Continuous Unilateral Cephalalgia Due to Systemic Lupus Erythematosus: A Case Report / Cefaleia unilateral contínua por lúpus eritematoso sistêmico: relato de caso

BACKGROUND: Hemicrania continua is a rare form of cephalalgia featuring a chronic and persistent headache in only one side of the head. OBJECTIVES: In this report, we present a case of a patient with hemicrania continua and systemic lupus erythematosus (SLE). METHODS: We collected patient data through the electronic medical record. Afterward, we reviewed the literature regarding hemicrania continua and its pathophysiology and correlation with neurovascular alterations, inflammation, and SLE. RESULTS: A 42-year-old woman visited the emergency department due to worsening constant unilateral cephalalgia that had been present for the past 6 months. The patient reported a highly intense (10/10) headache in the entire left hemicrania that radiated to the left shoulder. During physical examination, she presented with nystagmus, vertigo, and aggravated cephalalgia associated to body movement and, despite having no optic nerve thickening. In addition, she had jaundice, tachycardia, and splenomegaly. Complimentary exams found deep anemia, depletion in complement system and anti-nuclear factors, suggesting a possible hemolytic anemia (AIHA) due to SLE. Treatment was initiated with hydrocortisone and prednisone, associated with amitriptyline, fluoxetine and diazepam, reaching full remission. CONCLUSION: These syndromes have aggravated each other, and possibly the explanation for the cephalalgia remission was the control of AIHA and SLE. It features a rare case in literature and thus warrants discussion.

INTRODUÇÃO: Hemicrania contínua é uma forma rara de cefaléia caracterizada por cefaleia crônica e persistente em apenas um lado da cabeça. OBJETIVOS: Neste relato apresentamos o caso de um paciente com hemicrania contínua e lúpus eritematoso sistêmico (LES). MÉTODOS: Coletamos dados dos pacientes por meio do prontuário eletrônico. Posteriormente, revisamos a literatura sobre a hemicrania contínua e sua fisiopatologia e correlação com alterações neurovasculares, inflamação e LES. RESULTADOS: Uma mulher de 42 anos recorreu ao serviço de urgência devido ao agravamento da cefaleia unilateral constante, presente nos últimos 6 meses. O paciente relatou cefaleia de alta intensidade (10/10) em toda a hemicrânia esquerda com irradiação para o ombro esquerdo. Ao exame físico apresentava nistagmo, vertigem e cefaléia agravada associada à movimentação corporal e, apesar de não apresentar espessamento do nervo óptico. Além disso, ela apresentava icterícia, taquicardia e esplenomegalia. Os exames complementares evidenciaram anemia profunda, depleção do sistema complemento e fatores antinucleares, sugerindo uma possível anemia hemolítica (AIHA) por LES. Iniciou-se tratamento com hidrocortisona e prednisona, associadas a amitriptilina, fluoxetina e diazepam, atingindo remissão completa. CONCLUSÃO: Essas síndromes agravaram-se mutuamente e possivelmente a explicação para a remissão da cefaléia foi o controle da AIHA e do LES. Apresenta um caso raro na literatura e, portanto, merece discussão.

A COVID-19 perspective of Vogt–Koyanagi–Harada disease

Vogt–Koyanagi–Harada (VKH) disease, a bilateral granulomatous panuveitis associated with multisystem involvement, is a T-cell-mediated autoimmune disorder in which cytotoxic T-cell target melanocytes in genetically susceptible individuals. Recently, there has been an increase in literature on the new onset of uveitis and reactivation of previously diagnosed cases of uveitis following Covid-19 vaccinations. It has been postulated that Covid-19 vaccines can lead to an immunomodulatory change resulting in an autoimmune phenomenon in the recipients. VKH following COVID-19 infection was reported in four patients and a total of 46 patients developing VKH or VKH-like disease following COVID-19 vaccinations. There are reports of four patients who had been recovering or recovered from VKH after receiving the first dosage of the vaccine and developed worsening of ocular inflammation after receiving the second dose of the vaccine.

