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Objetivo: evaluar los síntomas y los cambios en la calidad de vida relacionada con la salud (CVRS) de pacientes con vulvovaginitis candidiásica o mixta, que recibieron tratamiento intravaginal con Nistatina/Dexametasona. Métodos: estudio antes y después, realizado en mujeres mayores de 18 años con vulvovaginitis candidiásica o mixta, tratadas Nistatina/Dexametasona intravaginal en monoterapia o combinada con imidazol oral. Para evaluar la CVRS se utilizó el cuestionario EQ-5D y un cuestionario de síntomas, los cuales fueron aplicados antes y después del tratamiento. Resultados: 236 pacientes fueron incluidas; 150 recibieron Nistatina/Dexametasona intravaginal (grupo 1) y 86 recibieron Nistatina/Dexametasona intravaginal e imidazol oral (grupo 2). La mediana de edad fue 35 años (RIC: 27- 43 años). Después del tratamiento, el tiempo de mejoría en los síntomas fue de 1 a 3 días en el 71.3 % (grupo 1) y 73.3 % (grupo 2), con un cambio de más del 80 %, en la mayoría de los aspectos evaluados. En el cuestionario EQ-5D, las dimensiones más afectadas fueron dolor (43 % grupo 1 vs. 30 % grupo 2), seguida por ansiedad/depresión (9 % grupo 1 vs. 19 % grupo 2), con una mejoría del índice EQ-5D antes y después del tratamiento en el grupo 1 (variación absoluta de 0.0589) y en el grupo 2 (variación absoluta de 0.0601). Conclusión: se observó una mejoría temprana en los síntomas y la CVRS en pacientes tratadas con Nistatina/Dexametasona intravaginal, sin diferencias en los resultados entre la monoterapia y la combinación con imidazoles orales.

Objective: To evaluate the symptoms and changes in health-related quality of life (HRQoL) in patients with candidiasis vulvovaginal or mixed infections who received intravaginal treatment with Nystatin/Dexamethasone. Methods: A before-and-after study conducted on women over 18 years of age with candidal or mixed vulvovaginitis, treated with intravaginal Nystatin/Dexamethasone as monotherapy or in combination with oral imidazole. The EQ-5D questionnaire and a symptom questionnaire were used to assess HRQoL, both of which were administered before and after treatment. Results: 236 patients were included; 150 received intravaginal Nystatin/Dexamethasone (group 1) and 86 received intravaginal Nystatin/Dexamethasone plus oral imidazole (group 2). The median age was 35 years (IQR: 27-43 years). After treatment, the time for symptom improvement was 1 to 3 days in 71.3% (group 1) and 73.3% (group 2), with a change of over 80% in most of the aspects evaluated. In the EQ-5D questionnaire, the most affected dimensions were pain (43% in group 1 vs. 30% in group 2), followed by anxiety/depression (9% in group 1 vs. 19% in group 2), with an improvement in the EQ-5D index before and after treatment in group 1 (absolute variation of 0.0589) and in group 2 (absolute variation of 0.0601). Conclusion: An early improvement in symptoms and HRQoL was observed in patients treated with intravaginal Nystatin/Dexamethasone, with no differences in outcomes between monotherapy and combination with oral imidazoles.

Objetivo: Avaliar sintomas e alterações na qualidade de vida relacionada à saúde (QVRS) em pacientes com vaginite por cândida. ou mistas, que receberam tratamento intravaginal com Nistatina/Dexametasona. Métodos: estudo antes e depois, realizado em mulheres maiores de 18 anos com vaginite por cândida ou mista, tratadas com Nistatina/Dexametasona intravaginal em monoterapia ou combinada com Imidazol oral. Para avaliar a QVRS foram utilizados o questionário EQ-5D e um questionário de sintomas, aplicados antes e após o tratamento. Resultados:foram incluídos 236 pacientes; 150 receberam Nistatina/Dexametasona intravaginal (grupo 1) e 86 receberam Nistatina/Dexametasona intravaginal e imidazol oral (grupo 2). A mediana de idade foi de 35 anos (IIQ: 27-43 anos). Após o tratamento, o tempo para melhora dos sintomas foi de 1 a 3 dias em 71.3% (grupo 1) e 73.3% (grupo 2), com alteração superior a 80% na maioria dos aspectos avaliados. No questionário EQ-5D, as dimensões mais afetadas foram a dor (43% grupo 1 vs. 30% grupo 2), segui-da da ansiedade/depressão (9% grupo 1 vs. 19% grupo 2), com melhoria no EQ índice -5D antes e após o tratamento no grupo 1 (variação absoluta de 0,0589) e no grupo 2 (variação absoluta de 0.0601). Conclusão: Foi observada melhora precoce dos sintomas e da QVRS nas pacientes tratadas com Nistatina/Dexametasona intravaginal, sem diferenças nos resultados entre a monoterapia e a combinação com imidazóis orais

