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1.
Internist (Berl) ; 60(11): 1201-1208, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31511906

RESUMO

This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.


Assuntos
Lesão Renal Aguda/etiologia , Glomerulonefrite/tratamento farmacológico , Prednisolona/efeitos adversos , Esteroides/efeitos adversos , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Idoso , Animais , Antiparasitários/uso terapêutico , Evolução Fatal , Feminino , Glomerulonefrite/diagnóstico , Humanos , Ivermectina/uso terapêutico , Prednisolona/uso terapêutico , Esteroides/uso terapêutico , Estômago/microbiologia , Estômago/patologia , Estrongiloidíase/complicações , Estrongiloidíase/tratamento farmacológico
2.
Undersea Hyperb Med ; 46(4): 437-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509900

RESUMO

Introduction: To determine if hyperbaric oxygen (HBO2) therapy has an effect on diabetic blood glucose levels (BGL) and, if so, the extent of this effect. Also, to examine factors that exacerbate any observed effect. Methods: This was a retrospective review of prospectively collected quality data on diabetics undergoing HBO2. Pre- and post-treatment BGL were recorded. Pre-treatment BGL ⟨120 mg/dL received glucose supplementation. Hypoglycemia was defined as BGL ⟨70 mg/dL. BGL ⟨90 mg/dL was included as an elevated hypoglycemia threshold. Results: 77 patients representing 1,825 treatments were included for analysis. No patient had deleterious side effects or required emergency care. BGL decreased in 75.4% of treatments in this group, with a median decrease of 25 mg/dL (IQR=54 mg/dL; range of decreased 374 mg/dL to increased 240 mg/dL). A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001). 1.1% of treatments had post-HBO2 serum glucose ⟨90 mg/dL, and 0.2% of treatments had post-HBO2 serum glucose ⟨70 mg/dL. The majority (70%) of patients with post-HBO2 BGL ⟨90 mg/dL were maintained on insulin alone (χ2(2, N=20) =12.4, p=0.002). Well-controlled diabetics (i.e., those with all BGLs within 50 mg/dL over all pre-HBO2 treatments) had no post-HBO2 BGL ⟨70 mg/dL or ⟨90 mg/dL. Conclusion: Our results suggest that HBO2 does not cause a clinically significant decrease in diabetic patient BGL. No patient in our study had deleterious side effects or required emergency care. We found that glucose level of ⟨90 mg/dL occurred more often in those who use insulin. Hyperbaric patients who exhibit consistent BGL values may represent a group who could be managed similarly to the non-diabetic population.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Oxigenação Hiperbárica , Idoso , Diabetes Mellitus/induzido quimicamente , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigenação Hiperbárica/estatística & dados numéricos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Estudos Retrospectivos , Esteroides/efeitos adversos
5.
Biomed Res Int ; 2019: 8298193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192258

RESUMO

Background: Steroid-induced osteonecrosis of the femoral head is a relatively serious condition which seriously reduces patient quality of life. However, the pathogenesis of steroid-induced ONFH is still unclear. In recent years, more scholars have found that the pathogenesis of steroid-induced ONFH is related to susceptibility factors such as MMPs/TIMPs system. The main purpose of this study is to investigate the correlation between MMP2 and MMP10 gene polymorphisms and steroid-induced ONFH in Chinese Han population. Methods: Six SNPs in MMP2 and two SNPs in MMP10 were genotyped using Agena MassARRAY RS1000 system from 286 patients of steroid-induced ONFH and in 309 healthy controls. The association between MMP2 and MMP10 polymorphisms and steroid-induced ONFH risk were estimated by the Chi-squared test, genetic model analysis, haplotype analysis, and stratification analysis. The relative risk was estimated by odd ratios (ORs) and 95% confidence intervals (CIs). Result: We found that the minor TG allele of rs470154 in MMP10 was associated with an increased risk of steroid-induced ONFH (OR = 1.45, 95% CI, 1.03 - 2.05, p = 0.032). In the genetic model analysis, we found that rs2241146 in MMP2 gene and rs470154 in MMP10 gene showed a statistically significant association with increased risk of steroid-induced ONFH. The six SNPs (rs470154, rs243866, rs243864, rs865094, rs11646643, and rs2241146) showed a statistically significant association with different clinical phenotypes. Conclusion: Our results verify that genetic polymorphisms of MMP2 and MMP10 contribute to steroid-induced ONFH susceptibility in the population of Chinese Han population, and our study provides new insights into the role that MMP2 and MMP10 plays in the mechanism of ONFH.