Treatment and Management Experience of Idiopathic Granulomatous Mastitis in a Low-income Country / Experiência de tratamento e manejo da mastite granulomatosa idiopática em um país de baixa renda

Abstract Objective Reporting our experience of the management and treatment of Idiopathic granulomatous mastitis (IGM) in a low-income country by describing patients characteristics and therapy with emphasis on conservative surgical excision and postoperative care as the cornerstone of treatment. Methods A retrospective cohort of women with histopathological diagnosis of IGM from 2014 to 2018 at Instituto Nacional Materno Perinatal in Lima, Peru. Patients' characteristics, clinical presentation, treatment, management, postoperative care, and follow-up were analyzed. Results Thirty-eight patients with histopathological diagnosis of IGM were identified. Their average age was 35.9 years and 23 (60.5%) reported previous use of hormonal contraceptives. Nine (23.7%) patients had chronic mastitis with previous treatment. The time from the onset of symptoms to the first clinic consult was 5.1 months on average. Twenty-one (55.3%) patients had the lesion in the right breast, with a mean size of 6.9 cm. Conservative surgical excision was performed in all patients. Additionally, 86.8% required corticosteroids and 78.9% were treated with antibiotics. Complete remission was obtained at 141 days on average (range 44 to 292 days). Six (15.8%) women reported ipsilateral recurrence and 5 (13.2%), contralateral. The latency time was 25.5 months on average. Conclusion The conservative surgical treatment demonstrated and close follow-up made for a high cure rate, but with recurrence similar to that reported in the literature. Use of gloves is an alternative to manage post operative wounds in a low-income country. The most frequent adverse effect was breast surgical scar.

Efficacy and safety of Omalizumab for the treatment of pediatric allergic asthma: a retrospective multicenter real-world study in China / 中华实用儿科临床杂志

Objective:To assess the clinical effectiveness and safety of Omalizumab for treating pediatric allergic asthma in real world in China.Methods:The clinical data of children aged 6 to 11 years with allergic asthma who received Omalizumab treatment in 17 hospitals in China between July 6, 2018 and September 30, 2020 were retrospectively analyzed.Such information as the demographic characteristics, allergic history, family history, total immunoglobulin E (IgE) levels, specific IgE levels, skin prick test, exhaled nitric oxide (FeNO) levels, eosinophil (EOS) counts, and comorbidities at baseline were collected.Descriptive analysis of the Omalizumab treatment mode was made, and the difference in the first dose, injection frequency and course of treatment between the Omalizumab treatment mode and the mode recommended in the instruction was investigated.Global Evaluation of Treatment Effectiveness (GETE) analysis was made after Omalizumab treatment.The moderate-to-severe asthma exacerbation rate, inhaled corticosteroid (ICS) dose, lung functions were compared before and after Omalizumab treatment.Changes in the Childhood Asthma Control Test (C-ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) results from baseline to 4, 8, 12, 16, 24, and 52 weeks after Omalizumab treatment were studied.The commodity improvement was assessed.The adverse event (AE) and serious adverse event (SAE) were analyzed for the evaluation of Omalizumab treatment safety.The difference in the annual rate of moderate-to-severe asthma exacerbation and ICS reduction was investigated by using t test.The significance level was set to 0.05.Other parameters were all subject to descriptive analysis.A total of 200 allergic asthma patients were enrolled, including 75.5% ( n=151) males and 24.5% ( n=49) females.The patients aged (8.20±1.81) years. Results:The median total IgE level of the 200 patients was 513.5 (24.4-11 600.0) IU/mL.Their median treatment time with Omalizumab was 112 (1-666) days.Their first dose of Omalizumab was 300 (150-600) mg.Of the 200 cases, 114 cases (57.0%) followed the first Omalizumab dosage recommended in the instruction.After 4-6 months of Omalizumab treatment, 88.5% of the patients enrolled ( n=117) responded to Omalizumab.After 4 weeks of treatment with Omalizumab, asthma was well-controlled, with an increased C-ACT score [from (22.70±3.70) points to (18.90±3.74) points at baseline]. Four-six months after Omalizumab administration, the annual rate of moderate-to-severe asthma exacerbation had a reduction of (2.00±5.68) per patient year( t=4.702 5, P<0.001), the median ICS daily dose was lowered [0 (0-240) μg vs. 160 (50-4 000) μg at baseline] ( P<0.001), the PAQLQ score was improved [(154.90±8.57) points vs. (122.80±27.15) points at baseline], and the forced expiratory volume in one second % predicted (FEV 1%pred) was increased [(92.80±10.50)% vs. (89.70±18.17)% at baseline]. In patients with available evaluations for comorbidities, including allergic rhinitis, atopic dermatitis or eczema, urticaria, allergic conjunctivitis and sinusitis, 92.8%-100.0% showed improved symptoms.A total of 124 AE were reported in 58 (29.0%) of the 200 patients, and the annual incidence was 0(0-15.1) per patient year.In 53 patients who suffered AE, 44 patients (83.0%) and 9 patients (17.0%) reported mild and moderate AE, respectively.No severe AE were observed in patients.The annual incidence of SAE was 0(0-1.9) per patient year.Most common drug-related AE were abdominal pain (2 patients, 1.0%) and fever (2 patients, 1.0%). No patient withdrew Omalizumab due to AE. Conclusions:Omalizumab shows good effectiveness and safety for the treatment of asthma in children.It can reduce the moderate-to-severe asthma exacerbation rate, reduce the ICS dose, improve asthma control levels, and improve lung functions and quality of life of patients.

