ABSTRACT
BACKGROUND/AIMS: There is a lack of effective and safe methods for preventing esophageal stricture after large endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer. We aimed to compare the effectiveness of oral prednisolone alone versus a combination of oral prednisolone and nasogastric tube in preventing esophageal stricture following extensive ESD. MATERIALS AND METHODS: We retrospectively gathered clinical data from a single center on patients with early esophageal cancer who underwent ESD. Patients were categorized into 2 groups: the steroid group (receiving only oral prednisolone) and the steroid+nasogastric tube retention (NGT) group. We analyzed the incidence of esophageal stricture and identified risk factors for its development. RESULTS: The study included 79 patients, with 30 in the steroid group and 49 in the steroid+NGT group. The incidence of stricture was significantly higher in the steroid group (9/30, 30.0%) compared to the steroid+NGT group (3/49, 6.1%) (P = .004). Notably, we observed a significant difference in the stricture rates between the 2 groups, particularly in patients with a complete circumferential defect (100% and 16.7%) (P = .015). Multivariate logistic regression analysis revealed that a full circumferential defect of the esophageal mucosa (OR 12.501; 95% CI 1.907, 81.047; P = .008), invasion depth beyond the lamina propria (OR 5.635; 95% CI 1.039, 30.559; P = .045), and the absence of NGT retention (OR 12.896; 95% CI 2.099, 79.219; P = .006) were independent risk factors predicting the development of a stricture. CONCLUSION: The combination of steroids with NGT retention is more effective than using oral steroids alone in preventing esophageal stricture after extensive ESD.
Subject(s)
Endoscopic Mucosal Resection , Esophageal Neoplasms , Esophageal Stenosis , Intubation, Gastrointestinal , Prednisolone , Humans , Esophageal Stenosis/prevention & control , Esophageal Stenosis/etiology , Male , Female , Esophageal Neoplasms/surgery , Prednisolone/administration & dosage , Retrospective Studies , Endoscopic Mucosal Resection/adverse effects , Endoscopic Mucosal Resection/methods , Middle Aged , Aged , Intubation, Gastrointestinal/methods , Administration, Oral , Postoperative Complications/prevention & control , Postoperative Complications/etiology , Risk Factors , Treatment Outcome , Incidence , Logistic ModelsABSTRACT
The severe acute respiratory syndrome coronavirus 2 vaccine has contributed to infection control and the prevention of complications due to coronavirus disease 2019 (COVID-19). Conversely, the COVID-19 vaccine has been associated with adverse effects due to liver injury caused by autoimmunity or drugs. To date, Japanese journals have only published five reports of autoimmune liver damage associated with the COVID-19 vaccination. Although the pathogenic mechanism has not yet been fully elucidated, corticosteroids or azathioprine have shown effectiveness in certain patients. However, there have been cases of liver injury resulting in deaths. Here, we encountered three patients who developed autoimmune hepatitis (AIH) within 10 days following vaccination. All three patients were treated with prednisolone (PSL) and achieved remission. However, the serum alanine aminotransferase levels in all cases were observed to either increase or cease to improve during the therapeutic course before PSL administration. It is therefore imperative to closely monitor liver injury after the COVID-19 vaccination. In cases where AIH is suspected and a recurrence of liver dysfunction occurs, PSL may be administered. Future considerations should not only encompass the underlying mechanism by which autoimmunity contributes to the development of liver injury following COVID-19 vaccination but also the optimal treatment period for PSL and the long-term prognosis of AIH after COVID-19 vaccination.
Subject(s)
COVID-19 Vaccines , Hepatitis, Autoimmune , Prednisolone , Recurrence , Humans , Hepatitis, Autoimmune/etiology , COVID-19 Vaccines/adverse effects , Female , Male , Prednisolone/administration & dosage , Prednisolone/therapeutic use , Middle Aged , Aged , COVID-19/prevention & control , Vaccination/adverse effectsABSTRACT
Kimura's disease (KD) is a chronic inflammatory disorder characterized by nontender lymphadenopathy involving the head and neck region. Renal involvement in KD is rare, especially in children. We report a 12-year-old boy who had been previously treated for classical KD and had presented with anasarca and oliguria after 4 years. There were no swellings or lymphadenopathy. The kidney biopsy revealed membranous nephropathy. Remission was achieved with oral prednisolone and tacrolimus therapy. This patient highlights the need to regularly monitor patients with KD for the evolution of renal diseases, even if lymphadenopathy regresses. Serial monitoring for eosinophilia, inflammatory markers, and urine examination is needed to help identify subclinical disease early and prompt initiation of specific therapy.
