32,962 results on '"corticosteroid"'
Search Results
2. Exclusive extragenital lichen sclerosis in a child presenting in a lichen planus distribution
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Murshidi, Rand, AlSamhori, Jehad Feras, AlSamhouri, Abdel Rahman Feras, Hamad, Salsabiela Bani, Abdaljaleel, Maram, and AlShammas, Faris
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corticosteroid ,hyperpigmented patches ,lichen planus ,pediatric dermatology ,sclerosus ,topical - Abstract
Lichen sclerosus (LS) is a chronic inflammatory dermatosis primarily affecting the genitalia, commonly characterized by pearly-white papules and plaques. Although predominantly affecting females, LS can manifest across all age groups, with a bimodal distribution observed in prepubescent girls and postmenopausal women. This case report presents an unusual instance of exclusive extragenital LS in a 10-year-old girl, showcasing hyperpigmented patches and wrinkled plaques resembling lichen planus on her forearms and lower legs. Histopathological analysis confirmed LS, revealing distinctive epidermal changes and lymphocytic infiltrates. The absence of mucosal involvement and unique clinical presentation differentiated this case from typical LS manifestations. Treatment with topical clobetasol propionate demonstrated significant improvement in pruritus. Extragenital LS is infrequent, particularly among children, and its diagnosis necessitates a comprehensive clinicopathological correlation. The reported case contributes valuable insights into this uncommon variant, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Additionally, it highlights the efficacy of high-potency topical corticosteroids in managing this condition.
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- 2024
3. Recurrence following ptosis repair surgery: a multivariate analysis of risk factors.
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Sweeney, Adam R., Dermarkarian, Christopher R., Williams, Katherine J., Allen, Richard C., and Yen, Michael T.
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PREOPERATIVE risk factors , *FACTOR analysis , *REGRESSION analysis , *MULTIVARIATE analysis , *SURVIVAL analysis (Biometry) , *FILTERING surgery , *BLEPHAROPLASTY - Abstract
PurposeMethodsResultsConclusionsTo identify and evaluate the risk factors for ptosis repair failure.Retrospective, case-controlled study evaluating adult patients with ptosis who underwent ptosis surgery by external levator advancement/resection (ELR) or Müller muscle conjunctival resection (MMCR) with at least 3 months postoperative follow-up. Regression analyses were performed of ptosis repair outcomes comparing preoperative and perioperative risk factors for failure.A total of 240 patients (404 eyelids) met the inclusion criteria for the study. Surgical outcomes were measured categorically by success rate and measured quantitively over time using Kaplan–Meier survival analysis. Success was categorically achieved in 101/112 (90%) eyelids after MMCR and 231/292 (79%) eyelids after ELR (
p = .0088). Success as measured over 5 years of follow-up was significantly better in eyelids following MMCR compared to ELR (p = .0469). In terms of surgical failure, the following variables were found to be predictive in order of decreasing risk: chronic topical prostaglandin use, chronic topical corticosteroid use, surgical approach, lower preoperative margin reflex distance 1, prior intraocular surgery, age, lower preoperative levator function, concomitant blepharoplasty, presence of a glaucoma filtering bleb, and female gender.Ptosis repair surgery is a complex and challenging procedure. This study provides the largest comparative analysis of ELR versus MMCR to date with findings suggesting MMCR to be more a successful surgery than ELR. Topical prostaglandin analogue use appears to be the highest known risk factor for MMCR and ELR ptosis repair failure. [ABSTRACT FROM AUTHOR]- Published
- 2024
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4. United States clinical practice experience with eculizumab in myasthenia gravis: symptoms, function, and immunosuppressant therapy use.
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Habib, Ali A., Klink, Andrew J., Muppidi, Srikanth, Parthan, Anju, Sader, S. Chloe, Balanean, Alexandrina, Gajra, Ajeet, Nowak, Richard J., and Howard Jr., James F.
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COMPLEMENT (Immunology) , *COMPLEMENT inhibition , *CHOLINERGIC receptors , *ECULIZUMAB , *MUSCLE weakness , *MYASTHENIA gravis - Abstract
Background/objectives: The phase 3 REGAIN study and its open-label extension demonstrated the efficacy of the complement C5 inhibitor eculizumab in patients with treatment-refractory, acetylcholine receptor antibody–positive generalized myasthenia gravis (gMG). The aim of the ELEVATE study was to assess the effectiveness of eculizumab in clinical practice in adults with MG in the United States. Methods: A retrospective chart review was conducted in adults with MG who initiated eculizumab treatment between October 23, 2017 and December 31, 2019. Outcomes assessed before and during eculizumab treatment using a pre- versus post-treatment study design included Myasthenia Gravis–Activities of Daily Living (MG-ADL) total scores; minimal symptom expression (MSE); physician impression of clinical change; minimal manifestation status (MMS); and concomitant medication use. Results: In total, 119 patients were included in the study. A significant reduction was observed in mean MG-ADL total score, from 8.0 before eculizumab initiation to 5.4 at 3 months and to 4.7 at 24 months after eculizumab initiation (both p < 0.001). At 24 months after eculizumab initiation, MSE was achieved by 19% of patients. MMS or better was achieved by 30% of patients at 24 months. Additionally, 64% of patients receiving prednisone at eculizumab initiation had their prednisone dosage reduced during eculizumab treatment and 13% discontinued prednisone; 32% were able to discontinue nonsteroidal immunosuppressant therapy. Discussion: Eculizumab treatment was associated with sustained improvements in MG-ADL total scores through 24 months in adults with MG. Prednisone dosage was reduced in approximately two-thirds of patients, suggesting a steroid-sparing effect for eculizumab. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Treatment of acute exacerbations of interstitial lung diseases with corticosteroids: Evidence?
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Hung, Chi F. and Raghu, Ganesh
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INTERSTITIAL lung diseases , *IDIOPATHIC pulmonary fibrosis , *DISEASE exacerbation , *STEROID drugs , *CORTICOSTEROIDS - Abstract
See relatedarticle [ABSTRACT FROM AUTHOR]
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- 2024
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6. Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology.
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Smith, Justine R., Thorne, Jennifer E., Flaxel, Christina J., Jain, Nieraj, Kim, Stephen J., Maguire, Maureen G., Patel, Shriji, Weng, Christina Y., Yeh, Steven, and Kim, Leo A.
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MACULAR edema , *TRIAMCINOLONE acetonide , *INTRAVITREAL injections , *INTRAOCULAR pressure , *VISUAL acuity - Abstract
To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Real‐world approaches to outpatient treatment of status migrainosus: A survey study.
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Robblee, Jennifer, Orlova, Yulia Y., Ahn, Andrew H., Ali, Ashhar S., Birlea, Marius, Charleston, Larry, Singh, Niranjan N., and Souza, Marcio Nattan P.
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ADRENOCORTICAL hormones , *NONSTEROIDAL anti-inflammatory agents , *RESEARCH funding , *OUTPATIENT medical care , *MEMBERSHIP , *DESCRIPTIVE statistics , *TREATMENT duration , *HOSPITAL emergency services , *ANTIPSYCHOTIC agents , *SURVEYS , *TRYPTAMINE , *DIHYDROERGOTAMINE , *PAIN management , *MIGRAINE - Abstract
Objectives: Identify how the American Headache Society (AHS) membership manages status migrainosus (SM) among outpatients. Background: SM is defined as a debilitating migraine attack lasting more than 72 h. There is no standard of care for SM, including whether a 72‐h duration is required before the attack can be treated as SM. Methods: The Refractory Headache Special Interest Group from AHS developed a four‐question survey distributed to AHS members enquiring (1) whether they treat severe refractory migraine attacks the same as SM regardless of duration, (2) what their first step in SM management is, (3) what the top three medications they use for SM are, and (4) whether they are United Council for Neurologic Subspecialties (UCNS) certified. The survey was conducted in January 2022. Descriptive statistical analyses were performed. Results: Responses were received from 196 of 1859 (10.5%) AHS members; 64.3% were UCNS certified in headache management. Respondents treated 69.4% (136/196) of patients with a severe refractory migraine attack as SM before the 72‐h period had elapsed. Most (76.0%, 149/196) chose "treat remotely using outpatient medications at home" as the first step, 11.2% (22/196) preferred procedures, 6.1% (12/196) favored an infusion center, 6.1% (12/196) sent patients to the emergency department (ED) or urgent care, and 0.5% (1/196) preferred direct hospital admission. The top five preferred medications were as follows: (1) corticosteroids (71.4%, 140/196), (2) nonsteroidal anti‐inflammatory drugs (NSAIDs) (50.1%, 99/196), (3) neuroleptics (46.9%, 92/196), (4) triptans (30.6%, 60/196), and (5) dihydroergotamine (DHE) (21.4%, 42/196). Conclusions: Healthcare professionals with expertise in headache medicine typically treated severe migraine attacks early and did not wait 72 h to fulfill the diagnostic criteria for SM. Outpatient management with one or more medications for home use was preferred by most respondents; few opted for ED referrals. Finally, corticosteroids, NSAIDs, neuroleptics, triptans, and DHE were the top five preferred treatments for home SM management. Plain Language Summary: In this research study, we asked members of the American Headache Society how they treat status migrainosus, a very severe migraine attack lasting more than 3 days. Out of the 196 people who answered the survey, most used stronger treatments before the headache lasted 72 h, and the majority preferred to use home‐based treatments to avoid the hospital. The five most common treatments they use are corticosteroids (like dexamethasone), nonsteroidal anti‐inflammatory drugs (like ketorolac), neuroleptics (like prochlorperazine), triptans (like naratriptan), and dihydroergotamine. [ABSTRACT FROM AUTHOR]
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- 2024
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8. A Case of Lyme Disease Presenting as Bilateral Panuveitis.
