Dose Corticosteroid Treatment Research Articles

The impact of high dose corticosteroid treatment affect on cardiac abnormalities in patients with multiple sclerosis

Aims: High-dose corticosteroids to control acute relapses of multiple sclerosis, leveraging their anti-inflammatory effects. However, these treatments can lead to cardiovascular side effects. Understanding the pathophysiology of corticosteroid induced bradycardia is paramount for healthcare providers. Our aim in this study are to identify risk factors for cardiac side effects and assess the timing of cardiac complications relative to treatment. Methods: Patients who met the McDonald's criteria for definite MS and patients requiring admission for pulse steroid treatment with an acute recurrence were included.Individuals taking cardiac medications, or with a heart illness were excluded.Patients were given 1 g IV methylprednisolone in 2 hours for five to seven days in order to treat acute relapses. Results: We studied with 23 patients(6 males and 17 females, 26.1/73.9% respectively).The mean±SD age of the patients was 34.6±9.9 (18-43) years and the mean±SD duration of disease was 5.5±4.9 years.Most of the patients were relapsing–remitting MS in 73.9%, primary progressive in 4.4% and secondary progressive in 21.7%.The most common cardiac arhythmia during corticosteroid pulse therapy was sinus bradycradia(n=6). Conclusion: The combination of direct effects on cardiac myocytes, electrolyte disturbances, autonomic dysfunction, and individual genetic factors can contribute to the development of bradycardia in MS patients treated with high-dose methylprednisolone. Close monitoring and prompt intervention are crucial to manage this adverse effect and optimize patient safety.

Tyrosine kinase inhibitor-induced immune hemolytic anemia; three different drugs in three separate cases.

Molecular multitargeted small tyrosine kinase inhibitory (TKI) agents such as axitinib, sunitinib and pazopanib are commonly used in several types of solid tumors. Anemia is not a rare effect of these drugs which may occur at all grades. However, drug-induced immune hemolytic anemia (IHA), a very rare condition is distinctive from other types of anemia with its specific mechanism and management strategy. We reported three different TKI-induced IHA cases that occurred due to axitinib, sunitinib, and pazopanib, respectively. The first two cases were diagnosed with renal cell carcinoma and the last one was diagnosed with soft tissue sarcoma. They all presented with the characteristic symptoms of anemia and hemolysis. All the cases were detected positive for the complement C3d direct antiglobulin (direct coombs) test. Discontinuation of the causative drug and 1 mg/kg/day dose of corticosteroid treatment were able to control IHA in all three cases. Excluding the other factors of IHA and an evident laboratory and clinical benefit after withholding the TKI led to the diagnosis of TKI-related IHA in each case. TKIs are relatively new in clinical practice and are being used for more indications and in more patients. To our knowledge#these three cases are unique in terms of axitinib#sunitinib#and pazopanib-related IHA.

The Effect Of Corticosteroid Therapy on the Frequency of Secondary Bacterial Infections And Mortality in COVID-19 Patients in ICU

Objectives:There are recommendations and studies for the corticosteroid treatment of cytokine storm and ARDS in COVID-19 disease. The aim is to evaluate the rates of secondary infections and mortality in COVID-19 patients receiving various doses of corticosteroid treatment in the ICU.
 Methods: In a retrospective approach, 621 patients were analyzed and recorded in terms of age, gender, duration of mechanical ventilation, length of stay in intensive care, CRP, procalcitonin, LDH, IL-6, lymphocyte, D-dimer, ferritin values and corticosteroid doses as well as blood, urine, and tracheal aspiration growths. The patients were examined in 6 groups those who never took corticosteroids and those who took Methylprednisolone (MP) in doses of 250 mg, >250 mg, 80 mg, 40 mg, and 6 mg dexamethasone. The data were evaluated to determine if there have been significant relationships between corticosteroid doses and the rates of secondary infection and mortality.
 Results: The mean hospital stay of the patients was 11.2 ± 7.71 days, and the mean of invasive mechanical ventilation was 7.5 days. There was no significant difference between patients who did not use corticosteroids and patients who received 40 mg MP for the length of hospital stay. The length of hospital stay was significantly longer in the corticosteroid groups (p

Association of immune deficiency with prognosis and corticosteroid treatment benefits among patients with acute respiratory distress syndrome.

