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long term corticosteroid management

Mariana Castells, Joseph Butterfield
Patients with clonal mast cell activation syndromes (MCAS) including cutaneous and systemic mastocytosis (SM) may present with symptoms of mast cell activation, but in addition can have organ damage from the local effects of tissue infiltration by clonal mast cells. Patients with nonclonal MCAS may have chronic or episodic mast cell activation symptoms with an increase in serum tryptase and/or urinary metabolites of histamine, prostaglandin D2, and leukotrienes. Symptoms of MCAS and SM can be managed by blockade of mediator receptors (H1 and H2 antihistamines, leukotriene receptor blockade), inhibition of mediator synthesis (aspirin, zileuton), mediator release (sodium cromolyn), anti-IgE therapy, or a combination of these approaches...
April 2019: Journal of Allergy and Clinical Immunology in Practice
Annabel Maruani, Mahtab Samimi, Natasha Stembridge, Rania Abdel Hay, Elsa Tavernier, Carolyn Hughes, Laurence Le Cleach
BACKGROUND: Guttate psoriasis displays distinctive epidemiological and clinical features, making it a separate entity within the heterogeneous group of cutaneous psoriasis types. It is associated with genetic, immune, and environmental factors (such as stress and infections) and usually arises in younger age groups (including children, teenagers, and young adults). There is currently no cure for psoriasis, but various treatments can help to relieve the symptoms and signs. The objectives of treatment when managing an acute flare of guttate psoriasis are to reduce time to clearance and induction of long-term remission after resolution...
April 8, 2019: Cochrane Database of Systematic Reviews
Muhammad Hassan, Samendra Karkhur, Jeonghun Bae, Muhammad S Halim, Maria S Ormaechea, Nam V Nguyen, Rubbia Afridi, Yasir J Sepah, Diana V Do, Quan Dong Nguyen
Uveitis is a spectrum of inflammatory disorders characterised by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease, and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with hi-dose corticosteroids is associated with side effects and cannot be maintained long term...
April 2, 2019: Clinical & Experimental Ophthalmology
Roland Buhl, Eckard Hamelmann
Despite major advances in therapeutic interventions and the availability of detailed treatment guidelines, a high proportion of patients with symptomatic asthma remain uncontrolled. Asthma management is largely guided by the Global Initiative for Asthma (GINA) strategy and is based on a backbone of inhaled corticosteroid (ICS) therapy with the use of additional therapies to achieve disease control. Inhaled long-acting bronchodilators alone and in combination are the preferred add-on treatment options. Although long-acting muscarinic antagonists (LAMAs) are a relatively recent addition to disease management recommendations for asthma, tiotropium has been extensively studied in a large clinical trial program...
2019: Therapeutics and Clinical Risk Management
Jean Paul Stahl, Alexandra Mailles
PURPOSE OF REVIEW: HSV is the most frequently identified cause of infectious encephalitis, in Western countries. This article is an update on the topic based on a review of recent studies from 2017 to 2018. RECENT FINDINGS: Acyclovir is still the first line treatment, and no new drugs are currently available for clinical use. The major considerations for HSV encephalitis are as follows: point one, clinical evaluation remains the most important factor, as though CSF HSV PCR has a good sensitivity, in a small proportion of patients the initial testing might be negative...
March 27, 2019: Current Opinion in Infectious Diseases
Paras P Vakharia, Jonathan I Silverberg
Atopic dermatitis is a complex, chronic inflammatory skin disorder with a profound symptom burden, and substantially affects patients' quality of life. It is particularly challenging to manage in children, because conventional treatments such as topical corticosteroids might be inadequate or cause considerable safety concerns. Research into the pathogenesis of atopic dermatitis has led to the testing and development of numerous topical, oral, and injectable targeted therapeutic agents. This Review explores relevant drugs that hold therapeutic promise and are being studied in the paediatric setting, with a focus on target relevance, available efficacy and safety data, potential safety concerns, and long-term effect in children with atopic dermatitis...
March 20, 2019: Lancet Child & Adolescent Health
Kim M Blakely, Aaron M Drucker, Cheryl F Rosen
Photosensitive drug eruptions are cutaneous adverse events due to exposure to a medication and either ultraviolet or visible radiation. In this review, the diagnosis, prevention and management of drug-induced photosensitivity is discussed. Diagnosis is based largely on the history of drug intake and the appearance of the eruption primarily affecting sun-exposed areas of the skin. This diagnosis can also be aided by tools such as phototesting, photopatch testing and rechallenge testing. The mainstay of management is prevention, including informing patients of the possibility of increased photosensitivity as well as the use of appropriate sun protective measures...
