Local Steroid Therapy Research Articles

Evaluation of different strategies for using steroids in the treatment of sudden sensorineural hearing loss

Introduction. Sudden sensorineural hearing loss is manifested by sudden or rapid hearing loss without obvious disturbances in the outer and middle ear. Often the cause of this condition is not established. At the moment, various methods are used in the treatment, including corticosteroids, which are most often used as primary therapy. Recent studies demonstrate the effectiveness of topical steroid administration.Aim. Assess the effectiveness and safety of various methods of topical and standard systemic use dexamethasone in the treatment of patients with acute sensorineural hearing loss, as well as to determine the optimal timing of therapy.Materials and methods. 61 patients with this disease were treated in the study. 20 of them received dexamethasone transtubarly, 21 – transtympanic, and 20 – systemically. Audiological examination was performed on all patients before treatment, at discharge, a month and six months after discharge. All participants regularly assessed their discomfort on a 10-point scale. Results. The results of treatment demonstrated the effectiveness of both systemic and local steroid therapy in patients with sensorineural hearing loss; however, with topical use of the drug, the proportion of patients with complete hearing restoration was greater. Transtympanic introduction of steroids after radiowave myringotomy turned out to be the most comfortable for patients the level of discomfort was 1.5 points out of 10, while against the background of transtubal administration of the drug and systemic treatment it was 4.5 and 2.3 points, respectively.Conclusions. The method of transtympanic administration of corticosteroids in patients with acute sensorineural hearing loss after radiowave myringotomy is a reliable and effective method of drug delivery to the windows of the labyrinth. This approach allows you to visually control the process of introducing the medication into the tympanic cavity. Transtympanic and transtubal methods of steroid administration are comparable in effectiveness to classical systemic steroid therapy in the treatment of patients with acute sensorineural hearing loss.

Treatment of serpiginous choroiditis with sub-tenon triamcinolone in conjunction with systemic steroids case report.

To report two cases of serpiginous choroiditis which were treated with sub-Tenon's triamcinolone in conjunction with systemic steroids to control acute and chronic disease progression. Increased success of disease remission has been postulated for sub-Tenon's triamcinolone therapy in conjunct with systemic steroids. Retrospective chart review of two serpiginous choroiditis patients who presented at an eye center. Both patients received sub-Tenon's triamcinolone and systemic steroids. Visual acuity and disease course are reported. Both cases of serpiginous choroiditis received sub-Tenon's triamcinolone on presentation and were hospitalized for intravenous corticosteroids and systemic work up. The first patient had been on oral corticosteroids before presentation. Both patients reported same day visual improvement after sub-Tenon's triamcinolone was administered. These two case reports describe unique clinical scenarios in which sub-Tenon's triamcinolone was used in both the acute and chronic phases of serpiginous choroiditis. Local steroid therapy can be a useful adjunctive therapy when systemic steroids are delayed, contraindicated or intolerable.

THE ROLE OF ENDONASAL ELECTROPHORESIS WITH DEXAMETHASONE IN THERAPY OF UVEITIS UNDER CONCOMITANT ANKYLOSING SPONDYLITIS

Uveitis is a severe clinical manifestation of ankylosing spondylitis, leading to the loss of vision, particularly among young and working-able individuals. This study aims at evaluating the outcomes of integrated treatment for uveitis in Bekhterev's disease using endonasal electrophoresis with dexamethasone. Materials and Methods. The study included 22 patients (23 eyes) with uveitis and underlying ankylosing spondylitis who received inpatient treatment at Acad. Z. Aliyeva National Centre of Ophthalmology between 2017 and 2022. The average age of the patients was 34 ± 8.7 years, including 5 female and 17 male patients. In the main group, consisting of 12 patients (12 eyes), endonasal electrophoresis with dexamethasone was performed in addition to general and local steroid therapy. The control group comprised 10 patients (11 eyes) who received treatment without physiotherapy. Endonasal electrophoresis was conducted using the "Potok-1" apparatus, with gauze swabs soaked in a 0.4% dexamethasone solution and inserted into the middle nasal passages. The active electrode was secured to the free ends, and the drug was administered from the cathode. A total of 10 procedures were performed, starting from 10 minutes and gradually increasing to 15 minutes. The patients received inpatient treatment for two to three weeks. Results: The patients from main and control groups demonstrated positive dynamics in terms of increased visual acuity and expanded visual fields. Inflammation signs subsided within 4-5 days since the beginning of the treatment in the main group and within 6-7 days in the control group. Clinical improvement was evident in both groups, characterized by hypopion resorption, reduced cell count in the anterior chamber, and decreased opacities in the vitreous body. In the posterior segment, perivascular infiltration, chorioretinal foci, and macular oedema also showed signs of improvement. Conclusion: The use of dexamethasone endonasal electrophoresis as part of the complex therapy for uveitis in ankylosing spondylitis demonstrated more pronounced clinical effects compared to traditional treatments. Positive dynamics were observed in clinical, functional, perimetric, and electrophysiological indicators. Dexamethasone endonasal electrophoresis proved to be well-tolerated by patients and economically viable, making it a valuable addition to the complex therapy of uveitis in ankylosing spondylitis in both inpatient and outpatient settings.

