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Arbaoui S, Rezziki A, Kejiou H, Serraj KA, Benzirar A, El Mahi O. [Bilateral sub-acute upper limb ischemia revealing Horton's disease, a rare presentation : A case report and literature review]. Ann Cardiol Angeiol (Paris) 2024; 73:101677. [PMID: 37984239 DOI: 10.1016/j.ancard.2023.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/22/2023]
Abstract
STUDY'S GOAL Our goal is to enrich the medical literature by sharing our experience in managing a case of sub-acute upper limb ischemia that revealed Horton's disease. This is particularly relevant given the current lack of well-established guidelines. INTRODUCTION Acute upper limb ischemia is rarely seen in Horton's disease. CASE REPORT We present a case of a 63-year-old female patient with sub-acute ischemia in both upper limbs, accompanied by jaw claudication and absence of bilateral temporal pulses. The CT Angiography scan revealed bilateral occlusions and stenosis of the axillary and sub-clavier arteries, as well as involvement of the external carotid arteries and its branches. The Arteriography confirmed abnormalities in the medium-sized arteries of the supra-aortic trunks. The histopathology examination of the temporal artery biopsy was negative. The patient received emergency corticosteroid therapy followed by an immunosuppressant. Due to the improved clinical condition of the upper limbs, surgical intervention was not performed.
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Affiliation(s)
- S Arbaoui
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - A Rezziki
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - H Kejiou
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - K A Serraj
- Département de médecine interne, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - A Benzirar
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - O El Mahi
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
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Morales-Puebla JM, Fernández-Fournier M, Plana-Blanco A, Lassaletta L. Variations in the treatment of acute peripheral facial paralysis. A nationwide survey. Acta Otorrinolaringol Esp (Engl Ed) 2024; 75:31-39. [PMID: 37722655 DOI: 10.1016/j.otoeng.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Acute peripheral facial paralysis may be diagnosed and treated by different specialists. OBJECTIVE The aim of this study was to explore the variability in the treatment of Bell's palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. METHODS An anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). RESULTS 1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). CONCLUSION There is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.
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Affiliation(s)
- José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain; Autonomous University of Madrid, School of Medicine, Madrid, Spain.
| | - Mireya Fernández-Fournier
- Neurology Department, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Neuroepidemiology Coordinator of the Spanish Society of Neurology, Spain
| | - Antoni Plana-Blanco
- Primary Care Center of Balàfia-Pardinyes-Secà de St. Pere, Lleida, Spain; Neurology Coordinator of the Spanish Society of Family and Community Medicine, Spain; University of Lleida, School of Medicine, Lleida, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain; Autonomous University of Madrid, School of Medicine, Madrid, Spain
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Nejadhosseinian M, Babagoli M, Faezi ST, Haerian H, Shahram F, Alikhani M, Davatchi F. Osteonecrosis as a rare musculoskeletal complication in Behcet's disease- the largest case series with literature review. BMC Rheumatol 2023; 7:42. [PMID: 38031147 PMCID: PMC10687826 DOI: 10.1186/s41927-023-00366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Behcet disease (BD) as a variable vessel vasculitis is mainly characterized by ocular involvement, genital and oral aphthosis, and erythema nodosum. However, major organ involvements including gastrointestinal involvement, nervous system, and vascular involvement are among the severe complications. Osteonecrosis is a rare complication of patients with BD. We aim to report the largest series of BD patients suffering from osteonecrosis. METHODS We have retrospectively reviewed all patients in Iran Behcet's Disease Registry and reported those with osteonecrosis. Patients' medication and clinical features, symptoms, and details of osteonecrosis will also be presented. Furthermore, previously reported cases will also be reviewed. RESULTS Seven thousand eight hundred thirty-one patients were diagnosed with BD and registered. 18 patients developed ON with an incidence of 0.22%. The most common involvement during the disease progression was oral aphthosis which appeared in 100% of patients followed by ocular involvement in 85.7% and skin involvement in 71.4%. Vascular, ocular, and nervous system involvements are significantly higher in BD patients with osteonecrosis than the other BD patients. For the management of acute episode of uveitis, deep vein thrombosis, severe gastrointestinal involvement, arterial involvement, nervous system Involvement, and joint involvement high dose of glucocorticoids is indicated. CONCLUSIONS ON tends to appear as a multifocal involvement in BD patients, hence, after diagnosis of ON in one joint other possible sites of ON should be investigated.
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Affiliation(s)
- Mohammad Nejadhosseinian
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mazyar Babagoli
- Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Seyedeh Tahererh Faezi
- Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hoda Haerian
- Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farhad Shahram
- Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Majid Alikhani
- Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fereydoun Davatchi
- Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Scheichel F, Popadic B, Pinggera D, Jaskolski DJ, Lubrano V, Foroglou N, Netuka D, Iliescu B, Novak L, Sherif C, Marhold F, Freyschlag CF. European survey on neurosurgical management of primary central nervous system lymphomas and preoperative corticosteroid therapy. Brain Spine 2023; 3:101791. [PMID: 38020980 PMCID: PMC10668066 DOI: 10.1016/j.bas.2023.101791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/29/2023] [Accepted: 08/11/2023] [Indexed: 12/01/2023]
Abstract
Introduction Preoperative corticosteroid therapy (CST) is common in primary central nervous system lymphoma (PCNSL) and may complicate histopathological diagnosis. There is an ongoing debate on the best management after preoperative CST. Research question We aimed to survey how different European neurosurgical units treat PCNSL patients after preoperative CST. Methods An English-language survey consisting of 21 questions addressing the management of patients with suspected PCNSL and preoperative CST was sent to European hospitals. The survey also included three clinical cases to assess the decision-making process in a clinical setting. Results The survey was completed by 74 European hospitals. There was no clear consensus on how to treat a patient with PCNSL after CST. Accordingly, 24.3% responded that they would generally defer surgery regardless of a possible radiological response, 47.3% would defer surgery only if there is regression in preoperative MRI and the remaining 28.4% would defer surgery only if the tumor had completely vanished. Furthermore, there were distinct discrepancies in responses of neurosurgical units regarding their general management approach and their case-based decision in the three example cases. The results of our survey also showed regional differences and differences in treatment decisions between high-, intermediate- and low-volume centers. Discussion and conclusion There was no clear consensus on how to treat patients with suspected PCNSL and preoperative CST. Furthermore, most centers also showed inconsistencies in their responses regarding their general approach as well as individual patient treatment. More high-quality evidence-based recommendations are needed to improve consensus and thus patient care.
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Affiliation(s)
- Florian Scheichel
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Branko Popadic
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dariusz J. Jaskolski
- Department of Neurosurgery and Neurooncology Medical University of Lodz, Norbert Barlicki University Hospital, Lodz, Poland
| | - Vincent Lubrano
- Clinique de l'Union, Saint Jean, France
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Nicolas Foroglou
- Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - David Netuka
- Central Military Hospital, Prague, Czech Republic
| | - Bogdan Iliescu
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Laszlo Novak
- Department of Neurosurgery, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Camillo Sherif
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Franz Marhold
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
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Chang MY, Zhang Y, Li MX, Xuan F. Integrated Chinese and Western medicine in the treatment of a patient with podocyte infolding glomerulopathy: A case report. World J Clin Cases 2023; 11:4684-4691. [PMID: 37469726 PMCID: PMC10353505 DOI: 10.12998/wjcc.v11.i19.4684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Podocyte infolding glomerulopathy (PIG) is a newly described and rare glomerular disease. To date, only approximately 40 cases have been reported globally.
CASE SUMMARY A 26-year-old female patient presented to our hospital with a complaint of intermittent edema of both lower limbs over the past 2 years. The patient was diagnosed with PIG. She was prescribed corticosteroid therapy in other hospitals during the initial stage, to which she had responded poorly and had developed femoral head necrosis. Therefore, we administered immunosuppressants, renin-angiotensin system inhibitors, combined with traditional Chinese medicine. The patient was followed for 1 year, during which her clinical condition improved.
CONCLUSION Integrated Chinese and Western medicine may be effective for PIG treatment, which requires active intervention to improve prognosis.
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Affiliation(s)
- Mei-Ying Chang
- Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Yu Zhang
- Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Ming-Xu Li
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Fang Xuan
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
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Yusuf KA, Kanhosh SF, Al-Madani AH. Coexistence of pulmonary tuberculosis with pulmonary sarcoidosis and skin sarcoidosis: a case report. Egypt J Intern Med 2023; 35:35. [PMID: 37214760 PMCID: PMC10184060 DOI: 10.1186/s43162-023-00221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
Background Necrotising granulomatous diseases of the lungs exhibit a narrow range of differential diagnoses. Tuberculosis accounts for most of these cases, while sarcoidosis is an uncommon entity in this group but both possess similar clinical and radiological similarities. One must consider a diagnosis of sarcoidosis once the standard anti-mycobacterial medications fail to achieve a clinical improvement. The case described highlights the coexistence of tuberculosis and sarcoidosis which is a rare entity in the medical literature. Case presentation A 57-year-old male presented with respiratory symptoms and was diagnosed with tuberculosis (TB) demonstrating a polymerase chain reaction (PCR) test positive showing microbial DNA in bronchial washing. The patient started standard anti-TB treatment; however, he did not respond initially. Further investigations led us to diagnose pulmonary followed by skin sarcoidosis, based on histology. After confirmation of sarcoidosis, administered corticosteroids for 6 months simultaneously along with anti-TB treatment; however, anti-TB treatment was prolonged for a total of 9 months. The patient was found clinically symptomless after the completion of treatment during subsequent follow-ups. Conclusion The use of corticosteroids as an adjunct with standard anti-TB treatment proves beneficial effects on the recovery of patients having a coexistence of pulmonary mycobacterium tuberculosis and sarcoidosis disease conditions.
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Affiliation(s)
- Khalifa Abdulrahman Yusuf
- Department of Internal Medicine, Bahrain Defence Force Hospital-Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Shadi Fayez Kanhosh
- Department of Internal Medicine, Bahrain Defence Force Hospital-Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Abdulrahman Hasan Al-Madani
- Department of Internal Medicine, Bahrain Defence Force Hospital-Royal Medical Services, Riffa, Kingdom of Bahrain
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Zhang C, Wang Y, Chen Y, Zhou H, Hong Q, Yu X, Ng TK, Cen LP. Acute phase clinical manifestations of patients with Vogt-Koyanagi-Harada disease in Southern China. BMC Ophthalmol 2023; 23:199. [PMID: 37147563 PMCID: PMC10161656 DOI: 10.1186/s12886-023-02952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUNDS To characterize the acute phase clinical manifestations and visual outcomes of the patients with Vogt-Koyanagi Harada (VKH) disease in southern China. METHODS In total, 186 patients with acute-onset VKH disease were recruited. The demographic data, clinical signs, ophthalmic examinations, and visual outcomes were analyzed. RESULTS Among the 186 VKH patients, 3 were diagnosed as complete VKH, 125 as incomplete VKH, and 58 as probable VKH. All patients visited the hospital within 3 months of onset and complained of decreased vision. For the extraocular manifestations, 121 patients (65%) referred neurological symptoms. Anterior chamber activity was negative in most eyes within an onset of 7 days, which increased slightly with onset beyond 1 week. Exudative retinal detachment (366 eyes, 98%) and optic disc hyperaemia (314 eyes, 84%) were commonly observed at presentation. A typical ancillary examination helped with the diagnosis of VKH. Systemic corticosteroid therapy was prescribed. The logMAR best-corrected visual acuity improved significantly from 0.74 ± 0.54 at baseline to 0.12 ± 0.24 at the 1-year follow-up visit. The recurrence rate was 18% in the follow-up visits. Erythrocyte sedimentation rate and C-reactive protein were significantly correlated to VKH recurrences. CONCLUSION Posterior uveitis, followed by mild anterior uveitis, is the typical initial manifestation in the acute phase of Chinese VKH patients. Visual outcome improvement is promising in most patients receiving systemic corticosteroid therapy in the acute phase. Detection of the clinical features at the initial onset of VKH could facilitate early treatment and better vision improvement.
