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A 23-year-old otherwise healthy female with family history of familial Mediterranean fever (FMF) in 2 siblings who are on colchicine presented with fever, pleuritis, pericarditis, peritonitis and multiple abscesses in the liver. Sampling from the liver abscess showed neutrophil predominance with no findings of granuloma, vasculitis, lymphoma or malignancy. Similarly, samples from peritoneum and pleural fluids are exudative and showed foamy histiocytes, polymorphonuclear leukocytes. No pathogens, including bacterial, viral and fungal agents, were grown in cultures. The inflamatuary markers were very high, and despite multiple antibiotherapy, the clinical status and biochemistry picture did not improve. After excluding malignancy and infection, the picture was evaluated as an autoinflammatory disease and steroid treatment was started as anti-inflammatory therapy. Anti-interleukin 1 was added to the treatment of the patient who showed a dramatic radiological and clinical response to the steroid, and the steroid dose was reduced. Genomic DNA sample isolated from peripheral blood test showed homozygous MEFV m694v gene mutation diagnosing the patient with FMF. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI 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.)

Mondor's disease (MD) is a rare disorder characterized by superficial thrombophlebitis or subcutaneous venous thrombosis. It is commonly seen on the anterior chest wall. Penile Mondor's disease (PMD) is seen less frequently than thoracic MD and presents as an indurated cord-like lesion along the vein tract. A 47-year-old patient presented to our outpatient clinic with a complaint of a painless, indurated, and sudden-onset lesion on the penis shaft that lasted for 15 days. He was using systemic steroids and antidiabetics for pemphigus and diabetes. He had a cord-like lesion along the penis shaft, becoming more prominent by stretching the skin. He was clinically diagnosed with PMD, regressing spontaneously after 1-week of sexual rest. He denied other triggering factors except for strenuous sexual activity. In this case, we think that diabetic angiopathy and the prothrombotic effect of steroids may have contributed to the development of PMD besides vigorous sexual activity. We found it valuable to share because of its rarity. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI 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.)

Objective: Multisystem Inflammatory Syndrome (MIS) is a condition seen in the early post-COVID-19 period and thought to develop with an impaired immune response. It has been usually reported in children but rarely in adults. Here we report the first adult MIS (MIS-A) case series from Turkiye. Material and Methods: Six patients who met the Centers for Disease Control and Prevention’s MIS-A diagnostic criteria were included in the study. The demographic, clinical, laboratory, radiological characteristics and therapy regimes and outcomes of the patients were recorded. Results: All of our cases had a history of mild COVID-19. They presented with fever, severe fatigue and hypotension. Abnormal echocardiography findings were detected in five patients. Only one patient had multiple mucocutaneous findings. Common laboratory features were lymphopenia, markedly increased C-Reaktive Protein, procalcitonin, pro-brain natriuretic peptide (pro-BNP), D-dimer, and ferritin. All patients had positive SARSCoV-2 antibody result. Corticosteroids and/or anakinra were used in five, and intravenous immunoglobulin was used in two patients. Low-molecular-weight heparin (LMWH) was used for all cases. Empirically initiated antibiotic treatments were discontinued after cultures were negative. After anti-inflammatory treatment, the hypotension of the patients resolved, they did not need intensive care follow-up and no mortality was seen in our cases. Conclusions: MIS-A is a severe and mortal condition that causes various clinical pictures and can be confused with sepsis. Anakinra, a recombinant IL-1 receptor antagonist, is a significant agent that can be used in the treatment of MIS-A since it blocks the cytokine cascade at an early stage. The satisfactory responses will be obtained with early diagnosis and anti-inflammatory treatment. In this period when the pandemic is not over yet, it is necessary to increase the awareness of clinicians about MIS-A, which can be fatal. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the role of diffusion-weighted magnetic resonance imaging (DW MRI) with an apparent diffusion coefficient (ADC) map in evaluating the response to treatment of steroid-treated idiopathic granulomatous mastitis (IGM) lesions. Materials and Methods: This retrospective study included 99 lesions of 58 female patients (average age: 32.91 years; range: 22–55 years) with biopsy-proven IGM. Patients were treated with oral and topical steroids. All pre-treatment and post-treatment MR examinations were evaluated. The maximal size of the masses and nonmass enhancement (NME) lesions were measured. Patients were classified as complete response (CR), partial response (PR), and non-response (NR) according to the dynamic contrast-enhanced (DCE) MR findings after treatment. Results: ADC values of areas occupied by IGM (0.933±0.317x10-3 mm2 /sec) were lower than contralateral normal parenchyma (1.259±0.423x10-3 mm2 /sec). Twenty-two (22.22%) of the lesions were in the NR group, 30 (30.30%) in the PR group, and 47 (47.47%) in the CR group. There was no significant difference between the pre-treatment ADC values in NR, PR, and CR groups (p=0.228). There was a significant difference between the pre-treatment and post-treatment ADC values in the PR groups (p=0.001). Conclusion: DW MR imaging in IGM is a useful method to monitor the response to treatment. However, it is not successful in predicting response to treatment. [ABSTRACT FROM AUTHOR]

