Use Of Systemic Corticosteroid Therapy Research Articles

P785 Obesity in the response to biological treatments in Inflammatory Bowel Disease patients

Abstract Background Obesity rates in patients with IBD reach up to 40%. Several authors suggest that obese patients have worse response rates to treatments. The aim of the study is to determine whether body mass index (BMI) influences the response to biological therapies in IBD. Secondly, other risk factors will be analyzed, and response rates to different biological treatments will be compared. Methods A retrospective cohort study of patients with IBD on biologic drugs under treatment between February 2013 and September 2022 is presented. Patients were recruited from IBD consultation of a tertiary center (Hospital Rey Juan Carlos, Madrid). Inclusion criteria included being under biologic treatment due to IBD and being näive to these therapies. The follow-up of these patients were carried out from February 2013 to September 2022. The main objective of the study is to determine if BMI influences the response to biological treatment in patients with IBD. As secondary objectives we will try to find the existence of other risk factors for loss of response and between different treatments. Treatment failure was defined as: need of dose increase, switch or swap to another biological treatment, clinical deterioration (measured by clinical indexes), use of systemic corticosteroid therapy, hospitalization, endoscopic inflammatory activity or surgical complications. The percentage loss of response was estimated using Kaplan-Meier curves, and factors influencing long-term response were studied using Cox regression. Results A total of 135 patients were included in the study, (mean age of 46.3 years), 59.3% male, 25.9% smokers, with a mean BMI of 26.1 kg/m2 (18.5% with BMI>30 kg/m2). In the study, 60% received infliximab and 45.9% received combined immunosuppressive therapy. Treatment failure was 59.1% in the non-obese and 80% in the obese (p=0.051). There were no differences in long-term response rates according to biologic treatments or disease subtypes. The only predictor factor for long-term response was combined treatment with immunosuppressants (p=0.037). Conclusion Obesity is not associated with a higher treatment failure rate in patients with IBD undergoing biological therapy. Combined treatment with immunosuppressants acts as a long-term response factor.

Development and Validation of a Novel Score to Predict Mortality in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: CRISTEN.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening, severe mucocutaneous adverse reactions. Severity prediction at early onset is urgently required for treatment. However, previous prediction scores have been based on data of blood tests. This study aimed to present a novel score that predicts mortality in patients with SJS/TEN in the early stages based on only clinical information. We retrospectively evaluated 382 patients with SJS/TEN in a development study. A clinical risk score for TEN (CRISTEN) was created according to the association of potential risk factors with death. We calculated the sum of these risk factors using CRISTEN, and this was validated in a multinational survey of 416 patients and was compared with previous scoring systems. The significant risk factors for death in SJS/TEN comprised 10 items, including patients' age of ≥65 years, ≥10% body surface area involvement, the use of antibiotics as culprit drugs, the use of systemic corticosteroid therapy before the onset, and mucosal damage affecting the ocular, buccal, and genital mucosa. Renal impairment, diabetes, cardiovascular disease, malignant neoplasm, and bacterial infection were included as underlying diseases. The CRISTEN model showed good discrimination (area under the curve [AUC]= 0.884) and calibration. In the validation study, the AUC was 0.827, which was statistically comparable to those of previous systems. A scoring system based on only clinical information was developed to predict mortality in SJS/TEN and was validated in an independent multinational study. CRISTEN may predict individual survival probabilities and direct the management and therapy of patients with SJS/TEN.

