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Corticosteroid resistance

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https://www.readbyqxmd.com/read/28077097/what-patients-really-think-about-asthma-guidelines-barriers-to-guideline-implementation-from-the-patients-perspective
#1
H Lingner, B Burger, P Kardos, C P Criée, H Worth, E Hummers-Pradier
BACKGROUND: Treatment of asthma does not always comply with asthma guidelines (AG). This may be rooted in direct or indirect resistance on the doctors' and/or patients' side or be caused by the healthcare system. To assess whether patients' concepts and attitudes are really an implementation barrier for AG, we analysed the patients' perspective of a "good asthma therapy" and contrasted their wishes with current recommendations. METHODS: Using a qualitative exploratory design, topic centred focus group (FG) discussions were performed until theoretical saturation was reached...
January 11, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28053559/systemic-lupus-erythematosus-and-pulmonary-arterial-hypertension-links-risks-and-management-strategies
#2
REVIEW
Konstantinos Tselios, Dafna D Gladman, Murray B Urowitz
Systemic lupus erythematosus (SLE) is characterized by the second highest prevalence of pulmonary arterial hypertension (PAH), after systemic sclerosis, among the connective tissue diseases. SLE-associated PAH is hemodynamically defined by increased mean pulmonary artery pressure at rest (≥25 mmHg) with normal pulmonary capillary wedge pressure (≤15 mmHg) and increased pulmonary vascular resistance. Estimated prevalence ranges from 0.5% to 17.5% depending on the diagnostic method used and the threshold of right ventricular systolic pressure in studies using transthoracic echocardiogram...
2017: Open Access Rheumatology: Research and Reviews
https://www.readbyqxmd.com/read/28043871/bcl-2-inhibitors-reduce-steroid-insensitive-airway-inflammation
#3
Bao-Ping Tian, Li-Xia Xia, Zheng-Qiang Bao, Hao Zhang, Zhi-Wei Xu, Yuan-Yuan Mao, Chao Cao, Luan-Qing Che, Jin-Kai Liu, Wen Li, Zhi-Hua Chen, Songmin Ying, Hua-Hao Shen
BACKGROUND: Asthmatic inflammation is dominated either by eosinophil and/or neutrophil accumulation in airways. Disposal of these inflammatory cells is the key to disease control. Eosinophilic airway inflammation is responsive to corticosteroid treatment, while neutrophilic inflammation is resistant and increases the burden of global health care. Corticosteroid resistant neutrophilic asthma remains mechanistically poorly understood and requires novel effective therapeutic strategies. OBJECTIVE: We thought to explore the underlying mechanisms of airway inflammation persistence as well as corticosteroid resistance, and to investigate a new strategy of effective treatment against corticosteroid-insensitive neutrophilic asthma...
December 30, 2016: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28042127/longterm-beneficial-effect-of-canakinumab-in-colchicine-resistant-familial-mediterranean-fever
#4
Katerina Laskari, Panagiota Boura, George N Dalekos, Alexandros Garyfallos, Dimitrios Karokis, Dimitrios Pikazis, Loukas Settas, Grigoris Skarantavos, Elena Tsitsami, Petros P Sfikakis
OBJECTIVE: To assess the efficacy and safety of the interleukin-1β (IL-1β) inhibitor canakinumab in all adolescent and adult patients with familial Mediterranean fever (FMF) identified from the Greek National Registry for off-label drug use between 2010 and 2015. METHODS: In this retrospective longitudinal outcome study, clinical and laboratory data were collected from 14 patients (7 men) aged median 38.5 years (range 13-70), with median disease duration of 14 years, and active FMF despite colchicine (n = 9) or both colchicine and anakinra (n = 5)...
January 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28008989/the-clinical-characteristics-of-corticosteroid-resistant-refractory-mycoplasma-pneumoniae-pneumonia-in-children
#5
Yongdong Yan, Yuzhen Wei, Wujun Jiang, Chuangli Hao
To analyze the clinical characteristics of corticosteroid-resistant refractory Mycoplasma pneumoniae pneumonia (RMPP) and explore the related factors that predict corticosteroid-resistant RMPP. Retrospective analysis of 183 children with RMPP in our hospital admitted between January 1, 2012, and December 31, 2014 was performed. Of the 183 RMPP cases, 36 (19.7%) were corticosteroid-resistant RMPP cases. Corticosteroid-resistant RMPP cases had a longer duration of fever and hospitalization compared with corticosteroid-sensitive RMPP cases (P < 0...
