Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 14.924
Filtrar
1.
Medicine (Baltimore) ; 100(9): e25012, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655971

RESUMEN

ABSTRACT: Epidural steroid injections (ESI) are commonly performed for the treatment of chronic cervical disc herniation (CDH). Although they are considered to be effective for both nociceptive and neuropathic types of pain, there is a lack of data regarding the impact of neuropathic pain (NP) and nociceptive pain components on treatment outcomes. The aim of this study is to compare the effectiveness of interlaminar epidural steroid injection (ILESI) between patients with predominantly NP and nociceptive pain due to CDH.Sixty five participants were initially included in the study and assessed by numeric rating scale (NRS), neck pain and disability scale (NPDS), short form-12 (SF-12), and self-reported Leeds assessment of neuropathic symptoms and signs (S-LANSS) pain scale at baseline and 1 month, 3 months, 6 months after ILESI.All patients were evaluated at 1st month and 3rd month follow-up periods while 54 of patients achieved to complete 6th month follow-up. There were significant improvements in all outcome measures for all time periods when compared with the pre-intervention scores. At baseline 24 (36.9%) of patients had predominantly NP in accordance with S-LANSS pain scale. The ratio of NP predominant patients reduced to 7.6% at 1st month, 12.3% at 3rd month, and 12.9% at 6th month with a significant difference for each follow-up period when compared with the baseline. Although all NRS and NPDS scores at baseline were significantly higher in patients with NP, improvement was significant at all follow-up periods in both groups. Minimal clinically important change in NRS was observed in >75% of patients at 1st, 3rd, and 6th month in both groups.The results of this study showed that NP is present in one-third of the patients suffering from neck and radiating arm pain due to CDH and cervical ILESI is an effective treatment approach for both neuropathic and nociceptive components of pain.Clinical Trials Registration Number: NCT04235478.


Asunto(s)
Glucocorticoides/administración & dosificación , Desplazamiento del Disco Intervertebral/tratamiento farmacológico , Dolor de Cuello/etiología , Neuralgia/etiología , Adolescente , Adulto , Anciano , Vértebras Cervicales , Enfermedad Crónica , Femenino , Humanos , Inyecciones Epidurales , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico , Neuralgia/diagnóstico , Dimensión del Dolor , Pronóstico , Estudios Prospectivos , Adulto Joven
2.
Lancet Haematol ; 8(4): e289-e298, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33770484

RESUMEN

BACKGROUND: Primary immune thrombocytopenia is an autoimmune bleeding disorder. Preclinical reports suggest that the sialidase inhibitor oseltamivir induces a platelet response in the treatment of immune thrombocytopenia. This study investigated the activity and safety of dexamethasone plus oseltamivir versus dexamethasone alone as initial treatment in adult patients with primary immune thrombocytopenia. METHODS: This multicentre, randomised, open-label, parallel group, phase 2 trial was done in five tertiary medical hospitals in China. Eligible patients were aged 18 years or older with newly diagnosed, treatment-naive primary immune thrombocytopenia. Participants were randomly assigned (1:1), using block randomisation, to receive either dexamethasone (orally at 40 mg per day for 4 days) plus oseltamivir (orally at 75 mg twice a day for 10 days) or dexamethasone monotherapy (orally at 40 mg a day for 4 days). Patients who did not respond to treatment (platelet counts remained <30 × 109 cells per L or showed bleeding symptoms by day 10) were given an additional cycle of dexamethasone for 4 days in each group. Patients in the dexamethasone plus oseltamivir group who relapsed (platelet counts reduced again to <30 × 109 cells per L) after an initial response were allowed a supplemental course of oseltamivir (75 mg twice a day for 10 days). The coprimary endpoints were 14-day initial overall response and 6-month overall response. Complete response was defined as a platelet count at or above 100 × 109 cells per L and an absence of bleeding. Partial response was defined as a platelet count at or above 30 × 109 cells per L but less than 100 × 109 cells per L and at least a doubling of the baseline platelet count and an absence of bleeding. A response lasting for at least 6 months without any additional primary immune thrombocytopenia-specific intervention was defined as sustained response. All patients who were randomly assigned and received the allocated intervention were included in the modified intention-to-treat population analysis. This study has been completed and is registered with ClinicalTrials.gov, number NCT01965626. FINDINGS: From Feb 1, 2016, to May 1, 2019, 120 patients were screened for eligibility, of whom 24 were ineligible and excluded, 96 were enrolled and randomly assigned to receive dexamethasone plus oseltamivir (n=47) or dexamethasone (n=49), and 90 were included in the modified intention-to-treat analysis. Six patients did not receive the allocated intervention. Patients in the dexamethasone plus oseltamivir group had a significantly higher initial response rate (37 [86%] of 43 patients) than did those in the dexamethasone group (31 [66%] of 47 patients; odds ratio [OR] 3·18; 95 CI% 1·13-9·23; p=0·030) at day 14. The 6-month sustained response rate in the dexamethasone plus oseltamivir group was also significantly higher than that in the dexamethasone group (23 [53%] vs 14 [30%]; OR 2·17; 95 CI% 1·16-6·13; p=0·032). During the median follow-up of 8 months (IQR 5-14), two of 90 patients discontinued treatment due to serious adverse events (grade 3); one (2%) patient with general oedema in the dexamethasone plus oseltamivir group and one (2%) patient with fever in the dexamethasone group. The most frequently observed adverse events of any grade were fatigue (five [12%] of 43 in the dexamethasone plus oseltamivir group vs eight [17%] of 47 in the dexamethasone group), gastrointestinal reactions (eight [19%] vs three [6%]), insomnia (seven [16%] vs four [9%]), and anxiety (five [12%] vs three [6%]). There were no grade 4 or 5 adverse events and no treatment-related deaths. INTERPRETATION: Dexamethasone plus oseltamivir offers a readily available combination therapy in the management of newly diagnosed primary immune thrombocytopenia. The preliminary activity of this combination warrants further investigation. Multiple cycles of oseltamivir, as a modification of current first-line treatment, might be more effective in maintaining the platelet response. FUNDING: National Natural Science Foundation of China.