Subject(s)
Glomerulonephritis, Membranous , Immunosuppressive Agents , Kimura Disease , Prednisolone , Tacrolimus , Humans , Male , Glomerulonephritis, Membranous/drug therapy , Glomerulonephritis, Membranous/diagnosis , Glomerulonephritis, Membranous/pathology , Child , Kimura Disease/diagnosis , Kimura Disease/complications , Kimura Disease/drug therapy , Biopsy , Immunosuppressive Agents/therapeutic use , Treatment Outcome , Prednisolone/therapeutic use , Tacrolimus/therapeutic use , Remission Induction , Kidney/pathology , Drug Therapy, Combination , Glucocorticoids/therapeutic useABSTRACT
The polymeric nanoparticles (PNPs) loaded with prednisolone were developed to exhibit pH-responsive properties owing to the attachment of a hydrazone linkage between the copolymer chitosan and mPEG. In the diseased cellular environment, the hydrazone bond tends to break due to reduced pH, leading to the release of the drug from the PNPs at the required site of action. The fabricated PNPs exhibit spherical morphology, optimum size (â¼200 nm), negative surface charge, and monodispersed particle size distribution. The encapsulation efficiency of the PNPs was determined to be 71.1 ± 0.79 % and two experiments (polymer weight loss and drug release) confirmed the pH-responsive properties of the PNPs. The cellular study cytotoxicity assay showed biocompatibility of PNPs and drug molecule-mediated toxicity to A549 cells. The ligand atrial natriuretic peptide-attached PNPs internalized into A549 cells via natriuretic peptide receptor-A to achieve target specificity. The PNPs cytotoxicity and pH-response medicated inflammation reduction functionality was studied in inflammation-induced RAW264.7 cell lines. The study observed the PNPs effectively reduced the inflammatory mediators NO and ROS levels in RAW264.7. The results showed that pH-responsive properties of PNPs and this novel fabricated delivery system effectively treat inflammatory and cancer diseases.
Subject(s)
Chitosan , Click Chemistry , Nanoparticles , Chitosan/chemistry , Chitosan/pharmacology , Hydrogen-Ion Concentration , Humans , Mice , Animals , Nanoparticles/chemistry , RAW 264.7 Cells , A549 Cells , Drug Carriers/chemistry , Drug Carriers/chemical synthesis , Drug Delivery Systems , Particle Size , Polymers/chemistry , Polymers/chemical synthesis , Polymers/pharmacology , Drug Liberation , Prednisolone/chemistry , Prednisolone/pharmacology , Cell Survival/drug effectsABSTRACT
Rheumatoid arthritis (RA) requires therapeutic approaches that alleviate symptoms and inhibit the progression of joint damage. Glucocorticoids (GCs) have been a cornerstone of RA treatment, yet their use is often limited by side effects. Recent advancements suggest that liposome-based delivery systems can improve GC biodistribution, minimizing toxicity. This study introduces an innovative tool for RA treatment using prednisone-encapsulated nonphospholipid liposomes (NPLs) in combination with a hyaluronic acid (HA) hydrogel. Our methodology involved incorporating prednisone (PR) with palmitic acid and cholesterol to formulate stable NPLs using a thin-film hydration technique. The synthesized PR-NPLs, characterized by a mean size of 150 nm, demonstrated uniform distribution and higher drug encapsulation in comparison with conventional phospholipid liposomes. In vitro assays revealed that PR-NPL markedly reduced inflammatory responses in macrophages. Additionally, we successfully incorporated PR-NPL into an HA hydrogel, employing a photoinitiated cross-linking process. This novel composite offered modulable PR release, governed by the degree of hydrogel cross-linking. The developed system presents a promising advancement in RA management, especially suited for intraarticular injections. It potentially enables targeted, controlled drug release with a reduced risk of side effects, signifying a significant improvement over existing RA therapies.
Subject(s)
Arthritis, Rheumatoid , Hyaluronic Acid , Hydrogels , Liposomes , Hyaluronic Acid/chemistry , Hyaluronic Acid/pharmacology , Liposomes/chemistry , Arthritis, Rheumatoid/drug therapy , Hydrogels/chemistry , Hydrogels/pharmacology , Mice , Animals , Prednisolone/chemistry , Prednisolone/pharmacology , Prednisolone/pharmacokinetics , Humans , RAW 264.7 CellsABSTRACT
An 11-year-old neutered male large crossbreed dog was presented for investigation because of a 10-day history of progressive lethargy, hyporexia, and pyrexia. Physical and dermatological examinations were unremarkable. Blood biochemical analysis identified a marked total and ionized hypercalcemia and increased C-reactive protein concentration. Bicavitary computed tomography screening for causes of the dog's clinical and biochemical abnormalities identified a diffuse panniculitis. Histopathological examination of full-thickness skin biopsies was consistent with pyogranulomatous inflammation. Extensive histochemical staining revealed no infectious etiology. Complete clinical and biochemical remissions were observed after starting immunosuppressive, followed by tapering, doses of prednisolone, supporting an immune-mediated etiology. Key clinical message: Sterile, immune-mediated pyogranulomatous inflammation should remain a differential diagnosis for hypercalcemia in dogs. Significant dermatological disease may occur without visible abnormalities.
