Course Of Steroids Research Articles

Organic Manic Episode: A Case Report on an Uncommon Presentation of Neurocysticercosis

Neurocysticercosis is the most commonly encountered helminthic infection of central nervous system caused by the larval stage of Taenia solium.The most common psychiatric manifestations seen in neurocysticercosis are depression, anxiety and psychosis. However, mania as a neuropsychiatric presentation is uncommon. The index case is a 34-year-old married female who presented to a tertiary medical centre with symptoms of fever, headache and dizziness for a period of 2 months. She was subjected to detailed evaluation by the Neurology Department of the institution. Magnetic Resonance Imaging (MRI) images showed cystic lesions in the right occipital lobe and in the intraventricular areas, demonstrating vesicular stage of cysticerci. She was treated with albendazole, antiepileptics and a short course of steroids and was discharged following resolution of symptoms after 2 weeks. Within days following discharge, patient started exhibiting behavioural changes suggestive of mania and was brought to the Psychiatry Outpatient Department and managed as a case of organic manic episode with mood stabilisers and antipsychotics. Patient improved symptomatically within 2 weeks and is presently being monitored on an outpatient basis. The present case shows a rare presentation of neurocysticercosis and the significance of early recognition and treatment of the psychiatric manifestations.

Kimura's disease involving the conjunctiva

A 50-year-old female presented with gradually increasing, pink nodular lesion on the temporal bulbar conjunctiva of the left eye, noticed in the past 15 days. She denied any history of trauma or similar episodes in the past or concurrent systemic illness. The lesion did not change after a 2-weeks long topical steroid course. It was then surgically excised. Histopathological analysis revealed lymphoid follicles with proliferating blood vessels lined up by plump endothelial cells with mixed infiltrate containing numerous eosinophils. Based on these findings, diagnosis of Kimura's disease (KD) was established. KD is a rare, chronic inflammatory disorder of possible allergic or autoimmune etiology which has been rarely described in conjunctiva.

Prurigo Pigmentosa and Confluent and Reticulated Papillomatosis a Spectrum of One Disease: A New Case Report

Background: Prurigo Pigmentosa (PP) is a rare inflammatory dermatitis first discovered in 1971. Characterized by a sudden eruption of pruritic reticulated, pink-brown papules coalescing into plaques distributed symmetrically over shoulders, neck, chest, and back. Various triggers have been identified, including the ketogenic diet. Clinicopathological presentation looks similar to confluent and reticulated papillomatosis (CARP) which is a rare dermatosis of unknown etiology characterized by hyperkeratotic pigmented papules & peripheral reticulation involving seborrheic areas. Aim: To document a new case presentation of PP caused by a low-carbohydrate restricted diet and discuss the comparison with CARP clinically, pathologically, and treatment modalities. Case report: A 15-year-old childhood male developed PP 3 weeks after self-initiating a low carbohydrate-restricted ketogenic diet for weight management. Clinically and histopathologically the lesion looks similar to CARP, treated successfully with re-introduction of high carbohydrates in his food, a short course of systemic steroids in combination with oral doxycycline capsules for the one-month duration. Conclusion: PP & CARP have been considered a spectrum of one disease, and PP is a pruritic variant from CARP caused by a low carbohydrate-restricted diet.

Resolution of Posttraumatic Brown Syndrome in a Child Following Treatment with Oral Steroid: A Case Report

Aim: To report a case of acquired Brown syndrome in a child following trauma and its response to oral steroids. Case Report: A 4-year-old child was brought to us with complaints of adopting abnormal head posture following a fall while playing and injuring his head. On examination, he had features of the acquired Brown syndrome of the right eye. Magnetic resonance imaging of the brain and orbits was normal. A course of oral steroids was given and the symptoms resolved after a month of treatment. Conclusion: Acute onset of abnormal head posture following trauma warrants keen evaluation of ocular movements and cover tests in all gazes to ascertain the cause. Acquired Brown syndrome should be considered in children following head trauma and it responds well to oral steroids.

