Combination Of Steroids Research Articles

IgG4-related uveitis. A French cohort and literature review

IntroductionIgG4-related disease (IgG4-RD) is a fibro-inflammatory disorder that can affect almost any organ. IgG4-related ophthalmic disease is a protean condition involving the orbit and ocular adnexa. Although a few cases of uveitis have been reported, the exact pattern of IgG4-related intraocular manifestations remains unclear. Here, we report on a nationwide French multicenter cohort of patients with IgG4-RD and uveitis and conducted a literature review. MethodsPatients with uveitis and a concomitant definite diagnosis of IgG4-RD (Revised Comprehensive Diagnostic criteria, American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-RD, International Consensus Diagnostic Criteria for auto-immune pancreatitis, or diagnostic criteria for IgG4-related hypophysitis), were screened from our national IgG4-RD and systemic fibrosis database. Concomitantly, we conducted a PubMed literature review and selected cases of definite IgG4-RD with uveitis. ResultsWe reported on 16 patients (8 from our database and 8 from the literature) and a total of 30 episodes of uveitis. Uveitis cases represented 3 % of total IgG4-RD patients in the national database on IgG4-RD and systemic fibrosis. Uveitis was inaugural in IgG4-RD in 4/16 cases (25 %) (appearing before any other IgG4-related symptom, at a median of 9 months), occurred concurrently to other IgG4-related symptoms in 9/16 cases (56 %) (at a median of 15 months before IgG4-RD diagnosis), and appeared during follow up in 3/16 patients (19 %) (at a median of 57 months after first IgG4-related symptoms). When uveitis occurred during follow up, it was associated with IgG4-RD manifestations in other organs in 6/9 patients (67 %). Uveitis was bilateral in 8/16 cases (50 %) and granulomatous in 5/10 cases (50 %). It was anterior in 8/13 (62 %), intermediate in 3/13 (23 %), and global (panuveitis) in 4/13 patients (31 %). Median serum IgG4 at diagnosis was 3.2 g/L. Median follow up time was of 6 years, during which 8/16 patients (50 %) experienced at least one relapse of uveitis. Treatment data was available for 29/30 uveitis flares. Steroids were used in 28/29 episodes of uveitis (97 %), leading to remission of uveitis in 16/28 cases (57 %). Methotrexate and rituximab (in combination with systemic steroids) were administered as second- or third-line therapy in 6/29 (21 %) and 5/29 (17 %) episodes of uveitis, respectively, and led to remission of uveitis in 4/6 cases (67 %) and 4/5 cases (80 %), respectively. One third of uveitides required at least two different lines of treatment for remission induction (mainly a combination of both systemic steroids and methotrexate or rituximab). Discussion and conclusionsUveitis may be one of the initial symptoms of IgG4-RD, and IgG4-RD should be considered in the diagnostic workup of uveitis. Its early onset in IgG4-RD may help with early diagnosis and treatment of the disease. Steroid monotherapy may be sufficient to treat IgG4-related uveitis, yet relapses were frequent (50 %) and ultimately a third of patients required at least two lines of treatment. Hence, steroid-sparing agents can be considered at early stages of the disease, particularly for patients with a high risk of relapse or steroid-related complications.

