Received Corticosteroid Therapy Research Articles

Impact of COVID-19 Disease on the Development of Osteomyelitis of Jaws: A Systematic Review

Background/Objectives: Osteomyelitis is characterized by an inflammatory process affecting both bone and bone marrow, leading to cell death and the formation of bone sequestrum. Recent literature from the past five years has documented instances of osteomyelitis following infections of SARS-CoV-2. This systematic review explores the link between osteomyelitis of the jaw (OMJ) and COVID-19 infections. Methods: This review adhered to the PRISMA guidelines, systematically analyzing literature from 2020 to 2024 sourced from databases including Medline, Embase, Scopus, and Web of Science. PROSPERO ID: CRD42024526257. Results: The review selected 42 articles, detailing 201 cases of osteomyelitis of the jaw related to COVID-19 (COMJ). The demographic breakdown included 195 male (74.4%) and 67 female patients (25.6%), with a median age of 52.7 years, ranging from 24 to 71 years. A significant portion of COMJ patients (41.5%) were hospitalized due to COVID-19, and 58.5% received corticosteroid therapy. Diabetes mellitus was a common comorbidity among COMJ patients (65.1%). Most cases involved maxilla (182 cases; 90.5%), with nearly half showing sinus involvement (49.4%). The mandible was affected in 19 cases (9.5%). Mucormycosis and aspergillosis emerged as the predominant fungal infections, identified in 103 (51.2%) and 50 (24.9%) cases, respectively. Conclusions: Individuals with pre-existing health conditions such as diabetes mellitus who have been treated for COVID-19 are at an increased risk of developing OMJ, particularly maxillary fungal osteomyelitis. COMJ poses a significant diagnostic and therapeutic challenge for dental and maxillofacial professionals, who are often the first to encounter these cases.

Cardiac sarcoidosis treated with nonsteroidal immunosuppressive therapy

BackgroundNonsteroidal immunosuppressive therapy is a potential therapeutic strategy for cardiac sarcoidosis. However, it is not recommended as an established treatment option. This study aimed to demonstrate the clinical outcomes of patients with cardiac sarcoidosis using nonsteroidal immunosuppressants through the ILLUstration of the Management and PrognosIs of JapaNese PATiEnts with Cardiac Sarcoidosis multicenter retrospective registry. MethodsFrom a cohort of 512 patients, 426 who received corticosteroid therapy and 26 who received other immunosuppressive therapy were included for analysis. Clinical outcomes included all-cause death, fatal ventricular arrhythmic events (FVAE), and worsening heart failure with hospitalization. ResultsNonsteroidal immunosuppressants were used for retained fluorodeoxyglucose uptake in the heart (n = 14), corticosteroid side effects (n = 7), ventricular arrhythmia (n = 4), complete atrioventricular block (n = 2), worsened extracardiac sarcoidosis (n = 2), and other reasons (n = 2). They comprised of methotrexate (n = 20), cyclosporine (n = 2), cyclophosphamide (n = 2), and azathioprine (n = 3). After the addition of a nonsteroidal immunosuppressant, corticosteroids were reduced in 14 of 26 patients (5 [5–17] mg), although no patient discontinued corticosteroids. Of the 14 patients, decreased fluorodeoxyglucose uptake was observed in seven at follow-up. Clinical outcomes were observed in 11 patients (42.3 %). Detected events included all-cause death in five patients (19.2 %), FVAE in four (15.4 %), and worsening heart failure with hospitalization in five (19.2 %), with some overlap. ConclusionsNonsteroidal immunosuppressive therapy may be a possible treatment option for patients who are not stabilized with corticosteroids alone or develop corticosteroid side effects.

