Características clínico-oftalmológicas y evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social, Paraguay / Clinical-ophthalmological characteristics and evolution of patients with moderately severe active thyroid ophthalmopathy treated with methylprednisolone boluses who attended the Central Hospital of the Instituto de Previsión Social, Paraguay

Introducción: La oftalmopatía tiroidea (OT) es un trastorno debilitante en pacientes con enfermedad tiroidea autoinmune, principalmente enfermedad de Graves, que se desarrolla entre el 30 a 50% de los casos. Objetivos: Describir las características clínico-oftalmológicas y la evolución de los pacientes con oftalmopatía tiroidea activa moderada severa tratados con bolos de metilprednisolona que acuden al Hospital Central del Instituto de Previsión Social en el tiempo comprendido entre enero de 2018 y setiembre de 2021. Materiales y métodos: Investigación de diseño observacional, con estudio descriptivo, retrospectivo. Resultados: Se revisaron fichas de 34 pacientes con OT activa moderada severa que recibieron bolos de metilprednisolona basado en las guías EUGOGO 2016, de los cuáles se excluyeron 3 pacientes por tener fichas incompletas y otros 3 pacientes ya que requirieron tratamiento de segunda línea previo al término del esquema de 12 sesiones. De los 28 pacientes estudiados, la edad promedio fue de 43,6 ±13,1 años, el 89% de sexo femenino y el 28,5%, fumadores. En cuanto a la función tiroidea de la población previo al tratamiento, se constató hipertiroidismo en el 82%, hipotiroidismo en el 11% y eutiroidismo en el 7%; y posterior al tratamiento, se constató hipertiroidismo en el 78,6% (subclínico), eutiroidismo en el 17,9% e hipotiroidismo en el 3,5%. La mayoría (92.6%) contaba con anticuerpos contra el receptor de TSH positivo, con un promedio de 18 ± 9,9 mIU/Ml. Respecto a la actividad de la oftalmopatía según la escala CAS, se constató un promedio de 4,1 ±1,0 previo al tratamiento y posterior 1,2 ±1,4; de ellos el 46,4% presentó un estado leve según escala de gravedad, 39% sin criterios de gravedad y 14 % persistió en moderada -severa. Se constató mejoría de la agudeza visual tras el tratamiento (57,1%), el promedio de exoftalmía previo al tratamiento fue 22,2 mm y posterior 21,1 mm; se presentó diplopía en el 7,1% previo al tratamiento y en el 3,6% posterior al tratamiento. Conclusión: El tratamiento con glucocorticoides endovenosos en la oftalmopatía de Graves moderada-severa (esquema EUGOGO 2016) fue muy efectivo, revirtiendo la actividad y consecuentemente ayudando a disminuir la gravedad, en la gran mayoría de nuestros pacientes. Esto podría explicarse porque la oftalmopatía era incipiente y por el alto grado de adherencia de los pacientes en el contexto de un manejo multidisciplinar bien protocolizado.

Introduction: Graves' orbitopathy (GO) is a debilitating disorder in patients with autoimmune thyroid disease, mainly Graves' disease, which develops in 30 to 50% of cases. Objectives: To describe the clinical-ophthalmological characteristics and evolution of patients with moderate-to- severe active GO treated with methylprednisolone boluses who attended the Central Hospital of the Institute of Social Security between January 2018 and September 2021. Materials and methods: Observational design research, descriptive, retrospective study. Results: Records of 34 patients with active moderate-to-severe GO who received boluses of methylprednisolone based on the EUGOGO 2016 guidelines, were reviewed, of which 3 patients were excluded due to having incomplete records and another 3 patients since they required second-line treatment prior to end the 12-session scheme. Of the 28 patients studied, the average age was 43.6 ±13.1 years, 89% were female and 28.5% were smokers. Regarding the thyroid function of the population prior to treatment, hyperthyroidism was found in 82%, hypothyroidism in 11% and euthyroidism in 7%; and after treatment, hyperthyroidism was found in 78.6% (subclinical), euthyroidism in 17.9% and hypothyroidism in 3.5%. The majority (92.6%) had positive thyrotropin receptor antibodies, with an average of 18 ± 9.9 mIU/Ml. Regarding the activity of orbitopathy according to the CAS scale, an average of 4.1 ±1.0 was found before treatment and 1.2 ±1.4 after; Of them, 46.4% presented a mild condition according to the severity scale, 39% without severity criteria and 14% persisted in moderate-severe. Improvement in visual acuity was noted after treatment (57.1%), the average exophthalmia before treatment was 22.2 mm and after 21.1 mm; Diplopia occurred in 7.1% before treatment and in 3.6% after treatment. Conclusion: Treatment with intravenous glucocorticoids in moderate-severe Graves' orbitopathy (EUGOGO 2016 scheme) was very effective, reversing the activity and consequently helping to reduce the severity, in the vast majority of our patients. This could be explained because the orbitopathy was incipient and by the high degree of patient adherence in the context of well-protocolized multidisciplinary management.

