Combination Of Corticosteroids Research Articles

Profile of Dermatologic Side Effects of Tyrosine Kinase Inhibitor (EGFR-TKIs) in Lung Cancer Patients

Background: Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKIs) drugs are commonly used target therapies in patients with advanced-stage non-small cell carcinoma lung cancer (NSCLC).Objectives: This study aims to provide an overview of dermatologic side effects and quality of life index of NSCLC patients who received EGFR-TKIs targeted therapy at Dharmais Cancer Hospital.Methods: This study used a cross-sectional design. Inclusion criteria were patients who received EGFR-TKIs targeted therapy, namely gefitinib, erlotinib, and afatinib, in September - October 2023, who were willing to be research subjects, and patients who were not in a medical emergency. In total, 52 patients filled out the dermatology life quality index (DLQI) questionnaire through interviews and medical records. Data evaluation was performed descriptively in the form of percentages.Results: The most common occurrence of dermatologic side effects was skin hypersensitivity reactions with mild severity (grade 1) by 59.6%, moderate severity (grade 2) by 19.2%, and severe severity (grade 3) by 1.9%, and no drug dermatologic side effects by 19.2%. In comparison, the most DLQI was in the category of not affecting patient life. In general, side effects with moderate (grade 2) and severe (grade 3). The severity will decrease to mild severity (grade 1) when already getting topical corticosteroid drugs or combinations with oral antibiotics and antihistamine drugs.Conclusion: The most severe side effect was grade 1, which slightly affected the patient's quality of life. Education and monitoring of side effects and management of symptoms are necessary to reduce the severity and improve patients' quality of life.

The Effect of Baricitinib and Corticosteroid Compared to that of Corticosteroid Monotherapy in Severely and Critically ill Patients with COVID-19: A Japanese Multicenter Inpatient Database Study.

BackgroundSystemic baricitinib and corticosteroids play important roles in treating severely and critically ill patients with coronavirus disease 2019 (COVID-19). However, the efficacy of the combination of baricitinib and corticosteroids compared to that of corticosteroid monotherapy in severely and critically ill hospitalized patients with COVID-19 remains unclear. MethodsWe analyzed severely and critically ill hospitalized patients with COVID-19 aged >18 years between January 1, 2020 and May 31, 2023, using a Japanese multicenter inpatient database. We performed propensity score matching to analyze the effect of the combination of baricitinib and corticosteroids within 2 days of hospital admission (combination group) on the 28-day and in-hospital mortality rates compared with those of corticosteroid monotherapy within 2 days of hospital admission (control group). Sensitivity analysis was performed using inverse probability weighting analysis and the generalized estimating equation method. ResultsThe eligible patients (n=7,433) were divided into a combination (n = 679) and a control group (n = 6,754). One-to-four propensity score matching analyses included 566 combination and 2,264 control group patients. There was no significant difference in 28-day (8.5% vs. 8.8%; risk difference, -0.3% [95% confidence interval, −2.9 to 2.3]) or in-hospital (11% vs. 10%; risk difference, 1.0 [−1.9 to 3.9]) mortality rates between 2 groups. The sensitivity analysis showed similar outcomes. ConclusionThis observational study, using a Japanese multicenter inpatient database, found that the combination of baricitinib and corticosteroid therapy did not improve the 28-day or in-hospital mortality rates in severely and critically ill patients with COVID-19 compared to corticosteroid monotherapy.

Immunomodulators in patients receiving extracorporeal membrane oxygenation for COVID-19: a propensity-score adjusted analysis of the ELSO registry