Asunto(s)
Dexametasona/uso terapéutico , Inhibidores Enzimáticos/uso terapéutico , Glucocorticoides/uso terapéutico , Oseltamivir/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Administración Oral , Adulto , China/epidemiología , Dexametasona/administración & dosificación , Dexametasona/efectos adversos , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/métodos , Inhibidores Enzimáticos/administración & dosificación , Inhibidores Enzimáticos/efectos adversos , Femenino , Estudios de Seguimiento , Glucocorticoides/administración & dosificación , Glucocorticoides/efectos adversos , Hemorragia/epidemiología , Humanos , Análisis de Intención de Tratar/métodos , Masculino , Persona de Mediana Edad , Oseltamivir/administración & dosificación , Oseltamivir/efectos adversos , Recuento de Plaquetas/estadística & datos numéricos , Recuento de Plaquetas/tendencias , Púrpura Trombocitopénica Idiopática/inmunología , Seguridad , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 100(10): e25067, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725896

RESUMEN

RATIONALE: Cronkhite-Canada syndrome (CCS) is a rare non-familial polyposis syndrome characterized by multiple gastrointestinal polyps with the ectodermal triad. To date, many complications of CCS have been reported in the literature, but perianal condyloma acuminatum with malignant transformation has not been included. PATIENT CONCERNS: This report presents the case of a 52-year-old Chinese man who presented with diarrhea, loss of appetite, and weight loss. He developed skin pigmentation and atrophy of the fingernails and toenails. Upper gastrointestinal endoscopy, colonoscopy, capsule endoscopy, and enteroscopy revealed diffuse polyps along the entire digestive tract. Histopathological examination revealed polyps of different pathological types dominated by hamartoma. Physical examination revealed a crissum cauliflower-like neoplasm (2.5 × 2.0 cm). After perianal tumor resection, pathology suggested that this was a perianal condylomatous lesion with malignant transformation, as well as well-differentiated squamous cell carcinoma. DIAGNOSES: These clinical features and endoscopic findings were consistent with CCS which associated with perianal condyloma acuminatum with malignant transformation. INTERVENTION: Clinical remission was achieved with glucocorticoid, azathioprine, and nutritional support. OUTCOME: At the 4-year follow-up, the patient had no diarrhea or loss of appetite, had gained 13 kg in weight, and the perianal tumor had not recurred. LESSONS: No previous report has described CCS in a patient with perianal condyloma acuminatum with malignant transformation. As both conditions are related to immune disorders, their occurrence may be correlated.


Asunto(s)
Neoplasias del Ano/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Condiloma Acuminado/diagnóstico , Poliposis Intestinal/diagnóstico , Canal Anal/patología , Canal Anal/cirugía , Neoplasias del Ano/etiología , Neoplasias del Ano/patología , Neoplasias del Ano/terapia , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Transformación Celular Neoplásica , Condiloma Acuminado/etiología , Condiloma Acuminado/patología , Condiloma Acuminado/terapia , Endoscopía Gastrointestinal , Glucocorticoides/administración & dosificación , Glutamina/administración & dosificación , Humanos , Poliposis Intestinal/complicaciones , Poliposis Intestinal/terapia , Masculino , Persona de Mediana Edad , Apoyo Nutricional , Resultado del Tratamiento
4.
Medicine (Baltimore) ; 100(10): e25164, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725918

RESUMEN

RATIONALE: Herein, we report 3 hemodialysis patients with idiopathic hypereosinophilic syndrome who were successfully treated using corticosteroid therapy. PATIENT CONCERNS: Case 1 was a 63-year-old man who was undergoing hemodialysis because of bilateral nephrectomy and developed hypereosinophilia with digestive symptoms, myocardial injury, and intradialytic hypotension. Case 2 was an 83-year-old man who was undergoing hemodialysis because of nephrosclerosis and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. Case 3 was a 59-year-old man who was undergoing hemodialysis because of diabetic nephropathy and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. DIAGNOSES: All 3 patients presented with hypereosinophilia (eosinophil count ≥1500 /µL for more than 1 month) and multiple-organ involvement (intradialytic hypotension, cardiac injury, digestive symptoms, and allergic dermatitis). A specific cause for the hypereosinophilia was not identified by systemic computed tomography, electrocardiography, echocardiography, bone marrow examination, or blood tests. Furthermore, Case 2 and 3 had not recently started taking any new drugs and drug-induced lymphocyte stimulation tests were negative in Case 1. Therefore, they were diagnosed with idiopathic hypereosinophilic syndrome. INTERVENTIONS: All 3 patients received corticosteroid therapy with prednisolone at a dose of 40 mg/d, 30 mg/d, and 60 mg/d in Case 1, 2, and 3, respectively. OUTCOMES: Their digestive symptoms, pruritus, intradialytic hypotension, and serum troponin I concentrations were immediately improved alongside reductions in their eosinophil counts. LESSONS: There have been few case reports of idiopathic hypereosinophilic syndrome in patients undergoing hemodialysis. We believe that recording of the clinical findings and treatments of such patients is mandatory to establish the optimal management of idiopathic hypereosinophilic syndrome.


Asunto(s)
Glucocorticoides/administración & dosificación , Síndrome Hipereosinofílico/tratamiento farmacológico , Diálisis Renal/efectos adversos , Insuficiencia Renal/terapia , Administración Oral , Anciano de 80 o más Años , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/terapia , Diagnóstico Diferencial , Relación Dosis-Respuesta a Droga , Eosinófilos , Humanos , Síndrome Hipereosinofílico/sangre , Síndrome Hipereosinofílico/diagnóstico , Síndrome Hipereosinofílico/etiología , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Nefrectomía/efectos adversos , Nefroesclerosis/complicaciones , Nefroesclerosis/terapia , Prednisolona/administración & dosificación , Insuficiencia Renal/etiología , Resultado del Tratamiento
5.
Chest ; 159(3): e151-e154, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33678283

RESUMEN

CASE PRESENTATION: A 64-year-old previously healthy man presented with 8 weeks of progressive dyspnea on exertion and cough. Prior to presentation, the patient was able to bicycle > 60 miles per week and work full-time in a home improvement store. He was up-to-date with age-appropriate cancer screening and immunizations, and home medications included famotidine for reflux and nonsteroidal antiinflammatories for osteoarthritis, both as-needed. He had no significant respiratory exposure, aside from previous work as an electrician. His symptoms began in mid-February 2020 amid the coronavirus disease 2019 pandemic, although he had no known exposure to the virus.