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Affiliation(s)
- Chuhua Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Yun Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Yun Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Hui Zhou
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Qiuxia Hong
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Xiuying Yu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ling-Ping Cen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, China.
- Shantou University Medical College, Shantou, 515041, Guangdong, China.
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Ballerini MG, Freire AV, Rodríguez ME, Suco Valle S, Castro S, Arcari A, Bergadá I, Ropelato MG. Diagnostic Accuracy of Morning Salivary Cortisol in the Assessment of the Hypothalamic-Pituitary-Adrenal Axis Recovery after Prolonged Corticosteroid Therapy in Children. Horm Res Paediatr 2023; 97:53-61. [PMID: 37231892 DOI: 10.1159/000530939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Assessment of the hypothalamic-pituitary-adrenal (HPA) axis is necessary after prolonged glucocorticoid therapy withdrawal. Salivary cortisol reflects 65% of the free circulating cortisol fraction. Saliva collection is non-invasive and child friendly. OBJECTIVE We aimed to evaluate the diagnostic accuracy of morning salivary cortisol (mSAF) to determine HPA recovery after prolonged corticosteroid therapy in children. METHODS We conducted a prospective, validation study in 171 paediatric patients (mean ± SD age: 13.0 ± 4.4 years) who received glucocorticoids for >4 weeks (median and interquartile range: 11 [7-14] months) and were referred for therapy withdrawal. Serum and saliva samples were collected between 8 and 9 a.m. on the same day. Cortisol was measured by an electrochemiluminescence immunoassay (ECLIA) 48 h after cessation of glucocorticoid therapy. Serum cortisol ≥193 nmol/L was used as the reference cut-off value for HPA recovery after glucocorticoid withdrawal and mSAF as the index test. RESULTS The cut-off concentration obtained by ROC for mSAF was ≥5.0 nmol/L. True positive and true negative results were observed in 85/171 and 40/171 children, respectively. The false-positive rate was low (3/171, 1.7%); however, false-negative results were observed in 43/171 (25%) children. The main ROC results (95% CI) were area under curve: 0.98 (0.96-0.99), sensitivity: 0.66 (0.57-0.75), specificity: 0.93 (0.81-0.99), positive predictive value: 0.97 (0.90-0.99), negative predictive value: 0.48 (0.37-0.59), LR+: 9.5, and diagnostic accuracy: 73.1%. CONCLUSION The present study supports that mSAF ≥5.0 nmol/L by ECLIA is a non-invasive biomarker for the assessment of HPA recovery after prolonged glucocorticoid therapy in paediatric patients, with a positive predictive value of 97%. This proposed cut-off should be further validated using gold standard techniques for steroid quantification such as liquid chromatography-tandem mass spectrometry.
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Affiliation(s)
- María Gabriela Ballerini
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Analía Verónica Freire
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - María Eugenia Rodríguez
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Sofía Suco Valle
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Sebastián Castro
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Andrea Arcari
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - María Gabriela Ropelato
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE) CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Li MZ, Guo T, Feng YL, Zhang SY, Bai XY, Wu X, Xu K, Yang AM. Diabetes mellitus in patients with type 1 autoimmune pancreatitis at diagnosis and after corticosteroid therapy. Hepatobiliary Pancreat Dis Int 2023:S1499-3872(23)00069-3. [PMID: 37121837 DOI: 10.1016/j.hbpd.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND A high prevalence of diabetes mellitus (DM) coexisting with autoimmune pancreatitis (AIP) is observed. However, evidence on the circumstances under which corticosteroid therapy (CST) for AIP improves or worsens DM is scarce. This study aimed to demonstrate and identify predictors of DM control under the influence of CST. METHODS Patients diagnosed with type 1 AIP were enrolled from a prospectively maintained cohort and were classified into three groups according to the chronology in which AIP and DM were diagnosed: pre-existing DM (pDM), concurrent DM (cDM), and non-DM (nDM). The responses of DM to CST were assessed when corticosteroid was ceased or tapered to a maintenance dose and classified as 'improvement' and 'non-improvement' (including 'no change' and 'exacerbation'). RESULTS Among 101 patients with type 1 AIP, 52 (51.5%) patients were complicated with DM at the time of AIP diagnosis, with 36 patients in the cDM group and 16 patients in the pDM group. The incidences of diffuse pancreatic swelling (72.2%) and pancreatic body/tail involvement (91.7%) were significantly higher in the cDM group than in both the pDM and nDM groups. Of the 52 patients with DM, CST was administered in 48 cases. Multivariate logistic analysis identified that elevated serum gamma-glutamyl transferase (GGT) level at AIP diagnosis [odds ratio (OR) = 0.032, 95% confidence interval (CI): 0.003-0.412, P = 0.008] and pancreatic atrophy after CST (OR = 0.027, 95% CI: 0.003-0.295, P = 0.003) were negatively associated with DM control improvement. CONCLUSIONS Patients with diffuse pancreatic swelling and pancreatic body/tail involvement in pancreatitis tended to be complicated with cDM at AIP diagnosis. CST exerted a beneficial effect on the clinical course of DM in nearly half of the AIP patients complicated with DM at diagnosis, particularly in those without elevated serum GGT levels at diagnosis and who did not experience pancreatic atrophy after CST.
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Affiliation(s)
- Mei-Zi Li
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Tao Guo
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yun-Lu Feng
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Sheng-Yu Zhang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Yin Bai
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xi Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Kai Xu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ai-Ming Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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Menat S, Jacquens A, Mathon B, Bonnet B, Schotar E, Boch AL, Carpentier A, Puybasset L, Abdennour L, Degos V. Corticosteroid treatment for refractory intracranial hypertension: a rescue therapy in patients with severe traumatic brain injury with contusional lesions-a feedback. Acta Neurochir (Wien) 2023; 165:717-725. [PMID: 36808006 DOI: 10.1007/s00701-023-05507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/21/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Refractory intracranial hypertension (rICH) is a severe complication among patients with severe traumatic brain injury (sTBI). Medical treatment may be insufficient, and in some cases, the only viable treatment option is decompressive hemicraniectomy. The assessment of a corticosteroid therapy against vasogenic edema secondary to severe brain injuries seems interesting to prevent this surgery in sTBI patients with rICH caused by contusional areas. METHODS This is a monocentric retrospective observational study including all consecutive sTBI patients with contusion injuries and a rICH requiring cerebrospinal fluid drainage with external ventricular drainage between November 2013 and January 2018. Patient inclusion criterium was a therapeutic index load (TIL; an indirect measure of TBI severity) > 7. Intracranial pressure (ICP) and TIL were assessed before and 48 h after corticosteroid therapy (CTC). Then, we divided the population into two groups according to the evolution of the TIL: responders and non-responders to corticosteroid therapy. RESULTS During the study period, 512 patients were hospitalized for sTBI, and among them, 44 (8.6%) with rICH were included. They received 240 mg per day [120 mg, 240 mg] of Solu-Medrol for 2 days [1; 3], 3 days after the sTBI. The average ICP in patients with rICH before the CTC bolus was 21 mmHg [19; 23]. After the CTC bolus, the ICP fell significantly to less than 15 mmHg (p < 0.0001) for at least 7 days. The TIL decreased significantly the day after the CTC bolus and until day 2. Among these 44 patients, 68% were included in the responder group (n = 30). DISCUSSION Short and systemic corticosteroid therapy in patients with refractory intracranial hypertension secondary to severe traumatic brain injury seems to be a potentially useful and efficient treatment for lowering intracranial pressure and decreasing the need for more invasive surgeries.
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Affiliation(s)
- Sophie Menat
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Alice Jacquens
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
| | - Bertrand Mathon
- Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Baptiste Bonnet
- Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Schotar
- Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.,Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Louis Puybasset
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.,Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Lamine Abdennour
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Vincent Degos
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
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Hartmann A, Bertschy S, Beeres FJP, Babst R, Link BC. [Pyoderma gangrenosum in a grade 3 open fracture after a forest accident : When one cannot see the wood for the trees]. Unfallchirurgie (Heidelb) 2023; 126:168-72. [PMID: 35420293 DOI: 10.1007/s00113-022-01176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 02/07/2023]
Abstract
We describe the case of a forest worker with a Gustilo-Anderson III dislocation fracture of the ankle joint. After initial external fixation, round necrotic skin lesions with hyperemic border walls appeared on the entire lower leg. Recurrent débridements worsened the soft tissue instead of improving it. An immunoglobulin and corticosteroid treatment was initiated, which diminished the inflammatory reaction and granulation of soft tissue began. Posttraumatic pyoderma gangrenosum is a rare diagnosis. Nevertheless, it needs to be on the list of differential diagnoses if uncommon soft tissue reactions appear.
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Colin-benoit E, Kalubi M, Zimmerli S. A case of chronic disseminated candidiasis in metamizole-induced neutropaenia. Infection 2022. [PMID: 36515891 PMCID: PMC9748381 DOI: 10.1007/s15010-022-01963-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Chronic disseminated candidiasis (CDC) is a severe complication of a disseminated yeast infection mainly seen after prolonged chemotherapy-induced neutropaenia in the context of haematological malignancy. We present a case of CDC in a patient with metamizole-induced neutropaenia. To the best of our knowledge, this is the first case described in this context. Furthermore, we highlight the role of steroids in the management of this disease.
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Morel R, Maddumabandara K, Amarasinghe N, Amarangani S, Amarasinghe A, Gunathilaka M, Wathsala G, Bandara L, Wijesundara S, Gunaratne N, Waduge R, Medagama A. Strongyloidiasis infection in a borderline lepromatous leprosy patient with adrenocorticoid insufficiency undergoing corticosteroid treatment: a case report. J Med Case Rep 2022; 16:458. [PMID: 36482424 PMCID: PMC9733215 DOI: 10.1186/s13256-022-03673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Strongyloidiasis is a soil-transmitted helminthiasis mainly caused by Strongyloides stercoralis. It is endemic to the tropics and subtropics. Sri Lanka has a 0-1.6% prevalence rate. S. stercoralis infection was identified in a 33-year-old Sri Lankan male patient treated with corticosteroids for borderline lepromatous leprosy with adrenocortical dysfunction. CASE PRESENTATION In March 2020, a 33-year-old Sri Lankan (Sinhalese) male patient presented with watery diarrhea, lower abdominal pain, and post-prandial abdominal fullness. Previously, he was diagnosed with borderline lepromatous leprosy and was treated with rifampicin, clofazimine, and prednisolone 60 mg daily since July 2019. After developing gastrointestinal symptoms, he had defaulted leprosy treatment including the prednisolone for 3 months. Duodenal biopsy revealed numerous intraepithelial nematodes within the lumina of glands in the duodenum whose appearance favored Strongyloides. Fecal wet smear revealed numerous Strongyloidis stercoralis L1 rhabditiform larvae. Larval tracks were seen in the agar plate culture. L3 filariform larvae of Strongyloidis stercoralis were seen in the Harada-Mori culture. In addition, the short synacthen test revealed adrenocortical insufficiency, and oral hydrocortisone and fludrocortisone were started with albendazole treatment against strongyloidiasis. Fecal wet smear and culture repeated after treatment with albendazole were negative for Strongyloidis stercoralis. The patient was discharged in July 2020 on oral hydrocortisone. One month later his condition was reviewed and the repeated fecal wet smear and agar plate culture was normal. He is being followed up every 3 months. CONCLUSION This is the first case of strongyloidiasis diagnosed in a patient with borderline lepromatous leprosy from Sri Lanka. The patient manifested symptoms of strongyloidiasis while on high-dose steroid therapy for his lepromatous reaction. Subsequently, the patient not only discontinued his steroid therapy, but also developed adrenocortical insufficiency as a complication of leprosy. Therefore, although diagnosis of strongyloidiasis was delayed, his subsequent low steroid levels probably protected him from disseminated disease. This is an interesting case where symptomatic strongyloidiasis was diagnosed in a patient who was initially treated with high-dose steroids but subsequently developed adrenocortical insufficiency. We emphasize the need to screen all patients prior to the commencement of immunosuppressive therapy.
