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1.
Medicine (Baltimore) ; 99(2): e18696, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914071

RESUMO

RATIONALE: Severe alcoholic hepatitis (AH) has a very high mortality rate. Current guidelines recommend oral corticosteroids as first-line agents in individuals with severe AH to reduce short-term mortality. However, systemic corticosteroids have serious adverse effects. In individuals with AH, infection, which is one of the complications of steroid use, can result in serious outcomes, such as acute-on-chronic liver failure. Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection which may occur when high-dose corticosteroids are prescribed for more than 1 month. Therefore, when high-dose corticosteroids are used, providing PCP prophylaxis is warranted. Although trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for the prophylaxis of PCP, its hepatotoxicity limits its use in patients with severe AH who are on high-dose corticosteroids. Moreover, there is a lack of consensus on which drugs should be used for PCP prophylaxis in individuals with severe AH who are on glucocorticoid treatment. Herein, we report a case of a 43-year-old male with fatal PCP that occurred after the use of corticosteroids for severe AH. PATIENT CONCERNS: A 43-year-old alcoholic man presented with a hematoma on his right leg. His liver function was poor, and he was he was diagnosed with severe AH and treated with oral corticosteroids for 26 days. After glucocorticoid treatment, he developed a productive cough. DIAGNOSES: A sputum PCR test was positive for Pneumocystis jirovecii. INTERVENTIONS: He was initially treated with TMP-SMX and required artificial ventilation. OUTCOMES: He developed disseminated intravascular coagulation and multi-organ failure, and died 10 days after starting TMP-SMX. LESSONS: To date, prevention of PCP in individuals with severe AH who are on corticosteroids has been overlooked. This case illustrates the need for prophylaxis of PCP in individuals with severe AH taking corticosteroids.


Assuntos
Hepatite Alcoólica/complicações , Hepatite Alcoólica/tratamento farmacológico , Metilprednisolona/uso terapêutico , Pneumonia por Pneumocystis/etiologia , Adulto , Humanos , Masculino , Metilprednisolona/efeitos adversos , Infecções Oportunistas , Pneumocystis carinii , Pneumonia por Pneumocystis/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
2.
Ann Hematol ; 99(2): 255-264, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31897676

RESUMO

We assessed the efficacy and toxicity of etoposide, methylprednisolone, high-dose cytarabine, and oxaliplatin (ESHAOx) combination chemotherapy in patients with refractory or relapsed Hodgkin's lymphoma (HL). This was an open-label, non-randomized, multi-center phase II study. The ESHAOx regimen consisted of intravenous (i.v.) etoposide 40 mg/m2 on days 1 to 4, i.v. methylprednisolone 500 mg on days 1 to 5, i.v. cytarabine 2 g/m2 on day 5, and i.v. oxaliplatin 130 mg/m2 on day 1. Cycles (up to six) were repeated every 3 weeks. In an effort to identify prognostic markers, the serum levels of cytokines including tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and vascular endothelial growth factor (VEGF) were measured at the time of study entry. A total of 37 patients were enrolled, and 36 were available for evaluation of tumor response. The overall response rate was 72.2% (26/36) (complete response, 33.3% [12/36]; partial response, 38.9% [14/36]). The median time to progression was 34.9 months (95% confidence interval, 23.1-46.7 months). The most common grade 3 or 4 hematological adverse events were neutropenia (16/37, 43.2%), followed by thrombocytopenia (10/37, 27.0%). Grade 3 or 4 non-hematological adverse events were nausea (3/37, 8.1%), anorexia (2/37, 5.4%), mucositis (1/37, 2.7%), and skin rash (1/37, 2.7%). There were no treatment-related deaths. High levels of TNF-α and CRP were significantly associated with poorer overall survival (p = 0.00005 for TNF-α, p = 0.0004 for CRP, respectively). The ESHAOx regimen exhibited antitumor activity and an acceptable safety profile in patients with refractory or relapsed HL. Trial Registration: ClinicalTrials.gov. Registered February 21, 2011, https://clinicaltrials.gov/ct2/show/NCT01300156.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Doença de Hodgkin , Proteínas de Neoplasias/sangue , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Proteína C-Reativa/metabolismo , Citarabina/administração & dosagem , Citarabina/efeitos adversos , Intervalo Livre de Doença , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Doença de Hodgkin/sangue , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/mortalidade , Humanos , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Oxaliplatina/administração & dosagem , Oxaliplatina/efeitos adversos , Recidiva , Taxa de Sobrevida , Fatores de Tempo , Fator de Necrose Tumoral alfa/sangue , Fator A de Crescimento do Endotélio Vascular/sangue
3.
Ann Hematol ; 99(1): 105-112, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31776726