Assuntos
Necrose da Cabeça do Fêmur , Predisposição Genética para Doença , Metaloproteinase 10 da Matriz/genética , Metaloproteinase 2 da Matriz/genética , Polimorfismo de Nucleotídeo Único , Esteroides/efeitos adversos , Adulto , Grupo com Ancestrais do Continente Asiático/etnologia , China/etnologia , Feminino , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/etnologia , Necrose da Cabeça do Fêmur/genética , Humanos , Masculino , Pessoa de Meia-Idade , Esteroides/uso terapêutico
6.
Clin Orthop Surg ; 11(2): 183-186, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31156770

RESUMO

Background: Spinal diseases are self-limited or non-progressive in many cases. Epidural steroid injection (ESI) is a common nonsurgical treatment option for spinal pain. Despite concerns about complications of repeated steroid injection, few studies reported on the adrenal function of spine disease patients undergoing surgery after ESI. We investigated the influence of preoperative multiple ESIs on adrenal function in spine surgery patients. Methods: This was a retrospective study with prospective data collection. Those who underwent elective spinal operations and had a history of multiple ESIs from January to June 2017 were selected as a study group. Those who underwent knee arthroplasty and did not have a history of ESI and any kind of steroid injection in other areas during 6 months before surgery were selected as a control group. Demographic data were compared to assess homogeneity between groups. We assessed the preoperative serum cortisol level (SCL) to compare the basal adrenal function between groups. Also, we assessed the elevation of SCL postoperatively to evaluate the adrenal response to the surgical stress in each group. For subgroup analysis, we divided all patients into normal (7-28 µg/dL) and subnormal groups according to SCL and analyzed risk factors of adrenal suppression with multivariate logistic regression test. Results: There were 53 patients in the study group and 130 in the control group. Age and sex were homogeneous between groups. There was significant intergroup difference in preoperative SCL (10.4 ± 4.8 µg/dL in the study group vs. 12.0 ± 4.2 µg/dL in the control group; p = 0.026).The postoperative day one SCL was 11.6 ± 5.0 µg/dL in the study group without significant increase from the preoperative level (p = 0.117), whereas the increase was significant in the control group with a postoperative level of 14.4 ± 4.4 µg/dL (p < 0.001). Among all patients, the SCL was subnormal in 18 patients and within the normal range in 165. Spine surgery was the independent risk factor irrespective of age and sex (odds ratio, 3.472; p = 0.015). Conclusions: Our results suggest that concern should be raised about the influence of preoperative multiple ESIs on adrenal suppression in spine surgery patients.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Doenças da Coluna Vertebral/tratamento farmacológico , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Idoso , Terapia Combinada , Descompressão Cirúrgica , Feminino , Humanos , Hidrocortisona/sangue , Injeções Epidurais , Masculino , Estudos Prospectivos , República da Coreia , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral
7.
BMJ Case Rep ; 12(6)2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31175112

RESUMO

Anabolic steroid use is prevalent among athletes and bodybuilders. There are known cardiovascular, reproductive, musculoskeletal and neuropsychiatric risks associated with their prolonged use. Although there have been very few documented cases of strokes associated with anabolic steroid use, cardiomyopathy and secondary erythropoiesis can increase the risk of strokes in users with no other risk factors. We present a 49-year-old man with left parietal ischaemic stroke with haemorrhagic conversion resulting in Gerstmann syndrome secondary to a hypercoagulable state from chronic anabolic steroid use.


