Steroid Therapy In Patients Research Articles

Progression of vertebral fractures in metastatic melanoma and non-small cell lung cancer patients given immune checkpoint inhibitors

IntroductionThe immune system mediates important effects on bone metabolism, but little has been done to understand immunotherapy’s role in this interaction. This study aims to describe and identify risk factors for the occurrence and/or exacerbation of vertebral fractures (vertebral fracture progression) during immune checkpoint inhibitors (ICIs). MethodsWe conducted an observational, retrospective, monocentric study. We collected data on melanoma and NSCLC patients, treated with first-line ICIs at the Medical Oncology Department ASST Spedali Civili of Brescia, between January 2015 and November 2021, and with a median follow-up of 20.1 (6–36) months. We collected data on patients, diseases, immune-related adverse events, and cortico-steroid therapy initiated on concomitant ICIs. ResultsWe identified 135 patients, 65 (48.2 %) with locally advanced/metastatic melanoma and 70 (51.8 %) with locally advanced/metastatic non-small cell lung cancer (NSCLC). Twenty-one (15.6 %) patients already had an asymptomatic vertebral fracture at baseline before starting ICIs in monotherapy. A total of ten patients, or 7.4 %, had a vertebra fracture progression defined as a new vertebral fracture or a worsening of a previous fracture. There was a strong relation between the steroid therapy and irAEs with vertebra fracture progression [OR (95 % CI) 8.1 (3.7–17.8) p-value < 0.001] in univariable analysis. However, only steroid therapy resulted to be an independent risk factor [8.260 (95 % CI 0.909–75.095); p-value 0.061] at the multivariable analysis. ConclusionConcurrent steroid therapy in patients receiving immunotherapy exposes them to a high risk of fractures due to skeletal fragility. The use of bone resorption inhibitors should be considered in these patients to prevent these adverse events.

The role of tissue IgG4 levels in steroid therapy in patients with idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory lesion of the breast. Immunoglobulin G4 (IgG4) associated disease is rare in the breast. In our study, we aimed to evaluate the efficacy of steroid treatment on IgG4 levels in tissue in patients diagnosed with IGM. Between 2008 and 2017, 55 patients diagnosed with IGM in our clinic were included in the study. Demographic, clinical, microbiologic and histopathologic characteristics, treatment modality and recovery time were evaluated retrospectively. Patients were divided into 3 groups according to tissue IgG4 levels: negative (Group I), infrequently and slightly positive (Group II), and highly positive (Group III). Group I patients had a complete response rate of 77.8%. In the rest of the patients (22.2%), insufficient response was detected from the beginning of the treatment. In Group II, the response rate was 91.3% and the permanent success rate after treatment was 87.0%. Although group III patients had a complete response at the beginning (95.65%), they relapsed in a short period of time (26.1%) after discontinuation of steroid treatment. At least one steroid-related side effect was observed in 47 (85.8%) patients in all groups. There is no consensus on the dose and duration of immunosuppressive treatment in IGM. In this study, responses to steroid treatment according to IgG4 concentration in pathologic breast tissue and recurrences after the end of treatment were determined. We think that high IgG4 concentration in the tissue is associated with recurrence and other immunosuppressive drugs should be added as maintenance after steroid treatment.

Steroid therapy in patients with inflammatory bowel disease complicating diabetes diagnosis

Inflammatory bowel diseases (IBDs), such as Crohn's disease (CD), ulcerative colitis (UC) or type 1 diabetes (T1D) are autoimmune diseases that may have common susceptibility pathways. In the etiology of these diseases, scientists are seeking not only genetic, but also environmental factors, infections, nutritional deficiencies, and iatrogenic causes, especially in T1D. The relationship between T1D and steroid therapy, used in the treatment of the inflammatory bowel disease, has been well established for years. Steroids are most commonly known for causing drug-induced diabetes. We present a 35-year-old man, in whom a drug-induced diabetes was suggested due to a 4-week steroid therapy used as a treatment for his newly diagnosed ulcerative colitis and a literature review describing a similar problem. To confirm the association between diabetes and steroid therapy, it was necessary to rule out an autoimmune background of the disease. However, the presence of autoantibodies to GAD and anti-α tyrosine phosphatase (IA-2) confirmed the diagnosis of T1D. Aim of the study This review aims to present the issue of type 1 diabetes in patients treated with steroid therapy for inflammatory bowel disease, and to summarize the current state of knowledge, so that in the future it will result in an accurate diagnosis and implementation of appropriate treatment. Methods and materials A literature review was conducted based on the PubMed database, using keywords: ”diabetes mellitus”, ”inflammatory bowel diseases”, ”ulcerative colitis”, „steroids”, ”insulin”. Conclusion We should suspect T1D in patients, especially in the young population suffering from autoimmune diseases in order to prevent serious complications including dysfunction and failure of various organs, such as eyes, kidneys, nerves, heart and blood vessels.

