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1.
Ann Pharmacother ; 57(1): 5-15, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35590468

RESUMO

BACKGROUND: Corticosteroids and tocilizumab have been shown to improve survival in patients who require supplemental oxygen from coronavirus disease 2019 (COVID-19) pneumonia. The optimal dose of immunosuppression for the treatment of COVID-19 acute respiratory distress syndrome (ARDS) is still unknown. OBJECTIVE: The objective of this study was to evaluate the effectiveness and safety of high- versus low-dose corticosteroids with or without tocilizumab for the treatment of COVID-19 ARDS. METHODS: This was a retrospective study of patients admitted to the intensive care unit (ICU) requiring mechanical ventilation who received high- versus low-dose corticosteroids with or without tocilizumab. The primary outcome was survival to discharge. Safety outcomes included infections and incidence of hyperglycemia. RESULTS: In this cohort, 110 (54%) and 95 (46%) patients received high-dose (≥10 mg dexamethasone equivalent) and low-dose (<10 mg dexamethasone equivalent) corticosteroids for more than 3 consecutive days, respectively. Thirty-five patients (32%) in the high-dose group and 33 patients (35%) in the low-dose group survived to hospital discharge (P = 0.85). There was no difference in 28-day mortality in patients who received high-dose corticosteroids without tocilizumab compared with those who received low-dose corticosteroids with tocilizumab (n = 38/82, 46% vs n = 19/40, 48% P = 0.99); however, there was a higher mortality if patients received low-dose corticosteroids without tocilizumab (n = 39/55, 71%, P = 0.01). The highest rate of a bacterial pneumonia was in patients who received high-dose corticosteroids with tocilizumab. CONCLUSIONS: In critically ill patients with COVID-19 ARDS requiring mechanical ventilation, we found no difference in high- versus low-dose corticosteroids with regard to survival to hospital discharge. However, patients receiving only low-dose corticosteroids without tocilizumab did worse than the other groups. Larger prospective studies are needed to determine the optimal immunosuppression dosing strategy in this patient population.


Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Humanos , COVID-19/tratamento farmacológico , SARS-CoV-2 , Estudos Retrospectivos , Síndrome do Desconforto Respiratório/tratamento farmacológico , Respiração Artificial , Corticosteroides/uso terapêutico , Dexametasona/uso terapêutico , Oxigênio
2.
Otolaryngol Clin North Am ; 56(1): 157-168, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36266108

RESUMO

Concurrent chronic rhinosinusitis with nasal polyps (CRSwNP) in the upper airway, and asthma in the lower airway, often have a shared underlying pathophysiology, namely type 2 inflammation; hence, the term "unified airway disease." The combination of CRSwNP and asthma is associated with uncontrolled disease. The range of treatment of CRSwNP includes intranasal corticosteroids, nasal saline irrigation, oral corticosteroids, antibiotics, and biologics. A combined clinical algorithm for the management of the upper and lower airways in type 2 inflammation will be beneficial, especially for patients with uncontrolled disease who may benefit from biologics.


Assuntos
Asma , Produtos Biológicos , Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/tratamento farmacológico , Pólipos Nasais/terapia , Pólipos Nasais/complicações , Sinusite/complicações , Asma/terapia , Corticosteroides/uso terapêutico , Inflamação/complicações , Doença Crônica , Produtos Biológicos/uso terapêutico
3.
J Intensive Care Med ; 38(1): 114-120, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35437034

RESUMO

Patients with antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis who were on immunosuppressive therapy with corticosteroids may be susceptible to cavitary lesions.1 Only a few cases have been reported in the literature to date. Immunosuppression was shown to improve prognosis in patients with vasculitis. However, adverse therapy events and the risk of opportunistic infections become a major cause of morbidity and mortality in this specific patient population. We present a case of a 75-year-old female who was diagnosed and treated in our hospital for ANCA-associated vasculitis and returned within a few weeks of medical therapy and was found to have developed cavitation concerning for worsening vasculitis or an opportunistic fungal infection or combination of both. Given the risk of severe complications from opportunistic fungal infections, close monitoring and prophylactic antifungal therapy should be considered. Further studies are needed to evaluate the benefit of prophylaxis in this patient population.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Anticorpos Anticitoplasma de Neutrófilos , Feminino , Humanos , Idoso , Imunossupressores/efeitos adversos , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/induzido quimicamente , Corticosteroides , Prognóstico
4.
Allergol Int ; 71(2): 185-192, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35236619

