Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study

Background: Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited. Aims: This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher’s exact test, and one-tailed Z-test. Results: Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant. Limitations: Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

Relative safety of steroid sparing agents in frequently relapsing, steroid dependent and steroid resistant nephrotic syndrome in pediatric patients

Background: In patients with frequently relapsing nephrotic syndrome (FRNS), steroid-dependent nephrotic syndrome (SDNS) and steroid resistant nephrotic syndrome (SRNS) steroids are either used for prolonged period of time or ineffective. To reduce the degree of steroid dependency and avoid steroid toxicity, several immunosuppressive steroid sparing agents (SPAs) have been proposed to treat these children. The present study tried to study the relative safety of most commonly steroid sparing agent in such children.Methods: A multi-centred, prospective observational study was conducted in paediatric nephrology OPD of two tertiary care hospitals in Kolkata over a period of 24 months. All consecutive children with diagnosed FRNS, SDNS and SRNS who were started on steroid sparing agents were enrolled and followed up for at least 6 months. Records of clinical examination, laboratory tests were collected and measured at the baseline and regular intervals. Safety parameters were noted and statistically analysed.Results: A total 110 patients were screened, examined and enrolled. Levamisole, cyclophosphamide and MMF were commonly used SPAs. Of the two tertiary care hospitals, all the patients of FRNS and SDNS were started with levamisole and SRNS with cyclophosphamide in one set-up, while in the other hospital some SDNS patients were started with cyclophosphamide and SRNS with MMF but without clinically significant outcomes. In comparison with few minor adverse events in MMF group, some serious adverse events were documented in the both cyclophosphamide and levamisole groups.Conclusions: Levamisole being a very efficacious, safe and easily affordable drug, should be used as an initial first line SPA in treating FRNS and SDNS children. The side effect profiles of levamisole and MMF are much more patient friendly.

Application of rituximab in children with primary nephrotic syndrome / 医学研究生学报

Childhood primary nephrotic syndrome (PNS) is a challenging and persistent renal disorder. Corticosteroids is the first-line drug for the treatment of PNS. To reduce the side effects caused by the accumulation of corticosteroids dose and to maintain the remission state of the disease, immunosuppressants are applied to the treatment of PNS. However, many children with PNS still cannot get remission. Rituximab (RTX) is a novel immunosuppressive agent. In recent years, many studies have reported the treatment of PNS in children with RTX. This review analyzes the mechanism, course of treatment, dose, efficacy, and safety of RTX in the treatment of children with PNS.

Effects of Rituximab Including Long-term Maintenance Therapy in Children with Nephrotic Syndrome in a Single Center of Korea

Rituximab (RTX) is a chimeric monoclonal antibody that inhibits CD20-mediated B-cell proliferation and differentiation. Several studies have examined its use in intractable nephrotic syndrome (NS) with some positive results. However, those studies examined such effects for a short-term period of 1 year, and some patients continued to relapse after a lapse in RTX treatment. Our use of RTX as a maintenance therapy (RTX injection when the CD19 cell count exceeded 100–200/µL before relapse) showed some noticeable efficacy. We used RTX in 19 patients with steroid-dependent NS (SDNS). In 12 patients treated with RTX maintenance therapy, only one relapse occurred. The mean treatment period was 23.4±12.7 months, and the mean number of RTX administrations was 3.9±1.6. The relapse rates were decreased (from 2.68/year to 0.04/year), and the drug-free period also increased (from 22.5 days/year to 357.1 days/year) during maintenance therapy. The other seven patients were treated with one cycle of RTX or additional cycles in case of relapse (non-maintenance therapy). Relapse rates were significantly decreased after RTX treatment (from 1.76/year to 0.96/year, P=0.017). The relapse-free period was 15.55±7.38 (range, 5.3–30.7) months. No severe side effects of RTX were found except for a hypersensitivity reaction such as fever and chills during its infusion. In conclusion, RTX is considered an effective and safe option to reduce the relapse rate by a single- or maintenance-interval therapy in SDNS.