Abstract 243: Local Periadventitial Delivery Of Dexamethasone Improves Murine Deep Vein Thrombosis Resolution

Background: Post deep vein thrombosis (DVT), up to 30-50% of patients will develop post-thrombotic syndrome (PTS), despite anticoagulation. Currently no preventive therapies, including catheter-based thrombectomy/thrombolysis (CDT), have shown to reduce PTS. Local steroid therapy adjunct to CDT is being tested clinically for DVT patients in the DEXTERITY trials, but minimal mechanistic data exists on DVT resolution. Here, we investigate effects of local dexamethasone (DEX) therapy on murine DVT resolution. Method: C57/BL6 male mice (n=146) underwent inferior vena cava (IVC) complete ligation to develop stasis DVT on day 0 (D0) followed by mechanical de-ligation on D2 to spur restoration of blood flow (RBF). On D2, mice were injected with PBS/DEX (0.1, 0.2, or 0.5 mg/mouse, 60μl volume, across four zones) in the periadventitial tissue of thrombosed IVC, with or without de-ligation (Fig. A-B). Mice underwent D4&D8 serial ultrasound imaging of IVC blood flow to assess RBF-defined as IVC mean flow velocity > 0 mL/sec. D8 thrombus burden was measured followed by histological/picrosirius red assessment of vein wall fibrosis. Results: N=6-11 mice per group underwent IVC DVT creation. Low-dose (0.1 mg) but not higher doses of DEX reduced thrombus burden (p=0.02) and weight (p=0.01) on D8 (Fig. C-D). Low-dose DEX increased D4 RBF rates and mean flow velocity (MFV) (Fig. E-F). Complete IVC stasis without de-ligation but with DEX non-significantly reduced thrombus burden and weight (Fig. G-H). Low-dose DEX further decreased vein wall fibrosis (Fig. I; p=0.001). D8 thrombi exhibited reduced macrophage content with DEX (Fig. J; n=15-18 sections/group, p=0.007). Conclusion: Following stasis DVT induction, locally delivered low-dose DEX improves DVT resolution by reducing thrombus burden, vein wall injury, macrophage content, and increases RBF rate. These data provide a scientific foundation for ongoing DEXTERITY trail testing adjunct DEX for DVT patients undergoing CDT.

Local vs Systemic Use of Steroids for Sudden Deafness with Diabetes: A Systematic Review and Meta-Analysis.