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Affiliation(s)
- Rumala Morel
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Kusala Maddumabandara
- grid.11139.3b0000 0000 9816 8637Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Nisansala Amarasinghe
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Sujeewa Amarangani
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Anjalie Amarasinghe
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Mihiri Gunathilaka
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Gayani Wathsala
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Lakmalee Bandara
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Sunil Wijesundara
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Nilupuli Gunaratne
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Roshitha Waduge
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Arjuna Medagama
- grid.11139.3b0000 0000 9816 8637Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
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Wiefels C, Weng W, Beanlands R, deKemp R, Nery PB, Boczar K, Mesquita CT, Birnie D. Investigating the treatment phenotypes of cardiac sarcoidosis: A prospective cohort study. Am Heart J Plus 2022; 24:None. [PMID: 37441681 PMCID: PMC10333413 DOI: 10.1016/j.ahjo.2022.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 07/15/2023]
Abstract
Introduction Data indicates there are 4 main pulmonary sarcoidosis duration/treatment phenotypes: asymptomatic, acute (disease duration <1-2 years), chronic and advanced. There are no data about disease duration/treatment phenotypes of cardiac sarcoidosis patients. Our study had 2 main aims (i) to assess the response to corticosteroids and (ii) to assess the incidence of relapse after a one-year course of corticosteroids (thereby classifying patients as acute or chronic treatment phenotype). Methods Consecutive, treatment naive patients with CS were prospectively recruited and treated with 0.5 mg/kg prednisone, to a maximum dose of 40 mg/day. Patients had a follow-up PET after 3-6 months of therapy (PET 2). In the responders (PET definition of response) the prednisone was then weaned and stopped after 12 months. Three months after stopping, the PET was repeated to look for disease relapse (PET 3). Results Twenty-one consecutive patients were included, and all patients showed a reduction in cardiac FDG uptake after 3-6 months and 19/21 (90.5 %) met the PET definition of response. Of these, 12/19 (63.1 %) relapsed after prednisone was stopped. There were no serious adverse effects during the trial of therapy cessation and there were no later relapses in the 7 non-relapsers during over 4 years of subsequent follow-up. Conclusion The initial response rate to prednisone was high with all patients showing a reduction in FDG uptake and 19/21 meeting a PET definition of >25 % response. Secondly, a trial of therapy discontinuation was able to classify 7/19 patients as acute treatment phenotype and 12/19 as chronic.
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Affiliation(s)
- Christiane Wiefels
- University of Ottawa, Department of Medicine, Division of Nuclear Medicine, Ottawa, ON, Canada
- Universidade Federal Fluminense, Pós-Graduação em Ciências Cardiovasculares, Niterói, Rio de Janeiro, Brazil
| | - Willy Weng
- University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON, Canada
| | - Rob Beanlands
- University of Ottawa Heart Institute, The National Cardiac PET Center, Department of Medicine, Division of Cardiology, Ottawa, ON, Canada
| | - Rob deKemp
- University of Ottawa Heart Institute, The National Cardiac PET Center, Department of Medicine, Division of Cardiology, Ottawa, ON, Canada
| | - Pablo B. Nery
- University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON, Canada
| | - Kevin Boczar
- University of Ottawa Heart Institute, The National Cardiac PET Center, Department of Medicine, Division of Cardiology, Ottawa, ON, Canada
| | - Claudio Tinoco Mesquita
- Universidade Federal Fluminense, Pós-Graduação em Ciências Cardiovasculares, Niterói, Rio de Janeiro, Brazil
| | - David Birnie
- University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON, Canada
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Gomerčić Palčić M, Turalija I, Vrbanić L, Folnožić I, Basioli Kasap E, Ulamec M. SUCCESSFULLY TREATED ACUTE INTERSTITIAL PNEUMONIA. Acta Clin Croat 2022; 61:722-726. [PMID: 37868166 PMCID: PMC10588378 DOI: 10.20471/acc.2022.61.04.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/04/2022] [Indexed: 10/24/2023] Open
Abstract
Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial pneumonia with histology finding of diffuse alveolar damage (DAD). It is characterized by progressive hypoxic respiratory failure, high mortality rate, and absence of guidelines for its treatment. Here we present a case of a 64-year-old woman with progressive dyspnea, acute respiratory failure, diffuse bilateral reticulonodular opacities on standard chest radiograph, diffuse ground-glass opacities on computed tomography, and biopsy proven DAD. Diagnosis of AIP was established after extensive work-up that excluded the known risk factors for acute respiratory distress syndrome. Oxygen therapy and high-dose parenteral corticosteroids led to gradual improvement and resulted in complete respiratory recovery. Since there are no existing guidelines for treating AIP, more case reports and case series if not randomized control trials are warranted in order to define the most effective therapeutic modality.
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Affiliation(s)
- Marija Gomerčić Palčić
- Sestre milosrdnice University Hospital Center, Zagreb; Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Ivan Turalija
- Sestre milosrdnice University Hospital Center, Zagreb; Croatia
| | - Luka Vrbanić
- Sestre milosrdnice University Hospital Center, Zagreb; Croatia
| | - Ivana Folnožić
- Sestre milosrdnice University Hospital Center, Zagreb; Croatia
| | | | - Monika Ulamec
- Sestre milosrdnice University Hospital Center, Zagreb; Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
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Swaminathan L, Kaatz S, Chubb H, Tae K, Ramesh MS, Fadel R, Big C, Jones J, Flanders SA, Prescott HC. Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study. Infect Dis Ther 2022; 11:887-898. [PMID: 35267172 PMCID: PMC8908754 DOI: 10.1007/s40121-022-00615-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/23/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION While guidelines stronglyrecommend dexamethasone in critical COVID-19, the optimal threshold to initiate corticosteroids in non-critically ill patients with COVID-19 remains unclear. Using data from a state-wide COVID-19 registry, we evaluated the effectiveness of early corticosteroids for preventing clinical deterioration among non-critically ill patients hospitalized for COVID-19 and receiving non-invasive oxygen therapy. METHODS This was a target trial using observational data from patients hospitalized for COVID-19 at 39 hospitals participating in the MI-COVID19 registry between March 16, 2020 and August 24, 2020. We studied the impact of corticosteroids initiated within 2 calendar days of hospitalization ("early steroids") versus no early steroids among non-ICU patients with laboratory-confirmed SARS-CoV2 receiving non-invasive supplemental oxygen therapy. Our primary outcome was a composite of in-hospital mortality, transfer to intensive care, and receipt of invasive mechanical ventilation. We used inverse probability of treatment weighting (IPTW) and propensity score-weighted regression to measure the association of early steroids and outcomes. RESULTS Among 1002 patients meeting study criteria, 231 (23.1%) received early steroids. After IPTW, to balance potential confounders between the treatment groups, early steroids were not associated with a decrease in the composite outcome (aOR 1.1, 95%CI 0.8-1.6) or in any components of the primary outcome. CONCLUSION We found no evidence that early corticosteroid therapy prevents clinical deterioration among hospitalized non-critically ill COVID-19 patients receiving non-invasive oxygen therapy. Further studies are needed to determine the optimal threshold for initiating corticosteroids in this population.
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Affiliation(s)
- Lakshmi Swaminathan
- Division of Hospital Medicine, St. Joseph Mercy Hospital, 5301 McAuley Dr, Ypsilanti, 48197, USA.
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Heather Chubb
- Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), Ann Arbor, USA
| | - Kim Tae
- Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), Ann Arbor, USA
| | - Mayur S Ramesh
- Division of Infectious Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Raef Fadel
- Division of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Cecilia Big
- Division of Infectious Disease, Beaumont Hospital-Dearborn, Dearborn, MI, USA
| | - Jessica Jones
- Department of Pharmacy, Beaumont Hospital-Dearborn, Dearborn, MI, USA
| | - Scott A Flanders
- Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, USA
- Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, USA
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
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Lazaro LG, Perea Cossio JE, Luis MB, Tamagnini F, Paguay Mejia DA, Solarz H, Fernandez Liguori NA, Alonso RN. Acute disseminated encephalomyelitis following vaccination against SARS-CoV-2: A case report. Brain Behav Immun Health 2022; 20:100439. [PMID: 35252891 PMCID: PMC8886679 DOI: 10.1016/j.bbih.2022.100439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/11/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory emyelinating disease of the central nervous system that is usually considered a monophasic disease Post-vaccination ADEM has been associated with several vaccines, however, there is scarce information related to SARS-CoV-2 vaccines. We present the case of a 26- year-old female who suffered from ADEM four weeks after Gam-COVID-Vac administration. Acute disseminated encephalomyelitis is a monophasic acute non-vasculitic inflammatory demyelinating disorder of the central nervous system. Pathogenesis is suspected to be related to an autoimmune response to myelin triggered by infection or immunisation via molecular mimicry. Once the SARS-CoV-2 infection was declared a global pandemic, vaccines became one the most important strategies to reduce mortality. There is current uncertainty about the safety and efficacy of vaccines in all populations of interest.
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Affiliation(s)
- Luciana G. Lazaro
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
- Corresponding author.
| | - Jhon E. Perea Cossio
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Maria B. Luis
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Flavia Tamagnini
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Diego A. Paguay Mejia
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | - Horacio Solarz
- Anatomical Pathology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
| | | | - Ricardo N. Alonso
- Department of Neurology, Sanatorio Güemes-University Hospital, Buenos Aires, Argentina
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Didehdar M, Chegini Z, Moradabadi A, Anoushirvani AA, Tabaeian SP, Yousefimashouf M, Shariati A. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021. Microb Pathog 2022; 163:105388. [PMID: 34995749 DOI: 10.1016/j.micpath.2022.105388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND GI mucormycosis (GI) is a rare but highly lethal infection in patients. There is no single comprehensive review of the literature that demonstrates the various clinical aspects of this infection. METHODS A structured search of PubMed/Medline was used to collect case reports of GI mucormycosis in patients of all ages published between 2015 and November 2021. RESULTS Eighty-seven cases were identified through PubMed bibliographic database searches, and final analyses were conducted on 70 adults and ten neonatal patients with GI mucormycosis. Asia had the highest number of reported cases, with 46 (57.5%). Neonatal cases had a mortality rate of 70%, while other cases had a mortality rate of 44%. Corticosteroid therapy and diabetes were the most significant risk factors in patients, while 11% were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in four adult patients. Moreover, neonatal cases included premature and low-weight infants, metabolic acidosis, and malnutrition. Abdominal pain, fever, and GI perforation were the most common signs of infection, while vomiting occurred in 40% of neonatal cases. In 97% of patients, a histopathologic examination was used to detect infection, whereas culture and molecular methods were used in only 28% and 17% of patients, respectively. Surgery plus anti-infection therapy, anti-infection therapy alone, and surgery alone were used in 61%, 28%, and 11% of patients, respectively. Nonetheless, all neonatal patients underwent surgery. Although used in a small number of patients, posaconazole (30%) and isavuconazole (11%) demonstrated high efficacy in treating patients. CONCLUSION GI mucormycosis is a rare but highly lethal disease. Treatment of underlying conditions, the use of multiple diagnostic techniques, and appropriate antifungals in conjunction with surgery can all contribute to infection control.