Clinical profile and visual outcome in patients with traumatic optic neuropathy

Purpose: To analyze the visual outcome in patients with traumatic optic neuropathy (TON) with respect to different treatment modalities, to study the correlation of initial visual loss with the final visual outcome, and to find out the predictor of final visual outcome in patients with indirect TON. Methods: A retrospective analysis of 36 eyes with TON was done. Data on clinical profile, including demographics, mode of trauma, best corrected visual acuity (BCVA), pupillary reflex examination, and anterior and posterior segment examination, was collected. Presence and location of orbital and cranial fractures were identified from computed tomography scan. Visual outcomes following steroid therapy, optic nerve (ON) decompression, and in untreated patients were analyzed. Pre? and post?treatment BCVA were divided into three groups based on logarithm of the minimum angle of resolution (logMAR) as follows: group A: 3, group B: 2.9–1.3, and group C<1.3. BCVA values at follow?up visits were taken as the primary outcome measure. Association between various risk factors and final visual outcome in patients with indirect TON was also analyzed. Results: Out of 34 patients whose 36 eyes were studied, three (8.8%) patients were females and 31 (91.2%) patients were males. Most common mode of trauma was road traffic accident (RTA; 91.2%), which was followed by fall (8.8%) and assault (2.9%). Pre? and post?treatment BCVA values of 36 eyes were compared, and improvement in BCVA after treatment was found to be statistically significant. Also, 28.6% of patients with presenting BCVA of no light perception showed improvement compared to 94.1% and 100% in groups B and C, respectively. Orbital wall fractures were seen in 80.5% (n = 29) of the patients, with lateral wall fracture being the most common (58.3%) followed by medial wall (33.3%), roof (27.7%), floor (27.7%), and optic strut (5%). Conclusion: Baseline BCVA had significant association with final vision improvement. Lateral wall fracture was the most common fracture associated with indirect TON. Patients treated with high?dose corticosteroids, irrespective of the time of presentation, had a better visual outcome

Krill's disease: a newer management option

Purpose: To report a case of a young female who presented with scotoma in the right eye for few days. Case Report: Krill's disease or acute retinal pigment epithelitis (ARPE) is a self-limiting retinal disease with no specific treatment. Typical clinical and imaging features helped us to diagnose her with ARPE. Intravenous methylprednisolone (IVMP), which gives a rapid anti-inflammatory response, was advised. An SD-OCT scan post-injection showed a reduction in hyperreflectivity and height of lesion at day 3 and near total resolution by day 5. Conclusion: This case suggests rapid resolution of ARPE with the use of IVMP.

Comparación entre el tratamiento con dexametasona y metilprednisolona en pacientes hospitalizados por COVID-19

RESUMEN Introducción: la dexametasona es un medicamento que demostró una disminución de la mortalidad en la neumonía por SARS-CoV-2. Se desconoce la utilidad de otros corticoides, dosis y su duración para mejorar este resultado clínico. Objetivo: comparar la mortalidad de los pacientes adultos con neumonía por SARS-CoV-2 tratados con dexametasona versus metilprednisolona en el Hospital Nacional, Itauguá, Paraguay. Materiales y métodos: estudio ambispectivo. Se incluyeron 97 pacientes, 52 recibieron dexametasona y 45 metilprednisolona. Se utilizó un muestreo no probabilístico de casos consecutivos. Las variables fueron sometidas a estadística descriptiva y analítica. El protocolo fue aprobado por el Comité de Ética del Hospital Nacional. Los autores no presentan conflictos de interés. Resultados: todos los pacientes ingresaron con neumonía con valoración de 4 (OMS). No se encontraron diferencias significativas en la mortalidad entre ambos grupos. Al aplicar un análisis estratificado por edad, en los pacientes <65 años la mortalidad en los que recibieron dexametasona fue 15,8% mientras que los que recibieron metilprednisolona no fallecieron (p 0,03). En el grupo de ≥65 años la mortalidad n los recibieron dexametasona fue 29,4% vs. 21,4% en los que recibieron metilprednisolona (p 0,7). Conclusiones: en los pacientes <65 años tratados con dexametasona la mortalidad fue mucho más alta que en los que recibieron metilprednisolona, ya que en este último grupo no se registraron fallecimientos.

ABSTRACT Introduction: Dexamethasone is a medication that demonstrated a decrease in mortality in SARS-CoV-2 pneumonia. The usefulness of other corticosteroids, dose and their duration to improve this clinical result is unknown. Objective: To compare the mortality of adult patients with SARS-CoV-2 pneumonia treated with dexamethasone versus methylprednisolone at the Hospital Nacional of Itauguá, Paraguay. Materials and Methods: Ambispective study. Ninety seven patients were included, 52 received dexamethasone and 45 methylprednisolone. A non-probabilistic sampling of consecutive cases was used. The variables were subjected to descriptive and analytical statistics. The protocol was approved by the Ethics Committee of the Hospital Nacional. The authors do not present conflicts of interest. Results: All patients entered with 4 (WHO) vaulting pneumonia. No significant differences were found in mortality between both groups. When applying an age stratified analysis, in patients <65 years who received dexamethasone the mortality was 15.8% while those who received methylprednisolone did not die (p 0.03). In the ≥65 years group, mortality in those who received dexamethasone was 29.4% vs. 21.4% in those who received methylprednisolone (p 0.7). Conclusions: In patients <65 years treated with dexamethasone, mortality was much higher than in those who received methylprednisolone, since in the latter group no deaths were recorded.