Diabetes is associated with a risk of idiopathic sudden deafness. The main treatment of diabetic sudden deafness is systemic and topical application of steroids. Topical steroid therapy reduces systemic adverse reactions compared with systemic therapy. The aim of this study was to conduct a meta-analysis design on the improvement value and recovery rate of pure tone mean hearing threshold (PTA).To investigate whether there is difference between local and systemic steroid treatment as the initial treatment for sudden deafness patients with diabetes. We searched databases from publication date to October 1, 2022 including PubMed, EMBASE, Cochrane Library, web of science, CNKI, Wan fang Database, China Biomedical Literature Database (CBM), and VIP information resource system. A systematic literature review was conducted on the efficacy and safety of local and systemic steroid therapy for diabetic sudden deafness. RevMan5.4 and stata14 software were used for Meta-analysis. A total of 23 studies were included in this study, covering 1777 patients, including 885 cases in the observation group (local steroid group) and 894 cases in the control group (systemic steroid group). Meta-analysis showed that there was a significant difference in the total effective rate of local and systemic steroid treatment for diabetic sudden deafness between groups (RR = 1.17, 95% CI = 1.11-1.22, P < 0.05). The effective rate in the observation group was higher than that in the control group. For the improvement of PTA, the difference between groups was statistically significant (RR = 6.60, 95% CI = 3.07-10.14, P < 0.05). The improvement of PTA in the local steroid group was higher than that in the systemic steroid group. Subgroup analysis showed that there were significant differences between groups in hormones, drug administration, follow-up time and course of disease. Topical steroid therapy is effective in the treatment of diabetic sudden deafness. Hormone methylprednisolone has high effective rate; the shorter the course of disease and the longer the follow-up time are, the higher the total effective rate will be. Tympanic injection is more effective than post-aural injection. Topical steroid injections are safer for hormonal side effect.

Psoriasis-Like Lesions Secondary to SARS-CoV-2 Infection

Abstract In 2019, the first case of severe acute respiratory syndrome coronavirus 2 pneumoniae was reported in Wuhan, People's Republic of China. Severe acute respiratory syndrome coronavirus 2 can involve different organ systems, including the skin. Twenty percent of patients in an Italian medical ward had cutaneous manifestations. We described a 65-year-old White woman who developed not itchy, not painful, erythematous, slightly infiltrated plaques characterized by fine desquamation and localized at the extremities secondary to severe acute respiratory syndrome coronavirus 2 infection. Local treatment with calcipotriene and betamethasone dipropionate was started with clinical response. The close association with Coronavirus disease diagnosis and the clinical response to calcipotriene and local steroid therapy suggested psoriasis-like eruption secondary to SARS-CoV-2 infection.

Prospective Study of Clinical Characteristics and Visual Outcome in Vogt–Koyanagi–Harada Syndrome in a Tertiary Eye Hospital in South India

Purpose: To describe the demographic pattern, clinical characteristics, treatment modalities, and visual outcome in Vogt–Koyanagi–Harada (VKH) disease patients observed at a tertiary eye care centre in South India. Methods: A prospective chart analysis of 38 patients with VKH disease. Results: Of the 38 VKH patients, 31 (81.6%) were female, the mean age was 39.8 years, and the median duration of symptoms was 10 days (range: 2 to 180 days). The most common ocular complaint was a defective vision (70 eyes or 92.1%). Extraocular manifestations were headache (13 patients or 34.2%) and tinnitus (4 patients or 10.5%). Twenty-four patients (63.2%) presented with bilateral panuveitis, and 12 patients (31.6%) had posterior uveitis. The most common posterior segment presentation included bilateral serous retinal detachment (100%), disc oedema (37 eyes or 48.7%), and vitritis (31 eyes or 40.8%). All patients (100%) were treated with oral and topical prednisolone, based on the ocular inflammation status, 9 patients (23.7%) required dexamethasone (intramuscular), 39 eyes (51.3%) required posterior subtenon triamcinolone, 16 patients (28.9%) required methotrexate, 1 (2.6%) required cyclophosphamide, 1 (2.6%) required azathioprine. At the final visit, the majority of the patients had statistically significant good visual outcomes. Conclusion: Prompt diagnosis and early initiation of treatment with systemic, local steroid and immunosuppressive therapy showed faster recovery with good visual outcome.

