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OBJECTIVE: To provide a comprehensive overview of treatment strategies for systemic lupus erythematosus, focusing on disease severity-based management, glucocorticoid utilization, and novel approaches to reduce treatment-related harm. METHODOLOGY: An extensive analysis of current guidelines, studies, and evidence-based recommendations related to systemic lupus erythematosus treatment. We examined strategies proposed by EULAR and GLADEL for achieving remission and low disease activity based on SLE Disease Activity Index (SLEDAI) scores and medication doses. RESULTS: The treat to target strategy, emphasizing complete disease remission, is central in systemic lupus erythematosus management. Low disease activity has shown sustained patient adherence and protection against relapse and organ damage. CONCLUSIONS: The optimal management of systemic lupus erythematosus entails aligning treatment with disease severity, judicious glucocorticoid use, and integration of emerging approaches to mitigate treatment-associated harm. Regular follow-up and adherence to established guidelines are crucial for achieving favorable outcomes in systemic lupus erythematosus patients. [ABSTRACT FROM AUTHOR]

Contrasting with the lymphopenia classically reported after administration of glucocorticoids, a lymphocytosis has been sometimes observed in patients after glucocorticoid administration. We here determine prospectively the timing and magnitude of methylprednisolone (mPDN)-induced lymphocytosis and study the effects of concomitant propranolol administration on lymphocyte count (Ly). Ly was measured before and 24 to 72 hours after initiating mPDN treatment in 20 patients with immune-mediated inflammatory disorders (IMID). After one week, patients with increased Ly were divided in two groups receiving, in addition to mPDN, either propranolol or a placebo; Ly was determined 4 days later. Lymphocyte subpopulations and mPDN plasma levels were determined in subsets of the patients. Values are expressed as median with 25%–75% interquartile range. A 73.4% (37–305) increase of Ly was observed in 18/20 patients as soon as 48 (48–72) hours after initiating mPDN (32 mg; 16–32). Lymphocytosis (Ly ≥ 4000/μL) was observed in 7 patients and hyperlymphocytosis (Ly ≥ 5000/μL) in 4 of them. The increase in Ly was noted both for B and T cells. Median mPDN plasma levels (n = 13) were 97.4 ng/mL (IQR 67–489) and 3.2 (IQR 2.1–5.1) respectively 8 hours and 24 hours after oral mPDN administration. No significant change in Ly was shown under propranolol (p = 0.570). A morning lymphocytosis observed during mPDN treatment occurs in the very first days of mPDN administration. Our results do not support the hypothesis of an increased adrenergic tone responsible for this phenomenon. Identifying this unexpected etiology of lymphocytosis could mitigate the need for unnecessary supplementary investigations in clinical practice. [ABSTRACT FROM AUTHOR]

Evidence evaluating the association between pre-frailty and frailty, and risk of adverse health outcomes in patients with Behçet's syndrome (BS) is limited in the literature. The aim of this study was to characterize the prevalence of frailty and associated factors in a single-centre cohort of patients with BS. Based on the International Study Group's criteria, this was a monocentric cross-sectional study of BS patients. The Fried frailty criteria were used to define frailty. The Turkish version of the Behçet's Disease Current Activity Form was used to measure the disease activity of BS. Damage index was assessed with the Behçet's Syndrome Overall Damage Index. Forty-four patients were enrolled. According to Fried frailty criteria, patients were classified as 13.6% frail, 59% pre-frail, and 27.2% robust, respectively. Compared to pre-frail and robust patients, frail patients had higher levels of inflammatory markers at the time of diagnosis. CRP levels at time of diagnosis and at the last visit were higher in the frail group than in the pre-frail and robust groups (p = 0.039 and p = 0.023, respectively). When active drugs for BS were evaluated, systemic glucocorticoid (50%, p = 0.030) and cyclophosphamide (33.3%, p = 0.006) treatments were higher in the frail group. Frailty and pre-frailty are commonly detected even in younger patients with BS. Inflammation can be described as potential determinants of frailty status. [ABSTRACT FROM AUTHOR]

Introduction: Primary adrenal insufficiency (PAI) in children is a rare condition characterized by deficient production of glucocorticoids and/or mineralocorticoids. The clinical manifestations are nonspecific and insidious. Providers need to know about this disorder to be able to make an early diagnosis, as appropriate management can be life-saving. Methods: We conducted a multicentre retrospective study including every patient aged less than 18 years given a diagnosis of PAI in the last 30 years at 5 Spanish hospitals. Objectives: The objective was to determine the aetiologies, signs, symptoms and laboratory findings of PAI in the paediatric age group. Results: Twenty nine patients received a diagnosis of PAI at a median age of 5.6 years. An aetiological diagnosis was established in 23 patients (79.3%): X-linked adrenoleukodystrophy in 8 (27.6%), autoimmune adrenalitis in 6 (20.7%), X-linked adrenal hypoplasia congenita in 4 (13.8%), adrenocorticotropic hormone (ACTH) resistance syndrome in 2 (6.9%), Pearson syndrome in 2 (6.9%) and Allgrove syndrome in 1 (3.4%). In the remaining 6 patients, no clear aetiology was identified. Sixteen patients (55.2%) had onset with an adrenal crisis. Twenty patients (69%) needed combination therapy (hydrocortisone and fludrocortisone). Conclusions: Asthenia, hyperpigmentation and hyponatraemia were the most prevalent sign, symptom and electrolyte abnormality at onset of PAI, although their absence does not rule out this disease. The elevation of ACTH persists despite adequate glucocorticoid replacement therapy. Resumen: Introducción: La insuficiencia suprarrenal primaria (ISP) es una enfermedad rara en niños caracterizada por la incapacidad en la producción de glucocorticoides y/o mineralocorticoides. Las manifestaciones clínicas son inespecíficas e insidiosas. Debemos conocer esta enfermedad para poder realizar un diagnóstico precoz, ya que el correcto manejo de la enfermedad puede salvar vidas. Diseño: Se ha realizado un estudio multicéntrico y retrospectivo, registrándose todos los pacientes diagnosticados de ISP (menores de 18 años) en los últimos 30 años de 5 hospitales españoles. Objetivos: Determinar la etiología, signos, síntomas y alteraciones analíticas en la insuficiencia suprarrenal primaria en la edad pediátrica. Resultados: Veintinueve pacientes fueron diagnosticados de ISP, con una mediana de 5,6 años. Se logró emitir un diagnóstico etiológico en 23 pacientes (79,3%): encontramos 8 casos de adrenoleucodistrofia ligada al cromosoma X (27,6%), 6 adrenalitis autoinmunes (20,7%), 4 hipoplasias suprarrenales congénitas ligadas al X (13,8%), 2 síndromes de resistencia a la ACTH (6,9%), 2 pacientes con síndrome de Pearson (6,9%) y un paciente con síndrome de Allgrove (3,4%). En los otros 6 pacientes, la etiología es desconocida por el momento. Dieciséis pacientes (55,2%) debutaron en forma de crisis adrenal. Veinte pacientes (69%) precisaron tratamiento combinado (hidrocortisona y fludrocortisona). Conclusiones: La astenia, la hiperpigmentación cutánea y la hiponatremia fueron el síntoma, el signo y la alteración electrolítica más frecuentes al debut, aunque su ausencia, no descarta una ISP. La ACTH (hormona adrenocorticotropa) permanece elevada a pesar de un correcto tratamiento con glucocorticoides.