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Affiliation(s)
- Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Moradabadi
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Ali Arash Anoushirvani
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seidamir Pasha Tabaeian
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Yousefimashouf
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Borujerd Branch, Islamic Azad University, Borujerd, Iran
| | - Aref Shariati
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran.
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Panandtigri S, Siaˡ NPX, Charkaouiˡ M, Benchakrounˡ N, Bouchbikaˡ Z, Jouhadiˡ H, Tawfiqˡ N, Sahraouiˡ S, Beniderˡ A. Paraneoplastic dermatomyositis revealing undifferentiated nasopharyngeal carcinoma at early stage: a case report. J Med Case Rep 2022; 16:3. [PMID: 34980241 PMCID: PMC8725533 DOI: 10.1186/s13256-021-03154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
Context Dermatomyositis is a rare autoimmune disease characterized by noninfectious inflammatory damage of skin and predominant muscles in the belts. It is believed to be associated with about 1 in 1000 cases of nasopharyngeal carcinoma. This association has been described for locally advanced stages II and III nasopharyngeal carcinoma. It has rarely been described in the early stages (stage I). Case presentation A 65-year-old Moroccan patient residing in Casablanca, with no particular history was referred to the Mohamed VI Center for the treatment of cancers of the University Hospital Center IBN ROCHD in Casablanca, for treatment of nasopharyngeal cancer. He was admitted in poor general condition, performance status 3, with erythema on the face, neck, and extremities. The diagnosis of paraneoplastic dermatomyositis was made owing to progressive muscle weakness and elevation of muscle enzymes associated with the typical rash of the face and hands. He received corticosteroid therapy and then radiotherapy to the nasopharynx with good clinical outcome, disappearance of skin lesions, and recovery of muscle strength. Conclusions We report this case of dermatomyositis in early-stage nasopharyngeal carcinoma, which is a rarely described entity. Rapid treatment of dermatomyositis improved the patient’s quality of life and enabled him to support specific cancer treatments. This can be used as an element of early diagnosis and monitoring after treatment.
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Affiliation(s)
- Souleymane Panandtigri
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco.
| | - Nioka Pierre Xavier Siaˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
| | - Meryeme Charkaouiˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
| | - Nadia Benchakrounˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
| | - Zineb Bouchbikaˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
| | - Hassan Jouhadiˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
| | - Nezha Tawfiqˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
| | - Souha Sahraouiˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
| | - Abdellatif Beniderˡ
- Center Mohamed VI for the Treatment of Cancers of the University Hospital Center IBN ROCHD Casablanca, Casablanca, Morocco
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20
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Ojuawo O, Htwe T, Farah S, King D, Ahmed I. Dual intestinal parasitosis unmasked by treatment for gastrointestinal sarcoidosis. IDCases 2021; 26:e01334. [PMID: 34815939 DOI: 10.1016/j.idcr.2021.e01334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 02/07/2023] Open
Abstract
The symptoms and complications of intestinal parasitosis can occur with long-term corticosteroid therapy. We highlight the case of a young man who developed chronic gastrointestinal (GI) symptoms of diarrhea, crampy abdominal pain, and vomiting while on treatment for multisystemic sarcoidosis with corticosteroids. His symptoms were initially thought to be related to the gastrointestinal manifestations of sarcoidosis, but further evaluation revealed a combined case of intestinal strongyloidiasis and giardiasis as well as previously undiagnosed human T-cell lymphotropic virus (HTLV -1) infection. This distinctive case of dual intestinal parasitosis highlights the need for clinicians to maintain a high level of awareness to screen for intestinal parasites, particularly Strongyloides when prescribing corticosteroids in the long term given the potential risk of hyperinfection in the setting of immunosuppression..
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21
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Uemasu K, Yasuda Y, Hirayama Y, Arasawa S, Iwashima D, Takahashi KI. Post-COVID-19 interstitial lung disease presenting with profound hypoxemia: Report of three cases demonstrating a good response to high-dose corticosteroid therapy. J Infect Chemother 2021; 28:321-325. [PMID: 34810106 PMCID: PMC8598950 DOI: 10.1016/j.jiac.2021.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/12/2021] [Accepted: 11/04/2021] [Indexed: 12/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which leads to critical pneumonia, although the clinical courses vary. In some cases, COVID-19 pneumonia causes secondary pulmonary fibrosis, which can retain radiological changes and prolong respiratory symptoms. Interstitial lung disease (ILD) secondary to COVID-19 is thought to be caused by multiple pathologies, such as excessive cytokines and abnormal repair processes elaborated by lung cells (epithelium, mesenchyme, and alveolar macrophages) after lung injury rather than viral invasion itself. Immunosuppression therapy may improve chronic respiratory symptoms and radiological changes in post-COVID-19 ILD, although the treatment is not yet established. Herein, we report three patients with post-COVID-19 ILD who presented with profound hypoxemia that had a good response to high-dose corticosteroid therapy. Further and larger studies are needed to establish post-COVID-19 ILD.
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Affiliation(s)
- Kiyoshi Uemasu
- Department of Respiratory Medicine, Kishiwada City Hospital, Japan.
| | - Yuto Yasuda
- Department of Respiratory Medicine, Kishiwada City Hospital, Japan
| | - Yutaka Hirayama
- Department of Respiratory Medicine, Kishiwada City Hospital, Japan
| | - Soichi Arasawa
- Department of Gastroenterology, Kishiwada City Hospital, Japan
| | - Daisuke Iwashima
- Department of Respiratory Medicine, Kishiwada City Hospital, Japan
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22
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Muccioli S, Albani S, Mabritto B, Musumeci G. Conduction disorders as the first hallmark of isolated cardiac sarcoidosis in a highly active individual: a case report. Eur Heart J Case Rep 2021; 5:ytab416. [PMID: 34755032 PMCID: PMC8573167 DOI: 10.1093/ehjcr/ytab416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/03/2021] [Accepted: 10/11/2021] [Indexed: 11/14/2022]
Abstract
Background Cardiac sarcoidosis (CS) is an inflammatory disease with various clinical presentations depending on the extension of cardiac involvement. The disease is often clinically silent, therefore diagnosis is challenging. Case summary We discuss the case of a middle-aged highly active individual presenting with an occasional finding of low heart rate during self-monitoring. The electrocardiogram shows a Mobitz 2 heart block; thanks to multimodality imaging CS was diagnosed and corticosteroid therapy improved cardiac conduction. Discussion To our knowledge, this is one of the first documented cases of occasional, early findings of CS in a middle-aged highly active individual who presented with cardiac conduction involvement. Despite the very early diagnosis, multimodality imaging suggested an advanced disease with no oedema detection at the cardiac magnetic resonance. Nevertheless, prompt corticosteroid therapy was able to improve clinical conduction. Although non-sustained ventricular arrhythmias were detected, electrophysiological study allowed to discharge the patient safely without implantable cardioverter-defibrillator implantation. Light-to-moderate physical activity was allowed at mid-term follow-up. A multidisciplinary evaluation should be considered to resume a high-intensity training.
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Affiliation(s)
- Silvia Muccioli
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
| | - Stefano Albani
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
| | - Barbara Mabritto
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
| | - Giuseppe Musumeci
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
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23
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Caterson HC, Li A, March L, Bannon PG, Marshman D, Wolfenden HD, Kench J, Davidson T, Soh HC, Sammel AM. Post-operative outcomes of inflammatory thoracic aortitis: a study of 41 patients from a cohort of 1119 surgical cases. Clin Rheumatol 2021. [PMID: 34731347 DOI: 10.1007/s10067-021-05978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
Aortitis is found in 2-12% of thoracic aortic aneurysm repair/replacement surgeries. Yet little is known about such patients' post-operative outcomes or the role of post-operative corticosteroids. The study was undertaken across three tertiary referral hospitals in Sydney, Australia. Prospectively collected data for all thoracic aortic repair/replacement patients between 2004 and 2018 was accessed from a national surgical registry and analysed. Histopathology records identified cases of inflammatory aortitis which were subclassified as clinically isolated aortitis (CIA), giant cell arteritis (GCA), Takayasu (TAK) or other aortitis. Between-group outcomes were compared utilising logistic and median regression analyses. Between 2004 and 2018, a total of 1119 thoracic aortic surgeries were performed of which 41 (3.7%) were inflammatory aortitis cases (66% CIA, 27% GCA, 5% TAK, 2% other). Eight out of 41 (20%) aortitis patients received post-operative corticosteroids. Compared to non-aortitis patients, the aortitis group was predominantly female (53.7% vs. 28.1%, p < 0.01), was older (mean 70 vs. 62 years, p < 0.01) and had higher prevalence of hypertension (82.9% vs. 67.1%, p = 0.03) and pre-operative immunosuppression (9.8% vs. 1.4%, p < 0.01). There was no difference (p > 0.05) between aortitis and non-aortitis groups for 30-day mortality (7.3% vs 6.5%), significant morbidity (14.6% vs. 22.4%), or infection (9.8% vs. 6.4%). Outcomes were similar for the non-corticosteroid-treated aortitis subgroup. Histologic evidence of inflammatory thoracic aortitis following surgery did not affect post-operative mortality or morbidity. Withholding corticosteroids did not adversely affect patient outcomes. These findings will assist rheumatologists and surgeons in the post-operative management of aortitis.
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24
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Robin F, Lescoat A, Jego P, Guggenbuhl P. [Is it (really) necessary to treat all postmenopausal women receiving corticosteroid therapy with bone preventive therapy?]. Rev Med Interne 2021; 42:597-599. [PMID: 34353612 DOI: 10.1016/j.revmed.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/17/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- F Robin
- Department of Rheumatology, CHU Rennes, France; Inserm, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), 35033 Rennes, France.
| | - A Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes 1, Rennes, France; University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - P Jego
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes 1, Rennes, France; University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - P Guggenbuhl
- Department of Rheumatology, CHU Rennes, France; Inserm, Univ Rennes, INRA, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), 35033 Rennes, France
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25
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Scheichel F, Marhold F, Pinggera D, Kiesel B, Rossmann T, Popadic B, Woehrer A, Weber M, Kitzwoegerer M, Geissler K, Dopita A, Oberndorfer S, Pfisterer W, Freyschlag CF, Widhalm G, Ungersboeck K, Roessler K. Influence of preoperative corticosteroid treatment on rate of diagnostic surgeries in primary central nervous system lymphoma: a multicenter retrospective study. BMC Cancer 2021; 21:754. [PMID: 34187419 PMCID: PMC8243818 DOI: 10.1186/s12885-021-08515-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSL patients with and without preoperative CST. Methods A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. Results A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSL patients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7–6.4). Conclusions Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSL patients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.
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Affiliation(s)
- Florian Scheichel
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, Dunant-Platz 1, 3100, St. Poelten, Austria
| | - Franz Marhold
- Karl Landsteiner University of Health Sciences, Krems, Austria. .,Department of Neurosurgery, University Hospital St. Poelten, Dunant-Platz 1, 3100, St. Poelten, Austria.
