Combined Use Of Corticosteroids Research Articles

Rising Incidence of Acute Epiglottitis in Eastern China: An Eight-Year Retrospective Study and Its Association with the 24 Solar Terms.

This study aimed to investigate the clinical characteristics of acute epiglottitis (AE) patients in East China and examine the correlation between the incidence of AE and the 24 solar terms (24 STs). A retrospective, observational study was conducted on patients diagnosed with AE between January 2014 and December 2021 at a single-center medical institution in East China. The clinical characteristics of patients with AE and their correlation with the 24 STs were investigated. A total of 287 patients with AE were included in this study, among which there were 179 males (62.37%) and 108 females (37.63%), with a mean age of 47.79 ± 13.83 years (range 16-87 years). Of these patients, 100 (34.84%) had at least one comorbidity and the most common comorbidities were hypertension, smoking and type 2 diabetes. The duration of hospitalization was 3 days (IQR, 1-16 days). All patients, except for one who required tracheal intubation, were cured with intravenous antibiotic administration and the combined use of corticosteroids. The incidence of AE showed significant fluctuations between the 24 STs and the highest number of cases occurred during the Summer solstice (24 cases, 8.36%). The incidence of AE was seen to increase annually in this study. The main features of AE are sore throat, dysphagia, odynophagia and fever, which may be accompanied by inflammation in surrounding areas. A clear correlation exists between the incidence of AE and the fluctuations within the 24 STs, notably with the peak incidence observed during the Summer solstice, which approximately corresponds to June 21 to July 7 in the Gregorian calendar.

A case of nontraumatic simultaneous bilateral Achilles tendon rupture.

Patients with corticosteroid-managed chronic obstructive pulmonary disease (COPD) are at increased risk of Achilles tendon rupture. This risk is further augmented in the setting of an acute COPD exacerbation in which antibiotics may be indicated, namely fluoroquinolones. This case concerns a 76-year-old man who experienced simultaneous nontraumatic bilateral Achilles tendon rupture during an acute COPD exacerbation. Treatment was conservative with analgesics, activity modification, and bilateral controlled ankle movement boots. Surgery was not advised because of his multiple medical comorbidities predisposing him to impaired wound healing and potential amputation. Included is a discussion on the pathophysiology, diagnosis, and treatment of Achilles tendon rupture. There is a need for greater awareness of the risk of Achilles tendon rupture from combined use of corticosteroids and fluoroquinolones. After this report, we hope to raise awareness of this complication and prevent patient suffering.

Early Use of Corticosteroids following CAR T-Cell Therapy Correlates with Reduced Risk of High-Grade CRS without Negative Impact on Neurotoxicity or Treatment Outcome.

Chimeric antigen receptor T-cell therapy (CAR T-cell therapy) is associated with potentially life-threatening toxicities, most commonly cytokine release syndrome (CRS) and immune-effector-cell-associated neurotoxicity syndrome (ICANS). These frequent adverse events are managed with the IL-6 receptor antagonist tocilizumab and/or corticosteroids. The prophylactic and early use of corticosteroids for CRS and ICANS have previously been reported, but eventual negative impacts on CAR T-cell efficacy are feared. Retrospective comparative analysis of two patient cohorts with hematological malignancies treated with CAR T-cell therapy: 43 patients received early administration of 10 mg dexamethasone preceding each dose of tocilizumab ("early corticosteroid/ tocilizumab", EcsTcz cohort) vs. 40 patients who received tocilizumab alone ("tocilizumab alone", Tcz cohort) for treatment of low-grade CRS. Despite overall higher CRS incidence (91% vs. 70%; p = 0.0249), no high-grade CRS was observed (0% vs. 10%; p = 0.0497) among patients receiving early corticosteroids in combination with tocilizumab. In terms of neurotoxicity, no worsening regarding incidence of ICANS (30% vs. 33%; p = 0.8177) or high-grade ICANS (20% vs. 14%; p = 0.5624) was observed in the EcsTcz cohort. Moreover, overall response rates (80% vs. 77%; p = 0.7936), complete response rates (50% vs. 44%; p = 0.6628), progression-free survival (p = 0.6345) and overall survival (p = 0.1215) were comparable for both cohorts. Our study suggests that the early use of corticosteroids in combination with the standard tocilizumab schedule for low-grade CRS following CAR T-cell therapy may significantly reduce the risk of high-grade CRS without negative impact on neurotoxicity or treatment outcome.