Expansion of effector regulatory T cells in steroid responders of severe alcohol-associated hepatitis.

While steroid therapy is the preferred treatment for severe alcohol-associated hepatitis, the role of effector regulatory T (eTreg) cells and their association with steroid response and clinical outcomes in these patients remains to be elucidated. We prospectively enrolled 47 consecutive patients with alcohol-associated hepatitis, consisting of severe alcohol-associated hepatitis treated with steroids (n=18; steroid-treated group) and mild alcohol-associated hepatitis (n=29; nontreated group). After isolating peripheral blood mononuclear cells from the patients at enrollment and again 7 days later, the frequency of eTreg cells was examined using flow cytometry. Single-cell RNA sequencing analysis was conducted using paired peripheral blood mononuclear cells. In vitro experiments were also performed to assess phenotype changes and the suppressive function of Treg cells following steroid treatment. The steroid-treated group exhibited significantly higher Model for End-Stage Liver Disease scores than the nontreated group ( p < 0.01). Within the steroid-treated group, the proportion of eTreg cells significantly expanded in the steroid responders (n=13; p = 0.01). Furthermore, a significant positive correlation was observed between the decrease in the Model for End-Stage Liver Disease score and the increase in eTreg cells ( p < 0.05). Single-cell RNA sequencing using paired peripheral blood mononuclear cells (pre-steroid and post-steroid therapy) from a steroid responder revealed gene expression changes in T cells and monocytes, suggesting enhancement of Treg cell function. In vitro results showed an elevation in the proportion of eTreg cells after steroid therapy. In conclusion, our findings suggest that the efficacy of steroid therapy in patients with severe alcohol-associated hepatitis is mediated by an increase in the number of eTreg cells.

Safety of non-standard regimen of systemic steroid therapy in patients with Graves' orbitopathy: a single-centre experience.

Graves' orbitopathy (GO) is an autoimmune disorder of the orbit and retro-ocular tissues and the primary extrathyroidal manifestation of Graves' disease. In moderate-to-severe and active GO iv glucocorticoids (GCs) are recommended as first-line treatment. The aim was to assess the safety profile of methylprednisolone administered intravenously for three consecutive days at 1g in patients with active, moderate-to-severe or sight-threatening Graves' orbitopathy. We retrospectively evaluated 161 medical records of patients with GO treated with high-dose systemic GCs in the Department of Endocrinology, Metabolic Disorders, and Internal Medicine in Poznań between 2014 and 2021. Clinical data included age, gender, laboratory results, activity and severity of GO, smoking status, disease duration, and presented side effects. The presence of mild side effects was observed during 114 (71%) hospitalizations. The most common complications were hyperglycemia (n = 95) and elevated aminotransferases (n = 31). Increased levels of aminotransferases were more likely observed in smokers and GO duration above 12months. Based on the multivariate logistic regression, higher TRAb and CAS values were significantly associated with lower odds of hyperglycemia. In turn, the increased odds of elevated aminotransferases were significantly correlated with higher initial ALT levels, female gender, and GO duration above 12months. In addition, the multidimensional correspondence analysis (MPA) showed that GO patients who declared smoking and had not L-ornithine L-aspartate applied demonstrated a higher probability of elevated aminotransferases. Active GO treatment with high-dose systemic GCs is not associated with serious side effects. Hyperglycemia is the most common steroid-induced complication.

Steroid therapy for patients with septic shock: A multicenter observational study conducted in Japan.

