Comparison of the Efficacy and Safety of Non-Steroidal Anti-Inflammatory Drugs and Corticosteroid Drugs for Prevention of Cystoid Macular Edema After Cataract Surgery: A Systematic Review and Network Meta-Analysis

Introduction: To compare the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAID), corticosteroid (CS), and a combination of both drugs to prevent cystoid macular edema (CME) after cataract surgery. Methods We searched Pubmed, Cochrane Library, and Embase electronic databases to assess the relevant randomized controlled trials (RCTs) up to 28 April 2021. Network meta-analysis was registered on PROSPERO (CRD42020182520). Results Twenty-four RCTs were included in this review. The NSAID and combination of both drugs were significantly reduced the risk of developing CME than CS alone in non-diabetics and mix population. In the ranking profiles, the combination therapy showed a significant advantage over the single drugs and was less likely to develop CME. Diclofenac was the most likely to reduce the odds of developing CME compared with bromfenac and nepafenac. Dexamethasone was the most likely to reduce the odds of developing CME compared with betamethasone and fluorometholone. Conclusion NSAID combination with CS has significantly reduced the risk of developing CME postoperatively than the single drug. Diclofenac was superior to bromfenac and nepafenac in preventing CME. Dexamethasone was superior to betamethasone and fluorometholone in preventing CME.

KPI-121 1% for pain and inflammation in ocular surgery

Pain and inflammation are common experiences following ocular surgery and, if uncontrolled, can compromise patients’ vision, functioning and quality of life. Corticosteroid drugs are available to manage inflammation and discomfort but have limitations in penetrating the ocular mucus barrier to reach the target ocular tissues. KPI-121 1% (INVELTYS®) is a novel formulation of loteprednol etabonate that employs innovative proprietary technology to deliver nanoparticle-sized mucus-penetrating particles to the cornea. Results from clinical trials demonstrate that KPI-121 1% is effective and well tolerated. KPI-121 1% uses mucopenetrative technology for ophthalmic use and is the only US FDA-approved twice-daily ocular corticosteroid indicated for the treatment of inflammation and pain after ocular surgery.

Chronic monocytic leukemia with transformation into acute monocytic leukemia

Chronic myelomonocytic leukosis (CMML) is rarely diagnosed and amounts to 1 per 100 thousand of adults per year, more often in men over 60 years. The clinical case of the rare, prolonged course of myelodysplastic chronic myelomonocytic leukosis (MD-CMML) in a middle-aged woman with rapid transformation into acute monocytic leukemia (AMoL-M5в) with the atypical fulminant course is presented. A retrospective analysis of the course of the disease drew attention to the severe vasculitis suffered by the patient 19 years ago, which could be regarded as the debut of CML in the presence of characteristic pathological changes in the hemogram. Non-pronounced clinical manifestations in the form of moderate cervical lymphadenopathy, skin lesions in the form of transient erythema, spotty eruptions over the next 10 years, fit into the clinical picture of MD-CMML. A detailed picture of the disease was observed after viral infection, bronchitis, antibiotic therapy. Absence of significant blastemia and severe inhibition of normal hematopoiesis with expressed extramedular manifestations of the disease in the patient were not typical for the course of AMoL-M5b in this case. The progression of skin lesions was noteworthy, which gave reason for unfavorable prognosis. For several weeks, the spread of erythematous elements was observed throughout the body with itching, not controlled by antihistamines and corticosteroid drugs; the appearance of maculopapular rashes, merging in places; small-point hemorrhages like vasculitis over the entire surface of the skin. Notable was the development of severe hemorrhagic syndrome without severe thrombocytopenia, significant changes in the coagulogram, as a manifestation of early severe coagulopathy.

Use of dexamethasone in the management of respiratory tract infections

Dexamethasone is a potent synthetic member of the glucocorticoid class of corticosteroid drugs that has been useful for the management of some pathological disorders because it affects a protean number of signaling pathways. It is used as adjunct therapy in the management of sepsis, arthritis, cardiac transplant, blood, hormone/immune system disorders, allergic reaction, skin, eye conditions, cancer and other pathologic disorders and as a mainstay of therapy in autoimmune hepatitis. With the advent of COVID-19, there have been investigations of its use as antiinflammatory agent in severely ill patients. This present review elucidates the various studies on the use of dexamethasone in the management of severe respiratory tract infections, with the ultimate aim of reducing mortality amongst severely ill patients, including COVID-19. Keywords: dexamethasone; adjunctive therapy; respiratory infections; COVID-19 English Title: Utilisation de la dexaméthasone dans la prise en charge des infections des voies respiratoires La dexaméthasone est un membre synthétique puissant de la classe des corticostéroïdes glucocorticoïdes qui a été utile pour la gestion de certains troubles pathologiques car elle affecte un nombre protéiforme de voies designalisation. Il est utilisé comme traitement d'appoint dans la prise en charge de la septicémie, de l'arthrite, de la transplantation cardiaque, du sang, des troubles hormonaux/du système immunitaire, des réactions allergiques, des affections cutanées, oculaires, du cancer et d'autres troubles pathologiques et comme pilier du traitement de l'hépatite auto-immune. Avec l'avènement du COVID-19, des études ont été menées sur son utilisation comme agent anti-inflammatoire chez des patients gravement malades. Cette revue présente les différentes études sur l'utilisation de la dexaméthasone dans la prise en charge des infections sévères des voies respiratoires, dans le but ultime de réduire la mortalité chez les patients gravement malades, y compris le COVID-19. Mots clés: dexaméthasone; thérapie d'appoint; infections respiratoires; COVID-19

