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1.
BMC Pulm Med ; 21(1): 73, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33648488

RESUMEN

BACKGROUND: Scarring central airway stenosis (SCAS) is a potentially life-threatening condition with debilitating symptoms. Interventional bronchoscopy is increasingly used to relieve symptoms in patients with SCAS, but recurrent stenosis is frequently observed. Little data exist on the long-term prognosis of interventional bronchoscopy for SCAS. We aimed to assess the prognostic factors of bronchoscopic interventions in patients with SCAS to optimize treatment. METHODS: This was a retrospective study that enrolled 119 consecutive patients with SCAS from January 2010 to April 2019 at our institution. Long-term clinical success was defined as airway stenosis < 50%, no limitation of physical activity, and a stable condition for > 12 months after the last interventional procedure. We compared patients' demographics, airway stenosis characteristics, and interventional procedures between the successful and unsuccessful groups, and identified significant predictors of long-term outcome with univariate and multivariate logistic regression. RESULTS: A total of 119 patients with 577 therapeutic bronchoscopies were included. Seventy-five (63%) patients were considered to have long-term clinical success. Older age, male gender, smoking, elevated C-reactive protein level, subglottic stenosis, stent or T-tube implantation, previous interventional treatment, and multiple procedures per year were potentially associated with unsuccessful long-term outcomes in the univariate analysis. Current smoker status (odds ratio [OR] 5.70, 95% confidence interval [CI] 1.35-24.17, P = 0.018), subglottic stenosis (OR 4.35, 95% CI 1.31-14.46, P = 0.017), and stent implantation (OR 4.96, 95% CI 1.33-18.48, P = 0.017) were associated with decreased odds of long-term success in the multivariate logistic regression analysis. Of note, there was no significant difference in odds of success between former smokers and nonsmokers. CONCLUSIONS: Current smoker status, subglottic stenosis, and stent implantation are independent factors associated with reduced long-term efficacy of interventional bronchoscopy for SCAS. Smoking cessation should be encouraged to improve the outcome of therapeutic bronchoscopy.


Asunto(s)
Enfermedades Bronquiales/cirugía , Broncoscopía/métodos , Cicatriz/cirugía , Laringoestenosis/cirugía , Stents , Estenosis Traqueal/cirugía , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapéutico , Enfermedades Bronquiales/patología , Enfermedades Bronquiales/fisiopatología , Cicatriz/fisiopatología , Constricción Patológica , Tos/fisiopatología , Criocirugia/métodos , Dilatación/métodos , Combinación de Medicamentos , Disnea/fisiopatología , Femenino , Volumen Espiratorio Forzado , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intralesiones , Laringoestenosis/fisiopatología , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Ápice del Flujo Espiratorio , Complicaciones Posoperatorias/epidemiología , Pronóstico , Recurrencia , Estudios Retrospectivos , Fumar , Estenosis Traqueal/fisiopatología , Capacidad Vital , Adulto Joven
2.
PLoS One ; 16(3): e0246314, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33739987

RESUMEN

During the last months of the coronavirus pandemic, with all those public restrictions and health interventions, the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears now to have been raised in some countries around the world. Iran was one of those first countries facing the second wave of coronavirus, due to the lack of appropriate public restrictions because of economic problems the country is facing. The clinical and demographic characteristics of severe cases and non-severe cases of Coronavirus Disease (COVID-19) in 192 patients in Tehran, Iran, between June 16 and July 11, 2020, were investigated. The patients were divided into severe cases (n = 82) and non-severe cases (n = 110). Demographic and clinical characteristics were compared between the two study clusters. The mean age was 54.6 ± 17.2 years, and the most common presenting symptom was persistent cough (81.8%) and fever (79.7%). The logistic regression model revealed that age, BMI, and affected family members were statistically associated with severity. Patients with complicated conditions of disorders faced more hospitalization days and medical care than the average statistical data. As the coronavirus spike in the case and death reports from June 2020, we observed the rise in the incidence of severe cases, where 42.7% (82/192) of cases have resulted in severe conditions. Our findings also suggested that the effect of IFB (Betamethasone) was more valid than the other alternative drugs such as LPV/r and IVIg.