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Tobias Rossmann
- Department of Neurosurgery, Donauspital SMZ-Ost, Vienna, Austria.,Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Branko Popadic
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, Dunant-Platz 1, 3100, St. Poelten, Austria
| | - Adelheid Woehrer
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - Michael Weber
- Department of Research Management, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Melitta Kitzwoegerer
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Pathology, University Hospital St. Poelten, St.Poelten, Austria
| | | | - Astrid Dopita
- Institute for Pathology and Microbiology, Donauspital SMZ-Ost, Vienna, Austria
| | - Stefan Oberndorfer
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurology, University Hospital St. Poelten, St.Poelten, Austria
| | | | | | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Karl Ungersboeck
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, Dunant-Platz 1, 3100, St. Poelten, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
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26
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Shroff D, Narula R, Atri N, Chakravarti A, Gandhi A, Sapra N, Bhatia G, Pawar SR, Narain S. Endogenous fungal endophthalmitis following intensive corticosteroid therapy in severe COVID-19 disease. Indian J Ophthalmol 2021; 69:1909-1914. [PMID: 34146056 PMCID: PMC8374784 DOI: 10.4103/ijo.ijo_592_21] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: To report endogenous fungal endophthalmitis, postrecovery from severe COVID-19 infection in otherwise immunocompetent individuals, treated with prolonged systemic steroids. Methods: Retrospective chart review of cases with confirmed and presumed fungal endogenous endophthalmitis, following severe COVID-19 disease, treated at two tertiary care referral eye institutes in North India. Results: Seven eyes of five cases of endogenous fungal endophthalmitis were studied. All cases had been hospitalized for severe COVID-19 pneumonia and had received systemic steroid therapy for an average duration of 42 ± 25.1 days (range 18–80 days). All the cases initially complained of floaters with blurred vision after an average of 6 days (range 1–14 days) following discharge from hospital. They had all been misdiagnosed as noninfectious uveitis by their primary ophthalmologists. All eyes underwent pars plana vitrectomy (PPV) with intravitreal antifungal therapy. Five of the seven eyes grew fungus as the causative organism (Candida sp. in four eyes, Aspergillus sp. in one eye). Postoperatively, all eyes showed control of the infection with a marked reduction in vitreous exudates and improvement in vision. Conclusion: Floaters and blurred vision developed in patients after they recovered from severe COVID-19 infection. They had received prolonged corticosteroid treatment for COVID-19 as well as for suspected noninfectious uveitis. We diagnosed and treated them for endogenous fungal endophthalmitis. All eyes showed anatomical and functional improvement after PPV with antifungal therapy. It is important for ophthalmologists and physicians to be aware of this as prompt treatment could control the infection and salvage vision.
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Affiliation(s)
- Daraius Shroff
- Shroff Eye Centre, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Ritesh Narula
- Centre for Sight, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Neelam Atri
- Shroff Eye Centre, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Arpan Gandhi
- Ocular Pathology and Microbiology Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Gagan Bhatia
- Shroff Eye Centre, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Shraddha R Pawar
- Centre for Sight, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Shishir Narain
- Shroff Eye Centre, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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27
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Shirahige T, Tashiro M, Taguchi M, Miyazaki Y, Shibuya K, Izumikawa K. Long-term trend in serum (1,3)-β-D-glucan level in a man with chronic disseminated candidiasis treated with corticosteroids. J Infect Chemother 2021; 27:1258-1260. [PMID: 34049793 DOI: 10.1016/j.jiac.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/17/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022]
Abstract
Chronic disseminated candidiasis (CDC) is a type of invasive candidiasis. CDC commonly appears in the neutrophil recovery phase after chemotherapy in patients with hematologic malignancies, and immune reconstitution inflammatory syndrome (IRIS) is thought to play a major role in CDC development. This report describes the case of a 33-year-old man with CDC as a complication of acute myeloid leukemia. We describe the clinical course, body temperature, therapy, and (1,3)-β-D-glucan (BDG) levels over the course of 22 months. He was initially treated with antifungals, but corticosteroids were added because of a persistently elevated body temperature, which we attributed to IRIS. After starting corticosteroids, his clinical condition improved, but his BDG levels became markedly elevated. We hypothesize that the suppression of the excessive immune response by corticosteroids lead to granuloma collapse, fungal release, and hematogenous dissemination, resulting in elevated BDG levels. The patient's condition gradually improved over the course of follow-up.
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Affiliation(s)
- Tomoyuki Shirahige
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4, Sakamoto, Nagasaki, 852-8102, Japan; Medical Education Development Centre, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8102, Japan.
| | - Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4, Sakamoto, Nagasaki, 852-8102, Japan; Infection Control and Education Centre, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8102, Japan.
| | - Masataka Taguchi
- Department of Hematology, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8102, Japan.
| | - Yasushi Miyazaki
- Department of Hematology, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8102, Japan.
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, School of Medicine, Toho University, Tokyo, Japan 6-11-1, Omori-nishi Ota-ku, Tokyo, 143-8541, Japan.
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4, Sakamoto, Nagasaki, 852-8102, Japan; Infection Control and Education Centre, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, 852-8102, Japan.
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28
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Bouali M, Kabura S, El Bakouri A, El Hattabi K, Bensardi F, Fadil A. Acute pancreatitis associated with Cushing syndrome - A case report and literature review. Ann Med Surg (Lond) 2021; 65:102260. [PMID: 33898033 PMCID: PMC8058516 DOI: 10.1016/j.amsu.2021.102260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cushing's syndrome (CS) is a rare and severe disease. Acute pancreatitis is the leading cause of hospitalization. The association of the two disease is rare and uncommon. We report the case of a 37-year-old woman admitted in our service for acute pancreatitis and whose Cushing syndrome was diagnosed during hospiatilisation. The aim of this work is to try to understand the influence of de Cushing in acute pancreatitis and to establish a causative relationship between the two diseases. OBSERVATION It is a 37-year-old woman with a history of corticosteroid intake for six months, stopped three months ago who consulted for epigastralgia and vomiting. The physical exam found epigastric sensitivity with Cushing syndrome symptoms. A CT scan revealed acute edematous-interstitial pancreatitis stage E of Balthazar classification. 24 h free cortisol of 95 μg/24 h and cortisolemia of 3.4 μg/dl. The patient was treated symptomatically and referred after to endocrinology service for further treatment. CONCLUSION The association with acute pancreatitis and CS is rare and uncommon. Although detailed studies and evidence are lacking, it can therefore be inferred that CS is one of the risk factors for the onset of acute pancreatitis. The medical treatment and management of acute pancreatitis in those patients do not differ from other pancreatitis of any etiologies.
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Affiliation(s)
- M. Bouali
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
- Department of General Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
| | - S. Kabura
- Department of General Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
- Hassan 2 University of Casablanca, Morocco
| | - A. El Bakouri
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
- Department of General Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
| | - K. El Hattabi
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
- Department of General Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
| | - F.Z. Bensardi
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
- Department of General Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
| | - A. Fadil
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
- Department of General Surgery, Ibn Rochd-Casablanca University Hospital Center, Morocco
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Abstract
The role of photocoagulation in retinal vein occlusion (RVO) has been studied since 1974. The most serious complications of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) are: (i) visual deterioration, most commonly due to macular edema, and (ii) the development of ocular neovascularization (NV), particularly neovascular glaucoma (NVG), with hazardous consequences for vision and even the eye itself. Before discussing the role of photocoagulation in the management of NV and macular edema in RVO, it is crucial to gain a basic scientific understanding of the following relevant issues: classification of RVO, ocular NV in RVO, and the natural history of macular edema and visual outcome of RVO. These topics are discussed. In CRVO, ocular NV is a complication of ischemic CRVO but not of nonischemic CRVO. Photocoagulation has been advocated to prevent and/or treat the development of ocular NV and NVG. Since NVG is the most dreaded, intractable and blinding complication of ischemic CRVO, the role of photocoagulation and its management are discussed. Findings of three randomized, prospective clinical trials dealing with photocoagulation in ischemic CRVO are discussed. The role of photocoagulation in the management of ocular NV and macular edema in BRVO, and three randomized, prospective clinical trials dealing with those are discussed. Recent advent of intravitreal anti-VEGF and corticosteroid therapies has drastically changed the role of photocoagulation in the management of macular edema and NV in CRVO and BRVO. This is discussed in detail.
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Affiliation(s)
- Sohan Singh Hayreh
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA.
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30
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Bouzehouane N, Borson-Chazot F, Abeillon J, Caron P. Treatment of moderate to severe orbitopathy: Current modalities and perspectives. Ann Endocrinol (Paris) 2021; 82:92-98. [PMID: 33676921 DOI: 10.1016/j.ando.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022]
Abstract
Graves' orbitopathy (GO) is the primary cause of exophthalmos in adults. It appears in 30 to 50% of patients with Graves' disease. About 5% are moderate-to-severe cases that might be see-threatening or lead to long term disabling sequelae. Recommendations have been established in 2016 by the European thyroid association (ETA) and the European group on Grave's orbitopathy (EUGOGO), suggesting a wide use of corticosteroids in moderate to severe forms. However, disappointing results have been reported in 20 to 30% of cases. Improved understanding of pathophysiological mechanisms has allowed the use of non-specific immunomodulatory agents, currently under evaluation, and which place in the therapeutic strategy remains to be determined. Very recently, new promising therapeutic advances have emerged with the identification of new therapeutic targets, such as the TSH receptor and IGF-1 receptor complex.
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Affiliation(s)
- Nadia Bouzehouane
- Fédération d'endocrinologie et maladies métaboliques, hôpital cardiovasculaire Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France.
| | - Françoise Borson-Chazot
- Fédération d'endocrinologie et maladies métaboliques, hôpital cardiovasculaire Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France
| | - Juliette Abeillon
- Fédération d'endocrinologie et maladies métaboliques, hôpital cardiovasculaire Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
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31
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Chaouki A, Mkhatri A, Bouhmadi KE, Rouadi S, Oukessou Y, Abada R, Roubal M, Mahtar M. Quality of life assessment in patients treated with nasal corticotherapy for allergic rhinitis: A cohort study. Ann Med Surg (Lond) 2020; 60:249-254. [PMID: 33194182 PMCID: PMC7645315 DOI: 10.1016/j.amsu.2020.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/18/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) is a chronic nasal pathology induced by an inflammation of the mucous membranes due to a dependent IgE reaction following allergenic exposure. The main symptoms are rhinorrhea, nasal itching, nasal obstruction and sneezing bursts. It highly affects the patient quality of life (QoL) in many levels making it a public health issue.The aim of this study is to assess the QoL of patients with AR as well as the level of its improvement after nasal corticotherapy. MATERIALS AND METHODS From June 2019 to February 2020, a prospective study was carried out based on the use of the validated Arabic version of the RQLQ (Rhinoconjunctivitis Quality of Life Questionnaire) on a cohort of AR patients to measure their QoL before and after three months of treatment by "Budesonide". RESULTS A total of 70 patients participated in the study with an average age of 39.54 years with a sex ratio of 0.60. Their total RQLQ score was up to 4.28, improved to 2.35 after treatment. Also, a statistically significant improvement in sub-scores was also observed (p < 0.001): activities (from 4.43 to 2.29), nasal symptoms (from 5.00 to 2.80), eye symptoms (from 3.38 to 1.80), practical problems (from 4.29 to 2.18), general problems (from 4.63 to 2.78) and emotional state (from 4.28 to 2.43). CONCLUSION The RQLQ is a reliable tool to evaluate the QoL in AR patients, stating the negative influence of AR on patients daily life and the effectiveness of nasal corticosteroid treatment.
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Affiliation(s)
- A. Chaouki
- ENT Department, Ibn Rochd Teaching Hospital, Morocco
| | - A. Mkhatri
- ENT Department, Ibn Rochd Teaching Hospital, Morocco
| | | | - S. Rouadi
- ENT Department, Ibn Rochd Teaching Hospital, Morocco
| | - Y. Oukessou
- ENT Department, Ibn Rochd Teaching Hospital, Morocco
| | - R. Abada
- ENT Department, Ibn Rochd Teaching Hospital, Morocco
| | - M. Roubal
- ENT Department, Ibn Rochd Teaching Hospital, Morocco
| | - M. Mahtar
- ENT Department, Ibn Rochd Teaching Hospital, Morocco
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Tala-Ighil T, Greffe S, Trad S, Delaroche M, Coutte L, Rouveix E, Kahn JE, Hanslik T. [Cerebral infarction and tuberculosis: case report and literature review]. Rev Med Interne 2020; 41:704-707. [PMID: 32861533 DOI: 10.1016/j.revmed.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/21/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Although tuberculous meningitis is an uncommon presentation of tuberculosis, it still remains one of the deadliest forms of this disease. In this context, the occurrence of a cerebral infarct is an aggravating factor. OBSERVATION A 48-year-old Asian man presented himself in the emergency room for dysarthria and dysphagia of progressive onset. Cerebral CT showed a recent ischemic defect of the right internal capsule. Lumbar puncture showed meningitis with low sugar levels. Pulmonary micronodules on the thoracic CT suggested tuberculosis, which was confirmed by a broncho-alveolar lavage. Anti-tuberculosis treatment and early corticosteroid resulted in an improvement of the patient's state. CONCLUSION Cerebral infarctions in patients with tuberculous meningitis are events that cannot be underestimated in terms of frequency or severity. Their poor prognosis is partly the result of insufficiently defined management, which combines anti-tuberculosis treatment and early corticosteroid therapy.
