Low-dose Steroid Therapy Research Articles

AN OBSERVATIONAL STUDY OF EFFECT ON LIPID PROFILE BY SHORT TERM USE OF LOW DOSE STEROID THERAPY IN COMMON ORTHOPAEDIC CONDITIONS

Introduction:Corticosteroids, potent anti-inflammatory drugs used for decades, provide symptomatic relief but carry risks like infection and chronic conditions. Despite complications, theyre prescribed for orthopedic issues. Glucocorticoids influence lipid levels, with conflicting effects. Steroids are termed a double-edged sword. This study aims to assess lipid profile effects of short-term, low-dose steroid therapy in Orthopedics and Rheumatology, evaluating glucocorticoid therapy impact and investigating other effects on musculoskeletal patients. Materials and Methods:This prospective, non-randomized observational study was conducted, focusing on patients with orthopedic and rheumatological issues. Over 150 patients were included, selected through convenient sampling. Inclusion criteria involved patients aged 18-65 without dyslipidemia or cardiovascular conditions, while exclusion criteria included those with specific medical conditions or high BMI. Patients provided written informed consent before undergoing blood tests for lipid profile and blood sugar levels, with vital signs measured. They received Medrol 4 mg thrice daily for ten days, after which outcomes including lipid levels, blood sugar, and blood pressure were assessed. Results:At baseline, 88.67% had desirable cholesterol levels and 11.33% had borderline levels. At follow-up, 20.67% had borderline levels and 79.33% had desirable levels, a statistically significant difference. Mean cholesterol levels decreased from 169.16 ± 19.70 mg/dl to 161.11 ± 27.60 mg/dl, also significant. For triglycerides, 92.67% had normal levels at baseline, decreasing to 65.33% at follow-up, with mean levels increasing from 131.33 ± 6.97 mg/dl to 139.12 ± 23.88 mg/dl. HDL levels showed improvement, with 84.67% having desirable levels at baseline compared to 43.33% at follow-up, with mean levels increasing from 41.09 ± 5.13 mg/dl to 50.71 ± 4.21 mg/dl. LDL levels decreased from 132.43 ± 16.86 mg/dl to 122.59 ± 16.93 mg/dl, with significant changes in distribution. Conclusions:Short-term steroid use for orthopedic conditions affects lipid profiles: Total cholesterol, LDL, and TG rise significantly, countered by increased HDL, offering protection. Long-term effects on lipid profiles and cardiovascular risk require further study. Risk of avascular necrosis due to subtle lipid profile changes also warrants investigation.

Pregnancy with mixed connective tissue disease: Exploration of factors influencing live birth outcomes.

Mixed connective tissue disease (MCTD) predominantly affects women in their reproductive age (30-40 years). This study is aimed to analyze a case series of MCTD-complicated pregnancies. The study design utilized a combined case-series and case-control approach. Pregnant women with MCTD were included and categorized into two groups: the live-birth and non-live birth (encompassing miscarriages at <12 weeks and stillbirths at ≥12 weeks) groups. Primary outcomes included delivery outcomes and factors associated with live births. A total of 57 pregnancies from 34 mothers (median age: 33.0 years) were included. Regarding delivery outcomes, the rates for live birth, miscarriage, and stillbirth were 64.9, 29.8, and 5.3%, respectively. Additionally, the respective rates of preterm delivery, fetal growth restriction (FGR), and small-for-gestational-age (SGA) were 18.9, 18.9, and 27.0%. Higher steroid usage (62.2 vs. 30.0%, p = 0.02) and lower prednisolone dosage in the live birth group (median dose: 7 vs. 10 mg, p = 0.03) were found to be significant factors contributing to live births. MCTD during pregnancy was associated with increased risks of miscarriage, stillbirth, preterm delivery, FGR, and SGA. Notably, low-dose steroid therapy was identified as a contributing factor to successful live births.

