Administration Of Corticosteroids In Patients Research Articles

Diagnosing and Treating IgAN: Steroids, Budesonide, or Maybe Both?

IgA nephropathy (IgAN), the most common primary glomerulonephritis worldwide, is characterized by a mesangial IgA deposit and a variety of histological lesions, as described by the Oxford classification system. Despite the well-described "four-hit hypothesis", there are still plenty of less or undescribed mechanisms that participate in the disease pathogenesis, such as B-cell priming, which seems to be initiated by different antigens in the intestinal microbiota. Diagnosis of the disease is currently based on kidney biopsy findings, as the sensitivity and specificity of the many serum and urinary biomarkers described so far do not seem to have diagnostic accuracy. Therapeutic strategies consist of the initial step of non-immune medication, aiming to reduce both the intraglomerular pressure and proteinuria to below 0.5 g/day, followed by systemic corticosteroid administration in patients who remain at high risk for progressive chronic kidney disease despite the maximum non-immune treatment. The 6-month systemic corticosteroid treatment reduces proteinuria levels; however, the increased possibility of adverse events and increased relapse rate after treatment raises the need for a new therapeutic approach. Targeted-release budesonide is a therapeutic modality that aims to inhibit disease pathogenetic pathways at early stages; it has minor systemic absorption and proven beneficial effects on renal function and proteinuria. In the present systemic review, the benefits and adverse events of steroids and budesonide are described, and the possibility of combined treatment is questioned in selected cases with active histologic lesions.

Evaluation of different strategies for using steroids in the treatment of sudden sensorineural hearing loss

Introduction. Sudden sensorineural hearing loss is manifested by sudden or rapid hearing loss without obvious disturbances in the outer and middle ear. Often the cause of this condition is not established. At the moment, various methods are used in the treatment, including corticosteroids, which are most often used as primary therapy. Recent studies demonstrate the effectiveness of topical steroid administration.Aim. Assess the effectiveness and safety of various methods of topical and standard systemic use dexamethasone in the treatment of patients with acute sensorineural hearing loss, as well as to determine the optimal timing of therapy.Materials and methods. 61 patients with this disease were treated in the study. 20 of them received dexamethasone transtubarly, 21 – transtympanic, and 20 – systemically. Audiological examination was performed on all patients before treatment, at discharge, a month and six months after discharge. All participants regularly assessed their discomfort on a 10-point scale. Results. The results of treatment demonstrated the effectiveness of both systemic and local steroid therapy in patients with sensorineural hearing loss; however, with topical use of the drug, the proportion of patients with complete hearing restoration was greater. Transtympanic introduction of steroids after radiowave myringotomy turned out to be the most comfortable for patients the level of discomfort was 1.5 points out of 10, while against the background of transtubal administration of the drug and systemic treatment it was 4.5 and 2.3 points, respectively.Conclusions. The method of transtympanic administration of corticosteroids in patients with acute sensorineural hearing loss after radiowave myringotomy is a reliable and effective method of drug delivery to the windows of the labyrinth. This approach allows you to visually control the process of introducing the medication into the tympanic cavity. Transtympanic and transtubal methods of steroid administration are comparable in effectiveness to classical systemic steroid therapy in the treatment of patients with acute sensorineural hearing loss.

Efficacy of low-dose corticosteroids in patients with acute respiratory distress syndrome: a prospective observational study.

BackgroundThere is still no agreement on whether corticosteroids can reduce mortality in patients with acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the efficacy of low-dose corticosteroid administration in patients with ARDS.MethodsA prospective observational study of patients with ARDS in 17 hospitals in China was performed between March 2016 and February 2018. Propensity score matching was performed to adjust for differences in baseline characteristics between different groups. The effects of corticosteroids were assessed by using the Kaplan-Meier method and a multivariate Cox regression.ResultsA total of 527 ARDS patients were enrolled in the study. Sixty-five patients (12.3%) were administered low-dose (methylprednisolone ≤1 mg·kg−1·d−1) corticosteroids. The median dose was equivalent to 0.67 (0.57–0.81) mg/kg methylprednisolone for a median duration of 10 days. The control group included 224 patients (42.5%) who had never receive corticosteroids. In the matched sample, the hospital mortality rates in the low-dose (n=40) and control groups (n=80) were 27.5% and 42.5% (P=0.110), respectively. The length of hospital stay was significantly longer in the low-dose corticosteroid group than in the control group (24.0 vs. 17.0, P=0.002), and the multivariate Cox regression analysis suggested that the low-dose group had a significantly lower risk of death than the control group (HR: 0.48; 95% CI: 0.24–0.97; P=0.040).ConclusionsThe administration of low-dose corticosteroids may reduce mortality in patients with ARDS.

