Use Of Systemic Steroids Research Articles

Use of systemic steroids in hospitalized patients with COVID-19

Use of systemic steroids in hospitalized patients with COVID-19

Use of Systemic Steroids for Inflammatory Bowel Disease Can Increase Intraocular Pressure

Use of Systemic Steroids for Inflammatory Bowel Disease Can Increase Intraocular Pressure

Asthma therapy concepts through the ages.

The development and approval of DMAADs ("disease-modifying anti-asthmatic drugs"), in particular inhaled steroids (alone or in combination with long-acting bronchodilators), biologics and modern allergen immunotherapies, has fundamentally changed the asthma therapy concept from symptom control to symptom prevention. This concept is linked to the new asthma treatment goal of asthma remission: long-term absence of symptoms (good asthma control), absence of exacerbations, and stable lung function, without the use of systemic steroids for asthma therapy. Three types of asthma remission are distinguished: spontaneous remission (e.g., childhood asthma), remission "off treatment" (e.g., after successful allergen immunotherapy), and remission "on treatment" (e.g., during inhaled therapy or biologic therapy). A treat-to-target approach is used, as in rheumatoid arthritis or chronic inflammatory bowel disease: The goal is to achieve asthma remission, through individually tailored treatment with highly effective drugs with minimal side effects. However, this requires precise phenotyping of the patient, including detailed history taking, pulmonary function diagnostics, allergological diagnostics, and measurement of type 2 biomarkers.

Tinea Incognito.

Tinea incognito (TI), or incognita, are superficial fungal dermatophyte infections that are changed in shape, most frequently because of topical, systemic steroids use and other immunosuppressants. There are different clinical presentations depending on host factors and the species of dermatophyte causing the disorder. Diagnosis can be challenging and might need combined methods. Once diagnosed the treatment is the usual antifungals, either topical or systemic or combined depending on the site, extent, and host factors.

Study of rhino-orbital-cerebral mucormycosis and its correlates during COVID-19 pandemic in a tertiary eye care institute of central India.

To evaluate factors associated with the occurrence of ROCM in COVID-19 patients and to compare its related parameters and outcomes between active and recovered COVID-19 groups. A total of 35 patients of ROCM associated with COVID-19 (active and post-COVID-19) were included. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessments of ROCM-associated COVID-19 during the second wave of the COVID-19 pandemic. The demographic data, clinical parameters, and outcome were recorded on MS excel sheet, and various parameters were compared between active and recovered COVID-19 groups. ROCM in recovered COVID-19 group was higher (57.1%) as compared to active COVID-19 (42.9%) (P = 1.00). High occurrence of ROCM was seen in those who had a history of hospitalization due to severity of COVID-19 (n 33, 94.28%), oxygen support (77.14), and received systemic steroids (82.9%). The most common comorbidity was diabetes mellitus (82.9%), and new-onset hyperglycemia was noticed in 17.1% of patients. Exenteration (28.6%) was performed in severe cases who had stage IV ROCM, bilateral, and CNS involvement (RR = 7.2, 95% CI: 2.91 to 18.00). The risk of globe exenteration was 1.35 (0.7-2.29) times higher in recovered COVID-19 group, and mortality was 1.76 (0.72-3.36) times higher in active COVID-19 group. Monitored use of systemic steroids and the prompt management of hyperglycemia in COVID-19 patients are important factors for favorable outcomes with reference to globe salvage and life-saving in ROCM associated with COVID-19. Even recovered COVID-19 patients should be observed for persistent hyperglycemia and occurrence of ROCM.

Predictors of local control after robotic stereotactic radiotherapy for brain metastases: 10-years-experience after Cyberknife installation.