A case report of pediatric mog-antibody disease with Bilateral optic neuritis

MOG – Antibody disease is an inflammatory demyelinating condition of the CNS characterized by a monophasic or relapsing course of neurological dysfunction which does not meet the typical criteria for multiple sclerosis or other known neuro inflammatory conditions and occurs in presence of serum MOG antibodies using specific cell based assays. In pediatric patients MOG antibodies are detected in range of relapsing phenotypes including relapsing inflammatory optic neuritis (RION), acute disseminated encephalomyelitis followed by optic neuritis (ADEM – ON), brain stem demyelination and aquaporin P4 antibody negative neuromyelitis optica spectrum disorder (AQP4-Ab negative NMOSD).MOG positive optic neuritis is frequently bilateral and associated with optic nerve head swelling.It is associated with neurological diseases like Multiple Sclerosis, ADEM or Transverse Myelitis.MOG antibody IgG is detected in serum by indirect fluorescence test.IV Methylprednisolone is the treatment of choice, if it fails to improve vision or if optic neuritis is recurring, then a combination of plasma exchange and IV Methylprednisolone should be considered.Long term immunosuppressants used for Prevention include corticosteroids, azathioprine, mycophenolate mofetil and rituximab. The optimal preventive therapy has yet to be determined.Once the disease has been diagnosed, uncertainty remains over the best treatment approach and clinical trials for the pharmacological management of MOG- antibody optic neuritis are still needed

Efficacy of Methylprednisolone and Etoricoxib Combination to attenuate Post-operative Pain and Nausea/Vomiting in Laparoscopic Surgeries

Background and Aims:Pain and PONV (postopera?ve nausea and vomi?ng) are common complaints in the period following surgery. A mul?modal approach targe?ng the reduc?on of postopera?ve pain with an opioid-sparing analgesic along with an an?eme?c medica?on would minimize opioid consump?on and its associated side effects. We evaluated the efficacy of methylprednisolone 125 mg IV taken along with oral 120 mg etoricoxib on postopera?ve pain and PONV in pa?ents undergoing laparoscopic surgeries Material and methods:A prospec?ve, randomized, double-blind study was conducted on 70 pa?ents aged between 18 and 60 years with ASA grade 1 and 2 posted for elec?ve laparoscopic surgeries. The test group was given a combina?on of methylprednisolone 125mgIV (given just before induc?on)& etoricoxib120mg oral (given 1 hr before surgery). (Group A, n=35) while control group received normal saline IV and a placebo per oral(Group B, n=35). Dura?on and quality of analgesia was assessed by visual analogue scale (VAS) score at 2,4,6,8,10,12,16,20 and 24hr as primary objec?ve. Total dose of rescue analgesic(injec?on Fentanyl 50 mcg) in first 24 hours, peri-opera?ve hemodynamic change and post op nausea vomi?ng (PONV) were observed as secondary objec?ve. Result:Demographic profiles were comparable. Dura?on of postopera?ve analgesia was significantly prolonged(p<0.05) in Group A(7.57±1.04hrs) as compared to Group B(3.05±0.5hrs). Group A showed a significant reduc?on in postopera?ve fentanyl consump?on in the form of rescue analgesic(p<0.05). Group A also showed significant reduc?on in the incidence of PONV(p<0.05). Conclusion:We conclude that single-dose administra?on of methylprednisolone IV along with oral etoricoxib has be?er analgesic efficacy in comparison to placebo for pa?ents undergoing laparoscopic surgeries.

An Observational Study of Clinical Profile & Short-Term Outcome with Use of Pulse Therapy of Methylprednisolone Alone Vs Methylprednisolone and Intravenous Immunoglobulin In Multisystem Inflammatory Syndrome In Children

Background: Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. There is persistent fever along with inflammation, which can lead to medical emergencies and neonates and children may require critical care. Aims and objectives: This study evaluates use of pulse therapy of methyl prednisolone versus prednisolone and intravenous immunoglobulin (IVIG) in multisystem inflammatory syndrome in children (MISC). Methodology: This analytical study was carried out in 30 children with history of SARS-CoV-19 or MISC attending the PICU or NICU of the Tertiary care centre of DVVPF's Medical College, Ahmednagar. The study was carried out from January 2021 to December 2021.Results: Total of 30 patients were studied with male majority (60%), and mean age of 7.35 years. 28 were kept in the ICU (93.33%). GI symptoms were seen in 24 cases (80%), Mucocutaneous manifestation in 25 cases (83.33%), Multiorgan involvement (>3 organs) in 23 cases (76.67%). D Dimer was raised in 29 cases (96.67%), Thrombocytopenia was seen in 24 cases (80%). CNS involvement in 14 cases (46.67%) with headaches in 7 (23.33%), encephalopathy in 5 cases (16.67%) and seizures in 4 cases (13.33%). Respiratory system involvement was seen in 16 cases (53.33%). We observed that the outcome characteristic features were better in the Methylprednisolone pulse therapy plus IVIG group. (p<0.05) Out of 15 patients in the two groups, 3 patients died in Methylprednisolone pulse therapy group (20%) while there was one death in the Methylprednisolone pulse therapy plus IVIG group. Significant difference was seen in the survival of the two groups. (p = 0.04). Conclusion: There is improvement in both the groups which received the treatment with either Methylprednisolone pulse therapy or Methylprednisolone pulse therapy plus IVIG. Comparatively there was less ICU stay, less complications and better patient survival in Methylprednisolone pulse therapy plus IVIG group.

