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1.
Wiad Lek ; 72(9 cz 1): 1676-1682, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586982

RESUMO

Rheumatoid arthritis (RA) is a chronic, systemic connective tissue disease, characterized by progressive, destructive polyarthritis with internal organs involvement due to active, systemic inflammation. The onset of disease occurs usually in 4th or 5th decade of life. Since the general population is ageing, beginning of RA in older age is more and more common. The term elderly onset of rheumatoid arthritis (EORA) describes the disease with onset at age over 60. Several observational studies indicated, that proportion of women and men is comparable in EORA. Clinical course of the disease is characterized by sudden onset with general constitutional symptoms, high disease activity and inflammatory parameters. Involvement of large joints is more common, specially shoulder joints. Antibodies typical for RA (rheumatoid factor, anti-citrullinated peptide) are usually negative. More advanced destructive changes of joints and functional impairment are also characteristic for EORA patients in comparison with younger onset of RA (YORA). In clinical practice the use of methotrexate and biological drugs is less common, and glucocorticosteroids more common in EORA. Due to high RA activity, patients with EORA should be treated in the same way as YORA, with careful monitoring due to higher risk of adverse events associated with treatment.


Assuntos
Artrite Reumatoide/diagnóstico , Idade de Início , Idoso , Artrite Reumatoide/terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Inflamação , Masculino , Metotrexato/uso terapêutico
2.
Medicine (Baltimore) ; 98(38): e17194, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567966

RESUMO

BACKGROUND: This study will systematically investigate the efficacy and safety of methylprednisolone for treatment of persistent vertigo (PV). METHODS: All following electronic databases will be searched from inception to the June 30, 2019 without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database. All randomized controlled trials focusing on assessing the efficacy and safety of methylprednisolone for patients with PV will be fully considered for inclusion. Cochrane risk of bias tool will be used for assessing methodological quality, and RevMan 5.3 software (Cochrane Community, London, UK) will be utilized for statistical analysis. RESULTS: This study will assess the efficacy and safety of methylprednisolone for PV via assessing primary outcome of vertigo, and secondary outcomes of somatization, depression, anxiety, health-related quality of life, and adverse events. CONCLUSION: This study will provide a high-quality evidence to judge whether methylprednisolone is an effective and safety therapy for patients with PV. DISSEMINATION AND ETHICS: No individual data will be utilized in this study, thus, it does not need ethical approval. The results of this study will be published at peer-reviewed journals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138890.


Assuntos
Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Vertigem/tratamento farmacológico , Glucocorticoides/efeitos adversos , Humanos , Metilprednisolona/efeitos adversos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(37): e17162, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517866

RESUMO

Vertebral compression fracture (VCF) is a common comorbidity of chronic obstructive pulmonary disease (COPD), and the coexistence of COPD and temporomandibular disorder (TMD) has been clinically noted. The present study aimed to investigate whether VCF increases the risk of TMD in patients with COPD.With a follow-up period of 15 years, this retrospective, population-based longitudinal cohort study enrolled sex- and age-matched COPD patients with and without VCF (1:3) who were identified from Taiwan's National Health Insurance Research Database from 2000 to 2015. Multivariate Cox regression analysis was performed to determine the risk of TMD in COPD patients with and without VCF. The cumulative risk of TMD between groups was estimated using Kaplan-Meier analysis.The risk factors for TMD in patients with COPD were VCF, osteoporosis, and winter season. The COPD with VCF group was more likely to develop TMD (adjusted hazard ratio = 3.011, P < .001) than the COPD without VCF group after adjustment for sex, age, variables, and comorbidities. In the subgroup analysis, the COPD with VCF group had a higher risk of TMD than the COPD without VCF group in almost all stratifications.COPD patients with VCF are at a higher risk of developing TMD. Clinicians taking care of patients with COPD should be aware of the occurrence of TMD as a comorbidity.


Assuntos
Fraturas por Compressão/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Fraturas da Coluna Vertebral/complicações , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fraturas por Compressão/epidemiologia , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Transtornos da Articulação Temporomandibular/complicações
4.
Z Rheumatol ; 78(8): 775-788, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31535201

RESUMO

Glucocorticoids (GC) have been proven drug substances in rheumatology for more than 70 years. They act very rapidly in high doses through membrane stabilizing effects. Genomic therapeutic effects of GC even in very low doses are mainly due to inhibition of the functions of the transcription factor nuclear factor kappa B (NFkB), which promotes the synthesis of proinflammatory mediators, adhesion molecules and other regulatory proteins. Indications for the use of GC in high doses in rheumatology are always given when a life-threatening, dangerous or treatment-resistant situation is involved. Lower doses of GC, usually administered orally, are particularly used in rheumatoid arthritis, vasculitis and collagenosis. In clinical practice the general principle is to use the smallest possible effective dose of GC for the shortest possible time in order to achieve the therapeutic effect of GC without running the risk of unacceptably severe side effects.


