Combination Of Steroids Research Articles

Comparison of the Prevention of Esophageal Stricture Between Oral Prednisolone Alone and Oral Prednisolone Combined with Nasogastric Tube in Superficial Esophageal Cancer After Endoscopic Submucosal Dissection.

There is a lack of effective and safe methods for preventing esophageal stricture after large endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer. We aimed to compare the effectiveness of oral prednisolone alone versus a combination of oral prednisolone and nasogastric tube in preventing esophageal stricture following extensive ESD. We retrospectively gathered clinical data from a single center on patients with early esophageal cancer who underwent ESD. Patients were categorized into 2 groups: the steroid group (receiving only oral prednisolone) and the steroid+nasogastric tube retention (NGT) group. We analyzed the incidence of esophageal stricture and identified risk factors for its development. The study included 79 patients, with 30 in the steroid group and 49 in the steroid+NGT group. The incidence of stricture was significantly higher in the steroid group (9/30, 30.0%) compared to the steroid+NGT group (3/49, 6.1%) (P = .004). Notably, we observed a significant difference in the stricture rates between the 2 groups, particularly in patients with a complete circumferential defect (100% and 16.7%) (P = .015). Multivariate logistic regression analysis revealed that a full circumferential defect of the esophageal mucosa (OR 12.501; 95% CI 1.907, 81.047; P = .008), invasion depth beyond the lamina propria (OR 5.635; 95% CI 1.039, 30.559; P = .045), and the absence of NGT retention (OR 12.896; 95% CI 2.099, 79.219; P = .006) were independent risk factors predicting the development of a stricture. The combination of steroids with NGT retention is more effective than using oral steroids alone in preventing esophageal stricture after extensive ESD.

Treatment strategies in MDA5-positive clinically amyopathic dermatomyositis: a single-center retrospective analysis

Melanoma differentiation-associated protein 5 (MDA5) antibody positive amyopathic dermatomyositis (DM) is a rare inflammatory disease. So far, there is no official treatment guideline in MDA5 amyopathic dermatomyositis, but early and aggressive immunosuppressive combination treatment can induce a stable remission. We retrospectively analyzed a cohort of eight patients (male n = 5) that were diagnosed with MDA5-positive amyopathic DM. Patient data comprised demographics, CT-guided diagnosis of pulmonary involvement, pulmonary function testing including forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) data on baseline and mean long-term follow-up of 51 months (24–92 months) to evaluate treatment strategies. Depending on severity of organ involvement treatments were individualized including cyclophosphamide, immunoglobulins and plasmapheresis. Simultaneously, oral treatment with tacrolimus was commenced in four of the eight patients. Most patients received remission maintenance therapy with a combination of tacrolimus, rituximab and low dose steroids. In all patients, improvement in FVC was recorded and five patients achieved an improvement in DLCO. An improvement in the CT imaging morphological findings was observed in four patients. Awareness for the entirety of all clinical and disease-related findings of amyopathic DM is crucial, and remission maintenance is often achieved with a combination of tacrolimus and rituximab.

Postnatal budesonide improved lung function in preterm lambs exposed to antenatal steroids and chorioamnionitis.

A combination of budesonide and surfactant decreases the rates of BPD in infants and lung injury in preterm sheep. Whether this combination will show benefit in the setting of chorioamnionitis and antenatal steroids is not known. Ewes at 123 ± 1 day gestational age received intra-amniotic (IA) injections of 10 mg LPS before being randomized to receive either 0.25 mg/kg maternal betamethasone phosphate and acetate or saline by intramuscular (IM) injection at 48 and 24 h prior to delivery at 125 ± 1 day. Lambs (N = 6-9/group) underwent intentionally injurious ventilation for 15 min, then lambs received surfactant mixed with either: (1) saline; or (2) Budesonide 0.25 mg/kg and were ventilated for 4 h. Compared with LPS-exposed animals that received no IM steroid treatment, betamethasone exposed fetuses had improved hemodynamic stability, lung compliance, and ventilation efficiency. The addition of budesonide to surfactant further improved markers of injury and pro-inflammatory cytokine mRNA in both betamethasone IM or no IM lambs exposed to LPS IA. Antenatal betamethasone and IA LPS exposures decreased budesonide levels in the fetal lung and plasma. Antenatal betamethasone stabilizes physiologic parameters in LPS treated lambs. Budesonide mixed with surfactant further decreases injury and improves respiratory physiology in betamethasone treated animals. Antenatal betamethasone improved lung and systemic physiology in the setting of intra-amniotic LPS. The addition of budesonide to the surfactant further improved lung function. Budesonide levels in the plasma and lung were lower in lambs exposed to either LPS or LPS and Betamethasone animals, and these findings were not explained by increased esterification in the lungs. The combination of antenatal steroids and budesonide with surfactant had the lowest markers of pro-inflammatory cytokines in the lung of LPS exposed animals.

