MedWorm: Corticosteroid Therapy

Severe Asthma Attacks Reduced By Combined Asthma Medication Therapy

Health News from Medical News Today — Wed, 08 Feb 2012 08:00:00 +0100

A Henry Ford Hospital study has found that using two types of common asthma medications in combination reduces severe asthma attacks. Researchers say using long-acting beta-agonists (LABAs) in fixed-dose combination with inhaled corticosteroid (ICS) appear to reduce asthma attacks as well as or better than corticosteroids alone... (Source: Health News from Medical News Today)

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Symptom-specific associations between low cortisol responses and functional somatic symptoms: The TRAILS study

Psychoneuroendocrinology — Tue, 07 Feb 2012 14:13:24 +0100

Conclusion: Two clusters of FSS are differentially associated with the stress hormone cortisol. (Source: Psychoneuroendocrinology)

Repair of Thoracic Aortic Aneurysm Due to Noninfectious Aortitis

Journal of Cardiac Surgery — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions: Surgical treatment of ITA has acceptable short‐ and mid‐term results. Because follow‐up serum levels of IgG and IgG4 were normal in survivors, postoperative corticosteroid therapy may not be indicated in patients in the absence of active vasculitis.(J Card Surg 2012;**:1‐6) (Source: Journal of Cardiac Surgery)

Choroidal tuberculoma in a patient with ocular Behçet disease

International Ophthalmology — Mon, 06 Feb 2012 19:36:46 +0100

We report a case of choroidal tuberculoma associated with tuberculosis in a patient with ocular Behçet disease. A 25-year-old female with known ocular Behçet disease contracted tuberculosis 3 months earlier. She had been receiving methotrexate and oral steroids. Funduscopy of the left eye revealed a choroidal tuberculoma located superonasally to the optic disc. Fluorescein angiography showed a central area of hypofluorescence surrounded by a hyperfluorescent zone. Since she was already receiving antituberculosis treatment combined with oral steroids, the same treatment was continued. Diagnosis of the other diseases that may cause uveitis in patients with Behçet disease should not be missed. This is especially important since immunosuppressive drugs, that cause an increased in...

Two distinct viral infections complicating pemphigus foliaceus.

Dermatol Online J — Mon, 06 Feb 2012 12:54:18 +0100

We describe a patient with pemphigus foliaceus who developed two distinct disseminated cutaneous viral infections. Our patient is an 83-year-old female with a recent diagnosis of pemphigus foliaceus, who presented with painful ulcerations while on corticosteroids. Histopathology examination revealed disseminated herpes simplex virus (HSV). Despite adequate treatment with anti-herpetic treatment, some ulcerations failed to heal. A second biopsy revealed the presence of cytomegalovirus (CMV). This was treated successfully with appropriate antiviral therapy. In patients with autoimmune bullous disease, the development of new skin pain or new constitutional symptoms, change in primary morphology, rapid disease progression, or failure to respond to appropriate therapies should prompt the clinic...

Persistent elevation of peripheral blood myeloid cell counts associated with omalizumab therapy.

American Journal of Health-System Pharmacy : AJHP — Mon, 06 Feb 2012 12:07:01 +0100

Conclusion A patient with asthma and common variable immunodeficiency developed an elevation of peripheral blood myeloid cells that was first noticed 29 months after the initiation of monthly omalizumab injections. Omalizumab was discontinued, and the abnormality persisted for 1 month after the last dose. The patient's blood count results remained within normal limits 3 months after the last dose. PMID: 22302255 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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Combined asthma medication therapy shown to reduce attacks

EurekAlert! - Medicine and Health — Mon, 06 Feb 2012 05:00:00 +0100

(Henry Ford Health System) A Henry Ford Hospital study has found that using two types of common asthma medications in combination reduces severe asthma attacks.Researchers say using long-acting beta-agonists in fixed-dose combination with inhaled corticosteroid (ICS) appear to reduce asthma attacks as well as or better than corticosteroids alone. Patient groups who had in greatest benefits were patients 18 and older, African-American patients, male patients, and patients with moderate to severe asthma. (Source: EurekAlert! - Medicine and Health)

Non‐atopic males with adult onset asthma are at risk of persistent airflow limitation

Clinical and Experimental Allergy — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions & Clinical RelevanceWe conclude that in patients with adult onset asthma, male gender and absence of atopy are associated with persistent airflow limitation. This might suggest that amongst patients with adult onset asthma, non‐atopic male patients are at increased risk of accelerated decline in lung function.© 2012 Blackwell Publishing Ltd (Source: Clinical and Experimental Allergy)

High-dose corticosteroids with or without etanercept for the treatment of idiopathic pneumonia syndrome after allo-SCT

Bone Marrow Transplantation — Mon, 06 Feb 2012 05:00:00 +0100

Authors: R Tizon, N Frey, D F Heitjan, K S Tan, S C Goldstein, E O Hexner, A Loren, S M Luger, R Reshef, D Tsai, D Vogl, J Davis, M Vozniak, B Fuchs, E A Stadtmauer & D L Porter (Source: Bone Marrow Transplantation)

Itraconazole: Hepatic failure treated with corticosteroids: case report

Reactions — Sun, 05 Feb 2012 18:29:54 +0100

(Source: Reactions)

25-Hydroxyivitamin D3 levels in patients with systemic lupus erythematosus and its association with clinical parameters and laboratory tests

Revista Brasileira de Reumatologia — Fri, 03 Feb 2012 10:19:07 +0100

CONCLUSIONS: High prevalence of 25(OH)D insufficiency/deficiency was found in patients with SLE (57.7%), with statistically significant difference as compared with the comparison group. No association of vitamin D insufficiency/deficiency was observed with the clinical variables and laboratory tests studied. The authors emphasize the importance of determining 25(OH)D serum levels in all patients with SLE, regardless of where they live and time to disease diagnosis (Source: Revista Brasileira de Reumatologia)

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Infections in patients with giant cell arteritis: Might hypogammaglobulinemia induced by corticosteroids be a risk factor?

Arthritis Care and Research — Fri, 03 Feb 2012 05:00:00 +0100

(Source: Arthritis Care and Research)

[Allergic march in children, from rhinitis to asthma: Management, indication of immunotherapy.]

Archives de Pediatrie — Fri, 03 Feb 2012 05:00:00 +0100

Authors: Scheinmann P, Pham Thi N, Karila C, de Blic J Abstract Allergic rhinitis (AR) is a common IgE dependent disorder. AR is maybe one of the steps of the allergic march, which starts with atopic dermatitis and food allergy and includes atopic asthma. AR and asthma are frequently associated. AR is frequently under-diagnosed and undertreated although it affects quality of life and school performance. Management of AR depends on its severity and will associate environmental control (best guided by environmental investigation and skin testing of specific IgE antibodies), pharmacotherapy (with antihistamines and intranasal corticosteroids as first line drugs). At present allergen immunotherapy is considered in patients with severe AR, insufficiently controlled by pharmacotherapy an...

On the nature of sarcoidosis.

European Journal of Internal Medicine — Fri, 03 Feb 2012 00:28:32 +0100

Authors: Reich JM Abstract More than 140years since its recognition as a clinical entity, sarcoidosis remains enigmatic. Its classification as a disease vs. a syndrome is uncertain. Its etiology remains undefined. The "immune paradox" (delayed type hypersensitivity anergy in a setting of exuberant systemic granulomatous response) resists explanation. Its relationship to the Kveim test is poorly understood. Its prognostic determinants and treatment indications are among the unsolved or disputed problems. Immunological investigations generated the thesis that the characterizing systemic granuloma arise as a fallback reaction to inefficient cellular immune processing, due most often to impaired myeloid dendritic cell function of unknown cause. The concept that sarcoidosis represents a...

Rapidly involuting congenital haemangioma (RICH) of the liver

Pediatric Radiology — Thu, 02 Feb 2012 18:08:25 +0100

Conclusion RICH should be suspected in neonates who present with a solitary liver lesion and normal-for-age serum alpha-fetoprotein. Serial US scans should be used to confirm a progressive shrinkage of the lesion. Corticosteroids and β2-adrenergic antagonists have no proven effect in treating RICH. If the lesion grows, percutaneous needle biopsy is recommended to exclude a malignant tumour and to direct further management. Infants with cardiac failure should be treated medically. Embolization (with or without needle biopsy) should only be performed when this strategy fails. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00247-011-2268-zAuthors Derek Roebuck, Department of Radiology, Great Ormond Street Hospital for Sick Children, Great ...

Microtrauma-induced recurrent hyphema and secondary glaucoma associated with chronic acetylsalicylic acid use

International Ophthalmology — Thu, 02 Feb 2012 06:54:11 +0100

Abstract To report a case of microtrauma-induced recurrent hyphema and secondary glaucoma associated with voluntary chronic acetylsalicylic acid (ASA) use. A 43-year-old male developed advanced glaucoma in his right eye after a two-month follow-up period of recurrent microhyphema, which had been induced by strong eye-rubbing. In spite of topical and systemic antiglaucoma medication, as well as topical corticosteroid and cycloplegic drugs and bed rest under hospitalization, the hyphema and glaucoma were not controlled. His medical history revealed that he had been using ASA for 2 years in order to prevent heart attacks. We asked the patient to stop ASA intake and the hyphema cleared considerably on the third day after discontinuation of the drug. One week after stoppin...

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Femoral head osteonecrosis after long‐term topical corticosteroid treatment in a psoriasis patient

The Journal of Dermatology — Thu, 02 Feb 2012 05:00:00 +0100

(Source: The Journal of Dermatology)

Topical corticosteroids applied with a squirt system are more effective than a nasal spray for steroid‐dependent olfactory impairment

The Laryngoscope — Thu, 02 Feb 2012 05:00:00 +0100

Conclusions:The application of topical corticosteroids with a squirt system was more effective than with a spray in maintaining olfactory improvement with oral corticosteroid treatment. Nevertheless, it only partially maintained the improvement so that topical corticosteroid treatment using a squirt system needs to be combined with intervals of short‐term oral corticosteroids to treat steroid‐dependent olfactory loss while avoiding the side effects of long‐term oral corticosteroid use. (Source: The Laryngoscope)

Is low dose inhaled corticosteroid therapy as effective for inflammation and remodeling in asthma? A randomized, parallel group study.

Respiratory Research — Thu, 02 Feb 2012 05:00:00 +0100

Conclusions: 200mcg/day of FP was as effective as 1000mcg/day in improving symptom control, airway inflammation, lung function and AHR in adults with mild to moderate asthma in the short term. Future studies should examine potential differential effects between low and high dose combination therapy (ICS/long acting beta agonist) on inflammation and airway remodeling over longer treatment periods. (Source: Respiratory Research)

Evaluation of metabolic syndrome after hematopoietic stem cell transplantation in children and adolescents

Pediatric Blood and Cancer — Thu, 02 Feb 2012 05:00:00 +0100

ConclusionsThe prevalence of MS was 32%, which was significantly higher than in a healthy pediatric population. We recommend prolonged follow‐up for transplant recipients, coupled with enforcement of preventive measures, such as early diagnosis and encouragement of a healthy lifestyle. Pediatr Blood Cancer © 2012 Wiley Periodicals, Inc. (Source: Pediatric Blood and Cancer)

Does Decline of Lung Function in Wheezy Infants Justify the Early Start of Controller Medications?

Indian Journal of Pediatrics — Wed, 01 Feb 2012 17:12:04 +0100

Conclusions Lung function, eosinophilic percentage, total serum IgE and asthma risk factors could be used as predictors for ongoing wheeze in this subset of children. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s12098-012-0694-zAuthors Magdy Zedan, Allergy Unit, Faculty of Medicine, Mansoura University, Pin Code: 35516 Box 50, Mansoura, EgyptNehad Nasef, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, EgyptMohamed El-Bayoumy, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, EgyptMohamed El-Assmy, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, EgyptGehan Attia, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, EgyptMohamed...

