Corticosteroids In Management Research Articles

Low Dose Corticosteroids in Management of Hyperemesis Gravidarum at Mansoura University Hospital

Low Dose Corticosteroids in Management of Hyperemesis Gravidarum at Mansoura University Hospital

The Efficacy of Corticosteroids in the Management of Tietze Syndrome: A Randomized Controlled Trial

Abstract Background So far there are no clinical trials in the literature discussing the methods of treatment of Tietze‟s syndrome. Particularly, conservative methods of treatment are used, which include pain management using analgesics and nonsteroidal anti-inflammatory drugs. Oral corticosteroids offer a safe and effective treatment modality that is proven to be useful in a significant number of chest wall syndromes such as Sternoclavicular arthritis, Painful xiphoid syndrome, Costovertebral arthritis, and Slipping rib syndrome as well as conditions arising from ligament and tendon diathesis. Objective To use oral Corticosteroids in management of patients with Tietze syndrome at Ain shams university hospitals‟ cardiothoracic department and measuring the outcome randomly compared with the conventional NSAIDs to achieve the best outcome and quality of life. Methods This study included 40 patients who were diagnosed clinically as Tietze Syndrome at Ain Shams University Hospitals-cardiothoracic department in the duration between August 2020 till March 2022 with age ranging from 14 to 45 years and were sorted randomly. Two groups of patients were chosen and matched randomly as „Control arm‟ and „Interventional arm‟. The control group received the conventional NSAIDs (in the form of 50 mg of diclofenac potassium as „cataflam‟ twice daily) and the Interventional group received oral corticosteroids (in the form of 20 mg of prednisolone as „solupred‟ twice daily). Results Our study suggested that in patients with moderate to severe chondritis diagnosed clinically as Tietze syndrome, a 3 week course of oral 40 mg prednisolone is superior to the conventional oral NSAIDs in alleviating pain and improving the quality of life which is evidenced by the decline in EQ-5D total score of patients receiving oral steroids at the end of the treatment course as well as during each week throughout the trial timeframe. A highly significant reduction in pain score demonstrated via NRS was evident in the steroid-treated group compared to the NSAIDs-treated group at the same time point. Conclusion Oral corticosteroids are effective and safe in non-responding, obstinate Tietze syndrome. The results were unexpectedly good, obtaining significant relief and an outstanding refinement in quality of life reported by patients receiving oral steoids. There is no widely accepted protocol for oral steroid usage in Tietze syndrome and similar chest wall pain syndromes. Some other studies propose surgery in such patients. We think that surgery is a troublesome intervention for the patient and his doctor as well.

Clinical and biochemical assessment of the effect of topical use of coenzyme Q10 versus topical corticosteroid in management of symptomatic oral lichen planus: randomized controlled clinical trial

BackgroundOral lichen planus (OLP) is a chronic mucocutaneous immunologically mediated condition that has a great adverse effect on oral functions. Corticosteroids are still the first drugs of choice used in the treatment of OLP; however, they have extensive medical side effects. The present study was carried out to assess the clinical therapeutic effect of the topical use of coenzyme Q10 (coQ10 or ubiquinol) versus topical corticosteroids in the management of symptomatic OLP and to determine whether the effect, if any, was due to the powerful antioxidant activity of coQ10.Subjects and methodsWe performed a randomized, double blinded controlled trial at the Faculty of Dentistry, Cairo University, Egypt. The study was conducted on 34 patients suffering from symptomatic OLP. Patients were randomly divided into two groups: intervention group (I),who received topical CoQ10 in the form of mucoadhesive tablets (40% CoQ10) 3 times daily for one month and control group (II),who received topical corticosteroid (kenacort in Orabase: triamcinolone acetonide 0.1% 5-g adhesive paste – dermapharm), 4 times daily for one month. Patients were evaluated at one-week intervals using the clinical parameters (score) of pain (VAS) and lesion size. Additionally, salivary levels of malondialdehyde (MDA) were detected in both groups before and after treatment using ELISA. All recorded data were analysed using independent t test, ANOVA followed by Bonferroni post hoc test for lesion size and salivary level of MDA data and Mann–Whitney U test and Friedman test for VAS data.ResultsBoth groups showed a significant reduction in pain and the size of the lesions (p ≤ 0.05) with no statistically significant difference between them (p > 0.05), and this clinical improvement was associated with a reduction in the salivary levels of MDA in both groups.ConclusionsThe topical use of CoQ10 mucoadhesive tablets was as effective as the topical use of triamcinolone acetonide, and its clinical effect was associated with a reduction in the salivary level of MDA.Trial registrationThe study protocol was registered at www.clinicaltrial.gov (NCT04091698) and registration date: 17/9/2019.