ANGLE RECESSION, THE SEQUELA OF EIGHT-BALL HYPHEMA AFTER SPRAYED BY FIRE HYDRANT: A CASE REPORT

Introduction : Hyphema results from damage to the blood vessels of the iris or anterior ciliary body after blunt trauma, and in 56–100% of cases can occur angle recession.
 Case Illustration : A 40-year-old man complaints of pain and blurred left eye after being sprayed by a high-pressure fire hydrant five hours before coming to the emergency room. Visual acuity was 20/20 and hand movement in right and left eye, IOP is 13 mmHg and 18 mmHg in both eyes. Subconjunctival bleeding, conjunctival and pericorneal injections were found with punctate fluorescein test in the left eye. The cornea was edema and the anterior chamber was full of hyphema. Five days after being hospitalized and treated with topical atropine, antibiotics, and steroid in combination with oral tranexamic acid, the visual acuity was 5/6.5 and the hyphema was resolved. The IOP elevated after 1-6 weeks of follow-up in the outpatient clinic then timolol eyedrops were given. Gonioscopy showed widening of CBB, torn iris processus 2 clock hours in the inferior quadrant. The antiglaucoma medication was stopped due to the controlled IOP in the end episode of the treatment.
 Discussion : Angle recession involves a tear between the longitudinal and circular muscle fibres of the ciliary body. Medication is needed to control the IOP, while surgical management only indicated in cases where medical treatment fails to control the IOP and risk of progressive visual loss.
 Conclusion : Angle recession can occur after blunt eye trauma with hyphema and IOP control is needed to prevent the development of secondary glaucoma.

Severe Ocular Manifestations in Stevens-Johnson syndrome : a case report

Introduction : Stevens-Johnson syndrome (SJS) is a severe mucocutaneous reactions, characterized by cell death in the epidermis, resulting in blistering and sloughing. Hypersensitivity reaction to drug causes the majority of SJS cases. Ocular involvement occurs in 80% of patients in the acute phase.
 Case Illustration m A 38-year-old female was consulted to the ophthalmology department with diagnosis of Stevens- Johnson syndrome (SJS). She complained of bilateral eye redness and blurred vision. She was first admitted to the Emergency Department with complaints of burning sensation, progressive rash, and blistering skin all over her body for the past 2 weeks. Ophthalmology examination revealed a visual acuity of no-light perception (NLP) for both eyes. The anterior segment examination in both eyes showed the palpebra was edema and lagophthalmos, conjunctival hyperemia and corneal ulcer, while the posterior segment could not be identified. The patient was hospitalized in the intensive care unit (ICU) due to her symptoms and clinical findings. She was treated with combination of systemic intravenous antibiotics and steroid, eye drops and eye ointment. After 2 weeks, she was able to blink partially. She was discharged after 20 days of intensive treatment.
 Discussion : 
 Conclusion : Ocular manifestations in SJS are a significant aspect of the disease that can lead to severe visual impairment or even blindness. A multidisciplinary approach to managing SJS is necessary to prevent and treat the ocular manifestations of the disease effectively.