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Affiliation(s)
- T Tala-Ighil
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France.
| | - S Greffe
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France
| | - S Trad
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France
| | - M Delaroche
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France
| | - L Coutte
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France
| | - E Rouveix
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France
| | - J-E Kahn
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France
| | - T Hanslik
- Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France
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De Martin E, Michot JM, Rosmorduc O, Guettier C, Samuel D. Liver toxicity as a limiting factor to the increasing use of immune checkpoint inhibitors. JHEP Rep 2020; 2:100170. [PMID: 33205034 PMCID: PMC7648167 DOI: 10.1016/j.jhepr.2020.100170] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) improve clinical outcomes in patients suffering from different types of cancer. Liver toxicity is one of the immune-related adverse events associated with immunotherapy; although not common, its management is challenging as it is extremely heterogeneous in terms of presentation and severity. Differences in the development and evolution of ICI-related toxicity in healthy or cirrhotic livers have not yet been elucidated. Assessing causality is key to diagnosing ICI-induced liver toxicity; liver biopsies can assist not only in the differential diagnosis but also in assessing the severity of histological liver damage. The current classification of severity overestimates the grade of liver injury and needs to be revised to reflect the views of hepatologists. Spontaneous improvements in ICI-related liver toxicity have been reported, so corticosteroid therapy should probably be individualised not systematic. The reintroduction of ICIs in a patient with previous immune-mediated hepatitis may be possible, but the risk/benefit ratio should be considered, as the risk factors for hepatitis recurrence are currently unclear. The management of these patients, requiring a balance between efficacy, toxicity and specific treatments, necessitates multidisciplinary collaboration. The incidence of immune-related liver toxicity will continue to rise based on the increasing use of ICIs for most cancers, mandating improved understanding and management of this complication.
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Key Words
- AIH, autoimmune hepatitis
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AMA, anti-mitochondrial antibodies
- ANA, anti-nuclear antibodies
- ASMA, anti-smooth muscles antibodies
- AST, aspartate aminotransferase
- CTLA-4, cytotoxic T lymphocyte-associated protein 4
- Corticosteroid therapy
- DCR, disease control rate
- DILI, drug-induced liver injury
- GGT, gamma-glutamyltransferase
- HCC, hepatocellular carcinoma
- ICI, immune checkpoint inhibitor
- INR, international normalised ratio
- Immune-mediated hepatitis
- Immunotherapy
- Liver biopsy
- MMF, mycophenolate mofetil
- ORR, objective response rate
- OS, overall survival
- PD-1, programmed cell death 1
- PD-L1-2, programmed cell death ligands 1-2
- PFS, progression-free survival
- TKI, tyrosine kinase inhibitor
- UDCA, ursodeoxycholic acid
- ULN, upper limit of normal
- anti-LC1, anti-liver cytosol type-1 antibodies
- anti-LKM, anti-liver-kidney microsomal antibodies
- anti-SLA, anti-soluble liver antigen antibodies
- irAE, immune-related adverse event
- trAE, treatment-related adverse event
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Affiliation(s)
- Eleonora De Martin
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, INSERM Unit 1193, Univ Paris-Sud, Université Paris-Saclay, FHU Hépatinov, Villejuif, F-94800, France
| | - Jean-Marie Michot
- Département d'innovation thérapeutique et d'Essais Précoces (DITEP), Institut Gustave-Roussy, Université Paris Saclay, Villejuif, France
| | - Olivier Rosmorduc
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, INSERM Unit 1193, Univ Paris-Sud, Université Paris-Saclay, FHU Hépatinov, Villejuif, F-94800, France.,Sorbonne-Université
| | - Catherine Guettier
- AP-HP Hôpital Bicêtre, Laboratoire Anatomie Pathologique, Le Kremlin-Bicêtre, France, Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, INSERM Unit 1193, Univ Paris-Sud, Université Paris-Saclay, FHU Hépatinov, Villejuif, F-94800, France
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Li Y, Zhang J, Cai N, He F. Efficacy and safety of corticosteroid therapy in patients with cardiac arrest: a systematic review of randomised controlled trials. Eur J Clin Pharmacol 2020; 76:1631-8. [PMID: 32696232 DOI: 10.1007/s00228-020-02964-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/16/2020] [Indexed: 01/14/2023]
Abstract
PURPOSES The role of corticosteroid therapy in patients with cardiac arrest (CA) is uncertain. We aimed to evaluate the efficacy and safety of corticosteroid therapy in CA patients. METHODS Randomised controlled trials were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure and the Chinese Biomedical Literature Database. The primary outcome was overall survival. Secondary outcomes were positive neurological status and probability of sustained restoration of spontaneous circulation (ROSC). Complications were infection and bleeding. Given the significant heterogeneity across previous studies, combining the data using meta-analysis was deemed not appropriate. RESULTS Five studies (551 patients) met the criteria. Two studies of co-intervention therapy (corticosteroid, vasopressin and epinephrine protocol) found that this approach could benefit in-hospital CA patient survival rates at hospital discharge, improve neurological function at hospital discharge and yield sustained ROSC rate. However, further two studies failed to demonstrate that corticosteroid therapy alone could improve survival and neurological outcomes among CA patients. Additionally, corticosteroid therapy did not increase the risk of infection and bleeding. CONCLUSIONS Due to the inherent limitations of the studies in this review, we have not been able to reach definitive conclusions. Larger-scale and better-designed studies are therefore recommended, to further evaluate the potential and rational use of corticosteroid therapy in CA patients.
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Ito H, Ito M, Kakuta Y, Kaneko T, Okudera K, Ogura T. Multisystem Langerhans cell histiocytosis in an adult non-smoker treated with steroid therapy. Respirol Case Rep 2020; 8:e00603. [PMID: 32547768 PMCID: PMC7290287 DOI: 10.1002/rcr2.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/11/2020] [Accepted: 05/29/2020] [Indexed: 11/09/2022] Open
Abstract
We describe the case of a 29-year-old female non-smoker who was treated with steroid therapy for a subacute exacerbation of multisystem Langerhans cell histiocytosis (MS-LCH) with worsening lung, skin, and oral mucosal lesions. The patient developed pneumonia, and computed tomography (CT) showed multiple thin-walled cavities. Transbronchial lung cryobiopsy (TBLC) specimens revealed Langerhans cells, which were positive for CD1a and S-100 expression. Similar histological findings were detected in the submandibular gland, skin, and tooth. On the basis of these findings, the patient was diagnosed with MS-LCH and subsequently treated with steroid therapy. From the literature review, case reports of non-smokers with pulmonary lesions that worsened and required treatment are rare. Almost all cases recurred and needed additional treatment. This case study contributes to our understanding of the potential role of steroid therapy in MS-LCH treatment. Additionally, TBLC is a novel, potentially safer, diagnostic tool that has not been previously described for LCH.
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Affiliation(s)
- Haruka Ito
- Department of Respiratory Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Masaru Ito
- Department of Respiratory Medicine Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Yukio Kakuta
- Department of Pathology Yokohama Rosai Hospital Yokohama Kanagawa Japan
| | - Takeshi Kaneko
- Department of Pulmonology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Koji Okudera
- Department of Pathology Kanagawa Cardiovascular and Respiratory Center Yokohama Kanagawa Japan
| | - Takashi Ogura
- Department of Respiratory Medicine Kanagawa Cardiovascular and Respiratory Center Yokohama Kanagawa Japan
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Vaquero-Herrero MP, Ragozzino S, Iriart X, Castaño-Romero F, Sailler L, Sánchez-González R, Cassaing S, Charpentier E, Berry A, Carbonell C, Siller-Ruiz M, García-García I, Soriano A, Marcos M, Ternavasio-de la Vega HG. Candida bloodstream infection in patients with systemic autoimmune diseases. Med Mal Infect 2020; 50:372-6. [PMID: 32113868 DOI: 10.1016/j.medmal.2020.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/09/2019] [Accepted: 01/29/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the epidemiological, clinical and microbiological characteristics and mortality of patients with Candida bloodstream infection and systemic autoimmune diseases. METHODS We performed a retrospective multicenter study of candidemia in adults with systemic autoimmune diseases between 2010 and 2016. RESULTS Among 1040 patients with candidemia, 36 (3.5%) had a systemic autoimmune disease. The most common systemic autoimmune disease was rheumatoid arthritis (27.8%). The most common species was Candida albicans (66.7%). Twenty-two (61.1%) patients received a corticosteroid therapy and nine (25%) received an immunosuppressive therapy at the time of candidemia. The mortality rate was 27.8%. CONCLUSIONS Systemic autoimmune diseases are not common in patients with candidemia. The unadjusted mortality rate was comparable to other candidemia studies in the general population.
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Székely L, Gáborján A, Dános K, Szalóki T, Fent Z, Tamás L, Polony G. Mid-term evaluation of perioperative i.v. corticosteroid treatment efficacy on overall and audiological outcome following CO 2 laser stapedotomy: a retrospective study of 84 cases. Eur Arch Otorhinolaryngol 2020; 277:1031-1038. [PMID: 31993767 PMCID: PMC7072067 DOI: 10.1007/s00405-020-05816-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
Purpose Our aim was to determine whether perioperatively administered corticosteroid treatment has any beneficial effect on the outcome of stapes surgery, with special regard to the audiological results and early postoperative morbidity. Methods 84 CO2 laser stapedotomies performed in our institute between 2013 and 2018 were included in our investigation. All cases underwent preoperative and mid-term postoperative pure-tone audiometric evaluation. Vestibular complications were also evaluated. The cases were subdivided into two groups, 23 patients received perioperative i.v. methylprednisolone treatment (“S”) while the other 61 patients (“nS”) did not receive any adjuvant pharmacological therapy. The data were analyzed retrospectively using IBM SPSS Statistics. Results CO2 laser stapedotomy proved to be a successful intervention with a significant improvement in ABG and AC thresholds as well. Long-term BC levels were significantly better compared to preoperative ones in the S group; however, in the nS group, no difference could be shown. Hearing and ABG gain were significantly superior in group S [28.1 dB (SD11.2) vs. 18.1 dB (SD 10.9) and 23.9 dB(SD 9.8) vs. 17.2 dB (SD 9.5), respectively]. Conclusion No significant inner ear damage was detectable in the results of our CO2 laser stapedotomy method; however, the positive effect of corticosteroid treatment could be demonstrated through the postoperative hearing levels. We found no statistical difference in early postoperative morbidity. According to our data, the routine administration of corticosteroids during stapes surgery could be an issue worthy of consideration. The effects of perioperative treatment vs that on the first day after surgery, and topical vs. systemic treatment could be the subject of further investigation in a prospective manner.