Effect of azithromycin on migration of peripheral blood NK cells from patients with chronic obstructive pulmonary disease

Currently, no drugs have been identified that could slow progression of chronic obstructive pulmonary disease (COPD), or have a significant impact on patient mortality. Therefore, research continues aimed at studying the mechanisms of COPD development and searching for drugs that affect its molecular pathogenesis. The aim of our work was to determine the ability of azithromycin combined with corticosteroids to affect the migration of peripheral blood NK cells from the COPD patients. In the present study, we have measured expression of chemokine receptors CCR5, CCR6, CCR7, CXCR3, CXCR4, CXCR6 on the surface of peripheral blood NK cells (CD3- CD56+) by means of flow cytometry in 54 smoking patients with COPD, 21 healthy smokers, and 20 healthy non-smokers. Moreover, the effect of azithromycin (10 µg/mL) and budesonide (10 nM) on the migration of NK cells from COPD patients (n = 8) towards CCL5 (10 nM) and CXCL10 (10 nM) was determined. We found that the percentage of NK cells expressing CXCR3 and CCR5 chemokine receptors was increased in smoking patients with COPD compared with healthy smokers and healthy non-smokers. However, the proportion of these NK cell subsets did not differ between healthy smokers and healthy non-smokers. There were no significant differences in the percentage of NK cells expressing CXCR4, CXCR6, CCR6, CCR7 chemokine receptors between the three groups of subjects. Addition of budesonide to the cell suspensions decreased the migration of blood NK cells towards CCL5 and CXCL10. Azithromycin was also shown to suppress the migration of blood NK cells towards these chemokines. The combination of azithromycin and budesonide was more potent at inhibiting NK cell chemotaxis towards CCL5 and CXCL10 than any of these drugs added alone. Our results demonstrate a change in the chemokine receptor profile of NK cells in COPD patients and indicate the advantages of the combined use of corticosteroids and azithromycin for COPD treatment.

Fungal complications with the new coronavirus infection COVID-19

BACKGROUND: The growth of fungal pathology observed in the last decade, including life-threatening invasive mycoses, is associated with the spread of immunodeficiency states of various etiologies. The COVID-19 pandemic has made a negative contribution, causing a significant increase in the number of patients with fungal complications.
 AIM: To characterize the types of fungal complications in the acute period of a new coronavirus infection COVID-19 based on an analysis of the clinical course and therapeutic tactics for managing the underlying disease.
 MATERIALS AND METHODS: The results of a bacteriological study of 1284 cultures from sputum samples of patients with suspected secondary pneumonia in COVID-19 are considered. The study included 404 cultures of various types of fungi. The analysis of the clinical picture was carried out in 70 patients with fungal complications of various localization, who were treated in a regional covid hospital. This group included the results of microbiological examination of sputum, bronchoalveolar lavage (BAL), scrapings from lesions in the oropharynx, urine, blood, biopsy and autopsy material. The study was conducted from April 01, 2020 to December 31, 2021. The patients were divided into subgroups depending on the isolated pathogen: Candida spp. ― 64 patients, and fungi (Aspergillus spp. and Mucor spp.) ― 6 patients; outcome of the disease: favorable 66, lethal 4.
 RESULTS: In the microbial landscape of the respiratory tract in patients with COVID-19, gram-negative microbial flora prevailed, one third of the cultures were represented by fungi. During the two years of the pandemic, the proportion of fungal cultures increased from 26.9% in 2020 to 34.2% in 2021, while maintaining sensitivity to amphotericin B and fluconazole in most cases. In 2021, there was a negative growth trend in the sputum of molds of the species Aspergillus spp. (5 cultures) and Mucor spp. (1 culture).
 Typical fungal complications of COVID-19 were: candidiasis stomatitis caused by Candida albicans (71%), candidiasis of other urogenital localizations in the form of candiduria (20%), lung damage of mixed viral-fungal etiology in isolated cases, leading to death due to invasive mycosis. Only fungal flora was isolated in 57.1% of cases, various combinations of fungal and bacterial flora in 42.9%. Candidiasis stomatitis was diagnosed on average on day 11.61.08 of COVID-19, which corresponded to days 2-3 of hospitalization. Preceding outpatient treatment, in most cases, included antibiotics and hormonal therapy with glucocorticosteroids. Urogenital Urogenital fungal infection was diagnosed on the 17.75.17 day of illness, on the second week of hospital treatment (8.03.11 days). Fungal flora in sputum was determined on average on the 18.54.33 day of illness, on the second third week of hospitalization against the background of intensive immunosuppressive therapy.
 CONCLUSION: Risk factors for the development of fungal complications are the age of patients older than 50 years, overweight and hypertension, uncontrolled use of antibiotics and glucocorticosteroids at the prehospital stage. Mycoses are recorded in both severe and moderate COVID-19. An additional factor in their development is immunosuppressive therapy of the underlying disease. The most formidable complication of the course of COVID-19, worsening the prognosis of survival, is the addition of fungi with invasive growth Aspergillus spp., Mucor, as well as the development of fungal-bacterial associations with damage to the lung tissue.
 In the context of the ongoing SARS-CoV-2 pandemic, the use of immunomodulatory agents, including the combined use of corticosteroids and targeted immunosuppressive drugs, it is important to develop a risk-based approach in diagnosis and treatment for patients at risk of generalized and invasive mycoses.

