A comparison of single-dose and multiple divided daily-dose oral steroids for sudden sensorineural hearing loss / Comparação entre dose única e múltiplas doses diárias de corticoides para perda auditiva neurossensorial súbita

Abstract Introduction: Glucocorticoids are considered the first-line therapy for sudden sensorineural hearing loss. But there is currently no consensus on administering them as a single dose versus multiple divided daily doses. Objective: We aim to evaluate the treatment outcome of sudden sensorineural hearing loss between a single-dose and multiple divided daily doses of steroid treatment. Methods: A total of 94 patients who were diagnosed and treated for sudden sensorineural hearing loss and followed up for more than three months were reviewed retrospectively. Patients were divided into single-dose and multiple divided-dose groups, based on their medication regimens. Hearing thresholds were repeatedly measured: on the initial visit and 1 week, 1 month, and 3 months after the initial treatment. Treatment outcomes were analyzed by comparing hearing recovery rates and post-treatment audiometric changes. Results: The hearing threshold was significantly reduced at three months post-treatment in both groups. The hearing recovery rate of the single-dose group was significantly higher than that of the multiple divided-dose groups. Audiometric changes showed no statistical difference either in pure tone threshold or speech discrimination. Conclusion: When oral steroids are indicated for sudden sensorineural hearing loss, both a single dose and multiple divided doses can be effective for treatment and have comparable results. However, the single-dose regimen seems to be more efficacious than the divided-dose regimen.

Resumo Introdução: Os glicocorticoides são considerados terapia de primeira linha para perda auditiva neurossensorial súbita. Contudo, atualmente não há consenso em como para administrá-los, se em dose única ou múltiplas doses diárias. Objetivo: Nosso objetivo é avaliar o resultado do tratamento da perda auditiva neurossensorial súbita com uma dose única ou várias doses diárias de tratamento com esteróides. Método: Um total de 94 pacientes que foram diagnosticados e tratados para perda auditiva neurossensorial súbita e acompanhados por mais de três meses pós-tratamento foram avalia-dos retrospectivamente. Os pacientes foram divididos em grupos de dose única diária e dose diária dividida em múltiplas tomadas, baseado em seu regime medicamentoso. Os limiares auditivos foram medidos repetidamente: na visita inicial e em 1 semana, 1 mês e 3 meses após o tratamento inicial. Os resultados do tratamento foram analisados comparando-se as taxas de recuperação da audição e as alterações audiométricas pós-tratamento. Resultados: O limiar auditivo foi significativamente reduzido aos três meses pós-tratamento em ambos os grupos. A taxa de recuperação auditiva no grupo de dose única foi significativamente maior do que no grupo de dose diária dividida em múltiplas tomadas. As alterações audiométricas não mostraram diferença estatística, tanto no limiar de tom puro quanto na discriminação da fala. Conclusão: Quando esteroides orais são indicados para perda auditiva neurossensorial súbita, tanto uma dose única quanto múltiplas doses podem ser eficazes para o tratamento e têm resultados comparáveis. No entanto, o regime de dose única diária parece ser mais eficaz do que o regime de dose diária dividida em múltiplas tomadas.

Chronic equine proliferative pododermatitis: case report / Pododermatite proliferativa crônica equina: relato de caso

Chronic equine proliferative pododermatitis (canker) is a chronic hypertrophic disease of the hoof, denoted by an excessive proliferation of the horn-producing tissues, which results from a dyskeratosis of the keratinocytes. It occurs mainly at the frog and sulci regions, but can sometimes also affect the heels, sole, bulbs or hoof wall. The etiology still remains unclear. Infectious agents such as anaerobic bacteria, viruses, spirochetes and fungi have been isolated from diseased tissues, but, moreover, an immune cause has been suggested, possibly related to a genetic predisposition. This report shows a case of a Brazilian Sport Horse, 10 years old, that had been affected on the right hindlimb for more than two years without a concise diagnosis. Success was achieved with the treatment consisting of oral prednisolone and topical Purple Mush(AU)

