14 results on '"Corticosteroids -- Analysis -- Health aspects"'
Search Results
2. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia
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Meduri, G. Umberto, Shih, Mei-Chiung, Bridges, Lisa, Martin, Thomas J., El-Solh, Ali, Seam, Nitin, and Davis-Karim, Anne
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Memphis VA Medical Center -- Analysis ,Methylprednisolone -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Company acquisition/merger ,Health care industry - Abstract
Purpose Severe community-acquired pneumonia (CAP) requiring intensive care unit admission is associated with significant acute and long-term morbidity and mortality. We hypothesized that downregulation of systemic and pulmonary inflammation with prolonged low-dose methylprednisolone treatment would accelerate pneumonia resolution and improve clinical outcomes. Methods This double-blind, randomized, placebo-controlled clinical trial recruited adult patients within 72-96 h of hospital presentation. Patients were randomized in 1:1 ratio; an intravenous 40 mg loading bolus was followed by 40 mg/day through day 7 and progressive tapering during the 20-day treatment course. Randomization was stratified by site and need for mechanical ventilation (MV) at the time of randomization. Outcomes included a primary endpoint of 60-day all-cause mortality and secondary endpoints of morbidity and mortality up to 1 year of follow-up. Results Between January 2012 and April 2016, 586 patients from 42 Veterans Affairs Medical Centers were randomized, short of the 1420 target sample size because of low recruitment. 584 patients were included in the analysis. There was no significant difference in 60-day mortality between the methylprednisolone and placebo arms (16% vs. 18%; adjusted odds ratio 0.90, 95% CI 0.57-1.40). There were no significant differences in secondary outcomes or complications. Conclusions In patients with severe CAP, prolonged low-dose methylprednisolone treatment did not significantly reduce 60-day mortality. Treatment was not associated with increased complications., Author(s): G. Umberto Meduri [sup.1] [sup.2], Mei-Chiung Shih [sup.3] [sup.4], Lisa Bridges [sup.1] [sup.2], Thomas J. Martin [sup.5] [sup.6] [sup.7], Ali El-Solh [sup.8] [sup.9], Nitin Seam [sup.10], Anne Davis-Karim [sup.11], [...]
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- 2022
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3. Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis
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Fujii, Tomoko, Salanti, Georgia, Belletti, Alessandro, Bellomo, Rinaldo, Carr, Anitra, Furukawa, Toshi A., and Luethi, Nora
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Corticosteroids -- Analysis -- Health aspects ,Mortality -- Australia ,Infection -- Health aspects -- Analysis ,Medical colleges -- Health aspects -- Analysis ,Vitamin C -- Analysis -- Health aspects ,Adults -- Health aspects -- Analysis ,Septic shock -- Analysis -- Health aspects ,Health care industry - Abstract
We aimed to compare the effects of vitamin C, glucocorticoids, vitamin B1, combinations of these drugs, and placebo or usual care on longer-term mortality in adults with sepsis or septic shock. MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and WHO-ICTRP were searched. The final search was carried out on September 3rd, 2021. Multiple reviewers independently selected randomized controlled trials (RCTs) comparing very-high-dose vitamin C ([greater than or equal to] 12 g/day), high-dose vitamin C (< 12, [greater than or equal to] 6 g/day), vitamin C (< 6 g/day), glucocorticoid (< 400 mg/day of hydrocortisone), vitamin B1, combinations of these drugs, and placebo/usual care. We performed random-effects network meta-analysis and, where applicable, a random-effects component network meta-analysis. We used the Confidence in Network Meta-Analysis framework to assess the degree of treatment effect certainty. The primary outcome was longer-term mortality (90-days to 1-year). Secondary outcomes were severity of organ dysfunction over 72 h, time to cessation of vasopressor therapy, and length of stay in intensive care unit (ICU). Forty-three RCTs (10,257 patients) were eligible. There were no significant differences in longer-term mortality between treatments and placebo/usual care or between treatments (10 RCTs, 7,096 patients, moderate to very-low-certainty). We did not find any evidence that vitamin C or B1 affect organ dysfunction or ICU length of stay. Adding glucocorticoid to other treatments shortened duration of vasopressor therapy (incremental mean difference, - 29.8 h [95% CI - 44.1 to - 15.5]) and ICU stay (incremental mean difference, - 1.3 days [95% CI - 2.2 to - 0.3]). Metabolic resuscitation with vitamin C, glucocorticoids, vitamin B1, or combinations of these drugs was not significantly associated with a decrease in longer-term mortality., Author(s): Tomoko Fujii [sup.1] [sup.2] [sup.3], Georgia Salanti [sup.4], Alessandro Belletti [sup.5], Rinaldo Bellomo [sup.2] [sup.6] [sup.7], Anitra Carr [sup.8], Toshi A. Furukawa [sup.3], Nora Luethi [sup.2] [sup.9], Yan Luo [...]
