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Indian Pediatrics Aug 2021To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and /or intravenous immunoglobulin (IVIG). (Observational Study)
Observational Study
OBJECTIVE
To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and /or intravenous immunoglobulin (IVIG).
METHOD
This prospective observational study included children satisfying CDC MIS-C criteria admitted from September to November, 2020. Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks.
RESULTS
Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5-9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respec-tively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (P=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group.
CONCLUSIONS
In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.
Topics: COVID-19; Child; Humans; Immunoglobulins, Intravenous; Methylprednisolone; SARS-CoV-2; Systemic Inflammatory Response Syndrome
PubMed: 33876782
DOI: 10.1007/s13312-021-2277-4 -
Gastroenterology Apr 2016
Topics: Adrenal Cortex Hormones; Enteral Nutrition; Female; Hepatitis, Alcoholic; Humans; Male; Methylprednisolone
PubMed: 26924095
DOI: 10.1053/j.gastro.2016.02.061 -
Anatomical Record (Hoboken, N.J. : 2007) Apr 2018In addition to imperiling an individual's daily life, spinal cord injury (SCI), a catastrophic medical damage, can permanently impair an individual's body function....
In addition to imperiling an individual's daily life, spinal cord injury (SCI), a catastrophic medical damage, can permanently impair an individual's body function. Methylprednisolone (MP), a medically accepted therapeutic drug for SCI, is highly controversial for the lack of consensus on its true therapeutic effect. In recent years, curcumin has served as a potential and novel therapeutic drug in SCI. Our study was intended to investigate the precise effect of MP and curcumin in SCI. We examined the function of MP and curcumin in a SCI model rat, both in vivo and in vitro, and found that there was a momentous improvement in Basso-Beattie-Bresnahan scores in the MP-treated group when compared with Cur-treated group within 14 days. Results obtained from the histological, immunohistochemistry and ultrastructural examinations evidenced the curative effect of MP was better than curcumin before Day 14. Nonetheless, there was a significant variation in the treatment effect between the MP-treated and Cur-treated groups after 14 days. The curcumin's effectiveness was more obvious than MP after 14 days following SCI. As such, we surmise that curcumin has a better therapeutic potential than MP with a prolong treatment time in the wake of SCI. Anat Rec, 301:686-696, 2018. © 2017 Wiley Periodicals, Inc.
Topics: Animals; Curcumin; Male; Methylprednisolone; Motor Activity; Neuroprotective Agents; Rats; Rats, Sprague-Dawley; Recovery of Function; Spinal Cord; Spinal Cord Injuries
PubMed: 29150987
DOI: 10.1002/ar.23729 -
Medicina Clinica Dec 2022Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of... (Observational Study)
Observational Study
INTRODUCTION
Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment. Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge.
MATERIALS AND METHODS
We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves.
RESULTS
The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816.
CONCLUSIONS
In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.
Topics: Humans; COVID-19; SARS-CoV-2; Methylprednisolone; Retrospective Studies; C-Reactive Protein; Adrenal Cortex Hormones
PubMed: 35718548
DOI: 10.1016/j.medcli.2022.02.025 -
BMJ Open Dec 2022Recent studies in animal models indicate that recombinant human erythropoietin (rHuEPO) is very effective in enhancing neurological recovery after spinal cord injury...
Recombinant human erythropoietin plus methylprednisolone versus methylprednisolone in treatment of acute spinal cord injury:protocol for a systematic review and meta-analysis.
INTRODUCTION
Recent studies in animal models indicate that recombinant human erythropoietin (rHuEPO) is very effective in enhancing neurological recovery after spinal cord injury (SCI). We described a protocol aimed at evaluating the efficacy of rHuEPO plus methylprednisolone (MP) compared with MP alone in improving neurological function of patients with SCI in randomised controlled trials (RCTs).
METHODS AND ANALYSIS
This study aims to explore the effect of rHuEPO combined with MP on neurological function in patients with SCI through a meta-analysis. To this end, the authors will search eight research databases for data retrieval: MEDLINE, China National Knowledge Infrastructure, Wan Fang, China Biology Medicine dis, Web of Science, PubMed, Cochrane and Embase for RCTs on SCI in any language. The primary outcome will be the American Spinal Injury Association score at the time of follow-up. The secondary outcomes will be the WHOQOL-100 instrument score, neurophysiological state and related factors. Two authors will independently search literature records, scan titles, abstracts and full texts, collect data, and assess materials for risk of bias. Stata V.14.0 will be used for statistical analysis.
ETHICS AND DISSEMINATION
This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in scientific conferences and a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER
CRD42021260688.