Antenatal prevention of fetal respiratory distress syndrome and surfactant therapy in premature infants: evaluating the course of prenatal steroids in determining respiratory support tactics

Antenatal prevention of fetal respiratory distress syndrome and surfactant therapy in premature infants: evaluating the course of prenatal steroids in determining respiratory support tactics

Role of steroid on management of limb swelling and local pain in haematotoxic snake bite.

Local Pain and swelling in the biting area of haematotoxic snake bite victims are very common symptoms. This study was conducted to retrospectively observe the effect of oral Tab Prednisolone on a short-term basis as an add-on therapy of haematotoxic snake bite management in respect of Local Pain and swelling recovery. This retrospective descriptive study was conducted in a tertiary care hospital in West Bengal among 36 haematotoxic snake bite victims, admitted from February 2020 to January 2021. After collection of the data from hospital records and screened by inclusion and exclusion criteria, 36 participants were included in two groups based on the treatment regimen. Group A (n: 24) received only conventional treatment and Group B (n: 12) received oral Tab Prednisolone on a short-term basis as an add-on therapy of conventional treatment. Swelling was measured as a distance from the site of the bite with measuring tape in centimeters and pain was measured by a numerical rating pain scale (NRS) between 0 and 10. Ethical permission has been waived from the Institutional Ethical Review Committee. A total of 36 patients (32 male and 4 female) were included in the study. Age (Mean ± SD) of the snake victim persons in Group A and Group B were 35.79 ± 8.34 years and 31.33 ± 6.47 years, respectively. The local swelling length and pain score reduced significantly among group B patients on day 6 in comparison to day 2. However, in Group A, the pain score and local swelling increased significantly on day 6 in comparison to day 2. A short course of systemic steroids as an adjuvant with anti-venom serum (ASV) for the management of local pain and edema in case of haematotoxic snake bite may be beneficial if there is no contraindication.

SARS-CoV-2 dilated cardiomyopathy.

SARS-CoV-2 is an emerging cause of viral myocarditis that generates multiple complications, such as dilated cardiomyopathy. We describe a young, obese male patient with severe myocardial involvement by the SARS-CoV-2 virus, who presented with chest pain, elevated cardiac enzymes, non-specific electrocardiographic findings, echocardiogram with evidence of dilated heart disease with reduced ejection fraction, and subsequent verification using magnetic resonance imaging (MRI). The results of the cardiac MRI were typical of viral myocarditis. The patient did not respond to a short course of systemic steroids and the standard management for heart failure, had multiple re-admissions, and, unfortunately, died.

A case of endogenous candida endophthalmitis with incidental cytomegalovirus infection and optic neuropathy in a patient recovered from severe COVID-19

A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications.

MATERNAL AND PERINATAL OUTCOMES WITH ANTENATAL CORTICOSTEROID ADMINISTRATION IN PRETERM DELIVERIES AT GOVERNMENT DISTRICT HOSPITAL, NANDYAL- AN OBSERVATIONAL STUDY

MATERNAL AND PERINATAL OUTCOMES WITH ANTENATAL CORTICOSTEROID ADMINISTRATION IN PRETERM DELIVERIES AT GOVERNMENT DISTRICT HOSPITAL, NANDYAL- AN OBSERVATIONAL STUDY

An Unusual Presentaton of Tuberculosis with Septic Shock and Immune Reconstitution Inflammatory Syndrome in an Immunocompetent Patient

Tuberculosis presenting as septic shock is a rare entity especially in an immunocompetent patient. It has been reported in only 1% of patients with septic shock. Tuberculosis associated immune reconstitution inflammatory syndrome (IRIS) is the paradoxical worsening of the current condition or the development of new lesions in patients who are on anti-tuberculosis treatment. In non-HIV patients with tuberculosis, the incidence of IRIS is only about 2.4%. We report a 29 year old immunocompetant female who presented with septic shock and on continued evaluation she tested positive for mycobacterium tuberculosis by Genexpert (sensitive to rifampicin) done in BAL fluid. All possible causes for immunodeficiency were ruled out. She was started on Anti-Tuberculosis therapy (ATT) and a month later, patient deteriorated clinically with high spiking temperatures and troublesome constitutional symptoms. Contrast-enhanced computed tomography (CECT) abdomen and chest revealed new onset multiple enlarged necrotic mediastinal, para aortic and hilar lymph nodes. After extensive evaluation including autoimmune profile, fungal culture, viral serology, Positron emission tomography (PET) scan, bone marrow analysis and ruling out all other possible causes for fever, IRIS was suspected and patient was started on steroids along with ATT. There was a drastic improvement in her symptoms within a week. She completed her course of ATT and steroids were gradually tapered. At 2 years of follow up, the patient is doing well.

Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review.

Asthma is one of the most common chronic diseases of childhood. There is a scarcity of published literature on critical asthma, considered acute asthma requiring pediatric intensive care unit (PICU) admission. The goal of this study was to describe the clinical care of children with critical asthma admitted to a single center PICU and to determine whether pulmonary medicine consultation during admission impacted outcomes. Retrospective chart review of known asthma patients aged 4-18 years admitted to a quaternary PICU between 01/2013 and 07/2019 for management of critical asthma. A total of 179 patients were enrolled with median age of 8 years. Median hospital length of stay (LOS) was 3.2 days and PICU LOS was 1.5 days. A total of 80 (44.7%) patients had a pulmonary medicine consultation. In the pulmonary medicine consultation group versus the no-pulmonary medicine consultation group, there was a significant difference in hospital LOS (4.16 vs. 2.86 days, p value <.0001) and PICU LOS (2.00 vs. 1.00, p value <.0001), escalation of controller medication (66% vs. 21%, p value <.0001), scheduled outpatient pulmonology follow-up (87.5% vs. 45.4%, p value <.0001), and receiving ≥3 courses of systemic steroids in the 12 months after discharge (32.2% vs. 14.7%). There was no difference in attendance of scheduled follow up appointments or in having ≥3 emergency room visits or admissions in the 12 months after discharge. Pulmonary medicine consultation during hospital admission may impact management of critical asthma by increasing escalation of controller medication and scheduled outpatient follow up.

A Good Outcome Following Delayed Debridement of Lumbar Paraspinal Abscess after Postoperative Epidural Catheterization: Case Report

Paraspinal abscess or clinically significant soft tissue infection following epidural analgesia is a rare but serious complication if left untreated. We report a 54-year-old gentleman with underlying chronic diabetes mellitus who had a motor vehicle accident and had undergone several surgeries. A course of steroid was provided for delayed left lower motor neuron facial nerve palsy (House-Brackmann stage 4). The epidural catheter was inserted with a single attempt at the L3/L4 level. One month later, he complained of crippling lower back pain and growing swelling with a punctum. MRI showed a paraspinal abscess with bilateral involvement of the spinae erector. This report is intended to highlight the excellent outcome of surgical treatment for paraspinal abscess despite the late presentation. A high level of suspicion should be taken into account when the patient is immunocompromised, particularly with steroid use and chronic diabetes mellitus. Early detection via MRI, high suspicion index and immediate surgery have extraordinary benefits in managing paraspinal abscesses.

RADT-30. MULTISESSION RADIOSURGERY ALONE FOR TREATMENT OF PRESUMED MENINGIOMAS: AN INTERIM REPORT FROM A SINGLE INSTITUTION PROTOCOL