Assuntos
Glucocorticoides/uso terapêutico , Doenças Reumáticas , Reumatologia , Artrite Reumatoide , Relação Dose-Resposta a Droga , Glucocorticoides/efeitos adversos , Humanos , Doenças Reumáticas/tratamento farmacológico , Febre Reumática , Fatores de Transcrição
5.
Internist (Berl) ; 60(10): 1059-1073, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31471629

RESUMO

Large-vessel vasculitis includes giant cell arteritis (GCA) and Takayasu arteritis (TA). GCA can affect persons from the age of 50 years and is more frequent among women. The disease course generally begins with an acute phase, with patients feeling very unwell and experiencing temporal headaches. Rapid diagnosis and treatment are necessary to reduce the risk of blindness. A suspected diagnosis must be confirmed by imaging, histology is optional. Initial treatment comprises oral prednisone. Recent studies have demonstrated inhibition of interleukin­6 with tocilizumab (TCZ) to be highly effective. Alternatively, methotrexate can be administered in a steroid-sparing approach. In contrast, TA onset is generally during childhood or adolescence, and begins with moderate systemic inflammation. The aorta and its main branches are affected. Treatment comprises steroids, disease-modifying antirheumatic drugs, and the tumor necrosis factor inhibitor infliximab or TCZ.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antirreumáticos/administração & dosagem , Arterite de Células Gigantes/tratamento farmacológico , Imunossupressores/administração & dosagem , Arterite de Takayasu/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Feminino , Células Gigantes , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Resultado do Tratamento
7.
Eur J Endocrinol ; 181(4): C13-C15, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505455

RESUMO

A study has examined the rates of adrenal crises in patients treated with pituitary or adrenal surgery. Rates were substantial (approximately 9 per 100 patient years), perhaps representing suppression of corticotrope ACTH secretion and deprivation of normal corticotrope number postoperatively. Hormone withdrawal syndrome may have contributed to the rates of apparent adrenal crises given the definition used. Higher rates were seen in patients given relatively high dose glucocorticoids postoperatively in one of the two centres where patients were treated - perhaps some of the patients in the high dose centre had longer periods of corticotrope suppression from exogenous glucocorticoids, increasing the risk period for adrenal crises. The question of optimal glucocorticoid dose and weaning rate after cure of Cushing's syndrome remains a balance between weaning at a rate sufficiently rapid to allow resumption of normal corticotrope function thereby preventing adrenal crises and providing sufficient glucocorticoid support to avoid hormone withdrawal syndrome or even precipitating an adrenal crisis, in the vulnerable 4-6 month period after successful surgery. There is likely to be considerable inter-individual variability in optimum glucocorticoid dose and weaning rate so that close clinical and biochemical monitoring is currently a practical approach.


Assuntos
Glândulas Suprarrenais/metabolismo , Hormônio Adrenocorticotrópico/metabolismo , Síndrome de Cushing/metabolismo , Síndrome de Cushing/terapia , Glândulas Suprarrenais/efeitos dos fármacos , Glucocorticoides/farmacologia , Glucocorticoides/uso terapêutico , Humanos , Estudos Multicêntricos como Assunto/métodos , Hipófise/efeitos dos fármacos , Hipófise/metabolismo , Resultado do Tratamento
9.
Artigo em Chinês | MEDLINE | ID: mdl-31446695