Asunto(s)
/patología , Adulto , Anciano , Betametasona/uso terapéutico , Índice de Masa Corporal , /epidemiología , Tos/etiología , Femenino , Fiebre/etiología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Irán/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
5.
Pain Physician ; 23(4S): S295-S304, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32942789

RESUMEN

BACKGROUND: Knee osteoarthritis (KOA) is characterized by the clinical symptoms of chronic knee pain and knee dysfunction, leading to disability and influencing the quality of life in severe cases. Radiofrequency treatment is a new method to reduce KOA-related pain and partially improve knee joint dysfunction without adverse effect. OBJECTIVE: The present study aimed to assess the treatment efficacy of radiofrequency thermocoagulation on the genicular nerve (RFTGN) and intraarticular pulsed radiofrequency (IAPRF) for KOA. STUDY DESIGN: Retrospective comparative study design. SETTING: This study took place at Shengjing Hospital of China Medical University. METHOD: KOA patients were randomly assigned to the RFTGN, IAPRF, and intraarticular steroid injection (IAS) groups. All procedures were performed under the guidance of computed tomography (CT). The observation indicators of this study were the numeric rating scale (NRS), Oxford knee scale (OKS), and perceived global effect (GPE). The time points for the assessment were 1-week, 1-month, 3-months, and 6-months after the treatment. RESULTS: The postoperative NRS scores in the 3 groups decreased significantly at all the observation time points as compared to the pretreatment scores (P < 0.05). For the patients in the IAS group, the analgesic effect was in a rebound trend, which was the best at 1-week posttreatment, and was close to the preoperative level at 6-months posttreatment. The short-term (1 week or 1 month) analgesic effect of the RFTGN group was better than that of the IAPRF group, and was similar in the long-term (3 or 6 months). The long-term analgesic effect of RFTGN and IAPRF groups was better than that of IAS group. The results of the OKS score were similar to the NRS score. The RFTGN group showed markedly improved knee function in the long-term than the IAPRF and IAS groups. The short-term treatment satisfaction was similar in each group, and some differences were detected between the groups with respect to long-term treatment satisfaction. LIMITATION: This study was a single-center retrospective study with a relatively small sample cohort and short follow-up periodCONCLUSION: Both RFTGN and IAPRF could alleviate the knee joint pain and improve the knee joint dysfunction; however, the treatment efficacy of RFTGN was better than that of IAPRF.


Asunto(s)
Betametasona/uso terapéutico , Electrocoagulación/métodos , Osteoartritis de la Rodilla/terapia , Tratamiento de Radiofrecuencia Pulsada/métodos , Terapia por Radiofrecuencia/métodos , Corticoesteroides/uso terapéutico , Anciano , China , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento
6.
Lakartidningen ; 1172020 08 07.
Artículo en Sueco | MEDLINE | ID: mdl-32969483

RESUMEN

Phimosis in boys is a common condition. In the majority of cases it is physiological without symptoms. Symptomatic phimosis can often be treated successfully with local steroid cream - only a minority of patients need surgery.  This study concludes that diagnosis, information to patients and guardians, initiation and follow-up of local steroid treatment can successfully, and safely, be delegated to trained assistant nurses.


Asunto(s)
Betametasona , Fimosis , Administración Tópica , Betametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Masculino , Fimosis/diagnóstico , Fimosis/tratamiento farmacológico , Resultado del Tratamiento
9.
J Shoulder Elbow Surg ; 29(7): 1310-1315, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32553436

RESUMEN

BACKGROUND: We investigated the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR). METHODS: We evaluated 128 shoulders undergoing ARCR and used block randomization to divide patients into 2 groups in this double-blind trial: The cocktail group received 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 mg of epinephrine, 2 mg of betamethasone, and saline solution to a total of 42 mL, whereas the control group received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL. Postoperatively, one of the drug mixtures was injected into the glenohumeral joint, subacromial bursa, suprascapular nerve, and anterior, middle, and posterior parts of the deltoid muscle according to the treatment group. We recorded patients' visual analog scale scores preoperatively and at 4, 8, 16, 24, and 48 hours postoperatively; the number of patients using postoperative diclofenac suppositories and buprenorphine hydrochloride; the number of patients experiencing nausea; the number of patients with infection and delayed wound healing as adverse effects; the surgery time; the retear rate; and passive shoulder range of motion. RESULTS: The cocktail group constituted 64 shoulders (50.0%), with 39 men (60.9%) and 25 women (39.1%); the mean age was 64.2 ± 10.2 years. The control group constituted 64 shoulders (50.0%), with 41 men (64.1%) and 23 women (35.9%); the mean age was 65.2 ± 7.5 years. We found no significant difference in age or sex between the 2 groups. There was also no significant difference in rotator cuff tear size or surgery time between the 2 groups. The visual analog scale scores at 8, 16, and 24 hours postoperatively were significantly lower in the cocktail group. The number of patients using suppositories was also significantly lower in the cocktail group. The number of patients receiving buprenorphine injections tended to be lower in the cocktail group, but the difference was not significant. Nausea occurred in 6.3% of patients in the cocktail group and 15.6% in the control group, but the difference was not significant. No infection or delayed wound healing occurred in either group. There was no significant difference in the retear rate between the 2 groups. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group than in the control group. CONCLUSION: We compared cocktail therapy and ropivacaine after ARCR and found no difference in results except for VAS score at 8, 16, and 24 hours postoperatively and frequency of postoperative suppository use without an apparent risk of infection or a detrimental effect on tendon healing.