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ABSTRACT Purpose: To compare the outcomes of intravitreal dexamethasone implant used as either an adjuvant or a switching therapy for diabetic macular edema in patients with poor anatomic response after three consecutive monthly injections of ranibizumab. Methods: This retrospective study included patients with diabetic macular edema who received three consecutive doses of ranibizumab as initial therapy and demonstrated poor response. A single dose of intravitreal de xamethasone implant was administered to these patients. The patients were divided into two groups according to the treatment modalities: the adjuvant therapy group, consisting of patients who continued treatment with ranibizumab injection after receiving intravitreal dexamethasone implant, and the switch therapy group, consisting of patients who were switched from ranibizumab treatment to intravitreal dexamethasone implant as needed. The main outcome measurements were best corrected visual acuity and central retinal thickness at baseline and at 3, 6, 9, and 12 months of follow-up. Results: In this study that included 64 eyes of 64 patients, the best corrected visual acuity and central retinal thickness values did not significantly differ between the groups at baseline and at 6 months of follow-up (p>0.05). However, at 12 months, the best corrected visual acuity values in the adjuvant and switch therapy groups were 0.46 and 0.35 LogMAR, respectively (p=0.012), and the central retinal thickness values were 344.8 and 270.9, respectively (p=0.007). Conclusions: In a real-world setting, it seems more reasonable to use intravitreal dexamethasone implant as a switch therapy rather than an adjuvant therapy for diabetic macula edema refractory to ranibizumab despite three consecutive monthly injections of ranibizumab. Patients switched to intravitreal dexamethasone implant were found to have better anatomic and visual outcomes at 12 months than those who continued ranibizumab therapy despite their less-than-optimal responses.

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Background: Postoperative nausea and vomiting (PONV) frequently occur as a side effect of general anesthesia, which can be intensified by the introduction of gas into the peritoneal cavity to create pneumoperitoneum during laparoscopic surgeries. Aims and Objectives: This study examines the comparative effectiveness of ondansetron as a standalone treatment versus its combination with dexamethasone in preventing PONV during laparoscopic surgeries. The research aims to assess the efficacy and duration of anti-nausea and anti-vomiting effects provided by ondansetron alone and in combination with dexamethasone. Materials and Methods: The Institutional Ethics Committee (IEC) approved the trial materials and methods following thorough deliberation. Before surgery, written informed consent was obtained from all patients. Sixty patients were recruited for the study and randomly allocated into groups, denoted as Group O and Group D, each consisting of 30 patients. Group O received intravenous administration of 4 mg of ondansetron, while Group D received a combination of 4 mg of ondansetron and 4 mg of dexamethasone intravenously 30 min before extubation. Duration of Study: The research was conducted at MGM Medical College and Hospital, located in Navi Mumbai, Maharashtra, India, from May 2016 to May 2017. Results: In this study, mild and moderate nausea were more prevalent in Group O at the 4-h mark, but there was no notable difference at 24 h. Mild and moderate retching showed no significant variance at 4 h, but Group O exhibited significantly more at 24 h. Mild, moderate, and severe vomiting were inconsequential in both groups at 4 h, but Group O showed a higher incidence of mild and moderate vomiting at 24 h. Instances of severe vomiting were absent in both groups. The need for rescue antiemetics after 24 h and medication-related side effects did not show significant differences between the two groups. Conclusion: The incidence of PONV was reduced in the combination group (ondansetron + dexamethasone) compared to ondansetron alone. Consequently, the combination group had a lower requirement for rescue antiemetics. Thus, the effectiveness of combination therapy surpassed that of ondansetron alone.

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Background: Pain after laparoscopic cholecystectomy arise from multiple sources and so require multimodal approaches to manage it. Dexamethasone is a corticosteroid drug with excellent anti-inflammatory properties. Present study was designed to study the effect of administering an intermediate dose of dexamethas one (8 mg), one hour before the induction of anaesthesia, on post-operative analgesia, time to first analgesia and total number of analgesics used in twenty four hours. Material and Methods: A total of 80 patients were randomly allocated into two study groups by computer generated randomization. Group 1 received 8 mg/2 ml of Inj. Dexamethasone intravenously 1 hour prior to induction of General Anaesthesia slowly over a period of 5 minutes. Group 2 received 2 ml of Normal Saline (NS) intravenously 1 hour prior to induction of General Anaesthesia slowly over a period of 5 minutes. Results: The mean Visual analogue score of group 1 was lower than that of group 2 and the difference was statistically significant at 0, 2, 6 and 12 hours postoperatively (p<0.05). The mean time taken by the patients in group 1 for the first rescue analgesic was (11.65±4.59) hours, which was statistically significant as compared to group 2 (4.01±2.03) hours(p=0.0001). Mean total number of analgesic used in Group I was significantly less as compared to Group 2 (p=0.0001) Conclusion: Use of dexamethasone 8 mg intravenously one hour before induction of general anaesthesia for post-operative analgesia causes a significant decrease in overall VAS scoreat 0, 2, 6 and 12 hours post-operatively, increases the duration between the surgery and the need for first rescue analgesia and decreases the total number of analgesics used with minimal adverse effects after laparoscopic cholecystectomy.

