Steroid Medication Research Articles

Avatrombopag treatment response in patients with immune thrombocytopenia: the REAL-AVA 1.0 study.

Thrombopoietin-receptor agonists (TPO-RAs) are used to treat immune thrombocytopenia (ITP), a disorder characterized by prolonged low platelet counts (PCs) that pose a risk of serious bleeding episodes. Avatrombopag (AVA) is the most recently approved TPO-RA for the treatment of chronic ITP. A high proportion of patients responded to AVA in clinical trials, and treatment was well-tolerated; however, limited real-world effectiveness data have been reported to date. To describe demographic and clinical characteristics, treatment patterns, and outcomes following the initiation of AVA in patients with ITP in the United States. This is a retrospective study using administrative claims data from the Komodo Healthcare Map (1 February 2017 to 28 February 2022) linked with PC laboratory data. Patients with ⩾1 diagnosis of ITP, ⩾1 paid prescription for AVA (index date), and ⩾1 month of pharmacy coverage after AVA initiation were selected. Baseline characteristics and follow-up steroid, immunosuppressant, and rescue medication use were described. The percentage of patients achieving clinically meaningful PC thresholds (⩾30 × 109/l) were assessed among patients with ⩾1 PC following AVA initiation and prior to AVA discontinuation/switch (effectiveness subgroup). A total of 205 patients met eligibility criteria and 49% reported TPO-RA use in the prior 6 months. Approximately 70% and 93% of patients did not require use of steroid or immunoglobulin rescue medication during follow-up, respectively. Among patients with concomitant steroid (n = 75) or immunosuppressant (n = 7) use at AVA initiation, 35% and 57% discontinued those treatments, respectively. Of the 21 patients in the effectiveness subgroup, 81% achieved clinically meaningful PC thresholds. A high proportion of evaluable patients with ITP in this real-world study achieved clinically meaningful PCs, without requiring rescue medication during AVA treatment, with many able to discontinue baseline concomitant steroid or immunosuppressant utilization. Despite limited availability of PC data, these results are consistent with results from the AVA pivotal clinical trials.

Association of Oral Candidiasis with Oral Lichen planus in patients using corticosteroid therapy- Meta-analysis

Oral lichen planus (OLP) is a chronic inflammatory disease that commonly affects the skin and mucous membranes. There is a difference of opinion among clinicians about whether OLP has been associated with oral candidiasis. Nonetheless, in OLP patients, the oral candidiasis prevalence rate ranges from 7.7 to 16.6%, as established through biopsy findings, whereas 37-50% of the prevalence rate has been noticed in culture findings. Oral candidiasis has been linked to several local and systemic factors, including salivary gland dysfunction, dental prostheses, topical or inhaled corticosteroids, smoking, and the use of systemic medications. The aim was to highlight the association of Candida in patients diagnosed with OLP, correlate the use of steroid therapy, and enumerate the factors of using steroid therapy as implicated causes for oral candidiasis. A search was made using search engines such as PubMed, Scopus, Cochrane Database of Systematic Reviews, Science Citation Index, NIH Public Access, and Clarivate Analytics (Figure 1). The keywords using the research option for this field were "Oral Candidiasis" AND "Oral Lichen planus" or "Candidiasis" AND "Corticosteroids" or "Topical Corticosteroids" AND Oral Lichen planus or "Inhalation Corticosteroids" AND "Candidiasis" or "Oral Lichen planus" AND "Corticosteroids." The database search was made for the duration of 1991 to -2021 (Table 1). Additional articles were obtained regarding the literature on OLP and oral candidiasis and were considered background material. The incidence of oral candidiasis and associated lichen planus following steroid therapy enlisted by various authors has been addressed. According to the results of this study, there is a positive correlation between the presence of oral candidiasis in the OLP's patients treated with corticosteroids. Finally, this meta-analysis concluded that there is a positive correlation between the presence of Candida species in OLP and steroid medication.

Diabetic Ketoacidosis (DKA), a Leading Risk Factor for Mucormycosis (Black Fungus), During the Era of Coronavirus Disease-2019 (COVID-19): An Overview.

