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1.
Neurol India ; 69(4): 910-915, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507411

RESUMO

Objective: This study aims to evaluate the effects of transforaminal epidural steroid injection (TFESI) on neuropathic pain (NP) in patients with chronic unilateral radiculopathy due to lumbar disc herniation (LDH). Patients and Methods: Between September 2018 and April 2019, a total of 61 patients who were diagnosed with unilateral/unilevel radiculopathy due to LDH and were scheduled for single-level TFESI were included in this study. The Numeric Rating Scale (NRS), modified Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and NP-Douleur Neuropathique 4 Questionnaire (DN4) were used before the procedure and at 1 hour, 3 weeks, and 3 months after the procedure. Results: There was a significant decrease in the NRS and significant improvement in the ODI, BDI, and DN4 scores in all patients at all postprocedural timepoints (P < 0.05). The number of patients with NP decreased from 35 (60.3%) at baseline to 23 (41.2%) at 3 months (P = 0.001). The NRS scores were similar at 3 weeks and 3 months between the patients with and without NP (P > 0.05). The ODI scores were significantly higher at 3 months in the patients with NP than those without NP (P = 0.013). The BDI scores at baseline, 3 weeks, and 3 months were significantly higher in the patients with NP than those without NP (P < 0.001, P = 0.016, and P = 0.016, respectively). Conclusion: Our study results suggest that TFESI is an effective and safe method to decrease not only nociceptive but also NP component in patients with chronic radiculopathy due to LDH. Clinicians should keep in mind that NP is a risk factor that adversely affects the TFESI success and patients should be evaluated before the procedure.


Assuntos
Deslocamento do Disco Intervertebral , Neuralgia , Radiculopatia , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Vértebras Lombares , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Estudos Prospectivos , Radiculopatia/tratamento farmacológico , Esteroides/uso terapêutico , Resultado do Tratamento
2.
Eur J Med Res ; 26(1): 98, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433495

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) is associated with a wide clinical spectrum of skin manifestations, including urticarial, vesicular, vasculitic and chilblain-like lesions. Recently, delayed skin reactions have been reported in 1% individuals following mRNA vaccination against SARS-CoV-2. The exact pathophysiology and the risk factors still remain unclear. PATIENTS AND METHODS: 6821 employees and patients were vaccinated at our institutions between February and June 2021. Every patient received two doses of the mRNA-1273 vaccine in our hospitals, and reported back in case of any side effects which were collected in our hospital managed database. RESULTS: Eleven of 6821 vaccinated patients (0.16%) developed delayed skin reactions after either the first or second dose of the mRNA-1273 vaccine against SARS-CoV-2. Eight of 11 patients (73%) developed a rash after the first dose, while in 3/11 (27%), the rash occurred after the second dose. More females (9/11) were affected. Four of 11 patients required antihistamines, with two needing additional topical steroids. All the cutaneous manifestations resolved within 14 days. None of the skin reactions after the first dose of the vaccine prevented the administration of the second dose. There were no long-term cutaneous sequelae in any of the affected individuals. CONCLUSION: Our data suggests that skin reactions after the use of mRNA-1273 vaccine against SARS-CoV-2 are possible, but rare. Further studies need to be done to understand the pathophysiology of these lesions.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Dermatite/etiologia , Eritema/etiologia , Adulto , Idoso , Dermatite/tratamento farmacológico , Dermatite/epidemiologia , Eritema/tratamento farmacológico , Eritema/epidemiologia , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Esteroides/uso terapêutico , Vacinação/efeitos adversos
3.
Medicine (Baltimore) ; 100(30): e26660, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397692

RESUMO

ABSTRACT: Steroid pulse therapy is widely used to treat virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We sought to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels.We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature >38°C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at 6 hours from onset, and AST elevation >90 IU/L within 6 hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1-2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy.Fifteen patients with acute encephalopathy and 5 patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, P = .405). Even after excluding 2 patients with brainstem lesions, no significant correlation between PCPC and steroid pulse therapy timing (rs = 0.583, P = .060) was noted. However, the prognosis tended to be better in patients who received steroid pulse therapy earlier.Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with elevated AST. Still, even earlier administration of treatment could prevent the possible neurological sequelae of this condition.