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Fungi and allergic lower respiratory tract diseases

Journal of Allergy and Clinical Immunology — Wed, 01 Feb 2012 05:00:00 +0100

Asthma is a common disorder that in 2009 afflicted 8.2% of adults and children, 24.6 million persons, in the United States. In patients with moderate and severe persistent asthma, there is significantly increased morbidity, use of health care support, and health care costs. Epidemiologic studies in the United States and Europe have associated mold sensitivity, particularly to Alternaria alternata and Cladosporium herbarum, with the development, persistence, and severity of asthma. In addition, sensitivity to Aspergillus fumigatus has been associated with severe persistent asthma in adults. Allergic bronchopulmonary aspergillosis (ABPA) is caused by A fumigatus and is characterized by exacerbations of asthma, recurrent transient chest radiographic infiltrates, coughing up thick mucus plugs,...

Perioperative Methylprednisolone and Outcome in Neonates Undergoing Heart Surgery

PEDIATRICS — Wed, 01 Feb 2012 05:00:00 +0100

Recent studies have called into question the benefit of perioperative corticosteroids in children undergoing heart surgery, but have been limited by small sample size, the lack of placebo control, and the grouping of various steroid regimens together in analysis. We evaluated outcomes across methylprednisolone regimens versus no steroids in a large cohort of neonates and found no mortality or length-of-stay benefit associated with any regimen, and a higher risk of infection in certain subgroups. (Read the full article) (Source: PEDIATRICS)

Multicenter Analysis of Quality Indicators for Children Treated in the Emergency Department for Asthma

PEDIATRICS — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes. (Source: PEDIATRICS)

Perioperative Methylprednisolone and Outcome in Neonates Undergoing Heart Surgery

PEDIATRICS — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: This multicenter observational analysis did not find any benefit associated with methylprednisolone in neonates undergoing heart surgery and suggested increased infection in certain subgroups. These data reinforce the need for a large randomized trial in this population. (Source: PEDIATRICS)

A pilot 24‐month study to compare mycophenolate mofetil and tacrolimus in the treatment of membranous lupus nephritis with nephrotic syndrome

Nephrology — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: Both MMF and Tac when combined with corticosteroids are effective treatment options for severe MLN.© 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology (Source: Nephrology)

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Pseudotumoral form of neuroschistosomiasis: report of three cases in ganzi, china.

The American Journal of Tropical Medicine and Hygiene — Wed, 01 Feb 2012 05:00:00 +0100

Authors: Wan H, Masataka H, Zhang LP, Zheng DF Abstract Abstract. The authors report three rare cases of neuroschistosomiasis lacking extracranial involvement. No parasitic eggs were detected in the stool with the Kato-Katz thick smear methods. Computed tomography of the brains showed hypodense signals, and magnetic resonance imaging showed isointense signals on T1-weighted images, hyperintense signals on T2-weighted images, and intensely enhancing nodules in the brain after intravenous administration of gadolinium. High-grade gliomas were suspected, and operations or radiosurgery was performed. Cerebral schistosomiasis was confirmed in all cases by biopsy of the brain lesions, revealing granulomas containing embedded Schistosoma japonicum eggs. All cases were definitively diagnose...

Cost, utilization, and patterns of medication use associated with chronic idiopathic urticaria.

Annals of Allergy, Asthma and Immunology — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: Primary care physicians managed most patients with CIU. Antihistamines were the most common treatment for CIU, although OCSs were frequently prescribed. Thirty days of OCS supply among users may represent multiple steroid bursts each year. Given the known risks of OCSs, identifying other CIU treatments with more favorable safety profiles may be beneficial. PMID: 22289728 [PubMed - in process] (Source: Annals of Allergy, Asthma and Immunology)

Infections in patients with giant cell arteritis: Might hypogammaglobulinemia induced by corticosteroids be a risk factor? Author's response

Arthritis Care and Research — Wed, 01 Feb 2012 05:00:00 +0100

(Source: Arthritis Care and Research)

Is management of acute traumatic brain injury effective? A literature review of published Cochrane Systematic Reviews.

Chinese Journal of Traumatology — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: For clinical physicians, to translate these conclusions into practice with caution is essential. Basic medication and nursing care deserve additional attention as well and can be beneficial. For researchers, high quality trials with perfect design and comprehensive consideration of various factors are urgently required. PMID: 22300914 [PubMed - in process] (Source: Chinese Journal of Traumatology)

A phase II, multicenter, open‐label study evaluating dosing and preliminary safety and efficacy of canakinumab in systemic juvenile idiopathic arthritis with active systemic features

Arthritis and Rheumatism — Mon, 30 Jan 2012 13:25:26 +0100

ConclusionCanakinumab has a promising preliminary safety and efficacy profile in this limited cohort. Based on the findings of this trial, further studies in a larger population of children with systemic JIA are warranted. (Source: Arthritis and Rheumatism)

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Systemic Effects of Inhaled CorticosteroidsSystemic Effects of Inhaled Corticosteroids

Medscape Today Headlines — Mon, 30 Jan 2012 04:00:00 +0100

Does inhaled corticosteroid use increase the risk of diabetes and tuberculosis? Current Opinion in Pulmonary Medicine (Source: Medscape Today Headlines)

Pretransplant Fasting Glucose Predicts New-Onset Diabetes after Liver Transplantation

Clinical and Developmental Immunology — Sun, 29 Jan 2012 11:22:18 +0100

New-onset diabetes after transplantation (NODAT) is common after liver transplant and associated with poorer outcomes. The aim of this study was to identify risk factors for NODAT in liver transplant recipients off corticosteroids. In 225 adult nondiabetic liver transplant recipients, the mean age was 51.7 years, the majority were men (71%), and half had HCV (49%). The mean calculated MELD score at transplantation was 18.7, and 19% underwent living-donor transplant (LDLT). One year after transplantation, 17% developed NODAT, and an additional 16% had impaired fasting glucose. The incidence of NODAT in patients with HCV was 26%. In multivariate analysis, HCV, pretransplant FPG, and LDLT were significant. Each 10 mg/dL increase in pretransplant FPG was associat...

A risk score for early cytomegalovirus reactivation after allogeneic stem cell transplantation identifies low‐, intermediate‐, and high‐risk groups: reactivation risk is increased by graft‐versus‐host disease only in the intermediate‐risk group

Transplant Infectious Disease — Sun, 29 Jan 2012 05:00:00 +0100

ConclusionsIdentification of these 3 risk groups in association with the presence or absence of GVHD will help transplant units to make pre‐transplant policy decisions about prophylactic, pre‐emptive, or experimental CMV prevention strategies in groups of patients undergoing HSCT, as well as in those developing GVHD post transplant. (Source: Transplant Infectious Disease)

Leptin and the hypothalamo-pituitary-adrenal stress axis.

General and Comparative Endocrinology — Sat, 28 Jan 2012 05:00:00 +0100

Authors: Roubos EW, Dahmen M, Kozicz T, Xu L Abstract Leptin is a 16-kDa protein mainly produced and secreted by white adipose tissue and informing various brain centers via leptin receptor long and short forms about the amount of fat stored in the body. In this way leptin exerts a plethora of regulatory functions especially related to energy intake and metabolism, one of which is controlling the activity of the hypothalamo-pituitary-adrenal (HPA) stress axis. First, this review deals with the basic properties of leptin's structure and signaling at the organ, cell and molecule level, from lower vertebrates to humans but with emphasis on rodents because these have been investigated in most detail. Then, attention is given to the various interactions of adipose leptin with the HPA-ax...

Severe Asthma: Future Treatments

Clinical and Experimental Allergy — Fri, 27 Jan 2012 05:00:00 +0100

ConclusionsA variety of new treatment options are being investigated to help improve overall asthma control in patients with severe refractory asthma. These include medications to optimize lung function; bronchial thermoplasty to reduce airway smooth muscle in central airways; and those which target specific inflammatory cells or receptors of inflammatory mediators.Clinical RelevancePatients with severe refractory asthma have the greatest unmet treatment needs to improve asthma control and reduce exacerbation risk. New treatment approaches have been identified which will benefit subsets of these patients. Phenotyping patients is necessary to select those likely to benefit.© 2012 Blackwell Publishing Ltd (Source: Clinical and Experimental Allergy)

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Predictive factors of internalized and externalized behavioral problems in children treated for acute lymphoblastic leukemia

Pediatric Blood and Cancer — Fri, 27 Jan 2012 05:00:00 +0100

ConclusionsAssessment of both internalized and externalized problems is required in this population. The impact of pharmacological variables on externalized behavioral problems is likely related to CS use. Pediatr Blood Cancer © 2012 Wiley Periodicals, Inc. (Source: Pediatric Blood and Cancer)

MeReC Bulletin: Implementing key therapeutic topics - NSAIDS, antibiotics, and inhaled corticosteroids in asthma

NeLM - News — Fri, 27 Jan 2012 05:00:00 +0100

Source: NPC Area: News This Bulletin is the first of three MeReC Bulletins which support the Quality, Innovation, Productivity and Prevention (QIPP) agenda. The bulletin focuses on three of the key prescribing topics outlined in the NPC document, Key therapeutic topics - Medicines management options for local implementation. The topics included in this Bulletin are: . Non-steroidal anti-inflammatory drugs (NSAIDs) . Antibiotic prescribing - especially quinolones and cephalosporins . High dose inhaled corticosteroids in asthma Topics to be included in the second bulletin are: antipsychotics in dementia; statins and ezetimibe; and hypnotics. The third bulletin will cover hypoglycaemic agents; long-acting insulin analogues; and self-monit...

Predictors of survival in a cohort of patients with polymyositis and dermatomyositis: effect of corticosteroids, methotrexate, and azathioprine

Arthritis Research and Therapy — Fri, 27 Jan 2012 05:00:00 +0100

Conclusions: Patients treated initially with intravenous corticosteroids had higher mortality, likely related to disease severity. Both methotrexate and azathioprine showed similar early survival benefit as first line immunosuppressives; survival was higher between 5-10 years in the methotrexate-treated group but could not be confirmed in multivariable modeling for the full follow-up period. Other important predictors of long-term survival included younger age, female sex, and the Caucasian race. (Source: Arthritis Research and Therapy)

Toll-like receptor 3 ligands induce CD80 expression in human podocytes via an NF-{kappa}B-dependent pathway

Nephrology Dialysis Transplantation — Fri, 27 Jan 2012 05:00:00 +0100

Conclusions. Activation of TLR3 on cultured human podocytes induces CD80 expression and phenotypic change via an NF-B-dependent mechanism and is partially blocked by dexamethasone. These studies provide a mechanism by which viral infections may cause proteinuria. (Source: Nephrology Dialysis Transplantation)

Hashimoto Encephalopathy Causing Drug-Resistant Status Epilepticus Treated With Plasmapheresis

Pediatric Neurology — Fri, 27 Jan 2012 01:46:49 +0100

Abstract: Hashimoto encephalopathy is a rare, clinically heterogenous condition. Its treatment is based on corticosteroids. A previously normal 12-year-old boy was admitted to our pediatric emergency department with status epilepticus. He experienced a recurrence of status epilepticus after pentobarbital withdrawal, and required repeated resumptions of drug-induced coma. He manifested acute personality changes. His limbic encephalitis markers were normal, but his level of anti-thyroid peroxidase antibody was high. A diagnosis of Hashimoto encephalopathy was considered. Our patient responded to plasmapheresis instead of corticosteroid treatment. This case report is the first, to the best of our knowledge, of plasmapheresis because of Hashimoto encephalopathy in a child. (Source: Pediatric N...