Diabetes mellitus (DM) and steroid medication, coincided with coronavirus disease 2019 (COVID-19), results in a weakened immune system, allowing some commonly found pathogens to become more harmful. Mucormycosis (black fungus) is such a type of opportunistic infection caused by fungi belonging to the Mucorales family. DM is the most prominent risk factor for mucormycosis. Excessive blood sugar and decreased insulin levels lead to diabetic ketoacidosis (DKA), a devastating complication of DM that can be fatal if left untreated. Diabetic ketoacidosis is more common in type 1 diabetic patients, although it can also be fall in type 2 diabetic patients. DKA occurs when the body lacks enough insulin to allow blood sugar to enter the cells and is used for energy. Instead, the liver breaks down fat for fuel producing chemicals known as ketones in the process. When too many ketones are created too quickly, they can reach dangerously high levels in the body. Mucormycosis is a rare but serious infectious disease that requires medication or surgical removal. The confluence of diabetes and COVID-19 makes managing mucormycosis a serious and dead issue. Although the effectiveness of prophylactic antifungal therapy has yet to be demonstrated, hyperglycemia control appears to be the most important step in managing mucormycosis in DKA patients.

TLR4 expression in the saliva of systemic lupus erythematosus correlated with the serum vitamin D/25-hydroxyvitamin D: A cross-sectional study

Aim: This study aimed to examine the correlation between serum vitamin D (25-hydroxyvitamin D [25(OH)D]) and the transmembrane Toll-like receptor (TLR) 4 expression on CD11b+ cells in systemic lupus erythematosus (SLE) saliva. Materials and Methods: A cross-sectional study was conducted on 30 SLE patients who regularly visited to rheumatology clinic and met the following criteria: no systemic diseases, no smoking, no drinking and use of oral contraceptives, no steroid and immunosuppressant medications, no pregnancy, no wearing of dentures, and orthodontic appliances. The subject’s blood samples were taken for electrochemiluminescence immunoassay analyzer methods of examining 25(OH)D level. Full unstimulated whole saliva collection for the measurement of TLR4 expression. The descriptive demographic data, the chi-square, t test, and linear regression (95% confidence level) were used to analyze the association between blood 25(OH)D concentrations and immune cells expressing TLR4 in saliva CD11b+ cells. Results: SLE subjects had an average blood concentration of 25(OH)D of 9.9 ± 4.6 ng/mL. in saliva CD11b+ cells, TLR4 expression was 26.0 ± 20.9%. r = 0.473 and P < 0.05 indicated a correlation between the saliva CD11b+ cells expressing TLR4 and the serum level of 25(OH)D. Only 25(OH)D predicted TLR4 expression of the saliva CD11b+ cells. Conclusions: TLR4 expression of Saliva CD11b+ cells correlated with the concentrations of serum 25(OH)D in SLE. Hence, vitamin D/25(OH)D may control the immune response of SLE patients’ oral cavity.

Canadian perspectives in multiple myeloma on the use of steroids in clinical practice based on patient and healthcare provider interviews.

Corticosteroid (steroid) medications are associated with challenging adverse effects that can negatively impact patient quality of life. However, owing to a long legacy of effective use in treatment protocols, they remain a cornerstone of multiple myeloma (MM) care. We conducted a roundtable with Canadian healthcare providers (HCPs) with diverse healthcare backgrounds and involvement in MM care as well as with patients with MM. Our goal was to develop clear guidance for steroid management aimed at improving patient quality of life, taking into account patient perspective and experiences with managing the disease. Our recommendations, which are based on the insights acquired from this discussion, can be categorized to the following areas: steroid prescribing, dosing, and modifications; managing adverse effects; and patient-HCP communication. These recommendations can be used by the entire multi-disciplinary hematology team to improve patient quality of life while being treated with steroid medication for multiple myeloma.

Opportunities to Treat Toxic Stress.

Opportunities to Treat Toxic Stress.