A Rare Case of Unilateral Lymphadenopathy: Unicentric Castleman Disease

Background Castleman Disease (CD) involves a group of disorders characterized by an enlargement of lymphoid follicles with capillary proliferation. The disorders are largely separated into unicentric (UCD) or multicentric (MCD) depending on the number of involved lymph nodes. MCD has been linked to HHV8 or immunosuppression secondary to HIV, while UCD has been thought to be driven by a clonal neoplastic process, likely from the follicular dendritic cell. Case Presentation A 14-year-old female with ADHD, OCD, and autism spectrum disorder (ASD) presents to clinic with a 2-year history of a right-sided neck mass. There was no history of trauma or illness around the time of the mass being noted and the mass has not changed significantly in size for the past two years. An excisional biopsy was attempted but, due to excessive vascularity around the mass, was ultimately deferred. Following subsequent MRI and CT scans, a core needle biopsy was performed, revealing lymphoid tissue with regressed follicles and focal hyalinization without signs of malignancy. PET/CT scans at this time showed increased metabolic activity confined to the right-sided neck mass without any increased metabolic activity in the other lymph nodes of the head and neck. Eventually, the 7 cm diameter mass was excised; pathology studies revealed distorted architecture with hyaline deposits in the germinal centers and sclerotic blood vessels penetrating the germinal centers consistent with the hypervascular variant of Castleman Disease. Pre- and post-operative labs such as the C-reactive protein, immunoglobulin counts, and protein electrophoresis panels were all within normal limits. Furthermore, post-operative PET/CT scans showed no metabolically active foci indicating that the lesion was indeed unicentric Castleman Disease. After the excision of the mass, the patient continues to do well without any further surgeries or complications. Discussion Differentiation between UCD and MCD requires imaging, often with a CT scan, to establish the number and locality of the affected lymph nodes. UCD often presents with one bulky lymph node or multiple enlarged lymph nodes within the same region, whereas MCD tends to be smaller lymph nodes spread over multiple regions. MCD is also more often associated with B symptoms and abnormal lab values such as elevated CRP or ESR along with abnormal protein levels. Other subtypes exist, thought to be driven primarily by cytokines like VEGF and IL-12 similar to other neoplasms. The hypervascular type, more commonly associated with UCD, consists of fibrous bands running through lymphoid follicles with regressed germinal centers while the plasmacytic type, found more often in MCD, consists of sheets of plasma cells and hyperplastic germinal centers. Lastly, mixed type has features of both the main types. Preferred treatment for resectable UCD is surgery with treatments for unresectable UCD involving observation (if asymptomatic) or a combination of rituximab and steroids with anti-IL6 monoclonal antibody treatment (such as tocilizumab) followed by surgery or radiation therapy. Similarly, MCD is often treated with rituximab, steroids, and tocilizumab. Conclusion Due to the presence or absence of other signs and symptoms, Castleman Disease is often difficult to diagnose without a biopsy. Further studies into the etiologies of CD, including possible associations with other neoplastic or immunosuppressed states, are needed to develop better criteria for diagnosing the disease. Developing standardized patient registries with information on disease progression as well as proper follow-up for patients after treatment are vital to diagnosing, treating, and providing surveillance for patients with Castleman Disease.

Safety and Efficacy of Combination Therapy of Remdesivir, Baricitinib, and High-dose Steroids in Patients Hospitalized with Moderate to Severe COVID-19.

Objective Dexamethasone, remdesivir (REM), and baricitinib (BAR) are commonly used to treat coronavirus disease 2019 (COVID-19). High-dose steroids have also been reported to be well tolerated, even when used in combination with multiple drugs. In this retrospective study, we assessed the safety and therapeutic efficacy of a three-drug combination of high-dose steroids, REM, and BAR in hospitalized COVID-19 patients. Methods We retrospectively evaluated the safety and efficacy of three-drug combination therapy. Patients We evaluated 107 patients hospitalized with moderate or severe COVID-19 who underwent 3-drug combination therapy with high-dose steroids (80 mg of methylprednisolone or more, REM, and BAR) in our institution from December 2020 to June 2021. The mean age was 62.1±13.7 years old, and 71.2% were men. The severity of the study patients was as follows: 18 (16.8%) with an 8-category ordinal score of 4, 84 (78.5%) with a score of 5, and 5 (4.7%) with a score of 6. Results The frequency of high-grade adverse events was low, except for hyperglycemia (n=59, 45.8%). The median duration from symptom onset to the start of three-drug combination therapy was eight days. All but one of the patients treated with the combination therapy improved. The median time to improvement by 1 category of the eight-category ordinal score was 6 days, and the 28-day mortality was 0.9%. Conclusion This study showed the safety profile of three-drug combination therapy of high-dose steroids, REM, and BAR in moderate to severe COVID-19 patients. The three-drug combination therapy is well tolerated and has the potential to prevent exacerbation of severity.

