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Background The epidemiology of cytomegalovirus (CMV) after chimeric antigen receptor–modified T-cell immunotherapy (CARTx) is poorly understood owing to a lack of routine surveillance. Methods We prospectively enrolled 72 adult CMV-seropositive CD19-, CD20-, or BCMA-targeted CARTx recipients and tested plasma samples for CMV before and weekly up to 12 weeks after CARTx. We assessed CMV-specific cell-mediated immunity (CMV-CMI) before and 2 and 4 weeks after CARTx, using an interferon γ release assay to quantify T-cell responses to IE-1 and pp65. We tested pre-CARTx samples to calculate a risk score for cytopenias and infection (CAR-HEMATOTOX). We used Cox regression to evaluate CMV risk factors and evaluated the predictive performance of CMV-CMI for CMV reactivation in receiver operator characteristic curves. Results CMV was detected in 1 patient (1.4%) before and in 18 (25%) after CARTx, for a cumulative incidence of 27% (95% confidence interval, 16.8–38.2). The median CMV viral load (interquartile range) was 127 (interquartile range, 61–276) IU/mL, with no end-organ disease observed; 5 patients received preemptive therapy based on clinical results. CMV-CMI values reached a nadir 2 weeks after infusion and recovered to baseline levels by week 4. In adjusted models, BCMA-CARTx (vs CD19/CD20) and corticosteroid use for >3 days were significantly associated with CMV reactivation, and possible associations were detected for lower week 2 CMV-CMI and more prior antitumor regimens. The cumulative incidence of CMV reactivation almost doubled when stratified by BCMA-CARTx target and use of corticosteroids for >3 days (46% and 49%, respectively). Conclusions CMV testing could be considered between 2 and 6 weeks in high-risk CARTx recipients. [ABSTRACT FROM AUTHOR]

Introduction: Endocrine hypertension (EHT) due to pheochromocytoma/paraganglioma (PPGL), Cushing's syndrome (CS), or primary aldosteronism (PA) is linked to a variety of metabolic alterations and comorbidities. Accordingly, patients with EHT and primary hypertension (PHT) are characterized by distinct metabolic profiles. However, it remains unclear whether the metabolomic differences relate solely to the disease-defining hormonal parameters. Therefore, our objective was to study the association of disease defining hormonal excess and concomitant adrenal steroids with metabolomic alterations in patients with EHT. Methods: Retrospective European multicenter study of 263 patients (mean age 49 years, 50% females; 58 PHT, 69 PPGL, 37 CS, 99 PA) in whom targeted metabolomic and adrenal steroid profiling was available. The association of 13 adrenal steroids with differences in 79 metabolites between PPGL, CS, PA and PHT was examined after correction for age, sex, BMI, and presence of diabetes mellitus. Results: After adjustment for BMI and diabetes mellitus significant association between adrenal steroids and metabolites - 18 in PPGL, 15 in CS, and 23 in PA - were revealed. In PPGL, the majority of metabolite associations were linked to catecholamine excess, whereas in PA, only one metabolite was associated with aldosterone. In contrast, cortisone (16 metabolites), cortisol (6 metabolites), and DHEA (8 metabolites) had the highest number of associated metabolites in PA. In CS, 18-hydroxycortisol significantly influenced 5 metabolites, cortisol affected 4, and cortisone, 11-deoxycortisol, and DHEA each were linked to 3 metabolites. Discussions: Our study indicates cortisol, cortisone, and catecholamine excess are significantly associated with metabolomic variances in EHT versus PHT patients. Notably, catecholamine excess is key to PPGL's metabolomic changes, whereas in PA, other non-defining adrenal steroids mainly account for metabolomic differences. In CS, cortisol, alongside other non-defining adrenal hormones, contributes to these differences, suggesting that metabolic disorders and cardiovascular morbidity in these conditions could also be affected by various adrenal steroids. [ABSTRACT FROM AUTHOR]

Aim and background: Hyperglycemia is considered an adaptive metabolic manifestation of stress and is associated with poor outcomes. Herein, we analyzed the association between glycemic variability (GV) and hospital mortality in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU), and the association between GV and mechanical ventilation (MV), ICU stay, length of hospital stays, renal replacement therapy (RRT), hypoglycemia, nosocomial infections, insulin use, and corticosteroid class. Materials and methods: In this retrospective observational study, we collected information on blood glucose levels during the first 10 days of hospitalization in a cohort of ICU patients with COVID-19 and its association with outcomes. Results: In 239 patients, an association was observed between GV and hospital mortality between the first and last quartiles among patients without diabetes [odds ratio (OR), 3.78; confidence interval, 1.24-11.5]. A higher GV was associated with a greater need for RRT (p = 0.002), regular insulin (p < 0.001), and episodes of hypoglycemia (p < 0.001). Nosocomial infections were associated with intermediate GV quartiles (p = 0.02). The corticosteroid class had no association with GV (p = 0.21). Conclusion: Glycemic variability was associated with high mortality in patients with COVID-19 and observed in the subgroup of patients without diabetes. Clinical significance: Glycemic control in critically ill patients remains controversial and hyperglycemia is associated with worse outcomes. Diabetes mellitus (DM) is one of the most prevalent comorbidities in patients with COVID-19. In addition, they require corticosteroids due to pulmonary involvement, representing a challenge and an opportunity to better understand how glycemic changes can influence the outcome of these patients. [ABSTRACT FROM AUTHOR]