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Park, Bo Hyun, Kwon, Han Jo, Park, Sung Who, Lee, Jeong Eun, and Byon, Iksoo
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BLOOD sedimentation , *ORAL drug administration , *EYE drops , *ANTIBODY titer , *BLOOD testing , *LYME disease - Abstract
Here, we describe a case of Lyme disease presenting as bilateral panuveitis. A 25-year-old woman presented to our clinic with decreased visual acuity of 20/320 and 20/160 in the right and left eye, respectively. An ophthalmic examination revealed the presence of anterior chamber cells 3+, vitreous cells 1+, vitreous haziness 2+/1+, and retinal infiltration in both eyes. She also had fever, headache, and difficulty in breathing. An initial blood analysis did not detect infection; however, high levels of erythrocyte sedimentation rate and C-reactive protein were noted. Pleural and pericardial effusions, and multiple reactive arthritis lesions were observed on chest computed tomography and bone scans, respectively. Oral steroids (30 mg/day) and steroid eye drops were initiated. Ten days later, she was diagnosed with Lyme disease, based on an indirect immunofluorescence antibody test. Ceftriaxone (2 g) was intravenously administered for 2 weeks followed by administration of oral trimethoprim-sulfamethoxazole (400 mg/80 mg/day) for 1 week. Thereafter, she received a 4-week course of doxycycline (100 mg) twice daily. Her symptoms and ocular findings improved; however, a gradually increasing dose of oral steroid was needed to control retinal lesions for some time, since multiple retinitis lesions developed in the peripheral retina after tapering the oral steroid dose to 5 mg/day. In conclusion, panuveitis can occur in patients with Lyme disease and can be treated with systemic antibiotics and steroids [ABSTRACT FROM AUTHOR]
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- 2024
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9. Corticosteroid use in neonatal hypotension: A survey of Canadian neonatologists.
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Kharrat, Ashraf, Diambomba, Yenge, and Jain, Amish
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To assess prescribing practices and perspectives regarding the use of corticosteroids in the management of neonatal hypotension. Cross-sectional questionnaire-based electronic survey of neonatologists (n = 206) practicing at tertiary neonatal intensive care units across 30 academic centres in Canada. The overall response rate was 33% (72/206), with a completion rate was 94%. Most (48/72, 64%) worked in a unit that covered both inborn and outborn infants, and 53% (37/70) worked in units with >100 very low birth weight infants admitted annually. Among the 72 respondents, 39% use a loading dose, of whom most (57%) use 2 mg/kg. Dosing ranges were variable, most using either 0.5 mg/kg or 1 mg/kg, q6h. Among the 56% (40/72) of neonatologists who reported measuring cortisol before initiation of hydrocortisone, cut-offs for initiation of hydrocortisone varied from <100 to <500 nmol/L, most of whom (48%) used <100 nmol/L. Of 71 respondents, 92% (65) indicated that a randomized control trial examining the use of corticosteroids in neonatal hypotension is needed, of whom 52% (37) indicated that the intervention group should receiving hydrocortisone after one vasopressor/inotrope. This survey provides insight into the prescribing practices of tertiary neonatologists with regards to the use of corticosteroids in neonatal hypotension. While corticosteroids are frequently prescribed, there is variability in the indication, dosing, and duration of corticosteroid use. The findings from this survey can be used to inform further research, including a clinical trial, regarding the practice in the management of neonatal hypotension. [ABSTRACT FROM AUTHOR]
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- 2024
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10. 类风湿关节炎患者颈椎失稳发生率及相关因素的 Meta 分析.
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徐铖菡, 禚汉杰, 柴旭斌, 黄 勇, 张博文, 陈 勤, 郝宇鹏, 栗 林, and 周英杰
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OBJECTIVE: At present, there are many reports on the related factors associated with the incidence of cervical spine instability in patients with rheumatoid arthritis, but there are problems such as small sample size and many confounding factors, and the research results of various studies on the same related factors are also different. This article analyzed the factors related to cervical spine instability in patients with rheumatoid arthritis by means of a systematic review. METHODS: Articles related to cervical spine instability in patients with rheumatoid arthritis were collected by searching both Chinese and English databases until March 2023. The outcome of cervical spine instability in patients with rheumatoid arthritis was used as the grouping criterion to abstract basic information, baseline patient characteristics, laboratory-related tests, medication use, and other relevant risk factors. Meta-analysis was done using Stata 14.0 software. RESULTS: (1) Sixteen relevant studies, all of moderate or above quality, were included, including seven studies with case-control studies and nine with cross-sectional studies. The overall incidence of cervical spine instability in patients with rheumatoid arthritis was 43.08%. (2) Meta-analysis showed: Related risk factors included female (OR=0.60, 95%CI: 0.44-0.82, P=0.002); age at disease onset (SMD=-0.52, 95%CI: -0.86 to -0.18, P=0.003); duration of disease (SMD=0.58, 95%CI: 0.14-1.02, P=0.01); body mass index (OR=0.74, 95%CI: 0.63-0.88, P=0.001); rheumatoid factors positive univariate analysis subgroup (OR=1.33, 95%CI:1.02 to 1.72, P=0.04), C-reactive protein (SMD=0.26, 95%CI: 0.16-0.35, P=0.00), erythrocyte sedimentation rate (SMD=0.15, 95%CI: 0.002-0.29, P=0.047), anti-cyclic-citrullinated peptide antibodies (OR=1.73, 95%CI: 1.19-2.51, P=0.004), 28-joint Disease Activity Score (SMD=0.20, 95%CI: 0.04-0.37, P=0.02), destruction of peripheral joints (OR=2.48, 95%CI: 1.60-3.85, P=0.00), and corticosteroids (OR=1.91, 95%CI: 1.54-2.37, P=0.00) were strongly associated with the development of rheumatoid arthritis-cervical spine instability. Female and corticosteroid use were independently associated with the occurrence of rheumatoid arthritis-cervical spine instability. CONCLUSION: Based on clinical evidence from 16 observational studies, the overall incidence of rheumatoid arthritis-cervical spine instability was 43.08%. However, the incidence of cervical spine instability in rheumatoid arthritis patients varied greatly among different studies. Gender (female) and the use of corticosteroids were confirmed as independent correlation factors for the onset of cervical spine instability in patients with rheumatoid arthritis. The results of this study still provide some guidance for early clinical recognition, diagnosis, and prevention of rheumatoid arthritis-cervical spine instability. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Efgartigimod combined with steroids as a fast-acting therapy for myasthenic crisis: a case report.
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Ohara, Hiroya, Kikutsuji, Naoya, Iguchi, Naohiko, and Kinoshita, Masako
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CLINICAL trials , *FC receptors , *IMMUNOSUPPRESSIVE agents , *RECEPTOR antibodies , *ACETYLCHOLINESTERASE inhibitors - Abstract
Background: Generalized myasthenia gravis (gMG) can be managed with acetylcholinesterase inhibitors (AChEis; e.g., pyridostigmine), corticosteroids, other immunosuppressive drugs (e.g., tacrolimus), and their combinations. Intravenous immunoglobulin (IVIg) or plasmapheresis (PLEX) may be administered if symptoms persist. PLEX and IVIg are also mainstays of treatment for myasthenic crisis. Recently, efgartigimod was approved in Japan for treating adults with gMG (irrespective of the antibody status) who do not have a sufficient response to corticosteroids and nonsteroidal immunosuppressive therapies. Efgartigimod is generally safe and well tolerated. However, since phase III trials of efgartigimod excluded those with myasthenic crisis, the efficacy of efgartigimod in treating myasthenic crisis is still unclear. Moreover, there are no reports that efgartigimod therapy can reduce the dose of corticosteroids needed to achieve a minimal manifestation status. Case presentation: We report the case of a 70-yeat-old woman with gMG who developed a myasthenic crisis. After she was diagnosed with gMG, the patient had been treated with oral corticosteroids and tacrolimus for 1 year. However, she refused to continue taking the medication, and two weeks later, she developed ptosis, dysphagia and dyspnea. The patient was intubated and treated with efgartigimod in combination with steroid therapy, and she recovered without PLEX or IVIg. Afterward, when she experienced worsening of fatigue and increased levels of anti-acetylcholine receptor antibodies, efgartigimod therapy was effective. The patient achieved minimal manifestation status even after the reduction of corticosteroids and showed improvements in the Myasthenia Gravis Activities of Daily Living scales after 4 cycles of efgartigimod infusion. Conclusions: Our case suggests that efgartigimod can be an alternative drug for achieving minimal manifestation status in patients with myasthenic crisis. Considering its strong efficacy and safety, efgartigimod could be expanded to use as bridging therapy in the acute and chronic phases of gMG. [ABSTRACT FROM AUTHOR]
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- 2024
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12. A diagnostic dilemma: cytomegalovirus colitis as an uncommon comorbidity in inflammatory bowel disease: a case report.
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Alhalabi, Marouf and Alziadan, Soumar Mueen
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INFLAMMATORY bowel diseases , *OPPORTUNISTIC infections , *ULCERATIVE colitis , *CYTOMEGALOVIRUS diseases , *IMMUNOSUPPRESSIVE agents - Abstract
Background: The role of cytomegalovirus infection as an opportunistic pathogen in exacerbating ulcerative colitis and its response to treatment remain a topic of ongoing debate. Clinicians encounter numerous challenges, including the criteria for differentiating between an acute ulcerative colitis flare and true cytomegalovirus colitis, the diagnostic tests for identifying cytomegalovirus colitis, and determining the appropriate timing for initiating antiviral therapy. Case presentation: A 28-year-old Syrian female with a seven-year history of pancolitis presented with worsening bloody diarrhea, abdominal pain, and tenesmus despite ongoing treatment with azathioprine, mesalazine, and prednisolone. She experienced a new flare of acute severe ulcerative colitis despite recently completing two induction doses of infliximab (5 mg/kg) initiated four weeks prior for moderate-to-severe ulcerative colitis. She had no prior surgical history. Her symptoms included watery, bloody diarrhea occurring nine to ten times per day, abdominal pain, and tenesmus. Initial laboratory tests indicated anemia, leukocytosis, elevated C-reactive protein (CRP) and fecal calprotectin levels, and positive CMV IgG. Stool cultures, Clostridium difficile toxin, testing for Escherichia coli and Cryptosporidium, and microscopy for ova and parasites were all negative. Sigmoidoscopy revealed numerous prominent erythematous area with spontaneous bleeding. Biopsies demonstrated CMV inclusions confirmed by immunohistochemistry, although prior biopsies were negative. We tapered prednisolone and azathioprine and initiated ganciclovir at 5 mg/kg for ten days, followed by valganciclovir at 450 mg twice daily for three weeks. After one month, she showed marked improvement, with CRP and fecal calprotectin levels returning to normal. She scored one point on the partial Mayo score. The third induction dose of infliximab was administered on schedule, and azathioprine was resumed. Conclusion: Concurrent cytomegalovirus infection in patients with inflammatory bowel disease presents a significant clinical challenge due to its associated morbidity and mortality. Diagnosing and managing this condition is particularly difficult, especially regarding the initiation or continuation of immunosuppressive therapies. [ABSTRACT FROM AUTHOR]
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- 2024
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13. A Study to Assess the Effectiveness of Corticosteroid Injection in the Treatment of Tennis Elbow at Teaching Hospital.
