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Li Y, Lv Y, Li J, Ling P, Guo X, Zhang L, Ni J, Long Y. Dexamethasone relieves the inflammatory response caused by inguinal hernia meshes through miR-155. Hernia 2024; 28:1113-1119. [PMID: 38492053 DOI: 10.1007/s10029-024-02985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Inguinal hernia is a relatively common condition. Most patients with inguinal hernia require surgery. At present, mesh repair is one of the most effective methods to treat inguinal hernia, but insertion of the mesh can cause inflammation. Dexamethasone (DEX) can treat inflammation, but the mechanism by which DEX alleviates inflammation caused by inguinal hernia mesh placement remains unclear. METHOD We randomly divided rats into groups: negative control (NC), inguinal hernia (IH), polypropylene mesh (PM), DEX treatment, and miR-155 treatment groups. RT-qPCR was performed to determine the expression of miR-155. ELISA was implemented to determine the secretion of IL-1β, IL-6, and IL-18. Western blotting was used to detect caspase-1, JAK1, p-JAK1, STAT3, and p-STAT3 expression. A dual-luciferase reporter gene array identified a connection between miR-155 and JAK1. RESULTS The results revealed that the expression of miR-155, IL-1β, IL-6, and IL-18 was upregulated in the PM group. After DEX treatment, the secretion of miR-155, caspase-1, IL-1β, IL-6, and IL-18 decreased. Dual luciferase results confirmed that miR-155 induced the targeted downregulation of JAK1, while a miR-155 mimic reversed the therapeutic effect of DEX, and the expression levels of p-JAK1 and p-STAT3 increased. CONCLUSION DEX regulates the JAK1/STAT3 signaling pathway through miR-155 to relieve inflammation caused by inguinal hernia meshes.
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Affiliation(s)
- Y Li
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China
| | - Y Lv
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China
| | - J Li
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China
| | - P Ling
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China
| | - X Guo
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China
| | - L Zhang
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China
| | - J Ni
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China
| | - Y Long
- Department of General Surgery, The First People's Hospital of Yunnan Province, Xishan District, No. 157, Jinbi Road, Kunming, 650032, Yunnan, China.
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Tanverdi MS, Navanandan N, Brackman S, Huber L, Leonard J, Mistry RD. Impact of a discharge prescription for dexamethasone on outcomes of children treated in the emergency department for acute asthma exacerbations. J Asthma 2024; 61:584-593. [PMID: 38112414 DOI: 10.1080/02770903.2023.2294910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To evaluate dexamethasone prescribing practices, patient adherence, and outcomes by dosing regimen in children with acute asthma discharged from the emergency department (ED). STUDY DESIGN Prospective study of children 2-18 years treated with dexamethasone for acute asthma prior to discharge from an urban, tertiary care ED between 2018 and 2022. Demographics, clinical characteristics, ED treatment, and discharge prescriptions were collected via chart review. The exposure was discharge prescription (additional dose) versus no discharge prescription for dexamethasone. The primary outcome was treatment failure, defined as return ED visit, unplanned primary care visit, and/or ongoing bronchodilator use. Secondary outcomes included medication adherence, symptom persistence, quality-of-life, and school/work absenteeism. Outcomes were assessed by telephone 7-10 days after discharge. RESULTS 564 subjects were enrolled; 338 caregivers (60%) completed follow-up. Children were a median age 7 years, 30% Black or African American, 49% Hispanic, and 79% had public insurance. A discharge prescription for dexamethasone was written for 482 (86%) children and was significantly associated with exacerbation severity, number of combined albuterol/ipratropium treatments, and longer length of stay. There was no difference in treatment failure between the discharge prescription and no discharge prescription groups (RR 0.87; 0.67, 1.12), including after adjusting for potential confounders; there was no difference between groups in secondary outcomes. CONCLUSIONS Prescription for an additional dexamethasone dose was not associated with reduced treatment failure or improved outcomes for children with acute asthma discharged from the ED. Single, ED-dose of dexamethasone prior to discharge may be sufficient for children with mild to moderate asthma exacerbations.
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Affiliation(s)
- Melisa S Tanverdi
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of CO School of Medicine, Aurora, CO, USA
| | - Nidhya Navanandan
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of CO School of Medicine, Aurora, CO, USA
| | - Savannah Brackman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lorel Huber
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jan Leonard
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of CO School of Medicine, Aurora, CO, USA
| | - Rakesh D Mistry
- Section of Pediatric Emergency Medicine, Department of Pediatrics, University of CO School of Medicine, Aurora, CO, USA
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Hora J, Rambhia N, Mani I. Drug repurposing for personalized medicine. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2024; 207:107-122. [PMID: 38942534 DOI: 10.1016/bs.pmbts.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Personalized medicine has emerged as a revolutionary approach to healthcare in the 21st century. By understanding a patient's unique genetic and biological characteristics, it aims to tailor treatments specifically to the individual. This approach takes into account factors such as an individual's lifestyle, genetic makeup, and environmental factors to provide targeted therapies that have the potential to be more effective and lower the risk of side reactions or ineffective treatments. It is a paradigm shift from the traditional "one size fits all" approach in medicine, where patients with similar symptoms or diagnoses receive the same standard treatments regardless of their differences. It leads to improved clinical outcomes and more efficient use of healthcare resources. Drug repurposing is a strategy that uses existing drugs for new indications and aims to take advantage of the known safety profiles, pharmacokinetics, and mechanisms of action of these drugs to accelerate the development process. Precision medicine may undergo a revolutionary change as a result, enabling the rapid development of novel treatment plans utilizing drugs that traditional methods would not otherwise link to. In this chapter, we have focused on a few strategies wherein drug repurposing has shown great success for precision medicine. The approach is particularly useful in oncology as there are many variations induced in the genetic material of cancer patients, so tailored treatment approaches go a long way. We have discussed the cases of breast cancer, glioblastoma and hepatocellular carcinoma. Other than that, we have also looked at drug repurposing approaches in anxiety disorders and COVID-19.