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Background: Fetal well-being is reflected in the fetal movements perceived by the mother. Corticosteroids are the most common therapy in clinical practice which can affect fetal activity. Aims and Objectives: The aim of this study was to evaluate the effect of dexamethasone administration on daily fetal movement count (DFMC) in pregnant women. Materials and Methods: A prospective and cohort study was performed in the Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and Hospital. A total of 100 pregnant women between gestational ages of 28 weeks and 38 weeks were enrolled in the study. They were asked to count DFMC on day 0, that is, before administration of injection dexamethasone, on day 2 (after 48 h of first dose), and during day 4 to 7. Women received injection dexamethasone 6 mg i.m. 4 doses at an interval of 12 h for various indications such as pre-term pre-labor rupture of membranes, placenta previa, pre-term labor, and previous cesarean. Outcome measures were changes in DFMC before and after dexamethasone administration. Results: DFMC was significantly reduced on day 2 of injection dexamethasone administration and returned to baseline values after 4th–7th days of receiving dexamethasone. Conclusion: Dexamethasone administration resulted in transient reduction in DFMC that mimics fetal compromise; hence, clinicians should be aware of this phenomenon to prevent iatrogenic pre-term birth of the fetus.

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Abstract Background: Due to the COVID-19 pandemic, randomized clinical studies were conducted with Remdesivir in combination with Bariticinib or Dexamethasone, which have shown effectiveness for the treatment of COVID-19. Objective: We analyzed the effect of co-treatment with Remdesivir in a retrospective in Mexico. Methods: Thirty-four patients treated with Remdesivir in combination with Baricitinib or Dexamethasone were included. Age, sex, comorbidities, signs, and symptoms were recorded at hospital admission, intubation needs, intensive care unit (ICU) requirements, days of hospital stay and their evolution, as well as laboratory data upon admission and upon admission terminate Remdesivir treatment. Results: Most were male, with an age of 56.5 years (49 years-60.3 years), whose main comorbidity was obesity. The main symptoms on admission were dyspnea and cough. Thirty-two patients received the short Remdesivir regimen, 22 were co-treated with Baricitinb and 12 with Dexamethasone. Most did not require ICU care, 9 patients died, 19% of those co-treated with Baricitinib and 42% of those co-treated with Dexamethasone. A significant decrease in hemoglobin, protein, albumin and LDH levels was observed. Conclusion: In this study, we observed lower mortality in patients co-treated with Baricitinib vs those co-treated with Dexamethasone, and a hospital stay similar to that reported in randomized clinical studies.

Resumen Introducción: Debido a la pandemia de COVID-19, se realizaron estudios clínicos aleatorizados con Remdesivir en combinación con Bariticinib o Dexametasona, que han demostrado efectividad para el tratamiento de COVID-19. Objetivo: Se realizo un análisis del efecto del co-tratamiento con Remdesivir en una muestra retrospectiva en México. Métodos: Se incluyeron 34 pacientes tratados con Remdesivir en combinación con Baricitinib o Dexametasona. Se registraron edad, sexo, comorbilidades, signos y síntomas al ingreso hospitalario, necesidades de intubación, requerimientos de unidad de cuidados intensivos (UCI), días de estancia hospitalaria y su evolución, así como datos de laboratorio al ingreso y al ingreso al final del tratamiento con Remdesivir. Resultados: La mayoría eran varones, con una edad de 56.5 años (49 años-60.3 años), cuya principal comorbilidad era la obesidad. Los principales síntomas al ingreso fueron disnea y tos. Treinta y dos pacientes recibieron el régimen corto de Remdesivir, 22 fueron cotratados con Baricitinb y 12 con Dexametasona. La mayoría no requirió atención en UCI, 9 pacientes fallecieron, 19% de los cotratados con Baricitinib y 42% de los cotratados con Dexametasona. Se observó una disminución significativa en los niveles de hemoglobina, proteínas, albúmina y LDH. Conclusión: En este estudio observamos una menor mortalidad en los pacientes cotratados con Baricitinib frente a los cotratados con Dexametasona, y una estancia hospitalaria similar a la reportada en estudios clínicos aleatorizados.