Evaluation of the efficacy of intralesional triamcinolone injection therapy in patients with granulomatous mastitis: a comparative study with oral methylprednisolone

Aims: This study aims to compare the efficacy of oral steroid therapy with the combination of topical and intralesional steroid (TILS) therapy in patients with granulomatous mastitis (GM).
 Methods: This is a single-center retrospective longitudinal study. Women with a diagnosis of GM who applied to Medipol Universty Pendik Hospital General Surgery Clinic between January 2020 and April 2022 were included in the study. Participants received TILS or peroral steroid (POS) treatment in sequential order, and each patient received only one of the treatment options. Participants were evaluated by physical examination, USG, and radiography before and after treatment to assess lesion size, side, number of foci, skin characteristics, and the presence of pain. The clinical and radiological findings were compared betwen the groups at the end of the 6-month follow-up and the participants were followed up for the next 12 months to demonstrate the efficacy. 
 Results: A total of 52 women participated in the study, with 26 in the POS group and 26 in the TILS group. The mean age was 33.33+6.94 years and similar between the two groups (p=0.831). Three patients (11.53%) in the TILS group and 7 patients (26.92%) in the POS group were nonresponders to treatment (p=0.159). Given the nonresponders, GM lesions persisted in one patient (3.84%) in the TILS group and 3 patients (11.53%) in the POS group at the end of the study (p=0.610). At the end of the 12-month follow-up, five patients (19.2%) in the TILS group and 20 patients (76.9%) in the POS group who achieved a complete remission at the posttreatment 6 months experienced disease recurrence (p

A Case of Allergic Reaction to 0.5% Moxifloxacin Eye Drops

Purpose: We report a rare case of allergic contact dermatitis after the use of a non-preservative 0.5% moxifloxacin ophthalmic solution.Case summary: A 60-year-old male presented with bacterial corneal ulceration of the right eye. He was treated with 50 mg/mL of fortified cefazolin and 14 mg/mL of tobramycin that were tapered as the corneal lesion improved after 1 month, and 0.5% moxifloxacin application was started. After 2 weeks of moxifloxacin treatment, the patient developed conjunctival injection, lid swelling, redness, and itching in the right eye. An allergic reaction was suspected and moxifloxacin administration was immediately stopped. The symptoms improved after the administration of oral antihistamines, 0.5% loteprednol eye drops, and steroid combination ointment.Conclusions: Patients treated with 0.5% topical moxifloxacin should be monitored for allergic contact dermatitis, even if preservative-free eye drops are used.

Treatments and Severe Outcomes for Patients Diagnosed With MIS-C at Four Children's Hospitals in the United States, March 16, 2020-March 10, 2021.

Clinical management of multisystem inflammatory syndrome in children (MIS-C) has varied over time and by medical institution. Data on patients with MIS-C were collected from 4 children's hospitals between March 16, 2020 and March 10, 2021. Relationships between MIS-C treatments and patient demographics, clinical characteristics, and outcomes were described. Propensity score matching was utilized to assess the relative risk of outcomes dependent on early treatment with intravenous immunoglobulin (IVIG) or low-dose steroids, controlling for potential confounding variables. Of 233 patients diagnosed with MIS-C, the most commonly administered treatments were steroids (88.4%), aspirin (81.1%), IVIG (77.7%) and anticoagulants (71.2%). Compared with those patients without respiratory features, patients with respiratory features were less likely to receive IVIG and steroids on the same day (combination treatment) (44.1%). Controlling for confounding variables, patients receiving IVIG within 1 day of hospitalization were less likely to have hospital length of stay ≥8 days (RR = 0.53, 95% CI: 0.31-0.88). Patients receiving low-dose steroids within 1 day of hospitalization were less likely to develop ventricular dysfunction (RR = 0.45, 95% CI: 0.26-0.77), have increasingly elevated troponin levels (RR = 0.55, 95% CI: 0.40-0.75) or have hospital length of stay ≥8 days (RR = 0.46, 95% CI: 0.29-0.74). Treatments for MIS-C differed by hospital, patient characteristics and illness severity. When IVIG and low-dose steroids were administered in combination or low-dose steroids were administered alone within 1 day of hospitalization, the risk of subsequent severe outcomes was decreased.

The Impact of Antibiotic Prophylaxis on a Retrospective Cohort of Hospitalized Patients with COVID-19 Treated with a Combination of Steroids and Tocilizumab.

