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long term corticosteroid management

Anil C Anand, Radha K Dhiman
Acute on chronic liver failure (ACLF) is a recently recognized syndrome and its definition has been evolving over last two decades. Currently, there is no universal consensus about the definition as kind of cases being seen in the Western world appear to be somewhat different from those that are seen in Asia Pacific region. But every one agrees that definition of ACLF should include following components. (a) The status of pre-existing liver disease, (b) defining the acute insult that leads to rapid deterioration of liver status, (c) time frame during which the acute insult can lead to rapid deterioration, (d) the quantification and definition of liver failure status after deterioration, which will determine the severity of ACLF, and (e) prediction of prognosis after analyzing first four components in the short and long terms...
September 2016: Journal of Clinical and Experimental Hepatology
John J Mccarthy, Martin H Leamon, Loretta P Finnegan, Catherine Fassbender
Increase in the number of opioid dependent pregnant women delivering babies at risk for neonatal abstinence syndrome (NAS) prompted a General Accountability Office (GAO) report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are three general sources of dependence: untreated opioid use disorder (OUD), pain management, and medication assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral...
October 8, 2016: American Journal of Obstetrics and Gynecology
Massimo Imazio, Elena Gribaudo, Fiorenzo Gaita
Recurrent pericarditis is the most common and troublesome complication of pericarditis affecting 20 to 50% of patients. Its pathogenesis is often presumed to be immune-mediated, but additional investigations are needed to clarify the pathogenesis in order to develop etiology-oriented therapies. Imaging with Computed Tomography and especially Cardiac Magnetic Resonance holds promise to help in the identification of more difficult cases and improve their management. Refractory recurrent pericarditis with corticosteroid dependence and colchicine resistance remain still an unsolved issue in search of new therapies, although old drugs such as azathioprine, intravenous immunoglobulins, and biological agents seem promising, but new randomized clinical trials are needed to confirm their role...
October 7, 2016: Progress in Cardiovascular Diseases
Alexandre Minetto Brabo, Nayrana Soares Do Carmo Reis, Pasqual Barretti, Daniela Ponce
Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis that carries a high morbidity and mortality. Although its pathogenesis is still not clear, the "two hit theory" suggests that long term deterioration of the peritoneum combined with intraperitoneal inflammation is needed in the pathogenesis of EPS. To date, there is no proven effective therapy with an absence of randomized controlled trials. Individual case reports and small case series have reported on the use of tamoxifen and corticosteroids for medical management of EPS...
October 9, 2016: Hemodialysis International
Linda S Chesterton, Krysia S Dziedzic, Danielle A van der Windt, Graham Davenport, Helen L Myers, Trishna Rathod, Milica Blagojevic-Bucknall, Sue M Jowet, Claire Burton, Edward Roddy, Elaine M Hay
BACKGROUND: Patients diagnosed with idiopathic mild to moderate carpal tunnel syndrome (CTS) are usually managed in primary care and commonly treated with night splints and/or corticosteroid injection. The comparative effectiveness of these interventions has not been reliably established nor investigated in the medium and long term. The primary objective of this trial is to investigate whether corticosteroid injection is effective in reducing symptoms and improving hand function in mild to moderate CTS over 6 weeks when compared with night splints...
October 6, 2016: BMC Musculoskeletal Disorders
Ryo Atsuta, Yasuo To, Susumu Sakamoto, Isao Mukai, Akihiro Kobayashi, Arisa Kinoshita, Kazuhisa Takahashi
BACKGROUND: Maintaining high treatment adherence levels is critical for effective management of chronic diseases. The Adherence Starts with Knowledge 20 (ASK-20) questionnaire is the only linguistically validated patient-reported treatment adherence tool available in Japan. We conducted additional analyses on ASK-20 data from Japanese adults with asthma. METHODS: This was a prospective, non-interventional, single-visit, multi-centre study in Japanese adults (n = 300) with asthma receiving long-term treatment with inhaled corticosteroids (ICS) or ICS/long-acting beta-agonists...
October 3, 2016: Allergology International: Official Journal of the Japanese Society of Allergology
Daniel B Drachman
The basic abnormality in myasthenia gravis (MG) is a reduction in acetylcholine receptors (AChRs) at neuromuscular junctions due to the effects of autoantibodies that are directed against the AChRs in most patients, or against neighboring proteins involved in the clustering of AChRs (MuSK, LRP-4, or agrin). Clinically, MG is characterized by muscle weakness and fatigue, often in typical patterns. The diagnosis may be missed early, and depends on the recognition of clinical manifestations, the measurement of autoantibodies, and/or electrophysiological features...