The role of corticosteroids in acute respiratory distress syndrome (ARDS) remains contentious. This study aims to investigate the prognostic significance of immune deficiency in patients with ARDS and its response to varying doses of corticosteroids. This single-center, retrospective cohort study enrolled 657 ARDS patients from January 24, 2008, to September 12, 2022, at Zhongshan Hospital of Fudan University, Shanghai, China. The patients were categorized into a discovery dataset (n=357) and a validation dataset (n=300), based on admission date. Further validation of the results in the validation dataset was used to enhance the credibility of the study conclusions. The study examined the association between immune deficiency and the patients' clinical characteristics, treatment measures, and prognosis. The primary outcome was 28-day mortality post disease onset. Data analysis was conducted from June 15, 2023 to August 15, 2023. The initial risk factor analysis in the discovery dataset was primarily based on the clinical characteristics, and the results suggested that immune deficiency likely impacted overall survival among patients receiving different doses of corticosteroid treatment. Multivariate analysis identified immune deficiency as an independent prognostic factor for overall survival in both the discovery and validation datasets. The final analysis revealed that patients with mild to moderate ARDS [discovery dataset: hazard ratio (HR) =1.719; 95% confidence interval (CI): 1.229-2.406; log-rank test P=0.001; validation dataset: HR =1.874; 95% CI: 1.238-2.837; log-rank test P=0.002] or severe ARDS (discovery dataset: HR =1.874; 95% CI: 1.007-3.488; log-rank test P=0.04; validation dataset: HR =1.698; 95% CI: 1.042-2.768; log-rank test P=0.03) with immune deficiency exhibited lower overall survival rates. Patients with mild to moderate ARDS and immune deficiency showed greater benefits from low-dose corticosteroid treatment (HR =0.409; 95% CI: 0.249-0.671; P<0.001 for interaction), whereas those with severe ARDS and immune deficiency benefitted from both low and high-dose treatments (low corticosteroid: HR =0.299; 95% CI: 0.136-0.654; high corticosteroid: HR =0.458; 95% CI: 0.214-0.981; P=0.005 for interaction). Immune deficiency is an independent risk factor in ARDS. Incorporating it into the disease severity grading system based on the Berlin criteria may enhance personalized treatment approaches for ARDS patients. These findings warrant further validation through prospective, large-scale, multicenter randomized controlled trials (RCTs).

Decreased cerebrospinal fluid kynurenic acid in epileptic spasms: A biomarker of response to corticosteroids.

SummaryBackgroundEpileptic (previously infantile) spasms is the most common epileptic encephalopathy occurring during infancy and is frequently associated with abnormal neurodevelopmental outcomes. Epileptic spasms have a diverse range of known (genetic, structural) and unknown aetiologies. High dose corticosteroid treatment for 4 weeks often induces remission of spasms, although the mechanism of action of corticosteroid is unclear. Animal models of epileptic spasms have shown decreased brain kynurenic acid, which is increased after treatment with the ketogenic diet. We quantified kynurenine pathway metabolites in the cerebrospinal fluid (CSF) of infants with epileptic spasms and explored clinical correlations.MethodsA panel of nine metabolites in the kynurenine pathway (tryptophan, kynurenine, kynurenic acid, 3-hydroxykynurenine, xanthurenic acid, anthranilic acid, 3-hydroxyanthranilic acid, quinolinic acid, and picolinic acid) were measured using liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). CSF collected from paediatric patients less than 3 years of age with epileptic spasms (n=34, 19 males, mean age 0.85, median 0.6, range 0.3–3 yrs) were compared with other epilepsy syndromes (n=26, 9 males, mean age 1.44, median 1.45, range 0.3–3 yrs), other non-inflammatory neurological diseases (OND) (n=29, 18 males, mean age 1.47, median 1.6, range 0.1–2.9 yrs) and inflammatory neurological controls (n=12, 4 males, mean age 1.80, median 1.80, range 0.8–2.5 yrs).FindingsThere was a statistically significant decrease of CSF kynurenic acid in patients with epileptic spasms compared to OND (p<0.0001). In addition, the kynurenic acid/kynurenine (KYNA/KYN) ratio was lower in the epileptic spasms subgroup compared to OND (p<0.0001). Epileptic spasms patients who were steroid responders or partial steroid responders had lower KYNA/KYN ratio compared to patients who were refractory to steroids (p<0.005, p<0.05 respectively).InterpretationThis study demonstrates decreased CSF kynurenic acid and KYNA/KYN in epileptic spasms, which may also represent a biomarker for steroid responsiveness. Given the anti-inflammatory and neuroprotective properties of kynurenic acid, further therapeutics able to increase kynurenic acid should be explored.FundingFinancial support for the study was granted by Dale NHMRC Investigator grant APP1193648, Petre Foundation, Cerebral Palsy Alliance and Department of Biochemistry at the Children's Hospital at Westmead. Prof Guillemin is funded by NHMRC Investigator grant APP1176660 and Macquarie University.

