Steroid Treatment
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2021 ◽  
Vol 62 (10) ◽  
pp. 1445-1448
Jaehyun Kim ◽  
So Hee Kim ◽  
Youna Choi ◽  
Seung Kwon Choi ◽  
Jae Jung Lee ◽  

Purpose: Here, we report a case of acute noninfectious endophthalmitis after removal of silicone oil (SO) and posterior capsulectomy in a patient with proliferative diabetic retinopathy.Case summary: SO removal and posterior capsulectomy were performed in a 61-year-old man who had undergone vitrectomy with combined cataract surgery, membrane peeling, laser photocoagulation, and SO injection to treat vitreous hemorrhage and tractional retinal detachment three months previously. The patient’s best-corrected visual acuity on the day after surgery was 20/50; it decreased to hand motion at five days after SO removal. Exudative membrane with hypopyon, anterior chamber cell (trace), and mild conjunctival injection were observed. The patient did not complain of ocular pain. Topical steroid was applied following a diagnosis of postoperative noninfectious endophthalmitis. The exudative membrane and hypopyon decreased after three days of treatment and had resolved completely after one month of treatment. The patient’s visual acuity improved to 20/50.Conclusions: Noninfectious endophthalmitis can develop after removal of SO and posterior capsulectomy. Topical steroid treatment is effective in such cases.

2021 ◽  
Vol 10 (20) ◽  
pp. 4678
Ana Muñoz-Gómez ◽  
Ana Fernández-Cruz ◽  
Cristina Lavilla-Olleros ◽  
Vicente Giner-Galvañ ◽  
Cristina Ausín-García ◽  

We aimed to determine the impact of steroid use in COVID-19 in-hospital mortality, in a retrospective cohort study of the SEMICOVID19 database of admitted patients with SARS-CoV-2 laboratory-confirmed pneumonia from 131 Spanish hospitals. Patients treated with corticosteroids were compared to patients not treated with corticosteroids; and adjusted using a propensity-score for steroid treatment. From March–July 2020, 5.262 (35.26%) were treated with corticosteroids and 9.659 (64.73%) were not. In-hospital mortality overall was 20.50%; it was higher in patients treated with corticosteroids than in controls (28.5% versus 16.2%, OR 2.068 [95% confidence interval; 1.908 to 2.242]; p = 0.0001); however, when adjusting by occurrence of ARDS, mortality was significantly lower in the steroid group (43.4% versus 57.6%; OR 0.564 [95% confidence interval; 0.503 to 0.633]; p = 0.0001). Moreover, the greater the respiratory failure, the greater the impact on mortality of the steroid treatment. When adjusting these results including the propensity score as a covariate, in-hospital mortality remained significantly lower in the steroid group (OR 0.774 [0.660 to 0.907], p = 0.002). Steroid treatment reduced mortality by 24% relative to no steroid treatment (RRR 0.24). These results support the use of glucocorticoids in COVID-19 in this subgroup of patients.

2021 ◽  
Xianwen Zhang ◽  
Peng Ren ◽  
Baohua Sang ◽  
Chunyan Song ◽  
Yunbi Lin ◽  

Abstract Background: Brucellosis is a common zoonotic illness in the world. Brucellosis is often characterized by hematologic abnormalities, including mild anemia, leukopenia, thrombocytopenia, or pancytopenia. However, severe refractory thrombocytopenia in brucellosis is very rare and easily misdiagnosed.Case presentation: The patient was a 5-year-old girl with brucellosis who developed severe refractory thrombocytopenia (platelet count: 3×109/L) with complaints of epistaxis, skin petechiae and purpura. Most conventional treatments including glucocorticoids and intravenous immunoglobulin (IVIg) did not elevate her platelets, but eltrombopag worked well and her platelet count recovered rapidly. One week later, the patient's symptoms improved and the platelet count returned to normal.Conclusions:Patients with severe refractory thrombocytopenia, particularly resistant to IVIg and steroid treatment should be considered for second-line drugs such as eltrombopag. Our results also increase the application experience of eltrombopag in Chinese patients with severe refractory thrombocytopenia in brucellosis. To the best of our knowledge, this case is the first reported case of the successful treatment of severe refractory thrombocytopenia in brucellosis with eltrombopag.

Romana Elisabeth Wass ◽  
David Lang ◽  
Andreas Horner ◽  
Bernd Lamprecht

SummaryImmune checkpoint blockade (ICB) has fundamentally improved the treatment landscape of advanced lung cancer. Improved tolerability and encouraging duration of response in selected patients are some of the advantages of ICB over conventional cytotoxic chemotherapies. However, immune-related adverse events (irAEs) possibly affecting multiple organs pose challenges in diagnosis and management. Checkpoint inhibitor pneumonitis (CIP) is a rare but clinically highly relevant irAE that can significantly impair quality of life and can be potentially life threatening. Since its heterogeneity in clinical and radiographic presentation, diagnosis can be challenging. Treatment usually consists of discontinuing or delaying the administration of ICB. If there is no sufficient recovery with this measure, steroid therapy is indicated. Although the majority of cases improves with this therapy, steroid-refractory CIP can be a therapeutic challenge as there is currently no evidence-based standard treatment. We herein present a short review of literature and a case report of relapsing CIP under steroid treatment.