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- 2022
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4. Corticosteroid exposure in pediatric acute respiratory distress syndrome
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Yehya, Nadir, Servaes, Sabah, Thomas, Neal J., Nadkarni, Vinay M., and Srinivasan, Vijay
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Corticosteroids -- Analysis -- Health aspects ,Pediatrics -- Health aspects -- Analysis ,Respiratory distress syndrome -- Health aspects -- Analysis ,Mortality -- United Kingdom -- Germany ,Children -- Injuries ,Health care industry - Abstract
Purpose Use of systemic corticosteroids in acute respiratory distress syndrome (ARDS) remains controversial, and studies in children are lacking. Methods We performed an observational, single-center study in a prospectively enrolled cohort of children meeting criteria for ARDS (both Berlin 2012 and AECC 1994 acute lung injury) and pediatric ARDS (PARDS, as defined by PALICC 2015). Comprehensive analysis of corticosteroid utilization was planned, and detailed information collected on corticosteroid use, timing, treatment duration, and cumulative dose while mechanically ventilated. We assessed the association between corticosteroid exposure >24 h and outcomes. Results Of the 283 children with PARDS (37 deaths, 13 %), 169 (60 %) received corticosteroids for >24 h while ventilated: 51 % hydrocortisone, 41 % methylprednisolone, 5 % dexamethasone, 3 % combination of corticosteroids. Corticosteroid exposure >24 h was associated with increased mortality, fewer ventilator-free days at 28 days (VFD), and longer duration of ventilation in survivors in unadjusted analyses (all p 24 h in patients with [greater than or equal to]3 organ failures and immunocompromised patients. Conclusions Corticosteroid exposure >24 h was independently associated with fewer VFD and longer duration of ventilation in survivors, even after adjustment for key potential confounders, including severity of illness, oxygenation index, immunocompromised status, and number of organ failures., Author(s): Nadir Yehya [sup.1], Sabah Servaes [sup.2], Neal J. Thomas [sup.3], Vinay M. Nadkarni [sup.1], Vijay Srinivasan [sup.1] Author Affiliations: (1) grid.239552.a, 0000000106808770, Department of Anesthesiology and Critical Care Medicine, [...]
