Low-Dose Oral Mini-Pulse Dexamethasone Therapy in Progressive Unstable Vitiligo

2013 ◽  
Vol 17 (4) ◽  
pp. 259-268 ◽  
Author(s):  
Amrinder J. Kanwar ◽  
Rahul Mahajan ◽  
Davinder Parsad
Keyword(s):  
Adverse Effects ◽  
Disease Activity ◽  
Low Dose ◽  
Disease Free Survival ◽  
Pulse Therapy ◽  
Dose Oral ◽  
Dexamethasone Therapy ◽  
Pulse Dexamethasone ◽  
The Mean

Background: The course of vitiligo is unpredictable. If the disease is spreading rapidly, the progression can be controlled with the use of systemic steroids daily or in pulsed form. The present study was planned to assess the efficacy of low-dose dexamethasone oral mini-pulse therapy in progressive unstable vitiligo. Materials and Methods: In this retrospective study, the case records of patients with vitiligo during the period from January 2006 to December 2010 were studied. Patients who had progressive unstable disease were included. These patients were administered oral dexamethasone 2.5 mg per day on 2 consecutive days after breakfast in a week. The patients were asked to come for regular follow-up to assess the arrest of disease activity, relapse of disease activity, and adverse effects. Results: A total of 444 patients were analyzed. In 408 (91.8%) patients, arrest of disease activity was achieved at a mean duration of 13.2 ± 3.1 weeks. In addition, some repigmentation of the lesions was seen in all patients after a mean of 16.1 ± 5.9 weeks. During the follow-up, 50 of 408 (12.25%) patients experienced one or two episodes of relapse in disease activity, which were treated with reinstitution of low-dose dexamethasone oral mini-pulse therapy. The mean disease-free survival (DFS) until the first relapse was 55.7 ± 26.7 weeks, and the mean DFS until the second relapse was 43.8 ± 7.2 weeks. Adverse reactions such as weight gain, lethargy, and acneiform eruptions were observed in 41 (9.2%) patients. Conclusion: Low-dose oral mini-pulse dexamethasone therapy is a good option for arresting progressive unstable vitiligo with minimal adverse effects.

scholarly journals Efficacy of low-dose Topiramate in Migraine Prophylaxis

2015 ◽  
Vol 31 (2) ◽  
pp. 70-75
Author(s):  
Muhammad Abdul Momen Khan ◽  
Mohammad Bahadur Ali Miah ◽  
Md Shahidullah ◽  
Md Rafiqul Islam ◽  
Subash Kanti Day ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Baseline Level ◽  
Low Dose ◽  
Prospective Trial ◽  
Severe Headache ◽  
Migraine Prophylaxis ◽  
Base Line ◽  
Population Total ◽  
The Mean

Background: Anticonvulsants are now commonly used for migraine prophylaxis, among them topiramate, one of the newer anticonvulsants, recently has been demonstrated to be effective as mono-therapy for migraine prophylaxis. Objectives: To observe the efficacy and safety of low dose topiramate in migraine prophylaxis. Methods: This prospective trial was carried out in the Out Patient Department (OPD) & Headache Clinic, Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Total 60 patients around the age range of 18 to 50 years diagnosed as migraine (with aura or without aura) according to ICHD-3 criteria, were recruited as the study population. Total 60 patients were administered by Tab.Topiramate 50 mg/ day. Out of them, total 47 patients had completed the study due to drop out of 13 patients. During trial, three follow up visits were taken, 1st follow up after 4 weeks of baseline information (Before starting prophylactic medication), 2nd follow up after 4 weeks of treatment, 3rd follow up after 8 weeks of treatment. Efficacy of treatment was measured by headache frequency, duration and severity as measured by the VAS. Effectiveness was assessed by comparing baseline & on-treatment migraine status. Results: The mean (SD) age of patients were found 29.72 (9.58) years. Female sex was predominant. The mean (SD) value of frequency of migraine at baseline level with 1st and 2nd follow up were statistically significant [Baseline 9.28 (2.39) vs. 1st FU 7.55 (3.07), p=0.001; Baseline 9.28 (2.39) vs. 2nd FU 4.72 (2.80), p<0.001]. Duration of each episode of migraine ,comparing the mean (SD) value of duration of migraine of baseline level with 1st and 2nd follow up were statistically significant [Baseline 10.85 (5.26) vs. 1st FU 8.06 (4.11) hr, p<0.001; Baseline 10.85 (5.26) vs. 2nd FU 5.53 (2.98) hr, p<0.001]. According to severity of migraine based on VAS in base line period all patients had experienced moderate & severe headache but in 1st follow up, few patients had experienced mild headache from moderate headache, few patients had experienced moderate headache from severe headache & in 2nd follow up, patients had better condition and had experienced mild and moderate headache, no patient had experienced severe headache. In this study, 23.4% patients developed adverse effects. Among the adverse effects, 8.5% develop dizziness, 6.3% drowsiness, 4.2% anorexia & blurring of vision. Conclusion: The present study suggest that low dose topiramate are effective for migraine prophylaxis in reduction of frequency, severity and duration of migraine headache . Bangladesh Journal of Neuroscience 2015; Vol. 31 (2): 70-75

