MedWorm: Corticosteroid Therapy

Corticosteroids for Bell's palsy (idiopathic facial paralysis).

Cochrane Database of Systematic Reviews — Sat, 20 Mar 2010 06:22:03 +0100

CONCLUSIONS: The available evidence from randomised controlled trials shows significant benefit from treating Bell's palsy with corticosteroids. PMID: 20238317 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Anthelmintics for people with neurocysticercosis.

Cochrane Database of Systematic Reviews — Sat, 20 Mar 2010 06:22:03 +0100

CONCLUSIONS: In patients with viable lesions, evidence from trials of adults suggests albendazole may reduce the number of lesions. In trials of non-viable lesions, seizure recurrence was substantially lower with albendazole, which is counter-intuitive. It may be that steroids influence headache during treatment, but further research is needed to test this. PMID: 20238309 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

[Letter: Tinea faciei exacerbated by topical immunomodulation: Two case reports.]

Dermatol Online J — Sat, 20 Mar 2010 01:42:03 +0100

We report two pediatrics cases of tinea faciei that have been evaluated in our unit. Both were exacerbated by topical application of pimecrolimus cream. It is important to note the exacerbation of dermatophyte infection by pimecrolimus in addition to the better known exacerbation by topical corticosteroids. PMID: 20233571 [PubMed - in process] (Source: Dermatol Online J)

Allergic contact dermatitis to shoes induced by dimethylfumarate: A new allergen imported from China.

Dermatol Online J — Sat, 20 Mar 2010 01:42:03 +0100

CONCLUSIONS: Contact dermatitis induced by dimethylfumarate should be suspected in appropriate cases. It is important to remember that this allergen is not included in most series for patch testing. PMID: 20233560 [PubMed - in process] (Source: Dermatol Online J)

Possible green tea-induced thrombotic thrombocytopenic purpura.

American Journal of Health-System Pharmacy : AJHP — Sat, 20 Mar 2010 01:34:31 +0100

Conclusion A 38-year-old woman developed TTP after consuming a weight-loss product containing green tea extract for two months. PMID: 20237380 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

Exercise-induced wheeze: Fraction of exhaled nitric oxide-directed management

Respirology — Sat, 20 Mar 2010 00:00:00 +0100

Conclusions: In patients with EIW and low FENO, the number of 'responders' to cromoglycate, formoterol and montelukast was similar. In a high FENO population the response to inhaled corticosteroid was highly significant and comparable to previous studies. (Source: Respirology)

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Treatment with calcimimetics in kidney transplantation

Transplantation Reviews — Fri, 19 Mar 2010 17:30:47 +0100

Abstract: Graft and patient survival in renal transplantation has increased with better immune suppression treatment, leading to the appearance of new complications such as posttransplant bone disease. After renal transplantation and the recovery of renal function, mineral metabolism disorders secondary to renal failure could be expected to normalize. However, both immediately after transplantation and later, and even with good renal graft function, we see bone disorders associated to renal osteodystrophy, a high incidence of osteopenia, persistent hyperparathyroidism, hypercalcemia, hypophosphoremia, and less commonly, aseptic bone necrosis. The causes potentially responsible for these disorders have basically been identified as different degrees of renal insufficiency in the graft, persi...

Osteonecrosis of the jaw on imaging exams of patients with juvenile systemic lupus erythematosus

Revista Brasileira de Reumatologia — Fri, 19 Mar 2010 16:37:09 +0100

CONCLUSIONS: Osteonecrosis of the mandible with mild TMJ dysfunction was observed in some of the patients, demonstrating the importance of odontological assessment during clinical follow-up. (Source: Revista Brasileira de Reumatologia)

Lymphadenopathy and systemic lupus erythematosus

Revista Brasileira de Reumatologia — Fri, 19 Mar 2010 16:37:09 +0100

We report the case of a patient with recurrent episodes of lymphadenopathy associated with hepatosplenomegaly, fever, and weight loss since the age of 13 years. The patient also developed arthritis, hypertension, proteinuria, cardiomyopathy, and peripheral neuropathy. His condition was investigated extensively without diagnostic clarification; he was treated, empirically, for tuberculosis. The patient received a diagnosis of SLE only five years after the original presentation and received the specific treatment. Early diagnosis in those cases is difficult because laboratorial exams may not show the presence of auto-antibodies and low complement levels. (Source: Revista Brasileira de Reumatologia)

Stem Cells Used To Model Infant Birth Defect

Health News from Medical News Today — Fri, 19 Mar 2010 10:00:00 +0100

Hemangiomas -- strawberry-like birthmarks that commonly develop in early infancy -- are generally harmless, but up to 10 percent cause tissue distortion or destruction and sometimes obstruction of vision or breathing. Since the 1960s, problematic hemangiomas have been treated with corticosteroids such as dexamethasone or prednisone. But steroids have considerable side effects, don't always work, and their mechanism of action in hemangioma has remained a mystery... (Source: Health News from Medical News Today)

Stem Cells Used To Model Infant Birth Defect

Dermatology News From Medical News Today — Fri, 19 Mar 2010 10:00:00 +0100

Hemangiomas -- strawberry-like birthmarks that commonly develop in early infancy -- are generally harmless, but up to 10 percent cause tissue distortion or destruction and sometimes obstruction of vision or breathing. Since the 1960s, problematic hemangiomas have been treated with corticosteroids such as dexamethasone or prednisone... (Source: Dermatology News From Medical News Today)

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Intravitreal bevacizumab vs intravitreal triamcinolone combined with macular laser grid for diffuse diabetic macular oedema

Eye — Fri, 19 Mar 2010 00:00:00 +0100

Authors: R Forte, G L Cennamo, M Finelli, E Farese, G D'Amico, G Nicoletti, G de Crecchio & G Cennamo (Source: Eye)

RCT: Adding triple antibiotic combination to standard treatment may help induce remission in UC

NeLM - News — Fri, 19 Mar 2010 00:00:00 +0100

Source: American Journal of Gastroenterology Area: News According to the results of a RCT conducted in Japan, adding a 2-week course of triple antibiotic therapy to existing medications may help to induce and maintain remission in ulcerative colitis (UC). The authors note that Fusobacterium varium may trigger flares of UC; they conducted their study to see whether the addition of antibiotic therapy to standard treatment could therefore induce and/or maintain remission of UC. They used an antibiotic regimen to which F. varium is susceptible: amoxicillin (1500mg/day), tetracycline (1500mg/day), and metronidazole (750mg/day). A total of 210 patients with chronic relapsing mild-to-severe UC were randomised to double-blind treatment with this combination (ATM group; n=10...

Intensive Insulin and Corticosteroids for Septic Shock

Medscape Today Headlines — Thu, 18 Mar 2010 19:37:23 +0100

Is there any benefit to tighter glucose control in critically ill patients with septic shock and corticosteroid-induced hyperglycemia? Medscape Critical Care (Source: Medscape Today Headlines)

Preschoolers' and parents' asthma education trial (P2AET)—a randomized controlled study

European Journal of Pediatrics — Thu, 18 Mar 2010 19:27:53 +0100

Abstract We aimed to evaluate a family-oriented psycho-educational asthma training program for the age group of 2–5 years, involving both parents and children. Children were included after having at least 3 obstructive episodes in their life plus chronic or recurrent wheeze in the 6 months before the start of the study. In the multicenter randomized trial we had (1) a waiting group (WG), (2) an instruction group (IG) trained in a structured way according to the national asthma guideline, and (3) an education group (EG), having a standardized multiprofessional psycho-educational program, according to the national licensed asthma education for the age group of 6–18 years. All were assessed after 6 months. A subgroup analysis was performed on those bei...

Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study

Rheumatology International — Thu, 18 Mar 2010 19:24:38 +0100

Abstract No data exist about the possibility that vertebral fracture in PMR patients could be independent of steroid therapy. For this reason, we aimed to investigate this topic by a case cohort study with a 1-year follow-up for each patient. We selected ten consecutive patients who experienced vertebral fractures (VF-group) during the first month of 1-year follow-up period and without any other significant associated condition. As a control group we studied ten control patients, without vertebral fractures and with a follow-up of 1 year, randomly selected among a larger group of patients affected by polymyalgia rheumatica. The following data were analysed: eritrosedimention rate (ESR), visual analogical scale score (VAS), methyprednisolone daily dosage. Each patient ...

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Inflammatory pseudotumor of the parapharyngeal space: A case report

Auris, Nasus, Larynx — Thu, 18 Mar 2010 14:19:51 +0100

Abstract: Inflammatory pseudotumor is an idiopathic granuloma characterized by infiltrative proliferation of inflammatory cells and myofibroblastic cells, as well as locally aggressive features, clinically and radiologically mimicking a neoplastic process. The occurrence of inflammatory pseudotumor in the head and neck area is uncommon, especially in the parapharyngeal space. The case of a 54-year-old female with inflammatory pseudotumor of the parapharyngeal space is presented. The patient initially complained of hoarseness, dysarthria, aspiration, and hearing impairment. MRI disclosed an expansive soft mass in the parapharyngeal space encompassing the carotid arteries. Histopathologically, the lesions were composed of numerous plasma cells, lymphocytes, histiocytes, and spindle myofibrob...

Review article: the modern management of autoimmune hepatitis

Alimentary Pharmacology and Therapeutics — Thu, 18 Mar 2010 14:08:18 +0100

Conclusions Despite ongoing limitations in the understanding of pathogenesis and difficulties in evaluating novel therapies, the management of AIH continues to evolve slowly. Multi-centre collaboration is necessary to obtain sufficient patient numbers to undertake good quality therapeutic studies. (Source: Alimentary Pharmacology and Therapeutics)

Researchers discover chemical that may protect hearts of muscular dystrophy patients.www.eurekalert.org

Parent Project Muscular Dystrophy — Thu, 18 Mar 2010 00:00:00 +0100

Researchers discover chemical that may protect hearts of muscular dystrophy patients By administering a chemical called a 'molecular band-aid,' U of M researchers were able to prevent heart injury in dystrophic canines MINNEAPOLIS / ST. PAUL (March 15, 2010) Researchers at the University of Minnesota Medical School have discovered a chemical that may, over the long term, protect the hearts of Duchenne muscular dystrophy patients – a fatal and most common form of muscular dystrophy in children. The chemical, which Medical School scientists have termed a "molecular band-aid," seeks out tiny cuts in diseased heart muscle. When injected into the bloodstream, the molecular band-aid finds these microscopic cuts and protects them from harmful substances so the heart muscle cells can survive ...

High prevalence of undiagnosed and severe chronic obstructive pulmonary disease at first hospital admission with acute exacerbation.

Chronic Respiratory Disease — Thu, 18 Mar 2010 00:00:00 +0100

Authors: Bastin AJ, Starling L, Ahmed R, Dinham A, Hill N, Stern M, Restrick LJ Chronic obstructive pulmonary disease (COPD) is a common cause of acute medical hospital admission, and the prevalence of undiagnosed COPD in the community is high. The impact of undiagnosed COPD on presentation to secondary care services is not currently known. We therefore set out to characterise patients at first admission with an acute exacerbation of COPD, and to identify potential areas for improvement in earlier diagnosis and further management. A retrospective case review of patients first admitted to a district teaching hospital with an acute exacerbation of COPD over a 1-year period was carried out. Forty-one patients with a first admission with an acute exacerbation of COPD were identified, 14 (3...