Complex Approach to the Bacterial Corneal Ulcers Treatment

Purpose: Objective: to evaluate the effect of treatment of bacterial corneal ulcers of varying severity using a combination of antibacterial and corticosteroid drugs.Material and methods. 63 patients with bacterial corneal ulcers of varying severity were treated. The study used a quantitative scale to assess the severity of corneal ulcers. Group 1 — patients with mild corneal ulcers (18 patients); Group 2 — patients with moderate corneal ulcer (17 patients); group 3 — severe corneal ulcer (11 patients); control group — patients with mild corneal ulcer (17 patients). Patients of groups 1, 2 and 3, in addition to the conventional treatment, received Dexamethasone 0.1 % — 0.3 ml in parabulbar injections from the first day of treatment for the entire treatment period. Kr). In addition to the standard ophthalmological examination, all patients were assessed for the ulcer defect using measurements on OCT-POG accessing the parameters of the diameter of the corneal ulcer (d) and the depth coefficient (Kr).Results. The patients in the 1st group received antibacterial treatment and the addition of parabulbar injections of a corticosteroid drug (Dexamethasone). It allowed to decrease the treatment time and the period of hospitalization, promoted faster epithelialization and a reduction in the depth of the ulcer, less coarse scarring of the cornea, allowed to increase the functional results of treatment. The proposed treatment for severe corneal ulcers in 55 % of cases allows to use only conservative treatment. It is possible to obtain moderate opacity with vascularization in 60 % cases, which contributes to the preservation and/or improvement of visual acuity, despite the severity of the inflammatory process without the use of surgical intervention.Conclusion. The proposed treatment, involving the use of the corticosteroid drug Dexamethasone 0.1 % in parabulbar injections of 0.3 ml once daily for a bacterial corneal ulcer of mild severity for, average, 15.0 ± 1.4 days, a bacterial corneal ulcer of moderate severity — 18.0 ± 1.3 days, severe bacterial corneal ulcer — 25.0 ± 4.4 days, seems to be effective if the proposed parameters of the diameter and depth of the corneal ulcer are controlled.

Experience on the use of photodynamic therapy in vulvovaginal lichen plane

BACKGROUND: Lichen plane (LP) occurs in 0.5%1% of the population. The exact epidemiology of genital LP is unknown. According to various data, LP occurs in 49% of all cases of vulvar lesions. The LP of the oral cavity and the vulva occurs in 1957% of cases. The clinical forms of LP that occur in the anogenital region in women include the erosive, papulosquamous, and less often hypertrophic forms. No distinct guidelines are available for the treatment of vulvar LP. Except for the use of photodynamic therapy (PDT), no randomized controlled trials have been conducted for the treatment of erosive vulvar LP. The research results have shown that PDT can be effective in lichen plane of the oral cavity. AIM: To evaluate the effectiveness of PDT in women with genital LP compared to topical glucocorticosteroids. MATERIALS AND METODS: The study group included 15 patients with a diagnosis of vulvar LP. The patients were divided into two groups depending on the treatment method. Group 1 patients were treated with PDT. Group 2 patients with topical 0.05% betamethasone cream once daily for 1.5 months. RESULTS: Six months after the last procedure, the regression on the genital LP rating scale was 32% in group 1 patients and 25% in group 2 patients. The severity of pain, according to the visual analog scale, was 29% in group 1 and 22% in group 2. As for adverse events, in group 1, four patients experienced a burning sensation and dryness for 23 days after the procedure, and one patient, after two procedures, had blood discharge, which ceased after 1 day. In group 2, five patients complained of burning and dryness during treatment, two patients had acute candidiasis during treatment, and one patient had bacterial vaginosis. CONCLUSION: The use of PDT can reduce the frequency of use of corticosteroid drugs in the genital area and accordingly reduce the frequency of steroid adverse events, such as atrophy and secondary infection.