S1189 Efficacy of Corticosteroid Administration in Patients With Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Meta-Analysis

Introduction: Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is considered an obstetrical emergency, posing risk for high maternal morbidity and mortality if left untreated. While corticosteroids (CS) have been postulated to modify some of the pro-inflammatory features of HELLP syndrome, results from meta-analyses have thus far lacked the evidence to support CS’ overall benefit in attenuating disease process. In the past several years, there has been additional data published on the use of CS in HELLP syndrome, prompting an updated meta-analysis on the matter. Our study aims to evaluate the prognostic benefits of CS in HELLP syndrome. Methods: We performed a systematic literature review using multiple electronic databases. Continuous data under the generic inverse variance model was pooled and expressed as a standardized mean difference while the dichotomous data was analyzed using the Mantel-Haenszel model and expressed as odds ratios. Results: Nineteen studies were included. Administration of CS in HELLP syndrome was associated with a significantly increased platelet count (MD: 38.71 p < 0.05), decreased LDH (MD: -0.17 p < 0.05), decreased requirement for packed red blood cell transfusion (OR: 0.46 p < 0.05), decreased requirement for plasma transfusion (OR: 0.29 p < 0.05), and an increased risk of infection (OR: 1.65 p < 0.05). There was no significant difference in the following outcomes: hemorrhage, cardiopulmonary edema, renal failure, transaminitis, mode of delivery, eclampsia, and maternal death. Conclusion: Our results reaffirm those of prior meta-analyses conducted on the effects of CS in HELLP syndrome. Particularly, they highlight CS known effect in optimizing platelet count for the obstetrical patient. Interestingly, our meta-analysis demonstrates a significant decrease in LDH amongs patients with HELLP who received CS. As LDH is a known byproduct of hepatic dysfunction, our findings suggest a possible hepato-protective role of CS on the cellular level. While the effect of CS on hepatic morbidity was not statistically significant, the small sample size of women diagnosed with serious liver pathology made it challenging to assess the clinical impact thereof. At this time, there is not enough evidence to recommend utilization of CS for a hepatic benefit, given their deleterious effect on rates of maternal infection. Future studies with larger sample size data of liver injury in HELLP are warranted to evaluate the impact of CS on hepatic morbidity.Figure 1.: This forrest plot reflects that platelet count increases with corticosteroid administration in patients with HELLP syndrome.

No clinical benefit of high dose corticosteroid administration in patients with COVID-19: A preliminary report of a randomized clinical trial

The aim of this study was to evaluate the clinical effects of dexamethasone administration in patients with mild to moderate acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). The study included 50 patients who were randomly assigned to the dexamethasone group or control group. Dexamethasone was administered at a dose of 20 mg/day from day 1–5 and then at 10 mg/day from day 6–10. The need for invasive mechanical ventilation, death rate, duration of clinical improvement, length of hospital stay, and radiological changes in the computed tomography scan were assessed. The results revealed that 92% and 96% of patients in the dexamethasone and control groups, respectively, required noninvasive ventilation (P = 0.500). Among them, 52% and 44% of patients in the dexamethasone and control groups, respectively, required invasive mechanical ventilation (P = 0.389). At the end of the study, 64% of patients in the dexamethasone group and 60% of patients in the control group died (P = 0.500); the remaining patients were discharged from the hospital during the 28-day follow-up period. The median length of hospital stay was 11 days in the dexamethasone group and 6 days in the control group (P = 0.036) and the median length of hospital stay was 7 days in the dexamethasone group and 3 days in the control group (P < 0.001). No significant differences were observed in the other outcomes. This study showed that corticosteroid administration had no clinical benefit in patients with COVID-19-induced mild to moderate ARDS.