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Background: Singleshot caudal block provides short lived postoperative analgesia necessitating continued exploration for adjuvants. Aim was to compare the analgesic efficacy between intravenous and caudal dexamethasone on bupivacaine based caudal block for paediatric infraumbilical surgeries. Methods: Following ethical clearance and parental consent, 69 children aged 1-6 years, of American society of anesthesiologists (ASA) physical status classification I and II were randomized into groups A, B and C, of 23 each. All subjects underwent laryngeal mask airway (LMA) general anaesthesia induced with propofol and maintained with isoflurane in 100% oxygen, and had caudal block with 1 ml/kg bupivacaine 0.25%. Additionally, groups B and C received caudal 0.1mg/kg and intravenous preinduction 0.25 mg/kg dexamethasone, respectively. Pain was assessed using FLACC scale. The time to first analgesic request (TTFAR) was defined as the interval from caudal injection until pain score was ?4; at this point, analgesic was given. Results: All 69 children were completely studied. The mean TTFAR (in minutes) was longest in Group B (485.40±24.50) followed by C (459.60±36.40), and shortest in group A (253.63±71.55), p=0.001, 0.024 and 0.968 for A versus B, A versus C and B versus C respectively, with greatest 24 hours pethidine consumption in Group A relative to groups B and C, p=0.001 and 0.025. Conclusions: Caudal 0.1 mg/kg or intravenous 0.25 mg/kg dexamethasone combined with bupivacaine significantly prolonged postoperative analgesic duration, with comparable analgesic profile between the caudal and intravenous routes, and without adverse effects.

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AIM: To investigate the effect of adalimumab combined with dexamethasone intravitreal implant in the treatment of refractory non-infectious uveitis macular edema(UME).METHODS: A total of 92 cases(131 eyes)of refractory non-infectious UME patients admitted to our hospital from January 2020 to January 2022 were selected and randomly divided into control group, with 46 cases(63 eyes)treated with dexamethasone intravitreal implant and observation group, with 46 cases(68 eyes)treated with adalimumab subcutaneous injection combined with dexamethasone intravitreal implant. The best corrected visual acuity(BCVA), central retinal thickness(CRT), vitreous opacity and Th17/Treg cytokines were measured before and after treatment, and the occurrence of adverse reactions was recorded.RESULTS: Totally 3 cases(4 eyes)were lost to follow-up. After treatment for 1, 3, 6 and 12 mo, BCVA was improved in both groups compared with that before treatment, and CRT, vitreous opacity score, serum interleukin(IL)-17 and IL-22 levels were decreased compared with those before treatment, and serum transforming growth factor-β(TGF-β)and IL-10 levels were increased compared with those before treatment. BCVA in the observation group was better than that in the control group, and CRT, vitreous opacity score, serum IL-17 and IL-22 levels were lower than those in the control group, and serum TGF-β and IL-10 levels were higher than those in the control group(all P&#x0026;#x003C;0.05). During treatment and follow-up, no serious adverse reactions occurred in both groups.CONCLUSION: Adalimumab combined with dexamethasone intravitreal implants in the treatment of refractory non-infectious UME can significantly subside the macular edema, reduce vitreous opacity and improve visual acuity.