#509 Idiopathic nephrotic syndrome in children in Chad

Abstract Background and Aims The objective of our study was to describe the characteristics and outcomes of Nephrotic Syndrome (SN) in children from three major hospitals in one of the world's poorest countries, Chad. Method This observational, cross-sectional, descriptive, and multicenter study took place over a period of 36 months (1 January 2019–31 December 2021) and was carried out in three hospitals in N'Djamena, Chad. Children aged 1–15 years presenting with NS were included in the study. Results Out of 16,776 children hospitalized or followed up with in outpatient clinics, 24 cases of NS were identified, yielding a prevalence of 0.14%. The median age at presentation was 6.16 years (1–10). Nineteen children were male (sex ratio 3.8). Eight cases were classified as impure NS (33.3%). Edema was present in all patients, while oliguria was present in 29.16% (n = 7), and arterial hypertension was present in 20.83% (n = 5) of cases. Mean proteinuria, albuminemia, and total proteins were 2.86 g/L, 19.13 g/L and 30.41 g/L, respectively. The median serum creatinine was 87.3 µmol/L (75–1375 µmol/L). Three patients experienced acute renal failure upon admission. Four patients had secondary NS. All idiopathic NS patients (n = 20) who had received corticosteroid therapy had a 90% response rate to steroids. Non-responsive or relapsed patients underwent kidney biopsy (n = 7), revealing focal segmental glomerulosclerosis (FSGS; n = 4) as the most common histological lesion, followed by minimal change disease (n = 2) and membranoproliferative glomerulonephritis (n = 1). The median length of hospitalization stay was 10.67 (5–27) days. None of the patients with idiopathic NS died. At the last follow-up, sixteen patients (80%) achieved long-term complete remission with normal renal function; however, four of those had subsequent relapses. One patient with secondary NS died. Conclusion In Chad, childhood idiopathic nephrotic syndrome predominantly affects young males; steroid sensitivity is as high as 95%, and in the long-term, 80% of patients achieve remission with normal renal function.

Spider bite presenting as fever, macrophage activation syndrome and a skin ulcer

Introduction: Fever of unknown origin (FUO) refers to a condition of prolonged increased body temperature, without identified causes. The most common cause of FUO worldwide are infections; arthropod bites (loxoscelism) should be considered in view of the spread of the fiddleback spider. Loxoscelism can present in a cutaneous form (a necrotic cutaneous ulcer) or in a systemic form with fever, haemolytic anaemia, rhabdomyolysis and, rarely, macrophage activation syndrome (MAS). For this suspicion, it is important to have actually seen the spider. Case description: A 71-year-old man was admitted to our department because of intermittent fever, arthralgia and a necrotic skin lesion on his right forearm that appeared after gardening. Laboratory tests were negative for infectious diseases, and several courses of antibiotics were administered empirically without clinical benefit. Whole-body computed tomography showed multiple colliquative lymphadenomegalies, the largest one in the right axilla, presumably of reactive significance. A shave biopsy of the necrotic lesion was performed: culture tests were negative and histological examination showed non-specific necrotic material, so a second skin and lymph node biopsy was performed. The patient developed MAS for which he received corticosteroid therapy with clinical/laboratory benefit. Cutaneous and systemic loxoscelism complicated by MAS was diagnosed. Subsequently, the second biopsy revealed morphological and immunophenotypic findings consistent with primary cutaneous anaplastic large cell lymphoma (PC-ALCL). Conclusions: Skin lesions and lymphadenomegalies of unknown origin should always be biopsied. It is very common to get indeterminate results, but this does not justify not repeating the procedure to avoid misdiagnosis.

Outcomes of corticosteroid treatment in critically ill COVID-19 patients

Objective: This study aims to examine the impact of low-dose and high-dose corticosteroids on the clinical outcomes and mortality of critically ill patients with COVID-19 in intensive care units. Material and Methods: This study was conducted on 197 confirmed COVID-19 patients who received corticosteroid therapy in the intensive care unit (ICU) between June 1st and December 31st, 2020. Patients were divided into two groups for low- and high-dose corticosteroid therapy. Both groups were compared according to demographic features, comorbid conditions, laboratory parameters, as well as the ordinal scale for clinical improvement (OSCI), hospital mortality, and length of stay in the intensive care unit. Results: A total of 140 patients received low-dose corticosteroids, while 57 patients received high-dose corticosteroid therapy. Our findings revealed a significantly higher median length of stay in the ICU and mortality in the group that received high-dose corticosteroid therapy. We observed a significant reduction in ferritin and D-dimer levels in the group receiving high-dose corticosteroid therapy (p < 0.003, p < 0.012, respectively). Furthermore, OSCIs on admission, day 5, and day 10 after corticosteroid therapy were higher in the group receiving high-dose corticosteroids. Conclusion: The results of this study indicate that high-dose corticosteroid therapy in critically ill patients with COVID-19 is associated with high mortality rates and prolonged intensive care stays.

Novel Perspectives of TSLP and RXR Signaling in Corticosteroid-Resistant Asthma: Updates on TSLP Blockers.