Efficacy of Tacrolimus in Treating Nephrotic Syndrome Children.

Nephrotic Syndrome (NS) is primarily a pediatric disorder, common in pre-schooler and school aged children. Immunosuppresive drugs like prednisolone, cyclophosphamide, cyclosporine A (CsA) has been the main treatment regimen in the management of Nephrotic syndrome. This has remain still the same therapy which is not satisfactory in the management of nephrotic syndrome children. The management of children with idiopathic Steroid-Resistant Nephrotic Syndrome (SRNS) and Steroid-Dependent Nephrotic Syndrome (SDNS) are difficult to treat but there is no consensus on the most appropriate treatment therapy. Pneumonia and urinary tract infection are also a challenge in the management of NS. The main goal of treatment is complete or partial remission of proteinuria, which is the most important marker of long term outcome. Calcineurin inhibitors (CNIs) are used to avoid steroid toxicity in children with NS. There are limited data on the relative efficacy and safety of calcineurin inhibitors and alkylating agents for NS in children. There are different immunosuppressant drugs but tacrolimus can be used in the treatment of childhood NS which is less expensive, have less cosmetic side effects and easy to administered. In this review we discuss the safety and efficacy of tacrolimus, a new drug which can be administered orally as a twice daily dose in the management of childhood NS. Some study suggests that application of tacrolimus can be a new turning point for the treatment of nephrotic syndrome.

Efficacy and Safety of Mycophenolate Mofetil in Children with Steroid Dependent Nephrotic Syndrome

PURPOSE: Steroid dependent nephrotic syndrome (SDNS) is a chronic illness in childhood hard to treat. Steroid sparing drugs are often used, because long-term steroid therapy can cause severe side effects. We studied to compare efficacy between MMF and other drugs including cyclosporine and levamisole. METHODS: This study was performed retrospectively on patients with SDNS, who were treated at Pusan National University Children's hospital. MMF group included 11 patients who were treated with MMF for at least six months between June 2012 and July 2014. As control groups, cyclosporine group (n=15) and levamisole group (n=18) included patients treated between January 2008 and July 2014. Number of relapse was analyzed in patients treated more than six months, and relapse free for one year was analyzed in patients treated more than one year. RESULTS: In MMF group, ten were boys and mean age at onset was 5.8 years. Mean age at starting of MMF was 8.6 years. Number of relapse in MMF group was reduced significantly after treatment from 3.4 /year to 0.2 /year (P=0.003). There was no significant difference in number of relapse among groups (MMF: 0.2 /year, cyclosporine: 0.5 /year, levamisole: 0.5 /year). Comparing the early relapse within six months after treatment levamisole group was significantly higher than the other two groups (P=0.04). CONCLUSIONS: MMF which is used in SDNS significantly reduced the relapse and side effects were rare. In addition, MMF did not show any significant difference in comparison with the other two groups in number of relapse and relapse free for one year.

Clinical observation on the effect ofKangyan-Yihao prescription on facial steroid-dependent dermatitis / 国际中医中药杂志

Objective To study the clinical effect ofKangyan-Yihao on facial steroid-dependent dermatitis.Methods 63 patients of steroid-dependent dermatitis in ShuGuang Hospital Affiliated to Shanghai University of TCM were recruited and randomly divided into a treatment group with 32 patients and a control group with 31 patients. Patients in both groups were forbidden to use hormone treatment and taken cetirizine 10 mg orally every night. On this basis, the treatment group was treated withKangyan-Yihao prescription and the control group was treated withTianQing-Fuxin. The total curative effects, itching-reliving degree and life quality were compared between the two groups after the treatment after two weeks.Results After the treatment, the EASI score, DLQI score skin itching score in the treatment group(2.41±2.64, 4.93±2.90, 1.07±0.83, respectively) were better than those in the control group(2.52±2.73,5.07±3.59, 1.30±0.65,P<0.01 orP<0.05).ConclusionsKangyan-Yihao has a significant effect in treating facial steroid-dependent dermatitis, specially for the oily and pustule lesions.

