take just one familiar verse from the Bible and compare the ways in which the two versions of the book interpret it. First John from the NIV. The KJV preserves the double meaning of the verse where 'light' is in no wise superior to 'darkness' and one principle can stand for the other, for as we point out in several of our articles our Earthly 'light' is darkness to the greater Light of the Spiritual realms and vice versa.
This duality, contradiction and subtlety is entirely lost in the NIV. Many seekers after Truth say they don't like the Bible because they believe it consists of 'fairy-tales' or is a publicity tract for the Christian Church.
In adopting such notions and ignoring the Bible, such seekers are depriving themselves of the opportunity to greatly expand their awareness and increase their knowledge of many vital occult truths, both in the macrocosm and the microcosm. Hardcover pp. Illustrated with photographs and line drawings. Also available second-hand from Abe books and other booksellers. We first read John Anthony West's groundbreaking reinterpretation of the science and civilisation of Egypt more than 30 years ago and were deeply impressed by it.
We remain impressed today, for what he has to say about the wisdom of ancient Egypt has rarely been expressed more clearly or completely by any other popular author. West challenged the prevailing dogmas about ancient Egypt for the very first time, providing a generation of readers with information which had either been suppressed, ignored or misinterpreted by orthodox archaeologists and Egyptologists. The service West has rendered to scholars and ordinary readers alike cannot be underestimated.
By summarising and extending the work of the philosopher and mathematician, R. Schwaller de Lubicz, he has not only made the ancient Egyptian sciences of art, architecture, mathematics, geometry and philosophy comprehensible to the lay reader who knows little or nothing about these subjects, but provided the serious occult student with a wealth of hitherto scarce and invaluable information on the hidden wisdom of ancient Egypt.
For most readers, Serpent in the Sky covers the same ground as de Lubicz, and is considerably easier to read. West is no New Age apologist promoting the weirder speculations of conspiracy theorists, but a conscientious and accomplished scholar who has the advantage over most orthodox Egyptologists in that he writes with great clarity, acuity and humour, dispelling the many popular misconceptions which surround the subject of ancient Egypt and its civilisation with rapier-like wit and inescapable logic.
If you are fascinated by ancient Egypt and we know few seekers after truth who are not you will not be disappointed by this book. NOTE: The paperback edition published in includes an update on the author's dating of the Sphinx.
Penguin Books, London Although written over 40 years ago, this lavishly illustrated book remains the most comprehensive compendium of accurate facts and data about the Great Pyramid we know. Many contemporary writers about Egypt, such as Graham Hancock, John Anthony West see previous review and Robert Bauval, have drawn much of their material from the enormous amount of data Tompkins collected together for his book.
The book contains over illustrations from sources ranging from the twenty-volume survey of Egypt commissioned by Napoleon to the first photographs taken inside the Pyramid in ; and an appendix by Professor Stecchini on the relations of ancient measures to the Great Pyramid. From the first Arabian investigations in the 8th century, to the latest theories and explanations, this book relates the complete history of the exploration of the Great Pyramid.
Peter Tompkins recounts the explorations and adventures of the archaeologists, treasure-hunters, soldiers, scientists and eccentrics who have tunnelled into and studied the Pyramid over many centuries.
He analyses the various theories as to how and why the Pyramid was built, and its relation to other monumental structures of antiquity, including Stonehenge and the ziggurats of Babylon. Whilst we would not necessarily endorse all the author's conclusions about the purpose and function of the Great Pyramid, we know of no other book in which so many different theories have been presented in such a thoroughly sensible and scientific manner.
This is in sharp contrast to many newer books on the subject, which, we are sorry to say, promote the most improbable fantasies based on variations of the same crackpot theories Tompkins demolishes in this book. Among these theories may be included the hair-brained notion that the Great Pyramid was a 'nuclear' power station, a prophetic device to predict the future or was built by aliens.
Several chapters in the book will be of great interest to occult students , not least those which explore the many astronomical, astrological and mystical aspects of this mysterious monument, whose primary purpose was a Temple of Initiation into the ancient Mysteries, as many of our readers will know.
For these reasons alone we highly recommend this book. Softcover, 85pps. Although the book was written at a time when the science of Egyptology was in its infancy, this in no way negates the invaluable esoteric lore the author has collected from the translations of Egyptian papyri available to her in the 19th century, which remain as much of an enigma to modern scholars as they were to Egyptologists in Farr's time. Understandably, she draws heavily on the books of E.
Wallis Budge, now sadly out of favour among Egyptologists for reasons of political correctness rather than scholarship in which he vastly exceeded all his modern contemporaries put together. The book includes a detailed examination and discussion of reincarnation, initiation, evolution and the afterlife which is in complete accord with the true laws and principles of occult science as expounded in many of our articles.
Farr correctly deduced that the principles of Egyptian magic were based on an elaborate series of correspondences derived from the fact that material and spiritual evolution follow the same Hermetic law of 'As above; so below' , and that matter and spirit are the opposite states of the one Universal Substance, or Prima Materia.
The book begins with a dissertation upon the seven principles of man as they were known in ancient Egypt, explaining how they enter into the body at birth, what happens to them at death, and the manner in which they are connected. Later chapters include several so-called 'spells' taken from the Book of the Dead , which are nothing of the kind, for all these exhortations and prayers are nothing more nor less than allegorical representations of the various transformations the Higher Self undergoes during life and after death.
Over half the book is taken up with extracts from a Gnostic papyrus entitled The Book of Knowledge of the Invisible God , which forms part of the Bruce codex found in Upper Egypt in , and now preserved in the Bodleian Library, in Oxford.
This luminous text is reminiscent of the Pistis Sophia in parts and consists of some of the esoteric teachings Jesus imparted to his disciples after his resurrection. These alone make this little book well worth studying. You can read about the hidden meaning of the resurrection in our article about the esoteric meaning of Easter. First published Philadelphia Hardcover, pp inc 26pp index. Copiously illustrated with monochrome plates throughout.
There is also a paperback edition published by Elibron Classics in , which is a photographic facsimile reprint of the edition, available from Amazon. The Qabbalah also written "Kabbalah", "Cabala", etc , which word means "doctrines received by tradition"—is a system of Jewish theosophy that played an important part in the establishment of the Christian Church. As such, it is a valuable work for the study of the origin of religions and their philosophy in general, and the origin of the formulations, dogmas and doctrines of early Christianity in particular.
We would add that Isaac Meyer's book has nothing whatsoever to do with the fashionable craze of 'kabbalah' popularised by various Hollywood celebrities in recent years! First published at the author's own expense in , Meyer's Qabbalah remains the most accessible and readable summary of these important Hebrew writings that we know of. The book includes a short account of the life and writings of the philosopher, Solomon ben Yehudah Ibn Gebirol or Avicebron; some parts of the Qabbalistic philosophy, quotations from the Zoharic books, explanations of many New Testament passages, the basic element in Religions, and extracts from the so-called "Pagan" writers on the Invisible and Visible and the Ideal and Real.
In addition, the book contains Qabbalistic accounts of the Creation which should be of interest to every seeker, for it is only by carefully comparing the various accounts to be found in the sacred books of all times that the diligent occult student may arrive at a true conception of the origins of Man and the Universe. Alfa Romeo 75 Owners Manual. Adobe Acrobat Document 6. Alfa 33 User Manual. Adobe Acrobat Document 4.
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