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Nafiza M, Imad-Addin A, Mohamad Moamen A, Raghad K, Hussein H, Ali Alakbar N, Jaber M. Clinical evaluation and treatment outcomes of caustic ingestion injuries in Syrian pediatric patients: A retrospective study: Short title: High-dose steroids for pediatric caustic ingestions in Syria. SAGE Open Med 2024; 12:20503121241234301. [PMID: 38495536 PMCID: PMC10943744 DOI: 10.1177/20503121241234301] [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: 08/17/2023] [Accepted: 01/25/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Accidental ingestion of caustic agents poses a significant concern in pediatric emergency departments globally. It is a growing public health concern in low-to-middle income countries, which often lack comprehensive data reporting. This study examines high doses of corticosteroid treatment outcomes of caustic ingestion injuries in Syrian pediatric patients, addressing clinical features, and associated variables. Methods and materials A retrospective observational study was conducted at University Pediatric Hospital from January 2016 to January 2019. Medical records were reviewed for patients aged <10 years with esophagoscopy-confirmed grade IIa, IIb, or III burns. Data collected included sociodemographics, esophagoscopy results, treatment details, and outcomes. Results Among 114 pediatric patients, 76 (67%) were males and 38 (33%) were females. Age groups included <1 year (11%), 1-3 years (39%), 3-5 years (29%), 5-7 years (11%), and >7 years (11%). Alkaline burns accounted for 54% of injuries, acidic for 32%, and other substances for 13%. Complications included bleeding (19%) and psychomotor disability (7%). The most common burn site was the entire esophagus (62%), with 81% having grade II burns. Healing was achieved in 71% of patients with high doses of corticosteroids treatment, and 29% required dilation, with final 92% healing rate. Conclusion The use of corticosteroids for esophageal strictures remains inconclusive, demanding further robust research with larger sample sizes and control groups. While our study revealed that high doses of corticosteroids treatment followed by esophageal dilation had a 92% success rate. However, our study demonstrates promising results, methodological limitations and absence of a control group underscore the need for more definitive evidence. Both alkali and acidic ingestion contribute to stricture development.
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Affiliation(s)
- Martini Nafiza
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Almasri Imad-Addin
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
- Applied Statistics Department, Damascus University, Damascus, Syrian Arab Republic
| | - Almouallem Mohamad Moamen
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Khaled Raghad
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Hamdar Hussein
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Nahle Ali Alakbar
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Mahmod Jaber
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
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Khadamy J, Khademi P, Baharypour S. Accelerated Recovery: The Role of Oral Steroid in the Management of Herpes Zoster Ophthalmicus-Related Ophthalmoplegia. Cureus 2023; 15:e50553. [PMID: 38226106 PMCID: PMC10788675 DOI: 10.7759/cureus.50553] [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] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
The use of systemic steroids in managing herpes zoster ophthalmicus-related ophthalmoplegia (HZORO) remains a topic of debate. Here, a case involving third nerve HZORO is highlighted, where a regimen of oral valacyclovir followed by a brief course of oral steroids resulted in significant improvement within days and complete resolution of the palsy within a month of initiating the treatment. This case underscores the need for randomized controlled studies to definitively determine the efficacy of systemic steroids in alleviating or shortening the course of HZORO.
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Kononowicz JE, Farhan Ali M, Palko W, Pyper S, Agasthya N. Rapidly Progressing Autoimmune Hemolytic Anemia in a Pediatric Patient With COVID-19. Cureus 2023; 15:e45633. [PMID: 37868512 PMCID: PMC10588281 DOI: 10.7759/cureus.45633] [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] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
SARS-CoV-2 is a novel virus that is known to have a predilection for complications associated with the respiratory system. Although COVID-19 has a wide spectrum of manifestations, the pathophysiology of severe illness remains poorly understood but is thought to be associated with fulminant cytokine release. While severe complications secondary to COVID-19 in the pediatric population are considered rare, they do happen. Children with and without comorbidities have required intensive care unit admissions for respiratory distress and, more notably, multisystem inflammatory syndrome in children (MIS-C). While MIS-C is associated with hematologic complications, such as thrombocytopenia and coagulopathies, it is not associated with blood hemolysis. In this report, we describe a case of a 23-month-old previously healthy female, who presented with lethargy and positive COVID-19 PCR status. This case illustrates the rapid and fatal sequela caused by autoimmune hemolytic anemia (AIHA) from COVID-19. It stresses the importance of thorough workup and management of AIHA secondary to COVID-19 illness. Currently, there is limited understanding of AIHA from COVID-19 illness in children. Our aim is to describe this rare complication of COVID-19 illness in pediatric patients and discuss the best practices to manage it.
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Affiliation(s)
- Julia E Kononowicz
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, USA
| | - Mohammed Farhan Ali
- Department of Pediatrics, Division of Nephrology, Children's Mercy, Wichita, USA
| | - William Palko
- Department of Pathology, Wesley Medical Center, Wichita, USA
| | - Sean Pyper
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, USA
| | - Nisha Agasthya
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, USA
- Department of Pediatrics, Division of Critical Care Medicine, Wesley Medical Center, Wichita, USA
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4
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Skafida E, Giannas R. Stevens-Johnson Syndrome in a Patient With Recent SARS-CoV-2 Infection and Ciprofloxacin Administration. Cureus 2023; 15:e45099. [PMID: 37842491 PMCID: PMC10569151 DOI: 10.7759/cureus.45099] [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] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Stevens-Johnson syndrome (SJS) is an acute, rare, and potentially life-threatening condition with high morbidity and mortality. It is characterized by a blistering rash and erosions with mucosal involvement, which depending on the extent of the skin area involved may be categorized as epidermal necrolysis, along with systemic symptoms. Symptoms are preceded by the administration of a newly introduced drug in almost 80% of cases and less commonly by infections in genetically predisposed individuals. We report a case of SJS in a female patient secondary to a recent SARS-CoV-2 infection and subsequent ciprofloxacin administration.
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Affiliation(s)
- Evgenia Skafida
- Internal Medicine, General Hospital of Syros, Ermoupoli, GRC
| | - Rafail Giannas
- Internal Medicine, General Hospital of Syros, Ermoupoli, GRC
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Baco SJ, Mišić J, Peruničić V. Postoperative Pyoderma Gangrenosum (PPG) After Appendectomy: A Case Report. Cureus 2023; 15:e42016. [PMID: 37469578 PMCID: PMC10353335 DOI: 10.7759/cureus.42016] [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] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare, poorly understood, non-infectious, autoimmune phenomenon. It is an inflammatory neutrophilic dermatosis characterized by hyperactivity of the skin and the development of papules and pustules that rapidly progress to painful ulcerations with a violaceous and necrotic border. Approximately three to six cases of PG per million of the population occur per year and in the case of postoperative pyoderma gangrenosum (PPG), it is only one to three cases per million operated people. We are presenting a 41-year-old patient with a clinical presentation of PPG, developed in the surgical site on the sixth postoperative day (POD 6) following open appendectomy for acute appendicitis. Initial treatment was for surgical site infection (SSI) with wound opening, regular dressings, and broad-spectrum antibiotics. Due to unresponsiveness to therapy and the unexpected postoperative course with the progression of skin lesions, we suspected PPG. Corticosteroid therapy was introduced in a shock dose, once daily intravenous (IV), with superb results and stopping the spread of the process after only two days. Considering the rarity of PPG, especially when it first occurs postoperatively, we believe that the image of skin changes with superficial spreading and characteristic violaceous ulcerations can be of crucial importance for early diagnosis. A multidisciplinary approach with a mandatory examination by a dermatologist is important in order to make an early diagnosis and prevent wrong treatment, with the potential worsening of the patient's condition. Atraumatic wound care and negative pressure wound therapy are recommended. Patients at risk should perioperatively receive corticosteroids and postoperatively be closely observed for the potential development of PPG. Debridement is not recommended, and surgical treatment and further tissue trauma are undesirable and even prohibited.