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Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondylarthritis) and gastrointestinal or liver comorbidity.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: On the basis of the current review, there is scant evidence to guide clinicians about how gastrointestinal or liver comorbidities should influence the choice of pain treatment in patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or other spondylarthritis. Based upon additional studies that included a mixed population of participants with a range of rheumatic conditions, NSAIDs should be used cautiously in patients with inflammatory arthritis and a history of gastrointestinaI comorbidity as there is consistent evidence that they may be at increased risk. PMID: 22258995 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Surgical decompression for cerebral oedema in acute ischaemic stroke.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: Surgical decompression lowers the risk of death and death or severe disability defined as mRS > 4 in selected patients 60 years of age or younger with a massive hemispheric infarction and oedema. Optimum criteria for patient selection and for timing of decompressive surgery are yet to be defined. Since survival may be at the expense of substantial disability, surgery should be the treatment of choice only when it can be assumed, based on their preferences, that it is in the best interest of patients. Since all the trials were stopped early, an overestimation of the effect size cannot be excluded. PMID: 22258954 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis

Clinical Rheumatology — Thu, 26 Jan 2012 06:44:07 +0100

Abstract The aim of this study was to compare—clinically and ultrasonographically—the therapeutic effects of physical therapy modalities (hot pack, ultrasound therapy, and friction massage), local corticosteroid injection, and extracorporeal shock wave treatment (ESWT) in lateral epicondylitis (LE). Fifty-nine elbows of 59 patients with LE were randomized into three treatment groups receiving either physical therapy, a single corticosteroid injection, or ESWT. Visual analogue scale (VAS) was used to assess pain intensity, Jamar hydraulic dynamometer for grip strength, finger dynamometer for pinch strength (before treatment, on the first, third, and sixth months of treatment). All subjects were also evaluated with ultrasonography before and 6 months after treatment...

Inhaled glucocorticoids during pregnancy and paediatric diseases in offspring: Cohort study

NeLM - News — Thu, 26 Jan 2012 05:00:00 +0100

This study assessed the association between use of ICS for asthma during pregnancy and the offspring's risk of a wide range of diseases, categorised according to major chapters of the International Classification of Diseases, 10th Revision (ICD-10), during early childhood. Data on the offspring (live singletons) of pregnant women with asthma during pregnancy (prevalence=6.3%; n=4083 mother-child pairs), from the Danish National Birth Cohort (births: 1996-2002; prospective data) were evaluated. Of the 1231 users of ICS, 79.9% were ... (Source: NeLM - News)

Chlamydophila pneumonia inhibits the corticosteroid-induced suppressions of metalloproteinase-9 and tissue inhibitor metalloproteinase-1 secretion by human peripheral blood mononuclear cells.

Journal of Medical Microbiology — Thu, 26 Jan 2012 05:00:00 +0100

Authors: Park CS, Lee YS, Kwon HS, Lee TH, Kim TB, Moon KA, Yoo B, Moon HB, Cho YS Abstract Chlamydophila pneumoniae infection has been suggested to be associated with severe asthma characterized by persistent airway limitation, which may be related to airway remodeling. We investigated whether C. pneumoniae infection affected the secretion of metalloproteinase-9 (MMP9) and tissue inhibitor metalloproteinase-1 (TIMP1), and altered the responsiveness of inflammatory cells to corticosteroids. Human peripheral blood mononuclear cells (PBMC) were cultured in vitro in the presence or absence of C. pneumoniae. Secretion of both MMP9 and TIMP1 was strongly suppressed by dexamethasone treatment in uninfected cells. MMP9 secretion was also significantly inhibited by dexamethasone in C. pneu...

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Syndrome of inappropriate antidiuretic hormone associated with moxifloxacin.

American Journal of Health-System Pharmacy : AJHP — Wed, 25 Jan 2012 14:49:21 +0100

Conclusion A 66-year-old woman developed severe hyponatremia after receiving moxifloxacin for five days for treatment of COPD exacerbation. PMID: 22261943 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

Comparison of two dosing schedules of palonosetron for the prevention of nausea and vomiting due to interleukin-2-based biochemotherapy

Supportive Care in Cancer — Wed, 25 Jan 2012 06:52:50 +0100

Conclusions Both dosing schedules of palonosetron were tolerated well. Alternate day dosing of palonosetron was more effective in controlling CINV in this patient population. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00520-011-1359-6Authors Rahat Noor, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 430, Houston, TX 77030, USAAgop Y. Bedikian, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 430, Houston, TX 77030, USASandy Mahoney, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 430, Houston, TX 77030, USARoland Bassett, Department...

Intravenous immunoglobulin therapy in adult patients with polymyositis/dermatomyositis: a systematic literature review

Clinical Rheumatology — Wed, 25 Jan 2012 06:52:40 +0100

The objectives of this study are to review and summarize published information on the use, effectiveness, and adverse effects of intravenous immunoglobulin (IVIG) in patients with polymyositis (PM) or dermatomyositis (DM) and to search MEDLINE and CNKI (Chinese) databases from 1985 to 2011 to retrieve clinical research articles concerning IVIG in adult patients with PM/DM. Of the 14 articles selected, two were randomized controlled trials, nine prospective open studies, and three retrospective studies with a total of 308 adult patients. IVIG has been used successfully in the treatment of PM/DM. The standard dose is 2 g/kg, given in two to five individual daily doses. The course of IVIG treatment is usually 3~6 months. IVIG therapy seemed rarely employed as first-line therap...

Sequence of treatments for adults with primary immune thrombocytopenia (ITP)

American Journal of Hematology — Wed, 25 Jan 2012 05:00:00 +0100

AbstractManagement of adults with primary immune thrombocytopenia (ITP) has changed dramatically in the past 10 years. New regimens of corticosteroids for 1st‐line treatment have been introduced and are currently being evaluated in a randomized clinical trial. Many patients may not have durable remissions with initial corticosteroid regimens and may require additional, 2nd‐line, treatment. For these patients, rituximab has been increasingly used, as it has for other autoimmune disorders, and new thrombopoietin (TPO)‐receptor agonists have been developed. Although splenectomy was the first effective and remains the most effective treatment for ITP, inducing durable complete remissions in 66% of patients, rituximab and TPO‐receptor agonists are now additional options for 2nd‐line t...

NICE issues final guidance on roflumilast for severe COPD

NeLM - Guidelines — Wed, 25 Jan 2012 05:00:00 +0100

Source: NICE Area: Evidence > Guidelines NICE has issued final guidance (TA 244) on roflumilast for the management of severe chronic obstructive pulmonary disease (COPD), which contains the following recommendations: . Roflumilast is recommended only in the context of research as part of a clinical trial for adults with severe COPD (defined as forced expiratory volume in 1 second [FEV1] post-bronchodilator less than 50% predicted) associated with chronic bronchitis with a history of frequent exacerbations as an add-on to bronchodilator treatment. . Such research should be designed to generate robust evidence about the benefits of roflumilast as an add-on to long-acting muscarinic antagonists (LAMA) plus long-acting beta2 agonists (LABA) plus inhaled cor...

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Effects of Local Microwave Diathermy on Shoulder Pain and Function in Patients With Rotator Cuff Tendinopathy in Comparison to Subacromial Corticosteroid Injections: A Single Blind Randomized Trial.

Physical Therapy — Wed, 25 Jan 2012 05:00:00 +0100

CONCLUSION: In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function and pain are equivalent to those elicited by subacromial corticosteroid injections. LEVEL OF EVIDENCE: 1b. J Orthop Sports Phys Ther, Epub 25 January 2012. doi:10.2519/jospt.2012.3787. PMID: 22281781 [PubMed - as supplied by publisher] (Source: Physical Therapy)

Ciclesonide - A Novel Corticosteroid for the Management of Asthma.

Current Clinical Pharmacology — Wed, 25 Jan 2012 05:00:00 +0100

Authors: Chopra D, Bhandari B, Vardhan N Abstract Ciclesonide (CIC) is a novel inhaled corticosteroid (ICS) approved by US Food and Drug Administration for the treatment of persistent asthma, available as a pressurized metered-dose inhaler in two strengths, 80 mcg/activation and 160 mcg/activation. Ciclesonide is a corticosteroid with unique pharmacological profile including a high degree of serum protein binding, a low oral bioavailability and rapid systemic elimination. Ciclesonide is a prodrug metabolized by esterases to desisobutyryl ciclesonide (des-CIC), an active metabolite with a 100-fold greater affinity for the glucocorticoid receptor. It has shown to improve pulmonary functions, reduce the need for oral corticosteroids (OCSs) and cause lesser suppression of the hypothala...

Factors Associated With the Initiation of Disease-Modifying Antirheumatic Drugs in Newly Diagnosed Rheumatoid Arthritis: A Retrospective Claims Database Study.

Clinical Therapeutics — Wed, 25 Jan 2012 05:00:00 +0100

CONCLUSIONS: Among managed care enrollees in the present analysis, 37% of patients newly diagnosed with RA were not being treated with DMARDs in the first 12 months after diagnosis. Time to DMARD initiation plateaued after 90 days, suggesting that if a patient was not prescribed a DMARD soon after RA diagnosis, he or she was not likely to receive one. PMID: 22284901 [PubMed - as supplied by publisher] (Source: Clinical Therapeutics)

Pseudomonas aeruginosa Keratitis: Outcomes and Response to Corticosteroid Treatment [Clinical Trials]

Investigative Ophthalmology — Wed, 25 Jan 2012 05:00:00 +0100

Conclusions. Although P. aeruginosa corneal ulcers have a more severe presentation, they appear to respond better to treatment than other bacterial ulcers. The authors did not find a significant benefit with corticosteroid treatment, but they also did not find any increase in adverse events. (ClinicalTrials.gov number, NCT00324168.) (Source: Investigative Ophthalmology)

Role of Medical Therapy in the Management of Nasal Polyps

Current Allergy and Asthma Reports — Tue, 24 Jan 2012 18:14:41 +0100

Abstract Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa that, despite differing hypotheses regarding its cause, remains poorly understood. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, postnasal drip, and facial pain or pressure. Among the objectives of CRSwNP management are to eradicate nasal polyps from nasal and sinusal cavities, eliminate symptoms, and prevent recurrences. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating CRSwNP. Other potential treatments are nasal saline irrigation and antihistamines (in allergic conditions). Endoscopic sinus surgery is recommended when medical treatment fails. After surgery, medical tre...

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Systemic corticosteroids reduce the risk of cellophane membranes after retinal detachment surgery: a prospective randomized placebo-controlled double-blind clinical trial

Graefe's Archive for Clinical and Experimental Ophthalmology — Tue, 24 Jan 2012 07:53:16 +0100

Conclusion Early stages of PVR such as cellophane membranes after retinal detachment surgery can be reduced with corticosteroids in oral doses. Content Type Journal ArticleCategory Retinal DisordersPages 1-7DOI 10.1007/s00417-011-1919-yAuthors Fritz Koerner, Klinik Siloah, CH-3073 Guemligen, Bern, SwitzerlandUrsula Koerner-Stiefbold, Klinik Siloah, CH-3073 Guemligen, Bern, SwitzerlandJustus G. Garweg, Berner Augenklinik am Lindenhofspital, CH-3012 Bern, Switzerland Journal Graefe's Archive for Clinical and Experimental OphthalmologyOnline ISSN 1435-702XPrint ISSN 0721-832X (Source: Graefe's Archive for Clinical and Experimental Ophthalmology)

Cutaneous polyarteritis nodosa associated with HLA-B39-positive undifferentiated spondyloarthritis in a Japanese patient

Modern Rheumatology — Tue, 24 Jan 2012 06:51:44 +0100

We present the case of a 43-year-old man diagnosed with HLA-B39-positive spondyloarthritis who developed cutaneous lesions consistent with cutaneous polyarteritis nodosa (CPN). Previous studies indicated an elevated incidence of HLA-B39 in HLA-B27-negative Japanese patients with spondyloarthritis. This case suggested that CPN may also occur in association with forms of HLA-B39-positive spondyloarthritis. The rarity of this association is emphasized. Therapy with corticosteroid and methotrexate improved both the cutaneous lesions and the clinical symptoms of spondyloarthritis. Content Type Journal ArticleCategory Case ReportPages 1-4DOI 10.1007/s10165-011-0576-7Authors Hiromasa Nakano, Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University ...