Previous studies described that asthma patients who received corticosteroid therapy have been constrained by the corticosteroid resistance subsequently fostered to severe refractory asthma. In this review, we discussed the implications of TSLP, RXR, the role of STAT5-activating cytokines, and IL-33/NH-cell signaling pathways, and recent clinical evidence on TSLP blockers in steroid-resistant asthma. We have searched several public databases such as Pubmed, Scopus, and Relemed and obtained information pertinent to the TSLP, RXR, TSLP blockers, the STAT5-activating cytokines, and IL-33. We discussed the multiple cell signaling mechanisms underlying steroid resistance. Blocking the TSLP and other key signaling molecules like STAT5 can retrieve the sensitivity of natural helper-cells to corticosteroids. RXR derivatives treatment can modulate the activity of TSLP, which further modulates steroid resistance in severe asthmatic patients and in patients with refractory asthma. We discussed the steroid-resistance mediated by the Th2 cells and Th2-driven eosinophilia upon corticosteroid intake. Thus, this review will be beneficial for clinicians and molecular biologists to explore the inflammatory pathways associated with refractory asthma conditions and develop novel therapies against corticosteroid-resistant asthma.

Baseline immune status and the effectiveness of response to enteral nutrition among ICU patients with COVID-19: An observational, retrospective study

ObjectivesThis study aimed to compare how immunocompromised and immunocompetent patients responded differently to enteral nutrition (EN) support in intensive care units (ICUs) during the COVID-19 pandemic, including serum nutritional biomarkers, inflammatory biomarkers, gastrointestinal (GI) intolerance symptoms, and clinical outcomes. MethodsAn observational, retrospective study was conducted in the ICUs of a teaching hospital in southwest China. We recruited a convenience sample of 154 patients between December 2022 and February 2023. We defined immunocompromise as primary immunodeficiency diseases, active malignancy, receiving cancer chemotherapy, HIV infection, solid organ transplantation, hematopoietic stem cell transplantation, receiving corticosteroid therapy with a target dose, receiving biological immune modulators, or receiving disease-modifying antirheumatic drugs or other immunosuppressive drugs. We conducted a Mann–Whitney U test, χ2 test, or generalized estimation equation model to explore the differences between immunocompromised and immunocompetent patients. ResultsAmong the 154 study participants, 41 (27%) were defined as immunocompromised. The immunocompromised patients were younger than the immunocompetent patients. There were no statistically significant differences between the two groups with respect to serum nutritional biomarkers, inflammatory biomarkers, incidence of GI intolerance symptoms, and in-hospital mortality. However, the immunocompromised patients exhibited a longer hospitalization duration than the immunocompetent patients. ConclusionWe found that the immunocompromised patients spent more time in the hospital. These findings may help us to standardize the participants before EN interventional studies better and better individualize EN supports based on patients’ immunity status.

Impact of Corticosteroid Therapy on ICU Patient Outcomes in Severe COVID-19 Cases: A Retrospective Cohort Study in Saudi Arabia.

The COVID-19 pandemic has presented significant challenges in clinical management, and intensive care units (ICUs) worldwide have become epicenters of high-stakes treatment decisions. Among these, corticosteroid therapy has risen as a pivotal, yet controversial, treatment modality. In Saudi Arabia, where unique demographic and health system characteristics intersect, understanding the specific effects of corticosteroids on ICU patient outcomes is not just critical but a pressing necessity in tailoring effective COVID-19 management strategies. This study aims to elucidate the effects of corticosteroid therapy on the outcomes of severe COVID-19 patients in Saudi Arabian ICUs, providing critical insights into treatment efficacy and guiding future clinical practices. In this cohort study, we meticulously reviewed the medical records of 1085 severe COVID-19 patients admitted to Saudi Arabian ICUs. Our analysis focused on demographic details, ICU outcomes, and the extent and implications of corticosteroid therapy. The study employed comprehensive methods for data collection, evaluation criteria, and statistical analysis, ensuring a thorough understanding of the impact of corticosteroids in this context. The study encompassed 1085 patients, predominantly male (74.5%, N=806), with an average age of 56 and a mean BMI of 30.07. A significant portion (72.3%, N=784) received corticosteroid therapy. These patients generally experienced longer ICU (mean 23 days) and hospital stays (mean 16 days), along with higher rates of microbiological cure (72.3%, N=648) and increased ICU discharge likelihood. Conversely, corticosteroid recipients showed higher mortality rates at ICU discharge. The statistical analysis confirmed the significance of these findings, reinforcing their importance in managing COVID-19 in ICUs. The research highlights the intricate dynamics of corticosteroid use in treating severe COVID-19 cases in ICUs. While associated with prolonged ICU stays and increased mortality, corticosteroids also correlate with higher microbiological cure rates and discharge likelihood. These insights call for careful deliberation in applying corticosteroid therapy, with implications for enhancing clinical protocols and guiding future research in severe COVID-19 treatment.