Asunto(s)
Anestésicos Locales/uso terapéutico , Artroscopía/efectos adversos , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Ropivacaína/uso terapéutico , Lesiones del Manguito de los Rotadores/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Betametasona/uso terapéutico , Buprenorfina/uso terapéutico , Diclofenaco/uso terapéutico , Método Doble Ciego , Quimioterapia Combinada , Epinefrina/uso terapéutico , Femenino , Humanos , Inyecciones Intraarticulares , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Náusea/etiología , Bloqueo Nervioso , Tempo Operativo , Rango del Movimiento Articular , Recurrencia , Ropivacaína/administración & dosificación , Articulación del Hombro , Infección de la Herida Quirúrgica/etiología , Vasoconstrictores/uso terapéutico , Cicatrización de Heridas
10.
Pain Physician ; 23(3): 253-262, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32517391

RESUMEN

BACKGROUND: Meralgia paresthetica (MP) is an entrapment mononeuropathy of the lateral femoral cutaneous nerve (LFCN), in which conservative treatment options are not always sufficient. OBJECTIVES: The aim of this study was to evaluate the efficacy of ultrasound (US)-guided LFCN injection in the management of MP by comparing with transcutaneous electrical nerve stimulation (TENS) therapy and sham TENS therapy. STUDY DESIGN: A prospective, randomized, sham-controlled study. SETTING: Health Sciences University Training and Research Hospital in Turkey. METHODS: Patients diagnosed with LFCN compression with clinical and electrophysiological findings were included in this study. Patients were randomly assigned to 3 groups: (1) US-guided injection group, (2) TENS group, and (3) sham TENS group. The blockage of the LFCN was performed for therapeutic MP management in group 1. Ten sessions of conventional TENS were administered to each patient 5 days per week for 2 weeks, for 20 minutes per daily session in group 2, and sham TENS was applied to group 3 with the same protocol. Visual Analog Scale (VAS), painDETECT questionnaire, Semmes-Weinstein monofilament test (SWMt), Pittsburgh Sleep Quality Index (PSQI), and health-related quality of life (36-Item Short Form Health Survey [SF-36]) at onset (T1), 15 days after treatment (T2), and 1 month after treatment (T3) were used for evaluation. Patients and the investigator who evaluated the results were blinded to the treatment protocol during the study period. RESULTS: A total of 54 of the 62 patients (group 1 n = 17, group 2 n = 16, group 3 n = 21) completed the study, 3 patients from group 1, 4 patients from group 2, and 1 patient from group 3 dropped out during the follow-up period. The mean changes in painDETECT and SWMt scores showed a statistically significant difference between groups in favor of group 1 at T2 and T3 compared with T1 (P < 0.05). There was no statistically significant difference between groups in terms of VAS, SF-36, and PSQI scores (P > 0.05). In-group analysis of VAS scores showed a statistically significant decrease in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of the VAS scores statistically significant decrease was shown in T2 compared with T1 in group 2 (P < 0.05). In-group analysis of painDETECT scores statistically significant decrease was shown in T2 and T3 compared with T1 in all groups (P < 0.05). In-group analysis of SWMt scores statistically significant decrease was shown in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of SF-36 and PSQI scores, there was no statistically significant decrease in all groups (P > 0.05). LIMITATIONS: The limitation of the study was a short follow-up period. CONCLUSIONS: US-guided LFCN injection and TENS may be therapeutic options for MP treatment, however, for patients with neuropathic pain symptoms, US-guided LFCN injection may be a safe and alternative method to conservative treatment. KEY WORDS: Meralgia paresthetica, ultrasound-guided injection, transcutaneous electrical nerve stimulation.


