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https://www.readbyqxmd.com/read/29440316/glial-fibrillary-acidic-protein-antibody-positive-meningoencephalomyelitis
#1
Angeliki Zarkali, Oliver Cousins, Dilan Athauda, Samuel Moses, Nicholas Moran, Sreedharan Harikrishnan
Glial fibrillary acidic protein antibody-positive meningoencephalomyelitis is a newly described, possibly under-recognised, severe inflammatory condition of the nervous system. The clinical presentation is variable but most commonly is a combination of meningitis, encephalitis and myelitis; other manifestations may include seizures, psychiatric symptoms and tremor. There is a significant association with malignancies, often occult, and with other autoimmune conditions. Although the disease responds well to corticosteroids acutely, it typically relapses when these are tapered, and so patients need long-term immunosuppression...
February 9, 2018: Practical Neurology
https://www.readbyqxmd.com/read/29416367/profile-of-dupilumab-and-its-potential-in-the-treatment-of-inadequately-controlled-moderate-to-severe-atopic-dermatitis
#2
REVIEW
Olabola Awosika, Lori Kim, Momina Mazhar, Monica Rengifo-Pardo, Alison Ehrlich
Atopic dermatitis (AD) is a common inflammatory skin disorder that manifests as eczematous lesions, often associated with allergic rhinitis and asthma. Historically, moderate-to-severe disease has been managed with systemic immunosuppression, such as oral corticosteroids, which result in relapse and limiting side effects. Due to recent advancements in the identification of interleukin (IL)-4 and IL-13 as key mediators in AD, new biological agents have been developed for treatment. Dupilumab is a recently approved monoclonal antibody that targets the alpha subunit of the IL-4 receptor and, thus, downregulates activity of IL-4 and IL-13...
2018: Clinical, Cosmetic and Investigational Dermatology
https://www.readbyqxmd.com/read/29401297/long-term-outcome-of-early-combined-immunosuppression-versus-conventional-management-in-newly-diagnosed-crohn-s-disease
#3
Daniël R Hoekman, Judith A Stibbe, Filip J Baert, Philip Caenepeel, Philippe Vergauwe, Martine De Vos, Daniel W Hommes, Marc A Benninga, Severine A Vermeire, Geert R D'Haens
Background and Aims: Long term outcomes of early combined immunosuppression (top-down) compared to conventional management (step-up) in recently diagnosed Crohn's disease (CD) are unknown. We aimed to investigate long-term outcomes of participants of the Step-up/Top-down-trial. Methods: Trial participants' medical records were reviewed retrospectively. For 16 semesters following the 2-year trial, we recorded: clinical activity, medication use, flares, hospitalization, surgery and fistulas...
February 1, 2018: Journal of Crohn's & Colitis
https://www.readbyqxmd.com/read/29395966/long-term-management-and-persistent-impairment-of-pulmonary-function-in-chronic-eosinophilic-pneumonia-a-review-of-the-previous-literature
#4
REVIEW
Yuzo Suzuki, Takafumi Suda
Chronic eosinophilic pneumonia (CEP) is an inflammatory disease characterized by accumulations of eosinophils in the lung with unknown etiology. Although corticosteroid treatment dramatically resolves these inflammations, relapse is common during the course of the disease. Approximately 50% of patients with CEP experience relapse. Subsequent to persistent disease and repeated relapse, and in cases of combined severe asthma, some CEP patients are administered corticosteroids indefinitely. Similar to patients with severe asthma who are often steroid dependent, a number of CEP patients exhibit prolonged persistent impairment of pulmonary function...
January 23, 2018: Allergology International: Official Journal of the Japanese Society of Allergology
https://www.readbyqxmd.com/read/29394648/-pneumatosis-cystoides-intestinalis-after-hematopoietic-stem-cell-transplantation-for-malignant-lymphoma-a-case-report
#5
Chihoko Nobori, Naoki Aomatsu, Yasutake Uchima, Takuma Okada, Hironari Miyamoto, Shigeaki Kurihara, En Wang, Toshiki Hirakawa, Takehiko Iwauchi, Junya Morimoto, Shigehito Yamagata, Kazunori Nakazawa, Kazuhiro Takeuchi
A 47-year-old man underwent hematopoietic stem cell transplantation for malignant lymphoma. He developed acute skin graft versus host disease(GVHD)and pneumomycosis which were treated with steroids. One hundred and fifteen days later, the patient had a diagnosis of free gas images in the abdominal cavity and streakly air collections in the bowel wall from the ascending colon to the sigmoid colon in the CT scan. He was asymptomatic and his physical examination was unrevealing. We diagnosed his condition as pneumatosis cystoides intestinalis(PCI)...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29336434/acg-clinical-guideline-alcoholic-liver-disease
#6
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
https://www.readbyqxmd.com/read/29333824/eosinophilic-esophagitis-and-esophageal-atresia-coincidence-or-causality
#7
Karen V Stave Salgado, Ana M Rocca
Eosinophilic esophagitis is an immune-mediated chronic disease of the esophagus characterized by symptoms related to esophageal dysfunction and tissue eosinophilia. In the endoscopy, the esophageal mucosa may appear normal or show exudates, rings, edema, furrows, and strictures. Its management is based on elimination diet, topical corticosteroids and/or esophageal dilation. Atresia is the most common congenital alteration of the esophagus; it requires surgical repair and poses potential complications, such as gastroesophageal reflux, strictures, and esophageal dysmotility...