Introduction: In real-world practice, most non-small cell lung cancer (NSCLC) patients receiving combined immunochemotherapy are exposed to short-course corticosteroids following immune checkpoint inhibitor (ICI) infusion to prevent chemotherapy-related adverse events. However, whether this early short-course corticosteroid use prevents immune-related adverse events (irAEs) remains unknown. Methods: Between January 1st, 2015, and December 31st, 2020, NSCLC patients who received at least one cycle of ICI with or without chemotherapy were enrolled. Early short-course corticosteroids were defined as corticosteroids administered following ICI injection and before chemotherapy on the same day and no longer than 3 days afterward. The patients were categorized as either "corticosteroid group" or "non-corticosteroid group" depending on their exposure to early short-course corticosteroid. The frequencies of irAEs requiring systemic corticosteroid use and irAEs leading to ICI discontinuation were compared between the two groups, and exploratory survival analyses were performed. Results: Among 252 eligible patients, 137 patients were categorized as "corticosteroid group" and 115 patients as "non-corticosteroid group." The corticosteroid group enriched patients in the first-line setting (n = 75, 54.7%), compared to the non-corticosteroid group (n = 28, 24.3%). Thirty patients (21.9%) in the corticosteroid group and 35 patients (30.4%) in the non-corticosteroid group developed irAEs requiring systemic corticosteroid use (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.35–1.18; p = 0.15). Eight patients (5.8%) in the corticosteroid group, as compared with 18 patients (15.7%) in the non-corticosteroid group, permanently discontinued ICI due to irAEs (OR, 0.34; 95% CI, 0.12–0.85; p = 0.013). Conclusion: Early short-course corticosteroids following each ICI injection may reduce the rate of irAEs that lead to ICIs discontinuation, warranting further investigation of its prophylactic use to mitigate clinically significant irAEs. [ABSTRACT FROM AUTHOR]

There are many types of cysts in the leg; the most common is a popliteal (Baker's) cyst. This occurs when synovial fluid fills the tissue plane between the medial head of the gastrocnemius and the semimembranosus muscle and is often associated with intraarticular knee pathology. Treatment for various types of cysts includes aspiration with or without fenestration, injections with corticosteroids, dextrose, or various sclerosing agents, and surgical excision. This case describes a 58-yr-old man with a large cyst measuring 14.7 x 2.7 x 3.1 cm in size in the lateral calf, within the lateral gastrocnemius, with atypical size and location for a calf cyst. Computed tomography arthrogram showed intraarticular communication with the knee. The cyst recurred after two aspirations and injections with 25% dextrose/lidocaine. Aspiration and injection with doxycycline resulted in temporary relief followed by recurrence. Complete cyst resolution occurred after final aspiration without injectate. The cyst was likely synovial based on location, intraarticular communication, and fluid analysis. We suspect that complete resolution may have been due to repeated aspiration and injection, essentially performing longitudinal cyst fenestration, with possible contribution from doxycycline injection. Further study of intracyst doxycycline injection with reaspiration after 10 mins for treatment of refractory cysts may be warranted. [ABSTRACT FROM AUTHOR]

Objective: Pes anserine bursitis is the most common cause of periarticular knee pain. The aim of the study was to evaluate the efficacy of local injection-based therapies with different materials. Design: The enrolled patientswere randomly allocated to three groups to receive different interventions. Outcomemeasures included pain severity using the visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index that was evaluated before the intervention, 1 and 8 wks after that. Results: This trial was performed on 72 participants, with male-tofemale ratio of 0.14 and with a mean age of 61.49 ± 9.35 yrs. Corticosteroids in the first group, oxygen-ozone in the second group, and dextrose 20% in the third group, were injected into the pes anserine bursa under ultrasound guidance. Interaction between time and group showed a statistically significant improvement in visual analog scale and Western Ontario andMcMaster Universities Arthritis Index (P = 0.05) in favor of corticosteroids and oxygen-ozone groups after 1 wk and in favor of oxygen-ozone and prolotherapy groups after 8 wks. Conclusions: All three treatment options are effective for patients with pes anserine bursitis. This study showed that the effects of oxygen-ozone injection and prolotherapy last longer than those of corticosteroid injection. [ABSTRACT FROM AUTHOR]

Objectives: Explore psychosocial outcome and impact of persisting deficits on quality of life (QoL) and global functioning after anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) in children and adolescents. Methods: Four female patients (age 7-16y) and their caregivers participated in the study. Information was collected from the medical records and the caregivers via a questionnaire. Both the patients and their caregivers were interviewed by means of the structured clinical interview for DSM-5 disorders, junior version (SCID-5 junior). CGAS and mRS scores were defined and the Pediatric Quality of Life Inventory (PedsQL) was used to assess quality of life of patients and caregivers. Results and conclusion: After the acute phase of the disease patients go through a post-acute phase in which several persisting physical, cognitive and psychiatric symptoms gradually resolve during the following months to a year. In long-term follow up these symptoms partly resolved, but deficits persisted on several domains. Psychiatric symptoms, fatigue and mild cognitive deficits were present in three out of four patients at current assessment. In three patients their academic trajectory was altered. These deficits can have an impact on the quality of life and the global functioning of the patients and caregivers. [ABSTRACT FROM AUTHOR]

A 62-year-old man attended ophthalmology for a simple ptosis repair. He had a chronic cough, a Horner's syndrome with post-gustatory hyperhidrosis. He was referred to the respiratory and neurology teams. MR scan of his head and neck found evidence of multifocal disease at the skull base and carotid canal, and further tests identified additional deposits in the hilar lymph nodes, heart and sacrum. A transbronchial biopsy confirmed the diagnosis of sarcoidosis. His symptoms and imaging responded well to corticosteroids, but he still undergoes regular imaging. We discuss the features of Horner's syndrome, and the autonomic associations of a chronic cough. [ABSTRACT FROM AUTHOR]