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Objective:To discuss the protective effect of velvet antler peptide(VAP)in the osteoporosis(OP)model rats,and to clarify the possible mechanism.Methods:Sixty 12-week-old SD rats were randomly divided into control group,model group,positive drug group(treated with 1 mg·kg-1·d-1 of alendronate sodium by gavage),low dose of VAP group(treated with 100 mg·kg-1·d-1 VAP),medium dose of VAP group(treated with 200 mg·kg-1·d-1 VAP),and high dose of VAP group(treated with 300 mg·kg-1·d-1 VAP),and there were ten rats in each group.Except for control group,the rats in the other groups were injected with dexamethasone(2 mg·kg-1)to replicate the OP rat model,while the rats in control group were injected with the equivalent volume of saline twice a week for 11 consecutive weeks.Dual-energy X-ray absorptiometry was used to detect the bone mineral density(BMD)of femur tissue of the rats in various groups;enzyme-linked immunosorbent assay(ELISA)method was used to detect the levels of serum calcium(Ca2+),phosphate(P),osteoprotegerin(OPG),alkaline phosphatase(ALP),and osteocalcin(OCN)in serum of the rats in various groups;biochemical method was used to detect the malondialdehyde(MDA)level and superoxide dismutase(SOD)activity in serum of the rats in various groups;HE staining was used to observe the pathomorphology of bone tissue of the rats in various groups;Western blotting method was used to detect the expression levels of silent information regulator 1(SIRT1),catalase(CAT),Runt-related transcription factor 2(RUNX2),and forkhead box protein O1(FOXO1)proteins in bone tissue of the rats in various groups.Results:Compared with control group,the BMD of femoral tissue of the rats in model group was decreased(P<0.05);compared with model group,the BMD of femur tissue of the rats in positive drug group,medium dose of VAP group,and high dose of VAP group were increased(P<0.05 or P<0.01).Compared with control group,the levels of Ca2+,P,OPG,and SOD activities in serum of the rats in model group were decreased(P<0.05),and the levels of ALP,OCN,and MDA were increased(P<0.05);compared with model group,the level of OPG in serum of the rats in low dose of VAP group was significantly increased(P<0.05),the levels of Ca2+,P,OPG,and activities of SOD in serum of the rats in positive drug group,medium dose of VAP group,and high dose of VAP group were significantly increased(P<0.05 or P<0.01),and the levels of ALP,OCN,and MDA in serum of the rats in positive drug group and different doses of VAP groups were decreased(P<0.05 or P<0.01).The HE staining results showed that compared with control group,the rats in model group had fewer bone cells and disordered arrangements in the bone tissue,thinner bone trabeculae with large fractures,and an expanded marrow cavity;compared with model group,the rats in positive drug group,medium dose of VAP group,and high dose of VAP group had thicker bone trabeculae arranged more tightly.The Western blotting results showed that compared with control group,the expression levels of SIRT1,CAT,RUNX2,and FOXO1 proteins in bone tissue of the rats in model group were decreased(P<0.05);compared with model group,the expression levels of SIRT1,CAT,RUNX2,and FOXO1 proteins in bone tissue of the rats in positive drug group,medium dose of VAP group,and high dose of VAP group were significantly increased(P<0.05 or P<0.01).Conclusion:VAP has the protective effect against OP in the rats,and its mechanism may be related to mediating the antioxidant stress action through the SIRT1/FOXO1 signaling pathway.

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BACKGROUND:Glucocorticoid-induced osteoporosis is a common complication of systemic glucocorticoid therapy,which is mainly characterized by its inhibitory effect on osteoblasts.Eriodictyol inhibits osteoclast differentiation and osteoporosis-induced by ovariectomy.However,it is unclear whether eriodictyol regulates glucocorticoid-induced osteoblasts. OBJECTIVE:To explore whether eriodictyol plays a role in glucocorticoid-induced osteoblast apoptosis and its potential regulatory mechanisms. METHODS:Dexamethasone-pretreated osteoblasts MC3T3-E1 were treated with the different concentrations(0,0.5,1,2.5,5,10 μmol/L)of eriodictyol or 5 μmol/L 3-methyladenine,an autophagy inhibitor,and then transfected with heme oxygenase 1 overexpression vector(pcDNA-HMOX1)and empty vector(pcDNA vector).Cell proliferation and apoptosis were assessed by using cell counting kit-8 assay and flow cytometry,respectively.The activity of caspase-3 was detected with ELISA.Western blot assay was used to detect the protein expression of autophagy-related proteins LC3-Ⅱ/LC3-Ⅰ,p62,Atg5 and Atg12,the expression of apoptotic related proteins Bax and Bcl-2,as well as the protein expression of AMPK and p-AMPK. RESULTS AND CONCLUSION:Low concentrations of eriodictyol were non-toxic to MC3T3-E1 cells and promoted cell proliferation,as well as increased the expression of autophagy related proteins LC3-Ⅱ/LC3-Ⅰ,p62,Atg5 and Atg12,decreased caspase-3 enzyme activity,inhibited Bax protein expression,promoted Bcl-2 protein expression and reduced dexamethasone-induced apoptosis in MC3T3-E1 cells in a dose-dependent manner.Moreover,eriodictyol significantly promoted heme oxygenase 1 expression in osteoblasts,whereas overexpression of heme oxygenase 1 promoted AMPK phosphorylation,activated autophagy,and inhibited dexamethasone-induced osteoblast apoptosis.While 3-methyladenine treatment counteracted the effects of heme oxygenase 1 overexpression on MC3T3-E1 cells.To conclude,low concentration of Eriodictyol is non-toxic to osteoblasts and activates AMPK signaling pathway by upregulating the expression of heme oxygenase 1,thereby promoting autophagy and inhibiting dexamethasone-induced osteoblast apoptosis.Eriodictyol has great potential for the treatment of glucocorticoid-induced osteoporosis.