P32 Therapeutic dilemma due to gut complications with spondyloarthritis

Introduction/BackgroundTumor necrosis factor (TNF) inhibitor therapy is one of the primary modalities of treating spondyloarthritis. However, infections secondary to biologic use is a common complication. Clostridium difficile is a gut colonizer which may become pathogenic in the presence of dysbiosis and antibiotic use. Symptomatic clostridium difficile infection(CDI) due to adalimumab(ADA) use causing lymphocytic colitis(LC) is rarely reported. We present a case of axial plus peripheral spondyloarthritis on adalimumab who developed CDI and presented a therapy related dilemma.Description/MethodWe present a case of a 52-year-old lady who was diagnosed as HLAB27 positive axial spondyloarthritis with bilateral sacroiliitis on MRI bilateral sacroiliac joint in 2016. She failed two non-steroidal antinflammatory drugs (NSAID) with high disease activity scores(BASDAI 8.6, BASFI 6.2, Spinal VAS 9). She was eventually initiated on injection adalimumab in 2017. There was clinical improvement after 6 months of initiating ADA. Repeat MRI spine and SI joint showed resolution of inflammatory changes with adalimumab. Sulfasalazine was added in the treatment protocol due to peripheral arthralgia, however she developed a drug rash to it and it was stopped. In September 2021, she developed recurrent non-bloody watery diarrhoeal episodes. Adalimumab was stopped and she tested positive for Clostridium difficile on three occasions. She received multiple courses of vancomycin, fidoxamycin and metronidazole with partial resolution of diarrhoea. Adalimumab was rechallended in January 2022 since her disease activity was worsening in the absence of NSAID and biologic use. However, it was paused again due to worsening of diarrhoea. Gastroenterology conducted a Colonoscopy and biopsy of colonic polyps which showed increased number of intraepithelial lymphocytes with no thickening of subepithelial collagen plate suggestive of lymphocytic colitis (LC). It was postulated that CDI may have been the trigger for her LC. She has been started on local corticosteroid therapy(budesonide) for her LC. At this junction, we were faced with the decision of restarting adalimumab for her which may have been the original cause of her CDI.Discussion/ResultsWe present this case in view of a dilemma regarding which problem occurred first Did immunosuppression due to adalimumab lead to CDI? Literature is not suggestive of increased risk of CDI with adalimumab, especially in a non-inflammatory bowel disease (IBD) background. Was the lymphocytic colitis triggered by the CDI or was clostridium difficile just incidentally detected on a background of LC? There is a well documented associated of LC with autoimmune conditions and use of NSAIDs along with proton pump inhibitor is another trigger for it. TNF alpha inhibitor is one of the treatment modalities of refractory LC. Would it be appropriate to restart ADA for her since she responded well despite there being a risk of recurrence of a CDI? Finally, what is the role of gut dysbiosis in the role of CDI and LC in this situation. Presently, she is planned to be treated with local steroid therapy for her LC. ADA will be rechallenged once her gut has responded to the steroid course. In the event of her gut worsening on a rechallenge, she will be given a trial of Infliximab.Key learning points/ConclusionThe case highlights the crucial point of thinking of causes of diarrhea apart from well documented conditions of ulcerative colitis/Crohn’s disease in an immunosuppressed spondyloarthritis patient. A detailed stool examination including bacterial and parasitic examination is crucial in recurrent diarrhea. The threshold for colonoscopy should be low when episodes are refractory to treatment. The case-based conference gives us an opportunity to receive feedback regarding further management approaches in this case.

Reactive arthritis occurring after COVID-19 infection: a narrative review.

PurposeReactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection.We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection.MethodsA literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data.ResultsA total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days.ConclusionThe diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.

Predictors of glaucoma in patients with uveitis and scleritis.

To examine risk factors for development of glaucoma in a large cohort of subjects with uveitis and scleritis. Retrospective review of subjects diagnosed with uveitis or scleritis between 2006 and 2019 at Auckland District Health Board. Subjects were excluded if they had glaucoma due to another cause. Main outcome measure was development of glaucoma. Data for local steroid use was not available. 3462 eyes of 2414 subjects were included in the study. Mean follow-up was 5.7 years (total follow-up time 19,897 eye years). Median age was 44.3 years and 1189 (49.3%) were female. Glaucoma developed in 222 eyes (6.3%) during the follow-up. Five-year cumulative risk of glaucoma was 6.2% (CI 5.0-7.5%) for anterior uveitis, 5.4% (CI 3.2-9.0%) for intermediate uveitis, 1.6% (CI 0.4-6.7%) for posterior uveitis, 8.7% (CI 6.5-11.7%) for panuveitis, and 3.2% (CI 1.0-9.5%) for scleritis. Five-year cumulative risk of glaucoma was lowest in HLA-B27 uveitis at 0.9% (CI 0.4-2.1%) and highest in viral uveitis 15.1% (CI 10.1-22.3%), sarcoidosis 9.9% (CI 6.1-15.9%) and tuberculosis 9.7% (CI 5.4-17.0%). On multivariate analysis, risk factors for development of glaucoma were older age at presentation, higher presenting intraocular pressure, chronic inflammation, and cystoid macular oedema. Glaucoma is a common complication of uveitis and scleritis and was more frequent in older subjects, high presenting IOP, chronic inflammation and those with cystoid macular oedema. Local steroid therapy contributes to this, but is not quantifiable in this study. Targeted screening is required to avoid irreversible progression of glaucomatous optic neuropathy.

