Assessment of Clinical Asthma Score and Asthma Severity Score in Preschool Children with Recurrent Wheezing

Objective: There is no definitive consensus on asthma exacerbation scoring for preschool children with recurrent wheezing. The Clinical Asthma Score (CAS) and Asthma Severity Score (ASS) are two scoring systems that can be used in this population. The aim of this study was to evaluate the relationship between CAS and ASS, acute treatment, and exacerbation outcomes in preschool children with wheezing. Materials and Methods: The study included 70 patients aged 2-5 years who presented to the pediatric emergency department due to an acute wheezing episode. CAS and ASS were evaluated at exacerbation presentation and after initial salbutamol therapy. Results: Presenting scores were significantly higher among patients who had three or more episodes within the last year (p=0.01 for CAS, p=0.019 for ASS). Presenting scores were significantly higher in patients treated with systemic steroid therapy during the episode compared to those who were not (p=0.006 for CAS; p=0.003 for ASS). CAS and ASS predicted the use of acute steroid therapy with a sensitivity of 73.7% and 52.6%, and predicted hospitalization with a sensitivity of 95% and 82.5%, respectively. Conclusion: Our data suggest that these scoring systems can be used to judge the need for systemic steroid therapy and that high scores are associated with greater likelihood of hospital admission. Keywords: Asthma score, children, hospitalization, wheezing, exacerbation

Melkersson–Rosenthal syndrome in the context of sarcoidosis: a case report

Background Melkersson–Rosenthal syndrome is a rare disease characterized by the triad of recurrent orofacial swelling with facial paralysis and fissured dorsal tongue. Histologically, noncaseating granulomatous inflammation occurs that confirms the diagnosis. Overlaps between granulomatous diseases such as sarcoidosis and Crohn’s disease are described. Systemic corticosteroid therapy is the treatment of choice for acute attacks. Case presentation We here present a case of a 59-year-old White woman suffering from Melkersson–Rosenthal syndrome with a past history of sarcoidosis on therapy with leflunomide in combination with low-dose tacrolimus successfully treated with the anti-leprosy drug clofazimine after failure of systemic steroid therapy. Conclusions We propose clofazimine as an alternative treatment in steroid-refractory cases.

A case report pemphigoid gestational case, responding to systemic steroid therapy

In this case report, a rare case of Pemphigoid Gestationis at 33 weeks’ of gestation is presented and the related literature is briefly reviewed. A 21-year-old at 33 weeks’ of gestation admitted with the complain of itchy skin lesions on the abdomen, arms and legs. Dermatologic examination revealed urticaria papules and plaques in the abdomen, arms and legs, more intensely around the umbilicus, which range from 1-2 cm diameter to 4-5 cm diameter. Papulovesicular lesions and few erosions were observed especially in the hand and foot dorsals. Spongiosis on epidermis, intracellular and subepidermal bullae formation, edema on papillary architecture and inflammatory infiltrate composed of mononuclear cells and eosinophils around the perivascular ares of the upper dermis were seen in histological examination. Direct immunofluorescence of perilesional skin showed linear deposition of complement (C3) along the basement membrane zone. The preliminary diagnosis of pemphigoid gestationis was confirmed by histopathologic findings. Pemphigoid gestationis is a rare autoimmune bullous dermatosis that begins in the second or third trimester of pregnancy. Healing occurs weeks after birth. It occurs more severely in subsequent pregnancies. Its main treatment is systemic steroid and antihistamine administration. A multidisciplinary approach both in dermatological and gynecological terms is required for the diagnosis, treatment and course of the disease.

P553 Factors related to steroid consumption in IBD patients: Evidence from a multicenter Study

Background Steroids are frequently used to induce remission in inflammatory bowel disease (IBD) but should not be used as maintenance treatment. Understanding the factors related to steroid consumption is essential in order to avoid over prescription of these drugs. Methods A cross-sectional study was conducted between 2019 and 2020 in six medical centers in Israel. Data was collected using a structured self-administered tool containing the following: socio demographic and clinical characteristics, knowledge of side effects and complications of steroid treatment, self-care and compliance with medical instructions, Steroid Assessment Tool (SAT) and objective physiological measures. Results The study included 402 IBD patients; 262 patients with Crohn’s disease (CD) (66%) and 135 patients with ulcerative colitis (UC) (34%). Most of the patients reported being monitored in the IBD unit in the medical centers (87.7%). A quarter of the patients (n=88) had been prescribed systemic steroids over the previous year, and 20 (23%) received 3 or more prescriptions for systemic steroids over the preceding year. Likewise, over 20% of patients were on systemic steroid therapy for over 4 months in the preceding year. Those patients were mostly men and ultra-orthodox. Patients with UC were prescribed steroids more often than CD patients. Knowledge levels regarding appropriate steroid consumption were significantly higher among women (F=40.24, p<.001) and lower among ultra-orthodox patients (X2=6.43, p<.05). Although most of the patients (85.9%) were routinely treated by gastroenterologist, the majority (80%) choose to visit the general practitioner when their disease had flared up. Conclusion Several factors were found to be related to inappropriateness use of steroids in IBD patients. Thus, tailored intervention for specific population should be developed to ensure that steroids are used correctly and that their side effects are minimized. Also, infrastructure and alignment of an integrated health care delivery system, with multidisciplinary team may provide the optimal environment for care coordination, especially during disease flare.

Clinical case of lupus erythematosus panniculitis

BACKGROUND: This clinical case is interesting because of extreme rarity of lupus panniculitis in the population, as well as the possible risk of developing systemic lupus erythematosus. CASE REPORT: The article presents a clinical observation of a rare skin disorder lupus erythematosus panniculitis and the results of a successful combined treatment of the disease with systemic glucocorticoids (prednisolone), and an antimalarial agent (hydroxychloroquine). A review of the literature on the etiology, pathogenesis, and diagnosis of lupus panniculitis has been conducted. CONCLUSION. Early detection of lupus erythematosus panniculitis (LEP) makes systemic steroid therapy and quinoline drugs more effective in achieving remission. That is why dynamic monitoring of patients with LEP is important to identify new or progressive symptoms.