Real-world evidence of tofacitinib in rheumatoid arthritis patients in Spain.

The purpose of this narrative review is to provide an overview of the real-world data on the use of tofacitinib in patients with active rheumatoid arthritis (RA) in Spain. Sixteen retrospective studies carried out in Spain between 2019 and 2021 have been analyzed, considering patients' characteristics, and treatment patterns, effectiveness, and safety. In those studies, approximately 511 patients received tofacitinib during the study period. They were predominantly women (mean age: 48-61 years). The percentage of patients receiving tofacitinib as monotherapy ranged between 20.0% and 67.9%. Only five studies reported the combined use of corticosteroids (42.0-84.5% of patients), with a mean dose varying from 1.8 to 7.2 mg. A wide range of patients (36.0-85.7%) had failed a previous biological disease-modifying anti-rheumatic drug. The most frequent reason for treatment discontinuation was the lack of efficacy, and the most common adverse event described was herpes zoster infection. Real-world studies complement clinical trials by adding efficacy and safety data in real-world settings to the benefit/risk profile of the drug. The profile of RA patients receiving tofacitinib in Spain has similarities with other real-world studies conducted in other countries.

ПРИНЦИПЫ НАЗНАЧЕНИЯ ГЛЮКОКОРТИКОСТЕРОИДОВ У ПАЦИЕНТОВ С COVID-19

Introduction. This article discusses the treatment of coronavirus infection (COVID-19) with glucocorticoste- roid drugs (GCS), side effects of drugs and their prevention, transfer from intravenous to intramuscular and then to oral administration, and the development of withdrawal syndrome. The article describes the conditions under which antibiotic therapy is prescribed, as well as the conditions under which the combined use of corticosteroids and antibiotics is neces- sary. Aim. The aim to analyze the basic principles of corticosteroids prescribing in the treatment of COVID-19: indications for corticosteroids administration, administration regimens and required dosages, side effects of corticosteroids admin- istration. Material and methods. The article uses data from the Interim Guidelines for the Prevention, Diagnosis and Treatment of New Coronavirus Infection (COVID-19), the Federal Clinical Guidelines for the Specialty “Rheumatology”, as well as using the literature on basic and clinical endocrinology, cardiology and pharmacology. The work was written using a systems approach, methods of analysis, induction and observation. Results and discussion. Systemic cortico- steroids are used in cases of severe and critical course of the disease COVID-19 (confirmation may be an increase in ferritin, procalcitonin, C-reactive protein (CRP), decreased cognitive functions, development of sopor). Their appointment is also justified when the initial course of the disease was not diagnosed as severe, but suddenly the patient’s condition deteriorated. The use of antibiotic therapy is advisable when a bacterial infection is attached - (procalcitonin (PCT)> 0.5 ng / ml, purulent sputum, leukocytosis> 12 × 109 / L (in the absence of previous use of glucocorticoids), an increase in band neutrophils of more than 10%). In the presence of chronic infectious diseases in patients with COVID-19 (for ex- ample, chronic obstructive pulmonary disease-COPD, chronic pyelonephritis, etc.), antibiotics are prescribed to prevent exacerbations of these diseases. Conclusion. In the course of the study, the authors of the article formulated the follow- ing principles of glucocorticoid therapy: drugs should be prescribed according to strict indications; maximum doses are applied in a short course; when the patient’s condition is stabilized, it is necessary to reduce the dose in a timely manner and gradually to complete withdrawal to prevent the development of “withdrawal” syndrome, adrenal insufficiency of cen- tral genesis, sympathoadrenal crises; during and after treatment, prevention of complications of glucocorticoid therapy (hyperglycemia, hypocalcemia, osteopenia, inflammatory diseases of the urinary system) is recommended; collegial management of patients by infectious diseases and endocrinologists is mandatory.