PACMAN trial protocol, Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac major surgery: a randomised, multicentre, double-blind, superiority study

IntroductionPostoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival after surgery. An excessive postoperative inflammatory response participates to the development of postoperative infection...

Practice Trends in Treating Central Nervous System Tuberculosis and Outcomes at a Tertiary Care Hospital: A Cohort Study of 244 Cases.

Introduction:Tubercular meningitis (TBM) is a common cause of chronic meningitis in India; however, there is a paucity of literature on optimum duration and choice of drug therapy.Materials and Methods:This was an ambispective cohort study.Results:Two hundred and forty-four patients of central nervous system tuberculosis (CNS TB) who were seronegative for HIV were studied of whom 198 had TBM and 46 patients had tuberculoma without meningitis. Before completion of treatment, 84% of TBM patients underwent imaging. There was no difference in disability or mortality in patients, who were treated with various drug regimens in terms of duration of therapy or number of drugs at initiation of treatment. However when patients developed new complications, adding more drugs improved survival. Prolonging corticosteroid administration in patients with nonsatisfactory improvement at 8 weeks was not associated with prevention of disability.Conclusions:CNS TB is treated by neurologists and physicians in India, as per their experience due to different recommendations in various guidelines. There is a tendency to decide when to stop treatment based on neuroimaging given the fear of poor outcomes associated with recurrence of the disease. The duration of treatment or choice of drugs at the start of treatment did not affect disability.

Improving Timeliness of β-Agonist and Corticosteroid Administration in Patients With Acute Wheezing.

Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. Our multidisciplinary team identified key contributing factors to timeliness, developed key driver diagrams, implemented and refined a management pathway, designed and executed rapid cycle improvements, and implemented interventions. A time series design was used to analyze outcomes with baseline data and continuous monitoring during active intervention steps. The primary outcomes analyzed were the times to first β-agonist and steroid administration. Secondary outcomes included admission rate, ED length of stay, and ED revisits. Assignment of the Pediatric Asthma Score, our initial pathway step, occurred in most patients within the first several months. Time to first β-agonist administration decreased from the baseline mean of 76 minutes to 27 minutes. Time to steroid administration decreased from the baseline mean of 108 minutes to 49 minutes. Mean monthly admission rate remained at 22% with no special cause variation identified. The ED revisit rate was not negatively impacted and, in most months, was 0%. By standardizing asthma care in our ED and redesigning care delivery processes, care variation decreased and significant improvements in timeliness of β-agonist and steroid administration occurred.

Clinical outcomes following corticosteroid administration in patients with delayed diagnosis of spinal arteriovenous fistulas

Background and purposeThere have been several previously reported cases of acute progression of myelopathic symptoms in patients with spinal arteriovenous fistula (SAVF) treated with intravenous methylprednisolone. This usually occurs during...

Clinical Outcomes Following Corticosteroid Administration in Patients with Delayed Diagnosis of Spinal Arteriovenous Fistulas (P6.076)

Clinical Outcomes Following Corticosteroid Administration in Patients with Delayed Diagnosis of Spinal Arteriovenous Fistulas (P6.076)

Corticosteroids in the treatment of community-acquired pneumonia: an evidence summary.

A strong inflammatory response to community-acquired pneumonia (CAP) is associated with excess morbidity and mortality. There is a growing interest in corticosteroids as an adjunctive treatment for patients hospitalized with CAP. We review recent randomized trials addressing the use of corticosteroids across the full range of CAP patients. Thirteen randomized controlled trials including 2005 patients have addressed the effect of short-term (single dose to 10 days) corticosteroid administration in patients with CAP. The results consistently show a shorter time to clinical stability and a shorter length of hospital stay on the order of 1 day. Some studies have also suggested a possible reduction in mortality. Adverse effects, primarily hyperglycemia and neuropsychiatric symptoms, are uncommon and neither serious nor prolonged. The results indicate a possibility that steroid administration should become a standard of care for patients with CAP.