RESUMO

Outcome of patients with relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) remains poor, highlighting the need for novel treatment approaches. The multicentre randomised phase II LEGEND trial evaluated lenalidomide in combination with rituximab, methylprednisolone and gemcitabine (R-GEM-L) vs. standard R-GEM-P as second-line treatment of DLBCL. The study closed early to recruitment after the planned interim analysis failed to demonstrate a complete response (CR) rate of ≥ 40% in either arm. Among 34 evaluable patients, 7/18 (38.9%) achieved CR with R-GEM-L and 3/16 (18.8%) with R-GEM-P. Median event-free and overall survival was 3.5/3.8 months and 10.8/8.3 months for R-GEM-L and R-GEM-P, respectively. The incidence of grade ≥ 3 toxicities was 52% in R-GEM-L and 83% in R-GEM-P. Efficacy and tolerability of R-GEM-L seem comparable with R-GEM-P and other standard salvage therapies, but a stringent design led to early trial closure. Combination of lenalidomide with gemcitabine-based regimens should be further evaluated in r/r DLBCL.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/mortalidade , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Rituximab/administração & dosagem , Rituximab/efeitos adversos , Taxa de Sobrevida
4.
Medicine (Baltimore) ; 98(50): e18299, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852108

RESUMO

RATIONALE: Cervical transforaminal epidural steroid injection (TFESI), can be an effective tool to improve pain associated with cervical radiculopathy. However, complications related to the procedure have been reported. PATIENT CONCERNS: A 50-year-old woman who experienced acute cervical myelopathy with quadriparesis after cervical TFESI under fluoroscopic guidance. DIAGNOSES: The initial post-procedure cervical MRI revealed acute cervical myelopathy INTERVENTIONS:: She received 1000 mg of methylprednisolone was injected intravenously daily for 3 days OUTCOMES:: Improvement in pain, with the only remaining complaints consisting of lingering mild pain in the left hand and occasional hypoesthesia LESSONS:: Cervical TFESI, despite careful fluoroscopic localization, resulted in spinal cord injury. A spinal cord injury may be treated with conservative treatments, such as medication and rehabilitation.


Assuntos
Injeções Epidurais/efeitos adversos , Metilprednisolona/efeitos adversos , Quadriplegia/etiologia , Radiculopatia/complicações , Doença Aguda , Vértebras Cervicais , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Imagem por Ressonância Magnética , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Quadriplegia/diagnóstico , Radiculopatia/diagnóstico
5.
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
6.
Acta otorrinolaringol. esp ; 70(4): 207-214, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185397

RESUMO

Introducción: La hipoacusia súbita neurosensorial idiopática (SSI) es la pérdida de al menos 30 dB de causa desconocida. Dado que la recuperación auditiva en SSI es variable, el rescate con corticoides intratimpánicos (CIT) podría contribuir a la recuperación auditiva. Nuestro objetivo es analizar la respuesta auditiva tras CIT como rescate, en ausencia de recuperación completa tras tratamiento sistémico. Material y método: Realizamos un estudio observacional de cohortes históricas de los 125 casos detectados de SSI entre 2006 y 2014. De ellos, 16 obtuvieron a la semana recuperación completa según los criterios de Siegel. Los 109 casos restantes se analizaron en dos grupos: el que recibió CIT (grupo de tratamiento) y otro que no lo recibió (grupo control). Evaluamos la recuperación auditiva a los 6 meses y a 2 años. Resultados: La media de audición en la audiometría al diagnóstico no tenía diferencias significativas entre los grupos. Al séptimo día del tratamiento sistémico, el PTA obtenido fue de 53,13 dB en el grupo control y de 66,11 dB en el grupo de estudio (p < 0,01). Tras 6 meses, la ganancia en decibelios obtenida tras el tratamiento con CIT de rescate fue de 10,84 dB, y en el grupo control, de 1,13 dB (p < 0,0001). Tras CIT, solo se consiguió la recuperación completa en 10 pacientes. Ningún paciente del grupo control obtuvo recuperación completa. Conclusión: Encontramos que el tratamiento de rescate con CIT en la SSI favorece la mejoría auditiva tras la ausencia de recuperación después de un tratamiento sistémico. Sin embargo, en la mayoría de los pacientes no consigue obtener una recuperación completa según criterios de Siegel


