PROSPECTIVE STUDY COMPARING THE EFFICACY OF ORAL PROCATEROL + LOW DOSE INHALED BUDESONIDE VS HIGH DOSE INHALED BUDESONIDE ALONE IN PREVENTING EXACERBATIONS AMONG MODERATE PERSISTENT ASTHMATICS AGED 7 - 18 YEARS

Abstract Introduction Primary immune thrombocytopenia (ITP) is an acquired autoimmune disorder that involves antibody and cell mediated destruction of platelets as well as suppression of their production. Corticosteroids are initial standard therapy in adults. Initially Rituximab (dose375mg/m2) was approved as one of the important second line therapy in chronic ITP. In the present prospective study, we will evaluate the efficacy, safety and response duration of low dose Rituximab (100mg) and high dose Dexamethasone as a front line therapy in new onset adult ITP cases. Methods Inj. Rituximab at a fixed dose of 100mg intravenous infusion for four doses (day 1,8,15,22) and Dexamethasone tablet 40 mg/daily PO for four days in a fifteen days' interval (day 1-4 and day 15-18). Response rate evaluated according to published guidelines. Results Total no. of cases was 15. Male 5, female 10. Age range 18 to 62 years with median age of 36 years. Course completed in 15 patients. Median follow up of the patients was 6 months. Complete response (CR) was achieved after 1st dose of rituximab in 3 cases, 2 after 2nd dose and 4 after 4th dose of Rituximab. Partial response (PR) was achieved in 2 cases after completion of therapy and no response seen in 4 cases. Seven cases (46.66%) achieving CR maintaining sustained response after 6 months of completion of therapy. Two cases who achieved CR initially reverted to PR after 6 months with dropping of platelet count but without any evidence of bleeding symptoms. Minor side effects like GI intolerance, nausea, vomiting occurred in 3 patients, High blood sugar level during treatment seen in 2 patients and severe adverse effects like pneumonitis and intestinal obstruction seen in 2 patients who needed hospitalization. We did not observe any infusion related reaction. Conclusions CR and PR rate was 60% (9/15) and 14%(2/15) respectively. Six months after completion of therapy 77.8% (7/9) showed sustained response after achieving CR. Low dose Rituximab and high dose Dexamethasone is a useful treatment option in adult acute ITP patients. Disclosures No relevant conflicts of interest to declare.

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A Comparison of Low-Dose Inhaled Budesonide plus Theophylline and High-Dose Inhaled Budesonide for Moderate Asthma

New England Journal of Medicine ◽

10.1056/nejm199711133372002 ◽

1997 ◽

Vol 337 (20) ◽

pp. 1412-1419 ◽

Cited By ~ 245

Author(s):

David J. Evans ◽

David A. Taylor ◽

Olle Zetterstrom ◽

K. Fan Chung ◽

Brian J. O'Connor ◽

...

Keyword(s):

Low Dose ◽

High Dose ◽

Moderate Asthma ◽

Inhaled Budesonide

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Randomized, Prospective Study of Low-Dose Versus High-Dose Inhaled Nitric Oxide in the Neonate With Hypoxic Respiratory Failure

PEDIATRICS ◽

10.1542/peds.108.4.949 ◽

2001 ◽

Vol 108 (4) ◽

pp. 949-955 ◽

Cited By ~ 25

Author(s):

N. N. Finer ◽

J. W. Sun ◽

W. Rich ◽

E. Knodel ◽

K. J. Barrington

Keyword(s):

Nitric Oxide ◽

Respiratory Failure ◽

Prospective Study ◽

Low Dose ◽

Inhaled Nitric Oxide ◽

High Dose ◽

Hypoxic Respiratory Failure

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Serum dehydroepiandrosterone sulfate concentration as an indicator of adrenocortical suppression during inhaled steroid therapy in adult asthmatic patients

Acta Endocrinologica ◽

10.1530/eje.0.1500687 ◽

2004 ◽

pp. 687-690 ◽

Cited By ~ 20

Author(s):

S Kannisto ◽

A Laatikainen ◽

A Taivainen ◽

K Savolainen ◽

H Tukiainen ◽

...