The therapeutic effect of hyperbaric oxygen therapy in patients with severe to profound idiopathic sudden sensorineural hearing loss

The optimal treatment for sudden sensorineural hearing loss (SSNHL) is unclear. Hyperbaric oxygen therapy (HBOT) has been suggested as a viable option for treatment of SSNHL as it improves vascular dysfunction. In this study, we evaluated the therapeutic effects of HBOT by retrospectively reviewing the records of 2206 patients with SSNHL. 54 who had received HBOT were selected for the HBOT groups, while 59 age-matched controls who had not were selected for the control groups. The HBOT and control groups were divided into subgroups according to intratympanic steroid (ITS) use. Groups A–D had received oral steroids + HBOT, oral steroids only, oral steroids + ITS + HBOT, and oral steroids + ITS, respectively. Of the 113 SSNHL patients, 21 had diabetes mellitus (DM) (2, 0, 9, and 10 patients in Groups A–D, respectively). There was no notable difference in hearing improvement between patients receiving HBOT and those in the control group. However, among diabetic patients, those who underwent HBOT demonstrated a significant improvement in hearing when compared to the control group. The combination of HBOT and steroids could potentially be beneficial for treating severe to profound SSNHL patients with DM.

Low-density Lipoprotein Receptor Activities, Lipids, Apolipoprotein, and Clinical Course of Patients with Steroid-resistant Nephrotic Syndrome Treated with Low-density Lipoprotein Apheresis: A Case Series.

We herein report three cases of steroid-resistant nephrotic syndrome successfully treated with low-density lipoprotein apheresis (LDL-A). All patients were treated with a combination of steroids, cyclosporine, and LDL-A. In all cases, the serum concentrations of LDL, total and high-density lipoprotein cholesterol, and triglycerides were significantly lowered following LDL-A administration. Furthermore, the estimated LDL receptor activity increased, while both serum LDL and total cholesterol levels decreased, suggesting that LDL-A increases LDL receptor activity by driving changes in serum cholesterol concentration. This case series suggests that LDL-A increases LDL receptor activity, which may improve the intracellular uptake of cyclosporine.

P635 Intravenous albumin infusion does not augment the response rate to a combination of exclusive enteral nutrition and intravenous steroids in Acute Severe Ulcerative Colitis: a randomized controlled trial

Abstract Background 30-40% patients with acute severe ulcerative colitis (ASUC) fail intravenous (IV) steroids requiring medical rescue therapy/colectomy. Low baseline albumin predicts steroid non-response, and exclusive enteral nutrition (EEN) has been shown to improve steroid response and albumin levels. Albumin infusion due to its anti-inflammatory and anti-oxidant properties can further improve steroid response in ASUC, which was evaluated in present study. Methods In this open-label randomized controlled trial, patients with ASUC were randomized in 1:1 ratio to albumin + SOC + EEN vs. SOC + EEN (Jan2021 – Feb2023). Both arms received 5 days of EEN with 400 mg IV hydrocortisone/day. Patients in albumin arm were administered 5 days of 20% w/v intravenous albumin (100 ml). Primary outcome was steroid failure (need for rescue medical therapy or colectomy) and proportion of patients with adverse events. Results Sixty-one patients (albumin-30, SOC-31) (mean age-31.6 ± 10.4 years, male- 57.4%), were included. Baseline characteristics were comparable. There was no difference in steroid failure between albumin and SOC arm (10/30 (33.33 %) vs 13/31 (41.94 %), p=0.49). No adverse events were reported with albumin infusions. Colectomy rate (10 % vs 9.68 %, P=1), response to salvage medical therapy (88.89 % vs 76.92 %, P=0.62) and median duration of hospitalization (10.5 (7-16) vs 10 (7-20), P=0.43) were also comparable. Long-term composite outcome of colectomy and re-admission rates was numerically higher in the albumin than SOC arm (37.04 % vs 17.86 %), although it did not reach statistical significance. Conclusion There was no benefit of intravenous albumin infusion as an adjunct to IV steroids and EEN in patients with ASUC.