Comparative study of local injections of autologous platelet rich plasma versus corticosteroid in management of chronic plantar fasciitis

BackgroundPlantar fasciitis is a known degenerative pathology and is a common cause of heel pain. We intend to evaluate the efficacy between locally injected Corticosteroids and autologous PRP in the management of chronic plantar fasciitis patients. Materials and methodsIn this prospective randomized controlled study, 70 chronic plantar fasciitis with failed conservative management for 3 months were randomly selected into 2 groups of 35 patients each. Group A received a local autologous platelet rich plasma injection of 3 ml and group B received a local corticosteroid injection of 2 ml. The Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between the groups at 15 days, 1 month, 3 months and 6 months. ResultsNo improvement in pain between autologous PRP and corticosteroids study subjects was noted in the initial period up to 15 days whereas after 1 month, 3 months and 6 months duration, it is seen that autologous PRP injected study subjects showed significant relief in pain compared to corticosteroids. ConclusionPRP was more effective in chronic plantar fasciitis patients compared to corticosteroids with pain relief coming after first 1st, 3rd and 6th month of the injection. Level of evidenceLevel 2.

A prospective cohort study of intranasal combined corticosteroids and antihistamines versus intra nasal corticosteroids in management of allergic rhinitis

A prospective cohort study of intranasal combined corticosteroids and antihistamines versus intra nasal corticosteroids in management of allergic rhinitis

Effectiveness of Corticosteroids Alone versus Corticosteroids and Cyclosporine in the Management of Patients with Severe Cutaneous Drug Reaction

Introduction: Severe Cutaneous Adverse Reactions (SCADRs) are emergency dermatologic manifestations associated with high morbidity and mortality. Their management includes immediate withdrawal of suspected causal agent followed by prompt management with drugs such as corticosteroids, cyclosporine and cyclophosphamide. Aim: To compare the effectiveness of corticosteroids alone versus cyclosporine and corticosteroids in management of SCADRs. Materials and Methods: This was a prospective observational study carried out in Indoor patients of Dermatology Department, Civil Hospital Ahmedabad, Gujarat, India, from October 2019 to September 2022. Twenty six patients were diagnosed with SCADRs and grouped according to the treatment received in two groups: corticosteroids alone (group B), and corticosteroids along with cyclosporine (group A). The efficacy was assessed based on: the days of disease arrest, days of complete reepithelialisation, duration of hospitalisation and final outcome. To know the prognosis of the patients, Score of Toxic Epidermal Necrosis (SCORTEN) score was used. Data was entered and analysed with the help of Microsoft excel ® 2019. Results: There were 14 patients in group A and 12 in group B. In a total 26 cases majority were of Stevens-Johnson Syndrome (SJS) (50%) followed by SJS-Toxic Epidermal Necrolysis (TEN) (27%) TEN (15%), Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) (8%). The mean duration of disease arrest was significantly shorter in group A (n=14) when compared to group B (n=12) (p-value <0.001**). Also, the time for complete re-epithelisation was significantly shorter in group A than group B (p-value=0.025*) While no significant difference between the two groups was observed in SCORTEN score. Mortality was 3/12 in group B, nil in group A. Conclusion: Combination therapy with corticosteroids and cyclosporine leads to an early arrest of the disease progression, better prognosis and outcome in patients of SCADRs.