Community-acquired pneumonia treatment: predictors of fatal outcomes

Aim. To analyze the quality of the medical aid in cases of community-acquired pneumonia with fatal outcomes and further development of recommendations for optimizing treatment strategy and tactics. Methods. Retrospective analysis of 62 medical charts of in-patients who passed away from community-acquired pneumonia during the calendar year. Results. The major part of all fatal outcomes of community-acquired pneumonia were seen at the intensive care units, to which the majority of such patients (41 cases, 66.1%) were admitted right from the admission ward. Differences of treatment tactics in patients with community-acquired pneumonia were revealed depending on the department type (internal diseases, intensive care unit, pulmonology) where the patients were admitted. The treatment manipulations structure and common mistakes made in administrating antibacterial and non-anti-infective drugs in cases of community-acquired pneumonia with fatal outcomes were analyzed. Anti-microbial treatment was assessed as completely adequate only in 18% of cases. In cases of severe community-acquired pneumonia with fatal outcomes the most commonly administered antibacterial drug was ceftriaxone (41 cases, 66.1%). At the same time, the potential of semisynthetic aminopenicillins was not unlocked (only 9 cases, 14.5%). The most common contraventions of rational anti-microbial treatment principles were irrational combinations, inadequate daily dosage and antimicrobial treatment change sequence. A trend for inappropriate administration of corticosteroids in patients with severe and extremely severe community-acquired pneumonia in the intensive care units was observed. The use of other non-anti-infective drugs (anticoagulants, diuretics, mucolytic agents and bronchodilators) as components of complex treatment in patinets with life-threatening community-acquired pneumonia should be strictly limited by their indications for use. Conclusion. Rational anti-bacterial treatment performed in compliance with national recommendations (2010) is the cornerstone of treating community-acquired pneumonia.

Role of Corticosteroids during Cardiopulmonary Bypass

Corticosteroids are commonly used in the peri-operative setting for patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The inflammatory response to CPB is associated with organ dysfunction and increased mortality. Corticosteroids reduce biochemical inflammatory markers associated with CPB, however the impact on clinical outcomes is mixed. The purpose of this article is to evaluate the evidence of changes in clinical outcomes associated with the peri-operative administration of corticosteroids in patients undergoing cardiac surgery with CPB. Randomized, placebo-controlled trials and meta-analyses were reviewed for evidence evaluating the impact of corticosteroids on clinical outcomes including mortality, myocardial infarction, atrial fibrillation (AF), duration of intubation, length of intensive care unit (ICU) or hospital stay, hyperglycemia, and gastrointestinal complications. Most of the relevant studies are underpowered to assess major clinical outcomes. Although corticosteroids likely reduce the risk of AF, this needs to be evaluated when used in addition to or in lieu of other anti-arrhythmic agents. Evidence does not equivocally support the use of corticosteroids to improve clinical outcomes in cardiac surgery patients.

Do Low-dose Corticosteroids Improve Mortality or Shock Reversal in Patients with Septic Shock? A Systematic Review and Position Statement Prepared for the American Academy of Emergency Medicine

BackgroundThe management of septic shock has undergone a significant evolution in the past decade. A number of trials have been published to evaluate the efficacy of low-dose corticosteroid administration in patients with septic shock. MethodsThe Sepsis Sub-committee of the American Academy of Emergency Medicine Clinical Practice Committee performed an extensive search of the contemporary literature and identified seven relevant trials. ResultsSix of the seven trials reported a mortality outcome of patients in septic shock. Analysis of the data revealed that the relative risk (RR) of 28-day all-cause mortality in septic shock patients who received low-dose corticosteroids was 0.92 (95% confidence interval [CI] 0.79–1.07). All seven trials reported data concerning shock reversal or the withdrawal of vasopressors. Pooled results revealed that the RR of shock reversal is 1.17 (95% CI 1.07–1.28), which suggests that there may be significant improvement in shock reversal after corticosteroid administration. It is important to understand that two of the seven studies reviewed were disproportionately represented and accounted for 799 of 1005 patients (80%) considered for this recommendation. ConclusionsThe evidence suggests that low-dose corticosteroids may reverse shock faster; however, mortality is not improved for the overall population.