Treatment effects of low dose theophylline combined with an inhaled corticosteroid in COPD.

Chest — Thu, 18 Mar 2010 00:00:00 +0100

CONCLUSIONS: Combination therapy with an inhaled corticosteroid and low dose theophylline may attenuate airway inflammation in COPD patients. PMID: 20299628 [PubMed - as supplied by publisher] (Source: Chest)

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A CT score for the assessment of lung disease in children with common variable immunodeficiency disorders.

Chest — Thu, 18 Mar 2010 00:00:00 +0100

CONCLUSION: In children with CVID disorders, mild structural lung disease is common. Expiratory CT scans show the most frequent abnormality, air trapping. The occurrence of (silent) lung disease progression and the clinical impact of CT scans require further investigations. PMID: 20299624 [PubMed - as supplied by publisher] (Source: Chest)

Rheumatoid arthritis, treatment with corticosteroids and risk of malignant lymphomas: results from a case-control study

Annals of the Rheumatic Diseases — Wed, 17 Mar 2010 14:45:57 +0100

Conclusion In this RA population, use of steroids was associated with reduced lymphoma risk. Whether this association is a generic effect of steroids or specific to the studied population remains unknown. (Source: Annals of the Rheumatic Diseases)

Revolade(R) (Eltrombopag) Receives European Marketing Authorisation For The Treatment Of Chronic Immune Thrombocytopenic Purpura (ITP)

Health News from Medical News Today — Wed, 17 Mar 2010 09:00:00 +0100

GlaxoSmithKline (GSK) announced that the European Medicines Agency (EMA) has granted marketing authorisation for Revolade® (eltrombopag), a once-daily oral treatment for adults with chronic immune thrombocytopenic purpura (ITP).1 Revolade is for patients who have already had their spleen removed (splenectomy) and are not responding to other treatments such as corticosteroids and immunoglobulins. It may also be considered as second line treatment for adult non-splenectomised patients where surgery is contraindicated... (Source: Health News from Medical News Today)

Add-on montelukast may protect asthmatics against excessive airway narrowing

MedWire News - Respiratory — Wed, 17 Mar 2010 00:00:00 +0100

Asthma patients taking inhaled corticosteroids may benefit from add-on therapy with the leukotriene receptor antagonist montelukast to protect against excessive airway narrowing, say researchers. (Source: MedWire News - Respiratory)

Corticosteroid Suppresses VEGF in Infantile Hemangioma

Modern Medicine — Wed, 17 Mar 2010 00:00:00 +0100

In a mouse model of infantile hemangioma, injections of the corticosteroid dexamethasone were able to suppress vasculogenesis by inhibiting the expression of vascular endothelial growth factor A, according to a study in the March 18 issue of the New England Journal of Medicine. (Source: Modern Medicine)

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Step-up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

New England Journal of Medicine — Wed, 17 Mar 2010 00:00:00 +0100

Many children have uncontrolled asthma symptoms when treated with low-dose inhaled corticosteroids (ICS). In this three-way crossover trial, the investigators asked whether doubling the dose of ICS, adding a leukotriene-receptor antagonist to the ICS, or adding a long-acting beta-agonist to the ICS would result in better asthma control. Most children had a best response to the long-acting beta-agonist, but some children had a best response to an increased dose of ICS or a leukotriene-receptor antagonist. (Source: New England Journal of Medicine)

Corticosteroid Suppression of VEGF-A in Infantile Hemangioma-Derived Stem Cells

New England Journal of Medicine — Wed, 17 Mar 2010 00:00:00 +0100

In this study, hemangioma-derived stem cells showed vasculogenic activity in vivo when implanted into nude mice. Systemic treatment with dexamethasone or pretreatment of the stem cells with dexamethasone inhibited vasculogenesis. Dexamethasone suppressed the production of vascular endothelial growth factor A (VEGF-A). Silencing of VEGF-A with short hairpin RNA also inhibited vasculogenesis. (Source: New England Journal of Medicine)

CME: Step-up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

New England Journal of Medicine — Wed, 17 Mar 2010 00:00:00 +0100

(No abstract is available for this citation) (Source: New England Journal of Medicine)

Acute Demyelinating Encephalomyelitis After Anti-venom Therapy in Russell's Viper Bite.

Journal of Medical Toxicology — Wed, 17 Mar 2010 00:00:00 +0100

CONCLUSION: Russels viper bite followed by treatment with antivenom may be complicated by the development of immune complex mediated demyelination and development of acute disseminated encephalomyelitis. MRI spectroscopy helps in early identification of demyelination and in a definite diagnosis. Treatment with corticosteroids was associated with resolution of symptoms in this case. PMID: 20237970 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)

Corticosteroid Therapy in a Case of Severe Cholestasic Hepatitis Associated with Amoxicillin-Clavulanate.

Journal of Medical Toxicology — Wed, 17 Mar 2010 00:00:00 +0100

Authors: Herrero-Herrero JI, García-Aparicio J Amoxicillin-clavulanate is the most common drug involved in drug-induced liver injury and the single most frequently prescribed product leading to hospitalization for drug-induced liver disease in Spain. The liver damage most frequently associated with amoxicillin-clavulanate is cholestasic type. The latency period between first intake and onset of symptoms is 3-4 weeks on average. A 76-year-old man developed fever, pruritus, and jaundice 3 weeks after having completed treatment with amoxicillin-clavulanate. Liver function tests showed cholestasic hepatitis (up to 50.75 mg/dL of total serum bilirubin level). The ultrasound-guided liver biopsy revealed severe canalicular cholestasis and portal and lobular eosinophilic infiltrates. Pred...

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Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort

Human Reproduction — Tue, 16 Mar 2010 17:05:41 +0100

CONCLUSIONS Between 24 and 27 weeks of gestation, risks of mortality and severe cranial haemorrhaging were higher for twins than singletons if they were from same sex pairs with discordant birthweights. (Source: Human Reproduction)

Does obesity produce a distinct asthma phenotype?

Journal of Applied Physiology — Tue, 16 Mar 2010 14:01:59 +0100

Obesity and asthma prevalence have been increasing over the past decade. Epidemiological evidence demonstrates that obesity results in an increased risk of developing incident asthma. Even modest levels of increased weight increase asthma risk. Recently published data suggest that obese asthma patients may represent a distinct phenotype of asthma. Obese asthma patients demonstrate increased asthma severity, as indicated by increased exacerbations and decreased asthma control; however, they do not appear to have increased airway cellular inflammation. It seems likely that obesity does not contribute to asthma through conventional Th type 2-mediated inflammatory pathways but, rather, through separate mechanisms that are specific to the obese state. This may explain the variable responses of ...

Obesity, asthma, and oxidative stress

Journal of Applied Physiology — Tue, 16 Mar 2010 14:01:59 +0100

Obesity is associated with increased systemic and airway oxidative stress, which may result from a combination of adipokine imbalance, comorbidities, and reduced antioxidant defenses. While obesity-mediated increased oxidative stress plays an important role in the pathogenesis of vascular disease and nonalcoholic hepatic steatosis, little is known of how it may affect the lung. Contrary to what has previously been thought, the combination of obesity and asthma, both chronic inflammatory diseases, does not necessarily result in a synergistic effect, leading to even greater oxidative stress. However, most available studies have compared the levels of oxidative stress biomarkers on stable asthma patients, and it is possible that the interaction of oxidative stress between obesity and asthma i...

Corticosteroid Regulation of Synaptic Plasticity in the Hippocampus

TheScientificWorldJOURNAL: Newly published articles. — Tue, 16 Mar 2010 00:00:00 +0100

We review the known effects of stress hormones on cellular functions and try to outline how activation of molecular mechanisms can be related to global functions of the hippocampus in relation to stress. (Source: TheScientificWorldJOURNAL: Newly published articles.)

Review: Addition of inhaled corticosteroids to long-acting {beta}2-agonists does not improve outcomes in stable COPD.

Annals of Internal Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Authors: PMID: 20231559 [PubMed - in process] (Source: Annals of Internal Medicine)

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Intervention to Reduce Unnecessary Dispensing of Short-Acting {beta}-Agonists in Patients with Asthma(April).

The Annals of Pharmacotherapy — Tue, 16 Mar 2010 00:00:00 +0100

CONCLUSIONS: This analysis shows that an intervention can succeed in reducing the overdispensing of quick-relief medication without compromising asthma control. Further investigation is warranted to better understand the interplay between reduction in excessive SABA use and improved clinical outcomes. PMID: 20233916 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

Effects of Inhaled Corticosteroids in Monotherapy or Combined with Long-Acting {beta}2-Agonists on Mortality Among Patients with Chronic Obstructive Pulmonary Disease (April).

The Annals of Pharmacotherapy — Tue, 16 Mar 2010 00:00:00 +0100

CONCLUSIONS: ICS were found to be associated with a reduction in mortality rate when compared to LABA among patients with COPD. However, the ICS/LABA combination therapy did not provide any additional benefit on mortality when compared to ICS monotherapy. PMID: 20233915 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

Endoscopic Airway Management of Laryngeal Sarcoidosis [Original Article]

Archives of Otolaryngology — Mon, 15 Mar 2010 19:50:56 +0100

Conclusions Minimally invasive endoscopic surgery with intralesional corticosteroid injection and laser reduction is an effective method of controlling laryngeal sarcoid. It improves symptoms immediately with minimal morbidity and, most importantly, reduces the need for systemic steroid administration in most patients. This study supports early recognition and endoscopic intervention in the management of laryngeal sarcoidosis. (Source: Archives of Otolaryngology)

3 Cases of Dissecting Cellulitis of the Scalp Treated With Adalimumab: Control of Inflammation Within Residual Structural Disease [Observation]

Archives of Dermatology — Mon, 15 Mar 2010 19:43:14 +0100

Conclusions Adalimumab is effective for treatment of DCS. Relapse on discontinuation of therapy can be expected depending on persisting structural disease. Continuous treatment or combined surgical resection of involved areas could be necessary for definitive resolution of disease.Published online March 15, 2010 (doi:10.1001/archdermatol.2010.16). (Source: Archives of Dermatology)

Sciatica

Best Practice & Research. Clinical Rheumatology — Mon, 15 Mar 2010 15:46:38 +0100

is a symptom rather than a specific diagnosis. Available evidence from basic science and clinical research indicates that both inflammation and compression are important in order for the nerve root to be symptomatic. Tumour necrosis factor-alpha (TNF-α) is a key mediator in animal models, but its exact contribution in human radiculopathy is still a matter of debate. Sciatica is mainly diagnosed by history taking and physical examination. In general, the clinical course of acute sciatica is considered to be favourable. In the first 6–8 weeks, there is consensus that treatment of sciatica should be conservative. We review and comment on the levels of evidence of the efficacy of patient information, advice to stay active, physical therapy analgesics, non-steroidal anti-inflammatory drugs ...