Incidence of secondary bacterial infections and risk factors for in-hospital mortality among coronavirus disease 2019 subjects admitted to secondary care hospital: A single-center cross-sectional retrospective study.

This study aims to determine the prevalence of secondary bacterial infections (SBIs) in hospitalized coronavirus disease 2019 (COVID-19) subjects and evaluate their antibiotic susceptibility. The study also sought to identify risk factors for the outcome of SBIs in COVID-19 subjects. This single-center cross-sectional retrospective study was carried out at Sohar Hospital in Oman. The study examined hospitalized COVID-19 subjects diagnosed with SBIs during March 2020-December 2022. The relevant subjects' data were extracted from hospital electronic health records and analyzed using STATA version 14. The Chi-square test or Fisher's exact test was employed for analyzing categorical variables, and P < 0.05 was deemed statistically significant. The research encompassed a total of 817 bacteria recovered from various clinical samples of 421 subjects. The older individuals (39.4%) and men (65.6%) experienced bacterial infections more frequently, with bloodstream and respiratory infections being the most common. Gram-negative bacilli (GNB) were responsible for a higher proportion (85.6%) of infections, with Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae being the most common pathogens. Subjects who underwent mechanical ventilation, received corticosteroid therapy, and who had underlying comorbidities, such as diabetes and chronic renal disease, were found to have higher mortality rates. Neutrophilia, elevated C-reactive protein, lymphocytopenia, decreased serum albumin level, sepsis, and pneumonia were found to be independent contributors to mortality. SBI is common among COVID-19-hospitalized subjects. GNB were primarily linked to SBI. The severity and the likelihood of SBI increased in subjects undergoing medical interventions and immunosuppressive therapy.

Clinical Experience of External Application of Clearing Heat and Removing Dampness in Relieving Grade 2 to 3 Rash Caused by Programed Cell Death Protein 1 (PD-1)/Programed Cell Death Ligand 1 (PD-L1) Inhibitors: A Single-Center Retrospective Study.

In China, grade 2 to 3 immune-related rash will probably lead to the interruption of immunotherapy. Corticosteroid (CS) is the main treatment, but not always effective. The external application of clearing heat and removing dampness, which is represented by Qing-Re-Li-Shi Formula (QRLSF), has been used in our hospital to treat immune-related cutaneous adverse events (ircAEs) for the last 5 years. The purpose of this study was to discuss its efficacy and safety in the treatment of grade 2 to 3 rash. A retrospective study of patients with grade 2 to 3 immune-related rash in our hospital from December 2019 to December 2022 was conducted. These patients received QRLSF treatment. Clinical characteristics, treatment outcome, and health-related quality of life (HrQoL) were analyzed. Thirty patients with grade 2 to 3 rash (median onset time: 64.5 days) were included. The skin lesions of 24 cases (80%) returned to grade 1 with a median time of 8 days. The accompanying symptoms were also improved with median time of 3 to 4 days. The addition of antihistamine (AH) drug didn't increase the efficacy of QRLSF (AH + QRLSF: 75.00% vs QRLSF: 83.33%, P = .66). No significant difference was observed in the efficacy of QRLSF treatment regardless of whether patients had previously received CS therapy (untreated population: 88.24% vs treated population: 69.23%, P = .36). During 1-month follow-up, 2 cases (8.33%) underwent relapses. In terms of HrQoL, QRLSF treatment could significantly reduce the median scores of all domains of Skindex-16, including symptoms (39.58 vs 8.33, P < .0001), emotions (58.33 vs 15.48, P < .0001), functioning (46.67 vs 13.33, P < .0001) and composite (52.60 vs 14.06, P < .0001). External application of clearing heat and removing dampness was proven to be an effective and safe treatment for such patients. In the future, high-quality trials are required to determine its clinical application in the field of ircAEs.