December 23, 2016: Scientific Reports
https://www.readbyqxmd.com/read/28003505/bortezomib-for-treatment-of-therapy-refractory-anti-nmda-receptor-encephalitis
#6
Franziska Scheibe, Harald Prüss, Annerose M Mengel, Siegfried Kohler, Astrid Nümann, Martin Köhnlein, Klemens Ruprecht, Tobias Alexander, Falk Hiepe, Andreas Meisel
OBJECTIVE: We assessed the therapeutic potential of the plasma-cell-depleting proteasome inhibitor bortezomib in severe and therapy-refractory cases of anti-NMDA receptor (anti-NMDAR) encephalitis. METHODS: Five severely affected patients with anti-NMDAR encephalitis with delayed treatment response or resistance to standard immunosuppressive and B-cell-depleting drugs (corticosteroids, IV immunoglobulins, plasma exchange, immunoadsorption, rituximab, cyclophosphamide) who required medical treatment and artificial ventilation on intensive care units were treated with 1-6 cycles of 1...
December 21, 2016: Neurology
https://www.readbyqxmd.com/read/27960015/-corticosteroid-induced-diabetes-mellitus-diagnosis-and-management
#7
Alberto De Micheli
Steroid diabetes occurs in 20% (range 10-60%) of the persons treated with corticosteroid drugs. Steroid diabetes diagnosis often is omitted or late because the diagnostic sensitivity of fasting blood sugar is low, so the postprandial blood glucose must be monitored and the diagnosis should be made clinically, based on 2 hours after lunch blood glucose or OGTT. Steroid diabetes causes increased hospitalizations for acute diabetic complications; there are few data on the chronic complications. Steroid therapy increases the macrovascular complications in diabetic people, while globally does not increase the mortality...
2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/27957618/autologous-whole-blood-versus-corticosteroid-local-injection-in-treatment-of-plantar-fasciitis-a-randomized-controlled-multicenter-clinical-trial
#8
Afshin Karimzadeh, Seyed Ahmad Raeissadat, Saleh Erfani Fam, Leyla Sedighipour, Arash Babaei-Ghazani
Plantar fasciitis is the most common cause of heel pain. Local injection modalities are among treatment options in patients with resistant pain. The aim of the present study was to evaluate the effect of local autologous whole blood compared with corticosteroid local injection in treatment of plantar fasciitis. In this randomized controlled multicenter study, 36 patients with chronic plantar fasciitis were recruited. Patients were allocated randomly into three treatment groups: local autologous blood, local corticosteroid injection, and control groups receiving no injection...
December 12, 2016: Clinical Rheumatology
https://www.readbyqxmd.com/read/27936525/a-case-of-multiple-vertebral-compression-fractures-due-to-glucocorticoid-induced-osteoporosis-in-a-pediatric-patient-with-nephrotic-syndrome%C3%A2
#9
Akira Ashida, Yuko Fujii, Hideki Matsumura, Hiroshi Tamai
INTRODUCTION: Glucocorticoid therapy has a number of adverse effects, among which osteoporosis and bone fracture can be major complications. Immunosuppressive therapy for nephrotic syndrome is effective and can help to reduce the cumulative dose of glucocorticoids. Therefore, for this reason, the number of patients with nephrotic syndrome who develop glucocorticoid-related osteoporotic compression fracture is decreasing. Here we describe a pediatric case of multiple vertebral compression fractures due to glucocorticoid-induced osteoporosis during treatment for nephrotic syndrome...
December 12, 2016: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/27929242/community-acquired-pneumonia-in-adults-diagnosis-and-management
#10
Alexander Kaysin, Anthony J Viera
Community-acquired pneumonia is a leading cause of death. Risk factors include older age and medical comorbidities. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g., fever, tachycardia) and lung examination findings. Diagnosis should be confirmed by chest radiography or ultrasonography. Validated prediction scores for pneumonia severity can guide the decision between outpatient and inpatient therapy. Using procalcitonin as a biomarker for severe infection may further assist with risk stratification...