March 19, 2019: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
M Göbel, R Eming
BACKGROUND: Bullous pemphigoid, the most common autoimmune blistering disease of the skin in adults, is caused by autoantibodies against hemidesmosomal adhesion proteins (BP180/type XVII collagen and BP230), leading into subepidermal blistering. Therefore patients, mostly older than 70 years, show tight bullae and erosions of the skin and rarely at mucous membranes. PROBLEM: Usually the disease shows a chronically relapsing course. Thus there is a need for long-term topical corticosteroids and if necessary systemic immunosuppressives...
March 12, 2019: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
Srilakshmi M Sharma, Erika Damato, Ann E Hinchcliffe, Colm D Andrews, Katie Myint, Richard Lee, Andrew D Dick
BACKGROUND/AIM: To report the efficacy and tolerability of antitumour necrosis factor-alpha therapy (TNF inhibitors [TNFi]) in the management of non-infectious ocular inflammation, including uveitis and scleritis, in adult patients over an 8-year period. MATERIALS AND METHODS: This is a prospective cohort study of infliximab and adalimumab in the treatment of non-infectious ocular inflammatory disease. 43 of 85 adult patients on TNFi (34 infliximab, 9 adalimumab) for ≥1 year with non-infectious uveitis or scleritis were followed from 2006 to 2014...
March 12, 2019: British Journal of Ophthalmology
Paolo G Arduino, Roberto Broccoletti, Mario Carbone, Alessio Gambino, Veronica Sciannameo, Davide Conrotto, Marco Cabras, Savino Sciascia, Fulvio Ricceri, Simone Baldovino, Marco Carrozzo
BACKGROUND: Despite the frequency of oral involvement, there are unexpectedly few studies of either on the oral manifestations of pemphigus or their long-term management, and diagnostic delay in Dentistry is frequent. METHODS: We have examined outcome of patients presenting with predominantly oral pemphigus vulgaris (PV). Ninety-eight subjects were followed-up for 85.12 months and treated with systemic steroids; 48 of them received adjunctive therapy with azathioprine, 16 with rituximab, 13 with mycophenolate mofetil, 3 with immunoglobulin, 1 with dapsone...
March 12, 2019: Journal of Oral Pathology & Medicine
Olga Růžičková Kirchnerová, Tomáš Valena, Jakub Novosad, Milan Teřl
Introduction: This was a sub-group analysis of patients with uncontrolled persistent allergic asthma (AA) in the healthcare setting of the Czech Republic, from a global non-interventional, 2-year post-marketing, observational eXpeRience registry. Aim: To evaluate the real-life effectiveness and safety of omalizumab. Material and methods: Patients with uncontrolled persistent AA (currently defined by the Global Initiative for Asthma (GINA) as uncontrolled severe AA) who started omalizumab treatment 15 weeks before inclusion in the registry were analysed for physicians' global evaluation of treatment effectiveness (GETE), asthma symptoms, corticosteroid use, exacerbation rate, asthma control, quality of life, healthcare utilisation and safety during a 24-month observation period...
February 2019: Postȩpy Dermatologii i Alergologii
Albert Y Cheung, Bradley J Anderson, David G Heidemann, Chirag Gupta
OBJECTIVE: To analyze 12 cases of late-onset diffuse lamellar keratitis (DLK) following uncomplicated LASIK and propose a method of management. DESIGN: Retrospective observational case series, literature review. PARTICIPANTS: Patients who developed late-onset DLK following LASIK. METHODS: Retrospective chart review of all patients with late-onset DLK from January 2014 to August 2015. Data collected included demographic information, probable cause of DLK, stage of DLK, baseline examination, treatment, clinical course, outcomes, complications, and last follow-up examination...
February 2019: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
Lai Shan Tam, James Cheng-Chung Wei, Amita Aggarwal, Han Joo Baek, Peter P Cheung, Praveena Chiowchanwisawakit, Leonila Dans, Jieruo Gu, Noboru Hagino, Mitsumasa Kishimoto, Heizel Manapat Reyes, Soosan Soroosh, Simon Stebbings, Samuel Whittle, Swan Sim Yeap, Chak Sing Lau
INTRODUCTION: Despite the availability of axial spondyloarthritis (SpA) recommendations proposed by various rheumatology societies, we considered that a region-specific guideline was of substantial added value to clinicians of the Asia-Pacific region, given the wide variations in predisposition to infections and other patient factors, local practice patterns, and access to treatment across countries. MATERIALS AND METHODS: Systematic reviews were undertaken of English-language articles published between 2000 and 2016, identified from MEDLINE using PubMed, EMBASE and Cochrane databases...
February 28, 2019: International Journal of Rheumatic Diseases
Thomas Greuter, Jeffrey A Alexander, Alex Straumann, David A Katzka
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus, which requires short- and long-term treatment. In addition, patients under long-term treatment for any chronic condition should have a structured follow-up. The mainstays in EoE treatment are drugs (such as swallowed topical corticosteroids [STC] and proton pump inhibitors), dietary exclusions, and endoscopic dilations. STC are the most widely used treatment and have proven efficacy in inducing clinical, endoscopic and histological remission in active EoE...