BackgroundMortality for patients receiving extracorporeal membrane oxygenation (ECMO) for COVID-19 increased over the course of the pandemic. We investigated the association between immunomodulators and mortality for patients receiving ECMO for COVID-19.MethodsWe retrospectively analysed the Extracorporeal Life Support Organisation registry from 1 January, 2020, through 31 December, 2021, to compare the outcomes of patients who received no immunomodulators, only corticosteroids, only other immunomodulators (selective interleukin blockers, janus-kinase inhibitors, convalescent plasma, and intravenous immunoglobulin), and a combination of corticosteroids and other immunomodulators administered either before or during ECMO. We used Cox regression models to estimate survival time until 90 days. We estimated the propensity score of receiving different immunomodulators using multinomial regression, and incorporated these scores into the regression models.ResultsWe included 7181 patients in the final analysis; 6169 patients received immunomodulators either before or during ECMO. The 90-day survival was 58.1% (95%-CI 55.1–61.2%) for patients receiving no immunomodulators, 50.7% (95%-CI 49.0–52.5%) for those receiving only corticosteroids, 62.2% (95%-CI 57.4–67.0%) for those receiving other immunomodulators, and 48.5% (95%-CI 46.7–50.4%) for those receiving corticosteroids and other immunomodulators. Compared to patients without immunomodulators, patients receiving either corticosteroids alone (HR: 1.13, 95%-CI 1.01–1.28) or with other immunomodulators (HR: 1.21, 95%-CI: 1.07–1.54) had significantly shorter survival time, while patients receiving only other immunomodulators had significantly longer survival time (HR: 0.79, 95%-CI: 0.66–0.96). The receipt of immunomodulators (across all three groups) was associated with an increase in secondary infections.ConclusionsIn this cohort study, we found that immunomodulators, in particular corticosteroids, were associated with significantly higher mortality amongst patients receiving ECMO for COVID-19, after adjusting for potential confounding variables and propensity score. In addition, patients receiving corticosteroids with or without other immunomodulators had longer ECMO runs, which has potential implications for resource allocation. While residual confounding likely remains, further studies are required to evaluate the timing of immunomodulators and better understand the possible mechanisms behind this association, including secondary infections.

Comparison of intra-articular injection of platelet-rich plasma with combination of bupivacaine and corticosteroid in osteoarthritis knee

Abstract Background and Aims: The use of intra-articular injection has been widely accepted as a therapy for pain due to osteoarthritis of the knee. We aimed to compare the efficacy of intra-articular injection of platelet-rich plasma (PRP) with a combination of bupivacaine and corticosteroid in osteoarthritis of the knee. Material and Methods: Fifty patients (aged more than 50 years) with pain pattern consistent with osteoarthritis of the knee who did not respond to conservative treatment were included in the study. They were randomly divided into two groups of 25 each: group I (n = 25) patients were administered fluoroscope-guided intra-articular knee injection of bupivacaine and steroid, and group II (n = 25) patients were administered intra-articular knee injection of PRP. In group I, patients were administered 9 ml of drug solution comprising 8 ml of 0.5% bupivacaine and 1 ml of triamcinolone (40 mg). In group II, patients were administered 6 ml of PRP. Pain, patient satisfaction, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed at different time intervals before and after the procedure for up to 12 months. Results: Pain score and WOMAC were both clinically and statistically better at 2 weeks and 1 month after injection in group I (P < 0.05). But results were better clinically in group II compared to group I at 2, 3, 6, and 12 months after the procedure. More than 50% of patients in both groups had excellent satisfaction. Conclusions: Both techniques were effective in providing good analgesia. Pain relief and improvement in disability were clinically higher with PRP for longer duration.

Mycophenolate Mofetil for the Treatment of Warm Autoimmune Haemolytic Anaemia Post-Rituximab Therapy: A Case Series.

Warm autoimmune haemolytic anaemia (wAIHA) is an acquired haemolytic disorder most commonly treated with a combination of corticosteroids, rituximab and/or splenectomy. Third-line therapies for refractory cases include immunosuppressive agents. Mycophenolate mofetil is frequently used in these scenarios, although its use is supported by small studies and anecdotal evidence rather than large-scale data. We describe three cases of refractory warm autoimmune haemolytic anaemia successfully treated with mycophenolate mofetil. Case 1: A persistent case of autoimmune haemolytic anaemia in a 56-year-old was ultimately managed with mycophenolate mofetil, leading to successful steroid tapering and stable haemoglobin levels without relapse. Case 2: A woman with a complex oncological history, including lymphoma and breast cancer, achieved remission with mycophenolate therapy, maintaining stability post-steroid treatment. Case 3: Mycophenolate proved effective for a 63-year-old with cirrhosis after recurrent autoimmune anaemia and deep vein thrombosis, enabling cessation of steroids and maintaining remission. Management of this condition can be challenging and balancing the available treatments is crucial to reduce potential complications from long-term therapies that appear to be ineffective. Our case series demonstrates anecdotal experience on successful use of mycophenolate mofetil for complex refractory cases of wAIHA. Warm autoimmune haemolytic anaemia can be a challenging condition to manage. Refractory cases that are steroid-dependent can benefit from trialling steroid-sparing agents such as mycophenolate.Anti-CD20 agents such as rituximab can be very effective in refractory cases, however there is a small percentage of patients that might not be responsive to this monoclonal antibody.Autoimmune haemolytic anaemias can be frequently complicated by thrombotic events, and part of the backbone treatment is establishing good thromboprophylaxis.