Lansoprazole for Children With Poorly Controlled Asthma: A Randomized Controlled Trial [Original Contribution]

JAMA — Tue, 24 Jan 2012 05:00:00 +0100

Conclusion In this trial of children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, compared with placebo, improved neither symptoms nor lung function but was associated with increased adverse events. Trial Registration clinicaltrials.gov Identifier: NCT00442013 (Source: JAMA)

Ciclesonide - A Novel Corticosteroid for the Management of Asthma.

Current Clinical Pharmacology — Tue, 24 Jan 2012 05:00:00 +0100

[The use of inhaled corticosteroids in preschool children].

Tidsskrift for den Norske Laegeforening — Tue, 24 Jan 2012 05:00:00 +0100

[The use of inhaled corticosteroids in preschool children]. Tidsskr Nor Laegeforen. 2012 Jan 24;132(2):160-2 Authors: Oymar K Abstract Due to the large variation in symptoms presented, diagnosing wheezing or asthma and deciding on treatment for preschool children may be difficult. Inhaled corticosteroids may be effective for controlling asthma symptoms and recurrent wheezing also in this age group, but due to the heterogeneity of the disease and lack of diagnostic tools, both over- and under-treatment may occur. The author discusses current guidelines and recommendations for the use of inhaled corticosteroids in the preschool group. Inhaled corticosteroids are frequently prescribed in Norway for children in the first two years of life, whereas the guidelines recommend restr...

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How to evaluate a patient with chronic cough?

Clinical Cases and Images — Mon, 23 Jan 2012 13:34:00 +0100

Initial evaluation of chronic cough (defined as more than 8 weeks' duration in adults and 4 weeks in children) should include a chest radiography (CXR) in most adult patients. Patients who are taking an angiotensin-converting enzyme inhibitor (ACEi) should switch to a medication from another drug class. Differential diagnosis of cough, a simple mnemonic is BAD CAT TOM (Bronchitis or pneumonia, Asthma, Drugs, CF or Cardiogenic, Aspiration, TB, Thyroid enlargement, Other, e.g. GERD, Malignancy, e.g. lung cancer). Click here to enlarge the image. The most common causes of chronic cough in adults are: - upper airway cough syndrome (post-nasal drip) - asthma - gastroesophageal reflux disease (GERD) - any combination of the above If upper airway cough syndrome is suspected, a trial of ...

Nocturnal Leg Cramps and Prescription Use That Precedes Them: A Sequence Symmetry Analysis [Original Investigation]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions Cramp treatment was substantially more likely in the year following introduction of LABAs, potassium-sparing diuretics, or thiazidelike diuretics, and 60.3% of quinine users (individuals experiencing cramp) received at least 1 of these medications during a 13-year period. In contrast, statin and loop diuretic associations were small. Physicians should be mindful that the use of these medications may worsen symptoms in patients experiencing nocturnal leg cramps. (Source: Archives of Internal Medicine)

Similar rates of relapse and time to return to normal activity with 2 or 5 days of systemic corticosteroids after asthma exacerbation but study confirmation of equivalence would require further study

Evidence-Based Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Context Asthma is common and flare-ups associated with exposure to a variety of triggers may result in emergency department (ED) visits, school and work absenteeism, hospitalisations and significant healthcare costs. The majority of adult patients presenting with acute asthma are discharged home following management in the ED. Many national and international guidelines have been developed on this topic.1 In the outpatient setting, care is focused on the use of systemic (SC) and inhaled corticosteroid (ICS) agents to regain asthma control. While prednisone is the most common SC used, there has been an interest in reducing the duration of treatment using agents with longer half life such as dexamethasone. Due to compliance and palatability concerns, this question has been most frequently add...

Risk Factors and Outcome of Changes in Adrenal Response to ACTH in the Course of Critical Illness

Journal of Intensive Care Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions. The findings favor the concept of dynamic adrenal function rather than poor reproducibility of the ACTH test, so that development of CIRCI, particularly in complicated septic shock and indicated by a fall in cortisol (to <100 nmol/L) upon ACTH, correlates to a poor prognosis, independently of baseline cortisol, cortisol binding in blood, and disease severity. (Source: Journal of Intensive Care Medicine)

Quadriplegia due to Celiac Crisis with Hypokalemia as Initial Presentation of Celiac Disease: A Case Report

Journal of Tropical Pediatrics — Mon, 23 Jan 2012 05:00:00 +0100

We report an 8-year-old girl with previously undiagnosed celiac disease who presented with flaccid quadriparesis secondary to severe hypokalemia associated with celiac crisis. Diagnosis was expedited by an elevated anti-tissue transglutaminase antibody titer. The patient improved with correction of hypokalemia, corticosteroids and gluten-free diet. In tropical countries such as India, where both acute flaccid paresis and diarrhea are usually of infective etiologies, this rare clinical condition should also be considered in the differential diagnosis of both. (Source: Journal of Tropical Pediatrics)

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Steroid psychosis in a polyarthritis nodosa patient successfully treated with risperidone: tracking serum brain-derived neurotrophic factor levels longitudinally

Annals of General Psychiatry — Mon, 23 Jan 2012 05:00:00 +0100

We previously reported a case in which steroid-induced psychosis was eliminated with risperidone treatment in a patient with polyarthritis nodosa (PN). In the present report, we longitudinally tracked the serum levels of brain-derived neurotrophic factor (BDNF). We found that corticosteroid lowered serum BDNF levels, and improvement of psychiatric symptoms was intact with the serum BDNF levels seen in the patients. (Source: Annals of General Psychiatry)

Nebulized Corticosteroids in Asthma and COPD: An Italian Appraisal.

Respiratory Care — Mon, 23 Jan 2012 05:00:00 +0100

Authors: Melani AS Abstract Inhaled corticosteroids (ICSs) are the mainstay of anti-inflammatory treatment in subjects with asthma and COPD. This review evaluates the role of nebulizers as alternative to inhalers for delivering ICSs in asthma and COPD. We have selected 16 randomized, placebo-controlled, blinded, long-term studies, mostly (N=14) carried out in asthma and COPD. Nebulized budesonide has demonstrated to be effective and safe in children aged 1-8 years and, with less evidence, in infants and adults with asthma. Other investigations, mostly in vitro and in vivo comparisons, have shown that nebulized beclomethasone, fluticasone and flunisolide are effective alternatives to nebulized budesonide in asthma and COPD. Efficient delivery of nebulized ICSs requires that the nebu...

Targeting phosphoinositide 3-kinase δ for allergic asthma.

Biochemical Society Transactions — Sun, 22 Jan 2012 22:25:55 +0100

Authors: Rowan WC, Smith JL, Affleck K, Amour A Abstract Chronic inflammation in the lung has long been linked to the pathogenesis of asthma. Central to this airway inflammation is a T-cell response to allergens, with Th2 cytokines driving the differentiation, survival and function of the major inflammatory cells involved in the allergic cascade. PI3Kδ (phosphoinositide 3-kinase δ) is a lipid kinase, expressed predominantly in leucocytes, where it plays a critical role in immune receptor signalling. A selective PI3Kδ inhibitor is predicted to block T-cell activation in the lung, reducing the production of pro-inflammatory Th2 cytokines. PI3Kδ is also involved in B-cell and mast cell activation. Therefore the inhibition of PI3Kδ should dampen down the inflammatory cascade invol...

Hydrocortisone attenuates cyclosporin A‐induced nephrotoxicity in rats

Journal of Cellular Biochemistry — Sat, 21 Jan 2012 18:16:06 +0100

This study clearly suggests the role of oxidative stress in the pathogenesis of CsA‐induced nephrotoxicity. J. Cell. Biochem. 113: 997–1004, 2012. © 2011 Wiley Periodicals, Inc. (Source: Journal of Cellular Biochemistry)

Preterm birth with antenatal corticosteroid administration has injurious and persistent effects on the structure and composition of the aorta and pulmonary artery.

Pediatric Research — Fri, 20 Jan 2012 23:38:01 +0100

Discussion:We conclude that moderate preterm birth after antenatal betamethasone can cause injury and persistent alterations in the structure and composition of the aorta, with lesser effects in the pulmonary artery. Our findings suggest that preterm birth may increase the risk of atherosclerosis and aortic aneurysms in later life.Methods:Using an established ovine model of preterm birth, lambs were born at 0.9 of gestation and underwent necropsy at 11 wk after birth; controls were born at term. PMID: 22258125 [PubMed - in process] (Source: Pediatric Research)

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Clinical and histological changes associated with corticosteroid therapy in IgG4-related tubulointerstitial nephritis

Modern Rheumatology — Fri, 20 Jan 2012 07:47:03 +0100

Conclusions Our study shows that persistent renal insufficiency associated with macroscopic atrophy and microscopic fibrosis is not so rare in IgG4-related TIN. Pathologically, the behavior of regulatory T cells during the clinical course is quite similar to that of IgG4-positive plasma cells, and the behavior pattern of those cells is distinctive. Content Type Journal ArticleCategory Original ArticlePages 1-12DOI 10.1007/s10165-011-0589-2Authors Ichiro Mizushima, Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, JapanKazunori Yamada, Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Ka...

European CHMP issues positive opinion on license extension of infliximab to include paediatric ulcerative colitis

NeLM - News — Fri, 20 Jan 2012 05:00:00 +0100

Source: EMA Area: News The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has adopted a positive opinion recommending extension of license for infliximab to include the treatment of severely active ulcerative colitis, in childen aged 6 to 17 years, who have had an inadequate response to conventional therapy including corticosteroids and 6-MP or AZA, or who are intolerant to or have medical contraindications for such therapies. (Source: NeLM - News)

Glucocorticoid therapy for trauma - ready for prime time?

BioMed Central — Fri, 20 Jan 2012 05:00:00 +0100

Conclusions: In intubated trauma patients, the use of an intravenous stress-dose of hydrocortisone, compared with placebo, resulted in a decreased risk of hospital-acquired pneumonia. (Source: BioMed Central)

Continuous versus intermittent inhaled corticosteroid (budesonide) for mild persistent asthma in children--not too much, not too little

Thorax — Fri, 20 Jan 2012 05:00:00 +0100

In this study, we summarise our experiences. In the 18-month intervention, we compared two budesonide regimens with a control group treated with a fixed dose of disodium cromoglycate (DSCG). The study evaluated the antiasthmatic efficacy... (Source: Thorax)

Continuous versus intermittent inhaled corticosteroids for mild persistent asthma in children: not too much, not too little

Thorax — Fri, 20 Jan 2012 05:00:00 +0100

The goal of asthma treatment is to prevent exacerbations, achieve daily asthma control and prevent adverse effects with a minimum of medication. In preschoolers, children and adolescents with mild persistent asthma, the most effective therapy remains daily use of low-dose inhaled corticosteroids.1 Why then consider intermittent therapy over maintenance inhaled corticosteroids? The intermittent approach is attractive to patients and families for a variety of reasons, including fear of corticosteroid side effects,2 the erroneous concept that no symptoms equate to no disease3 and ease of compliance with medications administered for symptoms rather than on a daily basis. Indeed, pharmacy records clearly show that most children with asthma infrequently renew their prescriptions for contro...

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A Large Subgroup of Mild-to-Moderate Asthma is Persistently Non-Eosinophilic.