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Affiliation(s)
- Jahnvi Hora
- Manipal School of Life Science, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nishita Rambhia
- Manipal School of Life Science, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Indra Mani
- Department of Microbiology, Gargi College, University of Delhi, New Delhi, India.
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4
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Waselewski AC, Klumpner TT, Kountanis JA, Sandberg ES, Shumer DE. Dexamethasone for postoperative nausea and vomiting prophylaxis in cesarean delivery and a delayed diagnosis of neonatal congenital adrenal hyperplasia. Int J Obstet Anesth 2024; 57:103969. [PMID: 38195332 DOI: 10.1016/j.ijoa.2023.103969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/19/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
The case of a false-negative newborn screen for congenital adrenal hyperplasia in a 37 weeks' gestation 46,XX neonate, thought to be due to maternal administration of dexamethasone intra-operatively prior to umbilical cord clamping, for postoperative nausea and vomiting prophylaxis after neuraxial anesthesia, is described.
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Affiliation(s)
- A C Waselewski
- University of Michigan, Department of Pediatric Endocrinology, Ann Arbor, Michigan, USA.
| | - T T Klumpner
- University of Michigan, Department of Anesthesiology, Ann Arbor, Michigan, USA
| | - J A Kountanis
- University of Michigan, Department of Anesthesiology, Ann Arbor, Michigan, USA
| | - E S Sandberg
- University of Michigan, Department of Pediatric Endocrinology, Ann Arbor, Michigan, USA
| | - D E Shumer
- University of Michigan, Department of Pediatric Endocrinology, Ann Arbor, Michigan, USA
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Kamta J, Fregoso B, Lee A, Kutsuris C, Kadow E, Walker C, Sensenbach B, O'Donnell C, Porter A, Blankenberg J, Acquisto N, Mazzillo J, Farney A, Cushman JT, Dorsett M. Improving Emergency Medicine Clinician Awareness of Prehospital-Administered Medications. PREHOSP EMERG CARE 2023; 28:506-512. [PMID: 37478002 DOI: 10.1080/10903127.2023.2238815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
Background/problem: Information transfer between emergency medical services (EMS) and emergency medicine (EM) is at high risk for omissions and errors. EM awareness of prehospital medication administration affects patient management and medication error. In April 2020, we surveyed emergency physicians and emergency department nurse practitioners (NPs) and physician assistants (PAs) regarding the EMS handoff process. Emergency physicians and NPs/PAs endorsed knowing what medications were given, or having received direct verbal handoff from EMS "Often" or "Always" only 20% of the time (n = 71), identifying a need to improve the written handoff process. To assess rates of medication error due to lack of awareness of prehospital administered medications, we measured glucocorticoid redosing in the emergency department (ED) following prehospital dexamethasone administration. In 2020, glucocorticoids were redosed 30% of the time, and our aim was to reduce glucocorticoid redosing to 10% by June 2022. Intervention: We developed and implemented a system innovation where prehospital-administered medications documented in a nursing flowsheet during verbal handoff are pulled directly into the triage note where they are more likely to be reviewed by receiving EM clinicians. Results: Shewhart p-charts were used to evaluate for statistical process change in the process measure of triage note documentation of prehospital medication administration and the outcome measure of glucocorticoid redosing. While the frequency of prehospital dexamethasone administration in the triage note increased, no statistical process change outcome measure of glucocorticoid redosing was observed. However, on repeat survey of EM clinicians in July 2022, 50% now indicated they were aware of prehospital medication administration "Often" or "Always" (n = 61, p = 0.003), 87% maintained they use the triage note as the main source of information regarding prehospital medication administration, and 81% "Always" review the triage note. Conclusions: Innovations that improve accessibility of written documentation of prehospital medication administration were associated with improved subjective assessment of EM clinician awareness of prehospital medications, but not the outcome measure of medication error. Effective error reduction likely requires better system integration between prehospital and EM records.