Topics: Humans; Methylprednisolone; Systematic Reviews as Topic; Meta-Analysis as Topic; Spinal Cord Injuries; China; Research Design
PubMed: 36600375
DOI: 10.1136/bmjopen-2021-056689 -
The Cochrane Database of Systematic... Feb 2017Simple bone cysts, also known as a unicameral bone cysts or solitary bone cysts, are the most common type of benign bone lesion in growing children. Cysts may lead to... (Review)
Review
BACKGROUND
Simple bone cysts, also known as a unicameral bone cysts or solitary bone cysts, are the most common type of benign bone lesion in growing children. Cysts may lead to repeated pathological fracture (fracture that occurs in an area of bone weakened by a disease process). Occasionally, these fractures may result in symptomatic malunion. The main goals of treatment are to decrease the risk of pathological fracture, enhance cyst healing and resolve pain. Despite the numerous treatment methods that have been used for simple bone cysts in long bones of children, there is no consensus on the best procedure. This is an update of a Cochrane review first published in 2014.
OBJECTIVES
To assess the effects (benefits and harms) of interventions for treating simple bone cysts in the long bones of children, including adolescents.We intended the following main comparisons: invasive (e.g. injections, curettage, surgical fixation) versus non-invasive interventions (e.g. observation, plaster cast, restricted activity); different categories of invasive interventions (i.e. injections, curettage, drilling holes and decompression, surgical fixation and continued decompression); different variations of each category of invasive intervention (e.g. different injection substances: autologous bone marrow versus steroid).
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the China National Knowledge Infrastructure Platform, trial registers, conference proceedings and reference lists. Date of last search: April 2016.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials evaluating methods for treating simple bone cysts in the long bones of children.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search results and performed study selection. We resolved differences in opinion between review authors by discussion and by consulting a third review author. Two review authors independently assessed risk of bias and data extraction. We summarised data using risk ratios (RRs) or mean differences (MDs), as appropriate, and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the overall quality of the evidence.
MAIN RESULTS
In this update in 2017, we did not identify any new randomised controlled trials (RCT) for inclusion. We identified one ongoing trial that we are likely to include in a future update. Accordingly, our results are unchanged. The only included trial is a multicentre RCT conducted at 24 locations in North America and India that compared bone marrow injection with steroid (methylprednisolone acetate) injection for treating simple bone cysts. Up to three injections were planned for participants in each group. The trial involved 90 children (mean age 9.5 years) and presented results for 77 children at two-year follow-up. Although the trial had secure allocation concealment, it was at high risk of performance bias and from major imbalances in baseline characteristics. Reflecting these study limitations, we downgraded the quality of evidence by two levels to 'low' for most outcomes, meaning that we are unsure about the estimates of effect. For outcomes where there was serious imprecision, we downgraded the quality of evidence by a further level to 'very low'.The trial provided very low quality evidence that fewer children in the bone marrow injection group had radiographically assessed healing of bone cysts at two years than in the steroid injection group (9/39 versus 16/38; RR 0.55 favouring steroid injection, 95% CI 0.28 to 1.09). However, the result was uncertain and may be compatible with no difference or small benefit favouring bone marrow injection. Based on an illustrative success rate of 421 children with healed bone cysts per 1000 children treated with steroid injections, this equates to 189 fewer (95% CI 303 fewer to 38 more) children with healed bone cysts per 1000 children treated with bone marrow injections. There was low quality evidence of a lack of difference between the two interventions at two years in functional outcome, based on the Activity Scale for Kids function score (0 to 100; higher scores equate to better outcome: MD -0.90; 95% CI -4.26 to 2.46) or in pain assessed using the Oucher pain score. There was very low quality evidence of a lack of differences between the two interventions for adverse events: subsequent pathological fracture (9/39 versus 11/38; RR 0.80, 95% CI 0.37 to 1.70) or superficial infection (two cases in the bone marrow group). Recurrence of bone cyst, unacceptable malunion, return to normal activities, and participant satisfaction were not reported.
AUTHORS' CONCLUSIONS
The available evidence is insufficient to determine the relative effects of bone marrow versus steroid injections, although the bone marrow injections are more invasive. Noteably, the rate of radiographically assessed healing of the bone cyst at two years was well under 50% for both interventions. Overall, there is a lack of evidence to determine the best method for treating simple bone cysts in the long bones of children. Further RCTs of sufficient size and quality are needed to guide clinical practice.
Topics: Adolescent; Bone Cysts; Bone Marrow Transplantation; Child; Glucocorticoids; Humans; Methylprednisolone; Methylprednisolone Acetate; Randomized Controlled Trials as Topic
PubMed: 28158933
DOI: 10.1002/14651858.CD010847.pub3 -
Frontiers in Public Health 2022Spinal cord injury (SCI) has devastating physical and social consequences for patients. Systemic administration of methylprednisolone (MP) at a higher dosage though can...
BACKGROUND
Spinal cord injury (SCI) has devastating physical and social consequences for patients. Systemic administration of methylprednisolone (MP) at a higher dosage though can reduce neurological deficits following acute SCI. Still, this treatment regimen is controversial, owing to the apparent dose-related side effects and relatively minor improvement in neurological function. Therefore, this study aimed at the bibliometric analysis of published literature related to SCI treatment, which may lead to future research trends.