Dynamics of synovitis activity after intraarticular administration of xefocam in patients with rheumatoid arthritis

The aim of the study was to assess the efficacy of intra-articular injection of lornoxicam (xefocam, Nycomed) in patients with rheumatoid arthritis. Xefocam was injected into knee joints of 15 patients with rheumatoid arthritis, 8 mg once a week for the period of 3 weeks. The following parameters were assessed: pronouncement of arthralgia, joint tenderness at palpation, circumference of knee joint on the level of the upper patellar margin. Prior and post treatment ultrasonography and thermography were used. Significant clinical improvement was observed in 11 patients. In 3 cases the dynamics was less positive and in 1 patients the effect of single dose drug injection was preserved for less than one week. Arthralgia manifestation (p0.01), joint tenderness at palpation (p0.01) and joint circumference (p0.05) showed reliable decrease. Ultrasonography showed reliable decrease the synovial membrane thickness. Xefocam injection could be successfully used to suppress moderate inflammatory joint changes in patients with rheumatoid arthritis when there are no strict indications to local steroid therapy.

Atopy as a specific predictor of response to systemic and local steroid therapy in patients with chronic rhinosinusitis without nasal polyps.

&lt;b&gt;Introduction:&lt;/b&gt; Studies on the pathophysiology of chronic rhinosinusitis have shown an effect of IgE antibodies on the course of the disease, as well as the effectiveness of treatment. Steroid therapy remains the most prevailing method of CRS treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim: &lt;/b&gt;The aim of our study was to determine the clinical response to systemic and local steroid therapy in patients with CRSsNP depending on the total IgE antibody serum concentration. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; A total of 92 patients with CRSsNP took part in the study, where they were divided randomly into 2 groups. In group I, the patients received fluticasone propionate 800 mcg/day intranasally for 12 weeks. Patients in group II were treated with prednisone at a dose of 0.5 mg/kg/day, given orally, for 7 consecutive days and continued by another week with decreasing dosage. Both groups were evaluated prior to and following treatment using the TSS score of CRS clinical symptoms, the endoscopic Lund-Kennedy scale and the Lund-Mackay CT staging of chronic rhinosinusitis. Statistical analy-sis of the effectiveness of treatment was carried out in subgroups according to the total IgE serum concentrations obtained before treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Both groups of patients achieved statistically significant improvement in the TSS evaluation, as well as in endosco-pic and CT imaging findings. In patients with a total IgE serum concentration over 100 IU/ml systemic steroid therapy sho-wed significantly greater effect on the relief of CRS symptoms in the TSS score than intranasal steroid therapy. Analogous differences in the effectiveness of both methods were not found in patients with a normal total IgE serum concentration (&lt;100 IU/ml). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; A short course of systemic steroid therapy is more effective than local treatment in relieving of CRS symptoms in patients with CRSsNP with elevated serum concentration of IgE antibodies. Atopy may be considered a specific predictor of response to steroid therapy in the treatment of chronic rhinosinusitis.