Assuntos
Encefalopatias/tratamento farmacológico , Pulsoterapia/normas , Esteroides/uso terapêutico , Fatores de Tempo , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Japão , Masculino , Prognóstico , Pulsoterapia/métodos , Pulsoterapia/estatística & dados numéricos
4.
Trials ; 22(1): 524, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372906

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is a common degenerative condition associated with old age. Its incidence continues to increase with the rapidly aging population in China. Treatment for LSS usually begins with conservative treatments, as some patients refuse surgical procedures or have surgery contraindications. Caudal epidural steroid injections (CESIs) and selective nerve root blocks (SNRBs) are two commonly used conservative treatments for LSS, which have proven to be effective at relieving LSS symptoms in many studies. However, there are no randomized controlled trials comparing these two procedures. We planned the first study to assess which one of these two procedures is more effective in treating LSS. We will compare the efficacy of these two treatment methods in terms of duration of symptom relief and recurrence rate. We hope our findings will help clinicians choose an optimal treatment for LSS patients. METHODS/DESIGN: We plan to conduct a 1-year randomized controlled trial that will include a total of 76 subjects. They will be randomly divided into two groups: group A (patients will receive CESIs) and group B (patients will receive SNRBs). Two days before the procedure, we will assess these patients using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale, Oswestry Disability Index (ODI), and numeric rating scale (NRS) for pain. One day, 2 weeks, 3 months, 6 months, and 1 year after the procedure, we will assess the condition of these patients again with the NRS and ODI. DISCUSSION: We hope our findings will lay the foundation for the design of further comprehensive studies and help clinicians make a choice between CESIs and SNRBs for LSS patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900028038 . Registered on 8 December 2019.


Assuntos
Anestesia Epidural , Bloqueio Nervoso , Estenose Espinal , Idoso , Humanos , Injeções Epidurais/efeitos adversos , Vértebras Lombares , Ensaios Clínicos Controlados Aleatórios como Assunto , Estenose Espinal/diagnóstico , Estenose Espinal/tratamento farmacológico , Estenose Espinal/cirurgia , Esteroides/uso terapêutico , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-34204785

RESUMO

Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (p < 0.0001). In the steroid and non-steroid groups, the median length of hospital stay was 13 and 6 days, respectively (p < 0.0001). Medical costs (median (interquartile range)) of hospitalization were 77,941 (26,647-237,540) and 26,653 (14,287-53,421) New Taiwan dollars in the steroid and non-steroid groups, respectively (p < 0.0001). The steroid group had a more fulminant course at baseline, a higher fatality rate, length of hospital stay, and medical cost of hospitalization. Therefore, the beneficial effects of the adjunctive use of corticosteroids in pediatric bacterial meningitis are inconclusive, and additional prospective multicenter investigations are required to clarify this issue.


Assuntos
Meningites Bacterianas , Anti-Inflamatórios/uso terapêutico , Criança , Humanos , Lactente , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/epidemiologia , Estudos Prospectivos , Esteroides/uso terapêutico , Taiwan/epidemiologia
6.
Isr Med Assoc J ; 23(7): 426-431, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34251125

RESUMO

BACKGROUND: Decisions on medication treatment in children dying from cancer are often complex and may result in polypharmacy and increased medication burden. There is no information on medication burden in pediatric cancer patients at the end of life (EOL). OBJECTIVES: To characterize medication burden during the last hospitalization in children dying from cancer. METHODS: We performed a retrospective cohort study based on medical records of 90 children who died from cancer in hospital between 01 January 2010 and 30 December 2018. Demographic and clinical information were collected for the last hospitalization. We compared medication burden (number of medication orders) at hospitalization and at time of death and examined whether changes in medication burden were associated with clinical and demographic parameters. RESULTS: Median medication burden was higher in leukemia/lymphoma patients (6 orders) compared to solid (4 orders) or CNS tumor patients (4 orders, P = 0.006). Overall, the median number of prescriptions per patient did not change until death (P = 0.42), while there was a significant reduction for some medication subgroups (chemotherapy [P = 0.035], steroids [P = 0.010]).Patients dying in the ICU (n=15) had a higher medication burden at death (6 orders) than patients dying on wards (3 orders, P = 0.001). There was a trend for a reduction in medication burden in patients with "Do not resuscitate" (DNR) orders (P = 0.055). CONCLUSIONS: Polypharmacy is ubiquitous among pediatric oncology patients at EOL. Disease type and DNR status may affect medication burden and deprescribing during the last hospitalization.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias , Cuidados Paliativos , Polimedicação , Esteroides/uso terapêutico , Assistência Terminal , Criança , Procedimentos Clínicos/estatística & dados numéricos , Demografia , Feminino , Pesquisa sobre Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Israel/epidemiologia , Masculino , Estadiamento de Neoplasias , Neoplasias/tratamento farmacológico , Neoplasias/mortalidade , Neoplasias/patologia , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal/métodos , Assistência Terminal/estatística & dados numéricos
7.
BMC Neurol ; 21(1): 264, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225703