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Objective:To analyze the efficacy and safety of daratumumab plus dexamethasone in the treatment of renal injury patients with light chain amyloidosis, and to provide clinical reference.Methods:It was a single center retrospective observational study. The clinical data before and after daratumumab treatment of renal injury patients with light chain amyloidosis treated with daratumumab plus dexamethasone from December 2021 to August 2022 were retrospectively collected. The hematologic response, kidney response, prognosis, and adverse events were analyzed. The treatment regimen was 16 mg/kg intravenous infusion of daratumumab on day 1 + 20 mg intravenous push of dexamethasone on day 1-2, once every 2 weeks. The follow-up was up to February 28, 2023.Results:The study included 18 patients, with age of (58.4±7.7) years old, and a male to female ratio of 11∶7. Eleven patients were newly diagnosed and 7 patients were retreated. There were 7, 5, 5 and 1 patients, respectively at the stage Ⅰ, Ⅱ, Ⅲ and Ⅳ of light chain amyloidosis according to 2012 Mayo stage criteria. The median course of disease before onset was 2.5 (1.0, 8.0) months and the follow-up time was (8.7±2.8) months. The patients received (10±3) times of treatment. The overall hematologic response rates were 9/13, 11/13 and 13/13 at 1 month, 3 months, and 6 months respectively after treatment, meanwhile 8/13, 10/13 and 12/13 achieved at least very good partial response at 1 month, 3 months, and 6 months respectively (the other 5 patients did not undergo detailed evaluation due to baseline difference of serum free κ and λ light chain <20 mg/L). The median duration of hematologic response was 16 (13, 40) days. At 3 months, 6 months and the end of follow-up, 10, 13 and 13 of 18 patients respectively achieved renal response, and the median duration of response was 66 (26, 182) days. During follow-up, the median difference of serum free κ and λ light chain decreased by 93% (72%, 97%). Until the last follow-up, one patient died of organ hemorrhage. Other infusion reactions, leukopenia, neutropenia and infection all improved after symptomatic treatments.Conclusion:Daratumumab plus dexamethasone treatment is effective for light chain amyloidosis nephropathy in inducing hematologic remission and kidney remission, with good safety.

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OBJECTIVE To evaluate the efficacy of the triple therapy of 5-HT3 receptor antagonists， neurokinin-1 receptor antagonists and dexamethasone （referred to as “triple therapy”） in the prevention and treatment of acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI and Wanfang data， randomized controlled trials （RCTs） about triple therapy or 5-HT3 receptor antagonist combined with dexamethasone （referred to as “dual therapy”） were collected during the inception to May 2023. After literature screening， data extraction and literature evaluation， network meta-analysis was performed by using Stata 16.0 software. RESULTS A total of 59 RCTs were included， involving 23 418 patients and 15 interventions. Results of network meta-analysis showed that fosaprepitant + palonosetron + dexamethasone （FPD） was most effective in terms of acute nausea and vomiting control rate， followed by fosaprepitant + granisetron + dexamethasone （FGD） and aprepitant + ramosetron + dexamethasone （AMD）. In terms of acute nausea control rate， FPD was the most effective， followed by aprepitant + palonosetron + dexamethasone （APD） and FGD. In terms of acute vomiting control rate， FPD was the most effective， followed by FGD and APD. CONCLUSIONS Fosaprepitant + palonosetron + dexamethasone is better than other triple therapy or dual therapy in preventing acute nausea and vomiting caused by moderately and highly emetogenic chemotherapy drugs.

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Objective To observe the clinical efficacy of dexamethasone intravitreal implant(Ozurdex)in the treatment of diabetic macular edema(DME).Methods This was a retrospective clinical study,we selected 14 cases(15 eyes)with Ozurdex because of DME in Tianjin bright eye hospital from January 2022 to January 2023.The patients were followed up at 1 week,1 month,2 months,3 months,4 months,5 months and 6 months after operation to observe the best corrected visual acuity(BCVA),central retinal thickness(CMT),intraocular pressure(IOP)and the state of Ozurdex.Results The BCVA at each time point after treatment was higher than that before treatment(F=6.93,P<0.05),the CMT at 1 week[(425.80±96.86)μm],1 month[(313.33±76.88)μm],2 months[(266.07±75.27)μm],3 months[(279.93±55.68)μm],4 months[(327.13±105.67)μm],5 months[(298.73±61.89)μm]and 6 months[(321.00±98.41)μm]after operation were significantly lower than that before treatment[(575.00±136.82)μm](F=18.91,P<0.05).With the decrease of CMT after treatment,the intraretinal cysts,hyperreflective dots and subretinal fluid were gradually absorbed,the external limiting membrane and ellipsoid zone were also partially recovered.The intraocular pressure was significantly higher within 5 months after treatment than that before treatment(P<0.05),but did not change significantly at 6 months compared with before treatment(P>0.05).Conclusion Ozurdex can effectively reduce macular edema,restore retinal morphology and interlaminar structure,improve BCVA in the treatment of DME.