COVID-19 pneumonitis and lupus pneumonitis: a challenge in diagnosis and early therapeutic consideration

Coronavirus disease 2019 (COVID-19) is an acute respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It has various clinical manifestations, from asymptomatic to severe disease with possible multi-organ involvement, with respiratory and vascular systems being the frequent affected. COVID-19 can affect patients with autoimmune diseases including systemic lupus erythematosus (SLE). The concurrent of both diseases may show the similar characteristic which can asa challenge in diagnosis and early therapeutic consideration. We report a case of 53 year-old Balinese woman patient who previously diagnosed with acute respiratory iIlness (Pneumonitis),The patient with past history of SLE since 2005, takes 200 mg hydroxychloroquine (HCQ) and 4 mg methylprednisolone once a day orally without adverse effect. Then she was confirmed with SARS-CoV-2 infection (COVID-19 pneumonitis) concurrent with SLE flare (Lupus pneumonitis). The clinical similarities were fever, dry coughand shortness of breath with the chest X-ray(CXR) was bilateral interstitiil infiltrate. Laboratory results; a positive SARS-CoV-2 polymerase chain reaction test, leucophenia, increased ESR, slightly increased CRP, decreased CD4 and CD8 cell count. Decreasedoxygen saturation, requiring 4 L of oxygen via nasal cannula on admission.She was given therapyofantibiotics, antivirus and other symptomatic. The prior SLE maintenance therapywas continued with increasingmethylprednisolone dose. The patient抯condition was improved and weaned off her oxygen requirements. Shewas dischargedandfollowed by home isolation for 14 days.

Tocilizumab or glucocorticoids treatment for patients with SARS-CoV-2 pneumonia: An observational study

Abstract Objective To estimate the effect of tocilizumab or glucocorticoids in preventing death and intubation in patients hospitalized with SARS-CoV-2 pneumonia. Methods This was a retrospective cohort study enrolling all consecutive patients hospitalized at Reggio Emilia AUSL between February the 11th and April 14th 2020 for severe COVID-19 and treated with tocilizumab or glucocorticoids (at least 80 mg/day of methylprednisolone or equivalent for at least 3 days). The primary outcome was death within 30 days from the start of the considered therapies. The secondary outcome was a composite outcome of death and/or intubation. All patients have been followed-up until May 19th 2020, with a follow-up of at least 30 days for every patient. To reduce confounding due to potential non-comparability of the two groups, those receiving tocilizumab and those receiving glucocorticoids, a propensity score was calculated as the inverse probability weighting of receiving treatment conditional on the baseline covariates. Results and conclusion Therapy with tocilizumab alone was associated with a reduction of deaths (OR 0.49, 95% CI 0.21-1.17) and of the composite outcome death/intubation (OR 0.35, 95% CI 0.13-0.90) compared to glucocorticoids alone. Nevertheless, this result should be cautiously interpreted due to a potential prescription bias.

Effect of Jianpi Huogu Formula on function damage of vascular endothelial cells induced by glucocorticoid / 中国中药杂志

This study aimed to observe the intervention effect of Jianpi Huogu Formula(JPHGF) on the functional damage of vascular endothelial cells caused by glucocorticoid, and explore its action mechanism from the PI3 K/Akt and mitogen activated protein kinase(MAPK) signaling pathways. The extracted thoracic aorta ring of normal SD rats were intervened first with vascularendothelial growth factor(VEGF, 20 μg·L-1) and/or sodium succinate(MPS, 0. 04 g·L-1) in vitro and then with JPHGF(8, 16, and 32 μg·L-1) for five mcontinuous ethylpdays, rednisolofollowed nebythe statistics of the number, length, and area of microvessels budding fromvascular rings. In addition, the human umbilical vein endothelial cells(HUVECs) induced by VEGF(20 μg·L-1) were added with MPS(0. 04 g·L-1) and then with JPHGF(8, 16, and 32 μg·L-1) for observing the migration, invasion, and luminal formation abilities of HUVECs in the migration, invasion and luminal formation experiments. The protein expression levels of PI3 K, p-Akt, p-JN K, and p-ERK in HUVECs were assayed by Western blot. The results showed that JPHGF dose-dependently improved the num-ber,length, and area of microvessels in MPS-induced rat thoracic aortic ring, reversed the migration, invasion and lumen formation abiliti es of HUVECs reduced by MPS, and up-regulated the protein expression levels of PI3 K, p-Akt, and p-JNK in HUVECs. All thesehave suggested that JPHGF exerts the protective effect against hormone-induced damage to the angiogenesis of vascular endothelial cells by activating the PI3 K/Akt and MAPK signaling pathways, which has provided reference for exploring the mechanism of JPHGF in treating s teroid-induced avascular necrosis of femoral head(SANFH) and also the experimental evidence for enriching the scientific connotationof spleen-invigorating and blood-activating therapy.

Analysis of clinical and imaging characteristics of radiation-induced optic neuritis / 中华眼底病杂志