Les glucocorticoïdes sont largement utilisés pour le traitement de diverses maladies et affections dans un certain nombre de spécialités. Les effets néfastes des glucocorticoïdes oraux sur la santé osseuse sont bien documentés et l'ostéoporose cortico-induite est la cause la plus répandue d'ostéoporose provoquée par des médicaments et de fractures. On ne sait toutefois pas avec certitude si, ni dans quelle mesure, les glucocorticoïdes administrés par d'autres voies ont des effets sur le squelette. Cette revue présente les résultats disponibles à propos des effets des glucocorticoïdes administrés par voie inhalée, épidurale, intra-articulaire et topique sur les paramètres osseux. Bien que les données probantes soient limitées et peu robustes, il semble qu'une petite proportion des glucocorticoïdes administrés puisse être absorbés, pénétrer dans la circulation systémique et avoir des effets néfastes sur le squelette. Les glucocorticoïdes puissants, les fortes doses et une longue durée de traitement pourraient entraîner un risque accru de perte osseuse et de fractures. On trouve peu de données, et celles qui sont disponibles concernent uniquement les glucocorticoïdes inhalés, sur l'efficacité des anti-ostéoporotiques chez les patients recevant une corticothérapie administrée par d'autres modes que la voie orale. Des études complémentaires sont nécessaires pour clarifier la relation entre les différentes voies d'administration des glucocorticoïdes et les paramètres osseux et contribuer à formuler des recommandations de prise en charge optimale de ces patients. Glucocorticoids (GCs) are widely used by several specialties for the treatment of a variety of diseases and conditions. The unfavorable effect of oral GCs on bone health is well-documented. The ensuing from their use glucocorticoid-induced osteoporosis (GIOP) is the most common cause of medication-induced osteoporosis and fractures. It is uncertain, however, if, and in what extent, GCs administered by other routes affect the skeleton. In the present review, we quote current evidence on the effect of inhaled GCs, epidural and intra-articular steroid injections, and topical GCs on bone outcomes. Although evidence is limited and weak, it seems that a small proportion of the administered GCs may be absorbed, enter the systemic circulation, and adversely affect the skeleton. Potent GCs, higher doses, and longer treatment duration seem to infer the greater risk for bone loss and fractures. There are scarce data, and only for inhaled GCs, regarding the efficacy of antiosteoporotic medications in patients receiving GCs through routes other than oral. Further studies are needed to clarify the relationship between GC administration through these routes and bone outcomes and to help establishing guidelines for the optimal management of such patients. [ABSTRACT FROM AUTHOR]

Diseñar un protocolo asistencial en las artritis inflamatorias crónicas durante el período preconcepcional, el embarazo, el posparto y la lactancia. Este protocolo tiene como objetivo ser práctico y aplicable en las consultas donde se atienden a pacientes con enfermedades inflamatorias reumatológicas crónicas, ayudando así a un mejor control de estas pacientes. Asimismo, se ofrecen recomendaciones sobre en qué momento se podría consultar/remitir a las pacientes a un centro especializado por parte del facultativo. Un panel multidisciplinar de médicos expertos de diferentes especialidades identificó los puntos claves, analizó la evidencia científica y se reunió para elaborar el protocolo asistencial. Las recomendaciones elaboradas se han dividido en 3 bloques: reumatología, ginecología y pediatría. El primer bloque se ha dividido en visita pregestacional, gestación y posparto. Este protocolo intenta homogeneizar el seguimiento de las pacientes desde el momento del deseo gestacional hasta el año de vida de los lactantes. Es importante realizar análisis en las pacientes en edad fértil y usar fármacos compatibles con la gestación. Si procede, se debe derivar a la paciente a unidades especializadas. La multidisciplinariedad (reumatología, ginecología y pediatría) es fundamental para mejorar en el control y en el seguimiento de estas pacientes y sus recién nacidos. To design a care protocol in chronic inflammatory arthritis during the pre-conceptional period, pregnancy, postpartum and lactation. This protocol aims to be practical and applicable in consultations where patients with chronic inflammatory rheumatological diseases are treated, thus helping to better control these patients. Likewise, recommendations are offered on when patients could be consulted/referred to a specialized center by the physician. A multidisciplinary panel of expert physicians from different specialties identified the key points, analyzed the scientific evidence, and met to develop the care protocol. The recommendations prepared have been divided into three blocks: rheumatology, gynecology and pediatrics. The first block has been divided into pre-pregnancy, pregnancy and postpartum visits. This protocol tries to homogenize the follow-up of the patients from the moment of the gestational desire until the year of life of the infants. It is important to perform tests in patients of childbearing age and use drugs compatible with pregnancy. If appropriate, the patient should be referred to specialized units. Multidisciplinarity (rheumatology, gynecology and pediatrics) is essential to improve the control and monitoring of these patients and their offspring. [ABSTRACT FROM AUTHOR]

Background: Trauma-focused treatments for post-traumatic stress disorder (PTSD) are effective for many patients. However, relapse may occur when acquired extinction memories fail to generalize beyond treatment contexts. A subgroup of PTSD patients – potentially with substantial exposure to early-life adversity (ELA) – show dysregulation of the hypothalamic– pituitary–adrenal (HPA) axis, which results in lower cortisol levels. Glucocorticoids, including cortisol, appear to facilitate strength and generalization of emotional memories. Objective: We describe the protocol of an integrated PTSD study. We investigate (A) associations between HPA-axis dysregulation, ELA, epigenetic markers, and PTSD treatment outcome (observational study); and (B) effects of exogenous glucocorticoids on strength and generalization of extinction memories and associated neural mechanisms [pharmacological intervention study with functional magnetic resonance imaging (fMRI)]. The objective is to provide proof of concept that PTSD patients with HPA-axis dysregulation often experienced ELA and may show improved strength and generalization of extinction learning after glucocorticoid administration. Method: The observational study (n = 160 PTSD group, n = 30 control group) assesses ELA, follow-up PTSD symptoms, epigenetic markers, and HPA-axis characteristics (salivary cortisol levels during low-dose dexamethasone suppression test and socially evaluated cold-pressor test). The pharmacological intervention study (n = 80 PTSD group, with and without HPAaxis dysregulation) is a placebo-controlled fMRI study with a crossover design. To investigate strength and generalization of extinction memories, we use a differential fear acquisition, extinction, and extinction recall task with spatial contexts within a virtual environment. Prior to extinction learning, 20 mg hydrocortisone or placebo is administered. During next-day recall, strength of the extinction memory is determined by recovery of skin conductance and pupil dilation differential responding, whereas generalization is assessed by comparing responses between different spatial contexts. Conclusion: The integrated study described in the current protocol paper could inform a personalized treatment approach in which these PTSD patients may receive glucocorticoids as a treatment enhancer in trauma-focused therapies. [ABSTRACT FROM AUTHOR]

