Search Results (30)

Background/Objectives: Low-dose corticosteroids have gained popularity in the treatment of acute respiratory distress syndrome (ARDS); however, the efficacy of high-dose corticosteroids as pulse steroid therapy remains controversial. This study aimed to evaluate the efficacy of pulse steroid therapy in patients with severe ARDS requiring venovenous (V-V) extracorporeal membrane oxygenation (ECMO), where enhanced anti-inflammatory effects may be beneficial. Methods: Using data from the J-CARVE registry, which included patients with severe ARDS managed with V-V ECMO across 24 Japanese hospitals between January 2012 and December 2022, we identified 373 patients treated with corticosteroids. The patients were divided into two groups: pulse steroid therapy and non-pulse steroid therapy. Propensity score matching was performed, and all-cause hospital mortality and ECMO-free days within 28 days were compared between groups. Pulse steroid therapy was defined as methylprednisolone at a dose of 1000 mg/day. Results: After matching, 48 patients were included in each group. The all-cause hospital mortality rates were 41.7% (20/48) in the pulse steroid group and 47.9% (23/48) in the non-pulse steroid group, with no significant difference (odds ratio, 1.28; 95% confidence interval: 0.53–3.12, p = 0.68). The median ECMO-free days were 9.5 (interquartile range [IQR]: 0–17.3) in the pulse steroid group and 3 (IQR: 0–17) in the non-pulse steroid group, showing no significant difference (p = 0.69). Conclusions: Pulse steroid therapy did not improve all-cause hospital mortality or ECMO-free days in patients with severe ARDS who required V-V ECMO. Full article

Background: Ulcerative colitis (UC) is increasing in incidence, including among pediatric populations. Treatment aims primarily to induce and maintain remission. For those inadequately responding to 5-aminosalicylic acid, remission may be induced via oral steroids or, in severe instances, intravenous methylprednisolone. This retrospective case series aims to evaluate the efficacy of high-dose intravenous methylprednisolone pulses (30 mg/kg, max 1 g per day for 3–5 days) in inducing remission in moderate and severe pediatric UC cases. Methods: From a cohort of pediatric patients (<18 years) hospitalized in 2018–2021 due to an acute flare of UC, those treated with high doses of methylprednisolone to induce remission were identified. The Pediatric Ulcerative Colitis Activity Index (PUCAI) was used to determine the response to treatment, considering a 20-point reduction or a score below 10 as significant improvement and indicative of remission induction. Results: Disease activity was severe in most patients (12/15), with 3/15 having moderate but refractory disease. We observed a clinically significant response in 9/15 patients (60%) with a mean PUCAI decrease of 39.4 ± 14.7 points. The median duration to clinical remission was 4 (IQR 3–4) days. For the 6/15 non-responders to methylprednisolone pulses, treatment was escalated. Adverse effects were not observed during the treatment period. Conclusions: High-dose methylprednisolone may be a viable alternative for inducing remission in pediatric UC. However, the small sample size and retrospective design warrant further prospective studies to validate these findings. Full article

The efficacy of steroid pulse therapy for treating severe coronavirus disease (COVID-19) pneumonia remains unclear. This study aimed to determine the efficacy of steroid pulse therapy for severe COVID-19 pneumonia in patients who did not respond to conventional therapy, including steroids. We included 76 patients with severe COVID-19 pneumonia treated with steroids in this single-facility retrospective observational study. Severe COVID-19 pneumonia was defined as requiring high-concentration oxygen administration (oxygen mask with reservoir mask (RM) > 6 L/min), high-flow nasal cannula oxygen therapy, or ventilatory support for respiratory control. The patient characteristics at admission and changes in them over time were examined in (a) a survival vs. death group, and (b) a steroid pulse vs. non-steroid pulse therapy group. Steroid pulse therapy significantly improved the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen just after the therapy and after one week of therapy, but had no effect on the sequential organ failure assessment scores over time. Multivariate logistic regression analyses showed that remdesivir use was associated with better survival outcomes, while steroid pulse therapy was associated with poor outcomes. In conclusion, steroid pulse therapy did not improve the prognosis of patients with severe COVID-19 pneumonia any more effectively than conventional steroid therapy. Full article

