Prior Corticosteroid Treatment Research Articles

Risk factors and mortality of carbapenem-resistant Pseudomonas aeruginosa bloodstream infection in haematology department: A 10-year retrospective study

ObjectivesThis study aims to investigate the risk factors for carbapenem-resistant Pseudomonas aeruginosa bloodstream infection (CRPA-BSI) and identify predictors of outcomes among patients with P. aeruginosa bloodstream infection (PA-BSI). MethodsA retrospective cohort study was conducted on patients with PA-BSI at Henan Cancer Hospital from 2013 to 2022. ResultsAmong the 503 incidences analysed, 15.1% of them were CRPA strains. Age, ANC < 100/mmc, receiving antifungal prophylaxis, exposure to carbapenems within the previous 90 days to onset of BSI, and allogeneic HSCT (allo-HSCT) were associated with the development of CRPA-BSI. CRPA-BSI patients experienced significantly higher 28-day mortality rates compared to those with carbapenem-susceptible P. aeruginosa bloodstream infection. Multivariate logistic regression analysis identified age at BSI, active stage of haematological disease, procalcitonin levels, prior corticosteroid treatment, isolation of CRPA, and septic shock as independent predictors of 28-day mortality. ConclusionsRisk factors for CRPA-BSI include age, ANC < 100/mmc, antifungal prophylaxis, exposure to carbapenems, and allo-HSCT. Additionally, age at BSI, active haematological disease, procalcitonin levels, prior corticosteroid treatment, CRPA isolation, and septic shock contribute to increased mortality rates among patients with PA-BSI.

Factors associated with the outcomes in ulcerative colitis patients undergoing granulocyte and monocyte adsorptive apheresis as remission induction therapy: A multicenter cohort study.

Ulcerative colitis (UC) patients harbor activated myeloid leukocytes, which exacerbate and perpetuate UC by releasing inflammatory cytokines. Granulocyte and monocyte adsorptive apheresis (GMA) with an Adacolumn depletes elevated myeloid leukocytes, inducing efficacy with favorable safety. To understand how the clinical outcome with GMA is affected by prior corticosteroid treatment or concomitant immunomodulators, a retrospective multicenter study in 102 UC patients, who had not responded well to first-line medications was undertaken. The remission rates after a course of GMA therapy were significantly higher in corticosteroid-naïve patients compared with those with prior corticosteroid exposure. Absence of corticosteroid background was an independent predictive factor of response to GMA. Further, in corticosteroid-naïve patients, the 1-year cumulative sustained remission rate in patients who did not receive immunomodulators was significantly higher than in patients who received immunomodulators. Accordingly, multivariate analysis revealed that immunomodulator was associated with higher risk of relapse. In conclusion, GMA was an effective treatment for corticosteroid-naïve patients and the efficacy sustained longer in those not receiving immunomodulators during GMA. GMA fulfills the notion that apheresis is to induce disease remission by removing from the body factors known to perpetuate disease. In therapeutic settings, these findings should help better decision making and avoid futile use of medical resources.

Influence of previous corticosteroid treatment on the efficacy and safety of infliximab therapy in Crohn disease.

To determine the effect of prior corticosteroid treatment on the results of infliximab (IFX) therapy in patients with Crohn disease (CD).Patients with CD treated with at least 3 IFX infusions between March 2009 and April 2017 were divided into steroid group (n = 43) and nonsteroid group (n = 22) and analyzed retrospectively.The cumulative probabilities of clinical remission and response to IFX at weeks 14, 30, 54, and 78 were higher in the steroid group, though this difference was not statistical significant. At the mean interval of 11.7 months following the initiation of IFX treatment, the mucosal healing rate was significantly higher in the steroid group (71.0% vs 22.2%, P < .01). There was no statistical difference in the incidence of adverse reactions between the 2 groups.In CD, patients with prior corticosteroid treatment may increase the response rate to IFX therapy.