INTRODUCCIÓN: durante la pandemia de COVID-19 se reportaron casos de hiperglucemia en pacientes hospitalizados con y sin diabetes mellitus. La hiperglucemia podría deberse al estado pro inflamatorio de la enfermedad, uso de corticoides, daño directo e indirecto del virus hacia las células pancreáticas, disfunción endotelial, entre otros. La hiperglucemia es una complicación muy común en las enfermedades infecciosas; incrementa la estadía hospitalaria, la mortalidad y complicaciones. OBJETIVO: determinar la frecuencia de hiperglucemia en pacientes con neumonía COVID-19 tratados con corticoides. MATERIALES Y MÉTODO: estudio observacional, retrospectivo, descriptivo. Se evaluaron pacientes de ambos sexos mayores a 18 años, sin antecedentes de diabetes mellitus, internados en la Clínica Universitaria Reina Fabiola con diagnóstico de neumonía por infección por COVID-19 que recibieron tratamiento corticoideo. Para ello se revisaron las historias clínicas durante el período comprendido entre 1° de marzo de 2021 hasta el 31 de octubre de 2021. Se analizaron las siguientes variables: edad, sexo, antecedente familiar de diabetes, índice de masa corporal (IMC), hiperglucemia en internado definida como glucemia plasmática mayor o igual a 140 mg/dl, índice de comorbilidad de Charlson, antecedente de diabetes gestacional y dosis de corticoide administrada. Las características de la muestra se presentaron con la estadística descriptiva; N y porcentaje para variables categóricas y medida de posición y dispersión para variables continuas. RESULTADOS: en este análisis se incluyeron 109 pacientes, los mismos tenían una edad media (desviación estándar, DE) de 54.24 (14.50) años de edad, con un predominio del género masculino (83%). La dosis media (DE) de dexametasona diaria utilizada fue de 8.03 (5.15) mg/día con una media de duración (DE) de 4.8 (2.2) días. Del total de los pacientes N= 76 (67.7%) presentaron hiperglucemia. Los pacientes con hiperglucemia tenían una edad media (DE) de 56.32 (14.06), de los cuales N= 58 (76.3%) eran hombres. En este grupo, el antecedente de diabetes mellitus familiar fue positivo en N= 50 (65.8%) pacientes y de diabetes gestacional en N=21 (27.6%). En N=51 (67%) pacientes con hiperglucemia el índice de comorbilidad de Charlson fue igual a 0. Finalmente, los pacientes con hiperglucemia tenían un IMC medio (DE) de 30 (5.9); N= 23 (30.3%) presentaban sobrepeso y N=41 (52.9%) obesidad. CONCLUSIONES: la frecuencia de hiperglucemia en pacientes con neumonía por COVID-19 hospitalizados y tratados con corticoides fue del 67%. La hiperglucemia se presentó con mayor frecuencia en hombres, de los cuales, en su mayoría presentan antecedentes familiares de diabetes y un índice de masa corporal elevado.

El Lupus Eritematoso Sistémico (LES) es uno de los prototipos de las enfermedades autoinmunes, compromete principalmente al sexo femenino, con una proporción 9:1 mujer-hombre. Se caracteriza por la formación de autoanticuerpos con la participación de la inmunidad adaptativa e innata, en interacción con los factores genéticos y medioambientales. Estos autoanticuerpos son parte central de la fisiopatología de la enfermedad, causando desde compromiso orgánico leve hasta compromiso multisistémico grave. El diagnóstico es clínico, orientado por una anamnesis detallada, un examen físico exhaustivo y los marcadores de autoinmunidad; eventualmente podría apoyarse en criterios clasificatorios de algunas sociedades científicas. La actual revisión pretende destacar las generalidades sobre la enfermedad, haciendo énfasis en su fisiopatología, presentación clínica, y su abordaje diagnóstico y terapéutico, sirviendo de apoyo para la formación médica integral en beneficio de los pacientes.

Introducción: la crisis hiperglucémica es la complicación aguda más grave en diabetes mellitus y los factores precipitantes suelen ser infección, intoxicación, inflamación, isquemia y yatrogenia. Esta última hace referencia a la ingesta de medicamentos como glucocorticoides, pues es paradójico que siendo uno de los efectos secundarios más conocidos, es de los más subestimados. Presentación del caso: mujer de 62 años con antecedente de púrpura trombocitopénica idiopática en tratamiento con prednisolona 50 mg/día, quién ingresó a urgencias por cuadro clínico de 5 días de evolución consistente en somnolencia, astenia e hiporexia. Se encontró somnolencia, deshidratación grado III, uroanálisis con cetonuria y osmolaridad de 320.48 mOsm/k, glucemia 1.035 mg/dL y gases arteriales con acidemia metabólica no compensada. Se consideró el cuadro como crisis hiperglucémica mixta de probable inducción por corticoides. Requirió insulinoterapia e hidratación endovenosa con evolución favorable. Discusión: los glucocorticoides tienen múltiples manifestaciones adversas, dentro de las que destaca el efecto deletéreo sobre el metabolismo de los carbohidratos, lo cual puede exacerbar la hiperglucemia en individuos con diabetes o en su defecto puede facilitar la aparición de diabetes sin diagnóstico previo. Conclusión: es necesario establecer la incidencia de los pacientes con enfermedades autoinmunes que reciben corticoterapia y desarrollan diabetes mellitus.

Objetivo: Comparar el nivel de control del asma mediante el uso del Asthma Control Test (ACT) y manifestaciones clínicas en dos grupos de pacientes tratados con diferentes corticosteroides inhalados (GCI). Materiales y métodos. Estudio descriptivo, observacional y prospectivo donde se registró en 521 niños del programa de asma del Hospital III Yanahuara (Arequipa, Perú) el Nivel de Control del Asma, durante el periodo de junio del 2020 a diciembre 2021, por medio de la consulta remota empleando el ACT y la recopilación de los hallazgos clínicos (síntomas diurnos, nocturnos, visita a emergencias y uso de broncodilatadores beta 2 agonistas), en dos momentos durante la pandemia COVID-19. Resultados. Ambos grupos tuvieron un control óptimo al inicio y final del estudio, con una mejoría significativa en el último control (P < 0.05). En las manifestaciones clínicas no hubo una diferencia estadística (P > 0.05) en ambos controles. El nivel promedio del ACT de la Fluticasona al egreso, tuvo una superioridad significativa frente a la Beclometasona (P = 0.03). Conclusiones. La Teleconsulta es una herramienta eficaz para el monitoreo de enfermedades crónicas como lo es el asma. Tanto Fluticasona cómo Beclometasona lograron un control óptimo de la enfermedad, destacando que el verdadero factor determinante para lograr un buen control es el uso continuo de cualquier GCI. Sin embargo, se encontró una diferencia estadística significativa a favor de la Fluticasona; no obstante, por su menor precio, la relación costo-eficacia favorece a Beclometasona como opción económica y eficiente para un óptimo control del asma.