American Journal of Respiratory and Critical Care Medicine — Fri, 20 Jan 2012 05:00:00 +0100

CONCLUSIONS: Approximately half of patients with mild-to-moderate asthma have persistently non-eosinophilic disease, a disease phenotype that responds poorly to currently available anti-inflammatory therapy. PMID: 22268133 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

A case of recurrent impetigo herpetiformis treated with systemic corticosteroids and narrowband UVB.

Cutaneous and Ocular Toxicology — Fri, 20 Jan 2012 05:00:00 +0100

Authors: Bozdag K, Ozturk S, Ermete M Abstract Impetigo herpetiformis is a rare pustular eruption with usual onset during the third trimester of pregnancy. The disease tends to remit after delivery, but may recur in subsequent pregnancies. Here we present a recurrent case of impetigo herpetiformis with earlier onset and poor response to corticosteroids in the subsequent pregnancy. She had widespread, erythematosquamous patches with tiny superficial pustules in the third trimester of her first pregnancy. Histopathological and clinical findings were consistent with impetigo herpetiformis. She was treated with systemic prednisolone and had a healthy baby without any complication. Three years later, the patient presented with impetigo herpetiformis again in the second trimester of her ...

Complicated secondary pneumonia after Swine-origin influenza a virus infection in an immunocompetent patient.

Herpes — Fri, 20 Jan 2012 03:30:02 +0100

We report an immunocompetent patient with methicillin-resistant Staphylococcus aureus (MRSA) and Herpes simplex virus (HSV) pneumonia secondary to S-OIV infection. A 57-year-old man previously without major medical illness was admitted to our hospital with severe pneumonia accompanied by ARDS due to S-OIV. In his clinical course, anti-influenza treatment was not effective. Sputum culture revealed the presence of MRSA, and HSV was isolated in broncho-alveoler lavage (BAL) fluid. Administration of an antiviral agent (acyclovir), an antibacterial agent (linezolid), and a corticosteroid (methylprednisolone) successfully improved the pneumonia and ARDS. HSV pneumonia can scarcely be seen in healthy people. However recently it has been recognized as a ventilator-associated pneumonia. Although co...

Corticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis

Hand — Thu, 19 Jan 2012 07:00:06 +0100

Conclusions Steroid injection is an appropriate treatment in carefully selected patients. Those who are female, diabetic and have neurophysiological confirmation of diagnosis have the highest risk of relapse. These results may be used to guide initial treatment and counsel patients about the risk relapse. Content Type Journal ArticleCategory Surgery ArticlesPages 1-6DOI 10.1007/s11552-012-9390-8Authors Paul J. Jenkins, Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife KY12 0SU, UKAndrew D. Duckworth, Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife KY12 0SU, UKAdam C. Watts, Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife KY12 0SU...

Spectrum of fungal infection in a neurology tertiary care center in India

Neurological Sciences — Thu, 19 Jan 2012 06:56:24 +0100

This study reports clinical, MRI and outcome of patients with central nervous system (CNS) fungal infections. 39 patients with CNS fungal infections treated in neurology service during the last 3 years were included and a detailed medical history and clinical examination were undertaken. Cranial MRI including paranasal sinuses were carried out and the location and nature of abnormalities were noted. Fungal infection was confirmed by CSF examination or histopathology. Death during hospital stay was noted. The median age was 37 (8–72) years and 8 were females. The clinical features included altered sensorium in 31, focal motor deficits in 13, visual loss in 12, seizures in 10, diplopia in 7, and papilledema in 9 patients. 28 patients had the following predisposing condition...

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Gout and Organ Transplantation

Current Rheumatology Reports — Thu, 19 Jan 2012 06:55:35 +0100

Abstract Acute and chronic gout are common complications following organ transplantation. Risk factors include those shared with the general population (eg, diuretic use) and transplant-specific risk factors (eg, cyclosporine). Clinical features of gout are similar to those seen in the general population, although tophi may be more common. A definitive diagnosis requires demonstration of monosodium urate crystals within synovial fluid or tophi. Treatment is often empiric, although a poor response should prompt joint aspiration to exclude septic arthritis. Corticosteroids are commonly used to treat acute gout due to the adverse profile and drug interactions with NSAIDs and colchicine. Sustained reduction of serum urate (≤6 mg/dL) is critical in long-term management. ...

How should talc be administered for chemical pleurodesis?

NeLM - Medicines Q and A — Thu, 19 Jan 2012 05:00:00 +0100

Source: East Anglia Medicines Information Service Area: Evidence > Medicines Q & A Malignant pleural effusion affects more than 40,000 people annually in the UK. Talc is the chemical sclerosant of choice for pleurodesis based on efficacy. Since 1st January 2008, the Medicines and Healthcare products Regulatory Agency (MHRA) has classified talc as a medicinal product. National guidelines recommend 4g or 5g of sterile graded talc in 50ml sodium chloride 0.9%. Intrapleural administration of sclerosing agents may be painful. Discomfort can be reduced by administering a local anaesthetic via the drain prior to pleurodesis. The most frequently studied local anaesthetic for intrapleural administration is lidocaine. Analgesia should also be given to the patient after the procedure;...

Corticosteroids and rituximab as adjunctive treatments for thrombotic thrombocytopenic purpura (TTP)

American Journal of Hematology — Thu, 19 Jan 2012 05:00:00 +0100

AbstractAlthough treatment with plasma exchange increased the survival of patients with thrombotic thrombocytopenia purpura (TTP) to 80% in the 1980s, no further increase of survival occurred over the next 20 years. However more consistent use of adjuvant treatment with corticosteroids and rituximab in recent years has begun to further increase survival as well as decrease the frequency of relapse. With adjuvant treatment, durable remissions can be achieved more quickly, requiring fewer days of plasma exchange. Fewer days of plasma exchange have resulted in fewer complications, such as central venous catheter‐related systemic infections. Future potential options for adjuvant treatment, recombinant ADAMTS13 to correct severe ADAMTS13 deficiency and agents to block von Willebrand factor‐...

SALTO: a randomized, multicenter study assessing octreotide LAR in inoperable bowel obstruction.

Bulletin du Cancer — Thu, 19 Jan 2012 05:00:00 +0100

Authors: Laval G, Rousselot H, Toussaint-Martel S, Mayer F, Terrebonne E, François E, Brixi H, Nguyen T, Bourdeix I, Bisot-Locard S, Zelek L Abstract This phase II, multicenter, randomized, double-blind, non-comparative study assessed the efficacy and safety of immediate-release octreotide and octreotide LAR, in combination with corticosteroids and standard medical care, on the symptoms of inoperable malignant bowel obstruction (MBO) due to peritoneal carcinomatosis. The primary efficacy endpoint was "success" at day 14 defined as a composite endpoint including the absence of a nasogastric tube, and vomiting less than twice per day and no use of anticholinergic agents. Patients in the octreotide arm received octreotide LAR 30 mg intramuscular (im) on days 1, 29 and 57, as w...

Corticosteroid use raises colorectal anastomotic leak risk

MedWire News - Gastroenterology — Thu, 19 Jan 2012 00:00:00 +0100

Anastomotic leakage after colorectal resection is significantly more common in patients who use corticosteroids than nonusers, Dutch researchers have found. (Source: MedWire News - Gastroenterology)

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Omalizumab beyond asthma.

Allergologia et Immunopathologia — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSION: There is not enough evidence to support the regular use of omalizumab in IgE diseases other than asthma. However, some experimental and clinical investigations indicate that omalizumab could be a therapeutic option in several allergic diseases like atopic dermatitis, urticaria, and eosinophilic gastrointestinal disorders. More control studies are needed in each IgE disease to evaluate the efficacy and safety of omalizumab in IgE mediated diseases. PMID: 22264640 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)

Rituximab Disappoints for Those With Lupus NephritisRituximab Disappoints for Those With Lupus Nephritis

Medscape Today Headlines — Tue, 17 Jan 2012 23:50:08 +0100

Adding rituximab to mycophenolate mofetil and corticosteroids did not improve clinical outcomes in patients with proliferative lupus nephritis. Medscape Medical News (Source: Medscape Today Headlines)

Idiopathic granulomatous lobular mastitis

International Journal of Dermatology — Tue, 17 Jan 2012 17:42:43 +0100

AbstractIdiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role. (Source: International Journal of Dermatology)

Fluorescence spectroscopy as a tool to detect and evaluate glucocorticoid-induced skin atrophy

Lasers in Medical Science — Tue, 17 Jan 2012 07:17:27 +0100

Abstract Topical glucocorticoid (GC) therapy has been successfully used in the treatment of several common cutaneous diseases in clinical practice for a long time, and skin atrophy is one of the most typical cutaneous side effects of this therapy. The aim of this study was to evaluate the potential of noninvasive fluorescence spectroscopy (FS) technique in the detection and classification of GC-induced skin atrophy. A total of 20 male Wistar rats were used in the experimental protocol under controlled environmental conditions and with free access to food. One group received topical application of clobetasol propionate 0.05% for 14 days to induce cutaneous atrophy (atrophic group) and the other (control) group received only vehicle application following the same protoc...

Tuberculosis-related choriocapillaritis (multifocal–serpiginous choroiditis): follow-up and precise monitoring of therapy by indocyanine green angiography

International Ophthalmology — Tue, 17 Jan 2012 07:12:50 +0100

Abstract To report the case of a patient initially diagnosed with acute posterior multifocal placoid pigment epitheliopathy (APMPPE), characterized by relentless evolution despite high-dose steroid therapy. An interferon-gamma release assay (IGRA) indicated a diagnosis of suspected tuberculous choriocapillaritis and the disease responded only to massive inflammation suppressive therapy and antibiotic therapy. Case report. Review of clinical features and investigational procedures. Smoldering relentless evolution and subsequent arrest of progression could be precisely monitored by indocyanine green angiography (ICGA). The patient did not recover after standard anti-tubercolosis (TB) therapy combined with corticosteroid. A fourth antibiotic had to be added in order to stop t...

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Refractory multisystem sarcoidosis responding to infliximab therapy

Clinical Rheumatology — Tue, 17 Jan 2012 07:07:51 +0100

We report outcomes of three patients with extensive multisystem sarcoidosis refractory to conventional treatment and treated at our center. Clinical assessment and radiographic imaging were used to assess the response to infliximab treatment. Infliximab therapy induced clinical remission in all three patients, and this clinical response correlated with radiographic evidence of the resolution of granulomatous disease. Serum ACE level was reduced in all cases, and daily steroid dosage was reduced. We propose that infliximab can be an effective treatment in patients with multisystem complex sarcoidosis refractory to conventional drug therapy and can result in sustained clinical remission. Our experience supports the urgent need for randomized controlled clinical trials of anti-TNF thera...

Primary IgG4-related lymphadenopathy with prominent granulomatous inflammation and reactivation of Epstein–Barr virus

Virchows Archiv — Tue, 17 Jan 2012 07:07:43 +0100

We report a unique case of primary IgG4-related lymphadenopathy showing prominent granulomatous inflammation and Epstein–Barr virus (EBV) reactivation. Involved lymph nodes showed an expanded interfollicular zone with prominent granulomatous inflammation, including a predominance of epithelioid macrophages and occasional Langhans multinucleated giant cells. Bundles of spindle cells were also observed. Intermingled with the granulomatous inflammation were numerous mature plasma cells, eosinophils, and neutrophils. The percentage of IgG4+/IgG+ plasma cells was markedly elevated (70%), along with raised serum IgG4 levels. The plasma cells did not show immunoglobulin light-chain restriction. EBV-positive lymphocytes were scattered throughout the paracortical areas. Corticosteroid treat...