To evaluate the factors influencing brain metastases (BM) local control (LC) after stereotactic radiotherapy (SRT). Between 2010 and 2020, a cohort of 145 patients (246 BM) treated consecutively with robotic radiosurgery was analysed. Median age was 61 years (range, 29-90 years). Median radiological follow-up of the lesions was 21.7 months (range, 3-115 months). The mean overall survival and LC were 33.0 and 82.7 months, respectively. On univariate analysis, sex, primary cancer site, histological type, use of systemic steroids, maximum diameter, volume, early MRI response, isodose line, number of fractions, BED10 value, and BED10 value proportional to volume and maximum diameter were significant factors for LC. On multivariate analysis, female sex (hazard ratio [HR]: 2.10 P: 0.035), adenocarcinoma histology (HR: 6.54 P: 0.001), no steroid use (HR: 3.60 P: 0.001), maximum diameter (≤1 cm) (HR: 2.64 P: 0.018), complete response of lesion at first follow-up MRI compared to stable or progressive disease (HR: 4.20, P = 0.024; HR: 19.15, P < 0.001), isodose line (≥90%) (HR: 2.00 P: 0.036), and tumour volume (PTV ≤2 cc) (HR: 5.19 P: 0.001) were independent factors improving LC. SRT is an effective treatment for patients with a limited number of BM with a high LC rate. There are many factors related to the patient, tumour, and radiotherapy plan that have an impact on LC after SRT in brain metastases. These results warrant further investigation in a prospective setting.

Budesonide Added to Post-Transplantation Cyclophosphamide, Tacrolimus and Mycophenolate Mofetil for Prevention of Graft-Versus-Host Disease

Background: Topically active corticosteroids have been shown to effectively treat inflammatory bowel disease with a systemic steroid-sparing effect. However, previous studies have not demonstrated their efficacy in preventing graft-versus-host disease (GVHD) when combined with the standard GVHD prophylaxis regimen consisting of calcineurin inhibitors and methotrexate. We hypothesized that the addition of orally administered ileal-controlled-release budesonide to the post-transplant cyclophosphamide (PTCy)-based regimen could effectively prevent severe acute gastrointestinal GVHD. In this study, we present outcomes of the first 43 consecutively treated patients (pts) with the PTCy-tacrolimus (T), mycophenolate mofetil (M) and budesonide (B) (PTCy-TMB) as a GVHD prophylaxis regimen after allogeneic stem cell transplantation (alloSCT). Methods: Pts with hematologic malignancies received their first alloSCT at our institution between 05/2020-04/2023. Thirty one pts received conditioning with fludarabine (160 mg/m 2) + melphalan (100-140 mg/m 2) + TBI (2-4Gy) or thiotepa 5 mg/kg. Twelve pts received fludarabine (150mg/m 2) + cyclophosphamide (29mg/kg) and TBI 4Gy ± ATG (4.5 mg/kg). GVHD prophylaxis consisted of Cy (50 mg/kg on D+3 and +4), T (trough goal 6-10 ng/mL), M (15mg/kg TID) and budesonide (3 mg TID) starting on D+5 and continued until D+90 followed by a weekly taper if no acute GVHD (aGVHD) occurred. T was continued for at least 6 months followed by a taper, unless otherwise indicated. Results: The median age was 50 years (range 22-73), 39 pts had hematologic malignancies including AML (N=14), ALL (N=11) and NHL (N=8). Seven pts (16%) classified as high/very-high DRI. The median of HCT-CI was 4 (range 0-7). Donors were haploidentical (N=32), MSD (N=8), MUD (N=1), MMSD (1) and MMUD (N=1). PBSCs were used in 28 pts (65%). Thirty pts (70%) received RIC regimens. Median follow-up was 407 days (range 91-996 days). At day 100, the cumulative incidence (CI) of grade 2 aGVHD was 7.0% (95%CI 1.8-17.2), while none developed grade 3-4 aGVHD (Figure 1). One patient had severe chronic GVHD (bronchiolitis obliterans) with CI at 2 years of 3.2% (95%CI 0-14.0). The CI of any systemic steroid use at D+100 and D+180 was 30.2% (95%CI 17.4-44.1) and 44.8% (95%CI 28.9-59.5), respectively. Among the pts who received treatment for aGVHD, the median cumulative systemic steroid exposure (in prednisone equivalents) was 1,318 mg (IQR 623-3,775) at D+100 and 1,325 mg (IQR 525-1,640) at D+180, with a median treatment duration of 40 days (IQR 25-110). At 1 year, the OS, PFS, GRFS, relapse and NRM were 79.6% (95%CI 61.4-89.9), 69.8% (95%CI 51.6-82.3), 66.6% (95%CI 48.4-79.8), 15.3% (95%CI 6.2-28.2) and 14.9% (95%CI 5.3-29.1), respectively. The 1-year CI of newly diagnosed/worsening hyperglycemia and Cushing syndrome was 18.2% (95%CI 7.9-31.9) and 5.0% (95%CI 0.9-14.2), respectively. 3 pts (7%) required insulin treatment. The median absolute lymphocyte count (ALC) at day 30, 90 and 180 was 200/mcL, 300/mcL and 500/mcL, respectively, with no differences in the median ALC at D+180 among pts with and without GVHD. Median cell numbers of CD3 +, CD3 +/CD4 +, CD3 +/CD8 +, CD19 + and CD56 + at 1, 3, 6 months post-transplant were D+30 - 63/mcL, 18/mcL, 34/mcL, 1/mcL, 87/mcL, D+90 - 111/mcL, 64/mcL, 34/mcL, 9/mcL, 216/mcL and D+180 - 269/mcL , 78/mcL , 126/mcL , 7/mcL, 189/mcL, respectively. After 10/2022 pts were tested routinely for Reg3α and ST2 (baseline and retested if developed any signs/symptoms of aGVHD). Among 18 tested pts at baseline, the median number (range) of Reg3α and ST2 at baseline was 28 ng/mL (16-90) and 23,308 pg/mL (4,678-56,226), respectively. Three low-risk pts developed grade 1 aGVHD (N=2) and grade 2 aGVHD (N=1). Fourteen pts with GI sign/symptoms after transplant showed median number (range) of Reg3α and ST2 of 78 ng/mL (16-837) and 34,904 pg/mL (13,329-160,000), respectively. Only one pt with high-risk aGVHD algorithm developed grade 2 aGVHD (Figure 1). Conclusions: The addition of budesonide to PTCy-based GVHD prophylaxis regimen (PTCy-TMB) is feasible and appears to be effective in preventing severe GI aGVHD, without compromising transplant outcomes and immunologic reconstitution.