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The BILAG multi-centre open randomized controlled trial comparing ciclosporin vs azathioprine in patients with severe SLE

Rheumatology — Mon, 15 Mar 2010 13:35:46 +0100

Conclusions. Both drugs were effective corticosteroid-sparing agents. Ciclosporin was not a more effective corticosteroid-sparing agent. Ciclosporin may be considered in patients who are unable to tolerate AZA. Patients on ciclosporin require close monitoring of blood pressure and creatinine. Trial registration. Current Controlled Trials, http://www.controlled-trials.com/, ISRCTN35919612. (Source: Rheumatology)

Treatment of primary angiitis of the central nervous system in childhood with mycophenolate mofetil

Rheumatology — Mon, 15 Mar 2010 13:35:46 +0100

Conclusions. MMF should be considered for maintenance treatment in the management of patients with cPACNS refractory to the combination of corticosteroids and first-line immunosuppressive agents. (Source: Rheumatology)

Efficacy and safety of anti-TNF therapies in psoriatic arthritis: an observational study from the British Society for Rheumatology Biologics Register

Rheumatology — Mon, 15 Mar 2010 13:35:45 +0100

Conclusions. Anti-TNF therapies have a good response rate in PsA, and have an adverse event profile similar to that seen in a control cohort of patients with seronegative arthritis receiving DMARD therapy. (Source: Rheumatology)

Antenatal corticosteroids and neonatal outcomes according to gestational age: a cohort study

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 15 Mar 2010 11:33:26 +0100

Conclusions Antenatal corticosteroid treatment is associated with improved survival in babies born between 24 and 29 weeks' gestation. This, however, does not lead to any significant improvements in length of stay, duration of respiratory support and CLD among survivors. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

Ligand Announces Approval For Revolade(R) In Europe

Health News from Medical News Today — Mon, 15 Mar 2010 11:00:00 +0100

Ligand Pharmaceuticals Incorporated (NASDAQ:LGND) today announced that GlaxoSmithKline (NYSE: GSK) was granted marketing authorization from the European Commission (EC) for Revolade® (eltrombopag) for the oral treatment of thrombocytopenia (reduced platelet count) in adults with the blood disorder chronic immune (idiopathic) thrombocytopenic purpura (ITP). Eltrombopag is indicated for adult chronic ITP splenectomized patients who have not responded (are refractory) to other treatments, such as corticosteroids and immunoglobulins... (Source: Health News from Medical News Today)

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EC approves eltrombopag for chronic immune (idiopathic) thrombocytopenic purpura

NeLM - News — Mon, 15 Mar 2010 00:00:00 +0100

Source: BioSpace Area: News According to a report by BioSpace, the European Commission has granted marketing authorisation for eltrombopag (Revolade) for the oral treatment of thrombocytopenia in adults with chronic immune (idiopathic) thrombocytopenic purpura (ITP). The marketing authorisation states that eltrombopag is indicated in adult chronic ITP splenectomised patients who have not responded (are refractory) to other treatments, such as corticosteroids and immunoglobulins. Furthermore, it may also be considered as second-line treatment for adult non-splenectomised patients where surgery is contraindicated. (Source: NeLM - News)

Review: Primary Central Nervous System Lymphoma

NeLM - News — Mon, 15 Mar 2010 00:00:00 +0100

Source: Archives of Neurology Area: News Primary central nervous system (CNS) lymphoma (PCNSL), is an uncommon variant of extra-nodal non-Hodgkin lymphoma (NHL), can affect any part of the neuraxis including the eyes, brain, leptomeninges, or spinal cord. This review, published in the Archives of Neurology, discusses: . The clinical features of the condition . Diagnostic evaluation . Treatment, including corticosteroids, combined-modality therapy, chemotherapy, intrathecal chemotherapy, high-dose chemotherapy with stem-cell rescue, and salvage therapy . Neurotoxic effects of the condition, as well as due to the results of the treatment strategies. (Source: NeLM - News)

Proposing an algorithm for treatment of different manifestations of neuro-Behcet’s disease

Clinical Rheumatology — Sun, 14 Mar 2010 12:25:42 +0100

Abstract “Neuro-Behcet’s disease” (NBD) is the constellation of neurologic manifestations as a direct consequence of Behcet’s disease usually confirmed by imaging studies and/or cerebrospinal fluid analysis. The authors propose a therapeutic algorithm for neuro-Behcet’s disease based upon pathological, clinical, prognostic, and medico-economical issues based on available evidences. The authors divide anti-NBD armamentarium to first-line, second-line, and experimental drugs. These drugs should be administered hierarchically in treatment of parenchymal manifestations of neuro-Behcet’s disease. First-line drug include corticosteroids, azathioprine, methotrexate, and cyclophosphamide. Second-line drugs are tumor necrosis factor (TNF) alpha blocking drugs, interfero...

Effect of Preoperative Single-Dose Corticosteroid Administration on Postoperative Morbidity Following Esophagectomy

Journal of Gastrointestinal Surgery — Sun, 14 Mar 2010 11:29:16 +0100

Conclusion We are in the presence of a potential benefit that cannot be accepted at face value due to the quality problems of the included studies. But in the presence of a remaining potential benefit after a Bayesian analysis starting from a skeptical prior, the best option would be the planning of a large multicenter prospective randomized study. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11605-010-1168-0Authors Edgard Engelman, Erasme Hospital Department of Anesthesiology; Post-anesthesia Care Unit and Acute Pain Service Route de Lennik 808 1070 Brussels BelgiumCécile Maeyens, Erasme Hospital Department of Anesthesiology; Post-anesthesia Care Unit and Acute Pain Service Route de Lennik 808 1070 Brussels Belgium Journal Journal of Ga...

Pharmacotherapeutic review and update of idiopathic nephrotic syndrome in children

Pharmacy World & Science — Sun, 14 Mar 2010 11:26:15 +0100

Conclusion The wide range of options available for the pharmacotherapeutic management of NS and the lack of evidence about the comparative efficacy and safety of the different therapeutic strategies, make its positioning rather difficult. Therefore each hospital needs to draw up protocols based not only on the small amount of evidence available, but also on the authorized indications, availability of the drugs, clinical experience, associated costs, and patient preferences with regard to the duration of treatment, incidence and type of adverse effects. Development of new randomized controlled trials should be encouraged and setting up national plans for the treatment of this pathology might be a good approach for this problem. Content Type Journal ArticleCategory Review ArticleDO...

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Adverse effects of biologics used for treating IBD

Best Practice & Research. Clinical Gastroenterology — Sat, 13 Mar 2010 14:21:59 +0100

In the last decade, biologic agents, in particular anti-TNF agents such as infliximab, adalimumab, and certolizumab have substantially extended the therapeutic armamentarium of inflammatory bowel disease (IBD). Additional approaches include biologicals, such as natalizumab, that block leucocyte adhesion; those that target cytokines, such as interleukin-12/23 antibodies; or those that inhibit T-cell signaling, such as interleukin-6 receptor antibodies. However, these drugs have a number of contraindications and side effects, especially when used in combination with classical immunosuppressive agents or corticosteroids. Areas of concern include opportunistic infections, malignancies, and miscellaneous complications such as injection/infusion reactions and autoimmunity and contraindications, ...

Chapter 8 - Fungal infections in immunocompromised patients

Jornal Brasileiro de Pneumologia — Fri, 12 Mar 2010 15:34:44 +0100

As complicações pulmonares se constituem na maior causa de morbidade e mortalidade no hospedeiro imunocomprometido, devido à deficiência nos mecanismos básicos de defesa. Independente da causa da imunodepressão, infecções bacterianas, virais e fúngicas são as mais frequentes. Entre as infecções fúngicas, a aspergilose é a mais comum (incidência de 1-9% e mortalidade de 55-92%) nos diferentes tipos de transplantados. Embora a forma pneumônica seja a mais frequente, lesões do sistema nervoso central e sinusite não são raras. O sinal do halo em TC de tórax representa uma área de baixa atenuação em volta do nódulo, revelando edema ou hemorragia. O padrão ouro para o diagnóstico é a identificação do fungo por cultura de escarro, amostras de LBA ou biópsia. Na falta...

Alitretinoin Decreases Activity of Chronic Hand Eczema

Medscape Medical News Headlines — Fri, 12 Mar 2010 13:33:47 +0100

Oral alitretinoin results in a near clearing of symptoms in close to half of patients with chronic severe hand eczema unresponsive to topical corticosteroids. Medscape Medical News (Source: Medscape Medical News Headlines)

Development of various arrhythmias and conduction disturbances following corticosteroid therapy for systemic lupus erythematosus with antiphospholipid syndrome

Modern Rheumatology — Fri, 12 Mar 2010 06:51:26 +0100

Abstract A 45-year-old Chinese woman with active systemic lupus erythematosus, lupus anticoagulant positive, was admitted to our hospital. Electrocardiography on admission was normal. Though anti-Sjögren’s syndrome A (anti SS-A/Ro) antibodies were negative and ultrasound cardiographic findings were normal, she developed various arrhythmias/conduction disturbances shortly after starting corticosteroid. Nearly all were resolved with continuous corticosteroid and aspirin therapy before discharge. Vasculitis, the presence of antiphospholipid antibodies, and platelet aggregation due to corticosteroid were possible mechanisms underlying the arrhythmias/conduction disturbances. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10165-010-0283-9Authors Yu Kasama...

Reproducibility of nasal allergen challenge in evaluating the efficacy of intranasal corticosteroid treatment

Clinical and Experimental Allergy — Fri, 12 Mar 2010 00:00:00 +0100

Although nasal challenge with allergen has often been used to evaluate the efficacy of therapeutic modalities used for the treatment of allergic rhinitis, the reproducibility of this model in quantitatively evaluating efficacy has not been rigorously examined. To examine the reproducibility of the suppressive effects of an intranasal corticosteroid on the clinical and biochemical outcomes of a nasal allergen challenge during two identical treatment periods using the same subjects. In a single-blind study, 25 seasonal allergic subjects with positive skin tests to grass or ragweed were studied outside of their pollen season. Subjects underwent a baseline, three-dose allergen challenge. Beginning 1 week later, subjects received two 7-day courses of intranasal beclomethasone (168 [mu]g b.i.d.)...

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ICS and LABA treatment not linked to pneumonia in COPD

MedWire News - Respiratory — Fri, 12 Mar 2010 00:00:00 +0100

Treatment with inhaled corticosteroids and long-acting beta-agonists, either alone or in combination, is not associated with a significantly increased risk for pneumonia in patients with chronic obstructive pulmonary disease, research shows. (Source: MedWire News - Respiratory)

[Factors Associated with Asthma Control in Primary Care Patients: The CHAS Study.]