Mucormycosis in COVID-19 Pandemic

Background Coronavirus disease-2019 (COVID-19) has been associated with a wide range of opportunistic fungal infections. Many countries have seen an unprecedented rise in cases of COVID-19-associated mucormycosis (CAM). The purpose of this study is to identify the correlation between the COVID-19 epidemic and mucormycosis. Our study also provides details on factors causing CAM. Methods A retrospective study from November 2020 to February 2022 includes four cases of COVID-19-associated rhino-orbital mucormycosis treated at Habib Thameur Hospital’s ENT Department. Results The mean age of patients was 67.5-years, 75% were males, and the most frequent underlying conditions were diabetes mellitus (100%). The median time interval between the diagnosis of COVID-19 and the first evidence of mucormycosis infection was 15-days; two patients required hospitalization in a COVID unit, and two patients received oxygen therapy at home. All patients received corticosteroid therapy at a dose of 1 mg/kg/d for an average of 10-days. Treatment using antifungals and surgery was described in all the patients. Amphotericin B deoxycholate was used in 75% and lipid formulation in 25%. Two patients presented renal insufficiency due to amphotericin B; the doses were adapted with good evolution. In that report, the case fatality rate was 75%. Conclusion Mucormycosis is a fatal fungal infection that usually affects patients with altered immunity. Several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide. Diabetes mellitus (DM), steroid overdose, immunosuppression, and high iron levels, combined with other factors such as prolonged hospitalization, unhygienic conditions, and the use of ventilators, combine to create an ideal environment for contracting mucormycosis. Lastly, there is a need to create awareness about fungal diseases among clinicians in order to help identify early symptoms and restrict the spread of lethal fungal diseases. A collaborative team of otolaryngologists, ophthalmologists, anesthesiologists, and resuscitators will be required in hospitals to accelerate optimal management.

Idiopathic Nephrotic Syndrome in Children in Chad: Epidemiology and Clinical Outcomes.

Nephrotic syndrome (NS) remains the most common presentation of glomerular diseases in children. Moreover, NS is primarily idiopathic, accounting for 90% of cases, with an average onset age between 2 and 10 years. The objective of our study was to describe the characteristics and outcomes of NS in children from three major hospitals in one of the world's poorest countries, Chad. This observational, cross-sectional, descriptive, and multicenter study took place over a period of 36 months (1 January 2019-31 December 2021) and was carried out in three hospitals in N'Djamena, Chad. Children aged 1-15 years presenting with NS were included in the study. Out of 16,776 children hospitalized or followed up with in outpatient clinics, 24 cases of NS were identified, yielding a prevalence of 0.14%. The median age at presentation was 6.16 years (1-10). Nineteen children were male (sex ratio 3.8). Eight cases were classified as impure NS (33.3%). Edema was present in all patients, while oliguria was present in 29.16% (n = 7), and arterial hypertension was present in 20.83% (n = 5) of cases. Mean proteinuria, albuminemia, and total proteins were 2.86g/L, 19.13g/L and 30.41g/L, respectively. The median serum creatinine was 87.3 µmol/L (75-1375 µmol/L). Three patients experienced acute renal failure upon admission. Four patients had secondary NS. All idiopathic NS patients (n = 20) who had received corticosteroid therapy had a 90% response rate to steroids. Non-responsive or relapsed patients underwent kidney biopsy (n = 7), revealing focal segmental glomerulosclerosis (FSGS; n = 4) as the most common histological lesion, followed by minimal change disease (n = 2) and membranoproliferative glomerulonephritis (n = 1). The median length of hospitalization stay was 10.67 (5-27) days. None of the patients with idiopathic NS died. At the last follow-up, sixteen patients (80%) achieved long-term complete remission with normal renal function; however, four of those had subsequent relapses. One patient with secondary NS died. In Chad, childhood idiopathic nephrotic syndrome predominantly affects young males; steroid sensitivity is as high as 95%, and in the long-term, 80% of patients achieve remission with normal renal function.

Coronavirus disease 2019 (COVID-19)-associated brain abscesses caused by Pseudomonas aeruginosa and Aspergillus fumigatus: two case and a review of the literature