Introduction: Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed. Material and method: An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegel's criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up. Results: The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13 dB and 66.11 dB in the treatment group (P < .01). After 6 months, the mean PTA improvement was 10.84dB in the treatment group, and 1.13 dB in the control group, a significant difference (P < .0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group. Conclusion: Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegel's criteria in most cases


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Anti-Inflamatórios/uso terapêutico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Súbita/tratamento farmacológico , Pregnenodionas/uso terapêutico , Metilprednisolona/uso terapêutico , Prednisona/uso terapêutico , Terapia de Salvação/métodos , Testes de Impedância Acústica , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Audiometria de Tons Puros , Emergências , Seguimentos , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Súbita/fisiopatologia , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Pregnenodionas/administração & dosagem , Pregnenodionas/efeitos adversos , Perfuração da Membrana Timpânica/etiologia
7.
BMJ Case Rep ; 12(5)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31129643

RESUMO

We report the case of a 6-year-old girl with juvenile idiopathic arthritis and anterior uveitis who was treated with two doses of intravenous methylprednisolone for acute arthritis. She developed severe ocular hypertension (intraocular pressures (IOPs) of 54 mm Hg in the right eye and 61 mm Hg in the left eye) requiring inpatient therapy with intravenous acetazolamide. The normal range of values for IOP is 12-22 mm Hg. This severe case of acute intraocular hypertension due to systemic steroids highlights the need to consider monitoring of IOPs for children on high-dose topical and systemic steroids with risk factors for raised IOP.


Assuntos
Anti-Inflamatórios/efeitos adversos , Artrite Juvenil/tratamento farmacológico , Metilprednisolona/efeitos adversos , Hipertensão Ocular/etiologia , Uveíte Anterior/tratamento farmacológico , Administração Intravenosa , Anti-Inflamatórios/administração & dosagem , Artrite Juvenil/complicações , Criança , Feminino , Humanos , Metilprednisolona/administração & dosagem , Hipertensão Ocular/tratamento farmacológico , Índice de Gravidade de Doença , Uveíte Anterior/complicações
8.
Ann Rheum Dis ; 78(6): 837-843, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30975645

RESUMO

OBJECTIVE: Steroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL. METHODS: This was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0-100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up. RESULTS: The estimated mean difference in the first week's maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups. CONCLUSION: Non-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption. TRIAL REGISTRATION NUMBER: NTC02403856.


Assuntos
Calcinose/terapia , Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Punções/métodos , Tendinopatia/terapia , Dor Aguda/etiologia , Dor Aguda/prevenção & controle , Adulto , Calcinose/diagnóstico por imagem , Método Duplo-Cego , Estudos de Equivalência como Asunto , Feminino , Seguimentos , Glucocorticoides/efeitos adversos , Humanos , Injeções Intra-Articulares , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Punções/efeitos adversos , Manguito Rotador , Solução Salina , Dor de Ombro/diagnóstico por imagem , Dor de Ombro/terapia , Tendinopatia/diagnóstico por imagem , Irrigação Terapêutica/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção
9.
J Dermatol ; 46(6): 522-525, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30969434