As our knowledge and experience of COVID-19 increases, our treatment approaches may change. For patients with respiratory failure due to COVID-19 disease, the disease table can be better controlled with systemic glucocorticoids, and mortality rates and hospitalization periods can also be reduced. Steroid therapy can be applied for the long-term, especially in cases with organized pneumonia, and patients can be discharged from hospital with maintenance treatment. Complications have been noted in patients in the post-COVID period resulting from the use of glucocorticoids. While mostly bacterial and fungal lung infections are seen, another side-effect of glucocorticoids is their negative effect on bone metabolism. We present here a case in which avascular bone necrosis developed as a result of long-term steroid use for the treatment of COVID-19. [ABSTRACT FROM AUTHOR]

To compare prolidase enzyme activity (PEA) in serum and polyp specimens of patients with nasal polyps obtained before and after the oral steroid therapy. Thirty three patients with nasal polyps (39 ± 13 years) received 1 mg/kg of oral steroids. Serum samples were collected from each patient, but nasal polyp specimens could be obtained only from 23 patients (38 ± 13 years) before and after the oral steroid therapy. PEA was measured by ELISA method. Serum PEA values were 210 (176–242) U/L and 184 (147–217) U/L before and after the oral steroid therapy, respectively (p = 0.015). Polyp tissue PEA was 1337 (738–2130) U/g and 871 (590–1663) U/g before and after the oral steroid therapy, respectively (p = 0.429). In patients with nasal polyps, significantly lower serum PEA after the oral steroid therapy may be a consequence of the role of prolidase enzyme in inflammatory processes which are important for the development of nasal polyps. More comprehensive studies with larger sample sizes are needed to elucidate the role of PEA in the pathogenesis of nasal polyps. [ABSTRACT FROM AUTHOR]

Objective: Idiopathic nephrotic syndrome (INS) is the most common glomerular disease in children. Approximately 80% of INS is steroid sensitive (SSNS), and half of SSNS patients are steroid dependent (SDNS). This study determines the risk factors that may predict steroid dependence in patients with SSNS. Material and Method: Patients with SSNS who followed in our Pediatric Nephrology clinic between September 2016 and September 2018 were retrospectively evaluated. The demographic characteristics, albumin, creatinine values, blood pressure, white blood cell, lymphocyte count, lymphocyte/white blood cell ratio, urine protein-creatinine ratio, time to remission, and triggers of the attack were recorded. Results: Twenty-three patients were diagnosed as SSNS and 16 as SDNS. The mean age at presentation was 77.34±32 months in the SSNS group and 73.62±27.32 months in the SDNS group (p=0.690). No significant difference was observed between the two groups in terms of blood albumin, creatinine, lymphocyte count, and lymphocyte/white blood cell ratio. Trigger initiating the attack was more common in the SDNS group (p=0.001). The most common trigger was upper respiratory tract infection. Urine protein/creatinine ratio and white blood cell levels were significantly higher in the SDNS group (p=0.014, p=0.004, respectively), and the time to remission was also longer in the SDNS group (p=0.001). Conclusion: Upper respiratory tract infection may be a trigger, and severe proteinuria and late remission time may be risk factors for the development of SDNS in INS. Early use of steroid-sparing agents in these patients can prevent long-term adverse effects of steroid therapy. [ABSTRACT FROM AUTHOR]