BackgroundBacterial and fungal superinfections are commonly reported in patients with coronavirus disease 2019.Case presentationWe report the first case of brain and intramedullary abscesses caused by Pseudomonas aeruginosa and a rare case of brain abscesses caused by Aspergillus fumigatus in two post-coronavirus disease 2019 patients. The first patient—34-year-old Iranian woman—presented with weakness of the left upper limb, headaches, and lower limb paresthesia. She had a history of undiagnosed diabetes and had received corticosteroid therapy. The second patient—45-year-old Iranian man—presented with right-sided weakness and had a history of intensive care unit admission. Both patients passed away despite appropriate medical therapy.ConclusionThe immune dysregulation induced by coronavirus disease 2019 and its’ treatments can predispose patients, especially immunosuppressed ones, to bacterial and fungal infections with unusual and opportunistic pathogens in the central nervous system. Pseudomonas aeruginosa and Aspergillus fumigatus should be considered as potential causes of brain infection in any coronavirus disease 2019 patient presenting with neurological symptoms and evidence of brain abscess in imaging, regardless of sinonasal involvement. These patients should get started on appropriate antimicrobial therapy as soon as possible, as any delay in diagnosis or treatment can be associated with adverse outcomes.

Lucio’s Phenomenon in Lepromatous Leprosy Patient: A Rare Case Report

BACKGROUND: Lucio’s phenomenon is a rare leprosy reaction, characterized by severe necrotic cutaneous lesions that generally occur in patients with untreated or inadequately treated lepromatous leprosy (LL). OBJECTIVE: to describe and comprehend the diagnosis and management of Lucio’s phenomenon in leprosy patients CASE: Male, 34 years old with extensive wounds on both arms and legs. About 3 years earlier, the patient felt burning heat in both hands and feet followed by loss of eyebrows and eyelashes, and a change in the shape of the nose. The patient had not received previous therapy. Physical examination showed that the patient appeared anaemic, leonine facies, megalobuli, madarosis, saddle nose, thickening of the ulnar and posterior tibial nerves, deformities of the fingers and toes, and amputations of several fingers. The dermatological status showed multiple ulcers of irregular shape and varying sizes with pus and necrotic tissue. Reitz serum test revealed a bacterial index of +3 with a morphological index of 90%, and routine blood showed hypochromic microcytic anaemia and leucocytosis. The patient received corticosteroid therapy, anti-leprosy combination therapy, antibiotics, iron tablets and wound care. DISCUSSION: Lucio’s phenomenon consists of skin lesions that range from painful red-black patches to flaky blisters and ulcerations. These lesions usually occur on the lower extremities, and may extend proximally and distally. The lesions improved after administration of corticosteroids and anti-leprosy. Delayed diagnosis leads to significant disability and community transmission of the disease. The later the diagnosis, the more serious the disease becomes and can lead to death due to sepsis. Early diagnosis and appropriate treatment are important. CONCLUSION: Early detection is crucial in order to deliver therapy earlier and prevent disease worsening.

Varicella-associated disseminated intravascular coagulation secondary to Henoch-Schönlein purpura with renal and gastrointestinal system involvement in a child: A case report.

Immunocompromised patients who developed varicella-zoster virus (VZV)-associated disseminated intravascular coagulation (DIC) previously included recipients of bone marrow, hematopoietic stem cell, or organ transplantations, patients with primary nephropathy receiving corticosteroid therapy, cancer patients receiving chemotherapy, and patients with human immune deficiency virus infection. The case reported here is novel because, to our knowledge, there has been no report of VZV-associated DIC after the onset of Henoch-Schönlein purpura (HSP). To report the successful treatment of a novel pediatric case with VZV-associated DIC secondary to HSP. An 8-year-old girl developed VZV-associated DIC 24 days after diagnosis of HSP with renal and gastrointestinal involvement. She was treated with methylprednisolone at a local hospital for 19 days, and suddenly developed fever starting from day 4 in our hospital. Her fever persisted with vesicular skin rashes on her back, strong abdominal and lower back pain, epistaxis, hematochezia, erosion and bleeding on her lips, in her mouth and at puncture sites on day 5. She was diagnosed with DIC with the laboratory evidence of dramatically decreased platelet count and fibrinogen, prolonged activated partial thromboplastin time and prothrombin time, and increased fibrin degradation products including d-dimers. She also developed multiple organ dysfunction syndrome. On day 7, the patient VZV nucleic acid result turned out to be positive. Methylprednisolone treatment was discontinued, and she was given a multi-modality therapy including medications of acyclovir and antibiotics, intravenous gamma-immunoglobulin, various blood product transfusions, continuous renal replacement therapy, plasma exchange, and administration of liver and gastrointestinal system protection drugs. The patient multi-organ function damage gradually recovered. After VZV control, the patient was treated with oral methylprednisolone again for HSP with nephritis. Urine analysis was normal 1 year later, and oral hormone was discontinued. No complication or relapse occurred during 2 years of follow-up. This case report, for the first time, adds HSP treated with corticosteroids to the spectrum of clinical conditions that progressed to life-threatening secondary varicella-associated DIC. Early identification of varicella infection and DIC, combined with timely antiviral, immunoglobulin transfusion, plasma exchange, and other combined therapies are essential for saving patients' lives.