Disponibles depuis le début des années 1950, les glucocorticoïdes (GC) font aujourd'hui partie intégrante de la prise en charge de la polyarthrite rhumatoïde (PR). Leur rapidité d'action les rend particulièrement intéressants pour le traitement des poussées ou comme agents relais dans la PR débutante. L'efficacité des GC dans la PR a été établie, à la fois pour contrôler l'activité de la maladie et pour retarder la progression des dégradations articulaires. Parallèlement à ces bénéfices, les GC ont également des effets indésirables bien identifiés. Il est généralement déconseillé d'utiliser les GC sur de longues périodes, surtout à forte dose, et les directives récentes pour la prise en charge de la PR préconisent de ne pas recourir à ces agents, ou suggèrent de ne les utiliser qu'à titre de thérapie relais. Les perceptions relatives aux effets néfastes des GC, essentiellement fondées sur des études observationnelles, demeurent. Les corticothérapies prolongées à faible dose restent très prévalentes dans la pratique clinique, et des données récentes semblent indiquer que cette stratégie présente un rapport bénéfice–risque plutôt favorable, même chez les patients âgés. Ainsi, l'objectif de parvenir à équilibrer les bénéfices et les risques du traitement de la PR par des GC est toujours quelque peu controversé. Cette revue narrative met en avant la place, historique et actuelle, des GC dans la prise en charge de la PR, et résume les éléments récents étayant leurs effets bénéfiques et néfastes. De plus, des stratégies pratiques pour l'utilisation et la diminution des GC dans la PR sont proposées. Glucocorticoids have been available since the early 1950s and have since become an integral part of the management of rheumatoid arthritis (RA). Due to their rapid effect, glucocorticoids have an appealing profile for treating flares or as ''bridging'' agents in early RA. The efficacy of glucocorticoids to treat RA has been well established, both to control disease activity and to delay the progression of joint damage. However, despite their benefits, glucocorticoids have equally well-known adverse effects. It is generally accepted that long-term use of glucocorticoids, particularly at higher doses, is not advisable, and recent guidelines for the management of RA therefore either recommend against the use of glucocorticoids or suggest using them only as bridging therapy. Perceptions on the harmful effects of glucocorticoids remain, mainly based on observational studies. Prolonged glucocorticoid therapy at low doses is still highly prevalent in clinical practice, but recent data suggested a rather favourable risk-benefit balance for this strategy, even in senior patients. Balancing the benefits and risks of treating RA with glucocorticoids thus remains a somewhat controversial topic. Therefore, this narrative review outlines the historical and current position of glucocorticoids in the management of RA, while summarising recent evidence on their beneficial and detrimental effects. Furthermore, practical strategies for the current use and tapering of glucocorticoids in RA were formulated. [ABSTRACT FROM AUTHOR]

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La osteonecrosis múltiple es una entidad poco frecuente que se define por el compromiso de al menos tres regiones diferentes. Es indispensable el abordaje multidisciplinario de los pacientes que la padecen tanto para el diagnóstico como el tratamiento oportuno. Presentamos el caso clínico de un paciente joven que presenta una osteonecrosis múltiple con compromiso de ambas caderas, hombros, rodillas, codo derecho y cuello de pie izquierdo. El principal factor de riesgo presente en nuestro caso es el consumo de glucocorticoides.

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BACKGROUND: Drug-induced acne is a manifestation associated with the long-term use of certain medications, including glucocorticoids and B-complex vitamins. In the current COVID-19 pandemic, management with these medications has increased for treatment and disease prevention. Typical lesions usually include monomorphic lesions such asinflammatory papules or papule-pustules, not associated with comedonic lesions. CLINICAL CASES: This paper reports the case of 12 patients diagnosed with COVID-19, who were treated with glucocorticoids and/or B complex vitamins who presented acneiform eruptions secondary to treatment. The mean age of these patients was 31 years; 7 patients were women, 7 received only systemic corticosteroids, 4 B-complex and one patient received B-complex and systemic corticosteroids. Papulopustular, papular, papulonodular and comedonic lesions were described, classified according to their severity as mild, moderate and severe.CONCLUSIONS: The indiscriminate use of B-complex vitamins and corticosteroids as treatment or prevention of SARS-CoV-2 disease can cause well-known side effects such as acneiform reactions. It is important to be informed about the indications for their use because, although these can be part of the treatment, their use is not justified in all cases [ABSTRACT FROM AUTHOR]

T -score bone mineral density (BMD) thresholds may influence guidance for treatment in patients under glucocorticoid (GC) therapy. Different BMD thresholds have been described but there is no international consensus. The aim of this study was to find a threshold to help in treatment decision-making in the population under GC therapy. A working group representing three scientific societies from Argentina was convened. The first team was formed by specialists with expertise in glucocorticoid-induced osteoporosis (GIO) who voted according to summary of evidence. The second team was constituted by a methodology group who coordinated and supervised each stage. We conducted two systematic reviews to synthesize the evidence. The first included trials of drugs used in GIO to analyze the BMD cut-off used as inclusion criteria. In the second, we analyzed the evidence regarding the densitometric thresholds to discriminate between fractured and non-fractured patients under GC treatment. In the first review, 31 articles were included for qualitative synthesis and more than 90% of the trials included patients regardless of their densitometric T -score or range of osteopenia. In the second review, 4 articles were included and more than 80% of the T -scores were in the range −1.6 to −2.0. The summary of findings was analyzed and put to a vote. With more than 80% agreement of the voting expert panel, a T -score ≤ −1.7 was considered the most appropriate for treatment in postmenopausal women and men over 50 years of age under GC therapy. This study could help in treatment decision-making in patients under GC therapy without fractures but other fracture risk factors should certainly be considered. [ABSTRACT FROM AUTHOR]

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Introducción: el Factor Activador de células B (BAFF) está implicado como una citocina clave que juega un papel significativo en la enfermedad autoinmune precancerosa Lupus Eritematoso Sistémico, (LES). El objetivo de este trabajo fue determinar cómo las dosis diferentes de glucocorticoides aplicados en estos pacientes afectan los niveles séricos de BAFF. Métodos: se realizó un estudio observacional de tipo descriptivo en dos grupos (29 pacientes): 1 - tratamiento con Glucocorticoides (21 pacientes); 2 - tratamiento convencional (8 pacientes). El primer grupo se dividió en tres subgrupos, según las dosis de glucocorticoides: bajas (

Glucocorticoids are associated with serious side effects related to dosing and time of use. Unfortunately, there is no standard method for determining glucocorticoid exposure, especially in patients undergoing long-term treatment. The aim of this work was to create a free and easy-to-use web application to calculate, in a systematic way, the total cumulative dose of corticosteroids. The total cumulative dose is calculated as the sum of all periods of treatment with different doses of corticosteroids, and is expressed as the equivalent dose of prednisone in mg. Glucocorticoid doses during periods in which the available information is missing or incomplete are estimated by systematic assumptions. A simulation exercise using standard patterns of steroid use in polymyalgia rheumatica, and giant cell arteritis showed that even when the period of no information reached 50% of the time, the accuracy of the calculator had a mean absolute percentage error (MAPE) < 7%. This tool simplifies and standardizes the glucocorticoids cumulative dose calculation, thereby minimizing bias in the assessment of glucocorticoid cumulative dose. [ABSTRACT FROM AUTHOR]