Panniculite pyogranulomateuse à médiation immunitaire avec hypercalcémie chez un chienUn grand chien croisé mâle castré de 11 ans a été présenté pour examen en raison d'antécédents de léthargie progressive, d'hyporexie et de pyrexie depuis 10 jours. Les examens physiques et dermatologiques étaient sans particularité. L'analyse biochimique du sang présentait une hypercalcémie totale et ionisée marquée et une concentration accrue de protéine C-réactive. Le dépistage par tomodensitométrie bicavitaire des causes des anomalies cliniques et biochimiques du chien a identifié une panniculite diffuse. L'examen histopathologique des biopsies cutanées de pleine épaisseur était compatible avec une inflammation pyogranulomateuse. Un examen par coloration histochimique extensive n'a révélé aucune étiologie infectieuse. Les rémissions cliniques et biochimiques complètes ont été observées après le début du traitement immunosuppresseur, suivies d'une diminution progressive des doses de prednisolone, confirmant une étiologie à médiation immunitaire.Message clinique clé:L'inflammation pyogranulomateuse stérile à médiation immunitaire doit rester un diagnostic différentiel de l'hypercalcémie chez le chien. Une maladie dermatologique importante peut survenir sans anomalies visibles.(Traduit par Dr Serge Messier).
Subject(s)
Dog Diseases , Hypercalcemia , Panniculitis , Animals , Dogs , Dog Diseases/diagnosis , Dog Diseases/drug therapy , Dog Diseases/pathology , Male , Panniculitis/veterinary , Panniculitis/diagnosis , Hypercalcemia/veterinary , Prednisolone/therapeutic use , Immunosuppressive Agents/therapeutic useABSTRACT
Objective: To present a case of ocular toxoplasmosis. Materials and methods: A sixteen-year-old female patient presented to our clinic with complaints regarding decreased vision in her right eye (BCVA 0.5), starting five days before the exam. Her anamnestic data revealed a previous history of ocular toxoplasmosis in her left eye. OCT scans of the inner retina identified a huge cystic space, located posterior to the inner line, off the outer plexiform layer, with a small amount of hyperreflective foci. Other features of OCT included membranous-like structures on inner borders and elongation and splitting of the inner segment/outer segment junction. In later stages, beginning signs of retinitis and scaring could be observed. Results: The patient was treated with sulfamethoxazole/trimethoprim and prednisolone. After two weeks, total regression occurred and visual acuity and OCT remained stable for 6 months (BCVA 1.0). Discussion: Ocular toxoplasmosis can cause significant vision loss due to retinitis and scarring. Following treatment with sulfamethoxazole/trimethoprim and prednisolone, the patient's condition improved significantly and her visual acuity remained stable. Conclusion: On clinical examination and using OCT, rare morphological cystoid spaces (CS) can be identified as huge outer retina cysts (HORC), which are pathognomonic for posterior uveitis. Abbreviations: HORC = huge outer retinal cyst, OCT = optical coherence tomography, BCVA = best corrected visual acuity, CS = cyst space, OPL = outer plexiform layer, HRF = hyper reflective foci, RPE = retinal pigment epithelium, IS = inner segment, OS = outer segment, ERM = epiretinal membrane, PORT = punctate outer retinal toxoplasmosis, ELM = external limiting membrane.
Subject(s)
Tomography, Optical Coherence , Toxoplasmosis, Ocular , Visual Acuity , Humans , Female , Toxoplasmosis, Ocular/diagnosis , Toxoplasmosis, Ocular/drug therapy , Toxoplasmosis, Ocular/parasitology , Tomography, Optical Coherence/methods , Adolescent , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/parasitology , Eye Infections, Parasitic/drug therapy , Fluorescein Angiography/methods , Prednisolone/therapeutic use , Retina/parasitology , Retina/pathology , Glucocorticoids/therapeutic use , Fundus Oculi , Toxoplasma/isolation & purificationABSTRACT
A 6-year-old spayed female domestic short-hair cat was presented for primary complaints of anorexia and lethargy. The cat was being treated with cyclosporine (25 mg/cat, PO q24h) and prednisolone (1 mg/kg, PO q12h) for feline hypersensitivity dermatitis and inflammatory bowel disease for 1 year, wherein prednisolone was withdrawn 2 weeks prior to presentation. At presentation, dehydration, hyperglycaemia, ketonaemia, increased fructosamine, glucosuria, ketonuria and metabolic acidosis were observed. The cat was diagnosed with diabetic ketoacidosis (DKA). Immediate treatments with insulin continuous-rate infusion and intravenous fluid therapy were initiated. A serum cyclosporine concentration was >2100 ng/mL, indicating cyclosporine toxicity. Cyclosporine was discontinued immediately. The cat's acidosis and ketonaemia were resolved within a week, allowing a switch from insulin continuous-rate infusion to subcutaneous glargine (1 IU/cat), which was eventually discontinued due to persistent normoglycaemia 12 days after initial presentation. Hyperglycaemia was not observed for 28 days thereafter without insulin, indicating remission of diabetes mellitus. This report suggests that using prednisolone, particularly immune suppressive doses, could be problematic in cats receiving long-term cyclosporine therapy. Additionally, diabetic cats receiving immune-suppressive agents can possibly achieve diabetic remission after surviving DKA through regular monitoring of blood glucose concentration, elimination of prednisolone and intensive blood glucose management.