The Role of Hyperbaric Oxygen Therapy in the Treatment of Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss (SSNHL) is defined as acute hearing loss of >30 dB at three consecutive frequencies, with an abrupt onset (within 3 days). In most patients with SSNHL, an exact cause is rarely identified. Diverse etiological theories have been proposed, including vascular disease, viral infection, autoimmune disease, inner ear hydrops, and genetic factors. Based on these hypotheses, various treatments have been tried, including corticosteroids (systemic and/or intratympanic), antivirals, vasoactive drugs, and hyperbaric oxygen therapy (HBOT), but the evidence remains inconclusive. The 2019 American Academy of Otolaryngology-Head and Neck Surgery guideline had suggested that HBOT can be provided as either initial or salvage treatment when combined with steroid therapy. HBOT, a noninvasive treatment involving the inhalation of 100% oxygen at a pressure of >1 atmosphere absolute (ATA) is another treatment option as a method to improve oxygen supply after cochlear damage. Although the pressure, frequency, and total time of HBOT remain variable among different studies, a protocol of 2.0-2.5 ATA and 10-20 sessions in total are commonly used. The treatment strategies for SSNHL have been evolving, and recent attempts involved increasing the effectiveness through various combinations of systemic steroid, intratympanic steroid, and HBOT. In this review, we will review various studies about HBOT and discuss the efficacy of HBOT in SSNHL.

Difficult to treat superficial fungal infections: Which factors one should consider in clinical practice – An Indian perspective

Dermatophytosis is a superficial fungal infection caused by filamentous fungi- dermatophytes affecting the skin, hair and/or nails. They have also been termed tinea infections. Dermatophytes, the most common contributing agents, are pretending high importance in developing countries like India. Emerging Pathogen Causing Recalcitrant Dermatophytosis like Trichophyton indotineae, which is terbinafine resistant. Development of Anti-fungal resistance due to irrational usage of antifungals, steroid misuse, availability of topical creams with steroid combination on OTC, improper and inadequate treatment, lack of patient counselling and education are the most important factors which made dermatophyte difficult to treat. Proper diagnosis, correct selection of anti-fungal, with adequate duration of therapy, avoidance of steroid, patient education on lifestyle changes will be probable solutions in resolving current challenges.

Effect of drug encapsulation and sterilization process on physicochemical properties and release of combined steroid hormones from poly (ε-caprolactone) fibers

Commercially available medications for contraception and other uterine medical conditions include oral pills, intramuscular injections, implantable devices etc. However, the side effects and limitations such as ease of use associated with the conventional techniques motivates the researchers to develop new drug delivery systems to address these issues. This article highlights the potential of electrospun fibers as a platform for use as a long-acting drug delivery system for contraceptive steroids. In this study, individual and combined hormonal contraceptive drugs (Levonorgestrel - LNG, and ethinylestradiol - EE) loaded poly (ε-caprolactone) (PCL) fibers were developed using electrospinning technique. The effect of drug loading and ethylene oxide (EtO) sterilization on the physicochemical properties of these fibers, as well as their drug release ability was then investigated to establish their use for sustained and prolonged drug delivery platform. The efficiency of drug encapsulation (DEE %) was found to be influenced by the amount of drug loaded. Morphological images demonstrated a smooth and continuous structure, with traces of drug crystals at higher concentrations on the fiber surfaces. In-vitro release data indicated that EE was released at a faster rate compared to LNG from both individually loaded and dual drug loaded fibers. No significant difference was observed in the release of LNG and EE from the fibers, with drug loaded individually or in combination. Drug release mechanism was found to be a combination of diffusion and erosion. The physicochemical and release properties of the electrospun fibers were not significantly affected by the sterilization process and thus proved to be a safe method of sterilizing the fibers. Furthermore, the drug-loaded fibers were found to be compatible with cellular structures, indicating their biocompatibility.

Durvalumab-Induced Triple-M Syndrome.