Comparative Evaluation of Efficacy of Jasminum grandiflorum with Honey and Corticosteroids in Management of Recurrent Aphthous Stomatitis- A Study Protocol

Aim: To determine the efficacy of J grandiflorum in the treatment of aphthous ulcer on the basis of reduction in size of the ulcer, erythema and pain.
 Study Design: Prospective, Observational.
 Place and Duration: Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Deemed to be University, Sawangi (Meghe), Wardha. 
 Duration: One year.
 Methodology: One Hundred and Twenty patients visiting to the dental OPD and diagnosed to have aphthous ulcer will be selected. The patients will be divided in three groups and the formulated gel will be prescribed to one group of patient and other will be given corticosteroid and monitoring will be done.
 Expected Results: With all the studies performed till now it is expected that the j. grandiflorum and honey together will have good synergistic effect over aphthous ulcer and will help in reduction of size, pain and erythema level of aphthous ulcer.
 Conclusion: J grandiflorum and honey may be effective in management of recurrent aphthous stomatitis.

Evaluation of diode laser versus topical corticosteroid in management of Behcet's disease-associated oral ulcers: a randomized clinical trial.

The current trial was conducted to assess the effect of diode laser therapy compared to topical corticosteroid in management of oral ulcers of BD. Fifty patients were divided randomly into two parallel groups. The first group received 980nm diode laser; the second group received topical corticosteroid (0.1% triamcinolone acetonide). The outcome measures included oral ulcer activity index (composite index), pain (VAS), number of oral ulcers, healing time, and oral health-related quality of life (OHIP-14). The collected data were analyzed for any statistical significance. A statistically significant difference was detected between laser and corticosteroid groups favoring laser on comparing composite index and VAS scores on the first and third days and on comparing number of ulcers on the third and fifth days. A statistically significant difference was detected between laser and corticosteroid groups on comparing scores of the questions assessing discomfort with eating food, irritability with other people, taste worsening, unsatisfactory diet, and painful aching on the first and/or third days. No adverse effects were reported by participants of both groups. Diode laser is efficient safe treatment modality for management of BD-associated oral ulcers. Diode laser was more efficient than triamcinolone acetonide in controlling pain and reducing oral ulcer activity. Laser therapy is efficient safe modality that could spare BD patient from adding a new medication to their long list, being just one visit compared to other regular daily regimen medications. ClinicalTrials.gov registration number: NCT03771768.

Meta Analysis Study and Systemic Review of the Efficacy of Combination of H1 Antihistamine with Intranasal Corticosteroid in Management of Allergic Rhinitis

Meta Analysis Study and Systemic Review of the Efficacy of Combination of H1 Antihistamine with Intranasal Corticosteroid in Management of Allergic Rhinitis

TO EVALUATE THE EFFECT OF INTRA-LESIONAL CORTICOSTEROIDS IN MANAGEMENT OF PATIENTS WITH OSMF.

Aim: The effect of intra-lesional corticosteroids in management of patients with OSMF.
 Materials and Methods: The present clinic-observational study was conducted among 100 diagnosed patients of OSMF who attended the OPD of Nalanda Medical College and Hospital Patna, Bihar, India. The collected data were subjected to statistical analysis using SPSS version 20 software.
 Results: Mean age of the study population was 29.12 years. Study shows a definite male predominance (74%). Statistical analysis revealed that there was a significant improvement in the mouth opening and VAS.
 Conclusion: The present study concluded that dexamethasone (2 ml Decadron 4 mg/ml) injection and hyaluronidase 1500 IU with 2% lignocaine was administered, and there was significant improvement in mouth opening and VAS.
 Keywords: Dexamethason, Mouth Opening, OSMF, VAS

A role of inhaled corticosteroids in management of patients with chronic obstructive pulmonary disease: current recommendations. Expert panel conclusion