RESUMO

Summary To analyze the clinical features of IgG4-related diseases mainly with otologic manifestations and investigate diagnosis and treatment of IgG4-related diseases. We report the clinical course and diagnosis and treatment process of a case of IgG4-related disease misdiagnosed as chronic suppurative otitis media. After looking through relevant literatures, we review 22 cases of IgG4-related diseases mainly with otologic manifestations, and summarize their epidemiological characteristics, clinical manifestations, histopathologic features, radiologic features, and diagnostic and therapeutic criteria. IgG4-related diseases mainly with otologic manifestations are usually clinically characterized by atypical symptoms such as otalgia, tinnitus, aural fullness, otorrhea and progressive or fluctuating hearing loss, together with nausea, vomiting, and dizziness. The three central histopathologic features are dense lymphoplasmacytic infiltration, storiform fibrosis and obliterative phlebitis. The exact diagnosis of IgG4-related diseases requires a combination of clinical manifestations, serology, histopathology and radiologic results. Glucocorticoids are currently the first-line approach for IgG4-related diseases. Otologic manifestations involved in IgG4-related diseases are poorly specific, which is likely to result in more misdiagnosis and treatment delay. Current golden standard for diagnosing IgG4-related diseases is the identification of characteristic histopathology. In addition, immunohistochemistry can help clinicians diagnose IgG4-related diseases as early as possible. Otologists should strengthen their understanding of otologic manifestations of IgG4-related diseases. Early diagnosis and treatments are the key factors in prognosis.


Assuntos
Pavilhão Auricular/fisiopatologia , Perda Auditiva/etiologia , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Fibrose , Glucocorticoides/uso terapêutico , Humanos , Imuno-Histoquímica , Prognóstico
10.
Orthop Clin North Am ; 50(4): 433-443, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466660

RESUMO

This article serves to provide an overview of molecular and surgical interventions to minimize the progression of posttraumatic arthritis following high-energy intra-articular fractures. The roles of cartilage and the microcellular environment are discussed, as well as the response of the joint and cartilage to injury. Molecular therapies, such as glucocorticoids, mesenchymal stem cells, and bisphosphonates, are presented as potential treatments to prevent progression to posttraumatic arthritis. High-energy intra-articular fractures of the elbow, hip, knee, and ankle are discussed, with emphasis on restoring anatomic alignment, articular reduction, and stability of the joint.


Assuntos
Cartilagem Articular/lesões , Fraturas Intra-Articulares/complicações , Osteoartrite/terapia , Artroplastia , Difosfonatos/uso terapêutico , Progressão da Doença , Glucocorticoides/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Transplante de Células-Tronco Mesenquimais , Osteoartrite/etiologia
11.
Medicine (Baltimore) ; 98(33): e16840, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415407

RESUMO

RATIONALE: Twin pregnancy in women with chronic kidney disease (CKD) is very rare but poses a great risk to both mother and children. In developing countries like China, advanced CKD twin pregnancies are often terminated. Here, we report a successful case and reviewed related cases, hope to facilitate further study. PATIENT CONCERNS: A 29-year-old woman with a twin pregnancy showed serum creatinine (Scr) 100 µmol/L (CKD2) at conception. During her 12th week, Scr reached 263 µmol/L (CKD4) with urine protein 3+ and hypertension. DIAGNOSES: Due to her pregnancy, renal biopsy was not considered. Lab tests showed deterioration of renal function and ultrasound detections showed small kidney size. INTERVENTIONS: The patient was given basic drug therapy to control her blood pressure and supplemental nutrition without hemodialysis. OUTCOMES: The patient delivered 2 healthy babies weighting 0.9 and 0.7 kg by cesarean section at the 28th week, but has been under maintenance hemodialysis since then. LESSONS: Despite low birth weight and preterm delivery, successful twin pregnancies in some patients with CKD could be realized under early multidisciplinary intervention, but this poses great risks for mothers and twins, especially for patients with advanced CKD and those on hemodialysis.


Assuntos
Complicações na Gravidez/fisiopatologia , Gravidez de Gêmeos , Insuficiência Renal Crônica/fisiopatologia , Adulto , Cesárea , China , Creatinina/sangue , Feminino , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Nifedipino/uso terapêutico , Prednisona/uso terapêutico , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Vasodilatadores/uso terapêutico
12.
BMC Ophthalmol ; 19(1): 179, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409322

RESUMO

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease is a T-cell-mediated autoimmune disorder characterized by bilateral granulomatous panuveitis with various systemic manifestations. Although VKH disease rarely occurs in the pediatric population, the clinical course tends to be aggressive, and the visual prognosis is worse than that in adult patients due to severe ocular complications secondary to recurrent inflammation. CASE PRESENTATION: A 3-year-old girl with probable VKH was referred to Kobe University Hospital. She had severe bilateral panuveitis with posterior synechiae of the iris, marked optic disk swelling, and serous retinal detachment in both eyes, and her best corrected visual acuities (BCVAs) were 20/200 OD and 20/125 OS. A third course of therapy was administered because serous retinal detachment remained after two courses of therapy. She was treated with three courses of high-dose intravenous corticosteroid therapy, followed by slow tapering of oral corticosteroids. Her BCVAs recovered to 20/16 OU, and relapse of ocular inflammation and side effect of treatment were not observed during the 1.5-year follow-up period. CONCLUSIONS: We experienced a pediatric patient with probable VKH disease who was treated with three courses of high-dose intravenous corticosteroid therapy. With the favorable clinical course in our patient, initial treatment with repeated high-dose intravenous corticosteroid therapy might be beneficial in pediatric VKH disease.