While the use of immunotherapy has revolutionised the treatment of various cancers, it is often associated with a myriad of immune-related adverse effects. In this article, we report a rare case of durvalumab-induced triple-M syndrome in a 69-year-old woman with stage III lung adenocarcinoma. She was admitted with profound generalised muscle weakness, myalgia, and exertional breathlessness, about a week into her second cycle of durvalumab, an immune checkpoint inhibitor. She had clinicopathological features of myositis, myasthenia and myocarditis with acute onset symptomatic tri-fascicular block on electrocardiogram, requiring urgent cardiology intervention. Durvalumab was discontinued and she was treated with a combination of high-dose steroids and intravenous immunoglobulin after which she had clinical and biochemical improvement, albeit with residual muscle weakness. Myocarditis-myositis-myasthenia complex is a rare side effect of immunotherapy which has been reported in other immune checkpoint inhibitors, but less so with durvalumab. We report this clinical case to raise awareness of this rare and potentially life-threatening adverse effect of this agent. Triple-M syndrome is a rare immune-related adverse effect, which has been noted in other immune checkpoint inhibitors, but less so with durvalumab specifically.Immunotherapy-induced myositis, myocarditis and myasthenia can occur in isolation or, rarely, in association as a syndrome.This case demonstrates the potentially life-threatening nature of this entity, the need for early recognition, and multi-specialist teamwork to ensure good outcome.

A study to assess the efficacy of oral itraconazole as an add-on to steroids in allergic fungal rhinosinusitis in a tertiary care hospital

Background: Allergic fungal rhinosinusitis (AFRS) is a distinct type of chronic polypoid rhinosinusitis that affects atopic individuals. The incidence worldwide ranges from 5% to 10%, with geographic variation in epidemiology. It imposes a significant negative impact on quality of life, concomitantly generating socioeconomic losses. Failure to remove all sinus disease increases the likelihood of relapse; thus, the best outcome is achieved through coordinated medical-surgical care. The antifungal activity of itraconazole in addition to standard steroid therapy may provide greater relief to patients with AFRS following functional endoscopic sinus surgery (FESS) by decreasing the chances of recurrence and long-term use of steroids. Therefore, this study has been taken up. Aim and Objectives: The aims and objectives of the study are to evaluate the efficacy of oral itraconazole as an add-on to the standard steroid therapy in allergic fungal rhinosinusitis from baseline to 6 weeks. Materials and Methods: This study was conducted among 60 patients who underwent FESS and were administered medications postoperatively. The efficacy was measured by the sinonasal outcome test-20 score, the nasal endoscopic grade, and the Lund and Mackay score from baseline to 6 weeks. Continuous data were analyzed using the unpaired t-test, repeated measure analysis of variance, and paired t-test, whereas categorical data were analyzed using the Chi-square test. Results: Comparable efficacy was observed between the group treated with standard steroids alone and the group receiving a combination of standard steroids and itraconazole. No significant improvement was seen with oral itraconazole as an add-on therapy when compared with standard steroids at the end of 6 weeks. Conclusion: Oral itraconazole as an add-on therapy will reduce the chances of recurrence such as steroids, but in this study, there was no statistically significant reduction. The disease has a long natural course, and further follow-up is needed to establish the importance of itraconazole.

Role of the Agnikarma in the Management of Frozen Shoulder

Shoulder joint discomfort and stiffness are indicators of frozen shoulder, which is also referred to as adhesive capsulitis. Symptoms and signs usually begin gradually subsiding before getting more severe. Frozen shoulder is a condition that is more prevalent in women than in men, particularly those between the ages of 40 and 60. Furthermore, individuals with diabetes are at an increased risk of developing frozen shoulder. Inflammation is the most common cause of frozen shoulder, which is characterized by swelling, pain, and irritation of the tissues surrounding the joint. The underlying cause of this ailment is not yet definitively understood. It is estimated that 2 to 5 percent of the general population will experience frozen shoulder at some point in their lives, with 8.2 percent of males and 10.1 percent of working-age women affected by it. This condition can affect one or both shoulders, and typically resolves on its own within one to two years. Depending on the severity of the disease, a combination of NSAIDs, steroids, physiotherapy, and surgical intervention may be recommended by modern medicine. Ayurveda has suggested Agnikarma as a potential treatment for frozen shoulder, as it was believed to be an effective therapy for Avbahuka. Frozen shoulder and Avbahuka may present with similar symptoms and indicators. Agnikarma, a distinct technique described in Ayurvedic texts, is used to treat Avbahuka that is caused by Dhatukshayajanya vata prakopa. Therefore, the aim of this research was to examine the therapeutic effects of Agnikarma in cases of frozen shoulder in Avabahuka.