Corticosteroid insensitivity is reversed by formoterol via phosphoinositide 3 kinase inhibition

British Journal of Pharmacology — Tue, 17 Jan 2012 05:00:00 +0100

Conclusions and Implications. FM reversed oxidative stress‐induced corticosteroid insensitivity and decreased β2 receptor dependent cAMP production via inhibition of PI3Kδ signalling. A combination of a corticosteroid with FM will be more effective than that with SM under conditions of high oxidative stress, such as in COPD. (Source: British Journal of Pharmacology)

An unusual case of Takayasu's arteritis: Evaluation by CT angiography

Annals of Indian Academy of Neurology — Tue, 17 Jan 2012 05:00:00 +0100

Mukund Vidhate, Ravindra Kumar Garg, Rajesh Yadav, Neera Kohli, Praveen Naphade, HK AnuradhaAnnals of Indian Academy of Neurology 2011 14(4):304-306Takayasu's arteritis is a chronic, idiopathic, medium and large vessel vasculitis involving aorta and its main branches. Frequent neurological manifestations include postural syncope, seizures, and blindness. Stroke, as presenting feature of Takayasu's arteritis, is unusual. CT angiography reveals characteristic involvement of aortic arch and its branches. Involvement of intracranial vasculature is rather unusual. We are describing an unusual patient of Takayasu's arteritis who presented with recurrent disabling syncopal attacks and had extensive involvement of intracranial vasculature. CT angiography revealed severe involv...

The investigation of severe asthma to define phenotypes

Clinical and Experimental Allergy — Tue, 17 Jan 2012 05:00:00 +0100

AbstractSevere asthmatics often exhibit poor control despite high doses of inhaled corticosteroids with or without systemic corticosteroids and suffer from persistent symptoms and/or recurrent exacerbations. 5 to 10% of the asthmatic population falls within this category. Patients with severe asthma are a heterogeneous group and should be investigated to confirm the diagnosis, identify comorbidities,exclude alternative diagnoses, together with an evaluation of treatment adherence and side‐effects from medications. Optimisation of asthma medications and monitoring the control and pattern of asthma usually takes place over a period of 6 months. In patients with confirmed severe refractory asthma, further evaluation is needed in terms of detailed lung function, of airway and lung structure ...

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Involvement of corticotropin‐releasing hormone and corticosteroid receptors in the brain‐pituitary‐gill of tilapia during the course of seawater acclimation

Journal of Neuroendocrinology — Tue, 17 Jan 2012 05:00:00 +0100

AbstractThe mRNA expression of corticotropin‐releasing hormone (CRH) and the hormone receptors CRH‐receptor/CRH‐R, glucocorticoid receptor 1/2 (GR1/2) and mineralocorticoid receptor (MR) were studied in the brain, pituitary and gill of tilapia (Oreochromis mossambibus) during salinity and handling stress by quantitative real‐time (Q‐PCR) analysis. The results indicated that the transcripts of CRH and CRH‐R were increased in the forebrain, midbrain and gill, whereas elevated hypothalamic CRH suppressed the CRH‐R mRNA in the pituitary in seawater (SW) fish. The levels of plasma osmolality and cortisol were significantly increased in SW when compared to freshwater (FW) fish. The up‐regulation of GR1, GR2, MR and α‐NKA (Na+/K+‐ATPase) transcripts in SW fish provided eviden...

Higher prevalence of obesity among children with asthma.

Obesity — Tue, 17 Jan 2012 05:00:00 +0100

In conclusion, overweight, moderate, and extreme obesity are associated with higher odds of asthma in children and adolescents, although the association varies widely with race/ethnicity. Increasing BMI among youth with asthma is associated with higher consumption of corticosteroids and emergency department visits. PMID: 22252049 [PubMed - as supplied by publisher] (Source: Obesity)

History of Actas Dermo-Sifiliográficas, Part I: 1909-1959.

Actas Dermo-Sifiliograficas — Tue, 17 Jan 2012 05:00:00 +0100

Authors: Del Río E Abstract Actas Dermo-Sifiliográficas was born in May 1909. At first, issues appeared in step with the academic year, but publication began to follow the calendar year in 1957. Volume 18 was skipped in 1926-7 in an effort to correct confusion in the numbering of volumes and pages of earlier issues. October 1928 saw the journal grow from 6 issues per year to 9. Although the Spanish Civil War brought publication to a halt during the 1936-7 academic year, Actas Dermo-Sifiliográficas was one of the first Spanish scientific journals to recover from the conflict. The initial print run of 100 copies was increased to 700 after the war. The content evolved over time: while originally conceived to provide a strict account of sessions of the Spanish Academy of Dermatology...

Fluticasone in Asthma Symptomatic on Inhaled CorticosteroidsFluticasone in Asthma Symptomatic on Inhaled Corticosteroids

Medscape Today Headlines — Tue, 17 Jan 2012 04:00:00 +0100

Can the once-daily inhaled corticosteroid fluticasone furoate provide effective asthma control with an acceptable tolerability profile? Thorax (Source: Medscape Today Headlines)

Auricular Keloids: Combined Therapy With a New Pressure Device [Original Article]

Archives of Facial Plastic Surgery — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion Overnight usage of the new pressure device seems to be a safe and effective extension of established auricular keloid therapy with the potential for prophylaxis of recurrence. (Source: Archives of Facial Plastic Surgery)

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High Frequency of Genital Lichen Sclerosus in a Prospective Series of 76 Patients With Morphea: Toward a Better Understanding of the Spectrum of Morphea [Study]

Archives of Dermatology — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions Genital LS is significantly more frequent in patients with morphea than in unaffected individuals. Forty-five percent of patients with plaque morphea have associated LS. Complete clinical examination, including careful inspection of genital mucosa, should therefore be mandatory in patients with morphea because genital LS bears a risk of evolution into squamous cell carcinoma and thus needs treatment with topical corticosteroids. (Source: Archives of Dermatology)

Trends in Pediatric Psoriasis Outpatient Health Care Delivery in the United States [Study]

Archives of Dermatology — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions Over the 28-year interval, outpatient visits for pediatric psoriasis were attended primarily by white children older than 8 years in equal number by sex. Dermatologists and pediatricians saw the majority, and treatment approach differed by physician specialty and patient age. Treatment guidelines for childhood psoriasis may help reduce treatment variability. (Source: Archives of Dermatology)

Surgical Management of Auricular Infantile Hemangiomas [Original Article]

Archives of Otolaryngology — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions Most infantile hemangiomas do not require treatment. Surgical excision of auricular infantile hemangiomas at any phase is effective in preventing fibrofatty scarring, reducing cartilage deformities, and treating complicated cases or patients who have failed medical management. Surgical excision with Z-plasty reconstruction is a viable option that should be considered to limit postoperative deformities. (Source: Archives of Otolaryngology)

Long-term and Perioperative Corticosteroids in Anastomotic Leakage: A Prospective Study of 259 Left-Sided Colorectal Anastomoses [Original Article]

Archives of Surgery — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions We found a significantly increased incidence of AL in patients treated with long-term corticosteroids and perioperative corticosteroids for pulmonary comorbidity. Therefore, we recommend that in this patient category, anastomoses should be protected by a diverting stoma or a Hartmann procedure should be considered to avoid AL. Trial Registration trialregister.nl Identifier: NTR1258 (Source: Archives of Surgery)

Atypical Neurofibroma and Osteosclerotic Metastasis

Journal of Biophysics — Mon, 16 Jan 2012 03:35:01 +0100

35-year-old male presented with multiple swellings in left leg, headache, weakness of limbs for 4 months, and blurring of vision for the last 15 days. On examination, he was pale, cachexic with generalized lymphadenopathy and lower motor neuron type weakness of limbs sparing right upper limb. Blood investigations showed anemia with high alkaline phosphatase. Chest radiograph revealed osteosclerotic metastatic lesion in humerus. Biopsy of leg lesion revealed atypical neurofibroma. Computed tomography (CT) of thorax revealed osteoblastic metastasis. Bone marrow aspiration showed cells with round to oval nuclei, fine granular chromatin with large central prominent nucleoli and eosinophilic cytoplasm with acini formation. Magnetic resonance imaging (MRI) of brain and spinal cord defined metast...

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Etanercept-Induced Myelopathy in a Pediatric Case of Blau Syndrome

Journal of Biomedicine and Biotechnology — Sun, 15 Jan 2012 16:11:39 +0100

We describe a case of pediatric Blau syndrome affected by etanercept-induced myelopathy, manifesting as a clinical syndrome of transverse myelitis. The patient experienced rapid recovery after etanercept was discontinued. To our knowledge, this is the first such case reported in the literature and, possibly, the one with the latest onset, following 8 years of treatment. We discuss the etiopathogenic mechanisms of this reaction and possible explanations for the imaging findings. (Source: Journal of Biomedicine and Biotechnology)

Methotrexate and Corticosteroids in the Treatment of Localized Scleroderma: A Standardized Prospective Longitudinal Single-center Study.

J Rheumatol — Sun, 15 Jan 2012 05:00:00 +0100

CONCLUSION: This single-center LS treatment protocol was effective and well tolerated. Clinical outcome in LS is affected by dose and route of administration of immunosuppressive regimens. Daily tapering dose of corticosteroids and parenteral MTX were effective in controlling LS activity without significant adverse reaction. This regimen should be considered as one of the therapies for LS clinical trials. PMID: 22247357 [PubMed - as supplied by publisher] (Source: J Rheumatol)

Efficacy and safety of topical halometasone in eczematous dermatoses in Indian population: An open label, noncomparative study

Indian Journal of Dermatology — Sat, 14 Jan 2012 05:00:00 +0100

Conclusions: Halometasone was shown to be safe and very effective in Indian patients with acute and chronic eczema and the drug was well tolerated. (Source: Indian Journal of Dermatology)

Dermatitis herpetiformis, primary hypothyroidism and pituitary mass mimicking macroadenoma regression after treatment with thyroxin, corticosteroids and dapsone

Indian Journal of Dermatology — Sat, 14 Jan 2012 05:00:00 +0100

We report a case of 15-year-old girl who was diagnosed as a case of pituitary macroadenoma on computed tomography and magnetic resonance imaging (MRI) scans for her complains of diminished vision in the left eye and headache. On investigation she was found to have optic atrophy of left eye and primary hypothyroidism. She was started on thyroxin therapy in October 2008 and planned for transcranial excision of the tumor. Just before the date for planned surgery she developed mildly itchy vesico-bullous rash and the surgery was postponed. On histopathology and immunoflourescence studies it was confirmed to be the rash of dermatitis herpetiformis (DH) and treatment was started with corticosteroids in the last week of December 2008 and dapsone was added from mid January 2009. The lesions respon...

Poor neurological sequelae of herpes simplex virus encephalitis in an infant despite adequate antiviral and adjunct corticosteroid therapy

Indian Journal of Dermatology — Sat, 14 Jan 2012 05:00:00 +0100

Ratna B Basak, Varsha Malpani, Khalid Kakish, Susan Vargese, Nageshwar Chauhan, Andreas BoeckIndian Journal of Dermatology 2011 56(6):749-751A 2-month-old infant presented to our emergency department with fever, altered consciousness, and focal seizures of acute onset. He had vesicular skin lesions over the right preauricular region. CT brain showed a large hypodense lesion involving the left temporo-parietal region, left basal ganglia and left thalamus. MRI brain revealed bilateral multifocal corticomedullary lesions suggestive of encephalitis. CSF-PCR was positive for herpes simplex virus (HSV) type I. He was treated with standard dose intravenous acyclovir for 15 days along with a trial of pulse methylprednisolone, but was readmitted within a week with features of an early relapse. The ...