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Affiliation(s)
- Jeff Kamta
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
- Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Bryan Fregoso
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Andrew Lee
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Catherine Kutsuris
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Elizabeth Kadow
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christopher Walker
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Benjamin Sensenbach
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | | | - Andrew Porter
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jessica Blankenberg
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Nicole Acquisto
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Justin Mazzillo
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Aaron Farney
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Maia Dorsett
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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6
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Roddy MR, Sellers AR, Darville KK, Teppa-Sanchez B, McKinley SD, Martin M, Goldenberg NA, Nakagawa TA, Sochet AA. Dexamethasone versus methylprednisolone for critical asthma: A single center, open-label, parallel-group clinical trial. Pediatr Pulmonol 2023; 58:1719-1727. [PMID: 36929864 DOI: 10.1002/ppul.26386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Evidence for the use of dexamethasone for pediatric critical asthma is limited. We sought to compare the clinical efficacy and safety of dexamethasone versus methylprednisolone among children hospitalized in the pediatric intensive care unit (PICU) for critical asthma. METHODS A prospective, single center, open-label, two-arm, parallel-group, nonrandomized trial among children ages 5-17 years hospitalized within the PICU from April 2019 to December 2021 for critical asthma consented to receive methylprednisolone (standard care) or dexamethasone (intervention) at a 2:1 allocation ratio, respectively. The intervention arm received intravenous dexamethasone 0.25 mg/kg/dose (max: 15 mg/dose) every 6 h for 48 h and the standard care arm intravenous methylprednisolone 1 mg/kg/dose every 6 h (max dose: 60 mg/dose) for 5 days. Study endpoints were clinical efficacy (i.e., length of stay [LOS], continuous albuterol duration, and a composite of adjunctive asthma interventions) and safety (i.e., corticosteroid-related adverse events). RESULTS Ninety-two participants were analyzed of whom 31 were allocated to the intervention arm and 61 the standard care arm. No differences in demographics, clinical characteristics, or acute/chronic asthma severity indices were observed. Regarding efficacy and safety endpoints, no differences in hospital LOS, continuous albuterol duration, adjunctive asthma intervention rates, or corticosteroid-related adverse events were noted. Compared to the intervention arm, participants in the standard care arm more frequently were prescribed corticosteroids at discharge (72% vs. 13%, p < 0.001). CONCLUSIONS Among children hospitalized for critical asthma, dexamethasone appears safe and warrants further investigation to fully assess clinical efficacy and potential advantages over commonly applied agents such as methylprednisolone.
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Affiliation(s)
- Meghan R Roddy
- Departments of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Austin R Sellers
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Kristina K Darville
- Departments of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Beatriz Teppa-Sanchez
- Departments of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Scott D McKinley
- Departments of Pulmonlogy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Meghan Martin
- Departments of Emergency Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Neil A Goldenberg
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Departments of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Departments of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas A Nakagawa
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Florida-Jacksonville, Jacksonville, Florida, USA
| | - Anthony A Sochet
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Departments of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dahan E, El Ghazal N, Nakanishi H, El Haddad J, Matar RH, Tosovic D, Beran A, Than CA, Stiasny D. Dexamethasone versus prednisone/prednisolone in the management of pediatric patients with acute asthmatic exacerbations: a systematic review and meta-analysis. J Asthma 2022:1-12. [PMID: 36461938 DOI: 10.1080/02770903.2022.2155189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Acute asthmatic exacerbation is a common condition for pediatric emergency visits. Recently, dexamethasone has increasingly been used as an alternative to prednisone. This study aimed to evaluate the safety and efficacy of dexamethasone (DEX) against prednisone/prednisolone (PRED) in managing pediatric patients with acute asthmatic exacerbation. DATA SOURCES Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to August 2022 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42022353462). STUDY SELECTIONS From 316 studies screened, seventeen studies met the eligibility criteria, with 5967 pediatric patients experiencing an asthma exacerbation requiring treatment with either DEX (n = 2865) or PRED (n = 3102). Baseline patient characteristics (age, sex, PRAM (pediatric respiratory assessment measure), previous corticosteroid and beta-agonist inhaler) were comparable between groups. RESULTS After treatment administration, the DEX group had fewer vomiting incidents (OR = 0.24, 95% CI: 0.11, 0.51, I2 = 58%) and reduced noncompliance events (OR = 0.12, 95% CI: 0.04, 0.34, I2 = 0%) when compared to the PRED group. Regarding emergency-department (ED)-related outcomes, there were no differences in hospital admission rates (OR = 0.83, 95% CI: 0.58, 1.19, I2 = 15%), time spent in the ED (MD= -0.11 h, 95% CI: -0.52; 0.30, I2 = 82%) or relapse occurrences (OR = 0.67, 95% CI: 0.30, 1.49, I2 = 52%) between both groups. CONCLUSION Although there were no differences between the DEX and PRED groups in terms of hospital admission rates, time spent in the ED or relapse events, pediatric patients receiving DEX experienced lower noncompliance and vomiting rates.
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Affiliation(s)
- Elise Dahan
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Nour El Ghazal
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Hayato Nakanishi
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Joe El Haddad
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Reem H Matar
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus.,Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Danijel Tosovic
- School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Christian A Than
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus.,School of Biomedical Sciences, The University of Queensland, St Lucia, Australia
| | - David Stiasny
- Pediatrics Department Swedish Medical Group, Chicago, IL, USA
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Resistance Mechanisms in Pediatric B-Cell Acute Lymphoblastic Leukemia. Int J Mol Sci 2022; 23:ijms23063067. [PMID: 35328487 PMCID: PMC8950780 DOI: 10.3390/ijms23063067] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023] Open
Abstract
Despite the rapid development of medicine, even nowadays, acute lymphoblastic leukemia (ALL) is still a problem for pediatric clinicians. Modern medicine has reached a limit of curability even though the recovery rate exceeds 90%. Relapse occurs in around 20% of treated patients and, regrettably, 10% of diagnosed ALL patients are still incurable. In this article, we would like to focus on the treatment resistance and disease relapse of patients with B-cell leukemia in the context of prognostic factors of ALL. We demonstrate the mechanisms of the resistance to steroid therapy and Tyrosine Kinase Inhibitors and assess the impact of genetic factors on the treatment resistance, especially TCF3::HLF translocation. We compare therapeutic protocols and decipher how cancer cells become resistant to innovative treatments—including CAR-T-cell therapies and monoclonal antibodies. The comparisons made in our article help to bring closer the main factors of resistance in hematologic malignancies in the context of ALL.