Efficacy and safety of steroids for chronic subdural hematoma: A systematic review and meta-analysis

Background: Chronic subdural hematoma (CSDH) is a condition characterized by the accumulation of fluid, blood, and blood breakdown products between the brain’s arachnoid and dura mater coverings. While steroids have been explored as a potential treatment option, their efficacy and safety remain uncertain. This meta-analysis and systematic review aimed to assess the impact of steroids on CSDH management, including mortality, recurrence, complications, and functional outcomes. Methods: We conducted a comprehensive literature search in major electronic databases up to June 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook for Systematic Reviews and Interventions. Inclusion criteria encompassed adult patients with CSDH, the use of steroids as monotherapy or adjuvant therapy, and clearly defined outcomes. Randomized controlled trials and cohort studies meeting these criteria were included in the study. Results: The initial search yielded 4315 articles, with 12 studies meeting the inclusion criteria. Our findings indicate a non-significant trend toward reduced mortality with steroids in combination with standard care (Odds ratios [OR] = 0.66, 95% confidence interval [CI] 0.20–2.18). However, substantial heterogeneity was observed (I2 = 70%). Sensitivity analysis, excluding influential studies, suggested a potential increased mortality risk associated with steroids (OR = 1.47, 95% CI 0.87–2.48). Steroids showed a possible benefit in reducing the recurrence of CSDH (OR = 0.58, 95% CI 0.20–1.67), but with significant heterogeneity (I2 = 89%). No clear advantage of steroids was observed in terms of functional outcomes at three months (modified Rankin scale scores). Furthermore, steroids were associated with a significantly higher incidence of adverse effects and complications (OR = 2.17, 95% CI 1.48–3.17). Conclusion: Steroids may have a potential role in reducing CSDH recurrence but do not appear to confer significant advantages in terms of mortality or functional outcomes. However, their use is associated with a higher risk of adverse effects and complications. Given the limitations of existing studies, further research is needed to refine the role of steroids in CSDH management, considering patient-specific factors and treatment protocols.

Primary angiitis of the central nervous system presenting as sudden vision loss in a young patient

Primary angiitis of the central nervous system is a rare disorder that primarily affects the cerebral vessels and can prove to be a diagnostic challenge to the clinicians. It can present with a variety of clinical manifestations and lacks the evidence of any systemic disease. Digital subtraction angiography is often necessary to confirm the diagnosis of cerebral vasculitis but in cases where it may fail to do so, brain biopsy is eventually required. Obliviousness to this condition may lead to false management strategies and hence it is imperative to make an accurate diagnosis to facilitate proper treatment that mainly includes a combination of steroids and immunosuppressive agents. We report a case of a 27-year-old male with sudden bilateral vision loss who underwent extensive workup and was ultimately diagnosed with primary angiitis of the central nervous system. He was treated with steroids and responded well to it.
 

Optimal Bell's Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach.