Introduction: Sacroiliac (SI) joint pain is defined as pain localized in the anatomical region of the SI joint. The reported prevalence of SI joint pain among patients with mechanical low back pain varies between 15% and 30%. Methods: In this narrative review, the literature on the diagnosis and treatment of SI joint pain was updated and summarized. Results: Patient's history provides clues on the source of pain. The specificity and sensitivity of provocative maneuvers are relatively high when three or more tests are positive, though recent studies have questioned the predictive value of single or even batteries of provocative tests. Medical imaging is indicated only to rule out red flags for potentially serious conditions. The diagnostic value of SI joint infiltration with local anesthetic remains controversial due to the potential for false‐positive and false‐negative results. Treatment of SI joint pain ideally consists of a multidisciplinary approach that includes conservative measures as first‐line therapies (eg, pharmacological treatment, cognitive‐behavioral therapy, manual medicine, exercise therapy and rehabilitation treatment, and if necessary, psychological support). Intra‐ and extra‐articular corticosteroid injections have been documented to produce pain relief for over 3 months in some people. Radiofrequency ablation (RFA) of the L5 dorsal ramus and S1‐3 (or 4) lateral branches has been shown to be efficacious in numerous studies, with extensive lesioning strategies (eg, cooled RFA) demonstrating the strongest evidence. The reported rate of complications for SI joint treatments is low. Conclusions: SI joint pain should ideally be managed in a multidisciplinary and multimodal manner. When conservative treatment fails, corticosteroid injections and radiofrequency treatment can be considered. [ABSTRACT FROM AUTHOR]

Objective: Hyperbaric oxygen therapy (HBOT) is an accepted treatment option for sudden sensorineural hearing loss (SSNHL), but it is still recommended in combination with corticosteroids. We investigated the efficacy of salvage HBOT in refractory SSNHL that does not respond to corticosteroid combination therapy. Methods: Eighty-four patients were included, who had unilateral SSNHL with an improvement of pure-tone average (PTA) less than 10 dB after using intratympanic plus systemic corticosteroids (combined therapy) as the initial therapy. The control group (n = 66) received no further treatment, and the HBOT group (n = 18) received additional treatment with HBOT (10 sessions in total with 2.5 atmospheres absolute for 1 hour). Results: No differences in PTA or WDS were found between the 2 groups. However, the mean hearing gain in the HBOT group (16.8 ± 4.49 dB) was significantly higher than that in the control group (4.45 ± 1.03 dB) (P =.015). The proportion of patients with hearing recovery (hearing gain of 10 dB or more) after treatment was significantly higher in HBOT group (38.9%) than in the control group (10.6%). Conclusions: In patients with refractory SSNHL after steroid combined therapy, salvage HBOT showed a significant effect on hearing gain and recovery rate. [ABSTRACT FROM AUTHOR]

Objective: Primary immune thrombocytopenia (pITP) is an acquired autoimmune disorder related to the increased destruction and/or impaired production of platelets. Its diagnosis and management are challenging and require expertise and the interpretation of international consensus reports and guidelines with national variations in availability. We aimed to assess the agreement of hematologists in Türkiye on certain aspects of both first-line and second-line management of patients with pITP. Materials and Methods: Applying a modified Delphi method, the Turkish National ITP Working Group (14 steering committee members), founded under the auspices of the Turkish Society of Hematology, developed a 21-item questionnaire consisting of statements regarding the first-line and second-line treatment of pITP. A total of 107 adult hematologists working in either university or state hospitals voted for their agreement or disagreement with the statements in two consecutive rounds. Results: The participants reached consensus on the use of corticosteroids as first-line treatment and with limited duration. Methylprednisolone was the corticosteroid of choice rather than dexamethasone. Use of intravenous immunoglobulin was not preferred for patients without bleeding. It was also agreed that thrombopoietin receptor antagonists (TPO-RAs) or rituximab should be recommended as second-line treatment and that splenectomy could be considered 12-24 months after diagnosis in patients with chronic pITP. Conclusion: The optimization of the dose and duration of TPO-RAs in addition to corticosteroids is necessary to improve the management of patients with pITP. [ABSTRACT FROM AUTHOR]

The clinical importance of adhering to the regimen in tuberculosis patients has been widely investigated, but most studies were conducted in controlled settings and in limited populations. We aimed to measure the level of real-world adherence during intensive phase and investigate the predictors and the risk of mortality and health outcomes of intensive phase non-adherence in tuberculosis patients. We conducted a nationwide cohort study by linking the Korean National Tuberculosis Surveillance System and the National Health Information Database. We included all incident drug-susceptible tuberculosis patients who initiated the regimens recommended by the World Health Organization from 2013 to 2018. Adherence was measured using the proportion of days covered (poor [<50%], moderate [50%–79%], and high [≥80%]). We used logistic regression model to assess predictors and the Cox proportional hazard model to evaluate the risk of mortality and health outcomes with intensive phase non-adherence. Of 46,818 patients, there were 8% and 11% with poor and moderate adherent groups, respectively. Age ≥45 years, insulin use, and history of renal failure were predictors of non-adherence. Compared with high adherent group, poor and moderate adherent groups were associated with a substantial risk of mortality (poor: hazard ratio, 2.14 [95% confidence interval, 1.95–2.34]; moderate: 1.76 [1.62–1.92]). Similar trends were observed for health outcomes. Stratified analyses showed a higher risk of mortality in patients with medical aid, low income, and history of renal failure, systematic corticosteroids, and immunomodulators. Non-adherence during intensive phase increased mortality risk by twofold, underscoring targeted intervention for high-risk population, including advanced diabetes, and immunocompromised patients. [ABSTRACT FROM AUTHOR]