The Effect of Diabetes Melitus and Blood Glucose on Patients Mortality with Severe COVID-19 Pneumonia Receiving Corticosteroids in RSUD Dr. Saiful Anwar Malang

Background: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). WHO has recommended the use of systemic corticosteroid therapy in patients with severe and critical COVID-19 pneumonia. However, the use of systemic corticosteroids is also a major contributor to hyperglycemia which is a strong prognostic predictor of poor outcome in hospitalized patients with COVID-19. Furthermore, diabetes mellitus (DM) is one of the most widely reported comorbidities in COVID-19 patients which affects the risk of morbidity and mortality and systemic corticosteroids can aggravate hyperglycemia in patients with this comorbidity. Objective : This study aims to determine the effect of DM and blood glucose on mortality in patients with severe COVID-19 pneumonia who received corticosteroids. Methods: The design of this study was an observational retrospective which was conducted on the medical records of COVID-19 patients who received convalescent plasma therapy at RSUD Dr. Saiful Anwar Malang (RSSA). Of the 229 patients who received convalescent plasma therapy and had fairly complete data, there were 85 patients with severe COVID-19 pneumonia who received corticosteroids with blood glucose data for analysis. Results: There were significant differences in mortality rates in DM and non-DM patients (OR 3.091; CI 1.232-7.756; p=0.015) with severe COVID-19 pneumonia who received corticosteroids. Analysis of blood glucose levels shows that the mean random blood glucose (RBG) and initial RBG levels were higher in patients with a death outcome compared to those who lived (mean RBG 176.07 ± 72.0 mg/dl VS 133.23 ± 56.38 mg /dl, p=0.02; initial RBG 198.40 ± 127.13 mg/dl VS 141.57 ± 73.28 mg/dl, p=0.022. Conclusion: DM and blood glucose levels (mean RBG and initial RBG) affect mortality rates in patients with severe COVID-19 pneumonia who are given corticosteroids. Keywords: COVID-19, diabetes mellitus, blood glucose, corticosteroids DOI: 10.7176/JHMN/102-07 Publication date: October 31 st 2022

Neutrophil gelatinase-associated lipocalin in patients with sarcoidosis.

Neutrophil gelatinase-associated lipocalin (NGAL) is a glycoprotein that is involved in the innate immune system and increased expression has been detected in diverse diseases. Sarcoidosis is a systemic granulomatous disorder and its clinical course and prognosis are changeable and highly divergent. This study aimed to examine the expression of NGAL in patients with sarcoidosis. In addition, we examined whether NGAL could serve as a marker of disease activity and prognosis. Ninety-six sarcoidosis patients were studied. Serum samples collected at the time of diagnosis were examined for NGAL by cellular enzyme-linked immunosorbent assay. The level of NGAL was compared with clinical, radiological and laboratory data. Patients with sarcoidosis had significantly higher levels of NGAL (the median [interquartile range] was 35.1 ng/mL [23.5-60.8] in sarcoidosis patients versus 17.2 ng/mL [13.0-27.0] in the reference population, p < .0001). NGAL levels were not correlated with markers for disease activity. During the follow-up period, 26 patients (27.1%) deteriorated and received systemic corticosteroid therapy for organ dysfunction. In those patients, NGAL levels were significantly higher than in those who did not receive corticosteroid therapy (56.5 ng/mL [27.3-92.3] versus 34.3 ng/mL [23.0-53.0], p = .0201). Upon multivariate logistic regression analysis, elevated NGAL levels at diagnosis were associated with subsequent use of systemic corticosteroid therapy (hazard ratio, 1.20; 95% confidence interval, 1.09-1.31; p = .0004). NGAL may be a useful marker to predict the disease course of sarcoidosis.

Asma na gestação: efeitos na vitalidade fetal, complicações maternas e perinatais

ObjectiveTo assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications. MethodsA retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteria were as follows: singleton pregnancy; pregnant women diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28th week of pregnancy; birth at this institution; newborn weighing over 500 g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed. ResultsOf the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056 g (SD 581g). The fetal biophysical profile performed during the antepartum period (n=90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n=28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p<0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p=0.039). ConclusionThe severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.

Asthma during pregnancy: effects on fetal well-being, and maternal and perinatal complications

ObjectiveTo assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications. MethodsA retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteria were as follows: singleton pregnancy; pregnant women diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28th week of pregnancy; birth at this institution; newborn weighing over 500g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed. ResultsOf the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056g (SD 581g). The fetal biophysical profile performed during the antepartum period (n=90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n=28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p<0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p=0.039). ConclusionThe severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.