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G. R., Kamala and G. H., Hanumantharaya
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Tennis elbow or lateral epicondylitis is a painful condition of the elbow. It is commonly seen in carpenters, musicians, gardeners and computer programmers. Steroid injections in periarticular or soft tissue structure relieve pain, inflammation and improve mobility. Aim of study is to evaluate the usefulness of intra-lesional steroid injections in tennis elbow. Materials and Methods: This was a prospective study of 42 patients conducted at teaching hospital from January 2023 to December 2023. Results were assessed with visual analog scale [VAS] and Patient Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Patients were injected with local injection of 1ml (40mg) of methylprednisolone acetate (corticosteroid) combined with 1 ml of 2% lignocaine at the maximal point tenderness at lateral epicondyle. Patients were followed-up at 2, 6, 12 weeks. Results: 26were males and 16 were females. All belong to the age group of 26-50 years, with the average age of 38.5 years. We observed significant decrease in pain level at 2 weeks, 6 weeks and 12 weeks follow up as compared to baseline with help of VAS and PRTEE scores. Conclusion: corticosteroid injection in tennis elbow patients showed significant pain reduction and functional improvement. [ABSTRACT FROM AUTHOR]
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- 2024
14. Undetected intraabdominal sepsis due to prolonged corticosteroid therapy in systemic lupus erythematosus: a case report and literature review.
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Leman, Yosephine Ervina, Irawany, Vera, and Manggala, Sidharta Kusuma
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SYSTEMIC lupus erythematosus , *LITERATURE reviews , *CONGESTIVE heart failure , *ARTERIAL diseases , *CORONARY disease - Abstract
Gastrointestinal manifestations are not included in the criteria for diagnosing systemic lupus erythematosus (SLE) by the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2019, however, gastrointestinal disorders are one of the potentially fatal complications of SLE. Mesenteric vasculitis and thrombosis are the two main mechanisms that cause gastrointestinal disorders in SLE patients. Long-term immunosuppressants used by SLE patients might alter the immune system's response to infection, leading to immunoparalysis. The delay in recognizing might cause sepsis, thus increasing the mortality risk. A 47-year-old woman with a history of SLE complained of hematochezia. The patient had been consistently consuming 12 mg of methylprednisolone every day for the past five years without doctor's supervision. Past medical history of congestive heart failure (CHF) caused by coronary arterial disease (CAD). After 24 days hospitalized for observation of hematochezia, an emergency laparotomy was performed due to deterioration caused by peritonitis. Intraoperative, 60 cm of jejunal necrosis was identified and intestinal resection was done. The patient's condition improved in two days after emergency laparotomy and intensive treatment. The undetected intraabdominal sepsis caused by jejunal infarction and gut necrosis due to long-term use of corticosteroid that masked the manifestations of severe infection in the gastrointestinal tract infarction and necrosis. [ABSTRACT FROM AUTHOR]
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- 2024
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15. Cost-effectiveness of treatment strategies for populations from strongyloidiasis high-risk areas globally who will initiate corticosteroid treatment in the USA.
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Joo, Heesoo, Maskery, Brian A, Alpern, Jonathan D, Weinberg, Michelle, and Stauffer, William M
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STRONGYLOIDIASIS , *DECISION trees , *MEDICAL screening , *ECONOMIC impact , *IVERMECTIN - Abstract
Background The risk of developing strongyloidiasis hyperinfection syndrome appears to be elevated among individuals who initiate corticosteroid treatment. Presumptive treatment or treatment after screening for populations from Strongyloides stercoralis -endemic areas has been suggested before initiating corticosteroids. However, potential clinical and economic impacts of preventative strategies have not been evaluated. Methods Using a decision tree model for a hypothetical cohort of 1000 individuals from S. stercoralis -endemic areas globally initiating corticosteroid treatment, we evaluated the clinical and economic impacts of two interventions, 'Screen and Treat' (i.e. screening and ivermectin treatment after a positive test), and 'Presumptively Treat', compared to current practice (i.e. 'No Intervention'). We evaluated the cost-effectiveness (net cost per death averted) of each strategy using broad ranges of pre-intervention prevalence and hospitalization rates for chronic strongyloidiasis patients initiating corticosteroid treatment. Results For the baseline parameter estimates, 'Presumptively Treat' was cost-effective (i.e. clinically superior with cost per death averted less than a threshold of $10.6 million per life) compared to 'No Intervention' ($532 000 per death averted) or 'Screen and Treat' ($39 000 per death averted). The two parameters contributing the most uncertainty to the analysis were the hospitalization rate for individuals with chronic strongyloidiasis who initiate corticosteroids (baseline 0.166%) and prevalence of chronic strongyloidiasis (baseline 17.3%) according to a series of one-way sensitivity analyses. For hospitalization rates ≥0.022%, 'Presumptively Treat' would remain cost-effective. Similarly, 'Presumptively Treat' remained preferred at prevalence rates of ≥4%; 'Screen and Treat' was preferred for prevalence between 2 and 4% and 'No Intervention' was preferred for prevalence <2%. Conclusions The findings support decision-making for interventions for populations from S. stercoralis -endemic areas before initiating corticosteroid treatment. Although some input parameters are highly uncertain and prevalence varies across endemic countries, 'Presumptively Treat' would likely be preferred across a range for many populations, given plausible parameters. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Effect of Corticosteroids on Long-Term Humoral and Memory T-Cell Responses in Follow-Up Visit of Hospitalized Patients With COVID-19.
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Wang, Yeming, Guo, Li, Fan, Guohui, Han, Yang, Zhang, Qiao, Wang, Weiyang, Ren, Lili, Zhang, Hui, Wang, Geng, Zhang, Xueyang, Huang, Tingxuan, Chen, Lan, Huang, Lixue, Gu, Xiaoying, Cui, Dan, Wang, Xinming, Zhong, Jingchuan, Wang, Ying, Li, Hui, and Huang, Chaolin
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COVID-19 , *IMMUNOLOGIC memory , *LONG-term memory , *HOSPITAL patients , *CORTICOSTEROIDS - Abstract
Corticosteroids have beneficial effects in improving outcomes in hospitalized patients with severe COVID-19 by suppressing excessive immune responses. However, the effect of corticosteroids on the humoral and T-cell responses of survivors of COVID-19 1 year after infection remains uncertain, as it relates to the extent of immediate, antigen-specific defense provided by protective memory. What is the effect of corticosteroids on long-term humoral and T-cell immune responses? In this retrospective cohort study conducted at a single center, we analyzed data from a cohort who had survived COVID-19 to compare the 1-year seropositivity and titer changes in neutralizing antibodies (NAbs) and SARS-CoV-2-specific antibodies. Additionally, we evaluated the magnitude and rate of SARS-CoV-2-specific T-cell response in individuals who received corticosteroids during hospitalization and those who did not. Our findings indicated that corticosteroids do not statistically influence the kinetics or seropositive rate of NAbs against the Wuhan strain of SARS-CoV-2 from 6 months to 1 year. However, subgroup analysis revealed a numerical increase of NAbs titers, from 20.0 to 28.2, in categories where long-term (> 15 days) and high-dose (> 560 mg) corticosteroids were administered. Similarly, corticosteroids showed no significant effect on nucleoprotein and receptor-binding domain IgG at 1 year, except for spike protein IgG (β, 0.08; 95% CI, 0.04-0.12), which demonstrated a delayed decline of titers. Regarding T-cell immunity, corticosteroids did not affect the rate or magnitude of T-cell responses significantly. However, functional assessment of memory T cells revealed higher interferon-γ responses in CD4 (β, 0.61; 95% CI, 0.10-1.12) and CD8 (β, 0.63; 95% CI, 0.11-1.15) memory T cells in the corticosteroids group at 1 year. Based on our findings, short-term and low-dose corticosteroid therapy during hospitalization does not appear to have a significant effect on long-term humoral kinetics or the magnitude and rate of memory T-cell responses to SARS-CoV-2 antigens. However, the potential harmful effects of long-term and high-dose corticosteroid use on memory immune responses require further investigation. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Surveying haemoperfusion impact on COVID-19 from machine learning using Shapley values.
