Long-term Systemic Steroid Research Articles

Review of the Association Between Long-Term and Current Systemic Steroid Use With Electromechanical Complications and Inpatient Mortality After ST-Elevation Myocardial Infarction.

Background The impact of long-term systemic steroid use on electrical and mechanical complications following ST-segment elevation myocardial infarction (STEMI) has not been extensively studied. Methods In a retrospective cohort study of the National Inpatient Sample (NIS) from 2018 to 2020, adults admitted with STEMI were dichotomized based on the presence of long-term (current) systemic steroid (LTCSS) use. The primary outcome was all-cause mortality. Secondary outcomes included a composite of mechanical complications, electrical, hemodynamic, and thrombotic complications, as well as revascularization complexity, length of stay (LOS), and total charge. Multivariate linear and logistic regressions were used to adjust for confounders. Results Out of 608,210 admissions for STEMI, 5,310 (0.9%) had LTCSS use. There was no significant difference in the odds of all-cause mortality (aOR: 0.89, 95%CI: 0.74-1.08, p-value: 0.245) and the composite of mechanical complications (aOR: 0.74, 95%CI: 0.25-2.30, p-value: 0.599). LTCSS use was associated with lower odds of ventricular tachycardia, atrioventricular blocks, new permanent-pacemaker insertion, cardiogenic shock, the need for mechanical circulatory support, mechanical ventilation, cardioversion, a reduced LOS by 1 day, and a reduced total charge by 34,512 USD (all p-values: <0.05). There were no significant differences in the revascularization strategy (coronary artery bypass graft (CABG) vs. percutaneous coronary interventions (PCI)) or in the incidence of composite thrombotic events. Conclusion LTCSS use among patients admitted with STEMI was associated with lower odds of electrical dysfunction and hemodynamic instability but no difference in the odds of mechanical complications, CABG rate, all-cause mortality, cardiac arrest, or thrombotic complications. Further prospective studies are needed to evaluate these findings further.

Клинический случай лечения окклюзирующего васкулита при внутриглазном воспалении после применения бролуцизумаба

Occlusive vasculitis is a rare complication of antiangiogenic therapy. Standardization of differential diagnosis of the genesis of inflammation and tactics of treatment of such patients remains an unsolved health problem. The article presents a clinical case of occlusive vasculitis and panuveitis in a patient receiving brolucezumab. Active management tactics with the use of long-term systemic steroid therapy, intravitreal administration of Ozurdex and drugs that improve microcirculation demonstrated the possibility of achieving effective treatment and preservation of objective vision Keywords: neovascular age-related macular degeneration, brolucizumab, occlusive vasculitis

Respiratory toxicities after concurrent chemoradiotherapy and subsequent consolidation immune checkpoint inhibitors in locally advanced non-small cell lung cancer: Infectious and non-infectious subtypes by pathogen NGS testing.