CORTICOSTEROIDS USAGE IN THE INTENSIVE CARE UNIT: SPECIFIC RECOMMENDATIONS BASED ON RECENT EVIDENCE

Corticosteroids are a class of drugs that mimic the effects of cortisol, a hormone naturally produced by the adrenal glands. They exert a wide range of effects on the body's immune, metabolic, and inflammatory responses. In the context of critically ill patients in the intensive care unit (ICU), corticosteroids are frequently utilised due to their potent anti-inflammatory and immunosuppressive properties. In the ICU setting, corticosteroids are commonly employed to manage various conditions such as severe sepsis, acute respiratory distress syndrome (ARDS), exacerbations of chronic obstructive pulmonary disease (COPD), and adrenal insufficiency. Their mechanism of action involves suppression of pro-inflammatory cytokines, inhibition of leukocyte migration, and stabilisation of cell membranes, among other effects. The choice of corticosteroid, dosing regimen, and duration of therapy in the ICU depends on the specific clinical condition being treated and individual patient factors. For instance, corticosteroids such as hydrocortisone are often administered to attenuate the systemic inflammatory response and improve hemodynamic stability in the management of septic shock. Dosing may vary but commonly involves an initial bolus followed by continuous infusion or intermittent dosing. In ARDS, corticosteroids may reduce lung inflammation and prevent further tissue damage. Methylprednisolone is a commonly utilised corticosteroid in this context, with dosing typically initiated at a high dose and then tapered gradually based on clinical response. For patients with exacerbations of COPD, corticosteroids help to reduce airway inflammation and improve lung function. Oral or intravenous corticosteroids such as prednisone or methylprednisolone are often prescribed for a short duration during exacerbations. In cases of adrenal insufficiency, corticosteroid replacement therapy is essential to restore physiological cortisol levels and prevent adrenal crisis. Hydrocortisone is the corticosteroid of choice in this scenario, with dosing adjusted based on the degree of adrenal dysfunction and stress level. Despite their efficacy, corticosteroids are associated with a range of potential adverse effects, including immunosuppression, hyperglycemia, fluid retention, electrolyte abnormalities, and increased risk of infection. Therefore, carefully monitoring patients receiving corticosteroid therapy in the ICU is paramount, with adjustments to minimise risks while optimising therapeutic benefits. In summary, corticosteroids play a crucial role in managing critically ill patients in the ICU, offering potent anti-inflammatory and immunomodulatory effects. However, their use requires careful consideration of the underlying condition, patient characteristics, and potential adverse effects, with dosing and duration tailored to individual needs.

Autism Spectrum Disorder and Role of the Inflammatory Theory: A Case Report

In this case study, an 8-year-old child from a consanguineous marriage with a complicated pregnancy due to maternal preeclampsia and a normal delivery experienced developmental delays, language problems, social challenges, and other autism spectrum disorder (ASD) symptoms. The child underwent various diagnostic tests, including the M-CHAT, ADI, and ADOS, which all supported an ASD diagnosis. Despite receiving psychomotor, speech, and ABA therapy, the child showed gradual improvement in language skills but continued to exhibit behavioral issues such as irritability, anger outbursts, and sleep disturbances. After experiencing a febrile episode with tonsillitis, followed by knee pain, walking difficulties, chest pain, and shortness of breath, the child was diagnosed with acute rheumatic fever and received corticosteroid therapy, resulting in significant clinical improvement in language, facial expressions, social interactions, and a renewed ASD assessment. The discussion focuses on the potential environmental factors contributing to ASD, emphasizing the role of shared environmental factors in twin studies and genetic factors. The study explores the inflammatory response as a possible common pathway for ASD development, particularly in cases where preeclampsia during pregnancy and its associated inflammation affect the mother and, subsequently, the placenta or fetus. Abnormal angiogenesis and elevated levels of soluble tyrosine kinase 1 (sFlt-1) are discussed as potential factors contributing to fetal neurodevelopmental abnormalities. The text also highlights the role of corticosteroid therapy in improving ASD symptoms, with references to previous studies showing positive responses to corticosteroid treatment in ASD patients. The impact of medications like prednisone and pregnenolone on ASD symptoms and their mechanisms of action, including potential modulation of GABA A receptors, is mentioned. In conclusion, the case study suggests a potential link between ........