2021 ◽  
Vol 10 (2) ◽  
pp. 74
Risza Subiantoro

CASE REPORTMANAGEMENT OF DEPRESSION IN CHILDREN WITH LUPUS ERYTHEMATOSUS SYSTEMRisza Subiantoro*, Nining Febriyana**, Lestari Basoeki**, Endang Wasiki** *Participant in Specialist I Psychiatric / Psychiatric Education Program, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia Bumi Panua Hospital, Pohuwato, Gorontalo, Indonesia** Psychiatrist (Consultant), Teaching Staff at Department / SMF Psychiatry, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia  ABSTRACT            Depression is a comorbid in patients with Systemic Lupus Erythematus (SLE). Depression can affect up to 60% of adolescents who are comorbid. Depression in adolescents is likely many factors, etiology, psychological burden, chronic disease, effects of long term steroid treatment, social, cultural and genetic factors. Depression is frequently associated with poorer treatment outcomes and poor treatment and health care outcomes in individuals with SLE. In this case, we will discuss the available treatment options. Keyword: Child Depression, Erythematous Systemic Lupus, Management.

Tyler D. Alexander ◽  
Sarah Collopy ◽  
Siyuan Yu ◽  
Michael Karsy ◽  
Chandala Chitguppi ◽  

Abstract Introduction In pituitary adenomas (PAs), the use of postoperative steroid supplementation remains controversial, as it reduces peritumoral edema and sinonasal complaints but disrupts the detection of adrenal insufficiency (AI). It is unclear whether postoperative cortisol supplementation has a measurable effect on improving outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery (ETS). The objective of the study was to evaluate a postoperative steroid treatment protocol on various surgical outcomes in patients with PA undergoing ETS. Methods A retrospective cohort study was performed for patients undergoing ETS from 2005 to 2020 for PA at a single tertiary academic center. Patients were divided into two groups: those managed by a routine postoperative glucocorticoid supplementation protocol (steroid protocol) and those who received supplementation based on postoperative cortisol laboratory assessment (steroid sparing protocol). Management was otherwise the same between groups. Evaluation of length of stay (LOS), sinonasal outcomes, 30-day readmission, and perioperative complications, including AI, were performed. Results Among 535 patients, 21% (n = 111) received postoperative steroids, while the remainder (n = 424) did not. There were no differences in mean LOS (3 vs. 3 days, p = 0.72), sinonasal complaints (27 vs. 19%, p = 0.12), 30-day readmission (5% vs. 5%, p = 0.44), and perioperative complications (5 vs. 5%, p = 0.79) between both the groups. A multivariate model supported that both groups were comparable in predicting LOS, 30-day readmission, and complications. No reduction in readmission for AI was seen. Conclusion Routine administration of postoperative glucocorticoids did not significantly improve patient outcomes in patients with PA who underwent ETS.

Molecules ◽  
2021 ◽  
Vol 26 (19) ◽  
pp. 5789
Agnese Paderi ◽  
Elisabetta Gambale ◽  
Cristina Botteri ◽  
Roberta Giorgione ◽  
Daniele Lavacchi ◽  

Background: Immune-related adverse events (irAEs) are inflammatory side effects, which can occur during immune-checkpoint(s) inhibitors (ICIs) therapy. Steroids are the first-line agents to manage irAEs because of their immunosuppressive properties. However, it is still debated whether or when steroids can be administered without abrogating the therapeutic efforts of immunotherapy. Methods: We retrospectively evaluated 146 patients with metastatic non-small cell lung cancer (NSCLC), melanoma and renal cell carcinoma (RCC) treated with ICIs. We assessed the progression-free survival (PFS) of patients treated with steroids due to an irAE compared to a no-steroid group. Results: The early treatment with steroid (within the first 30 days from the beginning of immunotherapy) was not related to a shorter PFS (p = 0.077). Interestingly, patients who were treated with steroids after 30 days from the start of immunotherapy had significantly longer PFS (p = 0.017). In a multivariate analysis, treatment with steroids after 30 days was an independent prognostic factor for PFS (HR: 0.59 [95% CI 0.36–0.97], p = 0.037). Conclusions: This retrospective study points out that early systemic steroids administration to manage irAEs might not have a detrimental effect on patient clinical outcome in NSCLC, melanoma and RCC patients.