Neither Conditioning Chemotherapy Nor GvHD-Prophylaxis: CD7 CAR-T Treatment Bridging to Haplo-HSCT

BACKGROUND: Relapsed/refractory (R/R) acute leukemia patients ineligible for allo-HSCT have poor prognosis. CAR-T therapy has shown promising therapeutic outcomes for these patients, but simultaneously confers the risk of pancytopenia and potential tumor relapse. Bridging CAR-T therapy with allo-HSCT has the potential to restore hematopoiesis and consolidate long-term efficacy. However, GvHD remains a major impediment, and the myeloablative conditioning regimen eradicates residual CAR-T cells and compromises CAR-mediated antitumor function. Furthermore, the implementation of conditioning regimen and GvHD-prophylaxis could lead to severe toxicities. Novel strategies are therefore warranted to preserve CAR-T cells, enhance antitumor potency and minimize complications. METHODS: In this study, we presented 10 patients (enrolled between November 2021 and June 2023) with R/R CD7-positive acute leukemia who proceeded directly to haploidentical HSCT (haplo-HSCT) after CAR-T therapy. All patients received allogeneic CD7 CAR-T therapy, manufactured from either haploidentical donors (n=8) in a phase I clinical trial of donor-derived CAR-T cells (NCT04599556) or (n=1) universal CD7 CAR-T cells (RD13-02) therapy (NCT05716113) or as a compassionate use program after the end of a phase I clinical trial of universal CD7 CAR-T cells (RD13-01) (NCT04538599). CAR-T cell doses were at 2´10 6(haploidentical donor, n=8), 4´10 6 (RD13-02, n=1) or 5´10 6 (RD13-01, n=1) cells/kg. After achieving complete remission with incomplete hematological recovery (CRi), all patients underwent haplo-HSCT without conditioning regimen or GvHD prophylaxis. The primary end point was efficacy, safety, hematopoiesis recovery, and donor chimerism. RESULTS: All patients relapsed from multiple lines of chemotherapy or immunotherapy (median, 7; range, 4-13), were ineligible for allo-HSCT and received palliative care. After CAR-T infusion, 9 patients achieved MRD-negative CRi, and 1 achieved MRD-positive CRi, on day 15 after CD7 CAR-T therapy. 9 patients developed grade 1-2 cytokine release syndrome, and no neurological toxicity was reported. All patients exhibited grade 4 pancytopenia and bone marrow hypocellularity and were directly bridging to haplo-HSCT. The median time from CAR-T infusion to haplo-HSCT was 19 (range, 15-89) days. One patient died of HHV6 infection in central nervous system on day 13 after haplo-HSCT and was not evaluable for the following safety and efficacy. 3 patients experienced short-term grade II acute GvHD, which was resolved completely after low dose steroid, anti-TNF-α or ruxolitinib therapy. One patient developed PTLD at 2.1 months post-HSCT. In 9 evaluable patients, 8 showed full donor chimerism at 1-month post-HSCT, and 1 showed autologous hematopoiesis recovery. At a median follow-up of 10.2 (range, 2.2-20.7) months after CAR-T therapy, 6 patients remained in MRD-negative CR with normal hematopoiesis (including the patient with autologous hematopoietic recovery), 1 had CD7-negative relapse at 5.6 months, 1 developed CD7-negative relapse at 4.3 months and died at 4.8 months, and 1 died from septic shocks at 3.7 months. OS, PFS, NRM, and CIR at 1 year were 64.3% (95% CI, 38.5%-100%), 51.4% (95% CI, 26.2%-100%), 22.9% and 25.7%, respectively. Peripheral normal T cells in 8/10 of patients remained CD7-negative at the last follow-up, illustrating a well-maintained CAR-T function post-HSCT. CONCLUSIONS: Our findings demonstrate a novel strategy to simultaneously achieve CAR-T persistence and complete HSC engraftment, while reducing the risks of GvHD, providing valuable insights into combining cellular therapy with allo-HSCT for the treatment of R/R acute leukemia patients ineligible for conventional allo-HSCT.