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- 2015
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5. Prognostic significance of hypothalamic-pituitary-adrenal axis hormones in early sepsis: a study performed in the emergency department
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Zhang, Qian, Dong, Guijuan, Zhao, Xin, Wang, Miaomiao, and Li, Chun-Sheng
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Brain -- Analysis -- Health aspects ,Vasopressin -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Mortality -- Analysis ,Hospitals -- Emergency service ,Infection -- Health aspects -- Analysis ,ACTH -- Analysis -- Health aspects ,Septic shock -- Analysis -- Health aspects ,Health care industry - Abstract
Purpose The response of the hypothalamic-pituitary-adrenal (HPA) axis to the sustained stress of sepsis has been the focus of study in recent years because the early phase of sepsis is known to be dominated by major alterations in the HPA axis. This prospective observational study aimed at assessing the predictive values of copeptin and HPA hormones in determining sepsis progression and mortality in the emergency department (ED). Methods Serum arginine vasopressin (AVP) and copeptin concentrations were measured upon ED admission. Baseline levels of total and free cortisol and adrenocorticotrophic hormone (ACTH) were measured within 24 h of ED admission. Mortality in Emergency Department Sepsis (MEDS) score was calculated at enrollment. Results Our findings demonstrated that serum copeptin, baseline total cortisol, baseline free cortisol and baseline ACTH concentrations gradually increased, based upon the increasing severity of the disease (p < 0.001). Multivariate logistic regression analysis showed that copeptin and total cortisol baseline concentrations were independent predictors of septic shock (odds ratio = 1.034 and 1.355, respectively) and 28-day mortality (odds ratio = 1.039 and 1.499, respectively). The areas under the receiver operating characteristic curve (AUC) for copeptin level in prediction of septic shock was 0.856 and 28-day mortality was 0.826. Importantly, AUC analysis of the combination of copeptin, total cortisol baseline, MEDS score, and procalcitonin level resulted in a more significant prognostic ability than analysis of each parameter alone (p < 0.001). Conclusions Increased copeptin and HPA hormones baseline levels may provide crucial information for risk stratification in a variety of septic states in the ED. Furthermore, measurements of copeptin level and serum baseline cortisol concentration are promising independent prognostic markers for mortality in patients with severe sepsis or septic shock., Author(s): Qian Zhang [sup.1], Guijuan Dong [sup.1], Xin Zhao [sup.1], Miaomiao Wang [sup.1], Chun-Sheng Li [sup.1] Author Affiliations: (1) grid.24696.3f, 000000040369153X, Department of Emergency Medicine, Beijing Chao-yang Hospital, Capital Medical [...]
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- 2014
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6. New Post-Traumatic Stress Disorders Findings Has Been Reported by Investigators at School of Medicine (Biomarker Response To Mindfulness Intervention In Veterans Diagnosed With Post-traumatic Stress Disorder)
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United States. National Institutes of Health -- Analysis ,Medical research -- Analysis -- Health aspects ,Medicine, Experimental -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Mental health -- Analysis -- Health aspects ,Group counseling -- Analysis -- Health aspects ,Stress management -- Health aspects -- Analysis ,C-reactive protein -- Health aspects -- Analysis ,Post-traumatic stress disorder -- Health aspects -- Analysis ,Health ,Psychology and mental health - Abstract
2022 OCT 10 (NewsRx) -- By a News Reporter-Staff News Editor at Mental Health Weekly Digest -- Current study results on Veterans Health - Post-Traumatic Stress Disorders have been published. [...]
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- 2022
7. Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study
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Wauters, Joost, Baar, Ingrid, Meersseman, Philippe, Meersseman, Wouter, Dams, Karolien, De Paep, Rudi, and Lagrou, Katrien
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Pulmonary aspergillosis -- Risk factors ,Health maintenance organizations -- Analysis -- Health aspects ,Medical research -- Analysis -- Health aspects ,Medicine, Experimental -- Analysis -- Health aspects ,Bacterial pneumonia -- Risk factors ,Corticosteroids -- Analysis -- Health aspects ,Pneumonia -- Risk factors ,Hospital patients -- Analysis -- Health aspects ,Virus diseases -- Risk factors ,Health care industry - Abstract
Purpose Despite their controversial role, corticosteroids (CS) are frequently administered to patients with H1N1 virus infection with severe respiratory failure secondary to viral pneumonia. We hypothesized that invasive pulmonary aspergillosis (IPA) is a frequent complication in critically ill patients with H1N1 virus infection and that CS may contribute to this complication. Methods We retrospectively selected all adult patients with confirmed H1N1 virus infection admitted to the intensive care unit (ICU) of two tertiary care hospitals from September 2009 to March 2011. Differences in baseline factors, risk factors, and outcome parameters were studied between patients with and without IPA. Results Of 40 critically ill patients with confirmed H1N1, 9 (23 %) developed IPA 3 days after ICU admission. Five patients had proven and four had probable IPA. Significantly more IPA patients received CS within 7 days before ICU admission (78 versus 23 %, p = 0.002). IPA patients also received significantly higher doses of CS before ICU admission [hydrocortisone equivalent 800 (360-2,635) versus 0 (0-0) mg, p = 0.005]. On multivariate analysis, use of CS before ICU admission was independently associated with IPA [odds ratio (OR) 14.4 (2.0-101.6), p = 0.007]. Conclusions IPA was diagnosed in 23 % of critically ill patients with H1N1 virus infection after a median of 3 days after ICU admission. Our data suggest that use of CS 7 days before ICU admission is an independent risk factor for fungal superinfection. These findings may have consequences for clinical practice as they point out the need for increased awareness of IPA, especially in those critically ill H1N1 patients already receiving CS., Author(s): Joost Wauters [sup.1], Ingrid Baar [sup.2], Philippe Meersseman [sup.1], Wouter Meersseman [sup.1], Karolien Dams [sup.2], Rudi De Paep [sup.2], Katrien Lagrou [sup.3], Alexander Wilmer [sup.1], Philippe Jorens [sup.2], Greet [...]