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Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.

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Background: Dexamethasone is a potent corticosteroid that has been widely used as COVID-19 treatment. However, optimal dose of dexamethasone in COVID-19 treatment and how its different doses affect the patient outcomes is uncertain. This retrospective study aimed to evaluate the use of dexamethasone dose and length of hospital stay in COVID-19 patients admitted to two public hospitals in the east coast region of Malaysia between February 2020 and August 2021. Methods: This study included all hospitalized patients who were receiving dexamethasone during the study period. Dexamethasone doses were categorized into high dose (?15 mg/day), moderate dose (7-14 mg/day) and low dose (?6 mg/day). A multivariable logistic regression was conducted to evaluate the potential risk factors associated with length of hospital stays. Results: Of 119 patients enrolled, majority (40%) of patients received high dose dexamethasone, followed by 33% received moderate dose and 27% received low dose. Patients who received high doses were associated with extended hospital stays of 4-5 days and more frequently required mechanical ventilation. Multivariable logistic regression showed that elderly (OR=1.03; 95% CI=1.00-1.06, p=0.001) and severe stage of COVID-19 (stage 4-stage 5) upon hospital admission (OR=2.79; 95% CI=1.17-6.68, p=0.021) increased the risk of prolonged hospital stay. Conclusions: COVID-19 patients treated with high and moderate doses of dexamethasone were associated with longer hospital stay and required mechanical ventilation compared to those on low doses. Future studies are needed to provide more evidence on benefits of low dexamethasone dose in COVID-19 patients.

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ABSTRACT Introduction: This study was performed to evaluate the degree of 3-day chemotherapy-induced nausea and vomiting (CINV) in children with cancer who received highly emetogenic chemotherapy (HEC) to ascertain the efficacy of aprepitant single-dose on dayL 1 plus granisetron and dexamethasone (DEX). Methods: This clinical trial study was conducted on 120 patients in the age range of 5 to 18 years old who received chemotherapy. Patients were divided into two groups; Group A received aprepitant at 125 mg/kg on day 1 orally, followed by 80 mg/kg daily on days 2 and 3 and Group B received a single dose of aprepitant 125 mg/kg on day 1 orally and placebo on days 2 and 3. All groups received granisetron 3 mg/m2 on day 1 and DEX on days 1 to 3. The primary and secondary endpoints were to evaluate the proportion of patients with acute, delayed and overall CINV within each group. Results: There were no significant differences between the two groups for vomiting, nausea or the use of rescue therapy. The number of patients without vomiting on day 1 was similar in both groups (96.5% vs. 98.3%, respectively; p = 0.848). Conclusion: According to the results of this study, a single dose of aprepitant 125 mg/kg was as effective as administering three doses of aprepitant on 3 days. Therefore, the use of a single dose of aprepitant in combination with other standard treatment regimens to prevent CINV in children who received HEC was safe and efficacious and can be beneficial.

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Background: The aim was to compare efficacy of methylprednisolone with dexamethasone in moderate to severe COVID-19 patients in a tertiary care hospital. Method: A retrospective observational study was conducted by collecting data of moderate to severe COVID-19 patients admitted to covid wards of a tertiary care hospital for a period of six months. Demographic data, information about SpO2 changes, duration of hospitalization, marker status and ventilation status were parameters collected and used to compare between two groups. Results: Total number of patients in this study were 130. Out of which 65 patients who were on Methylprednisolone belonged to group A and 65 patients taking dexamethasone belonged to group B. In group A 56 (86.2%) were males and 9 (13.8%) were females. In group B 51 (78.5%) were males and 14 (21.5%) were females. Mean age in group A was 54.75±14.96 (age range b/w 25-80 years) and in group B was 55.43±15.83 (age range between 23-84 years). Patients in group A showed more presence of comorbidity (44.6%) as compared to group B (32.3%). Mean SpO2 level on day 1 in group A was 86.37±7.58 and in group B was 88.11±4.38. On day of discharge mean SpO2 level was 95.05±1.54 in group A and 94.63±2.09 in group B. Mean length of hospital stay in group A was 9.78±7.38 and in group B was 7.88±4.76. Improvement in marker status for group A was 100% and for group B 95.4%. Ventilation status in both groups showed 100% improvement. Conclusions: Both steroids are effective in management of moderate to severe COVID-19 patients.