Corticosteroid Injection With and Without Local Anesthetic for the Treatment of Trigger Finger: A Randomized Clinical Trial

This study aimed to report pain during and following injection for trigger finger as well as failure to resolve triggering. We hypothesized that a corticosteroid injection alone would be equally or less painful compared with the standard combination of corticosteroid and lidocaine for the treatment of trigger fingers, and there would be no difference in the resolution of triggering. Our study was a prospective, single-blinded, randomized controlled trial at a single institution, comprising 76 patients with a diagnosis of trigger finger. Each treatment group consisted of 38 patients. Patients were randomized to receive either a betamethasone (1 mL, 6 mg) injection without lidocaine or a betamethasone injection (1 mL, 6 mg) with 1% lidocaine (1 mL). Patients were assessed during injection and at 1 hour, 6 hours, 2 days, and 6 weeks after the injection. The primary outcome was pain measured using a numerical rating scale. The secondary outcome was the rate of failure to resolve symptoms at 6 weeks. There was a statistically significant difference in pain scores between the lidocaine and betamethasone versus betamethasone-only injections during administration (4.6 vs 6.2) and after 1 hour (1.3 vs 2.5). There was no statistically significant difference in pain scores after 6 hours (1.5 vs 2.0) and 2 days (0.7 vs 0.6) or in failure rate at the 6-week time point (21% vs 18%). This study showed that there is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone for the treatment of trigger finger, but that difference may not be clinically relevant. There was no significant difference in the failure rate between the treatments. Therapeutic II.

Hepatitis E virus and SARS-CoV-2 co-infection in an immunocompromised patient: A case report

Hepatitis E virus (HEV) is a major cause of acute viral hepatitis. Since the coronavirus disease 2019 (COVID-19) pandemic, immunocompromised individuals face an increased risk of HEV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection, posing a threat of liver failure and prolonged illness. A 69-year-old male, with a history of chronic lymphocytic leukemia, was co-infected with HEV and SARS-CoV-2. Given the progressive decline in liver function post-admission, steroid therapy was initiated, which led to treatment-related complications. Additionally, the patient experienced an aggravation of COVID-19 symptoms due to persistent SARS-CoV-2 infection, effectively managed through a combination of antiviral medications and corticosteroids. This case describes the intricate clinical trajectory and therapeutic approach for managing HEV and SARS-CoV-2 co-infection, underscoring the potential efficacy of short-term corticosteroid intervention alongside comprehensive antiviral treatment.

Breakthrough Opportunities of Nanotheranostics in Psoriasis: From Pathogenesis to Management Strategy.

In this paper, we have discussed recent advances in our understanding of the aetiology of psoriasis, particularly as they relate to aryl hydrocarbon receptors in DCs, Langerhans cells, macrophages, signal transducer and activator of transcription 3 pathways, and dermal vascular endothelial cells. Here, we have shown that the ability to target specific cellular and molecular components of psoriasis pathogenesis with nanoscale precision using phos-phodiesterase 4 inhibitors represents a transformative opportunity to address the complex nature of this dermatological condition. In this review, we have examined the molecular mechanisms behind the pathogenic features of psoriasis and new treatments being tested in clinical settings. There is research being done on new treatments created in the last ten years. This field highlights the advantages of nan-otechnological technologies as cutting-edge candidates for drug delivery systems in psoriasis and other inflammatory chronic skin disorders. Future Developments: Nanotechnology-based treatments currently under study show good effi-cacy and low side effect profiles. However, long-term prospective trials are required to demon-strate long-term safety and effectiveness. Phosphodiesterase inhibitors, Janus kinase inhibitors, nonsteroidal anti-inflammatory drugs, combinations of vitamin D3 derivatives and corticoster-oids, and coal tar formulations are some of the newer topical treatments for psoriasis. The psoriasis treatment continues to involve conventional medications (i.e., medi-cines that are generally acknowledged as either normal therapy or outdated remedies), whether used topically or orally. Nonetheless, we are starting to see initiatives to create pharmaceuticals and biosimilars with better therapeutic results, fewer side effects, and greater efficacy.

