Course Of Glucocorticoids Research Articles

Complete remission after glucocorticoid therapy in a patient with primary hypophysitis.

Primary hypophysitis is a rare disease that may have variable clinical presentations. The main treatment options are clinical observation, immunosuppressive drugs, and surgery. Glucocorticoids are used as first-line medical therapy; however, non-responsiveness and recurrences are the major problems. We present a 30-year-old male patient who had an excellent radiologic response to a single course of glucocorticoids. The patient presented with malaise and severe headaches of acute onset. Cranial MRI revealed a pituitary mass compressing the optic chiasm. Hormonal evaluation studies were consistent with anterior pituitary hormone dysfunction except for the growth hormone axis. There was a mild compression on the optic chiasm in the pituitary MRI. The patient was started on methylprednisolone therapy at a dose of 80 mg/day. The pituitary MRI revealed complete regression of the mass after 2 months, and there was a complete recovery of pituitary functions after 6 months. There is no consensus on the optimal dose and duration of glucocorticoid therapy for primary hypophysitis in the literature. We report that steroid therapy, even in lower doses, might be effective in mild-to-moderate cases. Primary hypophysitis is a rare disease with a varied clinical course, and hence the treatment strategies should be individualized. There is no consensus on the optimal dose and duration of glucocorticoid therapy. Glucocorticoid therapy may induce complete remission in some patients, especially with a mild-to-moderate disease course and during the acute phase of the disease.

P185 Anatomical patterns of pain in primary care patients with polymyalgia rheumatica compared to the general population

Abstract Background/Aims Polymyalgia rheumatica (PMR) is common in older adults, causing severe pain and stiffness, particularly in the shoulder and hip girdles. A tapered course of glucocorticoids is recommended, but not always straightforward, with frequent symptom recurrence. Reasons are unclear, but partial masking of painful comorbidities (e.g., osteoarthritis) may play a part. Methods 652 people with incident PMR were recruited from English general practice (2012-2014) to a postal survey study (questionnaires at diagnosis, 1, 4, 8, 12, 18, 24, [mean] 61 months). Surveys included a body manikin (front and back views). Participants were asked to shade anywhere they experienced pain >1 day in the last month. 44 mutually exclusive areas were defined as painful or not. For comparison, an age-gender matched random sample of 652 people was selected from a general population survey in North Staffordshire that used the same manikins. Pain prevalence was compared between the 2 studies. Results In the PMR study, surveys were completed by 244 participants at 24 months and 197 at 61 months. Pain was reported in a mean of 17.1 areas at diagnosis (Table). Bilateral shoulder and hip pain were present in the majority at diagnosis (shoulder 81%; hips 59%) and in around a third and a fifth of patients respectively throughout the study. The prevalence of bilateral shoulder and hip pain remained higher than in the general population sample, while unilateral pain in these areas was less common. Bilateral hand (27%) and knee (45%) pain were also common at diagnosis. After 1 month, the mean number of pain areas was 7 - similar to the general population. However, prevalence of bilateral shoulder and hip pain remained higher than the general population throughout follow-up. Unilateral hip and knee pain were persistently less common in those with PMR, whilst unilateral hip pain was more common. Conclusion Bilateral pain was reported more commonly across the disease course in people with PMR than the general population. Causes of pain cannot be accurately attributed, but are likely multifactorial, including PMR disease activity, treatment and painful comorbidities. However, the persistence of bilateral pain suggests untreated PMR symptoms, requiring further research. Disclosure N. Hammad: None. R. Partington: None. S. Hider: None. H. Butt: None. T. Helliwell: None. C. Mallen: None. S. Muller: None.