scholarly journals Comparative Efficacy of Low-Dose Oral Corticosteroids and Oral Mini Pulse Dexamethasone in Patients of Vitiligo

2016 ◽  
Vol 11 (1) ◽  
pp. 54-58
Author(s):  
Md Shirajul Islam Khan
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Oral Prednisolone ◽  
Oral Dexamethasone ◽  
Oral Corticosteroids ◽  
Dose Oral ◽  
Group A ◽  
Pulse Dexamethasone ◽  
The Mean ◽  
Group B

Introduction: Vitiligo is a common, acquired, discoloration of the skin with unknown etiology. There are numerous treatment options available for vitiligo, but none is universally effective. Systemic corticosteroids suppress immunity and lead to repigmentation but produce unacceptable side effects. Oral corticosteroid low dose treatment may be associated with fewer side effects than usual dose-treatment. Several data also showed that oral dexamethasone pulse treatment was effective in arresting progression of vitiligo yet fails to induce satisfactory repigmentation in the great majority of their patients.Objectives: A clinical trial was carried out to compare the efficacy of low-dose oral corticosteroids and oral mini pulse dexamethasone in patients of vitiligo.Materials and Methods: The study was conducted in the Department of Dermatology and Venereology, Combined Military Hospital (CMH), Dhaka, Bangladesh during January 2013 to December 2013. Total sixty patients of vitiligo were enrolled and divided into group A and group B. Thirty of group A patients were treated with oral prednisolone daily and thirty of group B patients were treated with oral dexamethasone pulse therapy weekly.Results: Out of sixty patients of vitiligo, maximum patients of both groups had progressive type of vitiligo. In Group-A, the duration of illness was an average of 10 months and in group-B, it was an average of 8.20 months. Single lesion was 15 (50%) for Group-A and 14 (46.7%) for Group-B. Multiple lesions were 15 (50%) & 16 (53.6%) for Group-A and Group-B respectively. The study showed that improvement rate was highest for the lesions on the extremities, which was 18 (34.6%) and lowest for back 03 (5.8%). Out of all patients from Group-A, the mean size of the lesions were 8.17cm, 5.90 cm, 4.32 cm and 3.57 cm at 1st visit, 2nd visit, 3rd visit and 4th visit respectively. In Group-B, the mean sizes of the lesions were 7.50 cm, 4.92 cm, 3.00 cm, and 4.75 cm at 1st visit, 2nd visit, 3rd visit and 4th visit respectively. Among the patients 27 (90%) of group-A and 25 (83.3%) of group B were improved after 16th week of treatment, slight response 4(13.3%) and 6(20%), moderate response 22(63.2%) and 18(59.4%) and marked response was 1(3.3%) and 1(3.3%) in group A and group B respectively.Conclusion: The study concluded that both the drugs, oral prednisolone and dexamethasone when used individually, were found to be equally effective in the treatment of vitiligo.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 54-58

scholarly journals Low-dose oral theophylline combined with inhaled corticosteroids for people with chronic obstructive pulmonary disease and high risk of exacerbations: a RCT

2019 ◽  
Vol 23 (37) ◽  
pp. 1-146
Author(s):  
Graham Devereux ◽  
Seonaidh Cotton ◽  
Shona Fielding ◽  
Nicola McMeekin ◽  
Peter J Barnes ◽  
...  
Keyword(s):  
High Risk ◽  
Low Dose ◽  
Hospital Admissions ◽  
Inhaled Corticosteroids ◽  
Drug Regimen ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Dose Oral ◽  
The Mean