Assuntos
Anabolizantes/efeitos adversos , Síndrome de Gerstmann/diagnóstico , Esteroides/efeitos adversos , Isquemia Encefálica/induzido quimicamente , Isquemia Encefálica/diagnóstico por imagem , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/terapia , Síndrome de Gerstmann/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Flebotomia , Policitemia/induzido quimicamente , Policitemia/diagnóstico por imagem , Levantamento de Peso
8.
J Vet Intern Med ; 33(4): 1719-1727, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31175683

RESUMO

BACKGROUND: Steroid-responsive meningitis-arteritis (SRMA) is a common inflammatory neurologic disorder of dogs for which certain breeds are predisposed. OBJECTIVES: To determine whether breed differences exist in clinical features, treatment response, and relapse in a population of North American dogs with SRMA, and to evaluate the effect of disease on dogs' quality of life (QoL). ANIMALS: Sixty-one client-owned dogs with SRMA: 29 dogs identified through an American Kennel Club-Canine Health Foundation survey and 32 dogs from North Carolina (NC) State Veterinary Hospital. METHODS: Retrospective case series. Caregivers completed an online survey to assess QoL. RESULTS: Breeds represented most often included the Golden Retriever (n = 12), Bernese Mountain Dog (10), Wirehaired Pointing Griffon (9), Boxer (9), and Beagle (6). No breed differences were identified with respect to clinical severity, diagnostic findings, or outcome. Twenty-nine dogs (48%) had ≥1 disease relapse. There was a significant effect of cerebrospinal fluid nucleated cell count on the frequency of disease relapse (P = .003), but no relationship was identified between treatment protocol and relapse. Dogs' QoL was associated with the severity of corticosteroid-related adverse effects (P = .03), which were dose-related (r = .24, P = .02) and more prevalent in Wirehaired Pointing Griffons than in other breeds (P = .04). CONCLUSION AND CLINICAL IMPORTANCE: Golden Retrievers and Wirehaired Pointing Griffons should be considered among the breeds recognized to develop SRMA. Treatment with higher corticosteroid dosages is correlated with more severe adverse effects and worse QoL, but it may not improve clinical outcome.


Assuntos
Arterite/veterinária , Doenças do Cão/patologia , Meningite/veterinária , Animais , Arterite/líquido cefalorraquidiano , Arterite/tratamento farmacológico , Canadá/epidemiologia , Doenças do Cão/líquido cefalorraquidiano , Doenças do Cão/tratamento farmacológico , Cães , Feminino , Predisposição Genética para Doença , Masculino , Meningite/líquido cefalorraquidiano , Meningite/tratamento farmacológico , Neutrófilos , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Esteroides/uso terapêutico , Inquéritos e Questionários , Estados Unidos/epidemiologia
9.
Rev. neurol. (Ed. impr.) ; 68(9): 389-397, 1 mayo, 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180676

RESUMO

Los corticoides se utilizan ampliamente en la práctica clínica habitual en neurooncología. Sin embargo, pese a lo extendido de su uso, no existe un consenso establecido sobre sus indicaciones, dosis y posología. En este artículo se realiza una revisión bibliográfica del mecanismo de acción de los corticoides, sus indicaciones de uso, efectos secundarios y manejo adecuado, dosis y duración de la terapia, así como el papel de nuevos tratamientos actuales para el edema cerebral. El corticoide con un uso mas extendido en neurooncología es la dexametasona, probablemente por su escaso efecto mineralocorticoide y por su elevada vida media. Su efecto sobre el edema cerebral es fundamental en el control sintomático de los pacientes con tumores cerebrales. Se recomienda iniciar tratamiento únicamente en pacientes sintomáticos, en dosis de 4-8 mg/24 h, buscando siempre la mínima dosis eficaz. Los efectos secundarios asociados al uso de corticoides son frecuentes e impactan negativamente en la calidad de vida de los pacientes


Corticosteroids are widely used in routine clinical practice in neuro-oncology. However, despite their widespread use, there is no established consensus on their indications, dosages and dosage schedule. This article reviews the mechanism of action of corticosteroids, their indications for use, side effects and the appropriate management, dosage and duration of therapy, as well as the role of new treatments currently being use to treat cerebral oedema. The most widely used corticosteroid in neuro-oncology is dexamethasone, probably due to its low mineralocorticoid effect and its long half-life. Its effect on cerebral oedema is fundamental in the symptomatic control of patients with brain tumours. It is recommended to start treatment only in symptomatic patients, in doses of 4-8 mg/24 h, always seeking the minimum effective dosage. Side effects associated with corticosteroid use are common and have a negative impact on patients' quality of life


Assuntos
Humanos , Esteroides/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Edema Encefálico/tratamento farmacológico , Esteroides/efeitos adversos , Imagem por Ressonância Magnética
10.
Int Urol Nephrol ; 51(6): 975-985, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30989564