Cabergoline and Low-Dose Steroid Therapy İn Idiopathic Granulomatous Mastitis

Introduction: Idiopathic granulomatous mastitis(IGM) is a rare, chronic granulomatous inflammatory disease of the breast. It is mostly seen in young women with a history of breastfeeding. It typically presents as a painful lump in the breast, erythema, focal abscess formation, skin ulceration, or fistula. The etiology and pathogenesis of IGM could not yet be well understood. It is thought to be caused by a localized autoimmune response against fat and protein-rich secretions leaking from the lobules due to previous hyperprolactinemia. There is no definite treatment protocol defined for IGM. Pharmacological agents and surgical interventions are used alone or in combination in the treatment. In this study, we aimed to examine the results of patients who were treated with cabergoline and low-dose steroids for IGM in our center.&#x0D; Methods: In this study, the files of patients who were treated with cabergoline and steroids for idiopathic granulomatous mastitis in our clinic were reviewed retrospectively. 36 patients were included in the study. The patients were invited to the outpatient clinic for the final examination. Demographic characteristics of the patients, symptoms at presentation, examination findings, laboratory tests, radiological imaging, tru-cut biopsy results, microbiological culture results, treatment doses and durations, remission times, surgery requirements, and recurrence were recorded.&#x0D; Results: All 36 patients included in the study were women of childbearing age. The most common presenting complaint was a palpable painful mass. Abscesses were present in 12 patients. Ulcers were observed in 9 patients and fistulas were observed in 4 patients. The most common involvement was in the lower outer quadrant. S.aureus was detected in the culture of 1 patient. Complete recovery was observed in 20 of 36 patients as a result of the treatment. The mean duration of remission was 2.85±2.54 months. The treatment of 29 (74.3%) patients was completed medically. Surgical excision was performed in 7 patients with a residual lump. No recurrence was observed during the follow-up period of 27.88 ± 8.21 months.&#x0D; Conclusion: The treatment of IGM is still controversial. The fact that cabergoline and low-dose steroid therapy provides remission in a short time, minimizes the need for surgery, and does not relapse in medium-term follow-up shows that it is a successful option in IGM treatment.

Primary sclerosing encapsulating peritonitis: a case report

BackgroundSclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge.Case presentationA 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved.ConclusionSclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.

Evidence-Based Guidelines for the Management of Allergic Bronchopulmonary Aspergillosis (ABPA) in Children and Adolescents with Asthma.

Allergic bronchopulmonary aspergillosis (ABPA) frequently complicates asthma. There is urgent need to develop evidence-based guidelines for the management of ABPA in children. The Evidence Based Guideline Development Group (EBGDG) of the Indian Academy of Pediatrics (IAP) National Respiratory Chapter (NRC) addressed this need. The EBGDG shortlisted clinical questions relevant to the management of ABPA in asthma. For each question, the EBGDG undertook a systematic, step-wise evidence search for existing guidelines, followed by systematic reviews, followed by primary research studies. The evidence was collated, critically appraised, and synthesized. The EBGDG worked through the Evidence to Decision (EtD) framework, to formulate recommendations, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Seven clinical questions were prioritized, and the following recommendations formulated. (1) Children with poorly controlled asthma should be investigated for ABPA (conditional recommendation, moderate certainty of evidence). (2) Low dose steroid therapy regimen (0.5mg/kg/d for the first 2 wk, followed by a progressive tapering) is preferable to higher dose regimens (conditional recommendation, very low certainty of evidence). (3) Oral steroid regimens longer than 16 wk (including tapering), should not be used (conditional recommendation, very low certainty of evidence). (4) Antifungals may or may not be added to steroid therapy as the evidence was neither in favour nor against (conditional recommendation, low certainty of evidence). (5) For clinicians using antifungal agents, the EBGDG recommends against using voriconazole instead of itraconazole (conditional recommendation, very low certainty of evidence). (6) No evidence-based recommendation could be framed for using pulse steroid therapy in preference to conventional steroid therapy. (7) Immunotherapy with biologicals including omalizumab or dupilumab is not recommended (conditional recommendation, very low certainty of evidence). This evidence-based guideline can be used by healthcare providers in diverse clinical settings.