October 2016: Seminars in Neurology
Alice He, Divya Sharma, Kazuki M Matsuda, Shawn G Kwatra
Chronic itch is a debilitating symptom that significant decreases patients' quality of life. Topical corticosteroids and antihistamines are commonly used for itch. However, these therapies are not long-term solutions for chronic pruritus because of their feared side effects, including skin atrophy and cognitive impairment, respectively. As such, dermatologists require additional therapies for long-term management of chronic pruritus. Topical anesthetics have been shown in many studies to be effective antipruritic agents...
September 30, 2016: Journal of Dermatological Treatment
Frank Ward, Joanne M Bargman
Membranous lupus nephritis (MLN) has a favorable prognosis compared to proliferative lupus nephritis (PLN) or combined MLN/PLN, although a significant proportion of cases will progress to end-stage kidney disease. There is considerable morbidity associated with thrombotic complications and treatment. Nondirected care includes renin-angiotensin-aldosterone system blockade, cardiovascular risk management, and antimalarial agents. There may be a role for corticosteroid monotherapy in some patients, but this requires further investigation...
September 20, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Belinda Sheary
BACKGROUND: Topical corticosteroid (TCS) withdrawal (addiction) is a potential complication of TCS treatment, particularly where there has been an inappropriate long-term use of moderate-to-potent TCS on the face or genital area. TCS addiction and withdrawal is increasingly being discussed in social and mainstream media; however, it has received little attention in medical publications. Australian general practitioners (GPs) may come into contact with patients who have read material or watched videos about this condition...
June 2016: Australian Family Physician
Stacy E Croteau, Deepti Gupta
Kasposiform hemoangioendothelioma (KHE) and tufted angioma (TA) are classifed as vascular tumors with locally aggressive and benign growth potential, respectively, within the classification schema proposed by the International Society for the Study of Vascular Anomalies. A unique feature of these vascular tumors is the risk of Kasabach-Merritt phenomenon (KMP), a severe thrombocytopenia with mild to moderate coagulopathy resulting from intralesional platelet trapping. As with many vascular anomalies, accurate description of clinical course, responses to therapy, and long-term outcomes have been hindered by lesion misidentification, imprecise nomenclature, and lack of prospective, randomized clinical trials to assess therapeutic efficacy...
September 2016: Seminars in Cutaneous Medicine and Surgery
Vincent Cottin, Elisabeth Bel, Paolo Bottero, Klaus Dalhoff, Marc Humbert, Romain Lazor, Renato A Sinico, Pasupathy Sivasothy, Michael E Wechsler, Matthieu Groh, Sylvain Marchand-Adam, Chahéra Khouatra, Benoit Wallaert, Camille Taillé, Philippe Delaval, Jacques Cadranel, Philippe Bonniaud, Grégoire Prévot, Sandrine Hirschi, Anne Gondouin, Bertrand Dunogué, Gérard Chatté, Amandine Briault, David Jayne, Loïc Guillevin, Jean-François Cordier
The respiratory manifestations of eosinophilic granulomatosis with polyangiitis (EGPA) have not been studied in detail.In this retrospective multicentre study, EGPA was defined by asthma, eosinophilia and at least one new onset extra-bronchopulmonary organ manifestation of disease.The study population included 157 patients (mean±sd age 49.4±14.1 years), with a mean±sd blood eosinophil count of 7.4±6.4×10(9) L(-1) at diagnosis. There was a mean±sd of 11.8±18.2 years from the onset of asthma to the diagnosis of EGPA, of 1...
September 1, 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Hajirah N Saeed, James Chodosh
PURPOSE OF REVIEW: Recent advances and outcomes data in the management of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) demonstrate the need for a universal standard of care for patients admitted with the disease. RECENT FINDINGS: Amniotic membrane transplantation, aggressive topical corticosteroids, and lubrication in the acute stage are necessary to prevent or mitigate long-term ocular sequelae. If chronic ocular disease does occur, several interventions can be employed to prevent progressive vision loss and discomfort...
November 2016: Current Opinion in Ophthalmology
Charles Feldman, Ronald Anderson
PURPOSE OF REVIEW: Describe recent studies that may impact on the management of community-acquired pneumonia (CAP). RECENT FINDINGS: CAP continues to be associated with a considerable burden of disease. Diagnosis remains problematic, and various biomarkers are neither accurate in the diagnosis of the presence of CAP nor superior to standard severity of illness scores in predicting outcome. Current evidence indicates that patients with nonsevere CAP can be effectively treated with antibiotic monotherapy, whereas those with severe infection, particularly ICU cases, do best with early initiation of combination antibiotic therapy...