Electrophysiological and Clinical Examination of Polymyositis: A Retrospective Analysis

BackgroundWe retrospectively analyzed electromyogram (EMG), laboratory and clinical data of 93 patients with polymyositis (PM) to help improve early diagnostic accuracy. MethodsData were collected from hospitalized patients who were diagnosed with PM between January 1, 2006 and April 1, 2010 at Chinese People’s Liberation Army General Hospital. ResultsEighty-six (92.47%) patients exhibited an isolated myopathic EMG pattern, 3 (3.23%) showed myopathy combined with neuropathy and 1 (1.08%) had diabetes mellitus. Among the 4 without myopathic EMG, 1 had inflammatory myopathy, and 3 had prior corticosteroid treatment with clinical improvement before EMG examination. Muscle biopsy, performed in 40 cases, inclusive of the 7 cases that did not show an isolated myopathic EMG patterns, revealed that 80% exhibited typical pathological features of PM, 17.5% showed nonspecific muscle fiber necrosis and 2.5% were normal. EMG showed that tibialis anterior and biceps brachii exhibited more abnormal EMG results than abductor pollicis brevis. Patients with disease duration >3 months had significantly higher alanine aminotransferase and reduced motor unit potential (MUP) amplitudes compared to patients with shorter disease duration. statistical analysis revealed a significant association between disease duration and MUP amplitude reduction. Patients without interstitial lung disease showed significantly longer disease duration and higher creatine kinase and lactate dehydrogenase levels than patients with interstitial lung disease. Conclusionsour results show that MUP is a sensitive yardstick for diagnosis of PM and is inversely related to disease duration. our study also highlights that selecting specific muscles for EMG may improve diagnostic accuracy in PM.

Surgical Debulking for Idiopathic Dacryoadenitis: A Diagnosis and a Cure

Idiopathic inflammatory tumor of the lacrimal gland, also called idiopathic dacryoadenitis, generally is treated with high-dose, long-term systemic corticosteroids, despite their limited success, high recurrence rate, and incidence of drug-induced side effects. This study describes the outcome of patients with idiopathic dacryoadenitis who were managed with surgical debulking. Retrospective case series from 2 tertiary referral centers. Forty-six patients (46 lacrimal glands). Review of the clinical records, radiologic scans, and histopathologic specimens, with additional immunoglobulin G4 immunostaining. Clinical signs and symptoms at 2 months after the surgery and off medications. Before referral, 41% (19 of 46) of the patients had received systemic high-dose corticosteroids, after which they all showed recurrence, of whom 26% (5 of 19) became dependent on corticosteroids. At referral, all patients underwent debulking surgery of the inflammatory lacrimal gland mass for diagnostic and therapeutic reasons. Additionally, intralesional or systemic low-dose corticosteroids were given during the operation or the first postoperative days in 54% (25 of 46) of the patients. At 2 months after the debulking surgery, a full clinical recovery was seen in 80% (37 of 46) of the patients. A recurrence occurred in 8% (3 of 37) of the patients 4 months and 2.2 and 4.6 years later. Surgical failure (20%; 9 of 46) was correlated with prior corticosteroid treatment (P = 0.002, Fisher exact test), but not with sclerosing inflammation present in 28% (13 of 46). The median follow-up time was 7.2 years (range, 0.7-18 years). Debulking biopsy procedures for idiopathic dacryoadenitis, in addition to being diagnostic, may be therapeutic.

The Sensitivity and Specificity of Esophagogastroduodenoscopy (EGD) for the Small Caliber Esophagus in Esophageal Eosinophilic Infiltration (EEI)