Archivos de Bronconeumologia — Fri, 12 Mar 2010 00:00:00 +0100

CONCLUSIONS: In Spain asthma is still uncontrolled and some factors leading to this situation appear to be modifiable by the health system. PMID: 20227808 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

Pityriasis lichenoides with ulceronecrosis and hyperthermia: A rare variant of pityriasis lichenoides et varioliformis acuta

Indian Journal of Dermatology, Venereology and Leprology — Thu, 11 Mar 2010 14:10:55 +0100

We report the case of a 49-year-old male with typical features of PLUH along with an unusual manifestation of extensive skin necrosis including involvement of the intertriginous regions. Systemic administration of corticosteroids and antibiotics did not help to control the disease and the patient succumbed to death due to its fulminant nature. (Source: Indian Journal of Dermatology, Venereology and Leprology)

Substitution of corticosteroid with everolimus after lung transplantation: a pediatric case report

Pharmacy World & Science — Thu, 11 Mar 2010 02:46:51 +0100

We report the case of a 12 year-old lung transplant recipient, in whom compressive epidural lipomatosis secondary to corticosteroid prompted us to replace prednisone with everolimus. Discontinuing corticosteroid treatment after lung transplantation is associated with a risk of graft rejection despite concomitant immunosuppressive therapy with tacrolimus and mycophenolate mofetil. During a follow-up of 18 months with everolimus instead of prednisone, we did not observe graft rejection. In parallel, all symptoms related to epidural compression disappeared within a month. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11096-010-9376-yAuthors Thibaut Caruba, Hopital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris Pharmacy Department Paris F...

Safety and efficacy profiles of tocilizumab monotherapy in Japanese patients with rheumatoid arthritis: meta-analysis of six initial trials and five long-term extensions

Modern Rheumatology — Thu, 11 Mar 2010 02:42:09 +0100

In conclusion, based on these results, TCZ has shown good tolerability and high efficacy during long-term treatment. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10165-010-0279-5Authors Norihiro Nishimoto, Wakayama Medical University 811-1 Kimiidera Wakayama Wakayama 641-8509 JapanKyoko Ito, Chugai Pharmaceutical Co., Ltd. 1-1 Nihonbashi-Muromachi 2-chome, Chuo-ku Tokyo 103-8324 JapanNobuhiro Takagi, Chugai Pharmaceutical Co., Ltd. 1-1 Nihonbashi-Muromachi 2-chome, Chuo-ku Tokyo 103-8324 Japan Journal Modern RheumatologyOnline ISSN 1439-7609Print ISSN 1439-7595 (Source: Modern Rheumatology)

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Modern therapeutic strategies for paediatric systemic lupus erythematosus and lupus nephritis

Acta Paediatrica — Thu, 11 Mar 2010 00:00:00 +0100

Conclusion: Modern therapeutic strategies include reduced doses and use of corticosteroids and intravenous cyclophosphamide respectively, with increased use of azathioprine, MMF and rituximab. (Source: Acta Paediatrica)

Childhood and adolescent orofacial granulomatosis is strongly associated with Crohn's disease and responds to intralesional corticosteroids

Australasian Journal of Dermatology — Thu, 11 Mar 2010 00:00:00 +0100

We present seven cases of orofacial granulomatosis occurring in paediatric patients aged 6[ndash]16 years. All patients were investigated for Crohn's disease and a strong association was found. All patients were treated with intralesional corticosteroid injections with excellent clinical responses. We review the literature and discuss the epidemiological association between childhood orofacial granulomatosis and Crohn's disease, as well as various treatment options, and propose a treatment protocol that was efficacious and well tolerated in all our patients. (Source: Australasian Journal of Dermatology)

Targeting Phosphoinositide-3-kinase-{delta} with Theophylline Reverses Corticosteroid Insensitivity COPD.

American Journal of Respiratory and Critical Care Medicine — Thu, 11 Mar 2010 00:00:00 +0100

CONCLUSIONS: Inhibition of oxidative stress dependent PI3K-delta activation by a selective inhibitor or theophylline provides a novel approach to reversing corticosteroid-insensitivity in COPD. PMID: 20224070 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Correlation of bite force with excitation-contraction coupling time of the masseter in myasthenia gravis.

Clinical Neurophysiology — Thu, 11 Mar 2010 00:00:00 +0100

CONCLUSIONS: Masseteric E-C coupling is impaired in some MG patients, and functional recovery of E-C coupling contributes at least in part to the increase in bite force after treatment. SIGNIFICANCE: Impaired E-C coupling contributes to muscle weakness in patients with MG. PMID: 20227340 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)

Use and accuracy of US guidance for image-guided injections of the temporomandibular joints in children with arthritis

Pediatric Radiology — Wed, 10 Mar 2010 16:11:29 +0100

Conclusion In our experience, TMJ injections using sonographic guidance is a safe, effective and accurate procedure. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00247-010-1581-2Authors Dimitri A. Parra, The Hospital for Sick Children Department of Diagnostic Imaging, Division of Image Guided Therapy 555 University Ave. Toronto Canada M5G 1X8Melissa Chan, McMaster University Division of Internal Medicine Hamilton CanadaGanesh Krishnamurthy, Children’s Hospital of Philadelphia Department of Diagnostic Imaging Philadelphia PA USALynn Spiegel, The Hospital for Sick Children Division of Rheumatology Toronto CanadaJoao G. Amaral, The Hospital for Sick Children Department of Diagnostic Imaging, Division of Image Guided Therapy 555 University Ave. Toront...

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Neoadjuvant targeting of glioblastoma multiforme with radiolabeled DOTAGA–substance P—results from a phase I study

Journal of Neuro-Oncology — Wed, 10 Mar 2010 16:00:43 +0100

Abstract Complete surgical resection beyond tumor margins cannot be achieved in glioblastoma multiforme (GBM) because of infiltrative nature. In several cancers, neoadjuvant treatment has been implemented to reduce the risk of tumor cell spreading during resection. In GBM, the objective of a neoadjuvant approach is reduction of tumor cells within the main tumor mass and beyond in the infiltration zone. Such an approach can only be performed if elevated intracranial pressure can be medically controlled. In a previous study with recurrent gliomas, we showed that local intratumoral injection of radiolabeled DOTAGA–substance P substantially inhibited further growth and led to radionecrotic transformation of the tumor (CCR 2006). We have now examined this modality as neoadjuv...

New pathophysiological insights and modern treatment of IBD

Journal of Gastroenterology — Wed, 10 Mar 2010 15:32:00 +0100

Abstract Inflammatory bowel disease (IBD), which comprises two main types, namely, Crohn’s disease and ulcerative colitis, affects approximately 3.6 million people in the USA and Europe, and an alarming rise in low-incidence areas, such as Asia, is currently being observed. In the last decade, spontaneous mutations in a diversity of genes have been identified, and these have helped to elucidate pathways that can lead to IBD. Animal studies have also increased our knowledge of the pathological dialogue between the intestinal microbiota and components of the innate and adaptive immune systems misdirecting the immune system to attack the colon. Present-day medical therapy of IBD consists of salicylates, corticosteroids, immunosuppressants and immunomodulators. However,...

Long-term reduction in local inflammation by a lipid raft molecule in atopic dermatitis

Allergy — Wed, 10 Mar 2010 00:00:00 +0100

Conclusion: We demonstrate that miltefosine is locally active in patients with AD and led to a sustained clinical improvement in local skin inflammation. Moreover, the increased frequency of FoxP3+ cells in the skin of patients with AD suggests its immunomodulatory properties. (Source: Allergy)

Pathophysiology of TMD pain – basic mechanisms and their implications for pharmacotherapy

Journal of Oral Rehabilitation — Wed, 10 Mar 2010 00:00:00 +0100

This article discusses the pathophysiology of temporomandibular disorders (TMD)-related pain and its treatment with analgesic drugs. Temporomandibular disorders are comprised of a group of conditions that result in temporomandibular joint pain (arthralgia, arthritis) and/or masticatory muscle pain (myofascial TMD). In at least some patients with TMD, a peripheral mechanism contributes to this pain. However, there is often a poor correlation between the severity of TMD-related pain complaints and evidence of definitive tissue pathology. This has led to the concept that pain in some patients with TMD may result from altered central nervous system pain processing and further that this altered pain processing may be attributable to specific genes that are heritable. Psychosocial stressors are ...

Deep vein and intracardiac thrombosis during the post-partum period in Behçet's disease.

International Journal of Hematology — Wed, 10 Mar 2010 00:00:00 +0100

Deep vein and intracardiac thrombosis during the post-partum period in Behçet's disease. Int J Hematol. 2010 Mar 10; Authors: Hiwarkar P, Stasi R, Sutherland G, Shannon M A 22-year-old woman presented on the 10th post-partum day with deep vein thrombosis involving the right ilio-femoral and popliteal veins. This thrombosis was refractory to conventional anticoagulation and subsequently over a period of 6 weeks progressed to involve inferior vena cava and right ventricle. A diagnosis of Behçet's disease was made on the clinical grounds of fever, night sweats, and recurrent oral ulcers. In view of refractory thrombosis, anticoagulation with lepirudin was commenced followed by thrombolysis with streptokinase. After thrombolysis, anticoagulation was switched to fondaparin...

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Stevens Johnson syndrome after carbamazepine and SJS/TEN overlap syndrome after amoxicillin: case reports and a review

Articles of Archives of Medical Science - TERMEDIA publishing house — Tue, 09 Mar 2010 16:16:09 +0100

We present a case of Stevens Johnson syndrome in a child after carbamazepine application and Stevens Johnson/TEN overlap syndrome in an adult after amoxicillin application. On the basis of two reported cases we review the most commonly associated drugs, the postulated pathogenesis, clinical manifestation and management in these severe life-threatening diseases. We especially discuss the controversial systemic corticosteroid therapy. Topical care is also discussed. (Source: Articles of Archives of Medical Science - TERMEDIA publishing house)

Growth retardation and delayed puberty in children and adolescents with juvenile idiopathic arthritis

Articles of Archives of Medical Science - TERMEDIA publishing house — Tue, 09 Mar 2010 16:05:51 +0100

Juvenile idiopathic arthritis (JIA) is the most common joint disorder in developing children. Juvenile idiopathic arthritis is difficult to diagnose and treat. In some patients, signs and symptoms can be frustratingly inconsistent, contradictory or idiosyncratic. Short stature in patients with JIA is usually due to reduced growth in the lower extremities, and only rarely due to reduced growth in the spinal column. In some studies, children with JIA were found to have infantile body proportions. Puberty is delayed in children with JIA. In children with chronic arthritic disorders, there is a strong correlation between the activity of the disease and the age of puberty. The main goals in reducing growth retardation in children with JIA are promoting timely remission and reducing the duration...

[Very premature births: Dilemmas and management. Part 1. Outcome of infants born before 28 weeks of postmenstrual age, and definition of a gray zone.]

Archives de Pediatrie — Tue, 09 Mar 2010 00:00:00 +0100

Authors: Moriette G, Rameix S, Azria E, Fournié A, Andrini P, Caeymaex L, Dageville C, Gold F, Kuhn P, Storme L, Siméoni U, With very preterm deliveries, the decision to institute intensive care, or, alternatively, to start palliative care and let the baby die, is extremely difficult, and involves complex ethical issues. The introduction of intensive care may result in long-term survival of many infants without severe disabilities, but it may also result in the survival of severely disabled infants. Conversely, the decision to withhold resuscitation and/or intensive care at birth, which is an option at the margin of viability, implies allowing babies to die, although some of them would have developed normally if they had received resuscitation and/or intensive care. Withhold...