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Affiliation(s)
- Stanko J Baco
- Department of General Surgery, Public Health Institution Hospital "Dr Mladen Stojanovic", Prijedor, BIH
| | - Jovica Mišić
- Department of General Surgery, Saint Luke the Apostle Hospital, Doboj, BIH
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Baltoyour AW. Idiopathic Orbital Pseudotumor: A Rare Case Report. Cureus 2023; 15:e41602. [PMID: 37559840 PMCID: PMC10409500 DOI: 10.7759/cureus.41602] [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] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
Orbital pseudotumor is a rare inflammatory condition affecting the orbit of the eye. It has diverse clinical manifestations. Although its exact etiology remains unknown, it is believed to involve an immune-mediated response. A 42-year-old male presented to the ophthalmology clinic with progressively worsening symptoms in his left eye, including pain, swelling, and blurry vision. He had no history of trauma or recent illness. Initial discomfort had escalated over three weeks. The patient had controlled hypertension but no known allergies. Examination showed eyelid edema, erythema, and mild anterior chamber cell, and flare in the left eye. Magnetic resonance imaging revealed orbital soft tissue enhancement, extraocular muscle thickening, and optic nerve involvement. Laboratory results showed elevated inflammatory markers. A diagnosis of orbital pseudotumor was made. The patient was treated with oral corticosteroids, resulting in symptom improvement and regression of inflammatory changes on follow-up. Orbital pseudotumor is a complex condition with diverse clinical manifestations. Its diagnosis requires a comprehensive approach involving clinical evaluation, imaging studies, and laboratory investigations.
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Maheshwari M, Athiraman H. A Rare Rheumatologic Case of Catastrophic Antiphospholipid Syndrome. Cureus 2023; 15:e41972. [PMID: 37465086 PMCID: PMC10350343 DOI: 10.7759/cureus.41972] [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] [Accepted: 07/16/2023] [Indexed: 07/20/2023] Open
Abstract
A very rare and severe disease catastrophic antiphospholipid syndrome is defined by small vessel occlusions resulting in multi-organ involvement in the presence of antiphospholipid antibodies. This case report presents a case of catastrophic antiphospholipid syndrome in a young female without past medical history.
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Qasemi F, Aini T, Ali W, Dost W, Rasully MQ, Anwari M, Dost W, Zaheer R, Dost R, Talpur AS. The Effectiveness of Ondansetron and Dexamethasone in Preventing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy. Cureus 2023; 15:e37419. [PMID: 37181978 PMCID: PMC10174678 DOI: 10.7759/cureus.37419] [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] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background The current research compared the effectiveness of dexamethasone with ondansetron in terms of the frequency of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Methodology A comparative cross-sectional study was conducted in the Department of Surgery, Civil Hospital, Karachi, Pakistan, between June 2021 and March 2022. All patients aged between 18 and 70 years who were scheduled for elective laparoscopic cholecystectomy under general anesthesia were included in the study. All women who were on antiemetics or cortisone before surgery pregnant, and had hepatic, or renal malfunction were excluded. Group A included patients who were administered 8 mg of dexamethasone intravenously, and group B included patients who were prescribed 4 mg of ondansetron intravenously. Observation of patients was done for any symptoms such as vomiting, nausea, or the need for any antiemetic medication after the surgery. The number of episodes of vomiting and nausea was recorded in the proforma along with the duration of stay in the hospital. Results A total of 259 patients were examined during the study - 129 (49.8%) in the dexamethasone group (group A) and 130 (50.2%) in the ondansetron group (group B). The mean age of group A was 42.56 ± 11.9 years, with a mean weight of 61.4 ± 8.5 kg. The mean age of group B was 41.19 ± 10.8 years, with a mean weight of 62.56 ± 6.3 kg. Upon assessing the effectiveness of each drug in preventing nausea and vomiting, postoperatively, it was found that both drugs were equally effective in preventing nausea in the majority of the patients (73.85% vs. 65.89%; P = 0.162). However, ondansetron was significantly more effective in preventing vomiting in patients than dexamethasone (91.54% vs. 79.07%; P = 0.004). Conclusions This study concluded that the use of either dexamethasone or ondansetron effectively reduces the incidence of postoperative nausea and vomiting. However, ondansetron was significantly more effective in reducing the incidence of vomiting in patients after laparoscopic cholecystectomy than dexamethasone.
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Affiliation(s)
- Farzad Qasemi
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Tahmina Aini
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Wahida Ali
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Wahidullah Dost
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
- General Surgery, Jamhuriat Hospital, Kabul, AFG
| | | | - Maiwand Anwari
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
| | - Wahida Dost
- General Surgery, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Rabia Zaheer
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Raisa Dost
- General Surgery, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, PAK
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Ck A, C A, Nedunchezian B, Srinivasan S, Augustine AT. Multisystem Inflammatory Syndrome in Adults Associated With COVID-19: A Case Series on the Importance of Early Diagnosis and Corticosteroid Therapy in Prognosis. Cureus 2023; 15:e36068. [PMID: 36923015 PMCID: PMC10010151 DOI: 10.7759/cureus.36068] [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] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a rare condition that can occur after an adult has been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It can occur anywhere between two and 12 weeks after the beginning of acute coronavirus disease 2019 (COVID-19) infection and is characterized by extrapulmonary multiorgan failure. It is primarily seen in young and previously healthy individuals. The exact prevalence of MIS-A is unclear. It is likely underdiagnosed due to overlapping symptoms with severe COVID-19 and difficulty in identifying the syndrome without a preceding COVID-19 infection. The pathogenesis of MIS-A is also largely unknown but is likely caused by an immune response that is dysregulated or antibody-mediated. Treatment primarily involves corticosteroids, but severe cases may require intravenous immune globulin (IVIG). The timing of starting corticosteroid therapy is crucial, as delays can result in increased complications and a longer hospital stay.
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Affiliation(s)
- Anees Ck
- Department of General Medicine, Dr. Moopen's Medical College, Wayanad, IND
| | - Arjun C
- Department of General Medicine, Dr. Moopen's Medical College, Wayanad, IND
| | | | - Shuba Srinivasan
- Department of General Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Chikkaballapur, IND
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Lansing L, Wendel SB, Hultcrantz M, Marsk E. Bell's Palsy in Pregnancy and Postpartum: A Retrospective Case-Control Study of 182 Patients. Otolaryngol Head Neck Surg 2023; 168:1025-1033. [PMID: 36939398 DOI: 10.1002/ohn.188] [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: 04/21/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the incidence of Bell's palsy in pregnant and postpartum women. Additionally, to compare facial outcomes in terms of Sunnybrook score following Bell's palsy with regard to corticosteroid treatment and other confounding factors. STUDY DESIGN Retrospective case-control study. SETTING University Hospital, Stockholm, Sweden. METHODS All women with Bell's palsy in pregnancy or postpartum (6 weeks after birth) with a computerized medical chart in the Stockholm Region 2005 to 2015 were included. The total number of births in the region during this period was retrieved from the Swedish Medical Birth Register. Nonpregnant age-matched women with Bell's palsy served as controls. Characteristics, medication, and Sunnybrook scores were collected. Risk factors for incomplete recovery (Sunnybrook score <96) at 3 months were calculated by logistic regression. RESULTS In total, 182 pregnant and postpartum women with Bell's palsy were identified. The estimated incidence among pregnant and postpartum women was 60.5/100,000 person-years. The mean Sunnybrook score at 3 months was 74 among pregnant and postpartum women and 83 for controls (p = .002). At 12 months, Sunnybrook score was 81 and 89, respectively (p = .017). Only one-third of the pregnant women received corticosteroid treatment. CONCLUSION The incidence of Bell's palsy in pregnancy and postpartum was 60.5 per 100,000 women and year in the Stockholm Region. Sunnybrook score was poorer in pregnant women compared with postpartum and nonpregnant women throughout. Corticosteroid treatment had little effect on any patients, however, only one-third of the pregnant women received this treatment.
