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Corticosteroids withdrawal

Guillaume Moulis, Grégory Pugnet, Nathalie Costedoat-Chalumeau, Alexis Mathian, Gaëlle Leroux, Jonathan Boutémy, Olivier Espitia, Laurence Bouillet, Sabine Berthier, Jean-Baptiste Gaultier, Pierre-Yves Jeandel, Amadou Konaté, Arsène Mékinan, Elisabeth Solau-Gervais, Benjamin Terrier, Daniel Wendling, Fanny Andry, Camille Garnier, Pascal Cathébras, Laurent Arnaud, Aurore Palmaro, Patrice Cacoub, Zahir Amoura, Jean-Charles Piette, Philippe Arlet, Maryse Lapeyre-Mestre, Laurent Sailler
OBJECTIVES: To assess the efficacy and the safety of biologics in a cohort of patients with relapsing polychondritis (RP). METHODS: We conducted a French multicentre retrospective cohort study including patients treated with biologics for RP. Efficacy outcomes were clinical response (partial or complete) and complete response during the first 6 months of exposure, plus daily corticosteroid dose at 6 months. Other outcomes were adverse drug reactions (ADRs), persistence of biologics and factors associated with a response...
March 13, 2018: Annals of the Rheumatic Diseases
Katherine G Gold, Stacy Scofield, Steven R Isaacson, Michael W Stewart, Michael Kazim
PURPOSE: To evaluate the effectiveness of orbital radiotherapy (ORT) in the treatment of thyroid eye disease (TED)-compressive optic neuropathy. METHODS: A retrospective review of patients with corticosteroid-responsive compressive optic neuropathy due to TED treated with ORT. Study was conducted in compliance with Health Insurance Portability and Accountability Act. One hundred four patients (163 orbits) with a mean age of 61.7 years met inclusion criteria. Seventy-four percent (77/104) were female, and 32...
March 2018: Ophthalmic Plastic and Reconstructive Surgery
Eugeni Domènech, Julián Panés, Joaquín Hinojosa, Vito Annese, Fernando Magro, Giacomo Carlo Sturniolo, Fabrizio Bossa, Francisco Fernández, Benito González-Conde, Valle García-Sánchez, Axel Dignass, José Manuel Herrera, José Luis Cabriada, Jordi Guardiola, Maurizio Vecchi, Francisco Portela, Daniel Ginard
Background and Aims: Steroid-dependency occurs in up to 30% of patients with ulcerative colitis (UC). In this setting, few drugs have demonstrated efficacy in inducing steroid-free remission. The aim was to evaluate the efficacy and safety of adding granulocyte/monocyte apheresis (GMA) to oral prednisone in patients with steroid-dependent UC. Methods: Randomized, multicentre, open trial comparing 7 weekly sessions of GMA plus oral prednisone (40mg/day and tapering) to prednisone alone in patients with active, steroid-dependent UC (Mayo score 4-10 and inability to withdraw corticosteroids in 3 months or relapse within the first 3 months after discontinuation)...
February 27, 2018: Journal of Crohn's & Colitis
Nemin Zhu, Neal E Rowe, Paul R Martin, Sean S Luke, Thomas B Mcgregor, Frank Myslik, Vivian C Mcalister, Alp Sener, Patrick P Luke
INTRODUCTION: We sought to determine whether protocol biopsies could be used to guide treatment and improve outcomes in simultaneous pancreas-kidney (SPK) patients. METHODS: Between 2004 and 2013, protocol biopsies were performed on SPK patients at 3-6 months and one year post-transplant. Maintenance immunosuppression consisted of a calcineurin inhibitor, anti-proliferative agent, and corticosteroid. Corticosteroid was withdrawn in negative early biopsies, maintained in subclinical/borderline biopsies, and increased if Banff IB or greater rejection was identified...
February 23, 2018: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Ben Kang, So Yoon Choi, Young Ok Choi, Min-Ji Kim, Kyunga Kim, Ji-Hyuk Lee, Yon Ho Choe
Background and aims: We aimed to investigate the outcome in paediatric-onset Crohn's disease patients who had discontinued infliximab after maintaining clinical remission with combined immunosuppression, and to determine factors associated with clinical relapse. Methods: We conducted a retrospective observational study of 63 paediatric-onset Crohn's disease patients who had stopped scheduled infliximab during sustained corticosteroid-free clinical remission for at least 1 year with infliximab and azathioprine, and were followed up for at least 1 year thereafter...