February 1, 2018: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/29317810/inhaled-therapies-in-patients-with-moderate-copd-in-clinical-practice-current-thinking
#8
REVIEW
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
https://www.readbyqxmd.com/read/29317770/corticosteroid-sparing-in-inflammatory-bowel-disease-is-more-often-achieved-in-the-immunomodulator-and-biological-era-results-from-the-dutch-population-based-ibdsl-cohort
#9
Steven F G Jeuring, Vince B C Biemans, Tim R A van den Heuvel, Maurice P Zeegers, Wim H Hameeteman, Mariëlle J L Romberg-Camps, Liekele E Oostenbrug, Ad A M Masclee, Daisy M A E Jonkers, Marieke J Pierik
OBJECTIVES: Corticosteroid-free remission is an emerging treatment goal in the management of inflammatory bowel disease (IBD). In the population-based Inflammatory Bowel Disease South Limburg cohort, we studied temporal changes in corticosteroid use and assessed the corticosteroid-sparing effects of immunomodulators and biologicals in real life. METHODS: In total, 2,823 newly diagnosed patients with Crohn's disease (CD) or ulcerative colitis (UC) were included. Corticosteroid exposure and cumulative days of use were compared between patients diagnosed in 1991-1998 (CD: n=316, UC: n=539), 1999-2005 (CD: n=387, UC: n=527), and 2006-2011 (CD: n=459, UC: n=595)...
January 9, 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29316778/role-of-liver-transplantation-in-severe-alcoholic-hepatitis
#10
Ravi Daswani, Ashish Kumar, Praveen Sharma, Vikas Singla, Naresh Bansal, Anil Arora
Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which can potentially provide long term benefit for patients who are steroid non-responders...
January 10, 2018: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/29315479/long-term-management-of-moderate-to-severe-atopic-dermatitis-with-dupilumab-and-concomitant-topical-corticosteroids-liberty-ad-chronos-a-critical-appraisal
#11
J Thomson, A G H Wernham, H C Williams
AIM: Blauvelt et al. (The Lancet 2017; 389: 2287-303) aimed to compare the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids (TCS) versus placebo with TCS in adults with moderate-to-severe atopic dermatitis (AD). SETTING AND DESIGN: This multicentre randomised, double-blinded, placebo-controlled trial was conducted in hospitals, clinics and academic institutions across 161 sites in 14 countries. STUDY EXPOSURE: Adults with moderate-to-severe AD were randomly assigned (3:1:3) to receive subcutaneous dupilumab 300mg once weekly (qw) plus TCS, dupilumab 300mg every 2 weeks (q2w) plus TCS, or placebo plus TCS until week-52...
January 6, 2018: British Journal of Dermatology
https://www.readbyqxmd.com/read/29313589/role-of-clarithromycin-in-acute-exacerbations-of-chronic-obstructive-pulmonary-disease
#12
Agam Vora
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in under-developing and developing countries. As per current estimations, COPD will become the third leading cause of death globally, by 2030. Long-acting anti-cholinergic agents, β2-agonists, inhaled corticosteroids, antibiotics and mucolytics are few of the agents currently used in the treatment of COPD, which improve the symptoms and overall quality of life. Several of the important classes of antibiotics are used in the management of COPD including penicillins, cephalosporins, tetracyclines, fluoroquinolones, sulphonamides, aminoglycosides and macrolides...
September 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29305377/are-corticosteroid-injections-more-beneficial-than-anaesthetic-injections-alone-in-the-management-of-rotator-cuff-related-shoulder-pain-a-systematic-review
#13
REVIEW
Tim Cook, Catherine Minns Lowe, Mark Maybury, Jeremy S Lewis
OBJECTIVE: To compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP). DESIGN: Systematic review with best evidence synthesis. DATA SOURCES: The Cochrane, PubMed, CINAHL Plus, PEDro and EMBASE electronic databases were searched (inception until 8 June 2017). Reference lists of included articles were also hand searched. ELIGIBILITY CRITERIA: Two reviewers independently evaluated eligibility...