Association between Wrist Circumference and Risk of Any Fracture in Adults: Findings from 15 Years of Follow-Up in the Tehran Lipid and Glucose Study.

We evaluated whether wrist circumference (WrC), as a novel anthropometric measure, is associated with incidences of any fractures. The study population included 8288 adults (45.3% men) aged ≥30 years, who were followed for incidences of any fractures from 31 January 1999 to 16 March 2016. We used Cox proportional hazard models adjusted for well-known risk factors to evaluate the association of WrC, both as continuous and categorical variables (bottom tertile as reference), with incidences of any fractures and major osteoporotic fractures (MOF). Over 15 years of follow-ups, 348 fractures occurred (men = 162). For a 1 cm increase in WrC, hazard ratios (HRs) were 1.18 (95% CI: 1.03-1.35) for incident any fractures and 1.22 (1.01-1.49) for incident MOF. In addition to WrC, age, female sex, lower BMI, higher WC, current smoking, and usage of steroidal medications were significantly associated with the incidences of any fractures. Moreover, participants in the middle and top tertiles of WrC had a higher risk of incidence for any fractures [HR = 1.62 (1.19-2.20) and 1.70 (1.14-2.55), respectively, p-value for trend = 0.012]. We presented WrC as a strong and independent risk factor for incidences of any fractures that might be considered in the risk prediction of bone fracture in Iranian adults.

Immunophenotyping of Circulating and Intratumoral Myeloid and T Cells in Glioblastoma Patients

Glioblastoma is the most common and lethal primary brain malignancy that almost inevitably recurs as therapy-refractory cancer. While the success of immune checkpoint blockade (ICB) revealed the immense potential of immune-targeted therapies in several types of cancers outside the central nervous system, it failed to show objective responses in glioblastoma patients as of now. The ability of glioblastoma cells to drive multiple modes of T cell dysfunction while exhibiting low-quality neoepitopes, low-mutational load, and poor antigen priming limits anti-tumor immunity and efficacy of antigen-unspecific immunotherapies such as ICB. An in-depth understanding of the GBM immune landscape is essential to delineate and reprogram such immunosuppressive circuits during disease progression. In this view, the present study aimed to characterize the peripheral and intratumoral immune compartments of 35 glioblastoma patients compared to age- and sex-matched healthy control probands, particularly focusing on exhaustion signatures on myeloid and T cell subsets. Compared to healthy control participants, different immune signatures were already found in the peripheral circulation, partially related to the steroid medication the patients received. Intratumoral CD4+ and CD8+ TEM cells (CD62Llow/CD45ROhigh) revealed a high expression of PD1, which was also increased on intratumoral, pro-tumorigenic macrophages/microglia. Histopathological analysis further identified high PSGL-1 expression levels of the latter, which has recently been linked to increased metastasis in melanoma and colon cancer via P-selectin-mediated platelet activation. Overall, the present study comprises immunophenotyping of a patient cohort to give implications for eligible immunotherapeutic targets in neurooncology in the future.

ODP030 Autoimmune Adrenalitis Following mRNA Covid- 19 Immunization In A Patient Without A Known Diagnosis Of Adrenal Insufficiency.