RESUMO

Non-HIV immune reconstitution inflammatory syndrome (non-HIV IRIS) is associated with the recovery from an immunocompromised condition. It is defined as inflammatory disorders caused by antigens, including drugs or pathogenic microorganisms present prior to immune recovery, or by the exacerbation of an inflammatory disorder that was already present. Drug-induced hypersensitivity syndrome is a prototype of IRIS, and the pathophysiology of non-HIV IRIS can be recognized in several disorders treated with corticosteroids, immunosuppressants, molecular-targeted drugs, TNF-α antibody drugs, immune checkpoint inhibitors, and dipeptidyl peptidase-4 inhibitors. This review focuses on the relationship between the immune mechanism of non-HIV IRIS and drug allergies, especially severe drug eruption. The antigen recognition mechanism in drug allergy varies depending on the clinical type and the causative drug. The p-i concept is the main mechanism in severe drug eruption such as Stevens-Johnson syndrome/toxic epidermal necrolysis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Lymphocytes activated by an antigen other than a drug, such as a virus, can also develop drug allergy by the loose binding of drugs with immune receptors of T cells or human leukocyte antigen. Therefore, fluctuations in the immune environment affect the onset of severe drug eruption. Novel agents that cause major changes in immunity have been marketed mainly for autoimmune diseases and malignant tumors; therefore, it is necessary to consider their effects when treating severe drug eruptions. Moreover, although a list of diagnostic criteria for this syndrome has been drafted, predictive and diagnostic biomarkers for this syndrome needs to be urgently developed.


Assuntos
Síndrome de Hipersensibilidade a Medicamentos , Eosinofilia , Síndrome Inflamatória da Reconstituição Imune , Síndrome de Stevens-Johnson , Corticosteroides/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Eosinofilia/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Síndrome de Stevens-Johnson/diagnóstico
6.
BMC Pulm Med ; 22(1): 397, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329425

RESUMO

BACKGROUND: Asthma severity is typically assessed through a retrospective assessment of the treatment required to control symptoms and to prevent exacerbations. The joint British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) guidelines encourage a stepwise approach to pharmacotherapy, and as such, current treatment step can be considered as a severity categorisation proxy. Briefly, the steps for adults can be summarised as: no controller therapy (Step 0), low-strength Inhaled Corticosteroids (ICS; Step 1), ICS plus Long-Acting Beta-2 Agonist (LABA; Step 2), medium-dose ICS + LABA (Step 3), and finally either an increase in strength or additional therapies (Step 4). This study aimed to investigate how BTS/SIGN Steps can be estimated from across a large cohort using electronic prescription records, and to describe the incidence of each BTS/SIGN Step in a general population. METHODS: There were 41,433,707 prescriptions, for 671,304 individuals, in the Asthma Learning Health System Scottish cohort, between 1/2009 and 3/2017. Days on which an individual had a prescription for at least one asthma controller (preventer) medication were labelled prescription events. A rule-based algorithm was developed for extracting the strength and volume of medication instructed to be taken daily from free-text data fields. Asthma treatment regimens were categorised by the combination of medications prescribed in the 120 days preceding any prescription event and categorised into BTS/SIGN treatment steps. RESULTS: Almost 4.5 million ALHS prescriptions were for asthma controllers. 26% of prescription events had no inhaled corticosteroid prescriptions in the preceding 120 days (Step 0), 16% were assigned to BTS/SIGN Step 1, 7% to Step 2, 21% to Step 3, and 30% to Step 4. The median days spent on a treatment step before a step-down in treatment was 297 days, whereas a step-up only took a median of 134 days. CONCLUSION: We developed a reproducible methodology enabling researchers to estimate BTS/SIGN asthma treatment steps in population health studies, providing valuable insights into population and patient-specific trajectories, towards improving the management of asthma.