Objective: The data reflecting adverse effects seen during the treatment of nephrotic syndrome (NS) in Turkey are limited. In this study, we aimed to evaluate the side effects of treatment of NS patients observed at our clinic. Material and Method: We retrospectively reviewed the data of 206 patients with NS (126 male; 80 female) followed up at the Pediatric Nephrology outpatient clinic of the Istanbul University Istanbul Medical Faculty between 1986-2010. Results: Mean age of 206 (126 male, 80 female) patients at the time of admission was 3.8±2.8 years (range: 0.2-13.8). During follow-up, 171 patients (83%) experienced at least one side effect due to any of the drugs. The most frequent side effects of steroid treatment in order of decreasing frequency were cushingoid appearance (52%), hypertension (23.4%), growth retardation (17%), cataract (6.8%) and osteoporosis (6.8%). Total duration of steroid use and steriod dose were higher in the patients who suffered from growth retardation, osteoporosis, cataract, hypertension than in those who did not suffer these side effects (p<0.05). Additionally, the patients with growth retardation had a higher relapse rate than in those without growth retardation (p=0.023). Neutropenia was detected in 13 (41.9%) patients who used cyclophosphamide, while in 5 (29.4%) patients who used cyclosporine A hypertension was observed. Conclusion: Adverse effects due to treatment of NS are seen in most of the patients with the diagnosis of nephrotic syndrome. The most serious adverse effects of steroids are growth retardation, osteoporosis, cataract and hypertension. These side effects were found to be related to duration of steroid treatment and total dose of steroids. Patients should be evaluated for these side effects periodically. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Dermatology / Turk Dermatoloji Dergisis is the property of Galenos Yayinevi Tic. LTD. STI 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.)

Objective: In patients with refractory septic shock corticosteroid therapy has been shown to improve hemodynamic instability. This has been named as critical illness related adrenal insufficiency. Several studies had been done on significance of corticosteroid treatment in vasopressor dependent patients. As well it is recommended in guidelines. The aim of this study was to study the effects of plasma Cortisol levels and corticosteroid therapy on intensive care unit(ICU) mortality of the patients. Material and methods: Patients who were hospitalized with septic shock at Gazi University Faculty of Medicine medical intensive care unit between February 2008- October 2010 were rewieved retrospectively. Patients whose Cortisol levels were measured and corticosteroid treatment was started at the begining of septic shock state enrolled. Age, sex, length of ICU stay, need for mechanical ventilation, APACHE II and glascow score, albumin, C reactive protein, spot blood sugar levels and daily insulin doses were recorded. Length of ICU stay, mortality and reversal of septic shock were choosen as the end points of the study. Results: Totally 91 patients were enrolled. Patients were grouped into two; according to their plasma Cortisol levels (≤15μg/dLand >15pg/dL). In 22 patients (24,2%) plasma Cortisol level was <15 pg/dL. There was no statiscal signifance between two groups' demographic variables. However in the plasma Cortisol levels > 15μg/dL group, independent of steroid treatment, ICU mortality rate was significantly higher. Patients were grouped depending on whether they received steroid treatment. There was no mortality difference but in the steroid treatment group length of stay in ICU was significantly shorter. Conclusion: Patients whose plasma Cortisol levels were >15 μg/dL had higher ICU mortality. Corticosteroid treatment was associated with shorter length of ICU stay. [ABSTRACT FROM AUTHOR]