Subject(s)
Cat Diseases , Cyclosporine , Immunosuppressive Agents , Prednisolone , Animals , Cats , Female , Cyclosporine/therapeutic use , Cat Diseases/drug therapy , Cat Diseases/chemically induced , Prednisolone/therapeutic use , Prednisolone/administration & dosage , Immunosuppressive Agents/therapeutic use , Diabetes Mellitus/veterinary , Diabetes Mellitus/drug therapy , Drug Therapy, CombinationABSTRACT
Treatment of Mycoplasma spp. pneumonia has rarely been described in domestic ferrets (Mustela putorius furo). A 10-month-old, 0.53 kg, female spayed domestic ferret was presented for oxygen-dependent, chronic dyspnea of one-month's duration. Physical examination findings included dyspnea, tachypnea, increased bronchovesicular sounds bilaterally, and an intermittent non-productive cough. Bloodwork abnormalities included a mild leukocytosis (8.6×103/µL), mild neutrophilia (4.0×103/µL), mild hypoalbuminemia (2.7 g/dL), mild hyperglobulinemia (3.3 g/dL), mild hyponatremia (147 mEq/L), and mild hypochloremia (111.4 mEq/L). Radiographs revealed a marked diffuse bronchial pattern with peribronchial cuffing, a mild main pulmonary artery bulge, distended caudal lobar pulmonary arteries, and decreased serosal detail within the abdomen. An echocardiogram revealed indications of moderate pulmonary hypertension and systolic anterior motion of the mitral valve. Polymerase chain reaction testing for Mycoplasma spp. was positive, and treatment was initiated with doxycycline (10 mg/kg PO q 12 h for 16 weeks), prednisolone (0.4 mg/kg PO q 12 h for 13 weeks, tapered to 0.2 mg/kg PO q 12 h for two weeks, then eventually increased to 0.7 mg/kg PO q 12 h until further notice), sildenafil (0.3 mg/kg PO q 24 h for 13 weeks), and oxygen supplementation via an oxygen cage for six weeks. On repeat echocardiogram eleven weeks after initiation of doxycycline therapy, the pulmonary hypertension had resolved. At follow up six months later, the ferret was stable on previously prescribed medications and did not require oxygen supplementation. Mycoplasma spp. and pulmonary hypertension should be considered in cases of respiratory distress in ferrets.
Subject(s)
Anti-Bacterial Agents , Ferrets , Hypertension, Pulmonary , Animals , Female , Hypertension, Pulmonary/veterinary , Anti-Bacterial Agents/therapeutic use , Pneumonia, Mycoplasma/veterinary , Pneumonia, Mycoplasma/drug therapy , Pneumonia, Mycoplasma/diagnosis , Doxycycline/therapeutic use , Prednisolone/therapeutic use , Sildenafil Citrate/therapeutic useABSTRACT
Optic neuritis is a rare presentation of vitamin B12 deficiency. We describe a 33-year-old female patient living with HIV presenting with progressive loss of vision for 1 week. She had a history of severe peripheral neuropathy that was managed with vitamin B12-containing tablets approximately three years before presenting with progressive loss of vision. On examination, she had no perception of light in the left eye and no perception of hand motion in the right eye. The fundus in her left eye had mild blurring of disc margins. Results from tests done showed a haemoglobin of 12.9g/dl, MCV 101fl, a serum vitamin B12 of 78pmol/l, and cytomegalovirus (CMV) test showed no active disease. She was diagnosed with optic neuritis and started on 30 mg tablets of prednisolone for 1 week with slight improvement. She was then started on vitamin B12 injections 1 mg daily for 10 days and thereafter, monthly for 6 months. She reported gradual improvement and regained her sight after 5 months treatment of with Vitamin B12 injections. Ophthalmic manifestations of vitamin B12 deficiency are not common and may present without haematological signs therefore, a high index of suspicion is required for early diagnosis and management of vitamin B12 deficiency.