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- 2012
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8. The effect of etomidate on adrenal function in critical illness: a systematic review
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Albert, Stewart G., Ariyan, Srividya, and Rather, Ayesha
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Medical research -- Analysis -- Health aspects ,Medicine, Experimental -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Etomidate -- Health aspects -- Analysis ,Mortality -- Colombia ,Anesthetics -- Health aspects -- Analysis ,Anesthesia -- Health aspects -- Analysis ,Health care industry - Abstract
Purpose Although etomidate is a preferred anesthetic agent for rapid sequence intubation (RSI) in critical illness, as an inhibitor of cortisol synthesis (11[beta]-hydroxylase), it may be associated with adrenal dysfunction. The objectives are to review the effects of etomidate versus comparator anesthetics in critical illness for: primary outcome of mortality and secondary outcome of adrenal insufficiency (AI). Methods Studies were extracted using MEDLINE and SCOPUS, regardless of language, between 1983 and 2010 using the keywords etomidate, intensive care units (ICU), critical illness, intensive care, glucocorticoids, and adrenal insufficiency. Studies of single dose etomidate versus comparator anesthetics with outcomes of adrenal function and/or mortality were included. All reviewers performed electronic data searches. One reviewer extracted data, which were checked by the other reviewers. Authors of trials were contacted for supplemental data. Primary outcome was 28-day mortality. AI was defined per article. Results Two hundred sixty-three articles were screened, and 21 articles (19 independent data sets) were evaluated. Meta-analysis comparing etomidate versus non-etomidate anesthesia demonstrated an increased risk ratio (RR) for AI of 1.64 (range 1.52-1.77; 14 studies, 2,854 patients, P < 0.0001, I.sup.2 = 88%) and an increased RR for mortality of 1.19 (1.10-1.30; 14 studies, 3,516 patients, P < 0.0001, I.sup.2 = 64%). Significance of re-analysis for mortality within the subset of sepsis was maintained [RR 1.22 (1.11-1.35), 7 studies, n = 1,767, I.sup.2 = 74%, P < 0.0001], but not for trials without sepsis [RR = 1.15 (0.97-1.35), 7 studies, n = 1,749, I.sup.2 = 53%, P = 0.10]. Conclusions There is an increased rate of AI and mortality in critically ill patients who received etomidate., Author(s): Stewart G. Albert [sup.1], Srividya Ariyan [sup.1], Ayesha Rather [sup.1] Author Affiliations: (1) grid.262962.b, 0000000121143893, Division of Endocrinology, Department of Internal Medicine, Saint Louis University School of Medicine, , [...]