Different Dose Corticosteroid Treatment Protocols for COVID-19 Patients Admitted to Intensive Care: Comparison of the Effects on Efficacy and Mortality

Different Dose Corticosteroid Treatment Protocols for COVID-19 Patients Admitted to Intensive Care: Comparison of the Effects on Efficacy and Mortality

Delayed Leukoencephalopathy and Foreign Body Reaction After Endovascular Treatment in Patients With Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage-A Systematic Review of the Literature.

Background: Delayed leukoencephalopathy and foreign body reaction are rare complications after endovascular treatment of intracranial aneurysms. However, cases are increasingly being described, given the rising case numbers and complexity.Methods: Clinical presentation, differentials, diagnostics, treatment, and formerly published data were reviewed in light of available cases. A systematic search of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: This article provides an extensive literature review of previously described cases, and discusses the causes and management of this rare and delayed complication by referring to 17 articles on this topic, with a total of 50 cases with sufficient data in the literature. Furthermore, we present the case of a 53-year-old female patient with subarachnoid hemorrhage from a large anterior communicating artery aneurysm with tortuous cervical vessels who was treated with endovascular coiling and has suffered delayed leukoencephalopathy 6 weeks after discharge. Diagnostics, treatment, and clinical course of this rare complication are presented on this case and based on formerly published literature. The patient timely recovered under high dose corticosteroid treatment and follow up MRI showed almost complete remission of the described lesions within 10 days in accordance with previously published data.Conclusion: Foreign body reaction might result in delayed leukoencephalopathy, especially following complex endovascular aneurysm treatment. Early high dose followed by low dose ongoing corticosteroid treatment might result in timely remission.

The Controversy About the Effects of Different Doses of Corticosteroid Treatment on Clinical Outcomes for Acute Respiratory Distress Syndrome Patients: An Observational Study.

Background: Corticosteroid usage in acute respiratory distress syndrome (ARDS) remains controversial. We aim to explore the correlation between the different doses of corticosteroid administration and the prognosis of ARDS.Methods: All patients were diagnosed with ARDS on initial hospital admission and received systemic corticosteroid treatment for ARDS. The main outcomes were the effects of corticosteroid treatment on clinical parameters and the mortality of ARDS patients. Secondary outcomes were factors associated with the mortality of ARDS patients.Results: 105 ARDS patients were included in this study. Corticosteroid treatment markedly decreased serum interleukin-18 (IL-18) level (424.0 ± 32.19 vs. 290.2 ± 17.14; p = 0.0003) and improved arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (174.10 ± 65.28 vs. 255.42 ± 92.49; p < 0.0001). The acute physiology and chronic health evaluation (APACHE II) score (16.15 ± 4.41 vs. 14.88 ± 4.57, p = 0.042) decreased significantly on the seventh day after systemic corticosteroid treatment. Interestingly, the serum IL-18 decreased significantly (304.52 ± 286.00 vs. 85.85 ± 97.22, p < 0.0001), whereas the improvement of PaO2/FiO2 (24.78 ± 35.03 vs. 97.17 ± 44.82, p < 0.001) was inconspicuous after systemic corticosteroid treatment for non-survival patients, compared with survival patients. Furthermore, the receiver operating characteristic (ROC) model revealed, when equivalent methylprednisolone usage was 146.5 mg/d, it had the best sensitivity and specificity to predict the death of ARDS. Survival analysis by Kaplan–Meier curves presented the higher 45-day mortality in high-dose corticosteroid treatment group (logrank test p < 0.0001). Multivariate Cox regression analyses demonstrated that serum IL-18 level, APACHE II score, D-dimer, and high-dose corticosteroid treatment were associated with the death of ARDS.Conclusion: Appropriate dose of corticosteroids may be beneficial for ARDS patients through improving the oxygenation and moderately inhibiting inflammatory response. The benefits and risks should be carefully weighed when using high-dose corticosteroid for ARDS.Trial registration: This work was registered in ClinicalTrials.gov. Name of the registry: Corticosteroid Treatment for Acute Respiratory Distress Syndrome. Trial registration number: NCT02819453. URL of trial registry record: https://register.clinicaltrials.gov.