Gene Therapy in Patients with the Crigler–Najjar Syndrome

BackgroundPatients with the Crigler–Najjar syndrome lack the enzyme uridine diphosphoglucuronate glucuronosyltransferase 1A1 (UGT1A1), the absence of which leads to severe unconjugated hyperbilirubinemia that can cause irreversible neurologic injury and death. Prolonged, daily phototherapy partially controls the jaundice, but the only definitive cure is liver transplantation.MethodsWe report the results of the dose-escalation portion of a phase 1–2 study evaluating the safety and efficacy of a single intravenous infusion of an adeno-associated virus serotype 8 vector encoding UGT1A1 in patients with the Crigler–Najjar syndrome that was being treated with phototherapy. Five patients received a single infusion of the gene construct (GNT0003): two received 2×1012 vector genomes (vg) per kilogram of body weight, and three received 5×1012 vg per kilogram. The primary end points were measures of safety and efficacy; efficacy was defined as a serum bilirubin level of 300 μmol per liter or lower measured at 17 weeks, 1 week after discontinuation of phototherapy.ResultsNo serious adverse events were reported. The most common adverse events were headache and alterations in liver-enzyme levels. Alanine aminotransferase increased to levels above the upper limit of the normal range in four patients, a finding potentially related to an immune response against the infused vector; these patients were treated with a course of glucocorticoids. By week 16, serum bilirubin levels in patients who received the lower dose of GNT0003 exceeded 300 μmol per liter. The patients who received the higher dose had bilirubin levels below 300 μmol per liter in the absence of phototherapy at the end of follow-up (mean [±SD] baseline bilirubin level, 351±56 μmol per liter; mean level at the final follow-up visit [week 78 in two patients and week 80 in the other], 149±33 μmol per liter).ConclusionsNo serious adverse events were reported in patients treated with the gene-therapy vector GNT0003 in this small study. Patients who received the higher dose had a decrease in bilirubin levels and were not receiving phototherapy at least 78 weeks after vector administration. (Funded by Genethon and others; ClinicalTrials.gov number, NCT03466463.)

Acute pancreatitis: An unusual presentation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a multi-system and chronic inflammatory autoimmune disease characterised by the presence of autoantibodies and the creation of immune complexes, coming up with protean manifestations. Its occurrence in children is rare and acute pancreatitis as the presenting manifestation of childhood SLE is exceptional. Diagnosis of lupus pancreatitis is clinical, biological and radiological. Here, we report an 8 year 8-month-old young girl who presented to our hospital with abdominal pain, nausea and vomiting. She also had a fever, alopecia, oral ulceration and glossitis. Her investigations showed elevated serum amylase and lipase levels, suggestive of acute pancreatitis. Other investigations revealed pancytopenia, low complement, microalbuminuria and high antinuclear antibodies level, indicative of SLE. As a result, the diagnosis of lupus pancreatitis was retained. Her clinical symptoms and signs markedly improved after a course of glucocorticoid and immunosuppressive therapy. The child is now being brought for regular follow-up and is doing well.

Rituximab as Initial Therapy in Adult Patients With Minimal Change Disease

Rituximab as Initial Therapy in Adult Patients With Minimal Change Disease

Pediatric obesity and severe asthma: Targeting pathways driving inflammation

Asthma affects more than 300 million people of all ages worldwide, including about 10–15% of school-aged children, and its prevalence is increasing. Severe asthma (SA) is a particular and rare phenotype requiring treatment with high-dose inhaled corticosteroids plus a second controller and/or systemic glucocorticoid courses to achieve symptom control or remaining “uncontrolled” despite this therapy. In SA, other diagnoses have been excluded, and potential exacerbating factors have been addressed. Notably, obese asthmatics are at higher risk of developing SA. Obesity is both a major risk factor and a disease modifier of asthma in children and adults: two main “obese asthma” phenotypes have been described in childhood with high or low levels of Type 2 inflammation biomarkers, respectively, the former characterized by early onset and eosinophilic inflammation and the latter by neutrophilic inflammation and late-onset. Nevertheless, the interplay between obesity and asthma is far more complex and includes obese tissue-driven inflammatory pathways, mechanical factors, comorbidities, and poor response to corticosteroids. This review outlines the most recent findings on SA in obese children, particularly focusing on inflammatory pathways, which are becoming of pivotal importance in order to identify selective targets for specific treatments, such as biological agents.