Crohn´s disease is an independent risk factor for liver fibrosis in patients with inflammatory bowel disease and non-alcoholic fatty liver disease

Background and aimsControversial data have been reported regarding the prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Inflammatory Bowel Disease (IBD) population and IBD-related risk factors. The aim of the study was to assess the prevalence and risk factors associated with NAFLD and liver fibrosis in IBD participants compared with non-IBD controls. MethodsCross-sectional, case-control study including 741 IBD cases and 170 non-IBD controls, matched by sex and age. All participants underwent liver ultrasound, transient elastography and laboratory tests. A logistic regression multivariable analysis was performed adjusting for classic metabolic risk factors and history of systemic steroid use. ResultsThe prevalence of NAFLD and significant liver fibrosis was 45 % and 10 % in IBD group, and 40 % and 2.9 % in non-IBD group (p = 0.255 and 0.062, respectively). Longer IBD duration (aOR 1.02 95% CI (1.001–1.04)) and older age at IBD diagnosis (aOR 1.02 95 % CI (1.001–1.04)) were independent risk factors for NAFLD in IBD group. Crohn´s Disease was an independent risk factor for significant liver fibrosis in participants with IBD and NAFLD (aOR 3.97 95 % CI (1.78–8.96)). NAFLD occurred at lower BMI levels in IBD group with NAFLD compared to non-IBD group with NAFLD (aOR 0.92 95 % CI (0.87–0.98)). ConclusionsAlthough we found no differences in the prevalence of NAFLD and liver fibrosis between IBD group and non-IBD group, our findings suggest that liver fibrosis progression should be closely monitored in patients with concomitant CD and NAFLD, more in particular in those with long standing active disease.