A Reduction in Antenatal Steroid Dose Was Associated with Reduced Cardiac Dysfunction in a Sheep Model of Pregnancy

Despite widespread use, dosing regimens for antenatal corticosteroid (ACS) therapy are poorly unoptimized. ACS therapy exerts a programming effect on fetal development, which may be associated with an increased risk of cardiovascular disease. Having demonstrated that low-dose steroid therapy is an efficacious means of maturing the preterm lung, we hypothesized that a low-dose steroid exposure would exert fewer adverse functional and transcriptional changes on the fetal heart. We tested this hypothesis using low-dose steroid therapy (10 mg delivered to the ewe over 36 h via constant infusion) and compared cardiac effects with those of a higher dose treatment (30 mg delivered to the ewe over 24 h by intramuscular injection; simulating currently employed clinical ACS regimens). Fetal cardiac function was assessed by ultrasound on the day of ACS treatment initiation. Transcriptomic analyses were performed on fetal myocardial tissue. Relative to saline control, fetuses in the higher-dose clinical treatment group had significantly lower ratios between early diastolic ventricular filling and ventricular filling during atrial systole, and showed the differential expression of myocardial hypertrophy-associated transcripts including βMHC, GADD45γ, and PPARγ. The long-term implications of these changes remain unstudied. Irrespective, optimizing ACS dosing regimens to maximize respiratory benefit while minimizing adverse effects on key organ systems, such as the heart, offers a means of improving the acute and long-term outcomes associated with this important obstetric therapy.

Lactobacillus Endocarditis With Mixed Glomerulonephritis: A Case Report

We present a case of Lactobacillus prosthetic valve endocarditis with associated antineutrophil cytoplasmic antibody glomerulonephritis. A 41-year-old man presented with recurrent dark brown urine, lower-extremity rash, and acute kidney injury. Kidney biopsy confirmed the diagnosis of glomerulonephritis, with pathologic findings concerning for an infectious cause. Blood cultures returned positive for Lactobacillus species, and transesophageal echocardiogram findings were positive for prosthetic valve vegetation. Antimicrobial and low-dose steroid therapy were initiated to treat the endocarditis with confidence that resolution of his glomerulonephritis also would occur.

Cardiac and vascular effects of low-dose steroids during the early phase of septic shock: An echocardiographic study.

BackgroundLow-dose steroids are known to increase arterial pressure during septic shock through restoration of vasopressor response to norepinephrine. However, their effects on cardiac performance and ventriculo-arterial coupling (VAC) have never been scrutinized during human septic shock. The aim of this study was to perform a comprehensive description of the cardiovascular effects of low-dose steroids using modern echocardiographic tools (including speckle tracking imaging).MethodsThis prospective study was conducted in the intensive care unit (ICU) of a university hospital in France. Consecutive adult patients admitted for septic shock and requiring low-dose steroid therapy were prospectively enrolled within 24 h of septic shock onset. We recorded hemodynamic and echocardiographic data to explore left ventricle (LV) contractility, loading conditions and VAC just before the initiation of low-dose steroids (50 mg intravenous hydrocortisone plus 50 μg enteral fludrocortisone) and 2–4 h after.ResultsFifty patients [65 (55–73) years; 33 men] were enrolled. Arterial pressure, heart rate, almost all LV afterload parameters, and most cardiac contractility parameters significantly improved after steroids. VAC improved with steroid therapy and less patients had uncoupled VAC (> 1.36) after (24%) than before (44%) treatment.ConclusionIn this comprehensive echocardiographic study, we confirmed an improvement of LV afterload after initiation of low-dose steroids. We also observed an increase in LV contractility with improved cardiovascular efficiency (less uncoupling with decreased VAC).

The role of lower dose steroid therapy with vitamin D replacement in patients with idiopathic granulomatous mastitis.

Low-dose steroid therapy has been recommended in idiopathic granulomatous mastitis (IGM) in various studies in the literature, but the therapeutic minimum dose has not been determined yet. Furthermore, vitamin D deficiency, the effect of which is accepted in autoimmune diseases, has not been previously examined in IGM. The aim of our study was to evaluate the efficacy of lower dose steroid theraphy with adjustment of vitamin D replacement doses with measuring serum 25-hydroxyvitamin D levels in patients with idiopathic granulomatous mastitis (IGM). Vitamin D levels were evaluated in 30 IGM patients who applied to our clinic between 2017-2019. Vitamin D replacement was performed in patients with serum 25-hydroxyvitamin D level below 30 ng/mL and prednisolone was given to all patients at a dose of 0.05-0.1 mg/kg/ day. Clinical recovery times of the patients were compared with the literature. Vitamin D replacement was given to 22 (73.33%) patients. Recovery time was shorter in patients receiving vitamin D replacement (7.62 ± 2.38; 9.00 ± 3.38; p= 0.680). Average recovery time was 8.00 ± 2.68 weeks. Treatment of IGM can be carried out with lower dose steroid therapy, leading to less complications and lower costs. Measuring serum 25-hydroxyvitamin D level and treating it with the appropriate dose may contribute to the healing process.

