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.

Clinical efficacy of intensive pulse light on facial telangiectasis and dermal atrophy caused by corticosteroiddependent dermatitis / 中华医学美学美容杂志

Objevtive To evaluate the efficacy and safety of intensive pulse light (IPL) on treating the telangiectasis and dermal atrophy due to corticosteroid-dependent dermatitis.Methods We applied the IPL on 13 patients who had telangiectasis and dermal atrophy caused by corticosteroid-dependent dermatitis every three to four weeks.The treatment lasted three to eight times.The patients's skin types were Fitzpatrick Ⅲ-V and they had had corticosteroid therapy from 15 months to 13 years.Results To telangiectasis,3 patients had excellent effect afterwards;7 patients achieved fair good effect;Another patients also achieved improvement;2 cases had no positive effect;The total effective rate reached 76.92%.10 patients of dermal atrophy among the total 13 had improvement of the thickness of dermis.Conclusion Intensive pulse light can improve the telangiectasis and dermal atrophy of corticosteroid-dependent dermatitis.It needs less recovery time with fewer side effects and therefore IPL is an effective method for the Iesions.

Comparison of Therapeutic Effect of High Dose Corticosteroid Pulse Therapy and Combination Therapy of Cyclosporine with Low Does Corticosteroid for Severe Alopecia Areata / 대한피부과학회지

BACKGROUND: Severe alopecia areata (AA) is difficult to treat. Treatment modalities such as topical and systemic immune modulators, corticosteroids and topical sensitizers have been tried. Among them, encouraging RESULTS have been reported with high dose pulse corticosteroid therapy. OBJECTIVE: The aim of this study was to determine the effectiveness of a high dose corticosteroid pulse therapy in patients with severe AA compared with a group treated with oral cyclosporine with low dose corticosteroid. METHODS: A total of 105 patients with severe AA were treated with high dose corticosteroid pulse therapy and 41 patients those were treated with oral cyclosporine (3~5 mg/kg/day) with low dose methylprednisolone (2.5~5 mg/day). RESULTS: Therapeutic effect of high dose corticosteroid pulse therapy was better in shorter disease duration (6~12 months, 52.6%;>13 months, 37.3%) and less extensive type (AA multiplex, 80.0%; alopecia totalis, 41.2%; alopecia universalis, 27.8%). Therapeutic effect of oral cyclosporine with low dose corticosteroid therapy was better in less extensive type (AA multiplex, 75.0%; alopecia totalis, 41.2%; alopecia universalis, 25.0%). Disease duration did not significantly affect treatment response. High dose corticosteroid pulse therapy was more effective method (65.7%) than combination regimen of oral cyclosporine with low dose methylprednisolone (46.3%), especially in the case of shorter disease duration (p<0.05). CONCLUSION: High dose corticosteroid pulse therapy might be a more effective therapy for severe AA than other treatments, especially when in the acute stage (<6 months).

A Case of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Associated with Perianal Abscess by Klebsiella pneumoniae / 대한소아신경학회지

Chronic inflammatory demyelinating polyradiculoneuropathy(CIDP) is a rare acquired demyelinating disease of peripheral nervous system(PNS), characterized by relapsing or progressive proximal and distal muscle weakness with possible sensory loss. It is one of several chronic neuropathic syndromes that are believed to have an autoimmune etiology. We experienced a case of CIDP in a 3-month-old boy associated with perianal abscess by Klebsiella pneumoniae who had a precipitous onset of symptoms after anesthesia. He was treated with intravenous immunoglobuline with little improvement but showed a remarkable clinical and electrophysiologic improvement after methylprednisolone pulse therapy. We report this case with a brief review of related literature.

A Case of Rhematogenous Retinal Detachment in Children with Nephrotic Syndrome during Systemic Corticosteroid Therapy

Retinal detachment is a rare disease in children but cases of serous retinal detachment due to use of systemic corticosteroids have been reported in and out country. Rhematogenous retinal detachment has developed in a child with oral and steroid pulse therapy due to nephrotic syndrome. He was treated with laser and buckling in right and left eye respectively. Currently he is under observation through the out patient department.