Asunto(s)
Anestésicos Locales/uso terapéutico , Neuropatía Femoral/terapia , Glucocorticoides/uso terapéutico , Bloqueo Nervioso/métodos , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapéutico , Tratamiento Conservador/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prilocaína/uso terapéutico , Estudios Prospectivos , Calidad de Vida , Estimulación Eléctrica Transcutánea del Nervio/métodos , Resultado del Tratamiento , Turquia , Ultrasonografía Intervencional
11.
Buenos Aires; s.n; 16 jun. 2020.
No convencional en Español | LILACS, BRISA/RedTESA | ID: biblio-1116497

RESUMEN

CONTEXTO CLÍNICO: La Enfermedad por el Coronavirus 2019 (COVID­19, por su sigla en inglés Coronavirus Disease 2019) es una enfermedad respiratoria de humanos producida por un nuevo coronavirus identificado con la sigla SARS-CoV-2. El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaro la COVID-19 como una pandemia. Desde ese momento hasta el 15 de junio su circulación se ha reportado en 205 países reportándose más de 7.800.000 casos y la muerte 430.000 personas. El período de incubación de la infección es de 2 a 14 días. La mayor parte de los contagios se producen persona a persona, siendo altamente transmisible.(3) La clínica varía desde casos asintomáticos a cuadros febriles con tos y dificultad respiratoria, neumonía y distrés respiratorio. También puede acompañarse de alteraciones gastrointestinales. En los casos con mal pronóstico, el paciente presenta un importante deterioro respiratorio en 4-8 días. Las imágenes radiológicas muestran generalmente neumonía focal o generalizada semejante al síndrome de distress respiratorio agudo. (3) La mayoría de los casos graves requieren ingreso hospitalario, siendo mayoritariamente casos primarios en pacientes de edad avanzada y con comorbilidades (diabetes, enfermedad crónica renal, hipertensión, enfermedad cardiaca y enfermedad pulmonar crónica). La tasa media de letalidad de los pacientes ingresados a UTI es cercana al 49%, siendo los valores más elevados en pacientes masculinos de más de 50 años con comorbilidades múltiples. Actualmente el tratamiento de la COVID­19 es sintomático y de sostén no existiendo hasta el momento tratamiento farmacológico específico curativo. Debido a la evidencia que sugiere que el daño pulmonar agudo observado en la infección por SARS-CoV-2 estaría asociada a la activación de las células inmunes circulantes, incluyendo células T y las citoquinas que conducen a un síndrome de liberación de citoquinas (similar al síndrome de activación macrofágica y hemofagocítico) por lo que se plantea que el uso de corticoides sistémicos podría disminuir la mortalidad y/o necesidad de soporte ventilatorio invasivo. TECNOLOGÍA: Los glucocorticoides (GCS) son una familia de medicamentos antiinflamatorios e inmunomoduladores que se utilizan en el tratamiento de diversas patologías cuyo principal componente etiopatogénico es la inflamación. Dentro de los mecanismos de acción propuestos se encuentran: inhibición de citoquinas inflamatorias (IL-1 y IL-2), inhibición de la migración de leucocitaria, inhibición de la desgranulación de mastocitos, depleción linfocitaria (principalmente linfocitos T), incremento de citoquinas anti-inflamatorias (IL-10). Dentro de las alternativas para la administración sistémica se pueden mencionar a la hidrocortisona, dexametasona, betametasona, prednisona, prednisolona, metilprednisolona y deflazacort. Todos ellos difieren principalmente en el grado de actividad mineralocorticorticoide y vida media. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de corticoides sistémicos en COVID­19. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y recomendaciones de diferentes organizaciones de salud. RESULTADOS: Se incluyeron un ECA, una RS, dos estudios observacionales, un documento de evaluación de tecnología sanitaria, 12 guías de práctica clínica, recomendaciones de organismos gubernamentales o sociedades científicas acerca del uso de corticoides sistémicos en pacientes con diagnóstico de COVID­19. CONCLUSIONES: Evidencia de alta calidad proveniente de los resultados de un ensayo clínico aleatorizado aún no publicado sugiere que el uso de corticoides sistémicos se asocia a una disminución en el riesgo de mortalidad principalmente en pacientes con requerimientos de oxigeno suplementario o asistencia mecánica invasiva. Evidencia de muy baja calidad también sugiere que podría tener el mismo beneficio en aquellos pacientes con COVID-19 que presentan síndrome de distrés respiratorio agudo. Múltiples ensayos clínicos aleatorizados en pacientes con cuadros moderados o severos se encuentran en curso. Las guías de práctica clínica de diferentes sociedades internacionales y organismos gubernamentales que lo recomiendan indican su utilización para el tratamiento de pacientes con criterios de síndrome de distrés respiratorio agudo. Si bien no se encontraron estudios de costo-efectividad en Latinoamérica, el costo total del tratamiento al igual que su impacto presupuestario sería muy bajo.