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Affiliation(s)
- Lovisa Lansing
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Sophia B Wendel
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Danderyd Hospital, Stockholm, Sweden
| | | | - Elin Marsk
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Karolinska Institutet, Stockholm, Sweden
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Muacevic A, Adler JR, Abugharbyeh A, Khader Y, Altorok N. A String of Pearls: Linear Immunoglobulin A (IgA) Bullous Dermatosis in the Setting of Imipramine Use and Newly Diagnosed Ulcerative Colitis. Cureus 2023; 15:e33448. [PMID: 36751220 PMCID: PMC9897714 DOI: 10.7759/cureus.33448] [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] [Accepted: 01/06/2023] [Indexed: 01/07/2023] Open
Abstract
Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is an autoimmune disease affecting children or adults that leads to subepithelial vesiculobullous lesions on the skin and/or mucosa. Due to the histologic and clinical appearance of the disease with tense and pruritic blisters, direct immunofluorescence is required for diagnosis, which features the characteristic linear deposition of IgA autoantibodies along the basement membrane zone. LABD can be idiopathic, drug-induced, or associated with a systemic disease such as inflammatory bowel disease. Many drugs have been implicated, such as antibiotics, anti-hypertensives, anti-epileptics, analgesics, and immunosuppressive medications. Treatment of LABD centers on discontinuation of the offending drug, if applicable, as well as pharmacotherapy with dapsone as the first-line treatment. Adjunctive therapy with sulphonamides, systemic corticosteroids, cyclosporine, colchicine, intravenous immunoglobulins, tetracyclines, erythromycin, and dicloxacillin has also shown benefits. We report the case of a young adult patient who developed LABD with a background of recent initiation of treatment with imipramine and newly diagnosed ulcerative colitis.
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Ghasemi S, Dashti M, Fahimipour A, Daryakenari G, Mirzaei F, Akbari F, Khurshid Z. Onset of Mucormycosis in Patients with COVID-19: A Systematic Review on Patients' Characteristics. Eur J Dent 2022; 17:24-38. [PMID: 36049777 PMCID: PMC9949939 DOI: 10.1055/s-0042-1751003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Mucormycosis has a significant impact on patients' standard of living and, therefore, a high clinical suspicion, prediagnosis, and rapid treatment are critical in easing patients' suffering and fast recovery. Our focus is to conduct an organized review based on various variables on the patients' characteristics having mucormycosis in severe novel coronavirus disease 2019 (COVID-19). We examined Embase, PubMed-Medline, LitCovid, Web of Science, Scopus, and the reference lists of included case reports up to September 20, 2021, using the Medical Subject Heading (MeSH) phrases and other keywords related to this topic. Subsequently, we investigated associated comorbidities, patient characteristics, position of mucormycosis, steroids use, body involvements, and outcomes. Overall, 77 studies were conducted and among these, 72 studies mentioned that the patients' age to be 48.13±14.33 (mean±standard deviation [SD]) years. Diabetes mellitus (DM) was reported in 77.9% (n=60) of cases. Studies showed that central nervous system (CNS) and bone involvement were reported in 62.3 (n=48) and 53.2% (n=41), respectively. More fatalities were observed in patients with mucormycosis with the active form of COVID-19. Also, men infected with mucormycosis significantly affected by COVID-19. In the end, mortality was higher in males with mucormycosis. As a result, a solid investigation into the root cause of mucormycosis, especially in COVID-19, should be included in the study plan. If the patient is COVID-19-positive and immunosuppressed, this opportunistic pathogen diagnostic test should not be overlooked.
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Affiliation(s)
- Shohreh Ghasemi
- Department of Oral and Maxillofacial Surgery, The Dental College of Georgia at Augusta University, Augusta, GA, USA,Department of Craniofacial Reconstruction and Trauma Queen Marry, University of London, London, UK
| | - Mahmood Dashti
- Department of Orthodontics, Georgia School of Orthodontics, Atlanta, Georgia, USA,Address for correspondence Mahmood Dashti, DDS Department of Orthodontics, Georgia School of OrthodonticsAtlanta, GeorgiaUSA
| | - Amir Fahimipour
- Department of Oral Surgery, Medicine and Diagnostics, School of Dentistry, Faculty of Medicine and Health, Westmead Centre for Oral Health, The University of Sydney, Sydney, Australia
| | - Ghazaleh Daryakenari
- Department of Oral and Maxillofacial Surgery, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Mirzaei
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Akbari
- Department of Dentistry, Mazandaran University of Medical Science, Mazandaran, Iran
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
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Tanaka H, Anno T, Takenouchi H, Koyama K, Kaneto H, Oga T, Monobe Y, Tomoda K. IgG4-related lung disease with multifocal pulmonary consolidations near the pleura: A case report. Medicine (Baltimore) 2022; 101:e30285. [PMID: 36042602 PMCID: PMC9410645 DOI: 10.1097/md.0000000000030285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a systemic immune-mediated condition that can cause fibroinflammatory lesions in multiple organs. Approximately 35% of IgG4-RD patients have some symptoms in the chest and IgG4-related lung disease (IgG4-RLD) is observed in about 10% of IgG4-RD cases. In addition, it is thought that glucocorticoid therapy is effective for IgG4-RD and IgG4-RLD. It is difficult to diagnose IgG4-RLD complicated with another lung disease. PATIENT CONCERNS An 85-year-old Japanese man was hospitalized due to pulmonary consolidations just below the pleura in chest computed tomography while being treated with antibiotics. Previously, an upper lobectomy of the right lung was performed for an upper lung mucinous adenocarcinoma, and he was diagnosed with chronic obstructive pulmonary disease. Although he took antibiotics before admission, C-reactive protein levels were elevated. DIAGNOSIS IgG4 levels were also elevated (IgG4; 733 mg/dL), and lung biopsy histology showed an abundance of IgG4-positive plasma cell infiltration; about 40% of the affected area was occupied by such infiltration. Based on such findings, we finally diagnosed him as IgG4-RLD. INTERVENTIONS We administered 20 mg/d prednisolone. OUTCOMES About 2 weeks after administration of prednisolone by intravenous injection, his multifocal pulmonary consolidations just below the pleura were markedly improved and his pulmonary symptoms disappeared. Four weeks after glucocorticoid therapy, IgG4 levels decreased from 831 mg/dL (peak) to 547 mg/dL. LESSONS We should consider IgG4-RLD, a rare disease, when lesions are detected as pulmonary consolidations near the pleura and are unresponsive to antibiotic therapy. Glucocorticoid therapy, however, is very effective for such IgG4-RLD.
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Affiliation(s)
- Hitomi Tanaka
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
- *Correspondence: Takatoshi Anno, Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama 700-8505, Japan (e-mail: )
| | - Haruka Takenouchi
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Katsumasa Koyama
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Yasumasa Monobe
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Koichi Tomoda
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
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Li M, Bai X, Xu K, Wu X, Guo T, Jiang Q, Wang Q, Zhang S, Yang Y, Feng Y, Yang A. Peripancreatic vascular involvement in patients with type 1 autoimmune pancreatitis. Hepatobiliary Surg Nutr 2022; 11:355-362. [PMID: 35693390 PMCID: PMC9186208 DOI: 10.21037/hbsn-21-82] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/13/2021] [Indexed: 08/30/2023]
Abstract
BACKGROUND Type 1 autoimmune pancreatitis (AIP) is the pancreatic manifestation of IgG4-related disease. However, this benign disease can result in the peripancreatic vascular involvement (PVI) on occasion, which increases the difficulty of diagnosis and treatment of this clinical entity as well as for differentiating it from pancreatic malignancies. METHODS We retrospectively reviewed the information on demographics, clinical presentation, laboratory, imaging and endoscopic findings of 101 hospitalized patients with type 1 AIP treated in our department. All the patients were divided into non-PVI and PVI groups according to the first hospitalized medical data. Univariate and multivariate analyses were performed to analyse the potential predictive parameter(s) of PVI in AIP patients. RESULTS Among the 101 type 1 AIP patients, 52 (51.5%) exhibited PVI, with a male/female ratio 5.5:1. Their average age was 58.37±8.68 years old. Univariate analysis revealed that the location of pancreatitis lesions, including the pancreatic tail (P=0.010), the presence of splenomegaly (P=0.001) and the white blood cell (WBC) number in peripheral blood (P=0.020), were significantly associated with PVI. The location of pancreatitis lesions, including the pancreatic tail (P=0.023), and the presence of splenomegaly (P=0.010) were found to be independent predictors of the development of PVI by a multivariable regression analysis. A total of 18 out of 25 patients in PVI group who underwent corticosteroid treatment and no less than 6 months radiological follow-up showed improvement in vascular lesions, and no case exhibited exacerbation of PVI lesions during follow-up. Of 36 patients in non-PVI group who were followed up for no less than 6 months, only one case exhibited PVI. CONCLUSIONS This retrospective study demonstrated that type 1 AIP was associated with a high proportion of PVI. Pancreatic tail involvement and splenomegaly may predict the PVI in type 1 AIP. PVI lesions are reversible in a subset of patients.