Asunto(s)
/diagnóstico , Fructosa-Bifosfato Aldolasa/sangre , Glucocorticoides/administración & dosificación , Pulmón/diagnóstico por imagen , Miositis , Intercambio Plasmático/métodos , Rituximab/administración & dosificación , Treonina-ARNt Ligasa/inmunología , Autoanticuerpos/sangre , Diagnóstico Diferencial , Progresión de la Enfermedad , Humanos , Inmunosupresores/administración & dosificación , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/fisiopatología , Masculino , Persona de Mediana Edad , Debilidad Muscular/diagnóstico , Debilidad Muscular/etiología , Miositis/sangre , Miositis/diagnóstico , Miositis/fisiopatología , Miositis/terapia , Terapia por Inhalación de Oxígeno/métodos , Pronóstico , Resultado del Tratamiento
6.
Medicine (Baltimore) ; 100(8): e24914, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663126

RESUMEN

INTRODUCTION: Gastrointestinal (GI) cytomegalovirus (CMV) infection coexisting with or followed by a diagnosis of inflammatory bowel disease (IBD) is infrequently reported. Not recognizing this condition may delay IBD diagnosis in patients with GI-CMV disease who do not or partially respond to antiviral agents, which could consequently result in unsatisfied treatment outcomes. PATIENT CONCERNS: Two immunocompetent patients with no known underlying GI conditions presented with acute bloody diarrhea. The first patient developed diarrhea and hematochezia after admission to intensive care unit (ICU) because of severe alcoholic pancreatitis for 10 days duration. Computed tomography abdomen showed segmental jejunal thickening. The other patient presented with a 1-week history of severe bloody diarrhea which required ICU admission. Colonoscopy showed multiple ulcers along terminal ileum and colon. DIAGNOSIS: These 2 patients were initially diagnosed with CMV jejunitis and ileocolitis, respectively, based on endoscopic and histopathologic findings. Both had partial response to treatment with 3 weeks of intravenous ganciclovir. Crohn disease was suspected because of persistent ulcerations on the follow-up endoscopy with the presence of pathological features of chronic inflammation and disappearance of previously detected CMV-infected cells. INTERVENTION: Both patients were treated with systemic corticosteroids and azathioprine. OUTCOMES: Both patients had complete clinical improvement. Prednisolone could be tapered off in 6 months. Follow-up video capsule endoscopy (VCE) at 6 months showed improvement of mucosal inflammation and ulcers, but neither were completely healed in the first patient. Follow-up colonoscopy at 6 months showed complete resolution of ulcers and inflammation in the second patient. LESSONS: IBD should be suspected in patients with a diagnosis of GI-CMV disease who are immunocompetent and have a partial response to antiviral agents. This clinical scenario could be caused by either CMV infection activating immune response resulting in IBD onset, or CMV infection superimposed on pre-existing latent IBD.


Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Enfermedades Inflamatorias del Intestino/diagnóstico , Azatioprina/administración & dosificación , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/inmunología , Diagnóstico Tardío , Femenino , Glucocorticoides/administración & dosificación , Humanos , Inmunocompetencia , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/inmunología , Masculino , Persona de Mediana Edad , Prednisolona/administración & dosificación
7.
Trials ; 22(1): 172, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33648568