In the context of COVID-19, patients with a severe or critical illness may be more susceptible to developing secondary bacterial infections. This study aims to investigate the relationship between the use of prophylactic antibiotic therapy and the occurrence of bacterial or fungal isolates following the administration of tocilizumab in hospitalized COVID-19 patients who had previously received steroids during the first and second waves of the pandemic in Spain. This retrospective observational study included 70 patients hospitalized with COVID-19 who received tocilizumab and steroids between January and December 2020. Data on demographics, comorbidities, laboratory tests, microbiologic results, treatment, and outcomes were collected from electronic health records. The patients were divided into two groups based on the use of antibiotic prophylaxis, and the incidence of bacterial and fungal colonizations/infections was analyzed. Among the included patients, 45 patients received antibiotic prophylaxis. No significant clinical differences were observed between the patients based on prophylaxis use regarding the number of clinically diagnosed infections, ICU admissions, or mortality rates. However, the patients who received antibiotic prophylaxis showed a higher incidence of colonization by multidrug-resistant bacteria compared to that of the subgroup that did not receive prophylaxis. The most commonly isolated microorganisms were Candida albicans, Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus epidermidis. Conclusions: In this cohort of hospitalized COVID-19 patients treated with tocilizumab and steroids, the use of antibiotic prophylaxis did not reduce the incidence of secondary bacterial infections. However, it was associated with an increased incidence of colonization by multidrug-resistant bacteria.

SAT170 Paraneoplastic Hypoglycemia Secondary To Hepatocellular Carcinoma

Abstract Disclosure: S. Dejhansathit: None. N. Sheung: None. A. Akofu: None. A. Uddin: None. F. marium: None. N.G. Akabogu: None. W. Salam, MD: None. Introduction: Hypoglycemia is a known but rare Paraneoplastic manifestation of hepatocellular carcinoma and can lead to significant morbidity and mortality. Even though HCC-related hypoglycemia is a known entity, knowledge about prevention and treatment is limited. Case Description: We report a 36-year-old male with no significant past medical history presenting initially to emergency room for abdominal pain and distension for 2 months. He reported associated 10 pounds unintentional weight loss, fatigue, night sweat and loss of appetite in the past 3 months. The patient noted to have hypoglycemia with blood glucose of 20 mg/dl on admission. He was given 2 ampoules of 50% dextrose and started on 5% dextrose solution intravenously. A CT abdomen and pelvis showed enlarged heterogenous liver with numerous hepatic lesions, concerning for multifocal hepatocellular carcinoma. A liver biopsy was done and confirmed hepatocellular carcinoma. Labs showed alpha fetoprotein level over 60500 ng/mL (0-8.3 ng/mL). Hepatitis B surface antigen was reactive with positive hepatitis B DNA, confirming the diagnosis of chronic hepatitis B infection. Gastroenterology, Oncology and Surgical Oncology were consulted. Patient was felt not to be a good surgical or transarterial chemo-embolization. Endocrinology was consulted when patient develops scrotal and legs swelling after receiving high rate of dextrose fluid since admission to maintain blood glucose. Prednisone 20 mg twice a day was initiated and later increased to 30 mg twice day after 2 days without significant improvement. Prednisone was then switched to dexamethasone 4 mg four times a day for longer half-life. 10% dextrose was slowly decreased from 200cc/hr to100cc/hr but resulted in rebound hypoglycemia. Somatropin 4 mg daily was also added with a goal to further decrease fluid rate in order to help with his discomfort from swelling. 10% dextrose was eventually decreased to 75 cc/hr. Patient subsequently opted for hospice care and passed away within 24 hours. Discussion: The paraneoplastic hypoglycemia associated with HCC can be classified into two categories. Type A hypoglycemia is usually found in the late-stage HCC when tumor burden is high. Type B hypoglycemia is caused by an increase in pro-IGF-2 level that is incompletely processed by the tumor cells, stimulating insulin receptors. It is likely our patient had type A hypoglycemia due to the extensive tumor burden. Overall, paraneoplastic hypoglycemia associated with HCC has very poor prognosis and high mortality rate. There is no single effective management and combination of steroids and Somatropin may provide palliative improvement as seen in our patient. Presentation: Saturday, June 17, 2023