Summary: Both COA and AOA have a genetically causal effect on osteoporosis. COA and AOA were independently associated with incident osteoporosis, and the risk was greatly higher in AOA. Besides corticosteroids, the increased risk of osteoporosis among asthma patients should be attributed to genetic susceptibility and other asthma medications. Purpose/Introduction: Childhood-onset asthma (COA) differs with adult-onset asthma (AOA) on genetic susceptibility, severity, and co-morbidities. Whether COA or AOA is independently associated with osteoporosis is unexplored. We aimed to determine the effects of COA and AOA on osteoporosis at genetic and individual level. Methods: We used two-sample Mendelian randomization analysis to explore the causal effects of COA and AOA on osteoporosis. In the UK Biobank cohort, we included 478,289 osteoporosis-free participants at baseline (2006–2010). Participants were classified as non-asthma, COA, and AOA at recruitment. Multivariate Cox regression analysis was used to evaluate the effects of COA, AOA, and multiple asthma medications on incident osteoporosis risk. Results: COA and AOA were causally related to osteoporosis, with odds ratio of 1.007 (95% confidence interval (CI), 1.0003–1.0132) and 1.012 (95% CI, 1.002–1.023), respectively. Multivariate Cox regression analysis suggested that COA (hazard ratio (HR), 1.46; 95% CI, 1.32–1.61) and AOA (HR, 1.70; 95% CI, 1.61–1.80) were independently associated with incident osteoporosis, and the risk was greatly higher in AOA (HR, 1.51; 95% CI, 1.34–1.70). In addition to corticosteroids, monotherapy with leukotriene modifiers (HR, 1.70; 95% CI, 1.20–2.42), long-acting beta agonists (HR, 1.49; 95% CI, 1.18–1.87), and short-acting beta agonists (HR, 1.72; 95% CI1.01–2.93) were independently associated with a higher risk of osteoporosis. Conclusions: Both COA and AOA have a genetically causal effect on osteoporosis, and the risk of osteoporosis is greatly higher in AOA. Besides corticosteroids, the increased risk of osteoporosis among asthma patients should be attributed to genetic susceptibility and other asthma medications. [ABSTRACT FROM AUTHOR]

Objective: Combination therapy, including inhaled corticosteroids (ICS), is often prescribed as initial treatment for Chronic Obstructive Pulmonary Disease (COPD) despite limited evidence that ICS therapy is beneficial. Prescribing rates exceed the estimated number of candidates diagnosed with COPD who are eligible for ICS treatment per guideline-directed therapy. Therefore, some patients would benefit from ICS withdrawal due to potentially inappropriate prescribing. This review aims to highlight evidence evaluating ICS withdrawal approaches in COPD. Methods: A comprehensive literature review was performed between June 2021 and March 2022 with assistance from a reference librarian. Sources of literature review include PubMed and Embase. The authors selected randomized controlled trials and articles evaluating ICS withdrawal approaches in patients with COPD. Three clinical trials and one post-hoc analysis are discussed in this review. Pertinent safety, efficacy, and statistical and clinical outcomes are summarized. Conclusions: The most appropriate approach to de-prescribe ICS maintenance therapy in COPD without clear indication remains uncertain. Pharmacists can play a role in optimizing clinical outcomes by analyzing ICS use in practice and identifying potential candidates for ICS withdrawal. The withdrawal protocols discussed in this review offer options for clinicians to help guide therapy decisions. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that dexamethasone has a positive effect on postoperative pain control, opioid consumption, nausea, and vomiting and length of hospital stay after arthroplasty surgery. Purpose/Hypothesis: The purpose of this study was to assess whether adding perioperative dexamethasone to our current pain regimen after hip arthroscopy is more effective than a placebo. It was hypothesized that dexamethasone would reduce postoperative pain, reduce opioid consumption, improve subjective pain and nausea scores, and reduce the number of vomiting events. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 50 patients requiring unilateral elective hip arthroscopy were randomized to receive intravenous dexamethasone immediately before induction of anesthesia and at 8 am on the first postoperative day (2 ×12 mg) or a placebo (sodium chloride 0.9%). The patient, the surgeons, the treating anesthesiologist, and the involved nursing and physical therapy personnel were blinded to group assignment. The primary outcome was postoperative pain, and secondary outcomes were opioid consumption and nausea scores—assessed using a translated revised version of the American Pain Society Patient Outcome Questionnaire 6 hours postoperatively and on days 1 and 2—and vomiting events. A clinical follow-up was performed 12 weeks postoperatively to assess adverse events. Results: The mean age at inclusion was 29 years in both groups. Postoperative pain levels did not differ significantly in most instances. Opioid requirements during the hospitalization in the dexamethasone group were significantly lower than those in the placebo group (31.96 ± 20.56 mg vs 51.43 ± 38 mg; P =.014). Significantly fewer vomiting events were noted in the dexamethasone group (0.15 ± 0.59 vs 0.65 ± 0.91; P =.034). Descriptive data and surgical parameters did not differ significantly. Conclusion: Perioperative intravenous dexamethasone significantly reduced postoperative opioid consumption by 40% without compromising pain level and safety, as no corticosteroid-related side effects were observed. Dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy. Registration: NCT04610398 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

C19 steroids and C22 steroids are vital intermediates for the synthesis of steroid drugs. Compared with C19 steroids, C22 steroids are more suitable for synthesizing progesterone and adrenocortical hormones, albeit less developed. 9,22-dihydroxy-23,24-bisnorchol-4-ene-3-one(9-OHBA), due to its substituents at positions C-9 and C-22, is a beneficial and innovative steroid derivative for synthesizing corticosteroids. We focused on the C22 pathway in Mycobacterium fortuitum ATCC 35855, aiming to develop a productive strain that produces 9-OHBA. We used a mutant strain, MFΔkstD, that knocked out kstds from Mycobacterium fortuitum ATCC 35855 named MFKD in this study as the original strain. Hsd4A and FadA5 are key enzymes in controlling the C19 metabolic pathway of steroids in Mycobacterium fortuitum ATCC 35855. After knocking out hsd4A, MFKDΔhsd4A accumulated 81.47% 9-OHBA compared with 4.13% 9-OHBA in the strain MFKD. The double mutant MFKDΔhsd4AΔfadA5 further improved the selectivity of 9-OHBA to 95.13%, and 9α-hydroxy-4-androstenedione (9-OHAD) decreased to 0.90% from 4.19%. In the end, we obtained 6.81 g/L 9-OHBA from 10 g/L phytosterols with a molar yield of 80.33%, which showed the best performance compared with formerly reported strains. [ABSTRACT FROM AUTHOR]