RESUMO

BACKGROUND: Henoch-Schönlein purpura nephritis (HSPN) is the most severe symptom of Henoch-Schönlein purpura. The role of immunosuppressive agents combined with steroids is controversial in treating HSPN. Our meta-analysis was performed to assess the efficacy and safety of the combined therapy in the treatment of HSPN compared with steroids alone. METHODS: Cochrane Library, Pubmed, Embase, and Web of Science were searched and Newcastle-Ottawa Scale was used to assess the quality of the literatures. Odds ratios (OR) and standard mean difference (SMD) with a 95% confidence interval (CI) were used for dichotomous and continuous variables. A random-effect model or fixed-effect analysis was applied according to heterogeneity. RESULTS: A total of 9 articles were selected in our study. HSPN patients treated with combined therapy demonstrated a significant increase in complete remission rates (OR = 1.95; 95% CI 1.17-3.23, P = 0.010) and total remission rates (OR = 2.30 95% CI 1.33-3.98, P = 0.003) when compared with steroids alone. Children seemed to benefit more from combined treatment (OR = 2.45; CI 1.20-5.02, P = 0.014) than adults (OR = 1.56; CI 0.76-3.20, P = 0.225). Additionally, immunosuppressants plus steroids had an advantage on decreasing proteinuria (SMD = 0.28; CI 0.05-0.52, P = 0.019) and increasing the level of serum albumin (SMD = 0.98; CI 0.35-1.60, P = 0.002). However, significant differences were not found in the estimated glomerular filtration rate (eGFR) and rates of side-effects. CONCLUSION: Administration of immunosuppressive agents combined with steroids may be a superior alternative for HSPN. Nevertheless, long-term, high-quality, large-sample, and multicenter RCTs are required to make the results more convincing.


Assuntos
Imunossupressores/uso terapêutico , Nefrite/tratamento farmacológico , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Esteroides/uso terapêutico , Adulto , Criança , Quimioterapia Combinada , Humanos , Imunossupressores/efeitos adversos , Nefrite/complicações , Púrpura de Schoenlein-Henoch/complicações , Esteroides/efeitos adversos , Resultado do Tratamento
11.
Dig Liver Dis ; 51(6): 761-768, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010745

RESUMO

Alcoholic hepatitis (AH) is a unique clinical syndrome that affects patients with chronic and active harmful alcohol consumption, and is associated with a high mortality of up to 40% at 1 month from presentation. It is important to assess disease severity and prognosis at time of presentation to identify patients at risk for high mortality and potential candidates for specific therapies. The cornerstone therapy for AH is enteral nutrition and abstinence. Steroids remain the only pharmacological option for severe AH however, adverse effects and lack of long-term benefit limit their routine use. Early liver transplantation is a potential salvage therapy for select severe AH patients. This review article comprehensively covers recent advances on the clinical unmet needs in the field including newer therapies and therapeutic targets, role of liver transplantation, and emerging biomarkers throughout the disease process from diagnosis, assessing prognosis and disease severity, and predicting responsiveness to medical therapies for severe AH.


Assuntos
Alcoolismo/terapia , Hepatite Alcoólica/diagnóstico , Hepatite Alcoólica/terapia , Transplante de Fígado , Abstinência de Álcool , Alcoolismo/complicações , Progressão da Doença , Nutrição Enteral , Humanos , Prognóstico , Esteroides/efeitos adversos , Esteroides/uso terapêutico , Resultado do Tratamento
12.
Int J Rheum Dis ; 22(7): 1216-1225, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30977300