Case Report: A successful treatment approach of rituximab and azathioprine for pemphigus vulgaris

Pemphigus Vulgaris is an uncommon autoimmune skin disorder that is characterized by persistent and blistering lesions. In approximately 50% of patients, mucous membrane erosions are the initial symptom. The primary presenting symptom is often oral mucosal erosions. Affected individuals frequently experience flaccid blisters and erosions on healthy skin and mucous membranes, and other areas of the body may also be affected. This condition is the result of autoantibodies that target desmosomal antigens. We are presenting a case of a 28-year-old male who presented to the hospital with fluid-filled lesions on his forehead and in his oral cavity. A skin biopsy was performed, and he was diagnosed with pemphigus vulgaris. Initially, he was started on a combination of steroids and azathioprine, but he did not respond to this treatment regimen. However, he was successfully treated with injection rituximab. Rituximab has been found to be an effective treatment approach towards pemphigus vulgaris. It can help prevent further complications and reduce the severity of the disease. By targeting the autoantibodies that cause the disorder, rituximab can help control the patient's symptoms and improve their quality of life. It is important to note that early diagnosis and treatment can play a critical role in the management of pemphigus vulgaris.

A Challenging Case of Oral Lichen Planus: A Comprehensive Review

Abstract Oral lichen planus (OLP) is a chronic mucocutaneous disorder affecting the oral mucosa. This case report presents a comprehensive assessment of a 64-year-old male patient with OLP, detailing the clinical presentation, diagnosis, and management. The patient’s chief complaint was a persistent burning sensation in the oral cavity for several months. Furthermore, he expressed the need to replace missing teeth. The patient was treated with a combination of topical corticosteroids, multivitamins, and systemic steroids, which yielded significant improvement in symptoms. This case highlights the importance of early diagnosis and effective management of Oral Lichen Planus,emphasizing the need for proper understanding and treatment of this oral condition.

Steroid-Dependency in Posner-Schlossman Syndrome: A Suggested Topical 2% Ganciclovir and Gradual Decrement of Topical Steroid Combination Therapy from Shanghai PSS Study

ABSTRACT Purpose This study focused on the prevalence, unique features, and required treatment of steroid-dependent Posner-Schlossman syndrome (SD-PSS), and analyzed the outcome of 2% Ganciclovir and gradual decrement steroid combination therapy in SD-PSS patients. Methods Retrospective comparative and interventional study. SD-PSS was defined as PSS patients with continuous steroid use for over 3 months and relapsed within 2 weeks after steroid withdrawal or tapered dosage. Totally 74 SD-PSS eyes were compared with 78 randomly chosen non-steroid dependent PSS eyes. SD-PSS patients who underwent 2% GCV and gradual decrement steroid therapy with at least two follow-ups (n = 50) were analyzed for the treatment outcome. Results The prevalence of SD-PSS is 26.87% (97/361) in our PSS patients. SD-PSS patients demonstrated significantly younger onset age, longer disease course, higher intraocular pressure (IOP), and higher degree of iris depigmentation at the first visit. They required significantly more IOP-lowering medication and stronger steroid after the first visit. Our 2% GCV and gradual decrement steroid therapy helped 66% (33/50) SD-PSS patients with steroid withdrawal (median stable time: 13 weeks) and another 32% (16/50) SD-PSS managed to lower the dose or strength of topical steroid. Steroid-induced ocular hypertension happened in 5.26% (19/361) of the PSS patients. Conclusion Young onset age, high IOP, and high iris depigmentation level during acute stage are indicators of steroid dependency in PSS patients. SD-PSS patients require more medical surveillance. Two percent ganciclovir and gradual decrement steroid combination therapy help with steroid withdrawal and minimize steroid use.

A newer approach in the treatment of seborrheic dermatitis with QR678® and QR678 Neo®-A prospective pilot study.