RESUMO

Pulse corticosteroid therapy is effective for alopecia areata (AA) in the early stage. The risk and efficacy of this therapy for patients with several backgrounds, however, remains controversial. To explore the predictive factors of the response and risk factors of this therapy, data from 105 AA patients treated with methylprednisolone (500 mg) i.v. for 3 days consecutively in our facility were retrospectively analyzed. Among good responders, longer time from the onset to therapy was correlated with longer time required for hair regrowth (P = 0.037, n = 27). Multivariate models demonstrated that "severity", "relapse" and longer "duration from the latest onset" were significantly and independently associated with poorer outcome (P < 0.01). "History of atopic dermatitis (AD)" was also associated with poorer outcome, but this correlation could be explained by the effect that duration from the latest onset of AA was longer among participants with AD. We propose that earlier initiation of pulse corticosteroid therapy is preferable for better outcome of AA, particularly among patients with AD. Clinicians should be mindful of the occurrence of mild adverse effects in the elderly patients.


Assuntos
Alopecia em Áreas/tratamento farmacológico , Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Adolescente , Adulto , Fatores Etários , Alopecia em Áreas/epidemiologia , Comorbidade , Dermatite Atópica/epidemiologia , Feminino , Seguimentos , Glucocorticoides/efeitos adversos , Humanos , Japão , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Prognóstico , Pulsoterapia/efeitos adversos , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
10.
Medicine (Baltimore) ; 98(14): e14984, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946325

RESUMO

To determine the incidence and risk of Parkinson disease (PD) in patients with Sjögren syndrome (SS) according to a nationwide population-based database.In total, 12,640 patients in the SS cohort and 50,560 in the non-SS cohort were enrolled from Taiwan's National Health Insurance Research Database from 2000 to 2010. We used the Cox multivariable proportional hazards model to determine the risk factors for PD in the SS cohort.We observed an increased incidence of PD in patients with SS, with a crude hazard ratio (HR) of 1.40 and an adjusted HR (aHR) of 1.23. The cumulative incidence of PD was 1.95% higher in the SS cohort than in the non-SS cohort. The SS cohort had an elevated HR under medication use, namely cevimeline and pilocarpine (crude HR, 1.28), hydroxychloroquine (crude HR, 1.43; aHR, 1.46), and methylprednisolone (crude HR, 2.21; aHR, 1.49). Patients receiving other non-hydroxychloroquine immunosuppressant therapies had a lower risk (aHR, 0.86) of PD. Furthermore, patients with SS aged 20 to 49 years had a 1.93-fold higher risk of PD than did those without SS (aHR, 1.93). The risk of PD was higher (aHR, 2.20) in patients with SS without comorbidities than in those with comorbidities. The aHR of PD significantly increased when the follow-up period exceeded 9 years (aHR, 1.93).We determined an increased risk of PD in patients with SS. Further investigation is warranted to determine the possible underlying mechanisms and the potential role of non-hydroxychloroquine immunosuppressants in ameliorating PD.


Assuntos
Imunossupressão/efeitos adversos , Doença de Parkinson/etiologia , Síndrome de Sjogren/tratamento farmacológico , Adulto , Idoso , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Comorbidade , Feminino , Humanos , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Imunossupressão/estatística & dados numéricos , Incidência , Masculino , Metilprednisolona/efeitos adversos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Agonistas Muscarínicos/efeitos adversos , Agonistas Muscarínicos/uso terapêutico , Programas Nacionais de Saúde/estatística & dados numéricos , Doença de Parkinson/epidemiologia , Pilocarpina/efeitos adversos , Pilocarpina/uso terapêutico , Quinuclidinas/efeitos adversos , Quinuclidinas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/epidemiologia , Taiwan/epidemiologia , Tiofenos/efeitos adversos , Tiofenos/uso terapêutico
11.
Mult Scler Relat Disord ; 32: 30-32, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31029055

RESUMO

Standard therapy for a relapse of multiple sclerosis is a high dose pulse corticosteroid therapy. Cardiovascular adverse events ranging from palpitations to serious arrhythmias like atrial fibrillation and ventricular tachycardia have been associated with this treatment. The underlying mechanism behind the development of atrial fibrillation and treatment of multiple sclerosis relapse with steroids is still unclear. In this case, a 27-year-old male with multiple sclerosis is presented who developed atrial fibrillation on two occasions following two consecutive treatments with high dose methylprednisolone for the treatment of multiple sclerosis relapse. Extensive work-up revealed mild sympathetic autonomic system dysfunction. Based on this case and previous studies, we propose that a disturbed function of the autonomic system increases the risk of atrial fibrillation and/or other arrhythmias in people with multiple sclerosis.