Objectives The Clinical Practice Guidelines for the Management of Sepsis and Septic Shock weakly recommend steroids for septic shock resistant to fluid resuscitation and vasopressors. This study aimed to describe the clinical practices for septic shock in the real world and to compare the association between the intermittent or continuous infusion of steroids and the prognosis. Methods This was a retrospective cohort study based on the AMOR-VENUS, in which Japanese intensive care unit (ICU) inpatients were enrolled between January and March 2018. Adult patients with sepsis who received vasopressors within 72 h of ICU admission were included. The patients were divided into non-steroid and steroid groups, which were further divided into intermittent and continuous infusion groups. The patient characteristics and details of the steroids are described. To investigate the association between intermittent or continuous infusion, shock reversal, and mortality, logistic regression analyses were performed after adjusting for possible confounding factors. Results A total of180 patients with septic shock from 18 ICUs were enrolled. The mean age was 69.6 (SD, 14.3) years. Sixty-three patients (35.0%) received steroids (26 intermittently, 37 continuously). In the steroid group, hydrocortisone was used in 85.7%, the median daily dose was 192 mg, and the steroids were administered within 6 h of initiating vasopressor in 71.4%. The adjusted odds ratios of shock reversal on the 7th day and the ICU mortality for continuous versus intermittent infusion were 1.90 (95%CI, 0.43-8.40) and 0.61 (0.10-3.85), respectively. Conclusions There was considerable variation in the criteria for the selection of patients and in the decision to use continuous or intermittent steroid infusion.

Evaluation of different strategies for using steroids in the treatment of sudden sensorineural hearing loss

Introduction. Sudden sensorineural hearing loss is manifested by sudden or rapid hearing loss without obvious disturbances in the outer and middle ear. Often the cause of this condition is not established. At the moment, various methods are used in the treatment, including corticosteroids, which are most often used as primary therapy. Recent studies demonstrate the effectiveness of topical steroid administration.Aim. Assess the effectiveness and safety of various methods of topical and standard systemic use dexamethasone in the treatment of patients with acute sensorineural hearing loss, as well as to determine the optimal timing of therapy.Materials and methods. 61 patients with this disease were treated in the study. 20 of them received dexamethasone transtubarly, 21 – transtympanic, and 20 – systemically. Audiological examination was performed on all patients before treatment, at discharge, a month and six months after discharge. All participants regularly assessed their discomfort on a 10-point scale. Results. The results of treatment demonstrated the effectiveness of both systemic and local steroid therapy in patients with sensorineural hearing loss; however, with topical use of the drug, the proportion of patients with complete hearing restoration was greater. Transtympanic introduction of steroids after radiowave myringotomy turned out to be the most comfortable for patients the level of discomfort was 1.5 points out of 10, while against the background of transtubal administration of the drug and systemic treatment it was 4.5 and 2.3 points, respectively.Conclusions. The method of transtympanic administration of corticosteroids in patients with acute sensorineural hearing loss after radiowave myringotomy is a reliable and effective method of drug delivery to the windows of the labyrinth. This approach allows you to visually control the process of introducing the medication into the tympanic cavity. Transtympanic and transtubal methods of steroid administration are comparable in effectiveness to classical systemic steroid therapy in the treatment of patients with acute sensorineural hearing loss.

Experience of using inhaled steroid therapy in children with whooping cough

The aim of study: аnalysis of the effectiveness of inhaled steroid therapy in patients with whooping cough.Materials and methods: 74 patients with whooping cough were observed, among whom 40 children included inhalations with Budesonide in complex therapy (main group). 34 patients in the comparison group received only basic therapy. The age structure in the main group was as follow: тhere were children under one years old 18 (47.4 ± 8.1%), 1—3 years — 7 (18.4 ± 6.3%); 4—6 years — 8 (21 ± 6.6%), 7—14 years — 7 (13.2 ± 5.5%) and comparable to the comparison group. To verify whooping cough were used the PCR method and serological diagnostic (IFA) using a test system “Ridascreen/Bordetella pertussis («R-biofarm AMG», Germany). Results: budеsonide was prescribed for a course of 5—7 days. Clinical analysis of dynamics of cough in main group showed, that a reduction in a number of attacks by the 4—5th day of budesonide was observed in majority of children (35/87.5 ± 5.2%). In the main group coughing attacks with a frequency of more than 15—25 times a day persisted for 2.7 ± 0.2 days, and in comparison group — 4.3 ± 0.2 (p &lt; 0.001). Relief of broncho-obstructive syndrome was observed in shorter period of time, which contributes to a reduction in the average length of stay of the patient in the hospital.