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Background: Dexamethasone is a synthetic corticosteroid similar to cortisol produced naturally by the adrenal glands. As an anti- inflammatory and immunosuppressive agent, it is used in many diseases such as rheumatoid arthritis and allergic anaphylactic shock, and its suppression test to diagnose Cushing's syndrome. Its further use includes its administration before antibiotics in bacterial meningitis, antitumor treatment, for treatment of glucocorticoid resistance, Addison抯 disease, and congenital adrenal hyperplasia. The drug is abused by using it in animal husbandry as a growth promoter and in horse sports to enhance their performance. Methods: In this study, the development of homologous ELISA using Dexamethasone-21-hemisuccinate (DEX-21-HS)-Bovine serum albumin antiserum and Dexamethasone-21-hemisuccinate (DEX-21-HS)-Horseradish peroxidase enzyme conjugate has been done. The n-hydroxysuccinimide ester method was used to prepare the immunogen and enzyme conjugate. Results: The sensitivity 0.25 ng/mL, affinity 2.8x10-8 L/mol and ED50 4.98 ng/mL of the assay were found. The cross-reactivity of the assay was checked and found with three steroids (Corticosterone- 1.13%, Progesterone- 2.25% and Prednisolone- 6.3%) out of 48 structurally related steroids. Then, analytical variables of the developed assay were studied, such as recovery (98.55% to 105.08%), precision (Inter and Intra- assay coefficient of variation <9.28%), correlation (R2= 0.98) by utilizing a commercially available Dexamethasone kit for comparison. Conclusion: This study concluded that low-cost indigenous ELISA for Dexamethasone had been developed, which can give results within 75-80 minutes.

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ABSTRACT We report two cases of stage 3A unilateral Coats' disease in pediatric patients. In both cases, disease control was achieved using a dexamethasone intravitreal implant in addition to other treatments. The treatment improved visual acuity in one patient and prevented the worsening of the decline in visual acuity in the other patient during follow-up periods of 7 and 3 years, respectively. One of the patients presented an increase in intraocular pressure, which was controlled with topical antiglaucoma medication, but developed a cataract that required surgery. In conclusion, dexamethasone intravitreal implant may be a useful adjuvant treatment to consider in some pediatric cases with Coats' disease.

RESUMO Relatamos dois casos de doença de Coats em estágio 3A unilateral em pacientes pediátricos. Em ambos os casos, o controle da doença foi obtido com implante intravítreo de dexametasona, além de outros tratamentos, com melhora da acuidade visual em um caso e sem piora da visão no outro, durante um período de acompanhamento de 7 e 3 anos. Um dos casos apresentou elevação da pressão intraocular controlada com medicação antiglaucoma tópica e desenvolveu catarata que exigiu cirurgia. Em conclusão, o implante intravítreo de dexametasona pode ser um tratamento adjuvante útil a ser considerado em alguns casos pediátricos com doença de Coats.

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Dexamethasone is a potent glucocorticoid and glucocorticoids are used in the treatment of rheumatic disorders, serious inflammatory rheumatic diseases, vasculitis disorders, Wegener granulomatosis, Churg-Strauss syndrome, nephrotic syndrome, bronchial asthma, other pulmonary diseases, Pneumocystis carinii pneumonia, hypoxia, and inflammation of the eye, inflammatory dermatosis, chronic ulcerative colitis, Crohn disease lymphocytic leukemia, bacterial meningitis, cerebral edema associated with parasites and neoplasm. Dexamethasone accelerates the surfactant production in fetal lung, stabilizes liposomal and cell membranes, inhibits complement-induced granulocyte aggregation, improves alveolar-capillary barrier, inhibits prostaglandin and leukocytes production, decreases pulmonary edema, relaxes bronchospasm, and produces hyperglycemia. In infants, dexamethasone is used to treat bacterial meningitis, hypertension, to facilitate extubation, to treat post-intubation laryngeal edema, croup, and surgical stress. In children, dexamethasone is used to suppress inflammation, to treat allergic disorders, croup, bacterial meningitis, and life-threatening cerebral edema. The effects caused by dexamethasone have been reviewed in infants and children. Dexamethasone is metabolized into 6-hydroxy-dexamethasone and this metabolite is further metabolized into different metabolites. The pharmacokinetics of dexamethasone have been studied in infants and children and the mean elimination half-life is 6.81 h in infants and 2.14–3.06 h in children. The prophylaxis, treatment, and trials with dexamethasone have been reviewed in infants and children. Dexamethasone interacts with drugs, treats bacterial meningitis, and is freely transferred across the human placenta. The aim of this study is to review dexamethasone dosing, effects, pharmacokinetics, prophylaxis, treatment, and trials in infants and children, and dexamethasone metabolism, interaction with drugs, treatment of bacterial meningitis, and placental transfer.