January 5, 2018: British Journal of Sports Medicine
https://www.readbyqxmd.com/read/29296878/management-of-newly-diagnosed-immune-thrombocytopenia-can-we-change-outcomes
#14
REVIEW
Cindy E Neunert
Immune thrombocytopenia resulting from antibody-mediated platelet destruction combined with impaired platelet production is a common cause of thrombocytopenia. The decision to treat newly diagnosed patients is based on several factors including ceasing hemorrhagic manifestations, increasing the platelet count, prevention of bleeding, and inducing remission. Current standard first-line therapy is a course of corticosteroids. Although this treatment paradigm increases the platelet count in the majority of patients, a high percentage relapse after discontinuation of corticosteroid therapy...
November 14, 2017: Blood Advances
https://www.readbyqxmd.com/read/29246209/airway-administration-of-corticosteroids-for-prevention-of-bronchopulmonary-dysplasia-in-premature-infants-a-meta-analysis-with-trial-sequential-analysis
#15
Zhi-Qun Zhang, Ying Zhong, Xian-Mei Huang, Li-Zhong Du
BACKGROUND: Uncertainly prevails with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. The meta-analysis with sequential analysis was designed to evaluate the efficacy and safety of airway administration (inhalation or instillation) of corticosteroids for preventing bronchopulmonary dysplasia (BPD) in premature infants. METHODS: We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL from their inceptions to February 2017...
December 15, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29238519/how-to-manage-anaphylaxis-in-primary-care
#16
REVIEW
Alberto Alvarez-Perea, Luciana Kase Tanno, María L Baeza
Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or circulation problems. It presents with very different combinations of symptoms and apparently mild signs and can progress to fatal anaphylactic shock unpredictably. The difficulty in recognizing anaphylaxis is due, in part, to the variability of diagnostic criteria, which in turn leads to a delay in administration of appropriate treatment, thus increasing the risk of death...
2017: Clinical and Translational Allergy
https://www.readbyqxmd.com/read/29226117/pediatric-anti-n-methyl-d-aspartate-receptor-encephalitis-a-review-with-pooled-analysis-and-critical-care-emphasis
#17
REVIEW
Kenneth E Remy, Jason W Custer, Joshua Cappell, Cortney B Foster, Nan A Garber, L Kyle Walker, Liliana Simon, Dayanand Bagdure
Purpose: Anti- N -methyl-d-aspartate receptor (NMDAR) encephalitis is being recognized with increasing frequency among children. Given the paucity of evidence to guide the critical care management of these complex patients, we provide a comprehensive review of the literature with pooled analysis of published case reports and case series. Methods: We performed a comprehensive literature search using PubMed, Scopus, EMBASE, and Web of Science for relevant published studies...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29222284/management-of-newly-diagnosed-immune-thrombocytopenia-can-we-change-outcomes
#18
REVIEW
Cindy E Neunert
Immune thrombocytopenia resulting from antibody-mediated platelet destruction combined with impaired platelet production is a common cause of thrombocytopenia. The decision to treat newly diagnosed patients is based on several factors including ceasing hemorrhagic manifestations, increasing the platelet count, prevention of bleeding, and inducing remission. Current standard first-line therapy is a course of corticosteroids. Although this treatment paradigm increases the platelet count in the majority of patients, a high percentage relapse after discontinuation of corticosteroid therapy...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29216852/access-to-affordable-medicines-and-diagnostic-tests-for-asthma-and-copd-in-sub-saharan-africa-the-ugandan-perspective
#19
Davis Kibirige, Leaticia Kampiire, David Atuhe, Raymond Mwebaze, Winceslaus Katagira, Winters Muttamba, Rebecca Nantanda, William Worodria, Bruce Kirenga
BACKGROUND: Equitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease (COPD). In Uganda, we lack contemporary data about the availability, cost and affordability of medicines and diagnostic tests essential in asthma and COPD management. METHODS: Data on the availability, cost and affordability of 17 medicines and 2 diagnostic tests essential in asthma and COPD management were collected from 22 public hospitals, 23 private and 85 private pharmacies...
December 8, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29214511/managing-gout-flares-in-the-elderly-practical-considerations
#20
Abhishek Abhishek
Gout is common in the elderly, affecting an estimated 4.7 million people aged > 60 years in the USA alone. The incidence and prevalence of gout increases, and male predisposition to gout reduces, with increasing age. The elderly have more comorbidities, and gout manifests differently, with more frequent involvement of knees, ankles, and wrists at disease onset, systemic upset, and tophi. Comorbidities and polypharmacy make the management of gout flares challenging in this population. Intra-articular corticosteroid injection remains the treatment of choice for accessible joints, oral prednisolone is preferred over low-dose colchicine, and non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided...
December 6, 2017: Drugs & Aging
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