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Affiliation(s)
- Meizi 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, China
| | - Xiaoyin 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, China
| | - Kai Xu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 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, 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, China
| | - Qingwei Jiang
- 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, China
| | - Qiang Wang
- 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, China
| | - Shengyu 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, China
| | - Yingyun 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, China
| | - Yunlu 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, China
| | - Aiming 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, China
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15
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Sozel H, Avsar E. TAFRO Syndrome Treated Effectively with Corticosteroids: A Case Report and Review of the Literature. Indian J Nephrol 2022; 32:168-171. [PMID: 35603117 PMCID: PMC9121716 DOI: 10.4103/ijn.ijn_520_20] [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: 11/22/2020] [Revised: 07/04/2021] [Accepted: 08/20/2021] [Indexed: 12/01/2022] Open
Abstract
TAFRO (thrombocytopenia, anasarca, fever, renal dysfunction, and organomegaly) syndrome is a subtype of Castleman's disease and has been described in recent years. In this case, a middle-aged woman was admitted to our clinic with a 2-week history of fever, weakness, cough, shortness of breath and edema all over the body. Physical examination on admission revealed pale conjunctiva, tachycardia, coarse crackles over left lower lung fields, pitting edema in the extremities, tense ascites, axillar, and bilateral inguinal lymph nodes measuring less than 2 cm. Inguinal lymph node excisional biopsy was compatible with TAFRO syndrome. We started corticosteroid treatment. The patient's general condition and physical findings improved. Laboratory values returned to normal limits. This case will help understand the clinical course and treatment strategy in TAFRO syndrome.
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Affiliation(s)
- Hasan Sozel
- Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Esin Avsar
- Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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16
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Sikjaer MG, Hilberg O, Ibsen R, Løkke A. Sarcoidosis-related mortality and the impact of corticosteroid treatment: A population-based cohort study. Respirology 2022; 27:217-225. [PMID: 35016255 DOI: 10.1111/resp.14202] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/07/2021] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The aims of this national cohort study were: (1) to evaluate mortality in patients with sarcoidosis, stratified by gender, age and systemic corticosteroid (SC) treatment and (2) to characterize comorbidities in this cohort. METHODS Patients diagnosed with sarcoidosis from 2001 to 2015 were identified in the Danish National Patient Registry. Subgroup analyses were performed on cases treated/not treated with SCs within 3 years of the initial sarcoidosis diagnosis (as a proxy for disease severity). The Deyo-Charlson Comorbidity Index was used to evaluate pre-diagnostic comorbidity. Cases were matched (1:4) with controls from the general population. RESULTS We identified 9795 cases with sarcoidosis. Mean age was 46.5 ± 15.9 years and 55% were male. The adjusted hazard ratio (HR) for death was 1.48 (95% CI 1.31-1.68). Mortality was higher than for controls in all age groups and in both genders. HR for death for cases treated with SCs was 1.78 (95% CI 1.49-2.13) and, for cases receiving no treatment, 1.24 (95% CI 1.04-1.48). Sarcoidosis was the most commonly registered cause of death (13.3%). CONCLUSION Patients with sarcoidosis have an increased mortality compared with matched controls. Mortality is particularly high in patients treated with SCs.
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Affiliation(s)
- Melina Gade Sikjaer
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
| | | | - Anders Løkke
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
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17
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Roy Choudhury A, Roy Choudhury A. Leukocytoclastic Vasculitis in a Patient With Rheumatoid Arthritis. Cureus 2021; 13:e17124. [PMID: 34548963 PMCID: PMC8437013 DOI: 10.7759/cureus.17124] [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] [Accepted: 08/12/2021] [Indexed: 11/15/2022] Open
Abstract
Leukocytoclastic vasculitis is a small vessel vasculitis that is usually confined to the skin with rare extracutaneous manifestation. While this condition can be idiopathic, it has been linked with systemic autoimmune conditions, malignancies, infections, and drugs. In this paper, we present a case of a patient who presented with leukocytoclastic vasculitis many years after her diagnosis of rheumatoid arthritis. It is important that physicians investigate leukocytoclastic vasculitis, as the condition, while often idiopathic, can be a presentation of something more sinister such as malignancy or systemic autoimmune condition.
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18
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Stylemans D, Van Cauwelaert S, D'Haenens A, Slabbynck H. COVID-19-Associated Eosinopenia in a Patient With Chronic Eosinophilia Due to Chronic Strongyloidiasis. Infect Dis Clin Pract (Baltim Md) 2021; 29:e305-6. [PMID: 34539164 DOI: 10.1097/IPC.0000000000000991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/15/2022]
Abstract
Eosinopenia was frequently encountered in patients with coronavirus disease 2019 (COVID-19). We describe a case of a 59-year-old man who was treated with high-dose corticosteroids and anti-interleukin 1 receptor antagonist therapy because of severe acute respiratory distress syndrome due to a so-called cytokine storm in COVID-19. He had chronic eosinophilia for many years due to an unknown Strongyloides stercoralis infection, proven by serology and a positive polymerase chain reaction test on a stool sample. COVID-19 led to a complete resolution of eosinophilia, even before immunosuppressive treatment was started. Eosinophilia returned after recovery from COVID-19 and started to decline under treatment with ivermectin. Our case confirms previous reports of eosinopenia in COVID-19, as it appears even in patients with chronic eosinophilia. Presence of eosinophilia should prompt screening for strongyloidiasis in all patients eligible for immunosuppressive therapy because of the risk of Strongyloides hyperinfection syndrome, especially if this treatment is empirical.
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19
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Zborowski J, Kida D, Szarwaryn A, Nartowski K, Rak P, Jurczyszyn K, Konopka T. A Comparison of Clinical Efficiency of Photodynamic Therapy and Topical Corticosteroid in Treatment of Oral Lichen Planus: A Split-Mouth Randomised Controlled Study. J Clin Med 2021; 10:jcm10163673. [PMID: 34441967 PMCID: PMC8397092 DOI: 10.3390/jcm10163673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/26/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 01/28/2023] Open
Abstract
Background: The aim of the study was to compare the effectiveness of photodynamic therapy (PDT) to steroid therapy in the treatment of oral lichen planus (OLP). Due to the lack of commercially available drug carriers, innovative proprietary solutions were used for both the photosensitiser and the steroid carrier—in the first case to shorten and in the second to extend the contact of the active substance with the mucosa. Methods: A prospective, randomised, single-blind, 12-week full contralateral split-mouth clinical trial of 30 patients with bilateral oral lichen planus was conducted. The prepared matrices were incorporated with active substances methylene blue 5% and 0,05% triamcinolone. The size of lesions, Thongprasom, ABISIS, and VAS scale were evaluated. Results: Relatively high rates of complete remission of lichen were demonstrated: immediately after treatment, 33.3% with PDT and 22.2% with triamcinolone (TA), and after 3 months, 54.2% with PDT and 62.9% with TA. After 3 months of treatment, a reduction in the area of evaluated lesions of 52.7% for PDT and 41.7% for TA was achieved. Conclusion: In situations of topical or general contraindications to oral corticosteroids, resistance to them, or the need for repeated treatment in a short period of time, PDT appears to be a very promising treatment option.