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Einollahi, Behzad, Javanbakht, Mohammad, Ebrahimi, Mehrdad, Ahmadi, Mohammad, Izadi, Morteza, Ghasemi, Sholeh, Einollahi, Zahra, Beyram, Bentolhoda, Mirani, Abolfazl, and Kianfar, Ehsan
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MACHINE learning , *INTERFERON beta-1a , *COVID-19 , *COVID-19 pandemic , *COMPUTED tomography , *FERRITIN , *ENOXAPARIN , *ADALIMUMAB - Abstract
Background: Haemoperfusion (HP) is an innovative extracorporeal therapy that utilizes special cartridges to filter the blood, effectively removing pro-inflammatory cytokines, toxins, and pathogens in COVID-19 patients. This retrospective cohort study aimed to assess the clinical benefits of HP for severe COVID-19 cases using Shapley values for machine learning models. Methods: The research involved 578 inpatients (≥ 20 years old) admitted to Baqiyatallah hospital (Tehran, Iran). The control group (359 patients) received standard treatment, including high doses of corticosteroids (a single 500 mg methylprednisolone pulse, followed by 250 mg for 2 days), categorized as regimen (I). On the other hand, the HP group (219 patients) received regimen II, consisting of the same corticosteroid treatment (regimen I) along with haemoperfusion using Cytosorb H300. The frequency of haemoperfusion sessions varied based on the type of lung involvement determined by chest CT scans. In addition, the value function v defines the Shapley value of the i th feature for the query point x , where the input matrix features represent individual characteristics, drugs, and history and clinical conditions of the patient. Results: Our data showed a favorable clinical response in the HP group compared to the control group. Notably, one-to-three sessions of HP using the CytoSorb® 300 cartridge led to reduced ventilation requirements and mortality rates in severe COVID-19 patients. Shapley values were calculated to evaluate the contribution of haemoperfusion among other factors, such as side effects, medications, and individual characteristics, to COVID-19 patient outcomes. In addition, there is a significant difference between the two groups among the treatments and medications used remdesivir, adalimumab, tocilizumab, favipiravir, Interferon beta-1a, enoxaparin prophylaxis, enoxaparin full dose, heparin prophylaxis, and heparin full dose (P < 0.05). It seems that haemoperfusion has a positive impact on the reduction of inflammation markers and renal functional such as ferritin and creatinine, respectively, as well as d-dimer and WBC levels in the HP group were significantly lower than the control group. Conclusion: The findings indicated that haemoperfusion played a crucial role in predicting patient survival, making it a significant feature in classifying patients' prognoses. [ABSTRACT FROM AUTHOR]
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- 2024
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18. IgG4‐related pleural disease diagnosed by thoracoscopic pleural biopsy: A case report.
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Miyoshi, Azusa, Katsura, Hideki, Akaba, Tomohiro, Kondo, Mitsuko, and Tagaya, Etsuko
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PLEURAL effusions , *PLEURA diseases , *VIDEO-assisted thoracic surgery , *BIOPSY , *CHEST X rays , *PLASMA cells , *DIAGNOSIS - Abstract
Here we report a rare case of immunoglobulin G4 (IgG4)–related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66‐year‐old man was admitted to our hospital with right‐dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right‐dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video‐assisted thoracoscopic surgery showed fibrosis‐associated lymphoplasmacytic infiltration, 45–60 IgG4‐positive plasma cells per high‐power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4‐related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Investigation Into the Effects of Intra-Articular Steroid on Post-Traumatic Osteoarthritis in Distal Radius Fractures: A Randomized Controlled Pilot Study.
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Logli, Anthony L., Evans, Christopher H., Duryea, Jeffrey, Larson, Dirk R., Bakri, Karim, Carlsen, Brian T., Dennison, David G., Karim, Kristin E., Pulos, Nicholas A., Rhee, Peter C., Rizzo, Marco, Shin, Alexander Y., Elhassan, Bassem T., and Kakar, Sanjeev
- Abstract
The aim of this prospective, randomized, controlled, double-blinded pilot study was to determine the rates of post-traumatic osteoarthritis and assess joint space width in the presence or absence of a single intra-articular injection of corticosteroid after an acute, intra-articular distal radius fracture (DRF). Forty patients received a single, intra-articular, radiocarpal joint injection of 4 mg of dexamethasone (DEX) (n = 19) or normal saline placebo (n = 21) within 2 weeks of a surgically or nonsurgically treated intra-articular DRF. The primary outcome measure was minimum radiocarpal joint space width (mJSW) on noncontrast computed tomography scans at 2 years postinjection. Secondary outcomes were obtained at 3 months, 6 months, 1 year, and 2 years postinjection and included Disabilities of the Arm, Shoulder, and Hand; Michigan Hand Questionnaire; Patient-Rated Wrist Evaluation; wrist range of motion; and grip strength. At 2-year follow-up, there was no difference in mean mJSW between the DEX group (2.2 mm; standard deviation, 0.6; range, 1.4–3.2) and the placebo group (2.3 mm; standard deviation, 0.7; range, 0.9–3.9). Further, there were no differences in any secondary outcome measures at any postinjection follow-up interval. Radiocarpal joint injection of corticosteroid within 2 weeks of an intra-articular DRF does not appear to affect the development of post-traumatic osteoarthritis within 2 years follow-up in a small pilot cohort. Therapeutic II. [ABSTRACT FROM AUTHOR]
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- 2024
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20. Effect of a Single Dose of Deflazacort on Postoperative Pain, Swelling, and Trismus after Impacted Lower Third Molar Surgery: Randomised Clinical Trial.
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Kaplan, Volkan, Ciğerim, Levent, Feslihan, Erkan, and Çınarsoy Ciğerim, Saadet
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THIRD molars ,TRISMUS ,POSTOPERATIVE pain ,VISUAL analog scale ,VITAMIN C - Abstract
Background and Objectives: The aim of this study was to investigate the efficacy of a single preoperative dose of deflazacort on pain, swelling, and trismus after impacted lower third molar surgery. Materials and Methods: This randomised, prospective, double-blind, split-mouth clinical study included 26 healthy individuals with bilaterally impacted lower third molars. Group 1 was given a placebo (single-dose vitamin C tablet), and group 2 was given a single 30 mg dose of deflazacort 1 h prior to surgery. Pain was evaluated using the visual analogue scale for 1 week postoperatively. Oedema (in mm) and trismus (in mm) were evaluated preoperatively and on postoperative days 2 and 7. The Mann–Whitney U test was applied for group analyses. p values < 0.05 were considered statistically significant. Results: Postoperative pain scores were significantly lower in the deflazacort group at the 6th and 12th hours after surgery (p < 0.05). There were no significant differences in trismus between the groups at any time point (p > 0.05). There was less oedema in the deflazacort group on postoperative days 2 and 7, without any statistically significant difference (p > 0.05). Conclusions: A single preoperative dose of 30 mg deflazacort was found to be clinically effective in reducing pain and oedema after extraction of impacted lower third molars. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial.
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Cakar, Albert and Gozlu, Ozgur Dogus
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TENNIS elbow , *CLINICAL trials , *TREATMENT effectiveness , *PATIENT dropouts , *COMBINED modality therapy , *CORTICOSTEROIDS , *ELBOW - Abstract
Background: Because lateral epicondylitis is a common musculoskeletal disorder that affects the forearm's extensor tendons, an effective therapeutic approach should reverse the degeneration and promote regeneration. This study aimed to compare the efficacies of autologous blood (AB) injection, corticosteroid (CS) injection, and a combined injection of both in treating lateral epicondylitis (LE), hypothesizing that the combined approach might offer immediate symptom resolution and a lower recurrence. Materials and methods: A total of 120 patients diagnosed with lateral epicondylitis were systematically distributed among three distinct therapeutic injection groups. Those in the AB group were administered 1 ml of autologous venous blood mixed with 2 ml of 2% prilocaine HCl. Participants in the CS category were given 1 ml of 40 mg methylprednisolone acetate mixed with 2 ml of 2% prilocaine HCl. Meanwhile, patients in the combined group received a mixture containing 1 ml each of autologous venous blood and 40 mg methylprednisolone acetate along with 1 ml of 2% prilocaine HCl. Prior to receiving their respective injections, a comprehensive assessment of all participants was carried out. Follow-up assessments were subsequently conducted on days 15, 30, and 90 utilizing metrics of the patient-rated tennis elbow evaluation (PRTEE) and measurements of hand grip strength (HGS). Results: One patient dropped out from the combined group, and 119 patients completed the trial. No complications were recorded during the course of follow-up. By day 15, all groups had demonstrated significant PRTEE improvement, with CS showing the most pronounced reduction (p = 0.001). However, the benefits of CS had deteriorated by day 30 and had deteriorated further by day 90. The AB and AB + CS groups demonstrated sustained improvement, with AB + CS revealing the most effective treatment, achieving a clinically significant improvement in 97.4% of the patients. The improved HGS parallelled the functional enhancements, as it was more substantial in the AB and AB + CS groups (p = 0.001), corroborating the sustained benefits of these treatments. Conclusions: The study concluded that while AB and CS individually offer distinct benefits, a combined AB + CS approach optimizes therapeutic outcomes, providing swift and sustained functional improvement with a lower recurrence rate. These findings have substantial clinical implications, suggesting a balanced, multimodal treatment strategy for enhanced patient recovery in LE. Level of evidence: Randomized clinical trial, level 1 evidence. Trial registration: NCT06236178. [ABSTRACT FROM AUTHOR]
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- 2024
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22. The effect of intra-articular steroid injection on the cartilage and tendon thicknesses in juvenile idiopathic arthritis.
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Şahin, Nihal, Özdemir Çiçek, Sümeyra, Paç Kısaarslan, Ayşenur, Dursun, İsmail, Poyrazoğlu, Muammer Hakan, and Düşünsel, Ruhan
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JUVENILE idiopathic arthritis , *QUADRICEPS tendon , *KNEE joint , *PATELLAR tendon , *ARTICULAR cartilage - Abstract
Objectives: Intra-articular corticosteroid injection (IACI) is a safe first-line or adjunct therapy used in any subtype of juvenile idiopathic arthritis (JIA). Limited studies evaluated the effect of IACI on cartilage. Our study aimed to examine the femoral cartilage thickness of patients with JIA who received IACI to the knee joint using ultrasound. Methods: We randomly selected JIA patients who performed IACI in the knee joint. Baseline bilateral joint cartilage and tendon thicknesses were measured. The articular fluid was aspirated, and applied IACI at the same period. Six months after injection, the exact measurements were repeated. Distal femoral cartilage, quadriceps tendon, and distal and proximal patellar tendon thicknesses were compared at the baseline (before IACI) and 6 months after IACI. Results: Thirty patients with JIA were included, and 23 (76.7%) were female. The median age was 11 years (interquartile range, 6 to 14), and the median disease duration was 3.3 years (interquartile range, 5 months to 5 years). The subtypes of JIA were oligoarticular in 25 (83.3%), polyarticular in 2 (6.7%), enthesitis-related arthritis in 2 (6.7%), and juvenile psoriatic arthritis in 1 (3.3%). Distal femoral cartilage thickness was 2.96 ± 0.79 mm at baseline and 2.85 ± 0.70 mm at 6 months after IACI (P = .35). The tendon thicknesses were similar at 6 months after baseline measurements. Conclusions: Our findings reveal that knee IACI in patients with JIA did not significantly change cartilage and tendon thicknesses. This observation could indicate that IACIs have no detrimental effects on the cartilage and the tendons. [ABSTRACT FROM AUTHOR]
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- 2024
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23. Hot-Melt Extrusion-Based Dexamethasone–PLGA Implants: Physicochemical, Physicomechanical, and Surface Morphological Properties and In Vitro Release Corrected for Drug Degradation.