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- 2011
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9. Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial
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Torgersen, Christian, Dünser, Martin W., Wenzel, Volker, Jochberger, Stefan, Mayr, Viktoria, Schmittinger, Christian A., and Lorenz, Ingo
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Vasopressin -- Analysis -- Health aspects ,Shock -- Health aspects -- Analysis ,Infection -- Health aspects -- Analysis ,Arginine -- Health aspects -- Analysis ,Lactates -- Health aspects -- Analysis ,Blood vessels -- Dilatation ,Cardiac patients -- Analysis -- Health aspects ,Bilirubin -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Sufentanil -- Analysis -- Health aspects ,Vasodilators -- Health aspects -- Analysis ,Liver -- Analysis -- Health aspects ,Enzymes -- Health aspects -- Analysis ,Health care industry - Abstract
Purpose To compare the effects of two arginine vasopressin (AVP) dose regimens on the hemodynamic response, catecholamine requirements, AVP plasma concentrations, organ function and adverse events in advanced vasodilatory shock. Methods In this prospective, controlled, open-label trial, patients with vasodilatory shock due to sepsis, systemic inflammatory response syndrome or after cardiac surgery requiring norepinephrine >0.6 [mu]g/kg/min were randomized to receive a supplementary AVP infusion either at 0.033 IU/min (n = 25) or 0.067 IU/min (n = 25). The hemodynamic response, catecholamine doses, laboratory and organ function variables as well as adverse events (decrease in cardiac index or platelet count, increase in liver enzymes or bilirubin) were recorded before, 1, 12, 24 and 48 h after randomization. A linear mixed effects model was used for statistical analysis in order to account for drop-outs during the observation period. Results Heart rate and norepinephrine requirements decreased while MAP increased in both groups. Patients receiving AVP at 0.067 IU/min required less norepinephrine (P = 0.006) than those infused with AVP at 0.033 IU/min. Arterial lactate and base deficit decreased while arterial pH increased in both groups. During the observation period, AVP plasma levels increased in both groups (both P < 0.001), but were higher in the 0.067 IU/min group (P < 0.001) and in patients on concomitant hydrocortisone. The rate of adverse events and intensive care unit mortality was comparable between groups (0.033 IU/min, 52%; 0.067 IU/min, 52%; P = 1). Conclusions A supplementary AVP infusion of 0.067 IU/min restores cardiovascular function in patients with advanced vasodilatory shock more effectively than AVP at 0.033 IU/min., Author(s): Christian Torgersen [sup.1], Martin W. Dünser [sup.2], Volker Wenzel [sup.1], Stefan Jochberger [sup.1], Viktoria Mayr [sup.1], Christian A. Schmittinger [sup.1], Ingo Lorenz [sup.1], Stefan Schmid [sup.1], Martin Westphal [sup.3], [...]
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- 2010
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10. H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment
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Quispe-Laime, Adolfo Maximo, Bracco, Jonas Daniel, Barberio, Patricia Alejandra, Campagne, Claudio German, Rolfo, Verónica Edith, Umberger, Reba, and Meduri, Gianfranco Umberto
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Methylprednisolone -- Analysis -- Health aspects ,Epidemics -- Care and treatment ,Oseltamivir phosphate -- Health aspects -- Analysis ,Corticosteroids -- Analysis -- Health aspects ,Swine influenza -- Care and treatment ,Mortality -- United Kingdom -- Canada ,Hospital patients -- Care and treatment ,Acute respiratory distress syndrome -- Care and treatment ,DNA polymerases -- Health aspects -- Analysis ,Health care industry - Abstract
Purpose During the 2009 H1N1 influenza A virus pandemic, a minority of patients developed rapidly progressive pneumonia leading to acute lung injury (ALI)-acute respiratory distress syndrome (ARDS). A recent meta-analysis provides support for prolonged corticosteroid treatment in ALI-ARDS. We prospectively evaluated the response to oseltamivir and prolonged corticosteroid treatment in patients with ALI-ARDS and suspected H1N1 influenza. Methods From June 24 through 12 July 2009, 13 patients with suspected H1N1 pneumonia and ALI-ARDS were admitted to the intensive care unit (ICU) of a tertiary care hospital. H1N1 influenza was confirmed with real-time reverse transcriptase-polymerase chain reaction assay in eight patients. Oseltamivir and corticosteroid treatment were initiated concomitantly at ICU admission; those with severe ARDS received methylprednisolone (1 mg/kg/day), and others received hydrocortisone (300 mg/day) for a duration of 21 ± 6 days. Results Patients with and without confirmed H1N1 influenza had similar disease severity at presentation and a comparable response to treatment. By day 7 of treatment, patients experienced a significant improvement in lung injury and multiple organ dysfunction scores (P < 0.001). Twelve patients (92%) improved lung function, were extubated, and discharged alive from the ICU. Hospital length of stay and mortality were 18.7 ± 9.6 days and 15%, respectively. Survivors were discharged home without oxygen supplementation. Conclusions In ARDS patients, with and without confirmed H1N1 influenza, prolonged low-to-moderate dose corticosteroid treatment was well tolerated and associated with significant improvement in lung injury and multiple organ dysfunction scores and a low hospital mortality. These findings provide the rationale for developing a randomized trial., Author(s): Adolfo Maximo Quispe-Laime [sup.1], Jonas Daniel Bracco [sup.1], Patricia Alejandra Barberio [sup.1], Claudio German Campagne [sup.1], Verónica Edith Rolfo [sup.1], Reba Umberger [sup.2], Gianfranco Umberto Meduri [sup.2] [sup.3] Author [...]