Asunto(s)
Humanos , Neumonía Viral/tratamiento farmacológico , Betametasona/uso terapéutico , Dexametasona/uso terapéutico , Hidrocortisona/uso terapéutico , Metilprednisolona/uso terapéutico , Prednisolona/uso terapéutico , Prednisona/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Betacoronavirus/efectos de los fármacos , Evaluación de la Tecnología Biomédica , Evaluación en Salud , Análisis Costo-Beneficio
13.
Am J Case Rep ; 21: e921495, 2020 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-32173718

RESUMEN

BACKGROUND Linear cutaneous lupus erythematosus (LCLE) is uncommon and occurs mainly in children and young adults. To our knowledge, only ten cases of LCLE in adults have been previously reported. A case is presented of LCLE of the left arm in a 55-year-old woman. CASE REPORT A 55-year-old Caucasian woman from the Midwestern United States presented with a three-month history of a pruritic linear eruption on the left arm. She had a previous history of methicillin-resistant Staphylococcus aureus (MRSA) infection of the left forearm. She had previously been treated with topical triamcinolone, hydrocortisone cream, hydroxyzine, and two courses of prednisone. Physical examination showed a unilateral and linear erythematous skin lesion of the left arm that contained papules and followed the embryonal developmental epidermal lines of Blaschko. Histopathology of a 4 mm skin punch biopsy showed an interface dermatitis with keratinocyte necrosis and increased dermal mucin. Immunofluorescence of the skin biopsy, including for antinuclear antigen (ANA), was negative. Prednisone treatment reduced the symptoms of pruritis but did not resolve the rash. However, following topical treatment with betamethasone dipropionate cream for between two and three weeks, and the use of sunblock, the skin lesions resolved. CONCLUSIONS This rare case of LCLE in an older adult showed a similar response to treatment as other forms of cutaneous lupus erythematosus, with treatment that included topical steroids and sun protection. Also, this case supports that environmental trigger factors, such as prior infections, might provide insights into the etiology of LCLE.


Asunto(s)
Antebrazo/patología , Lupus Eritematoso Cutáneo/clasificación , Lupus Eritematoso Cutáneo/diagnóstico , Piel/patología , Administración Tópica , Factores de Edad , Antiinflamatorios/uso terapéutico , Betametasona/análogos & derivados , Betametasona/uso terapéutico , Exantema/etiología , Femenino , Humanos , Lupus Eritematoso Cutáneo/tratamiento farmacológico , Persona de Mediana Edad , Medio Oeste de Estados Unidos/epidemiología , Prurito/etiología , Protectores Solares/uso terapéutico , Resultado del Tratamiento
15.
J Dermatol ; 47(2): 155-162, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31762070

RESUMEN

Psoriasis is a T-helper (Th)1/Th17-mediated, chronic inflammatory dermatitis that is commonly treated with topical corticosteroids and vitamin D3 analogs. The combination of a topical corticosteroid and vitamin D3 analog showed superior efficacy to each alone in clinical trials; however, the mechanisms by which the topical corticosteroid and vitamin D3 analog exert their effects on lesional skin in combination and each alone remain unknown. In this study, we examined the effects of combined calcipotriol (Cal)/betamethasone dipropionate (BD) ointment on psoriasis in vivo, utilizing imiquimod (IMQ)-induced murine psoriasiform skin inflammation, compared with each alone. Vehicle, Cal/BD, Cal or BD was applied on the shaved back skin for 3 consecutive days. Then, IMQ was applied for 6 consecutive days. Twenty-four hours after the last IMQ treatment, the murine skin was evaluated clinically and pathologically. mRNA expressions were examined by quantitative polymerase chain reaction. All ointments alleviated IMQ-induced psoriasiform skin inflammation clinically in comparison with vehicle application. Cal/BD suppressed mRNA expressions of cytokines involved in psoriasis pathogenesis such as interleukin (IL)-17A and IL-22 efficiently. Cal alone induced IL-10 expression, whereas BD alone reduced IL-6 mRNA expression and the number of phosphorylated signal transducer and activator of transcription 3-positive cells in lesional skin. Our study revealed that Cal and BD have different effects on IMQ-induced psoriasiform skin. Some of the immune effects of Cal and BD may be additive or synergistic, which may account for the superior clinical efficacy of their combination.