Assuntos
Angiofluoresceinografia/métodos , Pressão Intraocular/fisiologia , Metilprednisolona/uso terapêutico , Tomografia de Coerência Óptica/métodos , Síndrome Uveomeningoencefálica/diagnóstico , Acuidade Visual , Pré-Escolar , Feminino , Fundo de Olho , Glucocorticoides/uso terapêutico , Humanos , Oftalmoscopia , Recidiva , Síndrome Uveomeningoencefálica/tratamento farmacológico , Síndrome Uveomeningoencefálica/fisiopatologia
14.
Medicine (Baltimore) ; 98(34): e16839, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441857

RESUMO

RATIONALE: H7N9 infection causes acute respiratory distress syndrome with high mortality. The use of glucocorticoids in the acute phase lessened inflammatory responses. Some case reports suggested that secondary organizing pneumonia (SOP) could occur at the recovery stage of the influenza virus infection, and the treatment with glucocorticoid was effective. However, the reports of organizing pneumonia after H7N9 infection are lacking. This study reported a patient with H7N9 virus infection who presented a suspected SOP during the recovery stage. PATIENT CONCERN: A 68-year-old woman who was diagnosed with H7N9 viral pneumonia. After standard antiviral treatment, venous-venous extracorporeal membranous oxygenation (VV-ECMO) and other supportive treatment, the antigen in the alveolar lavage fluid turned negative, and the shadow in the lung was partially absorbed. However, the imaging manifestations were deteriorated at 3 weeks after disease onset, presented as exudation and consolidation shadow distributed under the pleura and along the bronchial vascular bundles. The oxygenation could not be improved. Repeated sputum, alveolar lavage fluid, and blood pathogen examinations showed negative results. Broad-spectrum anti-infective treatment was ineffective. However, the autoantibodies (ANA, anti-SSA/Ro60, anti-SSA/Ro52) were detected. DIAGNOSIS: SOP was considered. INTERVENTIONS: Glucocorticoid treatment begun at week 4 from the disease onset. The regimen was methylprednisolone at an initial dose of 40 mg twice a day for 1 week, tapering within 70 days until total withdrawal. OUTCOMES: The oxygenation was rapidly improved after initiation of methylprednisolone. The shadow in the lung gradually resolved, and the patient was discharged after improvement of the disease condition. The clinical disease course, imaging findings, and treatment effects in the previous cases of SOP after influenza virus infection were similar to those in this case, suggesting the occurrence of SOP after H7N9 virus infection. LESSONS: Organizing pneumonia might occur during the recovery stage of influenza virus infection. When the clinical symptoms do not improve and the shadow in the lung shows no obvious absorption after elimination of the H7N9 influenza virus, or the clinical symptoms are aggravated again after improvement, the probability of transforming into the organizing pneumonia should be taken into consideration.


Assuntos
Pneumonia em Organização Criptogênica/tratamento farmacológico , Glucocorticoides/uso terapêutico , Subtipo H7N9 do Vírus da Influenza A , Influenza Humana/virologia , Metilprednisolona/uso terapêutico , Pneumonia Viral/virologia , Idoso , Pneumonia em Organização Criptogênica/etiologia , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Influenza Humana/tratamento farmacológico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/terapia
15.
Z Rheumatol ; 78(7): 636-644, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31338681

