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long term corticosteroid management

Katsuhisa Ikeda, Shin Ito, Remi Hibiya, Hirotomo Homma, Noritsugu Ono, Hiroko Okada, Yoshinobu Kidokoro, Akihito Shiozawa, Takeshi Kusunoki
Introduction  Eosinophilic chronic rhinosinusitis (ECRS) is characterized by an eosinophilic inflammation driven by Th2-type cytokines. Glucocorticosteroids are the most common first-line treatment for ECRS with nasal polyps. Objective  We have evaluated the long-term treatment with double-dose intranasal corticosteroids in refractory ECRS nasal polyps resistant to the conventional dose and assessed the risk of adverse systemic effects Methods  Sixteen subjects were enrolled in this study. All subjects had ECRS after endoscopic sinus surgery that resulted in recurrent mild and moderate nasal polyps and were undergoing a postoperative follow-up application of mometasone furoate at a dose of 2 sprays (100 μg) in each nostril once a day (200 μg)...
January 2019: International Archives of Otorhinolaryngology
João Coelho, Bernardete Pessoa, Angelina Meireles
Introduction: Macular edema after central retinal vein occlusion is a common cause of vision loss. Upregulation of vascular endothelial growth factor and higher levels of inflammatory mediators have been involved in the pathogeny of the macular edema in central retinal vein occlusion. Case report: The authors report a case with non-ischemic central retinal vein occlusion that was successfully treated with a single sustained-release fluocinolone acetonide intravitreal implant...
January 2019: Therapeutic advances in ophthalmology
Almutez Gharaibeh, Howard I Savage, Roberta W Scherer, Morton F Goldberg, Kristina Lindsley
BACKGROUND: Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g. corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications can lead to permanent impairment of vision. People with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure...
January 14, 2019: Cochrane Database of Systematic Reviews
Lieven Dupont, Charles Pilette, Florence Schleich, Guy Joos
OBJECTIVES: Non-adherence to asthma medication can lead to lower disease control and asthma exacerbations that may be fatal. This survey assessed the attitude and expectations of Belgian asthma patients towards their treatment. METHODS: This cross-sectional survey was conducted between June 2015 and February 2016 in 70 Belgian pharmacies. Participants completing the survey had to be ≥15 years, diagnosed with asthma, and on inhaled corticosteroid-based treatment...
January 14, 2019: Acta Clinica Belgica
Rhys D R Evans, Tamsin Cargill, George Goodchild, Ben Oliveira, Manuel Rodriguez-Justo, Ruth Pepper, John Connolly, Alan Salama, George Webster, Eleanor Barnes, Emma L Culver
Introduction: IgG4-related disease (IgG4-RD) is a relapsing multisystem fibro-inflammatory disease, which may involve the kidney (IgG4-related kidney disease [IgG4-RKD]) and retroperitoneum (IgG4-related retroperitoneal fibrosis [IgG4-RPF]). The aim of this study was to describe IgG4-RKD and IgG4-RPF in the United Kingdom. Methods: We conducted a retrospective observational study of patients with IgG4-RKD and IgG4-RPF in a multicenter IgG4-RD cohort. Data were collected through review of medical records...
January 2019: KI Reports
Carlos Adrián Chávez-Mendoza, José Antonio Niño-Cruz, Ricardo Correa-Rotter, Norma Ofelia Uribe-Uribe, Juan Manuel Mejía-Vilet
Introduction: High-dose corticosteroids remain the first-line therapy for focal and segmental glomerulosclerosis (FSGS), whereas calcineurin inhibitors (CNIs) are reserved for those patients resistant to corticosteroid therapy. Methods: This is a retrospective cohort analysis in patients with primary FSGS diagnosed between 2007 and 2014. According to the administered treatment, patients were segregated into 3 groups: high-dose prednisone, first-line CNIs plus low-dose prednisone, and rescue CNIs...