Pododermatite proliferativa crônica equina (cancro) é uma doença hipertrófica dos cascos, caracterizada por uma proliferação excessiva dos tecidos produtores de túbulos, o que resulta de uma disqueratose dos queratinócitos. Concentra-se principalmente na região da ranilha e seus sulcos, mas algumas vezes pode afetar também talões, bulbos, sola e parede do casco. A etiologia ainda não foi confirmada. Agentes infecciosos como bactérias anaeróbias, vírus, espiroquetas e fungos já foram isolados de tecidos afetados, mas cada vez mais uma hipótese imune vem sido discutida, possivelmente relacionada a uma predisposição genética. Este relato traz o caso de um Brasileiro de Hipismo, 10 anos, afetado no membro pélvico direito há mais de dois anos sem um diagnóstico conciso. O êxito foi obtido com o tratamento consistindo em Prednisolona oral e Purple Mush tópico.(AU)

Comparative study on the efficacy of non-steroidal, steroid and non-use of anti-inflammatory in the treatment of acute epidemic conjunctivitis

Abstract Purpose To evaluate the effects of prednisolone against sodium diclofenac both with ciprofloxacin compared to artificial tears on the symptoms and signs of acute viral conjunctivitis. Methods Study included 37 patients diagnosed with acute conjunctivitis and distributed by three groups: A (1% prednisolone acetate + ciprofloxacin (0.3%); B (Sodium diclofenac (0.1%) + ciprofloxacin (0.3%) and C (artificial tears + ciprofloxacin (0.3%). Patients received medication 6/6 hours daily. Signs and symptoms (e.g. lacrimation, burning, photophobia, etc.) were scored at baseline and on the first, third, fifth and seventh days and in the end of treatment using a standardized questionnaire and slit lamp anterior segment examination. Results All three groups demonstrated an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group A and B and B and C in the study visits ( p >0.05). However, the comparison between groups A and C showed a clinical trend (p=0.05) on third evaluation suggesting better clinical action using the corticosteroids. Conclusion The prednisolone acetate was not superior to the use of sodium diclofenac or artificial tears in relieving the signs and symptoms of viral conjunctivitis.

Whole-genome sequences of influenza A(H3N2) viruses isolated from Brazilian patients with mild illness during the 2014 season

The influenza A(H3N2) virus has circulated worldwide for almost five decades and is the dominant subtype in most seasonal influenza epidemics, as occurred in the 2014 season in South America. In this study we evaluate five whole genome sequences of influenza A(H3N2) viruses detected in patients with mild illness collected from January-March 2014. To sequence the genomes, a new generation sequencing (NGS) protocol was performed using the Ion Torrent PGM platform. In addition to analysing the common genes, haemagglutinin, neuraminidase and matrix, our work also comprised internal genes. This was the first report of a whole genome analysis with Brazilian influenza A(H3N2) samples. Considerable amino acid variability was encountered in all gene segments, demonstrating the importance of studying the internal genes. NGS of whole genomes in this study will facilitate deeper virus characterisation, contributing to the improvement of influenza strain surveillance in Brazil.

Efficacy and tolerability of a gatifloxacin/prednisolone acetate fixed combination for topical prophylaxis and control of inflammation in phacoemulsification: a 20-day-double-blind comparison to its individual components

OBJECTIVE: To compare the efficacy and tolerability of a fixed combination of 0.3% gatifloxacin and 1% prednisolone (Zypred®) versus the individual components used separately (Zypred® and Predfort®) for infection prophylaxis and inflammation control after cataract surgery with intraocular lens implantation. METHODS: A prospective, randomized, double-blind, parallel-group study of 108 patients who underwent phacoemulsification and intraocular lens implantation was conducted. After random assignment, 47 eyes received the fixed combination of topical 0.3% gatifloxacin/1% prednisolone drops, and 61 eyes received the same doses of the individual components as separate solutions four times a day for 15 days. Baseline and postoperative assessments were made on postoperative days 1, 7, 15, and 20. RESULTS: All objective (best corrected visual acuity, sign of active ocular inflammation, central and incisional corneal edema, the number of cells per high-power field in the anterior chamber, and intraocular pressure) and subjective (eye pain, photophobia, burning sensation, itching, and foreign body sensation) criteria of efficacy were similar in both groups, with no significant differences. Group I included 47 eyes that received the fixed combination of gatifloxacin/prednisolone acetate eye drops and a placebo eye drop solution. Group II included 61 eyes that were treated with 0.3% gatifloxacin and 1% prednisolone acetate eye drops separately. The intraocular pressure was slightly higher in Group II (p<0.05). CONCLUSION: Treatment with the fixed-dose combination of gatifloxacin/prednisolone eye drops was as effective as the non-fixed combination in preventing infection and controlling inflammation after phacoemulsification and intraocular lens implantation. .

