Dexamethasone as adjunctive therapy for treatment of varicella pneumonia

The most common and most serious complication of varicella [chickenpox] in adults is pneumonia, which can lead to severe respiratory failure. Whether addition of corticosteroids to antiviral treatment benefits patients with varicella pneumonia is unclear. To assess the effect of dexamethasone as adjunctive therapy for treatment of varicella pneumonia on the length of hospital stay, which might cause earlier resolution of varicella pneumonia. Forty patients were diagnosed as varicella pneumonia and divided into two groups, the first one involved 20 patients who received dexamethasone and acyclovir, and the second one involved also 20 patients but they received placebo and acyclovir. We measured liver function test, kidney profile, complete blood count, blood glucose, C-reactive protein and the levels of interleukin-6 on the day of presentation, after 4 days of admission and on the day of discharge from the hospital. The mean length of hospital stay in the dexamethasone group was 6.5 days compared with 7.1 days in the placebo group and was significantly different between two groups. The mean time of switching to oral administration of acyclovir was 3.4 days in the dexamethasone group and 4.2 days in the placebo group. The mean time of switching to oral was significantly lower in dexamethasone group than in placebo group. Adding of dexamethasone to acyclovir in patients with varicella pneumonia can reduce the length of hospital stay

effect of chronic intermittent hypoxia in the evolution of NASH

Obstructive sleep apnea [OSA] causes chronic intermittent hypoxia [CIH] during sleep. OSA is associated with nonalcoholic steatohepatitis [NASH] in obese individuals and may contribute to progression of nonalcoholic fatty liver disease [NAFLD] from steatosis to steatohepatitis. To assess the potential role of hypoxia in the development of NASH in obstructive sleep apnea patients. Nocturnal polysomnography was performed in 60 consecutive patients for clinical suspicion of OSA. We investigated fasting blood glucose, serum insulin, TNF-alpha, ABG and liver enzymes for 30 patients with nocturnal polysomnographic recording of OSA and for 15 patients without recording OSA used as controls. Liver biopsy was offered to 15 of 30 patients with elevated liver enzymes. Patients with OSA had significantly higher levels of insulin and were more insulin-resistant according to HOMA-IR than in controls. We found that the parameters which significantly correlated with AHI were elevated liver enzyme, BMI, ultrasound grading, TNF-alpha and HOMA-IR in patients group but did not find a similar correlation in controls. Liver biopsy showed steatosis with lobular necrosis or hepatocyte ballooning in the 15 patients, associated with fibrosis in 5 patients. Hypoxic stress of obstructive sleep apnea may be implicated in the evolution of insulin resistance and steatohepatitis in obese individuals