RESUMEN

OBJECTIVES: The primary objective of this study is to test the hypothesis that administration of dexamethasone 20 mg is superior to a 6 mg dose in adult patients with moderate or severe ARDS due to confirmed COVID-19. The secondary objective is to investigate the efficacy and safety of dexamethasone 20 mg versus dexamethasone 6 mg. The exploratory objective of this study is to assess long-term consequences on mortality and quality of life at 180 and 360 days. TRIAL DESIGN: REMED is a prospective, phase II, open-label, randomised controlled trial testing superiority of dexamethasone 20 mg vs 6 mg. The trial aims to be pragmatic, i.e. designed to evaluate the effectiveness of the intervention in conditions that are close to real-life routine clinical practice. PARTICIPANTS: The study is multi-centre and will be conducted in the intensive care units (ICUs) of ten university hospitals in the Czech Republic. INCLUSION CRITERIA: Subjects will be eligible for the trial if they meet all of the following criteria: 1. Adult (≥18 years of age) at time of enrolment; 2. Present COVID-19 (infection confirmed by RT-PCR or antigen testing); 3. Intubation/mechanical ventilation or ongoing high-flow nasal cannula (HFNC) oxygen therapy; 4. Moderate or severe ARDS according to Berlin criteria: • Moderate - PaO2/FiO2 100-200 mmHg; • Severe - PaO2/FiO2 < 100 mmHg; 5. Admission to ICU in the last 24 hours. EXCLUSION CRITERIA: Subjects will not be eligible for the trial if they meet any of the following criteria: 1. Known allergy/hypersensitivity to dexamethasone or excipients of the investigational medicinal product (e.g. parabens, benzyl alcohol); 2. Fulfilled criteria for ARDS for ≥14 days at enrolment; 3. Pregnancy or breastfeeding; 4. Unwillingness to comply with contraception measurements from enrolment until at least 1 week after the last dose of dexamethasone (sexual abstinence is considered an adequate contraception method); 5. End-of-life decision or patient is expected to die within next 24 hours; 6. Decision not to intubate or ceilings of care in place; 7. Immunosuppression and/or immunosuppressive drugs in medical history: a) Systemic immunosuppressive drugs or chemotherapy in the past 30 days; b) Systemic corticosteroid use before hospitalization; c) Any dose of dexamethasone during the present hospital stay for COVID-19 for ≥5 days before enrolment; d) Systemic corticosteroids during present hospital stay for conditions other than COVID-19 (e.g. septic shock); 8. Current haematological or generalized solid malignancy; 9. Any contraindication for corticosteroid administration, e.g. • intractable hyperglycaemia; • active gastrointestinal bleeding; • adrenal gland disorders; • presence of superinfection diagnosed with locally established clinical and laboratory criteria without adequate antimicrobial treatment; 10. Cardiac arrest before ICU admission; 11. Participation in another interventional trial in the last 30 days. INTERVENTION AND COMPARATOR: Dexamethasone solution for injection/infusion is the investigational medicinal product as well as the comparator. The trial will assess two doses, 20 mg (investigational) vs 6 mg (comparator). Patients in the intervention group will receive dexamethasone 20 mg intravenously once daily on day 1-5, followed by dexamethasone 10 mg intravenously once daily on day 6-10. Patients in the control group will receive dexamethasone 6 mg day 1-10. All authorized medicinal products containing dexamethasone in the form of solution for i.v. injection/infusion can be used. MAIN OUTCOMES: Primary endpoint: Number of ventilator-free days (VFDs) at 28 days after randomisation, defined as being alive and free from mechanical ventilation. SECONDARY ENDPOINTS: a) Mortality from any cause at 60 days after randomisation; b) Dynamics of inflammatory marker (C-Reactive Protein, CRP) change from Day 1 to Day 14; c) WHO Clinical Progression Scale at Day 14; d) Adverse events related to corticosteroids (new infections, new thrombotic complications) until Day 28 or hospital discharge; e) Independence at 90 days after randomisation assessed by Barthel Index. The long-term outcomes of this study are to assess long-term consequences on mortality and quality of life at 180 and 360 days through telephone structured interviews using the Barthel Index. RANDOMISATION: Randomisation will be carried out within the electronic case report form (eCRF) by the stratified permuted block randomisation method. Allocation sequences will be prepared by a statistician independent of the study team. Allocation to the treatment arm of an individual patient will not be available to the investigators before completion of the whole randomisation process. The following stratification factors will be applied: • Age <65 and ≥ 65; • Charlson Comorbidity index (CCI) <3 and ≥3; • CRP <150 mg/L and ≥150 mg/L • Trial centre. Patients will be randomised in a 1 : 1 ratio into one of the two treatment arms. Randomisation through the eCRF will be available 24 hours every day. BLINDING (MASKING): This is an open-label trial in which the participants and the study staff will be aware of the allocated intervention. Blinded pre-planned statistical analysis will be performed. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The sample size is calculated to detect the difference of 3 VFDs at 28 days (primary efficacy endpoint) between the two treatment arms with a two-sided type I error of 0.05 and power of 80%. Based on data from a multi-centre randomised controlled trial in COVID-19 ARDS patients in Brazil and a multi-centre observational study from French and Belgian ICUs regarding moderate to severe ARDS related to COVID-19, investigators assumed a standard deviation of VFD at 28 days as 9. Using these assumptions, a total of 142 patients per treatment arm would be needed. After adjustment for a drop-out rate, 150 per treatment arm (300 patients per study) will be enrolled. TRIAL STATUS: This is protocol version 1.1, 15.01.2021. The trial is due to start on 2 February 2021 and recruitment is expected to be completed by December 2021. TRIAL REGISTRATION: The study protocol was registered on EudraCT No.:2020-005887-70, and on December 11, 2020 on ClinicalTrials.gov (Title: Effect of Two Different Doses of Dexamethasone in Patients With ARDS and COVID-19 (REMED)) Identifier: NCT04663555 with a last update posted on February 1, 2021. FULL PROTOCOL: The full protocol (version 1.1) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the standard formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
/terapia , Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Respiración Artificial , /terapia , /complicaciones , Ensayos Clínicos Fase II como Asunto , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Estudios de Equivalencia como Asunto , Humanos , Tiempo de Internación , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , /etiología
8.
Ital J Pediatr ; 47(1): 46, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33653401

RESUMEN

BACKGROUND: Glucocorticoid treatment is used in children with Graves' disease (GD) only in cases of exophthalmos. The purpose of this study was to observe the effects of glucocorticoid pulse therapy on thyroid function and thyroid antibodies in children with GD. METHODS: Twenty children who were treated by intravenous methylprednisolone pulse therapy (MPT) followed by oral prednisolone administration and antithyroid drugs were included in the pulse group. Twenty children who were treated with antithyroid drugs alone were included in the control group. Serum concentrations of free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TGAb), and thyrotropin receptor antibodies (TRAb) were recorded at baseline and 10 days, 30 days, and 60 days after treatment. RESULTS: Significant differences in FT3, FT4, TSH, TPOAb, TGAb, and TRAb levels were found in the pulse group and the control group from baseline to follow-up time points (all p < 0.05). On the 30th day, the TRAb level in the pulse group was significantly lower than that in the control group (p = 0.023). However, the level of TRAb rose on the 60th day. For values of TRAb at baseline, 10 days, and 60 days after treatment, there were no significant differences respectively between the pulse group and the control group (all p > 0.05). No significant differences were observed in FT3, FT4, TSH, TPOAb, and TGAb levels between the pulse group and the control group (all p > 0.05). CONCLUSIONS: The results suggested that the effect of intravenous MPT followed by oral prednisolone on TRAb level was temporary in children with GD. Glucocorticoid pulse therapy was not beneficial for the sustained recovery of thyroid function.


