Short-term Prednisolone Therapy Research Articles

Traumatic Macular Hole and Uveitis: A Case Report

Introduction: Blunt ocular trauma may be associated with a variety of complications, including traumatic macular holes (TMH) and uveitis. Concerning the TMH, there is no standard treatment protocol. There have been reports of spontaneous closure and of the use of certain medications and surgical techniques. Our purpose is to present a case of bilateral blunt ocular trauma with TMH in the right (OD) and uveitis in the left eye (OS) in a 24-year-old Caucasian man.
 Case presentation: The patient had complaints of decreased vision in OD and redness and discomfort in OS. Three days previously, he had sustained trauma to both eyes with an exercise resistance band. The diagnosis was made with a thorough ophthalmic exam and optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) of OD was 20/40 and of OS – 20/20. The intraocular pressure was within normal limits. There was a TMH in OD and iridocyclitis in OS. The therapy included prednisolone with an initial dose of 60 mg q.d. PO, a lutein/zeaxanthin supplement, and additional topical treatment for OS – dexamethasone and cyclopentolate. The TMH in OD had improved significantly within 6 days. BCVA of OD recovered to 20/20 in a month.
 Conclusion: We observed closure of the TMH with complete recovery of vision in the affected eye, most likely spontaneous, and with full resolution of the uveitis in the other, in the setting of short-term prednisolone therapy. The uveitis in OS was also treated with topical dexamethasone and cyclopentolate.

Short-term prednisolone therapy has minimal impact on calcium metabolism in dogs with atopic dermatitis

Glucocorticoids (GCs) are a large group of drugs used to treat a range of inflammatory, autoimmune and neoplastic diseases in dogs. Glucocorticoids have been linked to disturbances in calcium metabolism and skeletal disorders in humans, yet their effects at therapeutically effective dosages in dogs with spontaneous diseases are poorly understood. Serum concentrations of calcium, phosphate, vitamin D metabolites and plasma concentrations of parathyroid hormone and ionised calcium together with urinary fractional excretion of calcium and phosphate, were measured in 16 dogs with atopic dermatitis before and 6 weeks after standard dosage prednisolone treatment (0.93-1.06 mg/kg) every other day after 7 days of treatment with the same dosage once daily. The severity of their physical signs, as assessed by the canine atopic dermatitis extent and severity index version 3 (CADESI-03) and the Edinburgh Pruritus Scale (EPS), decreased in all dogs following prednisolone treatment. There was no significant difference in any of the biochemical parameters measured following prednisolone treatment. This study indicates that prednisolone, used at a therapeutically effective dose, has minimal impact on calcium metabolism in dogs with atopic dermatitis.

Lasertherapie infantiler Hämangiome und anderer kongenitaler vaskulärer Tumore des Säuglings- und Kleinkindalters

As a high rate of spontaneous regression exists for infantile haemangioma, the indication for an active therapy is rare. On the other hand excessive growth can cause permanent defects. Thus, an early differential diagnosis and indication for therapy are necessary. Besides the phase, the localisation and the behaviour are the keys for complications and therefore crucial for the indication. The most important investigation for correct diagnosis as well as for exact determination of the phase and expansion is colour-coded duplex sonography (CCDS). This is an essential prerequisite for an adjusted haemangioma therapy. For the congenital haemangioendothelioma the type and therefore the behaviour determine the indication for therapy. In Kaposiform haemangioendotheliomas, the Kasabach-Merritt phenomenon with disseminated intravasal coagulopathia is the major complication. By means of an early laser therapy these complication can be avoided or reduced. Important is the correct selection of the laser type and laser proce-dure. For superficial strong intracutaneous early stages of infantile haemangioma with less than 3 mm thickness, the flashlamp pumped dye laser (FLPDL) is a good option and superior to cryotherapy because with the FLPDL even larger flat haemangiomas can be treated without epithelial damage. For thicker and primary subcutaneous haemangiomas this laser is not suitable. This is an indication for the cw Nd:YAG-laser applied transcutaneously with ice-cube cooling or mucously in the impression technique. These haemangiomas with a thickness of up to 30 mm are treatable without any epithelial damage. More voluminous or primary deep subcutaneous haemangiomas are interstitially treated with the CCDS-controlled puncture technique. Especially subglottic or tracheal haemangiomas can be treated endoscopically so early that a tracheostomy can be avoided. However, in these haemangiomas and even in periorbital haemangiomas an adjuvant prednisolone therapy is obligatory. Also in Kaposiform haemangioendotheliomas with Kasabach-Merritt phenomenon an adjuvant prednisolone therapy is necessary. The intercurrent laser therapy, preferably transcutaneous Nd:YAG laser with ice-cube cooling, induces the regression and prevents the rebound effect after finishing the prednisolone therapy, so even here a short-term prednisolone therapy is sufficient.