Suppression of Corticosteroid-Induced Ocular Hypertension in Sheep by Anecortave [Laboratory Sciences]

Archives of Opthalmology — Mon, 08 Mar 2010 20:50:47 +0100

Conclusion Elucidation of the mechanisms of action of anecortave in animal models may prove relevant to the design of novel interventions for the management of primary open-angle glaucoma. (Source: Archives of Opthalmology)

Suppression and Reduction of Corticosteroid-Induced Ocular Hypertension by Anecortave in Sheep [Editorial]

Archives of Opthalmology — Mon, 08 Mar 2010 20:50:47 +0100

(Source: Archives of Opthalmology)

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The evidence for the use of oral mucolytic agents in chronic obstructive pulmonary disease (COPD)

British Medical Bulletin — Mon, 08 Mar 2010 15:36:35 +0100

This article reviews the evidence for their use and their possible benefits. Sources of data The review is based upon peer reviewed publications relating to the use of mucolytics in COPD cited in PubMed. Areas of agreement Much of the published evidence is of somewhat poor quality and many studies include patients with both chronic bronchitis and COPD. Mucolytics reduce exacerbations by up to 0.8 exacerbations per year, but have little additional benefit in those on standard maximum therapy. Areas of controversy Data that mucolytics improve symptoms, alter mucus or impact health-related quality of life in COPD patients receiving other standard therapy are unconvincing. In those on little or no other treatment, they may reduce exacerbation rate. Growing points The use of mucolytics to t...

Outcome and treatment of late-onset noninfectious pulmonary complications after allogeneic haematopoietic SCT

Bone Marrow Transplantation — Mon, 08 Mar 2010 00:00:00 +0100

Authors: K Ueda, T Watadani, E Maeda, S Ota, K Kataoka, S Seo, K Kumano, A Hangaishi, T Takahashi, Y Imai, K Ohtomo, M Fukayama, Y Nannya & M Kurokawa (Source: Bone Marrow Transplantation)

Cognition and dorsolateral prefrontal cortex volume in corticosteroid-treated patients given lamotrigine

Stress and Health — Mon, 08 Mar 2010 00:00:00 +0100

In addition to changes in declarative memory and the hippocampus, corticosteroid excess is associated with prefrontal cortex changes. We previously reported that patients receiving exogenous corticosteroid therapy had impaired performance on prefrontal cortex-related tasks, including working memory and executive functioning tasks. Glutamate release inhibitors attenuate corticosteroid-effects on the hippocampus in both animal and human models. Twenty-eight outpatients receiving chronic prednisone therapy for transplant rejection or other medical conditions were randomized to lamotrigine (a glutamate release inhibitor) or placebo for 24 weeks. Dorsolateral prefrontal cortex (DLPFC) volume was manually traced from MRI scans by trained staff members. Cognition was examined using the Stroop Col...

Linear erosive herpes simplex virus: the 'knife-cut sign' in a patient on high-dose corticosteroids

Clinical And Experimental Dermatology — Mon, 08 Mar 2010 00:00:00 +0100

(Source: Clinical And Experimental Dermatology)

Biologic and pharmacologic therapies in clinical development for the inflammatory response in COPD.

Drug Discovery Today — Mon, 08 Mar 2010 00:00:00 +0100

This article gives an up-to-date summary of these novel therapies and their status of clinical development in targeting the various inflammatory pathways of COPD. PMID: 20223295 [PubMed - as supplied by publisher] (Source: Drug Discovery Today)

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Timing of fledging is influenced by glucocorticoid physiology in Laysan Albatross chicks.

Hormones and Behavior — Mon, 08 Mar 2010 00:00:00 +0100

Authors: Sprague RS, Breuner CW Fledging is a major life transition for birds, when juveniles move from the safety of a nest into an environment where they must find food and avoid predators. The timing of fledging within a season can have significant effects on future survival and breeding success. Proximate triggers of fledging are unknown: though wing development is likely a primary factor, other physiological changes, such as elevated plasma corticosterone (CORT), may affect fledging behavior. Laysan Albatross (Phoebastria immutabilis) chicks have an extended post-hatching period during which they reach 150% of adult mass. However, approaching fledging, chicks fast for days to weeks and lose mass while still putting energy into feather growth. We evaluated chick morphology and phys...

The effect of topical ocular corticosteroid administration in dogs with experimentally-induced latent canine herpesvirus-1 infection.

Experimental Eye Research — Mon, 08 Mar 2010 00:00:00 +0100

Authors: Ledbetter EC, Kice NC, Matusow RB, Dubovi EJ, Kim SG Recurrent herpes simplex virus-1 (HSV-1) ocular infection is a frequent cause of morbidity and blindness. Factors that trigger viral reactivation are poorly understood and the role of topical ocular corticosteroid administration in the development of recurrent HSV-1 ocular disease is not clear. Clinical reports and epidemiological studies suggested topical corticosteroids may reactivate latent HSV-1 and result in recrudescent ocular disease; however, experimental studies to establish this causal relationship produced inconsistent results. The previous experimental studies were performed by infecting unnatural host species with HSV-1 and aspects of viral behavior and reactivation within these animals may differ from the host ...

New means to monitor the effect of glucocorticoid therapy in children.

World Journal of Gastroenterology : WJG — Sun, 07 Mar 2010 00:00:00 +0100

CONCLUSION: GC response could be monitored at an individual level by studying the effect of patient serum on signaling pathways of target immune cells. PMID: 20205281 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

[Steroid-induced spinal epidural lipomatosis in pediatric patients.]

Zeitschrift fur Rheumatologie — Sat, 06 Mar 2010 00:00:00 +0100

We describe three adolescent patients with chronic autoimmune disorders who developed back pain and, in two cases, spinal symptoms several months after initiating chronic treatment with glucocorticoids. In all cases, MRI showed extensive spinal epidural lipomatosis, a rare but classic untoward effect of chronic glucocorticoid therapy. Analysis of these three, as well as 11 other pediatric cases extracted from the international literature, revealed that spinal epidural lipomatosis manifests most commonly with back pain and within a mean of 1.3 years (range, 3 month-6.5 years) after initiation of therapy with corticosteroids. It frequently remits after reduction of the corticosteroid dose. PMID: 20213089 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Rheumatologie)

AAAAI: Test May Identify Asthma Patients Unresponsive to Steroids (CME/CE)

MedPage Today Allergy — Fri, 05 Mar 2010 21:14:19 +0100

NEW ORLEANS (MedPage Today) -- Asthma patients who will be unlikely to gain control of symptoms with inhaled corticosteroids might be identified with a blood test, a researcher suggested here. (Source: MedPage Today Allergy)

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Abrogation of Glucocorticoid Receptor Dimerization Correlates with Dissociated Glucocorticoid Behavior of Compound A [Gene Regulation]

Journal of Biological Chemistry — Fri, 05 Mar 2010 14:37:13 +0100

Compound A (CpdA), a dissociated glucocorticoid receptor modulator, decreases corticosteroid-binding globulin (CBG), adrenocorticotropic hormone (ACTH), and luteneinizing hormone levels in rats. Whether this is due to transcriptional regulation by CpdA is not known. Using promoter reporter assays we show that CpdA, like dexamethasone (Dex), directly transrepresses these genes. Results using a rat Cbg proximal-promoter reporter construct in BWTG3 and HepG2 cell lines support a glucocorticoid receptor (GR)-dependent transrepression mechanism for CpdA. However, CpdA, unlike Dex, does not result in transactivation via glucocorticoid-responsive elements within a promoter reporter construct even when GR is co-transfected. The inability of CpdA to result in transactivation via glucocorticoid-resp...

Lupus panniculitis as an initial manifestation of systemic lupus erythematosus

Indian Journal of Dermatology — Fri, 05 Mar 2010 14:02:58 +0100

Patel Raksha M, Marfatia Y SIndian Journal of Dermatology 2010 55(1):99-101In May, 2003, a 28-year-old female presented with large non-healing ulcers on face, trunk and limbs covered with black hemorrhagic crust. There were no other systemic manifestations. Diagnosis of lupus panniculitis was considered on clinical and histopathological grounds. The lesions healed completely, with scarring, with systemic corticosteroid, hydroxychloroquine and topical 2% mupirocin. She came again in November, 2005, with malar rash, joint pain, scarring alopecia of the scalp and albuminuria. Her ANA, AntidsDNA came positive and diagnosed as having systemic lupus erythematosus (SLE). She responded well to systemic corticosteroid, antimalarial and topical antibacterial. The evolution of lupus panniculit...

[Seminar] Bacterial septic arthritis in adults

LANCET — Fri, 05 Mar 2010 00:00:00 +0100

Symptoms and signs of septic arthritis are an important medical emergency, with high morbidity and mortality. We review the changing epidemiology of septic arthritis of native joints in adults, encompassing the increasing frequency of the disorder and its evolving antibiotic resistance. We discuss various risk factors for development of septic arthritis and examine host factors (tumour necrosis factor α, interleukins 1 and 10) and bacterial proteins, toxins, and enzymes reported to be important determinants of pathogenesis in mouse models. Diagnosis of disease is largely clinical, guided by investigations and the opinion of skilled clinicians. We emphasise the need for timely medical and surgical intervention—most importantly, through diagnostic aspiration of relevant joints, choice of ...

Adjuvant triamcinolone acetonide injections in oro-pharyngeal pemphigus vulgaris

Journal of the European Academy of Dermatology and Venereology — Fri, 05 Mar 2010 00:00:00 +0100

Conclusion Perilesional/intralesional triamcinolone acetonide injections seems to represent a helpful clinical tool to successfully join CIST, in terms of shortening the time of complete clinical remission, reducing the total amount of corticosteroids and obtaining an acceptable compliance. (Source: Journal of the European Academy of Dermatology and Venereology)

Triple inhaled therapy in stable chronic obstructive pulmonary disease: the earlier, the better? Evaluation of Welte T, Miravitlles M, Hernandez P, et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;180:741-50.

Respiratory Care — Fri, 05 Mar 2010 00:00:00 +0100

Authors: Antoniu SA, Carone M, Sampablo I Inhaled long-acting bronchodilators (of beta(2)-agonist or muscarinic antagonist type) or corticosteroids are used in stable chronic obstructive pulmonary disease (COPD) treatment in a step-up approach according to disease severity. Consequently, in more severe disease triple therapy with two bronchodilators and an inhaled corticosteroid can often be encountered in clinical practice, but its short- and long-term effects on disease outcomes are not very well known. The results of a study evaluating the short-term effects of budesonide/formoterol (inhaled corticosteroid/inhaled long-acting beta2-agonist combination) and tiotropium (inhaled long-acting muscarinic antagonist) against tiotropium alone are analysed and discussed. On a short-term basi...

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AAAAI: Lack of Controller Meds Linked to Asthma Deaths (CME/CE)

MedPage Today Allergy — Thu, 04 Mar 2010 17:58:37 +0100

NEW ORLEANS (MedPage Today) -- Almost everyone who died from an out-of-hospital acute asthma attack in Milwaukee over a four-year period had one thing in common: they weren't using inhaled corticosteroids, a researcher said here. (Source: MedPage Today Allergy)

Chapter 8: Fungal infections in immunocompromised patients

Jornal Brasileiro de Pneumologia — Thu, 04 Mar 2010 16:48:33 +0100

Systemic allergic reaction to a caterpillar in a 3-month-old infant.