Abstract PURPOSE Meningiomas are the most commonly diagnosed primary intracranial tumor. Resection and single-fraction radiosurgery are treatment options with well-established long-term outcomes data. Multisession radiosurgery is an alternative treatment option with promising early results. However, mature outcomes literature does not yet exist. In this study, we report our institution’s interim results on the efficacy and safety of 5-fraction radiosurgery alone for radiographically diagnosed meningiomas. MATERIALS AND METHODS Between 2005-2015 all patients who completed treatment on a single institution protocol utilizing 5-fraction robotic radiosurgery alone for the treatment of progressing radiographically diagnosed meningiomas were eligible for inclusion. Local control was calculated using the Kaplan-Meier Method. RESULTS Forty-four consecutive predominately female patients (84%) ranging in age from 33-85 (median: 59) were included in the present study. Median tumor volume was 4.05mm3 (range: 0.94-15.4mm3) and the majority of tumors were located at the base of skull (66%). A median dose of 25Gy (range: 25Gy-35Gy), was delivered to a median isodose line of 82%, (range: 70%-90%) over a median of 7 days (range: 5-11 days). Acute toxicity was minimal with 7 patients (15%) requiring a short course of steroids for symptomatic edema during treatment. Of 16 patients who presented with a cranial nerve deficit, symptom improvement was noted in 11 patients (69%). No permanent treatment related toxicity was noted in our cohort. The median radiographic follow-up was 6.9 years (range: 0.5-14.8 years). The 5 and 8-year local control rates were 100% and 95%. The median time to local failure (n=2) in our cohort was 8.2 years. CONCLUSIONS The treatment of radiographically diagnosed meningiomas with 5-fraction robotic radiosurgery provides excellent local control to date, with low rates of acute and late toxicity. However, with late failures noted in our series, continued follow-up is needed to determine the optimal dose required for long-term tumor control.

P065 A case of fibrodysplasia ossificans progressiva in Kenya

Abstract Background Fibrodysplasia Ossificans Progressiva (FOP) is an extremely rare and disabling disorder affecting 1 in 2 million individuals worldwide. It is caused by mutations in bone morphogenetic protein which leads to extra-skeletal ossification of soft tissues in a characteristic cranio-caudal pattern. Hallux valgus, episodic flares and progressive functional disability are characteristic features. The cause of death is often cardio-respiratory failure following thoracic insufficiency. The objective of our case study is to describe a rare but interesting case of fibrodysplasia ossificans progressiva (FOP) in an African setting. Methods This was a retrospective case review Results Two-year-old boy presented with painful firm masses of bony consistency over the axilla, neck, occiput and the forehead for seven months. He developed progressive inability to lift the arms, flex his neck and had a characteristic stiff posture while walking. The masses had a waxing and waning nature lasting about 4–5 days but with no complete resolution. He was previously treated with antibiotics for lymphadenitis which was diagnosed by biopsy of the neck mass at a different health facility. On examinationhe had bony masses on the posterior aspect of the neck tender on palpation and attached to the underlying subcutaneous tissue. Similar masses were found on his anterior and posterior chest wall measuring 1 cm by 1 cm anteriorly and larger masses- measuring 5 cm by 5 cm posteriorly. He had bilateral hallux valgus and both elbows held in fixed flexion. His fingers had varying degrees of fixed flexion. The lower limbs were unaffected. Laboratory evaluation within normal ranges. extensive dystrophic soft tissue calcification around both elbows outlining the joint capsules. dystrophic soft tissue calcification in the bilateral axillae extensive “sheet like” soft tissue dystrophic calcifications overlying the posterior elements of the vertebral column separate from the vertebrae. Histology showed muscle replacement by hyaline cartilage and bone with intervening fibromyxoid stroma. Discussion &amp; Conclusions This case is meant to raise awareness of this rare disease across Africa. The misdiagnosis of FOP approaches 90% of cases worldwide. Definitive genetic testing of FOP is now available and can now confirm a diagnosis before the appearance of heterotopic ossifications. Clinical suspicion of FOP early in life on the basis of malformed great toes can lead to early clinical diagnosis. Current management focuses on early diagnosis, avoidance of trauma and optimization of function. A short course of oral steroids is beneficial in prevention of flares.

Bacterial Sinusitis in the COVID-19 Era: A Reminder for Antibiotic Stewardship

The COVID-19 pandemic has necessitated the trial of novel treatment regimens to improve clinical outcomes. However, the liberal use of antibiotic and steroid therapy during this period may have also contributed to unintended consequences including the development of multidrug-resistant (MDR) bacterial infections. In this report, we discuss the case of a 76-year-old woman treated with an extended course of steroids for COVID-19 infection. The patient then developed MDR bacterial sinusitis requiring multiple courses of antibiotics complicated by medication side effects. Thus, this case highlights the continued importance of discretion in long-term steroid use and antibiotic stewardship.