Seventeen years old male patient was admitted to the clinic with complaints of pain in the right eye, reduction of vision, painful eye movements and headache for 10 days. Visual acuity was found Snellen 0.2 on the right eye and 1.0 on the left eye. Anterior segment examination was normal. Fundus examination revealed bilateral chorioretinal fold on the papillo-macular bundle and serous macular detachment on the right eye. Fundus angiography (FA) revealed late macular hyperfluorescence due to leakage. Exudative retinal detachment on the right macula was observed in optical coherence tomography (OCT). Orbital ultrasonography and computed tomography were revealed thickening of the right posterior scleral wall. Investigations did not reveal any other cause of headache or systemic associated autoimmune disease. Oral steroid treatment (metil prednisolon 64 mg/day) was started. It was seen that the left eye also affected at the second week of treatment. OCT revealed bilateral exudative retinal detachment. Treatment was going on. Complaint of decreased visual acuity was recovered one month later, and bilateral exudative retinal detachment resolved. In this article, we aimed to present a case of bilateral idiopathic posterior scleritis and associated exudative retinal detachment and with good response to therapy. [ABSTRACT FROM AUTHOR]

Objectives: In order to maximize the benefits from steroids, patients should understand treatment with this drug. The aim of this study was to investigate inpatients' compliance to steroid treatment. Materials and methods: This study was carried out from April to June 2005 on a total voluntary 118 inpatients in internal medicine clinics of a university hospital. The data were collected using by a questionnaire form and data analysis was performed using frequency tables and chi-square tests. Results: The mean age of the subjects was 48.94±14.72 years and 70.3% of them was female. With regard of educational status, 44.9% of patients were elementary school graduates. A total of 45.8% reported that they had received information about steroids from a health professional. Although 99.2% - 94.6% of subjects knew the correct drug scheduling, only 52.5% knew how to calculate steroid dose. Additionally majority of them (83.1%) did not know side effects of drug and prevention from their side effects. Conclusion: According to our results, patients using steroid did not have sufficient information for adherence to this drug therapy and the patients experienced various problems. In order to relieve these problems, the patients should be better trained about steroid therapy by health professionals. [ABSTRACT FROM AUTHOR]

Man In The Barrel Syndrome is a term used to describe the clinical picture found proximal muscle weakness in the both upper extremities with normal muscle strength in the lower limbs. Man In The Barrel Syndrome also named as the brachial diplegia is a rare disease and can occur due to a variety of etiologic factors. We described that a case of brachial diplegia asosiated with post-cervical trauma and responding to the steroid therapy. [ABSTRACT FROM AUTHOR]

Steroid induced osteoporosis is the most prevalent form of drug induced osteoporosis. The usage of steroid therapy has various side effects which are associated with organs as skin, eye and many systems such as musculoskeletal system, cantral vervous system, endocrin system, cardiovascular system, immune system and gastrointestinal system. However the most common and serious of these side effects is bone loss leading to osteoporosis. The ratio of bone loss changes according to duration and dosage of steroid use. It is known that fractures occur in %30 to %50 of patients receving long-term steroid therapy. Many people undergo steroids therapy but they are not treated for osteoporosis and fracture risk. Therefore pathophysiology, diagnostic methods, prevention and treatment strategies of steroid induced osteoporosis presents in this review. [ABSTRACT FROM AUTHOR]