Abstract A 45-year-old female with a past medical history of Hashimoto thyroiditis and celiac disease presented after a syncopal episode that resulted in a motor vehicle accident. The patient had symptoms of fatigue, nausea, and anorexia for three weeks following the second dose of the Pfizer-BioNTech COVID-19 Vaccine. Initial laboratory tests revealed hyponatremia with serum sodium (Na) of 123mEq/L that worsened to 111mEq/L after receiving the normal saline infusion. Serum potassium was 3.4mEq/l, Thyroid-stimulating hormone level was 6.350mIU/l, free thyroxine level was 1.1 ng/dl and glucose were 85mg/dl. The PCR test for COVID-19 was negative. Vitals were unremarkable except for a low blood pressure of 90/60. On physical examination, the patient was alert and communicative and there was no hyperpigmentation of the skin. The patient denied personal and family history of adrenal insufficiency. She denied prior use of any steroid medications. Her prior outpatient serum Na levels were normal (138-140 mEq/L). The patient was admitted to the ICU for severe hyponatremia, where she was treated with fluid restriction and hypertonic saline. However, she remained hypotensive, and serum sodium failed to improve above 118mEq/l. Serum cortisol at 8: 00 am and 10: 00 am were 4.5 and 5.8 mcg/dl, respectively. She was started on stress doses of hydrocortisone 100 mg intravenous (IV) followed by hydrocortisone 50 mg IV every 8 hours and serum Na improved to 130m Eq/l. Steroids were tapered gradually to physiological doses. The levothyroxine dose was also increased from the home dose of 75mcg to 88 mcg daily due to the elevated TSH. Hormonal workup showed aldosterone of 0.3ng/dl, plasma renin activity of 20, and adrenocorticotropic hormone(ACTH) levels of &amp;gt;1250pg/ml. Gonadotropins, insulin-like growth factor-1, and prolactin were within normal limits. Cosyntropin stimulation test after holding steroids for 24 hours was abnormal, with pre-cosyntropin cortisol level 7. 0mcg/dl, and the 60-minute post-cosyntropin cortisol level 7.1mcg/dl. The diagnosis of autoimmune adrenalitis was confirmed with a positive 21-hydroxylase antibody test. The patient had an uneventful recovery and was discharged on oral hydrocortisone. Presentation: No date and time listed

Autoimmune Pancreatitis: From Pathogenesis to Treatment.

Autoimmune pancreatitis (AIP) is a rare disease. The diagnosis of AIP is difficult and should be made by a comprehensive evaluation of clinical, radiological, serological, and pathological findings. Two different types of AIP have been identified: autoimmune pancreatitis type 1 (AIP-1), which is considered a pancreatic manifestation of multiorgan disease related to IgG4, and autoimmune pancreatitis type 2 (AIP-2), which is considered a pancreas-specific disease not related to IgG4. Although the pathophysiological conditions seem to differ between type 1 and type 2 pancreatitis, both respond well to steroid medications. In this review, we focused on the pathogenesis of the disease to develop a tool that could facilitate diagnosis and lead to the discovery of new therapeutic strategies to combat autoimmune pancreatitis and its relapses. The standard therapy for AIP is oral administration of corticosteroids. Rituximab (RTX) has also been proposed for induction of remission and maintenance therapy in relapsing AIP-1. In selected patients, immunomodulators such as azathioprine are used to maintain remission. The strength of this review, compared with previous studies, is that it focuses on the clear difference between the two types of autoimmune pancreatitis with a clearly delineated and separate pathogenesis. In addition, the review also considers various therapeutic options, including biologic drugs, such as anti-tumor necrosis factor (TNF) therapy, a well-tolerated and effective second-line therapy for AIP type 2 relapses or steroid dependence. Other biologic therapies are also being explored that could provide a useful therapeutic alternative to corticosteroids and immunosuppressants, which are poorly tolerated due to significant side effects.

Severe Ocular Hypertension in a Child with Pediatric Optic Neuritis

Purpose: To report a rare case of severe ocular hypertension following intravenous methylprednisolone treatment in a child with bilateral optic neuritis.Case summary: A 6-year-old girl presented with bilateral severe visual loss and disc swelling. Magnetic resonance imaging revealed optic nerve enhancement, and she received high-dose intravenous methylprednisolone for 3 days and oral prednisolone 30 mg/day for 2 weeks. Two weeks after initiating treatment, ophthalmologic examination revealed an intraocular pressure (IOP) of 46 mmHg in the right eye and 42 mmHg in the left eye. The best-corrected visual acuity was 1.0 in the right eye and 0.6 in the left eye. Relative afferent pupillary defect was noted in the left eye. Fundus examination showed normal cup-to-disc ratio (0.4) in both eyes. The iridocorneal angle was open in all directions. The treatment plan included the cessation of oral prednisolone and initiation of latanoprost and dorzolamide-timolol fixed combination agent. After 12 hours, the IOP decreased to 18 mmHg in the right eye and 14 mmHg in the left eye. Six months later, her visual acuity was 1.0 in both eyes, and IOP was maintained at 11 and 13 mmHg in the right and left eye, respectively. Optic disc examination showed no sign of glaucomatous change with normal cup-to disc ratio in both eyes.Conclusions: Since steroid medication may cause asymptomatic IOP elevation, regular intraocular pressure measurements are required during steroid treatment for pediatric optic neuritis. The administration of IOP-lowering eyedrops returned IOP to the normal range without damaging the optic nerve.

