Ten new studies were identified so a total of 34 studies (3033 total participants) were included in the 2015 review update. The risk of bias attributes were frequently poorly performed. Low risk of bias was reported in 18 studies for sequence generation, 16 studies for allocation concealment , seven for performance and detection bias , 15 for incomplete reporting and 16 for selective reporting. Three months or more of prednisone significantly reduced the risk of frequently relapsing nephrotic syndrome (FRNS) (6 studies, 582 children: RR , 95% CI to ) and of relapse by 12 to 24 months (8 studies, 741 children: RR , 95% CI to ) compared with two months. Five or six months of prednisone significantly reduced the risk of relapse (7 studies, 763 children: RR , 95% CI to ) but not FRNS (5 studies, 591 children: RR , 95% CI to ) compared with three months. However there was significant heterogeneity in the analyses. Subgroup analysis stratified by risk of bias for allocation concealment showed that the risk for FRNS did not differ significantly between two or three months of prednisone and three to six months among studies at low risk of bias but was significantly reduced in extended duration studies compared with two or three months in studies at high risk or unclear risk of bias . There were no significant differences in the risk of adverse effects between extended duration and two or three months of prednisone. Four studies found that in children with FRNS, daily prednisone during viral infections compared with alternate-day prednisone or no treatment significantly reduced the rate of relapse .
Corticosteroids are useful in the treatment of both allergic and idiosyncratic asthma. Although the mechanisms of corticosteroid action in asthma are poorly understood, several possible sites of action have been proposed. Corticosteroids alter the cellular and vascular inflammatory response to bronchial injury, affect catecholamine action on airways, and alter the production of eicosanoids, all of which aid in the resolution of bronchospasm in asthmatic patients. Corticosteroids should only be used for the treatment of asthma after therapeutic levels of methylxanthines and beta agonists have been achieved. Although the optimal doses of corticosteroids in asthma have not been defined, guidelines exist to aid in therapy. In the treatment of status asthmaticus, the intravenous route of administration is preferable. Short courses of corticosteroids may be useful in the treatment of chronic asthma. When long-term corticosteroid therapy is the only option for control of bronchospasm, alternate-day and/or aerosolized corticosteroids are preferable to daily corticosteroids and are associated with fewer side effects. Corticosteroids are useful in the pregnant asthmatic patient when bronchospasm cannot be controlled with bronchodilators. The major risk to the fetus in pregnant asthmatics is hypoxia from uncontrolled bronchospasm, and not from therapy. However, the lowest possible dose of systemic corticosteroids needed to control symptoms, with or without the use of aerosolized corticosteroids, is recommended. All asthmatics who have needed systemic or aerosolized corticosteroids within 6 months prior to surgery should receive preoperative and post-operative corticosteroid therapy. For patients not usually on systemic corticosteroids, conversion to oral prednisone, with a rapid taper is recommended. Side effects from short-term corticosteroid therapy are minimal, with hyperglycemia and psychosis being the major concerns. Long-term steroid therapy has significant side effects, however, and use should be minimized. Suppression of the HPA axis is one of the most potentially dangerous side effects of corticosteroids, and therefore any patient who has been treated with corticosteroids for longer than 4 weeks should be evaluated for possible adrenal suppression.
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