e20557 Background: Consolidation immune checkpoint inhibitors (ICIs) following concurrent chemoradiotherapy (CCRT) have significantly improved survival in locally advanced non-small cell lung cancer (LA-NSCLC), while the associated respiratory toxicities were of particular concern. We aimed to investigate the &gt; = G2 respiratory toxicities, the characteristics of concomitant infection, and provide detailed information for clinical management. Methods: We reviewed 77 LA-NSCLC patients treated with CCRT and consolidation ICIs. The details of &gt; = G2 respiratory toxicities and concomitant infection were analyzed. Potential risk factors for &gt; = G2 respiratory toxicities were explored by univariable and multivariable analysis. Respiratory toxicities were collected from the start of consolidation ICIs till 6 months after the last infusion of ICIs. Concomitant infection was defined as positive findings from next-generation sequencing (NGS) of bronchoalveolar lavage sampling. Results: Patients were treated with definitive radiotherapy at a median dose of 60 Gy (IQR, 60-64), concurrently with weekly docetaxel and platinum and followed by single-agent ICIs. The median duration of consolidation ICIs was 5.4 months (IQR, 2.3-8.2). Twenty-six patients (33.8%) experienced &gt; = G2 respiratory toxicities by a median of 4.8 months (IQR 1.5-6.6) after initiation of consolidation ICIs. Pneumonitis (14, 18.2%) and tracheobronchitis (13, 16.9%) were the most common &gt; = G2 respiratory disorders. Location of primary tumor (p = 0.027) and the proportion of CD3+ lymphocyte before consolidation ICIs (p = 0.044) were independent risk factors for the occurrence of &gt; = G2 respiratory toxicities. Eleven patients (14.3%) had &gt; = G2 respiratory toxicities and concomitant infection. Identified pathogens included bacteria (n = 9), Aspergillus (n = 5), Pneumocystis (n = 1) and Leptosvirus (n = 1). Concomitant infection was more commonly detected in patients with tracheobronchitis compared with those with pneumonitis ( p= 0.002), was associated with a higher grade of toxicity ( p= 0.050) and relatively poorer outcome after management ( p= 0.002). Conclusions: Respiratory toxicities after CCRT and subsequent consolidation ICIs in LA-NSCLC mainly included pneumonitis and tracheobronchitis, and could be separated into infectious and non-infectious subtypes. Bacteria and Aspergillus were the predominant pathogens. Our findings highlight the importance of the bronchoscopy and pathogen NGS testing to detect airway disease and specific infection. Long-term systemic steroids might adversely affect respiratory toxicities with concomitant opportunistic infection, which should be taken into account at the onset of management.

Severe Dehydration Due to Low Intake in Patients with Oral Candidiasis in Malignancy: A Case Report

Oral candidiasis is an infection in oral cavity caused by Candida albicans. This disease is frequently caused by immunological suppression, which can be local or systemic, caused by immunosuppression due to extremes of age (newborns and the elderly), diseases that impair immunity, such as in infection of human immunodeficiency virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS), long-term systemic steroid use, and long-term systemic antibiotic use. Oral candidiasis could lead to low-intake condition due to swallowing difficulties. This case report aimed to present a patient with severe dehydration due to oral candidiasis that needs to be hospitalized.

ODP067 Long-term Systemic Steroid Use And Its Impact on In-hospital Outcomes Among Patients Admitted With Acute Pericarditis

Abstract Background Early use of systemic steroids in the acute setting of acute pericarditis has been associated with increased recurrence rate and a longer course of treatment. It is not clear if long-term systemic steroids use, has a similar unfavorable impact in patients admitted for acute pericarditis. Our study aimed to determine if the presence of long-term systemic steroid use as a comorbidity during admission for acute pericarditis, was associated with worse outcomes. Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. The international diseases classification code, tenth revision (ICD-10), was used to identify patients admitted with a principal diagnosis of acute pericarditis who were further dichotomized into 2 cohorts, based on the presence of a secondary diagnosis of long-term systemic steroid use. Primary outcomes of the study were, mortality rate, length of stay (LOS) and total hospital charge. Secondary outcomes assessed included rates of pericardial effusion, cardiac tamponade, cardiogenic shock, pericardial window, and cardiac arrest. A multivariate linear and logistic regression were used to adjust for confounders. Results Our sample included a total of 36,570 adult hospitalizations for acute pericarditis, out of which 2.24% had associated long-term systemic steroid use as a secondary diagnosis. There was a 3- fold increased odds of mortality among patients with long-term systemic steroid use compared to the group without, (2.44% vs 0.84%, AOR: 2.92, 95% CI: 1. 06 to 8. 01, p: 0. 038). Both length of stay (LOS) and total charge were increased among patients with long-term systemic steroid use compared to their counterpart cohort, with an adjusted mean difference of 0.2 days and 1,693.65 USD respectively but these did not meet statistical significance. There was no statistically significant difference in terms of secondary clinical outcomes including, pericardial effusions, cardiac tamponade, cardiogenic shock, rate of pericardial window and cardiac arrest between the two groups analyzed. Conclusion The presence of long-term corticosteroid therapy as a comorbidity during admission for acute pericarditis was associated with a 3–fold increased odds of mortality during hospitalization and there was a trend towards increased LOS and total charge among such patients, though the latter did not meet statistical significance. Further prospective studies need to be done on this topic to better improve understanding and to assess its impact on patient care. Presentation: No date and time listed