Assuntos
Antiasmáticos , Asma , Prescrição Eletrônica , Adulto , Humanos , Administração por Inalação , Estudos Retrospectivos , Asma/tratamento farmacológico , Asma/epidemiologia , Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Quimioterapia Combinada
7.
Respir Res ; 23(1): 301, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333729

RESUMO

PURPOSE: Acute respiratory distress syndrome (ARDS) is an acute and critical disease among children and adults, and previous studies have shown that the administration of corticosteroids remains controversial. Therefore, a meta-analysis of randomized controlled trials (RCTs) was performed to evaluate the safety and efficacy of corticosteroids. METHODS: The RCTs investigating the safety and efficacy of corticosteroids in ARDS were searched from electronic databases (Embase, Medline, and the Cochrane Central Register of Controlled Trials). The primary outcome was 28-day mortality. Heterogeneity was assessed using the Chi square test and I2 with the inspection level of 0.1 and 50%, respectively. RESULTS: Fourteen RCTs (n = 1607) were included for analysis. Corticosteroids were found to reduce the risk of death in patients with ARDS (relative risk (RR) = 0.78, 95% confidence interval (CI): 0.70-0.87; P < 0.01). Moreover, no significant adverse events were observed, compared to placebo or standard support therapy. Further subgroup analysis showed that variables, such as adults (RR = 0.78; 95% CI: 0.70-0.88; P < 0.01), non-COVID-19 (RR = 0.71; 95% CI: 0.62-0.83; P < 0.01), methylprednisolone (RR = 0.70; 95% CI: 0.56-0.88; P < 0.01), and hydrocortisone (RR = 0.79; 95% CI: 0.63-0.98; P = 0.03) were associated with 28-day mortality among patients who used corticosteroids. However, no association was found, regarding children (RR = 0.21; 95% CI: 0.01-4.10; P = 0.30). CONCLUSION: The use of corticosteroids is an effective approach to reduce the risk of death in ARDS patients. However, this effect is associated with age, non-COVID-19 diseases, and methylprednisolone and hydrocortisone use. Therefore, evidence suggests patients with age ≥ 18 years and non-COVID-19 should be encouraged during the corticosteroid treatment. However, due to substantial differences in the use of corticosteroids among these studies, questions still remain regarding the dosage, optimal corticosteroid agent, and treatment duration in patients with ARDS.


Assuntos
Hidrocortisona , Síndrome do Desconforto Respiratório , Criança , Adulto , Humanos , Adolescente , Hidrocortisona/uso terapêutico , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Corticosteroides/efeitos adversos , Metilprednisolona/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Allergy Asthma Proc ; 43(6): 474-493, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36335413

RESUMO

Background: The treatment of chronic refractory moderate-to-severe atopic dermatitis (AD) has traditionally relied on broad-spectrum systemic anti-inflammatory agents. With the introduction of biologics and Janus kinase inhibitors (Jakinib), the step management of moderate-to-severe AD is rapidly changing; however, guidelines have yet to provide formal recommendations for how to best incorporate these agents into the treatment plan. Objective: To summarize the updated evidence-based medical treatment for AD, including a proposed position for biologics and Jakinibs in the treatment algorithm. Methods: A literature search of several medical literature data bases for guidelines, position papers, systematic reviews, and clinical trials from 2012 to 2022 on the treatment of moderate-to-severe AD was conducted to prepare this narrative review. Results: Emollients and topical corticosteroids are the mainstay for treating acute flares and for maintaining chronic control. Second-line topical agents include calcineurin inhibitors, e.g., tacrolimus and pimecrolimus; crisaborole; and ruxolitinib. For acute flares, cyclosporine is preferred over systemic corticosteroids. For chronic treatment, phototherapy should be considered before systemic anti-inflammatory agents. Of the traditional anti-inflammatory agents, cyclosporine is the first-line choice, with methotrexate and azathioprine equal secondary choices. Although abrocitinib may have better efficacy then dupilumab based on indirect comparisons, abrocitinib requires closer monitoring for adverse events. Based on package labeling, Jakinibs, e.g., abrocitinib and upadacitinib, should be used only after failure with other systemic agents, including biologics (e.g., dupilumab and tralokinumab). Biologics and Jakinibs should be considered before the traditional systemic anti-inflammatory agents. Conclusion: Clinicians should consider a modified step management for AD as they await the development of national and international guideline recommendations for how best to position the biologics and Jakinibs into the AD treatment algorithm.