Methylprednisolone and Hyaluronic Acid versus Each Agent Alone to Control Complication of Impacted Wisdom Removal.

Introduction Extraction of impacted molars is commonest operation in oral cavity and associated with complications disturbing patient's quality of life. Hyaluronic acid is a nontoxic agent recommended for wound management due to its anti-inflammatory effects. Also, methylprednisolone sodium is used to reduce pain and edema. The aim this study was to compare the effect of combined use of corticosteroid and hyaluronic acid versus each agent alone in controlling postextraction complications of impacted mandibular third molars. Materials and Methods This prospective randomized trial included patients suffering from impacted mandibular third molar. Patients were divided into four groups. Group I, control, and group II received methylprednisolone sodium succinate injection preoperatively, group III received hyaluronic acid applied in extraction socket, and group IV received preoperative methylprednisolone sodium succinate injection and topical hyaluronic acid in the socket. All patients were evaluated preoperatively and postoperative day to assess swelling, pain, mouth opening, and total analgesic dose. Results Group IV showed insignificant edema along the study period, and other groups showed significant edema on third postoperative day that improved on seventh postoperative in group II and III and tenth postoperative day in group I. Significant decreased mouth opening occurred on second postoperative day in group I, while in other groups, it occurred in third postoperative day. Significant improvement occurred on seventh postoperative day in all groups except in group I which occurred on tenth postoperative day. There was less pain and analgesic dose reported in group IV than other groups. Conclusion Combined use of methylprednisolone sodium succinate and hyaluronic acid significantly decrease postoperative complications than using each agent alone.

Advances with pharmacotherapy for the treatment of interstitial lung disease

ABSTRACT Introduction In recent decades, the primary focus of pharmaceutical research in interstitial lung diseases (ILD) has been on idiopathic pulmonary fibrosis (IPF). Recently, pharmaceutical development has also focused on other forms of ILDs, including connective tissue diseases associated ILD, fibrotic hypersensitivity pneumonitis, and sarcoidosis. Areas Covered The authors summarize the advances in pharmacotherapy for the treatment of ILD. Specifically, the authors review the most recent studies and discuss the most recent research findings and future prospects. Expert opinion Data collected over the past years have confirmed the efficacy of antifibrotic drugs on slowing disease progression in IPF. The usual strategy for CTD-ILD management is represented by the combined use of corticosteroids and immunosuppressive agents. There is an urgent need for new target therapies. The concept of progressive fibrosing ILD has emerged in the ILD community in recent years, which has led to grouping several diseases with a common disease behavior to find an effective treatment . At present, selecting the best therapy in ILDs should be reasonably performed on a case-by-case basis through a multidisciplinary team discussion in tertiary ILD centers, taking into consideration patients’ symptoms, lung functional trends, and radiological changes.

COVID-19 and mucormycosis superinfection: the perfect storm.