Asunto(s)
Autoanticuerpos/sangre , Glucocorticoides/administración & dosificación , Enfermedad de Graves/tratamiento farmacológico , Metilprednisolona/administración & dosificación , Quimioterapia por Pulso , Hormonas Tiroideas/sangre , Administración Oral , Adolescente , Antitiroideos/uso terapéutico , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Masculino , Prednisolona/uso terapéutico , Estudios Retrospectivos , Hormonas Tiroideas/inmunología
9.
Life Sci ; 271: 119155, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33548286

RESUMEN

Acute kidney injury (AKI) is a progressive renal complication which significantly affects the patient's life with huge economic burden. Untreated acute kidney injury eventually progresses to a chronic form and end-stage renal disease. Although significant breakthroughs have been made in recent years, there are still no effective pharmacological therapies for the treatment of acute kidney injury. Toll-like receptor 4 (TLR4) is a well-characterized pattern recognition receptor, and increasing evidence has shown that TLR4 mediated inflammatory response plays a pivotal role in the pathogenesis of acute kidney injury. The expression of TLR4 has been seen in resident renal cells, including podocytes, mesangial cells, tubular epithelial cells and endothelial cells. Activation of TLR4 signaling regulates the transcription of numerous pro-inflammatory cytokines and chemokines, resulting in renal inflammation. Therefore, targeting TLR4 and its downstream effectors could serve as an effective therapeutic intervention to prevent renal inflammation and subsequent kidney damage. For the first time, this review summarizes the literature on acute kidney injury from the perspective of TLR4 from year 2010 to 2020. In the current review, the role of TLR4 signaling pathway in AKI with preclinical evidence is discussed. Furthermore, we have highlighted several compounds of natural and synthetic origin, which have the potential to avert the renal TLR4 signaling in preclinical AKI models and have shown protection against AKI. This scientific review provides new ideas for targeting TLR4 in the treatment of AKI and provides strategies for the drug development against AKI.


Asunto(s)
Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/metabolismo , Sistemas de Liberación de Medicamentos/métodos , Receptor Toll-Like 4/metabolismo , Lesión Renal Aguda/inmunología , Animales , Sistemas de Liberación de Medicamentos/tendencias , Medicamentos Herbarios Chinos/administración & dosificación , Células Endoteliales/efectos de los fármacos , Células Endoteliales/inmunología , Células Endoteliales/metabolismo , Glucocorticoides/administración & dosificación , Humanos , Inhibidores de la Bomba de Protones/administración & dosificación , Receptor Toll-Like 4/antagonistas & inhibidores , Receptor Toll-Like 4/inmunología
10.
Medicine (Baltimore) ; 100(6): e24627, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578576

RESUMEN

RATIONALE: Steroid-resistant nephrotic syndrome (SRNS) is a special kidney disease. SRNS is characterized by steroid-resistant, clinical variability, and genetic heterogeneity. Patients with SRNS often may eventually need renal transplantation. PATIENT CONCERNS: A 10-month-old Chinese male infant presented with oliguria, renal dysfunction, hypertension, and anemia. DIAGNOSES: Combined with clinical manifestations, laboratory testing and sequencing results, the patient was diagnosed as SRNS. INTERVENTIONS: Combined intravenous methylprednisolone and cefoperazone sulbactam did not improve the patient's condition. Thus, SRNS associated with hereditary nephrotic syndrome was strongly suspected. Genetic testing for hereditary renal disease of the patient revealed 2 novel heterozygous mutations in the Nucleoporin 93 (NUP93) gene, which were predicted pathogenic and harmful by bioinformatic softwares of SIFT, PolyPhen_2 and REVEL. OUTCOMES: As general physical health deterioration and renal dysfunction, the patient died of a severe infection. LESSONS: The novel NUP93 heterozygous mutations identified in the current study broadened the genetic spectrum of SRNS and further deepened our insight into pathogenic mutations of NUP93 to improve disease diagnosis.


Asunto(s)
Síndrome Nefrótico/diagnóstico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Cefoperazona/administración & dosificación , Cefoperazona/uso terapéutico , Resultado Fatal , Asesoramiento Genético , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Lactante , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/genética
11.
Medicine (Baltimore) ; 100(3): e23847, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545951

RESUMEN

BACKGROUND: Sudden hearing loss (SHL) is a disease, at the same time a symptom, which needs to be treated in a timely manner and counts as an emergency health problem in the Department of Otolaryngology. There are many types of sudden hearing loss and among them, the occurrence of all-frequency descending sudden hearing loss and high frequency sudden hearing loss are high. The conventional treatment for these 2 types of sudden hearing loss sometimes is not as effective as expected. Postauricular injection of glucocorticoids could be the most effective treatment method. However, the effectiveness and safety of postauricular injection of glucocorticoid needs to be assessed systematically. METHODS: The protocol for the meta-analysis was conducted under the guidance of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The aim is to undertake a systematic review and meta-analysis on the effectiveness and safety of postauricular injection of glucocorticoid to treat patient diagnosed with all-frequency and high frequency descending sudden hearing loss. We searched through the following databases: English databases (PubMed, EMBASE, Web of Science) and Chinese databases (CNKI, Wanfang databases, CBM, VIP). The final selected articles will be evaluated using Cochrane RCT evaluation criteria. Revman 5.0 will be used for data analysis. Subgroup analysis, sensitivity analysis, and meta regression will detect sources of heterogeneity. Ethics approval was not required for this protocol. The findings will be disseminated through journal articles or conference presentations. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/5Q9NA. RESULTS: Objectively, evaluate the efficacy and safety of postauricular injection of glucocorticoid in treating all-frequency descending sudden hearing loss and high frequency sudden hearing loss. CONCLUSION: To provide evidence-based medicine for glucocorticoid treatment methods in patients with all-frequency descending sudden hearing loss and high frequency descending hearing loss.