Epidemiology and outcome of infantile spasms in Denmark in 1996–2019

PurposeTo investigate the treatment of infantile epileptic spasm syndrome (IESS) in Denmark. MethodsNational retrospective cohort study of all patients born 1996–2019 who had a diagnosis of IESS in the National Patient Registry. Medical records were reviewed to evaluate the diagnosis. Patients were included if semiology was compatible with IESS, or if unclear semiology if there was an abnormal EEG or EEG with hypsarrhythmia. ResultsNumber of cases with a register based IESS diagnosis was 538. Medical records were unavailable in 48 and 164 did not fulfil the inclusion criteria. Thereby the cohort consisted of 326 children. Mean age at onset of IESS was 5.9 months and mean lead time to treatment was 26.6 days (SD= 63.5). Consistent with the Danish treatment guidelines most patients received vigabatrin as first treatment. In the cohort 44.7 % of patients solely received vigabatrin, whereas combined vigabatrin and corticosteroid was given to 28.3 % (either hydrocortisone or prednisolone). Other anti-seizure medication was given to 28.4 % within 90 days of IESS onset. Aetiology was prenatal (40.3 %), perinatal (10.5 %), postnatal (3.7 %), with unknown timing (10.2 %) or with unknown aetiology (33.5 %). The cohort was followed to a mean age of 8.2 years. At latest follow-up severe neurodevelopmental outcome was seen in 44.2 % and 76.4 % still had epilepsy. The incidence of IESS was 22 per 100.000 live births. ConclusionIn Denmark treatment algorithm is based on start of treatment with vigabatrin. A total of 44.7 % became seizure free by vigabatrin. Neurodevelopmental outcome was severe. A national incidence could be established.

Phenytoin-induced toxic epidermal necrolysis (TEN). Combined treatment with steroids and human intravenous immunoglobulin: Case report

Background. Toxic epidermal necrolysis (TEN) is a severe systemic disease that affects the skin and mucosa, with a mortality rate above 30%. Pharmaceutical drugs are the main causal agents of this reaction, with most cases being largely associated with phenytoin. There is no generally accepted treatment for TEN. The administration of systemic corticosteroids combined with human intravenous immunoglobulin (IVIG) may be a possible adjuvant therapy. Case presentation. A 72-year-old patient who received phenytoin for four weeks as a prophylactic treatment after undergoing surgery to drain a chronic subdural hematoma developed TEN-compatible symptoms, which prompted treatment with methylprednisolone (1 g/day for 3 days) combined with IVIG (0.5 gr/kg/day for 5 days), with favorable response. Conclusion. Our patient’s response to the combination of corticosteroids and IVIG was favorable. However, due to the nature of this report, the function this combination of drugs has must be further researched.

Pharmacological Interventions for Menière's Disease: A Systematic Review and Network Meta-Analysis.