Assuntos
Produtos Biológicos , Dermatite Atópica , Humanos , Dermatite Atópica/diagnóstico , Dermatite Atópica/tratamento farmacológico , Ciclosporina/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Produtos Biológicos/uso terapêutico , Corticosteroides/uso terapêutico
9.
Allergy Asthma Proc ; 43(6): 494-500, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36335418

RESUMO

Background: Eosinophils have a double-edged role in the human body, being essential in important physiologic functions but whose presence is conspicuous in a variety of diseases characterized by a T2 inflammation phenotype. Eosinophils are exquisitely sensitive to corticosteroids, and the latter have, until recently, represented the cornerstone of treatment of eosinophilic diseases. However, most patients remain dependent on oral corticosteroids, with a notable adverse effect burden and experience a chronic relapsing disease that leads to high morbidity and mortality. Treatment prospects have changed with the advent of biologic drugs that target the eosinotropic cytokine interleukin (IL) 5 or its receptor. The success of the latter drugs in severe eosinophilic asthma has paved the way for their use in other, rarer, eosinophilic lung diseases. Recently, mepolizumab, a humanized monoclonal antibody that works against IL-5, was approved for the add-on treatment of relapsing-remitting or refractory eosinophilic granulomatosis with polyangiitis (EGPA) in patients ages ≥ 6 years. Benralizumab, a humanized antibody that binds to the α portion of the IL-5 receptor, is also being tested for its efficacy in EGPA in two clinical trials, after a growing number of case reports and case series supported its use as a steroid-sparing agent in the treatment of EGPA. Methods: In this review, we summarized the scientific literature evaluating the efficacy of benralizumab treatment in patients afflicted with rare primary eosinophilic lung diseases. Results: The literature we found, largely case reports, reported that the use of benralizumab in EGPA, chronic eosinophilic pneumonia (CEP) and allergic bronchopulmonary aspergillosis (ABPA) often led to a depletion of eosinophils, less exacerbations and a decreased systemic corticosteroid burden. No adverse effects were reported. Conclusion: Benralizumab has a prospective role in the treatment of rare eosinophilic lung diseases, which needs to be further elucidated in randomized controlled trials.


Assuntos
Asma , Síndrome de Churg-Strauss , Eosinofilia , Granulomatose com Poliangiite , Humanos , Criança , Síndrome de Churg-Strauss/metabolismo , Granulomatose com Poliangiite/metabolismo , Granulomatose com Poliangiite/terapia , Eosinofilia/tratamento farmacológico , Eosinófilos , Asma/tratamento farmacológico , Corticosteroides/uso terapêutico
10.
Sci Rep ; 12(1): 18374, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36319704

RESUMO

An evidence-based treatment for a Multiple Sclerosis (MS) relapse is an intravenous administration of 3-5 g of Methylprednisolone. In case of insufficient effect or corticosteroids intolerance, the therapeutic plasma exchange (TPE) is indicated. To assess the clinical effect of TPE in treatment of relapse in patients with relapsing-remitting MS (RRMS), we enrolled 155 patients meeting the following criteria (study period: January 2011 to February 2021): (1) age > 18, (2) RRMS according to the McDonald´s 2017 criteria, (3) MS relapse and insufficient effect of corticosteroids/corticosteroids intolerance, (4) baseline EDSS < 8. Exclusion criteria: (1) progressive form of disease, (2) history of previous TPE. Following parameters were monitored: EDSS changes (before and after corticosteroid treatment, before and after TPE; EDSS after TPE was assessed at the next clinical follow-up at the MS Center), and improvement of EDSS according to the number of procedures and baseline severity of relapse. 115 females (74%) and 40 males (26%) were included. The median age was 41 years (IQR 33-47)-131 patients underwent the pulse corticosteroids treatment and TPE, while 24 patients underwent only TPE without any previous corticosteroid treatment. Median baseline EDSS was 4.5 (IQR 3.5-5.5), median EDSS after finishing steroids was 4.5 (IQR 4.0-5.5). EDSS prior to the TPE was 4.5 (IQR 4-6), EDSS after TPE was 4.5 (IQR 3.5-5.5). We observed a significant improvement in the EDSS after TPE (p < 0.001). Sex differences were seen in TPE effectiveness, with median improvement of EDSS in females being -0.5 (IQR 1-0) and in males being 0 (IQR -0.5 to 0), p = 0.048. There was no difference in EDSS improvement by age category: 18-30 years, 31-40 years, 41-50 years, > 50 (p = 0.94), nor by total TPE count (p = 0.91). In this retrospective study of patients with an aggressive relapse and insufficient effect of intravenous corticosteroid treatment, a significant effect of TPE on EDSS improvement was observed. There was no significant difference in TPE effectivity according to the number of procedures, age, nor severity of a relapse. In this cohort, TPE was more effective in females.


