UNASSIGNED: Adrenal insufficiency is a rare chronic disease with a prevalence of 39 to 60 cases per million peoples in Europe. However, the prevalence is higher in sub-saharian Africa. The occurrence of pregnancy in adrenal insufficiency is rare but associated with high maternal and perinatal morbidity and mortality. For this reason, the management of pregnancy in adrenal insufficiency patient must be provided by a multidisciplinary team.
UNASSIGNED: The authors report the case of a 34-year-old pregnant woman followed for adrenal insufficiency secondary to prolonged corticosteroid therapy. Treatment consisted to an obstetrical and endocrinological follow-up and corticosteroid replacement therapy with hydrocortisone. A prophylactic cesarean section at 38 weeks resulted in the birth of a newborn male weighing 3395 g. Maternal and perinatal prognosis was good.
UNASSIGNED: Pregnancy in adrenal insufficiency is a therepeutic challenge in developing countries. Through this case, the authors discuss the therapeutic and prognostic aspects of adrenal insufficiency in our setting.
UNASSIGNED: With the introduction of gluco-corticosteroid replacement therapy, pregnancy in adrenal insufficiency can progress normally.

Fibrosing mediastinitis is a rare entity generally caused by granulomatous disease. Most cases develop as a complication of histoplasmosis. Association with tuberculosis has been rarely documented. We report the case of 3 young patients who presented with superior vena cava syndrome several years after treated tuberculosis. Biological, radiological, and histological investigations led to the diagnosis of fibrosing mediastinitis.

WHAT ARE THE INDICATIONS FOR CORTICOSTEROID THERAPY IN COPD? In stable state chronic obstructive pulmonary disease (COPD), inhaled corticosteroids (ICS) should be used in case of frequent exacerbation only, associated with long-term bronchodilators including long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA). When frequent exacerbations persist despite dual inhaled therapy (LABA + CSI or LABA+LAMA), triple inhaled therapy (LAMA+LABA+CSI) is indicated. In COPD exacerbation, the level of evidence for systemic corticosteroids is very low, justifying not to systematically prescribe systemic corticosteroids and when used to restrict this use to short-term (5 days) and low doses.
QUELLES SONT LES INDICATIONS POUR LA CORTICOTHÉRAPIE DANS LA BPCO ? Dans la bronchopneumopathie chronique obstructive (BPCO) à l’état stable, les corticostéroïdes inhalés (CSI) ne sont à utiliser qu’en cas d’exacerbations fréquentes, en association avec des bronchodilatateurs de longue durée d’action de type bêta-2-agoniste de longue durée d’action (LABA) et anticholinergique de longue durée d’action (LAMA). En cas de persistance d’exacerbations fréquentes malgré une bithérapie inhalée (LABA-CSI ou LAMA-LABA), une triple thérapie (LAMA-LABA CSI) peut être proposée. En cas d’exacerbation de BPCO, le niveau de preuve de la corticothérapie systémique est faible, justifiant ne pas recourir à ce traitement de façon systématique ou de le réaliser en cures courtes (cinq jours) et à faibles doses quand il est prescrit.

Horton\'s disease is the most common inflammatory disease of the vessels after the age of 50 years. We report here the caseof a 64-year-old male, who presented a chronic frontal headache resistant to usual analgesics. Physical examination found pain on bitemporal pressure, a slight induration of temporal arteries and a bilateral decreased temporal pulse. Biological inflammatory testing was normal. However, Doppler ultrasound revealed bilateral intimal infiltration of the temporal artery, supporting the diagnosis of Horton\'s disease. Put on corticoids, headaches were completely resolved.
La maladie de Horton (MH) est la plus fréquente des maladies inflammatoires des vaisseaux après l’âge de 50 ans.Nous rapportons le cas d’un patient de 64 ans, ayant présenté une céphalée frontale, d’aggravation progressive etrebelle aux antalgiques usuels. L’examen physique a retrouvé une douleur à la pression bitemporale, une légère induration et une diminution des pouls temporaux de façon bilatérale. Le bilan biologique inflammatoire est revenu normal. Par contre, l’échographie doppler a mis en évidence une infiltration intimale bilatérale de l’artère temporale en faveur de la MH. Mis sous corticothérapie, le patient a rapporté une disparition des céphalées.