Postdischarge Glucocorticoid Use and Clinical Outcomes of Multisystem Inflammatory Syndrome in Children

Minimal data are available regarding the postdischarge treatment of multisystem inflammatory syndrome in children (MIS-C). To evaluate clinical characteristics associated with duration of postdischarge glucocorticoid use and assess postdischarge clinical course, laboratory test result trajectories, and adverse events in a multicenter cohort with MIS-C. This retrospective cohort study included patients with MIS-C hospitalized with severe illness and followed up for 3 months in an ambulatory setting. Patients younger than 21 years who were admitted between May 15, 2020, and May 31, 2021, at 13 US hospitals were included. Inclusion criteria were inpatient treatment comprising intravenous immunoglobulin, diagnosis of cardiovascular dysfunction (vasopressor requirement or left ventricular ejection fraction ≤55%), and availability of complete outpatient data for 3 months. Glucocorticoid treatment. Main outcomes were patient characteristics associated with postdischarge glucocorticoid treatment, laboratory test result trajectories, and adverse events. Multivariable regression was used to evaluate factors associated with postdischarge weight gain (≥2 kg in 3 months) and hyperglycemia during illness. Among 186 patients, the median age was 10.4 years (IQR, 6.7-14.2 years); most were male (107 [57.5%]), Black non-Hispanic (60 [32.3%]), and Hispanic or Latino (59 [31.7%]). Most children were critically ill (intensive care unit admission, 163 [87.6%]; vasopressor receipt, 134 [72.0%]) and received inpatient glucocorticoid treatment (178 [95.7%]). Most were discharged with continued glucocorticoid treatment (173 [93.0%]); median discharge dose was 42 mg/d (IQR, 30-60 mg/d) or 1.1 mg/kg/d (IQR, 0.7-1.7 mg/kg/d). Inpatient severity of illness was not associated with duration of postdischarge glucocorticoid treatment. Outpatient treatment duration varied (median, 23 days; IQR, 15-32 days). Time to normalization of C-reactive protein and ferritin levels was similar for glucocorticoid duration of less than 3 weeks vs 3 or more weeks. Readmission occurred in 7 patients (3.8%); none was for cardiovascular dysfunction. Hyperglycemia developed in 14 patients (8.1%). Seventy-five patients (43%) gained 2 kg or more after discharge (median 4.1 kg; IQR, 3.0-6.0 kg). Inpatient high-dose intravenous and oral glucocorticoid therapy was associated with postdischarge weight gain (adjusted odds ratio, 6.91; 95% CI, 1.92-24.91). In this multicenter cohort of patients with MIS-C and cardiovascular dysfunction, postdischarge glucocorticoid treatment was often prolonged, but clinical outcomes were similar in patients prescribed shorter courses. Outpatient weight gain was common. Readmission was infrequent, with none for cardiovascular dysfunction. These findings suggest that strategies are needed to optimize postdischarge glucocorticoid courses for patients with MIS-C.

ODP122 Recurrent Episodes of Hypercalcemia due to Disseminated Mycobacterium Avium Complex Infection-related Immune Reconstitution Inflammatory Syndrome

Abstract Introduction Immune reconstitution inflammatory syndrome (IRIS) may occur in patients with acquired immunodeficiency syndrome (AIDS) following initiation of antiretroviral therapy (ART) due to exacerbation of preexisting infectious process, such as disseminated mycobacterium avium complex (dMAC). This type of inflammatory process may be associated with granuloma formation and 1,25(OH) 2 vitamin D-mediated hypercalcemia. Hypercalcemia typically is controlled with a single dose of intravenous bisphosphonate or a two to four-week course of glucocorticoid, in addition to antibiotics for dMAC and ART. Here we present a case of IRIS-associated hypercalcemia related to dMAC resistant to intravenous bisphosphonate therapy and an extended glucocorticoid course. Case presentation A 30-year-old man with AIDS with CD4 count 4 cells/mm^3 (441-2,156) was admitted with subacute fevers, chills, and cough one month after starting ART. Cultures drawn during admission were positive for MAC and he was started on therapy for dMAC with ethambutol and azithromycin. Seven months after starting ART, he was readmitted with weakness and fatigue and found to have calcium 13.5 mg/dL (8.6-10.4), albumin 3.9 g/dL (3.9-5. 0), creatinine 1.40 mg/dL (0.6-1.3), CD4 count 80 cells/mm3. Further workup revealed intact PTH 2 pg/mL (11-51), 25-OH vitamin D 38 ng/mL (20-50), 1,25(OH) 2 vitamin D 171 pg/mL (19.9-79.3), PTHrP < 2. 0 pmol/L (0. 0-2.3), suggestive of PTH-independent hypercalcemia mediated by 1,25(OH) 2 vitamin D. CT scan of the chest showed multiple cavitary lesions, ground glass nodularity, and diffuse lymphadenopathy. He was treated with intravenous fluids, zoledronic acid 4mg, and continued ART and antibiotics for MAC. On discharge calcium was 9.5 mg/dL. He had recurrence of 1,25(OH) 2 vitamin D-mediated hypercalcemia (calcium 13.6mg/dL) 11 months after starting ART, which was controlled with intravenous fluid and prednisone 60mg tapered over 6 weeks. He then had recurrence of hypercalcemia 13 and 16 months after starting ART, each resolved with intravenous fluids and repeat prolonged prednisone courses. Testing for other infectious causes of granulomatous disease including Cryptococcus, Histoplasma, Mycoplasma tuberculosis was negative during multiple presentations. At 13 months, his CD4 count was 214 cells/mm^3 and repeat CT scan of the chest showed improvement in size of cavitary nodule and ground glass nodularity. Conclusion IRIS related to dMAC is an uncommon cause of 1,25(OH)2 vitamin D-mediated hypercalcemia. Multiple recurrences of hypercalcemia and the need for extended courses of glucocorticoid despite improvement of underlying infectious process has not previously been reported. Presentation: No date and time listed