January 2019: KI Reports
Dario Gregori, Giampaolo Giacovelli, Clara Minto, Beatrice Barbetta, Francesca Gualtieri, Danila Azzolina, Paola Vaghi, Lucio C Rovati
Importance: Even though osteoarthritis is a chronic and progressive disease, pharmacological agents are mainly studied over short-term periods, resulting in unclear recommendations for long-term disease management. Objective: To search, review, and analyze long-term (≥12 months) outcomes (symptoms, joint structure) from randomized clinical trials (RCTs) of medications for knee osteoarthritis. Data Sources and Study Selection: The databases of MEDLINE, Scopus, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched until June 30, 2018 (MEDLINE alerts through August 31, 2018) for RCTs of patients with knee osteoarthritis that had treatment and follow-up lasting 1 year or longer...
December 25, 2018: JAMA: the Journal of the American Medical Association
Elida Zairina, Gesnita Nugraheni, Gusti Nv Achmad, Arie Sulistyarini, Yunita Nita, Arief Bakhtiar, Muhammad Amin
BACKGROUND: Asthma is a chronic disease that requires indefinite long-term therapy. Many approaches have been developed to enable people with asthma to live as normally as possible. In medication therapy management, pharmacists could play important roles in supporting the everyday life of asthmatic patients, such as by providing education therapy management to ensure that patients achieve optimal therapeutic outcomes. A good collaboration between health care practitioners and patients will produce a better system in terms of therapeutic management, which will lead to health care cost savings related to emergency visits...
December 18, 2018: JMIR Research Protocols
Robert J Barry, Mohammad O Tallouzi, Nick Bucknall, Jonathan M Mathers, Philip I Murray, Melanie J Calvert, David J Moore, Alastair K Denniston
BACKGROUND: Non-infectious uveitis describes a heterogenous group of ocular disorders characterised by intraocular inflammation in the absence of infection. Uveitis is a leading cause of visual loss, most commonly due to uveitic macular oedema (UMO). Treatment is aimed at reducing disease activity by suppression of the intraocular inflammatory response. In the case of macular oedema, the aim is to restore macular architecture as quickly as possible, in order to prevent irreversible photoreceptor damage in this area...
December 18, 2018: Cochrane Database of Systematic Reviews
Daniel F Jones, Jeffrey D Hodgden, Cheyn D Onarecker
Clinical Question: In adults with osteoarthritis of the knee, do conservative management methods such as weight reduction, physical therapy, Tai Chi, non-steroidal anti-inflammatory drugs (NSAIDs), and others provide more and longer pain relief and functionality of the knee, as well as overall well-being, when compared to corticosteroid knee injections? Answer: Yes. Although there are limited head-to-head trials directly comparing each alternative method to corticosteroid injections, overall evidence appears to indicate conservative methods as being more effective than injections, especially when considering long-term pain relief and functionality...
August 2018: Journal of the Oklahoma State Medical Association
Risa B Burns, C Christopher Smith, Robert H Shmerling, Anjala Tess
Gout is the most common form of inflammatory arthritis. In 2012, the American College of Rheumatology (ACR) issued a guideline, which was followed in 2017 by one from the American College of Physicians (ACP). The guidelines agree on treating acute gout with a corticosteroid, nonsteroidal anti-inflammatory drug, or colchicine and on not initiating long-term urate-lowering therapy (ULT) for most patients after a first gout attack and in those whose attacks are infrequent (<2 per year). However, they differ on treatment of both recurrent gout and problematic gout...
December 4, 2018: Annals of Internal Medicine
Philippe Lavigne, Stella E Lee
Objective: To provide new insight into how chronic rhinosinusitis (CRS) is conceptualized and treated with a focus on immunomodulator therapy. Data sources: Pubmed, Medline, and Embase. Methods: A current review of the evidence is provided for immunomodulators investigated for treatment of CRS with nasal polyps (CRSwNP). Results: Biologic therapies targeting IgE, IL-4, IL-5, and IL-13 for the treatment of CRSwNP have shown promise and are currently in phase 3 trials...