Incidence, Risk Factors, and Severity of Herpesvirus Infections in a Cohort of 121 Patients With Primary Dermatomyositis and Dermatomyositis Associated With a Malignant Neoplasm

Opportunistic infections have been reported in 15% to 21% of patients with inflammatory myositis. However, to our knowledge, no data are available regarding the incidence, risk factors, and severity of herpesvirus infections. Retrospective inception cohort study. Two departments in tertiary teaching hospitals. Patients All patients diagnosed as having dermatomyositis (DM) according to the criteria of Bohan and Peter seen during a 13-year period. Cumulative incidence rates of herpesvirus infections using the Kaplan-Meier method and risk factors for herpesvirus infections during the first year of DM using Cox proportional hazards models. A total of 121 patients met the inclusion criteria (mean [SD] age, 52 [15] years; 85 were women [70%]). Seventy-six percent had primary dermatomyositis, and 24% had dermatomyositis associated with a malignant neoplasm. The mean (SD) duration of follow-up was 42 (33) months. During follow-up, 20 patients developed a total of 22 herpesvirus infections (16 developed herpes zoster infections). The incidence rates for herpesvirus and for herpes zoster infections were 49 and 33 episodes per 1000 patient-years, respectively. In multivariate analysis, a positive association was noted between the risk of herpesvirus infection and use of systemic corticosteroid therapy (hazard ratio [HR], 3.71 [95% confidence interval {CI}, 1.02-13.41]; P = .04), lymphocyte count lower than 6000/microL (HR, 3.55 [95% CI, 1.00-12.65]; P = .05), and creatine phosphokinase level higher than 300 U/L (HR, 4.81 [95% CI, 1.28-18.06]; P = .02). Dermatomyositis associated with a malignant neoplasm tended to be negatively associated with the risk of herpesvirus infection (HR, 0.16 [95% CI, 0.02-1.29]; P = .08). The risk of serious herpesvirus infections in patients with DM is high. Educational strategies and studies evaluating the risk-to-benefit and the cost-to-benefit balances of a prophylaxis with valacyclovir hydrochloride in selected patients with DM are warranted.

Measuring the Quality of Inpatient Care for Asthma

Hospital Care| March 01 2009 Measuring the Quality of Inpatient Care for Asthma AAP Grand Rounds (2009) 21 (3): 30. https://doi.org/10.1542/gr.21-3-30 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Measuring the Quality of Inpatient Care for Asthma. AAP Grand Rounds March 2009; 21 (3): 30. https://doi.org/10.1542/gr.21-3-30 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: asthma, inpatients Source: Nkoy FL, Fassl BA, Simon TD, et al. Quality of care for children hospitalized with asthma. Pediatrics. 2008;122(5):1055–1063; doi:10.1542/peds.2007–2399 In this retrospective, observational study researchers from Primary Children’s Medical Center in Salt Lake City developed evidence-based measures of quality for the inpatient management of asthma, and evaluated rates of compliance with these measures at their institution. Utilizing systematic methodologies to review the literature and develop expert consensus, the research team identified 43 potential measures of quality. Of these, a consensus panel selected nine final measures that were evidence-based, feasible, and could be reliably assessed using chart review. The nine final quality measures evaluated specific medical decisions or attributes of the processes of care for asthma in the hospital. Clinical outcomes were not measured directly, but were assumed to be linked to the quality measures based on support from the medical literature. Compliance with the identified measures was rated utilizing retrospective chart review of children 2–17 years of age discharged from the hospital with a primary diagnosis of asthma exacerbation during 2005. The medical records of 252 patients were reviewed. Provider compliance with quality measures specific to acute inpatient management of asthma included: documentation of asthma severity at admission, 39%; use of systemic corticosteroid therapy, 98%; use of oral, not intravenous, corticosteroid, 87%; use of ipratropium bromide limited to the first 24 hours after admission, 71%; and use of metered-dose inhaler rather than nebulizer for children >5 years of age, 20%. Provider compliance with these measures was higher than compliance with the four measures related to preventing re-exacerbation and readmission: documentation of chronic asthma severity, 22%; parental participation in asthma education class, 33%; provision of a written asthma action plan, 5%; and scheduled follow-up with the primary care provider at discharge, 22%. This research team identified nine potential determinants of quality of care for children hospitalized with asthma. Variable and low compliance with these measures suggests that emphasizing and monitoring these measures may lead to improvements in the quality of inpatient care for these patients. Dr. Pate has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. This study has important limitations, many of which are discussed comprehensively by the authors. Two deserve special attention. First, the study may have been subject to bias in the selection of patients, the selection of final quality measures, and the description of institutional compliance with the measures. Second, due to the chart review methodology, several important indicators of quality of asthma care were not included in the group of final measures. Taken together, these limitations weaken the implied association between the nine measures and overall quality of clinical outcomes in asthma care for hospitalized patients. Measuring specific medical decisions, documentation, and processes as determinants of quality is attractive because these endpoints may be easier to measure than clinical outcomes. However, in order to maximize the value of this intermediate focus, we must demonstrate a... You do not currently have access to this content.