The potential benefits and risks of sex-steroids therapy in thalassemic patients with hypogonadism

Introduction: A recent review from 14 Mediterranean and Middle East countries (n =4477, mean age = 16.5 years) showed that the pooled prevalence of delayed puberty / hypogonadism in patients with BTM was 45.6%. Studying the consequences of hypogonadism and the potential benefits versus unwanted side effects of sex-steroid hormone replacement therapy (HRT) in children and adolescents with Beta Thalassemia Major (BTM) represent an important issue for these patients. Objectives: We reviewed the literature (Pubmed, Google scholar, Scopus, Research gate) (1995: 2022) on the consequences of hypogonadism and benefits versus side effects of using sex Steroid therapy (HRT) in hypogonadal adolescents with BTM. Thirty-five papers were included and analyzed. Results: HRT had a variable but significant beneficial effect on improving bone mineral density (BMD), pubertal growth spurt, development of secondary sexual characteristics and subsequently improved quality of life (QOL) in children and adolescents with BTM. Increased side effects of HRT in these patients may occur due to their state of hypercoagulability especially in splenectomized patients and those with cardiomyopathy, chronic hepatitis, and dysglycemia. Gynecomastia and local pain in the site of injection confirmed in a considerable number of males on testosterone therapy. Local reaction to sex steroid patches appeared in around 30% of patients. Based on this review recommendations for using HRT in these patients were updated. Conclusion: Proper and wise use of sex steroid therapy in patients with BTM can significantly improve many consequences of hypogonadism.

Level of CSF CXCL10 is highly elevated and decreased after steroid therapy in patients with autoimmune glial fibrillary acidic protein astrocytopathy

AbstractObjectivesTo examine the chemokine profile in the cerebrospinal fluid (CSF) of patients with glial fibrillary acidic protein astrocytopathy (GFAP‐A), central nervous system immune‐related adverse event (CNS‐irAE), neurosarcoidosis (NS), neuromyelitis optica spectrum disorders (NMOSD), multiple sclerosis (MS), and human T‐cell leukemia virus‐1 (HTLV‐1)‐associated myelopathy (HAM).MethodsThe study included 38 patients presenting to St. Marianna University Hospital between May 2013 and November 2021 with GFAP‐A, CNS‐irAE, NMOSD, MS, NS, HAM and noninflammatory neurological diseases (NIND). We recorded the age, sex, duration of disease, brain/spinal lesions on magnetic resonance imaging (MRI), blood data, and measured chemokines (CXCL9, −10, −13, CCL3, −4, −17, −20, −22) in CSF. In patients with GFAP‐A, clinical symptoms, and CSF CXCL10 levels were compared before and after steroid treatment.ResultsPatients with GFAP‐A had higher CSF levels of CXCL10, CXCL13, and CCL22 (10736.1 [8786.7–149079.0] pg/ml (p &lt; .05), 378.4 [239.9–412.2] pg/ml (p &lt; .01) and 159.9 [130.5–413.9] pg/ml (p &lt; .01), respectively). The CSF levels of CXCL10 improved from 10736.1 [8786.7–149079.0] pg/ml to 1879.0 [783.9–4360.0] pg/ml in patients with GFAP‐A by steroid therapy.ConclusionCSF CXCL10 levels were particularly high in GFAP‐A, and changes in levels after treatment correlated with clinical improvements, suggesting CXCL10 involvement in GFAP‐A pathogenesis.

Role of apoptosis inhibitor of macrophages in patients with IgG4‑related disease/autoimmune pancreatitis and the clinical characteristics associated with this condition.

Type 1 autoimmune pancreatitis (AIP) is a pancreatic manifestation of IgG4-related disease (IgG4-RD) and is a unique chronic inflammatory disease characterized by fibrosis. IgG4-RD is caused by an autoimmune mechanism that mimics malignant tumors and inflammatory disorders. Apoptosis inhibitor of macrophages (AIM) can function as a biomarker of autoimmune or inflammatory diseases with tissue fibrosis, including in inflammatory bowel disease and chronic liver disease. Therefore, the aim of the present study was to clarify the role of serum AIM levels and the clinical characteristics of patients with IgG4-RD and AIP. For this purpose, serum AIM concentrations were assessed using ELISA and the association between AIM and the laboratory and clinical data from patients with IgG4-RD/AIP, patients with pancreatic cancer (PC) and healthy controls (HCs), was determined. The results demonstrated that the serum AIM concentrations were not associated with the laboratory data. However, the serum AIM levels were significantly elevated in patients with AIP compared with the HCs and patients with PC. Furthermore, the serum AIM levels significantly decreased following steroid therapy in patients with AIP who were in remission. Overall, the present study demonstrates that serum AIM levels may be a potentially useful biomarker for the differential diagnosis of AIP and for evaluating the therapeutic reactivity of affected patients.