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Interventions for treating oral lichen planus

British Journal of Dermatology — Fri, 13 Jan 2012 05:00:00 +0100

Conclusions: Although TCSs are considered to be first line treatment, we identified no RCTs that compared TCSs with placebo in patients with symptomatic OLP. From the 28 trials included in this systematic review, the wide range of interventions compared means there is insufficient evidence to support the effectiveness of any specific treatment as being superior. (Source: British Journal of Dermatology)

Meta‐analysis: diagnostic medical radiation exposure in inflammatory bowel disease

Alimentary Pharmacology and Therapeutics — Fri, 13 Jan 2012 05:00:00 +0100

ConclusionsAbout 1 in 10 patients may be exposed to potentially harmful levels of diagnostic medical radiation. Corticosteroid use and IBD related surgery increased this risk. Strategies to reduce radiation exposure while assessing disease activity need to be considered. (Source: Alimentary Pharmacology and Therapeutics)

Interventions for treating oral lichen planus.

The British Journal of Dermatology — Fri, 13 Jan 2012 05:00:00 +0100

Osteodystrophy in chronic liver diseases

Internal and Emergency Medicine — Thu, 12 Jan 2012 16:47:58 +0100

Abstract Osteoporosis and osteomalacia are, to date, among the most common metabolic diseases in the world. Lately, an association between metabolic bone diseases and chronic liver disease has been increasingly reported, inducing many authors to create a new nosographic entity known as ‘hepatic osteodystrophy.’ The importance of such a condition is further increased by the morbidity of these two diseases, which greatly reduce the quality of life because of frequent fractures, especially vertebral and femoral neck ones. For this reason, early identification of high-risk patients should be routinely performed by measuring bone mass density. The explanation for the association between bone diseases and chronic liver disease is still uncertain, and involves many factors: f...

Spontaneous and serial rupture of both Achilles tendons associated with secondary hyperparathyroidism in a patient receiving long-term hemodialysis

International Urology and Nephrology — Thu, 12 Jan 2012 16:47:18 +0100

Abstract The spontaneous and serial rupture of the bilateral Achilles tendons without history of significant trauma is an uncommon complication in long-term hemodialysis (HD) patients. The majority of these patients have additional predisposing factors, such as previous use of fluoroquinolone antibiotics or corticosteroids. In general, this condition is associated with a coexisting systemic disease, including chronic kidney disease (CKD), secondary hyperparathyroidism, systemic lupus erythematosus (SLE), and diabetes mellitus (DM). Here, we report a 46-year-old man who had been undergoing regular HD for 11 years. He developed a spontaneous and consecutive rupture of both Achilles tendons. Based on previous reports of tendon ruptures in uremic patients and on the patie...

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Spontaneous Rupture of the Patellar Tendon and the Contralateral Quadriceps Tendon, Associated with Lupus Erythematosus: Analysis of the Literature

Computational Intelligence and Neuroscience — Thu, 12 Jan 2012 11:11:41 +0100

Bilateral rupture of the patellar tendon is a rare injury. A case of a 67-year-old man with systemic lupus erythematosus under corticosteroid treatment for the last 10 years, who sustained spontaneous rupture of the patellar tendon and the contralateral quadriceps tendon, is herein presented. The patient was operated bilaterally, had an optimal outcome considering his age and the comorbidities, and was followed up for 24 months. (Source: Computational Intelligence and Neuroscience)

COPD exacerbations in general practice: variability in oral prednisolone courses

BMC Family Practice — Thu, 12 Jan 2012 05:00:00 +0100

Conclusion: Under normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration. (Source: BMC Family Practice)

The Efficacy and Safety of the Novel Long-Acting β2 Agonist Vilanterol in COPD Patients: a Randomized Placebo-Controlled Trial.

Chest — Thu, 12 Jan 2012 05:00:00 +0100

CONCLUSIONS:VI 25 and 50μg once daily provided both statistically and clinically relevant 24-h improvements in lung function in patients with COPD compared with placebo. All doses of VI had a safety and tolerability profile similar to placebo. PMID: 22241764 [PubMed - as supplied by publisher] (Source: Chest)

A geranyl acetophenone targeting cysteinyl leukotriene synthesis prevents allergic airway inflammation in ovalbumin-sensitized mice.

Toxicology and Applied Pharmacology — Thu, 12 Jan 2012 05:00:00 +0100

Authors: Ismail N, Jambari NN, Zareen S, Akhtar MN, Shaari K, Zamri-Saad M, Tham CL, Sulaiman MR, Lajis NH, Israf DA Abstract Asthma is associated with increased pulmonary inflammation and airway hyperresponsiveness. The current use of corticosteroids in the management of asthma has recently raised issues regarding safety and lack of responsiveness in 5-10% of asthmatic individuals. The aim of the present study was to investigate the therapeutic effect of a non-steroidal small molecule that has cysteinyl leukotriene (cysLT) inhibitory activity, upon attenuation of allergic lung inflammation in an acute murine model. Mice were sensitized with ovalbumin (OVA) and treated with several intraperitoneal doses (100, 20, 2 and 0.2mg/kg) of 2,4,6,-trihydroxy-3-geranylacetophenone (tHGA). Br...

Prescription for antiresorptive therapy in Mexican patients with rheumatoid arthritis: is it time to reevaluate the strategies for osteoporosis prevention?

Rheumatology International — Wed, 11 Jan 2012 17:51:08 +0100

In conclusion, a low proportion of Mexicans with RA receive antiresorptive therapy independently regardless of whether they consume or not chronically corticosteroids. Additional strategies should be evaluated to encourage the prevention and early treatment for osteoporosis in patients with RA. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00296-011-2341-9Authors J. I. Gamez-Nava, Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social (IMSS) Hospital de Especialidades Centro Médico Nacional de Occidente, Guadalajara, MexicoS. A. Zavaleta-Muñiz, Posgrado en Ciencias Biomédicas, Orientación Inmunología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Unidad de Investigación en Epidemiolog...

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ANCA-associated vasculitis in systemic sclerosis report of 3 cases

Rheumatology International — Wed, 11 Jan 2012 17:51:07 +0100

Abstract The aim of the study was to describe the occurrence of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in systemic sclerosis (SSc) patients. SSc patients who developed biopsy-proven AAV were identified. Their clinical manifestations, autoantibodies, presentation with vasculitis, treatment and outcome were described and compared with previously reported patients with these two conditions. Of 985 patients, 3 were identified. All patients had interstitial lung disease, and all presented with acute renal failure, proteinuria and hematuria, and were P-ANCA- and anti-Scl-70-positive. One required hemodialysis. Two were hypertensive; additionally, one patient had sinusitis, and another had monoarthritis and a macular rash. All were treated with ...

Pediatric ulcerative colitis associated with autoimmune diseases: A distinct form of inflammatory bowel disease?

Inflammatory Bowel Diseases — Wed, 11 Jan 2012 05:00:00 +0100

Conclusions:Precise clinical, histological, and molecular analyses reveal marked differences between patients with CUC and those with associated AI phenomena, supporting the hypothesis of a distinct AI presentation of IBD. (Inflamm Bowel Dis 2012;) (Source: Inflammatory Bowel Diseases)

Adrenocortical dysfunction in liver disease: A systematic review

Hepatology — Wed, 11 Jan 2012 05:00:00 +0100

AbstractIn patients with cirrhosis adrenal insufficiency (AI) is reported during sepsis and septic shock, and is associated with increased mortality. Consequently, the term “hepato‐adrenal syndrome” was proposed. Some studies have shown that AI is frequent in stable cirrhosis, and in cirrhosis associated with decompensation other than sepsis, such as bleeding and ascites. Moreover, other studies showed a high prevalence in liver transplant recipients, immediately after or some time after liver transplantation. The effect of corticosteroid therapy in critically ill patients with liver disease has been evaluated in some studies, but the results remain controversial.The 250 µg ACTH stimulation test to diagnose AI in critically ill adult patients is recommended by an international task ...

Association of Hypothalamic-Pituitary-Adrenal Axis-Related Polymorphisms with Stress in Asthmatic Children on Inhaled Corticosteroids

Neuroimmunomodulation — Tue, 10 Jan 2012 23:00:00 +0100

Neuroimmunomodulation 2012;19:88–95 (DOI:10.1159/000329592) (Source: Neuroimmunomodulation)

A Large Subgroup Of Mild-To-Moderate Asthma Is Persistently Non-Eosinophilic

Health News from Medical News Today — Tue, 10 Jan 2012 08:00:00 +0100

A large percentage of patients with mild-to-moderate asthma have persistently non-eosinophilic disease which may not respond to currently available anti-inflammatory treatments, according to a new study. In a cross-sectional study of 995 asthmatic subjects enrolled in nine clinical trials conducted by the NHLBI's Asthma Clinical Research Network, sputum eosinophilia (â�¥2% eosinophils) was found in only 36% of asthmatics not using an inhaled corticosteroid (ICS) and 17% of those using an ICS... (Source: Health News from Medical News Today)

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Mineralocorticoid Receptor Overexpression Facilitates Differentiation and Promotes Survival of Embryonic Stem Cell-Derived Neurons.

Endocrinology — Tue, 10 Jan 2012 05:00:00 +0100

Authors: Munier M, Law F, Meduri G, Le Menuet D, Lombès M Abstract Mineralocorticoid receptor (MR), highly expressed in the hippocampus, binds corticosteroid hormones and coordinately participates, with the glucocorticoid receptor, to the control of stress responses, memorization, and behavior. To investigate the impact of MR in neuronal survival, we generated murine embryonic stem (ES) cells that overexpress human MR (hMR) (P1-hMR) and are induced to differentiate into mature neurons. We showed that recombinant MR expression increased throughout differentiation and is 2-fold higher in P1-hMR ES-derived neurons compared with wild-type controls, whereas glucocorticoid receptor expression was unaffected. Although proliferation and early neuronal differentiation were comparable in P1...

Recurrent Dense Deposit Disease After Renal Transplantation: An Emerging Role for Complementary Therapies

American Journal of Transplantation — Tue, 10 Jan 2012 05:00:00 +0100

Dense deposit disease is a rare glomerulonephritis caused by uncontrolled stimulation of the alternative complement pathway. Allograft survival after kidney transplantation is significantly reduced by the high rate of disease recurrence. No therapeutic interventions have consistently improved outcomes for patients with primary or recurrent disease. This is the first reported case of recurrent dense deposit disease being managed with eculizumab. Within 4 weeks of renal transplantation, deteriorating graft function and increasing proteinuria were evident. A transplant biopsy confirmed the diagnosis of recurrent dense deposit disease. Eculizumab was considered after the failure of corticosteroid, rituximab and plasmapheresis to attenuate the rate of decline in allograft function. There was a ...

Community‐acquired Pneumonia in Immunocompromised Older Patients: Incidence, Causative Organisms and Outcome

Clinical Microbiology and Infection — Tue, 10 Jan 2012 05:00:00 +0100

In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram‐negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality. (Source: Clinical Microbiology and Infection)

The increasing incidence of initial steroid resistance in childhood nephrotic syndrome

Pediatric Nephrology — Mon, 09 Jan 2012 19:36:10 +0100

Conclusions Our results show the increasing incidence of primary steroid resistance in childhood nephrotic syndrome. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00467-011-2083-7Authors Beata Banaszak, Division of Pediatrics in Zabrze, Medical University of Silesia, Katowice, ul. 3 maja 13/15, 41-800 Zabrze, PolandPaweł Banaszak, Department of Congenital Heart Diseases and Pediatric Cardiology, Silesian Centre for Heart Diseases, Zabrze, Poland Journal Pediatric NephrologyOnline ISSN 1432-198XPrint ISSN 0931-041X (Source: Pediatric Nephrology)

Does fingolimod in multiple sclerosis patients cause macular edema?