February 21, 2018: Journal of Crohn's & Colitis
U D Kombila, W Ka, F B R Mbaye, N F Diouf, L Fall, P Ouedraogo, A N E Koutonin, Y Dia Kane, N Oumar Toure Badiane
INTRODUCTION: The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe drug-induced reaction. CASE REPORT: We report the case of a 35-year-old man treated by RHEZ for a first episode of a smear positive pulmonary tuberculosis and who developed a DRESS syndrome due to pyrazinamide after twenty days of treatment, associated with a viral reactivation to Human Herpes Virus 6 (HHV6). He had a skin eruption, liver involvement and hypereosinophilia...
January 2018: Revue des Maladies Respiratoires
S X Li, J T Wang, Y Jiang, X Wang, W Y Shi
Objective: To evaluate the efficacy of modified deep lamellar keratoplasty (DLKP) combined with antiviral medications for severe herpes necrotizing stromal keratitis. Methods: Retrospective case series study. Modified DLKP was performed in combination with antiviral medications in fifty patients (50 eyes) with severe necrotizing stromal keratitis, which was unresponsive to systemic and topical antiviral treatment for 1 week, at Shandong Eye Hospital. Before surgery, the operated eyes were examined using slit-lamp microscopy...
February 11, 2018: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
Angelica Tiotiu, Yves Martinet, Roger Jankowski, Philippe Devillier
We report on five adult cases of the rare association of asthma with humoral immunodeficiency (huID). All patients had uncontrolled asthma related to recurrent respiratory infections. Asthma was diagnosed according to the Global Initiative for Asthma (GINA) guidelines, and bronchiectasis was ruled out by a CT chest scan. Two men (aged 28 and 60) presented with pollen allergies, chronic rhinosinusitis, and IgG deficiency (7.8 and 7.6 g/L, respectively). Both patients underwent surgery for nasal polyposis but relapsed with acute sinusitis and severe asthma exacerbations requiring treatment with oral corticosteroids and antibiotics...
February 8, 2018: Journal of Asthma: Official Journal of the Association for the Care of Asthma
Zaurbek Aisanov, Sergey Avdeev, Vladimir Arkhipov, Andrey Belevskiy, Alexander Chuchalin, Igor Leshchenko, Svetlana Ovcharenko, Evgeny Shmelev, Marc Miravitlles
The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs) in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Sophie Demarche, Florence Schleich, Monique Henket, Virginie Paulus, Renaud Louis, Thierry Van Hees
BACKGROUND: While non-eosinophilic asthmatics are usually considered poorly responsive to inhaled corticosteroids (ICS), studies assessing a step-down of ICS in this specific population are currently lacking. OBJECTIVES: To assess the proportion of non-eosinophilic asthmatics in whom ICS may be withdrawn without any clinical degradation and to determine the predictive markers of a failure to stop treatment with ICS. METHODS: This prospective study was completed by 36 non-eosinophilic asthmatics, defined by sputum eosinophils <3% and blood eosinophils <400/μL...
January 31, 2018: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
Mitsuru Sakakibara, Kazuyoshi Ohkawa, Takatoshi Nawa, Yutaro Abe, Akira Kusakabe, Toshihiro Imai, Kazuhiro Katayama
We describe a rare case of drug-induced hepatitis due to the smoking cessation agent varenicline in a 46-year-old Asian woman. The liver injury progressed in two steps. First, the liver injury started in the absence of viral/autoimmune responses, and withdrawal of varenicline lowered the increase in the levels of liver enzymes immediately. Such findings suggested varenicline-induced liver injury. Second, hepatitis recurred in association with conversion of antinuclear antibody from negative to positive about 8 weeks after the initial episode...
January 30, 2018: Clinical Journal of Gastroenterology
Sandra Shenouda, Khaled Al-Farawi, Jenna Dolan, Susan L Flesher
Idiopathic intracranial hypertension is a diagnosis of exclusion defined by elevated intracranial pressure without mass lesions or hydrocephalus. Causes of idiopathic intracranial hypertension include obesity, vitamin derangements, antibiotics, corticosteroids, and autoimmune disorders. Cushing's disease and Addison's disease have been associated with idiopathic intracranial hypertension. Secondary adrenal insufficiency following withdrawal of inhaled corticosteroids has been found to be a relatively common phenomenon...