Advances in antenatal corticosteroid application in extremely preterm infants / 国际儿科学杂志

The rate of antenatal corticosteroid application in extremely preterm infants is generally increasing.Although a large number of clinical trials have demonstrated that antenatal corticosteroids significantly reduce mortality and improve prognosis in extremely preterm infants, their application rates still vary widely among different countries and gestational age groups, and the applicability and safety of the clinical applications are controversial.In the treatment of extremely preterm infants in China, the clinical application of antenatal corticosteroids is not widespread.The current situation of antenatal corticosteroid application in extremely preterm infants at home and abroad is reviewed to provide a theoretical basis for the application of antenatal corticosteroid in extremely preterm infants in China.

Tuberculosis pericárdica de evolución inusual en paciente inmunocompetente / Unusual evolution pericardial tuberculosis in immunocompetent patient

RESUMEN La tuberculosis pericárdica es una manifestación poco frecuente de la tuberculosis extrapulmonar. Se presenta de manera insidiosa e inespecífica, lo que dificulta el diagnóstico, retrasa el tratamiento, y lleva a complicaciones graves, como el derrame pericárdico con signos de taponamiento cardíaco o pericarditis constrictiva. Se describe el caso de una paciente femenina de 18 años, embarazada, con antecedente de contacto estrecho con familiar con tuberculosis pulmonar, que consultó al servicio de urgencias por disnea. Entre los estudios solicitados, el ecocardiograma evidenció la presencia de un derrame pericárdico con compresión de cavidades, por lo que requirió pericardiocentesis. El cultivo del líquido pericárdico informó Mycobacterium tuberculosis y se inició trata miento antituberculosis y corticoides. Evolucionó con recurrencia del derrame a pesar de tratamiento médico adecuado y realización de ventana pericárdica.

ABSTRACT Pericardial tuberculosis (TBP) is a rare manifestation of extrapulmonary tuberculosis (TB). It presents insidiously and nonspecifically, making diagnosis difficult and delaying treatment, leading to serious complications such as pericardial effusion with signs of cardiac tamponade or constrictive pericarditis. The case of an 18-year-old female patient, pregnant, with a history of close contact with a relative with pulmonary TB is described; she consulted the Emergency Service for dyspnea. Among the studies requested, the echocardiogram showed pericardial effusion with compression of cavities, requiring pericardiocentesis. Pericardial fluid culture revealed Mycobacterium tuberculosis and antituberculous treat ment plus corticosteroids were started. It evolved with a recurrence of effusion despite adequate medical treatment and the performance of a pericardial window.

Hemosiderosis pulmonar idiopática, caso clínico en México. Importancia de un diagnóstico y tratamiento oportuno / Idiopathic pulmonary hemosiderosis, clinical case in Mexico. The relevance of performed an early diagnosis and treatment

La hemosiderosis pulmonar idiopática (HPI) es una patología poco frecuente; su distribución geográfica, su incidencia y prevalencia se desconocen de manera exacta a nivel mundial. Tiene una fuerte asociación con condiciones autoinmunes y una adecuada respuesta al tratamiento inmunosupresor. A pesar de ser una patología grave, presenta una tasa de morbilidad y mortalidad mediana, siempre que se realice un diagnóstico y tratamiento precoz. Se presenta el caso clínico de una paciente femenina con diagnóstico de HPI quien cursó con la triada clásica de esta enfermedad: hemoptisis, anemia ferropénica e infiltrados pulmonares difusos. Se descartaron otras causas de hemorragia pulmonar difusa y se realizó el diagnóstico por biopsia pulmonar. Se trató con esteroides sistémicos e inhalados y azatioprina. Tras casi 2 años después del diagnóstico, estando sin tratamiento por 3 meses, presentó una exacerbación con hemorragia pulmonar masiva ocasionando el fallecimiento de la paciente.