According to current evidence, therapy with inhales corticosteroids (ICS) is unsuccessful in majority of patients with chronic obstructive pulmonary disease (COPD). Moreover, long-term therapy with ICS significantly increases the risk of adverse events. According to recent international and Russian guidelines, there is a limited role of ICS in the management of COPD patients. The optimal risk/benefit ratio could be achieved in specific populations of COPD patients only. Therefore, an therapeutic algorithm for COPD patients in Russia needs to be updated. A strategy of ICS with-drawal in patients who would not benefit from ICS should be included in the algorithm. Based on actual findings, experts of Russian Respiratory Society updated the Russian algorithm for management of COPD patients including possibility of ICS withdrawal.

Clinical and Biochemical Assessment of the Effect of Topical Use of Coenzyme Q10 Versus Topical Corticosteroid in Management of Symptomatic Oral Lichen Planus: Randomized Controlled Clinical Trial

Clinical and Biochemical Assessment of the Effect of Topical Use of Coenzyme Q10 Versus Topical Corticosteroid in Management of Symptomatic Oral Lichen Planus: Randomized Controlled Clinical Trial

Corticosteroid eye drop instillation aggravates the development of Acanthamoeba keratitis in rabbit corneas inoculated with Acanthamoeba and bacteria

The role of topical corticosteroids in management of Acanthamoeba keratitis (AK) remains controversial. Using a rabbit AK model, we investigated whether corticosteroid use is a risk factor of AK. Acanthamoeba (1 × 105/ml) was incubated with two densities of P. aeruginosa (PA; high-PA: 1 × 108/ml, low-PA: 3 × 105/ml) before corneal inoculation. Rabbit corneas were inoculated with Acanthamoeba alone or Acanthamoeba plus PA and administered levofloxacin and betamethasone sodium phosphate (BSP) eye drops for 5 or 7 days. Infected rabbit eyes were evaluated for clinical score and Acanthamoeba by histological examination. Acanthamoeba alone and BSP treatment did not produce keratitis. Corneas inoculated with Acanthamoeba plus low-PA treated immediately with levofloxacin and BSP remained clear with few infiltrates. Corneas inoculated with Acanthamoeba plus low-PA treated with levofloxacin immediately and BSP 12 h later developed severe keratitis. Corneas inoculated with Acanthamoeba plus high-PA treated immediately with levofloxacin and BSP also developed severe keratitis. Acanthamoebae were detected by PAS staining in corneas inoculated with Acanthamoeba plus high-PA treated with levofloxacin and BSP. Topical corticosteroids have the potential to aggravate AK when cornea is infected by Acanthamoeba with a critical number of bacteria or when corticosteroids are given after infection has established by Acanthamoeba with small number of bacteria.

Use of antenatal fluorinated corticosteroids in management of congenital heart block: Systematic review and meta-analysis.

ObjectiveTo evaluate outcomes of fluorinated corticosteroids, with or without other medications, for treatment of congenital heart block in-utero.Study designA search was conducted through MEDLINE, EMBASE, WEB OF SCIENCE and SCOPUS from inception to October 2017. Only comparative studies are considered eligible. Outcomes include fetal death, downgrade of heart block, neonatal death, need for neonatal pacing, fetal and maternal complications. Random effects model was used.ResultsOut of 923 articles, 12 studies were eligible. Compared to no treatment, there was no significant difference in incidence of fetal death (OR 1.10, 95%CI 0.65–1.84), neonatal death (OR 0.98, 95%CI 0.41–2.33), or need for pacing (OR 1.46, 95%CI 0.78–2.74). Heart block downgrade was significantly higher in treatment group (9.48%vs.1.76%, OR 3.27, 95%CI 1.23–8.71).Conclusionantenatal fluorinated corticosteroids do not improve fetal/neonatal morbidity or mortality of congenital heart block and are associated with higher incidence of fetal and maternal complications.