Assuntos
Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Esclerose Múltipla/tratamento farmacológico , Troca Plasmática/métodos , Estudos Retrospectivos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Recidiva , Corticosteroides/uso terapêutico
11.
Rev Med Suisse ; 18(804): 2181-2183, 2022 Nov 16.
Artigo em Francês | MEDLINE | ID: mdl-36382980

RESUMO

Osteoarthritis is a growing pathology due to aging population and sedentary lifestyles. Pharmacological and non-pharmacological treatments are available, but their effectiveness is debatable. We describe the case of a 73-year-old woman who benefited from intra-articular corticosteroids injection for refractory knee arthritis. This procedure was complicated by a septic arthritis requiring hospitalization, joint lavage, and intravenous antibiotic treatment. To date, there is no clear consensus regarding the use of intra-articular corticosteroid injection. Thus, the choice of treatment must be made according to patient's comorbidities and preferences. Patients should be informed about the potential complications and lack of proven long-term efficacy.


Assuntos
Corticosteroides , Artrite Infecciosa , Feminino , Humanos , Idoso , Injeções Intra-Articulares/efeitos adversos , Injeções Intra-Articulares/métodos , Corticosteroides/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Resultado do Tratamento
12.
BMJ Case Rep ; 15(11)2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36400717

RESUMO

Autoimmune glial fibrillar acidic protein (GFAP) astrocytopathy typically presents as acute or subacute meningoencephalitis with or without myelitis. We describe a case of autoimmune GFAP astrocytopathy that mimicked tuberculous meningitis. A man in his 70s was referred to our hospital with lethargy persistent for 2 months, appetite loss for 1 month and fever with headache for 10 days. The cerebrospinal fluid test revealed lymphocytic pleocytosis with elevated adenosine deaminase (ADA). Laboratory investigations ruled out microbial and neoplastic causes. Empirical therapy for tuberculous meningitis combined with corticosteroid improved the patient's condition. Culture for Mycobacterium tuberculosis failed to show microbial growth despite 1 month of incubation. The cerebrospinal fluid was examined for GFAP antibody and returned positive result. Antituberculous agents were discontinued, and corticosteroid was administered until patient's symptoms resolved completely. Thus, clinicians should consider autoimmune GFAP astrocytopathy as one of the differential diagnoses of lymphocytic meningitis with elevated ADA.


Assuntos
Meningoencefalite , Tuberculose Meníngea , Masculino , Humanos , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológico , Proteína Glial Fibrilar Ácida , Meningoencefalite/diagnóstico , Meningoencefalite/tratamento farmacológico , Anticorpos , Corticosteroides
14.
Neurol India ; 70(5): 1896-1900, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36352584

RESUMO

Background: This pilot survey aims to provide an insight into the variations of corticosteroid prescription among health care professionals across the Indian subcontinent and serve as a prerequisite for the future development of corticosteroid therapy guidelines in brain tumor patients. Materials and Methods: Participants of this anonymized online questionnaire-based survey included health care professionals involved in treating brain tumor patients. Unique links were electronically mailed to health care professionals from a database populated from professional associations. Descriptive statistical analysis, Chi-square test, and/or exact test were used for data analysis. Results: Seventy-three percent of the respondents were radiation oncologists followed by neurosurgeons (23%), medical oncologists (2%), and other specialties (2%). Raised intracranial pressure (90%) was the commonest indication for prescribing corticosteroids. Fifty percent of neurosurgeons preferred corticosteroids to be given routinely for all patients undergoing surgery for brain tumors while 64% of the radiation oncologists would prescribe based on imaging findings and/or on appearance of neurologic symptoms. Most of the respondents (90%) used a flat dosage pattern for determining the starting dose of corticosteroids. Emerging data about the long-term use of corticosteroids having a negative impact on the survival of brain tumor patients were not known by 52% of the respondents. The majority of the practitioners (94%) agreed regarding the formulation of evidence-based guidelines for prescribing corticosteroids in brain tumor patients. Conclusion: In view of the wide variations of corticosteroid therapy practices among health care professionals across various parts of the world, our pilot survey provides significant information which can act as a suitable benchmark to form uniform practice guidelines.