Idiopathic pulmonary hemosiderosis (IPH) is a rare pathology; its geographic distribution, incidence and prevalence are not accurately known worldwide. It has a strong association with autoimmune conditions and has an adequate response to immunosuppressive treatment. Despite being a serious pathology, it has a medium morbidity and mortality rate, provided that early diagnosis and treatment is performed. We present the clinical case of a female patient diagnosed with IPH who presented with the classic triad of this disease: hemoptysis, iron deficiency anemia and diffuse pulmonary infiltrates. Other causes of diffuse pulmonary hemorrhage were ruled out and the diagnosis was made by lung biopsy. She was managed with systemic and inhaled steroids and azathioprine. After almost 2 years before the diagnosis, being without treatment for 3 month she had a massive pulmonary hemorrhage, causing the death of the patient.

The efficacy of corticosteroid after facial nerve neurorrhaphy: a systematic review and meta-analysis of randomized controlled trial

Abstract Objectives: The benefit of corticosteroids following facial nerve neurorrhaphy in the setting of complete transection is questionable. This systematic review and meta-analysis aimed to evaluate corticosteroid efficacy on facial nerve regeneration and functional recovery after complete disruption and neurorrhaphy. Methods: Randomized controlled trials on both human and animal models from Ovid MEDLINE and Ovid EMBASE studying corticosteroid efficacy in complete facial nerve disruption followed by neurorrhaphy were included. Data were extracted and pooled for meta-analysis. The outcomes were evaluated from electrophysiology, histology, and functional recovery. However, no randomized controlled trial in human was performed. Possibly, performing human trials with histopathology may not be feasible in clinical setting. Results: Six animal studies (248 participants) met inclusion criteria. Electrophysiologic outcomes revealed no differences in latency (Standardized Mean Difference (SMD) = −1.97, 95% CI −7.38 to 3.44, p = 0.47) and amplitude (SMD = 0.37, 95% CI −0.44 to 1.18, p = 0.37) between systemic corticosteroids and controls. When analysis compared topical corticosteroid and control, the results provided no differences in latency (Mean Difference (MD)=0.10, 95% CI −0.04 to 0.24, p = 0.16) and amplitude (SMD = 0.01, 95% CI −0.08 to 0.10, p = 0.81). In histologic outcomes, the results showed no differences in axon diameter (MD = 0.13, 95% CI −0.15 to 0.41, p = 0.37) between systemic corticosteroid and control; however, the result in myelin thickness (MD = 0.06, 95% CI 0.04 to 0.08, p < 0.05) favored control group. When comparing systemic corticosteroid with control in eye blinking, the results favored control (MD= 1.33, 95% CI 0.60 to 2.06, p = 0.0004). Conclusions: This evidence did not show potential benefits of systemic or topical corticosteroid deliveries after facial nerve neurorrhaphy in complete transection when evaluating electrophysiologic, histologic, and functional recovery outcomes in animal models.

Imaging and clinical perspectives of rhino-orbito-cerebral mucormycosis: An epidemic born out of a pandemic

Purpose: To study the imaging and clinical perspectives of a recent epidemic of rhinocerebral mucormycosis during the COVID-19 (coronavirus disease) pandemic in India. Materials and Methods: This retrospective study included clinical and imaging data of 24 diagnosed cases of acute rhinocerebral mucormycosis who were presented to our hospital in May 2021. The clinical profile and imaging data of the patients were documented. Results: 18 patients (75.0%) had moderate to severe COVID-19 illness with a history of oral or intravenous corticosteroid intake. 19 patients (79.2%) had presented with hyperglycemia at the time of admission. Nasal discharges with or without black crusts and facial swelling (79.2%) were the most commonly reported complaints, followed by headaches or facial pain (62.5%). All cases demonstrated the involvement of one or more paranasal sinuses in imaging, with predominantly unilateral involvement. Extra sinusoidal involvement was commonly seen, with abnormalities seen in retromaxillary and masticator space, orbit, face, oral cavity, pterygopalatine fossa, and deep spaces of the neck, cavernous sinus, and brain. Conclusion: An upsurge of mucormycosis cases during the COVID-19 pandemic appears to be closely related to uncontrolled hyperglycemia and corticosteroid therapy. Computed tomography (CT) and magnetic resonance (MR) imaging are invaluable in establishing an early diagnosis, defining the extent of disease, and helping in immediate surgical planning.