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9
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Sellers AR, Roddy MR, Darville KK, Sanchez-Teppa B, McKinley SD, Sochet AA. Dexamethasone for Pediatric Critical Asthma: A Multicenter Descriptive Study. J Intensive Care Med 2022; 37:1520-1527. [PMID: 35236174 DOI: 10.1177/08850666221082540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Systemic corticosteroids are vital to critical asthma management. While intravenous methylprednisolone is routinely used in the pediatric intensive care unit (PICU) setting, recent data supports dexamethasone as an alternative. Using the Pediatric Health Information System (PHIS) registry, we assessed trends and variation in corticosteroid prescribing among children hospitalized for critical asthma. METHODS We performed a multicenter retrospective cohort study using PHIS data among children 3-17 years of age admitted for critical asthma from 2011 through 2019. Primary outcomes were corticosteroid prescribing rates by year and participating sites. Exploratory outcomes were corticosteroid-related adverse effects, rates of adjunctive pharmaceutical and respiratory interventions, mortality and length of stay. RESULTS Of the 49 children's hospitals assessed, 26 907 encounters were included for study. Mean dexamethasone exposure rates were 18.1 ± 2.4% where 2.4 ± 1.2% represented dexamethasone-alone prescribing. Dexamethasone alone prescribing exhibited a linear trend (annual increase of 0.5 ± 0.1% annually R2 = 0.845) without correlation to cumulative site critical asthma admission rates. Compared to encounters prescribed solely methylprednisolone or a combination of dexamethasone and methylprednisolone, subjects provided dexamethasone alone had reduced asthma severity indices, length of stay, and exposure rates to adjunctive asthma interventions. Adverse events were rare and the dexamethasone-alone group less frequently experienced gastritis and hyperglycemia. CONCLUSIONS In this multicenter retrospective study from 49 children's hospitals, dexamethasone prescribing rates appear increasing for pediatric critical asthma. Observed variability in corticosteroid prescribing implies a continued need for controlled prospective comparative analyses to define ideal corticosteroid regimens for pediatric critical asthma.
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Affiliation(s)
- Austin R Sellers
- Institute for Clinical and Translational Research, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Meghan R Roddy
- Department of Pharmacy, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Kristina K Darville
- Department of Medicine, Division of Pediatric Critical Care Medicine, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Beatriz Sanchez-Teppa
- Department of Medicine, Division of Pediatric Critical Care Medicine, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Scott D McKinley
- Department of Medicine, Division of Pediatric Pulmonology and Sleep Medicine, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Anthony A Sochet
- Institute for Clinical and Translational Research, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Medicine, Division of Pediatric Critical Care Medicine, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Anesthesiology and Critical Care Medicine, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Zheng X, Li C, Gao X. Overexpression of miR‑375 reverses the effects of dexamethasone on the viability, migration, invasion and apoptosis of human airway epithelial cells by targeting DUSP6. Int J Mol Med 2022; 49:26. [PMID: 35014672 PMCID: PMC8788922 DOI: 10.3892/ijmm.2022.5081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/03/2021] [Indexed: 11/09/2022] Open
Abstract
Airway epithelial cell (AEC) dysfunction has been proven to be involved in the pathogenesis of asthma, which may be induced by the use of dexamethasone (Dex). The altered expression of microRNAs (miRNAs/miRs) has been found in asthma. However, the detailed mechanisms responsible for the effects of miR-375 on Dex-induced AEC dysfunction remain elusive. Thus, the present study aimed to elucidate these mechanisms. Following treatment with Dex for 0, 6, 12 and 24 h, AEC viability, migration, invasion and apoptosis were examined using Cell Counting Kit-8 (CCK-8), wound healing and Transwell assays, and flow cytometry, respectively. The expression levels of miR-375, dual specificity phosphatase 6 (DUSP6) and apoptosis-related proteins (Bcl-2, Bax, cleaved caspase-3) were measured using reverse transcription-quantitative polymerase chain reaction and western blot analysis. The target genes and potential binding sites of miR-375 and DUSP6 were predicted using TargetScan and confirmed using dual-luciferase reporter assay. The viability, migration, invasion and apoptosis of Dex-treated AECs were further assessed with or without miR-375 and DUSP6. In the AECs (9HTE cells), Dex treatment suppressed cell viability and miR-375 expression, whereas it promoted cell apoptosis and the expression of DUSP6, the target gene of miR-375. The overexpression of miR-375 reversed the effects of Dex treatment on miR-375 expression, cell viability, migration and invasion, and apoptosis-related protein expression; in turn, these effects were reversed by the overexpression of DUSP6, with the exception of miR-375 expression. On the whole, the present study demonstrates that the overexpression of miR-375 counteracts the effects of Dex treatment on AEC viability, migration, invasion and apoptosis by targeting DUSP6. Thus, it was suggested that the downregulated expression of miR-375 may be a therapeutic target for AEC dysfunction.