December 2018: Clinical and Translational Gastroenterology
Fabiano Di Marco, Piero Balbo, Francesco de Blasio, Vittorio Cardaci, Nunzio Crimi, Giuseppe Girbino, Girolamo Pelaia, Pietro Pirina, Pietro Roversi, Pierachille Santus, Nicola Scichilone, Alessandro Vatrella, Patrizio Pasqualetti, Mauro Carone
Purpose: There is a lack of consensus on the most appropriate early diagnostic strategy, criteria for early access to treatment and follow-up approach for patients with COPD. Materials and methods: A Delphi consensus project investigated the early management of COPD. We formulated two questionnaires for completion by pneumologists in Italy. Results: A total of 207 specialists completed questionnaire 1 and 184 of them questionnaire 2, between November 2016 and October 2017...
2019: International Journal of Chronic Obstructive Pulmonary Disease
Tyler J M Jordan, Verena K Affolter, Catherine A Outerbridge, Elizabeth C Goodale, Stephen D White
BACKGROUND: Few studies have described the pathophysiology, clinical course, treatment outcomes and quality of life (QoL) of cats with pemphigus foliaceus (PF). OBJECTIVE: Describe clinicopathological features, treatment outcomes and impacts on QoL in feline PF. ANIMALS: Forty-nine client-owned cats with PF that presented to a veterinary teaching hospital between 1987 and 2017. METHODS AND MATERIALS: Medical records and histopathological reports were reviewed to obtain clinicopathological data and treatment outcomes...
February 18, 2019: Veterinary Dermatology
Ines Pires da Silva, Isabella C Glitza, Lauren E Haydu, Romany Johnpulle, Patricia D Banks, George D Grass, Simone Ma Goldinger, Jessica L Smith, Ashlyn S Everett, Peter Koelblinger, Rachel Roberts-Thomson, Michael Millward, Victoria G Atkinson, Alexander Guminski, Rony Kapoor, Robert M Conry, Matteo S Carlino, Wei Wang, Mark J Shackleton, Zeynep Eroglu, Serigne Lo, Angela M Hong, Georgina V Long, Douglas B Johnson, Alexander M Menzies
BACKGROUND: Brain radiotherapy is used in the management of melanoma brain metastases (MBM), and can result in radionecrosis. Anti-PD-1 is active in the brain and may increase the risk of radionecrosis when combined with radiotherapy. We studied the incidence, associated factors and management of radionecrosis in longer-term survivors with MBM treated with this combination. METHODS: Patients with MBM treated with radiotherapy and anti-PD-1 who survived greater than 1-year were identified to determine radionecrosis incidence (cohort A, n=135)...
February 15, 2019: Pigment Cell & Melanoma Research
Lindsay A Sceats, Arden M Morris, M Kate Bundorf, K T Park, Cindy Kin
BACKGROUND: Sex-based treatment disparities occur in many diseases. Women undergo fewer procedural interventions, and their care is less consistent with guideline-based therapy. There is limited research exploring sex-based differences in ulcerative colitis treatment. We hypothesized that women are less likely to be treated with strategies consistent with long-term disease remission, including surgery and maintenance medications. OBJECTIVE: The aim of this study was to determine if patient sex is associated with choice of treatment strategy for ulcerative colitis...
February 8, 2019: Diseases of the Colon and Rectum
Jiangtao Lin, Xiuhua Fu, Ping Jiang, Weidong Song, Xiaoyun Hu, Zhijun Jie, Chuntao Liu, Zhengguang He, Xiangdong Zhou, Huaping Tang
In China, there are an estimated 30 million people with asthma, a condition that remains poorly controlled in many patients. The INITIAL study (NCT02143739) was a 12-week, multicentre, prospective, observational study comprising 45 centres across Northern and Southern China that aimed to assess asthma severity among newly diagnosed patients as well as their prescribed medications and response to treatment. The primary objective was to evaluate asthma severity using Global Initiative for Asthma (GINA) 2006 research criteria...
February 4, 2019: Scientific Reports
Elshahat Ibrahem Ismail, Ashraf Elsayed Morgan, Akram Mohamed Abdel Rahman
BACKGROUND: The management strategy for functional recovery after vestibular neuritis (VN) has not yet been established. Therapeutic choices involve corticosteroids, vestibular rehabilitation therapy (VRT) and the combination of corticosteroids with VRT. OBJECTIVE: The present study aimed to compare the efficacy of corticosteroids, vestibular rehabilitation, and combination of them in terms of subjective and objective improvement in patients with VN. METHODS: A prospective randomized study was conducted on 60 patients with acute vestibular neuritis within 3 days after symptom onset...
January 29, 2019: Journal of Vestibular Research: Equilibrium & Orientation
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