Background/Objectives: The usefulness of presepsin, which is released from macrophages, in acute exacerbation of interstitial lung diseases (AE-ILDs) is unknown. We aimed to investigate the utility of monitoring presepsin with other AE-ILD markers before and after steroid pulse therapy in AE-ILDs. Methods: This pilot single-center retrospective observational study involved 16 patients with AE-ILDs, including the AE of idiopathic pulmonary fibrosis and idiopathic nonspecific interstitial pneumonia and rapidly progressive connective tissue disease-associated ILD. Patients who survived 90 days were assigned to the survival group (n = 9). The remaining patients were classified in the non-survivor group (n = 7). To evaluate the therapeutic efficacy of steroid pulse therapy, specific serum markers were selected—presepsin, as a novel AE-ILD marker, and surfactant protein D, C-reactive protein, and lactate dehydrogenase (LDH), as classical AE-ILD markers. Results: Thirteen out of sixteen patients with AE-ILDs showed high presepsin levels (presepsin ≥ 470 pg/mL) before steroid pulse therapy. The post-/pre-presepsin ratio and the post-/pre-LDH ratio, calculated by dividing the presepsin and LDH levels after therapy by the levels before therapy, respectively, showed a positive correlation (r = 0.579, p = 0.021). As a result of this correlation, the post-/pre-presepsin–LDH index was created, obtained from the “post-/pre-presepsin ratio” multiplied by the “post-/pre-LDH ratio”. In a receiver operating characteristic curve analysis for non-survival, the post-/pre-presepsin–LDH index showed good discrimination as a prognostic marker for a poor outcome (AUC: 0.873, 95% confidence interval: 0.655–0.999). Conclusions: Tracking presepsin and LDH simultaneously may be useful for determining treatment response to steroid pulse therapy in the clinical management of AE-ILDs. Full article

Graves’ ophthalmopathy is the most common extrathyroidal manifestation of Graves–Basedow disease. Radiotherapy is effective especially when used in synergy with the administration of glucocorticoids. The aim of our study was to analyze the effectiveness and safety of radiotherapy, using different protocols, to improve ocular symptoms and quality of life. Methods: We retrospectively analyzed the clinical data of two-hundred and three patients treated with retrobulbar radiotherapy between January 2002 and June 2023. Ninety-nine patients were treated with a schedule of 10 Gy in 10 fractions and one-hundred and four were treated with 10 Gy in 5 fractions. Radiotherapy (RT) was administrated during the 12 weeks of pulse steroid therapy. Patients were evaluated with a clinical exam, orbital CT, thyroid assessment, and Clinical Activity Score (CAS). Results: The median follow-up was 28.6 months (range 12–240). Complete response was found in ninety-four pts (46.31%), partial response or stabilization in one hundred pts (49.26%), and progression in nine pts (4.43%). In most subjects, an improvement in visual acuity and a reduction in CAS of at least 2 points and proptosis by more than 3 mm were observed. Three patients needed decompressive surgery after treatment. Only G1 and G2 acute eye disorders and no cases of xerophthalmia or cataract were assessed. Conclusions: RT is an effective and well-tolerated treatment in this setting, especially when associated with the administration of glucocorticoids. Although the most used fractionation schedule in the literature is 20 Gy in 10 fractions, in our clinical practice, we have achieved comparable results with 10 Gy in 5 or 10 fractions with a lower incidence of toxicity. Full article

Background: Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated inflammatory disorder of the central nervous system (CNS), typically characterized by the acute onset of multifocal demyelination. The pathogenesis of ADEM remains unclear, but it is believed to be triggered by an autoimmune response, often following viral infections or vaccinations. Case report: This case report describes a 3-year-old child who developed ADEM after receiving two concurrent influenza vaccines: one for seasonal influenza and one for the 2009 H1N1 pandemic. The patient presented with motor regression, mild pleocytosis in cerebrospinal fluid (CSF), and typical MRI findings of ADEM. Steroid pulse therapy resulted in rapid improvement, and the patient recovered fully without sequelae. Results: Although the influenza vaccine has been linked to ADEM in some studies, it remains uncertain whether the simultaneous administration of both vaccines contributed to the onset of ADEM. While influenza vaccines are considered safe and effective by health organizations such as the CDC, data suggest that the incidence of ADEM and other neurological complications is significantly higher after natural influenza infections compared to vaccination. This highlights the importance of vaccination in preventing severe outcomes. Conclusions: This case underscores the importance of monitoring and reporting adverse events following vaccination to refine our understanding of rare complications like ADEM. While simultaneous vaccine administration warrants further research, the benefits of vaccination in preventing severe complications from natural infections far outweigh the risks. Continued vigilance and improved surveillance systems are essential for maintaining public confidence in vaccination programs. Full article