Ocular drug delivery is very challenging and fascinating for pharmaceutical researchers, especially in the treatment of ocular conjunctivitis. The challenges include delivery of the drug to the eye without causing permanent tissue damage while maintaining a stable therapeutic level at the site of action for a prolonged period of time. The present work focuses on the treatment of ocular conjunctivitis by using combined mechanisms of fluroquinolone antibiotics, providing sustained release of drug from ocular inserts, and using corticosteroid for anti-inflammatory effect and providing comfort to the patient. Quinolone antibiotics, anti-inflammatory agents and polymers with excipients were procured from pharmaceutical companies as gift samples. Different combinations of antibiotics and anti-inflammatory agents were prepared by solvent cast method and the dried films were cut into defined size containing drug and evaluated for different parameters and sustained drug release. Based on in vitro, in vivo correlation stability studies, the formulation (antibiotic + anti-inflammatory agent) promising the best once a day sustained release of the drug has been chosen. [ABSTRACT FROM AUTHOR]

Scleritis, an inflammatory disease of the eye affecting scleral tissue, presents unique challenges in the older adult population. Unlike their younger counterparts, older individuals manifest a distinct spectrum of the disease with different underlying etiologies, co-morbidities, altered immune function, and an increased risk of systemic side effects from medication choices. Addressing these complexities necessitates a comprehensive and multidisciplinary approach. Treatment of choice will depend on any underlying cause but generally involves non-steroidal anti-inflammatory drugs, systemic or local corticosteroids, and potentially disease-modifying anti-rheumatic drugs. Utilization of these therapeutic agents in older adults warrants careful consideration because of their potential side-effect profiles. This article critically examines the specific concerns for the use of these drugs in older patients and reviews the existing literature on their use in this specific cohort. [ABSTRACT FROM AUTHOR]

Background: There are few comparative studies on dual immune checkpoint inhibitors (ICIs) (i.e., IO-IO) and combination therapies comprising ICIs plus tyrosine kinase inhibitors (TKIs) (i.e., IO-TKI) for advanced renal cell carcinoma (RCC), especially in real-world settings. Methods: We retrospectively evaluated data of 175 patients with IMDC intermediate-risk or poor-risk RCC; as first-line therapy, 103 received IO-IO, and 72 received IO-TKI. An inverse probability of treatment weighting (IPTW) analysis was conducted to balance patients' backgrounds in the IO-IO and IO-TKI groups. Results: Based on the IPTW analysis, progression-free survival (PFS) was longer in the IO-TKI group than in the IO-IO group (median: 15.6 vs. 8.3 months; p = 0.0386). In contrast, overall survival was not different between groups (median: 46.7 vs. 49.0 months; p = 0.465). Although the IPTW-adjusted objective response rate was not significantly different (51.2% vs. 43.9%; p = 0.359), the progressive disease rate as the best overall response was lower in the IO-TKI group than in the IO-IO group (3.3% vs. 27.4%; p < 0.0001). Regarding the safety profile, the treatment interruption rate was higher in the IO-TKI group than in the IO-IO group (70.3% vs. 49.2%; p = 0.005). In contrast, the IO-IO group had a higher corticosteroid administration rate (43.3% vs. 20.3%; p = 0.001). Conclusion: IO-TKI therapy exhibited superior effectiveness over IO-IO therapy in terms of PFS improvement and immediate disease progression prevention and was associated with a higher risk of treatment interruption and a lower risk of needing corticosteroids. [ABSTRACT FROM AUTHOR]

Objectives: Sudden smell loss is one of the early symptoms of COVID‐19. Although it is stated that the loss of smell and taste following COVID‐19 improves within a few weeks, there are also cases that do not improve for a long time. The aim of this study is to reveal long‐term smell loss experiences after COVID‐19. Methods: A qualitative approach was adopted. We conducted semistructured interviews with 11 participants who had smell loss for at least 3 months. Interviews were recorded, transcribed and evaluated using a thematic analysis for qualitative data. Results: Nutrition and appetite, personal hygiene, threats to safety and emotional changes were the main themes created by the authors and were the areas where participant expressions focused. The participants used oral/nasal corticosteroid therapy for smell loss and received short‐term olfactory training, but could not find a solution. Conclusions: Long‐term smell loss problems, which were neglected during the pandemic period, should be carefully evaluated due to their negative effects. Understanding and focusing on the negative effects of loss of smell may contribute to the solution of long‐term smell loss problems. Patient and Public Contribution: Eleven participants who experienced long‐term loss of smell following COVID‐19 contributed to the study. They enriched the study by describing the effects of their experiences. There was no other participation or contribution from the public to the research. [ABSTRACT FROM AUTHOR]

Background: In this study, the clinical and radiographic manifestations of a patient with linear morphea as well as her clinical features are reported with more emphasis on the oral effects of this connective tissue disease. This patient was referred to the orthodontic department due to the misalignment of her teeth and a diagnosis of linear scleroderma made three years earlier by her dermatologist. The most important intervention in such patients is to not start treatment without knowledge, since it will cause more harm to the patient. Therefore, it is necessary to find the best treatment plan with the fewest complications as soon as possible. [ABSTRACT FROM AUTHOR]

