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Inflammatory Bowel Diseases Jan 2020Inflammatory bowel diseases are known for a chronic inflammatory process of the gastrointestinal tract and include Crohn's disease and ulcerative colitis (UC). Patients... (Review)
Review
Inflammatory bowel diseases are known for a chronic inflammatory process of the gastrointestinal tract and include Crohn's disease and ulcerative colitis (UC). Patients who are dependent on or resistant to corticosteroids account for about 20% of severe UC patients. Tacrolimus is a calcineurin inhibitor that has recently been used in the treatment of steroid-refractory ulcerative colitis. Tacrolimus has been demonstrated to have remarkable therapeutic efficacy in UC patients, without increased risk of severe adverse effects such as induction of remission and maintenance therapy. This article reviews the mechanism of action, pharmacogenetics, efficacy, and safety of tacrolimus for patients with steroid-refractory ulcerative colitis.
Topics: Calcineurin Inhibitors; Colitis, Ulcerative; Humans; Induction Chemotherapy; Maintenance Chemotherapy; Steroids; Tacrolimus; Treatment Outcome
PubMed: 30980713
DOI: 10.1093/ibd/izz068 -
Pediatric Clinics of North America Oct 2017Septic shock remains the major cause of childhood morbidity and mortality worldwide. Although early sepsis recognition, fluid resuscitation, timely administration of... (Review)
Review
Septic shock remains the major cause of childhood morbidity and mortality worldwide. Although early sepsis recognition, fluid resuscitation, timely administration of antimicrobials, and vasoactive-inotropic drug infusions are all key to achieving good sepsis outcomes, therapy using various steroid drug classes remains an attractive adjunctive intervention to minimize the duration of septic shock and transition to multiple organ dysfunction syndrome. All steroid drug classes possess biological plausibility to affect a beneficial clinical effect among children with septic shock, but none has undergone rigorous, prospective assessment in a large, high-quality pediatric interventional trial.
Topics: Anti-Inflammatory Agents; Biomarkers; Child; Combined Modality Therapy; Critical Care; Humans; Pediatrics; Shock, Septic; Steroids
PubMed: 28941540
DOI: 10.1016/j.pcl.2017.06.010 -
International Journal of Dermatology Jun 2021Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of... (Review)
Review
Keloid scar formation arises from a disorganized fibroproliferative collagen response that extends beyond the original wound margins because of excessive production of extracellular matrix (ECM). Despite treatment options for keloid scars including medical and surgical therapies, such as intralesional steroid injection and surgical excision, the recurrence rate remains high. Herein we consolidate recently published narrative reviews, systematic reviews, and meta-analyses to provide an overview of updated treatment recommendations for keloidal scar formation. PubMed search engine was used to access the MEDLINE database to investigate updates regarding keloid incidence and treatment. More than 100 articles were reviewed. Keloid management remains a multimodal approach. There continues to be no gold standard of treatment that provides a consistently low recurrence rate; however, the increasing number of available treatments and synergistic combinations of these treatments (i.e., laser-based devices in combination with intralesional steroids, or 5-fluorouracil (5-FU) in combination with steroid therapy) is showing favorable results. Future studies could target the efficacy of novel treatment modalities (i.e., autologous fat grafting or stem cell-based therapies) for keloid management. This review article provides updated treatment guidelines for keloids and discusses insight into management to assist patient-focused, evidence-based clinical decision making.
Topics: Fluorouracil; Humans; Injections, Intralesional; Keloid; Recurrence; Steroids
PubMed: 32905614
DOI: 10.1111/ijd.15159 -
Digestion 2012Although systemic corticosteroids are successfully administered for the induction of clinical response and remission in the majority of patients with inflammatory bowel... (Review)
Review
BACKGROUND AND AIMS
Although systemic corticosteroids are successfully administered for the induction of clinical response and remission in the majority of patients with inflammatory bowel disease (IBD) presenting with a flare, a proportion of these patients demonstrate a primary nonresponse to steroids or in the case of an initial response, they develop a resistance or a steroid dependence. Long-term therapy with corticosteroids for treatment of IBD should be avoided, given the high frequency of adverse treatment effects. Knowledge about treatment strategies in case of steroid nonresponse is therefore highly relevant.
METHODS
A systematic literature research was performed using Medline and Embase to summarize the currently recommended treatment strategies for steroid-resistant IBD.
RESULTS
Treatment of steroid-resistant Crohn's disease is based on the introduction of immunomodulators such as azathioprine, 6-mercaptopurine or methotrexate, the anti-TNF drugs infliximab, adalimumab and certolizumab pegol. In the case of steroid resistance in ulcerative colitis, aminosalicylates, the above-mentioned immunomodulators, infliximab, adalimumab or calcineurin inhibitors such as ciclosporin or tacrolimus may be administered.
CONCLUSION
This review summarizes the current evidence for treating steroid-resistant IBD.
Topics: Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Crohn Disease; Drug Resistance; Humans; Immunosuppressive Agents; Induction Chemotherapy; Maintenance Chemotherapy; Prednisolone
PubMed: 23051721
DOI: 10.1159/000341952 -
The Veterinary Clinics of North... Mar 2020Asthma is an important allergic lower-airway disease in cats affecting approximately 1% to 5% of the pet cat population. New diagnostics are being developed to help... (Review)
Review
Asthma is an important allergic lower-airway disease in cats affecting approximately 1% to 5% of the pet cat population. New diagnostics are being developed to help better differentiate asthma from other lower-airway diseases and improve monitoring. In addition, new treatments are being developed to help in refractory cases or in those cases in which traditional therapeutics are contraindicated. This article discusses potential pitfalls in the diagnosis of asthma. In addition, current literature investigating new diagnostic tests and therapies for feline asthma is reviewed.