Health-Related Quality of Life Difference between Early Diagnosed and Finished Therapy of Nephrotic Syndrome in Children

BACKGROUND: Nephrotic syndrome is the most common glomerular disease in children with high economic burden. The management of nephrotic syndrome at present is not only focusing in outcomes of disease but also the burden related to health-related quality of life (HRQOL). HRQOL of children with nephrotic syndrome is influenced by steroid dependence, steroid resistance, cytotoxic therapy, frequency of relapse, disease severity, socioeconomic status, and duration of illness. AIM: The objective of the study is to determine the difference of HRQOL in children between early diagnosed nephrotic syndrome and finished therapy of nephrotic syndrome. METHODS: A cross-sectional study was conducted between January and December 2018. Subjects were children aged 1–18 years with nephrotic syndrome and then divided into 2 groups based on either in the 1st week of full dose corticosteroid treatment or in the 1st week after finishing therapy equally. Demographical data, nutritional status, and laboratory results were obtained. HRQOL was measured using PedsQL 4.0 questionnaire in the Indonesian language. The difference of HRQOL was analyzed using independent T-test. RESULTS: A total of 100 subjects enrolled in this study and divided into two groups. Male-to-female ratio was 4:1 in early diagnosed group and 7.3:1 in finished therapy group. Mean age of subjects for the early diagnosed group was 4.6 years and finished therapy group was 5.3 years. Total HRQOL was improved after treatment administration in children with nephrotic syndrome (p &lt; 0.001). The improvement was most significant in physical domain (p = 0.002). CONCLUSION: HRQOL in children with early diagnosed nephrotic syndrome was lower compared to children with finished therapy of nephrotic syndrome.

Immediate and Short-term Outcome of Acute Disseminated Encephalomyelitis (ADEM) after corticosteroid therapy

Background : Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disorder of the central nervous system (CNS) occurring predominantly but not exclusively in children. The presence of severe disturbance of consciousness together with multifocal neurological symptoms and signs especially in a child under 10 years of age; favours a diagnosis of ADEM. Neuroimaging is essential investigation for establishing the diagnosis of ADEM. High-dose steroid treatment frequently results in a dramatic clinical improvement.&#x0D; Objective: This study aimed to describe our experience with Acute Disseminated Encephalomyelitis (ADEM) focusing on the clinical features, neuroimaging, and outcome after treatment with high-dose steroid.&#x0D; Method: This retrospective observational study was conducted in children who were admitted as inpatients in Paediatric Neurosciences Department of Dhaka Shishu Hospital (DSH) with the diagnosis of ADEM during the period of 2017- 2019. All patients got high dose IV methylprednisolone for 5 days followed by 2 weeks tapering dose of steroid. Outcome was observed on the 7th day of treatment and 6 months after discharge from hospital.&#x0D; Result: A total of 16 patients who were diagnosed as ADEM were included in this study. Twelve children (75%) had a recent upper respiratory tract illness. Patients presented most often with motor deficits (88%) and secondly with altered consciousness (63% ) followed by seizure ( 50% ). MRI brain was the preferable neuroimaging which mostly (41.7%) showed multifocal symmetrical demyelination patch. On the 7th day of steroid treatment, significant improvement in motor function and level of consciousness occurred (p values were 0.001% and 0.014% respectively). After 6 months of discharge from hospital; no motor deficit, age-appropriate cognitive level and no seizure in 71%, 57% and 71% respectively.&#x0D; Conclusion: High dose corticosteroid treatment in ADEM is significantly effective in improvement of motor impairment and consciousness level on immediate follow up.&#x0D; Northern International Medical College Journal Vol.11 (2) Jan 2020: 468-470