Background Despite widespread use of therapies such as inhaled corticosteroids (ICSs), people with chronic obstructive pulmonary disease (COPD) continue to suffer, have reduced life expectancy and utilise considerable NHS resources. Laboratory investigations have demonstrated that at low plasma concentrations (1–5 mg/l) theophylline markedly enhances the anti-inflammatory effects of corticosteroids in COPD. Objective To determine the clinical effectiveness and cost-effectiveness of adding low-dose theophylline to a drug regimen containing ICSs in people with COPD at high risk of exacerbation. Design A multicentre, pragmatic, double-blind, randomised, placebo-controlled clinical trial. Setting The trial was conducted in 121 UK primary and secondary care sites. Participants People with COPD [i.e. who have a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of < 0.7] currently on a drug regimen including ICSs with a history of two or more exacerbations treated with antibiotics and/or oral corticosteroids (OCSs) in the previous year. Interventions Participants were randomised (1 : 1) to receive either low-dose theophylline or placebo for 1 year. The dose of theophylline (200 mg once or twice a day) was determined by ideal body weight and smoking status. Primary outcome The number of participant-reported exacerbations in the 1-year treatment period that were treated with antibiotics and/or OCSs. Results A total of 1578 people were randomised (60% from primary care): 791 to theophylline and 787 to placebo. There were 11 post-randomisation exclusions. Trial medication was prescribed to 1567 participants: 788 in the theophylline arm and 779 in the placebo arm. Participants in the trial arms were well balanced in terms of characteristics. The mean age was 68.4 [standard deviation (SD) 8.4] years, 54% were male, 32% smoked and mean FEV1 was 51.7% (SD 20.0%) predicted. Primary outcome data were available for 98% of participants: 772 in the theophylline arm and 764 in the placebo arm. There were 1489 person-years of follow-up data. The mean number of exacerbations was 2.24 (SD 1.99) for participants allocated to theophylline and 2.23 (SD 1.97) for participants allocated to placebo [adjusted incidence rate ratio (IRR) 0.99, 95% confidence interval (CI) 0.91 to 1.08]. Low-dose theophylline had no significant effects on lung function (i.e. FEV1), incidence of pneumonia, mortality, breathlessness or measures of quality of life or disease impact. Hospital admissions due to COPD exacerbation were less frequent with low-dose theophylline (adjusted IRR 0.72, 95% CI 0.55 to 0.94). However, 39 of the 51 excess hospital admissions in the placebo group were accounted for by 10 participants having three or more exacerbations. There were no differences in the reporting of theophylline side effects between the theophylline and placebo arms. Limitations A higher than expected percentage of participants (26%) ceased trial medication; this was balanced between the theophylline and placebo arms and mitigated by over-recruitment (n = 154 additional participants were recruited) and the high rate of follow-up. The limitation of not using documented exacerbations is addressed by evidence that patient recall is highly reliable and the results of a small within-trial validation study. Conclusion For people with COPD at high risk of exacerbation, the addition of low-dose oral theophylline to a drug regimen that includes ICSs confers no overall clinical or health economic benefit. This result was evident from the intention-to-treat and per-protocol analyses. Future work To promote consideration of the findings of this trial in national and international COPD guidelines. Trial registration Current Controlled Trials ISRCTN27066620. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 37. See the NIHR Journals Library website for further project information.

scholarly journals THU0440 LOW DOSE COLCHICINE COMBINED WITH SPORADIC INTRAMUSCULAR INJECTIONS OF BETAMETHASONE – EFFICIENT AND SUSTAINED TREATMENT OF ACUTE GOUTY ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 457.1-457
Author(s):  
A. Sargsyan ◽  
V. Vardanyan ◽  
K. Ginosyan ◽  
S. Vardanyan ◽  
V. Mukuchyan
Keyword(s):  
Uric Acid ◽  
Disease Activity ◽  
Low Dose ◽  
Gouty Arthritis ◽  
Activity Score ◽  
Evidence Based ◽  
Acute Gouty Arthritis ◽  
Intramuscular Injections ◽  
Inflammatory Effect