Aspergillus fumigatus cytochrome c impacts conidial survival during sterilizing immunity.

Aspergillus fumigatus can cause a life-threatening infection known as invasive pulmonary aspergillosis (IPA), which is marked by fungus-attributable mortality rates of 20%-30%. Individuals at risk for IPA harbor genetic mutations or incur pharmacologic defects that impair myeloid cell numbers and/or function, exemplified by bone marrow transplant recipients, patients that receive corticosteroid therapy, or patients with chronic granulomatous disease (CGD). However, treatments for Aspergillus infections remain limited, and resistance to the few existing drug classes is emerging. Recently, the World Health Organization classified A. fumigatus as a critical priority fungal pathogen. Our cell death research identifies an important aspect of fungal biology that impacts susceptibility to leukocyte killing. Furthering our understanding of mechanisms that mediate the outcome of fungal-leukocyte interactions will increase our understanding of both the underlying fungal biology governing cell death and innate immune evasion strategies utilized during mammalian infection pathogenesis. Consequently, our studies are a critical step toward leveraging these mechanisms for novel therapeutic advances.

Symptoms and Management of Aseptic Liver Abscesses.

Aseptic liver abscesses occur very rarely. Clinical guidelines on the management of the disease do not exist, and the diagnosis is challenging.We screen MEDLINE and PUBMED databases for relevant case reports from inception to November 2022. Information on patient age, sex, initial symptoms, the extent of abscess formation, further diagnoses, treatment, and course of the disease is analyzed.Thirty cases with sterile hepatic abscess formation are identified. In most patients (n=18), the spleen is affected as well. Patients typically present with fever, abdominal pain, and increased inflammatory values. Comorbidity with inflammatory bowel disease is very common (n=18) and is associated with a significantly younger age at the time of hepatic abscess development. In addition, many patients show autoimmune-mediated cutaneous, ocular, or arthritic rheumatoid manifestations. Histological examination of abscess material reveals neutrophilic infiltration. The majority of patients initially receive corticosteroid therapy. Furthermore, response to azathioprine, anti-TNF-α antibodies, and other immunomodulatory drugs is reported. Ten out of fourteen patients with a long-term follow-up (≥ 36 months) have at least one relapse of hepatic abscess formation.Aseptic hepatic abscesses should be considered in the case of sterile punctures and non-response to antibiotics. Patients with aseptic liver abscesses have a high risk of recurrence warranting immunomodulatory maintenance therapy.

The Predictors of Long COVID in Southeastern Italy.

Long COVID is now recognized as a common consequence of the SARS-CoV-2 infection, but we are still far from fully understanding its pathogenesis and predictive factors. Many pathophysiological factors have been studied, including ethnicity. To our knowledge, the risk factors for Long COVID have not been studied in Southeastern Italy. The aim of this study was to evaluate the predictive factors of Long COVID in a cohort of patients from Southeastern Italy. We conducted a retrospective longitudinal study, enrolling inpatients and outpatients diagnosed with COVID-19 from June 2021 to March 2022. A total of 436 subjects were evaluated in an outpatient setting 12 weeks after a SARS-CoV-2 infection, recording comorbidities, symptoms, therapy, and clinical information. Univariate and multivariate binomial logistic regression analyses were performed on different risk factors to define the probability of developing Long COVID. A total of 71.8% of patients (313) developed Long COVID, while the remaining 123 (28.3%) had a complete remission of symptoms 3 months after acute infection. During the acute phase of COVID-19, 68.3% of patients experienced respiratory failure and 81.4% received corticosteroid therapy. In a multivariate analysis, the female sex (SEX M ODD 0.513) and corticosteroids (ODD 2.25) were maintained as predictive values. From our data and in line with other studies, the female sex emerges as a risk factor for Long COVID in the population of Southeastern Italy. Corticosteroid therapy administered in the acute phase also appears to be associated with an increased risk of Long COVID. Although indications for the prescription of corticosteroid therapy in the acute phase were indicated by the presence of pneumonia complicated by respiratory insufficiency, there was an over-prescription of corticosteroid therapy in the real life of our cohort, with 64% of patients having respiratory insufficiency and 81% having corticosteroid therapy. We hypothesize that a synergistic link between viral infection and the side effects of corticosteroid therapy may arise in selected cases.