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Affiliation(s)
- L Székely
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary.
| | - A Gáborján
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - K Dános
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - T Szalóki
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - Z Fent
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - L Tamás
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - G Polony
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
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Katsuyama A, Kusuhara S, Awano H, Nagase H, Matsumiya W, Nakamura M. A case of probable Vogt-Koyanagi-Harada disease in a 3-year-old girl. BMC Ophthalmol 2019; 19:179. [PMID: 31409322 PMCID: PMC6693137 DOI: 10.1186/s12886-019-1192-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background Vogt–Koyanagi–Harada (VKH) disease is a T-cell-mediated autoimmune disorder characterized by bilateral granulomatous panuveitis with various systemic manifestations. Although VKH disease rarely occurs in the pediatric population, the clinical course tends to be aggressive, and the visual prognosis is worse than that in adult patients due to severe ocular complications secondary to recurrent inflammation. Case presentation A 3-year-old girl with probable VKH was referred to Kobe University Hospital. She had severe bilateral panuveitis with posterior synechiae of the iris, marked optic disk swelling, and serous retinal detachment in both eyes, and her best corrected visual acuities (BCVAs) were 20/200 OD and 20/125 OS. A third course of therapy was administered because serous retinal detachment remained after two courses of therapy. She was treated with three courses of high-dose intravenous corticosteroid therapy, followed by slow tapering of oral corticosteroids. Her BCVAs recovered to 20/16 OU, and relapse of ocular inflammation and side effect of treatment were not observed during the 1.5-year follow-up period. Conclusions We experienced a pediatric patient with probable VKH disease who was treated with three courses of high-dose intravenous corticosteroid therapy. With the favorable clinical course in our patient, initial treatment with repeated high-dose intravenous corticosteroid therapy might be beneficial in pediatric VKH disease.
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Affiliation(s)
- Atsuko Katsuyama
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of medicine, Kobe, Japan
| | - Wataru Matsumiya
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Ahmed SA, El-Moselhy A, El-Moammaly A, El-Shewy K. Strongyloides stercoralis in Patients on Corticosteroids Therapy Using Enzyme-Linked Immunosorbent Assay and Gelatin Particles Indirect Agglutination Tests: A Diagnostic Approach. Acta Parasitol 2019; 64:394-405. [PMID: 31069645 DOI: 10.2478/s11686-019-00060-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients on corticosteroids therapy (POCT) are more likely to flare up concealed Strongyloides infection and develop Strongyloides hyperinfection syndrome and/or dissemination. Such critical complications can lead to high mortality rates. Rapid detection methods are, therefore, necessary to detect Strongyloides infection in POCT with the advantage of being applicable in a developing country. METHODS Two hundred POCT have been enrolled in this study to determine the rate of infection with Strongyloides. Three different groups of POCT (Strongyloides infected, non-infected, infected with other parasites) were used to evaluate the antibodies detection capability of two serological techniques (enzyme-linked immunosorbent assay (ELISA) and gelatin particles indirect agglutination (GPIAT) against the results of the gold standard agar plate culture (APC). RESULTS With APC, the infection rate of Strongyloides stercoralis in POCT was 9.5% (19/200). POCT with Strongyloides infection displayed related risk factors (job, rural settlements, and soil contact) for infection combined with the subtropical nature of Ismailia Governorate. With regard to serology, ELISA detection results were poor compared to APC with sensitivity and specificity of 42.1% and 82.6%, respectively, and positive and negative predictive values of 72% and 30%. GPIAT appeared to be closely related to APC with sensitivity and specificity of 89.4% and 81.8%, respectively, and positive and negative predictive values of 80.9% and 96.7%. Statistical moderate correlation was detected between GPIAT and ELISA. CONCLUSION The GPIAT technique is more convenient, easier, cheaper and faster to rule out the infection of Strongyloides in POCT. It might be the test of choice for routine immunodiagnosis of human strongyloidiasis.
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Affiliation(s)
- Shahira A Ahmed
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Amany El-Moselhy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Amal El-Moammaly
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Khalid El-Shewy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
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He M, Gao D, Zhang J, Huang D, Tian Y, Yu S. Suspected bacterial meningoencephalomyelitis as the trigger or presentation of neuromyelitis optica spectrum disorder flare. Mult Scler Relat Disord 2019; 30:38-41. [PMID: 30738276 DOI: 10.1016/j.msard.2019.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Suspected bacterial meningoencephalomyelitis as the presentation or trigger of neuromyelitis optica spectrum disorders (NMOSD) flare has not been reported in literature. CASE PRESENTATION A 29 year old female, who has a history of neuromyelitis optica spectrum disorder (NMOSD) for 6 years, presented with symptoms of meningitits, encephalitis, myelitis, headache and fever. Cerebrospinal fluid analysis revealed pleocytosis (1131 × 106/L [83% neutrophils]) and a glucose level of 39.6 mg/dl. Magnetic resonance imaging revealed lesions in the cervical cord, medulla, right frontal-parietal lobe, and corpus callosum. Serum anti-aquaporin-4 (AQP-4) antibody was positive. An initial diagnosis of bacterial meningoencephalomyelitis was considered. Despite broad-spectrum antimicrobial therapy, her neurologic symptom continued to deteriorate. Intravenous gamma immunoglobulin and methylprednisolone was initiated, which improved her symptoms rapidly. CONCLUSION Suspected bacterial meningoencephalomyelitis as the presentation or trigger of NMOSD flare was considered in our case. Literature review revealed that bacterial meningitis-like presentation was a rare presentation in the attack phase of NMOSD. Corticosteroid therapy should be initiated in such cases.
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Affiliation(s)
- Mianwang He
- Neurology Department, Chinese PLA General Hospital, 28# Fuxing Road, Beijing, People's Republic of China
| | - Dan Gao
- Medical School of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China
| | - Jiatang Zhang
- Neurology Department, Chinese PLA General Hospital, 28# Fuxing Road, Beijing, People's Republic of China.
| | - Dehui Huang
- Neurology Department, Chinese PLA General Hospital, 28# Fuxing Road, Beijing, People's Republic of China
| | - Yaping Tian
- Medical School of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China; Core Laboratory of Translational Medicine, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28# Fu-Xing Road, Beijing 100853, People's Republic of China.
| | - Shengyuan Yu
- Neurology Department, Chinese PLA General Hospital, 28# Fuxing Road, Beijing, People's Republic of China; Medical School of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China.
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Mandigers L, Epker JL. A case report of iatrogenic deterioration of yet undiagnosed Rhombencephalitis; always be careful with corticoids. BMC Clin Pathol 2019; 18:15. [PMID: 30602941 PMCID: PMC6307248 DOI: 10.1186/s12907-018-0083-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/07/2018] [Indexed: 11/25/2022] Open
Abstract
Background Listeria monocytogenes is a bacterium present in some food products. It is rarely the cause of Rhombencephalitis in immunocompetent patients. Case presentation We report a case of an immunocompetent patient, presenting with progressive perioral numbness and dizziness. Despite treatment with antiplatelet drugs, antiviral medication, antibiotics and corticosteroids for a wide differential diagnosis, the patient deteriorated tremendously. Eventually the patient died of Listeria rhombencephalitis, most likely due to the late diagnosis and concomitant late initiation of antibiotics combined with badly timed and inappropriate corticosteroid prescription. Conclusion Early adequate antibiotic treatment is essential in Listeria rhombencephalitis and corticosteroid therapy should be avoided when Listeriosis is suspected.
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Affiliation(s)
- L Mandigers
- Erasmus Medical Center Rotterdam The Netherlands, Intensive Care Unit - Adults, Rotterdam, The Netherlands
| | - J L Epker
- Erasmus Medical Center Rotterdam The Netherlands, Intensive Care Unit - Adults, Rotterdam, The Netherlands
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Jiménez-Zarazúa O, Guzmán-Ramírez A, Vélez-Ramírez LN, López-García JA, Casimiro-Guzmán L, Mondragón JD. A Case of Acute Pemphigus Vulgaris Relapses Associated with Cocaine Use and Review of the Literature. Dermatol Ther (Heidelb) 2018; 8:653-663. [PMID: 30415373 PMCID: PMC6261113 DOI: 10.1007/s13555-018-0271-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 12/28/2022] Open
Abstract
Pemphigus is a bullous autoimmune disease that affects the skin and mucous membranes. It is very difficult to establish the etiology and the triggering factors that influence reactivations in pemphigus vulgaris (PV). The case of a 33-year-old male with chronic history of intranasal cocaine consumption is presented in this report. We present the clinical case of the patient, followed for a total of 86 weeks, with ten relapses secondary to probable cocaine use. The patient was admitted to the emergency department after presenting polymorphic dermatosis characterized by blisters, vesicles, and excoriations extending from the oral cavity to the thorax, and to the inguinal and genital regions, affecting approximately 35 % of the body surface area with a score of 56 on the Pemphigus Skin Disorder Index. Skin biopsies were compatible with PV diagnosis. The patient had clinical improvement with a combination of methylprednisolone 500 mg intravenously (IV) and cyclophosphamide 500 mg IV every 15 days, along with prednisone 50 mg orally (PO) q24 h and mycophenolic acid 500 mg PO q6 h. Persistent cocaine use is highly likely to be the factor triggering lesion reactivation and responsible for the torpid evolution. We cannot definitively conclude whether the change from azathioprine to mycophenolic acid after the tenth relapse was the adjuvant medication responsible for the end of the consolidation phase and complete remission on therapy. This case study could potentially serve as a guide for management of patients who continuously persist with cocaine use, leading to a clinical picture refractory to multiple therapeutic schemes.
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Affiliation(s)
- Omar Jiménez-Zarazúa
- Department of Internal Medicine, Hospital General León, León, Guanajuato, Mexico.,Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico
| | | | | | - Jesús A López-García
- Head of the Department of Internal Medicine and Rheumatology, Hospital General León, León, Guanajuato, Mexico
| | | | - Jaime D Mondragón
- Department of Neurology, Alzheimer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Goto D, Ohashi N, Takeda A, Fujigaki Y, Shimizu A, Yasuda H, Ohishi K. Case of human immunodeficiency virus infection presenting as a tip variant of focal segmental glomerulosclerosis: A case report and review of the literature. World J Nephrol 2018; 7:90-95. [PMID: 30090707 PMCID: PMC6081390 DOI: 10.5527/wjn.v7.i4.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023] Open
Abstract
The incidence of the collapsing variant of focal segmental glomerulosclerosis (FSGS) as a human immunodeficiency virus (HIV)-associated nephropathy has reduced since the introduction of antiretroviral therapy (ART). However, the incidence of other variants of FSGS, except for the collapsing variant, is increasing, and its therapeutic strategies remain uncertain. A 60-year-old HIV infected man in remission with ART was admitted for progressive renal insufficiency and nephrotic-ranged proteinuria. Renal biopsy revealed a tip variant of FSGS and his clinical manifestations resolved with corticosteroid therapy. HIV infected patients might develop non-collapsing FSGS, including tip variant of FSGS and corticosteroid therapy might be effective for them. A renal biopsy might be essential to determine the renal histology and to decide on corticosteroid therapy.