RESUMO

BACKGROUND: The term "Tolosa-Hunt syndrome" (THS) has been used to refer to painful ophthalmoplegia associated with nonspecific inflammation of the cavernous sinus and many processes can result in a similar clinical picture, including infectious, inflammatory and neoplastic diseases. Rosai-Dorfman disease (RDD) is a lymphoproliferative disorder that rarely affects the central nervous system. We report a case of isolated CNS Rosai-Dorfman disease involving the cavernous sinus and presenting as "Tolosa-Hunt syndrome". CASE PRESENTATION: Our patient presented with horizontal diplopia due to impairment of cranial nerves III, IV and VI and a stabbing/throbbing headache predominantly in the left temporal and periorbitary regions. There was a nonspecific enlargement of the left cavernous sinus on MRI and the patient had a dramatic response to steroids. Biopsy of a frontal meningeal lesion was compatible with RDD. CONCLUSIONS: We highlight the importance of including Rosai-Dorfman disease as a differential diagnosis in cavernous sinus syndrome and demonstrate a satisfactory long-term response to steroid treatment in this disease.


Assuntos
Seio Cavernoso/fisiopatologia , Histiocitose Sinusal , Esteroides/uso terapêutico , Síndrome de Tolosa-Hunt , Diagnóstico Diferencial , Diplopia , Cefaleia , Humanos , Imageamento por Ressonância Magnética
8.
Diabetes Metab Syndr ; 15(4): 102167, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34186344

RESUMO

BACKGROUND AND AIMS: The COVID-19 pandemic continues to challenge us. Despite several strides in management, steroids remain the mainstay for treating moderate to severe disease and with it arises challenges such as hyperglycemia. The review aims to enhance awareness amongst physicians on steroid use and hyperglycemia. METHODS: An advisory document describing various strategies for hyperglycemia management was prepared in the public interest by DiabetesIndia. RESULTS: The review provides awareness on steroids and hyperglycemia, adverse outcomes of elevated blood glucose levels and, advice at the time of discharge. CONCLUSIONS: The article emphasizes enhancing awareness on effective management of hyperglycemia during COVID-19.


Assuntos
COVID-19/complicações , Hiperglicemia/tratamento farmacológico , SARS-CoV-2/isolamento & purificação , Esteroides/uso terapêutico , COVID-19/transmissão , COVID-19/virologia , Humanos , Hiperglicemia/virologia
9.
J Dermatol ; 48(9): 1372-1380, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34128260

RESUMO

BACKGROUND: IgE autoantibodies targeting BP230 can be identified in 38%-68% of bullous pemphigoid (BP) patients, yet the diagnostic and pathogenic value of anti-BP230 IgE still remains inconclusive. OBJECTIVE: We intend to investigate the clinical and immunological characteristics of anti-BP230 IgE in BP patients. METHODS AND RESULTS: Fifty-four BP patients were divided into two groups based on the responsiveness of a topical steroid. We investigated clinical features and IgE autoantibodies profiles by indirect immunofluorescence, ELISA and western blot between the two groups. BP disease area index (BPDAI) scores, total IgE, peripheral eosinophil counts, and anti-BP230 IgE level were significantly higher in the topical-steroid-resistant group. The majority of topical-steroid-resistant patients present with blister/erythematous phenotype (64.3%) and anti-BP230 IgE (59.5%), which correlates with total IgE levels. ELISAs of domain-specific BP230 recombinant proteins indicated that IgE in the topical-steroid-resistant group can react with all seven domains of BP230 and more frequently with the BP230-R1 epitope. CONCLUSION: Anti-BP230 IgE is more frequently observed in topical-steroid-therapy-resistant patients and the prefers R1 domain of BP230, which is not included in commercially available testing kits. Our study further suggests the pathogenic role of anti-BP230 IgE in BP. Performing anti-BP230 IgE detection can serve as an indicator for initiating systemic steroid therapy.