Background/Objectives: Chronic neuropathic pain (CNP) stands as one of the most debilitating complications in patients with myelitis owing to its challenging management. Bright spotty lesions (BSLs) are frequently observed in neuromyelitis optica spectrum disorder (NMOSD), but few reports have discussed CNP in myelitis. We aim to demonstrate that BSLs could be one of the potential prognostic factors for CNP development in myelitis. Methods: We examined 63 patients diagnosed with myelitis. Patients were categorized into CNP and non-CNP groups. We assessed the severity of clinical symptoms and the oral steroid dose administered after pulse therapy. Spine magnetic resonance imaging (MRI) of each patient was reviewed to analyze the characteristics of myelitis. Serological and cerebrospinal fluid (CSF) findings were also examined to confirm the etiology. Results: CNP was observed in 27 patients (42.9%). The mean onset age of patients with CNP was 45.26 ± 14.16 years. The MRI lesions exhibited more enhanced features and bright spotty lesions (BSLs) in the CNP group (χ² test, p < 0.05). Patients with CNP received a lower oral steroid dose during the first month after symptom onset (χ² test, p < 0.05). Multivariate logistic regression analysis revealed that patients with CNP exhibited significant BSLs in their myelitis lesions on spine MRI (OR 4.965; 95% CI, 1.282 to 19.235, p = 0.02). Conclusions: Although the exact mechanism remains unknown, the presence of BSLs on spine MRI could serve as an independent prognostic factor for CNP development. Additionally, our study suggests that lower oral steroid doses administered immediately after symptom onset are associated with CNP development. Further investigation with a larger cohort is warranted to validate our findings. Full article

Background/Objectives: Recurrent lumbar disc herniation (RLDH) refers to a lumbar disc herniation (LDH) that recurs at the same level, location, and side following surgical repair. This study aimed to evaluate the efficacy of transforaminal epidural steroid injection (TESI) and dorsal root ganglion pulsed radiofrequency (DRG PRF) therapy with and without caudal epidural steroid injection (CESI) for the treatment of lumbar radicular pain (LRP) associated with RLDH. Methods: This retrospective cohort study included 57 patients treated for RLDH in a hospital pain clinic between September 2022 and February 2024. A total of 27 patients received TESI and DRG PRF therapy (Group 1) and 30 patients received TESI, DRG PRF, and CESI therapy (Group 2). We evaluated patient age, sex, symptom duration, pain medication use, number of prior LDH operations, presence of stabilization on magnetic resonance imaging (MRI), intervention received, lumbar level and side of the intervention, and Numeric Rating Scale (NRS) pain scores before and at 1, 3, and 6 months post-procedure. Treatment success was defined as an NRS score at least 50% or 4 points lower than the pre-procedure score at post-procedure 6 months. Results: There was no significant difference in NRS scores between the groups during the 6-month follow-up period. Moreover, NRS scores did not differ based on the presence of stabilization on MRI or the use of pain medication (p > 0.05). Conclusions: TESI and DRG PRF therapy were effective in the treatment of LRP associated with RLDH over a 6-month follow-up period, and adding CESI did not increase treatment success. Full article

Tonsillectomy with steroid pulse therapy (SPT) has been established as an effective treatment for immunoglobulin A nephropathy (IgAN) in Japan. However, the underlying mechanisms supporting tonsillectomy remain unclear. This study assessed palatine tonsils from 77 patients with IgAN, including 14 and 63 who received SPT before and after tonsillectomy, respectively. Tonsils from 21 patients with chronic tonsillitis were analyzed as controls. Specific tonsillar lesions were confirmed in patients with IgAN, correlating with active or chronic renal glomerular lesions and SPT. T-nodule and involution of lymphoepithelial symbiosis scores in tonsils correlated with the incidence of active crescents and segmental sclerosis in the glomeruli, respectively. The study revealed an essential role of the tonsil–glomerular axis in early active and late chronic phases. Moreover, the SPT-preceding group demonstrated no changes in the T-nodule score, which correlated with active crescent formation, but exhibited a considerable shrinkage of lymphatic follicles that produced aberrant IgA1. The study underscores the involvement of innate and cellular immunity in IgAN and advocates for tonsillectomy as a necessary treatment alongside SPT for IgAN, based on a stepwise process. Full article