Influence of selected parenteral drugs on tightness and morphological parameters of enteroanastomosis in rats

During the past few years many scientific investigations regarding the status of enteroanastomoses after surgical resections have been performed all over the world. General surgery wards perform intestinal resections on patients with neoplastic processes or with advanced nonspecific intestinal inflammation. Partial resections of the intestines are also performed on patients with necrotic changes caused by intestinal torsion or embolism of the branches of the mesenteric artery. These types of surgeries often require additional treatment which should cause a minimal strain for the patient in the postoperative period in order to obtain the highest percentage of recoveries. In proliferative diseases chemo- and radiotherapy are the most commonly used methods of treatment whereas general and local steroid therapy are used in inflammatory diseases. Additionally, immunomodulating agents are used with conventional therapy to improve the therapeutic effect. In a few studies, the influence of drugs on the local status of the intestine and wound healing status after surgeries was examined. The influence of selected agents on the status of experimental enteroanastomoses performed on the large intestine of rats was evaluated based on physical and morphometric tests. The study was performed on 60 Wistar rats, all of whom were male, of a similar body weight (250-350 grams) and the same age (2 months old). The rats were operated on to create an experimental anastomosis of the ascending colon. Then we administered selected drugs to evaluate their effect on the status of the newly created intestinal anastomosis. Selected parameters were evaluated after 4, 7 and 14 days after the surgery. In our experimental cycle animals were divided into 4 groups with 15 individuals in each group. The first group (I) was given physiological saline intraperitoneally (control group). Animals in the second group (II) were given the immuno-modulating drug interferon (Intron A) (45.000 IU/kg of b.w./day) after the surgery. Animals in the third group (III) were given the steroid Dexaven (0.5 mg/day) after the surgery. Animals in the fourth group (IV) were given a cytostatic agent (5-fluoroauracil) after the surgery (20 mg/kg/day). All of the drugs were administered in the same form as intra-peritoneal injections with the same amount of fluid. The study was planned for 5 cycles. 12 animals participated in one experimental cycle: 3 animals each from groups I, II, III and IV were operated on. The drugs were given for 5 days starting from the second day after the surgery. The rats were dissected after the 4th, 7th and 14th days of the experimental cycle to evaluate the status of the enteroanastomosis and the skin, according to previously mentioned parameters. Macroscopic changes of the enteroanastomosis were examined. Swabs were taken from all individuals with features of inflammation around this location. Next, the tightness of the anastomosis was evaluated by examining the appearance of air in the area of the anastomosis. The most important and last part of the experiment was amorphometric analysis of the large intestine with the anastomosis. In preparations stained with hematoxylin and eosin the following parameters were evaluated: amount of active intestinal crypts/mm, amount of non-active intestinal crypts/mm, total amount of intestinal crypts/mm, thickness of the mucous membrane, thickness of the submucous membrane, thickness of the muscular layer, fractal dimension of the mucosal membrane, fractal dimension of conjunctive tissue. Under the influence of steroid agents tightness disorders of the anastomosis were observed. Evaluation of the influence of the used substances on the morphometry of the enteroanastomosis revealed evident changes in the later days of the trial. In the days following the dissection of the animals from the control group histological changes were also observed that can suggest that the surgical intervention in itself influenced the morphometric parameters and caused disorders in the activity of intestinal crypts, decreased the dimension of the submucous membrane and altered the regeneration of the mucous membrane of the large intestine. Generally, agents used in the study caused disorders in the healing of the anastomosis, which significantly decreased particular dimensions of analyzed parameters. The substances examined influenced the thickness of the submucous membrane by making it thinner. Steroid and immunotherapy changed the reconstruction of conjunctive tissue which significantly affected the status and the resistance of the anastomosis. Intraperitoneal administration of selected therapeutical substances, especially Dexaven and Intron A have influenced the complete healing process of the anastomosis by disturbing the regenerative processes.

Fractal Dimension and Texture Analysis of Lesion Autofluorescence in the Evaluation of Oral Lichen Planus Treatment Effectiveness.