Background: Psychological stress is a reaction to an unexpected situation that favours adaptation and response to the event. However, when psychological stress is chronic or very intense, it can induce changes in various systems and tissues, causing diseases or aggravating existing ones. Objective: To briefly analyse the pathophysiological conditions caused by psychological stress. Method: A narrative review of the scientific literature on pathophysiological conditions as a consequence of psychological stress was performed. Results: Psychological stress can induce various conditions at the gastrointestinal, immune and cardiovascular levels. This is mainly due to the neurobiological and endocrine response because when faced with a stressful stimulus, a deregulated release of glucocorticoids and catecholamines is generated, altering the normal physiology of the organism. Gastrointestinal disorders are mainly due to goblet cell dysfunction, resulting in intestinal hyperpermeability, inflammation and infection. Changes at the immune level lead to an increase in inflammatory responses but a decrease in the protective activities of the immune system. Finally, cardiovascular conditions include atherosclerosis, increased blood pressure and stroke. Conclusion: Psychological stress can induce real physiological pathologies and, in some cases, fatal ones. Some of the molecular mechanisms involved in these pathologies have already been studied and identified. Knowledge of these molecular mechanisms can help clinicians and therapists to improve the treatment and therapy of patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería Investiga: Investigaciin, Vinculación, Docencia y Gestiin is the property of Revista Enfermeria Investiga and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Primary adrenal insufficiency (PAI) in children is a rare condition characterized by deficient production of glucocorticoids and/or mineralocorticoids. The clinical manifestations are nonspecific and insidious. Providers need to know about this disorder to be able to make an early diagnosis, as appropriate management can be life-saving., Methods: We conducted a multicentre retrospective study including every patient aged less than 18 years given a diagnosis of PAI in the last 30 years at 5 Spanish hospitals., Objectives: The objective was to determine the aetiologies, signs, symptoms and laboratory findings of PAI in the paediatric age group., Results: Twenty nine patients received a diagnosis of PAI at a median age of 5.6 years. An aetiological diagnosis was established in 23 patients (79.3%): X-linked adrenoleukodystrophy in 8 (27.6%), autoimmune adrenalitis in 6 (20.7%), X-linked adrenal hypoplasia congenita in 4 (13.8%), adrenocorticotropic hormone (ACTH) resistance syndrome in 2 (6.9%), Pearson syndrome in 2 (6.9%) and Allgrove syndrome in 1 (3.4%). In the remaining 6 patients, no clear aetiology was identified. Sixteen patients (55.2%) had onset with an adrenal crisis. Twenty patients (69%) needed combination therapy (hydrocortisone and fludrocortisone)., Conclusions: Asthenia, hyperpigmentation and hyponatraemia were the most prevalent sign, symptom and electrolyte abnormality at onset of PAI, although their absence does not rule out this disease. The elevation of ACTH persists despite adequate glucocorticoid replacement therapy., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Off-label (OL) drug use is the prescription of a drug for indications other than those authorised in its technical datasheet. The objective of this study was to identify drugs recommended in rheumatology but considered for off-label use in Argentina. A list of medications for certain selected rheumatic conditions was compiled. A drug was considered recommended if it was endorsed by a) at least one Argentine or Pan-American treatment guideline or consensus, or b) two international treatment guidelines, or c) one international treatment guideline and one selected textbook. Approval of these drugs for any condition in Argentina until December 31st, 2018 was explored, and medicines were divided into those with on-label indications and those considered for OL use. One hundred and thirty-six medications were analysed in 13 clinical conditions. Sixty-seven OL recommendations (49%) were found, and several drugs had more than one. All the conditions included the recommendation of at least 1 OL drug except osteoporosis and rheumatoid arthritis. The frequency of OL recommendations for the following conditions was 100%: calcium pyrophosphate dihydrate crystal deposition disease, polymyalgia rheumatica, Sjögren syndrome, and systemic sclerosis. The drugs with the highest number of OL recommendations were methotrexate (in 7 conditions), and glucocorticoids and mycophenolate (in 4). There were 2 OL recommendations for rituximab and 1 for abatacept. Almost all the rheumatic disorders analysed involved the recommendation of at least 1 OL medication, and in 4 conditions all the recommendations were OL. Most OL drugs recommended in rheumatology are neither biological nor small-molecule therapies. [ABSTRACT FROM AUTHOR]

La gonarthrose est une maladie dégénérative courante qui représente un lourd fardeau économique et sanitaire. Les traitements symptomatiques médicaux actuels comprennent les infiltrations intra-articulaires (IA) de corticoïdes (CO), dont l'efficacité et le profil de sécurité ne font pas l'unanimité. Nous avons réalisé une revue systématique de la littérature (RSL) et une méta-analyse d'essais comparatifs randomisés (ECR) évaluant les effets des infiltrations IA de CO dans la gonarthrose. Les effets des interventions sur la douleur et la capacité fonctionnelle ont été extraits des études individuelles et les différences moyennes standardisées (DMS) compilées ont été calculées. Sur 520 études sélectionnées, 23 ont été incluses dans la RSL et 15 ont ensuite été prises en compte pour la méta-analyse. À court terme (≤ 6 semaines), nous avons observé une tendance à un effet supérieur des infiltrations IA de CO par rapport aux interventions témoins concernant la douleur (DMS −0,61 [IC 95 % −1,25 à 0,03]) et la capacité fonctionnelle (DMS −1,02 [IC 95 % −2,14 à 0,10]), tandis que l'analyse du suivi à long terme (≥ 24 semaines) montrait une tendance à la supériorité des traitements témoins (acide hyaluronique IA, anti-inflammatoires non stéroïdiens IA, physiothérapie) pour la douleur (DMS 0,68 [IC 95 % −0,11 à 1,47]) et la capacité fonctionnelle (DMS 0,88 [IC 95 % −0,36 à 2,12]). Aucune différence entre les interventions n'a été relevée à moyen terme (> 6 semaines et < 24 semaines). Dans cette revue, les infiltrations IA de CO ont réduit la douleur et amélioré la capacité fonctionnelle peu de temps après l'administration (≤ 6 semaines) par rapport au placebo, mais ce résultat n'a pas atteint la significativité statistique pour d'autres comparateurs (acide hyaluronique IA ou physiothérapie). Il semble que d'autres interventions soient plus efficaces sur le long terme (≥ 24 semaines), mais cet effet est fortement influencé par des études individuelles ayant des ampleurs d'effet importantes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the efficacy and safety of 8 cumulative grams of methylprednisolone combined with doxycycline 50 mg/day for 12 weeks in patients with active Graves orbitopathy. MATERIALS AND METHODS: Quasiexperimental, prospective, longitudinal, before and after, open study, done from November 1st, 2016 to April 30th, 2017 at Endocrinology Department of Centro Medico Nacional La Raza, Mexico City. Patients with Graves orbitopathy with CAS (Clinical Activity Score) ≥ 3 points of the EUGOGO scale were included. RESULTS: There were included 15 patients, 9 women and 6 men, mean age 51.06 ± 9.75 years. The mean decrease in CAS was 2 points (95% CI, p < 0.001), the mean proptosis was 1 mm (95% CI, p = 0.002), the final GO-QOL total was 40-48% (95% CI, p < 0.001), 2 patients had sinusitis (95% CI, p = 0.14), 2 patients uroinfection (95% CI, p = 0.14) and 4 patients hyperglycemia (95% CI, p = 0.03); other side effects of medications there were not observed. CONCLUSIONS: The combined scheme of methylprednisolone plus doxycycline causes a decrease in the severity and activity of Graves orbitopathy and improvement in quality of life without serious side effects. [ABSTRACT FROM AUTHOR]

