scholarly journals High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0243964
Author(s):  
Miguel Ángel López Zúñiga ◽  
Aida Moreno-Moral ◽  
Ana Ocaña-Granados ◽  
Francisco Andrés Padilla-Moreno ◽  
Alba María Castillo-Fernández ◽  
...  
Keyword(s):  
At Risk ◽  
Inflammatory Response ◽  
Time Course ◽  
Survival Rates ◽  
Pulse Therapy ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Laboratory Markers ◽  
Patients At Risk ◽  
Dose Corticosteroid

Objective Test whether high dose corticosteroid pulse therapy (HDCPT) with either methylprednisolone or dexamethasone is associated with increased survival in COVID-19 patients at risk of hyper-inflammatory response. Provide some initial diagnostic criteria using laboratory markers to stratify these patients. Methods This is a prospective observational study, 318 met the inclusion criteria. 64 patients (20.1%) were treated with HDCPT by using at least 1.5mg/kg/24h of methylprednisolone or dexamethasone equivalent. A multivariate Cox regression (controlling for co-morbidities and other therapies) was carried out to determine whether HDCPT (among other interventions) was associated with decreased mortality. We also carried out a 30-day time course analysis of laboratory markers between survivors and non-survivors, to identify potential markers for patient stratification. Results HDCPT showed a statistically significant decrease in mortality (HR = 0.087 [95% CI 0.021–0.36]; P < 0.001). 30-day time course analysis of laboratory marker tests showed marked differences in pro-inflammatory markers between survivors and non-survivors. As diagnostic criteria to define the patients at risk of developing a COVID-19 hyper-inflammatory response, we propose the following parameters (IL-6 > = 40 pg/ml, and/or two of the following: C-reactive protein > = 100 mg/L, D-dimer > = 1000 ng/ml, ferritin > = 500 ng/ml and lactate dehydrogenase > = 300 U/L). Conclusions HDCPT can be an effective intervention to increase COVID-19 survival rates in patients at risk of developing a COVID-19 hyper-inflammatory response, laboratory marker tests can be used to stratify these patients who should be given HDCPT. This study is not a randomized clinical trial (RCT). Future RCTs should be carried out to confirm the efficacy of HDCPT to increase the survival rates of COVID-19.

High-Dose Corticosteroid Pulse Therapy Increases the Survival Rate in COVID-19 Patients at Risk of Cytokine Storm

2020 ◽  
Author(s):  
Miguel Ángel López-Zúñiga ◽  
Aida Moreno-Moral ◽  
Ana Ocaña-Granados ◽  
Francisco Padilla-Moreno ◽  
Alba María Castillo-Fernández ◽  
...  
Keyword(s):  
At Risk ◽  
Survival Rate ◽  
Pulse Therapy ◽  
High Dose ◽  
Cytokine Storm ◽  
High Dose Corticosteroid ◽  
Patients At Risk ◽  
Corticosteroid Pulse Therapy ◽  
Dose Corticosteroid

scholarly journals Switch from previous major depression comorbid with CLIPPERS to mania-like episode following glucocorticosteroid therapy: a case report

2018 ◽  
Vol 31 (1) ◽  
pp. e000007
Author(s):  
Xiaohua Liu ◽  
Yan Wu
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Episode ◽  
Psychiatric Symptoms ◽  
Medical Condition ◽  
Pulse Therapy ◽  
High Dose ◽  
Major Depressive ◽  
High Dose Corticosteroid ◽  
Psychiatric Disturbances ◽  
Dose Corticosteroid

Bipolar disorder is associated with high rates of general medical conditions, but few cases of overlap between bipolar disorder and chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) have been reported in the current literature. The following is a case of a 29-year-old patient with a previous major depressive episode comorbid with CLIPPERS. Following glucocorticosteroid therapy, the patient switched to mania-like presentation and was diagnosed with bipolar disorder due to another medical condition. So it is strongly suggested that high-dose corticosteroid pulse therapy could easily induce psychiatric disturbances for patients with previous psychiatric symptoms, and there may be potential links between bipolar disorder and CLIPPERS in the area of inflammation.

scholarly journals Reversible blindness after erroneous prescription of closantel: A case report

2021 ◽  
Author(s):  
Hamed Cheraghmakani ◽  
Reza Jafari ◽  
Elahe Karimpour-razkenari ◽  
monireh Ghazaeian
Keyword(s):  
Case Report ◽  
Plasma Exchange ◽  
Vision Loss ◽  
Pulse Therapy ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Peripheral Nerve Fiber ◽  
Corticosteroid Pulse Therapy ◽  
Dose Corticosteroid

A 20-year-old girl referred with vision loss upon closantel use. Plasma exchange and high-dose corticosteroid pulse therapy were administered. A 2.5-year follow-up showed improved vision and increased layer thickness of the peripheral nerve fiber. Early treatment with plasma exchange and high-dose corticosteroid therapy can be beneficial to reverse closantel toxicity.

scholarly journals Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone

2021 ◽  
Vol 11 (1) ◽  
pp. 198
Author(s):  
Moncef Belhassen-García ◽  
Antonio Sánchez-Puente ◽  
Pedro-Ignacio Dorado-Díaz ◽  
Amparo López-Bernús ◽  
Jesús Sampedro-Gómez ◽  
...  
Keyword(s):  
Machine Learning ◽  
Mechanical Ventilation ◽  
Observational Studies ◽  
Invasive Mechanical Ventilation ◽  
Pulse Therapy ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Treatment Groups ◽  
Treatment Type ◽  
Dose Corticosteroid

Background: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. Methods: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400–600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. Results: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. Conclusions: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.