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Affiliation(s)
- Jacek Zborowski
- Department of Periodontology, Wroclaw Medical University, ul. Krakowska 26, 50-425 Wroclaw, Poland;
- Correspondence:
| | - Dorota Kida
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland; (D.K.); (A.S.); (K.N.); (P.R.)
| | - Aleksandra Szarwaryn
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland; (D.K.); (A.S.); (K.N.); (P.R.)
| | - Karol Nartowski
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland; (D.K.); (A.S.); (K.N.); (P.R.)
| | - Patrycja Rak
- Department of Drug Form Technology, Wroclaw Medical University, Borowska 211 A, 50-556 Wroclaw, Poland; (D.K.); (A.S.); (K.N.); (P.R.)
| | - Kamil Jurczyszyn
- Department of Dental Surgery, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland;
| | - Tomasz Konopka
- Department of Periodontology, Wroclaw Medical University, ul. Krakowska 26, 50-425 Wroclaw, Poland;
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20
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Ezeokoli OT, Gcilitshana O, Pohl CH. Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants. J Fungi (Basel) 2021; 7:545. [PMID: 34356924 PMCID: PMC8304654 DOI: 10.3390/jof7070545] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 05/24/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
Severe cases of coronavirus disease 2019 (COVID-19) managed in the intensive care unit are prone to complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in hospitalized COVID-19 patients may exacerbate COVID-19 disease severity, hamper treatment effectiveness and increase mortality. Here, we reiterate the role of fungal co-infections in exacerbating COVID-19 disease severity as well as highlight emerging trends related to fungal disease burden in COVID-19 patients. Furthermore, we provide perspectives on the risk factors for fungal co-infections in hospitalized COVID-19 patients and highlight the potential role of prolonged immunomodulatory treatments in driving fungal co-infections, including COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated candidiasis (CAC) and mucormycosis. We reiterate the need for early diagnosis of suspected COVID-19-associated systemic mycoses in the hospital setting.
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Affiliation(s)
| | | | - Carolina H. Pohl
- Yeast Research Group, Department of Microbiology and Biochemistry, University of the Free State, Bloemfontein 9300, South Africa or (O.T.E.); (O.G.)
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21
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Docu Axelerad A, Stroe AZ, Gogu AE, Docu Axelerad D. Assessing the values of circulating immune complexes in multiple sclerosis patients following immunomodulator or corticosteroid treatment. Exp Ther Med 2021; 21:542. [PMID: 33815615 DOI: 10.3892/etm.2021.9974] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/04/2021] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis is defined as an immune-mediated disease that affects the central nervous system, and also is characterized by the presence of immune cells and mediators which contribute to the subsidiary neuroinflammation associated with multiple sclerosis. Throughout the evolution of multiple sclerosis, it has been observed that circulating immune complexes (CICs) have higher values in these patients, especially in the acute phase of the disease. Thus, the aim of the present study was to observe, if in acute attack, relapsing-remitting multiple sclerosis patients still present high values of CICs after treatment with glatiramer and prednisone. We divided 70 patients with multiple sclerosis with high values of CICs into two treatment groups, one treated with glatiramer (Copaxone) (immunomodulatory treatment) and the other with prednisone (corticosteroid treatment). After three months of treatment, we assessed the levels of CICs of the two multiple sclerosis groups and we observed that the patients that followed the immunomodulatory treatment had lower values of CICs than the group that followed the corticosteroid treatment. In addition, another observation established was that the glatiramer treatment group had higher levels of vitamin D in the serum than the prednisone group of multiple sclerosis patients. To conclude, better outcomes, from the point of view of the results obtained from the comparative analysis of the values of CICs and vitamin D, were demonstrated by following immunomodulatory treatment.
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Affiliation(s)
- Any Docu Axelerad
- Department of Neurology, Faculty of General Medicine, 'Ovidius' University of Constanta, 900470 Constanta, Romania
| | - Alina Zorina Stroe
- Department of Neurology, Faculty of General Medicine, 'Ovidius' University of Constanta, 900470 Constanta, Romania
| | - Anca Elena Gogu
- Department of Neurology, Faculty of General Medicine, Victor Babeș University of Medicine and Pharmacy Timișoara, 300041 Timisoara, Romania
| | - Daniel Docu Axelerad
- Department of Sports, Faculty of Physical Education and Sports, 'Ovidius' University of Constanta, 900470 Constanta, Romania
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22
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Merlini L, Cecconi I, Parmeggiani A, Cordelli DM, Dormi A. Quadriceps muscle strength in Duchenne muscular dystrophy and effect of corticosteroid treatment. Acta Myol 2021; 39:200-206. [PMID: 33458575 PMCID: PMC7783426 DOI: 10.36185/2532-1900-023] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022]
Abstract
Objectives In Duchenne muscular dystrophy, quadriceps weakness is recognized as a key factor in gait deterioration. The objective of this work was three-fold: first, to document the strength of the quadriceps in corticosteroid-naïve DMD boys; second, to measure the effect of corticosteroids on quadriceps strength; and third, to evaluate the correlation between baseline quadriceps strength and the age when starting corticosteroids with the loss of ambulation. Methods Quadriceps muscle strength using hand-held dynamometry was measured in 12 ambulant DMD boys who had never taken corticosteroids and during corticosteroid treatment until the loss of ambulation. Results Baseline quadriceps muscle strength at 6 years of age was 28% that of normal children of the same age; it decreased to 15% at 8 years and to 6% at 10 years. The increase in quadriceps muscle strength obtained after 1 year of corticosteroid treatment had a strong direct correlation with the baseline strength (R = 0.96). With corticosteroid treatment, the age of ambulation loss showed a very strong direct relationship (R = 0.92) with baseline quadriceps muscle strength but only a very weak inverse relationship (R = -0.73) with the age of starting treatment. Age of loss of ambulation was 10.3 ± 0.5 vs 19.1 ± 4.7 (P < 0.05) in children with baseline quadriceps muscle strength less than or greater than 40 N, respectively. Conclusions Corticosteroid-naïve DMD boys have a quantifiable severe progressive quadriceps weakness. This long-term study, for the first time, shows that both of the positive effects obtained with CS treatment, i.e. increasing quadriceps strength and delaying the loss of ambulation, have a strong and direct correlation with baseline quadriceps muscle strength. As such, hand-held dynamometry may be a useful tool in the routine physical examination and during clinical trial assessment.
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Affiliation(s)
- Luciano Merlini
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Italy
| | - Ilaria Cecconi
- Child Neurology and Psychiatry Unit, S. Orsola Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
| | - Antonia Parmeggiani
- Child Neurology and Psychiatry Unit, S. Orsola Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
| | - Duccio Maria Cordelli
- Child Neurology and Psychiatry Unit, S. Orsola Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
| | - Ada Dormi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
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Abstract
Juvenile hyaline fibromatosis (JHF) is an extremely rare autosomal recessive disease with less than a hundred cases reported worldwide and is more prevalent in the middle east due to higher rates of interfamilial marriages. Manifestations can be debilitating, and patients typically present with decreased joint mobility, gingival hypertrophy, nodular skin lesions, papulonodular skin lesions and osteolytic bone disease. JHF is a relatively mild presentation of the hyaline fibromatosis syndrome (HFS) family of diseases, with Infantile hyaline fibromatosis (IHF) being the more lethal form. A mutation of the (CMG2) gene on chromosome 4q21 is hypothesized to result in the abnormal deposition of amorphous hyaline substance in different body tissues. There are few studies that evaluated the role of surgery, corticosteroid therapy and physiotherapy or a combination of these modalities in providing symptomatic relief. In our paper, we present a literature review and case presentation for 28-year-old women with JHF, treated with surgical excision and corticosteroid therapy. Early surgical treatment provided instantaneous and more sustainable results, while corticosteroids can be used as alternative modalities with temporary outcomes.