Use of Corticosteroids in Prenatal Treatment of Congenital Pulmonary Adenomatoid Malformation: Integrative Review / Uso de corticosteroides no tratamento pré-natal da malformação adenomatoide pulmonar congênita: Revisão integrativa

Abstract Objective To review data on the use of corticosteroids for the treatment of fetuses with high-risk congenital pulmonary adenomatoid malformation (CPAM). Methods Integrative review based on the literature available onMEDLINE and LILACS, including articles published until November, 2020. Results The initial search resulted in 87 articles, 4 of which were selected for analysis, with all of them being retrospective descriptive observational studies. In the group of fetuses that received only a single corticosteroid cycle, the hydrops resolution rate was 70%, and the survival rate was 83.8%. In fetuses treated with 2 or more cycles of corticosteroids, there was an improvement in the condition of hydrops or edema in a single body compartment in 47%, and survival of 81.8% of the fetuses. Conclusion The use of corticosteroids for the prenatal treatment of high-risk CPAM appears to be associated with an improvement in perinatal outcomes.

Resumo Objetivo Revisar os dados sobre o uso de corticoide no tratamento de fetos com malformação adenomatoide pulmonar congênita (MAPC) de alto risco. Métodos Revisão integrativa com base na literatura disponível no MEDLINE e LILACS, incluindo artigos publicados até novembro de 2020. Resultados A busca inicial resultou em 87 artigos, dos quais 4 foram selecionados para análise, todos tratando-se de estudos observacionais descritivos retrospectivos. No grupo de fetos que recebeu apenas um único ciclo de corticosteroide, a taxa de resolução da hidropsia foi de 70% e a taxa de sobrevida de 83,8%. Emfetos tratados com 2 ou mais ciclos de corticosteroides, houve melhora do quadro de hidropsia ou edema em um único compartimento corporal em 47% dos fetos e taxa de sobrevida de 81,8%. Conclusão O uso de corticosteroides para o tratamento pré-natal da MAPC de alto risco parece estar associado à melhora dos resultados perinatais.

Oral mucormycosis in post-COVID-19 patients: A case series

The rise of mucormycosis in COVID-19 patients is predisposed by indiscriminate intake of corticosteroids, poorly controlled diabetes, injury, prolonged neutropenia, organ transplant, hematopoietic malignancies, prolonged stays in the intensive care unit, and due to nosocomial infection. Oral lesions seen in COVID-19 patients are more probably caused by co-infections, adverse reactions, and immunocompromised conditions instead of direct COVID-19 infection. We would like to report a case series of four patients who had oral mucormycosis after the COVID-19 recovery period.

A meta-analysis of pre-and postoperative corticosteroids for reducing the complications following facial reconstructive and aesthetic surgery / Uma meta-nálise sobre o uso de corticosteroides pré e pós-operatórios para reduzir as complicações após cirurgia estética e reconstrutiva facial

Abstract Introduction Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. Objective We conducted this systematic review and meta-analysis to determine the effect of preand postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. Methods A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of preor postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. Results Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo −0.82, 95% CI (−1.37, −0.26), and -0.95, 95% CI (−1.32, −0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. Conclusion This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.

Resumo Introdução O edema e a equimose no pós-operatório da cirurgia plástica facial constituem um problema preocupante para pacientes e cirurgiões. Considera-se que a administração de corticosteroides diminua o período de recuperação e reduza essas complicações. Os dados sobre a eficácia da administração de corticosteroides permanecem controversos entre os cirurgiões. Objetivo Fizemos essa revisão sistemática e metanálise para determinar o efeito da administração de corticosteroides nos períodos pré- e pós-operatório sobre as complicações pós-operatórias em pacientes submetidos à cirurgia reconstrutiva facial apoiada em diferentes análises de subgrupos. Método Foi feita uma busca abrangente de artigos nos bancos de dados PubMed, Cochrane Central, Scopus e Ebsco até outubro de 2019. Incluímos todos os ensaios clínicos cujos pacientes foram submetidos a qualquer tipo de cirurgia plástica facial para estudar o efeito dos corticosteroides nas complicações pós-operatórias. Fizemos a análise de subgrupos de acordo com os tipos e as doses de preparação de corticosteroides, além de uma análise de subgrupos de uso de corticosteroides pré ou pós-operatório. Todas as análises estatísticas foram feitas no software RevMan. Resultados Dezenove estudos foram incluídos nesta revisão sistemática, mas apenas 10 deles foram elegíveis para a metanálise. Os escores de edema periorbital e equimoses reduziram significantemente no grupo de corticosteroides em comparação com o placebo: -0,82, IC95% (-1,37, -0,26) e -0,95, IC95% (-1,32, -0,57), respectivamente. Essas diferenças significantes não se mantiveram nos dias 3 e 7. Doses menores de corticosteroides (8 mg e 10 mg) foram associadas a menores diferenças no escore médio de edema e equimoses palpebrais superiores e inferiores, enquanto as doses mais altas foram associadas a diferenças maiores. Além disso, o corticosteroide pré-operatório reduziu significantemente o sangramento intraoperatório quando comparado ao placebo para doses maiores > 50 mg por dia (p < 0,0001), mas não para 8 mg de corticosteroide (p = 0,06). O uso de corticosteroides no pós- e pré-operatório foi associado a uma diminuição maior de edema e equimoses do que no pré-operatório isoladamente. Conclusão Esta metanálise abrangente confirma um benefício estatisticamente significante do uso de corticosteroides no pré-operatório. Além disso, a manutenção dos esteroides no pós-operatório está associada à redução das complicações em longo prazo. Doses mais altas de corticosteroides estão associadas a uma redução mais significativa no edema e nas equimoses, mas estudos adicionais são recomendados para determinar os efeitos colaterais pós-operatórios como infecção do sítio cirúrgico e atraso na cicatrização.