The importance of children and young person involvement in scoping the need for a paediatric glucocorticoid-associated patient reported outcome measure

BackgroundFor many children and young people (CYP) with paediatric rheumatic conditions, glucocorticoid medications and their associated side-effects have a substantial impact on disease experience. Whilst there are physician-rated measures of glucocorticoid toxicity, no parallel patient reported measure has been developed to date for CYP with rheumatic disease. This manuscript describes a series of public patient involvement (PPI) events to inform the development of a future paediatric glucocorticoid-associated patient reported outcome measure (PROM).MethodsOne large group PPI event was advertised to CYP with experience of glucocorticoid medication use and their parents through clinicians, charities and existing PPI groups. This featured education on the team’s research into glucocorticoid medication and interactive polls/structured discussion to help participants share their experiences. Further engagement was sought for PPI group work to co-develop future glucocorticoid studies, including development of a glucocorticoid associated PROM. Quantitative and qualitative feedback was collected from online questionnaires. The initiative was held virtually due to the Covid-19 pandemic.ResultsNine families (n = 15) including 6 CYP joined the large group PPI event. Online pre-attendance and post-attendance questionnaires showed improvement in mean self-reported confidence [1 = not at all confident, 5 = very confident] in the following: what steroid medications are (pre = 3.9, post = 4.8), steroid side effects (pre = 3.8, post = 4.6), patient-reported outcome measures (pre = 2.0, post = 4.5), available research on steroids (pre = 2.2, post = 3.5). Five families (n = 7) were involved in a monthly PPI group who worked alongside the research team to identify priorities in glucocorticoid research, produce age-appropriate study materials, identify barriers to study participation (e.g. accessibility & convenience) and recommend appropriate modalities for dissemination. The participants found discussing shared experiences and learning about research to be the most enjoyable aspects of the initiative.ConclusionsThis PPI initiative provided a valuable forum for families, including young children, to share their perspectives. Here, the authors explore the effective use of PPI in a virtual setting and provide a unique case study for the involvement of CYP in PROM development. The monthly PPI group also identified a need for the development of a new PROM related to glucocorticoid medication use and provided unique insights into how such a study could be structured.

A Review of Corneal Blindness: Causes and Management.

Corneal blindness refers to a group of eye disorders that change thecorneal transparency, causing corneal scarring and blindness. The leading causes of corneal blindness include infectious causes, i.e., due to bacteria, viruses, fungi, and protozoa. The most common predisposing factors are trauma, contact lens usage, or the use of steroid medications. The various other diseases included are trachoma, dry eye disease, keratoconus, ophthalmia neonatorum, and non-infectious uveitis. Various clinical modalities are used for treating corneal blindness, including organ transplantation. Organ donation is cumbersome as various ethical and other factors are involved. Hence the concept of eye banking was introduced to meet the increasing demand for donors of the cornea. The eye bank's role is harvesting, processing, and keeping a record of the cornea being transplanted and donated. Furthermore, various recent advancements have been made for lamellar keratoplasty surgeries, including bioengineered corneas to fulfil the need for the unavailability of donors for the cornea. Various specific health interventions have been implemented to reduce the prevalence of corneal blindness globally. For proper management of corneal blindness, we have three components that are needed to be taken care of: prevention of corneal blindness, appropriate treatment modalities, and providing adequate rehabilitation services to the patients. This review encompasses the main reasons for corneal blindness and the management and treatment modalities available for the patients. The terms cornea, corneal blindness, treatment, management, causes, and complications were used for the review article on PubMed.

