Importance of Eosinophilic Infiltration of the Colonic Mucosa in Ulcerative Colitis Patients who are Refractory to Maintenance Therapy

Eosinophilic infiltration is sometimes observed histologically in ulcerative colitis (UC), but the effect of the degree of infiltration on the treatment course for UC is not completely studied. We investigated whether short-term steroid administration in UC patients refractory to maintenance therapy, with high eosinophilic infiltration in the colonic mucosa, contributed to clinical and endoscopic improvement. Ten patients with endoscopically active and pathologically high eosinophilic infiltration, based on pathological examination using endoscopic biopsy, were examined for clinical background when starting steroid treatment; clinical and endoscopic improvement before and after steroid use were assessed prospectively. The average initial steroid dosage and duration of use were 21.0 mg and 102.7 days, respectively. The mean values before and after steroid use of clinical activity index, Mayo endoscopic subscore, and UC endoscopic index of severity were 2.4 and 1.0, 1.8 and 0.7, and 3.9 and 1.1, respectively. All these scores improved significantly after steroid use (P=0.04, P<0.01, P<0.01, respectively). Steroids were discontinued in all patients; no patients required steroid re-administration. There may be cases of UC with eosinophilic infiltration into the colonic mucosa and resistant to maintenance treatment, suggesting that short-term steroid administration may contribute to clinical and endoscopic improvements.

Assessment of Post-Covid Symptoms in Covid-19 Recovered Patients: A Prospective Cohort Study in a Tertiary Care Centre of South India

Background: The post-Covid symptoms among patients hospitalised with covid has to be determined for elucidating the spectrum of illness which persists even after the apparent recovery. The understanding of the post-Covid symptoms will help us to better manage aftermath of the pandemic.Aim: To determine the incidence of post-Covid symptoms in a cohort of inpatients who recovered from COVID-19 from a tertiary care centre in South India.Method: 120 survivors from patients admitted with COVID 19 were prospectively followed up for 6 weeks after their discharge from the hospital. The cohort included 50 patients requiring Intensive care unit (ICU) care and 70 ward patients. The follow-up was conducted on the second and sixth week after discharge with a structured questionnaire. The questionnaire was filled by the patient/bystanders during their visit to the hospital for follow-up at 2 weeks and through telephone follow up at 6 weeks.Results: Mean age of the cohort was 55 years and 55% were males. 58.3% had mild covid and 41.7% had moderate to severe covid infection. 60.8% (n=73) of patients had at least one persistent symptom at sixth week of discharge. 50 (41.7%) patients required intensive care during their inpatient stay. Presence of persistent symptoms at 6 weeks was not associated with severity of illness, age or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8% followed by weight loss (22.5%) and dyspnoea (20%). Female sex (OR 2.4, 95% CI: 1.03–5.58, p = 0.041) and steroid administration during hospital stay (OR: 4.43; 95% CI: 1.9–10.28, p = 0.001), were found to be significant risk factors for the presence of post-Covid symptoms at 6 weeks as revealed by logistic regression analysis.Conclusion: 60.8% of inpatients treated for covid had post-Covid symptoms at 6 weeks post- discharge from hospital. Female sex and steroid administration during hospital stay were identified as predictors of persistence of post-Covid symptoms at 6weeks.

Sensorineural Hearing Loss of Suspected Autoimmune Etiology: Two Cases of Cogan’s Syndrome

Cogan’s syndrome is a rare inflammatory disease characterized by non-syphilitic keratitis and vestibulo-auditory symptoms including hearing loss, tinnitus, and vertigo. Although its precise pathogenesis is not known, Cogan’s syndrome is generally considered an autoimmune disease. This hypothesis is supported by the frequently successful remission of hearing loss after steroid administration and the association with other autoimmune disorders such as rheumatoid arthritis. Medical treatment of Cogan’s syndrome depends on disease severity and on how extensive the disease is. The involvement of inner ear pathology requires systemic corticosteroid therapy. In cases of treatment failure or the need for a corticosteroid-sparing effect, other immunosuppressive drugs can be used. We experienced two patients with typical Cogan’s syndrome, presenting bilateral progressive sensorineural hearing loss and dizziness with ocular involvement, which we have successfully treated with systemic steroid administration and immunosuppressive therapy.

B Lymphocyte Subsets in Children With Steroid-Sensitive Nephrotic Syndrome: A Longitudinal Study

Background: B-cell subsets may be involved in the pathogenesis of childhood steroid-sensitive nephrotic syndrome (SSNS). Horizontal control studies have shown that homeostasis of B-cell subsets changes at different stages of the SSNS. However, there is a lack of longitudinal studies that have investigated dynamic changes in B cell subpopulations.Methods: Blood samples were collected at the following time points from 15 children with SSNS treated at our hospital: before administration of steroid and after 3 days, 1 week, and 3, 6, 9, and 12 months. The proportions of circulating total B cells (CD19+), transitional B cells (CD19+CD24highCD38high), mature B cells (CD19+CD24lowCD38intermediate), and memory B cells (CD19+CD24highCD38−) were monitored by flow cytometry.Results: The proportion of CD19+ B cells before steroid administration was significantly higher than that observed at any other time point or in the healthy control (HC) group (p &lt; 0.001). However, this proportion was significantly lower than that in the HC group at 12 months (p = 0.031). Transitional B cells before (%BL 9.5 ± 4.4) and 3 days after steroid administration (%BL 10.6 ± 5.1) were significantly higher than at any other time point or in the HC group (p &lt; 0.001). Although these cells declined after the 3rd day the percentage was still significantly lower than that of the HC group at 12 months (p = 0.029). Memory B cells increased gradually after steroid administration and decreased to the normal range after 9 months.Conclusions: B cell subpopulations show dynamic changes in children with SSNS, suggesting that they are involved in the pathogenesis of the disorder. Further studies are required to determine whether this change can guide individualized treatment.

PATTERN OF GLYCEMIC STATUS AFTER STEROID ADMINISTRATION FOR FETAL LUNG MATURITY IN NORMOGLYCEMIC PREGNANT WOMEN ; A CLINICAL ANALYSIS

Objectives To study the patterns of glycemic status in response to steroid administered to women with risk of preterm delivery between 24 weeks and 36 weeks 6 days of gestation in normoglycemic subjects and to evaluate if maternal characteristics predicted the development of hyperglycemia and if Insulin was necessary in the glycemic management Design : longitudinal study Participants : 76 antenatal women, normoglycemic status between 24 weeks and 36 week 6 days of gestation Methods : Antenatal women who screened negative for Gestational Diabetes Mellitus by 75 gm GTT who received Injection Betamethasone for risk of preterm delivery . Fasting and Postprandial blood sugar levels were recorded from day 1 to 7 after steroid administration. Results Forty seven out of seventy six patients had hyperglycemia of varying severity. Among the risk factors associated with hyperglycemia, age>25 years, family history ofdiabetes and hypertension and BMI >25 have statistically significant association with hyperglycemia. Insulin was started in a total of 40 patients of 47 hyperglycemic patients (85.1%). Mean Insulin dosage required for day 1 was9.66 units. Among the 40 patients started on Insulin 15 (37.5 %) had to be continued on Insulin on Day 7 after steroid administration. Conclusion Significant hyperglycemia can occur in normoglycemic women also leading to serious maternal- fetal consequences . Testing of all antenatal patients especially in age group more than 25years, BMI over 25, hypertensive patients, family history of diabetes who are at risk for development of hyperglycemia ie recommended and start insulin accordingly thus preventing complications.