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Ghaffari, Alireza, Matter, Brock A., Hartman, Rachel R., Bourne, David W. A., Wang, Yan, Choi, Stephanie, and Kompella, Uday B.
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DRUG delivery systems , *GENERIC products , *SURFACE roughness , *SURFACE properties , *PHARMACODYNAMICS - Abstract
Developing bioequivalent (BE) generic products of complex dosage forms like intravitreal implants (IVIs) of corticosteroids such as dexamethasone prepared using hot-melt extrusion (HME), based on biodegradable poly (lactide-co-glycolide) (PLGA) polymers, can be challenging. A better understanding of the relationship between the physicochemical and physicomechanical properties of IVIs and their effect on drug release and ocular bioavailability is crucial to develop novel BE approaches. It is possible that the key physicochemical and physicomechanical properties of IVIs such as drug properties, implant surface roughness, mechanical strength and toughness, and implant erosion could vary for different compositions, resulting in changes in drug release. Therefore, this study investigated the hypothesis that biodegradable ophthalmic dexamethasone-loaded implants with 20% drug and 80% PLGA polymer(s) prepared using single-pass hot-melt extrusion (HME) differ in physicochemical and/or physicomechanical properties and drug release depending on their PLGA polymer composition. Acid end-capped PLGA was mixed with an ester end-capped PLGA to make three formulations: HME-1, HME-2, and HME-3, containing 100%, 80%, and 60% w/w of the acid end-capped PLGA. Further, this study compared the drug release between independent batches of each composition. In vitro release tests (IVRTs) indicated that HME-1 implants can be readily distinguished by their release profiles from HME-2 and HME-3, with the release being similar for HME-2 and HME-3. In the early stages, drug release generally correlated well with polymer composition and implant properties, with the release increasing with PLGA acid content (for day-1 release, R2 = 0.80) and/or elevated surface roughness (for day-1 and day-14 release, R2 ≥ 0.82). Further, implant mechanical strength and toughness correlated inversely with PLGA acid content and day-1 drug release. Drug release from independent batches was similar for each composition. The findings of this project could be helpful for developing generic PLGA polymer-based ocular implant products. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Surgically induced necrotizing scleritis (SINS): Is it a standalone condition or a variant of necrotizing scleritis?
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Magesan, Kowsigan, Majumder, Parthopratim Dutta, Agarwal, Mamta, George, Amala E., Nair, Vinita, Ganesh, Sudha K., and Biswas, Jyotirmay
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- *
EYE care , *SCLERITIS , *IDIOPATHIC diseases , *OPERATIVE surgery , *SIN - Abstract
Purpose: To report the clinical pattern of surgically induced necrotizing scleritis (SINS) in a tertiary eye care center in Southern India. Methods: Retrospective analysis of all SINS cases visiting the uveitis clinic of a tertiary eye institute between January 2009 and April 2019. Results: In total, 15 patients with a median age of 65 (IQR: 52-70) years were included in the study. Male (53%) predominance was noted, and SINS was unilateral (100%) in all cases. Most (87%) of the patients developed SINS after a single surgical procedure, with a median onset period of 251 (IQR: 127-1095) days. None of these patients had any evidence of systemic association. Ocular hypertension (n = 3, 20%), and cataract (n = 5, 33%) were the most common complications. When compared with a cohort of patients with idiopathic necrotizing scleritis, the index study did not find any statistically significant difference between SINS and idiopathic scleritis. Conclusion: SINS is idiopathic necrotizing scleritis rather than an independent entity of scleritis. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Necrosis avascular de la cabeza femoral tras COVID-19: presentación clínica y manejo. Resultados clínico-funcionales de descompresión y suplementación con aspirado de células de médula ósea.
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D., Godoy-Monzón, A., Cid-Casteulani, S., Svarzchtein, S., Sasaki, and J. M., Pascual-Espinosa
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Introduction: the pandemic of COVID-19 has led to clinical complications such as avascular necrosis of the femoral head (AVNFH) associated with the use of corticosteroids. The aim of the study is to report the functional and radiographic results of 13 patients with post-COVID-19 ANFH after decompression using Forage and bone marrow aspirate concentrate (BMAC). Material and methods: single-center, prospective, uncontrolled clinical study. From April 2020 to September 2021, 13 patients (21 hips) with post-COVID-19 ANFH were treated. All received corticosteroids during infection (average daily dose: 480 mg). Clinical, radiographic and magnetic resonance imaging evaluations were performed; the Ficat classification was applied for the classification of AVNFH. The surgical technique used was decompression with Forage and ACMO. Results: the mean age was 47 years, with a follow-up of 30.4 months. Symptoms appeared with a mean of 4.2 months after COVID-19 infection. Harris score improved from 41.2 ± 5.2 to 86.6 ± 3.4. Radiographic evaluation showed that 14.3% of the sample experienced femoral head collapse and underwent total hip arthroplasty. Conclusions: post-COVID-19 ANFH is a clinical entity with rapid progression and different degrees of severity. Decompression with Forage and ACMO seems a promising initial treatment, however, the variable response and the probability of collapse emphasize the importance of longterm follow-up and identification of patients who may require additional interventions. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Canadian Expert Consensus on the Use of Halobetasol Propionate/Tazarotene Lotion for Plaque Psoriasis.
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Guenther, Lyn, Turchin, Irina, Vender, Ron, Albrecht, Lorne E., Maari, Catherine, Yanofsky, Howard, and Prajapati, Vimal H.
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OINTMENTS , *PSORIASIS , *PROPIONATES , *PATIENT compliance - Abstract
Introduction: An expert panel of Canadian dermatologists was assembled to develop consensus statements regarding the current landscape of topical therapies for plaque psoriasis and the place in therapy of the recently approved fixed-dose combination halobetasol propionate (HP)/tazarotene (TAZ) lotion (HP/TAZ) in the treatment algorithm for plaque psoriasis. Method: A modified nominal group technique, which combined both independent and group input from the expert panel, was used to develop the consensus statements. The expert panel completed surveys to elicit their independent views on the current landscape of topical therapies for plaque psoriasis in Canada. The first expert panel session was held to discuss the existing body of literature and develop draft consensus statements about topical therapies and the place in therapy of HP/TAZ. Independent feedback on the draft consensus statements was solicited from expert panel members prior to another expert panel session where the amended consensus statements were further discussed, edited and, finally, voted on. Results: The expert panel reached consensus on 20 statements. Conclusion: Expert panel members agreed, based on the existing body of literature, that there is a place in therapy for HP/TAZ to address several current unmet treatment needs of patients with plaque psoriasis. Studies have shown that HP/TAZ is an effective and safe first-line treatment for moderate-to-severe plaque psoriasis. Due to its cosmetically pleasing vehicle and once-daily administration, HP/TAZ may improve patient acceptance and treatment adherence. [ABSTRACT FROM AUTHOR]
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- 2024
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27. Subkonjonktival, Subtenon ve İntravitreal Enjeksiyonlarda İşlem Sırasında, Erken Dönemde ve Geç Dönemde Karşılaşılan Komplikasyonlar.
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YILMAZ, Mevlüt
- Abstract
Copyright of Current Retina Journal / Güncel Retina Dergisi is the property of Anadolu Kitabevi Basim Yayim Medikal Turizm Kirtasiye 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.)
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- 2024
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28. Short-Term Outcomes of Intraarticular Corticosteroid Injection into the Lumbar Facet Joint According to the Findings of Single-Photon Emission Computed Tomography Imaging.