ODP062 Clinical Outcomes of Cardiogenic Shock Hospitalization Among Patients with Long-term Systemic Steroid Use

Abstract Background Cardiogenic shock is a state of immense stress, and our innate human response depends on a robust metabolic, neuroendocrine, and immunologic reserves. Long term use of systemic corticosteroids takes its toll on all aspects of this mechanism. Knowledge of how this basic physiology translates into clinical outcomes is scarce among patients with cardiogenic shock. Our study sought to identify such effects. Method: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age &amp;gt;18) with principal admission diagnosis of cardiogenic shock were identified using the international diseases classification code, tenth revision (ICD-10), and separated into two cohorts based on whether they had a secondary diagnosis of long term systemic steroid use. Primary outcomes assessed were, mortality, length of stay (LOS) and total hospital charge. Secondary outcomes included rate of mechanical ventilation, mechanical circulatory support device use and cardiac arrest. Multivariate linear and logistic regressions were used to adjust for confounders. Results There was a total of 477,695 adult hospitalizations for cardiogenic shock, out of which 1. 06% had associated secondary diagnosis of long-term systemic steroid use. The presence of long-term systemic steroid use was associated with 15% increased odds of mortality, (36.63% vs 33.32%, AOR: 1.15, 95% CI: 1. 01 to 1.30, p: 0. 039). However, there was a significant reduction in both length of stay (LOS), (9.85 days vs 11.56 days, adjusted mean difference: -1.59 days, 95%CI: -2.41 days to - 0.77 days, p &amp;lt; 0. 001) and total charge (178,624.8 USD vs 240,859.3 USD, adjusted difference of -55,719.4 USD, 95% CI: - 70,348. 0 to -41,090.8) among patient with long-term systemic steroid use compared to the other cohort. Similarly, there was significantly reduced odds of both the rate of mechanical circulatory support device utilization (15.43% vs 20.32%, AOR: 0.99, 95%CI: 0.62 to 0.77, p: 0. 001) and rate of cardiac arrest (7.22% vs 9.31%, AOR: 0.78, 95%CI: 0.61 to 0.98, p: 0. 035) among patients with long term systemic steroid use. There was no difference in the rate of mechanical ventilation between the two groups. Conclusion the presence of long-term systemic steroid use as a comorbidity during hospitalization for cardiogenic shock was associated with an increased mortality but a reduction of LOS, total hospital charge, mechanical circulatory support device utilization and cardiac arrest. One can only hypothesize that the antiparallel relationship between mortality and the other primary and secondary outcomes could be brought about by earlier discharge from hospital due to death, thus truncating further needs for hospitalization and other interventions. This crucial paradox needs further studies to ascertain. Presentation: No date and time listed

Stable and exacerbation period serum cytokine and periostin levels of the five distinct phenotypes of severe asthma.