Objective: Evaluation of the effectiveness and posttreatment effects of intratympanic gentamicin and corticosteroids in treating patients with Ménière's disease (MD). Methods: Based on PubMed and Embase databases, randomized controlled trials using intratympanic injections of 4 drugs (gentamicin, methylprednisolone, dexamethasone, and placebo) for the treatment of MD were searched from 1995 to October 2023, and the literature was screened according to inclusion and exclusion criteria, and data were netted for meta-analysis using Stata 17. Results: A total of 13 studies were selected, involving 559 participants, with follow-up time ranging from 3 to 28 months. Meta-analysis showed that there was no statistically significant difference in pure-tone average between gentamicin and dexamethasone [standardized mean difference (SMD) = 0.09, 95% confidence interval (CI) (-0.42, 0.24), P < .05]. Compared to placebo, intratympanic injection of gentamicin [risk ratio (RR) = 1.18, 95% CI (0.43, 1.93)], methylprednisolone [RR = 0.88, 95% CI (0.07, 1.70)], and dexamethasone [RR = 0.70, 95% CI (-0.01, 1.41)] all showed better efficacy in treating vertigo. For the treatment of tinnitus, the SUCRA ranking results showed that dexamethasone was the most effective, followed by methylprednisolone and gentamicin. Conclusion: Pharmacological intervention is more effective than placebo in treating MD. Although gentamicin treatment shows significant effects in treating vertigo, corticosteroid combination therapy is markedly superior to gentamicin in controlling hearing loss and vertigo symptoms.

Stevens Johnson Syndrome Review

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are dermatologic emergencies that are distinguished by extensive epidermal necrolysis and sloughing. The incidence rates are location-dependent. Mortality rates vary from 4.8-9% to 14.8-48%, with females being more frequently affected than males. Supportive care, infection control, wound care, and fluid and electrolyte management comprise nonpharmacologic treatment for SJS/TEN patients. The identification and cessation of the causative substance are the most critical components. The management of fluid, electrolytes, and nutrition is essential for SJS/TEN patients, as they have lower fluid requirements than burn patients. Prophylactic antibiotics do not improve outcomes; however, infection prevention necessitates appropriate wound care and antiseptic handling. The decision to pursue surgical debridement is contingent upon the location of care, and the function of this treatment option has been a subject of controversy. Anti-shear therapy, which entails the preservation of denuded epidermis and the aspiration of blister fluid, has been demonstrated to be effective in decreasing mortality rates. The disease's rarity has resulted in a scarcity of prospective studies on pharmacologic treatment for SJS/TEN. There have been reports of a variety of treatment regimens that involve corticosteroids, IVIg, cyclosporine, and TNF-alpha inhibitors. However, it is difficult to ascertain whether the disease's remission was caused by a specific treatment or the natural course of the disease. Studies have demonstrated that supportive care and cyclosporine have the potential to serve as alternative treatments for SJS/TEN. A meta-analysis of 10 studies revealed that patients who received cyclosporine had a survival advantage, while a meta-analysis of 67 studies revealed that the combination of corticosteroids and IVIg resulted in statistically significant improvements in outcomes. The severity of illness scores in patients with SJS/TEN overlap or TEN was reduced by plasmapheresis, which entails plasmapheresis and corticosteroids. In 86.8% of patients, TNF-alpha inhibitors have also demonstrated positive outcomes, despite their immunosuppressive properties. Nevertheless, the most effective pharmacological treatment for SJS/TEN must be determined by taking into account practical factors, such as cost. There is a lack of consensus regarding the most effective treatment, and additional research is required to ascertain the most effective treatment.

A novel approach to induce early remission in high-risk primary membranous nephropathy.

This prospective single-arm trial with historic controls evaluated the efficacy and safety of treatment based on a combination of rituximab, intravenous cyclophosphamide and corticosteroids (RCP) administered at lower cumulative doses for the induction of early remission in primary membranous nephropathy (PMN). We prospectively enrolled 30 high-risk PMN patients with persistent nephrotic syndrome (NS) and elevated antibodies to the phospholipase A2 receptor who underwent RCP therapy. We compared the effectiveness of RCP with that of historic controls who received rituximab-based therapy (RTX, n=15) or cyclosporine+corticosteroids (CSA, n=42). The primary outcomes were complete remission (CR) and overall remission (OR) by Month 12 and the time to remission. In the RCP group, the OR and CR rates by 12months (97% and 60%) were higher than those in the RTX group (60% and 7%, P≤.009) and the CSA group (50% and 24%, P≤.003). The median time to OR [2.8 (1.6-3.9) months] was shorter compared with RTX [7.1 (3.4-17.5) months, P=.008] and CSA [7.3 (6.0-13.6) months, P<.001]. In adjusted Cox regression, hazard ratios for OR and CR attainment for RCP versus other treatments were 5.2 (95% CI 2.8-9.6) and 4.8 (95% CI 2.2-10.3), respectively. Propensity score-matched group analyses confirmed these results. One serious adverse event occurred in the RCP group in the follow-up of 56 patient-years. RCP therapy is considered effective and safe for inducing early remission in high-risk PMN patients.