暂无摘要。

BACKGROUND: Rheumatoid arthritis is an inflammatory disease with joint manifestations. In the presence of extra-articular manifestations, the morbidity and severity of the disease increase. Glucocorticoid is used as a treatment and may result in side effects related to cardiovascular risk.
METHODS: This was a cross-sectional study including 59 volunteers with rheumatoid arthritis receiving treatment at a hospital of Campos Gerais that aimed to establish the relation between cardiovascular risk, glucocorticoid treatment and myeloperoxidase in these patients. Subjects were divided into two groups: using (n = 39) and without glucocorticoids (n = 20). They underwent clinical evaluation, physical examination and blood samples were taken. Statistical analysis was performed using Student\'s t test and Mann-Whitney test. Logistic regression was performed to assess the cardiovascular risk. The significance level was 5% (α = 0.05). Calculations were performed using the Statistical Package for the Social Science version 21.0.
RESULTS: There has been a significant difference between groups in blood glucose values (p = 0.012), which can be explained by the different percentage of diabetic patients in the groups. When assessing cardiovascular risk using the predictors of glucocorticoid dose, time of glucocorticoid use, myeloperoxidase, and C-reactive protein together, these were responsible for significantly predicting this risk (p = 0.015).
CONCLUSIONS: A significant relation between the predictor myeloperoxidase alone was also demonstrated (p = 0.037), it may be an important predictor of cardiovascular risk among individuals with rheumatoid arthritis.

Side effects of long-term oral corticosteroid therapy. Systemic corticosteroid therapy has been used for over 70 years, and is still the cornerstone of the treatment of many conditions, in particular systemic, autoimmune or inflammatory diseases. Side effects of corticosteroids are numerous, and for most of them well known by prescribers. Nonetheless, guidelines for the prevention of corticosteroids toxicity are scarce, and the implementation of protective measures by prescribers is heterogenous. Hence, corticosteroids related complications entail a significant morbidity, which, importantly, could be largely prevented. We conducted therefore a systematic literature, through the Medline database, the Cochrane database and the grey literature until January 2021. After recalling the history of the discovery of corticosteroid therapy and its main pharmacological properties, we present the various complications associated with long-term corticosteroid therapy, and discuss the relevance of the preventive measures that may be proposed in daily practice in the light of available scientific evidence. This work highlights the importance of multidisciplinary follow-up, but above all of a thorough screening of the risk factors of complications at treatment initiation, and of a repeated evaluation of the complications all along the treatment course, in order to reduce the significant burden of morbidity associated with long-term corticosteroid therapy and to improve patient quality of life.
Effets indésirables de la corticothérapie orale au long cours. La corticothérapie systémique est utilisée depuis plus de 70 ans et reste la pierre angulaire du traitement de nombreuses affections. Ses effets indésirables sont nombreux et, pour la plupart, bien connus. Pour autant, les recommandations concernant leur prévention sont parfois manquantes, et souvent hétérogènes, y compris dans leur mise en œuvre par les prescripteurs. De ce fait, les complications induites par la corticothérapie sont à l’origine d’une morbidité importante, la plupart du temps évitables. Nous avons donc réalisé une revue systématique de la littérature, à travers les bases Medline, Cochrane et la littérature grise, jusqu’à janvier 2021. Après avoir rappelé l’histoire de la découverte de la corticothérapie et ses principales caractéristiques pharmacologiques, nous présentons les différentes complications associées à une corticothérapie au long cours et les mesures de prévention disponibles, en discutant leur efficacité et leur pertinence à la lumière des recommandations actuelles ou, à défaut, des dernières données scientifiques disponibles. Ce travail met en évidence l’importance du suivi multidisciplinaire des patients traités par corticothérapie systémique au long cours, mais surtout celle d’un dépistage préalable des facteurs associés à la survenue de complications et de réévaluations répétées de ces complications sous traitement, afin de diminuer le poids très important de la morbidité qui y est associée et ainsi d’améliorer la qualité de vie des patients.