Bortezomib, Lenalidomide and Dexamethasone (VRd) Followed By Ciltacabtagene Autoleucel Versus Vrd Followed By Lenalidomide and Dexamethasone (Rd) Maintenance in Patients with Newly Diagnosed Multiple Myeloma Not Intended for Transplant: A Randomized, Phase 3 Study (CARTITUDE-5)

Bortezomib, Lenalidomide and Dexamethasone (VRd) Followed By Ciltacabtagene Autoleucel Versus Vrd Followed By Lenalidomide and Dexamethasone (Rd) Maintenance in Patients with Newly Diagnosed Multiple Myeloma Not Intended for Transplant: A Randomized, Phase 3 Study (CARTITUDE-5)

Ocular Manifestations and Full House Membranous Nephropathy as a Rare Presentation of Secondary Syphilis

Introduction: Syphilis is known as the great mimicker with symptoms that overlap many diseases. Here we present a patient with secondary syphilis which manifested as ocular symptoms, as well as membranous nephropathy with a full house staining pattern. Case Description: Our patient was a 54-year-old male who presented with a rash, joint pain, foamy urine and vision changes. Initial work up found a positive ANA and other autoimmune labs, and he was admitted for concern of lupus papillitis. Labs and CSF were positive for syphilis, and he was found to have nephrotic range proteinuria. Renal biopsy showed membranous nephropathy with full house staining, which is seen primarily in lupus nephritis with only one case report noting its presentation in syphilis (Jaunin E, Kissling S, Rotman S, Waeber G, Halfon M. Syphilis and parvovirus B19 co-infection imitating a lupus nephropathy: A case report. Medicine (Baltimore). 2019;98(36):e17040). He completed a course of penicillin and steroids with clinical improvement, and the diagnosis of secondary syphilis was made. Discussion: This case illustrates the importance of maintaining a broad differential diagnosis, and carefully examining all labs, imaging, pathology and symptoms in order to determine the definitive diagnosis. It also illustrates the importance of teamwork when faced with a challenge requiring input from multiple subspecialties to arrive at a final diagnosis.

Medical Image of the Month: Cavitating Pseudomonas aeruginosa Pneumonia

No abstract available. Article truncated after 150 words. A 56-year-old woman presented with cough and shortness of breath to hospital. She had a temperature of 39.2°C and had recently completed course of steroids and antibiotics for exacerbation of chronic obstructive pulmonary disease (COPD). She was an active smoker of 15 cigarettes/day for about 40 years. No other past medical history was noted. On examination she had left-sided crepitations and oxygen saturations of 90% on room air. Chest x-ray (CXR) (Fig 1:A) showed features of background emphysema with upper lobe peripheral bullae, larger on the left. Dense left peri-hilar consolidation was also described. SARS-CoV-2 swab was negative. White blood cells (WBC) were raised at 16.9x109/L and C-reactive protein (CRP) at 331 mg/L. The rest of the blood tests were unremarkable. CURB-65 score was zero but treatment was commenced with intravenous (IV) amoxicillin &amp; oral clarithromycin in view of level of CRP and CXR findings. On Day 4 of admission …

Jaundice in a Preterm Infant Twelve Hours After Birth.

Jaundice in a Preterm Infant Twelve Hours After Birth.

Enabling self-management of eczema in primary care

Eczema is a very common and, generally, long-term condition found across all age groups. Practice nurses are skilled in chronic disease management and are ideally placed to manage eczema in general practice, and the step-wise principles of asthma care can also be applied to eczema care. These principles are aimed at enabling patient self-management by supporting and educating them in ‘preventers’, daily complete emollient therapy and ‘relievers’, treating symptoms quickly, generally with a short course of topical steroids. Patients with eczema can be educated in identifying individual triggers (such as irritants and allergens), recognising flares and complications, such as infection, and knowing when to seek health professional support.