The differences in molecular mechanisms during a stable period and the changes in the inflammatory responses during exacerbations between distinct severe asthma phenotypes remain unclear. In this study, we aimed to characterize stable and exacerbation period serum cytokine and periostin levels of 5 different predefined severe asthma phenotypes with real-life data. Changes in the viral infection-induced exacerbations were also analyzed. Serum levels of 8 cytokines and periostin were measured from the sera obtained from the adult patients with five different severe asthma phenotypes based on the presence/absence of aeroallergen sensitivity, peripheral eosinophilia and chronic rhinosinusitis with nasal polyposis (CRSwNP) during stable and exacerbation periods, and from the matched controls. Serum IL-13, IL-25, TSLP, and periostin levels were similar between the patient and the control groups during stable and exacerbation periods. Serum IL-25 and TSLP levels, and peripheral eosinophil count and periostin level showed a strong correlation. Stable period periostin levels were significantly higher in eosinophilic patients, and eosinophilic patients without long-term systemic steroid therapy had higher IL-13 levels. Compared to stable period, exacerbation period serum periostin levels found significantly lower [5853 (2309-8427) pg/mL vs. 4479 (2766-6495) pg/mL; p = 0.05] and periostin levels were much lower in viral infection-induced exacerbations [2913 (893-4770) pg/mL vs. 7094 (4782-9596) pg/mL; p = 0.022]. Our study showed that serum periostin levels were decreased in viral infection-induced exacerbations and increased in the presence of eosinophilia independent from atopy and it can help to differentiate eosinophilia even if the patient is under long-term systemic steroid therapy. Also, serum IL-13 levels may reflect peripheral eosinophilia in patients without long-term systemic steroid use.

The impact of COVID-19 pandemic in dermatology outpatient clinics in Turkey: A survey study.

BackgroundThe COVID‐19 pandemic has substantially affected the healthcare systems around the world. It has also induced some changes in working habits at dermatology clinics. The majority of dermatology clinics limited the number of patients at outpatient clinics and postponed the elective procedures.Aims and ObjectivesTo evaluate the working conditions and habits of dermatologists in Turkey during the COVID‐19 pandemic.MethodsThis is a survey study with seventeen questions in which two hundred fifteen dermatologists working in Turkey participated.ResultsOur results revealed that 53.5% of the participants worked in the areas related to COVID‐19 during the pandemic. The average number of dermatology outpatient days in a week was five among the 48.8% of dermatologists, 21.4% of those had three working days, and 18.1% of those had four days. During the pandemic, the most common reasons for referral to outpatient clinics were acne and acneiform eruptions (88.8%), dermatitis (73.5%), and hair loss (71.2%). Participants hesitated to use the following treatments: long‐term systemic steroid (77.7%), cyclosporine (69.8%), and methotrexate (60%).ConclusionIt is observed that the COVID‐19 pandemic had affected the working habits and conditions of the dermatologists, which might be considered for the designing of new working approaches.

Stable and exacerbation period serum cytokine and periostin levels of the five distinct phenotypes of severe asthma.

The differences in molecular mechanisms during stable period and the changes in the inflammatory responses during exacerbations between distinct severe asthma phenotypes remain unclear. In this study, we aimed to characterize stable and exacerbation period serum cytokine and periostin levels of 5 different pre-defined severe asthma phenotypes with real-life data. Changes in the viral infection-induced exacerbations were also analyzed. Serum levels of 8 cytokines and periostin were measured from the sera obtained from the adult patients with five different severe asthma phenotypes based on the presence/absence of aeroallergen sensitivity, peripheral eosinophilia and chronic rhinosinusitis with nasal polyposis (CRSwNP) during stable and exacerbation periods, and from the matched controls. Serum IL-13, IL-25, TSLP and periostin levels were similar between the patient and the control groups during stable and exacerbation periods. Serum IL-25 and TSLP levels, and peripheral eosinophil count and periostin level showed a strong correlation. Stable period periostin levels were significantly higher in eosinophilic patients and eosinophilic patients without long-term systemic steroid therapy had higher IL-13 levels. Compared to stable period, exacerbation period serum periostin levels found significantly lower [5853 (2309-8427) pg/mL vs. 4479 (2766-6495) pg/mL; p=0.05] and periostin levels were much more lower in viral infection-induced exacerbations [2913 (893-4770) pg/mL vs. 7094 (4782-9596) pg/mL; p=0.022]. Our study showed that serum periostin levels were decreased in viral infection-induced exacerbations and increased in the presence of eosinophilia independent from atopy and it can help to differentiate eosinophilia even if the patient is under long-term systemic steroid therapy. Also, serum IL-13 levels may reflect peripheral eosinophilia in patients without long term systemic steroid use.