Background. Various methods have been proposed to treat plantar fasciitis. Among these, autologous blood transfusion has been discussed and investigated in the past few years, the findings indicate its effects in the medium term, and in some studies, better results were observed compared to corticosteroids. This study was conducted with the aim of comparing the effect of two therapeutic methods of local injection of autologous blood and corticosteroid with the control group in the treatment of plantar fasciitis. Methods. In this prospective study that took place in Shahid Beheshti Hospital, Babol, during 2020–2021, 90 plantar fasciitis patients were examined in two treatment groups by corticosteroid injection or autologous blood. Their levels of pain and satisfaction were recorded during three and six months by the visual analog scale (VAS) and the Roles and Maudsley Scale (RMS). The data were described and analyzed by SPSS-22 using descriptive indices and statistical analysis tests at a significance level of 0.05. Results. There was no significant difference in pain and satisfaction during the third month of steroid and autologous blood transfusions. However, in the sixth month, the patients in the autologous blood group had significantly less pain than those in the steroid group (P= 0.001), and their level of satisfaction was significantly higher than that of patients in the steroid injection group (P= 0.018). The mean pain intensity based on VAS in six months was 5.40 ± 1.37 and 3.76 ± 1.87 in the steroid and autologous blood groups, respectively (P< 0.001). Based on the Wilcoxon test, the VAS score increased significantly in the steroid group in the sixth month compared to the third month (P= 0.011), while it decreased in the autologous blood group (P< 0.001). Conclusion. Based on the findings, autologous blood injection in plantar fasciitis over six months had significant pain-reducing effects and satisfaction versus corticosteroid injection. However, after three months, these effects were not significant compared to corticosteroids. Practical Implications. Based on the findings, autologous blood injection in plantar fasciitis over six months had significant pain-reducing effects and satisfaction versus corticosteroid injection. However, after three months, these effects were not significant compared to corticosteroids. [ABSTRACT FROM AUTHOR]

Copyright of Revista Pediatría de Atención Primaria is the property of LUA Ediciones 3.0 S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Pediatría de Atención Primaria is the property of LUA Ediciones 3.0 S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of global morbidity and mortality, with acute exacerbations significantly worsening patient outcomes. These exacerbations often lead to hospitalizations and increased healthcare costs. Proper management, guided by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, is essential to improving care. However, real-world adherence to these recommendations can vary. Objective: To assess how acute COPD exacerbations were handled at a tertiary care hospital of Peshawar. Methodology: In the emergency department of Hayatabad Medical Complex Peshawar, between November 2021 and December 2023, we retrospectively examined clinical data of patients presenting with acute exacerbations of COPD. The management was assessed in light of the GOLD 2019 report's and earlier audits' recommendations. Results: Total 170 patients (mean age 73 years, range 41-95 years, 54% male) were included. GOLD risk group (A-D) was only documented in 39% of the cases. At the time of presentation, 74% of the patients had their respiratory rate evaluated, and 69% had their blood gas analysis done. In all, 95% of the patients had chest imaging performed. Short-acting bronchodilators were used as initial symptomatic management in 56% of cases. Among them, 92% had systemic steroid therapy implemented. Conclusion: The GOLD guidelines were not fully followed, particularly in relation to non-invasive breathing, early symptomatic treatment, and severity assessment. These findings highlight the significance of periodic practice revisions on a regular basis, which may raise practitioners' knowledge and enhance the standard of COPD care in the long run. [ABSTRACT FROM AUTHOR]

Asthma is one of the most common allergic diseases affecting millions of people of all ages worldwide and in- fluencing socioeconomic issues. Asthma, particularly uncontrolled asthma, not only reduces the quality of life but is also a major cause of disability for employment. The current pharmacologic strategy to therapy consists mostly of inhaled glucocorticoids and β-agonists, as well as leukotriene antagonists, long-acting muscarinic antagonists, and oral corticosteroids. However, the conventional therapy may provide insufficient control of severe asthma and may induce a number of adverse effects when used long-term. These limitations prompted the development of targeted biological drugs that inhibit the mediators involved in T helper 2-inflammation, which is linked to the pathogenesis of asthma, such as interleukin 4, 5, 9, 13 and immunoglobulin E. In many individuals, biological treatment provides significant relief and allows for the reduction or elimination of oral corticosteroids without compromising asthma control. However, some patients do not improve to their full potential. The cause of this phenomenon is unknown and requires further investigation. [ABSTRACT FROM AUTHOR]

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Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed. [ABSTRACT FROM AUTHOR]

Multidrug-resistant bacterial infections (MDRIs) constitute a major global threat due to increased patient morbidity/mortality and hospital stay/healthcare costs. A few studies from KSA, including our locality, addressed antimicrobial resistance in pediatric patients. This study was performed to recognize the incidence and clinical/microbiologic features of MDRIs in hospitalized pediatric patients. A retrospective cross-sectional study included pediatric patients < 18 years, admitted to King Abdulaziz University Hospital, between October 2021 and November 2022, with confirmed positive cultures of bacteria isolated from blood/body fluids. Patients' medical files provided the required data. MDR organisms (MDROs) were identified in 12.8% of the total cultures. The incidence of MDRIs was relatively high, as it was detected in 42% of patients and in 54.3% of positive bacterial cultures especially among critically ill patients admitted to the NICU and PICU. Pneumonia/ventilator-associated pneumonia was the main type of infection in 37.8% of patients with MDROs. Klebsiella pneumoniae was the most common significantly isolated MDRO in 39.5% of MDR cultures. Interestingly, a low weight for (no need for their as terminology weight for age is standard and well-known) was the only significant risk factor associated with MDROs (p = 0.02). Mortality was significantly higher (p = 0.001) in patients with MDROs (32.4%) than in patients without MDROs (3.9%). Patients who died including 85.7% of patients with MDROs had significantly longer durations of admission, more cultures, and utilized a larger number of antibiotics than the surviving patients (p = 0.02, p = 0.01, p = 0.04, respectively). This study provided a comprehensive update on the seriously alarming problem of MDROs, and its impacts on pediatric patients. The detected findings are crucial and are a helpful guide to decid for implementing effective strategies to mitigate MDROs. [ABSTRACT FROM AUTHOR]