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Chang, Min Cheol and Yang, Seoyon
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SINGLE-photon emission computed tomography ,ZYGAPOPHYSEAL joint ,LUMBAR pain ,TREATMENT effectiveness ,INTRA-articular injections - Abstract
Bone single-photon emission computed tomography (SPECT) preferentially localizes areas exhibiting greater bone remodeling and enhanced perfusion, which helps identify areas of pain and inflammation in the lumbar facet joints (LFJs). Herein, we investigated the treatment outcome of intraarticular (IA) corticosteroid injection in patients with LFJ-origin lower back pain (LBP) depending on the presence of increased LFJ uptake on bone SPECT. Methods: We retrospectively recruited 38 patients with LFJ-origin LBP. Of the 38 patients, 22 patients showed increased uptake on bone SPECT (SPECT+ group), and 16 patients did not show increased uptake on bone SPECT (SPECT- group). A numeric rating scale (NRS) was used to assess pain reduction 1 month after treatment with a corticosteroid injection. Treatment was considered successful when the posttreatment NRS score was ≥ 50% lower than the pretreatment NRS score. Results: The NRS scores of the SPECT+ group at the 1-month follow-up were significantly lower than those of the SPECT- group. Additionally, the degree of change in the NRS scores was larger in the SPECT+ group than that in the SPECT- group. In addition, 18 of the 22 patients (81.8%) in the SPECT+ group underwent successful treatment. Eight of the 16 patients (50%) in the SPECT- group underwent successful treatment. The ratio of successful treatment was significantly higher in the SPECT+ group than in the SPECT- group. Discussion: Bone SPECT could help predict the therapeutic outcome after IA LFJ corticosteroid injection and determine the treatment plan for patients with LFJ-origin LBP. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Corticosteroid use in neonatal hypotension: A survey of Canadian neonatologists
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Ashraf Kharrat, Yenge Diambomba, and Amish Jain
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Neonate ,Hypotension ,Corticosteroid ,Survey ,Preterm ,Vasopressor ,Pediatrics ,RJ1-570 - Abstract
Objective: To assess prescribing practices and perspectives regarding the use of corticosteroids in the management of neonatal hypotension. Methods: Cross-sectional questionnaire-based electronic survey of neonatologists (n = 206) practicing at tertiary neonatal intensive care units across 30 academic centres in Canada. Results: The overall response rate was 33% (72/206), with a completion rate was 94%. Most (48/72, 64%) worked in a unit that covered both inborn and outborn infants, and 53% (37/70) worked in units with >100 very low birth weight infants admitted annually. Among the 72 respondents, 39% use a loading dose, of whom most (57%) use 2 mg/kg. Dosing ranges were variable, most using either 0.5 mg/kg or 1 mg/kg, q6h. Among the 56% (40/72) of neonatologists who reported measuring cortisol before initiation of hydrocortisone, cut-offs for initiation of hydrocortisone varied from
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- 2024
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30. Efgartigimod combined with steroids as a fast-acting therapy for myasthenic crisis: a case report
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Hiroya Ohara, Naoya Kikutsuji, Naohiko Iguchi, and Masako Kinoshita
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Efgartigimod ,Neonatal Fc receptor inhibitor ,FcRn inhibitor ,Myasthenia gravis ,Myasthenic crisis ,Corticosteroid ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Background Generalized myasthenia gravis (gMG) can be managed with acetylcholinesterase inhibitors (AChEis; e.g., pyridostigmine), corticosteroids, other immunosuppressive drugs (e.g., tacrolimus), and their combinations. Intravenous immunoglobulin (IVIg) or plasmapheresis (PLEX) may be administered if symptoms persist. PLEX and IVIg are also mainstays of treatment for myasthenic crisis. Recently, efgartigimod was approved in Japan for treating adults with gMG (irrespective of the antibody status) who do not have a sufficient response to corticosteroids and nonsteroidal immunosuppressive therapies. Efgartigimod is generally safe and well tolerated. However, since phase III trials of efgartigimod excluded those with myasthenic crisis, the efficacy of efgartigimod in treating myasthenic crisis is still unclear. Moreover, there are no reports that efgartigimod therapy can reduce the dose of corticosteroids needed to achieve a minimal manifestation status. Case presentation We report the case of a 70-yeat-old woman with gMG who developed a myasthenic crisis. After she was diagnosed with gMG, the patient had been treated with oral corticosteroids and tacrolimus for 1 year. However, she refused to continue taking the medication, and two weeks later, she developed ptosis, dysphagia and dyspnea. The patient was intubated and treated with efgartigimod in combination with steroid therapy, and she recovered without PLEX or IVIg. Afterward, when she experienced worsening of fatigue and increased levels of anti-acetylcholine receptor antibodies, efgartigimod therapy was effective. The patient achieved minimal manifestation status even after the reduction of corticosteroids and showed improvements in the Myasthenia Gravis Activities of Daily Living scales after 4 cycles of efgartigimod infusion. Conclusions Our case suggests that efgartigimod can be an alternative drug for achieving minimal manifestation status in patients with myasthenic crisis. Considering its strong efficacy and safety, efgartigimod could be expanded to use as bridging therapy in the acute and chronic phases of gMG.
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- 2024
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31. A diagnostic dilemma: cytomegalovirus colitis as an uncommon comorbidity in inflammatory bowel disease: a case report
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Marouf Alhalabi and Soumar Mueen Alziadan
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Ulcerative colitis ,Inflammatory bowel disease ,Cytomegalovirus ,Anti-TNFα ,Azathioprene ,Corticosteroid ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background The role of cytomegalovirus infection as an opportunistic pathogen in exacerbating ulcerative colitis and its response to treatment remain a topic of ongoing debate. Clinicians encounter numerous challenges, including the criteria for differentiating between an acute ulcerative colitis flare and true cytomegalovirus colitis, the diagnostic tests for identifying cytomegalovirus colitis, and determining the appropriate timing for initiating antiviral therapy. Case presentation A 28-year-old Syrian female with a seven-year history of pancolitis presented with worsening bloody diarrhea, abdominal pain, and tenesmus despite ongoing treatment with azathioprine, mesalazine, and prednisolone. She experienced a new flare of acute severe ulcerative colitis despite recently completing two induction doses of infliximab (5 mg/kg) initiated four weeks prior for moderate-to-severe ulcerative colitis. She had no prior surgical history. Her symptoms included watery, bloody diarrhea occurring nine to ten times per day, abdominal pain, and tenesmus. Initial laboratory tests indicated anemia, leukocytosis, elevated C-reactive protein (CRP) and fecal calprotectin levels, and positive CMV IgG. Stool cultures, Clostridium difficile toxin, testing for Escherichia coli and Cryptosporidium, and microscopy for ova and parasites were all negative. Sigmoidoscopy revealed numerous prominent erythematous area with spontaneous bleeding. Biopsies demonstrated CMV inclusions confirmed by immunohistochemistry, although prior biopsies were negative. We tapered prednisolone and azathioprine and initiated ganciclovir at 5 mg/kg for ten days, followed by valganciclovir at 450 mg twice daily for three weeks. After one month, she showed marked improvement, with CRP and fecal calprotectin levels returning to normal. She scored one point on the partial Mayo score. The third induction dose of infliximab was administered on schedule, and azathioprine was resumed. Conclusion Concurrent cytomegalovirus infection in patients with inflammatory bowel disease presents a significant clinical challenge due to its associated morbidity and mortality. Diagnosing and managing this condition is particularly difficult, especially regarding the initiation or continuation of immunosuppressive therapies.
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- 2024
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32. Randomized feasibility study of an autologous protein solution versus corticosteroids injection for treating subacromial pain in the primary care setting – the SPiRIT trial
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Alex Woods, Anthony Howard, Nicholas Peckham, Ines Rombach, Asma Saleh, Juul Achten, Duncan Appelbe, Praveen Thamattore, and Stephen E. Gwilym
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subacromial pain ,injection ,corticosteroid ,aps ,feasibility trial ,corticosteroids injection ,randomized controlled trial ,shoulder pain ,patient-reported outcome measures (proms) ,clinicians ,clinical outcomes ,subacromial impingement syndrome ,clinical diagnosis ,patient-reported outcome measurement information system ,blood ,Orthopedic surgery ,RD701-811 - Abstract
Aims: The primary aim of this study was to assess the feasibility of recruiting and retaining patients to a patient-blinded randomized controlled trial comparing corticosteroid injection (CSI) to autologous protein solution (APS) injection for the treatment of subacromial shoulder pain in a community care setting. The study focused on recruitment rates and retention of participants throughout, and collected data on the interventions’ safety and efficacy. Methods: Participants were recruited from two community musculoskeletal treatment centres in the UK. Patients were eligible if aged 18 years or older, and had a clinical diagnosis of subacromial impingement syndrome which the treating clinician thought was suitable for treatment with a subacromial injection. Consenting patients were randomly allocated 1:1 to a patient-blinded subacromial injection of CSI (standard care) or APS. The primary outcome measures of this study relate to rates of recruitment, retention, and compliance with intervention and follow-up to determine feasibility. Secondary outcome measures relate to the safety and efficacy of the interventions. Results: A total of 53 patients were deemed eligible, and 50 patients (94%) recruited between April 2022 and October 2022. Overall, 49 patients (98%) complied with treatment. Outcome data were collected in 100% of participants at three months and 94% at six months. There were no significant adverse events. Both groups demonstrated improvement in patient-reported outcome measures over the six-month period. Conclusion: Our study shows that it is feasible to recruit to a patient-blinded randomized controlled trial comparing APS and CSI for subacromial pain in terms of clinical outcomes and health-resource use in the UK. Safety and efficacy data are presented. Cite this article: Bone Jt Open 2024;5(7):534–542.
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- 2024
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33. Nevus Unius Lateris (NUL) in a Theree-Year-Old Child Treated by Tretinoin 0.025%, Desoxymethasone 0.25%, and Urea 20% Cream
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Aurelia Stephanie, NLP Ratih Vibriyanti Karna, IGAA Dwi Karmila, Hermina Laksmi, and Aurelia Stella
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blaschko line ,corticosteroid ,epidermal nevus ,tretinoin ,urea ,Dermatology ,RL1-803 - Abstract
Background: Linear verrucous epidermal nevus is the most frequent variant of the epidermal nevus classification. Linear verrucous epidermal nevus is characterized by the proliferation of epithelium arranged in a configuration that follows Blaschko's line. Nevus unius lateris (NUL) is a variant of the verrucous epidermal nevus, which has a unilateral distribution of lesions. Lesions are usually found at birth or in the first year of life as brown to grey verrucous papules or papillomatous plaques. The management of NUL is challenging as the results are varied and there is a high risk of recurrence. Purpose: to report a case of NUL and its management, especially in children. Case: A 3-year-old girl presented with brownish spots and multiple small lumps on the left buttock that have extended to the left leg since she was 9-days-old. On dermatologic examination, there were numerous hyperpigmented verrucous papules and plaques along the Blaschko line over the affected area. In this case, the diagnosis of NUL, is based on clinical symptoms and dermoscopy examination showed multiple large brown oval or round structures with hyperpigmented brown border. The patient was treated with combination topical therapy of tretinoin 0.025%, corticosteroid desoxymethasone 0.25%, and urea 20% cream, and the lesion improved within four weeks. Discussion: Epidermal nevus is often cosmetically disturbing. The treatment is still challenging and various, including surgical and non-surgical, but none is ideal and could potentially recur over months or years. dst.
