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Infiltrative Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aniruddha Agarwal, Sabia Handa, Vishali Gupta
The management of ocular TB involves the use of anti-tubercular treatment for 9–12 months. The use of adjunctive systemic corticosteroid therapy may help reduce the inflammatory reaction.79,93,94
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Corticosteroids, including budesonide, are pregnancy category C. Steroid therapy is frequently used in the treatment of moderate to severe and fulminant UC, and moderate to severe active CD. In severely ill, hospitalized patients, high doses of intravenous steroids are employed to control bowel inflammation. Corticosteroid enemas are important topical agents for the treatment of proctitis and left-sided colitis. The major side effects associated with long-term corticosteroid therapy (such as cataracts, osteoporosis, diabetes, and hypertension) make it imperative that patients be tapered off this medication as soon as possible. Unfortunately, some patients with IBD require long-term corticosteroid use to treat persistently active disease; in these patients, a trial of an immunosuppressive agent such as 6-mercaptopurine (6-MP) or azathioprine (AZA) may be used to facilitate steroid tapering.
Disorders of the digestive tract
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Most medications used to treat IBD can be continued safely during pregnancy and lactation39. Exacerbations will be treated with medication and may include corticosteroids (which may also be taken regularly as a preventative measure). If corticosteroid therapy is taken during pregnancy, there may also be a need for increased blood pressure surveillance, glucose tolerance testing and serial growth scans28,30. Plans may be necessary for additional oral doses or IV hydrocortisone during labour and immediately postnatal. Some drugs may need to be discontinued in the 3rd trimester to allow effects to clear from the fetus before delivery30,40.
Tinnitus following COVID-19 vaccination: report of three cases
Published in International Journal of Audiology, 2022
Daniela Parrino, Andrea Frosolini, Chiara Gallo, Romolo Daniele De Siati, Giacomo Spinato, Cosimo de Filippis
A 37-year-old woman was referred to our department complaining of sudden onset of right tinnitus 7 hours after her first dose of COVID-19 vaccine. She reported short-term dizziness, but she did not notice hearing loss. Local pain at injection site was reported as another vaccine side effect. Her previous medical history was relevant for glaucoma and undifferentiated connective tissue disease. She denied any previous audio-vestibular disorder except for an episode of transient tinnitus related to unremembered side acute otitis media 20 years previously. She was not taking any home medications and had no known allergies. She did not report any previous COVID-19 diagnosis. Otoscopy examination was normal bilaterally. Spontaneous nystagmus was absent as well as other focal neurological symptoms. PTa revealed bilateral normal hearing with slight asymmetry on the right ear. The Psychoacoustic Measures of Tinnitus resulted in a 20 dB pure tone at 10000 Hz. The THI score was 90/100. A 10-day course of oral corticosteroid therapy with tapering regimen was started. PTa performed after treatment showed no significant changes. The Psychoacoustic Measures of Tinnitus and THI score slightly improved (78/100), but the patient still complained of tinnitus and an accompanying bilateral ear fullness sensation. A second line therapy was started. A magnetic resonance imaging (MRI) of the internal auditory meatus or cerebellopontine angle ruled out any possible abnormality.
Effects of different corticosteroid therapy on severe COVID-19 patients: a meta-analysis of randomized controlled trials
Published in Expert Review of Respiratory Medicine, 2022
Jiayuan Tu, Xiaoqiao Mo, Xiangda Zhang, Jing Xun, Xueshun Chen, Yun Liu, Wenhua Jing, Tian Xie
The safety of corticosteroids in COVID-19 still is debated. Corticosteroid therapy attenuates the immune response, which increased the chance of infection and other adverse events [37]. In our study, seven studies reported the incidence rate of adverse events in COVID-19 patients (corticosteroid:7.0% vs control:5.9%) [10,18–21,23,24]. Four studies reported the incidence rate of nosocomial infections (corticosteroid:22.8% vs control:26.7%) [10,19–21]. There was no difference in the rates of adverse events and nosocomial infections between the corticosteroids group and the control group. One of 7 studies (GLUCOCOVID) showed that hyperglycemia (>180 mg/dl) was more frequent in the corticosteroid group in the ICU, with a significant difference [21]. Tomazini et al. [20] also reported unspecified hyperglycemia. Except for hyperglycemia, the incidence of adverse events was similar in either group. Similarly, a systematic review including peer-reviewed studies of any design reported that hyperglycemia was the most common adverse effect [38]. Therefore, when corticosteroids are used in clinical treatment, we need to pay more attention to blood sugar levels.
False negative results on PCR for SARS-COV-2 using nasopharyngeal swab
Published in Infectious Diseases, 2021
Yu Kusaka, Kasumi Tsukamoto, Hiroki Fujiwara, Ryusaku Hosoya, Shinya Fujii, Kenjiro Sato, Katsuaki Yazawa, Takehiko Oba, Takashi Kumagai, Susumu Isogai
Further, subsequent nasopharyngeal swab PCRs on post-admission days 2 and 3 were negative. On post-admission day 4, enlargement of the GGOs and hypoxaemia progression were observed. Therefore, oxygen therapy (3 L/min) with nasal cannula was started. Given the possibility of organizing pneumonia, prednisolone was administered as a low-dose corticosteroid therapy at a dose of 30 mg/d. On post-admission day 3, PCR using specimen from the lower respiratory tract yielded a positive result, which led to a diagnosis of COVID-19. After long-term rehabilitation the patient was discharged on day 47. Remdesivir was started on post-admission day 5; moreover, corticosteroid administration was changed to 6 mg/d dexamethasone on post-admission day 7. The patient was weaned off oxygen therapy and recovered from fever on post-admission day 7. Remdesivir and dexamethasone were administered for 5 and 8 d, respectively. The patient was discharged on post-admission day 47 after long-term rehabilitation.