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Affiliation(s)
- Omar Braizat
- Department of Plastic Surgery, Hamad Medical Corporation, Doha, QAT
| | - Saif Badran
- Department of Plastic Surgery, Hamad Medical Corporation, Doha, QAT.,Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, QAT
| | - Atalla Hammouda
- Department of Plastic Surgery, Hamad Medical Corporation, Doha, QAT
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24
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Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect 2020; 81:e13-e20. [PMID: 32283144 PMCID: PMC7195158 DOI: 10.1016/j.jinf.2020.03.062] [Citation(s) in RCA: 226] [Impact Index Per Article: 56.5] [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: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES An outbreak of novel coronavirus in 2019 threatens the health of people, and there is no proven pharmacological treatment. Although corticosteroids were widely used during outbreaks of severe acute respiratory syndrome and Middle East respiratory syndrome, their efficacy remainedhighly controversial. We aimed to further evaluate the influence of corticosteroids on patients with coronavirus infection. METHODS We conducted a comprehensive search of literature published in PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI) from January 1, 2002 to March 15, 2020. All statistical analyses in this study were performed on stata14.0. RESULTS A total of 5270 patients from 15 studies were included in this meta-analysis. The result indicated that critical patients were more likely to require corticosteroids therapy (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.28-1.90, P<0.001). However, corticosteroid treatment was associated with higher mortality (RR = 2.11, 95%CI = 1.13-3.94, P = 0.019), longer length of stay (weighted mean difference [WMD] = 6.31, 95%CI = 5.26-7.37, P<0.001), a higher rate of bacterial infection (RR = 2.08, 95%CI = 1.54-2.81, P<0.001), and hypokalemia (RR = 2.21, 95%CI = 1.07-4.55, P = 0.032) but not hyperglycemia (RR = 1.37, 95%CI=0.68-2.76, P = 0.376) or hypocalcemia (RR = 1.35, 95%CI = 0.77-2.37, P = 0.302). CONCLUSIONS Patients with severe conditions are more likely to require corticosteroids. Corticosteroid use is associated with increased mortality in patients with coronavirus pneumonia.
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Affiliation(s)
- Zhenwei Yang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
| | - Jialong Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
| | - Yunjiao Zhou
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
| | - Xixian Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
| | - Jing Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China.
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25
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Mohammad Razali A, Mohd Zain A, Bt Wan Abdul Halim WH, Md Din N. Good Visual Outcome Following Corticosteroid Treatment for Compressive Optic Neuropathy Secondary to Sinonasal Carcinoma. Cureus 2020; 12:e7732. [PMID: 32440379 PMCID: PMC7237059 DOI: 10.7759/cureus.7732] [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] [Indexed: 11/13/2022] Open
Abstract
Most patients with sinonasal carcinoma present to the otorhinolaryngologist with nasal symptoms. It is however uncommon for them to present with acute visual loss at first presentation. We report a case of compressive optic neuropathy secondary to sinonasal carcinoma, which presented acutely with right eye blurring of vision upon waking up. Computed tomography (CT) of the brain and orbit with contrast showed a locally invasive nasopharyngeal mass extending into the right orbit and cranial fossa. Histopathological examination revealed squamous cell sinonasal carcinoma. Her visual acuity improved with a three-day course of pulsed intravenous methylprednisolone 1 g per day, followed by a gradual tapering dose of oral prednisolone (1 mg/kg/day).
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Affiliation(s)
| | - Ayesha Mohd Zain
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | | | - Norshamsiah Md Din
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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26
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Amr NH, Baioumi AY, Serour MN, Khalifa A, Shaker NM. Cognitive functions in children with congenital adrenal hyperplasia. Arch Endocrinol Metab 2019; 63:113-120. [PMID: 31038592 PMCID: PMC10522139 DOI: 10.20945/2359-3997000000125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/12/2017] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE There is controversy regarding cognitive function in patients with congenital adrenal hyperplasia (CAH). This study is aimed at the assessment of cognitive functions in children with CAH, and their relation to hydrocortisone (HC) therapy and testosterone levels. SUBJECTS AND METHODS Thirty children with CAH due to 21 hydroxylase deficiency were compared with twenty age- and sex-matched healthy controls. HC daily and cumulative doses were calculated, the socioeconomic standard was assessed, and free testosterone was measured. Cognitive function assessment was performed using the Wechsler Intelligence Scale - Revised for Children and Adults (WISC), the Benton Visual Retention Test, and the Wisconsin Card Sorting Test (WCST). RESULTS The mean age (SD) of patients was 10.22 (3.17) years [11 males (36.7%), 19 females (63.3%)]. Mean (SD) HC dose was 15.78 (4.36) mg/m 2 /day. Mean (SD) cumulative HC dose 44,689. 9 (26,892.02) mg. Patients had significantly lower scores in all domains of the WISC test, performed significantly worse in some components of the Benton Visual Retention Test, as well as in the Wisconsin Card Sorting Test. There was no significant difference in cognitive performance when patients were subdivided according to daily HC dose (< 10, 10 - 15, > 15 mg/m 2 /day). A positive correlation existed between cumulative HC dose and worse results of the Benton test. No correlation existed between free testosterone and any of the three tests. CONCLUSION Patients with CAH are at risk of some cognitive impairment. Hydrocortisone therapy may be implicated. This study highlights the need to assess cognitive functions in CAH.
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Affiliation(s)
- Nermine Hussein Amr
- Department of PaediatricsAin Shams UniversityCairoEgyptDepartment of Paediatrics, Ain Shams University, Cairo, Egypt
| | - Alaa Youssef Baioumi
- Department of PaediatricsAin Shams UniversityCairoEgyptDepartment of Paediatrics, Ain Shams University, Cairo, Egypt
- Department of PaediatricsAin Shams UniversityCairoEgyptDepartment of Paediatrics, Ain Shams University, Cairo, Egypt.
- Kent, Surrey and Sussex, Health EducationEnglandUKKent, Surrey and Sussex, Health EducationEngland, UK
| | - Mohamed Nagy Serour
- Department of PaediatricsAin Shams UniversityCairoEgyptDepartment of Paediatrics, Ain Shams University, Cairo, Egypt
| | - Abdelgawad Khalifa
- Institute of PsychiatryAin Shams UniversityCairoEgyptInstitute of Psychiatry, Ain Shams University, Cairo, Egypt
| | - Nermine Mahmoud Shaker
- Department of PsychiatryAin Shams UniversityCairoEgyptDepartment of Psychiatry, Ain Shams University, Cairo, Egypt
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Yamamoto K, Itoi T, Sofuni A, Tsuchiya T, Tsuji S, Tanaka R, Tonozuka R, Honjo M, Mukai S, Kamada K, Fujita M, Asai Y, Matsunami Y, Nagakawa Y. The Role of Endoscopic Ultrasound-guided Drainage for Autoimmune Pancreatitis-associated Pancreatic Cysts: A Report of Five Cases and a Literature Review. Intern Med 2018; 57:1523-1531. [PMID: 29434161 PMCID: PMC6028677 DOI: 10.2169/internalmedicine.9779-17] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/26/2017] [Indexed: 12/29/2022] Open
Abstract
Objective Autoimmune pancreatitis (AIP) has been recognized as a benign disease, which that shows a prompt response to corticosteroid treatment (CST). It was previously believed to not be associated with cyst formation; however, a few cases of AIP-associated pancreatic cyst (PC) have been reported. Some cases were reported to have been effectively treated by CST, while others were refractory to CST. Many of the patients received interventional treatment. Until now, there has been no consensus on the therapeutic strategies for AIP-associated PC. The aim of the present study is to describe a therapeutic strategy for this condition. Methods We conducted a retrospective study of 5 cases of AIP-associated PC that were treated by endoscopic ultrasonography-guided pancreatic fluid collection drainage (ESPD) or CST at Tokyo Medical University Hospital between March 2012 and October 2016, analyzed the therapeutic outcomes, and performed a literature review. Results The initial treatments included CST (n=2) and ESPD (n=3). All of the PCs disappeared after treatment In 1 of the patients who received CST case and 3 of the patients who received ESPD; however, the PC did not disappear in one of the patients who received CST (corticosteroid maintenance therapy), even after the dose of corticosteroids was increased; ESPD was eventually performed and the PC disappeared. There were no procedure-related complaints. Conclusion We propose that CST be administered as the first-line treatment for AIP-associated PC, particularly in cases of PC without a history of CST. However, ESPD can be applied to treat cases of corticosteroid refractory PC.