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- 2010
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11. Treatment strategies for atopic dermatitis: optimizing the available therapeutic options
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Paller, Amy S., Simpson, Eric L., Eichenfield, Lawrence F., Ellis, Charles N., and Mancini, Anthony J.
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Infection control -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Staphylococcus aureus -- Analysis -- Health aspects ,Atopic dermatitis -- Drug therapy -- Analysis -- Health aspects ,Infection -- Drug therapy -- Analysis -- Health aspects ,Staphylococcus aureus infections -- Drug therapy -- Analysis -- Health aspects ,Immunosuppressive agents -- Analysis -- Health aspects ,Anti-inflammatory drugs -- Analysis -- Health aspects ,Health ,Health care industry - Abstract
Bathing and moisturization to control dryness, applications of topical anti-inflammatory agents (including corticosteroids and calcineurin inhibitors[TCIs]) to control flares, minimization of the risk for infection, and relief of pruritus are [...]
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- 2012
12. Treatment strategies for atopic dermatitis: optimizing the available therapeutic options
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Paller, Amy S., Simpson, Eric L., Eichenfield, Lawrence F., Ellis, Charles N., and Mancini, Anthony J.
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Infection control -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Staphylococcus aureus -- Analysis -- Health aspects ,Atopic dermatitis -- Drug therapy -- Analysis -- Health aspects ,Infection -- Drug therapy -- Analysis -- Health aspects ,Staphylococcus aureus infections -- Drug therapy -- Analysis -- Health aspects ,Immunosuppressive agents -- Analysis -- Health aspects ,Anti-inflammatory drugs -- Analysis -- Health aspects ,Health ,Health care industry - Abstract
Bathing and moisturization to control dryness, applications of topical anti-inflammatory agents (including corticosteroids and calcineurin inhibitors [TCIs]) to control flares, minimization of the risk for infection, and relief of pruritus [...]
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- 2012
13. Reports on Hypertension Findings from Novartis Pharma Provide New Insights (Aldosterone synthase inhibition for the treatment of hypertension and the derived mechanistic requirements for a new therapeutic strategy)
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Novartis Pharma AG ,Steroids -- Analysis -- Health aspects ,Corticosteroids -- Analysis -- Health aspects ,Aldosterone -- Analysis -- Health aspects ,Hypertension -- Drug therapy -- Analysis -- Health aspects ,Pharmaceutical industry -- Analysis -- Health aspects ,Biotechnology industry ,Pharmaceuticals and cosmetics industries - Abstract
By a News Reporter-Staff News Editor at Biotech Week -- Investigators publish new report on Cardiovascular Diseases and Conditions. According to news originating from Basel, Switzerland, by NewsRx correspondents, research [...]
- Published
- 2014
14. Study results from Yale University, Howard Hughes Medical Institute provide new insights into influenza immunology
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Corticosteroids -- Analysis -- Health aspects ,Influenza -- Analysis -- Health aspects ,Bacterial infections -- Analysis -- Health aspects ,Universities and colleges -- Analysis -- Health aspects ,Health - Abstract
Researchers detail in 'Influenza virus-induced glucocorticoids compromise innate host defense against a secondary bacterial infection,' new data in influenza. 'Multicellular organisms are continuously exposed to many different pathogens. Because different [...]
- Published
- 2010
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