Assuntos
Penfigoide Bolhoso , Autoanticorpos , Autoantígenos , Distonina , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina E , Colágenos não Fibrilares , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/tratamento farmacológico , Esteroides/uso terapêutico
12.
J Ayub Med Coll Abbottabad ; 33(2): 213-216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137531

RESUMO

BACKGROUND: This study has been done in children with Steroid dependent nephrotic syndrome (SDNS) to check for the response to cyclophosphamide and relapse on follow up for one year after completion of treatment. METHODS: This study was conducted over two years and nine months. Patients were taken as steroid dependent when there were two consecutive relapses occur on steroids tapering or within two weeks of stopping treatment. Children of either sex between ages of 1-14 years, diagnosed case of SDNS were included in this study. Renal biopsy was not done in any patient. After achieving remission with oral steroids, cyclophosphamide was given after calculation of maximum cumulative dose 168 mg/kg for 8 - 12 weeks along with oral steroids. Follow up done every two weeks till completion of treatment for response and adverse effects and thereafter for one year. RESULTS: There were 31 patients, 23 (74.2%) male and 8 (25.8%) females. Age ranged from 1.5 years to 11 years with mean age 5.44±2.39 years. There was full response to cyclophosphamide as none of patient had proteinuria on cyclophosphamide therapy. After completion of cyclophosphamide course, four patients (12.9%) relapsed on follow up while 87.9% remain in complete remission. Only one female patient (3.23%) had adverse effect in form of hair fall and she recovered after completion of treatment. None of patient showed any other adverse effect including haematuria. CONCLUSIONS: Cyclophosphamide is an effective therapy in management of childhood SDNS with minimum adverse effects in medium term.


Assuntos
Ciclofosfamida/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Esteroides/uso terapêutico , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais de Ensino , Humanos , Lactente , Masculino , Recidiva , Indução de Remissão
14.
J Infect Dev Ctries ; 15(4): 480-489, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33956647

RESUMO

INTRODUCTION: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan. METHODOLOGY: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality. RESULTS: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = 268; 60%) had ≥ 1 co-morbid [37.5% hypertension, 36.4% diabetes]. In-hospital mortality was 13%. Age ≥ 60 (aOR] =1.92; 95 %CI = 1.23-3.03), shortness of breath (aOR=4.43; 95% CI=2.73-7.22), CRP ≥150mg/L (aOR:1.77; 95% CI=1.09-2.85), LDH ≥ 500 I.U/L (aOR:1.98; 95% CI=1.25-3.16), Neutrophil-to-Lymphocyte ratio (NLR) ≥5 (aOR:2.80; 95%CI = 1.77-4.42) and increase in serum creatinine (aOR:1.32; 95%CI=1.07-1.61) were independently associated with disease severity. Septic shock (aOR: 13.27; 95% CI=3.78-46.65), age ≥ 60 (aOR: 3.26; 95% CI=1.07-9.89), Ferritin ≥ 1500ng/ml (aOR: 3.78; 95% CI=1.21-11.8), NLR ≥ 5 (aOR: 4.04; 95% CI=1.14-14.35) and acute kidney injury (aOR: 5.52; 95% CI=1.78-17.06) were independent predictors of in-hospital mortality. CONCLUSIONS: We found multiple predictors to be independently associated with in-hospital mortality, except diabetes and gender. Compared to reports from other countries, the in-hospital mortality among COVID-19 patients was lower, despite a high burden of co-morbidities. Further research is required to explore reasons behind this dichotomy.