Aim: Osteopenia is an important morbidity of very low birth weight infants. In this study we aimed to appreciate the frequancy of osteopenia, the ethiological factors and the clinical and laboratory findings of osteopenia in our clinic. Material and Method: The records of preterm infants who were admitted from January 2004 to December 2006 with the diagnosis of osteopenia were reviewed. Clinical data and information about these infants were assessed according to the data base of our clinic and the files of cases. The gestational age, sexuality, birth weight, clinical findings and laboratory findings of our cases were recorded. This was a retrospective medical chart review. Results: Out of a total of 3691 cases, 113 were diagnosed as osteopenia. The incidence was 3.1%. 94 cases (83%) were pretems with <32 gestational age and 91 of them had <1250 gr birth weights. Respiratory dystress (39% mild and 47% severe) was the most common initial complaint of these preterm infants and among these cases 73% had been supported by ventilation. 42 cases received steroid treatment because of bronchopulmonary dysplasia. 50% of the cases were diagnosed at the age of 15- 30 days postnatally. The cases who were symptomatic comprised 50% of the total number and thorax deformities were the major manifestations. Also, in 4 cases femur fracture was identified. As the evidence of bone undermineralisation, increased ALP and decreased P levels were the mostly determined laboratory findings. Conclusions: The incidence of osteopenia of prematurity in our clinic was determined as 3.1% wich was lower than that reported in the literature. The incidences of osteopenia among infants born before 32 week of gestational age and with <1000 gr. birth weight were, respectively, 22.5% and 18.4%. The pathogenesis of disease is multifactorial. Respiratory dystress syndrome, ventilation support, steroid treatment for bronchopulmonary dysplasia, sepsis, necrotizing enterocolitis, total parenteral nutrition, prolonged hospitalization were confirmed as common ethiological factors. [ABSTRACT FROM AUTHOR]

Background: Corticosteroids have been widely used in attacks of Multiple Sclerosis (MS) and Clinically Isolated Syndromes but may rarely cause psychiatric manifestations, such as depression, mania, psychosis and delirium. Steroid-induced mood disorders have common clinical features, such as subacute onset, manic predominance and having psychotic history. Case Presentation: A 28 year-old housewife who had presented with a sudden blurring of vision had been diagnosed MS and applied 1000 mg/day intravenous methylprednisolone therapy for 10 days as a MS attack therapy in another hospital 20 days ago. One week after the steroid therapy she was taken to our outpatient clinic with paranoia, aggressive behaviors and disorientation. Neurological examination was normal except right optic neuritis. Brain MRI revealed periventricular and cerebellar demyelination. In her medical history she had behavioral pathologies as paranoia, aggression, visual hallucinations 5 years ago and her symptoms recovered without any psychiatric treatment less than one month. She didn't have another attack except optic neuritis, therefore we considered her diagnosis as Clinically Isolated Syndrome. After psychiatry consultation olanzapine at 20 mg/day was initiated and psychiatric excitations were taken under control. Conclusions: Intravenous methylprednisolone is usually administered in 0,5-1 gr/day dosage for 3-10 days in MS. It is considered that there's no significant difference between the administration periods in terms of the efficacy. We consider that it's important to take the psychiatric history before the steroid therapy and to reevaluate the necessity of the high dose steroid therapy and to choose the minimum dosage and period for the patients that have psychotic attack history. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri 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.)

Acute hemorrhagic edema of infancy is a rare form of leukocytoclastic vasculitis. Mostly it appears under three years of age and is characterized by purpuric skin lesions, fever and edema. A three years-old boy, who has cough and coryzea was admitted to our clinic for fever and red spots on legs and arms. In physical examination; ecimotic skin lesions on right ear, face, arms, dorsal of the hands, buttocks, legs and dorsal of the feet were found. In the laboratory tests acute phase reactants were elevated and blood coagulation tests were in normal range. Hepatit A,B,C and TORCH markers were negative. Punch biopsy obtained from gluteal area showed leukositoclastic vasculity. Focal fibrinogen accumulation was detected by immun fluorescent microscopy. Regression on lesions was not observed despite supportive therapy, so prednisolone (1 mg/kg/day) therapy was started. On the third day of the steroid therapy, complete recovery was achived. [ABSTRACT FROM AUTHOR]

Autoimmune inner ear disease is characterized as a disease with progressive sensorineural hearing loss. The disease can occur primarily or it can accompany other systemic autoimmune diseases. The diagnosis is based on clinical presentation and response to the administration of corticosteroids. The first choice of therapy is the administration of steroids. If the disease is refractory to steroids, immunosuppressants are the second choice. Autoimmune inner ear disease should be kept in mind, when differential diagnosis of any patient with progressive sensorineural hearing loss is made. Here, we present distinguishing characteristics of autoimmune inner ear disease in the lights of literature. [ABSTRACT FROM AUTHOR]