Annals of Tropical Paediatrics — Thu, 04 Mar 2010 16:32:03 +0100

Authors: Ramesh Bhat Y, Vinayaka G, Sushma S Systemic reactions to contact with a caterpillar are rare in children. A 3-month-old infant presented to the emergency department with acute onset of rash, severe respiratory distress and shock. Her mother volunteered that the infant had been exposed to a tree processionary caterpillar. The infant responded to systemic corticosteroids and antihistamines although the rash persisted for more than 5 days. PMID: 20196941 [PubMed - in process] (Source: Annals of Tropical Paediatrics)

Symptomatic, steroid-induced, multifocal diaphyseal osteonecrosis in a patient with multiple sclerosis

Multiple Sclerosis — Thu, 04 Mar 2010 15:11:15 +0100

We present a case of symptomatic, multifocal, diaphyseal osteonecrosis in a woman receiving pulsed corticosteroids for symptom control of multiple sclerosis (MS). She was investigated for knee pain, which could have been attributed to her primary disease, and magnetic resonance imaging (MRI) revealed bone infarcts within the femur, tibia and talus. She underwent successful intra-medullary reaming to the diaphyseal infarcts. This case highlights the importance of investigating musculoskeletal pain in patients with MS, receiving corticosteroids. (Source: Multiple Sclerosis)

Research Findings Presented At American Academy Of Allergy Asthma & Immunology

Health News from Medical News Today — Thu, 04 Mar 2010 13:00:00 +0100

Dozens of National Jewish Health faculty presented their latest research findings at the annual meeting of the American Academy of Allergy Asthma & Immunology in New Orleans Feb 27-March 2, 2010. Below are several noteworthy presentations. Vitamin D May Boost Effectiveness of Corticosteroids in Asthma Vitamin D enhances the activity of the corticosteroid dexamethasone more than ten-fold in cells taken from asthma patients... (Source: Health News from Medical News Today)

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For Children With Poorly Controlled Asthma, Long-Acting Beta-Agonists Shown To Be Most Effective Step-Up Therapy

Health News from Medical News Today — Thu, 04 Mar 2010 09:00:00 +0100

For children whose asthma is not well controlled and on low doses of inhaled corticosteroids, a long-acting beta-agonist (LABA) may be the most effective of three possible step-up treatments. National Jewish clinician-scientists Stanley Szefler, Joseph Spahn, Ronina Covar Gary Larsen and Lynn Taussig, and colleagues in the NIH-funded Childhood Asthma Research and Education Network published their findings March 2, 2010, online in the New England Journal of Medicine... (Source: Health News from Medical News Today)

For Children With Poorly Controlled Asthma, Long-Acting Beta-Agonists Shown To Be Most Effective Step-Up Therapy

Pediatrics News From Medical News Today — Thu, 04 Mar 2010 09:00:00 +0100

'Stepping up' asthma treatment in children leads to improvement

ScienceDaily Headlines — Thu, 04 Mar 2010 07:00:00 +0100

ICSs do not have dose-dependent effects on growth in asthmatic girls

MedWire News - Respiratory — Thu, 04 Mar 2010 00:00:00 +0100

Results from a US study suggest that inhaled corticosteroid treatment is not associated with significant dose-dependent growth reductions in adolescent girls. (Source: MedWire News - Respiratory)

LABA step-up therapy best for poorly controlled childhood asthma

MedWire News - Respiratory — Thu, 04 Mar 2010 00:00:00 +0100

Treatment with a long-acting beta-agonist is the most likely step-up therapy to illicit a good response among children with asthma that remains poorly controlled despite taking low-dose inhaled corticosteroids, say researchers. (Source: MedWire News - Respiratory)

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A case of emphysematous pyelonephritis in a patient with rheumatoid arthritis taking corticosteroid and low-dose methotrexate

APLAR Journal of Rheumatology — Thu, 04 Mar 2010 00:00:00 +0100

In this report, we describe a case of emphysematous pyelonephritis in a patient with RA associated with AA amyloidosis and steroid-induced diabetes mellitus who was taking corticosteroid and low-dose methotrexate. (Source: APLAR Journal of Rheumatology)

NICE issues Final Appraisal Determination on infliximab and adalimumab for Crohn's disease

NeLM - News — Thu, 04 Mar 2010 00:00:00 +0100

Source: NICE Area: News NICE has prepared a Final Appraisal Determination on infliximab and adalimumab for Crohn's disease which contained the following preliminary recommendations: . Infliximab and adalimumab, within their licensed indications, are recommended as treatment options for adults with severe active Crohn's disease whose disease has not responded to conventional therapy (including immunosuppressive and/or corticosteroid treatments), or who are intolerant of or have contraindications to conventional therapy. Infliximab or adalimumab should be given as a planned course of treatment until treatment failure (including the need for surgery), or until 12 months after the start of treatment, whichever is shorter. People should then have their disease reassessed to det...

Fluticasone Reverses Oxymetazoline Induced Tachyphylaxis of Response and Rebound Congestion.

American Journal of Respiratory and Critical Care Medicine — Thu, 04 Mar 2010 00:00:00 +0100

CONCLUSIONS: Oxymetazoline induced tachyphylaxis and rebound congestion is reversed by intranasal fluticasone. Further studies are indicated to evaluate if combination nasal sprays of decongestant and corticosteroid are an effective strategy to obviate tachyphylaxis and rebound in rhinitis. Clinical trials registration information available at www.clinicaltrials.gov, i.d. #NCT00487032. PMID: 20203244 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

[Infantile hemangioma.]

Presse Medicale — Thu, 04 Mar 2010 00:00:00 +0100

Authors: Léauté-Labrèze C, Sans-Martin V Infantile hemangioma is the most common tumor in children, but its pathophysiology is still not well understood. Infantile hemangioma develops during the first weeks of life, usually builds up over 3 to 6 months, and then regresses very slowly over a period of 3 to 7 years. Three quarters of these hemangiomas are lobular and are not associated with malformations. On the other hand, the hemangiomas referred to as segmental may be associated with developmental abnormalities (PHACES and PELVIS/SACRAL syndromes). Because of their spontaneous involution, most infantile hemangiomas do not require therapeutic intervention. In 10 to 15 % of cases, treatment is necessary because of complications when life or physiological functioning is th...

Step-Up Therapy Improves Asthma Control in Children

Medscape Today Headlines — Wed, 03 Mar 2010 21:57:33 +0100

Adding or increasing the dose of either a long-acting beta agonist or a leukotriene-receptor antagonist to inhaled corticosteroids improves disease control in children with asthma. Medscape Medical News (Source: Medscape Today Headlines)

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'Stepping Up' Asthma Treatment In Children Leads To Improvement

Health News from Medical News Today — Wed, 03 Mar 2010 10:00:00 +0100

Children with asthma who continue to have symptoms while using low-dose inhaled corticosteroids could benefit from increasing the dosage or adding one of two asthma drugs, a new study by researchers at Washington University School of Medicine and other institutions finds. Results of the study, called BADGER (Best ADd-on therapy Giving Effective Responses) may also allow physicians to better predict which of the three options will help a patient the most... (Source: Health News from Medical News Today)

'Stepping Up' Asthma Treatment In Children Leads To Improvement

Pediatrics News From Medical News Today — Wed, 03 Mar 2010 10:00:00 +0100

Magnetic resonance imaging of pachymeningeal enhancement in Vogt-Koyanagi-Harada disease

Neurological Sciences — Wed, 03 Mar 2010 08:51:36 +0100

We report a case of VKH disease with panuveitis and meningeal involvement of the anterior temporal lobe detected by brain MRI. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10072-010-0236-2Authors Hyun Jeong Han, Kwandong University Department of Neurology, College of Medicine, Myongji Hospital 697-24 Hawjeong-dong, Deukyang-gu, Goyang-shi Gyeonggi-do KoreaHye Yun Kim, Kwandong University Department of Neurology, College of Medicine, Myongji Hospital 697-24 Hawjeong-dong, Deukyang-gu, Goyang-shi Gyeonggi-do KoreaJong-Ho Park, Kwandong University Department of Neurology, College of Medicine, Myongji Hospital 697-24 Hawjeong-dong, Deukyang-gu, Goyang-shi Gyeonggi-do KoreaEun Ja Lee, Kwandong University Department of Radiology, College of Medicine, Myongji Hospital Gyeo...

Viral meningoencephalitis: a review of diagnostic methods and guidelines for management

European Journal of Neurology — Wed, 03 Mar 2010 00:00:00 +0100

Background: Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury.Methods: We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points.Recommendations: Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, p...

Combined ICS/LABA treatment cost-effective for COPD

MedWire News - Respiratory — Wed, 03 Mar 2010 00:00:00 +0100

Combined treatment with a fixed-dose inhaled corticosteroid and a long-acting beta-2 agonist is more cost-effective for the treatment of chronic obstructive pulmonary disease than either treatment alone or placebo, researchers have found. (Source: MedWire News - Respiratory)

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Step-up therapy for children with asthma not controlled by inhaled corticosteroids

NeLM - News — Wed, 03 Mar 2010 00:00:00 +0100

Source: NEJM Area: News In a controlled trial, inhaled long-acting beta-agonist (LABA) was more likely than increased inhaled corticosteroid (ICS) dose or leukotriene antagonist to be effective as step-up treatment in children with asthma not controlled with ICS, however many children responded better to ICS or leukotriene antagonist. A significant proportion of children with asthma will not be controlled with low-dose ICS, however the evidence for the most effective step-up therapy is uncertain. This three-way crossover study was intended to determine whether inhaled LABA, increased ICS dose, or oral leukotriene antagonist would be most effective in such children. It involved children aged 6 to 17 years with mild to moderate asthma not adequately controlled on inhaled f...

Step-up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

New England Journal of Medicine — Wed, 03 Mar 2010 00:00:00 +0100

Background For children who have uncontrolled asthma despite the use of low-dose inhaled corticosteroids (ICS), evidence to guide step-up therapy is lacking. Methods We randomly assigned 182 children (6 to ... (Source: New England Journal of Medicine)

NIH Study Looks At Long-Acting Asthma Drugs For Children

WSJ.com: Health — Tue, 02 Mar 2010 20:36:06 +0100

A study found that certain long-acting asthma drugs such as GlaxoSmithKline PLC's Advair were more likely to be the best add-on therapy for children whose asthma isn't well controlled by inhaled corticosteroids. (Source: WSJ.com: Health)

Statement of Anthony S. Fauci, M.D. Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, on National Women and Girls HIV/AIDS Awareness Day, March 10, 2010

National Institutes of Health (NIH) News Releases — Tue, 02 Mar 2010 20:31:00 +0100

A new study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental, treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids alone. The study was designed to provide needed evidence for selecting step-up care for such children and was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. (Source: National Institutes of Health (NIH) News Releases)

Maternal Serum Interleukin-6, C-Reactive Protein, and Matrix Metalloproteinase-9 Concentrations as Risk Factors for Preterm Birth

American Journal of Perinatology — Tue, 02 Mar 2010 17:35:20 +0100

Amer J PerinatolDOI: 10.1055/s-0030-1249366ABSTRACTElevated concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), and matrix metalloproteinase-9 (MMP-9) in fetal and neonatal compartments have been associated with an increased risk for preterm birth (PTB) and/or neonatal morbidity. The purpose of this study was to determine if the maternal serum concentration of IL-6, CRP, and MMP-9 in women at risk for PTB, who are not in labor and have intact membranes, are associated with an increased risk for PTB <32 weeks and/or neonatal morbidity. Maternal serum samples collected from 475 patients enrolled in a multicenter randomized controlled trial of single versus weekly corticosteroids for women at increased risk for preterm delivery were assayed. Serum was collected at randomizati...