September 2018: World Journal of Otorhinolaryngology—Head and Neck Surgery
Omer Karti, Ali Osman Saatci
Macular Edema (ME) is a common complication, leading to severe vision loss in patients with Non-Infectious Uveitis (NIU). The treatment of uveitic ME is still very challenging for many ophthalmologists. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combatting uveitic ME. However, there is not enough evidence to support the efficacy of any of these agents. Intravitreal Dexamethasone Implant (IDI) (Ozurdex; Allergan Inc, Irvine, CA) is a widely administered corticosteroid for the long-term management of uveitic ME in certain cases...
2018: Medical Hypothesis, Discovery and Innovation in Ophthalmology
Tania Jain, Mark R Litzow
Therapeutic options for acute lymphoblastic leukemia, especially in the relapsed/refractory setting, have expanded significantly in recent times. However, this comes at the cost of toxicities: medical as well as financial. We highlight some of the unique toxicities associated with the novel agents to apprise our readers about what to expect, how to recognize them, and how to manage these toxicities. One of the toxicities seen with inotuzumab, a CD22 antibody drug conjugate, is sinusoidal obstruction syndrome, which can be fatal in >80% of patients if associated with multiorgan failure...
November 30, 2018: Hematology—the Education Program of the American Society of Hematology
Konstantinos Argyriou, Sunil Samuel, Gordon W Moran
BACKGROUND: Mesalazine-refractory ulcerative proctitis is common, with a significant proportion of the patients requiring escalation to immunomodulators or biological therapy. Three small preliminary cohort studies suggested good clinical efficacy for the organic arsenic derivative acetarsol in the management of proctitis. Our aim was to describe our experience on the use of acetarsol in proctitis and to review all existing evidence on its safety and efficacy. PATIENTS AND METHODS: We retrospectively reviewed clinical records of all ulcerative colitis patients exposed to acetarsol at Nottingham University Hospitals since 2012...
February 2019: European Journal of Gastroenterology & Hepatology
Tania Jain, Mark R Litzow
Therapeutic options for acute lymphoblastic leukemia, especially in the relapsed/refractory setting, have expanded significantly in recent times. However, this comes at the cost of toxicities: medical as well as financial. We highlight some of the unique toxicities associated with the novel agents to apprise our readers about what to expect, how to recognize them, and how to manage these toxicities. One of the toxicities seen with inotuzumab, a CD22 antibody drug conjugate, is sinusoidal obstruction syndrome, which can be fatal in >80% of patients if associated with multiorgan failure...
November 27, 2018: Blood Advances
Joseph Dadabo, Prakash Jayabalan
Traumatic cervical spine injuries represent a significant cause of morbidity and mortality in sports. Appropriate management of such injuries is critical to minimizing harm and facilitating optimal long-term recovery and outcome. Management strategies begin with emergency preparedness amongst sideline providers and extends to paramedic services and medical teams in the acute care setting. This chapter outlines the principles of treatment across the care continuum, with a primary focus on hospital-based care...
2018: Handbook of Clinical Neurology
Rosanna Coppo
The search of personalized treatment for a subject with immunoglobulin A nephropathy (IgAN) is appealing since the individual long-term outcome is highly variable in spite of common mild clinical signs such as microscopic haematuria, moderate proteinuria and slightly reduced glomerular filtration rate (GFR). The only risk factor considered by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines to target corticosteroid/immunosuppressive treatment in IgAN is proteinuria persistently >1 g/day despite 3-6 months of optimized supportive care...
November 26, 2018: Nephrology, Dialysis, Transplantation
Wilson C Lai, Brandon J Erickson, Ryan A Mlynarek, Dean Wang
Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques...
2018: Open Access Journal of Sports Medicine
Maciej Kupczyk, Piotr Kuna
The triple therapy term covers the combination of inhaled corticosteroid (ICS), long-acting β-receptor agonist (LABA) and long-acting anticholinergic drug (LAMA) in one or in separate inhalers. The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations...
November 21, 2018: Expert Review of Respiratory Medicine
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