Subject(s)
Alkynes , Anti-HIV Agents , Benzoxazines , Blindness , Cyclopropanes , HIV Infections , Optic Neuritis , Vitamin B 12 Deficiency , Vitamin B 12 , Humans , Female , Adult , Vitamin B 12 Deficiency/diagnosis , Vitamin B 12 Deficiency/drug therapy , Vitamin B 12 Deficiency/complications , Vitamin B 12/administration & dosage , HIV Infections/complications , HIV Infections/drug therapy , Benzoxazines/administration & dosage , Benzoxazines/adverse effects , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/adverse effects , Blindness/etiology , Cyclopropanes/administration & dosage , Optic Neuritis/diagnosis , Optic Neuritis/drug therapy , Prednisolone/administration & dosage , Glucocorticoids/administration & dosageABSTRACT
Granulomatous mastitis (GM) is a long-term inflammatory disease of the breast that usually occurs in women of reproductive age. Autoimmune mastitis is one of the most common pathological breast conditions necessitating tailored treatment. However, GM as a first clinical manifestation of sarcoidosis is uncommon. Simultaneous occurrence of GM, erythema nodosum (EN), and arthritis, termed "GMENA" syndrome, is a rare clinical entity associated with autoimmune rheumatic diseases. Herein, we report the case of a 31-year-old female patient with GMENA syndrome, who presented with a painful nodule of the left breast. Initial treatment entailed antibiotics under the presumption of a breast abscess, yielding negligible improvement. During this period, the patient developed polyarthritis and bilateral EN on the lower extremities. Histopathologic examination of the breast tissue exhibited noncaseating granulomas. The patient responded positively to prednisolone and methotrexate treatment. Literature review revealed a coherent pattern across GMENA cases. Our findings suggest that the "GMENA" syndrome represents a unique acute manifestation of sarcoidosis and highlight the necessity for heightened awareness, accurate diagnosis, and tailored therapeutic approaches for GMENA syndrome. Further research is warranted to elucidate its cause and optimize patient management. This case highlights the importance of identifying and effectively managing such interrelated clinical presentations.
Subject(s)
Arthritis , Erythema Nodosum , Granulomatous Mastitis , Sarcoidosis , Humans , Female , Erythema Nodosum/diagnosis , Erythema Nodosum/drug therapy , Erythema Nodosum/pathology , Adult , Granulomatous Mastitis/diagnosis , Granulomatous Mastitis/pathology , Granulomatous Mastitis/drug therapy , Sarcoidosis/diagnosis , Sarcoidosis/complications , Sarcoidosis/drug therapy , Sarcoidosis/pathology , Arthritis/diagnosis , Arthritis/drug therapy , Methotrexate/therapeutic use , Prednisolone/therapeutic use , SyndromeABSTRACT
Relapsing polychondritis (RP) is a systemic immune mediated disease characterized by recurrent episodes of inflammation in various cartilage-rich areas. RP may cause extensive tissue destruction and is associated with significant morbidity and mortality. In this multicenter study, we considered the remission status and long-term outcomes of RP in patients who were followed-up in six referral rheumatology centers in Iran. Outcomes of disease was assessed by remission status and RP induced damage. A total of 29 patients with RP were examined for enrollment in the study, and 26 patients with a minimum follow-up period of 6 months were included in the RP outcome analysis. Median time to control of symptoms and sustained remission were 5 and 23 weeks, respectively. Prednisolone was discontinued in 8 (30.8%) patients and medication-free remission was achieved in 7 (23.1%) patients. Regarding the disease course, 34.6% of patients had a relapsing-remitting course, 42.3% had a monophasic course, and 23.1% had an always-active course. Despite extensive treatment with immunosuppressive medications, RP induced damage was developed in 21 (80.8%) patients. Ear deformity and osteoporosis were the most common RP induced damage. Long-term remission and medications-free remission in RP is accessible. However, RP related damage occur in majority of patients.
Subject(s)
Polychondritis, Relapsing , Humans , Polychondritis, Relapsing/drug therapy , Polychondritis, Relapsing/complications , Male , Female , Iran/epidemiology , Adult , Middle Aged , Treatment Outcome , Remission Induction , Prednisolone/therapeutic use , Aged , Immunosuppressive Agents/therapeutic use , Young Adult , Follow-Up StudiesABSTRACT
A male patient in his early 30s was diagnosed with bronchial asthma 3 years previously. He responded well to inhaled corticosteroids and long-acting beta-agonists. Approximately 18 months from the onset, the patient reported worsening symptoms. These symptoms included severe functional limitations, requiring frequent exposure to high-dose prednisolone. Mepolizumab was added to the treatment, leading to optimal control of bronchial asthma. Despite receiving seven doses of mepolizumab at monthly intervals, the patient developed cervical and postauricular lymphadenopathy and subcutaneous swelling of soft tissue. A cervical lymph node biopsy confirmed the diagnosis of Kimura disease. Following treatment with oral glucocorticoids and methotrexate, the patient experienced a complete resolution of symptoms. He has been in remission and off oral prednisolone for the last 13 months. In this case, we highlight the development of Kimura disease in a patient undergoing mepolizumab treatment.