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Affiliation(s)
- Kenjiro Yamamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Shujiro Tsuji
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Mitsuyoshi Honjo
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Kentaro Kamada
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Mitsuru Fujita
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Yasutsugu Asai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Yukitoshi Matsunami
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
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Vry J, Gramsch K, Rodger S, Thompson R, Steffensen BF, Rahbek J, Doerken S, Tassoni A, Beytía MDLA, Guergueltcheva V, Chamova T, Tournev I, Kostera-Pruszczyk A, Kaminska A, Lusakowska A, Mrazova L, Pavlovska L, Strenkova J, Vondráček P, Garami M, Karcagi V, Herczegfalvi Á, Bushby K, Lochmüller H, Kirschner J. European Cross-Sectional Survey of Current Care Practices for Duchenne Muscular Dystrophy Reveals Regional and Age-Dependent Differences. J Neuromuscul Dis 2018; 3:517-527. [PMID: 27911335 PMCID: PMC5240601 DOI: 10.3233/jnd-160185] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Indexed: 01/16/2023]
Abstract
Background: Publication of comprehensive clinical care guidelines for Duchenne muscular dystrophy (DMD) in 2010 was a milestone for DMD patient management. Our CARE-NMD survey investigates the neuromuscular, medical, and psychosocial care of DMD patients in Europe, and compares it to the guidelines. Methods: A cross-sectional survey of 1677 patients contacted via the TREAT-NMD patient registries was conducted using self-report questionnaires in seven European countries. Results: Survey respondents were 861 children and 201 adults. Data describe a European DMD population with mean age of 13.0 years (range 0.8–46.2) of whom 53% had lost ambulation (at 10.3 years of age, median). Corticosteroid medication raised the median age for ambulatory loss from 10.1 years in patients never medicated to 11.4 years in patients who received steroids (p < 0.0001). The majority of patients reported receiving care in line with guidelines, although we identified significant differences between countries and important shortcomings in prevention and treatment. Summarised, 35% of patients aged≥ nine years received no corticosteroid medication, 24% of all patients received no regular physiotherapy, echocardiograms were not performed regularly in 22% of patients, pulmonary function was not regularly assessed in 71% of non-ambulatory patients. Patients with regular follow-up by neuromuscular specialists were more likely to receive care according to guidelines, were better satisfied, and experienced shorter unplanned hospitalization periods.
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Affiliation(s)
- Julia Vry
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - Kathrin Gramsch
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - Sunil Rodger
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | - Rachel Thompson
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | | | - Jes Rahbek
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Sam Doerken
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Adrian Tassoni
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - María de Los Angeles Beytía
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - Velina Guergueltcheva
- Medical University of Sofia, Department of Neurology, University Hospital Sofiamed and Bulgarian Neuromuscular Disorders Society, Sofia, Bulgaria
| | - Teodora Chamova
- Medical University of Sofia, Department of Neurology, University Hospital Alexandrovska and Bulgarian Neuromuscular Disorders Society, Sofia, Bulgaria
| | - Ivailo Tournev
- Medical University of Sofia, Department of Neurology, University Hospital Alexandrovska and Bulgarian Neuromuscular Disorders Society, Sofia, Bulgaria
| | | | - Anna Kaminska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Lusakowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Lenka Mrazova
- Department of Paediatric Neurology, University Hospital in Brno and Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Lenka Pavlovska
- Institute of Biostatistics and Analyses, Masaryk University Brno, Czech Republic
| | - Jana Strenkova
- Institute of Biostatistics and Analyses, Masaryk University Brno, Czech Republic
| | - Petr Vondráček
- Department of Paediatric Neurology, University Hospital in Brno and Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Marta Garami
- Department of Molecular Genetics and Diagnostics, National Institute of Environmental Health, Budapest, Hungary
| | - Veronika Karcagi
- Department of Molecular Genetics and Diagnostics, National Institute of Environmental Health, Budapest, Hungary
| | | | - Katherine Bushby
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | - Hanns Lochmüller
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
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Otani K, Seo Y, Ogawa K. Radiation-Induced Organizing Pneumonia: A Characteristic Disease that Requires Symptom-Oriented Management. Int J Mol Sci 2017; 18:E281. [PMID: 28134830 DOI: 10.3390/ijms18020281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 11/30/2016] [Accepted: 01/24/2017] [Indexed: 11/17/2022] Open
Abstract
Radiation-induced organizing pneumonia (RIOP) is an inflammatory lung disease that is occasionally observed after irradiation to the breast. It is a type of secondary organizing pneumonia that is characterized by infiltrates outside the irradiated volume that are sometimes migratory. Corticosteroids work acutely, but relapse of pneumonia is often experienced. Management of RIOP should simply be symptom-oriented, and the use of corticosteroids should be limited to severe symptoms from the perspective not only of cost-effectiveness but also of cancer treatment. Once steroid therapy is started, it takes a long time to stop it due to frequent relapses. We review RIOP from the perspective of its diagnosis, epidemiology, molecular pathogenesis, and patient management.
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Maas A, Braun KPJ, Geleijns K, Jansen FE, van Royen-Kerkhof A. Risks and Benefits of Rituximab in the Treatment of Hashimoto Encephalopathy in Children: Two Case Reports and a Mini Review. Pediatr Neurol 2017; 66:28-31. [PMID: 27789116 DOI: 10.1016/j.pediatrneurol.2016.09.002] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 01/18/2023]
Abstract
UNLABELLED Hashimoto encephalopathy is a rare condition, characterized by the association of encephalopathy with a variety of neurological symptoms and autoantibodies to the thyroid gland. Its etiology is unknown, and symptoms are usually treated with immune suppressive therapy, e.g., high doses of corticosteroids. METHODS AND RESULTS Here, we report the long-term outcome in two steroid-refractory adolescents with Hashimoto encephalopathy who were treated with rituximab, a monoclonal antibody directed against CD20. In addition, we reviewed the literature regarding treatment strategies in Hashimoto encephalopathy. CONCLUSIONS Anti-B-cell therapy can be of value in the treatment of Hashimoto encephalopathy, especially in steroid refractory cases, but side effects due to low levels of immunoglobulins warrant careful monitoring.
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Affiliation(s)
- Annemieke Maas
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Karin Geleijns
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Annet van Royen-Kerkhof
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
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Takahashi N, Shinohara T, Oi R, Ota M, Toriumi S, Ogushi F. Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report. J Thorac Dis 2016; 8:E319-24. [PMID: 27162691 DOI: 10.21037/jtd.2016.03.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sporadic patients with acute respiratory distress syndrome (ARDS) caused by Mycoplasma pneumoniae have been reported. However, knowledge about the pathophysiology and pharmacological treatment of this condition is insufficient. Moreover, the pulmonary vascular permeability in ARDS related to M. pneumoniae infection has not been reported. We report a case of ARDS caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability, which was successfully treated using low-dose short-term hydrocortisone, suggesting that pulmonary infiltration in ARDS caused by Mycoplasma pneumoniae does not match the criteria of permeability edema observed in typical ARDS.
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Affiliation(s)
- Naoki Takahashi
- 1 Division of Pulmonary Medicine, 2 Department of Clinical Investigation, 3 Division of Anesthesiology, National Hospital Organization Kochi Hospital, Kochi 780-8077, Japan
| | - Tsutomu Shinohara
- 1 Division of Pulmonary Medicine, 2 Department of Clinical Investigation, 3 Division of Anesthesiology, National Hospital Organization Kochi Hospital, Kochi 780-8077, Japan
| | - Rie Oi
- 1 Division of Pulmonary Medicine, 2 Department of Clinical Investigation, 3 Division of Anesthesiology, National Hospital Organization Kochi Hospital, Kochi 780-8077, Japan
| | - Muneyuki Ota
- 1 Division of Pulmonary Medicine, 2 Department of Clinical Investigation, 3 Division of Anesthesiology, National Hospital Organization Kochi Hospital, Kochi 780-8077, Japan
| | - Shinichi Toriumi
- 1 Division of Pulmonary Medicine, 2 Department of Clinical Investigation, 3 Division of Anesthesiology, National Hospital Organization Kochi Hospital, Kochi 780-8077, Japan
| | - Fumitaka Ogushi
- 1 Division of Pulmonary Medicine, 2 Department of Clinical Investigation, 3 Division of Anesthesiology, National Hospital Organization Kochi Hospital, Kochi 780-8077, Japan
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Abstract
Alopecia areata (AA) is a common form of autoimmune nonscarring hair loss of scalp and/or body. Atypical hair regrowth in AA is considered a rare phenomenon. It includes atypical pattern of hair growth (sudden graying, perinevoid alopecia, Renbok phenomenon, castling phenomenon, and concentric or targetoid regrowth) and atypical dark color hair regrowth. We report a case of AA that resulted in a concentric targetoid hair regrowth and discuss the possible related theories regarding the significance of this phenomenon.