Seborrheic dermatitis is a common chronic inflammatory skin disorder that affects the scalp and is characterized by erythema and oily scales. It could perhaps be difficult to control and could seriously degrade one's quality of life. The study's objective is to assess the effectiveness of intradermal administrations of QR678 Neo® hair growth factor therapy for the treatment of scalp seborrheic dermatitis in both men and women. Forty male and female patients with clinically diagnosed seborrheic dermatitis of the scalp in the age 18-45 years, not satisfactorily responding to standard therapy for at least 6 months, were included. 1 mL solution of QR678 Neo® was administered in the scalp skin of all patients at 3-week interval till eight sessions. Patients were advised to continue with antifungal shampoo and topical antifungal solution with steroid combination which they had been on during the treatment. Assessment of disease severity, dermoscopic evaluation, and self-assessment were done at baseline and at the end of the fourth and the eighth sessions. Improvement was observed in adherent scalp flaking score after eighth session (mean = 12) compared to baseline (mean = 60). The dermoscopic evaluation showed a noticeable difference from baseline (mean = 11) in erythema and scaling with the Seborrheic Dermatitis Scalp Severity Index tool at the end of treatment (mean = 2). A high satisfaction score was given for the efficiency in the self-assessment questionnaire. Our study proved that treatment with QR678 Neo® led to an improvement in the overall scalp condition by the resolution of flaking and inflammation.

Acquired Postpartum Hemophilia A Presentation of Severe Hematuria: A Case Report

BACKGROUND: Acquired hemophilia A (AHA) is a rare, severe bleeding disorder caused by the development of autoantibodies against FVIII that may be idiopathic or secondary to medical conditions. Postpartum AHA can occur as early as 1–4 months after delivery or as late as 1-year postpartum. CASE REPORT: A 20-year-old female presented with vaginal bleeding 20 days after delivery, then ecchymotic patches developed 2 months later, followed by hematuria 2 months after that. Laboratory investigation revealed isolated, prolonged partial thromboplastin time that was not corrected by mixing 50:50 with fresh normal plasma. FVIII activity was markedly deficient, with a high titer of immediate-acting FVIII inhibitor antibodies. CONCLUSION: The case was diagnosed as postpartum AHA with a good response to the combined steroids and cyclophosphamide treatment.

Various Postoperative Medical Lines for Management of Allegic Fungal Rhinosinusitis (Meta-Analyical Study)

Abstract Background Allergic fungal rhinosinusitits (AFRS) is a subset of polypoid chronic rhinosinusitis that is characterized by the presence of eosinophilic mucin with fungal hyphae within the sinuses and a type I hypersensitivity to fungi. The treatment of allergic fungal rhinosinusitis usually involves surgery in combination with medical therapies to keep the disease in a dormant state. However, what constitutes an optimal post-operative medical regimen is still controversial. Hence, the purpose of this study is to assess the efficacy of various postoperative medical lines for management of AFRS. Objective To find out the role and efficacy of various medical therapies for postoperative treatment of allergic fungal rhinosinusitis (through a systematic review study). Materials and Methods Fifty studies were included in the present systematic review and meta-analysis, the total number of patients included in all studies (No = 1,655 patients). Our review has investigated the literature on 5 medical therapies (steroids, antifungal, immunotherapy, mepolizumab, and omalizumab) concerning the management of postoperative AFRS patients. Results The results showed that the recurrence rate after postoperative systemic steroids was 26.3%, topical steroids was 38.4%, antifungals therapy was 32.1%, immunotherapy was 17.4%, the percentage of recurrence after combination of antifungal and steroids was 9.6%, recurrence risk difference between antifungal and placebo was 18.2%, recurrence risk difference between steroids and placebo was 6.5%. Base on the above results, the combination of steroids and antifungal therapy is the best treatment for postoperative patients with AFRS. Conclusion This review investigated the literature on 5 medical therapies (steroids, antifungal, immunotherapy, mepolizumab, and omalizumab) concerning the management of postoperative AFRS, and provided an evidence-based review with recommendations, the use of steroids alone or antifungals as well, resulted in some degree of recurrence reduction in disease, the evidence supports the use of postoperative combination (oral steroids and systemic antifungal) as a better line of post-operative medical treatment in AFRS patients.

The clinical efficacy of ozone combined with steroid in the treatment of discogenic low back pain: a randomized, double-blinded clinical study.