Background: Oral Lichen planus (OLP) is a chronic inflammatory disease. Topical steroids are used as the treatment of choice. The alternative is photodynamic therapy (PDT). The study aimed to fabricate optimal biodegradable matrices for methylene blue or triamcinolone acetonide because of a lack of currently commercially available carriers that could adhere to the mucous. Methods: The study was designed as a 12-week single-blind prospective randomized clinical trial with 30 patients, full contralateral split-mouth design. Matrices for steroid and photosensitizer and laser device were fabricated. Fractal and texture analysis of photographs, taken in 405, 450, 405 + 450 nm wavelength, of lesions was performed to increase the objectivity of the assessment of treatment. Results: We achieved two total responses for treatment in case of steroid therapy and one in the case of PDT. Partial response was noted in 17 lesions treated using local steroid therapy and 21 in the case of PDT. No statistically significant differences were found between the effectiveness of both used methods. Statistically significant differences in fractal dimension before and after treatment were observed only in the analysis of photographs taken in 405 + 450 nm wavelength. Conclusions: Photodynamic therapy and topical steroid therapy are effective methods for treating OLP. Using a carrier offers the possibility of a more predictable and effective method of drug delivery into the mucous membrane. Autofluorescence enables the detection of lesions especially at the early stage of their development.

Retrospective analysis of the effectiveness of local corticosteroid therapy in children with oligoarticular juvenile idiopathic arthritis

Background . Despite the progress in diagnosis and treatment of chronic rheumatic diseases in children, the choice of anti-inflammatory drugs in case of the onset of oligoarticular juvenile idiopathic arthritis (JIA) still remains relevant. Till present, pediatric rheumatologists have not reached a consensus on this issue yet. The aim of this study was to search for predictors of early failure of local steroid therapy and assessment of its feasibility in patients with oligoarticular JIA. Materials and methods. In a retrospective study, 92 children aged 11 months – 9 years with chronic oligoarticular JIA without extra-articular manifestations were monitored. The features of the clinical, instrumental and laboratory diagnosis during the disease onset were studied, along with the dynamics of the articular syndrome and the effectiveness of intra-articular administration of corticosteroid drugs. Results and discussion. The data on 92 children with 164 active joints who received 218 local intra-articular injections of triamcinolone acetonide at the onset of the disease were analyzed. Intra-articular injections of triamcinolone acetonide at a dose of 20–40 mg were performed with an interval of 3, 6, and 12 months, depending on the intensity of the disease. In about one third of children with oligoarticular JIA, arthritis became inactive on average after two intra-articular injections of triamcinolone acetonide. The study did not reveal the predictors of early ineffective topical corticosteroid monotherapy in children. No clinical, instrumental, and laboratory signs were identified that would directly indicate the need for early therapy with methotrexate. Conclusion . Triamcinolone acetonide is an effective and safe drug for children with oligoarticular JIA. Despite the widespread use of biological, gene, and other innovative therapies, application of local corticosteroids as the firstline therapy in children with oligoarticular JIA should not be neglected.

Juvenile Idiopathic Arthritis-Associated Chronic Uveitis: Recent Therapeutic Approaches.

Pediatric patients with early onset (before the age of 6 years), antinuclear antibody positive, oligoarticular or polyarticular juvenile idiopathic arthritis (JIA), and some children with no arthritis may develop chronic, anterior uveitis. Recent recommendations insist on the need to perform slit lamp examination every 3 months for at least 5 years in early onset JIA patients in order to diagnose uveitis before complications develop. Local steroid therapy is usually the first-line treatment. However, in patients requiring steroid eye drops for several months, systemic immunomodulatory therapy is indicated. Methotrexate (MTX) is then prescribed in most cases; however, some patients also need anti-tumor necrosis factor alpha monoclonal antibody therapy and, in some cases, other biologics to control uveitis and avoid long-term ocular damage. Expert ophthalmologists and pediatricians must be involved in taking care of such patients. Immunomodulatory treatment must not be too easily interrupted and may even be intensified in some cases, particularly if there is a need for optimal disease control before ophthalmologic surgery. In good responders to MTX and/or biologics, treatment must be maintained at least 1 year, possibly even 2 years after achieving remission before tapering treatment intensity.

Outcomes, Toxicities, and Patterns of Use of Programmed Death-1 (PD-1) Inhibitors in Hodgkin Lymphoma Patients in the United States: A Multicenter Retrospective Study

Outcomes, Toxicities, and Patterns of Use of Programmed Death-1 (PD-1) Inhibitors in Hodgkin Lymphoma Patients in the United States: A Multicenter Retrospective Study

Comparison of Intranasal Steroid Application Using Nasal Saline Irrigation and a Mucosal Atomization Device to Treat Chronic Rhinosinusitis.