PMON100 IgG4 hypophysitis with granulomatous histopathology

Abstract Background IgG4-related disease is characterized by a dense lymphoplasmacytic infiltrate rich in IgG4 plasma cells that may be accompanied by elevated serum IgG4 levels, presence of granulomatous histopathology with multinucleated giant cells has not been reported in patients with IgG4 related hypophysitis.Clinical case: A 39-year-old female with no significant past medical history until April of 2021, when she developed gradual onset of headaches. MRI brain showed a mass in the sella, she was treated for over a month with glucocorticoids by ENT and her headaches improved. She finished the course of glucocorticoids, and soon after, she had a recurrence of her symptoms. Repeat brain MRI revealed a large pituitary mass and she had her first endoscopic endonasal transsphenoidal resection on 8/2021 at an outside hospital. Pathology report of the surgery suggested that she had a colloid cyst of the pituitary and cultures grew actinomyces and streptococcus oralis, likely, as a consequence of contamination from an ethmoid sinus infection/surgical infection, she was treated with antibiotics. Surgery was also complicated by diabetes insipidus for which she is taking desmopressin tablets.She presented to our hospital in November 2021, with persistent symptoms (headaches and worsening vision), and a postoperative brain MRI showing an expansion of the lesion with compression of the optic chiasm, she was evaluated by neurosurgery who recommended repeat revision endoscopic endonasal transsphenoidal resection of this lesion.The patient underwent a second transsphenoidal surgery on 11/29/2021 at our institution. During admission TSH was 0.123 mcIU/ml (0.27-4.2mcIU/ml) with Free T4 0.52ng/dL (0.93-1.7ng/dL). She was discharged on hydrocortisone, desmopressin tablets, and levothyroxine.The pathology report of the second surgery revealed mixed chronic and acute inflammation with granulomatous components containing histiocytic clusters and multinucleated giant cells. Many plasma cells, rare eosinophils, and foci of neutrophils are present. The ratio of IgG4 to IgG is over 70%, with more than 10 IgG4 (+) cells per 10HPF. GMS and AFB were negative for fungi and mycobacteria.Patient's outpatient labs were consistent with panhypopituitarism with AM cortisol of 1.9mcg/dL, ACTH 19pg/mL (6-50 pg/ml), FSH 6.5 mIU/ml, LH 2.4 mIU/ml and estradiol <15pg/ml. TSH was 1.26 mcIU/ml (0.27-4.2mcIU/ml) with Free T4 0.8ng/dL (0.8-1.8ng/dL). IGF-1 level was 72ng/ml (79-259ng/ml). Prolactin was 7.0 ng/ml (3.0-30.0ng/ml). IgG4 serum level was 100.2mg/dL (4.0-86.0mg/dL), IgG1 serum level was 446mg/dL (382-929mg/dL). Conclusion This is a unique patient with panhypopituitarism that meets the criteria for IgG4 related hypophysitis but also has secondary granulomatous components developed after the rupture of the colloid cyst during the first surgery. The implications of these findings are unknown in terms of management and prognosis. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Efficacy of three different budesonide treatments in Chinese preschool children with recurrent wheezing