Non-islet cell tumour hypoglycaemia in adrenocortical carcinoma responding to combined growth hormone and corticosteroid therapy

Non-islet cell tumour hypoglycaemia in adrenocortical carcinoma responding to combined growth hormone and corticosteroid therapy

Medullary sponge kidney with IgA nephropathy: a case report and literature review

BackgroundMedullary sponge kidney (MSK)is rare in association with glomerulonephritis. We report a patient with medullary sponge kidney, and the kidney biopsy revealed a diagnosis of IgA nephropathy.Case presentationA 27-year-old female presented with hematuria and proteinuria, and imaging studies indicated the presence of medullary spongy kidney. With appropriate preparation, a kidney biopsy was performed. Considering the patient’s clinical and pathological characteristics, the final diagnosis was determined to be medullary sponge kidney associated by IgA nephropathy. The combination of corticosteroids and angiotensin receptor blockers (ARBs) proved to be significantly effective in reducing proteinuria in the current case. To the best of our knowledge, this is the first reported case that demonstrates the coexistence of MSK and IgA nephropathy.ConclusionsAdministering precise therapy based on renal pathology can potentially enhance outcomes for patients with renal conditions, necessitating the need for clinicians to be vigilant about differential diagnosis in order to reduce the rates of missed diagnoses and misdiagnosis.

Corticosteroid monotherapy versus combined cytarabine continuous rate infusion and corticosteroid therapy in dogs with meningoencephalitis of unknown origin: A blinded, randomized, controlled trial.

Treatment options available for meningoencephalitis of unknown origin (MUO) in dogs are suboptimal, and currently, no single treatment protocol appears to be superior. Compare neurological deterioration rates at 7 days between dogs with MUO treated with corticosteroids alone or combined with cytosine arabinoside (CA) continuous rate infusion (CRI) and compare clinical deterioration and survival at 30 and 100 days. Sixty-nine dogs with magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) features or both compatible with MUO. Parallel, blinded, randomized controlled trial. Simple randomization into 2 treatment groups: 4 mg/kg/day prednisolone (or dexamethasone equivalent) for 2 days or 200 mg/m2 CA CRI over 8 hours plus 2 mg/kg/day prednisolone. Blinding of the treatment protocol was carried out using reversible redaction of clinical records, and treatment failure was defined as deterioration of neurological assessment or death. Using intention-to-treat analysis, proportions failing treatment at 7, 30, and 100 days were compared using Fisher's exact test. All-cause mortality at 100 days was compared using Kaplan-Meier survival curves. Thirty-five dogs were allocated to corticosteroid only, and 34 dogs were allocated to combined CA CRI and corticosteroid. Proportions failing treatment at 7, 30, and 100 days were 7/35 (20%), 9/35 (26%), and 15/35 (43%) in the corticosteroid-only group and 8/34 (24%), 11/34 (32%), and 23/34 (68%) in the corticosteroid and CA CRI group. All-cause mortality at 100 days was not significantly different between groups (P = .62). Clinically relevant treatment-related adverse effects were not observed. We foundno difference in outcome between corticosteroid monotherapy and combined cytarabine CRI and corticosteroid therapy at 7, 30, and 100 days after diagnosis in dogs with MUO.