Steven Toh ◽  
Chean Chung Shen

Chronic relapsing inflammatory optic neuropathy (CRION) is a recently described form of recurrent isolated subacute optic neuropathy, with accumulating evidence that it is a nosological distinct entity. The condition is highly responsive to systemic steroid treatment and prone to relapse on steroid withdrawal. Diagnosis and management of this condition is often challenging. This 33-year-old lady with family history of multiple sclerosis (MS), with uniocular visual loss of her right eye since 2 years old without apparent cause, presented with reduction of vision and loss of colour vision in the left eye, associated with painful eye movement. There was internuclear ophthalmoplegia but slit lamp examination were unremarkable. She had no other related sensory or motor symptoms. Magnetic resonance imaging (MRI) did not reveal any features of MS. Aquaporin-4 antibody, anti-MOG and gene testing for Leber’s hereditary optic neuropathy were all negative. Metabolic, infective, and other autoimmune causes were also excluded. Visual evoked potential studies of left eye showed a mild reduction in amplitude with no prolongation of latency. Her multiple optic neuritis recurrences were treated with intravenous steroids followed by tapering regime of oral prednisolone with good effect. Knowledge of this rare condition as part of the differential diagnoses of possible aetiologies of optic neuropathy is important among Ophthalmologists, as prompt diagnosis and steroid treatment helped reduce the associated risk of blindness. Multiple relapses after initial successful treatment of inflammatory optic neuropathy should raise the suspicion of CRION.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S19

2021 ◽  
pp. 1-10
George Psillas ◽  
Grigorios G. Dimas ◽  
Michalis Daniilidis ◽  
Paris Binos ◽  
Thomas Tegos ◽  

<b><i>Introduction:</i></b> The aim of this study was to illustrate clinical and audiological patterns of hearing impairment in patients with autoimmune hearing loss (AIHL). <b><i>Methods:</i></b> Fifty-three patients with AIHL were retrospectively recruited, and a tapering schema of steroid treatment was administered in all these patients. The diagnosis of AIHL was essentially based on clinical symptoms, such as recurrent, sudden (sensorineural hearing loss [SSHL]), fluctuating, or quickly progressing (&#x3c;12 months) SSHL (uni-/bilateral), in association with the coexistence of autoimmune diseases, high antinuclear antibodies (ANA) and the presence of human leukocyte antigen (HLA) B27, B35, B51, C04, and C07. Logistic regression analysis was applied to correlate the clinical data and laboratory features of AIHL with final outcomes. <b><i>Results:</i></b> The onset of AIHL was mainly progressive (49%), followed by SSHL (39.6%) or fluctuating (11.3%). The pure-tone audiogram showed more commonly a downsloping pattern (42.6% of ears), but also an upsloping, flat, cookie-bite, or inverse cookie-bite shape. Bilateral progressive AIHL was more frequently simultaneous (23 patients) than heterochronous (4 patients). Nineteen patients (35.8%) showed a favorable response to steroid therapy. The presence of recurrent, bilateral SSHL versus recurrent, unilateral SSHL had statistically negative effect on hearing recovery (OR = 0.042, <i>p</i> &#x3c; 0.05). The heterochronous bilateral SSHL may have better prognosis than simultaneous bilateral SSHL (OR = 10.000, <i>p</i> = 0.099). The gender, age, concomitant autoimmune disease, high ANA, HLA alleles, tinnitus, and vestibular symptoms had no statistical effect on a favorable outcome of AIHL. <b><i>Conclusions:</i></b> A bilateral, simultaneous, and progressive hearing loss combined with downsloping audiogram occurred more often in patients with AIHL. Bilateral simultaneous SSHL with recurrences represents the worse prognostic form of AIHL.

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1653
Nicolò de Pretis ◽  
Stefano Francesco Crinò ◽  
Luca Frulloni

Autoimmune pancreatitis (AIP) is an increasingly recognized disease classified into two different subtypes based on histology. According to the International Diagnostic Criteria (ICDC), the diagnosis is achieved using a combination of different criteria. In patients presenting with a typical imaging appearance, the diagnosis may be straightforward, and steroid treatment is recommended, even without histological confirmation. In patients with atypical imaging or mass-forming appearance, the differential diagnosis with pancreatic cancer is challenging and crucial for treatment strategy. Endoscopic ultrasound (EUS)-guided tissue acquisition has been proposed to achieve a histological diagnosis. Fine-needle aspiration (FNA) was first proposed to aspirate cells from pancreatic lesions. Despite excellent results in terms of sensitivity for pancreatic cancer, the data are disappointing regarding the diagnosis of AIP. The recent development of new needles allowing fine-needle biopsy (FNB) has been associated with improved diagnostic accuracy based on preserving the tissue architecture, which is necessary to detect the typical histological features of AIP. However, the published literature on the role of EUS-guided FNA and FNB is limited and mainly focused on type 1 AIP. The present study aimed to review the available literature on the role of EUS-guided FNA and FNB in the diagnosis of AIP.

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