Assuntos
Fibrilação Atrial/induzido quimicamente , Fibrilação Atrial/diagnóstico , Metilprednisolona/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Fibrilação Atrial/fisiopatologia , Eletrocardiografia/efeitos dos fármacos , Humanos , Masculino , Metilprednisolona/administração & dosagem , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Pulsoterapia/efeitos adversos , Recidiva , Resultado do Tratamento
12.
Reg Anesth Pain Med ; 44(5): 586-594, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30962251

RESUMO

BACKGROUND: Studies have found that diffuse pain, indicative of central sensitization, portends poor interventional outcomes. Multiple chemical sensitivities are associated with signs of central sensitization. We sought to prospectively determine whether hypersensitivity reactions (HR) were associated with epidural steroid injection (ESI) outcomes. METHODS: HR were classified as immune-related or non-immune-related and categorized by number (0=low, 1 or 2=intermediate, ≥3=high). The primary outcome measure was mean reduction in average leg pain score 1 month post-procedure. A positive outcome was defined as a two-point or greater decrease in average leg pain accompanied by satisfaction 1 month post-procedure. RESULTS: The mean number of immune-mediated and non-immune-mediated HR were 0.6±1.2 and 0.8±1.4, respectively. Individuals in the high (n=24) total HR group had a mean reduction in average leg pain of 0.1±2.7, compared with those in the low (n=61; 1.8±2.1, p=0.025) and intermediate groups (n=52; 1.6±3.1, p=0.060). For back pain and categorical successful outcome, those with fewer HR experienced greater benefit. There were no differences in outcomes when patients were stratified by immune-related HR. Among participants in the low, intermediate and high non-immune-mediated HR groups, the mean reductions in average leg pain scores were 1.7±2.5, 1.6±3.0, and -0.2±2.3, respectively (p = 0.002). 51%, 35%, and 12% of people with low, intermediate and high numbers of non-immune-mediated HR experienced a positive categorical outcome, respectively (p=0.007). CONCLUSIONS: Non-immune-related HR were inversely correlated with some ESI outcome measures.


Assuntos
Hipersensibilidade a Drogas/diagnóstico , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Fenótipo , Adulto , Estudos de Coortes , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Injeções Epidurais/efeitos adversos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
13.
Curr Med Sci ; 39(1): 75-80, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30868494

RESUMO

Nowadays, the cumulative intake of glucocorticoids has become the most common pathogenic factor for non-traumatic osteonecrosis of the femoral head (ONFH). Apoptosis of osteoblasts is considered as the main reason of ONFH at the molecular level. Glycogen synthase kinase 3ß (GSK3ß) is an important regulator of cellular differentiation and apoptosis pathway, which can modulate the balance between osteoblasts and osteoclasts. Several studies have reported about its function in osteoporosis, but little is known about it in osteonecrosis. In our study, lipopolysaccharide and methylprednisolone were utilized to establish a rat ONFH model. The phosphorylation of GSK3ß Ser-9 was decreased in the model. Western blotting examination of ß-catenin, Bcl-2, Bax and caspase-3 revealed that the osteoblasts were apoptotic. In dexamethasone (Dex)-incubated primary osteoblasts, the expression profile of GSK3ß phosphorylation and apoptotic factors were consistent with those in the rat ONFH model. To further investigate the regulation of osteonecrosis caused by GSK3ß, the expression and function of GSK3ß were inhibited in Dex-incubated primary osteoblasts. The knockdown of GSK3ß by siRNA decreased the expression of Bax and cleaved caspase-3, but increased Bcl-2 and ß-catenin. On the other hand, selective inhibition of GSK3ß function by LiCl counteracted the activation of caspase-3 induced by Dex. Our work is the first study about the GSK3ß phosphorylation in ONFH, and provides evidence for further therapeutic methods.