EP18 Testicular sarcoidosis: a challenging diagnosis

EP18 Testicular sarcoidosis: a challenging diagnosis

Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19

ObjectivesUse of corticosteroids is common in the treatment of coronavirus disease 2019, but clinical effectiveness is controversial. We aimed to investigate the association of corticosteroids therapy with clinical outcomes of hospitalized COVID-19 patients. MethodsIn this single-centre, retrospective cohort study, adult patients with confirmed coronavirus disease 2019 and dead or discharged between 29 December 2019 and 15 February 2020 were studied; 1:1 propensity score matchings were performed between patients with or without corticosteroid treatment. A multivariable COX proportional hazards model was used to estimate the association between corticosteroid treatment and in-hospital mortality by taking corticosteroids as a time-varying covariate. ResultsAmong 646 patients, the in-hospital death rate was higher in 158 patients with corticosteroid administration (72/158, 45.6% vs. 56/488, 11.5%, p < 0.0001). After propensity score matching analysis, no significant differences were observed in in-hospital death between patients with and without corticosteroid treatment (47/124, 37.9% vs. 47/124, 37.9%, p 1.000). When patients received corticosteroids before they required nasal high-flow oxygen therapy or mechanical ventilation, the in-hospital death rate was lower than that in patients who were not administered corticosteroids (17/86, 19.8% vs. 26/86, 30.2%, log rank p 0.0102), whereas the time from admission to clinical improvement was longer (13 (IQR 10–17) days vs. 10 (IQR 8–13) days; p < 0.001). Using the Cox proportional hazards regression model accounting for time varying exposures in matched pairs, corticosteroid therapy was not associated with mortality difference (HR 0.98, 95% CI 0.93–1.03, p 0.4694). DiscussionCorticosteroids use in COVID-19 patients may not be associated with in-hospital mortality.

Corticosteroid Usage in Giant Cell Arteritis

ABSTRACT Giant cell arteritis (GCA) is a condition that can cause irreversible visual loss if untreated. While corticosteroids remain the mainstay of treatment to prevent visual loss, the type, dose, route, and duration of corticosteroid treatment of GCA remain controversial. Our study surveyed neuro-ophthalmologists to determine commonly prescribed dosages of corticosteroids for the treatment of GCA with or without visual loss. For patients with acute visual loss, 52% would use intravenous (IV), 46% would use IV or oral and 2% would use oral corticosteroids. Seventy-three per cent would use 500 to 1000 mg IV methylprednisolone in this group. For patients with GCA without acute visual loss, 67% would use the oral route, 30% would use IV or oral, and 3% indicated they would use IV route of treatment. Seventy-five per cent would use 1.0 to 1.5 mg/kg oral prednisone in this group. Our results suggest a majority but not a complete consensus for route and dose of corticosteroid treatment in GCA and confirm conventional recommendations for high dose IV corticosteroids for GCA with visual loss and lower dose oral regimens for GCA without visual loss.