Spectrum of sensitization to aeroallergens as one of the risk factors for uncontrolled severe asthma

BACKGROUND: Asthma is considered one of the urgent medical and social problems of the XXI century. In recent years, not only an increase in the incidence, but also an increase in the prevalence of severe forms of asthma has been noted in all countries of the world. The effect of the sensitization spectrum on the severity and level of asthma control has not been studied enough.&#x0D; AIM: Evaluate the importance of sensitization spectrum to aeroallergens in severe asthma patients as indicators for disease exacerbation risk.&#x0D; MATERIALS AND METHODS: Single-center cross-sectional study at North-Western State Medical University n.a. I.I. Mechnikov. Examined 93 severe asthma patients. Analysis covered demographic traits, comorbidities, hereditary history, living conditions, exacerbations, past-year hospitalizations, medications, spirometry, and specific IgE presence for 10 aeroallergens.&#x0D; RESULTS: Aspergillus fumigatus specific IgE notably impacted asthma control. Disease exacerbation risk was 8.4 times higher with A. fumigatus sensitization. Multivariate logistic regression revealed higher risk with A. fumigatus sensitization (4.79), fixed obstruction (6.2), systemic steroids use (5.85), indoor mold exposure (4.45), and familial asthma history (2.53).&#x0D; CONCLUSION: A. fumigatus sensitization significantly influences asthma course and control, worsening prognosis. Targeted examination of patients measuring sIgE levels for common aeroallergens is necessary to identify control obstacles. The results of the study were previously reported at the All-Russian Congress on Medical Microbiology, Clinical Mycology and Immunology and published in the form of abstracts in the journal Problems in medical mycology, 2022, Vol. 24, No 2.

An early Indian experience with benralizumab - A compendium on severe asthma cases: a case series.

Background: Severe eosinophilic asthma (SEA), one of the phenotypes of asthma that is characterized by elevated blood eosinophil counts, is a common cause of uncontrolled asthma. Patients with SEA often experience severe persistent symptoms and have frequent exacerbations despite optimal inhaler therapy. They also have poor lung function and quality of life (QoL). Benralizumab (Fasenra), a monoclonal antibody, has been approved for managing cases of SEA. This series of six cases, the first of its kind from India, aims to add to the real-world evidence of benralizumab in India. Methods: Benralizumab 30 mg (once in four weeks for the first three doses followed by a dose every eight weeks for two years) was administered in six patients with symptoms of cough, breathlessness on exertion, and wheezing, diagnosed with SEA. The following were the endpoints assessed: (i) overlap between high immunoglobulin E (IgE) and eosinophilic asthma; (ii) reduction of exacerbations; (iii) withdrawal of oral corticosteroids; and (iv) improvement in lung function and QoL. Results: In all cases, management with benralizumab resulted in optimal clinical and functional improvement, a decline in systemic steroid use, and improved QoL. Conclusions: The cases presented here are the first of their kind in the Indian asthmatic population with all SEA patients demonstrating significant improvement in symptoms with the use of benralizumab.

56 Audit of assessment, prevalence, and treatment of osteoporosis for patients attending the inflammatory bowel disease Service in Mullingar Regional Hospital