Outcome of patients with severe COVID-19 pneumonia treated with high-dose corticosteroid pulse therapy: A retrospective study

Objective: To assess the effectiveness of high-dose corticosteroid pulse therapy and evaluate possible factors associated with 28-day mortality in hospitalised patients with severe COVID-19 pneumonia. Methods: We conducted a single-centre retrospective cohort study on hospitalised patients with clinical, epidemiological, and/or radiologically confirmed and suspected COVID-19 at Bitlis Tatvan State Hospital in Turkey between December 1, 2020 and June 1, 2021. All data of the study participants were recorded, and all patients received intravenous high-dose corticosteroid pulse therapy. The Ordinal Scale for Clinical Improvement (OSCI), Charlson Comorbidity Index and Total Severity Score were calculated. Univariate and multivariate Cox regression models were performed to evaluate the clinical and laboratory parameters that may affect the 28-day mortality. Results: A total of 126 patients were included in the analysis. The 28-day mortality rate of the patients was 22.2%. Laboratory and clinical improvement were observed in 77.8% (98/126) of patients after high-dose corticosteroid pulse therapy. There was a statistically significant difference between the survivors and non-survivors in terms of age, platelet count, neutrophil/lymphocyte ratio, and OSCI, Charlson Comorbidity Index, and Total Severity Score (P<0.001). Multivariate Cox regression analysis revealed that age [HR 1.047 (95% CI 1.01-1.08)], use of prophylactic anticoagulation [HR 0.838 (95% CI 0.79-0.89)], and bacterial co-infection [HR 3.966 (95% CI 1.40-11.21)] were significant determinants of mortality. Early C-reactive protein (CRP) response, decreased oxygen requirement, and improving respiratory rate/OSCI scores after administration of high-dose corticosteroid pulse therapy could contribute to clinical improvement. Conclusions: CRP response, needed oxygen and OSCI scores can be used as prognostic factors to select patients who will benefit from high-dose corticosteroid pulse therapy.

Factors associated with dietary behaviour among patients With Type 2 Diabetes Mellitus in rural Indonesia / Journal of the ASEAN Federation of Endocrine Societies

Background@#Type 2 Diabetes Mellitus (T2DM) is one of the fastest-growing diseases and most serious major health problems worldwide. Few studies have focused on the association of social support with diabetes-related dietary behaviour.@*Objective@#To examine the relationship between social support and dietary behaviour among patients with diabetes in a rural area of Indonesia.@*Methodology@#This was a descriptive cross-sectional study that included 120 physically healthy patients above 18 years old with T2DM for at least 6 months. Data analysis was done using a stepwise regression model.@*Results@#The mean age was 61.97 years (SD = 7.85, range = 52-74); 86.7% of the participants were females. Social support (β = 0.272, p = <0.001), diabetes medications (β = 0.169, p = 0.003), duration of diabetes (β = 0.118, p = 0.0047), and presence of diabetes complications (β = 0.197, p = 0.008) were significant predictors of dietary behaviour and accounted for 34.2% of the variance.@*Conclusions@#Social support, diabetes medications, presence of diabetes complications, and duration of diabetes were associated with improved dietary behaviour. Therefore, social support should be considered when designing dietary interventions for patients with type 2 diabetes mellitus.