Objective:To observe the clinical and imaging characteristics of radiation optic neuropathy (RION).Methods:A retrospective clinical study. A total of 43 patients (69 eyes) who were diagnosed with RION at the Chinese PLA General Hospital from 2010 to 2021 were included in this study. There were 23 males (36 eyes) and 20 females (33 eyes). The age of patients at the time of radiation therapy was 49.54±13.14 years. The main dose of radiotherapy for lesions was 59.83±14.12 Gy. Sixteen patients were treated with combined chemotherapeutic agents. The clinical details of best corrected visual acuity (BCVA) and color photography of the fundus were collected. Forty-six eyes underwent optical coherence tomography (OCT), visual field were examined in 30 eyes, magnetic resonance imaging (MRI) were performed in 40 eyes. The BCVA examination was performed using Snellen visual acuity chart, which was converted to minimum resolution angle logarithm (logMAR) visual acuity during recording. Hyperbaric oxygen therapy (HBOT) was performed in 10 patients (13 eyes), 9 patients (12 eyes) were treated with intravenous methylprednisolone (IVMP), 12 patients (23 eyes) were treated with HBOT combined with IVMP and control group of 12 patients (21 eyes) were only treated with basal treatment. And grouped accordingly. To observe the changes in onset, recovery, and final BCVA of the affected eye as well as thickness changes of the retinal nerve fiber layer (RNFL) of the optic disc and inner limiting membrane-retinal pigment epithelium (ILM-RPE) layer of the macular area, and final outcome of BCVA with different treatment modalities in affected eyes. The RNFL and ILM-RPE layer thicknesses were compared between patients with different disease duration as well as between treatment regimens using independent samples t-test. Results:Of the 43 cases, vision loss was monocular in 17 patients (39.53%, 17/43) and binocular in 26 patients (60.47%, 26/43). The latency from radiotherapy to onset of visual loss was 36.33±30.48 months. The duration of RION ranged from 1 week to 10 years, in which the disease duration of 37 eyes ≤2 months. Subacute visual acuity loss was present in 41 eyes. logMAR BCVA<1.0, 1.0-0.3, >0.3 were 45, 15, and 9 eyes, respectively. Optic disc pallor and optic disc edema were found in 10 (27.03%, 10/37), 3 (8.11%, 3/37) eyes, respectively, within 2 months. The superior RNFL [95% confidence interval ( CI) 2.08-66.56, P=0.038] and the outer circle of the inner limiting membrane to retinal pigment epithelium (ILM-RPE) (95% CI 4.37-45.39, P=0.021) layer thinned significantly during the first month. The center of the ILM-RPE layer thickened (95% CI-32.95--4.20, P=0.015) significantly during the first two months. The inner circle temporal quadrant of the ILM-RPE layer thickened (95% CI -42.22--3.83, P=0.022) significantly from the third to sixth month, and the RNFL except for the temporal quadrants and the average RNFL, inner circle superior quadrant and outer circle of the ILM-RPE layer thinned significantly after 6 months ( P<0.05). Among the 40 eyes that underwent MRI examination, 33 eyes (82.50%, 33/40) were affected by T1 enhancement of optic nerve, including 23 eyes (69.70%, 23/33) in intracranial segment; 12 eyes with thickening and long T2 signal (36.36%, 12/33). After treatment, BCVA was restored in 17 eyes (24.6%, 17/69) and final BCVA improved in 9 eyes (13.0%, 9/69). There was no significant difference between HBOT, IVMP and HBOT combined with IVMP therapy in improving BCVA recovery or final BCVA compared with the control group, respectively ( t=-1.04, 0.61, 1.31,-1.47, -0.42, 0.46; P>0.05). Conclusions:The structural damage of the RNFL and ILM-RPE layer occurred during the first month, the RNFL showed progressive thinning during the follow-up period, while the ILM-RPE layer showed thinning-thickening-thinning. MRI shows T1 enhancement of the optic chiasma and segments of the optic nerve, and the enhanced segments are usually accompanied by thickening and long T2. HBOT and IVMP have no obvious effect on RION.

Observation of the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis and its regulating effect on patients' serum interleukin-17/ interleukin-4 / 中国医师进修杂志

Objective:To explore the curative effect of methylprednisolone combined with methotrexate in the treatment of ankylosing spondylitis (AS) and its regulation of serum interleukin (IL)-17/IL-4.Methods:A total of 117 patients with AS in the First Hospital of Baoding from July 2016 to June 2019 were selected as prospective research subjects, and they were simply randomized into three groups, with 39 cases in each group. The control group A was treated with methotrexate, the control group B was treated with methylprednisolone, and the observation group was treated with methotrexate combined with methylprednisolone. The chi-square test was used to compare the clinical efficacy and the incidence of adverse reactions in the three groups. F-test was used to compare the thoracolumbar spine mobility, Bath AS disease activity index (BASDAI), Bath AS function index (BASFI) scores, the levels of serum high mobility protein 1 (HMGB1), matrix metalloproteinase-3 (MMP-3), interleukin (IL)-4, IL-17, and IL-17/IL-4 before and after the treatment of the three groups. Results:The total effective rate of treatment in the observation group was better than that in the control groups A and B :92.31%(36/39) vs. 74.36%(29/39) and 69.23%(27/39), P<0.05. After the course of treatment, the BASDAI and BASFI scores in the observation group were lower than those in the control group A and B, and the thoracolumbar spine mobility were higher than those in the control group A and B: (3.36 ± 1.03) scores vs. (4.62 ± 1.19), (4.98 ± 1.25) scores; (3.70 ± 0.89) scores vs. (4.36 ± 0.96), (4.64 ± 0.95) scores; (4.96 ± 1.17) cm vs. (4.18 ± 1.02), (3.98 ± 1.15) cm, (5.93 ± 1.32) cm vs.(5.02 ± 1.15), (4.92 ± 1.25)cm, P<0.05. After the course of treatment, serum HMGB1, MMP-3, IL-17, IL-17/IL-4 in the observation group were lower than those in the control group A and B: (20.25 ± 6.41) μg/L vs. (27.81 ± 7.63), (29.26 ± 7.31) μg/L; (4.83 ± 1.06) μg/L vs. (9.26 ± 1.25), (9.71 ± 1.28) μg/L; (13.41 ± 5.06)ng/L vs.(17.62 ± 5.61), (19.06 ± 6.14) ng/L; 0.51 ± 0.27 vs. 0.92 ± 0.41, 1.04 ± 0.45, P<0.05; and IL-4 was higher than that in the control groups A and B: (26.15 ± 4.94) ng/L vs. (19.16 ± 5.14), (18.32 ± 5.26) ng/L, P<0.05. There was no significant difference in the incidence of adverse reactions among the three groups ( P>0.05). Conclusions:The combination of methylprednisolone and methotrexate in the treatment of AS can significantly reduce serum HMGB1 and MMP-3 levels, regulate serum IL-17/IL-4 and further improve the therapeutic effect, and it has high safety.