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Childhood Asthma Treatment: Not One-Size-Fits-All

National Institutes of Health (NIH) News Releases — Tue, 02 Mar 2010 16:51:00 +0100

Practice parameter - corticosteroid treatment of Duchenne dystrophy

Neurological Conditions Specialist Library — Tue, 02 Mar 2010 14:35:12 +0100

Aims: Duchenne dystrophy (DD), an X-linked, recessive disorder, with onset before age 5 years, is the most common and severe form of childhood muscular dystrophy. This guidance aims to review available evidence on corticosteroid treatment of boys with this condition. (Source: Neurological Conditions Specialist Library)

Treatment of Diabetic and Nondiabetic Lumbosacral Radiculoplexus Neuropathy

Current Treatment Options in Neurology — Tue, 02 Mar 2010 10:08:07 +0100

Opinion statement Lumbosacral radiculoplexus neuropathy (LRPN) is a multifocal, asymmetric, painful neuropathic disorder affecting multiple levels of lumbosacral plexus, nerve roots, and distal nerves that emerge from the plexus. The disorder was first described in diabetic patients (DLRPN) and was later found to occur in nondiabetic patients as well. There have been debates as to the pathogenesis of DLRPN and LRPN. Recent detailed and extensive pathologic studies, however, have shown that the main pathogenesis is inflammation and microvasculitis affecting various components in the peripheral nerves, resulting in ischemic injury to the nerves. Even though studies on the natural history of this disorder have shown that the majority of patients recover within a few years aft...

Treatment of Chronic Inflammatory Demyelinating Polyneuropathy

Current Treatment Options in Neurology — Tue, 02 Mar 2010 10:08:07 +0100

Opinion statement Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, immune-mediated, non–length-dependent polyradiculoneuropathy that is progressive or relapsing over a period of at least 8 weeks, often evolving over time to a relatively symmetric pattern. Although the exact pathogenesis is unclear, it is thought to be mediated by both cellular and humoral reaction to the peripheral nerve myelin sheath involving nerve roots and proximal and distal nerves. Early medical treatment of CIDP is important to prevent axonal loss occurring as a secondary effect of progressive demyelination. Only three treatments for CIDP have demonstrated benefit in randomized controlled studies: corticosteroids, plasma exchange, and intravenous immunoglobulin. About 2...

Asthma and Dehydroepiandrosterone (DHEA): Facts and Hypotheses

Inflammation — Tue, 02 Mar 2010 10:04:40 +0100

Abstract Dehydroepiandrosterone (DHEA) is considered as an important immunomodulating and anti-inflammatory hormone. Despite the continuing interest in DHEA replacement therapy, our knowledge of its effects upon asthma is very limited. DHEA is able to reverse cytokine imbalances associated with asthma, may prevent and attenuate allergic inflammation in airways, and does not possess the undesirable side effects of glucocorticoids; therefore, it may be potentially applied in the treatment of asthma. The steroid-sparing effect observed with DHEA clinically could appear especially favorable in asthmatic patients receiving oral treatment and those inhaling high doses of glucocorticoids. In addition, DHEA and its analogs might prove useful in reversing relative glucocorticoids i...

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Non-immunologic mechanisms of calcineurin inhibitors explain its antiproteinuric effects in genetic glomerulopathies

Pediatric Nephrology — Tue, 02 Mar 2010 10:01:42 +0100

Abstract It has been reported (this issue Pediatric Nephrology) that cyclosporine A (CyA) therapy in combination with corticosteroids, angiotensin-converting enzyme inhibitor, and an angiotensin receptor blocker decreased proteinuria in three patients with nephrotic syndrome (NS) due to WT1 mutations. Treatment with calcineurin inhibitors were found to induce a partial remission of proteinuria in several other children with genetic forms of NS, such as mutation in the podocine and in the phospholipase C epsilon gene. CyA therapy has also been reported to be beneficial to patients with Alport syndrome. Recent data have shown that the antiproteinuric effect of CyA in these cases may be due to a non-immunologic mechanism. CyA exerts an antiproteinuria effect by preventing the d...

Postsurgical Recurrence of Ileal Crohn’s Disease: An Update on Risk Factors and Intervention Points to a Central Role for Impaired Host-Microflora Homeostasis

World Journal of Surgery — Tue, 02 Mar 2010 10:00:19 +0100

Conclusions Current evidence points to defects in mucosal immunity and intestinal dysbiosis of either innate (NOD2/CARD15) or induced (smoking) origin in postoperative CD recurrence. Prophylactic strategies should aim to limit dysbiosis (antibiotics, side-to-side anastomoses) or prevent downstream chronic inflammatory sequelae (anti-inflammatory, immunosuppressive, and immunomodulatory therapy). Content Type Journal ArticleDOI 10.1007/s00268-010-0504-6Authors Michael F. Cunningham, St Vincent’s University Hospital Surgical Professorial Unit Elm Park Dublin 4 IrelandNeil G. Docherty, Trinity College Dublin Department of Physiology, School of Medicine Dublin IrelandJ. Calvin Coffey, St Vincent’s University Hospital Surgical Professorial Unit Elm Park Dublin 4 Irel...

Long-acting beta-agonists most effective step-up therapy for children with poorly controlled asthma

EurekAlert! - Medicine and Health — Tue, 02 Mar 2010 05:00:00 +0100

(National Jewish Medical and Research Center) For children whose asthma is not well controlled and on low doses of inhaled corticosteroids, a long-acting beta-agonist (LABA) may be the most effective of three possible step-up treatments. National Jewish clinician-scientists Stanley Szefler, Joseph Spahn, Ronina Covar, Gary Larsen and Lynn Taussig, and colleagues in the NIH-funded Childhood Asthma Research and Education Network published their findings March 2, 2010, online in the New England Journal of Medicine. (Source: EurekAlert! - Medicine and Health)

Occlusion and brain function: mastication as a prevention of cognitive dysfunction

Journal of Oral Rehabilitation — Tue, 02 Mar 2010 00:00:00 +0100

Summary Research in animals and humans has shown that mastication maintains cognitive function in the hippocampus, a brain area important for learning and memory. Reduced mastication, an epidemiological risk factor for the development of dementia in humans, attenuates spatial memory and causes hippocampal neurons to deteriorate morphologically and functionally, especially in aged animals. Active mastication rescues the stress-attenuated hippocampal memory process in animals and attenuates the perception of stress in humans by suppressing endocrinological and autonomic stress responses. Active mastication further improves the performance of sustained cognitive tasks by increasing the activation of the hippocampus and the prefrontal cortex, the brain regions that are essential for cognitive ...

Nausea and Vomiting in Advanced Cancer.

The American Journal of Hospice and Palliative Care — Tue, 02 Mar 2010 00:00:00 +0100

Authors: Ang SK, Shoemaker LK, Davis MP Nausea and vomiting are relatively common in advanced cancer and is dreaded more than pain by patients. The history, pattern of nausea and vomiting, associated symptoms, and physical examination provides clues as to etiology and may guide therapy. Continuous severe nausea unrelieved by vomiting is usually caused by medications or metabolic abnormalities, while nausea relieved by vomiting or induced by eating is usually due to gastroparesis, gastric outlet obstruction, or small bowel obstruction. Drug choices are empiric or based on etiology. Metoclopramide has the greatest evidence for efficacy followed by phenothiazines and tropisetron. Corticosteroids have not been effective in randomized trials except in the case of bowel obstruction. Treatmen...

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Wegener’s granulomatosis: experience from a Brazilian tertiary center

Clinical Rheumatology — Mon, 01 Mar 2010 18:08:36 +0100

Abstract Most epidemiological studies with Wegener’s granulomatosis (WG) patients are based on populations from the Northern hemisphere, whereas very few studies have been conducted in Southern hemisphere populations, particularly from South America. The authors performed a large retrospective, demographic study including clinical and laboratory profiles of 134 consecutive WG patients seen at one Brazilian center from 1999 to 2009. Mean age at initial WG diagnosis was 43.4 ± 15.5 years, and mean disease duration was 8.6 ± 6.6 years. Sixty-four (47.8%) patients were male and a total of 113 (84.3%) subjects were white. Ear/nose/throat involvement occurred in 85.8%. The classic lung and renal involvement were observed in 77.6% and 75.4%, respectively, fol...

Acute Necrotizing Encephalopathy in 3 Brothers

PEDIATRICS — Mon, 01 Mar 2010 16:02:29 +0100

We report here a multiply affected kindred with recurrent familial ANE. These affected male siblings (a set of twins and their older brother) all presented with prodromal fever and upper respiratory tract infection that progressed within 72 hours to seizures, coma, and ultimately death, a course that is typical of ANE. It should be noted that 1 brother was treated with early aggressive management, including corticosteroids, and he survived for an additional 5 years. This represents the second reported case of familial ANE in the United States and the only case of male siblings with consanguineous parents. We hope that early recognition and growing awareness can lead to more effective treatment and better outcomes in the future. (Source: PEDIATRICS)

Corticosteroids/mycophenolate mofetil/tacrolimus: Atypical acute leukaemia?: case report

Reactions — Mon, 01 Mar 2010 14:50:10 +0100

(Source: Reactions)

European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society – First Revision

Journal of the Peripheral Nervous System — Mon, 01 Mar 2010 00:00:00 +0100

Background: Consensus guidelines on the definition, investigation, and treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have been published (J Peripher Nerv Syst 2005; 10: 220[ndash]228, Eur J Neurol 2006; 13: 326[ndash]332). Objectives: To revise these guidelines. Methods: Disease experts, including a representative of patients, considered references retrieved from MEDLINE and Cochrane Systematic Reviews published between August 2004 and July 2009 and prepared statements that were agreed in an iterative fashion. Recommendations: The Task Force agreed on Good Practice Points to define clinical and electrophysiological diagnostic criteria for CIDP with or without concomitant diseases and investigations to be considered. The principal treatment recommendations we...

Mineralocorticoid receptor activation restores medial perforant path LTP in diabetic rats

Synapse — Mon, 01 Mar 2010 00:00:00 +0100

In the hippocampus, glucocorticoids bind to two types of receptors: the mineralocorticoid receptor, which binds corticosterone with high affinity and is tonically occupied; and the glucocorticoid receptor, which is occupied during stress and at certain phases in the circadian cycle. Diabetes mellitus increases levels of glucocorticoids in both humans and animal models. To explore the contributions of hippocampal corticosteroid receptors to the diabetes-induced suppression of neuroplasticity, we manipulated these receptors in hippocampal slices from streptozocin-diabetic rats, a model of Type 1 diabetes mellitus. STZ-diabetes reduced long-term potentiation (LTP) at medial perforant path synapses in the dentate gyrus, and induced a bias in favor of long-term depression following intermediate...