Clinical research of autohemotherapy combined with bacillus calmette-guerin polysaccharide and nucleic acid in treatment of facial steroid-dependent dermatitis / 中国医师进修杂志

Objective To observe the clinical effect and security of autohemotherapy combined with bacillus calmette-guerin polysaccharide and nucleic acid in treatment of facial steroid-dependent dermatitis.Methods The 74 patients with facial steroid-dependent dermatitis were divided into treatment group (38patients) and control group (36 patients) according to the treatment method.The patients in treatment group were treated with autohemotherapy combined with bacillus calmette-gnerin polysaccharide and nucleic acid 1 ml muscle injection,every 3 days a time for 4 weeks.The patients in control group were treated with bacillus calmette-guerin polysaccharide and nucleic acid,every 3 days a time for 4 weeks.The effect was compared between the two groups.Results The total effective rate in treatment group was 84.2％(32/38),in control group was 63.9％(23/36),there was significant difference between the two groups (P ＜ 0.05).No serious adverse reaction was found in two groups.Conclusion Autohemotherapy combined with bacillus calmettegnerin polysaccharide and nucleic acid is safe and effective in treatment of facial steroid-dependent dermatitis.

Disease Course in Steroid Sensitive Nephrotic Syndrome.

Objective: To review the disease course in patients with steroid sensitive nephrotic syndrome (SSNS) and the factors that determine outcome Design: Retrospective, analytical Setting: Pediatric Nephrology Clinic at referral center in North India Participants/patients: All patients with SSNS evaluated between 1990 and 2005 Intervention: None Main outcome measures: Disease course, in patients with at least 1-yr follow up, was categorized as none or infrequent relapses (IFR), frequent relapses or steroid dependence (FR), and late resistance. Details on complications and therapy with alternative agents were recorded. Results: Records of 2603 patients (74.8% boys) were reviewed. The mean age at onset of illness and at evaluation was 49.7±34.6 R E S E A R C H P A P E R INDIAN PEDIATRICS 881 VOLUME 49__NOVEMBER 16, 2012 and 67.5±37.9 months respectively. The disease course at 1-yr (n=1071) was categorized as IFR in 37.4%, FR in 56.8% and late resistance in 5.9%. During follow up, 224 patients had 249 episodes of serious infections. Alternative medications for frequent relapses (n=501; 46.8%) were chiefly cyclophosphamide and levamisole. Compared to IFR, patients with FR were younger (54.9±36.0 vs. 43.3±31.4 months), fewer had received adequate (≥8 weeks) initial treatment (86.8% vs. 81.7%) and had shorter initial remission (7.5±8.6 vs. 3.1±4.8 months) (all P<0.001). At follow up of 56.0±42.6 months, 77.3% patients were in remission or had IFR, and 17.3% had FR. Conclusions: A high proportion of patients with SSNS show frequent relapses, risk factors for which were an early age at onset, inadequate initial therapy and an early relapse.

A retrospective analysis of azathioprine in the treatment of 24 patients with refractory ulcerative colitis / 中华内科杂志