Safety and efficacy of low-dose glucocorticoid regimen in the induction phase treatment of class 4, 5 lupus nephritis

Background Renal involvement in systemic lupus erythematosus is known as lupus nephritis (LN). LN presents with varied renal features. Class 4 and 5 LN are traditionally treated with prolonged standard high doses of prednisolone with various immunosuppressants such as cyclophosphamide and mycophenolate. These high doses of prednisolone are associated with numerous side effects. There is deficient data on the dose, duration of glucocorticoid therapy, and also paucity of data on comparison between the standard dose versus low-dose glucocorticoid therapy. Hence, this study can help in evaluating the use of low-dose glucocorticoids, its impact on renal outcome, and looking at side effects. Materials and methods It was a retrospective observational study conducted to look at the safety and efficacy of low-dose glucocorticoid regimen in induction phase treatment of class 4, 5 LN. Results On treatment, it was found that the resolution of microscopic hematuria, and improvement of low C4, and hypoalbuminemia were statistically significant in the low-dose steroid group. The resolution of proteinuria was seen in both groups and the resolution of renal failure was noted in both groups but was statistically significant in the standard dose group. Increased incidence of steroid-related complications was seen in the standard dose steroid group. Conclusions These findings possibly indicate that low-dose steroid therapy is good enough to treat LN with proteinuria, but a standard dose steroid is required in the presence of renal failure in LN, though increased incidence of steroid-related complications was seen in the standard dose steroid group.

The effectiveness of methotrexate and low-dose steroid therapy in the treatment of idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis (IGM) is a rare, chronic, benign, inflammatory breast disease of unknown cause. Patients usually present with a single breast mass, hyperemia, discharge, skin disorders, and fever. Radiological and clinical findings can mimic carcinoma and infection. To examine the treatment of IGM with methotrexate (MTX) + low-dose steroid, and present the results and follow-up data from our center. Sixty-two patients, diagnosed with IGM in our center between January 2009 and December 2017 were included in this study. Patients diagnosed with granulomatous mastitis histopathologically underwent testing with anamnesis, physical examination and imaging methods to exclude other diseases that cause granulomatous reactions. Patients with a history of malignancy, chronic infectious diseases such as hepatitis B and pregnant women were excluded from this study. Data collected from 62 patients were reviewed retrospectively for this study. The mean patient age was 36.58 ±5.83 years (range: 28-54 years). Lesions were present in the right breast in 30 (48.38%) patients, the left breast in 26 (41.94%) patients and both breasts in 6 (9.68%) patients. Methotrexate was administered orally at a dose of 15 mg/week and methylprednisolone at a dose of 8 mg/day. The mean clinical and radiological remission periods of these patients were 10.14 ±1.21 months (range: 3-14 months). All patients attended regular follow-up appointments. The recovery rate of patients during follow-up was determined to be 93.71%. Methotrexate + low-dose steroid therapy is successful in the treatment of IGM. Prospective, large case series and/or multi-center studies are needed to develop an IGM treatment algorithm.

Low-dose steroids are associated with indeterminate QuantiFERON-TB Gold In-Tube assay results in immunocompetent children

Immunocompromised status can result in indeterminate QuantiFERON-TB Gold In-Tube (QFT-GIT) results, but the association of indeterminate results with immunocompetent status in children is unknown. Therefore, we aimed to identify factors associated with indeterminate QFT-GIT results for immunocompetent children. We conducted a retrospective chart review of children (aged ≤ 18 years) who underwent QFT-GIT between September 2006 and July 2017 at the Severance Hospital, Seoul, South Korea. Of the 2037 QFT-GIT assays included in the present study, 7.7% yielded indeterminate QFT-GIT results. Multivariable logistic regression analysis identified younger age (OR 0.88; 95% CI 0.836–0.927; P < 0.001), elevated white blood cell (WBC) count (OR 1.066; 95% CI 1.020–1.115; P = 0.005), decreased albumin levels (OR 0.505; 95% CI 0.316–0.807; P = 0.004), and low-dose steroid therapy (< 1 mg/kg per day of prednisone or equivalent for < 2 weeks) (OR 76.146; 95% CI 8.940–648.569; P < 0.001) as significant factors influencing indeterminate results. Younger age, high WBC count, low albumin levels, and low-dose steroid therapy were associated with indeterminate QFT-GIT results. Low-dose steroid therapy had the highest OR for the indeterminate results compared to other significant risk factors. Our study suggests that screening for steroid doses is important prior to performing interferon-gamma release assays for immunocompetent children.