The catastrophic antiphospholipid syndrome (CAPS) is a rare life-threatening clinical condition that represents the most severe clinical presentation of the antiphospholipid syndrome (APS). It was first described in 1992 in a group of patients that presented with multiorgan involvement and microangiopathic features of APS. Most of the current knowledge of CAPS comes from the analysis of all cases collected at the "CAPS Registry" that was created in 2000 to perform studies on this condition. Most cases are triggered by a prothrombotic situation that leads to a multiorgan thrombosis and a cytokine storm. The analysis of cases included in the "CAPS Registry" has shown that the triple therapy with anticoagulation, glucocorticoids, and plasma exchange and/or intravenous immunoglobulins is associated to a better prognosis of CAPS. The improvement of the knowledge allowed a decrease from the 50% mortality rate reported in the first series to 25-30% in the most recent publications., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Objective: To study the physicochemical and microbiological stability over 90 days of two preservative-free methylprednisolone sodium succinate (MTPSS) 1 mg/ml and 10 mg/ml eye drops for use in ocular pathologies such as Sjögren's syndrome and dry eye syndrome., Method: The two eye drops were prepared from injectable MTPSS (Solu-moderin® and Urbason®), water for injection and normal saline solution. In accordance with ICH (International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use) guidelines, they were then stored in triplicate under refrigerated conditions (5 ±3 °C), at room temperature (25 ± 2 °C), and at 40 °C (±2 °C). In accordance with the USP (United States Pharmacopeia), physicochemical controls of the active ingredient content were carried out by HPLC-UV (High Performance Liquid Chromatography with Ultraviolet detection), together with controls of pH, osmolality, and visual examination. Microbiological sterility was also tested under refrigerated conditions up to 30 days in open containers and up to 90 days in closed ones., Results: The eye drops stored at 5 °C were the most stable; in the 1 mg/ml eye drops, degradation of the drug fell below 90% from day 21, and in the 10 mg/ml eye drops, from day 42. pH change did not vary by ≥1 unit in formulations stored at 5 °C, unlike the other formulations. Changes in osmolality did not exceed 5% on day 90 in any storage conditions. Samples of non refrigerate eye drops at 10 mg/ml, presented a white precipitate from day 14 and 28 respectively. Non-refrigerated 1 mg/ml eye drops presented suspended particles on day 90. There were no color changes. Microbiological analysis showed that sterility was maintained for over 90 days in the closed containers, although microbial contamination was detected from day 21 in the open containers., Conclusions: 1 mg/ml MTPSS eye drops show physicochemical and microbiological stability for 21 days under refrigeration, compared to 42 days for 10 mg/ml eye drops stored under the same conditions. However, since they do not include preservatives in their composition, they should not be used for more than 7 days after opening., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To study the physicochemical and microbiological stability over 90 days of two preservative-free methylprednisolone sodium succinate (MTPSS) 1 and 10 mg/mL eye drops for use in ocular pathologies such as Sjögren's syndrome and dry eye syndrome., Method: The two eye drops were prepared from injectable MTPSS (Solu-moderin® and Urbason®), water for injection and normal saline solution. In accordance with ICH (International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use) guidelines, they were then stored in triplicate under refrigerated conditions (5±3 °C), at room temperature (25±2 °C), and at 40 °C (±2 °C). In accordance with the USP (United States Pharmacopeia), physicochemical controls of the active ingredient content were carried out by HPLC-UV (High Performance Liquid Chromatography with Ultraviolet detection), together with controls of pH, osmolality, and visual examination. Microbiological sterility was also tested under refrigerated conditions up to 30 days in open containers and up to 90 days in closed ones., Results: The eye drops stored at 5 °C were the most stable; in the 1 mg/mL eye drops, degradation of the drug fell below 90% from day 21, and in the 10 mg/mL eye drops, from day 42. pH change did not vary by ≥1 unit in formulations stored at 5 °C, unlike the other formulations. Changes in osmolality did not exceed 5% on day 90 in any storage conditions. Samples of non refrigerate eye drops at 10 mg/mL, presented a white precipitate from day 14 and 28, respectively. Non-refrigerated 1 mg/mL eye drops presented suspended particles on day 90. There were no color changes. Microbiological analysis showed that sterility was maintained for over 90 days in the closed containers, although microbial contamination was detected from day 21 in the open containers., Conclusions: 1 mg/mL MTPSS eye drops show physicochemical and microbiological stability for 21 days under refrigeration, compared to 42 days for 10 mg/mL eye drops stored under the same conditions. However, since they do not include preservatives in their composition, they should not be used for more than 7 days after opening., Competing Interests: Declaration of competing interest None of the co-authors had any conflicts of interest to declare., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

BACKGROUND: Evans' syndrome is the association between autoimmune hemolytic anemia and primary immune thrombocytopenia. OBJECTIVES: To describe an Evans' syndrome population's characteristics and its response to treatment. MATERIALS AND METHODS: A retrospective, analytic study including cases diagnosed from January 2008 to December 2018 at Regional Hospital PEMEX, Tamaulipas, Mexico; we evaluated the clinical and biochemical characteristics, as well as their outcomes after treatment. RESULTS: We observed 9 cases with similar clinical and biochemical characteristics, 4 primary and 5 secondary Evans' syndrome. All of them received glucocorticoids as first line of treatment; 6 presented global response; 2 of them complete response, 4 partial response, and 3 no response, regardless the scheme prescribed. An average of 2.78 ± 1.3 lines of treatment were prescribed and four patients required more than three; 3 patients developed systemic autoimmune diseases after mean time of 4.6 years (range: 0.55-9), whose Evans' syndrome had responses after treating the systemic autoimmune disease. CONCLUSIONS: Evans' syndrome is an infrequent entity where an important immunologic imbalance participates and which responses to the first line treatments are torpid with frequent relapses; those patients with more relapses have been associated with the development of systemic autoimmune diseases and most of the cases are secondary, so, we must investigate the background for improving the treatment. [ABSTRACT FROM AUTHOR]