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Affiliation(s)
- Daiki Goto
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Naro Ohashi
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Asumi Takeda
- Division of Nephrology, Hamamatsu Medical Center, Hamamatsu 432-8580, Japan
| | - Yoshihide Fujigaki
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Akira Shimizu
- Department of Pathology, Nihon University School of Medicine, Tokyo 113-8602, Japan
| | - Hideo Yasuda
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Kazuhisa Ohishi
- Division of Nephrology, Hamamatsu Medical Center, Hamamatsu 432-8580, Japan
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Yang T, Li Z, Jiang L, Xi X. Corticosteroid use and intensive care unit-acquired weakness: a systematic review and meta-analysis. Crit Care 2018; 22:187. [PMID: 30075789 PMCID: PMC6091087 DOI: 10.1186/s13054-018-2111-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023]
Abstract
Background The association between corticosteroid use and intensive care unit (ICU)-acquired weakness remains unclear. We evaluated the relationship between corticosteroid use and ICU-acquired weakness in critically ill adult patients. Methods The PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Cumulative Index of Nursing and Allied Health Literature databases were searched from database inception until October 10, 2017. Two authors independently screened the titles/abstracts and reviewed full-text articles. Randomized controlled trials and prospective cohort studies evaluating the association between corticosteroids and ICU-acquired weakness in adult ICU patients were selected. Data extraction from the included studies was accomplished by two independent reviewers. Meta-analysis was performed using Stata version 12.0. The results were analyzed using odds ratios (ORs) and 95% confidence intervals (CIs). Data were pooled using a random effects model, and heterogeneity was evaluated using the χ2 and I2 statistics. Publication bias was qualitatively analyzed with funnel plots, and quantitatively analyzed with Begg’s test and Egger’s test. Results One randomized controlled trial and 17 prospective cohort studies were included in this review. After a meta-analysis, the effect sizes of the included studies indicated a statistically significant association between corticosteroid use and ICU-acquired weakness (OR 1.84; 95% CI 1.26–2.67; I2 = 67.2%). Subgroup analyses suggested a significant association between corticosteroid use and studies limited to patients with clinical weakness (OR 2.06; 95% CI 1.27–3.33; I2 = 60.6%), patients with mechanical ventilation (OR 2.00; 95% CI 1.23–3.27; I2 = 66.0%), and a large sample size (OR 1.61; 95% CI 1.02–2.53; I2 = 74.9%), and not studies limited to patients with abnormal electrophysiology (OR 1.65; 95% CI 0.92–2.95; I2 = 70.6%) or patients with sepsis (OR 1.96; 95% CI 0.61–6.30; I2 = 80.8%); however, statistical heterogeneity was obvious. No significant publication biases were found in the review. The overall quality of the evidence was high for the randomized controlled trial and very low for the included prospective cohort studies. Conclusions The review suggested a significant association between corticosteroid use and ICU-acquired weakness. Thus, exposure to corticosteroids should be limited, or the administration time should be shortened in clinical practice to reduce the risk of ICU-acquired weakness. Electronic supplementary material The online version of this article (10.1186/s13054-018-2111-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Yang
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, 20A Fu Xing Men Wai Da Jie, Xicheng District, Beijing, 100038, China
| | - Zhiqiang Li
- Department of Critical Care Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Li Jiang
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, 20A Fu Xing Men Wai Da Jie, Xicheng District, Beijing, 100038, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, 20A Fu Xing Men Wai Da Jie, Xicheng District, Beijing, 100038, China.
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Kita T, Araya T, Ichikawa Y, Terada N, Kawashima A, Kasashima S, Kasahara K. IgG4-Related Pleuritis With No Other Organ Involvement. Am J Med Sci 2018; 356:487-491. [PMID: 30055756 DOI: 10.1016/j.amjms.2018.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 02/07/2023]
Abstract
A 65-year-old man was admitted for productive cough and dyspnea. Bilateral pleural effusions were observed on chest X-ray. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, bacterial culture and polymerase chain reaction analysis for Mycobacterium tuberculosis were negative. Immunological examinations showed high levels of immunoglobulin G4 (IgG4) in both serum and pleural effusion fluid. Pathologic evaluation of a left pleural biopsy specimen using hematoxylin and eosin staining and immunohistochemical staining showed fibrosis-associated lymphoplasmacytic infiltration, 50 IgG4-positive plasma cells per high-power field, and an IgG4/IgG ratio of 40%. Thus, a diagnosis of IgG4-related pleuritis without other systemic manifestations was established. The bilateral pleural effusion improved following corticosteroid therapy. This is a rare case of IgG4-related pleuritis with no other organ involvement.
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Affiliation(s)
| | | | | | | | - Atsuhiro Kawashima
- Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | | | - Kazuo Kasahara
- Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Khochtali S, Zayani M, Ksiaa I, Ben Meriem I, Zaouali S, Jelliti B, Khairallah M. [Idiopathic orbital inflammatory syndrome: Report of 24 cases]. J Fr Ophtalmol 2018; 41:333-42. [PMID: 29685738 DOI: 10.1016/j.jfo.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/30/2017] [Accepted: 09/25/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Idiopathic orbital inflammatory syndrome (IOIS) is an inflammatory condition of unknown etiology. The inflammation may affect all the structures within the orbit (anterior, diffuse, apical, myositic, dacryoadenitis) and corresponds to uniquely orbital inflammation without an identifiable local cause or systemic disease. The goal of this study is to describe the clinical and radiographic characteristics of IOIS and discuss the role of orbital biopsy in this condition. PATIENTS AND METHODS This is a retrospective review of the charts of 24 patients diagnosed with IOIS at Fattouma Bourguiba hospital, Monastir, Tunisia, from January 2007 to December 2015. This study included all patients with IOIS and a minimum follow-up of six months. All patients had a complete ophthalmological examination and orbital and head CT scan and/or MRI. A work-up was performed in all cases to rule out local causes and systemic disease. Only 11 patients underwent biopsy. The diagnosis of the clinical entity IOIS was made according to the Rootman criteria. Oral steroids were the first line therapy. A bolus of intravenous methylprednisolone was administered first in vision-threatening cases. Response to treatment was defined as disappearance of signs and symptoms of IOIS. RESULTS Orbital pain was the most common symptom (62.5%), followed by proptosis and decreased vision (37.5% each). Best-corrected visual acuity (BCVA) was greater than 5/10 in 70.7% of patients. Lacrimal gland enlargement was observed in 3 patients. Oculomotor disorders were present in 70% of cases and 20.8% of patients had compressive optic neuropathy. Orbital imaging showed, in most cases, oculomotor muscle inflammation (87.5%) involving particularly the superior rectus muscle (54.2%) and inflammation of orbital fat (66.7%). Fifty percent had myositic inflammation. Biopsy was performed in 11 patients, showing nonspecific inflammation (n=10) and the sclerosing form (n=1). A total of 83.3% of patients received oral corticosteroids for a mean duration of 5.5 months. CONCLUSION IOIS is a diagnosis of exclusion, based on history, clinical course, response to steroid therapy, laboratory tests, or even biopsy in selected cases. Orbital imaging provides valuable clues for diagnosis of IOIS and for identification of affected structures. Prolonged steroid therapy is necessary as IOIS classically responds to steroids; nevertheless, partial recovery or relapses often occur.
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Shimada Y, Adachi M, Kobayashi N, Okada T, Yamazaki H, Nagaba Y, Yokomori H. A superelderly case of TAFRO syndrome treated effectively using corticosteroid hormones. Clin Case Rep 2018; 6:638-643. [PMID: 29636931 PMCID: PMC5889227 DOI: 10.1002/ccr3.1417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/09/2018] [Accepted: 01/18/2018] [Indexed: 11/24/2022] Open
Abstract
Peripheral lymphocyte subsets may be less time‐consuming and are a prognostic tool for managing thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome. Here, we report a superelderly case of plasma cell type TAFRO syndrome treated effectively using corticosteroid hormones.
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Affiliation(s)
- Yoshitaka Shimada
- Departments of Internal Medicine Kitasato University Medical Center Kitamoto Saitama Japan
| | - Mizuho Adachi
- Departments of resident University Medical Center Kitamoto Saitama Japan
| | - Noritada Kobayashi
- Division of Biomedical Research Kitasato University Medical Center Kitasato University Kitamoto Saitama Japan
| | - Takemichi Okada
- Department of Radiology Kitasato University Medical Center Kitamoto Saitama Japan
| | - Hitoshi Yamazaki
- Department of Pathology Kitasato University Medical Center Kitamoto Saitama Japan
| | - Yasushi Nagaba
- Departments of Internal Medicine Kitasato University Medical Center Kitamoto Saitama Japan
| | - Hiroaki Yokomori
- Departments of Internal Medicine Kitasato University Medical Center Kitamoto Saitama Japan
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Toh H, Mori S, Keno M, Yokota S, Shinkura Y, Izawa Y, Nagamatsu Y, Shimoyama S, Fukuzawa K, Doi T, Hirata KI. Serial observation of electrocardiographic responses to corticosteroid therapy in a patient with right ventricular-predominant cardiac sarcoidosis. J Electrocardiol 2018; 51:658-662. [PMID: 29997007 DOI: 10.1016/j.jelectrocard.2018.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/22/2018] [Accepted: 04/11/2018] [Indexed: 11/19/2022]
Abstract
Predominant or isolated right ventricular involvement in cardiac sarcoidosis is uncommon, but should always be considered in a case of right ventricular hypertrophy combined with ventricular arrhythmia and/or conduction disturbance. Although improvement in right ventricular hypertrophy and atrioventricular conduction disturbance following corticosteroid therapy has been reported, the detailed serial electrocardiographic responses during corticosteroid therapy, as well as temporal changes in the electrocardiographic, biochemical, and morphological responses, have not been reported. We describe the clinical course and supportive imaging findings of reversible right ventricular hypertrophy and cardiac conduction disturbance in a case of right ventricular-predominant cardiac sarcoidosis.
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Affiliation(s)
- Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan.
| | - Marika Keno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Shun Yokota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Yuto Shinkura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Yuichi Nagamatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Shinsuke Shimoyama
- Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Tomofumi Doi
- Department of Cardiology, Japanese Red Cross Kobe Hospital, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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Djaballah-Ider F, Djeraba Z, Chemli M, Dammene-Debbihe N, Lounis D, Belguendouz H, Medour Y, Chaib S, Touil-Boukoffa C. Influence of corticosteroid therapy on IL-18 and nitric oxide production during Behçet's disease. Inflammopharmacology 2018; 26:725-735. [PMID: 29600486 DOI: 10.1007/s10787-018-0472-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Behçet's disease (BD) is a chronic multisystemic inflammatory disease with complex etiopathogenesis. Th1-proinflammatory cytokines seem to be involved in its pathogenesis. Our current study aims to evaluate interleukin-18 (IL-18) and nitric oxide (NO) involvement in the development of different clinical manifestations of BD as well as to investigate the corticosteroid therapy effect on this production in Algerian patients. METHODS For this purpose, we evaluated in vivo and ex vivo IL-18, interferon-γ (IFN-γ) levels using ELISA and NO production by the Griess' method in naïve-active and corticosteroid-treated BD patients with different clinical manifestations. Additionally, we assessed CD40/CD40L expression by flow cytometrics assay in these groups of patients. RESULTS AND DISCUSSION Our results indicate that IL-18 and nitrite levels were higher in naïve-active BD patients. Interestingly, this high production differed according to the clinical manifestations and was associated with an increased risk of mucocutaneous and vascular involvement. Concerning corticosteroid treated-active BD patients, no difference was observed in this production between each clinical subgroup. However, IFN-γ levels increased in all categories of active patients. Interestingly, corticosteroid therapy reduced significantly these inflammatory mediators regardless of the clinical manifestations studied. In addition, the CD40/CD40L expression differed according to the clinical presentations. CONCLUSION Collectively, our results suggest that concomitant high production of IL-18 and NO in naïve-active BD patients is related to an increased risk of mucocutaneous lesions and vascular involvement. Moreover, the relationship between these two inflammatory markers could constitute a predictable tool of BD clinical presentations and an early factor of therapy efficiency.
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Affiliation(s)
| | - Zineb Djeraba
- Universite des Sciences et de la Technologie Houari Boumediene, Algiers, Algeria
| | - Mourad Chemli
- Service de Medecine Interne, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
| | | | - Doulkifly Lounis
- Service de Medecine Interne, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
| | - Houda Belguendouz
- Universite des Sciences et de la Technologie Houari Boumediene, Algiers, Algeria
| | - Yanis Medour
- Service d'Immunologie, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
| | - Samia Chaib
- Service d'Immunologie, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
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