Objective To evaluate the efficacy and safety of azathioprine (AZA) in the treatment of refractory ulcerative colitis (UC).Methods Retrospective analysis of the clinical improvement,endoscopic improvement and mucosal healing rate,inflammation marker improvement after AZA administration and its safety in 24 refractory UC patients were performed,who were recruited between January 2007 and December 2011 in West China Hospital,Sichuan University,China.Results Twenty-four patients were enrolled,with a median age of 36 years old and a median course of 4 years.Among them,14 cases were moderate UC and 10 cases were severe UC.The patients were treated with AZA in a dose of (1.23 ±0.34) mg· kg-1 · d-1 from 7 weeks to 42 months.Efficacy was judged by Mayo disease activity index.At 3 months,6 months and 1 year after treatment,the effective rates were 73.9％ ( 17/23),81.8％(18/22) and 14/16 respectively,and the remission rates were 17.4％ (4/23),54.5％ (12/22) and 12/16respectively.Both ESR and C reactive protein level after treatment for 6 months and 1 year were significantly lower than those before treatment [ (9.3 ±8.9) mrn/1h,(10.9 ±7.3) mm/1h vs (22.3 ± 10.7) mm/1h;2.5(1.0-22.3) mg/L,2.3(1.0-28.0) mg/L vs 18.4(3.6-137.0) mg/L; all P ＜0.05].Corticosteroid withdrawal rates at 3 months and 1 year after AZA treatment were 16/18 and 15/16,respectively.At 6 months and 1 year after AZA treatment,the endoscopic improvement rates were 85.7％ ( 18/21 ) and 13/15 respectively; the cndoscopic remission rates were 61.9％ ( 13/21 ) and 11/15 respectively; and the mucosal healing rates were 61.9％ ( 13/21 ) and 11/15 respectively.Adverse effects were occurred in 8 patients.Leukopenia was the most common adverse effect,followed by liver function injury,alopecia and epigastric discomfort.Conclusions AZA is effective in the treatment of refractory UC patients with a low dose of ( 1.23 ± 0.34) mg· kg - 1 · d - 1,especially in the steroid withdrawing,maintaining remission and mucosal healing without severe adverse effects.

Treatment of Erythema Nodosum Leprosum (ENL) with high-dose Clofazimine in patients with Lepromatous Leprosy

ENL is a type ll leprosy reaction and occurs in people with borderline lepromatous and lepromatous leprosy, usually as a complication following treatment. The treatment of choice for ENL is prednisolone in view of its’ ready availability and affordability1. Howeve r, glucocorticoid therapy, even in low doses, can produce substantial toxicity. The risk is clearly greater as the dose increases. However, in cases where there are steroid-induced complications, high-dosed clofazimine may be used to reduce or withdraw corticosteroids in steroid-dependant cases2,3. We described 2 steroid-dependent ENL patients with steroid-induced complications who are successfully managed with the addition of highdosed clofazimine and the resultant weaning down of systemic glucocorticoids.

Clinical application of tacrolimus in children with primary nephrotic syndrome / 中华肾脏病杂志

ObjectiveTo investigate the clinical application of tacrulimus (TAC, FK506) in children with primary nephrotic syndrome (NS). MethodsSixty-five primary NS children received routine or decreased-dosage glucocorticosteroid according to clinical NS types after hospitalization. At the same time, TAC was given orally with the dosage of 0.1 to 0.15 mg/kg, once every 12 hours, for 6 to 24 months. And the serum concentration of TAC was monitored during the course. ResultsAfter the treatment of TAC for 1 to 2 months, 65 patients were recovered with gradually reduced urinary protein, rapidly increased serum albumin, and improvement of cholesterol and triglycerides. Total remission rate was 83.1% and onset time was 7 to 54 days. Twelve cases experienced recurrence. Increased CD4, as well as 3/3 or 3/1 TAC genotype, indicated higher remission rate. Various pathological types had different remission rates or ratio, which were as follows: minimal change nephropathy (96.4%), mesangial proliferative glomendonephritis (90.0%), membranous nephropathy (2/3), membranous proliferative glomerulonephritis (3/5), focal segmental glomerulosclerosis (4/9). The patients would recover in the course of treatment under the conditions of TAC initial dose as 0.1 to 0.15 mg /kg per 12 hours and controlled serum concentration as 5 to 10 g/L. During the treatment, 12 cases appeared gastrointestinal symptoms, mainly as anorexia, nausea and vomiting, 1 abdominal pain, 2 headache, 1 tremor, 1 paresthesia, 3 insomnia, 4 transient increased Scr, 8 slightly increased NAG, 6 increased C3 and α-2 macroglobulin. The symptoms disappeared within one week or after stopping TAC. ConclusionsTAC is effective in primary NS children, even with abnormal liver function or tuberculosis infection. TAC can also be a substitute to cyclosporine A.