Lasertherapie infantiler Hämangiome und anderer kongenitaler vaskulärer Tumore des Säuglings- und Kleinkindalters

Da die infantilen Hämangiome eine hohe Rate der Spontanregression zeigen, muss einerseits die Indikation zu einer Therapie streng gestellt werden, andererseits kann exzessives Wachstum zu bleibenden Schäden führen, so dass eine frühzeitige Differentialdiagnose und damit Indikationsstellung erforderlich ist. Neben dem Stadium sind die Lokalisation und das Wachstumsverhalten für Komplikationen und damit für die Indikation zur Therapie entscheidend. Die wichtigste Untersuchungsmethode, mit der sowohl eine Artdiagnose, exakte Bestimmung des Stadiums und der Ausdehnung möglich ist, ist die Farbkodierte Duplexsonografie (FKDS). Sie ist somit die Säule einer adjustierten Hämangiomtherapie. Bei den kongenitalen Hämangioendotheliomen bestimmt der Typ und somit die Verlaufsform die Therapieindikation. Bei den kaposiformen Hämangioendotheliomen stellt die Kasabach-Merritt-Symptomatik mit disseminierter Koagulopathie die Hauptkomplikation dar. Durch eine frühzeitige Lasertherapie können diese Komplikationen verhindert, zumindest in ihrer Schwere vermindert werden. Entscheidend ist die korrekte Auswahl der Lasertypen und der Laserverfahren. Für oberflächliche rein intrakutane Frühstadien der infantilen Hämangiome mit einer Dicke von weniger 3 mm ist der Farbstofflaser eine wichtige Behandlungsoption und der Kryotherapie überlegen, damit dem FLPDL auch großflächige infantile Hämangiome behandelt werden können und mit geeigneten Kühlverfahren eine Epithelverletzung vermieden werden kann. Er versagt aber bei allen dickeren und vor allem den subkutanen Hämangiomen. Diese werden mit dem cw-Nd:YAG Laser entweder transkutan mit Eiswürfelkühlung oder mukosal in Impressionstechnik behandelt. Damit sind Hämangiomdicken von bis zu 30 mm sicher ohne Oberflächenverbrennung zu behandeln. Voluminösere oder primär tief subkutan gelegene Hämangiome werden nach Farbduplexsonografie gesteuerter Punktion interstitiell behandelt. Insbesondere subglottische und tracheale Hämangiome können endoskopisch so rechtzeitig behandelt werden, dass eine Tracheotomie verhindert werden kann. Jedoch ist bei diesen Hämangiomen, genauso wie bei ausgedehnten periorbitalen Hämangiomen immer eine adjuvante kurzzeitige Hochdosis-Prednisolon-Therapie erforderlich. Auch bei kaposiformen Hämangioendotheliomen mit Zeichen einer Kasabach-Merritt-Symptomatik ist eine adjuvante Prednisolon-Therapie notwendig. Die intercurrente Lasertherapie, vorzugsweise transkutane Nd:YAG-Laser mit Eiswürfelkühlung leitet die Regression ein und verhindert so den Rebound-Effekt nach Absetzen des Prednisolon, so dass auch hier eine kurzzeitige Therapie ausreichend ist.

Short course of prednisolone in patients with solitary cysticercus granuloma: A double blind placebo controlled study

The study was conducted to confirm the role of a short course of oral corticosteroids in patients with solitary cysticercus granuloma with seizures by a double-blind placebo-controlled study. In an open-label trial we, in past, had demonstrated a beneficial role of prednisolone. A short course of prednisolone helped in early resolution of solitary cysticercus granuloma. In this double-blind placebo-controlled randomized study, 60 patients with new-onset seizures and a single enhancing computed tomography (CT)-detected lesion of cysticercosis were randomly divided in two groups to receive either anti-epileptic monotherapy with prednisolone (n=30) or anti-epileptic monotherapy along with placebo (n=30). The patients received prednisolone, 1mg/kg/day for 10 days, followed by tapering over next 4 days. None of the patients received albendazole therapy. The patients were followed up monthly, at least for 9 months. A repeat CT scan was performed after 6 months. The data were analysed by chi-square test. The majority of patients were young. Simple partial seizure, with or without secondary generalization, was the commonest seizure type encountered. Follow-up CT scans at 6 months demonstrated non-significantly better response for prednisolone treated patients. In prednisolone group the lesion disappeared in 52% of patients and in 48% patients who received placebo. However, a significantly lesser number of prednisolone treated patients (n=12%) than controls (n=48%), had seizure recurrence. Our study suggests that short-term prednisolone therapy may not help in rapid resolution of solitary cysticercus granuloma, however, prednisolone therapy improves seizure-related prognosis.