Update in immunosuppressive therapy of myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction. Immunosuppressive treatments are part of the therapeutic armamentarium in MG. Long-term systemic steroid administration carry considerable risks and adverse events. Consequently, steroid-free immunosuppressive therapy is necessary to reduce the dose or discontinue steroids. First immunosuppressive drug trials in MG, were performed in the mid-60s, using standard and nonspecific immunosuppression. Since then, only few randomized controlled clinical trials were developed in MG, showing inconclusive results; and drug efficacy was assessed in terms of its steroid-sparing capacity and the ability to reduce myasthenic signs and symptoms. Treatment strategy in MG is quite challenging, mainly due to the disease heterogeneity in terms of clinical presentation, immunopathogenesis and drug response. To solve this dilemma, emerging treatment are based on biological drugs and use new targets of the immune pathway.

The Clinical Course of Asthma After Withdrawal of Inhaled Corticosteroids

Maintenance of inhaled corticosteroids (ICSs) is recommended in adults with asthma. However, adherence rates in patients with mild asthma and side effects of long-term ICS use can lead to withdrawal. To analyze the real-world outcomes of ICS withdrawal by analyzing data from the Korean National Health Insurance database. Based on claims data from the National Health Insurance of Korea between 2011 and 2014, we identified patients diagnosed with asthma without chronic obstructive pulmonary disease or long-term systemic steroid use who had an ICS medication possession rate of more than 50% in a year. We compared patients who received ICS consistently (maintenance group) with patients who had no ICS prescription for more than 6 months (withdrawal group). We evaluated exacerbation leading to prescription of systemic steroid and emergency department visit or hospitalization. Excluding patients with chronic obstructive pulmonary disease and long-term systemic steroid users, we identified 145,511 patients for the asthma cohort (mean age, 60.0 years; ever-smoker, 63.5%): 132,175 maintained ICS and 13,336 withdrew ICS for more than 6 months. Only 71 patients (0.5%) experienced exacerbation leading to an emergency department visit or hospitalization in the withdrawal group. ICS was restarted within 1 year for 33.6% of the withdrawal group, and 90% of these patients restarted ICS within 158 days. This nationwide study of patients with asthma, characterized by a high proportion of elderly and smokers, showed that ICS withdrawal in about 10% of patients appeared to confer relatively minimal harm and exacerbation leading to hospitalization was not common. Further prospective studies are warranted to carefully explore the safety of ICS withdrawal in younger, nonsmoking, and well-controlled patients with asthma.

Аналіз чинників ризику розвитку неспецифічного гнійного остеомієліту хребта

SummaryBackground. Nonspecific pyogenic spondylodiscitis is a common form of spinalinfection, which represents 2–7% of all musculoskeletal infections. Due to the lowspecificity of symptoms and diagnostic signs, the delay in diagnosis remains animportant issue, disability and mortality among patients with back pain are frequentlyseen. Risk factors of this disease, besides adjacent infactive structures inflammation andhematogenous spread of pathogen, often include spinal invasive procedures. There arenumerous factors which facilitate purulent inflammation of disco-vertebral complex byaltering patient’s immune response. They include diabetes mellitus, long-term systemicsteroid use, liver dysfunction, intravenous drug use, malignancy.Purpose. The aim of the present study was to analyze the structure of infectiousagents, risk factors for the pyogenic vertebral osteomyelitis among patients of theNeurosurgery Department of Military Medical clinical Center of western Region(MMCC WR).Study design and methods. We conducted the analysis of retrospectively collectedstandardized clinical data of patients (n=54), who underwent inpatient and outpatienttreatment at the Neurosurgery Department of MMCC WR during the period from 2010to 2020 with a diagnosis “Nonspecific spondylodiscitis”.Results. Diabetes mellitus as comorbidity was established in 37.0% of examinedpatients, liver dysfunction – in 16.7%, 11.1% of persons had extravertebral malignancy.The hematogenous spread of the infectious agent was most frequently seen (38.9%),dissemination from nearby tissues rated 14.8% of cases, 12.9% of examined patientsunderwent spinal surgery, lumbar punctures or paravertebral injections during the last1–12 months. The cause of nonspecific spondylodiscitis was not determined in 20.4% ofcases.Conclusions. The most important risk factor for vertebral osteomyelitis is diabetesmellitus. This comorbidity not only facilitates spondylodiscitis, but also complicates itscourse, extents pyogenic destructive inflammation, resulting in formation of epiduralabscesses, compression myelopathy, weakening of local r diabetes mellitus as comorbidity epair and regenerative processes. Thus, such patients should be monitored forglycemia, and glucose levels should be precisely corrected.A number of surgery- and patient-related risk factors could be avoided or at leastdetermined preoperatively.The key point concerning treatment approach is down to identification of thebacterial cause of spinal infection to consider rational antibacterial therapy.