A Case of Psoriasis and Pemphigus Foliaceous in a 55-year-old Filipino

Pemphigus foliaceous is a rare autoimmune blistering disease, while psoriasis is a common immune-mediated inflammatory skin disease. The coexistence of psoriasis and pemphigus foliaceous has rarely been reported. We report a case of a 55-year-old Filipino female with an 8-year history of chronic plaque-type psoriasis biopsy-proven. After 5 years, she developed generalized flaccid bullae and crusted erosions over the face, trunk, and extremities, with no mucous membrane involvement. Skin punch biopsy, direct immunofluorescence, and enzyme-linked immunosorbent assay were consistent with pemphigus foliaceous. The combination of topical corticosteroids and oral methotrexate was selected as the therapeutic approach, leading to a notable improvement in the patient’s condition. This case report underscores the significance of identifying the simultaneous presence of psoriasis alongside autoimmune blistering diseases like pemphigus foliaceous. Examining predisposing and triggering factors, performing re-biopsy, and further work-up as the disease evolves may yield more profound insights. Nonetheless, effectively managing this condition poses a significant challenge.

Effects of prednisolone tapering on effectiveness of infliximab in patients with ulcerative colitis: data from a retrospective cohort

Background and objectiveThe influence of concomitant prednisolone on clinical outcomes and safety in infliximab-treated ulcerative colitis (UC) patients is unknown.Design, setting, participants and outcome measuresA retrospective cohort study was performed,...

Chronic inflammatory demyelinating polyradiculoneuropathy associated with neuromyelitis optica spectrum disorder: A rare case report

IntroductionChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare disease that targets the myelin sheath, while neuromyelitis optica spectrum disorder (NMOSD) with anti-aquaporin-4 antibodies (AQP4-Ab) affects astrocytes. We report a unique case of CIDP associated with NMOSD. Case presentationA 49-year-old woman presented to the emergency department with recurrent episodes of vertigo and blurred vision. Brain magnetic resonance imaging (MRI) with contrast eight months before admission showed Dawson’s finger, and follow-up brain MRI showed a new hyperintense lesion. Visual evoked potential showed bilateral pre-chiasma lesions, and somatosensory evoked potential indicated lesions between the medulla and cerebral cortex. The patient tested positive for AQP4-Ab, and had ascending lower motor neuron weakness for the past 10 weeks. Electromyography revealed multiple demyelinating lesions suggestive of CIDP. The patient was intravenously administered corticosteroids, methotrexate, and azathioprine, resulting in clinical improvement. ConclusionCIDP associated with NMOSD is a rare occurrence. In our patient, a combination of corticosteroids and immunosuppressants was effective. The mechanism of combined demyelination of the central and peripheral nervous systems is still not fully understood, and further immunological and pathological studies are needed.

Assessing the effect of remdesivir alone and in combination with corticosteroids on time to death in COVID-19: A propensity score-matched analysis

BackgroundThis study aimed to evaluate the impact of remdesivir, alone or in combination with corticosteroids, on the time to death in COVID-19 patients. MethodsThis retrospective cohort study was conducted between March 20, 2020, and March 18, 2021, on 5318 patients with confirmed COVID-19 at three tertiary educational hospitals in Tehran, Iran. The treated group consisted of COVID-19 patients who received remdesivir, either alone or in combination with corticosteroids, while the untreated group included infected patients who did not receive these treatments. The two groups were matched by propensity score matching method, which adjusted for 92 confounding factors such as demographic, sign and symptom, clinical, and treatment-related factors, to provide balanced covariates between the treated and untreated groups. ResultsOf the 4,322 patients, 791 received remdesivir alone and 694 received remdesivir combined with corticosteroids. Among the patients who received remdesivir, 456 were male, and the mean (±standard deviation) age was 59.52±16.49 with a median hospitalization stay of 8 (interquartile range: 5–13) days. After applying the nearest neighbor propensity score matching method, there were no significant differences found in the hazard of death between patients who received remdesivir alone and those who did not receive treatment (hazard ratio: 0.94; 95 % confidence interval: 0.76, 1.16). In addition, the combination of remdesivir and corticosteroids was not associated with a reduced hazard of death (hazard ratio: 1.00; 95 % confidence interval: 0.80, 1.26). The median hospitalization stay was significantly longer in the group treated with remdesivir (alone/combined with corticosteroids) compared to the untreated group, both before and after matching. ConclusionNo association was observed between remdesivir treatment (alone/combined with corticosteroids) and a reduced hazard of death among COVID-19 patients. However, longer hospitalization stays were observed in patients receiving remdesivir, either alone or in combination with corticosteroids, compared to the untreated group.