Nephrotic syndrome in Thai children: Nakornping Hospital experience.

Objective: The purposes of this study are to determine the incidence, age of onset, gender, initial presentations, predictive parameters of frequent relapsers/steroid dependence and steroid resistance, results of disease course, growth retardation and complications of long term prednisolone therapy. Methods: A retrospective descriptive study was done in 37 pediatric patients with their first episode of primary nephrotic syndrome admitted at Nakornping Hospital during 1 October 2002 to 30 September 2005. The data in medical records were analyzed by using descriptive statistics. This study used percentage, mean, median and standard deviation for basic data. Statistical analyses were done by Student’s t – test, Fisher’s exact test and Chi-square test for testing of statistically significant differences. Results: The average age of patients was 7.7 years (male 7.7 years, female 7.7 years). The estimated annual incidence of nephrotic syndrome in healthy children in Chiang Mai was at least 3.48 new cases per 100,000 children younger than 15 years of age with the average of treatment period 19.2 months (2-36 months). Initial presentations consisted of generalized edema (86.4%), renal insufficiency (48.6%), fever (37.8%), hypertension (32.4%), gross hematuria (21.65%), and microscopic hematuria (21.6%). Initial therapy consisted of 60 mg/m2/day prednisolone daily for 4 weeks followed by 40 mg/m2 on alternate days for 4 weeks, thereafter decreasing alternate-day therapy every month by 25% over the next 4 months. Thirty-one patients (83.8%) were steroid-responsive, 6 patients (16.2%) were steroid-resistant. Of the 31 initial responders, 4 patients were excluded because of short follow-up period. Of the remaining 27 patients, 16 patients (59.2%) were nonrelapsers, 4 patients (14.85%) were infrequent relapsers, 6 patients (22.2%) were frequent relapsers/steroid dependence and one (3.7%) subsequently became steroid-resistant. The average of initial remission time (protein-free urine) was 16.4 days (15.2 days in nonrelapsers and infrequent relapsers, 21days in frequent relapsers/steroid-dependent patients). The study for predictive parameters predicting the response of steroid therapy found that a group of the frequent relapsers/steroid-dependent and steroid-resistant patients had ascites, pulmonary edema/plural effusion, moderate renal insufficiency (GFR <60 ml/min/1.73m2 ), and gross hematuria more frequent than a group of the nonrelapsers and infrequent relapsers. But mild renal insufficiency (GFR 60-89 ml/min/1.73m2) was found less than the latter group. Only moderate renal insufficiency was statistically different in both groups. Six frequent relapsers/steroid-dependent patients had average occurrence of 2.83 relapses. All had complete remission. Three patients who used cyclophosphamide had longer complete remission than nonuser group (17 months versus 3.6 months). Seven steroid-resistant patients were treated with cyclophosphamide, 2 patients (28.56%) had complete remission for 25 months, the other two patients had complete remission for 1.5 and 3 months, respectively. Three patients were still depended on steroid. BMI and height for age in all patients were normal except one patient with BMI> 25. Conclusion: The increasing average age of first diagnosis of primary NS may indicate that there are more frequent relapsers/steroid-dependent and steroid-resistant patients than the past. The frequent initial presentations are generalized edema, renal insufficiency, hematuria, fever, and hypertension. The initial parameters that can predict the frequent relapsers/steroid dependence and steroid resistance are moderate renal insufficiency, gross hematuria, pulmonary edema/pleural effusion, and ascites. The frequent relapsers/steroid dependence and steroid resistance had more severe degree of renal insufficiency. The longer duration of treatment until the patient’s urine became protein-free may be a predictor of frequent relapsers/steroid dependence. The long regimen of steroid therapy for the initial episode may result in sustained complete remission and reduce frequency of relapses with few complications and growth retardation. The treatment of frequent relapsers/steroid dependence with cyclophosphamide may result in longer complete remission. Failure of cyclophosphamide therapy in steroid resistance indicates a consideration of other drugs. Therefore, this study indicates the benefits of completed information collection which may improve the outcome of treatment and encourage the physicians to study further for more completed outcomes.