Fulminant Herpes Pneumonia Postaortic Surgery with Known Ankylosing Spondylitis.

Herpes simplex virus (HSV) pneumonitis is rare after cardiac surgery. A 36-year-old gentleman with ankylosing spondylitis underwent emergency surgery for a complex aortic aneurysmal disease. Preoperative treatment of aortitis with antitumor necrosis factor and steroid medication and surgical stress including cardiopulmonary bypass potentially created an immunosuppressive state and reactivation of undiagnosed HSV. Rapid HSV pneumonia ensued, culminating in fulminant organ failure and mortality. HSV pneumonia should be considered postoperatively in patients with severe respiratory distress, especially if immunocompromised.

Use of Oxandrolone as Adjunctive Therapy in Right Ischiotibial Injury

Androgen hormones serve a variety of roles, including determining and maintaining sexual traits. The effects of Anabolic Androgen Steroids (AAS) like oxandrolone on body composition and muscle mass development are intriguing. We provide a case of a 38-year-old woman who was treated with oxandrolone for multiple fractures and a current right ischiotibial injury, indicating that androgen steroid medication may aid in the recovery of bone and tendon-muscle health in injuries. The improvement in pain was significantly relevant, allowing the patient to return to her normal activities.

Case report of possible iatrogenic Cushing's disease with low-dose prednisone to treat dermal filler hypersensitivity.

The aim of this article is to report a case of iatrogenic Cushing's disease associated with a delayed inflammatory response due to a facial dermal filler procedure. A case report according to CARE guidelines was performed. A delayed inflammatory reaction due to dermal filler injection resulted in iatrogenic Cushing's disease in a patient with no comorbidities or allergies. Prolonged use of glucocorticoids can cause adverse effects, such as iatrogenic Cushing's disease. Dermal fillers have a very low incidence of complications, but these need to be discussed with patients. Drugs used to treat delayed inflammatory reaction include antibiotics, antihistamines, steroids, and intralesional hyaluronidase. Reversal of dermal fillers should be explained to the patient and included in the written consent. Due to patient non-compliance and possible adverse effects of steroid medications, physicians should consider limiting their prescriptions of steroid medications to no more than 2 weeks and require frequent follow-up to discuss hyaluronidase if the condition returns off of steroid medication. In addition, it may be advisable to only treat with one filler brand, especially in the same session as this may be a risk factor.

Canaliculotomy as A Canalicular Obstruction Management Approach: a Case Series

Lacrimal drainage obstruction is a common disorder of lacrimal system. This obstruction could affect lacrimal punctum, canaliculi, lacrimal sac, and lacrimal duct. The etiology could be congenital or acquired, such as triggered by infection or other conditions. This case series illustrates the procedure of canaliculotomy to reduce the epiphora symptom caused by lacrimal drainage obstruction, specifically in punctum and canaliculi. The aim of this case series was to report the management of punctal and canaliculi obstruction with canaliculotomy procedure. Case 1, an eighty-two years old woman with chronic canaliculitis on the right eye due to Actynomyces sp. infection, underwent canaliculotomy and curetage of canalicular area of the right eye. Case 2, a sixty-years old man with chronic canaliculitis with canalicular fistula on the left eye underwent canaliculotomy with silicone tube procedure on the left eye. Case 3, a sixty-seven years old man with recurrent punctal obstruction due to punctal stenosis of the left eye, previous punctoplasty, underwent canaliculotomy with silicone tube. Identification of the patient's symptoms is very important in determining the diagnosis and management plan for the patient. Canaliculotomy procedure with antimicrobial and steroid medication after procedure leads to a good result in reducing symptoms caused by lacrimal drainage obstruction due to various etiology.