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34. Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial
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Albert Cakar and Ozgur Dogus Gozlu
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Lateral epicondylitis ,Tennis elbow ,Autologous blood ,Corticosteroid ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Background Because lateral epicondylitis is a common musculoskeletal disorder that affects the forearm's extensor tendons, an effective therapeutic approach should reverse the degeneration and promote regeneration. This study aimed to compare the efficacies of autologous blood (AB) injection, corticosteroid (CS) injection, and a combined injection of both in treating lateral epicondylitis (LE), hypothesizing that the combined approach might offer immediate symptom resolution and a lower recurrence. Materials and methods A total of 120 patients diagnosed with lateral epicondylitis were systematically distributed among three distinct therapeutic injection groups. Those in the AB group were administered 1 ml of autologous venous blood mixed with 2 ml of 2% prilocaine HCl. Participants in the CS category were given 1 ml of 40 mg methylprednisolone acetate mixed with 2 ml of 2% prilocaine HCl. Meanwhile, patients in the combined group received a mixture containing 1 ml each of autologous venous blood and 40 mg methylprednisolone acetate along with 1 ml of 2% prilocaine HCl. Prior to receiving their respective injections, a comprehensive assessment of all participants was carried out. Follow-up assessments were subsequently conducted on days 15, 30, and 90 utilizing metrics of the patient-rated tennis elbow evaluation (PRTEE) and measurements of hand grip strength (HGS). Results One patient dropped out from the combined group, and 119 patients completed the trial. No complications were recorded during the course of follow-up. By day 15, all groups had demonstrated significant PRTEE improvement, with CS showing the most pronounced reduction (p = 0.001). However, the benefits of CS had deteriorated by day 30 and had deteriorated further by day 90. The AB and AB + CS groups demonstrated sustained improvement, with AB + CS revealing the most effective treatment, achieving a clinically significant improvement in 97.4% of the patients. The improved HGS parallelled the functional enhancements, as it was more substantial in the AB and AB + CS groups (p = 0.001), corroborating the sustained benefits of these treatments. Conclusions The study concluded that while AB and CS individually offer distinct benefits, a combined AB + CS approach optimizes therapeutic outcomes, providing swift and sustained functional improvement with a lower recurrence rate. These findings have substantial clinical implications, suggesting a balanced, multimodal treatment strategy for enhanced patient recovery in LE. Level of evidence: Randomized clinical trial, level 1 evidence. Trial registration: NCT06236178.
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- 2024
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35. CA Breast with Spinal Cord Compression
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Goswami, Jyotsna, Pal, Angshuman Rudra, Mitra, Suparna, Gupta, Nishkarsh, editor, Dattatri, Rohini, editor, Kumar, Vinod, editor, and Bhatnagar, Sushma, editor
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- 2024
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36. Upper Extremity Joint Injections
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Sio, Lady Christine Ong, Elmati, Praveen, Razeeq, Dominqiue, Bautista, Alexander, Singh, Vijay, editor, Falco, Frank J.E., editor, Kaye, Alan D., editor, Soin, Amol, editor, Hirsch, Joshua A., editor, and Manchikanti, Laxmaiah, Editor-in-Chief
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- 2024
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37. Injections of Anatomical Regions and Diseases: Elbow
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Alentorn-Geli, Eduard, Haua, Jorge Ramírez, Kocaoglu, Baris, editor, Laver, Lior, editor, Girolamo, Laura de, editor, and Compagnoni, Riccardo, editor
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- 2024
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38. Corticosteroids and Local Anesthetics
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Ollivier, Matthieu, Mabrouk, Ahmed, Kocaoglu, Baris, editor, Laver, Lior, editor, Girolamo, Laura de, editor, and Compagnoni, Riccardo, editor
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- 2024
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39. HPLC-UV Determination and Comparison of Extracted Corticosteroids Content with Two Methods
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Dacić, M., Uzunović, Alija, Alagić-Džambić, Larisa, Pilipović, Saša, Magjarević, Ratko, Series Editor, Ładyżyński, Piotr, Associate Editor, Ibrahim, Fatimah, Associate Editor, Lackovic, Igor, Associate Editor, Rock, Emilio Sacristan, Associate Editor, Badnjević, Almir, editor, and Gurbeta Pokvić, Lejla, editor
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- 2024
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40. Comparing Platelet Rich Plasma and Corticosteroid for Military & Civilian Patients With Glenohumeral Osteoarthritis (PRP)
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United States Naval Medical Center, San Diego, Brooke Army Medical Center, Uniformed Services University of the Health Sciences, and Kelly Kilcoyne, MD, Principal Investigator
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- 2023
41. Tunable polymeric micelles for taxane and corticosteroid co-delivery.
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Shalmani, Armin Azadkhah, Wang, Alec, Ahmed, Zaheer, Sheybanifard, Maryam, Mihyar, Rahaf, Buhl, Eva Miriam, Pohl, Michael, Hennink, Wim E., Kiessling, Fabian, Metselaar, Josbert M., Shi, Yang, Lammers, Twan, and Peña, Quim
- Abstract
Nanomedicine holds promise for potentiating drug combination therapies. Increasing (pre)clinical evidence is available exemplifying the value of co-formulating and co-delivering different drugs in modular nanocarriers. Taxanes like paclitaxel (PTX) are widely used anticancer agents, and commonly combined with corticosteroids like dexamethasone (DEX), which besides for suppressing inflammation and infusion reactions, are increasingly explored for modulating the tumor microenvironment towards enhanced nano-chemotherapy delivery and efficacy. We here set out to develop a size- and release rate-tunable polymeric micelle platform for co-delivery of taxanes and corticosteroids. We synthesized amphiphilic mPEG-b-p(HPMAm-Bz) block copolymers of various molecular weights and used them to prepare PTX and DEX single- and double-loaded micelles of different sizes. Both drugs could be efficiently co-encapsulated, and systematic comparison between single- and co-loaded formulations demonstrated comparable physicochemical properties, encapsulation efficiencies, and release profiles. Larger micelles showed slower drug release, and DEX release was always faster than PTX. The versatility of the platform was exemplified by co-encapsulating two additional taxane-corticosteroid combinations, demonstrating that drug hydrophobicity and molecular weight are key properties that strongly contribute to drug retention in micelles. Altogether, our work shows that mPEG-b-p(HPMAm-Bz) polymeric micelles serve as a tunable and versatile nanoparticle platform for controlled co-delivery of taxanes and corticosteroids, thereby paving the way for using these micelles as a modular carrier for multidrug nanomedicine. [ABSTRACT FROM AUTHOR]
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- 2024
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42. Canadian Expert Consensus on the Use of Halobetasol Propionate/Tazarotene Lotion for Plaque Psoriasis
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Lyn Guenther, Irina Turchin, Ron Vender, Lorne E. Albrecht, Catherine Maari, Howard Yanofsky, and Vimal H. Prajapati
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Consensus ,Corticosteroid ,Halobetasol ,Plaque psoriasis ,Retinoid ,Tazarotene ,Dermatology ,RL1-803 - Abstract
Abstract Introduction An expert panel of Canadian dermatologists was assembled to develop consensus statements regarding the current landscape of topical therapies for plaque psoriasis and the place in therapy of the recently approved fixed-dose combination halobetasol propionate (HP)/tazarotene (TAZ) lotion (HP/TAZ) in the treatment algorithm for plaque psoriasis. Method A modified nominal group technique, which combined both independent and group input from the expert panel, was used to develop the consensus statements. The expert panel completed surveys to elicit their independent views on the current landscape of topical therapies for plaque psoriasis in Canada. The first expert panel session was held to discuss the existing body of literature and develop draft consensus statements about topical therapies and the place in therapy of HP/TAZ. Independent feedback on the draft consensus statements was solicited from expert panel members prior to another expert panel session where the amended consensus statements were further discussed, edited and, finally, voted on. Results The expert panel reached consensus on 20 statements. Conclusion Expert panel members agreed, based on the existing body of literature, that there is a place in therapy for HP/TAZ to address several current unmet treatment needs of patients with plaque psoriasis. Studies have shown that HP/TAZ is an effective and safe first-line treatment for moderate-to-severe plaque psoriasis. Due to its cosmetically pleasing vehicle and once-daily administration, HP/TAZ may improve patient acceptance and treatment adherence.
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- 2024
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43. Survival benefit of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a nationwide cohort study
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Jiyoung Shin, Sojung Park, Ji-Young Lee, and Jin Hwa Lee
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Bronchodilator ,Chronic obstructive pulmonary disease ,Corticosteroid ,Mortality ,Survival ,Medicine ,Science - Abstract
Abstract The role of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) is debated. We investigated whether the administration of ICS could lower the mortality risk in patients with COPD. We utilized the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2019. We included patients who had claim codes for COPD and inhalation respiratory medicine at least twice a year. A time-dependent Cox regression model was employed to estimate the association between ICS usage and survival. The cumulative dose of ICS was classified into three groups, and the mortality risk was compared among these groups. Of 16,463 included patients, there were 4395 (26.7%) deaths during the mean follow-up period of 5.0 years. The time-dependent Cox regression model demonstrated that ICS users had a significantly lower mortality risk compared to non-users (adjusted hazard ratio, 0.89; 95% CI, 0.83–0.94; p
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- 2024
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44. A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color
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Bronte J, Zhou C, Vempati A, Tam C, Khong J, and Hazany S
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corticosteroid ,bleomycin ,5-fu ,laser ,fst iv-vi ,skin of color ,Dermatology ,RL1-803 - Abstract
Joshua Bronte,1 Crystal Zhou,1 Abhinav Vempati,1 Curtis Tam,2 Jeffrey Khong,3 Sanam Hazany,1 Salar Hazany1 1Department of Research, Scar Healing Institute, Los Angeles, CA, USA; 2Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 3Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USACorrespondence: Joshua Bronte, Scar Healing Institute, Los Angeles, CA, USA, Tel +1 424 225 2453, Email info@shi.orgAbstract: Hypertrophic and keloid scars are fibroproliferative growths resulting from aberrant wound healing. Individuals with Fitzpatrick skin types (FSTs) IV–VI are particularly predisposed to hypertrophic and keloid scarring, yet specific guidelines for these populations are still lacking within the literature. Therefore, this comprehensive review provides a list of various treatments and considerations for hypertrophic and keloid scarring in patients with skin of color. We constructed a comprehensive PubMed search term and performed quadruple-blinded screening on all resulting studies to achieve this objective. Our findings demonstrate 1) the lack of efficacious treatments for raised scars within this population and 2) the need to empirically investigate individualized and multimodal therapeutic options for those with skin of color.Keywords: corticosteroid, bleomycin, 5-FU, laser, FST IV-VI, skin of color
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- 2024
45. Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching
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Wang-Da Liu, Jann-Tay Wang, Ming-Chieh Shih, Kai-Hsiang Chen, Szu-Ting Huang, Chun-Fu Huang, Tien-Hao Chang, Ming-Jui Tsai, Po-Hsien Kuo, Yi-Chen Yeh, Wan-Chen Tsai, Mei-Yan Pan, Guei-Chi Li, Yi-Jie Chen, Kuan-Yin Lin, Yu-Shan Huang, Aristine Cheng, Pao- Yu Chen, Sung-Ching Pan, Hsin-Yun Sun, Shih-Chi Ku, Sui-Yuan Chang, Wang-Huei Sheng, Chi-Tai Fang, Chien-Ching Hung, Yee-Chun Chen, Yi-Lwun Ho, Ming-Shiang Wu, and Shan-Chwen Chang
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SARS-CoV-2 ,Coronavirus ,Corticosteroid ,Timing ,Viral shedding ,Microbiology ,QR1-502 - Abstract
Background: The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain. Methods: We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians’ decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days. Results: A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97–1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94–1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12–1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02–1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01–1.98). Conclusion: An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.