GVHD After Orthotopic Liver Transplant: Successful Treatment With High Dose Steroids and Anti Thymocyte Globulin (ATG)

Introduction: Graft versus host disease (GVHD) is an uncommon complication after orthotopic liver transplantation (OLT) with an incidence of 0.1-2%, but an 80-100% mortality rate. We present two cases of GVHD that resolved with high dose systemic steroids and anti thymocyte globulin (ATG). Case 1: A 66 year old male with HCV cirrhosis complicated by hepatocellular carcinoma underwent OLT. 4 weeks later, he presented with a generalized erythematous maculopapular eruption. Biopsy demonstrated evidence of vacuolar type interface dermatitis with follicular involvement consistent with GVHD. Labs showed mild pancytopenia without any evidence of viral infections. Peripheral blood chimerism was negative for donor cells. He received intravenous (IV) methylprednisolone and three doses of ATG with subsequent resolution of symptoms. The patient was followed up to two years without any recurrence. Case 2: A 53 year old male with HBV cirrhosis who underwent orthotopic liver transplant presented five weeks later with fever and generalized maculopapular rash and oral ulcers. Skin biopsy showed interface dermatitis with follicular involvement consistent with GVHD. peripheral blood chimerism study did not show any donor cells. The patient received high dose IV methylprednisolone and ATG. The patient subsequently improved and had complete resolution of cutaneous findings without any recurrence on follow up. Discussion: Graft-versus-host disease after OLT usually presents 2 to 8 weeks postoperatively with bone marrow aplasia, skin rash and diarrhea. Detection of donor lymphocytes in skin and a nonspecific lichenoid reaction pattern with basal vacuolar changes, dyskeratosis and epidermal apoptotic cells may be seen. Although published literature describes the role of corticosteroids in management, treatment beyond steroids has been heterogeneous and has included antimetabolites, alkylating agents, anti-T cell antibodies, anti-B cell antibodies, intravenous immunoglobulin, cytokine inhibitors, immunostimulants and cellular therapy, including T cell infusions and hematopoietic stem cell transplantation. Despite aggressive treatment, reported mortality rate exceeds 80%. Conclusion: GVHD is a rare clinical entity but carries a high mortality. Reducing the risk factors for development of GVHD, identifying the disease promptly, preventing infection, and starting treatment as early as possible as seen in our cases may improve the dismal outcome associated with this disease.2444_A Figure 1. Papular rash seen on lower extremity2444_B Figure 2. Vacuolar type interface dermatitis with follicular involvement

Clinical Audit for Use of Corticosteroids in Treatment of Nervous System Infections

Abstract Background: Anti-inflammatory therapy is indicated for CNS infection. Corticosteroids are the most valuable anti-inflammatory drugs for CNS disease. They reduce CNS edema via their action on blood vessels, and they produce anti-inflammatory effects via their action on neutrophils and inhibition of cytokine synthesis.Aim of the Study: To assess how much the adopted protocol of using corticosteroids in management of CNS infections is implemented in Assiut University Children Hospital (A.U.C.H).Patients and Methods: Retrospective study was conducted on patients admitted to Emergency unit, intermediate care unit, pediatric intensive care unit and department of neurology at Assiut University Children Hospital during the period from January 2016 to December 2016. Data were collected and compared to guidelines. Results: Corticosteroids was used in 100% of cases. Most of cases with CNS infection who received steroid treatment guided by treatment protocol showed marked improvement in GCS score, tendon reflexes, muscle tone and convulsions.Conclusion: Corticosteroids are usually the primary drugs used to treat immune-mediated disorders of the CNS, including corticosteroid-responsive meningitis and corticosteroid-responsive meningomyelitis.