Purpose: To determine the clinical usefulness of esophagram with calculation of esophageal diameter in patients with symptomatic esophageal eosinophilic infiltration (EEI). Methods: Patients who presented with dysphagia between 2004 and 2012 were identified. All patients had at least 15 eosinophils per high powered field on esophageal biopsy and were evaluated with an esophagram. In addition, all patients were clinically evaluated by a single investigator (JAA). A small caliber esophagus (SCE) was defined as an esophageal maximal diameter (EDmax) less than or equal to 21 mm. EGD sensitivity and specificity were evaluated against a gold standard of esophagram. Gender, food impaction and frequency, impaction requiring emergent endoscopic removal, PPI use at time of EGD, prior corticosteroid treatment, gross endoscopic findings, skin testing, body mass index and serum eosinophil count were evaluated as potential univariate predictors of small caliber esophagus using Fisher's exact test. The patient's clinical course was reviewed retrospectively. Results: Of the 63 patients identified, 30 had a small caliber esophagus using an EDmax of less than or equal to 21 mm. EGD had poor sensitivity (14.3%, 95% CI 4.8-30.3%) for detection of a small caliber esophagus and only modest specificity (82.1%, 95% CI 63.1-93.9%) (Table 1). Female gender (p=0.012), food impaction (p=0.041), food impaction frequency (p<0.001), emergency endoscopic removal of food impaction (p<0.024), endoscopic rings (p=0.031) were all predictors of a small caliber esophagus. Univariate variables that are not predictors of a small caliber esophagus include proton pump inhibitor treatment at the time of EGD, corticosteroid treatment prior to EGD, furrows on endoscopic exam, skin testing, age at time of EGD, body mass index, and serum eosinophil count (Table 2). 7 patients had persistent dysphagia post PPI and/or topical steroid therapy and eventually underwent esophageal dilation. At esophagram 5 had focal narrowing, 2 had diffuse SCE with an EDmax esophageal diameter of 15 mm; 5/7 were perceived as having normal esophageal diameter at EGD. 6/7 had a minimal diameter of less than or equal to 13 mm. All 6 patients on treatment (budesonide 5, PPI 1) had < 10 eos/hpf at the time of dilation. 6/7 reported clinical improvement in their dysphagia. The nonresponding patient had a concomitant esophageal motility disorder.Table: Sensitivity and specificity of EGDTable: [36] Univariate variables that do not predict small caliber esophagusConclusion: 1. SCE may be predicted by female gender, food impaction, food impaction frequency, emergent endoscopic removal of food impaction, and endoscopic rings. 2. Esophagography frequently detects clinically important SCE that is not detected with endoscopy.

Prior Corticosteroid Treatment Worsens Outcomes in ICU-Acquired Pneumonia

Treatment with systemic corticosteroids is common in critically ill patients. However, these agents interfere with immune response and thus alter the

Influence of Previous Corticosteroid Therapy on Temporal Artery Biopsy Yield in Giant Cell Arteritis

To determine the impact of prior corticosteroid treatment on temporal artery biopsy (TAB) yield to establish the diagnosis of giant cell arteritis (GCA). Retrospective study of a consecutive cohort of 78 patients clinically diagnosed and managed as GCA, who received corticosteroids before TAB. Among the 78 patients, TAB was positive in 57 (73%) and negative in 21 (27%). No significant differences in the length of the specimen were found between the positive and negative biopsies. We grouped patients according to treatment duration before TAB. In those with newly diagnosed GCA treated with high-dose steroid therapy, the biopsy results were positive in 78% (35/45) of patients treated for less than 2 weeks, in 65% of those treated for 2 to 4 weeks (13/20), and in 40% of those treated for more than 4 weeks (2/5). We also observed 8 patients that developed GCA on a background of a prior history of polymyalgia rheumatica (PMR); in this group biopsy was positive in 88% of the cases, after a median duration of treatment of 180 +/- 172 days and an average daily dose of 7.1 +/- 1.4 mg/d. The performance of TAB should not delay the prompt institution of steroid therapy on diagnosis of GCA, since the diagnostic yield of TAB seems valuable within 4 weeks of starting high-dose steroid treatment. In patients that developed GCA on a background of a prior history of PMR, a late TAB is also generally informative despite long-term treatment with low doses of corticosteroids.

In polymyalgia rheumatica serum prolactin is positively correlated with the number of typical symptoms but not with typical inflammatory markers.