Clinical Findings of 68 Cases of Severe Alopecia Areata and the Results of Methyl Prednisolone Pulse Therapy / 대한피부과학회지

BACKGROUND: Extensive involvernent of alopecia areata seems to be different from the usual common type of alopecia areata in its damage to the patient and its pragnosis. The two forms are best dealt with differently. OBJECTIVE: We performed a clinical observation of a severe form of alopecia areata to understand to its course and therapeuic respones. METHODS: Clinical analysis of 68 cases of severe alopecia areata (37 alopecia totalis, 6 alopecia subtotalis, 13 alopecia universalis, 11 alopecia subtotal universalis, 1 ophiasis) was done for 9 years from 1985 to 1994. RESULTS: 1. The sex distribution was equal. The developrnent of hair loss started before the age of 30 in 67.6%(46/68). Twenty two patients(32.4%) developed the alopecia during the early twenties. The overall mean age was 26.4 years. 2. The duration from the initial hair loss to the involvement of the whole scalp was less than 3 months in 80%(40/50~) of patierits showing whole scalp baldness. 3. Exclamation mark hairs were seen in 85% (57/67) of severe alopecia areata. In 5 patients who were examined just at the start of the hair loss, exclamation mark hairs were found several weeks later. 4. When treated by methyl prednisolone pulse therapy, duration of the disease and type of involvement are the most important prognastic factors as follows. a) 71%(32/45) of patients with less than 6 months duration showed satisfyingly good results cosmetically, but this figure dropped to 30.4% (7/23) in patients with longer than 6 months duration. b) 83.7% (36/43) of patients with alopecia totalis or subtotalis showed good results but this figure dropped to 12%(3/25) in patients with alopecia universalis, subtotal universalis or ophiasis. 5. Methyl prednisolone pulse therapy seemed to be recommended in the acute stage of extensive involvement of alopecia areata. CONCLUSION: Severe alopecia areata has predilection for young adults and seems to show extensive involvement frorn its early stage. Exclamation mark hairs need some time to appear even in their early active stage of hair hedding. Pulse methyl prednisolone therapy is thought to be recommended when the disease is in its early active stage.

Clinical Findings of 68 Cases of Severe Alopecia Areata and the Results of Methyl Prednisolone Pulse Therapy / 대한피부과학회지

BACKGROUND: Extensive involvernent of alopecia areata seems to be different from the usual common type of alopecia areata in its damage to the patient and its pragnosis. The two forms are best dealt with differently. OBJECTIVE: We performed a clinical observation of a severe form of alopecia areata to understand to its course and therapeuic respones. METHODS: Clinical analysis of 68 cases of severe alopecia areata (37 alopecia totalis, 6 alopecia subtotalis, 13 alopecia universalis, 11 alopecia subtotal universalis, 1 ophiasis) was done for 9 years from 1985 to 1994. RESULTS: 1. The sex distribution was equal. The developrnent of hair loss started before the age of 30 in 67.6%(46/68). Twenty two patients(32.4%) developed the alopecia during the early twenties. The overall mean age was 26.4 years. 2. The duration from the initial hair loss to the involvement of the whole scalp was less than 3 months in 80%(40/50~) of patierits showing whole scalp baldness. 3. Exclamation mark hairs were seen in 85% (57/67) of severe alopecia areata. In 5 patients who were examined just at the start of the hair loss, exclamation mark hairs were found several weeks later. 4. When treated by methyl prednisolone pulse therapy, duration of the disease and type of involvement are the most important prognastic factors as follows. a) 71%(32/45) of patients with less than 6 months duration showed satisfyingly good results cosmetically, but this figure dropped to 30.4% (7/23) in patients with longer than 6 months duration. b) 83.7% (36/43) of patients with alopecia totalis or subtotalis showed good results but this figure dropped to 12%(3/25) in patients with alopecia universalis, subtotal universalis or ophiasis. 5. Methyl prednisolone pulse therapy seemed to be recommended in the acute stage of extensive involvement of alopecia areata. CONCLUSION: Severe alopecia areata has predilection for young adults and seems to show extensive involvement frorn its early stage. Exclamation mark hairs need some time to appear even in their early active stage of hair hedding. Pulse methyl prednisolone therapy is thought to be recommended when the disease is in its early active stage.