Abstract Background Courses of steroids are common in patients with Inflammatory Bowel Disease (IBD) and are a risk factor for developing osteoporosis. Osteoporosis is a clinically silent entity and osteoporosis-related fractures are associated with chronic pain, disability, and impact quality of life. Screening of high-risk populations is the mainstay of fracture prevention. In this audit, we aimed to assess adherence to international guidelines for osteoporosis risk assessment and bone protection. Methods A retrospective audit was performed with a random sampling of 10% of the patients attending between October 2021 to October 2022 the IBD outpatient clinic in Mullingar Regional Hospital. Data included demographics, IBD diagnosis, FRAX tool components, FRAX score, bone health screening, DEXA results, and use of bone mineral protection. Clinical practice was compared against European Crohn’s and Colitis Organisation (ECCO) recommendations on bone protection in IBD. Results Of 150 charts reviewed, 39 charts were missing essential data and 8 had a diagnosis other than IBD. All 103 patients included in the analysis had received &amp;gt;3 months of systemic steroid use, of which 50 had a diagnosis of Crohn’s disease and 63 with ulcerative colitis. Two (2%) patients had a FRAX risk assessment for osteoporosis, and 22 (21%) had a DEXA ordered, of which 7 (7%) were by the IBD clinic. Two (2%) patients had a previous fragility fracture and 3 (3%) had been diagnosed with osteoporosis. Bone protection was used in 21 (20%) patients receiving steroids, including calcium and vitamin D supplementation (n = 19), and bisphosphonate (n = 2). Conclusion There are low rates of osteoporosis screening for IBD patients attending this service. There was inadequate data in the charts to calculate FRAX scores to assess osteoporosis prevalence. An intervention tool is currently being designed and the audit cycle will be completed with a repeat audit after implementation.

The Role of Systemic Steroids in Sciatica Due to Herniated Lumbar Disc: A Systematic Review and Meta-analysis.

Systematic review and meta-analysis. Evaluate the role of systemic steroids in treating patients with sciatica due to lumbar disc herniation (LDH). The association between LDH and sciatica has been well described. Use of steroids seems logical in this context; however, their efficacy is not well described and use remains controversial. A comprehensive search on PubMed, EMBASE and Scopus databases (up to 15, February 2022) was performed to identify randomized clinical trials that included patients with symptoms of sciatica due to LDH that were treated with systemic steroids. Risk of bias was judged using the Cochrane RoB2 tool. Meta-analysis was conducted using random effects model to estimate the between-group effect size for pain and functional outcomes. The risk of developing adverse events (AE) was computed using relative risks (RR). All pooled results are reported with their 95% confidence interval (CI) and certainty of evidence analyzed using the GRADE framework. Ten studies met inclusion criteria, comprising a total of 1,017 participants: 540 in the treatment group and 477 in the control group. Steroid treatment was associated with a significant superior reduction of pain (SMD = -0.42, 95% CI -0.76 to -0.08, weak effect, very-low certainty) and reduction in disability (SMD = -0.30, 95% CI -0.51 to -0.10, weak effect, very-low certainty). Corticosteroid administration was associated with significant increased risk of developing an AE (RR = 2.00, 95% CI 1.40 to 2.85, low certainty). The use of systemic steroids in the treatment of sciatica due to LDH seems reasonable despite a two-fold higher risk for developing mild AEs. However, the effect size is small for reducing pain in the short-term and improving functional outcomes at long-term follow-up.

Inflammatory Bowel Disease Is an Independent Risk Factor for Metabolic Dysfunction-Associated Steatotic Liver Disease in Lean Individuals.

Despite classical association between metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity, there is increasing evidence on the development of MASLD in lean individuals. The aim of the study was to assess the prevalence and risk factors of MASLD and significant liver fibrosis in lean participants with inflammatory bowel disease (IBD). This was a cross-sectional, case-control study including 300 lean cases with IBD and 80 lean controls without IBD, matched by sex and age. All participants underwent a liver ultrasound, transient elastography, and laboratory tests. The lean IBD group showed a significantly higher prevalence of MASLD compared with lean non-IBD group (21.3% vs 10%; P = .022), but no differences were observed in the prevalence of significant liver fibrosis (4.7% vs 0.0%; P = 1.000). No differences were found between the prevalence of MASLD in IBD and non-IBD participants who were overweight/obese (66.8% vs 70.8%; P = .442). In addition, the prevalence of MASLD was significantly higher in the overweight/obese IBD group compared with the lean IBD group (P < .001). IBD was an independent risk factor for MASLD in lean participants (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.05-7.01; P = .04), after adjusting for classic metabolic risk factors and prior history of systemic steroid use. Nevertheless, no association between IBD related factors and MASLD was identified in lean IBD participants. When the overweight/obese and lean IBD groups with MASLD were compared, the overweight/obese IBD group with MASLD showed higher levels of the homeostatic model assessment of insulin resistance (OR, 1.49; 95% CI, 1.11-1.98; P = .007) and history of smoking (OR, 4.66; 95% CI, 1.17-18.49; P = .029). MASLD prevalence was higher in the lean IBD group compared with lean non-IBD group, independent of classic metabolic risk factors.