Relationship between mechanism underlying methylprednisolone-induced alleviation of ventilator-induced lung injury and p38MAPK/NLRP3 pathway in lung tissues of rats / 中华麻醉学杂志

Objective:To evaluate the relationship between the mechanism underlying methylprednisolone-induced alleviation of ventilator-induced lung injury (VILI) and p38 mitogen-activated protein kinase (p38 MAPK)/nucleotide binding oligomerization domain (NOD)-like receptor protein 3 (NLRP3) pathway in lung tissues of rats.Methods:Sixty clean-grade male Sprague-Dawley rats, weighing 270-320 g, aged 4-5 months, were divided into 3 groups ( n=20 each) using a random number table method: control group (group C), mechanical ventilation group (group V), and methylprednisolone group (group M). Group C breathed air spontaneously for 4 h without mechanical ventilation.Group V was mechanically ventilated (RR 40 times/min, V T 40 ml/kg, I∶E 1∶1, PEEP 0, FiO 2 21%) for 4 h. Group M received intravenous methylprednisolone 10 mg/kg at 20 min before mechanical ventilation.At 4 h of mechanical ventilation, broncho-alveolar lavage fluid (BALF) was collected to measure the concentrations of interleukin-1beta (IL-1β), IL-18, and tumor necrosis factor-alpha (TNF-α) and wet/dry lung weight ratio (W/D ratio), and lung tissues were obtained for microscopic examination of the histopathological changes and for detection of the expression of p38MAPK, phosphorylated p38MAPK (p-p38MAPK), NLRP3, apoptosis-related speck-like protein containing a CARD (ASC), and cysteinyl aspartate-specific protease-1 (caspase-1) (using Western blot). Results:Compared with group C, the W/D ratio of lung tissues and concentrations IL-1β, IL-18 and TNF-α in BALF were significantly increased, and the expression of p-p38MAPK, NLRP3, ASC and caspase-1 was up-regulated in group V ( P<0.05), and no significant change was found in group M ( P>0.05). Compared with group V, the W/D ratio of lung tissues and concentrations of IL-1β, IL-18 and TNF-α in BALF were significantly decreased, and the expression of p-p38MAPK, NLRP3, ASC and caspase-1 was down-regulated in group M ( P<0.05). Conclusion:The mechanism by which methylprednisolone alleviates VILI may be related to inhibition of p38MAPK/NLRP3 pathway activity and reduction of inflammatory responses in lung tissues of rats.

Clinical analysis of hormone combined with cerebral glycoside carnosine and dehydrating drugs in the treatment of traumatic optic nerve injury / 中华急诊医学杂志

Objective:To retrospectively analyze the effect of hormone combined with cerebral glycoside carnosine and dehydration drugs in traumatic optic neuropathy (TON) patients.Methods:The enrolled 215 TON patients in our hospital from February 2014 to September 2021 were randomly divided into the combination group ( n=143) and routine group ( n=142). The baseline data, visual acuity recovery before and after treatment and adverse reactions of each group were compared. Univariate analysis was conducted to analyze the differences in indicators of good prognosis and visual acuity improvement between the two groups. Results:The effective rate of vision recovery in the combination group was significantly increased than that in the routine group ( P<0.05). After treatment, the intraocular pressure and visual field defect in the combination group were significantly decreased than those in the routine group ( P<0.05). Univariate subgroup analysis showed that there were statistically significant differences between TON patients with age ≤40 years, residual light sensation after injury, visit time ≤24 h, and VEP not extinguished with combined treatment of hormone, brain glycoside carnotin and dehydrating drugs and the routine group ( P<0.05). Univariate subgroup analysis showed that TON patients with optic canal fracture without optic nerve swelling and tortuosity had a good prognosis after treatment with combined hormone, cerebral glucoside carnosine and dehydration, which was statistically different from that in the routine group ( P<0.05). Conclusions:Brain glycosides carnosine and dehydration therapy on the basis of combined hormone a prednisolone sodium succinate treatment can improve vision in TON patients, lighten the optic nerve injury, will not increase the occurrence risk of adverse reactions, and have higher security. It is necessary to focus on high-risk patient over 40 years old, more than 24 h of treatment time, VEP extinction, optic nerve swelling poor efficacy. It is worthy of clinical promotion.

Protective Effect of Tongluo Shenggu Capsule on Function Damage of Human Umbilical Vein Endothelial Cells Induced by Glucocorticoid / 中国实验方剂学杂志