Keyword(s):

Dose Group ◽

Low Dose ◽

Serum Cortisol ◽

Dehydroepiandrosterone Sulfate ◽

Forced Expiratory Volume ◽

High Dose Group ◽

High Dose ◽

Adrenal Androgen ◽

Asthmatic Patients ◽

Inhaled Budesonide

OBJECTIVE: Supraphysiological doses of exogenous glucocorticosteroids cause adrenocortical suppression. Dehydroepiandrosterone sulfate (DHEA-S) is the most abundant adrenal androgen and estrogen precursor. We studied to what extent inhaled glucocorticosteroid therapy for asthma decreases serum DHEA-S concentrations. DESIGN AND METHODS: We measured serum DHEA-S and cortisol concentrations in 101 adult patients with newly detected mild asthma before and after 2 and 12 weeks of treatment with inhaled glucocorticosteroids. The patients were randomized to receive budesonide 200 microg/day (low dose group, n=50) or 800 microg/day (high dose group, n=51) in two parallel groups double-blindly. RESULTS: In the low dose group, serum DHEA-S concentrations decreased from the baseline by a mean of 8 % (95 % confidence interval (CI), 3-13 %, P<0.01) after 2 weeks of therapy, and by 2 % (95 % CI, 9 % decrease to 5 % increase, NS) after 12 weeks. In the high dose group, the respective decreases were 16 % (95 % CI, 10-21 %, P<0.001) and 18 % (95 % CI, 12-24 %, P<0.001). The difference between the treatment groups was significant at both 2 and 12 weeks. During the 12 week treatment period the baseline concentrations of serum cortisol did not decrease in the low dose group, while in the high dose group the decrease was significant at 12 weeks (P<0.01), but not at 2 weeks. The forced expiratory volume in 1 s improved equally well in both groups. CONCLUSIONS: Inhaled budesonide decreased serum DHEA-S concentrations, which may indicate adrenocortical suppression. Reduced adrenal production of androgen and estrogen precursors may increase the risk of osteoporosis especially in postmenopausal women.

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Acetaminophen: Neonatal hepatotoxicity due to late pregnancy exposure

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100127906 ◽

1987 ◽

Vol 45 ◽

pp. 718-719

Author(s):

G.A. Miranda ◽

M.A. Arroyo ◽

C.A. Lucio ◽

M. Mongeotti ◽

S.S. Poolsawat

Keyword(s):

Low Dose ◽

Fetal Liver ◽

Late Pregnancy ◽

Toxic Chemicals ◽

Control Group ◽

High Dose ◽

Over The Counter ◽

Liver And Kidney ◽

Neonatal Liver ◽

Childbearing Women

Exposure to drugs and toxic chemicals, during late pregnancy, is a common occurrence in childbearing women. Some studies have reported that more than 90% of pregnant women use at least 1 prescription; of this, 60% used more than one. Another study indicated that 80% of the consumed drugs were not prescribed, and of this figure, 95% were “over-the-counter” drugs. Acetaminophen, the safest of all over-the-counter drugs, has been reported to induce fetal liver necrosis in man and animals and to have abortifacient and embryocidal action in mice. This study examines the degree to which acetaminophen affects the neonatal liver and kidney, when a fatty diet is simultaneously fed to the mother during late pregnancy.Timed Swiss Webster female mice were gavaged during late pregnancy (days 16-19) with fat suspended acetaminophen at a high dose, HD = 84.50 mg/kg, and a low dose, LD = 42.25 mg/kg; a control group received fat alone.

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Evaluation of hippocampus in rhesus monkeys after chronic (1-year) inhalation exposure to marijuana: I. Electron microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100159539 ◽

1990 ◽

Vol 48 (3) ◽

pp. 398-399

Author(s):

A.M. Andrews ◽

S.W. Wilson ◽

A.C. Scallet ◽

S.F. Ali ◽

J. Bailey ◽

...

Keyword(s):

Synaptic Vesicles ◽

Rhesus Monkeys ◽

Low Dose ◽

Inhalation Exposure ◽

Synaptic Cleft ◽

High Dose ◽

Withdrawal Time ◽

Treatment Groups ◽

Ultrastructural Evidence ◽

Male Rhesus

Exposure of rhesus monkeys (Macaca mulatta) to marijuana via inhalation or to intravenous delta-9-tetrahydrocannabinol (THC), reportedly caused ultrastructural evidence of increased synaptic width. Chronic marijuana smoke in a single rhesus monkey examined after a six month withdrawal time caused ultrastructure changes in the septal, hippocampal and amygdala regions; the synaptic cleft was widened, electron opaque material was found in the cleft and in the pre- and postsynaptic regions, with some clumping of the synaptic vesicles. The objective of our study was to assess neuropathological alterations produced by chronic inhalation of marijuana smoke.Nineteen male rhesus monkeys, 3-5 years of age and weighing 3-8 kg, were divided into four treatment groups: a) sham control, b) placebo smoke (7 days/ week) c) low dose marijuana (2 times/week with 5 days/week sham) and d) high dose marijuana (7 times/week). A smoke exposure consisted of smoke from one cigarette (2.6% THC) burned down to 10 mm butt length. Smoke was administered via smoke generator (ADL II, Arthur D. Little, Inc. Cambridge, MA) and nose-mouth only masks (local production) equipped with one-way valves.

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