Postauricular versus systemic use of steroids for sudden hearing loss: A systematic review and meta-analysis of randomized controlled trials.

Sudden sensorineural hearing loss (SSNHL) can be debilitating and is one of the most common otological diseases. Steroids play an important role in its treatment. There are many ways to administer steroids, and the efficacy and safety of different administration routes remain unclear. This meta-analysis aimed to investigate the effect and safety of different types of steroid delivery administration for the treatment of SSNHL. We searched the Weipu, Wanfang, Chinese Biomedical Literature, National Knowledge Infrastructure, Web of Science, Embase and PubMed databases for randomized controlled trials (RCTs) on glucocorticoid treatments for SSNHL to compare the efficacy of postauricular injection and systemic steroid administration. Review Manager 5.4 software was used for data synthesis, which included the recovery rate (RR) of reported hearing improvement and change level in pure-tone audiometry (PTA). Subgroup analyses were performed based on different drugs, basic treatment, initial PTA, drug administration methods, onset time, and treatment course. Stata 15.1 software was used for analyses of publication bias and sensitivity. Our meta-analysis included 38 studies involving 3609 patients with SSNHL. In all included studies, the risk difference (RD) using reported improvement as an outcome measure was 0.12 for postauricular injection administration compared with systemic therapy (95% confidence interval [CI] = 0.008, 0.16, P < .00001, I2 = 59%). When examining PTA changes as an outcome measure (19 studies), the mean difference was 6.06 (95% CI = 3.96, 8.16, P < .00001, I2 = 70%). The RD for hearing improvement was compared among different factors, and the results showed that postauricular injection is superior to systemic steroid administration. Postauricular injection may be safer and more effective treatment than systemic therapy as a treatment for SSNHL.

Association between clinical features and course of systemic sclerosis and serum interleukin-8, vascular endothelial growth factor, basic fibroblast growth factor, and interferon alpha.

Certain mediators, such as soluble growth factors and cytokines, among others, are implicated in the immunopathogenesis of systemic sclerosis (SSc). This study aimed to examine the association between serum levels of vascular endothelial growth factor (VEGF), interleukin-8 (IL-8), interferon alpha (IFN-α), and basic fibroblast growth factor (bFGF) and the clinical presentation and course of SSc. This longitudinal, observational study included 43 patients with SSc and 24 healthy subjects. Serum concentrations of VEGF, IL-8, IFN-α, and bFGF were measured at baseline in patients previously treated for SSc. Medical history of patients was analyzed retrospectively at the time of cytokine measurement to infer clinical correlations, and during follow-up for a median of 5 years, assessing the incidence of death or cancer. The bFGF and IFN-α concentrations differed between SSc patients and controls (p < 0.01). In turn, organ involvement and SSc phenotypes did not impact studied cytokine concentrations, similar to systemic steroid and/or immunosuppressant use at enrollment. However, we have documented a positive correlation between the current oral steroid dose and serum levels of IL-8 and bFGF. Furthermore, patients with a VEGF level ≥95.7 pg/mL and IFN-α level ≥3.6 pg/mL required cyclophosphamide therapy more often, currently or in the past (approx. 3-fold and 4-fold, respectively). Substantially elevated VEGF and IFN-α concentrations at baseline were associated with higher cancer occurrence (n = 4) during follow-up, while elevated circulating IL-8 level was associated with an increased risk of death (n = 9). The SSc group was characterized by higher serum concentrations of bFGF and IFN-α compared to healthy controls. Patients treated with cyclophosphamide or receiving higher systemic steroid doses, thus suffering from a more severe disease type, had increased cytokine levels. Elevated circulating IFN-α and VEGF levels might be correlated with cancer, whereas raised IL-8 levels may be associated with an increased risk of death. However, further research is needed to verify our findings.