Assuntos
Necrose da Cabeça do Fêmur/induzido quimicamente , Glicogênio Sintase Quinase 3 beta/genética , Glicogênio Sintase Quinase 3 beta/metabolismo , Osteoartrite/induzido quimicamente , Osteoblastos/citologia , Serina/metabolismo , Animais , Apoptose/efeitos dos fármacos , Dexametasona , Modelos Animais de Doenças , Necrose da Cabeça do Fêmur/genética , Necrose da Cabeça do Fêmur/metabolismo , Técnicas de Silenciamento de Genes , Lipopolissacarídeos/efeitos adversos , Cloreto de Lítio/farmacologia , Metilprednisolona/efeitos adversos , Osteoartrite/genética , Osteoartrite/metabolismo , Osteoblastos/metabolismo , Fosforilação/efeitos dos fármacos , Ratos , Regulação para Cima/efeitos dos fármacos
14.
Endocrinol Diabetes Nutr ; 66(6): 353-360, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30898606

RESUMO

INTRODUCTION: There are no agreed protocols on hospital management of hyperglycemic decompensation induced by pharmacological doses of glucocorticoids (GCs). The study objective was to assess the efficacy and safety of an insulin therapy protocol specific for patients treated with glucocorticoids (CP) as compared to a general protocol (GP) in diabetes decompensation secondary to glucocorticoids. Materials and methods An experimental study in patients with glucocorticoids-induced decompensated diabetes admitted to a respiratory ward including a non-randomized control group. Two protocols (CP and GP), both based on basal-bolo insulin regimens, but with different insulin doses and distribution, were compared. The difference in mean blood glucose (MBG) levels between both protocols was measured during hospital stay, as was the risk of having MBG levels > 200mg/dL, adjusted for potential confounding factors (related to patients and to the glucocorticoid therapy used). RESULTS: A total of 131 patients were included, 60 assigned to the GP and 71 to the CP groups. Seventy-four percent of patients had been admitted due to COPD exacerbation. There was a significant difference in the total daily insulin dose used between the CP and GP groups (29.4 vs. 57.4 IU; P<.0001). The adjusted difference in MBG levels (CP-GP) was -14.8 (95% CI, -26.2 to -3.3) mg/dL. Patients in the CP group had a lower adjusted risk of having MBG levels >200mg/dL during hospital admission (OR=0.31; 95% CI, 0.11-0.91; P=.033). There were no differences in the risk of severe hypoglycemia between the CP and GP groups (0% vs. 1.4%; P=.36). CONCLUSIONS: The study protocol has been shown to decrease MBG levels in patients with glucocorticoids-induced decompensation of diabetes during hospital admission without compromising their safety.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/induzido quimicamente , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Metilprednisolona/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Feminino , Hospitalização , Humanos , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(13): e14636, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921179

RESUMO

BACKGROUND: The systemic use of corticosteroids for patients in severe community-acquired pneumonia (CAP) remains disputed in clinical practice. We undertook a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with severe CAP. METHODS: We searched MEDLINE (1946 to June 2018), EMBASE (1966 to June 2018), and the Cochrane Library database for randomized controlled trials (RCTs) conducted for severe CAP. The endpoints of the study included total mortality, length of intensive care unit (ICU) stay and mechanical ventilation. RESULTS: Nine trials which contained 914 patients were included for final meta-analysis. Of the 488 patients in the corticosteroid group, there were 37 deaths (7.58%) and 56 deaths occurred in 426 patients in the control group (13.1%). Corticosteroid therapy was associated with a lower rate of all-cause mortality compared to control (odd ratio [OR] 0.63, 95% confidence interval [CI] 0.42-0.95, P = .03). Subgroup analysis was conducted to show that the drug type modified the effect of steroids for mortality rate: prednisolone or methylprednisolone therapy (OR 0.37, 95% CI 0.19-0.72) reduced total mortality, whereas hydrocortisone use did not (OR 0.90, 95% CI 0.54-1.49). We found the length of ICU stay was significantly shorter in the steroid group compared to control (MD -2.52 days, 95% CI -4.88 to -0.15; P = .04). And there was a reduction trend in the need for mechanical ventilation in corticosteroid group (OR 0.53, 95% CI 0.28-1.02; P = .06). There was no trend towards more adverse events in the corticosteroid arm compared to control (OR 0.92, 95% CI 0.58-1.47; P = .74). CONCLUSION: Overall, adjunctive systemic corticosteroids therapy was effective and safe for patients with severe CAP. In addition, the effects of mortality may differ according to the type of corticosteroids.