To explore and compare the clinical control of three atomized inhalation budesonide (BUD) regimens for Chinese preschool children with recurrent wheezing using Test for Respiratory and Asthma Control (TRACK) scores. A total of 474 preschool children with positive Modified Asthma Predictive Index (mAPI) were randomly assigned to a daily group (initially given inhaled BUD 1 mg once a day and assessed every 4 weeks; if symptom were well controlled for 12 weeks, the dose was reduced to 25–50% of the previous dose until afinal dose of 0.25 mg once a day, maintained until 52 weeks), an intermittent high-dose group (1 mg twice daily for 7 days starting early during a predefined respiratory tract illness) and an intermittent medium-dose group (0.5 mg twice daily as soon as they contacted allergens or experienced nasal congestion, a runny nose, cough or other suspicious respiratory symptoms and continuing until symptoms were reduced or risk factors were absent for 3 days) for 52 weeks of treatment. The TRACK questionnaire was administered every 4 weeks. When TRACK scores were ≥ 80, symptoms were considered to be controlled. The average TRACK scores of the three groups after treatment were significantly higher than those before treatment (P < 0.001). There were no significant differences in the average TRACK scores and control rate after treatment at every 4 weeks in the three groups (P > 0.05). Te number of systemic glucocorticoid courses, urgent care visits for wheezing, and wheezing episodes before and after treatment were significantly different within each of the three groups (P < 0.001), but not among the three groups (P > 0.05). In clinical treatment of children, one of the three treatment options can be selected according to the specific situation case of mAPI- positive recurrent wheezing children.

Ciprofloxacin-Induced Crystal Nephropathy and Allergic Interstitial Nephritis: Case Report and Review of Literature

Ciprofloxacin is a commonly used antibiotic that has the potential to cause acute kidney injury (AKI) secondary to interstitial injury or vasculitis. Of all causes, allergic interstitial nephritis is the most common of ciprofloxacin-induced AKI. There have been very few case reports of crystal nephropathy resulting from ciprofloxacin. Most patients with crystal nephropathy respond well to conservative management, but some require hemodialysis and glucocorticoids treatment. We describe a patient case of a 67-year-old woman who developed AKI secondary to ciprofloxacin-induced crystal nephropathy and allergic interstitial nephritis who was successfully managed with hemodialysis and a short course of glucocorticoids.

How to decrease systemic corticosteroids in pemphigus patients under rituximab.

How to decrease systemic corticosteroids in pemphigus patients under rituximab.

Gout and the COVID-19 pandemic.

This review gives an overview of recently published articles on COVID-19 and gout. People with gout are likely to be at an increased risk of poor outcomes after COVID-19 infection due to comorbid cardiometabolic conditions. The effects of chronic hyperuricemia on trained immunity, and the hyperinflammatory state induced by gout itself may also play a role. Frequent courses of glucocorticoids for gout flares may be associated with adverse outcomes after COVID-19 infection and reduced immunogenicity to the COVID-19 vaccination. Similarities between the pathophysiology of gout flares and the dysregulated inflammatory response of severe COVID-19 have been identified. Medications used in the treatment of gout, including colchicine and interleukin-1 inhibitors, have shown promise in the treatment of COVID-19 in clinical trials. Overall, the COVID-19 pandemic has had a negative impact on gout care, with patients reporting more difficulty with disease control, accessing medications and healthcare, and poorer quality of life. The COVID-19 pandemic has created many challenges for people with gout. At present, there is a lack of guidance on the management of gout during the pandemic and paucity of research assessing outcomes of COVID-19 infection in people with gout.