Background:Gouty arthritis is a common, potentially disabling and increasingly prevalent disease [1]. The main goals of treatment are to treat acute arthritis, decrease uric acid (UA) levels and prevent occurrence of further attacks. According to 2016 updated EULAR evidence-based recommendations for the management of gout, the most common and efficient options include prescription of colchicine (up to 6 mg during the first day) and intra-articular injections of glucocorticoids (GC) [2]. First option often causes diarrhea, the latter is extremely traumatic and painful in this group of patients.Objectives:The aim of this study was to determine the efficacy of sustainability of anti-inflammatory effect of combination of low dose colchicine with sporadic intramuscular injections of betamethasone in the treatment of acute gouty arthritis.Methods:41 treatment naïve patients with acute gouty arthritis (27 male /65,9 %/, 14 female /34,1 %/, mean age 55,9 ± 13,7 years, mean disease duration 5,9 ± 4,4 years) were recruited in the study. On the first visit all the patients were prescribed 1.5 mg of colchicine per day and 2 intramuscular injections of betamethasone preparation (7mg-1ml) with an interval of 4 days. On the second visit (30thday) daily dose of colchicine was decreased to 1.0 mg, urate-lowering therapy (ULT) was begun. 21 patients (51,2%) received febuxostat 80 mg/day, 20 patients (48,8%) – allopurinol 100-150 mg/day.Routine investigation included accurate collection of disease history, objective examination with determining the disease activity (Gout Activity Score /GAS/) and visual analogue scale (VAS patient), CBC, CRP, measurement of serum UA and creatinine level, urinalysis and other examinations [4]. GAS, VAS, CRP and uric acid were measured 3 times: at baseline, on 30thand 60thday of follow-up period.Results:Investigation had shown the following results at baseline: sUA1- 9,2 ± 1,5 mg/dl, CRP1- 24,3 ± 21,5 mg/L, VAS1- 8,3 ± 1,3 cm, GAS16,3 ± 0,7. All enrolled patients completed 60 days of treatment. Preparations were well tolerated, no serious adverse events occurred: mild dyspepsia was observed in 4 (9,8%) patients, mild hypertension – in 7 (17,1%), 10 (24,4%) patients had transient diarrhea. Only in 14 out of 41 patients (34,1 %) there was a necessity to add NSAIDs to the main scheme of treatment.On the second visit (30thday) all investigated measures with exception for UA (sUA2- 8,8 ± 1,9 mg/dl, p>0.05) had shown significantly lower results: CRP2- 4,9±3,5 mg/dl, VAS2– 4,2±1,2 cm, GAS2- 4,9 ± 0,7 (p<0.001).On the third visit (60thday) the following results were obtained: sUA3- 4,7 ± 1,3 mg/dl, CRP3- 3,5±2,0 mg/L, VAS3- 3,3±2,1 cm, GAS3- 3,7±0,9. All the measures were significantly lower than at baseline (p<0,001).During all the follow-up period recurrent attacks of arthritis were observed in 6 patients (14,6%), particularly, only 2 patients experienced arthritis after the prescription of ULT.Conclusion:Low dose colchicine in combination with sporadic (1-2) intramuscular injections of betamethasone can present as an efficient, non-traumatic, safe and cost-effective option for the treatment of acute gouty arthritis. Moreover, according to results of our study, anti-inflammatory effect was stable even after the prescription of ULT.References:[1]Kuo C-F, Grainge MJ, Zhang W, et al. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015;11:649–62. doi:10.1038/nrrheum.2015.91[2]Richette P, et al. 2016 updated EULAR evidence-based recommendations for the management of gout Ann Rheum Dis 2017;76:29–42. doi:10.1136/annrheumdis-2016-209707[3]Scirè, Carlo A et al. “Development and First Validation of a Disease Activity Score for Gout.” Arthritis care & research vol. 68,10 (2016): 1530-7. doi:10.1002/acr.22844Disclosure of Interests: :None declared

Long-term follow-up of fixed low-dose oral immunotherapy for children with wheat-induced anaphylaxis

2021 ◽  
Author(s):  
Ken-ichi Nagakura ◽  
Yoko Miura ◽  
Takaaki Itonaga ◽  
Makoto Nishino ◽  
Kyohei Takahashi ◽  
...  
Keyword(s):  
Low Dose ◽  
Oral Immunotherapy ◽  
Long Term Follow Up ◽  
Dose Oral

Neurodevelopmental Outcome at 36 Months' Corrected Age of Preterm Infants in the Multicenter Indomethacin Intraventricular Hemorrhage Prevention Trial

PEDIATRICS ◽  
1996 ◽  
Vol 98 (4) ◽  
pp. 714-718 ◽  
Author(s):  
Laura R. Ment ◽  
Betty Vohr ◽  
William Oh ◽  
David T. Scott ◽  
Walter C. Allan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Intraventricular Hemorrhage ◽  
Maternal Education ◽  
Low Dose ◽  
Very Low Birth Weight ◽  
Cranial Ultrasound ◽  
The Mean ◽  
English Monolingual