Since the first appearance of coronavirus disease 2019 (COVID-19), multiple studies have focused on this novel coronavirus. Within a few months, the clinical and paraclinical manifestations and the mechanisms by which these changes are induced were elaborated. Clinically, the virus mainly causes the common cold, but can also result in severe or fatal pneumonia/acute respiratory syndrome. Regarding the biological changes, similar to any other virus, it can lead to a reduced lymphocyte count. The second most common change is represented by a reduced thrombocyte count. Furthermore, most patients have blood clotting abnormalities, inflammatory syndrome, raised D-dimer and lactate dehydrogenase levels. Detection of immune thrombocytopenia in asymptomatic patients who tested positive for COVID-19 justifies the need to perform differential diagnosis and testing for COVID-19. Typically, patients with severe forms of COVID-19 develop mild thrombocytopenia, while severe thrombocytopenia is rarely reported. The aim of this case report was to present the situation in which one asymptomatic patient who tested positive for COVID-19 developed severe immune thrombocytopenia.

UNASSIGNED: There are few means to treat large keloid scars, as exeresis-even if partial-impedes direct closure without tension in the absence of a flap or a skin graft. This study evaluates the efficacy, indications for use and limitations of a new therapeutic protocol, combining an extralesional keloid excision left to heal by secondary intention with a paraffin dressing and glucocorticoid ointment, followed by monthly intrascar injections of corticosteroids upon full re-epithelialisation.
UNASSIGNED: A retrospective study of patients treated for keloid scars by using the new therapeutic protocol. Scars were categorised as either healed or recurring. Their recurrence was scored according to the changes in functional signs and the scar volume.
UNASSIGNED: A total of 36 scars were studied. The mean follow-up was 14.1 months. Healing occurred in a mean of 6.8 weeks. The mean surface area was 21.6cm2. Healing rate was 30.5%. Scar volume was improved in 60% of recurrent cases and functional signs in 56%. Based on adherence with the corticotherapy, two patient groups could be discerned. For patients in the \'adherent\' group, the healing rate was 40%, and scar volume was improved in 75% of recurrent cases and the functional signs in 83% of cases.
UNASSIGNED: The healing rate in this study was close to that reported in the literature. Excision-healing by secondary intention could therefore be offered to patients for whom adherence is uncertain. The protocol in this study offers a straightforward, fast, accessible solution that does not appear to entail any risk of additional keloids. It could potentially offer a treatment option in case of failure of other treatments, large keloid scars or scalp keloids.

The adrenal gland serve important roles in the modulation of the immune response, the adjustment of blood pressure, the stress reaction via glucocorticoids and the hydroelectrolytic balance via mineralocorticoids. Primary adrenal insufficiency, known as Addison disease, is characterized by a decrease in glucocorticoid secretion (cortisol) and, more rarely, by a hyposecretion of mineralocorticoids (aldosterone). The production of cortisol, which is a hormone that helps the body respond to stress, is regulated in the brain, the hypothalamus and the pituitary gland. The hypothalamus stimulates the pituitary gland to produce adrenocorticotropic hormone, which stimulates cortisol production from the adrenal gland. If left untreated, Addison disease has a high mortality rate. Corticotherapy used in the treatment of Addison disease is associated with a certain cardiovascular risk. The proatherogenic effect of corticoids is based on the chronic inflammatory response of the vascular wall to a series of events. The aim of the current case report was to review the pathophysiological mechanisms and interactions that may lead to the onset of acute coronary syndrome with ST elevation in a patient with Addison disease.