Порівняльна ефективність гормональної пульс-терапії при рецидивуючому та вторинно-прогредієнтному типах перебігу розсіяного склерозу з різним характером прогнозу. Повідомлення I. Ефективність гормональної пульс-терапії в дебюті та на рецидивуючому етапі п

Проведено дослідження ефективності пульс-терапії глюкокортикоїдами (ГКT) в дебюті та на рецидивуючому етапі (РЕ) у 98 хворих з розсіяним склерозом (РС): 28 осіб (24 жінки і 4 чоловіки) з невизначеним прогнозом при рецидивуючому перебігу (РП) — 1-ша група; 30 осіб (21 жінка і 9 чоловіків) з невизначеним прогнозом при вторинно-прогредієнтному перебігу (ВПП) — 2-га група; 40 осіб (36 жінок і 4 чоловіки) з несприятливим прогнозом при ВПП — 3-тя група. Проводився облік наступних клінічних показників: вік, тривалість захворювання, вік дебюту, тяжкість дебютів, тривалість ремісії після дебюту, тривалість рецидивуючого етапу, тяжкість і число рецидивів на РЕ, середня частота рецидивів і тривалість ремісій на РЕ, ступінь інвалідизації за шкалою EDSS. Проведено 287 курсів ГКТ-терапії: при невизначеному прогнозі РП — 98 (у дебютах — 9, на РЕ — 89); при невизначеному прогнозі ВПП — 99 (у дебютах — 3, на РЕ — 96); при несприятливому прогнозі ВПП — 90 (у дебютах — 8, на РЕ — 82). Клініко-діагностичні критерії ефективності лікування в усіх групах хворих включали динаміку регресу неврологічної симптоматики під впливом першого курсу ГКТ-терапії на етапі дебютів; порівняльну оцінку тривалості ремісії після дебюту при прийомі і без прийому ГКТ; середню частоту рецидивів на РЕ під впливом повторних курсів ГКТ-терапії; тривалість ремісій після 1-го курсу гормональної терапії; тривалість РЕ залежно від тривалості ремісій після першого курсу ГКТ-терапії. У групі хворих з невизначеним прогнозом РП додатково враховувалися: тривалість ремісій перед останнім курсом ГКТ; швидкість прогресування на РЕ; динаміка балів за шкалою інвалідизації EDSS після 1-го і перед останнім курсами ГКТ-терапії. Проведене дослідження показало, що в процесі лікування клінічні показники, що характеризують перебіг дебютів і РЕ, зазнають складної системної реорганізації залежно від типу перебігу та характеру прогнозу. Найбільш ефективною гормональна терапія виявилася при невизначеному прогнозі РП. Для цієї групи хворих було виділено дві категорії ефективності лікування: висока (у 17 осіб) і помірна (в 11 осіб). Критерієм ефективності лікування служила позитивна динаміка більшості клінічних показників. Вона проявлялася швидким і повноцінним регресом неврологічної симптоматики в дебютах, збільшенням тривалості ремісії після дебюту, зменшенням частоти і тяжкості рецидивів на РЕ, збільшенням числа хворих з величиною середньої частоти рецидивів &lt; 1,0, збереженням мінімального неврологічного дефіциту, низькою швидкістю прогресування, нерізкою негативною динамікою балів за шкалою інвалідизації EDSS. У результаті зазначеної реорганізації збільшувалась тривалість РЕ і відбувалося запобігання безпосередньої загрози трансформації РП у ВПП.

Проблема диагностики приобретенных гемолитических анемий в детском возрасте

Аутоиммунная гемолитическая анемия (АИГА) — это группа заболеваний, в основе которых лежит декомпенсированный приобретенный гемолиз. АИГА у детей чаще всего наблюдается после вирусного заболевания. Это достаточно редкое состояние с частотой менее 0,2 случая на 100 000 педиатрического населения. Целью статьи было представить клинический случай больного АИГА. Представлен случай гемолитической анемии у ребенка 4 лет на фоне острой вирусной инфекции с пневмонией и диспептическим синдромом. Во время пребывания в больнице состояние мальчика резко ухудшилось за счет быстрого нарастания слабости и бледности кожных покровов. Общий анализ крови выявил прогрессирующую гемолитическую анемию (Hb 57 г/л, эритроциты 2,58 × 1012/л, Ht 0,16, лейкоциты 13,88 × 109/л, СОЭ 69 мм/ч, тромбоциты 400 × 109/л). Наблюдалось умеренное повышение билирубина за счет неконъюгированной фракции (31,3 и 21,2 мкмоль/л соответственно). В связи с критическим нарастанием анемического синдрома встал вопрос о необходимости гемотрансфузии, но в результате теста на индивидуальную совместимость 20 пакетов крови одной группы было отклонено из-за несовместимости. Интенсивная иммуносупрессивная терапия (комплексное введение высоких доз кортикостероидов в сочетании с внутривенными иммуноглобулинами в дозе 2 г/кг/день) позволила остановить гемолиз и улучшить состояние пациента, вопрос о переливании крови был отклонен. Особенностью представленного случая было критическое нарастание анемии при отсутствии классических признаков гемолиза, невозможность проведения гемотрансфузии и положительная динамика при назначении высоких доз кортикостероидов и иммуноглобулина. Осведомленность об АИГА должна присутствовать у педиатров, и важно расширить их знания о правильном алгоритме диагностики в таких случаях. Препаратами выбора для лечения АИГА являются внутривенные иммуноглобулины в иммуносупрессивных дозах и глюкокортикоиды коротким курсом. В случаях резистентности к такому лечению показано переливание перфторана.