Clinical Audit Study for Use of Corticosteroids in Treatment of Nervous System Infections

Abstract Background: Anti-inflammatory therapy is indicated for CNS infection. Corticosteroids are the most valuable anti-inflammatory drugs for CNS disease. They reduce CNS edema via their action on blood vessels, and they produce anti-inflammatory effects via their action on neutrophils and inhibition of cytokine synthesis.Aim of the Study: To assess how much the adopted protocol of using corticosteroids in management of CNS infections is implemented in Assiut University Children Hospital (A.U.C.H).Patients and Methods: Retrospective study was conducted on patients admitted to Emergency unit, intermediate care unit, pediatric intensive care unit and department of neurology at Assiut University Children Hospital during the period from January 2016 to December 2016. Data were collected and compared to guidelines. Results: Corticosteroids was used in 100% of cases. Most of cases with CNS infection who received steroid treatment guided by treatment protocol showed marked improvement in GCS score, tendon reflexes, muscle tone and convulsions.Conclusion: Corticosteroids are usually the primary drugs used to treat immune-mediated disorders of the CNS, including corticosteroid-responsive meningitis and corticosteroid-responsive meningomyelitis.

Role of local corticosteroid in management of tennis elbow

Background: Lateral epicondylitis or tennis elbow is common clinical and functionally limiting condition encountered by orthopedic surgeon having chronic course and its etiology and management is under controversies. The aim of this study is to know the efficacy of local corticosteroids in its management. Materials and methods: The study was conducted in Department of Orthopaedics, RIMS Ranchi from November 2016 to October 2017. Sixty patients of either sex (33 female and 27 male), mean age 38yrs presenting with pain over lateral epicondyle were selected for the study. After written informed consent local steroids (0.5ml methylprednisolone with 0.5ml of 2% lignocaine) were injected over the maximum tender point in elbow. Results: The incidence was more common in females and dominant arm is been involved mostly. Out of 60 patients 42 patients (70%) got almost complete relief from pain in 6 weeks of time. But at the end of 12 weeks, the final follow up only 11 patients (18.33%) were pain free and 30 patients (50%) had recurrence of symptoms. Conclusion: Local corticosteroids are very effective treatment for lateral epicondylitis if used over short term and for early symptomatic relief.

Evolving Role of Regional Depot Corticosteroids in Management of Diabetic Macular Edema.

Evolving Role of Regional Depot Corticosteroids in Management of Diabetic Macular Edema.

The Changing Paradigm of Management of Liver Abscesses in Chronic Granulomatous Disease.

Chronic granulomatous disease (CGD) is a rare genetic disorder causing recurrent infections. More than one-quarter of patients develop hepatic abscesses and liver dysfunction. Recent reports suggest that disease-modifying treatment with corticosteroids is effective for these abscesses. Comparison of corticosteroid therapy to traditional invasive treatments has not been performed. Records of 268 patients with CGD treated at the National Institutes of Health from 1980 to 2014 were reviewed. Patients with liver involvement and complete records were included. We recorded residual reactive oxygen intermediate (ROI) production by neutrophils, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase germline mutation status, laboratory values, imaging characteristics, time to repeat hepatic interventions, and overall survival among 3 treatment cohorts: open liver surgery (OS), percutaneous liver-directed interventional radiology therapy (IR), and high-dose corticosteroid management (CM). Eighty-eight of 268 patients with CGD suffered liver involvement. Twenty-six patients with a median follow-up of 15.5 years (8.5-32.9 years of follow-up) had complete records and underwent 100 standard interventions (42 IR and 58 OS). Eight patients received a treatment with high-dose corticosteroids only. There were no differences in NADPH genotype, size, or number of abscesses between patients treated with OS, IR, or CM. Time to repeat intervention was extended in OS compared with IR (18.8 vs 9.5 months, P = .04) and further increased in CM alone (median time to recurrence not met). Impaired macrophage and neutrophil function measured by ROI production correlated with shorter time to repeat intervention (r = 0.6, P = .0019). Treatment of CGD-associated liver abscesses with corticosteroids was associated with fewer subsequent hepatic interventions and improved outcome compared to invasive treatments.