Objective:To observe the effect of Tongluo Shenggu capsule （TLSGC） on glucocorticoid-induced vascular endothelial cell functional damage， and to preliminally explore the mechanism of action through MEK-ERK signaling pathway. Method:The blood vessel of aorta rings of normal SD rats were induced <italic>in vitro</italic> intervention with methylprednisolone sodium succinate （MPS， 0.04 g·L^-1） and/or vascular endothelial growth factor （VEGF， 20 μg·L^-1）， and were treated with TLSGC（12.5， 25， 50 μg·L^-1） continuously for 5 days to observe the number， length and area of microvascular ring buds．In addition， human umbilical vein endothelial cells （HUVEC） induced by VEGF（20 μg·L^-1） were added into MPS（0.04 g·L^-1） and TLSGC （12.5， 25， 50 μg·L^-1） were added. Then， Transwell migration， Transwell invasion and lumen formation experiments were used to detect the migration， invasion and lumen formation ability of HUVEC， respectively. The content of nitric oxide（NO） in the cell supernatant was detected by nitrate reductase method， the content of endothelin 1（ET-1） in the cell supernatant was detected by dry powder method. Moreover， the protein contents of vascular endothelial growth factor receptor 2 （VEGFR2）， extracellular signal-regulated kinase （ERK）， phospho-extracellular signal-regulated kinase （p-ERK）， mitogen extracellular kinase1（MEK） and phosphorylated mitogen extracellular kinase1（p-MEK） in the cells were determined by Western blot. Result:Compared with the normal group， MPS could significantly inhibit the number， length and area of VEGF-induced rat thoracic aortic ring microvessels， HUVEC cell migration， invasion and lumen formation ability. It could reduce NO content and increase ET-1 content. MPS could also significantly reduce the protein content of VEGF-induced VEGFR2， p-MEK and p-ERK in HUVEC（<italic>P</italic><0.05，<italic>P</italic><0.01）. Compared with the model group， TLSGC could dose-dependently increase the number， length and area of MPS-induced abnormally reduced rat thoracic aortic ring microvessels， promote MPS-induced abnormally decreased HUVEC cell migration， invasion and lumen formation ability. It could increase the protein contents of NO， VEGFR2， p-MEK and p-ERK in HUVEC， and reduce abnormally increased ET-1 content（<italic>P</italic><0.05<italic>，P</italic><0.01）. Conclusion:TLSGC has a protective effect on the damage of angiogenesis and secretion of vascular endothelial cells induced by glucocorticoid， and the mechanism may be related to the activation of MEK/ERK signaling pathway.

Application of Methylprednisolone Sodium Succinate Combined with Tropisetron in Prevention of Nausea and Vomiting under Microvascular Decompression of Hemifacial Spasm / 中国医学科学院学报

Objective To evaluate the effect of methylprednisolone sodium succinate combined with tropisetron on postoperative nausea and vomiting(PONV)under microvascular decompression of hemifacial spasm.Methods From January to June 2019,485 patients undergoing microvascular decompression for facial spasm at Department of Neurosurgery,Peking University People's Hospital were randomly assigned into two groups with random number table method.For group A(n=242),2 ml saline was administrated by intravenous drip before induction and 5 mg tropisetron after operation.For group B(n=243),40 mg methylprednisolone sodium succinate was administrated by intravenous drip before induction and 5 mg tropisetron after operation.The anesthesia time,operation time,and incidence of PONV in 0-24 h and 24-48 h were recorded for the comparison of the remedial treatment rate of nausea and vomiting between the two groups.Results There was no significant difference in age,gender,smoking history,body mass index value,American Society of Anesthesiologists score,medical history,surgical side,PONV history,operation time or anesthesia time between the two groups(all P > 0.05).The incidence of PONV in group A was 35.5% and 18.2% during 0-24 h and 24-48 h,respectively,which was significantly higher than that(18.5%,χ

Methylprednisolone Induced Hypokalemia In An Idiopathic Thrombocytopenic Purpura (ITP) Patient

We reported an Idiopathic Thrombocytopenic Purpura (ITP) patient, 66-years-old (woman), with hypokalemia. She received 125 mg three times daily of methylprednisolone injection for her ITP. Corticosteroids are the initial treatment of ITP. Her potassium level decrease after she took methylprednisolone. Hypokalemia is also a common problem affecting the elderly or geriatric population. Many literatures reported side effects of corticosteroid is associated with hypokalemia. Monitoring potassium levels must be check during corticosteroid therapy. In this report, we describe the association between corticosteroid with hypokalemia effect.

Influence of methylprednisolone on the reversal time of sugammadex: a randomized clinical trial / Influência da metilprednisolona no tempo de reversão do sugammadex: estudo clínico randomizado

Abstract Background and objectives: Sugammadex is a modified gamma-cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway edema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium-induced moderate neuromuscular blockade in those who received intraoperative 1 mg kg-1 methylprednisolone or saline. Method: This single-centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear-nose-throat procedures (aged from 18 to 65, an ASA physical status I-II, a BMI less than 30 kg m-2, and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5 mL of saline, while the Methylprednisolone Group (Group M) received 1 mg kg-1 of methylprednisolone in 5 mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2 mg kg-1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study. Results: Median time to TOFr = 0.9 was for 130.00 s (range of 29-330) for Group C and 181.00 s (100-420) for Group M (p < 0.001). The differences between the two groups were statistically significant. Conclusion: When using 2 mg kg-1 of sugammadex to reverse rocuronium-induced neuromuscular blockade in patients who received 1 mg kg-1 of intraoperative methylprednisolone, demonstrated delayed recovery times.