Leukocyte Dynamics in Mechanically Ventilated COPD Exacerbation Patients Treated With Corticosteroids

PURPOSE: Leukocytes are often found to be increased in patients treated with corticosteroids. This study was conducted to evaluate quantitative changes in total leukocyte count (TLC), neutrophil, lymphocyte and eosinophil counts following corticosteroid administration in patients on mechanical ventilator due to COPD exacerbation.

REGRESSION OF PRIMARY CENTRAL NERVOUS SYSTEM GERMINOMA AFTER DEXAMETHASONE ADMINISTRATION: A Case Report

Childhood central nervous system (CNS) germinoma are highly curable brain tumors characterized pathologically by varying degrees of lymphocytic infiltration. The authors present a case of a CNS germinoma with significant regression in size following surgery and administration of dexamethasone, prior to initiation of chemotherapy or irradiation. The authors speculate the possible mechanism involved in its occurrence. Perioperative corticosteroid administration in patients with CNS germinoma may obfuscate the increase in response demonstrated with various chemotherapy regimens or with irradiation in CNS germinomas.

MRI evaluation of osteonecrosis in knee joints after intravenous administration of corticosteroids in patients with severe acute respiratory syndrome

目的 分析严重急性呼吸综合征(SARS)糖皮质激素治疗后膝关节骨缺血性坏死的发生和MRI特点.方法 4所医院感染SARS并经糖皮质激素治疗的医护人员共18例,均行双侧膝关节和双髋关节MR检查,确定骨坏死发生与否、病变特点及其与糖皮质激素用量的关系.结果 18例中,11例出现膝关节骨坏死,3例合并双侧髋关节股骨头坏死.7例为双侧膝关节骨坏死,4例为单侧.膝关节骨坏死病灶共计38个,34个位于股骨内、外侧髁以及相邻的股骨干,4个位于胫骨内或外侧髁.膝关节骨坏死的大、中病灶多为不规则形,周边呈细带状低信号,其中4个在T2WI上可见双边征;坏死灶内T1WI多为等或稍低信号,T2WI多为高、等或混杂信号.小病灶在T1WI上为低信号,T2WI上多为低或高信号.髋关节股骨头坏死灶位于其中上部、软骨下,呈类椭圆形异常信号,病灶内T1WI为等信号,T2WI为高或混杂信号;周边有不规则低信号带,其中1例双侧病灶T2WI上可见双边征.结论该组SARS病例糖皮质激素治疗后骨缺血性坏死以膝关节为多,对这类病人应注意早期行膝关节MR检查.膝关节坏死以股骨内、外侧髁和相邻的股骨干最多见,胫骨内外、侧髁亦可发生.骨缺血性坏死的发生及严重程度与静脉糖皮质激素用量有关。

Addison's disease and hypothyroidism untreated until twenty-four weeks of pregnancy

Addison's disease and hypothyroidism untreated until twenty-four weeks of pregnancy

Addison's disease and hypothyroidism untreated until twenty-four weeks of pregnancy

Addison's disease and hypothyroidism untreated until twenty-four weeks of pregnancy

An evidence-based approach to the evaluation and treatment of premature rupture of membranes: Part II.

Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is responsible for one third of all preterm births. In part I of this series, the definition, pathophysiology, and diagnosis of PPROM was reviewed. In this part, treatment is discussed. Adjunctive antibiotic and corticosteroid therapy has the strongest evidence for improving neonatal outcome. Treatment is gestational age-dependent and will be influenced by local neonatal intensive-care unit (NICU) survival statistics. This review presents the available evidence and grades it according to the U.S. Preventative Task Force recommendations. After completion of this article, the reader should be able to summarize the data on the use of labor inhibition in the setting of PPROM, list potential antibiotics regimens that are recommended for prophylaxis in patients with PPROM, to describe the benefits of corticosteroid administration in patients with PPROM, and to outline potential management strategies for patients with PPROM based on gestational age.