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Affiliation(s)
- Xiaojing Zheng
- Department of Pediatrics, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Chunlian Li
- Department of Pediatrics, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Xiang Gao
- Department of Cardiology, Fangzi District People's Hospital, Weifang, Shandong 261206, P.R. China
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11
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Hemani SA, Glover B, Ball S, Rechler W, Wetzel M, Hames N, Jenkins E, Lantis P, Fitzpatrick A, Varghese S. Dexamethasone Versus Prednisone in Children Hospitalized for Acute Asthma Exacerbations. Hosp Pediatr 2021; 11:1263-1272. [PMID: 34610967 DOI: 10.1542/hpeds.2020-004788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Extensive literature supports using dexamethasone (DEX) in children presenting to the emergency department (ED) with mild-to-moderate asthma exacerbations; however, only limited studies have assessed this in hospitalized children. In this study, we evaluate the outcomes of DEX versus prednisone/prednisolone (PRED) use in children hospitalized for mild-to-moderate asthma exacerbations. METHODS This multisite retrospective cohort study included children between 3 and 21 years of age hospitalized to a tertiary care children's hospital system between January 1, 2013, and December 31, 2017, with a primary discharge diagnosis of acute asthma exacerbation or status asthmaticus. Primary study outcome was mean hospital length of stay (LOS). Secondary outcomes included PICU transfers during initial hospitalization and ED revisits and hospital readmissions within 10 days after discharge. Generalized linear models were used to model logged LOS as a function of steroid and demographic and clinical covariates. The analysis was stratified by initial steroid timing. RESULTS Of the 1410 children included, 981 received only DEX and 429 received only PRED. For children who started oral steroids after hospital arrival, DEX cohort had a significantly shorter adjusted mean hospital LOS (DEX 24.43 hours versus PRED 29.38 hours; P = .03). For children who started oral steroids before hospital arrival, LOS did not significantly differ (DEX 26.72 hours versus PRED 25.20 hours; P = .45). Rates of PICU transfers, ED revisits, and hospital readmissions were uncommon events. CONCLUSION Children hospitalized with mild-to-moderate asthma exacerbations have significantly shorter hospital LOS when starting DEX rather than PRED on admission.
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Affiliation(s)
- Sunita Ali Hemani
- Division of Hospital Medicine .,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Brianna Glover
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Samantha Ball
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Willi Rechler
- Rollins School of Public Health and Emory University School of Medicine, Atlanta, Georgia
| | - Martha Wetzel
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nicole Hames
- Division of Hospital Medicine.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Elan Jenkins
- Division of Hospital Medicine.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Patricia Lantis
- Division of General Pediatrics and Adolescent Medicine.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Anne Fitzpatrick
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep.,Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Varghese
- Division of Hospital Medicine.,Children's Healthcare of Atlanta, Atlanta, Georgia
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12
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Vohra M, Sharma AR, Satyamoorthy K, Rai PS. Pharmacogenomic considerations for repurposing of dexamethasone as a potential drug against SARS-CoV-2 infection. Per Med 2021; 18:389-398. [PMID: 34086487 PMCID: PMC8186476 DOI: 10.2217/pme-2020-0183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
Immunomodulatory and analgesic effects of dexamethasone are clinically well established, and this synthetic corticosteroid acts as an agonist of glucocorticoid receptors. Early results of the RECOVERY Trial from the United Kingdom and others suggest certain benefits of dexamethasone against COVID-19 chronic patients. The efforts have been acknowledged by World Health Organization with an interim guideline to use in patients with a severe and critical illness. The inherent genetic variations in genes such as CYP3A5, NR3C1, NR3C2, etc., involved in the pharmacokinetic and pharmacodynamic processes may influence dexamethasone's effects as an anti-inflammatory drug. Besides, the drug may influence transcriptome or metabolic changes in the individuals. In the present review, we summarize the reported genetic variations that impact dexamethasone response and discuss dexamethasone-induced changes in transcriptome and metabolome that may influence potential treatment outcome against COVID-19.
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Affiliation(s)
- Manik Vohra
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Anu Radha Sharma
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Kapaettu Satyamoorthy
- Department of Cell & Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Padmalatha S Rai
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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13
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Peterson R, Young KD. Dexamethasone Versus Prednisone for Pediatric Acute Asthma Exacerbations: Specialists' Practice Patterns. Pediatr Emerg Care 2021; 37:343-347. [PMID: 32149997 DOI: 10.1097/pec.0000000000002036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Dexamethasone has emerged as a viable alternative to prednisone in the treatment of pediatric acute asthma exacerbations, with the potential for improved compliance secondary to decreased frequency of dosing, improved taste, and decreased cost. The objective of this study is to identify whether providers are prescribing dexamethasone for pediatric acute asthma exacerbations. Secondary objectives are to describe variation in practice between different specialties and to identify the commonly used dosing and frequency for dexamethasone. METHODS We conducted a cross-sectional, descriptive study with an anonymous, web-based survey (surveymonkey.com). The survey population included all fellowship program directors listed on FRIEDA Online for pediatric emergency medicine, pediatric pulmonology, and allergy and immunology, and emergency medicine residency directors through the Council of Emergency Medicine Residency Directors listserv. Program directors were contacted via e-mail up to 5 times for 3 months. RESULTS Overall, 300 respondents (70% of the program directors) completed the survey. Response rates by specialty varied from 60% to 94%. One third of providers are using dexamethasone, whereas just more than half of providers (51%) are prescribing a 5-day prednisone course. The preferred maximum dose for dexamethasone is 10 mg (45%), with 82% using a dose of 0.6 mg/kg.Pediatric emergency medicine fellowship directors demonstrated a preference for dexamethasone (59%). Prednisone is favored by emergency medicine (56%), pediatric pulmonology (89%), and allergy and immunology (93%) program directors. CONCLUSIONS Although most pediatric emergency medicine academic physicians have transitioned to using dexamethasone to treat acute pediatric asthma exacerbations, other specialties continue to favor prednisone.