Resumo Justificativa e objetivos: Sugammadex é uma gama-ciclodextrina modificada que reverte os efeitos de agentes de bloqueio neuromuscular aminoesteroides. Da mesma forma, algumas moléculas esteroides, como toremifene, ácido fusídico e flucloxacilina, podem ser encapsulados pelo sugammadex. A metilprednisolona, esteroide sintético usado geralmente para a profilaxia de edema de vias aéreas, também pode ser encapsulada pelo sugammadex. O objetivo do estudo foi comparar os tempos de recuperação do sugammadex na reversão de bloqueio neuromuscular moderado induzido pelo rocurônio em pacientes em que foi administrado 1 mg.kg-1 de metilprednisolona ou solução salina no período intraoperatório. Método: Este estudo prospectivo, randomizado, controlado, unicêntrico incluiu 162 pacientes adultos (idades de 18-65, ASA I-II, IMC abaixo de 30 kg.m-2, e não usando medicação esteroide) submetidos à anestesia geral para procedimento eletivo de otorrinolaringologia com propofol, remifentanil, rocurônio e sevoflurano. A monitorização neuromuscular foi realizada usando aceleromiógrafo calibrado. O grupo controle (Grupo C) recebeu 5 mL de solução salina, enquanto o grupo metilprednisolona (Grupo M) recebeu 1 mg.kg-1 de metilprednisolona em 5 mL de solução salina logo após a indução. Ao término da cirurgia, em relação à contagem do número de respostas à sequência de quatro estímulos (TOFc), dois pacientes mostraram recuperação espontânea e todos os pacientes receberam 2 mg.kg-1 de sugammadex. A recuperação da razão T4/T1 (TOFr) para 0,9 foi registrada nos dois grupos, e o desfecho primário do estudo foi o tempo estimado de recuperação, momento em que a razão TOFr alcançou o valor de 0,9 (TOFr = 0.9). Resultados: O tempo mediano para TOFr = 0,9 foi 130 s (29-330) para o Grupo C e 181s (100-420) para o Grupo M (p < 0,001). As diferenças entre os dois grupos foi estatisticamente significante. Conclusões: Pacientes que receberam 1 mg.kg-1 de metilprednisolona no intraoperatório apresentaram tempo de recuperação mais prolongado após o uso de 2 mg.kg-1 de sugammadex para reverter o bloqueio neuromuscular induzido pelo rocurônio.

Tratamiento exitoso con Remdesivir y corticoides en un paciente con neumonía asociada a COVID-19: reporte de un caso / Successful treatment with Remdesivir and corticosteroids in a patient with COVID-19-associated pneumonia: a case report

El síndrome respiratorio agudo grave coronavirus 2 (SARS-CoV-2) se ha diseminado rápidamente a lo largo del mundo causando una mortalidad significativa en pacientes de alto riesgo con manifestaciones severas. A la fecha, Remdesivir ha sido el único antiviral autorizado por la FDA para uso de emergencia. Una de las posibles complicaciones de esta infección es el desarrollo de tormenta de citoquinas, para la cual no existe un tratamiento óptimo. Presentamos el caso de un varón de 48 años sin antecedentes médicos que acudió al hospital con disnea, tos, fiebre subjetiva y diarrea durante 10 días. La reacción de cadena polimerasa nasofaríngea fue positiva para SARS-CoV-2. Su estado respiratorio empeoró rápidamente hasta el punto de requerir oxígeno suplementario a través cánula nasal de alto flujo con 80% de FiO2. La tomografía computarizada de tórax mostró opacidades confluyentes en vidrio esmerilado en los lóbulos superiores, acompañadas de opacidades irregulares alveolares en los lóbulos inferiores bilateralmente. Se inició terapia con hidroxicloroquina, la cual se cambió a Remdesivir cuando estuvo disponible. Luego se inició metilprednisolona como tratamiento de una posible tormenta de citoquinas. La oxigenación del paciente mejoró significativamente en los días posteriores y fue dado de alta sin requerir oxigeno adicional y saturando 96% en medio ambiente. Nuestro caso ilustra el papel de Remdesivir en el tratamiento de la neumonía grave por COVID-19. También observamos un posible beneficio clínico de los corticoides en tormenta de citoquinas. Se necesitan más estudios para evaluar la eficacia de esta estrategia terapéutica.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world causing significant mortality in high risk patients with severe manifestations. To date, Remdesivir has been the only antiviral authorized by FDA as therapy for emergency use. One of the potential complications of this infection is cytokine storm, which optimal treatment remains unknown. We present the case of a 48-year-old man with no past medical history who presented to the hospital with dyspnea, cough, subjective fever, and diarrhea for 10 days. Nasopharyngeal PCR was positive for SARS-CoV-2. His respiratory status rapidly worsened to the point of requiring supplemental oxygen by high flow nasal cannula with FiO2 of 80%. Chest computed tomography showed confluent ground glass opacities in upper lobes accompanied by patchy airspace opacities in lower lobes bilaterally. He was started on hydroxychloroquine, which was switched to Remdesivir when it became available. Then, methylprednisolone was initiated for suspected cytokine storm. The patient's oxygenation improved significantly over the following days and he was discharged home with no oxygen supplementation and saturating 96% on room air. Our case illustrates the role of Remdesivir for the treatment of severe COVID-19 pneumonia. We also observed a possible clinical benefit of corticosteroids in the context of suspected cytokine storm. Further studies are needed to evaluate this therapeutic strategy.

Acute Necrotizing Encephalopathy of Childhood: A Severe Case with Fatal Outcome

@#Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition which is important for clinicians to recognize as it has a high mortality rate and can result in significant neurological morbidities. It presents as acute encephalopathy with radiological findings of symmetrical brain lesions in bilateral thalami, putamen, brain stem tegmentum, internal capsule, periventricular white matter and cerebellar medulla. Intravenous methylprednisolone is the mainstay of treatment. Immunoglobulin therapy and therapeutic hypothermia may be used as adjunctive therapy in cases with severe clinical and neuroradiological presentation. We present a case of severe ANEC and discuss the clinical manifestations, neuroimaging and management options.