Long-Term Safety of Rituximab in Rheumatoid Arthritis: Analysis From the SUNSTONE Registry.

ObjectiveTo evaluate the long‐term safety of rituximab in an observational cohort of patients with rheumatoid arthritis (RA) who had an inadequate response to ≥1 anti–tumor necrosis factor therapy in the US (SUNSTONE [Study of the Safety of Rituxan in Patients With Rheumatoid Arthritis After an Inadequate Response to Previous Anti‐TNF Therapy] registry).MethodsIn this prospective, observational cohort study, patients received rituximab according to their physician's standard practice and were evaluated at standard‐of‐care follow‐up visits at least every 6 months. The primary outcome was the incidence of protocol‐defined significant infections. Secondary outcomes included serious adverse events potentially associated with rituximab, cardiovascular or thrombotic events, seizures, deaths, and pregnancies. Post hoc analyses assessed outcomes by concomitant medication use.ResultsOverall, 989 patients (safety‐evaluable population) received ≥1 dose of rituximab, with a total follow‐up of 3,844 patient‐years (mean duration 3.9 years). In total, 341 significant infections occurred in 197 patients (19.9%). The incidence rates (95% confidence intervals [95% CIs]) for significant infections, cardiovascular or thrombotic events, and seizures were 8.87 (95% CI 7.98–9.86), 1.95 (95% CI 1.56–2.45), and 0.18 (95% CI 0.09–0.38) per 100 patient‐years, respectively. The incidence of significant infections did not increase with time or with cumulative rituximab exposure. During the study, 64 patients died (crude mortality rate 1.66 per 100 patient‐years [95% CI 1.30–2.13]). The most common causes of death were infections (n = 19), malignancy (n = 14), and cardiovascular events (n = 13). Eight pregnancies were reported in 7 patients.ConclusionIn patients with RA treated with rituximab for up to 5 years, the rates of significant infections were stable over time and higher in patients who received long‐term systemic steroid treatment.

Eosinophilic Gastroenteritis That Remitted and Maintained in the Absence of Long-term Systemic Steroids and/or Elimination of Multiple Foods

Eosinophilic Gastroenteritis That Remitted and Maintained in the Absence of Long-term Systemic Steroids and/or Elimination of Multiple Foods

Omalizumab Treatment for Atopic Severe Persistant Asthma: A Single-Center, Long-Term, Real-Life Experience with 38 Patients.