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Affiliation(s)
- Robert Peterson
- From the Department of Pediatrics, Division of Emergency Medicine and Emergency Department, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
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14
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Ewulonu UC, Dyer H. Inpatient management of an acute asthma exacerbation using clinical care pathways. Curr Probl Pediatr Adolesc Health Care 2021; 51:100995. [PMID: 34053850 DOI: 10.1016/j.cppeds.2021.100995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma exacerbations remain a leading cause of hospitalization in the pediatric population, and many children who require hospitalization for status asthmaticus are managed using clinical care pathways (CPGs). Clinical care pathways are often created or adopted by healthcare systems in order to establish specific, evidence-based guidelines that standardize and coordinate quality care in both the emergency room and inpatient settings. This paper reviews the use of these guidelines and the updated evidence-based recommendations regarding best-practice for acute asthma care of hospitalized children, including the 2020 recommendations from the National Asthma Education and Prevention Program Expert Panel (NAEPP).
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Affiliation(s)
- Uchenna C Ewulonu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
| | - Heather Dyer
- Dayton Children's Hospital, Assistant Professor in Pediatrics, Boonshoft School of Medicine at Wright State University, Dayton, OH, USA
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15
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Adikwu E, Ezerioha CE, Kemelayefa J. Dexamethasone Attenuates Cyclophosphamide-induced Hepatotoxicity in Albino Rats. EGYPTIAN JOURNAL OF BASIC AND CLINICAL PHARMACOLOGY 2020. [DOI: 10.32527/2020/101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elias Adikwu
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Niger Delta University, Bayelsa State, Nigeria
| | - Chidi Emmanuel Ezerioha
- Department of Pharmacology, Faculty of Basic Medical Sciences, University of Port Harcourt, Rivers State, Nigeria
| | - James Kemelayefa
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Niger Delta University, Bayelsa State, Nigeria
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16
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DeLaroche AM, Mowbray F, Parker SJ, Ravichandran Y, Jones A. Clinical factors associated with the use of dexamethasone for asthma in the pediatric emergency department. J Asthma 2020; 58:1581-1588. [PMID: 32876509 DOI: 10.1080/02770903.2020.1817938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dexamethasone is efficacious for the treatment of pediatric asthma exacerbations but is not specifically recommended by current national guidelines. OBJECTIVES To describe the factors associated with prescribed dexamethasone in a pediatric emergency department (PED) and upon patient discharge. METHODS Retrospective chart review of patients aged 2 to 18 years discharged home from a PED with a diagnostic code for asthma (J45x). Descriptive statistics are reported and binary logistic regression with generalized estimating equations was used to examine the demographic and clinical factors associated with dexamethasone use in the PED and upon discharge. RESULTS 594 children contributed 690 visits for asthma. Two-thirds of patients received prednisone in the PED (n = 430; 62%). Among 260 children who received dexamethasone, 76% (n = 198) were prescribed a second dose for post-discharge administration. Multivariable models showed that patients triaged as most urgent had a 50% reduction in the odds of receiving dexamethasone in the PED (OR = 0.5; 95% CI = 0.28-0.87). Patients seen by a pediatrician (OR 4.2; 95%CI 2.1-8.3) and those triaged as urgent (OR 2.9; 95% CI = 1.8-7.8) were more likely to receive a single dose of dexamethasone. CONCLUSIONS Dexamethasone is less commonly used in the PED for asthmatic patients triaged as most urgent. Triage acuity and level of training were associated with single-dose treatment of asthma in those receiving dexamethasone. Further studies are needed to clarify the use of dexamethasone across the spectrum of asthma severity.
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Affiliation(s)
- Amy M DeLaroche
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Fabrice Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Sarah J Parker
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, ON, Canada
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17
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Wu YF, Chen YQ, Li Q, Ye XY, Zuo X, Shi YL, Guo XY, Xu L, Sun L, Li CW, Yang Y. Supplementation with Tetrahydrocurcumin Enhances the Therapeutic Effects of Dexamethasone in a Murine Model of Allergic Asthma. Int Arch Allergy Immunol 2020; 181:822-830. [PMID: 32784298 DOI: 10.1159/000509367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tetrahydrocurcumin (THC) is the major active metabolite of curcumin, which is a dietary factor derived from Curcuma species. Our previous study demonstrated a significant beneficial effect of THC in mice with allergic asthma. Glucocorticosteroids (GCs) are commonly used drugs in asthma. Whether THC supplementation could promote the beneficial effects of GC therapy on asthma has not yet been reported. The current study aimed to investigate the combined efficacy of GC and THC treatment in a mouse model of allergic asthma. METHODS BALB/c mice were randomly divided into 5 groups: the control group, ovalbumin (OVA)-induced group, and OVA-induced mice treated with dietary THC only, intraperitoneal injection of dexamethasone (DEX) only, or THC combined with DEX. The nasal symptoms, histopathological alterations of lung tissues, lung cytokine production, and Th cell subsets were assessed. RESULTS THC or DEX had beneficial effects on nasal symptoms and pathological lung changes, and the therapeutic effects between THC and DEX treatment were comparable. Importantly, compared to the monotherapy groups (THC or DEX only), the combination of THC and DEX showed a significantly reduced nasal rubbing frequency, lower mucus hyperproduction, lower Th2 and Th17 cell numbers as well as lower related cytokine levels (IL-4, IL-5, and IL-17A). CONCLUSIONS Supplementation with THC can enhance the therapeutic effects of DEX to alleviate airway symptoms, lung inflammation, and the Th2 response. Our findings suggest that dietary administration of THC could act as an add-on therapy for asthma treated with GCs.