Assuntos
Corticosteroides/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hidrocortisona/uso terapêutico , Metilprednisolona/uso terapêutico , Pneumonia/tratamento farmacológico , Prednisolona/uso terapêutico , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Idoso , Infecções Comunitárias Adquiridas/epidemiologia , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/efeitos adversos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Mortalidade/tendências , Pneumonia/mortalidade , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Int J Rheum Dis ; 22(4): 583-591, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30740904

RESUMO

AIM: To investigate the impact of corticosteroids on the outcome of antiviral therapy in rheumatic patients with cytomegalovirus (CMV)-emia. METHOD: Sixty-two patients with rheumatic disease complicated by CMV infection from 2011 to 2014 were retrospectively analyzed. RESULTS: Fifty-five of 62 patients were diagnosed with CMV-DNAemia. Most patients (43/55, 78.2%) achieved viral clearance within 5 weeks. It was shown that, while undergoing active antiviral therapy, there was no significant difference in the CMV-DNAemia clearance rate between the pulse methylprednisolone (MPSL) therapy group and non-pulse group (8/9, 88.9% vs 30/36, 83.3%; OR = 1.600, 95% CI 0.168-15.273, P > 0.05) at the end of the 5-week follow-up. However, pulse MPSL might slightly prolong duration of CMV-DNAemia than non-pulse MPSL patients (20.78 ± 19.18 days vs 14.33 ± 9.01 days, P = 0.1430), especially in the high baseline titer group (33.7 ± 29.1 days in pulse MPSL group vs 18.3 ± 13.1 days in non-pulse group, P = 0.457). But in the low baseline titer group, CMVemia duration in the pulse MPSL group (14.3 ± 10.0 days) was about the same as that in the non-pulse MPSL group (13.4 ± 7.8 days). CONCLUSION: With effective antiviral therapy, pulse MPSL is acceptable in rheumatic disease patients with CMV-DNAemia, without significant impact on final clearance of virus. However, duration of CMV-DNAemia may be prolonged, especially in patients with high CMV-DNA titer at baseline.


Assuntos
Corticosteroides/administração & dosagem , Antirreumáticos/administração & dosagem , Antivirais/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Infecções por Citomegalovirus/tratamento farmacológico , Citomegalovirus/efeitos dos fármacos , Ganciclovir/uso terapêutico , Metilprednisolona/administração & dosagem , Infecções Oportunistas/tratamento farmacológico , Corticosteroides/efeitos adversos , Adulto , Idoso , Antirreumáticos/efeitos adversos , Antivirais/efeitos adversos , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Citomegalovirus/genética , Citomegalovirus/imunologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , DNA Viral/genética , Feminino , Ganciclovir/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Pulsoterapia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
BMC Musculoskelet Disord ; 20(1): 61, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736773

RESUMO

BACKGROUND: Although intraoperative periarticular multi-drug injection has been used for postoperative pain control after total knee arthroplasty (TKA), the injection has the inherent shortcoming of limited acting time. This randomized controlled trial was performed to assess whether adding percutaneous periarticular multi-drug injection at the day following TKA would improve the postoperative pain relief. METHODS: A total of 43 participants were randomly assigned to receive additional periarticular injection at 08:30, postoperative day 1 or no additional injection. The multi-drug solution including 40 mg of methylprednisolone, 150 mg of ropivacaine, and 0.1 mg of epinephrine was infiltrated into the muscle belly of the vastus medialis. In both groups, patients were treated with intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. We did not use any narcotic pain medications postoperatively. The primary outcome was the patients' global assessment of postoperative pain at rest measured using a visual analog scale (VAS) and quantified as the area under the curve (AUC) of serial assessments until 20:00, postoperative day 5. RESULTS: The mean AUC for the postoperative pain VAS at rest was 1616 ± 1191 in patients received the additional periarticular injection versus 2808 ± 1494 in those received no injection (mean difference, - 1192; 95% confidence interval, - 2043 to - 340; p = 0.007). No wound complication or surgical site infection was observed in either groups. CONCLUSIONS: Adding percutaneous periarticular multi-drug injection at the day following TKA may provide better postoperative pain relief. Further studies are needed to confirm the safety of the percutaneous injection. TRIAL REGISTRATION: University Hospital Medical Information Network UMIN000029003 . Registered 5 September 2017.