RESUMO

BACKGROUND: In juvenile idiopathic arthritis and related chronic inflammatory diseases, proinflammatory cytokines inhibit bone formation and stimulate bone resorption. Anti-inflammatory drugs, such as glucocorticoids and nonsteroidal antirheumatic drugs (NSARD) have as a side effect the potential to inhibit growth and maintenance of bone. These issues are of particular importance for the growing skeleton in childhood and adolescence. OBJECTIVE: This article presents a narrative overview about the dimension of the problem, a critical evaluation of diagnostic procedures and a discussion of available countermeasures. METHODS: A systematic literature search was carried out and the available evidence was evaluated based on the authors' knowledge and clinical experience as experts in the field. RESULTS AND CONCLUSION: In recent years solid data have been accumulated with respect to the interpretation of bone mineral density (BMD) measurements in children and adolescents. Based on these data from the literature and given that the radiation exposure is also very low, it is now possible to clinically apply BMD measurements in this population using dual energy X­ray absorption (DXA) technology for risk evaluation and diagnosis, taking the respective phase of development and body length into consideration. Dynamic measurements over time appear to be especially valuable in the context of individual clinical data. Hence, BMD measurements can be helpful in monitoring bone health, especially in juvenile idiopathic arthritis and other related inflammatory diseases. Apart from the specific indications for extended diagnostics and bone targeted pharmacological treatment, this method can also contribute to the management of preventive measures, such as sufficient calcium and vitamin D intake and targeted exercise interventions. Even in times of extremely effective antirheumatic drugs, children with chronic inflammatory diseases still bear a risk for bone health.


Assuntos
Artrite Juvenil , Densidade Óssea , Osso e Ossos/efeitos dos fármacos , Glucocorticoides/efeitos adversos , Absorciometria de Fóton , Adolescente , Artrite Juvenil/complicações , Artrite Juvenil/tratamento farmacológico , Osso e Ossos/fisiologia , Criança , Fraturas Ósseas , Glucocorticoides/uso terapêutico , Humanos , Radiografia
16.
Medicine (Baltimore) ; 98(30): e16654, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348320

RESUMO

RATIONALE: Transforaminal epidural steroid injection (TFESI) is a conservative method to treat back pain due to radiculopathy. However, epidural hematoma can occur after the procedure by various mechanisms, which can cause serious complications. PATIENT CONCERNS: An 82-year-old man with spinal stenosis was treated with TFESI in the right intervertebral foramen at the L2-L3 level. The next morning, he experienced severe back pain and diffuse motor deficit. DIAGNOSIS: Emergency magnetic resonance imaging revealed fluid collection in the posterior epidural space at the T11-L1 level with central-canal stenosis. INTERVENTIONS: Emergency hematoma evacuation was performed to remove the epidural hematoma. OUTCOMES: After the surgery, the back pain disappeared. LESSONS: Epidural hematoma may occur due to causes other than direct needle injury after TFESI. Therefore, careful observation of the patient is necessary after the procedure.


Assuntos
Glucocorticoides/uso terapêutico , Hematoma Epidural Espinal/etiologia , Injeções Epidurais/efeitos adversos , Idoso de 80 Anos ou mais , Glucocorticoides/administração & dosagem , Hematoma Epidural Espinal/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Estenose Espinal/tratamento farmacológico
17.
Emerg Med Clin North Am ; 37(3): 431-444, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262413

RESUMO

Acute hypoxemic respiratory failure (AHRF) is a common challenge in emergency medicine. Patient outcomes depend on interventions performed during preintubation, intubation, and postintubation. The article presents recommendations for evidence-based practice to optimally manage patients with AHRF and the acute respiratory distress syndrome.


Assuntos
Hipóxia/terapia , Respiração Artificial , Insuficiência Respiratória/terapia , Algoritmos , Medicina de Emergência , Oxigenação por Membrana Extracorpórea , Hidratação , Glucocorticoides/uso terapêutico , Humanos , Hipóxia/complicações , Hipóxia/epidemiologia , Bloqueadores Neuromusculares/uso terapêutico , Oxigenoterapia , Decúbito Ventral , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Volume de Ventilação Pulmonar , Vasodilatadores/uso terapêutico , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle
18.
HNO ; 67(8): 639-648, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31321448

RESUMO

Sudden sensorineural hearing loss is not an emergency, but an urgency. Depending on severity, the disease may have a major impact on quality of life. Gold standard in Germany is a systemic, high-dosage glucocorticoid therapy. During oral or intravenous therapy with glucocorticoids, systemic side effects may occur. Especially in diabetics, this therapy may cause acute prominent disorders in glucose metabolism and therefore may be contraindicated. An alternative therapeutic option is intratympanic injection of steroids into the middle ear. Hereby the systemic side effects are absent and only local otologic complications may occasionally occur.