Short- and long-term oral steroid therapy in patients with asthma exacerbation.

Steroids are frequently used for symptom control in cases of asthma exacerbation. The aim of this study was to compare the effect of short-term and long-term oral steroid therapy on symptom control in patients with asthma exacerbation. Patients that received short-term (<10 d) and long-term (≥10 d) oral steroid therapy during asthma exacerbation were compared retrospectively. A visual analog scale (VAS) for symptom severity was administered, and the asthma control test (ACT) and pulmonary function tests were performed before and after treatment. The study included 69 patients and the overall mean duration of steroid treatment was 9.57±3.58 d (range: 5-25 d). Mean duration of short-term and long-term steroid treatment was 6.54±0.99 d and 11.63±3.21 d, respectively. Serious side-effects were not observed following oral steroid therapy. Post the short- and long-term oral steroid therapy there were not any significant differences between the 2 groups in terms of ACT, FEV1 (forced expiratory volume 1), or VAS symptom scores. The findings show that in patients with mild asthma exacerbation short-term oral steroid therapy is as effective as long-term steroid therapy and can be safely used for symptom control during periods of mild asthma exacerbation.

Atopy as a specific predictor of response to systemic and local steroid therapy in patients with chronic rhinosinusitis without nasal polyps.

&lt;b&gt;Introduction:&lt;/b&gt; Studies on the pathophysiology of chronic rhinosinusitis have shown an effect of IgE antibodies on the course of the disease, as well as the effectiveness of treatment. Steroid therapy remains the most prevailing method of CRS treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim: &lt;/b&gt;The aim of our study was to determine the clinical response to systemic and local steroid therapy in patients with CRSsNP depending on the total IgE antibody serum concentration. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; A total of 92 patients with CRSsNP took part in the study, where they were divided randomly into 2 groups. In group I, the patients received fluticasone propionate 800 mcg/day intranasally for 12 weeks. Patients in group II were treated with prednisone at a dose of 0.5 mg/kg/day, given orally, for 7 consecutive days and continued by another week with decreasing dosage. Both groups were evaluated prior to and following treatment using the TSS score of CRS clinical symptoms, the endoscopic Lund-Kennedy scale and the Lund-Mackay CT staging of chronic rhinosinusitis. Statistical analy-sis of the effectiveness of treatment was carried out in subgroups according to the total IgE serum concentrations obtained before treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Both groups of patients achieved statistically significant improvement in the TSS evaluation, as well as in endosco-pic and CT imaging findings. In patients with a total IgE serum concentration over 100 IU/ml systemic steroid therapy sho-wed significantly greater effect on the relief of CRS symptoms in the TSS score than intranasal steroid therapy. Analogous differences in the effectiveness of both methods were not found in patients with a normal total IgE serum concentration (&lt;100 IU/ml). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; A short course of systemic steroid therapy is more effective than local treatment in relieving of CRS symptoms in patients with CRSsNP with elevated serum concentration of IgE antibodies. Atopy may be considered a specific predictor of response to steroid therapy in the treatment of chronic rhinosinusitis.

Comparison of infective profile in alcohol - associated hepatitis amongst patients managed with steroids vs supportive care

Background and Aim: Corticosteroids are a therapeutic option for patients with alcohol-associated hepatitis (AAH) and are associated with a short-term mortality benefit. However, concern of infections precludes many clinicians from using steroid therapy in patients with AAH. Therefore, we aimed to compare the incidence of infections in patients with AAH who received steroids against those who did not.