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Affiliation(s)
| | | | - Marcelo S Teixeira
- Department of Dermatology, Universidade Federal Fluminense, Niterói, Brasil
| | - Marcia Kalil Aide
- Department of Dermatology, Universidade Federal Fluminense, Niterói, Brasil
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Abstract
Background The aim of this study was to evaluate the clinical outcome of patients with bacterial meningitis following the introduction of dexamethasone treatment in Denmark. Methods Adult patients with bacterial meningitis, admitted from 2003-2010 to two different university hospitals, were included retrospectively. Data at clinical presentation, Glasgow outcome scale (GOS), cerebrospinal fluid and blood biochemistry were collected. Relative risk (RR) with 95% confidence interval (CI) was computed by Cox proportional hazard regression analysis. Results One hundred and forty-seven patients were included in the study. The population had a median age of 62 years and 31% had an immunosuppressive co-morbidity. Eighty-nine patients had an unfavourable outcome (GOS score = 1-4). Adjuvant treatment with corticosteroids (RR = 0.48; 95% CI = 0.30-0.76) was associated with a favourable outcome (GOS score = 5), while altered mental status (RR = 2.36; 95% CI = 1.17-4.78) and age (RR = 1.03; 95% CI = 1.01-1.04) per year increment was associated with an unfavourable outcome. Adjuvant corticosteroid treatment did not affect short- or long-term survival. Short-term mortality was influenced by age (RR = 1.06; 95% CI = 1.04-1.09). Long-term mortality was influenced by age (RR = 1.06; 95% CI = 1.03-1.08) and female sex (RR = 1.81; 95% CI = 1.05-3.14). Conclusion This study indicated that adjuvant corticosteroid treatment in acute bacterial meningitis improves the outcome and can safely be administered in an elderly population with high levels of immunosuppressive co-morbidity.
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Affiliation(s)
- Gertrud Baunbæk-Knudsen
- a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark.,b Department of Infectious Diseases
| | - Mette Sølling
- a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark
| | - Annette Farre
- c Department of Clinical Biochemistry , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark
| | | | - Christian T Brandt
- a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark.,b Department of Infectious Diseases
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Çiftci F, Abdurrahman İ, Tatar Z. The effect of corticosteroid treatment on bilateral idiopathic granulomatous mastitis. Turk J Surg 2015; 33:113-115. [PMID: 28740962 DOI: 10.5152/ucd.2015.2950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/31/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
Abstract
Idiopathic granulomatous mastitis (IGM) is the commonly encountered form of granulomatous mastitis that may result into repetitive infections and/or abscess formation. Mastitis may develop secondary to a systemic disorder such as tuberculosis, diabetes mellitus, or rheumatoid arthritis, or it may develop as an idiopathic disorder. Idiopathic granulomatous mastitis is the most frequent form of all granulomatous diseases affecting the breast. This disorder frequently presents as painful and fast-growing mass in the breast. Biopsy is required to confirm diagnosis. Surgical excision and immunosuppressive treatment with corticosteroids are employed for therapeutic management. Here we present 3 female cases of bilateral IGM who were followed up and treated successfully with 1 mg/kg/day prednisolone.
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Affiliation(s)
- Fatih Çiftci
- Department of General Surgery, İstanbul Gelişim University Safa Hospital, İstanbul, Turkey
| | | | - Zeynep Tatar
- Department of Pathology Patomer, İstanbul, Turkey
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AKAHANE KAZUHISA, TSUNODA NOBUYUKI, KATO MASAMICHI, NODA SUMIYO, SHIMOYAMA YOSHIE, ISHIGAKI SATOKO, SATAKE HIROKO, NAKAMURA SHIGEO, NAGINO MASATO. Therapeutic strategy for granulomatous lobular mastitis: a clinicopathological study of 12 patients. Nagoya J Med Sci 2013; 75:193-200. [PMID: 24640175 PMCID: PMC4345679] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Granulomatous lobular mastitis (GLM) is a rare inflammatory pseudotumor. No therapeutic modality for this disease has been established because of its rarity. The purpose of this study is to evaluate the treatment strategies of GLM. Twelve women who met the histological criteria for GLM were retrospectively studied. The clinical data and the presentation, histopathology, and management of the disease were analyzed by reviewing the patients' medical records. The diagnosis of GLM was confirmed histologically by core needle biopsy in 9 cases, by vacuum-assisted biopsy in 2 cases, and by excisional biopsy in 1 case. Ten patients received corticosteroid treatment and another two patients were treated with local excision or incision and drainage. The median initial dosage of corticosteroid (Prednisolone) was 30 mg/day (range: 15-60 mg/day), and the dosages were tapered according to improvement. The median duration of corticosteroid treatment was 5 months (range: 1-12 months). The median follow-up period was 22 months (range: 6-104 months), and no patient treated with corticosteroid demonstrated recurrence. However, patients treated with excision or incision and drainage had recurrences. These results suggest that steroid treatment may be the first choice in treatment strategies for GLM.
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Affiliation(s)
- KAZUHISA AKAHANE
- Department of Breast Oncology, Aichi Cancer Center Aichi Hospital, Okazaki, Japan,Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - NOBUYUKI TSUNODA
- Division of Breast and Endocrine Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - MASAMICHI KATO
- KATO Surgery-gynecology-Obstetrics-Breast Clinic, Nagoya, Japan
| | - SUMIYO NODA
- Division of Breast and Endocrine Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - YOSHIE SHIMOYAMA
- Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - SATOKO ISHIGAKI
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - HIROKO SATAKE
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - SHIGEO NAKAMURA
- Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - MASATO NAGINO
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kale N, Agaoglu J, Tanik O. Correlation of cumulative corticosteroid treatment with magnetic resonance imaging assessment of avascular femoral head necrosis in patients with multiple sclerosis. Neurol Int 2010; 2:e17. [PMID: 21577331 PMCID: PMC3093202 DOI: 10.4081/ni.2010.e17] [Citation(s) in RCA: 4] [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: 01/22/2010] [Revised: 08/13/2010] [Accepted: 08/20/2010] [Indexed: 11/23/2022] Open
Abstract
Increased risk of osteoporosis, fractures, and avascular necrosis (AVN) has been suggested in multiple sclerosis (MS). Patients with MS are often exposed to corticosteroid treatment (CST) during the disease course and conflicting reports exist regarding complications of CST. Our study aims to investigate the association between cumulative doses of CST and radiographic evaluation of AVN of the femoral head in MS. Twenty-six MS patients (mean age, 38.4±10 yr) were enrolled and prospectively evaluated for AVN by magnetic resonance imaging (MRI). The mean disease duration was 11.5±8.5 years and mean expanded disability status scale (EDSS) score was 3±2. The cumulative dosage of CST varied between 20 g and 60 g; patients were grouped into two categories: 1) CST between 20–40 g, 17 (65%) patients; 2) CST ≥40 g; 9 (35%) patients. The relationship between cumulative CST dosage and MRI diagnosis of AVN was statistically insignificant (P>0.9). Clarification of the cumulative effect of CST in the development of AVN is of great importance for future long-term steroid treatment strategies.
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Affiliation(s)
- Nilufer Kale
- Department of Neuro-Ophthalmology, Michigan State University, East Lansing, MI, USA
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