Efficacy of Mycophenolate Mofetil on Children with Steroid-Dependent Nephrotic Syndrome / 实用儿科临床杂志

Objective To evaluate the clinical efficacy and safety of mycophenolate mofetil(MMF)on children with steroid-dependent nephrotic syndrome(SDNS).Methods Sixteen children with SDNS,diagnosed at onset,included 12 males and 4 females,aged(5.0?1.6) years,were administrated with MMF[25 mg/(kg?d)] and low-dose prednisone[0.5-1.0 mg/(kg?d),average 0.67 mg/(kg?d)].MMF was reduced to half of initial dosage after 6 months and maintained for 3 months,while dosage of prednisone was tapered gradually based on patients disease profile.Twenty-four hours urinary protein excretion,serum creatinine and blood urea nitrogen,liver function were conducted regularly,respectively.The clinical efficacy and safety were assessed after 3 months treatment.Results Thirteen of 16 patients treated with MMF and prednisone remained in complete remission.Three children remained remission partly.Difference markedly was observed in 24 hours urinary protein excretion and serum albumin before and after treatment.Conclusions MMF is an effective and safe immunosuppressive agent for children with SDNS.

Effect of three-stage sequential therapy on the functions of hypothalamic-pituitary-adrenal axis and levels of the glucocorticoid receptor in patients with steroid-dependent asthma / 中华中医药杂志

Objective:To observe the effect of three-stage sequential therapy on the functions of hypothalamic-pituitary-adrenal(HPA)axis and levels of the glucocorticoid receptor in patients with steroid-dependent asthma.Methods:55 patients with SDA were divided randomly into two groups,29 patients were treated with three-stage sequential recipes plus Pulmicort Turbuhaler(400?g/d)in the treatment group,while the other 26 patients with Pulmicort Turbuhaler(800?g/d)in the control group. The therapeutic courses were both 12-14 weeks.The plasma concentrations of ACTH and COR and the levels of PBMC GCR were determined before and after treatment.Results:The plasma concentrations of ACTH and COR and the levels of PBMC GCR in the two groups were all increased remarkably and there were significant difference between the two groups after treatment(P

Mutations in NPHS2 Gene in A Child with Steroid-Dependent Nephrotic Syndrome / 实用儿科临床杂志

T were also detected in the controls.Conclusion Nephrotic syndrome may be associated with NPHS2 identified in children.

Methotrexate na asma grave dependente de corticóide sistêmico / Methotrexate in the treatment of ashma

Introdução: a utilização do methotrexate (MTX) no tratamento da asma brônquica contínua controverso. O objetivo deste manuscrito é apresentar uma série de casos de asma tratados com esta medicação. Métodos: estudo descritivo, de uma série de casos de pacientes portadores de asma brônquica grave atendidos no ambulatório de Pneumologia do Hospital Universitário Antônio Pedro. Resultados: no período de março de 1993 a setembro de 2001 foram avaliados 32 pacientes portadores de asma grave em uso de MTX. Vinte e um pacientes utilizaram 7,5 mg semanais de MTX e 11 pacientes foram medicados com 15 mg semanais. Após 6 meses de uso do MTX observou-se uma melhora clínica em todos os pacientes. Não houve correlação entre a melhora clínica e os achados funcionais dos pacientes. Não foi observada diferença estatisticamente significante entre os achados espirométricos e os achados gasométricos encontradas antes e após 6 meses de uso de MTX nos dois grupos analisados. Não foi verificada diferença na melhora funcional entre os pacientes usando 7,5 mg e os pacientes usando 15 mg semanais de MTX. Entretanto, o grupo de pacientes usando 15 mg de MTX referiu melhora clínica em relação ao grupo que usou 7,5 mg. Conclusão: nesta série de casos o MTX pareceu ser uma alternativa terapêutica viável e segura nos asmáticos crônicos graves corticodependentes.