METHODS
The literature published relating to SCI and using glucocorticoids for its treatment between 1982 and 2022 was collected and scanned in the Web of Science collection database using the keywords glucocorticoid, dexamethasone, MP, corticosteroids, and SCI, followed by using VOSviewer for bibliometric analysis of these articles.
RESULTS
A total of 1,848 published articles and 7,448 authors on SCI and glucocorticoid usage were identified. The SCI total link strength accounts for 1,341, and MP for 762 has a strong link to neuroprotection and inflammation. The mean citation count for the top 20 most-cited articles was 682 (range: 358-1,828), where most of these were descriptive studies having focused on clinical features. The Journal of Neurotrauma was the highest-ranked journal with 6,010 citations. A total of 69 articles were published by Michael G Fehlings from the University of Toronto with 6,092 citations. The University of Toronto has published 90-related manuscripts with 7,632 citations. In contrast, 800 articles were published in the United States, with 39,633 citations and total link strength of 5,714. The second-ranked country was China, with 241 published articles and 3,403 citations.
CONCLUSIONS
The research published on applying MP in treating SCI has increased with time. Although the United States has made a significant global contribution to this important field of research, it requires rigorous clinical trials designed to verify the therapeutic role of MP in SCI and its appropriate dosage to find solutions for neurological recovery.
Topics: Bibliometrics; Databases, Factual; Glucocorticoids; Humans; Methylprednisolone; Spinal Cord Injuries; United States
PubMed: 36003626
DOI: 10.3389/fpubh.2022.907372 -
Clinical Pharmacology and Therapeutics Aug 1979Rectal absorption of methylprednisolone acetate and oral absorption of methylprednisolone and methylprednisolone acetate were investigated in a single-dose 3-way... (Comparative Study)
Comparative Study
Rectal absorption of methylprednisolone acetate and oral absorption of methylprednisolone and methylprednisolone acetate were investigated in a single-dose 3-way crossover study of 12 normal male volunteers. The median value of bioavailability (relative to oral dose) of methylprednisolone acetate based on unchanged methylprednisolone plasma levels was 14.2% after rectal administration, suggesting that the drug exerts its therapeutic effect topically rather than systemically. In contrast, the median of total radioactivity in urine (as a percentage of rectal dose) was 34.3% (range, 4.52% to 58.8%), suggesting partial bacterial metabolism in the rectum prior to absorption. Mean bioavailability (relative to oral administration of methylprednisolone acetate) of methylprednisolone after oral administration was 89.9%, indicating somewhat better systemic availability of the ester than the alcohol. The average apparent elimination rate constant for methylprednisolone after oral administration of both ester and alcohol was 0.290 hr-1, corresponding to a half-life of 2.39 hr.
Topics: Absorption; Administration, Oral; Adult; Biological Availability; Chromatography, High Pressure Liquid; Enema; Feces; Humans; Male; Methylprednisolone; Prednisolone
PubMed: 455892
DOI: 10.1002/cpt1979262232 -
Annals of Surgery Jan 1975Standardized flank wounds were made on 20 rabbits divided into the following five groups: Group 1 served as controls, Group 2 were given cortisone acetate 6.25 mg/kg/day... (Comparative Study)
Comparative Study
Standardized flank wounds were made on 20 rabbits divided into the following five groups: Group 1 served as controls, Group 2 were given cortisone acetate 6.25 mg/kg/day (I.M.), Group 3--methylprednisolone (Solu-Medrol) 1 mg/kg/day, Group 4--medroxyprogesterone (Depo-Provera) 35 mg/kg/day, Group 5--methylprednisolone 1 mg/kg/day and medroxyprogresterone 35 mg/kg/day. Wound contracture and epithelization was measured by planimetry of photographs taken twice weekly; weekly weights were recorded, and the maturation phase of wound healing followed in the control and methylprednisolone groups. All three steroids prolonged the latent phase of wound healing, slowed the rate and decreased the total amount of contracture. Cortisone showed the most inhibition of wound contracture and was the only steroid to inhibit epithelization suggesting it may have a slightly different or more potent mode of action. When the methylprednisolone group was followed for seven weeks on daily injections, the maturation phase of wound healing was inhibited, and this inhibition persisted during the next nine weeks after the drug was withdrawn. Only the control and the medroxyprogesterone group gained weight. Combining medroxyprogesterona and methylprednisolone resulted in the severest weight loss of 20% with a 60% mortality.
Topics: Animals; Contracture; Cortisone; Disease Models, Animal; Drug Evaluation; Epithelium; Medroxyprogesterone; Methylprednisolone; Rabbits; Wound Healing
PubMed: 1119869
DOI: 10.1097/00000658-197501000-00015 -
Canadian Medical Association Journal Nov 1982
Topics: Contraceptive Agents, Female; Endometriosis; Female; Humans; Methylprednisolone; Methylprednisolone Acetate; Risk
PubMed: 7139435
DOI: No ID Found