Combination Therapy Of Methylprednisolone Research Articles

Retrospective analysis of methylprednisolone treatment alone and in combination with methotrexate in patients with extensive alopecia areata.

Alopecia areata (AA) is a chronic autoimmune disorder that primarily affects the hair follicle. Systemic corticosteroids and methotrexate (MTX) are among the therapeutic options in severe cases. This study aimed to show whether the combination therapy of methylprednisolone (MP) and MTX was superior to MP alone in the management of extensive AA. A total of 26 patients with extensive AA, 14 treated with MP alone and 12 treated with the combination of MP and MTX, were retrospectively evaluated in terms of gender, age, severity of disease, clinical characteristics, disease duration, dose and duration of medications, therapy response, and side effects. Of the 26 patients with extensive AA, 14 were male and 12 were female, and the average age was 17.02 ± 10.70 years. All patients had more than 50% hair loss, 23 had extensive multifocal AA, and three had alopecia totalis. A total of 14 patients were treated with MP alone (starting dose: 0.3-0.5mg/kg, maximum 32 mg/day), and 12 were treated with MP + MTX (starting dose: 5-15 mg/week, maximum 20 mg/week). A total of 12 of the 14 patients (85.7%) who were treated with MP alone showed a complete response, with the response rate of the patients who showed more than 50% response being 92.85%. Seven of the 12 patients (58.3%) who were treated with MP + MTX achieved complete healing, and all patients on this regimen had more than 50% treatment response. Our results showed that the combination therapy of MP and MTX was not superior to MP alone in the management of extensive alopecia areata.

A Retrospective Evaluation of Combination Therapy of Methylprednisolone and Remdesivir for Severe COVID-19 Patients

Introduction: Severe and threatening complications of Corona Virus Disease-2019 (COVID-19) are caused by direct viral injury as well as excessive and aberrant host immune response induced by the virus. In this context, use of Methylprednisolone (MP) to prevent cytokine storm and Remdesivir to prevent viral replication seems prudent. Aim: To assess the clinical outcome of combination therapy of Remdesivir and MP pulse therapy in patients with severe COVID-19 in Intensive Care Unit (ICU). Materials and Methods: The retrospective study was conducted in the COVID-19 ICU, dealing exclusively with 21 severe illness severe illness cases at Safdurjung Hospital, New Delhi, India from June to July 2020. They were given MP pulse therapy (500 mg/day for three days, followed by 1 mg/kg orally once daily, tapered by 10 or 20 mg/day and finishing with 10 mg) along with intravenous Remdesivir. Pre and post-therapy examination of the patients included clinical features, inflammatory markers (Interleukin-6, ferritin and D-dimer), gas parameters like ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and changes in chest radiograph. Values of PaO2/ FiO2, inflammatory markers on day 1 and day 3 were expressed as mean±SD and their difference compared using student t-test. Statistical significance was defined as p<0.05. Results: This treatment regimen was associated with significant improvement in PaO2/FiO2 (p<0.001), significant decrease in inflammatory markers (p<0.001) and reversal of radiological changes. Ten patients were discharged within two weeks of treatment while six patients were shifted to high dependency unit for further oxygen requirement. They were all successfully discharged from hospital without oxygen requirement within next two weeks. Five patients developed opportunistic infections and succumbed to death. Side-effects of therapy included hyperglycaemia in nine patients, which was managed by insulin infusion. Conclusion: Combination therapy of MP pulse and Remdesivir in patients with severe COVID-19 resulted in significant clinical improvement. Given the high efficacy, it could be one of the promising approaches to the management of patients with severe COVID-19.

Evaluation of the neuroprotective effects of ozone in an experimental spine injury model.