Diabetes, COVID-19 and Mucormycosis: Unanswered Questions!

Diabetes, COVID-19 and Mucormycosis: Unanswered Questions!

US7 score in the subacute phase does not correlate with outcomes in Chikungunya arthritis

Introduction: Chikungunya fever is a remerging disease and may lead to postchikungunya inflammatory joint pain. Objective: To study the clinical and ultrasound (US) features of chikungunya arthritis in the subacute phase and to determine if high disease activity on US on is associated with chronic disability. Materials and Methods: We conducted a prospective observational study of all patients who presented with subacute chikungunya arthritis over 1 year duration. Chikungunya fever was diagnosed by consistent clinical picture with specific immunoglobulin M positivity. Disease activity assessments and US-7 score were performed at baseline. Indian Health Assessment Questionnaire (HAQ) and pain on numerical rating scale were done at baseline and 1 year of follow-up. Results: We included 23 patients (18 females) with a median age of 43 years. Most (22/23) patients had polyarticular disease with negative rheumatoid factor and anticyclic citrullinated peptide. Ultrasound revealed synovitis in all and tenosynovitis in most patients. The median (interquartile range) US7 score, Disease Activity Score 28 erythrocyte sedimentation rate (DAS28-ESR) score, Indian HAQ, and pain at presentation were 15 (11), 4.4 (2), 0.92 (0.7), and 5 (6), respectively. Twenty patients were treated with a short course of glucocorticoids. One-year follow-up was available in 20 patients. The median HAQ and pain score at follow-up were 0.08 (0.21) and 1 (1), respectively . No correlation was found between US7 score, DAS28, swollen joint count, tender joint count, ESR, HAQ score, or pain at presentation with HAQ and pain at follow-up. Conclusion: Disease activity at presentation as assessed by US7 score did not correlate with disability and pain at 1 year of follow-up in patients with chikungunya arthritis.

Use of corticosteroid hormones in patients with moderate COVID-19: what goals can be achieved

BACKGROUND: There is strong evidence of the effectiveness of glucocorticoids (dexamethasone) in the treatment of critically ill patients with COVID-19. However, the condition of most of them, at the time of hospitalization, is not assessed as severe or critical, but at the same time, with dynamic observation, it may worsen. It is in this group of patients that data on the effectiveness of glucocorticoids use remain few and contradictory.&#x0D; AIMS: to study the relationship between the use of a short course of corticosteroid hormones (CSH) in recommended doses and clinical and laboratory parameters of generalized inflammation in patients with a moderate course of new coronavirus infection (COVID-19) in a hospital setting.&#x0D; MATERIALS AND METHODS: The study included 121 patients with probable (clinically confirmed) and confirmed (laboratory) cases of COVID-19. A retrospective analysis of the data of electronic medical records of all patients admitted sequentially from October 1, 2020 to January 31, 2021 was carried out. The demographic indicators, comorbidities, symptoms, clinical indicators, results of laboratory tests and computed tomography were studied. Statistical analysis was performed using the standard Statistica 10 software for Windows.&#x0D; RESULTS: The data of electronic medical records of 121 patients were studied. Glucocorticoids were prescribed to 71 patients (58.7%), most often dexamethasone was used 70 out of 71 (98.5%). 73 (60.3%) patients had concomitant chronic diseases. 114 (94.2%) were discharged with recovery. patients, died ― 5 (4.1%), the cause of deaths was multiple organ failure. When evaluating groups of patients, in the period before the appointment of glucocorticoids and a similar period of illness in those who did not receive glucocorticoids significant differences were found in the groups in terms of generalized inflammation (body temperature, C-reactive protein concentration), indicators of respiratory disorders (respiration rate, oxygen saturation), according to indicators of the cellular composition of blood (lymphopenia and thrombocytopenia) in patients treated with glucocorticoids. After completing the course of glucocorticoids, patients showed a statistically significant increase in lymphocytes ― by 76.9%, platelets ― by 67.4%. The level of C-reactive protein significantly decreased by more than 4 times. The obtained data show a decrease in the severity of generalized inflammation, correction of the activation syndrome. acrophages, activation of bone marrow germs and positive clinical and laboratory dynamics of COVID-19.&#x0D; CONCLUSION: The study demonstrated reliable data on a decrease in the activity of generalized inflammation after the use of a short course of corticosteroid hormones in recommended doses. This led to the stabilization of the state in 53 of 71 (73%) patients and the termination of the escalation of further treatment.