November 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27918219/a-new-treatment-regimen-with-high-dose-and-fractioned-immunoglobulin-in-a-special-subgroup-of-severe-and-dependent-cidp-patients
#11
Rabab Debs, Pauline Reach, Corina Cret, Sophie Demeret, Samir Saheb, Thierry Maisonobe, Karine Viala
BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is treated with intravenous immunoglobulins (IVIg), corticosteroids or plasma exchange (PE). IVIg dosage is not universal and markers for treatment management are needed. METHODS: We report the response to high-dose and fractioned IVIg in a subgroup of definite CIDP patients, resistant to corticosteroids and PE, responders to IVIg but with an efficacy window <15 d. RESULTS: Four patients were included with similar predominantly clinical motor form and conduction abnormalities...
December 20, 2016: International Journal of Neuroscience
https://www.readbyqxmd.com/read/27910127/treatment-of-severe-chronic-hand-eczema-results-from-a-uk-wide-survey
#12
I L Smith, S Brown, J Nixon, F C Cowdell, S Ersser, C Fernandez, M Goodfield, C M Green, P Hampton, J T Lear, C H Smith, L Sunderland, S Tubeuf, M Wittmann
Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first-line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first-line treatment for vesicular HE, followed by PUVA and alitretinoin...
December 2, 2016: Clinical and Experimental Dermatology
https://www.readbyqxmd.com/read/27900326/case-of-severe-alcoholic-hepatitis-treated-with-granulocytapheresis
#13
Yukari Watanabe, Kenya Kamimura, Tomohiro Iwasaki, Hiroyuki Abe, Shunsaku Takahashi, Ken-Ichi Mizuno, Manabu Takeuchi, Atsushi Eino, Ichiei Narita, Shuji Terai
Severe alcoholic hepatitis (AH) has a high mortality, and it is associated with encephalopathy, acute renal failure, sepsis, gastrointestinal bleeding, and endotoxemia. The 28-d mortality remains poor (34%-40%), because no effective treatment has been established. Recently, corticosteroids (CS) have been considered effective for significantly improving the prognosis of those with AH, as it prevents the production of pro-inflammatory cytokines. However, CS are not always appropriate as an initial therapeutic option, such as in cases with an infection or resistance to CS...
November 16, 2016: World Journal of Clinical Cases
https://www.readbyqxmd.com/read/27897120/dropless-cataract-surgery-an-overview
#14
Richard L Lindstrom, M Stewart Galloway, Andrzej Grzybowski, Jeffrey T Liegner
Risk reduction and the attainment of good outcomes in contemporary cataract surgery depend in part on patient compliance with a postoperative regimen of topical eye drops. Topical drops are expensive and challenging to instill properly for patients. The consequences of noncompliance or poor compliance can be significant for the patient (in the case of a complication) and for society (in the case of development of antibiotic resistance). For all of these reasons, new approaches that reduce the need for topical therapy are beginning to emerge, including intracameral injection, sustained or slow-release drug delivery mechanisms, and the recently introduced "Dropless cataract surgery," which involves intravitreal injection of single-use, compounded combination of antibiotics and corticosteroids...
November 29, 2016: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/27895446/a-case-of-fatal-sepsis-due-to-multidrug-resistant-corynebacterium-striatum
#15
M Chatzopoulou, T Koufakis, I Voulgaridi, I Gabranis, M Tsiakalou
BACKGROUND: Although non-diphtheria corynebacteria have traditionally been regarded as avirulent members of human bacterial flora, their pathogenic potential is increasingly recognized in our time. Reasons for this include the prolonged survival of severely ill and immunocompromised patients, the development of more invasive diagnostic and therapeutic procedures and the sub-optimal use of antibiotics that disrupts normal microbial balance and favors superinfections. CASE REPORT: We present a rare case of sepsis due to multidrug-resistant Corynebacterium striatum in a 76-year-old host...