Asunto(s)
Betametasona/análogos & derivados , Calcitriol/análogos & derivados , Fármacos Dermatológicos/farmacología , Glucocorticoides/fisiología , Psoriasis/tratamiento farmacológico , Administración Cutánea , Animales , Betametasona/farmacología , Betametasona/uso terapéutico , Calcitriol/farmacología , Calcitriol/uso terapéutico , Citocinas/metabolismo , Fármacos Dermatológicos/uso terapéutico , Modelos Animales de Enfermedad , Sinergismo Farmacológico , Quimioterapia Combinada/métodos , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica/inmunología , Glucocorticoides/uso terapéutico , Humanos , Imiquimod/toxicidad , Ratones , Pomadas , Psoriasis/sangre , Psoriasis/inmunología , Psoriasis/patología , Piel/efectos de los fármacos , Piel/inmunología , Piel/patología , Células TH1/efectos de los fármacos , Células TH1/inmunología , Células TH1/metabolismo , Células Th17/efectos de los fármacos , Células Th17/inmunología , Células Th17/metabolismo
16.
J Perinatol ; 40(1): 30-38, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31748655

RESUMEN

OBJECTIVE: To examine the effect of antenatal corticosteroid administration (ACS) on fetal thymus growth in women who received ACS compared with gestational-age-matched controls. STUDY DESIGN: Fetal thymus size and growth were measured in women at risk for preterm delivery who received ACS and compared with a matched cohort of women who were at low risk for preterm delivery and did not receive ACS. Fetal thymus perimeter and diameter were measured by 2-D ultrasound at baseline and every 2 weeks until delivery. RESULTS: After adjusting for confounders, ACS exposure was associated with a significant reduction in thymus perimeter size (-0.70; 95% CI: -1.33, -0.07; P = 0.03). For every additional week of exposure, thymus growth trajectory was significantly decreased in ACS-exposed fetuses (P = 0.04). CONCLUSION: The association between ACS and reduced fetal thymus growth should be further examined to establish the impact of ACS on childhood thymus development and immune programming.


Asunto(s)
Betametasona/farmacología , Glucocorticoides/farmacología , Timo/embriología , Adulto , Betametasona/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Masculino , Embarazo , Nacimiento Prematuro , Estudios Prospectivos , Timo/efectos de los fármacos , Timo/crecimiento & desarrollo , Ultrasonografía Prenatal
17.
J Clin Endocrinol Metab ; 105(1)2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31585006

RESUMEN

CONTEXT: Antenatal synthetic glucocorticoid (sGC) treatment constitutes a potent programming factor of the hypothalamic-pituitary-adrenal (HPA) axis. Previous findings from our group revealed long-term changes in cortisol stress reactivity following antenatal sGC therapy. However, the few prior studies exclusively relied on spot measurements of phasic HPA axis activity, which may not adequately capture cortisol output over prolonged periods of time. OBJECTIVE: To address this gap, the current study utilized hair steroid concentrations, a valid marker of integrated long-term HPA-axis activity, to investigate endocrine changes in individuals treated with antenatal sGC. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study comprised 76 term-born children (7-12 years) and 58 adolescents (14-18 years). Cumulated hormonal secretion in scalp hair over a 3-month period was determined for different biomarkers of tonic HPA axis activity by liquid chromatography coupled with tandem mass spectrometry. Hair steroid levels were compared between participants with antenatal sGC therapy (dexamethasone or betamethasone) and different control groups. RESULTS: Findings from this study provide no evidence for a significant effect of antenatal sGCs on long-term hair steroid concentrations. Participants treated with antenatal sGC exhibited comparable levels of hair cortisol, cortisone, dehydroepiandrosterone, and cortisol/dehydroepiandrosterone ratios compared to those of mothers who had been admitted to hospital for pregnancy complications but had never received sGC therapy and controls from physiological pregnancies. CONCLUSION: In conjunction with data from previous studies, it is thus tempting to speculate that sGC may affect the capacity of dynamic changes and flexible adaption of an individual's HPA axis rather than changes in tonic steroid output.