The pathophysiology of spine injury consists of primary and secondary damage mechanisms. The vast majority of treatments aim to prevent or at least stop the progression of secondary neurotoxic events during the acute period. Ozone has been found to have potent antiinflammatory effects, to activate the immune system, and to have a substantial impact on the antioxidant system. In this study the authors aimed to evaluate the neuroprotective effects of ozone and their possible roles in recovery from spine injury, assessed based on biochemical, histological, and neurological parameters using an experimental spine injury model in rats. The study included 31 female Wistar albino rats. The rats were divided randomly into 5 groups, with 7 rats in each group except the sham group, which contained 3 rats, as follows: group 1 (sham), laminectomy; group 2 (control), laminectomy and spinal trauma with no medical treatment (0.5 ml isotonic saline applied 1 hour postsurgery); group 3, single medical treatment with 30 mg/kg methylprednisolone applied intraperitoneally 1 hour after laminectomy and trauma; group 4, single medical treatment with 60 μg/ml ozone at 0.7 mg/kg applied intraperitoneally 1 hour after laminectomy and trauma; and group 5, double medical treatment with 30 mg/kg methylprednisolone and 60 μg/ml ozone at 0.7 mg/kg applied intraperitoneally 1 hour after laminectomy and trauma. After neurosurgery, neurobehavioral tests were performed in all groups. After 7 days of follow-up, all the rats were killed. Biopsy specimens obtained from trauma sites were examined using H & E, cresyl violet, immunohistochemical (anticonnexin-43), and TUNEL staining processes. Levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) and total oxidant status (TOS) and total antioxidant status (TAS) were measured in blood samples. The level of neurobehavioral healing was the highest in the double-treatment group (group 5), and the difference between the groups was significant. The minimum IL-6 level was found in group 5, indicating that the antiinflammatory impact was the most significant in this group (p = 0.01). Additionally, ozone was found to reduce oxidant stress more effectively than methylprednisolone (p = 0.03). Although methylprednisolone was superior to ozone in terms of the antiinflammatory effect, this effect was greater in group 5. Nevertheless, the number of neurons in group 5 was close to that of the control group, and the number of apoptotic cells was the least in group 5 (p < 0.001). In acute spinal injury, the combined application of methylprednisolone and ozone was found to have a greater antiinflammatory effect, hasten clinical recovery, and increase histological recovery compared with methylprednisolone therapy alone. This study showed that this combination therapy of methylprednisolone with the addition of ozone might have a more beneficial effect in the treatment of spinal injury than methylprednisolone therapy alone.

The Comprehensive Therapy of Electroacupuncture Promotes Regeneration of Nerve Fibers and Motor Function Recovery in Rats after Spinal Cord Injury.

The present study aimed to evaluate the role of the combination treatment of methylprednisolone (MP) and electroacupuncture (EA) in regeneration of nerve fibers and functional recovery in rats with spinal cord injury (SCI). Female Wistar rats were used for an SCI model by using a weight-drop hammer at levels T10 (spinal cord segment corresponding to the 10th thoracic vertebra). Four groups received different treatments for the study: SCI control, MP, MP and EA, and Sham. The growth of nerve fibers was examined by counting fluorescein positive nerve fibers. The motor functional recovery was evaluated by Basso, Beattie, Bresnahan (BBB) score, and electrophysiology analysis. We found that, compared to MP groups, there were more well-oriented and paralleled fluorescein positive nerve fibers in MP and EA group. Both latencies and amplitudes of the Motor Evoked Potential (MEP) in the combination therapy of MP and EA were higher than MP group. Additionally, recovered hindlimb movements were sustained in most rats in the MP and EA group. Our study indicated that combination therapies could become a powerful treatment for SCI in rats.

EFFECTIVITY AND RENAL SAFETY OF CYCLOSPORINE AND METHYLPREDNISOLONE COMBINATION THERAPY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Cyclosporine and methylprednisolone combination are second line therapy for moderate to severe systemic lupus erythemathosus. Some study suggest that the combination were effective to decrease of systemic lupus erythematosus disease activity. But record from the study, cyclosporine cause nephrotoxicity side effect. Therefore, this study should be considered to monitore therapy effect on disease activity and renal side effect. The aim of this study is to analyze the effect of cyclosporine and methylprednisolone combination therapy on disease activity in systemic lupus erythematosus (SLE) assessed by MEX-SLEDAI and renal side effect assessed by creatinine, ureum and proteinuria. A cohort, observational prospective study was conducted to determine the effect of cyclosporine and methylprednisolone combination therapy on disease activity of SLE and renal side effect of this combination. Patients who met criteria were given cyclosporine and methylprednisolone combination that normally renal function tests. MEX-SLEDAI score, creatinine, ureum and proteinuria were measured for fourth times (one time in one mounth), before study, 1st mounth, 2nd mounth, and 3rd mounth. The study comprised 9 patients SLE were given cyclosporine and methylprednisolone combination that normally renal function tests. All patients were female and had productive age. At 3rd mounth, there was increase patients who had MEX-SLEDAI score &lt;2 (55,6%) and one patient (11,1%) had increase of creatinine, ureum and proteinuria. In conclusion, cyclosporine and methylprednisolone combination therapy showed the effectiveness and safety in 88,9% patients and renal dysfunction in 11,1% patients.