Aggressive corticosteroid treatment in childhood idiopathic pulmonary hemosiderosis with better outcome

Idiopathic pulmonary hemosiderosis (IPH) is a rare but fatal disease characterized by a triad of anemia, hemoptysis, and increased pulmonary infiltration. This study is aimed to review the clinical manifestations, diagnostic tools, medication and outcome of childhood IPH in Taiwan. We retrospectively enrolled the patients less than 18 years old in National Taiwan University Hospital in the past 30 years. The clinical data were collected and analyzed. All of the twelve children diagnosed with IPH had anemia and increased pulmonary infiltration, eight had hemoptysis, and ten were confirmed with detection of hemosiderin-laden macrophages. The mean age at diagnosis were 4.9 (interquartile range 2.5-6.3) years old. Patients with high dose corticosteroid (CS, ≥ 1mg/kg/day prednisolone equivalent) treatment had lower odds ratio for ICU admission and significant higher Hb recovery rate than those with mild disease activity not receiving high dose CS treatment (p=0.011). The only factor that is significantly associated with persistent anemia is the usage of high dose CS (p<0.001) after adjusting for hemoptysis, fulfilling triad, serum ferritin level, and ICU admission by multiple regression. The only factor that is significantly associated with ICU admission is the presence of microorganism yielded in sputum (p<0.001) after adjusting for fever, serum ferritin level, usage of invasive MV, and high dose CS treatment days. The aggressive high dose CS therapy might prevent ICU admission and improve anemia. Aggressive high dose CS treatment is suggested in IPH patients regardless of the disease activity.

Severe asthma in humans and mouse model suggests a CXCL10 signature underlies corticosteroid-resistant Th1 bias.

We previously showed that Th1/type 1 inflammation marked by increased IFN-γ levels in the airways can be appreciated in 50% of patients with severe asthma, despite high dose corticosteroid (CS) treatment. We hypothesized that a downstream target of IFN-γ, CXCL10, which recruits Th1 cells via the cognate receptor CXCR3, is an important contributor to Th1high asthma and CS unresponsiveness. We show high levels of CXCL10 mRNA closely associated with IFNG levels in the BAL cells of 50% of severe asthmatics and also in the airways of mice subjected to a severe asthma model, both in the context of high-dose CS treatment. The inability of CS to dampen IFNG or CXCL10 expression was not because of impaired nuclear translocation of the glucocorticoid receptor (GR) or its transactivational functions. Rather, in the presence of CS and IFN-γ, STAT1 and GR were recruited on critical regulatory elements in the endogenous CXCL10 promoter in monocytes, albeit without any abatement of CXCL10 gene expression. High CXCL10 gene expression was also associated with a mast cell signature in both humans and mice, CXCR3 being also expressed by mast cells. These findings suggest that the IFN-γ-CXCL10 axis plays a central role in persistent type 1 inflammation that may be facilitated by CS therapy through GR-STAT1 cooperation converging on the CXCL10 promoter.

Spectrum and visual outcomes of Vogt-Koyanagi-Harada disease in Argentina.

To review all cases of Vogt-Koyanagi-Harada (VKH) disease in an Inflammatory Eye Disease Service in Argentina and to describe the clinical profile and outcomes of treatment. The records from patients with VKH disease between January 1980 and December 2008 were retrospectively analyzed for clinical profile, complications, and treatment. Patients were classified according to their initial treatment in group 1: high corticosteroid dose [≥1 mg/(kg·d)] within 2wk of illness onset; group 2: high corticosteroid dose, 2 to 4wk of onset and group 3: patients who received the high dose after 1mo of illness onset, patients who received lower oral doses than 1 mg/(kg·d) without regarding the time of beginning of the disease. A total of 210 eyes of 105 patients were included. The mean age at presentation was 32.6±13y (range: 10-74y), and 86.7% were female. The mean duration of follow up was 144±96.6mo. Patients in the group 1 had significantly higher visual acuity than the other groups (P<0.0001), none had (loss of, or no) light perception at the end of follow up, whereas 24.7% patients in group 3 ended in light perception (P<0.004). Patients with early high dose corticosteroid treatment have better visual acuity and fewer complications. Proper timing in referral and treatment is critical for better visual outcome in VKH disease.