Low‐dose steroids do make a difference: Independent risk factors for impaired linear growth after pediatric liver transplantation

Growth failure persists after pediatric liver transplantation and impairs pediatric development and quality of life. Steroid dose minimization attempts to prevent growth impairment, yet long-term assessment in pediatric liver recipients is lacking. We identified risk factors for impaired linear growth after pediatric liver transplantation, with a special focus on low-dose steroid therapy. This is a single-center retrospective analysis of height development in pediatric liver recipients up to 5years after transplantation. Risk factors for impaired linear growth (height Z-scores≤-2) at transplantation, after two (n=347) and five years (n=210) were identified by univariate and multivariate logistic regression. At transplantation, growth retardation was found in 52.2%, predominantly younger children. Height Z-scores improved from -2.23 to -1.40 (SE 0.11; 95%CI 0.74-1.16; p<.001) two years and -1.19 (SE 0.07;0.08-0.34; p=.017) five years post-transplant. Multivariate analysis showed previous growth impairment (OR=1.484; 95%-CI=1.107-1.988; p=.004), graft loss (49.006;2.232-1076; p=.006), and prolonged cold ischemic time (1.034;1.007-1.061; p=.011) as main long-term risk factors; steroid use was a significant predictor of 2-year but not 5-year growth impairment. In univariate analysis, impaired growth after 2 and 5years was associated with continuous low-dose (2.5mg/m2 BSA) steroid therapy (OR=3.323;1.578-6.996; p<.001/OR=8.352;1.089-64.07; p=.006)and graft loss (OR=2.513;1.395-4.525; p=.003/OR=3.378;1.815-7.576; p<.001). Furthermore, indication and era of transplantation affected growth. Our results show significant catch-up growth after pediatric liver transplantation, yet growth failure strongly affects particularly young liver recipients. The main influenceable long-term risk factor is pre-existing growth failure, emphasizing the importance of early aggressive nutritional therapy. Moreover, low-dose steroid therapy might impair growth and should therefore be critically questioned in long-term immunosuppression.

Consensus Statement for Pharmacological Management of Coronavirus Disease 2019 (COVID-19): A Pragmatic Approach

Introduction: In the absence of high-quality evidence for Coronavirus disease-2019 (COVID-19), supportive care is advocated during this pandemic. We aim to develop a consensus statement from global experts for pharmacological management, based on the pathophysiology of COVID-19. Material and Methods: We used a modified Delphi methodology in three steps: 1) Formulation of the steering committee and questionnaire; 2) Delphi methodology and selection of experts; 3) Final meeting of the steering committee and analysis, discussion, preparation, and presentation of captured data. Results: 34 (73·9%) experts accepted the invitation for the study. We conducted two rounds of Delphi and consensus (&gt;70% votes) was achieved on 11 out of 24 statements after the end of round two. Conclusion: This global consensus suggests that “Anti-viral therapy should be administered in the early infection phase of COVID-19 followed by low dose steroid therapy in pulmonary phase. Prophylactic dose anticoagulation should be used in hospitalized, mild to moderate COVID-19 patients. We make no suggestions for the use of immune modulation therapy”.

Treatment of abdominal granuloma and hypercalcaemia caused by Cladophialophora bantiana with combination antifungal chemotherapy and hyperbaric oxygen therapy in a dog

A 5-year-old intact male Boxer was evaluated for a 4-month history of ventral abdominal mass with fistulous tracts. Thoracic and abdominal CT revealed a large soft-tissue mass in the rectus...

Combination therapy of low-dose cyclosporine and steroid in adults with IgA nephropathy .