Introduction: the use of methotrexate (MTX) in the treatment of bronchial asthma remains controversy. The objective of the present manuscript is to present a serie of asthma cases treated with MTX. Methods: descriptive study of a series of cases of patients affected by bronchial asthma handled in a the ambulatory of Pneumology of Hospital Universitário Antônio Pedro. Results: in the period of March 1993 through September 2001, 32 patients treated with MTX were evaluated. Twenty one patients received 7,5 mg weekly and 11 patients received 15 mg weekly. After 6 months of treatments with MTX all patients presented clinical improvement. There was no correlation between the clinical improvement and the respiratory function. There was no difference statistically significant between spirometric and gasometrical findings among patients before and after six months of using MTX. There was no functional difference between the group using 7,5 mg and group using 15 mg of MTX. However patients using 15 mg of MTX referred clinical improvement. Conclusion: In those series of cases MTX appeared to be both a safe and viable alternative for the bearers of severe chronicle asthma corticosteroid-dependents.

Differences of glucocorticoid and beta2-adrenergic receptor mRNA expression in steroid-dependent asthma / 천식및알레르기

BACKGROUND: Steroid-dependency is one of Phenotypes of severe asthma. Because steroid-dependent asthmatics require long-term systemic steroids to control their symptoms. they have potentially increased risks to experience serious events caused by systemic steroids. But the pathophysiology of steroid-dependent asthma is poorly understood. Differences of glucocorticoid and beta2-aderenergic receptor expression may have some roles in the pathophysiology of steroid-dependent asthma. OBJECTIVE: The aim of this study was to evaluate the differences of mRNA expression of glucocorticoid receptor and beta2-adrenergic receptor between the steroid-dependent severe asthmatics and those with mild-to-moderate severity. METHODS: Thirty-nine asthmatic patients were enrolled, twenty with mild-to-moderate severity and nineteen with steroid-dependent severe asthma. Induced sputum was collected using 4% hypertonic saline nebulization and total RNA was extracted from the cells collected. Using RT-PCR, we asessed the amounts of glucocorticoid receptor and beta2-adrenergic receptor mRNA semiquantitatively from the extracted RNA. RESULTS: There were no significant differences in sex, age, smoking history, duration of asthma, positive rate of atopy, and percent predicted value of FEV1 between the two groups. The amount of glucocorticoid receptor mRNA expression was significantly lower in steroid-dependent asthmatic group than in mild-to-moderate severity group(p<0.05). There was no significant difference in amount of beta2-adrenoreceptor mRNA expression between the two groups. CONCLUSION: Decreased expression of glucocorticoid receptor mRNA may have some role in the pathophysiology of steroid-dependent asthma.

A Case of Focal Glomerular Sclerosis (Glomeruloscrelosis) Treated with Bunsho-to / 日本東洋医学雑誌

We report a case of a patient with steroid-dependent nephrotic syndrome, who achieved complete remission with a combination of steroid therapy and Bunsho-to. The patient was a 27-year-old female who became aware of edema, and was diagnosed as suffering from focal glomerular sclerosis (glomerulosclerosis) with nephrotic syndrome in November 1992. She responded to steroid therapy, but nephrotic syndrome relapsed frequently after the repeated reduction of steroids. In July 1995, she came to our hospital, and was diagnosed as having a recurrence of nephrotic syndrome. Although the combination therapy of steroid and Kampo formulas, Shinbu-to or Shimotsu-to and/or Keigairengyo-to, was effective, an exacerbation of nephrotic syndrome occurred after steroid therapy was discontinued, in July 1997. The prescription was changed to Bunsho-to, and steroid therapy was re-initiated with 10mg of prednisolone daily. As a result, she achieved complete remission. The steroid therapy could be discontinued in July 1999, and now she has taken Bunsho-to only for 18 months. But the complete remission of nephrotic syndrome has been maintained.