A case of unilateral and spontaneously resolving posterior uveitis with overlapping features of Vogt-Koyanagi-Harada disease and Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

IntroductionVKH disease is a chronic, bilateral, granulomatous panuveitis with potential involvement of neurological, auditory and integumentary systems. On the other hand, APMPPE is believed to be an immune-driven chorioretinal vascular disease characterized by multifocal, flat, grey-white placoid lesions at the level of the RPE. We describe a case with overlapping figures of both conditions.Case descriptionA 19-year-old female presented with unilateral blurry vision and was found to have clinical and IVFA findings consistent with APMPPE. Her OCT study demonstrated typical VKH findings with large areas of serous neurosensory retinal detachment and intra-retinal cystoid spaces with enclosed membranous structures. She was closely followed but was not treated with high dose corticosteroid. Spontaneous and complete resolution of her symptoms and clinical, IVFA and OCT findings were achieved by day 25.DiscussionThis is the first reported case of spontaneously resolving, unilateral VKH disease in the absence of high dose corticosteroid treatment with overlapping features of APMPPE.ConclusionsThe imaging and clinical findings of both VKH disease and APMPPE raise the notion that VKH disease and APMPPE could be an overlapping spectrum of inflammatory processes, rather than distinct disease entities.

Postpartum corticosteroids in HELLP syndrome - standard to prompt recovery.

To perform a complex review of HELLP syndrome and its treatment from up to date scientific literature. Study of the interresting treatement regime of the patient. Complex analysis of the syndrome, systematic search of medical scientific databases and Slovak Medical Library. Analysis of the life threatening state of the patient, retrospective analysis of the diagnostics, treatment, acute management, complications and clinical results. According to up to date literature and our good clinical experiences we can encourage the use of high-dose corticosteroid therapy in HELLP syndrome. The most recent studies definitely recommend the high dose corticosteroid treatment in recovery management by the HELLP syndrome. We have used the high-dose corticosteroid regime as a recovery management for the patient with postpartum HELLP with very good clinical and laboratory response followed by prompt recovery of the patient and without other complications. We want to support and empasize the indication of the Dexamethasone regiment by HELLP, becouse the clinical experiences with this treatment are not well-known and usually the corticosteroids are not given to the patients with HELLP, or the treatment is "daemonized". Our clinical experience with this treatment was successful and the patient definitely profited of it. We support the opinion, that the benefit of described regiment highly exceedes the possible adverse effects of the therapy (Fig. 8, Ref. 61).

Invasive Fusariosis in Patients with Hematologic Malignancies at a University Hospital