A few clinical trials in IgA nephropathy (IgAN) have shown that cyclosporine A (CyA) had therapeutic efficacy in reducing proteinuria. This is a retrospective study, and all cases were selected based on kidney biopsy-proven IgAN. We reviewed the data of IgAN patients in the glomerulonephritis registry at Kyung Hee University Medical center and collected data on 86 patients with urinary protein/Cr ratio (PCR; g/g) > 0.5 and estimated GFR (eGFR) of > 50 mL/min/1.73m2 who were treated with combination therapy of low-dose CyA plus low-dose steroid (C+P; n=37) and high-dose steroid single therapy (P; n=49). In the C+P group, themean duration of therapy was 14.5 ± 13.1months, and the mean duration of follow-up 66.2 ± 36.3 months. In the C+P group, the urine PCR levels significantly declined after treatment (< 0.05). After 6months of treatment, 12 (32%) patients were in complete remission and 7 (19%) in partial remission in the C+P group, compared with 21 (42%) and 11 (22%) in the Pgroup, respectively. Urine PCR levels were also significantly reduced in 12 patients in the C+P group who had initial urine PCR between 0.5 and 1.0. The degree of hematuria was significantly reduced after treatment in the C+P group. These effects of C+P therapy on proteinuria and hematuria were very comparable to high-dose P therapy. After 2 years, a decline in renal function, > 25% decrease in eGFR from baseline levels, developed in 3 (8.1%) in the C+P group, compared with 4 (8.2%) in the P group. The rate of decline in renal function during follow-up was -0.14 ± 0.40 mL/min/1.73m2/month in the C+P group compared with -0.12 ± 0.22mL/min/1.73m2/month in the P group. There were no changes of mean eGFR during the first 24 months, but the eGFR significantly decreased at last follow-up in both groups. When patients in the C+P group were divided into progressive (n = 9) and nonprogressive (n = 28) groups, a significant reduction in the amount of proteinuria after treatment was observed in the nonprogressive group, in contrast to the progressive group. In the C+P group, there were no severe adverse effects, especially no acute renal impairment, requiring discontinuation of CyA in this study. The incidence of infection was much lower in the C+P group than that in the P group. The limitation is that CyA acts to nonspecifically reduce proteinuria, so it requires long-term follow-up off CyA therapy for more than 2 years to determine. Our retrospective uncontrolled study provides only weak evidence that combination therapy of low-dose C+P could be an alternative to high-dose P therapy and be safe in adult IgAN patients with relatively normal renal function and proteinuria of > 0.5 g/g. Development of safe and effective therapy is still a major challenge requiring well-controlled prospective studies with this or other combination therapies.

MON-034 A case of frequent relapse minimal change nephrotic syndrome with steroid-induced psychiatric syndromes treated by a low-dose and short-term steroid therapy in combination with cyclosporine

Oral prednisolone (PSL) alone in an initial dosage of 1.0 mg/kg/day is generally administered for a minimum of 4 weeks in adult patients with minimal change nephrotic syndrome (MCNS), and 80% of patients with MCNS achieve clinical remission. However, relapses frequently occur in manyMCNS patients,rendering repeathigh-dosePSLtreatment necessary. Long-term treatment with high-dose steroids increasesthe risk of steroid toxicity, such as diabetes mellitus, gastric complications, infections, osteoporosis, and steroid-induced psychiatric syndrome, which may compromise the patient’s quality of life. Therefore, useful strategies are necessary to reduce the dosage and duration of steroid therapy for frequent relapse MCNS (FRNS) troubled by steroid toxicity.Here we suggest a new combination therapy of low-dose and short-term steroid with cyclosporine (CyA). A 51-year-old man with FRNS with a history of recurrent steroid-induced psychiatric syndrome was admitted to our department in April 2018. Immunosuppressive therapy with both PSL and CyA (initial dose0.3 mg/kg/day and 1.5 mg/kg/day, respectively)was started. Complete remission was obtained just 2 weeks later;the dose of PSL was promptly reduced and tapered. Clinical course and Results A 51-year-old man was admitted to our hospital for biopsy-proven recurrence of FRNS. MCNS initially occurred at the age of 15, and he was basically treated withPSL(initial dosage 1.0 mg/kg/day at onset and at relapses). The steroid therapy had finished at the age of 42, after which complete remission was maintained. At the age of 16 he had developed steroid-induced depression ;hispsychiatric symptoms were maintained in stable condition with psychiatrist visits andfluvoxamine maleate acid (300 mg/day). After admission we started an immunosuppressive therapy with PSL in combination with CyA (initial dosage of 0.3 mg/kg/day and 1.5 mg/kg/day, respectively), based on his history of depression and in attempt to reduce the dosage and duration of steroid therapy. Complete remission was obtained after 2 weeks of treatment, but steroid-induced psychiatric syndrome recurred the day after remission. Thus, we promptly reduced the dosage of PSL (weekly by 2.5-5 mg/day), which rapidly improvedpsychiatric syndrome. The dosage of PSL was 5 mg/day at 5 weeks after the start of treatment, and complete remission wasmaintained without relapse of MCNS. We successfully treated a recurrent case of FRNS with steroid-induced psychiatric syndrome by alow-dose,short-term steroid therapy andCyA, which induced early complete remission,allowed promptPSL dose reductionwithout relapse,and quickly resolved psychiatric symptoms. This treatment protocol is very useful and can be a future treatment strategy for FRNS with steroid-induced psychiatric syndrome.