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Risk factors for periventricular-intraventricular hemorrhage in premature infants.

J Korean Med Sci — Mon, 01 Mar 2010 00:00:00 +0100

This study aimed to determine the perinatal factors associated with PV-IVH. We conducted a retrospective case-control study from preterm infants born at </=34 weeks of gestation and admitted to Neonatal Intensive Care Units of Seoul National University Children's Hospital and Seoul National University Bundang Hospital between June 2003 and December 2007. Neonates with no cranial sonographic data or infants transferred from other centers after three days of age were excluded. Of 1,044 eligible subjects, 59 infants with PV-IVH grade 2, 3, and 4 were allocated to the case group. The control group consisted of 118 infants without PV-IVH who were matched for gestational age and birth weight to each case of PV-IVH. At the multivariate logistic regression model, metabolic acidosis (odds ratio ...

Pseudomonas keratitis after collagen crosslinking for keratoconus: Case report and review of literature

Journal of Cataract and Refractive Surgery — Mon, 01 Mar 2010 00:00:00 +0100

A 19-year-old woman presented with a 3-day history of pain, redness, and diminution of vision occurring one day after collagen crosslinking (CXL) with riboflavin and ultraviolet-A had been performed for keratoconus in the right eye. On presentation, severe keratitis with a 7.0mm×6.0mm central infiltrate was present. Culture results from the patient's contact lens and corneal scrapings were positive for Pseudomonas aeruginosa. Keratitis can occur following CXL because of the presence of an epithelial defect, use of a soft bandage contact lens, and topical corticosteroids in the immediate postoperative period, and patients should be counseled about it.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. (Source: Journal of Cataract and...

Non-infectious Pneumonitis After Everolimus Therapy for Advanced Renal Cell Carcinoma.

American Journal of Respiratory and Critical Care Medicine — Mon, 01 Mar 2010 00:00:00 +0100

CONCLUSIONS: Early recognition, prompt intervention, and a conservative approach are important in managing the risk associated with non-infectious pneumonitis in association with everolimus. PMID: 20194812 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Antibody status in children with steroid-sensitive nephrotic syndrome.

Yonsei Medical Journal — Mon, 01 Mar 2010 00:00:00 +0100

CONCLUSIONS: IgG levels correlated positively with albumin levels, and all antibodies, including immune and natural antibodies, were depressed in the acute stage of NS. Our results suggest that hypogammaglobulinaemia in NS may be associated with intravascular homeostasis of oncotic pressure. PMID: 20191016 [PubMed - in process] (Source: Yonsei Medical Journal)

CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement.

Med J Aust — Mon, 01 Mar 2010 00:00:00 +0100

Authors: Gibson PG, Chang AB, Glasgow NJ, Holmes PW, Katelaris P, Kemp AS, Landau LI, Mazzone S, Newcombe P, Van Asperen P, Vertigan AE Cough is a common and distressing symptom that results in significant health care costs from medical consultations and medication use. Cough is a reflex activity with elements of voluntary control that forms part of the somatosensory system involving visceral sensation, a reflex motor response and associated behavioural responses. At the initial assessment for chronic cough, the clinician should elicit any alarm symptoms that might indicate a serious underlying disease and identify whether there is a specific disease present that is associated with chronic cough. If the examination, chest x-ray and spirometry are normal, the most common diagnoses in AD...

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Effects of birth advancement in Chiari malformation in a surgical myelomeningocele model in rabbits

Journal of Pediatric Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: Birth advancement and prenatal administration of corticosteroids decrease the severity of the hindbrain herniation component of Chiari II malformation in surgical MMC in fetal rabbits. (Source: Journal of Pediatric Surgery)

Myocarditis during Acute Schistosomiasis in Two Travelers.

The American Journal of Tropical Medicine and Hygiene — Mon, 01 Mar 2010 00:00:00 +0100

We report two cases of myocarditis complicating acute schistosomiasis in returning travelers. Treatment with corticosteroids led to full recovery in both cases. Although the pathophysiology of this complication remains unclear, we recommend treating such patients with corticosteroids rather than praziquantel, which can be associated with clinical deterioration. PMID: 20207856 [PubMed - in process] (Source: The American Journal of Tropical Medicine and Hygiene)

NSAID effects on pyloric and duodenal mucosa of dogs

Advances in Small Animal Medicine and Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Non-steroidal anti-inflammatory drugs (NSAIDs) can produce gastrointestinal ulcers. In dogs, NSAID-associated gastrointestinal ulcers are most commonly found in the pylorus and proximal portion of the duodenum. The incidence of ulcers in dogs is unknown because of the non-specific or mild clinical signs associated with erosions and minor gastric ulcers. Risk factors include a history of bleeding from the gastrointestinal tract, concurrent administration of different NSAIDs, concomitant use of corticosteroids or anticoagulant, hepatic dysfunction, renal dysfunction, and administration of NSAIDs at higher-than-recommended doses on the label. (Source: Advances in Small Animal Medicine and Surgery)

Tacrolimus Combined With Corticosteroids in Treatment of Nephrotic Idiopathic Membranous Nephropathy: A Multicenter Randomized Controlled Trial.

The American Journal of the Medical Sciences — Mon, 01 Mar 2010 00:00:00 +0100

CONCLUSIONS:: Tacrolimus plus corticosteroids is an alternative therapeutic regimen for nephrotic IMN. The short-term efficacy might be better than cyclophosphamide plus prednisone. PMID: 20220333 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)

SMART isn't

Journal of Allergy and Clinical Immunology — Mon, 01 Mar 2010 00:00:00 +0100

In the mid-1980s, the respiratory community responded with surprising speed and consensus to identify the treatment factors most responsible for the phenomenon of rising asthma mortality. Overreliance on bronchodilator therapy had led to a crisis-oriented approach to care whereby symptoms were responded to rather than prevented. Guidelines subsequently emphasized the early use of inhaled corticosteroids to quench underlying airways inflammation, thereby preventing symptoms and clinical instability. This widely adopted approach has been successful in reducing asthma mortality, and more recent guidelines have taught physicians to titrate their maintenance therapy to suppress all or nearly all day-to-day symptoms of asthma not only because this is intrinsically worthwhile to patients seeking ...

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Small-Particle Corticosteroids May Help Resistant Asthma

Family Practice News — Mon, 01 Mar 2010 00:00:00 +0100

KEYSTONE, COLO. — Small-particle–size inhaled corticosteroids may provide increased clinical efficacy in tough to control asthma with marked distal airways inflammation. “A lot of our asthma patients are really easy to treat—it doesn't matter what medication you use, so long as there's an inhaled steroid in there,” Dr. Richard J. Martin said at a meeting on allergy and respiratory disease. “But we should really ask in some of our more difficult to control patients if we are missing the inflammatory response in the distal lung.” (Source: Family Practice News)

Letter 5

Neuromuscular Disorders — Mon, 01 Mar 2010 00:00:00 +0100

The jury is still out on the issue of the timing of starting steroids for patients with Duchenne muscular dystrophy (DMD). Glucocorticoid therapy is an effective therapy to slow the progression of this relentlessly progressive disease. Ideally, if corticosteroids were without side effects, they would be initiated as soon as the diagnosis of DMD is certain. However, as long term corticosteroid therapy is associated with significant side effects, that in turn negatively impact motor function and cardiopulmonary health (in particular endocrine complications of growth suppression, insulin resistance (weight gain) and steroid induced osteopenia), many providers in the past delay the initiation of steroids till there is obvious decline/loss of motor function (“about to go off the feet stage”...

Letter 7

Neuromuscular Disorders — Mon, 01 Mar 2010 00:00:00 +0100

In relation to the supportive management of Duchenne dystrophy with KAFOs and Corticosteroids, I think there is a major problem with the opinion of experts without personal clinical experience. They may get it wrong. (Source: Neuromuscular Disorders)

[Cutaneous periarteritis nodosa recurring over a period of 30 years in streptococcal infections and progressing toward systemic vasculitis.]

Annales de Dermatologie et de Cenereologie — Mon, 01 Mar 2010 00:00:00 +0100

CONCLUSION: Post-streptococcal PAN of childhood onset generally carries a better prognosis than adult systemic forms. However, our case shows that on rare occasions, there may be very long progression complicated by systemic involvement. PMID: 20227567 [PubMed - as supplied by publisher] (Source: Annales de Dermatologie et de Cenereologie)

[Cutaneous, mucosal and systemic pyoderma gangrenosum.]

Annales de Dermatologie et de Cenereologie — Mon, 01 Mar 2010 00:00:00 +0100

We report a case of cutaneous-mucosal and systemic pyoderma gangrenosum (PG) revealing myelodysplasic syndrome. CASE REPORT: A 56-year-old man was hospitalised for an inflammatory abdominal plaque with an ulcerated centre that appeared rapidly in a setting of fever of 40 degrees C, odynophagia, weight loss and arthritis of the ankle. Despite surgical abdominal repair and combined dual antibiotics, the patient remained febrile and the ulcer size continued to increase. The edges were raised, purple and necrotic. Examination revealed vegetative legions with a purple edge on the lower lip and tongue. Histological examination of the skin and mucosal biopsy samples was consistent with a diagnosis of PG. A chest-abdomen CT scan showed mesenteric panniculitis and interstitial lung disease. The bon...

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Membranous glomerulopathy associated with idiopathic hypereosinophilic syndrome.

Saudi Journal of Kidney Diseases and Transplantation — Mon, 01 Mar 2010 00:00:00 +0100

We reported a case of a 52-year-old man with idiopathic hypereosinophilic syndrome associated with membranous glomerulopathy. The eosinophilia and the proteinuria greatly improved with corticosteroid treatment. We review the literature regarding the nephropathy of this hematologic disorder. PMID: 20228521 [PubMed - in process] (Source: Saudi Journal of Kidney Diseases and Transplantation)

Toddlers Exposed to Steroids Should Be Followed Closely

Clinical Endocrinology News — Mon, 01 Mar 2010 00:00:00 +0100

CHICAGO — The risk of death or neurologic impairment was similar at 2 years after exposure to either single or multiple courses of antenatal corticosteroids, according to a follow-up analysis of data from the multicenter MACS trial. (Source: Clinical Endocrinology News)

Comparison of high-dose extracorporeal shockwave therapy and intralesional corticosteroid injection in the treatment of plantar fasciitis.

Journal of the American Podiatric Medical Association — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results. PMID: 20237361 [PubMed - in process] (Source: Journal of the American Podiatric Medical Association)

Do Corticosteroids Influence the Granulocyte Macrophage Colony-Stimulating Factor-mediated Effects on Monocyte Function?

American Journal of Respiratory and Critical Care Medicine — Sun, 28 Feb 2010 02:48:10 +0100

Authors: Ijland MM, Pickkers P PMID: 20185752 [PubMed - in process] (Source: American Journal of Respiratory and Critical Care Medicine)