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Background: Vitiligo is a common acquired depigmentory skin disorder supposed to be of autoimmune aetiology. Different immunosuppressants have been tried with varying success. Azathioprine has been less studied in vitiligo. Aims and Objectives: To study the efficacy of oral azathioprine and compare with systemic steroid in the treatment of vitiligo. Materials and Methods: It was an interventional study with multi-armed (three), parallel group, an open-label, randomized controlled trial with allocation ratio of 1:1:1. Patients of vitiligo aged between 18 and 60 years having more than 5 body surface involvement were included in the study. Patients were divided into three groups. Group A--patients received oral azathioprine 50 mg OD daily, group B--patients received combination of oral azathioprine 50 mg OD and PUVASOL and group C--patients received combination of betamethasone oral mini pulse (OMP) and PUVASOL. All the groups were treated for 1 year. Repigmentation was evaluated by vitiligo area severity index (VASI), and stabilization was evaluated by vitiligo disease activity (VIDA). Results: Group A, group B and group C showed 24.24, 53.24 and 47.28 improvement in VASI score, respectively, at the end of 1 year. Group B and group C showed statistically significant superior repigmentation as compared to azathioprine monotherapy. Though azathioprine and betamethasone showed equivalent efficacy, azathioprine has a better safety profile. Side effects were minimal in azathioprine groups, whereas 50 patients developed various side effects in group C. Conclusion: Azathioprine is safe and effective option in the treatment of vitiligo. Keywords: Azathioprine, oral minipulse, vitiligo, Author(s): Sugat Jawade (corresponding author) [1]; Vikrant Saoji [1]; Bhushan Madke [1]; Adarshlata Singh [1] Introduction Vitiligo is a common acquired depigmentory skin disorder with significant impact on the self-esteem.[sup.[1]] [...]

Purpose We performed a retrospective analysis of a sarcoidosis cohort who had sACE obtained at their initial clinic visit, but the treating physician was blinded to the results. We examined the relationship between sACE and the treating physician's decision to escalate sarcoidosis treatment. Methods Treatment was considered escalated if the prednisone dose was increased or if the prednisone dose was not changed but an additional anti-sarcoidosis drug was added or the dose was increased. Results 561 sarcoidosis patients were analyzed. The most common target organ was the lung (84%). Using a cut-off of > 82 units/L for an elevated sACE, 31/82 (38%) with an elevated sACE had treatment escalation whereas 91/497 (18%) had treatment escalation with a normal sACE (p 82) had sensitivity 0.25, specificity 0.89, positive predictive value 0.38, negative predictive value 0.81. These results were not appreciably different using other sACE cut-off values such as 70, 80, 90, or 100. A multivariable logistic regression model that included demographics, the target organ, spirometry results estimated that sACE level and lower FVC were significantly associated with the likelihood of treatment escalation. These findings held when sACE > 82 replaced sACE level in the multivariable logistic regression model. Conclusions Although there was a strong correlation between sACE at the initial sarcoidosis clinic visit and subsequent treatment escalation of sarcoidosis, the predictive power was such that sACE is not adequately reliable to be used in isolation to make this determination., Author(s): Boris Shkolnik [sup.1], Rou Sore [sup.2], Muhammad Salick [sup.1], Gowthami Kobbari [sup.1], Sana Ghalib [sup.1], Anoosh S. Parimi [sup.1], Kenneth M. Fish [sup.1], Robert Deluca [sup.1], Recai Yucel [sup.2], [...]

Corticosteroid treatment (CST) failure is associated with poor outcomes for patients with gastrointestinal (GI) graft-versus-host disease (GVHD). CST is intended to target the immune system, but the glucocorticoid receptor (GR) is widely expressed, including within the intestines, where its effects are poorly understood. Here, we report that corticosteroids (CS) directly targeted intestinal epithelium, potentially worsening immune-mediated GI damage. CS administered to mice in vivo and intestinal organoid cultures ex vivo reduced epithelial proliferation. Following irradiation, immediate CST mitigated GI damage but delayed treatment attenuated regeneration and exacerbated damage. In a murine steroid-refractory (SR) GVHD model, CST impaired epithelial regeneration, worsened crypt loss, and reduced intestinal stem cell (ISC) frequencies. CST also exacerbated immune-mediated damage in organoid cultures with SR, GR-deficient T cells or IFN-[gamma]. These findings correlated with CS-dependent changes in apoptosis-related gene expression and STAT3-related epithelial proliferation. Conversely, IL-22 administration enhanced STAT3 activity and overcame CS-mediated attenuation of regeneration, reducing crypt loss and promoting ISC expansion in steroid-treated mice with GVHD. Therefore, CST has the potential to exacerbate GI damage if it fails to control the damage-inducing immune response, but this risk may be countered by strategies augmenting epithelial regeneration, thus providing a rationale for clinical approaches combining such tissue- targeted therapies with immunosuppression., Introduction The epithelial lining of the gastrointestinal (GI) tract undergoes turnover every 5-7 days (1). This renewal is maintained by the cycling of leucine-rich, repeat-containing GPCR 5-positive ([Lgr5.sup.+]) intestinal stem [...]

Byline: Eda. Ustaoglu, Zafer. Turkoglu, Ovgu. Ulgen, Ceyda. Caytemel, Senay. Agirgol Background: This study aims to investigate the anti-inflammatory effects of cinnamaldehyde in atopic dermatitis (AD) in the mouse model. [...]

Current literature addressing the pharmacological principles guiding glucocorticoid (GC) administration in ARDS is scant. This paucity of information may have led to the heterogeneity of treatment protocols and misinterpretation of available findings. GCs are agonist compounds that bind to the GC receptor (GR) producing a pharmacological response. Clinical efficacy depends on the magnitude and duration of exposure to GR. We updated the meta-analysis of randomized trials investigating GC treatment in ARDS, focusing on treatment protocols and response. We synthesized the current literature on the role of the GR in GC therapy including genomic and non-genomic effects, and integrated current clinical pharmacology knowledge of various GCs, including hydrocortisone, methylprednisolone and dexamethasone. This review addresses the role dosage, timing of initiation, mode of administration, duration, and tapering play in achieving optimal response to GC therapy in ARDS. Based on RCTs' findings, GC plasma concentration-time profiles, and pharmacodynamic studies, optimal results are most likely achievable with early intervention, an initial bolus dose to achieve close to maximal GR[alpha] saturation, followed by a continuous infusion to maintain high levels of response throughout the treatment period. In addition, patients receiving similar GC doses may experience substantial between-patient variability in plasma concentrations affecting clinical response. GC should be dose-adjusted and administered for a duration targeting clinical and laboratory improvement, followed by dose-tapering to achieve gradual recovery of the suppressed hypothalamic-pituitary-adrenal (HPA) axis. These findings have practical clinical relevance. Future RCTs should consider these pharmacological principles in the study design and interpretation of findings., Author(s): Gianfranco Umberto Meduri [sup.1] [sup.8], Djillali Annane [sup.2], Marco Confalonieri [sup.3], George P. Chrousos [sup.4], Bram Rochwerg [sup.5] [sup.9], Amanda Busby [sup.6], Barbara Ruaro [sup.3], Bernd Meibohm [sup.7] Author [...]

INTRODUCTION Alcohol use disorder (AUD), a diagnosis that combines criteria for alcohol abuse and alcohol dependence from the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders into [...]

Byline: Hiraku. Kokubu, Takeshi. Kato, Sino. Fujimoto, Toshihiro. Tanaka, Noriki. Fujimoto Context: Few reports focused on the sex differences in alopecia areata (AA) treated with steroid pulse therapy. Aims: This [...]