Asunto(s)
Glucocorticoides/uso terapéutico , Pérdida Auditiva Súbita/tratamiento farmacológico , Pabellón Auricular , Glucocorticoides/administración & dosificación , Humanos , Inyecciones , Metaanálisis como Asunto , Ondas de Radio , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
12.
N Engl J Med ; 384(7): 599-609, 2021 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-33596356

RESUMEN

BACKGROUND: The C5a receptor inhibitor avacopan is being studied for the treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. METHODS: In this randomized, controlled trial, we assigned patients with ANCA-associated vasculitis in a 1:1 ratio to receive oral avacopan at a dose of 30 mg twice daily or oral prednisone on a tapering schedule. All the patients received either cyclophosphamide (followed by azathioprine) or rituximab. The first primary end point was remission, defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 (on a scale from 0 to 63, with higher scores indicating greater disease activity) at week 26 and no glucocorticoid use in the previous 4 weeks. The second primary end point was sustained remission, defined as remission at both weeks 26 and 52. Both end points were tested for noninferiority (by a margin of 20 percentage points) and for superiority. RESULTS: A total of 331 patients underwent randomization; 166 were assigned to receive avacopan, and 165 were assigned to receive prednisone. The mean BVAS at baseline was 16 in both groups. Remission at week 26 (the first primary end point) was observed in 120 of 166 patients (72.3%) receiving avacopan and in 115 of 164 patients (70.1%) receiving prednisone (estimated common difference, 3.4 percentage points; 95% confidence interval [CI], -6.0 to 12.8; P<0.001 for noninferiority; P = 0.24 for superiority). Sustained remission at week 52 (the second primary end point) was observed in 109 of 166 patients (65.7%) receiving avacopan and in 90 of 164 patients (54.9%) receiving prednisone (estimated common difference, 12.5 percentage points; 95% CI, 2.6 to 22.3; P<0.001 for noninferiority; P = 0.007 for superiority). Serious adverse events (excluding worsening vasculitis) occurred in 37.3% of the patients receiving avacopan and in 39.0% of those receiving prednisone. CONCLUSIONS: In this trial involving patients with ANCA-associated vasculitis, avacopan was noninferior but not superior to prednisone taper with respect to remission at week 26 and was superior to prednisone taper with respect to sustained remission at week 52. All the patients received cyclophosphamide or rituximab. The safety and clinical effects of avacopan beyond 52 weeks were not addressed in the trial. (Funded by ChemoCentryx; ADVOCATE ClinicalTrials.gov number, NCT02994927.).


Asunto(s)
Compuestos de Anilina/uso terapéutico , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Ácidos Nipecóticos/uso terapéutico , Prednisona/administración & dosificación , Receptor de Anafilatoxina C5a/antagonistas & inhibidores , Administración Oral , Compuestos de Anilina/efectos adversos , Azatioprina/administración & dosificación , Ciclofosfamida/administración & dosificación , Método Doble Ciego , Quimioterapia Combinada , Femenino , Glucocorticoides/efectos adversos , Humanos , Inmunosupresores/administración & dosificación , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Ácidos Nipecóticos/efectos adversos , Prednisona/efectos adversos , Recurrencia , Inducción de Remisión , Rituximab/administración & dosificación
13.
Eur Rev Med Pharmacol Sci ; 25(2): 1070-1079, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33577063

RESUMEN

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has elevated mortality in severe and critical patients globally. This study examined the effect of glucocorticoids (GCS) on the time of virus clearance and absorption of lung lesions in severe and critical COVID-19 patients. PATIENTS AND METHODS: Severe and critical COVID-19 cases diagnosed in Wuhan Pulmonary Hospital from January 7 to February 10, 2020 were analyzed. The generalized linear model was utilized to assess the effects of GCS therapy on the times of nucleic acid test turning negative and improved pulmonary imaging, respectively. RESULTS: Of 66 patients, 51 (77.3%) and 15 (22.7%) were severe and critical cases, respectively, and aged 62 ± 11 years. A total of 58 patients (87.9%) tested negative, and 56 (84.8%) showed improved lung imaging. Age, thrombocytopenia, CD8 + T cell count, course of GCS therapy, and total dose were correlated with the time of nucleic acid test turning negative (p < 0.05), and sex was correlated with the time of initial pulmonary imaging improvement (p < 0.05). The time of nucleic acid test turning negative in individuals with GCS therapy course ≤ 10 days was shorter than that of the GCS therapy course > 10 days group (p=0.001). No statistical difference was found in the dose, course of GCS, and initial time of improved lung imaging. CONCLUSIONS: Increasing the dose of GCS and prolonging the course of treatment do not shorten the time of nucleic acid test turning negative or improved absorption of pulmonary lesions. Thus, the rational use of GCS is particularly important.


Asunto(s)
/diagnóstico por imagen , Enfermedad Crítica/terapia , Glucocorticoides/administración & dosificación , Índice de Severidad de la Enfermedad , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento
14.
Med. clín (Ed. impr.) ; 156(1): 7-12, ene. 2021. tab, graf
Artículo en Español | IBECS | ID: ibc-196134

RESUMEN

OBJETIVO: Analizar si existe asociación entre el uso de glucocorticoides a dosis altas y la evolución de la SAFI (saturación/fracción inspirada de oxígeno) o el tiempo hasta el alta, en pacientes hospitalizados por COVID-19. MÉTODOS: Estudio observacional sobre una cohorte de 418 pacientes ingresados en 3 hospitales comarcales de Cataluña (España). Como resultados primarios se estudiaron la evolución de la SAFI en las primeras 48h de tratamiento y el tiempo hasta el alta. Los resultados se compararon entre pacientes tratados y no tratados con glucocorticoides (metilprednisolona 1-2mg/kg/día o dexametasona 20-40mg/día), mediante el análisis de subcohortes emparejadas por múltiples factores clínicos y pronósticos, así como mediante modelos multivariantes de Cox, ajustados por diversos factores pronósticos. El uso simultáneo de diferentes tratamientos para la COVID-19 fue tenido en cuenta, tanto en el emparejamiento de subcohortes como en la regresión de Cox. RESULTADOS: Hubo 187 pacientes con glucocorticoides; de ellos, 25 pacientes pudieron ser emparejados con un número equivalente de pacientes control. En las subcohortes emparejadas, no se apreció diferencia en el tiempo hasta el alta (log-rank: p = 0,291), ni en el cambio en la SAFI a las 48h desde la basal (glucocorticoides: −0,04; controles: +0,37; p = 0,095). Los modelos multivariantes mediante regresión de Cox mostraron un tiempo hasta el alta significativamente más largo en pacientes tratados con glucocorticoides (hazard ratio: 7,26; IC 95%: 3,30-15,95). CONCLUSIONES: No hemos encontrado mejoría en la función respiratoria o tiempo hasta el alta, asociado al uso de glucocorticoides a dosis altas