RESUMO

AIM: The use of healthcare resources by rheumatoid arthritis (RA) patients can be related to the presence of disease, comorbid conditions, use of steroids, and the combined use of immunosuppressants. This study evaluated the risk factors associated with infection and hospitalization in RA. METHODS: This multicenter, cross-sectional study enrolled 3247 RA subjects fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria to examine the prevalence of hospitalization and episodes of documentable non-tubercular infections as a part of the "Karnataka rheumatoid arthritis comorbidity" study (KRAC). The study included 2081 subjects and 1166 were excluded due to incomplete data. Demographic, clinical and treatment variables were collected, and the events related to infections and hospitalization were extracted from the medical records. Comparative analysis and multivariate logistic regression were performed. RESULTS: Around 22% of the subjects had hospitalizations and 2.9% had infections. Infections were pertaining to dental (1.3%), urinary tract (1.6%) and candidiasis (0.2%). Skin- and soft tissue-related infections were found in 1.8% and 0.3% of patients, respectively. Increased need of hospitalization in RA patients was associated with advanced age (≥60 years), lower education, family income, and longer duration of RA. Presence of comorbidity, usage of three or more disease-modifying anti-rheumatic drugs (DMARDs) and family income influenced the likelihood of infection. Dental infections were less likely in working subjects and more likely in patients with increased disease duration, higher family income, comorbidities and those between the age group 40-59 years. Urinary tract infection was associated with DMARD usage. CONCLUSION: Patient-specific risk factors should be considered to improve treatment strategies and to reduce the risk of infection and hospitalization in RA patients.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Hospitalização , Imunossupressores/efeitos adversos , Infecções Oportunistas/terapia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Esteroides/efeitos adversos , Adulto , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Hospedeiro Imunocomprometido , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/imunologia , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo
13.
Biomed Res Int ; 2019: 8163780, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30956985

RESUMO

Objective: Steroid-resistant graft-versus-host disease (GvHD) is a major challenge after allogeneic stem cell transplantation and associated with significant morbidity and mortality. There is no therapeutic standard defined beyond calcineurin inhibitors (CNI) and steroids. Furthermore, some patients may have contraindications against CNI or high-dose steroids. Efficacy of ruxolitinib against GvHD has been described recently. Methods: Ruxolitinib was used for treatment of acute or chronic GvHD in eight patients. The patients either needed intensification of therapy or had contraindications against use of CNI or high-dose steroids. Results: Supplementation of therapy in acute GvHD with severe diarrhea with ruxolitinib was unsuccessful. All these patients died from acute GvHD. Introduction of ruxolitinib into therapy and relapse prophylaxis in other patients was successful in 4/4 cases (CR=3, PR=1). Indications for ruxolitinib were contraindications against CNI due to aHUS in two cases and the need for steroid sparing in two other cases. None of these patients suffered from diarrhea at the initiation of ruxolitinib. Conclusion: Ruxolitinib was effective for therapy of acute and chronic GvHD in higher lines in patients without severe diarrhea. Ruxolitinib could replace successfully CNI and high-dose steroids. Further investigations are necessary to define the position of ruxolitinib in GvHD-therapy.


Assuntos
Resistência a Medicamentos/efeitos dos fármacos , Doença Enxerto-Hospedeiro/tratamento farmacológico , Pirazóis/administração & dosagem , Doença Aguda , Adulto , Idoso , Doença Crônica , Feminino , Doença Enxerto-Hospedeiro/patologia , Doença Enxerto-Hospedeiro/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pirazóis/efeitos adversos , Esteroides/administração & dosagem , Esteroides/efeitos adversos
14.
Prensa méd. argent ; 105(2): 92-97, apr 2019. tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1025712

RESUMO

Central serous chorioretinopathy (CSC) is an ophthalmic disorder that often affects young male patients under psychological stres and is clinically characterized by blurring of vision, metamorphopsia, a visual abnormality in which normally straight lines appears curved, and micropsia, a visual abnormality in which objects appear smaller than normal. The annual incidence of the condition is not well recognized in our country. The objective of this cross-sectional study was to highlight the incidence rate of CSC in our community and to make an insight on possible associated risk factors. This cross-sectional study included 92 patients with vissual impairment that has been proved due to central serous chorioretinoplathy (CRC). The sample included 68 males and 24 females. The sample of CRC was all the available patients visiting ophthalmology unit at Al-Diwaniyah teaching hospital and at the ophthalmology unit at Medical Committee Instituion, both these health centers lie at Al-Diwaniyah province, mid-Euphrates region, Iraq. A rough estimation of the annual incidence of CRC in this mid-Euphrates region of Iraq was 3.5 per 100.000. Mean age of patients was 43.02 ± 4.71 years, and the disease was 2.83 times more common in males. The main possible risk factors are psychosocial stress and steroid therapy. CRC is common in our community, and the main possible risk factors are psychosocial stress, and steroid use and these associations need to be validated in a large longitudinal study or at least a case-control study