This randomized double-blinded clinical study is to investigate the clinical efficacy of per-paravertebral disk ozone injection combined with steroids in the treatment of patients with chronic discogenic low back pain (CDLBP). Group A (N = 60) received a per-paravertebral injection of a steroid mixture of 10 mL with pure oxygen 20 mL, while group B (N = 60) received a per-paravertebral injection of a steroid mixture of 10 mL combined with ozone 20 mL (30 μg/mL). Injections were administered once a week for 3 weeks, with a follow-up of 6 months. Clinical outcomes were assessed at week 1, month 3, and month 6 with the help of Visual Analog Scale (VAS) scores and Macnab efficacy evaluation. The VAS score of both group A (1.65 vs. 6.87, p = 0.000) and group B (1.25 vs. 6.85, p = 0.000) at week 1 was significantly reduced compared to baseline. The effect was sustained at the 3- and 6-month follow-up periods (p < 0.05). Group B had significantly lower VAS scores at month 3 (1.53 vs. 3.82, p = 0.000) and month 6 (2.80 vs. 5.05, p = 0.000) compared to group A, respectively. Based on Macnab criteria, 95 and 96.7% of patients in groups A and B had good rates "excellent plus good" at week 1, respectively. Good rates were significantly higher in group B at month 3 (91.7 vs. 78.3%, p = 0.041) and month 6 (85.0 vs. 68.3%, p = 0.031) compared to group A, respectively. No serious adverse events were noted in both groups. Per-paravertebral injection of steroid and ozone combination resulted in better relief of CDLBP compared to pure oxygen plus steroid. ChiCTR2100044434 https://www.chictr.org.cn/showproj.html?proj=121571.

Traditional Chinese medication for oral submucous fibrosis: A systematic review and network meta-analysis of randomized controlled trials.

The purpose of this study was to investigate the effectiveness of various drug therapy methods for treating oral submucous fibrosis (OSF) in terms of increasing mouth opening, reducing VAS score, decreasing lesion area, minimizing side effects, and determining effective proportion. A database search was conducted. Only randomized clinical trials were included, and Cochrane checklist was used for assessing the risk of bias. Stata.17 software was employed and effective treatment ranking was used. Thirty-one RCT studies, with a total of 2986 patients, were included in the period of 2010-2022. The combination of oral Chinese herbal medicine formulas (OC) and intralesional Salvia miltiorrhiza (ISM) was found to be the most effective treatment in improving mouth opening. For reducing the burning pain, the combination of intralesional steroids (IS) and oral Salvia miltiorrhiza (OSM) was found to be more effective than the others. In terms of lesion area, IS combined with OC was more effective than the others. IS combined with ISM had the highest effective proportion while having the lowest incidence of side effects which mentioned the incidence of side effects. This study indicates that OC and SM can be employed by clinicians for treating OSF effectively.

Efficacy of isatuximab in combination with steroids for the treatment of relapsed/refractory multiple myeloma patients exhibiting only biochemical progression-A single center retrospective study.

Isatuximab is approved for treatment of relapsed/refractory multiple myeloma (RRMM) with dexamethasone and carfilzomib or pomalidomide. Patients receiving these three-drug regimens have exhibited more Grade ≥ 3 adverse events (AEs) compared to the two-drug class combination of isatuximab and steroids alone. Thus, this single-center retrospective study investigated the efficacy of isatuximab with dexamethasone and methylprednisolone (ISAdm) for RRMM patients showing only biochemical progression (BP) of their disease. Twenty-four RRMM patients exhibiting only BP were administered isatuximab at 10 mg/kg with dexamethasone once weekly for cycle 1 of a 28-day cycle, followed by every other week for each cycle thereafter. Starting in cycle 2, oral methylprednisolone was added every other day stopping 48 h before and starting 48 h after each dexamethasone infusion. Overall response rate and clinical benefit rate were 63% and 79%, respectively. Progression free survival was 12.9 months. There were only 5 AEs of Grade ≥ 3 which included lymphocytopenia (13%), leukopenia (4%), and neutropenia (4%). No Grade ≥ 3 AE related to respiratory infection, anemia, or thrombocytopenia were reported. This study shows that the two-drug class combination of ISAdm is an effective and well tolerated treatment option for RRMM patients exhibiting only BP.