Electrocardiographic changes after high-dose corticosteroid pulse therapy in pemphigus patients

2018 ◽  
Vol 29 (8) ◽  
pp. 802-805 ◽  
Author(s):  
Mehdi Pishgahi ◽  
Sahar Dadkhahfar ◽  
Reza M. Robati ◽  
Zohreh Kheradmand ◽  
Mohammad Shahidi-Dadras ◽  
...  
Keyword(s):  
Pulse Therapy ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Electrocardiographic Changes ◽  
Corticosteroid Pulse Therapy ◽  
Dose Corticosteroid

Fatigue in multiple sclerosis presenting as acute relapse: subjective and objective assessment

2007 ◽  
Vol 14 (2) ◽  
pp. 274-277 ◽  
Author(s):  
Peter Flachenecker ◽  
Heike Meissner
Keyword(s):  
Multiple Sclerosis ◽  
Time Course ◽  
Objective Assessment ◽  
Neuropsychological Testing ◽  
High Dose ◽  
Subjective Symptoms ◽  
High Dose Corticosteroid ◽  
Acute Relapse ◽  
Dose Corticosteroid ◽  
Neuropsychological Methods

We report on a patient with multiple sclerosis (MS) who presented with fatigue as the only manifestation of an acute MS relapse. Fatigue was assessed by the `Würzburg Fatigue Inventory in MS (WEIMuS)' scale and confirmed by neuropsychological testing of attention. After high-dose corticosteroid therapy, subjective symptoms were completely abolished. The improvement was corroborated by both, the WEIMuS score and neuropsychological testing. MS-related fatigue may be the only symptom of an acute MS relapse, and neuropsychological methods may be used to objectively assess and follow the time course of this common and disabling symptom. Multiple Sclerosis 2008; 14: 274—277. http://msj.sagepub.com

scholarly journals Magnetic Resonance Imaging Evaluation in Patients with Linear Morphea Treated with Methotrexate and High-Dose Corticosteroid

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammad Shahidi-Dadras ◽  
Fahimeh Abdollahimajd ◽  
Razieh Jahangard ◽  
Ali Javinani ◽  
Amir Ashraf-Ganjouei ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Dose ◽  
Skin Thickness ◽  
Resonance Imaging ◽  
High Dose Corticosteroid ◽  
Before And After ◽  
Lesion Extension ◽  
Dose Corticosteroid ◽  
Mri Changes

Background. Morphea is an inflammatory disease of the connective tissue that may lead to thickening and hardening of the skin due to fibrosis. The aim of this study was to document magnetic resonance imaging (MRI) changes in patients with linear morphea who were treated with methotrexate (MTX) and high-dose corticosteroid. Methods. This study was conducted on 33 patients from the outpatient’s dermatology clinic of our institute, who fulfilled the inclusion criteria. Patients received 15 mg/week of MTX and monthly pulses of methylprednisolone for three days in six months. The effectiveness of the treatment was evaluated by MRI, modified LS skin severity index (mLoSSI), and localized scleroderma damage index (LoSDI). Results. All parameters of mLoSSI and LoSDI including erythema, skin thickness, new lesion/lesion extension, dermal atrophy, subcutaneous atrophy, and dyspigmentation were also noticeably improved after treatment. Subcutaneous fat enhancement was the most common finding in MRI. MRI scores were significantly associated with clinical markers both before and after the treatment with the exception of skin thickness and new lesion/lesion extension which were not associated with MRI scores before and after the treatment, respectively. Limitations. The lack of correlative laboratory disease activity markers, control group, and clearly defined criteria to judge the MRI changes. Conclusion. MRI could be a promising tool for the assessment of musculoskeletal and dermal involvement and also monitoring treatment response in patients with morphea.

Indications for Tonsillectomy in Infectious Mononucleosis

PEDIATRICS ◽  
1971 ◽  
Vol 48 (2) ◽  
pp. 338-339
Author(s):  
Edward J. Feroli ◽  
Gordon W. Mella ◽  
Frank A. Pedreira ◽  
Regis T. Storch ◽  
Howard P. Gutgesell
Keyword(s):  
Case Report ◽  
Infectious Mononucleosis ◽  
Community Hospital ◽  
Nasotracheal Intubation ◽  
Benign Disease ◽  
Therapeutic Modality ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Acute Airway Obstruction ◽  
Dose Corticosteroid

We read with interest the recent report, "Acute Airway Obstruction in Infectious Mononucleosis."1 Dr. Gutgesell appropriately has called attention to a serious complication of a usually benign disease. He mentions brief, high-dose corticosteroid therapy, tracheotomy, nasotracheal intubation, and IPPB as potential modes of therapy. The following case report suggests an additional therapeutic modality in the management of these patients. A 4-year-old girl was admitted to a community hospital in acute respiratory distress associated with suspected infectious mononucleosis.

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