Introduction: Chronic rhinosinusitis (CRS) is a disease that can significantly reduce patients' quality of life (QoL). Intranasal steroid therapy is the most commonly used treatment for CRS. There are many evaluation tools dedicated to assessing CRS patients' QoL, but none of them evaluates QoL during local steroid therapy. Mucosal atomization devices (MADs) and nasal saline irrigation (NSI) are effective and safe methods of applying intranasal steroids for CRS patients. Materials and Methods: The sample population for this prospective study comprised 43 CRS patients. Following endoscopic sinus surgery, all participants received intranasal steroids administered via an MAD, followed by NSI for 1.5 months. Each participant completed the SNOT-22 (22-item Sino-Nasal Outcomes Test) score and a new questionnaire, the Complementary Topical Nasal Drug Delivery Questionnaire (the Complementary Questionnaire), at the end of 3 months of intranasal steroid therapy. Results: The patients' responses in both the SNOT-22 score and the Complementary Questionnaire revealed significant differences in their adverse experiences. The patients who received intranasal steroid treatment using NSI experienced more frequently delayed nasal drainage, higher frequency of ear symptoms, and facial pain/pressure, while those whose therapy was administered using an MAD reported complaints such as nasal irritation, nasal dryness, and postnasal drip with unpleasant taste/smell. Conclusion: We used the Complementary Questionnaire as an effective tool for assessment of the QoL of CRS patients. The SNOT-22 score and the Complementary Questionnaire make it possible to select an intranasal applicator tailored to a CRS patient's specific complaints.

Three cases of brolucizumab-associated retinal vasculitis treated with systemic and local steroid therapy.

To describe three Japanese cases of retinal vasculitis that occurred following intravitreal brolucizumab injections and the systemic and local steroid treatment administered. Three patients developed intraocular inflammation (IOI) and retinal vasculitis following the first injection of brolucizumab for age-related macular degeneration. For two eyes, monthly aflibercept injections did not control exudation, and therapy was changed to brolucizumab; one eye was treatment-naïve. All three patients noticed blurry vision and floaters 11-18 days after brolucizumab injections, and the treated eyes exhibited anterior chamber cells, fine keratic precipitates, vitreous cells, and vitreous haze. Ultra-widefield color images of the fundus showed retinal hemorrhage in the peripheral retina and, in two cases vascular sheathing. Ultra-widefield fluorescein angiography (FA) showed segmental vascular leakage in all eyes and leakage from the optic disc in two eyes. Vascular filling defects were noted in the peripheral retinae of two eyes. Brolucizumab-associated retinal vasculitis was diagnosed, and treated with 30 mg/day of oral prednisolone, subtenon triamcinolone acetonide injection (20 mg/0.5 ml), and 0.1% betamethasone sodium phosphate solution. After 1 week, color fundus images and FA showed improvements in vascular sheathing, leakage from retinal vessels, and optic disc leakage, but the vascular filling defects remained. Visual acuity was restored in all three eyes 6 weeks after the onset. Brolucizumab-associated IOI, including retinal vasculitis and retinal occlusion, is a rare but important adverse event that can cause severe vision loss. Prompt diagnosis with FA and treatment with systemic or local steroids should be considered.

Adalimumab in the treatment of non-infectious uveitis.

Non-infectious uveitis (NIU) is a serious sight-threatening condition whose pathogenesis is often autoimmune in nature. It may manifest in any age group, though adults aged 20-50 are the group most often affected. It causes 5-10% of visual impairment worldwide. The epidemiology of some specific uveitis diseases varies worldwide, because they are influenced by genetic, environmental and socioeconomic factors. It can occur only in the eye or as a symptom of a systemic condition. The most common cause of NIU is HLA-B-27-associated anterior uveitis (4-32%). The standard treatment for NIU is a local, topical and systemic steroid therapy in combination with immunomodulatory therapy. However, recently, a new drug - adalimumab, which is a tumor necrosis factor α (TNF-α) inhibitor - was approved by FDA in the treatment of NIU and is increasingly used to treat various conditions. Adalimumab has been proven in many studies to be safe and effective in the treatment of NIU associated with diverse systemic diseases.