Subject(s)
Antibodies, Monoclonal, Humanized , Asthma , Kimura Disease , Humans , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/administration & dosage , Asthma/drug therapy , Male , Kimura Disease/drug therapy , Adult , Glucocorticoids/therapeutic use , Glucocorticoids/administration & dosage , Prednisolone/therapeutic use , Prednisolone/administration & dosage , Anti-Asthmatic Agents/therapeutic use , Anti-Asthmatic Agents/adverse effects , Methotrexate/therapeutic use , Methotrexate/administration & dosageABSTRACT
Severe Alcoholic Hepatitis (sAH) is an acute form of liver injury caused by chronic and heavy alcohol drinking. A one-month corticosteroids course is the only sAH reference treatment, and its interactions with the Gut Microbiota (GM), which is a key contributor to liver injury, remain unknown. To evaluate the evolution of the GM in sAH patients, we retrospectively investigated the composition of the GM of 27 sAH patients at the Amiens University Hospital before (D0) and after (D7) a 7-day corticotherapy course using fecal metagenomics sequencing. We also quantified fecal Short-Chain Fatty Acids (SCFA) and fecal and serum Bile Acids (BA), as well as serum Lipopolysaccharide-Binding Protein (LBP). Overall, the community and taxonomical analyses did not reveal any GM evolution between D0 and D7, nor did the SCFA profiles analysis. However, in serum but not fecal samples, the ratio of glyco-conjugated to tauro-conjugated BA was significantly reduced at D7, independently of the response to treatment, while two BA were enriched in non-responder patients. LBP concentration significantly diminished between D0 and D7, which may indicate an improvement of the gut barrier. The stability of the GM of sAH is interesting in the perspective of new treatments based on GM modulation.
There is a gap in the understanding of the effects of corticosteroids on the gut microbiota of severe alcoholic hepatitis patients.In this study, the composition of the Gut Microbiota of sAH patients treated with prednisolone remains unchanged after 7 days of prednisolone treatment.Short-Chain Fatty Acid profiles are not impacted by the treatment, while Bile Acids profiles change in serum but not in stool samples.Responders and non-responders show different lipopolysaccharide-binding protein serum concentration evolution across time, as well as distinct Bile Acid profiles.
Subject(s)
Bile Acids and Salts , Feces , Gastrointestinal Microbiome , Hepatitis, Alcoholic , Prednisolone , Humans , Gastrointestinal Microbiome/drug effects , Hepatitis, Alcoholic/drug therapy , Hepatitis, Alcoholic/blood , Male , Feces/microbiology , Feces/chemistry , Bile Acids and Salts/blood , Bile Acids and Salts/metabolism , Middle Aged , Female , Retrospective Studies , Prednisolone/administration & dosage , Adult , Bacteria/classification , Bacteria/genetics , Bacteria/isolation & purification , Bacteria/drug effects , Fatty Acids, Volatile/metabolism , Fatty Acids, Volatile/blood , Carrier Proteins/genetics , Carrier Proteins/blood , Acute-Phase Proteins/metabolism , Membrane Glycoproteins/blood , Membrane Glycoproteins/genetics , Aged , MetagenomicsABSTRACT
PURPOSE: To investigate the functional and structural outcomes after treatment with prednisolone eye drops in the following pachychoroid-related diseases: chronic central serous chorioretinopathy, pachychoroid pigment epitheliopathy, and peripapillary pachychoroid syndrome. METHODS: In this retrospective study, 54 eyes of 48 patients with pachychoroid-related disease were treated with prednisolone acetate 1% eye drops 3 times a day. Change in macular volume and retinal central subfield thickness on optical coherence tomography was measured. In addition, the foveal or complete resolution of fluid and the change in visual acuity were studied. RESULTS: The follow-up visit was at a mean of 41.2 ± 14.5 days. In the 44 eyes with chronic central serous chorioretinopathy, a significant reduction in retinal central subfield thickness ( P < 0.001) and macular volume ( P < 0.001) was observed. Foveal intra- or subretinal fluid resolved completely in 22% of the eyes. In the 8 peripapillary pachychoroid syndrome eyes, a reduction in the nasal retinal thickness was observed ( P = 0.025). One of the 2 pachychoroid pigment epitheliopathy eyes showed structural improvement. No significant change in visual acuity was observed in any of the pachychoroid spectrum diseases. CONCLUSION: In patients with chronic central serous chorioretinopathy, peripapillary pachychoroid syndrome, and pachychoroid pigment epitheliopathy, anatomical improvement was observed after therapy with prednisolone eye drops. Visual acuity did not change significantly.