Journal of Neurology — Mon, 09 Jan 2012 19:35:31 +0100

We report a case of relapsing–remitting MS treated with fingolimod. The patient presented with an acute decrease in vision in the left eye. Eye examination showed clinical macular edema (ME) in the left eye, which was confirmed on fluorescein angiogram and optical coherence tomography (OCT). After discontinuation of fingolimod and treatment with topical corticosteroid medication, there was complete resolution of the ME. The ME as a side-effect of fingolimod is reversible after discontinuing, which was seen on OCT. Content Type Journal ArticleCategory Short CommentaryPages 1-3DOI 10.1007/s00415-011-6367-4Authors Kiran Turaka, Associated Retina Consultants Ltd, 7600 N 15th Street, Phoenix, AZ 85020, USAJoseph Shepard Bryan, Associated Retina Consultants Ltd, 7600 N 15th Street, ...

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Lipid profiles in untreated patients with dermatomyositis

Journal of the European Academy of Dermatology and Venereology — Mon, 09 Jan 2012 05:00:00 +0100

Conclusion Dyslipoproteinemia is a common feature in patients with DM that is characterized by an increase in TG and a decrease in HDL‐C, suggesting a high risk of atherosclerosis. Inflammation might partly account for the changes of serum lipid profiles in DM. (Source: Journal of the European Academy of Dermatology and Venereology)

Fulminant Postpartum Cerebral Vasoconstriction Syndrome [Original Contribution]

Archives of Neurology — Mon, 09 Jan 2012 05:00:00 +0100

Conclusions Postpartum vasoconstriction can be fatal, with rapid progression of vasoconstriction, ischemia, and brain edema. Clinicians need to be aware of the potential consequences of this condition. Postpartum women with acute neurologic symptoms require prompt investigation with noninvasive cerebrovascular imaging and close monitoring for possible secondary deterioration. (Source: Archives of Neurology)

Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: The lupus nephritis assessment with rituximab (LUNAR) study

Arthritis and Rheumatism — Mon, 09 Jan 2012 05:00:00 +0100

CONCLUSIONS:Although rituximab therapy led to more responders and greater reductions in anti‐dsDNA and C3/C4 levels, it did not improve clinical outcomes after 1 year of treatment. The combination of rituximab with MMF and corticosteroids did not result in any new or unexpected safety signals. (Source: Arthritis and Rheumatism)

The importance of recognizing juvenile idiopathic arthritis‐associated uveitis and preventing blindness from it

Arthritis Care and Research — Mon, 09 Jan 2012 05:00:00 +0100

AbstractJuvenile idiopathic arthritis is largely associated with uveitis, one of the leading preventable causes of blindness worldwide. Screening for childhood uveitis is underappreciated, with ocular complications seen in up to 86.3% of patients 3 years after initial diagnosis as a consequence of delayed diagnosis and/or imprudent chronic employment of corticosteroid monotherapy. Many patients are legally blind upon initial presentation to an ophthalmologist. Long‐term follow‐up studies over 20 years reveal surprisingly poor outcomes. A step‐ladder approach to treatment with corticosteroid‐sparing therapy is vital to keeping stubborn ocular inflammation from causing permanent complications, with consideration of the discordance between ocular and systemic disease activity and resp...

Improved survival ratios correlate with myeloid dendritic cell restoration in acute-on-chronic liver failure patients receiving methylprednisolone therapy.

Cellular and Molecular Immunology — Mon, 09 Jan 2012 05:00:00 +0100

Authors: Zhao J, Zhang JY, Yu HW, He YL, Zhao JJ, Li J, Zhu YK, Yao QW, Wang JH, Liu HX, Shi SY, Zou ZS, Xu XS, Zhou CB, Wang FS, Meng QH Abstract Acute-on-chronic liver failure (ACLF) is a severe life-threatening complication. Liver transplantation is the only available therapeutic option; however, several limitations have restricted its use in patients. The use of corticosteroids as an optional therapy for ACLF has received a great deal of interest. The rationale behind its use is the possible role of the immune system in initiating and perpetuating hepatic damage. In order to assess the relationship between myeloid dendritic cells (mDCs) and the efficacy of methylprednisolone (MP) treatment for hepatitis B virus (HBV)-associated ACLF patients, we recruited 30 HBV-associated ACLF...

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Effect of high dose inhaled corticosteroids on cell mediated immunity in patients with asthma.

Allergologia et Immunopathologia — Mon, 09 Jan 2012 05:00:00 +0100

CONCLUSION: Patients with asthma taking high dose inhaled corticosteroids chronically (>6 months) did not have significantly greater impaired cell mediated immunity than patients not taking inhaled corticosteroids in this study. PMID: 22236734 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)

When Is More Treatment Needed for Infantile Hemangiomas?

PediatricEducation.org — Mon, 09 Jan 2012 00:30:57 +0100

Discussion Infantile hemangiomas (IH) are the most common soft tissue tumors in infants. They are usually considered birthmarks but are dynamic lesions. They usually begin in the first few weeks of life and rapidly grow in the first 3-5 months of life. By 5 months, most lesions will have achieved 80% of their final size. Almost all IH have cessation of growth after 9 month of age. Images of IH can be seen in the To Learn More section below. Learning Point Often no treatment is necessary for IH other than expectant monitoring. Additional treatment may be necessary depending on the patient’s age, lesion type, location, size and complication being considered. The results of a prospective cohort of 1058 children in 7 pediatric dermatology clinics found that overall 24% of patients had c...

Metabolic evaluation of young women with congenital adrenal hyperplasia

Arquivos Brasileiros de Endocrinologia e Metabologia — Sun, 08 Jan 2012 19:33:01 +0100

CONCLUSIONS: Young women with 21OHD CAH had infrequent dyslipidemia, but had a higher prevalence of insulin resistance and central obesity, that were independent of BMI or corticosteroid dosage.OBJETIVO: Avaliar a presença de resistência insulínica e dislipidemia em mulheres com hiperplasia adrenal congênita (HAC) por deficiência da 21-hidroxilase (21OHD) e investigar a associação com índice de massa corporal (IMC) e dose de glicocorticoide prescrita. PACIENTES E MÉTODOS: Em 18 mulheres jovens (média ± DP, 19,3 ± 3,0 anos), avaliamos IMC, circunferência abdominal, dose de glicocorticoide, glicemia, insulinemia e perfil lipídico. RESULTADOS: O IMC foi normal em 12 pacientes; 5 apresentavam sobrepeso e 1 apresentou obesidade. Circunferência abdominal estava aumentada em 7 paci...

An overview of asthma and airway hyper-responsiveness in Olympic athletes.

British Journal of Sports Medicine — Sun, 08 Jan 2012 05:00:00 +0100

Authors: Fitch KD Abstract Data from the past five Olympic Games obtained from athletes seeking to inhale β2 adrenoceptor agonists (IBA) have identified those athletes with documented asthma and airway hyper-responsiveness (AHR). With a prevalence of about 8%, asthma/AHR is the commonest chronic medical condition experienced by Olympic athletes. In Summer and Winter athletes, there is a marked preponderance of asthma/AHR in endurance-trained athletes. The relatively late onset of asthma/AHR in many older athletes is suggestive that years of endurance training may be a contributory cause. Inspiring polluted or cold air is considered a significant aetiological factor in some but not all sports. During the last five Olympic Games, there has been improved management of athletes with a...

Early initiation of low-dose corticosteroid therapy in the management of septic shock: a retrospective observational study

Critical Care — Sat, 07 Jan 2012 05:00:00 +0100

Conclusions: Early initiation of low-dose corticosteroid therapy was significantly associated with decreased mortality. (Source: Critical Care)

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Pharmacokinetics of tacrolimus and mycophenolate mofetil in renal transplant recipients on a corticosteroid-free regimen.

American Journal of Health-System Pharmacy : AJHP — Fri, 06 Jan 2012 20:28:03 +0100

Conclusion Overall exposure and C(min) values for tacrolimus were similar but C(max) values were higher than those documented in renal transplant patients treated with corticosteroid-based regimens. This may have clinical implications in corticosteroid-free patients experiencing symptoms of tacrolimus toxicity despite trough levels within target ranges. Mycophenolic acid exposure increased with time, but AUC values fell within the range expected for patients receiving concurrent corticosteroids. PMID: 22215359 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

Is adjunctive corticosteroid beneficial in pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone?

Journal of Neurology — Fri, 06 Jan 2012 06:44:39 +0100

Abstract The role of adjunctive corticosteroids remains controversial in meningitis by penicillin-resistant pneumococci. We determined the effect of adjunctive corticosteroids in adults with pneumococcal meningitis in a region with a high rate of penicillin resistance. A multicenter, retrospective cohort study was conducted between 1998 and 2008 in Korea. The mortality and neurological sequelae were evaluated. Among 93 patients with pneumococcal meningitis, adequate adjunctive corticosteroids were given in 45.2%. The penicillin resistance rate was 60.0%, and 42.1% were nonsusceptible to ceftriaxone. The 30-day mortality rates in the group receiving adequate corticosteroid therapy, the group in which corticosteroid was not given, and that inadequately given were 24.3, 31.6,...

Corticosteroids and duchenne muscular dystrophy: Does earlier treatment really matter?

Muscle and Nerve — Fri, 06 Jan 2012 05:00:00 +0100

(Source: Muscle and Nerve)

Why Don't Some People With Asthma Respond to Medication?

WebMD Health — Fri, 06 Jan 2012 05:00:00 +0100

All asthma is not the same. As a result, a new study shows many people with asthma are not helped by corticosteroid medication prescribed to control their breathing problems. (Source: WebMD Health)

Efficacy and Safety of Deracoxib for Control of Postoperative Pain and Inflammation Associated with Soft Tissue Surgery in Dogs

Veterinary Surgery — Fri, 06 Jan 2012 05:00:00 +0100

ConclusionsResults suggest perioperative administration of deracoxib to dogs at 1–2 mg/kg/day for 3 days significantly improves analgesia in the postoperative surgical period after soft tissue surgery. Placebo dogs not rescued after painful procedures highlight the need for refinement of current pain assessment tools. (Source: Veterinary Surgery)

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Why Don't Some People With Asthma Respond to Medication?

WebMD Health — Fri, 06 Jan 2012 05:00:00 +0100

All asthma is not the same. As a result, a new study shows many people with asthma are not helped by corticosteroid medication prescribed to control their breathing problems. (Source: WebMD Health)

MRI preclinical detection and asymptomatic course of a progressive multifocal leucoencephalopathy (PML) under natalizumab therapy

Journal of Neurology, Neurosurgery and Psychiatry — Fri, 06 Jan 2012 05:00:00 +0100

Early detection of progressive multifocal leucoencephalopathy (PML) in the setting of natalizumab therapy currently is performed by rapid evaluation of new symptoms occurring in treated patients. The role of MR scanning has not been investigated but holds promise since MR detection is highly sensitive for PML lesions. The authors report a case of presymptomatic PML of the posterior fossa detected by MR scans. Immediate suspension of natalizumab and plasma exchanges resulted in a rapid decline of natalizumab serum concentration. Intravenous steroids started together with plasma exchanges followed by an oral tapering course were used to minimise the immune reconstitution inflammatory syndrome. No symptoms (beyond mild headache) developed, and the repeat PCR for JC Virus (JCV) DNA detection p...

The actual role of sodium cromoglycate in the treatment of asthma-a critical review.

Sleep and Breathing — Fri, 06 Jan 2012 05:00:00 +0100

CONCLUSION: Compared to SABA and LABA, cromoglycates alone are unsuspicious of being used to enhance physical performance. PMID: 22218743 [PubMed - as supplied by publisher] (Source: Sleep and Breathing)

A Herbal Composition of Scutellaria baicalensis and Eleutherococcus senticosus Shows Potent Anti-Inflammatory Effects in an Ex Vivo Human Mucosal Tissue Model

Advances in Pharmacological Sciences — Thu, 05 Jan 2012 14:27:20 +0100

Discussion. The combination of S. baicalensis and E. senticosus may be able to significantly block allergic early-and late-phase mediators and substantially suppress the release of proinflammatory, and Th1-, Th2-, and Th17—derived cytokines. (Source: Advances in Pharmacological Sciences)