The Development of a Protocol for Critical Illness-Related Corticosteroid Insufficiency (CIRCI) at a Tertiary Hospital / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#The diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) remains a challenge. This initiative aimed to develop a protocol for the diagnosis and management of CIRCI which will facilitate informed decision-making among clinicians through consensus-building among a multi-disciplinary team.@*Methodology@#This was a single-center, qualitative study which utilized the modified Delphi method, consisting of a sequential iterative process with two rounds of voting. A cut-off value of 70% was set as the threshold for reaching consensus.@*Results@#The protocol on the diagnosis and management of CIRCI was approved after two rounds of voting, with all the components reaching 83.3%-100% agreement. This protocol on CIRCI provided a framework for the clinical approach to refractory shock. It was advocated that all cases of probable CIRCI should immediately be started on hydrocortisone at 200 mg/day. The definitive diagnosis of CIRCI is established through a random serum cortisol <10 mcg/dL or increase in cortisol of <9 mcg/dL at 60 minutes after a 250 mcg ACTH stimulation test in patients with indeterminate random cortisol levels@*Conclusion@#The presence of refractory shock unresponsive to fluid resuscitation and vasopressors should warrant the clinical suspicion for the existence of CIRCI and should trigger a cascade of management strategies.

Pediatric Neurology Patients: Parental awareness of adverse effects of long-term Corticosteroid therapy

Background@#Corticosteroids are potent medications used to treat many inflammatory conditions in paediatric neurology practice. Although corticosteroids are beneficial, their adverse effects may be numerous and varied. As parents are the primary caregivers of paediatric patients, assessing their awareness is important. @*Methods@#To determine the parental awareness on the adverse effects of corticosteroid therapy in Paediatric Neurology Patients in the Neurology Unit at the Lady Ridgeway Hospital, Colombo, Sri Lanka, this descriptive cross-sectional study, looked at 300 parents of paediatric neurology patients on long-term corticosteroid therapy. Parents volunteered for the study and signed with informed consent. Ethical approval was obtained from the Ethics Review Committee of the same hospital. Data were collected using content validated, pre-tested self-administered questionnaire during January to March 2020. @*Results@#Of the total parents, the majority were mothers (87%, n=262) and more than 70% (n=211) of them completed their secondary education. Findings demonstrated that parents had average awareness about adverse effects of long-term steroid therapy including child's susceptibility to infections (69.0%, n=207), increase blood glucose levels (69.7%, n=209), moon face (60.3%. n=181), central obesity (60.3%, n=181), increase blood pressure levels (58.0%, n=174) and (irritability 50.3%, n=151) while poor awareness on adverse effects include buffalo humps (26.7%, n=80) increase fracture tendency (24.3%, n=73), tarry colour stools (24.3%, n=73), vision impairment (24.0%, n=72), glaucoma (17.3%, n=52), cataract (16.0%, n=48 ) and delayed wound healing (23.0%, n=69). According to the findings, overall mean (SD) knowledge percentage on parental awareness of adverse effects was found to be low (38.24 ± 20.57).@*Conclusion@#Since parental awareness of the adverse effects of long-term corticosteroid therapy is inconsistent, special attention is needed to plan and implement appropriate awareness sessions.

Intra-articular triamcinolone hexacetonide injections in hands osteoarthritis - A double-blinded randomized controlled trial with a one year follow-up

Abstract Objective: to evaluate the effectiveness of triamcinolone Hexacetonide (TH) Intra-Articular Injection (IAI) in hand Interphalangeal Joints (IP) of Osteoarthritis (OA) patients to improve pain and joint swelling; improve function, goniometry, and grasping force, and assess IAI influence on radiographic evolution over 1-year. Methods: A randomized, double-blind study. 60 patients who underwent IAI at the most symptomatic IP joint were randomly assigned to receive TH+Lidocaine (LD) (TH/LD group) or just LD (LD group). Patients were assessed blindly for 1-year, at baseline and 1, 4, 8, 12, and 48 weeks. The following variables were assessed: articular pain and swelling, AUSCAN and COCHIN functional questionnaires, grip and pinch strength, goniometry, perception of improvement, acetaminophen consumption, and simple radiography. Repeated-measures ANOVA test was used to analyze the intervention response. Results: Sixty patients completed the follow-up. There were nine missed assessments. 97% were women; mean age of 61-years (SD = 8.2), and approximately 5-years of disease (SD = 3.6). Half of the patients present radiographic classification Kellgren and Lawrence (KL) grades I and II, and the other half grades III and IV. The two groups evolved similarly at 48-weeks. TH/LD group had a better evaluation in joint swelling and acetaminophen consumption (p = 0.04 and p < 0.001, respectively) at 48-weeks. Radiographically there was no statistical difference between groups (KL, p = 0.564; erosive OA, p = 0.999; worsening, p = 0.573). Conclusion: The IAI IP hands OA is effective for the improvement of joint swelling and decrease of analgesic consumption and does not influence the radiographic evolution of the injected joint.