Plasma IL-6 Levels following Corticosteroid Therapy as an Indicator of ICU Length of Stay in Critically ill COVID-19 Patients

Intensive Care Unit (ICU) admissions and mortality in severe COVID-19 patients are driven by cytokine storms and acute respiratory distress syndrome (ARDS). Interim clinical trial results suggest that the corticosteroid dexamethasone displays superior 28-day survival in severe COVID-19 patients requiring ventilation or oxygen. Among 16 patients with plasma IL-6 measurement post-corticosteroid administration, a higher proportion of patients with an IL-6 value over 10 pg/mL have worse outcomes (i.e. ICU Length of Stay > 15 days or death) when compared to 41 patients treated with non-corticosteroid drugs including antivirals, tocilizumab, azithromycin, and hydroxychloroquine (p-value = 0.0024). Given this unexpected clinical association between post-corticosteroid IL-6 levels and COVID-19 severity, we hypothesized that the Glucocorticoid Receptor (GR or NR3C1) may be coupled to IL-6 expression in specific cell types that govern cytokine release syndrome (CRS). Examining single cell RNA-seq data from bronchoalveolar lavage fluid of severe COVID-19 patients and nearly 2 million human cells from a pan-tissue scan shows that alveolar macrophages, smooth muscle cells, and endothelial cells co-express both NR3C1 and IL-6. The mechanism of Glucocorticoid Receptor (GR) agonists mitigating pulmonary and multi-organ inflammation in some COVID-19 patients with respiratory failure, may be in part due to their successful antagonism of IL-6 production within lung macrophages and vasculature.

Risk Factors for Central Serous Chorioretinopathy: A Case-Control Study

Aim of the study: Assessment of the influence of potential risk factors on the development of central serous chorioretinopathy in a large industrial city. Materials and Methods: Case-control study of persons aged 18 years and older. The study group included 100 patients with central serous chorioretinopathy, confirmed by optical coherence tomography, and controls – 100 patients without central serous chorioretinopathy. The groups are comparable in gender and age. Interviewing of patients was carried out according to the developed questionnaire, including 33 questions. One-way and multivariate analysis of the results using logistic regression was carried out. Statistical data processing was carried out using Microsoft Office Excel 2010, Jamovi programs, R – Studio statistical package, OpenEpi online calculators (http://www.openepi.com). Results: The following risk factors for CSC were identified: taking corticosteroid drugs in the last year – OR 13.5; 95% CI 3.4-53.2 and the presence of arterial hypertension – OR 8.3; 95% CI 1.3-54.1. Intake of antihypertensive drugs and psychotropic drugs from the group of anxiolytics were statistically significant factors in the "prevention" of the development of CSC (OR 0.1; 95% CI 0.02-0.9 and OR 0.01; 95% CI 0.0003− 0.5), respectively. The presence of myopia also proved to be a protective factor for CSC –OR 0.3; 95% CI 0.14-0.8. Conclusion: In a case-control study, significant risk factors for CSC for the population of a large industrial city were arterial hypertension and the use of corticosteroid drugs. The presence of myopia is associated with a lower incidence of CSC.

CHARACTERISTICS OF AUTOIMMUNE INFLAMMATION IN THE PATIENTS WITH LUNG TUBERCULOSIS

Tuberculosis is a granulomatous disease caused by Mycobacterium tuberculosis, being characterized by the development of caseous granulomas in various organs, mainly in lungs. M. tuberculosis is known to be a trigger for autoimmune inflammation, due to the possible mimicry of bacterial proteins as autoantigens. Recently, a significance of mesenchymal vimentin as an autoantigen in mycobacterial infections has been actively discussed. The aim of the present study was to determine autoantibodies for various vimentin modifications in the patients with tuberculosis.The study was performed in 2014-2017 and included 28 patients with pulmonary tuberculosis (group I), 30 patients with nonspecific lung diseases (group II): 15 with granulomatous polyangiitis, and 15 with different alveolites. Control group consisted of healthy subjects (n = 40). Concentration of antibodies to mutated citrullinated vimentin (anti-MCV) was measured using ELISA (ORGENTEC, Germany). The patients with elevated anti-MCV levels were tested for antibodies to cyclic citrullinated peptide (anti-CCP) using ELISA technique (EUROIMMUN, Germany). Statistical analysis was carried out using GraphPad Prism 6 (GraphPad Software, USA), Statistica 10 (Statsoft, USA) using nonparametric analysis of samples with Mann-Whitney and Chi-square criteria, and Spearman method for correlation analysis. The differences were considered statistically significant at p < 0.05.The anti-MCV concentrations were significantly higher in patients with tuberculosis (group I, 60.7% of cases, 17/28) than in group II, and control group (23.6 and 25.0% of cases, respectively). No statistically significant differences were revealed between the results of anti-MVC and anti-CCP levels in comparison group with the control group (p = 0.18).High levels of anti-MCV antibodies in the patients with pulmonary tuberculosis reflect an opportunity of developing autoimmune process in the disease pathogenesis. Measurement of plasma anti-MCV antibody concentrations may be important for correction of the therapy, especially upon administration of immunosuppressive and hormonal corticosteroid drugs. It has been shown that anti-CCP are not characteristic to the lung diseases.