Efficacy and Safety of Steroid Therapy for Posttransplant Hyperbilirubinemia Caused by Early Allograft Dysfunction: A Randomized Controlled Trial.

BackgroundHyperbilirubinemia is a common event that occurs after liver transplantation. Hyperbilirubinemia is usually caused by early allograft dysfunction. Glucocorticoid is widely used for immunosuppression, but few studies have analyzed the effects of steroid therapy on posttransplantation hyperbilirubinemia. The aim of this study was to assess whether glucocorticoid was beneficial in treating hyperbilirubinemia caused by early allograft dysfunction.Material/MethodsPatients with postoperative hyperbilirubinemia (those with conditions such as biliary complications and rejections were excluded) were randomly assigned, in a 2: 1 ratio, to the steroid and control groups. Patients in the steroid group were treated with glucocorticoid combined with ursodeoxycholic acid, whereas patients in the control group were only treated with ursodeoxycholic acid. The primary endpoint was decrease in bilirubin and the secondary endpoint was safety.ResultsFrom 1st June 2016 to 30th April 2018, 40 patients were enrolled into the steroid group, and 20 were enrolled into the control group. Donor, recipient, and operative data were similar between the 2 groups. The decrease in bilirubin levels in the steroid group was significantly greater than that in the control group on the first day after the intervention was finished (9.25±1.30 mg/dL vs. 3.11±1.45 mg/dL, p=0.005), and after 2 weeks (15.01±1.20 mg/dL vs. 8.88±1.98 mg/dL, p=0.007). The steroid group did not have a higher complication rate but it did have a shorter postoperative hospital stay than in the control group.ConclusionsLow-dose steroid therapy was effective and safe for treating hyperbilirubinemia caused by early graft dysfunction, and it improved liver function.

Effect of low-dose systemic steroid therapy on the management of severe community-acquired pneumonia

Introduction The rationale behind the study is that as severe pneumonia is associated with local and systemic inflammatory response, the systemic steroid with its anti-inflammatory effect may affect the outcome and prognosis in severe pneumonia. Objective The aim was to assess the effect of systemic steroid on the course and outcomes of severe community-acquired pneumonia (CAP). Patients and methods This study was a prospective, randomized, controlled study conducted on 60 patients, hospitalized with severe CAP. The patients were divided into two groups: a case group undergone usual antibiotic regimen for CAP according to the guidelines plus systemic steroid therapy with prednisolone 0.5 mg/kg daily for 1 week and a control group without any systemic steroids. The primary outcome was the treatment success and duration of hospitalization. Results The treatment was more successful in the case group compared with the control group (93.3 vs. 70.0%, respectively) with statistically significant difference. The mean days of hospitalization, the mean levels of C-reactive protein after treatment, and the mean decline of C-reactive protein levels were significantly lower among the case group. However, there was no significant difference between the two groups as regards mortality. Conclusion Low-dose systemic steroids significantly increase the success of treatment in severe CAP with less days of hospitalization.