The optimal treatment approach for patients with Bell's palsy, a condition characterized by acute facial nerve palsy, remains unclear. The present study was designed to provide insights into the most effective treatment strategies, whether steroids alone or steroids plus antiviral agents, as well as the optimal timing of treatment initiation. To investigate the impact of treatment modalities and timing on the recovery rates of Bell's palsy patients and to assess the roles of individual factors. This retrospective analysis included 1504 patients with Bell's palsy who visited Kyung Hee University Hospital. Patients were divided based on the treatment modality (steroid monotherapy vs. combined steroid and antiviral therapy) and the timing of treatment initiation (≤72 vs. >72 h). The primary outcome was the recovery rate, as assessed by the House-Brackmann (HB) grade. Secondary outcomes included factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions. A combined comparison of patients treated with steroids plus antivirals and steroids alone, stratified by treatment start time, showed that recovery rates were highest in patients who received steroid monotherapy initiated within 72 h (OR 2.36; p < 0.05). Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 h. The recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%, p < 0.05). Initiating treatment beyond 72 h was associated with a higher recovery rate than starting treatment within 72 h (85.69% vs. 76.92%, p < 0.05). An evaluation of the factors affecting recovery showed that patients aged 20 to 39 years had a higher recovery rate than other age groups (OR 1.47; p < 0.05). Fairly predictive EMG results were associated with significantly higher recovery rates (OR 3.52; p < 0.05). These findings underscore the importance of individualized treatment approaches in Bell's palsy management. Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease. The best treatment results were achieved when steroid treatment was administered within 72 h. Our results suggest that there may be more flexibility in the application of the 72 h treatment period if we consider the time of treatment initiation alone, but this should take into account patient behavior patterns and the limitations of retrospective analysis. Further research is warranted to validate these findings and refine treatment recommendations for patients with Bell's palsy.

Sjogren's syndrome meets Meige's syndrome

This report details a rare case where a patient simultaneously suffered from Sjogren's syndrome (SS) and Meige's syndrome (MS). SS, an autoimmune disorder, and MS, a rare neurological condition characterized by involuntary eyelid closure, presented in a 73-year-old male. The patient had been experiencing dry eye symptoms for the past 5 years, with the onset of eyelid spasms and tetanic eye closure occurring 3 years ago. Traditional treatments, including subthalamic nucleus deep brain stimulation, provided only temporary relief. Diagnostic evaluations, including blood tests and imaging, confirmed SS and MS coexistence. Treatment involved a combination of steroids, immunosuppressants, and immunoglobulin, leading to significant symptom relief. This case suggests a potential association between SS and the development of MS, highlighting the importance of immunomodulatory therapy in managing neurological symptoms. Further research is needed to explore the relationship between these two conditions and to develop more effective treatment strategies.

Bacillary Layer Detachment as a Presenting Feature of Ocular Sarcoidosis.

Bacillary layer detachment (BALAD) is a recently described finding on optical coherence tomography (OCT) that has been reported in a variety of uveitic and retinal diseases. To add to the growing literature on conditions associated with this finding, we report on the first cases of BALADs in ocular sarcoidosis. Observational, retrospective chart review of patients with BALADs as a feature of sarcoid-associated uveitis. Three patients presented with blurry vision and bacillary layer detachments on OCT who were either known to have or found to have sarcoid-associated uveitis. All three patients had resolution of the BALAD and improvement in visual acuity with a combination of high-dose oral steroids and/or systemic immunosuppression. Patients presenting with BALAD should be assessed for sarcoidosis, if appropriate, given the systemic implications of this diagnosis. [Ophthalmic Surg Lasers Imaging Retina 2023;54:686-690.].

Real-life data comparing the efficacy of vigabatrin and oral steroids given sequentially or combined for infantile epileptic spasms syndrome

AimsThe prognosis of Infantile epileptic spasm syndrome (IESS), relates to the underlying etiology and delay in controlling epileptic spasms. Based on the spasm-free rate, a randomized controlled trial has demonstrated the superiority of combining oral steroids and vigabatrin over oral steroids alone but confirmation in real-life conditions is mandatory. MethodsWe compared two real-life IESS cohorts: a multicenter, retrospective cohort of 40 infants treated with vigabatrin followed by a sequential (ST) addition of steroids, and a prospective, single-center cohort of 58 infants treated with an immediate combination of vigabatrin and steroids (CT). ResultsThe two cohorts were similar. When the rate of spasm-free infants in the two cohorts was compared on day 14, a significant difference was observed between the ST (27,5 %) and CT cohorts (64 %) (p < 0.0004). This difference remained significant on day 30, with 55 % spasm-free patients in the ST cohort compared to 76 % in the CT cohort (p = 0.03). After the infants had received both vigabatrin and steroids, without taking into account the time point after treatment initiation, no significant difference was observed in the spasm-free rate between the two cohorts (p = 0.38). InterpretationReal-life data confirm the interest of combination therapy as a first-line treatment for IESS.