January 2016: Hippokratia
https://www.readbyqxmd.com/read/27890958/nonhealing-genital-ulcer-in-aids-a-diagnostic-dilemma
#16
Yogesh S Marfatia, Devi Sathianadha Menon, Sheethal Jose, Brijesh Kumar Patel
HIV/AIDS-related immune alteration poses many diagnostic and therapeutic challenges. HIV-positive 44-year-old male, on second-line antiretroviral therapy (ART) presented with asymptomatic non healing, well-defined, erythematous ulcer over penis since 8 months with serosanguinous discharge. Inguinal lymph nodes were not palpable. Tzanck smear was negative. Biopsy was not done as the patient was not willing for the same. Acyclovir was given considering herpes infection to which there was no response, and hence azithromycin and metronidazole were given, without improvement...
July 2016: Indian Journal of Sexually Transmitted Diseases
https://www.readbyqxmd.com/read/27886803/relapsing-polychondritis-a-2016-update-on-clinical-features-diagnostic-tools-treatment-and-biological-drug-use
#17
REVIEW
Alexis Mathian, Makoto Miyara, Fleur Cohen-Aubart, Julien Haroche, Miguel Hie, Micheline Pha, Philippe Grenier, Zahir Amoura
Relapsing polychondritis (RP) is a very rare autoimmune disease characterised by a relapsing inflammation of the cartilaginous tissues (joints, ears, nose, intervertebral discs, larynx, trachea and cartilaginous bronchi), which may progress to long-lasting atrophy and/or deformity of the cartilages. Non-cartilaginous tissues may also be affected, such as the eyes, heart, aorta, inner ear and skin. RP has a long and unpredictable course. Because no randomised therapeutic trials are available, the treatment of RP remains mainly empirical...
April 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27886616/serial-fdg-pet-scans-help-to-identify-steroid-resistance-in-cardiac-sarcoidosis
#18
Abhijeet B Shelke, Hrushikesh U Aurangabadkar, Jason S Bradfield, Zakir Ali, K Shiv Kumar, Calambur Narasimhan
BACKGROUND: Cardiac sarcoidosis (CS) is increasingly being recognized. Immunosuppression with corticosteroids is the mainstay of therapy. But the optimal dose of steroids and how to assess response to therapy is not known. Prognosis is poor if these patients are untreated or undertreated. Fluorine-18-flurodeoxyglucose positron emission computed tomography ((18)FDG-PET CT) is a sensitive tool in diagnosing CS. It correlates closely with the level of granulomatous inflammation and can be used to monitor response to therapy...
February 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/27884795/forced-oscillation-technique-as-a-predictor-of-fev1-improvement-in-asthma
#19
Taisuke Akamatsu, Toshihiro Shirai, Yukiko Shimoda, Takahito Suzuki, Ichiro Hayashi, Rie Noguchi, Eisuke Mochizuki, Shogo Sakurai, Mika Saigusa, Akito Yamamoto, Yuichiro Shishido, Takefumi Akita, Satoru Morita, Kazuhiro Asada
The usefulness of the forced oscillation technique (FOT) for predicting the treatment outcomes in untreated asthmatic patients is unknown. We investigated whether FOT could predict an improvement in FEV1 following treatment. FOT, spirometry, and fractional exhaled nitric oxide were performed in 31 outpatients before and after undergoing a minimum of two months combination therapy of inhaled corticosteroids and long-acting β2-agonists. The patients were classified as responders or nonresponders to treatment based on the presence or absence of a 10% improvement in the FEV1...
February 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/27884537/-nephrotic-syndrome-complicated-by-chylous-ascites-in-a-girl-of-2%C3%A2-years-and-8%C3%A2-months-old
#20
J R Mabiala Babela, L C Ollandzobo Ikobo, R Loumingou, E R Nika, A Mouko
We report on a case of nephrotic syndrome with focal and segmental hyalinosis complicated by chylous ascites in a girl of 2 years and 8 months old. This pure nephrotic syndrome in its early stage was initially treated with intensive steroid treatment at 2mg/kg/day orally for 2 months, followed by a bolus of methylprednisolone. The persistence of proteinuria meant corticosteroid resistance. Renal biopsy then revealed focal and segmental hyalinosis. A recurrence of the edema-ascites syndrome was associated with macroscopic hematuria...
January 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
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