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- 2024
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46. Survival benefit of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a nationwide cohort study.
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Shin, Jiyoung, Park, Sojung, Lee, Ji-Young, and Lee, Jin Hwa
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CHRONIC obstructive pulmonary disease , *COHORT analysis , *ADRENERGIC beta agonists , *NATIONAL health insurance , *CORONARY disease , *CORTICOSTEROIDS , *AGE - Abstract
The role of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) is debated. We investigated whether the administration of ICS could lower the mortality risk in patients with COPD. We utilized the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2019. We included patients who had claim codes for COPD and inhalation respiratory medicine at least twice a year. A time-dependent Cox regression model was employed to estimate the association between ICS usage and survival. The cumulative dose of ICS was classified into three groups, and the mortality risk was compared among these groups. Of 16,463 included patients, there were 4395 (26.7%) deaths during the mean follow-up period of 5.0 years. The time-dependent Cox regression model demonstrated that ICS users had a significantly lower mortality risk compared to non-users (adjusted hazard ratio, 0.89; 95% CI, 0.83–0.94; p < 0.001), particularly among individuals aged ≥ 55 years, women, never smokers, and those with history of asthma or coronary heart disease. Higher cumulative dose groups were associated with a lower mortality risk compared to the lowest cumulative dose group. In conclusion, the administration of ICS seemed to be associated with a lower mortality risk in patients with COPD. [ABSTRACT FROM AUTHOR]
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- 2024
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47. Early vestibular rehabilitation training of peripheral acute vestibular syndrome--a systematic review and meta-analysis.
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Agger-Nielsen, Helle Elisabeth, Grøndberg, Thomas Stig, Berg-Beckhoff, Gabriele, and Ovesen, Therese
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REHABILITATION ,SYNDROMES ,CINAHL database ,EQUILIBRIUM testing ,DISABILITIES ,VESTIBULAR apparatus diseases - Abstract
Objective: This study aimed to investigate the impact of early vestibular rehabilitation training combined with corticosteroids initiated within 2 weeks, compared with corticosteroid treatment, after the peripheral acute vestibular syndrome (pAVS) onset. Data sources: PubMed, CINAHL, EMBASE, and SCOPUS. From inception to January 24, 2024. The International Prospective Register of Systematic Reviews approved this study (CRD42023422308). Results: Five studies involving 235 patients were included in this systematic review and meta-analysis. The subjective outcome measure Dizziness Handicap Inventory (DHI) was pooled for a meta-analysis and was statistically significantly in favor of early vestibular rehabilitation training (early VRT) plus corticosteroids compared with corticosteroids alone: at one-month follow-up (p = 0.00) and 12 months follow-up (p = 0.01). DHI was a critical outcome for measuring the differences in effect of early VRT. The objective outcome measures of caloric lateralization, cervical vestibular-evoked myogenic potentials, and posturography were gathered for a narrative synthesis. Conclusion: This meta-analysis showed that early VRT in combination with corticosteroids was more effective for treating pAVS than corticosteroid treatment alone. No adverse effects were reported for early VRT. [ABSTRACT FROM AUTHOR]
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- 2024
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48. The use of corticosteroid injection in the treatment of chronic shoulder pain.
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Yousaf, Haroon, Khan, Abdus Samad, Zia, Aiman, Khan, Zahir, Ahmad, Maria, and Khan, Shafqat Ullah
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SHOULDER pain , *CHRONIC pain , *VISUAL analog scale , *PEOPLE with diabetes , *EXPERIMENTAL design , *INTRA-articular injections - Abstract
Objective: To determine the short term outcome of intra-articular corticosteroid injection the treatment of chronic shoulder pain. Study Design: Descriptive Study. Setting: Mardan Medical Complex, MTI. Period: 12th August 2023 to 15th December 2023. Methods: All patients of chronic shoulder pain fulfilling inclusion criteria were administered intraarticular corticosteroid injection. Pre intervention demographic and visual analogue scale (VAS) score and DASH (Disabilities of the Arm, Shoulder and Hand) scores were noted. All patients underwent through intraarticular corticosteroid injection procedure. VAS score and DASH score was calculated again on four week follow up visit. Both scores were compared by paired t test using SPSS version 23. The pre and post injection VAS and DASH scores were compared and p value calculated using paired t test. P value <0.05 was considered significant. Results: Total of 50 patients were included in the study. The mean age of patients was 50.08+6.43yrs and mean duration of symptoms was 5.7+1.6 months. 64% (n=32) of the patients were male, while 36% (n=18) were female about a total of 64% (n=32) of the patients were diabetic. Majority (56%, n=28) of patients exhibited left-side involvement, while 44% (22) presented with right-side involvement. The mean pre intervention VAS score was 79.86 + 6.32 and DASH score was 59.98+8.44. The mean post intervention VAS score was 15.7+4.1and DASH score was 49.78+6.33. After applying paired t-test on pre and post intervention scores, both VAS and DASH score was statistically significant with p value of <0.001. Conclusion: Intra-articular corticosteroid injection significantly relieved shoulder pain and improved functional outcome in short term follow up in patients with chronic shoulder pain. [ABSTRACT FROM AUTHOR]
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- 2024
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49. Impact of a discharge prescription for dexamethasone on outcomes of children treated in the emergency department for acute asthma exacerbations.
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Tanverdi, Melisa S., Navanandan, Nidhya, Brackman, Savannah, Huber, Lorel, Leonard, Jan, and Mistry, Rakesh D.
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HOSPITAL emergency services , *EMERGENCY room visits , *DISEASE exacerbation , *DEXAMETHASONE , *MEDICAL prescriptions , *WHEEZE - Abstract
To evaluate dexamethasone prescribing practices, patient adherence, and outcomes by dosing regimen in children with acute asthma discharged from the emergency department (ED). Prospective study of children 2–18 years treated with dexamethasone for acute asthma prior to discharge from an urban, tertiary care ED between 2018 and 2022. Demographics, clinical characteristics, ED treatment, and discharge prescriptions were collected via chart review. The exposure was discharge prescription (additional dose) versus no discharge prescription for dexamethasone. The primary outcome was treatment failure, defined as return ED visit, unplanned primary care visit, and/or ongoing bronchodilator use. Secondary outcomes included medication adherence, symptom persistence, quality-of-life, and school/work absenteeism. Outcomes were assessed by telephone 7–10 days after discharge. 564 subjects were enrolled; 338 caregivers (60%) completed follow-up. Children were a median age 7 years, 30% Black or African American, 49% Hispanic, and 79% had public insurance. A discharge prescription for dexamethasone was written for 482 (86%) children and was significantly associated with exacerbation severity, number of combined albuterol/ipratropium treatments, and longer length of stay. There was no difference in treatment failure between the discharge prescription and no discharge prescription groups (RR 0.87; 0.67, 1.12), including after adjusting for potential confounders; there was no difference between groups in secondary outcomes. Prescription for an additional dexamethasone dose was not associated with reduced treatment failure or improved outcomes for children with acute asthma discharged from the ED. Single, ED-dose of dexamethasone prior to discharge may be sufficient for children with mild to moderate asthma exacerbations. [ABSTRACT FROM AUTHOR]
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- 2024
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50. Drug Use Patterns in Myasthenia Gravis: A Real-World Population-Based Cohort Study in Italy.
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Finocchietti, Marco, Crescioli, Giada, Paoletti, Olga, Brunori, Paola, Sciancalepore, Francesco, Tuccori, Marco, Addis, Antonio, Vannacci, Alfredo, Lombardi, Niccolò, and Kirchmayer, Ursula
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DRUG utilization , *MYASTHENIA gravis , *COHORT analysis , *NEUROMUSCULAR diseases , *DRUG efficacy , *VITAMIN D - Abstract
Background: In the context of a comparative study of efficacy and safety of drugs used in rare neuromuscular and neurodegenerative diseases (CAESAR—call AIFA_FV_2012-13-14), we assessed the use patterns of drugs indicated for myasthenia gravis (MG). Methods: A retrospective cohort study was conducted based on administrative healthcare data. For a cohort of MG patients, prevalent and incident use of pyridostigmine (Py) and other indicated drugs in the first year after case identification was evaluated. Prevalent combined use of major therapies (azathioprine (Az), prednisone (Pr), vitamin D (Vd)) stratified by Py use was assessed, and a comparison between therapies at the time of MG identification and during the first year of follow-up was performed. Results: We included 2369 MG patients between 2013 and 2019. Among them, prevalent and incident Py users were 38.4% and 22.0%, respectively. In the first year of follow-up, the use of Pr was observed in 74.5% of Py prevalent users and in 82.0% of Py incident users, respectively; the use of Az was observed in 24.9% and 23.0%, respectively; and the use of Vd was observed in 53.3% and 48.2%, respectively. Among 910 Py prevalent users, 13.1% also used Az, Pr, and Vd, while 15.3% used none of these. Among 938 non-Py users, 2.7% used Az, Pr, and Vd, while 53.8% used none of these. During the first year, an increase in combined therapies was evident in incident Py users. Conclusions: Our results suggest that, for some MG patients, there may be a need for treatments that combine a rapid onset of benefit with long-term and consistent disease control. These issues may be addressed by the new treatments currently being developed. To date, more studies are needed to address the heterogeneity, quality, and generalizability of the existing data and to evaluate patterns of use, efficacy, and safety of new or emerging therapies for MG. [ABSTRACT FROM AUTHOR]
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- 2024
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