Asunto(s)
Glucocorticoides/uso terapéutico , Cabello/química , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Esteroides/análisis , Adolescente , Betametasona/análisis , Betametasona/uso terapéutico , Niño , Cortisona/análisis , Estudios Transversales , Dexametasona/análisis , Dexametasona/uso terapéutico , Femenino , Glucocorticoides/análisis , Humanos , Hidrocortisona/análisis , Sistema Hipotálamo-Hipofisario/efectos de los fármacos , Recién Nacido , Masculino , Sistema Hipófiso-Suprarrenal/efectos de los fármacos , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Drogas Sintéticas/análisis , Drogas Sintéticas/uso terapéutico
19.
J Dermatolog Treat ; 31(1): 18-26, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30663443

RESUMEN

Pruritus, a very broad, subjective, and complex symptom, troubles the majority of patients with psoriasis. However, the subjective and multidimensional nature of the symptom renders it challenging for patients to appropriately communicate their experiences with itch to providers. This review explores current perspectives regarding the underlying mechanisms, assessment tools, burden, and treatment modalities for psoriatic pruritus. It emphasizes the significance of incorporating a standardized, thorough, and verified metric that incorporates severity, distribution, and character of pruritus as well as its effects on various aspects of quality of life. It also underscores the importance of continued research to fully understand the pathogenesis of psoriatic itch for establishment of novel, targeted therapeutics.


Asunto(s)
Prurito/etiología , Psoriasis/patología , Betametasona/uso terapéutico , Calcitriol/análogos & derivados , Calcitriol/uso terapéutico , Costo de Enfermedad , Fármacos Dermatológicos/uso terapéutico , Humanos , Prurito/psicología , Prurito/terapia , Psoriasis/complicaciones , Calidad de Vida , Índice de Severidad de la Enfermedad
20.
Psychol Med ; 50(2): 247-257, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30688183

RESUMEN

BACKGROUND: Synthetic glucocorticoids, to enhance fetal maturation, are a standard treatment when preterm birth before 34 gestational weeks is imminent. While morbidity- and mortality-related benefits may outweigh potential neurodevelopmental harms in children born preterm (<37 gestational weeks), this may not hold true when pregnancy continues to term (⩾37 gestational weeks). We studied the association of antenatal betamethasone exposure on child mental health in preterm and term children. METHODS: We included 4708 women and their children, born 2006-2010, from the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction Study with information on both antenatal betamethasone treatment and child mental and behavioral disorders from the Finnish Hospital Discharge Register from the child's birth to 31 December 2016. Additional follow-up data on mother-reported psychiatric problems and developmental milestones were available for 2640 children at 3.5 (s.d. = 0.07) years-of-age. RESULTS: Of the children, 187 were born preterm (61 betamethasone-exposed) and 4521 at term (56 betamethasone-exposed). The prevalence of any mental and behavioral, psychological development, emotional and behavioral, and comorbid disorders was higher in the betamethasone-exposed, compared to non-exposed children [odds ratio 2.76 (95% confidence interval 1.76-4.32), 3.61 (2.19-5.95), 3.29 (1.86-5.82), and 6.04 (3.25-11.27), respectively]. Levels of psychiatric problems and prevalence of failure to meet the age-appropriate development in personal-social skills were also higher in mother-reports of betamethasone-exposed children. These associations did not vary significantly between preterm and term children. CONCLUSIONS: Antenatal betamethasone exposure may be associated with mental health problems in children born preterm and in those who end up being born at term.


Asunto(s)
Betametasona/efectos adversos , Trastornos de la Conducta Infantil/inducido químicamente , Glucocorticoides/efectos adversos , Trastornos Mentales/inducido químicamente , Efectos Tardíos de la Exposición Prenatal , Betametasona/uso terapéutico , Preescolar , Femenino , Finlandia , Estudios de Seguimiento , Glucocorticoides/uso terapéutico , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Modelos Logísticos , Masculino , Embarazo
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