Expression profile of miR-15 and miR-16 in peripheral blood mononuclear cells of patients with steroid-resistant nephrotic syndrome

Introduction: Steroids are considered first-line therapeutic opportunities in cases with idiopathic nephrotic syndrome (INS). The trustworthy biomarkers for steroid-resistant NS (SRNS) would permit more precise decisions in the treatment of INS. Objectives: This study aimed to evaluate the miR-15 and miR-16 levels in NS cases. Patients and Methods: Adult cases with primary NS (n=60) including 30 FSGS (Focal segmental glomerulosclerosis) and 30 membranous glomerulonephritis (MGN) patients and 24 healthy individuals were included. The evaluation of miR-15 and miR-16 expression in blood cells was performed using real-time polymerase chain reaction (qPCR). Moreover, gene ontology analysis and prediction of the miRNA targets were completed to recognize the biological procedures and signaling pathways involved in the pathophysiology of NS. Results: A significant increase was observed in miR-15a-5p expression in cases with primary MGN and FSGS compared with healthy subjects. Conversely, the miR-16-5p expression was significantly decreased in both conditions compared with healthy controls. In the clinical subdivision of FSGS group to steroid-resistant-FSGS and steroid-responsive-FSGS, significant elevated levels of miR-15a-5p and diminished levels of miR-16-5p were observed in both groups compared to normal controls. Gene annotation demonstrated that these miRNAs contribute to cell cycle, ion transport, biological adhesion, cation transport, cellular response to endogenous stimulus, and regulation of small GTPase-related signal transduction. Conclusion: Dysregulated levels of miR-15 and miR-16 may be involved in the pathogenesis and response to steroid therapy in patients with INS.

Benefits of Steroid Therapy in COVID-19 Patients with Different PaO2/FiO2 Ratio at Admission.

Introduction: The use of steroid therapy in patients within the context of SARS-CoV-2 infection is still a matter of debate. This study aimed to evaluate if potential steroid benefits could be predicted by the ratio of arterial oxygen partial pressure (PaO2 in mmHg) to fractional inspired oxygen (FiO2) (P/F) in COVID-19 patients at admission. Materials and Methods: Medical records were retrospectively collected from all adult patients admitted because of COVID-19 from 29 January to 31 July 2020. The association of steroid therapy with 28-day all-cause mortality outcome was analysed in a multivariable logistic regression model adjusted for confounding factors. Results: Overall, 511 patients were analysed, of which 39.1% underwent steroid therapy. Steroid treated patients were mostly male, older, and more frequently treated with antiviral drugs and aminoquinolines; the most common comorbidities were hypertension, followed by cardiovascular disease. Overall, 51 patients died within 28-days, and overall 28-days mortality was 19.5% in the cohort of patients exposed to steroids versus 3.9% mortality in unexposed patients (p < 0.001). Steroid therapy on patients with P/F ratio of 235 mmHg or higher at admission can be considered as detrimental, with an 8% increased probability of death. Conclusions: Steroid therapy is associated with increased 28-day mortality in COVID-19 in patients with mild or no ARDS.

Clinical valuables related to resolution of complete or advanced atrioventricular block after steroid therapy in patients with cardiac sarcoidosis.

BackgroundPrediction of atrioventricular block (AVB) resolution after steroid therapy in patients with cardiac sarcoidosis (CS) is difficult.MethodsWe identified 24 patients with CS and complete or advanced AVB receiving steroid therapy. AVB resolution was assessed by reviewing surface electrocardiogram and the percentage of ventricular pacing required on subsequent device interrogation reports.ResultsAVB resolution was noted in eight (33%) patients 1 year after receiving steroid therapy. Univariate Cox regression analysis demonstrated that left ventricular ejection fraction (LVEF) (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.01‐1.14, P = .016), interval from recognized AVB to start of steroid therapy (HR 0.98, 95% CI 0.95‐0.99, P < .001), and lysozyme (HR 1.51, 95% CI 1.12‐2.19, P = .013) were significantly associated with resolution of AVB. Combination of area under the curve (AUC) of each variable that was significantly related to resolution of AVB (AUC, 0.969; 95% CI 0.921‐1.000, P < .001) was tended to be higher compared with each variable alone.ConclusionsA shorter interval from recognition of AVB to start of steroid therapy, higher LVEF, and higher lysozyme levels were significantly associated with resolution of AVB after steroid therapy in patients with CS. The combination of each variable could be able to distinguish patients with resolution of AVB from those without.