BackgroundThe recent emergence of the Coronavirus Disease (COVID-19) disease had been associated with reports of fungal infections such as aspergillosis and mucormycosis especially among critically ill patients treated with steroids. The recent surge in cases of COVID-19 in India during the second wave of the pandemic had been associated with increased reporting of invasive mucormycosis post COVID-19. There are multiple case reports and case series describing mucormycosis in COVID-19.PurposeIn this review, we included most recent reported case reports and case-series of mucormycosis among patients with COVID-19 and describe the clinical features and outcome.ResultsMany of the mucormycosis reports were eported from India, especially in COVID-19 patients who were treated and recovered patients. The most commonly reported infection sites were rhino-orbital/rhino-cerebral mucormycosis. Those patients were diabetic and had corticosteroids therapy for controlling the severity of COVID-19, leading to a higher fatality in such cases and complicating the pandemic scenario. The triad of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), corticosteroid use and uncontrolled diabetes mellitus have been evident for significant increase in the incidence of angioinvasive maxillofacial mucormycosis. In addition, the presence of spores and other factors might play a role as well.ConclusionWith the ongoing COVID-19 pandemic and increasing number of critically ill patients infected with SARS-CoV-2, it is important to develop a risk-based approach for patients at risk of mucormycosis based on the epidemiological burden of mucormycosis, prevalence of diabetes mellitus, COVID-19 disease severity and use of immune modulating agents including the combined use of corticosteroids and immunosuppressive agents in patients with cancer and transplants.

Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): a diagnostic and treatment guidance from the Rheumatology Study Group of the Italian Society of Pediatrics

BackgroundItaly was the first Western country to be hit by the SARS-CoV-2 epidemic. There is now mounting evidence that a minority of children infected with SARS-CoV2 may experience a severe multisystem inflammatory syndrome, called Multisystem inflammatory Syndrome associated with Coronavirus Disease 2019 (MIS-C). To date no universally agreed approach is available for this disease.Main bodyas Italy is now facing a second hity of COVID-19 cases, we fear a recrudescence of MIS-C cases. We have, therefore, decided to prepare a report that will help clinicians to face this novel and challenging disease. We propose a diagnostic algorithm, to help case definition and guide work-up, and a therapeutic approach. MIS-C should be promptly recognized, based on the presence of systemic inflammation and specific organ involvement. Early treatment is crucial, and it will be based on the combined use of corticosteroids, high-dose immunoglobulins and anti-cytokine treatments, depending on the severity of the disease. Ancillary treatments (such as. aspirin and thrombo-profilaxis) will be also discussed.Conclusionswe propose a document that will help physicians to diagnose and treat MIS-C patients. Given the level of evidence available and the methodology used, this document should not be interpreted as a guideline; the final decision about the optimal management should still be taken by the caring physician, on an individual basis.

Analysis of clinical experience of children with toxic epidermal necropysis

Toxic epidermal necrolysis (TEN) is a severe drug allergy. The objective was to analyze the clinical experience of 17 children of different age with toxic epidermal necrolysis. The authors found that medications against infection diseases were the most common reason for the development of the disease. In some cases we observed the delayed diagnosis, therapy without consideration of causative agents, and wrong doses of corticosteroids. The majority of cases require combined use of corticosteroids and intravenous immunoglobulins, however bacterial complications are possible in some cases.

Corticosteroids alleviate adverse events associated with enzalutamide in patients with metastatic castration-resistant prostate cancer.