OBJECTIVE: To analyze whether there is an association between the use glucocorticoids at high doses, and the evolution of saturation/fraction of inspired oxygen (SAFI) or time to discharge, in patients hospitalized with COVID-19. METHODS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI in the first 48hours of treatment and the time to discharge. The results were compared between patients treated and untreated with glucocorticoids (methylprednisolone 1-2mg/kg/day o dexamethasone 20-40mg/day) through sub-cohort analyses matched for multiple clinical and prognostic factors, as well as through Cox multivariate models adjusted for prognostic factors. The simultaneous use of different treatments for COVID-19 was taken into account, both in sub-cohorts matching and in Cox regression. RESULTS: There were 187 patients treated with glucocorticoids; of these, 25 patients could be matched with an equivalent number of control patients. In the analysis of these matched sub-cohorts, no significant difference was observed in time to discharge (log-rank: p = 0.291) or the increment in SAFI at 48hours of treatment (glucocorticoides: −0.04; controls: +0.37; p = 0.095). Multivariate models using Cox regression showed a significantly longer time to discharge in patients treated with glucocorticoids (hazard ratio: 7.26; 95% IC: 3.30-15.95). CONCLUSIONS: We have not found improvement in respiratory function or time until discharge, associated with the use of glucocorticoids at high doses


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Glucocorticoides/administración & dosificación , Alta del Paciente , Estudios de Cohortes , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Betacoronavirus/efectos de los fármacos , Oxígeno/administración & dosificación , Metilprednisolona/administración & dosificación , Dexametasona/administración & dosificación , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico
15.
Eur J Endocrinol ; 184(4): R111-R122, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33449912

RESUMEN

Glucocorticoids are, besides non-steroidal anti-inflammatory drugs, the most widely used anti-inflammatory medications. Prevalence studies indicate substantial use of both systemic and locally acting agents. A recognised adverse effect of glucocorticoid treatment is adrenal insufficiency, which is highly prevalent based on biochemical testing, but its clinical implications are poorly understood. Current evidence, including randomised trials and observational studies, indicates substantial variation among patients in both risk and course of glucocorticoid-induced adrenal insufficiency, but both are currently unpredictable. Oral and intra-articular formulations, as well as long-term and high-dose treatments, carry the highest risk of glucocorticoid-induced adrenal insufficiency defined by biochemical tests. However, no route of administration, treatment duration, or dose can be considered without risk. More research is needed to estimate the risk and temporal pattern of glucocorticoid-induced adrenal insufficiency, to investigate its clinical implications, and to identify predictors of risk and prognosis. Randomized trials are required to evaluate whether hydrocortisone replacement therapy mitigates risk and symptoms of glucocorticoid-induced adrenal insufficiency in patients discontinuing glucocorticoid treatment. This review aims to provide an overview of the available evidence, pointing to knowledge gaps and unmet needs.


Asunto(s)
Insuficiencia Suprarrenal/inducido químicamente , Insuficiencia Suprarrenal/tratamiento farmacológico , Glucocorticoides/efectos adversos , Terapia de Reemplazo de Hormonas , Insuficiencia Suprarrenal/fisiopatología , Antiinflamatorios/efectos adversos , Antiinflamatorios/uso terapéutico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Hidrocortisona/uso terapéutico , Sistema Hipotálamo-Hipofisario/efectos de los fármacos , Sistema Hipotálamo-Hipofisario/fisiopatología , Sistema Hipófiso-Suprarrenal/efectos de los fármacos , Sistema Hipófiso-Suprarrenal/fisiopatología
16.
Eur J Endocrinol ; 184(4): 553-563, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33460392

RESUMEN

Objective: Despite published guidelines no unified approach to hormone replacement in congenital adrenal hyperplasia (CAH) exists. We aimed to explore geographical and temporal variations in the treatment with glucocorticoids and mineralocorticoids in CAH. Design: This retrospective multi-center study, including 31 centers (16 countries), analyzed data from the International-CAH Registry. Methods: Data were collected from 461 patients aged 0-18 years with classic 21-hydroxylase deficiency (54.9% females) under follow-up between 1982 and 2018. Type, dose and timing of glucocorticoid and mineralocorticoid replacement were analyzed from 4174 patient visits. Results: The most frequently used glucocorticoid was hydrocortisone (87.6%). Overall, there were significant differences between age groups with regards to daily hydrocortisone-equivalent dose for body surface, with the lowest dose (median with interquartile range) of 12.0 (10.0-14.5) mg/m2/day at age 1-8 years and the highest dose of 14.0 (11.6-17.4) mg/m2/day at age 12-18 years. Glucocorticoid doses decreased after 2010 in patients 0-8 years (P < 0.001) and remained unchanged in patients aged 8-18 years. Fludrocortisone was used in 92% of patients, with relative doses decreasing with age. A wide variation was observed among countries with regards to all aspects of steroid hormone replacement. Conclusions: Data from the I-CAH Registry suggests international variations in hormone replacement therapy, with a tendency to treatment with high doses in children.


Asunto(s)
Corticoesteroides/uso terapéutico , Hiperplasia Suprarrenal Congénita/tratamiento farmacológico , Terapia de Reemplazo de Hormonas/métodos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Corticoesteroides/administración & dosificación , Factores de Edad , Niño , Preescolar , Femenino , Fludrocortisona/administración & dosificación , Fludrocortisona/uso terapéutico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Terapia de Reemplazo de Hormonas/estadística & datos numéricos , Humanos , Hidrocortisona/administración & dosificación , Hidrocortisona/uso terapéutico , Lactante , Recién Nacido , Masculino , Sistema de Registros , Estudios Retrospectivos
17.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431450

RESUMEN

An 83-year-old woman was referred to hospital with a 2-week history of short-lived episodic unpleasant sensations in her head and running down her body. This was accompanied by new short-term memory impairment and arm spasms. Initial investigations including blood tests and brain imaging did not reveal the diagnosis. The patient developed an increasing frequency of abnormal movements of her face and arm. These were clinically recognised as faciobrachial dystonic seizures (FBDS). FBDS are pathognomonic of an autoimmune encephalitis caused by an antibody directed against leucine-rich glioma-inactivated 1 (LGI1). The clinical diagnosis resulted in treatment with immunotherapy, leading to cessation of seizures and rapid cognitive recovery. Later, the predicted serology was confirmed. This reversible and under-recognised cause of cognitive impairment, typically affecting elderly patients, can be diagnosed clinically to enable early and effective treatment.