Background: Amiodarone-induced thyrotoxicosis (AIT) may pose treatment challenges. We present a series of patients in which we achieved the normalisation of free T3 (FT3) using intravenous methylprednisolone (ivMP) in AIT refractory to thiamazole and oral prednisone. Namely, in three males (aged 56, 50 and 64, all with a history of AF and/or a low ejection fraction), an addition of ivMP resulted in the normalisation of FT3, which allowed successful thyroidectomy. In another case of a 65-year-old man, we initially succeeded in the normalisation of FT3 using ivMP from FT4 > 7.77 ng/dL (0.93–1.7) to 2.41 ng/dL and in that of FT3 from 14.95 pg/mL (2–4.4) to 2.05 pg/mL), but four weeks after stopping ivMP, despite the continuation of thiamazole and prednisone, there was rebound thyrotoxicosis: FT4 > 7.77 ng/dL and FT3—5.46 pg/mL. Intravenous MP was restated leading to a decline in FT4 to 2.51 ng/dL and in FT3 to 1.92 pg/mL, thus allowing a successful thyroidectomy. Finally, in a 78-year-old man with AF, goitre, and AIT resistant to thiamazole, prednisone and lithium carbonate, we obtained a reduction in FT4 to 1.51 ng/dL and in FT3 to 3.17 pg/mL after seven pulses of ivMP. Oral prednisone was gradually reduced and successfully stopped about six months later. He remained on low-dose thiamazole (5 mg od). Conclusions: Pulse ivMP in addition to oral steroids may be a useful adjunct therapy either for the preparation of a thyroidectomy or as a treatment modality in drug-resistant AIT. Though a total cure is possible, there is a danger of a rebound worsening of thyrotoxicosis after premature discontinuation of ivMP. Full article

The recent classification of pediatric thrombotic microangiopathies (TMA) takes into consideration mechanisms of disease for guidance to targeted therapies. We present our experience with seven patients with antibody mediated atypical hemolytic uremic syndrome (aHUS) and thrombotic thrombocytopenic purpura (TTP). Five children had aHUS with antibodies against complement factor H (CFH-ab) and two with TTP with antibodies against metalloproteinase ADAMTS13. In the aHUS cases diagnosed and treated before the eculizumab era, CFH-ab was detected using the ELISA assay. Mutational analysis of selected complement genes was performed. TTP was diagnosed if, in addition to microangiopathic hemolytic anemia and thrombocytopenia, ischemic organ involvement and severe deficiency in ADAMTS13 activity were present. Treatment protocol consisted of plasma exchanges (PE) and steroid pulses, followed by the combination of cyclophosphamide and rituximab to achieve long-term immunosuppression. Four patients with CFH-ab and the TTP patients with ADAMTS13 antibodies came into sustained remission. After a median follow-up of 11.7 (range 7.7–12.9) years without maintenance therapy, no disease recurrence was observed; nevertheless, six patients, two had hypertension and two had proteinuria as a late consequence. One patient, with late diagnosis of CFH-ab and additional genetic risk factors who was treated only with PE and plasma substitution, reached end-stage renal disease and was later successfully transplanted using eculizumab prophylaxis. In the cases of antibody-mediated TMAs, PE and early immunosuppressive treatment may result in sustained remission with preserved kidney function. Further data are needed to establish optimal treatment of anti-FH antibody-associated HUS. Full article