Machine learning for prediction of asthma exacerbations among asthmatic patients: a systematic review and meta-analysis

BackgroundAsthma exacerbations reduce the patient’s quality of life and are also responsible for significant disease burdens and economic costs. Machine learning (ML)-based prediction models have been increasingly developed to predict asthma exacerbations in recent years. This systematic review and meta-analysis aimed to identify the prediction performance of ML-based prediction models for asthma exacerbations and address the uncertainty of whether modern ML methods could become an alternative option to predict asthma exacerbations.MethodsPubMed, Cochrane Library, EMBASE, and Web of Science were searched for studies published up to December 15, 2022. Studies that applied ML methods to develop prediction models for asthma exacerbations among asthmatic patients older than five years and were published in English were eligible. The prediction model risk of bias assessment tool (PROBAST) was utilized to estimate the risk of bias and the applicability of included studies. Stata software (version 15.0) was used for the random effects meta-analysis of performance measures. Subgroup analyses stratified by ML methods, sample size, age groups, and outcome definitions were conducted.ResultsEleven studies, including 23 prediction models, were identified. Most of the studies were published in recent three years. Logistic regression, boosting, and random forest were the most used ML methods. The most common important predictors were systemic steroid use, short-acting beta2-agonists, emergency department visit, age, and exacerbation history. The overall pooled area under the curve of the receiver operating characteristics (AUROC) of 11 studies (23 prediction models) was 0.80 (95% CI 0.77–0.83). Subgroup analysis based on different ML models showed that boosting method achieved the best performance, with an overall pooled AUROC of 0.84 (95% CI 0.81–0.87).ConclusionThis study identified that ML was the potential tool to achieve great performance in predicting asthma exacerbations. However, the methodology within these models was heterogeneous. Future studies should focus on improving the generalization ability and practicability, thus driving the application of these models in clinical practice.

Association Between the Use of Systemic Steroids and Ocular Hypertension as a Side Effect in Pediatric Population: A Systematic Review.

Steroids are commonly used in children for the treatment of various medical conditions. However, systemic steroids can lead to the development of ocular hypertension (OHT), an increase in intraocular pressure. Limited literature is available on the systemic route of steroid administration in children and the development of this side effect. For literature writing and review, a thorough research was conducted across various platforms, such as PubMed, PubMed Central (PMC), Medline, and Cochrane Database of Systematic Reviews (CDSR). After all the screening processes and quality checks, 12 articles were finalized for review writing. The aim was to explore if OHT development is a common side effect developed in children on systemic steroid use for various medical conditions and if any particular risk factors were present among children that lead to its development. The results indicate that OHT is a common side effect of systemic steroid use in children. Children may or may not present with the symptoms of raised intraocular pressure. The development of OHT occurs within one month of the beginning of the steroid treatment in most of the reviewed studies. Several risk factors associated with developing this side effect were also found. In conclusion, systemic steroid use in children leads to the development of OHT. Awareness among healthcare professionals regarding this potential association is necessary. This information can be used to develop guidelines for serial ocular examinations in children on prolonged systemic steroid use.