The aim of the present study was to investigate the impact of the combined use of corticosteroid on adverse events (AEs) induced by enzalutamide (Enz) in patients with metastatic castration-resistant prostate cancer (mCRPC). The cohort of the present study included 121 consecutive patients with mCRPC who sequentially received androgen receptor-axis-targeted (ARAT) agents, abiraterone acetate (AA) and Enz, in any order, without prior docetaxel therapy. Detailed assessments of AEs during treatment with Enz were conducted according to whether or not corticosteroid was administered. Of these patients, 63 and 58 received ARAT therapy with the Enz-to-AA sequence (group 1) and the AA-to-Enz sequence (group 2), respectively. No patient in group 1 received corticosteroid during treatment with Enz, while corticosteroid was continuously administered in combination with Enz to all patients in group 2 following AA failure. When ARAT therapy was initiated, no significant differences in the major baseline characteristics were observed between the two groups. During Enz therapy, there were no significant differences in the incidence of any AEs or AEs ≥ grade 3 between the two groups. However, the incidences of fatigue and appetite loss in group 1 were significantly higher when compared with those in group 2. Furthermore, the combined use of corticosteroid was revealed to be independently associated with the prevention of fatigue and appetite loss during Enz therapy. The results of the present study suggested that the combined use of corticosteroids could reduce the incidence of certain types of AE, particularly fatigue and appetite loss, in mCRPC patients treated with Enz.

Novel insight into the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ)

SummaryBisphosphonate-related osteonecrosis of the jaw (BRONJ), characterized by refractory bone exposure, has recently emerged as a serious side effect of bisphosphonate (BPs) treatment. We discuss novel insights that may help to improve the efficacy of BRONJ treatment and prevention. Our report highlights the following: (1) The presence of exposed bone in patients taking BPs does not necessarily reflect BRONJ, and diagnoses of oral ulceration with bone sequestration and malignancy must be excluded. (2) Osteonecrosis type of BRONJ is difficult to avoid using preventive dental measures alone. However, as with osteomyelitis type of BRONJ, preventive dental measures are indispensable for reducing the risk of secondary infection and disease progression. (3) The importance of tooth extraction as a risk factor for BRONJ among patients taking BPs has been overstated, particularly when they are administered at low doses. Delaying tooth extraction may increase the risk for the onset and progression of osteomyelitic BRONJ. (4) In patients taking low doses of BPs, dental implant surgery is not necessarily contraindicated if there are no other risk factors, such as combined use of corticosteroids or concomitant diabetes. However, the risk of BRONJ due to peri-implantitis must be explained when obtaining patient consent.

Treatment of Interstitial Lung Disease Associated With Myositis and the Anti-Synthetase Syndrome

The idiopathic inflammatory myopathies, including the anti-synthetase syndrome, are frequently complicated by interstitial lung disease (ILD). ILD in these patients can range from indolent to fulminant, and its presence is associated with increased morbidity and mortality. This review will focus on the most recent evidence guiding the management of myositis-associated ILD. Treatment of ILD typically involves the use of corticosteroids in combination with one or more immunosuppressive agents. Evidence supporting the use of each agent is limited to retrospective studies and case series, and there may be a benefit to starting more intensive therapy at the time of ILD diagnosis. Response to therapy is monitored by serial pulmonary function testing, as well as functional studies assessing O2 requirements with ambulation. A majority of patients demonstrate stabilization or improvement in pulmonary function with therapy; however, a minority worsens despite treatment. In a select group of these patients who fail to respond to conventional therapy, lung transplantation may be an option. Despite limited supporting data, a combination of corticosteroids and various immunosuppressive agents remains the first-line treatment of myositis-associated ILD. Outcomes are variable, and randomized trials are needed to determine the most effective combination of these drugs.

Modern aspects of pathogenesis, diagnosis and treatment of back pain

Chronic lower back pain (LBP) is the most widespread in the world cause of disability. The number of people suffering from this disease increases every year, making it a serious socioeconomic problem. The article deals with the latest information on BNS explain the mechanisms that are based on the interaction of mechanical, biological and chemical effects on the intervertebral disc (IVD). Proved that increased innervation degenerative IVD is one of the main components of pain in degenerative processes in IVD. There is a hypothesis that the reorganization of internal and external communications of certain areas of the hippocampus plays a role in the transition from pain subacute to chronic stage that was found in the investigated with chronic back pain using functional MRI. The modern treatment strategy LBP using mesenchymal stem cells. Restoration number of healthy cells in IVD leads to normalization of intercellular matrix and normalization of the morphology of the disc. LBP increases in inflammation of the lumbar spinal root ganglion as a result of immune response to the pathological process in the nucleus pulposus. In this situation, the use of corticosteroids in combination with a mineralocorticoid receptor blockers are an effective treatment for LBP. The article describes a method low wave laser therapy and its main operating principles that are widely used today to treat pain caused by disorders of the musculoskeletal system.