Effects of steroid therapy in patients with severe fever with Thrombocytopenia syndrome: A multicenter clinical cohort study.

Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. Here, we evaluated the effects of steroid therapy in Korean patients with SFTS. A retrospective study was performed in a multicenter SFTS clinical cohort from 13 Korean university hospitals between 2013 and 2017. We performed survival analysis using propensity score matching of 142 patients with SFTS diagnosed by genetic or antibody tests. Overall fatality rate was 23.2%, with 39.7% among 58 patients who underwent steroid therapy. Complications were observed in 37/58 (63.8%) and 25/83 (30.1%) patients in the steroid and non-steroid groups, respectively (P < .001). Survival analysis after propensity score matching showed a significant difference in mean 30-day survival time between the non-steroid and steroid groups in patients with a mild condition [Acute Physiology and Chronic Health Evaluation II (APACHE II) score <14; 29.2 (95% CI 27.70-30.73] vs. 24.9 (95% CI 21.21-28.53], P = .022]. Survival times for the early steroid (≤5 days from the start of therapy after symptom onset), late steroid (>5 days), and non-steroid groups, were 18.4, 22.4, and 27.3 days, respectively (P = .005). After steroid therapy, an increase in complications was observed among patients with SFTS. Steroid therapy should be used with caution, considering the possible negative effects of steroid therapy within 5 days of symptom onset or in patients with mild disease (APACHE II score <14).

The Clinical Profile of Idiopathic Optic Neuritis at the Ophthalmology OPD of Tertiary Centre of Army Hospital, Nepal

Introduction: Inflammation of the optic nerve is a common cause of visual loss due to optic nerve pathology. This study was conducted to report the clinical features, demographic pattern and response to pulse steroid therapy in patients with idiopathic optic neuritis in a tertiary care teaching institute in Kathmandu, Nepal.&#x0D; Methods: The hospital data of patients with idiopathic optic neuritis admitted to the Department of Ophthalmology of Shree Birendra Hospital, Chhauni, Kathmandu, Nepal between Jan 2015 to Dec 2018 were retrospectively analysed. The parameters studied were demographic pattern, clinical features, and visual acuity. &#x0D; Results: Eighteen eyes of 15 patients were found to have optic neuritis (papillits in eight and retrobulbar optic neuritis in 10 eyes). The male to female ratio was 1.4:1. The mean age of the patients was 38.07 ± 11.37 years (95% CI = 31.77- 42.37). The most common modes of presentation were loss of visual acuity, painful ocular movement and colour vision defect. One patient had features suggestive of multiple sclerosis. Response to pulse methylprednisolone therapy was good in most (16 eyes) of the cases except for the patients having recurrent episode and started oral steroid elsewhere before presenting to our hospital. &#x0D; Conclusions: Response to pulse methylprednisolone therapy was good in patients with initial visual acuity of at least perception of light. Demographic and clinical features of our patients were different from those reported from the western world.

Efficacy of pulse steroid therapy in patients critically ill with COVID-19.

The aim of this study was to determine the efficacy of pulse steroid therapy administered to patients critically ill with COVID-19 progressing into severe pneumonia. A total of 600 patients included in this retrospective study were divided into three groups. Group 1 (control group): 200 patients who did not receive steroid treatment, Group 2: 200 patients who received dexamethasone 1x8 milligram (mg) or methylprednisolone 1x80 mg, Group 3: (pulse steroid therapy group): 200 patients who received 1 g methylprednisolone followed by 1x80 mg methylprednisolone. Demographic and laboratory data were recorded. Mortality rates in groups 1, 2 and 3 were 77 %, 53.55 %, and 58.5 %, respectively. The ratios of intubated patients in groups 1, 2 and 3 were 70 %, 45.5 % and 56 %, respectively. The numbers of patients whose D‑dimer values were above 2,250 ng/mL (cut-off value for D-dimer in this study) in groups 2, 1 and 3 were 65, 107, and 105, respectively. Pulse steroid therapy does not shorten the duration of hospital stay, does not reduce the need for intubation and increases the risk of thrombosis by significantly increasing the level of D-dimer among patients critically and severely ill with COVID-19 (Tab. 4, Fig. 3, Ref. 20) Keywords: COVID-19, pulse steroid therapy, thrombosis, d-dimer, corticosteroid.