Hyperprolactinaemia has been associated with the active phase of human systemic lupus erythematosus and rheumatoid arthritis. In the present study, we investigated the role of prolactin (PRL) in relation to the number of typical symptoms and serum markers of systemic inflammation in patients with polymyalgia rheumatica (PMR). One hundred and two PMR patients presented with typical symptoms such as adynamia, bilateral muscular pain in shoulders, upper arms or neck, bilateral muscular pain in the pelvic girdle, headache, morning stiffness, arthralgia, symptoms of depression, fever, initial weight loss (>4 kg/month), and transient visual symptoms. If one of the mentioned symptoms was present, the corresponding item was scored with one point (maximum unweighted item points=10). PRL, interleukin-2 (IL-2), IL-6, IL-1 receptor antagonist (IL-1ra), tumour necrosis factor (TNF), soluble IL-2 receptor (sIL-2R), and soluble vascular cell adhesion molecule (sVCAM) were measured by enzyme-linked immunosorbent assay in patients and 31 age-matched healthy controls. Fifteen PMR patients with elevated PRL had a higher number of symptoms as compared with patients with normal levels (P=0.003). PRL was correlated with the number of symptoms (all PMR patients: r(rank)=+0.380, P<0.001) and duration of morning stiffness (all PMR patients: r(rank)=+0.335, P=0.002) irrespective of prior corticosteroid treatment. However, PRL did not correlate with markers of systemic inflammation such as erythrocyte sedimentation rate, C-reactive protein, serum IL-1ra, IL-2, sIL-2R, IL-6, TNF, and sVCAM. The number of symptoms in PMR patients was positively correlated with PRL, but PRL was not correlated with serum markers of inflammation. This indicates that PRL is not a pro-inflammatory stimulus in patients with PMR. The inter-relationship between PRL and symptoms or duration of morning stiffness may be more a sign of central nervous system involvement, as it can be observed in people with depressed mood or under psychological stress.

Corticosteroid therapy does not prevent nephritis in Henoch-Sch�nlein purpura

Nephritis occurs in 20%-50% of children with Henoch-Schönlein purpura (HSP), and the onset of renal involvement may be delayed for weeks or months in a substantial proportion of patients. The present study was performed to determine whether corticosteroid therapy was effective in preventing delayed nephritis in children with HSP. The medical records of 69 children with HSP were reviewed. Nineteen patients had acute nephritis occurring from 1-12 days after the onset of other signs and symptoms. The remaining 50 patients had no evidence of acute renal involvement. Of these 50 patients, 20 were treated during the acute phase of the illness with corticosteroids, while 30 never received corticosteroid therapy. Delayed nephritis (> 3 weeks following an initial normal urinalysis) occurred in 4 of 20 (20%) patients who received prior corticosteroid treatment, and in 6 of 30 (20%) patients who were not treated. These results indicate that early corticosteroid therapy does not prevent delayed nephritis in children with HSP.

Immunosupression with corticosteroids and thymectomy in myastenia gravis: an evaluation of immediate and short term results in 20 patients

A comparative study was conducted on two groups of patients with the generalized severe form of myasthenia gravis. The first group of 20 patients received oral daily doses of 60-100 mg of prednisone prior to thymectomy. The control group of 20 were submitted to surgery without prior corticosteroid treatment. The study included statistical analysis of the clinical results and surgical complications for both groups. The authors concluded that the use of steroids preoperatively is beneficial.

SANATORIUM MANAGEMENT OF RHEUMATOID ARTHRITIS.

The sanatorium course of 200 patients was studied for comparison with published series and for information concerning the effect of prior corticosteroid treatment. Seventy-four patients achieved complete remission or major improvement. Fifty patients advanced from severe or complete functional incapacity to minor incapacity or full functional ability. These results are superior to those reported for comparable groups. Prior administration of corticosteroids was associated both with disease duration (known to be importantly related to severity and prognosis of rheumatoid arthritis) and with the age of patients on admission. Steroid toxicity contributed significantly to the numbers of patients making unsatisfactory progress. There was no evidence that corticosteroids had any extended benefit on the course of rheumatoid arthritis.