Introduction: Fusarium species cause severe infections in patients with hematologic malignancies. The types of infection caused by Fusarium spp. in humans range from infections of nail, skin, and eye in immunocompetent host to invasive and disseminated infections in mainly immunocompromised patients.Methods: We retrospectively indentified patients with hematologic malignancy and positive cultures for Fusarium species at the University Hospital (1995-2014).Results: Thirteen cases were identified over study period. Patient demographic and underlying risk factors for fusariosis are presented in Table I. Most patients had uncontrolled hematological malignancy. All patients were neutropenic at diagnosis. Pulmonary involvement was evident in 3/13 patients (23%). Skin lesions were present in 2/13 (15%) patients. Fusariosis presented as a breakthrough infection in 8/13 (62%) of patients (Table II). Positive blood cultures were in the 6/13 (46%).Conclusions: Our study has several limitations due to its retrospective nature and its relatively small size. Fusariosis, althought uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia. The optimal therapy for fusariosis remains undefined, because of its rarity and the complex clinical scenarious in patients with severe immunosupression.Table 1Characteristics of 13 patients with fusariosisNoSex/ageUnderlying diseaseDuration of neutropenia before/after (days)Fusarium spp.DiagnosisBreakthrough infectionsConcomitant infectionsTreatment of fusarium infectionOutcome of Fusarium infection1F/41AML/Ri15 /6F. verticillioidesBloodNoneNoneAmp- BEradicated, in 23 days2M/19Aplastic anemia67/54F. proliferatumBronchilavageNoneC. kefyr, C. glabrata, P. aeruginosaAmp- B, voriconazoleEradicated, in 51 days3M/38AML/RÝ31/1F. proliferatumBronchi lavageFluconazoleC. albicansAmp- B, voriconazoleEradicated, in 199 days4M/50ALL/RÝ25/0F. proliferatumBloodFluconazoleK. pneumoniaeAmp- BDied5M/43AML/consolidation37/9F. solani SC haplotype 6Skin biopsyFluconazoleC. bovis, S. arolisVoriconazoleDied6M/45Relapse AML/ RÝ37/5F. petroliphilumBlood + tissuebiopsyItraconazole, voriconazoleVRE, S. capitis, S. maltophiliaAmp- B, voriconazoleDied7M/65AML/ RÝ41/0F. andiyaziBloodPosaconazolA. baumaniiAmp - BDied8M/63MDS tr. AML/ RÝNoneF. petroliphilumNasalbiopsyFluconazoleHSV, C. albicans, alternans spp.Amp- B, voriconazoleDied9M/49Refractary MDS tr. AML/ RÝ67/94F. solaniss.NasalbiopsyNoneS. hominis, S. saprophyticusVoriconazoleEradicatedin 68 days10F/53Relapse MDS tr. AML/ RÝ25/27F. proliferatumNasalbiopsyPosaconazoleVRE, Klebsiella, EnterobactericeaAmp- B, voriconazoleEradicated, in 84 days11F/49ALL/ RÝ23/13F. petroliphilumNasalbiopsyNoneEnterococcus, S. epidermidis, E. faecalis, MRS, BLPSAmp- B, voriconazoleDied12M/50HCL65/4F. petroliphilumBloodNoneNoneAmp- BDied13M/52Relapse AML/ consolidation34/3F. petroliphilumBlood , skin biopsyPosaconazoleC. parapsilosis, C. meningosepticum, S. capitisEchinocandine, voriconazoleEradicated , in 90 daysTable 2Patient characteristicsDemographic and disease characteristicsNumber of patients, n=13 (%)Median age49(19-63)Male49,5(19-63)Female49(41-53)Female patient3 (23)Male patient10(77)AML/ MDS tr. AML9 (69)Relapse3Remission induction7Consolidation2Reinduction1ALL (remission induction)2 (15)Hairy cell leukemia1 (8)Aplastic anemia1 (8)Median duration of neutropenia before diagnosis (day)34 (15-67)Median duration of neutropenia after diagnosis (day)6 (0-94)History of DM0Albümin <3.5 mg/dLAllHýgh dose corticosteroid treatment within 30 days of diagnosis1Breakthrough infections8 (62)While receiving posaconazole3 (23)While receiving voriconazole1 (8)While receiving fluconazole4 (31)Concominant infectionBacterial, viral, fungal=11 (85)Exitus7 (54) DisclosuresNo relevant conflicts of interest to declare.

Depression and hypomania symptoms are associated with high dose corticosteroids treatment for MS relapses

BackgroundPsychiatric side effects are known to occur with low dose corticosteroids. Standard of care for Multiple Sclerosis (MS) relapses is high dose corticosteroids (HDC), at least 1g/day for 3–5 days, and yet the relationship between this treatment and mood is not known. We sought to determine the frequency and potential predictors of (hypo)manic and depressive symptoms with HDC treatment for MS relapses. MethodsConsecutive MS subjects requiring HDC treatment were identified. The Mood Disorders Questionnaire (MDQ) and the Beck Depression Inventory-Fast Screen (BDIFS) were administered for (hypo)manic and depressive symptoms, respectively, prior to HDC, 3 days and one month post-HDC. ResultsEighty eight subjects completed the study. At relapse diagnosis, the mean BDIFS score was 4.2 (SD 3.1); the mean number of (hypo)manic symptoms endorsed on the MDQ was 4.3 (SD 3.5). Three days after completing HDC, 22.5% had an increase on the BDIFS and 38.2% endorsed more symptoms on the MDQ. A history of depression (p=0.006) and low reported quality of life (p=0.029) predicted an increase on the MDQ; the odds of an increase in (hypo)manic symptoms was 5.6 times higher with a history of any psychiatric disease/substance abuse (p=0.005). No predictors for worsening on the BDIFS were found. LimitationsSelf-reported measures were used, anxiety was not evaluated and 17 subjects were lost to follow up. ConclusionDepressive and hypo(manic) symptoms are commonly associated with HDC for MS relapses. It is important for clinicians and MS patients to be aware of this risk.