Omalizumab is a monoclonal antibody that is used as add-on therapy for treating moderate-to-severe persistant atopic asthma in patients with persistant symptoms and frequent exacerbations, despite step 4 treatment according to GINA guidelines. Real-life studies on omalizumab treatment are limited in Turkey. Thus, the present study aims to assess the clinical efficacy and treatment outcomes of omalizumab in patients with atopic severe persistant asthma. Patients with atopic severe persistant asthma who were treated with omalizumab between 2009 and 2017 were retrospectively evaluated. Baseline and last results of the following variables were compared: symptom scores (GINA categorical), controller medications, blood eosinophil counts, forced expiratory volume in 1 second (FEV1) values, and the number of exacerbations that were treated with systemic corticosteroids for at least 3 days within the last 1 year. The effect of coexisting aspirin-exacerbated respiratory disease (AERD) on these parameters was also analyzed. Step-down of other asthma medications was attempted in patients with symptom control and in those without an exacerbation history within the last 6 months. Thirty-eight patients (mean age, 50 years; females, 30) were included in this study, of whom four showed AERD. After treating with a mean time of 30±22.1 (min: 6, max: 92) months, 26 (68%) patients showed complete controlled disease and 12 (32%) showed partly controlled disease, of whom all had uncontrolled disease before. Mean exacerbation rates within the last 1 year decreased by approximately 76% (9.4±8.4 vs. 1.8±1.5; p<0.001) and FEV1 values increased by approximately 14% (2075±729 vs. 2321±800 cc; p=0.001) compared with baseline levels. Although the reduction in eosinophil count was not significant in all patients (503.8±524.8 vs. 370.8±314.5; p=0.134), repeated measures analysis of variance revealed a more prominent reduction in eosinophil count in the AERD group than in the non-AERD group, independent from the treatment period (F: 4.23, p=0.049). The mean inhaled corticosteroid dose (budesonide eq., 1063±397 vs. 958±439 mcg; p=0.084), the number of other controller medications, and the number of patients with long-term systemic steroid use decreased after omalizumab treatment. No serious adverse events were recorded during the follow-up period. Our results confirm that omalizumab significantly improves disease control and is a safe add-on therapy. In addition, in suitable patients with controlled disease over time, the step-down of other asthma medications will be appropriate.

Is Arterial Stiffness a Predictor of Cardiovascular Disease in All Patients With Psoriasis?

We read the article by Balta et al entitled ‘‘Aortic Arterial Stiffness is a Moderate Predictor of Cardiovascular Disease in Patients With Psoriasis Vulgaris’’ with interest. They enrolled 32 patients with psoriasis vulgaris. Patients who were receiving lipid-lowering therapy, antihypertensive or antiaggregant drugs, nitrates, or long-term systemic steroids were excluded. They concluded that patients with psoriasis had higher high-sensitivity C-reactive protein (hsCRP) level and pulse wave velocity (PWV) compared with controls. In patients with psoriasis, PWV correlated positively with age, sex, body mass index, diastolic blood pressure, and hsCRP level. The PWV was not associated with psoriasis area and severity index and duration of disease. Balta et al evaluated only 32 patients with psoriasis vulgaris but several clinical types of psoriasis have been described. Additionally, the patients who received medical treatment were excluded from their study. However, in daily practice, a significant number of patients with psoriasis receive various topical or systemic treatments. Therefore, the study does not exactly represent the real-world situation. A study design including increased number of patients with different types of psoriasis who receive treatment may be more representative. Such a study may help better understand the relationship between arterial stiffness, atherosclerosis, inflammation, and psoriasis.

Familial Pulmonary Capillary Hemangiomatosis Early in Life

Background. Pulmonary capillary hemangiomatosis (PCH) is a rare disease, especially in infancy. Four infants have been reported up to the age of 12 months. So far, no familial patients are observed at this age. Patients. We report three siblings, two female newborns and a foetus of 15-week gestation of unrelated, healthy parents suffering from histologically proven PCH. The first girl presented with increased O2 requirements shortly after birth and patent ductus arteriosus (PDA). She subsequently developed progressive respiratory failure and pulmonary hypertension and died at the age of five months. The second girl presented with clinical signs of bronchial obstruction at the age of three months. The work-up showed a PDA—which was surgically closed—pulmonary hypertension, and bronchial wall instability with stenosis of the left main bronchus. Transient oxygen therapy was required with viral infections. The girl is now six years old and clinically stable without additional O2 requirements. Failure to thrive during infancy and a somewhat delayed development may be the consequence of the disease itself but also could be attributed to repeated episodes of respiratory failure and a long-term systemic steroid therapy. The third pregnancy ended as spontaneous abortion. The foetus showed histological signs of PCH. Conclusion. Despite the differences in clinical course, the trias of PCH, PDA, and pulmonary hypertension in the two life born girls suggests a genetic background.