Metilprednisolona intratimpânica como terapia de resgate na surdez neurossensorial súbita / Intratympanic methylprednisolone as rescue therapy in sudden sensorineural hearing loss

O tratamento da surdez súbita é uma das questões mais controversas da Otologia. No entanto, os corticoides sistêmicos têm sido a opção mais escolhida por referidos autores como padrão ouro de tratamento. O uso de corticoide intratimpânico como terapia de segunda linha para tratamento de casos refratários de surdez súbita tem sido relatado e os resultados promissores têm feito alguns autores promoverem o seu uso como terapia de primeira linha, indicando-a para todos os casos de surdez súbita. OBJETIVOS: Descrever essa nova modalidade de tratamento e avaliar a sua segurança e eficácia em quatorze pacientes tratados após falha da corticoterapia oral. MATERIAIS E MÉTODOS: Trata-se de estudo analítico prospectivo em que quatorze pacientes portadores de surdez súbita neurossensorial foram tratados com metilprednisolona intratimpânica após falha da corticoterapia oral. Limiares tonais e o índice de reconhecimento de fala pré-tratamento e pós-tratamento foram analisados. RESULTADOS: Dez dos quatorze pacientes tratados com metilprednisolona intratimpânica apresentaram recuperação da audição superior a 20 dB nos limiares tonais ou 20 por cento no IRF. CONCLUSÃO: Três injeções intratimpânicas de metilprednisolona aumentaram os limiares tonais e índices de reconhecimento da fala em um grupo de pacientes portadores de surdez súbita neurossensorial que não obtiveram benefício após corticoterapia oral.

Treatment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids. AIM: To describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone. METHODS: In a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed. RESULTS: Ten from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery > 20 dB in PTA or 20 percent in SRT. CONCLUSION: Three intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids.

Linfoma de Hodkin en Chile: Experiencia de 15 años del Programa Nacional de Cáncer del Adulto / Hodgkin lymphoma in Chile: Experience of the national adult cancer program

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61 percent of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73 percent and 66 percent with RT, 80 percent and 74 percent with C-MOPP+RT, 73 percent and 71 percent with C-MOPP/ABV, 59 percent and 59 percent with NOVP+RT, and 81 percent with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82 percent and 70 percent with RT, 82 percent and 76 percent with C-MOPP+RT, 82 percent and 80 percent with C-MOPP/ABV, 68 percent and 60 percent with NOVP, and 85 percent with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49 percent and 43 percent with C-MOPP, 69 percent and 62 percent with C-MOPP/ABVD or C-MOPP/ABV, and 71 percent at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52 percent and 46 percent with C-MOPP, 70 percent and 63 percent with C-MOPP/ABVD or C-MOPP/ABV and 76 percent with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early...

Thrombocytopenic purpura in a patient with macrolide-treated upper airway infection - drug related side effect or idiopathic thrombocytopenic purpura (ITP)

Os autores apresentam relato de caso de um homem de 55 anos de idade que desenvolveu púrpura trombocitopênica com sangramento da pele e membranas mucosas e macro-hematúria após infecçäo das vias aéreas superiores tratada com o macrolídeo roxitromicina. Foi feito o diagnóstico de púrpura trombocitopênica idiopática crônica com início agudo e excluído o de citopenia droga-induzida devido ao rápido início após ingestäo de apenas três comprimidos, à recuperaçäo retardada, ao curso crônico e aos dados epidemiológicos. O diagnóstico deferencial e o tratamento säo discutidos resumidamente