Avascular Necrosis in a Corticosteroid-treated Rheumatic Disease Population / 대한류마티스학회지

OBJECTIVES: Avascular necrosis of bone has been frequently documented in association with systemic lupus erythematosus and it has been suggested by many investigators that systemic factors may be implicated in its pathogenesis. In order to define the incidence, clinical feature and related risk factors of avascular necrosis in corticosteroid- treated rheumatic disease patients, we conducted this retrospective study. METHODS: Medical records of 278 patients with diagnoses of systemic lupus erythematosus (SLE), polymyositis/dermatomyositis, overlap syndrome comprising either of SLE, polymyositis, or dermatomyositis, and mixed connective tissue disease were reviewed with regards to the following: 1) duration of disease, risk factors of avascular necrosis, such as the presence of Raynaud phenomenon, small vessel vasculitis, alcoholism. 2) history of steroid treatment, including duration, initial dose, cumulative dose and mean daily dose during follow-up, cumulative dose and mean daily dose during the first year of disease, history of steroid pulse therapy, and history of cytotoxic drug therapy. 3) laboratory findings including false positive VDRL, lupus anticoagulant, anti-phospholipid antibody, and activated partial thromboplastin time. 4) Development of avascular necrosis, duration of disease, activity of disease at the time of diagnosis of avascular necrosis, and the site. RESULTS: Nineteen patients developed avascular necrosis leading to the incidence rate of 18.5/1,000 patient-year. Sites of involvement were hip in 16 cases(84.2%), talus in 2 cases(10.5% ), and phalanx, scaphoid, and humerus in 1 case(5.3% ), respectively. Fifty-eight percent of patients had involvement in more than one site. Presence of Raynaud phenomenon, small vessel vasculitis, history of cytotoxic therapy, history of steroid pulse therapy, cumulative dose and mean daily dose of steroid during follow-up and 1st year of diagnosis were not significantly different between the 2 groups. CONCLUSIONS: The incidence of avascular necrosis in our patient population was similar to that reported in SLE patients previously, but other risk factor including steroid dosage could not be identified.

A Case of Neuromyelitis Optica

Neuromyelitis optica(Devie's disease) is a demyelinating disorder of unknown etiology that is characterized by bilateral acute optic neuritis, associated with transverse myelitis. The authors experienced a case of Neuromyelitis optica in a 28 year old female who developed acute visual disturbance, sensory loss under the thoracic dermatome 8, and paraplegia, shortly after upper respiratory infection. Bilateral acute optic neuritis was noted with abnormal visually evoked potential. We confirmed this case by neurologic features, magnetic resonance imaging, and cerebrospinal fluid finding, and treated with Corticosteroid "pulse therapy".

Effect of Methyl - Prednisolone Pulse Therapy on Alopecia Totalis / 대한피부과학회지

Authors tried methyl-prednisolone pulse therapy in 12 cases of severe cases of alopecia areats(eight cases of alopecia totalis, two cases of alopecia universalis, and two cases of alopecia subtotalis) by the assumption that administration of corticosteroid by pulse method minimize its side effects and maximize its therapeutic effect. Authors followed the courses of therapeutic result of the 12 cases for at least one year after finishing t.he treatment. The results were as follows : 1. The overall evaluation of the treatment showed four cases with excellent response, one case with good response, one case with disappointed response and six cases with no response. 2. The responses of the therapy appeared to be dependent on the duration of the alopecia areata ; the better the response is, the shorter the duration of the alopecia is. Most cases shorter than 6 months duration of alopecia showed excellent response. 3. Side effects of the treatment were as follows ; facial flushing(12/12), intermenstrual spotting(4/7), weight gain(4/12), moon face(3/12), acneiform eruption(1/12), exacerbation of hypertension (1/12). Those side effects did not keep any patient from the planned treatment.