Pathological Changes of the Rabbit Femoral Head Induced by Long-term Systemic Steroids

Pathological Changes of the Rabbit Femoral Head Induced by Long-term Systemic Steroids

Esophageal Dissection After Transesophageal Echocardiography in a Patient With Barrett's Esophagus and Long-term Systemic Steroid Therapy

BARRETT’S ESOPHAGUS is a condition in which an intestinal-type epithelium called specialized intestinal metaplasia or Barrett’s metaplasia replaces the stratified squamous epithelium that normally lines the distal esophagus.1 Barrett’s esophagus develops as a consequence of chronic gastroesophageal reflux disease and predisposes to the development of adenocarcinoma of the esophagus.1 Barrett’s esophagus is usually discovered during endoscopic examinations in middle-aged and older adults whose mean age at the time of diagnosis is approximately 55 years.1 Although arrett’s esophagus can affect children, it rarely occurs before he age of 5 years.2 This observation supports the hypothesis hat a Barrett’s esophagus is an acquired condition in the vast ajority of patients. The male-to-female ratio is approximately :1.3 The columnar metaplasia of a Barrett’s esophagus causes no symptoms. Most patients are seen initially for symptoms of the associated gastroesophageal reflux disease such as heartburn, regurgitation, and dysphagia. Estimates of the frequency of Barrett’s esophagus in the general population have varied widely, ranging from 0.9% to 4.5% depending in part on the population studied and the definitions used.4,5 The overall reiability of endoscopy with a biopsy for the detection of Barett’s esophagus is approximately 80%.6 A case of esophageal issection after transesophageal echocardiography (TEE) perormed during mitral valve repair in a patient whose past edical history was positive for Barrett’s esophagus is preented.

Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis

Psoriasis is associated with an increased risk of atherosclerosis. This study compared subclinical atherosclerosis of the carotid and brachial arteries in psoriasis vulgaris patients and healthy controls using high-resolution ultrasonography. We studied 43 psoriasis patients and 43 healthy controls matched for age and sex. Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NTD) of the brachial artery and intima-media thickness (IMT) of the common carotid arteries (CCA) were measured ultrasonographically. Diabetes mellitus, hypertension, renal failure, a history of cardiovascular or cerebrovascular disease were exclusion criteria. Subjects who were receiving lipid-lowering therapy, antihypertensive or anti-aggregant drugs, nitrates or long-term systemic steroids were also excluded. The mean IMT values of the right, left and averaged CCA of the psoriasis patients were significantly higher, compared with the controls (0.607+/-0.144 mm vs. 0.532+/-0.101 mm, 0.611+/-0.157 mm vs. 0.521+/-0.117 mm, and 0.609+/-0.146 mm vs. 0.526+/-0.104 mm; P=0.006, P=0.003 and P=0.003, respectively). The mean FMD and NTD values of the psoriasis patients were significantly lower, compared with the controls (13.36+/-6.39 mm vs. 19.60+/-11.23 mm and 21.08+/-8.38 mm vs. 26.85+/-12.38 mm; P=0.002 and P=0.013, respectively). Multiple linear regression analysis revealed a significant association between psoriasis and the IMT, FMD and NTD. Moreover, the FMD in psoriasis patients was associated with disease duration. Psoriasis patients had impaired endothelial function and thicker IMT of the CCA, compared with the healthy control subjects. The presence of psoriasis was an independent risk factor for subclinical atherosclerosis.