Effects of Theophylline with Methylprednisolone Combination Therapy on Biomechanics and Histopathology in Diaphragm Muscles of Rats.

The purpose of this study was to investigate the effects of theophylline and methylprednisolone on the mechanical response and histopathology of hemidiaphragm muscle in rats. In the current study, we aimed to investigate the effects of theophylline and methylprednisolone, which are frequently used in clinics and which have different effects on the respiratory system and on the biomechanics and histopathology of the diaphragm muscle. The study included four groups of rats. Group T received 1mg/kg of intraperitoneal theophylline, group M received 2mg/kg of intraperitoneal methylprednisolone, group TM received 1mg/kg of intraperitoneal theophylline plus 2mg/kg of intraperitoneal methylprednisolone, and group K received of 1mL intraperitoneal isotonic solution (of 0.9% NaCl). The medications were continued for 7days in each group. The rats underwent cervical dislocation under anesthesia on the eighth day, and their diaphragm samples were extracted. The left hemidiaphragm was used for the investigation of biomechanical parameters, and the right hemidiaphragm was used for the histopathological evaluation. It was observed that the medication administered in group T increased the contraction strength and duration compared with that in group M. Additionally, the duration of semi-relaxation was prolonged in group T compared with group M. The highest contraction strength and the longest contraction period among all of the groups were observed in group TM. It was concluded that the combined use of theophylline and methylprednisolone had positive effects on the contraction strength and the durations of contraction and semi-relaxation of the diaphragm muscle. In addition, both drugs had synergistic effects on each other.

A purple rash

In July, 2010, a 60-year-old white woman with uncontrolled type 2 diabetes mellitus presented with pain and swelling of the hands, wrists, and feet, and a purpuric rash on both heels. She had a 10-year history of diabetes, hypertension, and hyperlipidaemia. Before admission, her baseline creatinine concentration was 126 μmol/L (normal <88 μmol/L for women), GFR was 40 mL/min, 2+ urine protein (1·0 g/L ), and haemoglobin A11c (HbA1c ) was 68 mmol/mol. Her medications included: atorvastatin, metoprolol, bena zepril, furosemide, glargine, and glipizide. While our patient was in the emergency department, a petechial rash developed on her forearms and feet, and a vasculitic rash with tender purpuric lesions on her inner thighs. She also reported new-onset “cokecoloured” urine. There was marked symmetrical polyarticular synovitis in both hands, and oedema with tenderness to palpation in both feet. Initial laboratory tests showed a creatinine concentration of 178 μmol/L, GFR of 30 mL/min, ESR of 62 mm/h (normal <30 mm/h), C-reactive protein of 22·9 mg/L (normal <10 mg/L), and HbA1c of 112 mmol/mol (normal <42 mmol/mol). Urinalysis showed copious red and white blood cells. A vasculitic aetiology was high on our diff erential diagnosis list. We suspected Henoch-Schonlein purpura when her rash progressed to a confl uent, purpuric appearance and spread to the buttocks. Extensive autoimmune and infectious disease investi gations showed a raised titre of anti-streptolysin O. Biopsy samples of the inner thigh lesions showed leukocytoclastic vasculitis with focal deposits of IgG, IgA, IgM, and C3. A renal biopsy sample showed diabetic glomerulosclerosis, IgA nephropathy, arteriolar nephro sclerosis, mild intimal fi brosis, basement membrane thickening, and podocyte eff acement. On the basis of these fi ndings, our patient was treated with methylprednisolone, but with little improvement of her rash and joint swelling. On hospital day 5, mycophenolate mofetil and intravenous immunoglobulin were added and the rash and joint swelling resolved, but her creatinine concentration was 394 μmol/L and GFR was 16 mL/min. Despite high-dose triple therapy, her renal function worsened and haemodialysis was started. After discharge, she had haemo dialysis three times per week. At last follow-up, in May, 2011, her condition was stable. 50–80% of adults with Henoch-Schonlein purpura develop nephritis, of whom 30% progress to chronic renal insuffi ciency. To our knowledge, this is the fi rst described case of refractory Henoch-Schonlein purpura nephritis in an elderly diabetic patient treated with a novel triple combination therapy of methylprednisolone, myco phenolate mofetil, and immunoglobulin therapy chosen because our patient’s renal function was deteriorating rapidly. Studies have shown eff ective treatment of steroid-resistant Henoch-Schonlein purpura with cyclophos phamide, myco phenolate mofetil, or plasmapheresis. In a case series, myco phenolate mofetil (an immuno suppres sant used in renal transplantation), showed promise in treating refractory Henoch-Schonlein purpura. No large studies have demonstrated an eff ective treatment for the prevention of renal failure in patients with this disorder. Despite combination treatment, our patient is likely to have had underlying diabetic nephropathy compounding the renal injury from IgA deposition. Whether she would have benefi ted from plasmapheresis is unclear, but it might be considered for similar cases. Cutaneous and joint manifestations seem to respond well to steroid and immunosuppressant therapy but prevention of renal insuffi ciency remains diffi cult. In adult HenochSchonlein purpura, practitioners should be aware of the high incidence of renal involvement and its devastating outcomes if not managed aggressively.