Daptomycin-induced eosinophilic pneumonia (DIEP) is a rare complication of daptomycin use. Manifestations most commonly include fever, hypoxia, dyspnea, cough, eosinophilia, and lung changes on radiographs and CT. Patients typically have had recent daptomycin exposure and develop fever, dyspnea, infiltrates on chest radiograph, more than 25% eosinophils on bronchoalveolar lavage, and improvement of symptoms after withdrawal of daptomycin. Treatment includes discontinuation of daptomycin, corticosteroids, and supportive measures such as supplemental oxygen. Clinicians should have a high index of suspicion for DIEP in patients who develop new onset of pulmonary and systemic signs and symptoms after initiation of daptomycin. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). A retrospective analysis was performed on a cohort of 335 patients who underwent PELD between January 2016 and January 2023. Data were derived from the Hospital Information System (HIS), and a comprehensive statistical assessment was performed using IBM SPSS Statistics version 25.0. Both univariate and multivariate logistic regression analyses assessed a range of risk determinants, such as age, body mass index (BMI), comorbidities, laboratory test parameters and surgery‐related variables. The incidence of SSI after PELD was 2.7% (9/335). Univariate analysis highlighted BMI, diabetes mellitus, long‐term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant predictors of SSI. Multivariate logistic regression identified BMI, diabetes mellitus, long‐term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant risk factors for SSI after PELD. High BMI, diabetes mellitus, long‐term corticosteroid consumption, long surgical time and postoperative cerebrospinal fluid leakage are predisposing factors for SSI in patients undergoing PELD. Precise interventions focused on such risk components, including careful preoperative assessment and strategic postoperative care, are essential to reduce the incidence of SSI and improve surgical efficacy. [ABSTRACT FROM AUTHOR]

Context: To investigate the effects of steroid injection (STE), prolotherapy (PRO), and exercise therapy in the treatment of partial tears of the supraspinatus. Design: A retrospective cohort study. Methods: A total of 64 patients with clinically and radiologically diagnosed partial-thickness supraspinatus tear who received either a cortisone injection (STE), dextrose PRO, or physical therapy combined with home-based exercise therapy were included. Main outcome measures were patients' visual analog scale scores, Western Ontario Rotator Cuff (WORC) Index scores, and the Shoulder Pain and Disability Index scores at the baseline, 3 weeks, and 3 months. Results: The effect of group, time, and group-time interaction on visual analog scale, WORC, and Shoulder Pain and Disability Index scores was statistically significant (P < .001). Visual analog scale and Shoulder Pain and Disability Index scores were the lowest in the STE group at week 3, and the lowest in the PRO group at month 3 (P < .001). WORC scores of the STE group were the highest at week 3 (P < .001). At month 3, WORC scores of STE and PRO groups were similar (P = .089). but significantly higher than exercise therapy. Conclusions: Corticosteroids provide a fast pain-relieving effect and improvement in function in partial-thickness rotator cuff tears, but these effects diminish over time, whereas PRO provides a long-lasting effect. [ABSTRACT FROM AUTHOR]

A quiz is presented about the case of a 27-year-old man with a three-month history of left neck pain, abdominal pain, and weight loss and whose computed tomographic (CT) imaging showed widespread lymphadenopathy and mild abdominopelvic ascites.

Most patients with chronic, neuromuscular, autoimmune myasthenia gravis (MG) are positive for acetylcholine receptor antibodies. Traditional therapy involves anticholinesterase inhibitors and immunosuppressants, including corticosteroids, that come with significant long-term tolerability concerns. Recent regulatory approvals of the complement inhibitors eculizumab, ravulizumab and zilucoplan, and neonatal Fc receptor blockers efgartigimod and rozanolixizumab, provide new, non-oral, monotherapy or add-on treatment options for refractory and/or severe MG. In randomized trials, these agents improved activities of daily living scores and were generally well tolerated, although headache was common and some serious infections occurred. Cost, non-oral routes of administration and the need for immunisations (for complement inhibitors) are the main limitations of treatment. [ABSTRACT FROM AUTHOR]

Kinpeygo (budesonide) is a corticosteroid‐based therapy approved for the treatment of adults with rapidly progressing primary immunoglobulin A nephropathy. This article discusses its mode of action, efficacy and adverse effects. [ABSTRACT FROM AUTHOR]

The article discusses the case of a pediatric patient with mevalonate kinase deficiency (MKD) caused by homozygous mutation in the MVK gene. Topics discussed include the patient's development of very early-onset, recurrent episodes and life-threatening colitis, the results of genetic testing and colonoscopic biopsy, and the management of the patient through combination therapy targeting interleukin-1 beta and tumor necrosis factor alpha.

The article discusses the case of a patient with severe trismus leading to the diagnosis of vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome. Topics discussed include magnetic resonance imaging revealing inflammation of masticatory muscles, the mutation in exon 3 of the UBA 1 gene, and the resolution of clinical symptoms following corticosteroid therapy with prednisone.