Immunoadjuvant Prednisolone Therapy for HIV‐Associated Tuberculosis: A Phase 2 Clinical Trial in Uganda

Background. Human immunodeficiency virus (HIV)-infected patients with tuberculosis (TB) respond to effective antituberculous therapy, but their prognosis remains poor. Mounting evidence from clinical studies supports the concept of copathogenesis in which immune activation that is triggered by TB and mediated by cytokines stimulates viral replication and worsens HIV infection, especially when immune function is preserved.Methods. We performed a phase 2, randomized, double-blind, placebo-controlled clinical trial in Kampala, Uganda, to determine whether immunoadjuvant prednisolone therapy in HIV-infected patients with TB who have CD4(+) T cell counts >/=200 cells/ mu L is safe and effective at increasing CD4(+) T cell counts.Results. Short-term prednisolone therapy reduced levels of immune activation and tended to produce higher CD4(+) T cell counts. Although prednisolone therapy was associated with a more rapid clearance of Mycobacterium tuberculosis from the sputum, it was also associated with a transient increase in HIV RNA levels, which receded when prednisolone therapy was discontinued. The intervention worsened underlying hypertension and caused fluid retention and hyperglycemia.Conclusion. The benefits of prednisolone therapy on immune activation and CD4(+) T cell counts do not outweigh the risks of adverse events in HIV-infected patients with TB and preserved immune function.

Skeletal effects of short-term prednisolone therapy in children with steroid-responsive nephrotic syndrome

Background. Osteoporosis or bone fracture can be induced in nephrotic children treated long-term with high doses of glucocorticoids. The purpose of this study was to determine whether short-term prednisolone therapy affects the skeleton in children with steroid-responsive nephrotic syndrome (NS). Methods. Bone mineral density (BMD) and biochemical parameters of mineral and skeletal homeostasis in nine children (four girls, five boys) aged between 2 and 7 years at the first episode of NS were measured. Prednisolone was started at 60 mg/m2 for 4 weeks, then decreased every 2 weeks for 12 weeks. All patients were steroid-responsive and had no relapse. All patients were examined at 0, 4, and 12 weeks of prednisolone therapy, and 16 weeks after the cessation of prednisolone therapy. Results. The Z-scores (BMD) before prednisolone therapy (−0.79 ± 0.51) were slightly low. The Z-scores at 4 weeks (−1.37 ± 0.46) and at 12 weeks of therapy (−1.22 ± 0.36) were significantly lower than those at 16 weeks after the cessation of prednisolone therapy (−0.29 ± 0.29). There was also a significant decrease in the mean serum levels of alkaline phosphatase, osteocalcin, and urinary deoxypyridinoline during the short-term prednisolone therapy. However, BMD and biochemical parameters of mineral and skeletal homeostasis returned to normal values at 16 weeks after the cessation of prednisolone therapy. Conclusions. Skeletal effects of short-term prednisolone therapy for 16 weeks were transient in children with steroid-responsive NS without relapse.

Short-term prednisolone for inducing seroconversion from hepatitis B e antigen to antibody along with clinical improvement in patients with chronic active hepatitis type B.

Short-term prednisolone therapy was instituted on 27 patients with chronic active hepatitis (CAH) type B, in an attempt to induce seroconversion from hepatitis B e antigen (HBeAg) to the corresponding antibody (anti-HBe). Patients with CAH received a four-week regimen of prednisolone with daily dosage tapering from 40 to 10 mg (total 700 mg). Within one year after the withdrawal of prednisolone, 19 (70%) lost HBeAg and 11 of them (41% of the total) developed anti-HBe, at rates significantly higher than 3 (12%) and 1 (4%) who spontaneously showed respective serological changes among 26 matched controls during one year (p less than 0.001). Within two years after the withdrawal, 21 (78%) lost HBeAg and 19 (70%) developed anti-HBe, in contrast to 6 (23%) and 2 (8%) of controls who showed respective changes during that period (p less than 0.001). Seroconversion to anti-HBe was invariably accompanied by clinical and biochemical improvements along with loss of DNA polymerase from circulation. Elevation in transaminase levels, reflecting the rebound of steroid withdrawal, always heralded and appeared to be required for the seroconversion, but serious aggravation of hepatitis was not encountered in any of the patients.

Plasma levels and hepatic extraction of renin and aldosterone in alcoholic liver disease

Arterial plasma levels and hepatic extraction of renin and aldosterone (ALDO) were measured in 24 patients with alcoholic liver disease and in 14 normal subjects being evaluated as prospective kidney donors. Patients with liver disease had higher plasma concentrations and lower fractional hepatic extractions of both renin and ALDO than the normal subjects. The quantity of renin extracted by the liver was highly correlated with plasma renin in both normal subjects and patients. Plasma ALDO concentration was positively correlated with plasma renin (p < 0.001) but not with serum sodium, potassium or albumin concentration, inferior vena cava pressure, corrected hepatic venous wedge pressure, plasma volume or sulfobromophthalein storage or transport. Sixteen patients were restudied after one month. Six had received 40 mg/day of prednisolone, and the remaining 10 had received a placebo. Neither group had a change in plasma volume, corrected hepatic venous wedge pressure, plasma concentration or hepatic extraction of renin or ALDO. Serum albumin concentration increased and inferior vena cava pressure decreased with prednisolone therapy. These studies document high plasma levels and impaired hepatic extraction of renin and ALDO in patients with liver disease that are not corrected by short-term prednisolone therapy.