Assuntos
Agonistas Adrenérgicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Epinefrina/administração & dosagem , Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Ropivacaina/administração & dosagem , Agonistas Adrenérgicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Combinação de Medicamentos , Epinefrina/efeitos adversos , Feminino , Glucocorticoides/efeitos adversos , Humanos , Injeções , Japão , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ropivacaina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
18.
Mod Rheumatol ; 29(4): 700-703, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28121197

RESUMO

Sinus bradycardia is reported as an adverse effect of high-dose glucocorticoid therapy. We report three cases of systemic lupus erythematosus, wherein intravenous pulse methylprednisolone was administered. The patients' average baseline heart rate was 72 beats/min, which decreased 30% from baseline at 61 h after beginning the therapy. The average minimum heart rate was 38 beats/min, and this rate continued for 169 h on average. No other causes for bradycardia were found, suggesting that the administration of glucocorticoid pulse therapy resulted in decreased heart rate.


Assuntos
Bradicardia/etiologia , Glucocorticoides/efeitos adversos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Metilprednisolona/efeitos adversos , Síndrome do Nó Sinusal/etiologia , Adulto , Cardiotoxicidade , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade
19.
Acta Otorrinolaringol Esp ; 70(4): 207-214, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30093088

RESUMO

INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed. MATERIAL AND METHOD: An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegel's criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up. RESULTS: The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13dB and 66.11dB in the treatment group (P<.01). After 6 months, the mean PTA improvement was 10.84dB in the treatment group, and 1.13dB in the control group, a significant difference (P<.0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group. CONCLUSION: Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegel's criteria in most cases.


Assuntos
Anti-Inflamatórios/uso terapêutico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Súbita/tratamento farmacológico , Metilprednisolona/uso terapêutico , Prednisona/uso terapêutico , Pregnenodionas/uso terapêutico , Terapia de Salvação/métodos , Testes de Impedância Acústica , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Audiometria de Tons Puros , Emergências , Feminino , Seguimentos , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Súbita/fisiopatologia , Humanos , Injeções/efeitos adversos , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Pregnenodionas/administração & dosagem , Pregnenodionas/efeitos adversos , Membrana Timpânica , Perfuração da Membrana Timpânica/etiologia
20.
Microsc Res Tech ; 82(3): 296-303, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30575194

RESUMO

Spinal cord injury (SCI) is catastrophic and can culminate in disability and death. The routine therapy employed in early stages of SCI currently entails surgical procedures combined with high doses of methylprednisolone (MP). MP is highly controversial for the lack of consensus on its true therapeutic effects. Resveratrol (RES) has recently been recognized as a potential and novel therapeutic drug in SCI. Herein, we investigated the effect of RES in a SCI rat-model and found significant improvement in Basso-Beattie-Bresnahan scores. Results obtained from histological, immunohistochemistry, and ultra-structural examinations evidenced the tremendous treatment effect of RES. On the basis of our experimental results, we hypothesize that RES could serve as an effective SCI therapeutic with prolong treatment time following injury.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Resveratrol/uso terapêutico , Traumatismos da Medula Espinal/tratamento farmacológico , Animais , Caspase 3/biossíntese , Modelos Animais de Doenças , Proteína GAP-43/biossíntese , Inflamação/tratamento farmacológico , Inflamação/prevenção & controle , Masculino , Metilprednisolona/efeitos adversos , Metilprednisolona/uso terapêutico , Microscopia Eletrônica , Ratos , Ratos Sprague-Dawley , Traumatismos da Medula Espinal/cirurgia , Proteína X Associada a bcl-2/biossíntese
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