Assuntos
COVID-19/etiologia , COVID-19/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico por imagem , Teste de Ácido Nucleico para COVID-19 , Portador Sadio , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Respiração Artificial , Índice de Gravidade de Doença , Esteroides/uso terapêutico , Centros de Atenção Terciária , Adulto Jovem
15.
Syst Rev ; 10(1): 144, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971949

RESUMO

BACKGROUND: Nephrotic syndrome is the most common kidney disease in children worldwide. Our aim was to critically appraise the quality of recent Clinical Practice Guidelines (CPGs) for idiopathic steroid-sensitive nephrotic syndrome (SSNS) in children in addition to summarize and compare their recommendations. METHODS: Systematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) instrument. We summarized the recommendations in a comparison practical table. RESULTS: Our search retrieved 282 citations, of which three CPGs were eligible and appraised: Kidney Disease: Improving Global Outcomes (KDIGO) 2012, Japan Society for Pediatric Nephrology (JSPN) 2014, and American Academy of Pediatrics (AAP) 2009. Among these, the overall assessment of two evidence-based CPGs scored > 70% (KDIGO and JSPN), which was consistent with their higher scores in the six domains of the AGREE II Instrument. In domain 3 (rigor of development), KDIGO, JSPN, and AAP scored 84%, 74%, and 41%, respectively. In domain 5 (applicability), they scored 22%, 16%, and 19%, respectively, and in domain 6 (editorial independence), they scored 94%, 65%, and 88%, respectively. CONCLUSIONS: The methodological quality of the KDIGO CPG was superior, followed by JSPN and AAP CPGs with the relevant recommendations for use in practice. SYSTEMATIC REVIEW REGISTRATION: The protocol was registered in the Center for Open Science (OSF) DOI: 10.17605/OSF.IO/6QTMD and in the International prospective register of systematic reviews PROSPERO 2020 CRD42020197511 .


Assuntos
Síndrome Nefrótica , Criança , Bases de Dados Factuais , Prática Clínica Baseada em Evidências , Humanos , Síndrome Nefrótica/tratamento farmacológico , Guias de Prática Clínica como Assunto , Esteroides/uso terapêutico
16.
J Wound Ostomy Continence Nurs ; 48(4): 345-349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33951706

RESUMO

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) presents multiple challenges for healthcare providers. The diagnosis of PPG may be delayed, and it may be mistaken for an irritant dermatitis or an infection. Patients with ostomies secondary to inflammatory bowel disease (IBD) may experience PPG. Issues related to PPG include difficulty maintaining a seal of the ostomy pouching system and preventing contamination of the painful, necrotic ulcerations characteristic of this condition. Treatment focuses on the appropriate assessment of the ulcers, successful pouch application, and proper management of IBD through a collaborative effort of both dermatologists and certified WOC nurses (CWOCN). CASES: We treated 3 patients diagnosed with Crohn's disease (CD) who developed refractory PPG. All 3 were treated with a topical steroid lotion, prednisone, and adalimumab or a combination of these agents. Ostomy products and application were tailored to prevent leakage and protect areas of ulceration. All ulcers were healed within 6 months of our initial consultation. CONCLUSION: We successfully managed 3 patients with CD and PPG with appropriate ostomy care, including revision of the ostomy pouching techniques, topical steroid treatment, and treatment based on assessment of ulcer status by the dermatologist and the WOC nurse.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Glucocorticoides/uso terapêutico , Doenças Inflamatórias Intestinais/complicações , Estomia/efeitos adversos , Pioderma Gangrenoso/tratamento farmacológico , Esteroides/uso terapêutico , Estomas Cirúrgicos/efeitos adversos , Adalimumab/administração & dosagem , Administração Tópica , Adulto , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Complicações Pós-Operatórias , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Pioderma Gangrenoso/diagnóstico , Esteroides/administração & dosagem , Resultado do Tratamento
18.
Front Immunol ; 12: 671013, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046038