Adhesive capsulitis is a pathology that affects the shoulder and can have a particularly long and disabling course. The usual therapies are treatment with non-steroidal anti-inflammatory drugs (NSAID) and painkillers, steroid injections, physiotherapy, and surgical treatment. This case report describes the effect of a single treatment with pulsed radiofrequency of the suprascapular nerve in a diabetic patient affected by this pathology, for whom steroid injections were contraindicated. Three weeks after the treatment, the reduction of pain and the improvement of ROM (range of movement) allowed the patient to start an adequate physiotherapy treatment, which was not feasible until that moment due to the severe pain despite NSAIDS therapy. The peculiarity of this work consists in the accurate measure of the impact of the analgesic treatment alone in improving the ROM and muscular activation in the patient. The patient was able to correctly perform physiotherapy only once the pain was reduced, after PRF (pulsed radio frequency) treatment. This study has two limitations: being a case report and not a prospective randomized study, and observing the kinematic and pain aspects for a limited period of time. Finally, the case report draws attention to the importance of cooperation between the various health figures involved in the treatment of patients suffering from adhesive capsules. Full article

Background: This study evaluated the clinical outcomes of patients with severe COVID-19 pneumonia treated with remdesivir plus standard corticosteroid treatment (SCT) or with remdesivir plus high-dose corticosteroid pulse therapy (HDCPT). Methods: One hundred and two patients with severe COVID-19 pneumonia and respiratory failure were included. The patients were divided into two cohorts. The first comprised patients who received remdesivir and SCT, consisting of 6 mg dexamethasone daily for up to 10 days or until hospital discharge. The second included patients who received remdesivir and HDCPT, composed of 250 mg iv of methylprednisolone for three days, followed by a slow reduction in the dose of steroids. The severity of hypoxemia was assessed using the SaO2/FiO2 peripheral oxygen saturation index. Results: 55 received remdesivir plus HDCPT, and 47 received remdesivir plus SCT. Mortality at 30 days was significantly lower among patients who received remdesivir plus HDCPT (4/55) than among those who did not (15/47). In patients who received remdesivir plus HDCPT, 7.3% required invasive mechanical ventilation and admission to the ICU and 36.4% non-invasive ventilation versus 29.8% and 61.7%, respectively, among those treated with remdesivir plus SCT. Remdesivir plus HDCPT induced a significantly faster improvement in the SaO2/FiO2 index. Conclusion: Early combination treatment with remdesivir plus HDCPT reduced in-hospital mortality and the need for admission to the ICU. Furthermore, it improved the SaO2/FiO2 index faster in patients with severe COVID-19 pneumonia. Full article

We describe the clinical presentation, radiological findings, treatment and outcomes of three patients with delayed leukoencephalopathy occurring after endovascular treatment (EVT) for cerebral aneurysms—a rare, albeit recurring, complication. The symptoms occurred 6 to 12 months following the EVT of the cerebral aneurysm. Characteristic imaging findings included high-signal changes on T2 images in the white matter without diffusion restriction predominantly at the distribution of the vascular territory of the catheterized arteries, coupled with patchy gadolinium enhancement or low susceptibility weighted imaging (SWI) signals within the white-matter lesions. Steroid pulse therapy is the treatment of choice and promptly improves clinical and imaging findings. Tapering or cessation of steroids may result in clinical and imaging relapses; close- and long-term follow-up for patients presenting this complication is warranted. Full article

Diabetic macular edema (DME) is one of the main causes of visual impairment in patients of working age. DME occurs in 4% of patients at all stages of diabetic retinopathy. Using a subthreshold micropulse laser is an alternative or adjuvant treatment of DME. Micropulse technology demonstrates a high safety profile by selectively targeting the retinal pigment epithelium. There are no standardized protocols for micropulse treatment, however, a 577 nm laser application over the entire macula using a 200 μm retinal spot, 200 ms pulse duration, 400 mW power, and 5% duty cycle is a cost-effective, noninvasive, and safe therapy in mild and moderate macular edemas with retinal thickness below 400 μm. Micropulse lasers, as an addition to the current gold-standard treatment for DME, i.e., anti-vascular endothelial growth factor (anti-VEGF), stabilize the anatomic and functional retinal parameters 3 months after the procedure and reduce the number of required injections per year. This paper discusses the published literature on the safety and application of subthreshold micropulse lasers in DME and compares them with intravitreal anti-VEGF or steroid therapies and conventional grid laser photocoagulation. Only English peer-reviewed articles reporting research within the years 2010–2022 were included. Full article