Concomitant use of corticosteroid and antimicrobials for liver abscesses in patients with chronic granulomatous disease

Chronic granulomatous disease (CGD) is a rare inherited disorder caused by defective nicotinamide adenine dinucleotide phosphate oxidase enzyme and characterized by recurrent bacterial and fungal infections. Although liver abscess is a common manifestation of CGD, its management in CGD patients is not well-defined. In addition, the generalized guidelines for treating liver abscesses do not necessarily apply to CGD patients. Corticosteroids are commonly used to control granulomatous complications, such as inflammatory gastrointestinal and genitourinary lesions, in patients with CGD, Corticosteroids have also been used in combination with antimicrobials to treat refractory infections in patients with CGD. Because corticosteroids are capable of suppressing symptomatic inflammation, all potential infections must be adequately controlled prior to corticosteroid initiation. We report 3 typical CGD cases with liver abscesses refractory to conventional treatments that were successfully treated with the concomitant use of corticosteroid and antimicrobials. It remains unclear whether corticosteroid therapy is required for liver abscesses in CGD refractory to conventional treatments. However, based on our observations, use of corticosteroids in combination with optimal antimicrobials should be considered for refractory liver abscesses in CGD.

Epidural steroid injection for spinal pain

Spinal pain is one of the most common complaints of patients and making an economic burden on society. The worldwidelifetime prevalence of lower back pain was reported as 84%. Most general physicians, as well as spine surgeons, commonlyencountered to the diagnostic and management strategy for spinal pain. Currently, nonsurgical invasive treatment includinginjection therapy before surgery had been routine management option. The epidural injections with or without corticosteroid wasproven to be effective for spinal pain, especially with radiculopathy, in short term period. The long term effect and combineduse of corticosteroid are under debate. Further rationalized studies for these debates should be conducted. To help the doctorsin choosing rationalized nonsurgical treatment methods for spinal pain, this study present the evidence based effectiveness ofepidural injections and comprehensive reviews of current trends for corticosteroids in use for spinal pain treatment.

Late profound muscle weakness following heart transplantation due to danon disease

Postoperative muscle weakness is a serious complication in surgical intensive care patients. It is mostly described as critical illness polyneuromyopathy. Risk factors include intensive care length of stay, sepsis, poor glycemic control, and combined use of corticosteroids and neuromuscular blocking agents, malnutrition, and electrolyte imbalance. We report a case of late-progressive, profound weakness after heart transplantation for noncompaction cardiomyopathy which required prolonged mechanical ventilation. The patient's muscle strength recovered completely after prolonged rehabilitation. Electromyographic assessment showed myopathy. Muscle biopsy revealed Danon disease, a genetic disorder affecting the lysosomal-associated membrane protein 2 gene (LAMP2). The finding of this genetic disorder was unexpected, because the preoperative echocardiographic diagnosis of noncompaction cardiomyopathy has not been reported in Danon disease. This report underlines the need for early availability of pathology results from the explanted heart, which showed the same disorder.

Long-term clinical and radiological evolution in one case of Susac’s syndrome

Susac's syndrome is a rare idiopathic microangiopathy affecting the precapillary arterioles of the brain, retina and cochlea leading to the clinical triad of encephalopathy, retinopathy and hearing loss. The objective of this study is to describe a new case of Susac's syndrome reactivated after a 12-year period with a good response to immunosuppressive therapy. The patient was a 32-year-old woman, complaining of diplopia, right blurred vision, progressive gait disturbance, tinnitus, attention deficit, and slight memory loss. The patient was diagnosed as having Susac's syndrome and discharged with steroid therapy. After a 12-year period of clinical stability she had a relapse. Immunosuppressive therapy resulted in significant clinical and radiological improvement. Early clinical identification of Susac's syndrome is crucial for the initiation of immunosuppressive therapy and differential diagnosis. In our case, the combined use of corticosteroids and azathioprine was key in the relapse management.