Objetivo: determinar los valores de cortisol salival en un pequeño grupo de escolares y adolescentes sanos entre los 6 y 18 años de edad de Medellín y determinar su relación con el ciclo circadiano según la hora de toma de la muestra. Introducción: el cortisol salival es un ultrafiltrado del cortisol plasmático y refleja los niveles biológicamente activos, este sigue la variación circadiana del cortisol sérico, encontrando los niveles más altos en la mañana y más bajos a media noche. Métodos: se realizó un estudio observacional descriptivo en el que se incluyeron escolares y adolescentes sanos entre 6 y 18 años de edad. Se recolectaron en cada niño dos muestras de saliva, la primera a las 8:00 horas y la segunda a las 23:00 horas de un mismo día. Las muestras fueron procesadas por inmunoensayo enzimático (EIA-ELISA) en Abad Laboratorio de Medellín. Se utilizó el método estadístico de Kolmogorov-Smirnov y Shapiro-Wilk para determinar normalidad. Para la presentación de resultados se utilizaron las medidas de tendencia central y dispersión según normalidad de la variable. Resultados: se analizaron los datos de 31 individuos. El 51.6 % de la población fueron hombres. La edad promedio fue de 11.26 años (±3.4) y el IMC promedio fue de 18.1 kg/m2 (±2.8). Respecto a los niveles de cortisol salival, se obtuvo una mediana de 4.39 ng/ml (RIQ 2.76-6.98) de cortisol salival a las 08:00 a.m.; y para el nivel del cortisol a las 11:00 p.m. se obtuvo una mediana de 0.51 ng/mL (RIQ 0.41-0.84). No hubo diferencias significativas por sexo. Conclusión: el promedio de los valores de cortisol salival en el grupo de escolares y adolescentes sanos de Medellín está dentro de los valores de referencia reportados en estudios internacionales, por lo que se recomienda para el diagnóstico y seguimiento de estados de hiper/hipocortisolismo.

Introducción: las recomendaciones actuales del tratamiento de la nefritis lúpica (NL) apuntan a dosis de glucocorticoides más bajas para lograr el control de la enfermedad y evitar el daño acumulado. Objetivo: conocer y comparar la respuesta al tratamiento de pacientes con NL proliferativa en su etapa de inducción con dos pautas de tratamiento con prednisona (PDN): dosis iniciales reducidas 30 mg/d. Método: se compararon variables clínicas, analíticas y terapéuticas de pacientes con NL proliferativa categorizados en dos grupos según la dosis inicial de prednisona (PDNi) estándar o reducida. Resultados: se estudiaron 21 pacientes con NL proliferativa (n=12 PDNi reducida vs. n=9 PDNi estándar). No hubo diferencias significativas en las variables clínicas y analíticas. Se observó una diferencia estadísticamente significativa en el número de pulsos de metilprednisolona (5 ± 2,95 PDNi 30 mg/d, p = 0,041) y en la dosis de prednisona acumulada a 6 meses (12,8 mg ± 4,9 PDNi 30 mg/d, p =0,008). No hubo diferencias significativas en la proporción de pacientes que alcanzaron la respuesta completa, en el tiempo hasta alcanzarla ni en los efectos adversos entre ambos grupos. Conclusiones: el esquema terapéutico del grupo PDNi

La enfermedad de Addison es el término utilizado para referirse a la insuficiencia adrenal primaria. Esta condición es poco común y se caracteriza por un déficit crónico de glucocorticoides y/o mineralocorticoides. La principal causa es autoinmune, pero también puede haber etiologías infecciosas, neoplásicas, genéticas o iatrogénicas. Para su diagnóstico se requiere de una alta sospecha clínica. Su tratamiento se basa en la reposición farmacológica de los esteroides adrenales deficientes.

Preventive management or early detection of adrenal insufficiency in patients with chronic glucocorticoid use is vital in the context of stress situation. The purpose of this article is to know the different situations in which this disease could present, as its management and prevention. The above with the objective of generating greater awareness about this entity and avoiding associated complications. [ABSTRACT FROM AUTHOR]

La orbitopatía tiroidea es la manifestación extratiroidea más frecuente del hipertiroidismo autoinmune; más del 90 % de los casos se asocian con enfermedad de Graves (EG). Es un trastorno complejo que puede provocar deformidad orbitaria, visión doble e incluso pérdida visual permanente, con gran impacto en la calidad de vida. Aproximadamente, el 2 % de los pacientes que desarrollan orbitopatía de Graves desarrolla enfermedad moderada a grave. Existe una creciente conciencia de la necesidad de un diagnóstico precoz y un manejo oportuno para disminuir las secuelas irreversibles. Su manejo inicial es con glucocorticoides; sin embargo, la recurrencia ocurre con frecuencia una vez que se retiran. En más del 60 % de los casos, la anatomía orbitaria normal no se restaura y se requiere cirugía de rehabilitación. En casos de refractariedad, las terapias biológicas son una alternativa, las cuales han demostrado ser efectivas. Dentro de estas están el teprotumumab, que reduce la proptosis, recientemente aprobado por la Food and Drug Administration (FDA); el rituximab, que reduce la inflamación; y el tocilizumab, que potencialmente beneficia ambos parámetros. A continuación, se describe el efecto del tocilizumab en 2 pacientes con orbitopatía tiroidea en el Hospital San José, en Bogotá.

Actualmente no se cuenta con instrumentos clinimétricos para la medición de la gravedad del síndrome de Cushing iatrógeno (SCI). Sonino et al. crearon un índice clínico de gravedad del síndrome de Cushing endógeno (IGC), pero no ha sido aplicado a pacientes con SCI. Validar y determinar la utilidad del IGC y su correlación con variables clínicas en pacientes reumatológicos con uso de glucocorticoides (GC) de forma continua. Se incluyó a pacientes con antecedentes de uso de GC sistémicos de forma continua indicados para el tratamiento de la enfermedad reumatológica, por lo menos durante 4 semanas. Todos los pacientes rellenaron un cuestionario sobre datos sociodemográficos, características de los GC empleados, la forma de uso y la presencia o ausencia de eventos adversos. Se aplicó el IGC por 2 observadores de forma independiente. Se calculó la consistencia, la concordancia interobservador y un análisis de componentes principales. Se estudió a 32 pacientes con edad promedio de 35,72 ± 12,8 años; 29 eran mujeres (90,6%). La calificación promedio del IGC por el primer observador fue de 3,50 ± 2,02 y la del segundo observador fue de 2,31 ± 1,75 (p = 0,004). La concordancia interobservador fue baja en los ítems con definiciones imprecisas, por lo cual se modificaron las definiciones para mejorar su desempeño. Los puntajes del IGC correlacionaron con la presencia de efectos adversos y el tipo de dosis utilizada. El IGC tiene una adecuada correlación con manifestaciones clínicas en pacientes con uso crónico de GC. Las características clinimétricas del cuestionario mejoraron al estandarizar las definiciones de variables clínicas subjetivas. Currently there are no clinimetric instruments for the measurement of the severity of iatrogenic Cushing's syndrome (ICS). Sonino et al. created a clinical severity index of endogenous Cushing's disease (CSI) but it has not been applied to patients with ICS. To validate and determine the utility of the CSI and its correlation with clinical variables in rheumatological patients with continuous use of glucocorticoids (GC). Patients with a history of continuous systemic GC use (for at least 4 weeks) indicated for treatment of rheumatological disease were included. All the patients filled out a questionnaire on sociodemographic data, characteristics of the CG used; the way of use and the presence or absence of adverse events. The CSI was applied by 2 observers independently. Consistency, interobserver concordance and principal component analysis were calculated. A total of 32 patients with an average age of 35.72 ± 12.8 years were studied; 29 were women (90.6%). The average CSI score by the first observer was 3.50 ± 2.02, and by the second observer was 2.31 ± 1.75 (p =.004). The interobserver concordance was low in the items with imprecise definitions; for which modifications were made in the definitions to improve their performance. The CSI scores correlated with the presence of adverse effects and the type of dose used. The CSI has an adequate correlation with clinical manifestations in patients with chronic use of GC. The clinimetric characteristics of the questionnaire improved by standardising the definitions of subjective clinical variables. [ABSTRACT FROM AUTHOR]