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Esteroides/efeitos adversos , Estresse Psicológico/diagnóstico , Transtornos da Visão/epidemiologia , Incidência , Estudos Transversais , Fatores de Risco , Estudos Longitudinais , Coriorretinopatia Serosa Central/diagnóstico
15.
Turk J Ophthalmol ; 49(1): 40-43, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30829024

RESUMO

Central serous chorioretinopathy (CSCR) is characterized by a well-defined serous choroidal detachment of the retinal pigment epithelium with one or more focal lesions of the neurosensory retina. Risk factors for CSCR are psychosocial stress, increased endogenous catecholamine, and increased endogenous cortisol. Systemic steroids can cause ocular side effects such as cataract development, increased intraocular pressure, and less frequently the development of CSCR, which can resolve spontaneously with close follow-up and simple treatment modification. CSCR should be considered in patients who complain of worsening vision under steroid treatment for pathologies requiring steroid therapy. In this study we present two patients, one man and one woman, who developed acute CSCR while under systemic steroid treatment for Behçet's disease.


Assuntos
Síndrome de Behçet/tratamento farmacológico , Coriorretinopatia Serosa Central/induzido quimicamente , Esteroides/efeitos adversos , Adulto , Feminino , Humanos , Masculino
16.
Ophthalmic Plast Reconstr Surg ; 35(5): 465-468, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730433

RESUMO

PURPOSE: To study the effect of periocular steroid use on intraocular pressure (IOP). METHODS: Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations. RESULTS: Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1-83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg. CONCLUSIONS: Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response.


Assuntos
Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/induzido quimicamente , Esteroides/efeitos adversos , Administração Tópica , Adolescente , Adulto , Dexametasona/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Hidrocarbonetos Fluorados/efeitos adversos , Hidrocortisona/efeitos adversos , Etabonato de Loteprednol/efeitos adversos , Masculino , Neomicina/efeitos adversos , Soluções Oftálmicas/efeitos adversos , Polimixina B/efeitos adversos , Estudos Retrospectivos , Esteroides/administração & dosagem , Adulto Jovem
17.
Acta Diabetol ; 56(6): 675-680, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30799524

RESUMO

AIMS: Intravitreal steroid implants have emerged as an adjunctive therapy in diabetic macular edema (DME) in patients refractory to anti-vascular endothelial growth factor agents. However, the use of these agents in patients with a prior history of steroid-induced ocular hypertension is limited. The present study aimed to analyze long-term intraocular pressure (IOP) response to the dexamethasone implant in patients with DME and a history of steroid-induced increase in IOP. METHODS: In a multicenter retrospective review, 17 eyes with DME and a history of steroid-induced increase in IOP to > 21 mmHg were treated with the dexamethasone implant and followed for 18 months. Patients with a history of vitrectomy of vitreoretinal interface pathology were excluded. The primary outcomes were the change in IOP and use of IOP-lowering agents. RESULTS: Among the study population (17 eyes), there was no significant change in mean IOP from baseline through 18 months (15.9 ± 2.0-14.6 ± 2.8 mmHg; p = 0.18). The number of patients requiring IOP-lowering agents rose from 5 at baseline to 14 at 18 months (p = 0.0049). None of the study eyes required surgical treatment. CONCLUSIONS: Though dexamethasone does predictably lead to an increase in IOP, this adverse effect was effectively managed with topical treatment. The present study suggests that the intravitreal dexamethasone implant may be considered in patients with DME and a history of steroid-induced ocular hypertension who have exhausted first-line treatments.


Assuntos
Dexametasona/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Implantes de Medicamento/efeitos adversos , Edema Macular/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Adulto , Idoso , Dexametasona/efeitos adversos , Dexametasona/uso terapêutico , Retinopatia Diabética/complicações , Feminino , Humanos , Pressão Intraocular , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Esteroides/efeitos adversos
18.
Artigo em Chinês | MEDLINE | ID: mdl-30704176

RESUMO

Nowadays, more than 300 000 deaf people around the world benefit from cochlea implantation. With the extension of cochlear implantation indications, it has become a research focus for how to apply the anti-inflammatory and anti-fibrotic drugs safely and effectively to better retain residual hearing, as well as to protect hair cells and the spiral ganglion cells from apoptosis. Due to the blood-labyrinth barrier, perioperative systemic steroids are often unable to achieve satisfactory drug concentration in the inner ear. Also, given that higher doses of steroids will cause more serious side effects and sometimes steroids are strictly limited to apply on some patients with certain diseases, the attention has been attracted on topical drug delivery to the inner ear. In this review, the methods of topical drug delivery to the inner ear are divided into four categories: transtympanic injection of liquid solutions, tympanic implantation of drug delivery systems, intracochlear injection and modified implant electrode. The results in each category and up to date progress are reviewed.