Factors associated with the persistence of oral 5-aminosalicylic acid monotherapy in ulcerative colitis: a nationwide Norwegian cohort study.

Background:Oral 5-aminosalicylic acid (5-ASA) is the mainstay treatment of ulcerative colitis (UC) and therapy with oral 5-ASA is associated with beneficial outcomes. We have examined factors associated with the persistence of oral 5-ASA treatment in a national cohort of UC patients.Methods:Patients with newly diagnosed UC from 2010 to 2014 using oral 5-ASA monotherapy were identified by combining data from the Norwegian Patient Registry and the Norwegian Prescription Database. The median follow-up time was 1029 days. Drug persistence was defined as duration of oral 5-ASA preparation as monotherapy. Non-persistence of a oral 5-ASA preparation as monotherapy was defined as stopping oral 5-ASA, initiation of any further anti-inflammatory treatment including a course of glucocorticoids and a change to another oral 5-ASA preparation. Drug persistence was analyzed using the Kaplan–Meier method and influence of covariates on drug persistence was analyzed with the Cox proportional hazard model.Results:A total of 3421 patients were identified. The overall median 5-ASA drug persistence was 179 days. In univariate analyses, persistence was associated with preparation type and high-dose treatment, while oral glucocorticoid use or hospitalization around the start of oral 5-ASA were associated with shorter 5-ASA persistence. In multivariate analyses, oral glucocorticoids [HR 1.67 (1.54–1.80), p < 0.005] and hospitalization around start of 5-ASA [HR 1.23 (1.14–1.34), p < 0.005] were associated with non-persistence, whereas high dose (⩾3 g/day) 5-ASA was associated with longer persistence [HR 0.68 (0.65–0.71), p < 0.005].Conclusion:High-dose treatment with oral 5-ASA was associated with longer persistence of oral 5-ASA monotherapy, whereas the presence of factors indicating more severe disease around initiation of 5-ASA monotherapy was associated with a shorter persistence.

Clinical and pathological findings of SARS-CoV-2 infection and concurrent IgA nephropathy: a case report

BackgroundSince the Coronavirus Disease 2019 (COVID-19) outbreak, there is accumulating data on the clinical characteristics, treatment strategies and prognosis of COVID-19 in patients with concurrent renal disease. Postmortem investigations reveal renal involvement in COVID-19, and most recently, several biopsy researches reveal that acute tubular injury, as well as glomerular nephropathy such as collapsing glomerulopathy were common histological findings. However, to our best knowledge, there is limited data regarding IgA nephropathy in the setting of COVID-19.Case presentationIn the present case, we report a 65-year old Chinese woman who presented with dark-colored urine, worsening proteinuria and decreased renal function after COVID-19 infection. She received a renal biopsy during COVID-19 infection. The renal biopsy revealed IgA nephropathy without any evidence for SARS-Cov-2. The findings suggest that the renal abnormalities were a consequence of exacerbation of this patient’s underlying glomerular disease after COVID-19 infection. After a regimen of 3-day course of glucocorticoid and angiotensin II receptor blocker therapy, the patient recovered and remained stable upon follow-up.ConclusionsIt is important to consider the underlying glomerular disease exacerbation as well as virus induced injury when dealing with renal abnormalities in patients with COVID-19. A kidney biopsy may be indicated to exclude a rapidly progressive glomerular disease.