Quality of Care for Children Hospitalized With Asthma

The goals were (1) to identify evidence-based clinical process measures that are appropriate, feasible, and reliable for assessing the quality of inpatient asthma care for children and (2) to evaluate provider compliance with these measures. Key asthma quality measures were identified by using a modified Rand appropriateness method, combining a literature review of asthma care evidence with a consensus panel. The feasibility and reliability of obtaining these measures were determined through manual chart review. Provider compliance with these measures was evaluated through retrospective manual chart review of data for 252 children between 2 and 17 years of age who were admitted to a tertiary care children's hospital in 2005 because of asthma exacerbations. Nine appropriate, feasible, reliable, clinical process measures of inpatient asthma care were identified. Provider compliance with these measures was as follows: acute asthma severity assessment at admission, 39%; use of systemic corticosteroid therapy, 98%; use of oral (not intravenous) systemic corticosteroid therapy, 87%; use of ipratropium bromide restricted to <24 hours after admission, 71%; use of albuterol delivered with a metered-dose inhaler (not nebulizer) for children >5 years of age, 20%; documented chronic asthma severity assessment, 22%; parental participation in an asthma education class, 33%; written asthma action plan, 5%; scheduled follow-up appointment with the primary care provider at discharge, 22%. Nine appropriate, feasible, reliable, clinical process measures of inpatient asthma care were identified. Provider compliance across these measures was highly variable but generally low. Our study highlights opportunities for improvement in the provision of asthma care for hospitalized children. Future studies are needed to confirm these findings in other inpatient settings.

Epidural Lipomatosis Complicating Lumbar Steroid Injections

Corticosteroid injections into the spinal epidural space are frequently used to effect a relief of back pain and associated radicular extremity symptoms. Spinal epidural lipomatosis has been documented after the use of systemic corticosteroid therapy. This case report documents the development of epidural lipomatosis after the administration of multiple epidural steroid injections. The development and subsequent resolution after discontinuation of the steroid injections are demonstrated with serial magnetic resonance imaging.

Progression of hip disease in rheumatoid arthritis.

Examination of the serial hip radiographs of patients with osteoarthrosis and rheumatoid arthritis undergoing total joint replacement has allowed the estimation of rates of progression using two measurements. One of these measurements, an index of acetabular thickness, correlates with the use of systemic corticosteroid therapy and demonstrates a more rapid deterioration. No correlation with the severity of inflammatory joint disease and the rate of progression could be found. A high incidence of avascular necrosis is seen using standardized criteria. A difference in the rate of deterioration between osteoarthrosis and rheumatoid arthritis is shown. The formation of protrusio acetabuli and the effects of indomethacin are discussed.