2018: SAGE open medical case reports
Ashwani K Singal, Ramon Bataller, Joseph Ahn, Patrick S Kamath, Vijay H Shah
Alcoholic liver disease (ALD) comprises a clinical-histologic spectrum including fatty liver, alcoholic hepatitis (AH), and cirrhosis with its complications. Most patients are diagnosed at advanced stages and data on the prevalence and profile of patients with early disease are limited. Diagnosis of ALD requires documentation of chronic heavy alcohol use and exclusion of other causes of liver disease. Prolonged abstinence is the most effective strategy to prevent disease progression. AH presents with rapid onset or worsening of jaundice, and in severe cases may transition to acute on chronic liver failure when the risk for mortality, depending on the number of extra-hepatic organ failures, may be as high as 20-50% at 1 month...
January 16, 2018: American Journal of Gastroenterology
Hanako Tsurumi, Yoshihide Fujigaki, Tadashi Yamamoto, Risa Iino, Kei Taniguchi, Michito Nagura, Shigeyuki Arai, Yoshifuru Tamura, Tatsuru Ota, Shigeru Shibata, Fukuo Kondo, Nozomu Kurose, Yasufumi Masaki, Shunya Uchida
Thrombocytopenia, ascites, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a newly recognized but rare disease, and its treatment has not yet been established. We reported a 50-year-old woman with TAFRO syndrome diagnosed 2 years after the initial symptoms of a fever, fatigue, epigastric pain, edema, ascites, lymphadenopathy, thrombocytopenia and renal insufficiency. The patient showed refractory ascites and required hemodialysis under corticosteroid mono-therapy for suspected immune-mediated disease but was successfully treated with additive rituximab, resulting in improvement in her laboratory data, the withdrawal of hemodialysis and the disappearance of ascites...
January 11, 2018: Internal Medicine
Amnon Ariel, Alan Altraja, Andrey Belevskiy, Piotr W Boros, Edvardas Danila, Matjaz Fležar, Vladimir Koblizek, Zvi G Fridlender, Kosta Kostov, Alvils Krams, Branislava Milenkovic, Attila Somfay, Ruzena Tkacova, Neven Tudoric, Ruxandra Ulmeanu, Arschang Valipour
COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Olivia Wilcox, Mohamed Hassanein, John Armstrong, Nader Kassis
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity drug reaction involving the skin and multiple internal organ systems. The symptoms typically present with fever and skin rash, and rapidly progress to multiple organ failures. Vancomycin is a rare drug to cause DRESS syndrome with 23 cases reported to date. CASE PRESENTATION: We described a case of a 39 year-old man who was treated with vancomycin for osteomyelitis of the foot...
December 28, 2017: BMC Pulmonary Medicine
Sohail Abdul Salim, Litty Thomas, Amanda Quorles, Seyed Mehrdad Hamrahian, Tibor Fülöp
The occurrence of the autoimmune blistering disease, bullous pemphigoid (BP), in patients with failed renal allograft is rare and the few reported cases suggest various provocative factors without reaching a consensus. Here we report the case of a patient presenting with bullous lesions soon after the complete discontinuation of immunosuppressant therapy following renal allograft failure. Skin biopsy confirmed the diagnosis of BP. Administration of systemic corticosteroid controlled the occurrence of BP lesions in our patient...
December 11, 2017: Hemodialysis International
Piia Sarajärvi, Minna Kubin, Kaisa Tasanen, Laura Huilaja
DRESS (drug reaction with eosinophilia and systemic symptoms) is a rare, severe multiorgan adverse drug reaction. Antiepileptic age's and antibiotics are the most frequently reported causative agents. Compared with other drug reactions, DRESS demonstrates a long latency period thus complicating recognition and diagnosis. DRESS is defined as presence of fever, skin eruption, hematologic abnormalities and systemic involvement, especially liver injury. Withdrawal of the culprit drug, commencement of systemic corticosteroid and supportive care are the mainstay of treatment...
2017: Duodecim; Lääketieteellinen Aikakauskirja
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