Клинический случай развития стероидной офтальмогипертензии на фоне перорального приема метилпреднизолона у пациента с системной красной волчанкой

The purpose of the work is to evaluate the dynamics of development and clinical course of secondary steroid ophthalmohypertension in a patient with systemic lupus erythematosus. Material and methods. We analyzed the primary medical documentation. In the following, we described this clinical case. Results and conclusions. The patient did not notice any positive dynamics during 2 months of conservative treatment of chronic blepharitis against the background of instillations of Dexamethasone 0.1% in both eyes. In addition, the patient was taking oral methylprednisolone for the treatment of systemic lupus erythematosus. At the initial appointment with an ophthalmologist, an increase in IOP was detected, and the diagnosis was made: allergic blepharitis, chalazions of the upper eyelid of both eyes, steroid ophthalmohypertension. Blepharitis treatment was prescribed, as well as hypotensive drops in both eyes. The patient came to our clinic 1.5 months after the start of treatment, without positive dynamics and with a persistently high level of IOP. Appropriate treatment was prescribed and all necessary methods of additional diagnostics were carried out. Conclusions. This clinical case is of interest to practitioners, as it reflects a multidisciplinary approach to the treatment and management of patients with rheumatological pathology requiring steroid medications. Keywords: steroid ophthalmohypertension, glaucoma, steroid glaucoma, systemic lupus erythematosus, glucocorticosteroids

The Prevalence and Risk Factors Associated with Myopia among Different Ages Students of Tangail District, Bangladesh

In children and young adults, myopia is the leading cause of preventable blindness. Multiple epidemiological studies have confirmed that Asian countries have a high frequency of myopia. The aim of the study to determine the prevalence of myopia and to investigate factors associated with myopia/refractive error among different ages students in Bangladesh. The prevalence of myopia was measured in a cross-sectional study of 300 (three hundred) students in Tangail, Bangladesh. To investigate the relationship between different risk variables and myopia, Chi-square tests and logistic regression analysis were used. Out of total 300 students, 159 (53%) were myopic. Among the participants, 55 % were between the ages of 18 and 24 years, and there was a statistically significant relationship (p was positive in 62.9% myopic students. The sleeping hours of 36% students were 8 hours per day in 8.7%. There were a strong significant relationship between refractive error and insufficient time spent on outdoor activities, low light work activity, spending their time on electronic devices etc. No significant statistical relationship was found between refractive error and diabetes, steroidal medications, blood pressure, smoking, dietary intake and allergic problem. The study revealed some key determinants of myopia that will help to expand our knowledge about health and future research.

Treatment-Associated Side Effects in Patients with Steroid-Dependent Nephrotic Syndrome.

Introduction:Nephrotic syndrome is one of the most extensively studied pediatric diseases for a nephrologist. Treatment for patients suffering from it has greatly improved the prognosis and reduced the mortality rate to 3% or less. Steroid medication is the first line, but non-steroid immunosuppressive drugs are useful in limiting steroid side effects and maintaining long-term remission. Objective: The aim of the study is to choose the best treatment for each patient in order to minimize long-term effects of corticosteroid therapy, taking into account the child's age, gender and other factors to optimize the quality of life. Materials and methods:Materials and methods: This is a retrospective study of pediatric patients older than one year and younger than 18 years of age diagnosed with idiopathic corticosteroid nephrotic syndrome. Study participants were treated in the Department of Pediatric Nephrology of "M. S. Curie" Emergency Clinical Hospital for Children, Bucharest, Romania, between January 2013 and December 2020. Thirty-seven subjects with steroid-dependent nephrotic syndrome from a total of 125 patients diagnosed with nephrotic syndrome were included in the present study. All study participants underwent clinical examination and laboratory tests and were regularly monitored. Results and discussion: Long-term corticosteroid therapy can lead to unwanted complications such as hypertension, short stature, behavior disturbances, or osteopenia. To minimize certain side effects, a second line steroid-sparing agents can be used due to their ability to induce complete remission and maintain it in patients with steroid-dependent nephrotic syndrome. Conclusion: Our study describes the most frequent side effects encountered in the Department of Nephrology in patients with steroid-dependent nephrotic syndrome. The purpose was to emphasize that pediatric patients' quality of life depends on limiting long-term corticosteroid treatment and preventing adverse reactions or complications.