Assuntos
Neoplasias Encefálicas , Padrões de Prática Médica , Humanos , Inquéritos e Questionários , Corticosteroides/uso terapêutico , Neurocirurgiões , Neoplasias Encefálicas/tratamento farmacológico
15.
J Infect Dev Ctries ; 16(10): 1660-1663, 2022 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-36332223

RESUMO

INTRODUCTION: Drug-induced liver injury (DILI) is one of the most common causes of liver damage. A large number of drugs, dietary supplements, and herbal medications can cause hepatotoxicity. In some situations, it is difficult to distinguish between DILI and autoimmune hepatitis, especially when the mechanism is immune-mediated. Albendazole is a drug that has been used for decades for the treatment of parasitic infections in humans. One of the side effects is liver enzyme elevation, but rarely requires the discontinuation of therapy. Previous experience has shown that hypersensitivity is the most common mechanism of albendazole hepatotoxicity. CASE REPORT: Here we presented a paediatric patient in whom albendazole induced severe liver injury. In laboratory analyses, in addition to markedly elevated transaminases and parameters of cholestasis, there was also a significant increase in IgG, so autoimmune hepatitis was considered. Even though the liver histology indicated toxic liver disease, prednisolone was started. Corticosteroid therapy resulted in the complete normalization of liver function, as well as IgG. With the cessation of corticosteroid therapy, transaminases, bilirubin and gamma-glutamyl transferase (GGT) remained within normal levels, but an increase in anti-smooth muscle antibodies (SMA) was noted in immunological analyses after one year of follow-up. CONCLUSIONS: Immune-mediated hepatotoxicity from albendazole is one possible mechanism of liver injury. The use of albendazole in the treatment of parasitic infections, especially in children, requires close monitoring. The question remains as to whether albendazole is a drug that can induce autoimmune hepatitis in the paediatric population.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Hepatite A , Hepatite Autoimune , Humanos , Criança , Hepatite Autoimune/tratamento farmacológico , Hepatite Autoimune/etiologia , Hepatite Autoimune/patologia , Albendazol/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Aguda , Imunoglobulina G , Transaminases , Corticosteroides
16.
J Can Dent Assoc ; 88: m8, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36322635

RESUMO

Bell's palsy is the most common mononeuropathy that causes acute unilateral facial paralysis or paresis. The condition peaks within 72 h and may be associated with numerous signs and symptoms, including post-auricular pain, drooping of the eyelid, loss of taste sensation and decreased lacrimation. Although the etiology of the condition is unknown, inflammation, viral infection, ischemia and anatomy of the facial nerve have all been implicated in the pathophysiology of the disease. Diagnosis and determination of etiology are significant in the early management of this condition. Most incidents resolve spontaneously; however, treatment reduces cases of incomplete recovery and entails the use of corticosteroids, with a possible role for antivirals if a viral etiology is suspected. For patients with incomplete recovery, long-term complications have esthetic, physiological and psychological implications, which greatly affect their quality of life. The purpose of this article is to summarize the current literature on etiology, diagnosis and management of Bell's palsy.


Assuntos
Paralisia de Bell , Paralisia Facial , Humanos , Paralisia de Bell/diagnóstico , Paralisia de Bell/etiologia , Paralisia de Bell/terapia , Paralisia Facial/diagnóstico , Paralisia Facial/etiologia , Paralisia Facial/terapia , Qualidade de Vida , Antivirais/uso terapêutico , Corticosteroides/uso terapêutico
17.
Eur Respir Rev ; 31(166)2022 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-36323417

RESUMO

BACKGROUND: The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes. OBJECTIVE: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity. METHODS: High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses. RESULTS: After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses. CONCLUSIONS: Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.