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Affiliation(s)
- Yin Fan Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University (Guangzhou Campus), Guangzhou, China.,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Yan Qiu Chen
- Department of Otolaryngology, Guangzhou Women and Children Medical Centre, Guangzhou, China
| | - Qin Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University (Guangzhou Campus), Guangzhou, China.,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xiao Yan Ye
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Zuo
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University (Guangzhou Campus), Guangzhou, China.,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yi Lin Shi
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University (Guangzhou Campus), Guangzhou, China.,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Xing Yue Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University (Guangzhou Campus), Guangzhou, China.,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Lin Xu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University (Guangzhou Campus), Guangzhou, China.,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Lin Sun
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chun Wei Li
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,
| | - Yan Yang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University (Guangzhou Campus), Guangzhou, China.,Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China.,School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
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18
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Ardila CM, Álvarez-Martínez E. A Case Report of a Lingual Cyst Lined by Respiratory Epithelium in a Child. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2020; 13:1179547620919695. [PMID: 32528226 PMCID: PMC7263107 DOI: 10.1177/1179547620919695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
The lingual cyst lined by respiratory epithelium is a rare pathology. It probably appears from the default of undifferentiated cells of the foregut during embryonic growth. This pathology is seen more often in males and children; however, only 5 patients younger than 4 years old have been reported. The pathophysiology and the management of this cyst were described in a 4-year-old girl. She presented with a soft mass on the dorsum of the tongue covered by normal mucosa, which existed since her birth, causing difficulty in eating, breathing, and talking. The magnetic resonance described a hyperintense image with an anteroposterior diameter of 27 mm, craniocaudal of 19 mm, and transversal of 26 mm in the midline groove of the tongue; the scintigraphy showed normality. The enucleation of the lesion was performed, eradicating the capsule of the cyst and obtaining a complete cleavage. The histopathologic examination defined a cyst lined predominantly by respiratory epithelium. Unlike in other cases, in this case their cystic lining and capsular constituents were contemplated considering the current histological recommendations. It is relevant to differentiate this pathology from other cysts with similar histological findings.
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Affiliation(s)
- Carlos-Martín Ardila
- Biomedical Stomatology Research Group, Universidad de Antioquia, Medellín, Colombia.,Basic Sciences Department, Faculty of Dentistry, Universidad de Antioquia, Medellín, Colombia
| | - Efraín Álvarez-Martínez
- Basic Sciences Department, Faculty of Dentistry, Universidad de Antioquia, Medellín, Colombia
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19
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Heck SO, Zborowski VA, Pinton S, Nogueira CW. Pro-apoptotic cell signaling in the prefrontal cortex contributes to depressive-/anxiogenic-like behavioral phenotype of mice subchronically exposed to dexamethasone. J Chem Neuroanat 2019; 100:101663. [PMID: 31374258 DOI: 10.1016/j.jchemneu.2019.101663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Suélen Osório Heck
- Laboratory of Synthesis, Reactivity, Pharmacological and Toxicological Evaluation of Organochalcogen Compounds, Department of Biochemistry and Molecular Biology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, 97105-900, Brazil
| | - Vanessa Angonesi Zborowski
- Laboratory of Synthesis, Reactivity, Pharmacological and Toxicological Evaluation of Organochalcogen Compounds, Department of Biochemistry and Molecular Biology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, 97105-900, Brazil
| | - Simone Pinton
- Federal University of Pampa, Campus Uruguaiana, RS, 97500-701, Brazil
| | - Cristina Wayne Nogueira
- Laboratory of Synthesis, Reactivity, Pharmacological and Toxicological Evaluation of Organochalcogen Compounds, Department of Biochemistry and Molecular Biology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, 97105-900, Brazil.
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20
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Villegas M, Cid AG, Briones CA, Romero AI, Pistán FA, Gonzo EE, Gottifredi JC, Bermúdez JM. Films based on the biopolymer poly(3-hydroxybutyrate) as platforms for the controlled release of dexamethasone. Saudi Pharm J 2019; 27:694-701. [PMID: 31297024 PMCID: PMC6598214 DOI: 10.1016/j.jsps.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 11/18/2022] Open
Abstract
Controlled drug delivery aims to achieve an effective drug concentration in the action site for a desired period of time, while minimizing side effects. In this contribution, biodegradable poly(3-hydroxybutyrate) films were evaluated as a reservoir platform for dexamethasone controlled release. These systems were morphological and physicochemically characterized. In vitro release assays were performed for five different percentages of drug in the films and data were fitted by a mathematical model developed and validated by our research group. When the profiles were normalized, a single curve properly fitted all the experimental data. Using this unique curve, the dissolution efficiency (DE), the time to release a given amount of drug (tX% ), and the mean dissolution time were calculated. Furthermore, the dissolution rate, the initial dissolution rate (a%) and the intrinsic dissolution rate were determined. The a% mean value was 1.968 × 10-2% released/min, t80% was about 14 days, and the DE was 59.6% at 14 days and 66.5% at 20 days. After 2 days, when approximately 40% of the drug was released, the dissolution rate decreased about 60% respect to the initial value. The poly(3-hydroxybutyrate) platforms behaved as an appropriate system to release and control the dexamethasone delivery, suggesting that they could be an alternative to improve drug therapy.
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Affiliation(s)
- Mercedes Villegas
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, Salta Capital 4400, Argentina
| | - Alicia Graciela Cid
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, Salta Capital 4400, Argentina
| | - Cintia Alejandra Briones
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
| | - Analía Irma Romero
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, Salta Capital 4400, Argentina
| | - Florencia Alejandra Pistán
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, Salta Capital 4400, Argentina
| | - Elio Emilio Gonzo
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, Salta Capital 4400, Argentina
| | - Juan Carlos Gottifredi
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, Salta Capital 4400, Argentina
| | - José María Bermúdez
- Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, Salta Capital 4400, Argentina
- Corresponding author at: Instituto de Investigaciones para la Industria Química, Universidad Nacional de Salta – Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Bolivia 5150, Salta Capital 4400, Argentina.