Behçet’s disease and COVID-19, retrospective analysis

Purpose This study aimed to investigate the impact of the COVID-19 pandemic and its consequences on the clinical condition of patients with Behçet’s uveitis and compare this with the pre-pandemic state. Patients and methods This retrospective observational study included patients with Behçet’s uveitis who had adequate follow-up before the pandemic (three visits before March 2020) and during the pandemic (two visits between March 2020 and September 2021). We compared uveitis activity, complication rates, and treatment changes during the pandemic with their preCOVID data. Patients who met the inclusion criteria were contacted by phone to confirm previous COVID-19 exposure and vaccination status. Results The study included 59 eyes of 30 patients with Behçet’s uveitis. There was a statistically significant difference between the preCOVID and COVID eras with respect to visual acuity, with median values changed from 1.033 to 1.3 (P=0.003). There was an increase in secondary glaucoma (16.9% to 30.5%, P=0.039), with a corresponding increase in antiglaucoma topical eye drops (20.3–35.6%) (P=0.012). The use of subtenon injections and systemic steroids decreased during the COVID-19 pandemic, but the difference was not statistically significant (P=0.687 and P=0.481, respectively). However, the average steroid dose and the number of subtenon injections per patient showed a statistically significant decrease during the pandemic (20 and 26.7 mg per day, respectively) compared to the preCOVID era (0 and 1 injection per patient) (P=0.007 and 0.027, respectively). Conclusion The COVID-19 pandemic did not result in increased uveitis activity, but a decrease in follow-up frequency led to more complications, mainly secondary glaucoma.

Use of Systemic Steroids, Hormone Replacement Therapy, or Oral Contraceptives Is Associated with Decreased Implant Survival in Women.

Systemic steroids, such as prednisone, hormonal replacement therapies, or oral contraceptives, are commonly prescribed to women who might also be receiving dental implant therapy. However, the effect of these medications on dental implant survival is unknown. The medical and dental records of individuals with dental implants (N = 1480 implants) who visited a postgraduate periodontics clinic between 2000 and 2017 were initially considered. Those younger than 21 years old, pregnant, or male were excluded according to the study's exclusion criteria. The presence of systemic diseases and conditions was assessed. Implant failure rates among female patients using systemic steroids, hormone replacement therapy, or oral contraceptives were compared with failure rates among patients not taking those medications. The implant failure rate for the 65 implants in patients taking steroid medications was 7.69%; the failure rate for the 712 implants in patients not taking steroids was 1.54% (p < 0.001). After adjusting for smoking and the presence of diabetes, that relationship persisted, with an 8.47% implant failure rate for the 59 implants in patients taking steroids (vs. 1.54% failure for the 585 implants in patients not taking steroids; p < 0.001). Regression analyses demonstrated that the odds of implant failure versus success were 5.31 times greater in patients taking systemic steroids, hormone replacement therapy, or oral contraceptives (p < 0.05). No statistically significant differences in patient plaque control were found between the experimental and control groups. Among women, the use of systemic steroids is associated with a five-fold increase in the rate of dental implant failure, regardless of the presence of smoking or diabetes.

Comparison of Effectiveness of Hiora SG Gel With Triamcinolone Acetonide Gel in Recurrent Aphthous Stomatitis.

Background The oral condition known as recurrent aphthous ulceration (RAU) or recurrent aphthous stomatitis (RAS) is very prevalent. Its etiopathogenesis is unknown; hence, symptomatic therapy is all that can be offered if it manifests clinically. Lesion care aims to minimize discomfort and the frequency of relapses by bringing active illness under local control in the affected area. The current treatment options that may have negative side effects include the use of topical and systemic steroids, antibiotics, cauterization, and laser therapy. Objectives and Importance This study aimed to compare the efficiency of HiOra SG gel with triamcinolone acetonide gel in the management of RAS. Materials and Methods Fifty individuals with RAS were recruited for the trial and randomly assigned to either group I (HiOra SG gel) or group II (0.1% triamcinolone acetonide ointment; Oraways). After each meal for a total of 10 days, those with mouth ulcers were instructed to topically administer the drugs. The clinical data were analyzed by comparing the ulcer severity scores from the first, fifth, and 10th days. Results There was a statistically significant (p = 0.001) reduction in reported pain, pain duration, and overall ulcer severity across all groups. After therapy, however, neither the HiOra gel group nor the triamcinolone group showed any discernible improvement over the other. Conclusion The present study's findings corroborate the efficacy of HiOra SG gel in the treatment of RAS when compared to triamcinolone acetonide gel (0.1%). In this trial, no patients had any negative reactions to HiOra SG gel. In the future, further studies are needed with larger samples to prove its benefits.