Uveitis for the non-ophthalmologist

Abstract The uveitides are a heterogeneous group of diseases characterized by inflammation inside the eye. The uveitides are classified as infectious or non-infectious. The non-infectious uveitides, which are presumed to be immune mediated, can be further divided into those that are associated with a known systemic disease and those that are eye limited,—ie, not associated with a systemic disease. The ophthalmologist identifies the specific uveitic entity by medical history, clinical examination, and ocular imaging, as well as supplemental laboratory testing, if indicated. Treatment of the infectious uveitides is tailored to the particular infectious organism and may include regional and/or systemic medication. First line treatment for non-infectious uveitides is corticosteroids that can be administered topically, as regional injections or surgical implants, or systemically. Systemic immunosuppressive therapy is used in patients with severe disease who cannot tolerate corticosteroids, require chronic corticosteroids at >7.5 mg/day prednisone, or in whom the disease is known to respond better to immunosuppression. Management of many of these diseases is optimized by coordination between the ophthalmologist and rheumatologist or internist.

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Mechanisms of Action of Topical Corticosteroids in Psoriasis

International Journal of Endocrinology ◽

10.1155/2012/561018 ◽

2012 ◽

Vol 2012 ◽

pp. 1-16 ◽

Cited By ~ 42

Author(s):

Luís Uva ◽

Diana Miguel ◽

Catarina Pinheiro ◽

Joana Antunes ◽

Diogo Cruz ◽

...

Keyword(s):

Systemic Disease ◽

Severe Disease ◽

Topical Therapy ◽

Mechanisms Of Action ◽

New Combination ◽

Mild Disease ◽

Combination Treatments ◽

Immune Mediated ◽

The Individual ◽

Almost All

Psoriasis is a lifelong, chronic, and immune-mediated systemic disease, which affects approximately 1–3% of the Caucasian population. The different presentations of psoriasis require different approaches to treatment and appropriate prescriptions according to disease severity. The use of topical therapy remains a key component of the management of almost all psoriasis patients, and while mild disease is commonly treated only with topical agents, the use of topical therapy as adjuvant therapy in moderate-to-severe disease may also be helpful. This paper focuses on the cutaneous mechanisms of action of corticosteroids and on the currently available topical treatments, taking into account adverse effects, bioavailability, new combination treatments, and strategies to improve the safety of corticosteroids. It is established that the treatment choice should be tailored to match the individual patient’s needs and his/her expectations, prescribing to each patient the most suitable vehicle.

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New First Line Treatment Options of Clear Cell Renal Cell Cancer Patients with PD-1 or PD-L1 Immune-Checkpoint Inhibitor-Based Combination Therapies

Journal of Clinical Medicine ◽

10.3390/jcm9020565 ◽

2020 ◽

Vol 9 (2) ◽

pp. 565 ◽

Cited By ~ 6

Author(s):

Marc-Oliver Grimm ◽

Katharina Leucht ◽

Viktor Grünwald ◽

Susan Foller

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitor ◽

Checkpoint Inhibitor ◽

Line Treatment ◽

First Line ◽

Immune Mediated ◽

First Line Treatment

In metastatic renal cell carcinoma (mRCC) the PD-1 immune-checkpoint inhibitor (ICI) Nivolumab became a standard second line treatment option in 2015 based on a significant improvement of overall survival compared to Everolimus. Current pivotal phase 3 studies showed that PD-1 ICI-based combinations were more efficacious than the VEGFR-TKI Sunitinib, a previous standard of care, leading to approval of three new regimens as guideline-recommended first-line treatment. Nivolumab plus Ipilimumab is characterized by a survival advantage, a high rate of complete response and durable remissions in intermediate and poor prognosis patients. Despite frequent immune-mediated side effects, fewer symptoms and a better quality of life were observed compared to Sunitinib. Pembrolizumab or Avelumab plus Axitinib were characterized by an improved progression-free-survival and a high response rate with a low rate of intrinsic resistance. In addition, Pembrolizumab plus Axitinib reached a significant survival benefit. The side effect profile is driven by the chronic toxicity of Axitinib, but there is additional risk of immune-mediated side effects of the PD-1/PD-L1 ICIs. The quality of life data published so far do not suggest any improvement regarding patient-reported outcomes compared to the previous standard Sunitinib. The PD-1/PD-L1 ICIs thus form the backbone of the first-line therapy of mRCC.

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DESCRIPTION OF STOMATITIS IN THE LIGHT OF UNANI SYSTEM OF MEDICINE

Indian Journal of Unani Medicine ◽

10.53390/ijum.v14.i2.13 ◽

2021 ◽

Vol 14 (2) ◽

Author(s):

Khan Maherosh ◽

Mushtaque Mukadam ◽

A.H. Farooqui ◽

Mohd Furqan ◽

Salma Shaikh ◽

...

Keyword(s):

The Body ◽

Line Treatment ◽

First Line ◽

Topical Medication ◽

Systemic Medication ◽

Mucus Membrane ◽

Mucosal Layer ◽

First Line Treatment

Stomatitis is the inflamatory condition of mucus membrane of mouth in unani system of medicine stomatitis is known as Qula. Qula is ulceration of oral mucosal layer caused by fasaad in any one of the akhlat-e-arbah of the body first line treatment consist of topical medication with use of systemic medication as nessesary. Management of Qula in unani system of medicine , Unani physician prescribe to manage the cases of Qula by musakkin, Qabiz, mutayyib-e-dahan, mujaff-e-Qarooh mulatif, mujaffi-e-zakhm adviya.

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Diagnosis and Management of Allergic Rhinitis in Children

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v5i2.253 ◽

2020 ◽

Vol 5 (2) ◽

pp. 159

Author(s):

Kavinda Dayasiri ◽

V Thadchanamoorthy ◽

Umasunthar Thisanayagam

Keyword(s):

Allergic Rhinitis ◽

Negative Impact ◽

Severe Disease ◽

Nasal Discharge ◽

Line Treatment ◽

First Line ◽

Pharmacological Management ◽

Oral Steroids ◽

Non Allergic Rhinitis ◽

First Line Treatment

Allergic rhinitis which is the most common pediatric allergic disease has a significant negative impact on quality of life in affected children. Further, overall poor control can lead to ‘allergic march’ and later development of bronchial asthma. The main symptoms of allergic rhinitis include nasal discharge, blockage and itchiness of nose, and sneezing. Clinical history focused on identification of nature and severity of symptoms, trigger factors and clinical features of non-allergic rhinitis is crucial for early and accurate diagnosis.The mainstay of non-pharmacological management of allergic rhinitis is allergen avoidance.Second-line antihistamines used either locally or orally are first-line treatment of mild to moderate allergic rhinitis whereas topical nasal corticosteroids are the first line treatment for moderate to severe disease, in whom the control of symptoms is not achieved with antihistamine and those with severe nasal obstruction.Combination therapy with antihistamines and intranasal steroids is more effective than either alone and is second line treatment for children who have poorly controlled rhinitis while on monotherapy. Oral steroids may be indicated in children with significant nasal obstruction and routine use of oral steroids should be avoided.Referral to specialist allergy clinic should be considered for those who are symptomatic despite optimal local and oral therapy. Consideration should be given for specialist otorhinolaryngologist evaluation of children who have features of non-allergic rhinitis and pharmacotherapy resistant nasal obstruction.International Journal of Human and Health Sciences Vol. 05 No. 02 April’21 Page: 159-162

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