INDIVIDUAL ARTICLE: Fixed Combination Calcipotriene/Betamethasone (Cal/BDP) Cream: Evaluating the Role of Polyaphron Dispersion (PAD) Technology in Psoriasis Treatment.

Most patients with plaque psoriasis exhibit mild-to-moderate disease and topical therapies remain the mainstay treatment option for these patients. The use of topical steroids in combination with vitamin D analogs can produce synergistic effects and minimize adverse effects. However, due to the incompatible pH ranges of topical steroids and vitamin D analogs, combination formulations can be difficult to manufacture. Until recently, only anhydrous formulations of these 2 agents were developed as foam, gel/suspension, and ointment. However, anhydrous vehicles can often result in greasy or oily skin, thus limiting treatment adherence. Recently, Polyaphron Dispersion (PAD) technology presents a new, more cosmetically appealing vehicle that allows for both topical steroids and vitamin D analogs to coexist in an aqueous environment, such as a cream formulation. The calcipotriene/betamethasone dipropionate (CAL/BDP) cream enhances drug delivery by reducing the greasy and oily side effects of anhydrous formulations. Phase 3 clinical trials have demonstrated CAL/BDP cream&rsquo;s superior efficacy in treating psoriasis over gel/suspension, and the clinical trials have also shown significantly improved patient satisfaction with the cream formulation.&nbsp; &nbsp.

Efficacy of subtenon steroid injection alone or in combination with topical steroid in the management of trematode-induced anterior granulomatous uveitis

Background Presumed trematode-induced uveitis is a newly recognized cause of intraocular granulomatous inflammation in children, usually presenting with single or multiple pearl-like white nodules in the anterior chamber (AC) with or without subconjunctival lesions or corneal opacities. Objective The aim of this study was to evaluate the efficacy of subtenon steroid injection alone or in combination with topical steroid in the management of trematode-induced anterior granulomatous uveitis. Patients and methods This is a prospective comparative study, that included the children who presented with AC granulomas at the Uveitis Unit at Tanta Ophthalmology Hospital, Tanta, Egypt. The patients were divided into two groups: Group A, who received subtenon steroid injection only, and Group B, who received both subtenon steroid injection and topical steroid eye drops. The basic demographic data, visual acuity (VA), granuloma site and size, and AC activity (cells and flare) were recorded and analyzed. A systemic work-up, including stool and urine analysis, full blood count, chest X-ray, and schistosomiasis titer, was performed. The patients were followed up on the first day, at 2 weeks, 1, and 3 months Results The study included 30 eyes of 30 patients. The mean age of the patients was 13.4±2.42 years, and 87% of the patients were males. Group B patients demonstrated statistically significant better improvement in VA, AC activity, and granuloma site and size compared to Group A patients (P&lt;0.001). The granuloma in group A did not change in size and continued to exhibit AC activity. Conclusion The combination of subtenon and topical steroid was found to be more effective in the treatment of granuloma than the subtenon injection alone.

Effectiveness of combined pulsed radiofrequency and steroid injection to the dorsal root ganglion in the treatment of postherpetic neuralgia: a prospective randomized clinical trial

Purpose The present study aimed to evaluate the effectiveness of a combination of pulsed radiofrequency and transforaminal steroid injection to the dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). Patients and methods Forty-six patients suffering from thoracic PHN with a duration of between 1 and 3 months were enrolled and were randomly assigned to either steroid group (n=23) or combination group (n=23). The efficacy was assessed by visual analog scale and by recording the dose of anticonvulsant before and after the procedure. Results Visual analog scores decreased in both groups in the postintervention period (2 h, 1 week, and 1 month) with no significant difference found between them. Throughout assessments, visual analog scale in the combination group was significantly lower than in the steroid group in third and sixth months. Regarding the dosage of anticonvulsant, in the first follow-up visit 1 week from intervention, the same preintervention dose of pregabalin was prescribed and then the dose was gradually decreased until the first month in both groups. In the steroid group, the dose was increased again after the first month, while in the combination group there was a gradual decease in the dose. The dose was significantly lower in the combination group compared with the steroid group in third and sixth months. Conclusion Pulsed radiofrequency in combination with steroid injection is more effective and lasting for a longer duration than the transforaminal steroid injection alone when used for controlling of pain in patients with thoracic PHN.