We describe a case report of a patient with Blastomycosis-induced acute respiratory distress syndrome (ARDS) and severe hypoxemia requiring mechanical ventilation, prone positioning, and neuromuscular blockade whose clinical condition rapidly improved with the use of corticosteroids resulting in the patient being discharged home without the need for supplemental oxygen. [ABSTRACT FROM AUTHOR]

Classical serum sickness is a type III immune complex-mediated hypersensitivity disease caused by immunization of the host by non-human serum proteins. Anti-thymocyte globulin is one of the agents mostly responsible. Prophylactic steroids are used in the treatment protocol of aplastic anemia in addition to anti-thymocyte globulin. A 33-year-old female patient diagnosed with aplastic anemia developed severe serum sickness with anti-thymocyte globulin, despite the administration of a prophylactic dose of methylprednisolone. The patient responded dramatically to a single dose of pulse steroid therapy. There are reports that high-dose steroids (1-2 mg/kg/day to 500-1000 mg/day methylprednisolone) and/or therapeutic plasma exchange are beneficial treatment options. Our report shows the benefit of a single pulse dose of steroid and gradual tapering of the dose in this case. [ABSTRACT FROM AUTHOR]

Background: Post-acute COVID-19 syndrome that is called long COVID-19 consists of the symptoms that last more than 12 weeks with no other explanation. The present study aimed to determine the prevalence, frequency of symptoms, and risk factors of long COVID-19 in the healthcare workers (HCWs) of a selected hospital in Kashan/Iran in 2023. Methods: A total of 350 HCWs with a history of COVID-19 infection were randomly recruited to the study from February to May 2023. Participants completed a questionnaire including demographic characteristics, information related to COVID-19 infection, underlying diseases, and a checklist of long COVID-19 symptoms. Mann‒Whitney U test, chi-square test, T‒tests, and binary logistic regression were used for data analysis by SPSS 16. Results: The results showed that 75.7% of HCWs experienced symptoms of long COVID-19. The most common symptoms were fatigue (53.1%), cough (43.1%) and muscle weakness (37.1%). In bivariate analysis job title, body mass index (BMI), frequency and number of symptoms of COVID-19 infection, preexisting disease, tobacco use, age, and years of experience showed a significant statistical association with long COVID-19. In binary logistic regression the number of symptoms during COVID-19 infection, nursing occupation, use of corticosteroids, and symptoms of dyspnea and loss of taste could explain the occurrence of long COVID-19. Conclusion: The long COVID-19 is a prevalent condition among HCWs especially nurses. Symptoms of long COVID-19 such as fatigue and cough can persists over time. This chronic condition has significant associations with different clinical risk factors. [ABSTRACT FROM AUTHOR]

• Juvenile male song sparrows are robustly aggressive, like adults. • Androgens and estrogens are low in the blood and brain of juveniles. • Blood and brain progesterone in juveniles increase after an aggressive encounter. • Blood and brain glucocorticoids increase after an aggressive encounter. • Juvenile and adult aggression might use distinct neuroendocrine mechanisms. Aggression is a social behavior that is critical for survival and reproduction. In adults, circulating gonadal hormones, such as androgens, act on neural circuits to modulate aggressive interactions, especially in reproductive contexts. In many species, individuals also demonstrate aggression before reaching gonadal maturation. Adult male song sparrows, Melospiza melodia , breed seasonally but maintain territories year-round. Juvenile (hatch-year) males aggressively compete for territory ownership during their first winter when circulating testosterone is low. Here, we characterized the relationship between the steroid milieu and aggressive behavior in free-living juvenile male song sparrows in winter. We investigated the effect of a 10 min simulated territorial intrusion (STI) on behavior and steroid levels in blood, 10 microdissected brain regions, and four peripheral tissues (liver, pectoral muscle, adrenal glands, and testes). Using liquid chromatography-tandem mass spectrometry (LC-MS/MS), we quantified 12 steroids: pregnenolone, progesterone, corticosterone, 11-dehydrocorticosterone, dehydroepiandrosterone, androstenedione, testosterone, 5α-dihydrotestosterone, 17β-estradiol , 17α-estradiol, estrone, and estriol. We found that juvenile males are robustly aggressive, like adult males. An STI increases progesterone and corticosterone levels in blood and brain and increases 11-dehydrocorticosterone levels in blood only. Pregnenolone, androgens, and estrogens are generally non-detectable and are not affected by an STI. In peripheral tissues, steroid concentrations are very high in the adrenals. These data suggest that adrenal steroids, such as progesterone and corticosterone, might promote juvenile aggression and that juvenile and adult songbirds might rely on distinct neuroendocrine mechanisms to support similar aggressive behaviors. [ABSTRACT FROM AUTHOR]

Simple Summary: In most cases, it is impossible to differentiate primary central nervous system lymphoma (PCNSL) from other brain tumors or neuroinflammatory diseases without histological confirmation. In most differential diagnoses of PCNSL, preoperative treatment with glucocorticoids is administered. This treatment reduces the symptoms of PCNSL but can also disguise the histological diagnosis, which can lead to an incorrect or delayed diagnosis of PCNSL and postponed therapy. To obtain a broader database for evidence-based decisions in the management of patients with PCNSL, we retrospectively evaluated all patients biopsied and diagnosed with PCNSL at our institution over the last 16 years. Particular focus was placed on the influence of preoperative glucocorticoid therapy and the effect of anticoagulation and dual antiplatelet therapy on the validity of histological diagnosis. In patients with primary central nervous system lymphoma (PCNSL), the choice of surgical strategy for histopathologic assessments is still controversial, particularly in terms of preoperative corticosteroid (CS) therapy. To provide further evidence for clinical decision-making, we retrospectively analyzed data from 148 consecutive patients who underwent surgery at our institution. Although patients treated with corticosteroids preoperatively were significantly more likely to require a second or third biopsy (p = 0.049), it was only necessary in less than 10% of the cases with preoperative (but discontinued) corticosteroid treatment. Surprisingly, diagnostic accuracy was significantly lower when patients were treated with anticoagulation or dual antiplatelet therapy (p = 0.015). Preoperative CSF sampling did not provide additional information but was associated with delayed surgery (p = 0.02). In conclusion, preoperative CS therapy can challenge the histological diagnosis of PCNSL. At the same time, our data suggest that preoperative CS treatment only presents a relative contraindication for early surgical intervention. If a definitive diagnosis cannot be made after the first surgical intervention, the timing of a repeat biopsy after the discontinuation of CS remains a case-by-case decision. The effect of anticoagulation and dual antiplatelet therapy on diagnostic accuracy might have been underestimated and should be examined closely in future investigations. [ABSTRACT FROM AUTHOR]