Assuntos
Antiasmáticos , Asma , COVID-19 , Adulto , Criança , Humanos , Antiasmáticos/efeitos adversos , Administração por Inalação , Asma/diagnóstico , Asma/tratamento farmacológico , Asma/epidemiologia , Corticosteroides/uso terapêutico
18.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 44(5): 828-836, 2022 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-36325781

RESUMO

Bullous pemphigoid (BP) is a common autoimmune subepidermal bullous disease.The diagnosis of BP relies on clinical manifestation,histopathology,direct and indirect immunofluorescence,and serological assay.In the past two decades,topical corticosteroids and systemic and/or topical corticosteroids were the major therapeutic options for localized/mild/moderate and extensive/severe BP,respectively.In 2021,several experts from the French Study Group on Autoimmune Bullous Skin Diseases collaboratively issued the updated guidelines for the therapeutic management of BP based on evidence-based medicine.The guidelines fully detailed the updated therapeutic options for extensive BP,BP of limited extent,localized form of BP,corticosteroid-dependent BP,and drug-induced/associated BP.In particular,systemic corticosteroids are no longer the first-line treatment for extensive BP.We interpret the guidelines to assist dermatologists in the comprehensive management of BP and promote the standardization of BP treatment.


Assuntos
Doenças Autoimunes , Penfigoide Bolhoso , Humanos , Penfigoide Bolhoso/tratamento farmacológico , Doenças Autoimunes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Corticosteroides/uso terapêutico
19.
J Obstet Gynaecol Res ; 48(11): 2956-2963, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36319195

RESUMO

AIM: Granulomatous lobular mastitis (GM) is an inflammatory breast disease with unknown etiology. Studies showed that some patients could achieve complete remission with corticosteroids and excisional surgery. However, some patients would suffer from corticosteroid resistance. We aim to report our single-center experience with the highest number of corticosteroid-resistant GM patients treated by methotrexate and low-dose corticosteroid. METHODS: The medical record database in our center was searched retrospectively for GM patients between January 2015 and January 2022. Patients suffered corticosteroid resistance and received methotrexate-containing regimen were included in this study. The clinical characteristics, management and outcomes were collected and analyzed. RESULTS: Eighty-one patients with the median follow-up of 18 months (range 5-61 months) were included. The median age was 30 years old (range 21-48 years). The common initial complaints were breast mass, pain, and erythema. The initial treatment of 80 (98.8%) patients was methylprednisolone. Patients were switched to methotrexate and low-dose corticosteroid due to corticosteroid resistance. Complete remission was achieved in 61 (75.3%) patients who received methotrexate and low-dose corticosteroid with or without segmental dissection. Nineteen methotrexate-resistant patients were referred for antimycobacterial treatment with the exception that one patient was lost during follow-up. Thirteen of them achieved complete remission, and the other five gained partial remission and received segmental dissection. None of these methotrexate-resistant patients recured. CONCLUSION: An approach with methotrexate and low-dose corticosteroid should be considered as an alternative method to corticosteroid-resistant GM patients.


Assuntos
Mastite , Metotrexato , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Corticosteroides , Bases de Dados Factuais
20.
Respir Med ; 204: 107024, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36332564

RESUMO

Association between asthma control and cardiovascular disease (CVD) remains highly plausible as the two are related to chronic systemic inflammation. Children with physician-diagnosed asthma and matched healthy controls underwent endothelial function assessment. Repeat measurements were performed in uncontrolled asthmatics after initiation or up-titration of inhaled corticosteroids (ICS), compared to those with well-controlled asthma without ICS therapy. We found that children with uncontrolled asthma had inferior endothelial function compared to matched healthy controls. Enhancement in endothelial function, lung function and symptom control was observed in uncontrolled asthmatics after initiation or up-titration of inhaled corticosteroids (ICS). These results provided further evidence of a likely relationship between asthma control and cardiovascular health.


Assuntos
Antiasmáticos , Asma , Criança , Humanos , Antiasmáticos/uso terapêutico , Administração por Inalação , Asma/tratamento farmacológico , Corticosteroides/uso terapêutico , Inflamação/tratamento farmacológico
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