Effect of combination therapy of methylprednisolone and cyclophosphamide on heart function and nursing in patients with refractory nephritic syndrome

0bjective To evaluate the heart function of patients with refractory nephmtic syndrome during a combination therapy of methylprednisolone(MP)and cyclophosphamide(CTX).Methods From January 2004 to December 2007.30 patients with refractory nephrotic syndrome.who were in hospital and received a combination therapy of MP and CTX.were recorded for their heart rate and blood pressure before and during treatment,as well as observed for the complications.ResulIs Comparing with those before treatment.patients' heart rates were much quickly and their blood pressure were remarkablv higher during the combination treatment. And there was a statistic siglnificance(P<0.05).When patients received MP treatment.complications.such as cardiopalmus and dizziness,proned to emerging in the third cycle.When they received CTX treatment, complications,just like sicchasia,vomit and cardiopalmus.appeared in the first cycle.In addition. Myelosuppression and lesion of liver function often occurred during the sequence therapy.Conclusions When patients received a combination therapy of MP and CTX,we should monitor their heart funcion SO as to promptly make propotional measure and prevent complications according to variation of heart rate and blood pressure. Key words: Methylprednisolon; Cyclophosphamide; Refractory nephrotic syndrome; Heart funetion monitoring: Children: Nursing

Clinical study of 10 cases of acute or subacute interstitial pneumonia associated with dermatomyositis

The prognosis for dermatomyositis (DM) with acute interstitial pneumonia (IP) is very poor. In the past 5 years, we have treated 10 DM patients with acute or subacute IP. Six cases were of acute-type IP, and 4 were of subacute-type IP. The treatment was a combination therapy of methylprednisolone (m-PSL) pulse therapy, cyclophosphamide (CPA) pulse therapy, oral cyclosporine A (CsA), and oral PSL. The outcome was 5 deaths and 5 survivals. All 5 cases of death had acute-type IP, four of which were complicated with pneumomediastinum, and these patients died within 40 days of IP onset. Furthermore, 4 of the 5 death cases were diagnosed with amyopathic DM, and one had hypomyopathic DM. The survivors comprised one case of acute-type IP with marked myositis, and 4 subacute cases. These results suggested that the prognosis for DM with IP might be dependent on the type of IP, the severity of the myositis, and the existence of pneumomediastinum. The rapid establishment of a more useful diagnostic technique and therapy for early-phase DM with acute IP is hoped for.