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21
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Volk AS, Marton SA, Richardson BS, Rauda L, Schwarzwald HL, Naik NM. Oral Dexamethasone to Control Wheezing in Children at an Outpatient Clinic. Clin Pediatr (Phila) 2019; 58:151-158. [PMID: 30378445 DOI: 10.1177/0009922818809466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma, a chronic childhood disease, has resulted in increased emergency department (ED) visits with high costs. Many asthma ED visits are nonemergent and could be treated in outpatient clinics. Literature has concluded that a 2-day course of oral dexamethasone has comparable outcomes to a 5-day course of prednisone in the ED and hospital setting. A retrospective chart review was performed on children requiring in-house treatment with a corticosteroid (dexamethasone n = 23, prednisone n = 40) for acute asthma exacerbations at an ambulatory medical home. The rates of hospital admissions, ED visits, and symptom follow-up were similar between the 2 groups ( P > .05). The cost for a course of dexamethasone was US$1.28 versus US$16.20 for prednisolone. The average cost for an asthma exacerbation office visit was US$79.89 compared with US$3113.28 for an ED visit. A 2-day course of oral dexamethasone appears to be a promising clinical and cost-effective treatment for acute asthma exacerbations at the primary care level.
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Affiliation(s)
| | | | | | - Luis Rauda
- 3 Texas Children's Health Plan, Bellaire, TX, USA
| | | | - Neel M Naik
- 2 Baylor College of Medicine, Houston, TX, USA
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22
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Abaya R, Delgado EM, Scarfone RJ, Reardon AM, Rodio B, Simpkins D, Mehta V, Hayes K, Zorc JJ. Improving efficiency of pediatric emergency asthma treatment by using metered dose inhaler. J Asthma 2018; 56:1079-1086. [PMID: 30207821 DOI: 10.1080/02770903.2018.1514629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Evidence suggests using metered dose inhaler (MDI) to treat acute asthma in the Emergency Department reduces length of stay, though methods of implementation are lacking. We modified a treatment pathway to recommend use of MDI for mild-moderate asthma in a pediatric ED. Methods: A baseline review assessed discharged patients >2 years with an asthma diagnosis and non-emergent Emergency Severity Index triage assessment (3/4). Our multi-disciplinary team developed an intervention to increase MDI use instead of continuous albuterol (CA) using the following: (1) Redesign the asthma pathway and order set recommending MDI for ESI 3/4 patients. (2) Adding a conditional order for Respiratory Therapists to reassess and repeat MDI until patient reached mild assessment. The primary outcome was the percentage discharged within 3 hours, with a goal of a 10% increase compared to pre-intervention. Balancing measures included admission and revisit rates. Results: 7635 patients met eligibility before pathway change; 12,673 were seen in the subsequent 18 months. For target patients, the percentage discharged in <3 hours increased from 39% to 49%; reduction in median length of stay was 33 minutes. We identified special cause variation for reduction in CA use from 43% to 25%; Revisit rate and length of stay for higher-acuity patients did not change; overall asthma admissions decreased by 8%. Changes were sustained for 18 months. Conclusion: A change to an ED asthma pathway recommending MDI for mild-moderate asthma led to a rapid and sustained decrease in continuous albuterol use, length of stay, and admission rate.
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Affiliation(s)
- Ruth Abaya
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Eva M Delgado
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard J Scarfone
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ann Marie Reardon
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bonnie Rodio
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Denise Simpkins
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vaidehi Mehta
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katie Hayes
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph J Zorc
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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23
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Abstract
Asthma still causes considerable morbidity and mortality globally and minimal improvement has been seen in key outcomes over the last decade despite increasing treatment costs. This review summarizes recent advances in the management of asthma in children and adolescents. It focuses on the need for personalized treatment plans based on heterogenous asthma pathophysiology, the use of the terminology 'asthma attack' over exacerbation to instill widespread understanding of severity, and the need for every attack to trigger a structured review and focused strategy. The authors discuss difficulties in diagnosing asthma, accuracy and use of Fractional exhaled nitric oxide both as second line test and as a method to monitor treatment adherence or guide the choice of pharmacotherapy. The authors discuss acute and long-term management of asthma. Asthma treatment goals are to minimize symptom burden, prevent attacks and (where possible) reduce risk and impact of progressive pathophysiology and adverse outcomes. The authors discuss pharmacological management; optimal use of short acting β2 agonists, long acting muscarinic antagonist (tiotropium), use of which is relatively new in pediatrics, allergen specific immunotherapy, biological monoclonal antibody treatment, azalide antibiotic azithromycin, and the use of vitamin D. They also discuss electronic monitoring and adherence devices, direct observation of therapy via mobile device, temperature controlled laminar airflow device, and the importance of considering when symptoms may actually result from dysfunctional breathing rather than asthma.
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Affiliation(s)
- Atul Gupta
- Department of Pediatric Respiratory Medicine, NHS Foundation Trust, King's College Hospital, Denmark Hill, London, UK.
- King's College London, London, UK.
| | | | - Paolo Pianosi
- Department of Pediatric Respiratory Medicine, NHS Foundation Trust, King's College Hospital, Denmark Hill, London, UK
- King's College London, London, UK
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