Cogan's syndrome (CS) is an inflammatory disease classified as variable vessel vasculitis. It is a rare disease with few published series, and therefore we reviewed our experience in the last ten years in two centres. Description of 7 diagnosed cases of CS, according to the classification criteria (typical or atypical), their clinical manifestations, treatments used and their complications. A comparative analysis was performed with the series and cases described in the literature. Seven cases were included, three men and four women, with a mean age at diagnosis of 43 years, and an average disease duration of 47 months. Five patients met the typical characteristics according to the 1980 classical criteria, the rest being atypical cases, one due to the absence of interstitial keratitis and another due to a period between the onset of ocular and auditory-vestibular clinical symptoms greater than two years. All received immunosuppressants, methotrexate being the most commonly used, followed by azathioprine. In 5 cases, biological drugs were used, infliximab in 4 times and 2 tocilizumab. One patient died from bacterial endocarditis and septic shock. The characteristics of the series presented are like those published to date, with clinical differences mainly in the involvement of large vessels. Given the low frequency, it seems necessary to create multicentre records to improve the evidence regarding the management of patients with CS. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of mucormycosis appears to be increasing despite current treatment options, which often include widespread disfiguring surgery and antifungal therapy. Mortality rates from mucormycosis vary between 50 and 100%. CLINICAL CASE: A 35-year-old male patient who, after prolonged glucocorticoid treatment, manifested a localized dermatosis in the left heface (left infraorbital region) and the ipsilateral maxillary region at the expense of an erythematous macula with imprecise borders, irregular shape, with subsequent increase volume and temperature to the touch, accompanied by ipsilateral maxillary abscess. Mucormycosis was diagnosed and treatment with liposomal amphotericin was started, as well as three surgical debridations to the maxilla and fatty tissue on the or bital floor. CONCLUSIONS: We are in a pandemic process with a high incidence of upper and lower respiratory infections for which some therapeutic guidelines specifically recommend the administration of steroids. However, the indications, guidelines and suggested schemes are not adequately respected, which significantly increases the use of this pharmacological tool, which can predispose to this type of infections that are associated with high mortality and psychological stigmas by the destructive nature of the disease by affecting areas as delicate as the facial region. [ABSTRACT FROM AUTHOR]

El lupus eritematoso sistémico es una enfermedad autoinmune crónica, que implica la producción de ciertos anticuerpos en todo el cuerpo y la consecuente inflamación de tejidos conjuntivos, así como afecciones cutáneas, hematológicas y cardiovasculares, entre otras. Se ha postulado su procedencia genética, ambiental o inmunológica, incluso de factores hormonales, pero en realidad su etiología es desconocida. El tratamiento convencional se basa en la severidad de sus manifestaciones clínicas. La primera línea de tratamiento es la administración de fármacos antipalúdicos, inmunosupresores, glucocorticoides y metotrexato. Por muchos años, estos han sido de ayuda para los pacientes que sufren esta enfermedad. Lamentablemente, son muy poco selectivos, por lo que causan graves efectos adversos. Ante esta situación, se ha probado el uso de terapias biológicas, las cuales presentan la ventaja de ser más específicas. Una de estas son los anticuerpos monoclonales, como el belimumab, que han disminuido los riesgos de brotes y han mejorado la actividad serológica de los pacientes. Como en el caso del lupus eritematoso sistémico, cada día se está ampliando la investigación enfocada en terapia biológica para el tratamiento de distintas enfermedades autoinmunes.

As humanity continues to alter the environment extensively, comprehending the effect of anthropogenic disturbances on the health, survival, and fitness of wildlife is a crucial question for conservation science. Many primate populations occupy suboptimal habitats prone to diverse anthropogenic disturbances that may be sources of acute and chronic stress. Quantification of glucocorticoid (GC) concentrations has repeatedly been used to explore the impact of disturbances on physiological stress. Although it is still debated, prolonged elevation of GC levels may impair reproduction, growth, and immune system activity of individuals. We quantified the effect of anthropogenic disturbances on physiological stress in primates with a global meta‐analysis based on data from 26 articles, covering 24 distinct species in 13 different countries. Anthropogenic disturbances were classified into 6 distinct categories: habitat loss, habitat degradation, ongoing logging, hunting, tourism, and other human activities. We calculated effect sizes (Hedges' g) with the standardized mean difference in GC concentrations between primates affected by human activity and their undisturbed conspecifics. We ran random‐effects models and subgroup analyses to estimate the overall effect as well as a cumulative effect size for each disturbance category. Overall, primates inhabiting sites subject to anthropogenic disturbances exhibited significantly higher GC levels (g = 0.60; 95% CI: 0.28–0.93). Habitat loss and hunting were overall associated with increased GC concentrations, whereas the cumulative effects of the other disturbances were not statistically significant. Biologically, high GC levels may increase fitness by enabling individuals to overcome the challenges linked to anthropogenic disturbances. However, primates in disturbed environments may have sustained elevated GC levels. To strengthen future research, it is necessary to control confounding factors systematically (e.g., diet, reproductive status, predatory pressure, and resource availability) and improve understanding of the link between GC levels and the health, fitness, and survival of animals. [ABSTRACT FROM AUTHOR]

The human circadian system creates and maintains cellular and systemic rhythmicity essential for the temporal organization of physiological processes promoting homeostasis and environmental adaptation. Sleep disruption and loss of circadian rhythmicity fundamentally affects master homeostasic regulating systems at the crossroads of peripheral and central susceptibility pathways, similar to acute or chronic stress and, thus, may play a central role in the development of stress-related disorders. Direct and indirect human and animal PTSD research accordingly suggests circadian-system-linked sleep, neuroendocrine, immune, metabolic and autonomic dysregulation, linking circadian misalignment to PTSD pathophysiology. Additionally, there is evidence that sleep and circadian disruption may represent a vital pre-existing risk factor in the prediction of PTSD development, while sleep-related symptoms are among the most prominent in trauma-associated disorders. These facts may represent a need for a shift towards a more chronobiological understanding of traumatic sequel and could support better prevention, evaluation and treatment of sleep and circadian disruption as first steps in PTSD management. In this special issue, we highlight and review recent advances from human sleep and chronobiological research that enhances our understanding of the development and maintenance of trauma-related disorders. Sleep and circadian disruption may be crucially involved in the development and maintenance of traumatic-stress-related disorders. There is a need for a chronobiological shift towards better evaluation, understanding and treatment of traumatic stress sequel. [ABSTRACT FROM AUTHOR]

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Copyright of Síndrome Cardiometabólico is the property of Sindrome Cardiometabolico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)