Subject(s)
Central Serous Chorioretinopathy , Glucocorticoids , Ophthalmic Solutions , Prednisolone , Tomography, Optical Coherence , Visual Acuity , Humans , Retrospective Studies , Male , Female , Prednisolone/analogs & derivatives , Prednisolone/therapeutic use , Prednisolone/administration & dosage , Middle Aged , Tomography, Optical Coherence/methods , Central Serous Chorioretinopathy/drug therapy , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/physiopathology , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Aged , Adult , Fluorescein Angiography/methods , Follow-Up Studies , Choroid Diseases/drug therapy , Choroid Diseases/diagnosisABSTRACT
Rheumatoid pleurisy is common in patients with rheumatoid arthritis, but distinguishing it from other diseases, such as heart failure and tuberculous pleurisy, is often difficult. A man in his 70s with stable rheumatoid arthritis presented with cardiac enlargement and bilateral pleural effusion on chest radiography. Pleural fluid studies showed lymphocytosis, adenosine deaminase level of 51.6 U/L and rheumatoid factor level of 2245.3 IU/mL, suggestive of rheumatoid pleurisy and tuberculous pleurisy. Thoracoscopy under local anaesthesia revealed erythema of the parietal pleura, small papillary projections and fibrin deposits. H&E-stained biopsy specimens showed inflammatory granulomas with strong lymphocytic infiltration and non-caseating granulomas. He was diagnosed with rheumatoid pleurisy. His symptoms improved with 30 mg of prednisolone. This study highlights that biopsy using thoracoscopy under local anaesthesia effectively diagnoses rheumatoid pleurisy, which may be challenging to diagnose.
Subject(s)
Anesthesia, Local , Pleurisy , Thoracoscopy , Humans , Male , Thoracoscopy/methods , Pleurisy/diagnosis , Pleurisy/pathology , Aged , Biopsy/methods , Thoracic Wall/pathology , Diagnosis, Differential , Arthritis, Rheumatoid , Prednisolone/therapeutic use , Prednisolone/administration & dosage , Pleura/pathology , Pleura/diagnostic imagingABSTRACT
A white Caucasian woman in her 30s presented with an indurated lesion on her right upper arm. Panniculitis was clinically suspected. Antinuclear antibody testing was positive but incisional biopsy showed subcutaneous panniculitis-like T-cell lymphoma (SPTCL), although with some unusual features more in keeping with lupus. Initial treatment was with oral prednisolone and radiotherapy but with only partial response. A second biopsy was taken from an area of presumed residual disease. This displayed histological features that were much more typical of lupus erythematosus profundus (LEP) but with tiny foci suggesting concomitant microscopic areas of SPTCL. Immunofluorescence for IgM was positive. This case highlights the rare occurrence of a patient with overlapping clinical and pathological features of SCPTL and LEP. It emphasises the need for close clinicopathological correlation in the workup of patients with suspected panniculitis and the importance of careful pathological examination for features of both diseases.
Subject(s)
Lymphoma, T-Cell , Panniculitis, Lupus Erythematosus , Panniculitis , Humans , Female , Panniculitis/diagnosis , Panniculitis/pathology , Panniculitis, Lupus Erythematosus/diagnosis , Panniculitis, Lupus Erythematosus/drug therapy , Panniculitis, Lupus Erythematosus/pathology , Lymphoma, T-Cell/diagnosis , Lymphoma, T-Cell/pathology , Adult , Diagnosis, Differential , Biopsy , Prednisolone/therapeutic useABSTRACT
BACKGROUND: Sarcoidosis is a systemic disease that can affect multiple organs. While pulmonary sarcoidosis is most commonly observed, renal sarcoidosis occurs less frequently. We herein report a case of sarcoidosis with an exceptionally rare distribution including renal lesions. CASE PRESENTATION: A 51-year-old Japanese female was referred because of bilateral parotid swelling and renal dysfunction. Computed tomography scan showed the swelling of bilateral kidneys, parotid glands, and uterus. Ga scintigraphy also showed remarkable accumulation in these organs. Renal biopsy and cytological evaluations of parotid gland and uterus were performed and she was diagnosed as sarcoidosis of these organs. Treatment was initiated with prednisolone 40 mg/day and then renal dysfunction subsequently improved. In addition, the swelling of parotid glands and uterus improved and Ga accumulation in each organ had disappeared. CONCLUSION: This is a first case of renal sarcoidosis complicated by parotid glands and uterus lesions. Pathological findings and the reactivity observed in Ga scintigraphy indicated the presence of lesions in these organs.