Topics: Animals; Asthma; Cat Diseases; Cats; Diagnosis, Differential; Immunotherapy; Steroids
PubMed: 31812220
DOI: 10.1016/j.cvsm.2019.10.002 -
Masui. the Japanese Journal of... Nov 2016It has been more than 60 years since the introduc- tion of glucocorticoid therapy as an effective treatment for patients with inflammatory process. Although glu-...
It has been more than 60 years since the introduc- tion of glucocorticoid therapy as an effective treatment for patients with inflammatory process. Although glu- cocorticoid therapy has been widely accepted as an essential part of certain clinical settings, long-term administration can suppress the hypothalamic pitu- itary-adrenal axis, causing secondary adrenocortical insufficiency with surgical or medical stress. Periopera- tive glucocorticoid replacement may be required in such circumstances, but the amount of supplementa- tion needed to cover their stress during severe illness or following surgery has not been clearly determined. Recent recommendations for glucocorticoid supplemen- tation suggest that steroid coverage should be based on the duration and dosage of chronic steroid therapy, in addition to the type and probable length of the sur- gery. In this article, we give an overview of the cur- rent strategy for determining optimal dose, frequency, and duration of supplemental steroid for the patients with chronic glucocorticoid therapy.
Topics: Adrenal Insufficiency; Glucocorticoids; Humans; Preoperative Care; Steroids
PubMed: 30351800
DOI: No ID Found -
Pediatrics and Neonatology Sep 2022
Topics: Humans; Immunization, Passive; Myositis; Scleroderma, Localized; Steroids
PubMed: 35803858
DOI: 10.1016/j.pedneo.2022.01.006 -
Medicine Jul 2021Steroid pulse therapy is widely used to treat virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We... (Observational Study)
Observational Study
Steroid pulse therapy is widely used to treat virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We sought to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels.We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature >38°C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at 6 hours from onset, and AST elevation >90 IU/L within 6 hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1-2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy.Fifteen patients with acute encephalopathy and 5 patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, P = .405). Even after excluding 2 patients with brainstem lesions, no significant correlation between PCPC and steroid pulse therapy timing (rs = 0.583, P = .060) was noted. However, the prognosis tended to be better in patients who received steroid pulse therapy earlier.Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with elevated AST. Still, even earlier administration of treatment could prevent the possible neurological sequelae of this condition.
Topics: Brain Diseases; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Japan; Male; Prognosis; Pulse Therapy, Drug; Steroids; Time Factors
PubMed: 34397692
DOI: 10.1097/MD.0000000000026660 -
Internal Medicine (Tokyo, Japan) Jul 1996
Review
Topics: Drug Administration Schedule; Humans; Immunosuppressive Agents; Lung Diseases, Interstitial; Scleroderma, Systemic; Steroids; Vasculitis
PubMed: 8842755
DOI: 10.2169/internalmedicine.35.525 -
Photobiomodulation, Photomedicine, and... Mar 2021To evaluate the efficiency of photobiomodulation therapy (PBMT) or photodynamic therapy (PDT) in treating oral lichen planus (OLP) as well as identifiy the side effects... (Meta-Analysis)
Meta-Analysis
To evaluate the efficiency of photobiomodulation therapy (PBMT) or photodynamic therapy (PDT) in treating oral lichen planus (OLP) as well as identifiy the side effects when compared with steroid therapy. Nowadays, PBMT and PDT are increasingly applied for treating OLP with minimal adverse effects. The electronic databases of PubMed, Cochrane Central Register of Controlled Trial, Web of Science, and Embase were searched until March 13, 2020. Randomized controlled trials (RCTs) with 1 month of follow-up period were selected. Two reviewers extracted data from selected studies independently. Cochrane collaboration's tool for assessing risk of bias was used for assessing the quality of the RCTs. The random-effects model was employed for meta-analysis. One thousand fifteen studies were initially identified. Finally, nine RCTs were included for quality assessment and seven studies for meta-analysis. Four RCTs were of unclear risk of bias and five were assessed as high risk of bias. The comparison showed no significant differences for pain scores [visual analog scale (VAS)] [mean differences (MD) = 0.38, confidence interval (CI) = 95% -0.64 to 1.40] and severity scores (reticular-atrophic-erosive scores) (MD = 1.67, CI = 95% -1.13 to 4.46) between topical corticosteroid therapy and PBMT after 1 month. For PDT, no significant differences were observed for sign scores (Thongprasm sign scoring) (MD = -0.31, CI = 95% -1.52 to 0.91) and pain scores (VAS) (MD = -2.30, CI = 95% -5.88 to 1.28) of the lesions when compared with topical corticosteroid therapy after 1 month of follow-up period. One study reported the discomfort of the affected area in patients of the PDT group when probe tip was moved. PBMT and PDT could be reliable alternatives to topical corticosteroids for OLP with no or less severe complications in a short-term period. However, further well-designed RCTs with long-term period are recommended to consolidate the conclusions in this regard.
Topics: Humans; Lichen Planus, Oral; Low-Level Light Therapy; Pain Measurement; Photochemotherapy; Steroids
PubMed: 33601953
DOI: 10.1089/photob.2020.4930