Smell disorders evolution after chronic rhinosinusitis with polyps surgery

: The effects of chronic rhino sinusitis with polyps (CRSWP) surgery on smell symptoms have not been sufficiently studied. The aim of this study was to evaluate the impact of CRSWP surgery on smell symptoms over short and long-term follow-up and to identify the factors that might influence their evolution. Patients and methods: This was a retrospective study about 184 patients operated endoscopically for CRSWP. In post operative period, long-term local steroids were prescribed systematically. The sense of smell was evaluated preand post-operatively according to a subjective score (1: good smell, 2: hyposmia, 3: anosmia). Some factors, related to the patient, the CRSWP and the treatment, were tested in order to identify predictors of smell outcome after surgery.. Results: Before surgery, the anosmia and the hyposmia were noted in 90.8% and in 8.7% of cases, respectively. At six months after surgery, the improvement of olfactory score was significant: 84% of patient had the score 1 compared with 0.5% preoperatively (p < 0.0001). This improvement was maintained during the 2 first years and decreased significantly at 3 years, although an average delay of polyps recurrence was 23.4 months. Among the factors studied in our series, only the observance of postoperative corticosteroids was retained as a predictor of smell recovery after surgery (p = 0,011). Conclusion: CRSWP surgery can significantly improve the smell sense, especially during the two first years. This effect can be sustainable if good post operative compliance for local corticosteroid are achieved

Smell disorders evolution after chronic rhinosinusitis with polyps surgery

The effects of chronic rhino sinusitis with polyps (CRSWP) surgery on smell symptoms have not been sufficiently studied. The aim of this study was to evaluate the impact of CRSWP surgery on smell symptoms over short and long-term follow-up and to identify the factors that might influence their evolution. Patients and methods: This was a retrospective study about 184 patients operated endoscopically for CRSWP. In post operative period, long-term local steroids were prescribed systematically. The sense of smell was evaluated preand post-operatively according to a subjective score (1: good smell, 2: hyposmia, 3: anosmia). Some factors, related to the patient, the CRSWP and the treatment, were tested in order to identify predictors of smell outcome after surgery.. Results: Before surgery, the anosmia and the hyposmia were noted in 90.8% and in 8.7% of cases, respectively. At six months after surgery, the improvement of olfactory score was significant: 84% of patient had the score 1 compared with 0.5% preoperatively (p < 0.0001). This improvement was maintained during the 2 first years and decreased significantly at 3 years, although an average delay of polyps recurrence was 23.4 months. Among the factors studied in our series, only the observance of postoperative corticosteroids was retained as a predictor of smell recovery after surgery (p = 0,011). Conclusion: CRSWP surgery can significantly improve the smell sense, especially during the two first years. This effect can be sustainable if good post operative compliance for local corticosteroid are achieved.

Analysis of clinical features and prognosis of acute severe autoimmune hepatitis / 中华肝脏病杂志

Objective: To analyze the clinical features and prognosis of acute severe autoimmune hepatitis (AIH). Methods: A retrospective analysis of the clinical data of patients with acute severe AIH admitted to our hospital from 2008 to 2019 was divided into acute AIH (A-AIH) and chronic acute AIH (AC-AIH) according to the presence or absence of liver diseases. Patients' general condition, liver biochemistry, immunology, histological features of liver, hormonal therapies prognosis and related factors were analyzed. Results: A total of 41 cases [39 females, age (54.24 ± 10.55) years] were collected. Alanine aminotransferase (ALT) and total bilirubin (TBil) were significantly increased, and the international normalized ratio (INR) was > 1.5. Acute lobular inflammation was the feature of acute and severe AIH in the histology of liver. The serum IgG level was (28.36 ± 8.35) g / L. The positive rate of antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA) was 82.9%, and 17.1%, respectively. Over 70% of acute severe AIHs were AC-AIH. The duration of onset of AC-AIH was > 8 weeks, while most A-AIHs < 8 weeks, and the differences between the two groups were statistically significant (P = 0.001). The mortality rate within 30 days after hormonal treatment was 19.5%. There were statistically significant differences in TBil, Model for End-Stage Liver Disease (MELD) score and leukocyte count between the death and survival group. Conclusion: The mortality rate in acute severe AIH is high, and most of them have the basis of chronic liver disease. Serum IgG level, autoantibodies and acute lobular inflammation are important factors for diagnosis. The prognosis of hormonal therapy is related to the patients' condition and course of disease.