RESUMO

The impact of Covid-19 pneumonia caused by SARS-CoV-2 on transplanted populations under chronic immunosuppression seems to be greater than in normal population. Clinical management of the disease, particularly in those patients worsening after a cytokine storm, with or without allograft impairment and using available therapeutic approaches in the absence of specific drugs to fight against the virus, involves a major challenge for physicians. We herein provide evidence of the usefulness of high-dose intravenous immunoglobulin (IVIG) combined with steroid pulses to successfully treat a case of Covid-19 pneumonia in a single-kidney transplanted patient with mechanical ventilation and hemodialysis requirements in the setting of a cytokine storm. A rapid decrease in the serum level of inflammatory cytokines, particularly IL-6, IL-8, TNF-α, MCP-1 and IL-10, as well as of acute-phase reactants such as ferritin, D-dimer and C-reactive protein was observed after the IVIG infusion and methylprednisolone bolus administration with a parallel clinical improvement and progressive allograft function recovery, allowing the patient's final discharge 40 days after the treatment onset. The immunomodulatory effect of IVIG together with the anti-inflammatory and immunosuppressive potential of steroids could be an alternative strategy to treat severe cases of Covid-19 pneumonia associated with an uncontrolled inflammatory response in transplanted populations.


Assuntos
Anti-Inflamatórios/uso terapêutico , COVID-19/tratamento farmacológico , Rejeição de Enxerto/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Falência Renal Crônica/terapia , Transplante de Rim , SARS-CoV-2/fisiologia , Esteroides/uso terapêutico , Transplantados , Doença Aguda , COVID-19/complicações , Progressão da Doença , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Diálise Renal , Respiração Artificial , Transplante Homólogo
19.
Indian Pediatr ; 58(4): 370-376, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33883312

RESUMO

BACKGROUND: Steroids are a potential treatment for pulmonary inflammation in meconium aspiration syndrome (MAS). OBJECTIVE: To assess the efficacy and safety of steroids for the management of neonates with MAS. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCT). DATA SOURCES AND SELECTION CRITERIA: A systematic search of PubMed, Embase, Cochrane, and CINAHL was performed from database inception to May 2020 for trials assessing the efficacy of steroids (inhaled/systemic or both) in neonates with MAS. The primary outcome was in-hospital mortality, with secondary outcomes being length of hospital stay and duration of oxygen support. RESULTS: Nine RCTs (758 neonates) were included. Overall, steroids did not decrease in-hospital mortality (RR: 0.59; 95% CI 0.28 to 1.23; I2 = 0%; GRADE: low) nor had any effect on the secondary outcomes. CONCLUSIONS: There is low quality of evidence that the administration of steroids is not associated with a reduction in mortality in infants with MAS. Further well-designed studies with low bias are needed to draw conclusions.


Assuntos
Síndrome de Aspiração de Mecônio , Humanos , Lactente , Recém-Nascido , Síndrome de Aspiração de Mecônio/tratamento farmacológico , Respiração Artificial , Esteroides/uso terapêutico
20.
Clin J Pain ; 37(7): 524-537, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33859113

RESUMO

OBJECTIVES: Epidural steroid injections (ESIs) can be used to reduce lumbosacral radicular syndrome (LRS) related pain. The clinical relevance of ESIs are currently unknown. This systematic review and meta-analyses aims to assess whether ESIs are clinically relevant for patients with LRS. MATERIALS AND METHODS: Comprehensive literature searches for randomized controlled trials regarding steroid injections for LRS were conducted in PudMed, EMBASE, CINAHL, and CENTRAL from their inception to September 2018 (December 2019 for PubMed). For each homogenous comparison, the outcomes function, pain intensity and health-related quality of life at different follow-up intervals were pooled separately. The GRADE approach was used to determine the overall certainty of the evidence. RESULTS: Seventeen studies were included. Two different homogenous comparisons were identified for which the randomized controlled trials could be pooled. In 36 of the 40 analyses no clinically relevant effect was found. The certainty of evidence varied between very low to high. Four analyses found a clinically relevant effect, all on pain intensity and health-related quality of life, but the certainty of the evidence was either low or very low. Two of the 33 subgroup analyses showed a clinically relevant effect. However, according to the GRADE approach the certainty of these findings are low to very low. DISCUSSION: On the basis of the analyses we conclude there is insufficient evidence that ESIs for patients with LRS are clinically relevant at any follow-up moment. High-quality studies utilizing a predefined clinical success are necessary to identify potential clinically relevant effects of ESIs. Until the results of these studies are available, there is reason to consider whether the current daily practice of ESIs for patients with LRS should continue.


Assuntos
Qualidade de Vida , Radiculopatia , Humanos , Injeções Epidurais , Radiculopatia/tratamento farmacológico , Esteroides/uso terapêutico
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