Objectives. Low-dose indomethacin has been shown to prevent intraventricular hemorrhage (IVH) in very low birth weight neonates, and long-term neurodevelomental follow-up data are needed to validate this intervention. We hypothesized that the early administration of low-dose indomethacin would not be associated with adverse cognitive outcome at 36 months' corrected age (CA). Methods. We enrolled 431 neonates of 600 to 1250 g birth weight with no IVH at 6 to 12 hours in a randomized, prospective trial to determine whether low-dose indomethacin would prevent IVH. A priori, neurodevelopmental follow-up examinations, including the Stanford-Binet Intelligence Scale and Peabody Picture Vocabulary Test-Revised, and standard neurologic examinations were planned at 36 months' CA. Results. Three hundred eighty-four of the 431 infants survived (192 [92%] of 209 infants receiving indomethacin versus 192 [86%] of 222 infants receiving saline), and 343 (89%) children were examined at 36 months' CA. Thirteen (8%) of the 166 infants who received indomethacin and 14 (8%) of 167 infants receiving the placebo were found to have cerebral palsy. There were no differences in the incidence of deafness or blindness between the two groups. For the 248 English-monolingual children for whom IQ data follow, the mean gestational age was significantly younger for the infants who received indomethacin than for those who received the placebo. None of the 115 infants who received indomethacin was found to have ventriculomegaly on cranial ultrasound at term, compared with 5 of 110 infants who received the placebo. The mean ± SD Stanford-Binet IQ score for the 126 English-monolingual children who had received indomethacin was 89.6 ± 18.92, compared with 85.0 ± 20.79 for the 122 English-monolingual children who had received the placebo. Although maternal education was strongly correlated with Stanford-Binet IQ at 36 months' CA, there was no difference in educational levels between mothers of the infants receiving indomethacin and the placebo. Conclusions. Indomethacin administered at 6 to 12 hours as prophylaxis against IVH in very low birth weight infants does not result in adverse cognitive or motor outcomes at 36 months' CA.

Does Lead at Low Dose Affect Intelligence in Children?

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 894-896
Author(s):  
Herbert L. Needleman ◽  
David Bellinger ◽  
Alan Leviton
Keyword(s):  
Adverse Effects ◽  
Low Dose ◽  
Intelligence Test ◽  
Pediatric Clinic ◽  
Study Find ◽  
Group Data ◽  
Low Levels ◽  
The One ◽  
The Individual

Ernhart et al, on the basis of their own follow-up data and an incorrect critique of a single study, find reason to question the entire literature documenting the adverse effects of low levels of lead. They assert that, if effects exist, they are minimal. To reach this sweeping conclusion, they contradict or ignore the findings of the earlier study by Perino and Ernhart, misread a table from the one study they single out for criticism, and draw debatable conclusions from their own data. We conclude by calling the readers' attention to this sentence: "While the effects of subclinical lead intoxication may not be noted in the individual cases seen in a pediatric clinic, analysis of group data indicate quite clearly (emphasis added) that performance on an intelligence test is impaired."

scholarly journals Percutaneous ultrasound-guided laser ablation for the treatment of cervical tuberculous lymphadenitis: a pilot study

2019 ◽  
Vol 47 (4) ◽  
pp. 1512-1520
Author(s):  
Gaoyi Yang ◽  
Jianhua Fang ◽  
Tianzhuo Yu ◽  
Ying Zhang ◽  
Wenzhi Zhang ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Adverse Effects ◽  
Lymph Nodes ◽  
Tuberculous Lymphadenitis ◽  
Good Tolerability ◽  
Minimal Invasiveness ◽  
Contrast Enhanced ◽  
The Mean ◽  
Larger Sample

Objective This study was performed to assess the feasibility, effectiveness, and safety of percutaneous ultrasound (US)-guided laser ablation (LA) for the treatment of cervical tuberculous lymphadenitis (CTBL). Methods We retrospectively reviewed 11 patients with CTBL (mean age, 32.0 ± 8.6 years; range, 18–47 years) who underwent percutaneous US-guided LA from June 2014 to December 2016 with a subsequent 12-month follow-up. We assessed the mean volume reduction and contrast-enhanced US (CEUS) changes of the target lymph nodes as well as the tolerability and adverse effects of LA. Results The mean ablation energy was 522 ± 312 J (range, 204–1317 J). All 17 enrolled target lymph nodes were completely non-enhanced after LA treatment as detected by CEUS, indicating complete ablation of all lymph nodes (100%). The target lymph nodes significantly decreased in volume by a mean of 74.0% ± 15.6% from baseline to 12 months after LA. The LA procedure was well tolerated, and none of the 11 patients developed severe complications during the 12-month follow-up. Conclusion Percutaneous US-guided LA for the treatment of CTBL exhibits good tolerability, minimal invasiveness, and few adverse effects. Further investigations with larger sample sizes and longer follow-up periods are warranted to confirm these findings.

Sign in / Sign up

Export Citation Format

Share Document