Assuntos
Glucocorticoides , Perda Auditiva Neurossensorial , Terapia de Salvação/métodos , Dexametasona , Complicações do Diabetes , Alemanha , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita , Humanos , Qualidade de Vida , Resultado do Tratamento , Membrana Timpânica
19.
Cornea ; 38(8): 933-937, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276456

RESUMO

PURPOSE: To understand medication use and patient burden for treatment of bacterial keratitis (BK). METHODS: A retrospective study was conducted examining medical records of adult patients with BK in an academic cornea practice. Data collected included medications used in the treatment of BK, dosing of medications, and the number and total duration of clinical encounters. Costs of medications were estimated using the average wholesale pharmacy price. Linear regression analysis was used to investigate associations of medication use with patient demographics and corneal culture results and reported with beta estimates (ß) and 95% confidence intervals (95% CIs). RESULTS: Forty-eight patients with BK (56% female) were studied. Patients were treated for a median of 54 days with 10 visits, 5 unique medications, 587 drops, and 7 prescriptions. The estimated median medication cost was $933 (interquartile range: $457-$1422) US dollars. Positive bacterial growth was significantly associated with more visits (ß: 6.16, 95% CI: 1.75-10.6, P = 0.007), more days of treatment (ß: 86.8, 95% CI: 10.8-163, P = 0.026), more prescribed medications (ß: 2.86, 95% CI: 1.04-4.67, P = 0.003), and more doses of medications (ß: 796, 95% CI: 818-1412, P = 0.012) compared with patients who did not undergo corneal scraping. Patients were prescribed 132 more drops of medication for every 10 years of older age (ß: 132, 95% CI: 18.2-246, P = 0.024). Sex and income were not associated with medication burden or treatment length. CONCLUSIONS: Older patients and those with positive cultures incur the most medication burden in treatment of BK. Providers should be aware of medication usage and cost burden as it may affect compliance with treatment.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Custos e Análise de Custo , Custos de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Infecções Oculares Bacterianas/tratamento farmacológico , Administração Oftálmica , Bactérias/isolamento & purificação , Úlcera da Córnea/microbiologia , Prescrições de Medicamentos/estatística & dados numéricos , Infecções Oculares Bacterianas/microbiologia , Feminino , Glucocorticoides/economia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Midriáticos/economia , Midriáticos/uso terapêutico , Soluções Oftálmicas , Estudos Retrospectivos
20.
Cornea ; 38(8): 955-958, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276459

RESUMO

PURPOSE: To describe the clinical features, risk factors, and treatment outcomes after supratarsal injection of triamcinolone for vernal keratoconjunctivitis (VKC). METHODS: A retrospective review of all patients treated with supratarsal triamcinolone for VKC between February 2002 and May 2017 at the Royal Victoria Eye and Ear Hospital and Our Lady's Children Hospital Crumlin, Dublin, Ireland, was performed. RESULTS: Twenty-five patients, 46 eyes, and 145 injections were included for analysis. The mean age at first injection was 9.1 ± 5.7 years. Ninety-six percent of the patients were male. A seasonal variation was noted, with 59 injections (41%) of triamcinolone administered for acute and refractive cases of VKC in the summer compared with 35 (24%), 35 (24%), and 16 (11%) in the spring, autumn, and winter months, respectively. The most common presenting complaint was red eye, which was seen in all cases. Hay fever (64%) was the most common associated systemic disease. Each eye required, on average, 3.2 injections (range 1-9 injections), and the mean duration from the onset of symptoms to final treatment was 3.03 years (range 0-7.9 years). The mean presenting and final visual acuities were 0.33 and 0.11 logarithm of the minimum angle of resolution, respectively (P < 0.0001). During our study period, no patient experienced intraocular pressure rise requiring treatment, development of lenticular opacity, or ptosis after supratarsal injection of triamcinolone. CONCLUSIONS: In this case series, supratarsal triamcinolone was used in cases of VKC in which topical medications had failed to control the disease process. All patients reported improvement after treatment. There were no cases of intraocular pressure rise, lenticular opacity, or ptosis development after treatment.


Assuntos
Conjuntivite Alérgica/tratamento farmacológico , Pálpebras/efeitos dos fármacos , Glucocorticoides/uso terapêutico , Triancinolona Acetonida/uso terapêutico , Adolescente , Criança , Pré-Escolar , Conjuntivite Alérgica/fisiopatologia , Feminino , Glucocorticoides/efeitos adversos , Humanos , Lactente , Injeções , Irlanda , Masculino , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Triancinolona Acetonida/efeitos adversos , Acuidade Visual/fisiologia , Adulto Jovem
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