Asunto(s)
Autoanticuerpos/sangre , Disfunción Cognitiva/inmunología , Inmunoterapia/métodos , Encefalitis Límbica/diagnóstico , Convulsiones/inmunología , Administración Intravenosa , Anciano de 80 o más Años , Autoanticuerpos/inmunología , Disfunción Cognitiva/terapia , Femenino , Glucocorticoides/administración & dosificación , Humanos , Péptidos y Proteínas de Señalización Intracelular/inmunología , Encefalitis Límbica/complicaciones , Encefalitis Límbica/inmunología , Encefalitis Límbica/terapia , Sistema Límbico/diagnóstico por imagen , Sistema Límbico/inmunología , Metilprednisolona/administración & dosificación , Intercambio Plasmático , Tomografía de Emisión de Positrones , Convulsiones/terapia , Resultado del Tratamiento
18.
Pediatr Nephrol ; 36(4): 1019-1023, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33495896

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is thought to cause kidney injury via a variety of mechanisms. The most common reported kidney injury following COVID-19 infection is acute tubular injury (ATI); however, the procoagulant state induced by the virus may also damage the kidneys. CASE-DIAGNOSIS/TREATMENT: Herein, we report two cases of acute necrotizing glomerulonephritis (GN) with fibrinoid necrosis in the context of COVID-19 infection. The one with more chronic features in the kidney biopsy progressed to permanent kidney failure but the second one had an excellent response to glucocorticoid pulse therapy with subsequent normal kidney function at 2-month follow-up. CONCLUSIONS: Both reported cases had an acute presentation of kidney injury with positive nasopharyngeal PCR test for COVID-19. Based on the data review by the researchers, this is the first report of acute necrotizing GN associated with COVID-19 infection.


Asunto(s)
Lesión Renal Aguda/etiología , Glomerulonefritis/etiología , Glomérulos Renales/patología , /patogenicidad , Lesión Renal Aguda/patología , Lesión Renal Aguda/terapia , Adolescente , Biopsia , Coagulación Sanguínea , /diagnóstico , Glomerulonefritis/patología , Glomerulonefritis/terapia , Glucocorticoides/administración & dosificación , Humanos , Glomérulos Renales/irrigación sanguínea , Masculino , Necrosis/inmunología , Necrosis/patología , Recuento de Plaquetas , Quimioterapia por Pulso , Diálisis Renal , Resultado del Tratamiento
19.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431469

RESUMEN

Bilateral sight threatening macular and optic nerve inflammation may occur with dengue fever, necessitating the use of systemic steroids. We report a case of bilateral dengue maculopathy in an elderly woman managed with targeted intravitreal steroid therapy. A 63-year-old woman presented with acute-onset painless diminution of vision in both eyes following a dengue fever episode. She had bilateral foveal inflammatory lesions, macular oedema, small vessel occlusions at the macula and scattered retinal haemorrhages and cotton-wool spots. Following systemic evaluation, intravitreal triamcinolone acetonide injection was performed in both eyes at an interval of 3 days. The foveal lesion and macular oedema resolved quickly in both eyes with a normal foveal architecture at the end of 6-week follow-up. The visual acuity improved considerably in both eyes. Inflammatory retinopathy in dengue fever may be managed with a targeted intravitreal steroid injection approach.


Asunto(s)
Dengue/complicaciones , Glucocorticoides/administración & dosificación , Edema Macular/tratamiento farmacológico , Edema Macular/virología , Triamcinolona Acetonida/administración & dosificación , Dengue/diagnóstico , Dengue/terapia , Femenino , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico , Persona de Mediana Edad
20.
Int J Pharm ; 595: 120241, 2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33484917

RESUMEN

Inhaled ciclesonide (CIC), a corticosteroid used to treat asthma that is also being investigated for the treatment of corona virus disease 2019, hydrolyzes to desisobutyryl-ciclesonide (des-CIC) followed by reversible esterification when exposed to fatty acids in lungs. While previous studies have described the distribution and metabolism of the compounds after inhalation, spatial localization in the lungs remains unclear. We visualized two-dimensional spatial localization of CIC and its metabolites in rat lungs after administration of a single dose of a CIC aerosol (with the mass median aerodynamic diameter of 0.918-1.168 µm) using desorption electrospray ionization-time of flight mass spectrometry imaging (DESI-MSI). In the analysis, CIC, des-CIC, and des-CIC-oleate were imaged in frozen lung sections at high spatial and mass resolutions in negative-ion mode. MSI revealed the coexistence of CIC, des-CIC, and des-CIC-oleate on the airway epithelium, and the distribution of des-CIC and des-CIC-oleate in peripheral lung regions. In addition, a part of CIC independently localized on the airway epithelium. These results suggest that distribution of CIC and its metabolites in lungs is related to both the intended delivery of aerosols to pulmonary alveoli and peripheral regions, and the potential deposition of CIC particles on the airway epithelium.


Asunto(s)
Glucocorticoides/administración & dosificación , Glucocorticoides/farmacocinética , Pulmón/diagnóstico por imagen , Pulmón/metabolismo , Pregnenodionas/administración & dosificación , Pregnenodionas/farmacocinética , Espectrometría de Masa por Ionización de Electrospray/métodos , Administración por Inhalación , Aerosoles/química , Animales , Células Epiteliales/metabolismo , Glucocorticoides/sangre , Pregnenodionas/sangre , Pregnenodionas/metabolismo , Alveolos Pulmonares/metabolismo , Ratas , Ratas Sprague-Dawley , Distribución Tisular
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...