Assuntos
Administração Tópica , Anti-Inflamatórios/administração & dosagem , Implante Coclear/efeitos adversos , Orelha Interna , Complicações Pós-Operatórias/prevenção & controle , Esteroides/administração & dosagem , Cóclea , Fibrose/prevenção & controle , Humanos , Inflamação/prevenção & controle , Esteroides/efeitos adversos
19.
BMJ Case Rep ; 12(2)2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30765453

RESUMO

Osteonecrosis, also known as avascular necrosis, is a condition that causes significant morbidity and loss of function. It is a common complication seen with supraphysiological steroid use. Early diagnosis is critical as it impacts prognosis. We report a 20-year-old man who developed bilateral osteonecrosis of the hip following 6 years of low-dose steroid replacement therapy for panhypopituitarism secondary to a transsphenoidal resection of a growth hormone-secreting pituitary macroadenoma. The patient presented with several weeks of right-sided hip pain and significant loss of function. X-ray and MRI showed bilateral osteonecrosis of the hips with the right side more severely affected than the left. He was initiated on analgesics and bisphosphonates and underwent right hip total arthroplasty followed 1 year later by left hip arthroplasty. Postsurgery, the patient is mobilising well and his pituitary hormones are well balanced. He continues on low-dose glucocorticoid replacement which will continue lifelong.


Assuntos
Necrose da Cabeça do Fêmur/terapia , Hipopituitarismo/tratamento farmacológico , Esteroides/efeitos adversos , Analgésicos/uso terapêutico , Artroplastia de Quadril/métodos , Difosfonatos/uso terapêutico , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Humanos , Hipopituitarismo/etiologia , Masculino , Neoplasias Hipofisárias/cirurgia , Resultado do Tratamento , Adulto Jovem
20.
Exp Mol Med ; 51(2): 23, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808872

RESUMO

The Wnt/ß-catenin signaling pathway is associated with the pathogenesis of steroid-induced osteonecrosis. Our investigation studied whether aberrant CpG island hypermethylation of the FZD1 gene was present in patients with osteonecrosis of the femoral head (ONFH), which results in Wnt/ß-catenin signaling inactivation and subsequent cell dysfunction. Bone marrow was collected from the proximal femurs of patients with steroid-associated ONFH (n = 21) and patients with new femoral neck fractures (n = 22), and then mesenchymal stem cells (MSCs) were isolated. We investigated cell viability, the transcription and translation levels of Wnt/ß-catenin signaling-related genes, the extent of methylation at CpG islands of the FZD1 promoter, and the osteogenic and adipogenic differentiation abilities of MSCs from the control group and from the ONFH group treated with or without 5'-Aza-dC. According to the results, MSCs from the ONFH group showed a reduced proliferation ability, low transcription and translation levels of FZD1, inhibition of the Wnt/ß-catenin signaling pathway, weakened osteogenesis and enhanced adipogenesis ability. Aberrant CpG island hypermethylation of FZD1 was observed in the ONFH group. Treatment with 5'-Aza-dC resulted in de novo FZD1 expression, reactivation of the Wnt/ß-catenin signaling pathway and promotion of osteogenesis. Taken together, our study not only provides novel insights into the regulation of the Wnt/ß-catenin signaling pathway in this disease but also reveals potential for the use of demethylating agents for the treatment of GC-associated ONFH.


Assuntos
Metilação de DNA , Receptores Frizzled/genética , Células-Tronco Mesenquimais/metabolismo , Osteonecrose/etiologia , Osteonecrose/metabolismo , Esteroides/efeitos adversos , Via de Sinalização Wnt , Adipogenia , Adulto , Idoso , Biomarcadores , Estudos de Casos e Controles , Diferenciação Celular , Sobrevivência Celular , Feminino , Imunofluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese , Osteonecrose/patologia
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