October 2016: Current Opinion in Critical Care
Kerry Dwan, Stephen J Milan, Lynne Bax, Nicola Walters, Colin Powell
BACKGROUND: Vilanterol (VI) is a long-acting beta2-agonist (LABA) that binds to the beta2-adrenoceptor on the airway smooth muscle, producing bronchodilation. LABA therapy, which is well established in adults as part of the British Thoracic Society (BTS) Guidelines for the Management of Asthma, leads to improvement in symptoms and lung function and reduction in exacerbations. At present, the commonly used LABAs licensed for use in asthma management (formoterol and salmeterol) require twice-daily administration, whereas VI is a once-daily therapy...
September 1, 2016: Cochrane Database of Systematic Reviews
Cody P Coyne, Lakshmi Narayanan
PURPOSE: Corticosteroids are effective in the management of a variety of disease states, such as several forms of neoplasia (leukemia and lymphoma), autoimmune conditions, and severe inflammatory responses. Molecular strategies that selectively "target" delivery of corticosteroids minimize or prevents large amounts of the pharmaceutical moiety from passively diffusing into normal healthy cell populations residing within tissues and organ systems. MATERIALS AND METHODS: The covalent immunopharmaceutical, dexamethasone-(C21-phosphoramide)-[anti-EGFR] was synthesized by reacting dexamethasone-21-monophosphate with a carbodiimide reagent to form a dexamethasone phosphate carbodiimide ester that was subsequently reacted with imidazole to create an amine-reactive dexamethasone-(C21-phosphorylimidazolide) intermediate...
2016: Drug Design, Development and Therapy
Quan Dong Nguyen, Pauline T Merrill, Glenn J Jaffe, Andrew D Dick, Shree Kumar Kurup, John Sheppard, Ariel Schlaen, Carlos Pavesio, Luca Cimino, Joachim Van Calster, Anne A Camez, Nisha V Kwatra, Alexandra P Song, Martina Kron, Samir Tari, Antoine P Brézin
BACKGROUND: Non-infectious uveitis is a potentially sight-threatening ocular disorder caused by chronic inflammation and its complications. Therapeutic success is limited by systemic adverse effects associated with long-term corticosteroid and immunomodulator use if topical medication is not sufficient to control the inflammation. We aimed to assess the efficacy and safety of adalimumab in patients with inactive, non-infectious uveitis controlled by systemic corticosteroids. METHODS: We did this multicentre, double-masked, randomised, placebo-controlled phase 3 trial at 62 study sites in 21 countries in the USA, Canada, Europe, Israel, Australia, and Latin America...
September 17, 2016: Lancet
Sophia Lionaki, John N Boletis
BACKGROUND: Pauci-immune glomerulonephritis is the most common cause of aggressive glomerulonephritis and occurs as a renal-limited disease or as a component of systemic necrotizing small-vessel vasculitis. It is characterized by paucity of staining for immunoglobulins, by immunofluorescence along with fibrinoid necrosis and crescent formation by light microscopy, while the vast majority of patients have anti-neutrophil cytoplasmic antibodies (ANCA) in their circulation, which also participate in the pathogenesis of the disease...
March 2016: Kidney Diseases
Desmond Y H Yap, Tak Mao Chan
BACKGROUND: Lupus nephritis (LN) is a common and severe organ involvement manifesting itself in systemic lupus erythematosus (SLE). There is a considerable difference in prevalence, severity, treatment response and outcomes between Asian LN patients and LN patients from other racial backgrounds. SUMMARY: Asian SLE patients have a higher prevalence of LN than Caucasian SLE patients and often present with a more severe disease. Increasing data from genetic studies, accompanied by progress in high-throughput genotyping, have advanced our knowledge about genetic predispositions that might partly contribute to the clinical variations observed...
September 2015: Kidney Diseases
S Monticone, F Satoh, A S Dietz, R Goupil, K Lang, F Pizzolo, R D Gordon, R Morimoto, M Reincke, M Stowasser, P Mulatero
OBJECTIVE: Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone-producing adenoma and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). To distinguish between unilateral and bilateral disease is of fundamental importance because it allows to allocate patients to the correct management: unilateral adrenalectomy for aldosterone-producing adenoma or pharmacotherapy with mineralocorticoid receptor antagonists for individuals with bilateral adrenal hyperplasia...
September 2016: Journal of Hypertension
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