Subject(s)
Kidney Diseases , Sarcoidosis , Humans , Female , Middle Aged , Sarcoidosis/complications , Sarcoidosis/diagnostic imaging , Sarcoidosis/drug therapy , Kidney Diseases/diagnostic imaging , Kidney Diseases/pathology , Kidney Diseases/complications , Kidney Diseases/etiology , Parotid Gland/pathology , Parotid Gland/diagnostic imaging , Uterine Diseases/complications , Uterine Diseases/pathology , Uterine Diseases/diagnostic imaging , Prednisolone/therapeutic use , Parotid Diseases/diagnostic imaging , Parotid Diseases/etiology , Parotid Diseases/pathology , Radionuclide Imaging , Tomography, X-Ray ComputedABSTRACT
An 84-year-old man presented with decreased right-eye visual acuity. Upon initial examination, the rightand left-eye visual acuities were 0.03 and 1.2, respectively; moreover, the right- and left-eye intraocular pressure was 12 mmHg and 13 mmHg, respectively. Examination revealed a shallow anterior chamber of the right eye, anterior chamber inflammation, vitreous opacity, and marked retinochoroidal detachment. Optical coherence tomography (OCT) revealed retinal detachment (RD) and choroidal folds; moreover, B-scan ultrasonography (B-scan) showed RD as well as thickened sclera with fluid in Tenon's space. Fluorescent fundus angiography revealed hyperfluorescence in the optic disc and vascular hyperpermeability in the right eye. The left eye lacked extra-ocular symptoms or abnormalities. The right ocular axis measured 23.4 mm with no apparent subretinal fluid migration due to positional changes. Accordingly, the patient was diagnosed with panuveitis associated with posterior scleritis and immediately started on 40 mg prednisolone, which improved his symptoms. However, at 3 post-treatment months, choroidal folds were observed and was restarted on 20 mg prednisolone. The choroidal folds subsequently disappeared, with a current visual acuity of 0.3 in the right eye and no recurrence. Our findings indicated the utility of accurate diagnosis of posterior scleritis by B-scan and prompt systemic steroid administration.
Subject(s)
Panuveitis , Prednisolone , Retinal Detachment , Scleritis , Tomography, Optical Coherence , Visual Acuity , Humans , Male , Scleritis/etiology , Scleritis/diagnosis , Scleritis/diagnostic imaging , Scleritis/complications , Retinal Detachment/etiology , Retinal Detachment/diagnostic imaging , Retinal Detachment/diagnosis , Aged, 80 and over , Panuveitis/diagnosis , Panuveitis/etiology , Panuveitis/complications , Prednisolone/administration & dosage , Treatment Outcome , Fluorescein Angiography/methods , Choroid/diagnostic imaging , Choroid/pathology , Choroid Diseases/etiology , Choroid Diseases/diagnostic imaging , Choroid Diseases/diagnosis , Choroid Diseases/complicationsABSTRACT
BACKGROUND: Traditionally, 6-month courses of prednisolone are used to treat steroid-responsive meningitis-arteritis (SRMA), but this medication is associated with adverse effects that can lead to poor quality of life. HYPOTHESIS/OBJECTIVES: Resolution of clinical signs and rate of relapse of SRMA would not be significantly different between a 6-month prednisolone protocol and a 6-week protocol. ANIMALS: Forty-four hospital cases from multiple referral centers in the United Kingdom (2015-2019). Twenty of 44 were treated with the 6-month protocol and 24/44 with the 6-week protocol. METHODS: Prospective, randomized trial with 12-month follow-up. The same prednisolone protocol reinitiated in the event of relapse. Analysis of relapses with binary logistic and Poisson regression modeling. RESULTS: All cases responded to their treatment protocol. Relapses occurred in 6/20 (30%) of the 6-month protocol and 9/24 (38%) of the 6-week protocol. There was no statistical difference in the incidence risk of at least 1 relapse between the 2 groups (odds ratio = 1.40; 95% confidence interval [CI], 0.40-4.96, P = 0.60). Among the 15 dogs that relapsed, 10/15 (67%) relapsed once, 3/15 (20%) relapsed twice, and 2/15 (13%) relapsed 3 times. No statistical difference was detected in the incidence rate ratio (IRR) of total relapse events between the 2 groups (IRR = 1.46; 95% CI, 0.61-3.48; P = 0.40). CONCLUSIONS AND CLINICAL IMPORTANCE: "Short" 6-week prednisolone protocols could be used to treat SRMA, thereby presumably reducing the duration and severity of prednisolone's adverse effects.