Background: Budesonide was effective in treating and keeping short-term remission with a fewer steroidspecific side effects in contrast to prednisone. Contradicting outcomes were detailed on the efficiency of budesonide in the management of Autoimmune Hepatitis. This review aiming at evaluating the use of budesonide for the treatment of autoimmune hepatitis. Methods: An electronic search was conducted in MEDLINE and EMBASE using these keywords steroids, autoimmune, liver, effectiveness, and side effects. The search was limited to clinical setting which resulted in 24 clinical studies. Results: The total number of AIH patients included in this review were 386 of which 304 females (78.7%), the sample size ranged from 9 patients to 207 and the mean age ranged from 13 years in to 54. Concerning the efficacy of Budesonide, it ranged from 15% to 78% as the end points were different among the included studies. Regarding the tolerability and side effects like Moon faces or cushingoid features, acne, heartburn, hirsutism, alopecia, osteoporosis, diabetes mellitus and easy bruising. Side effects reported in X studies and the incidence ranged from 28% to 56%. Conclusion: Budesonide could be a promising treatment option especially in patients prone to corticosteroid side effects like elderly individuals and postmenopausal women with high risk for osteoporosis or children with risk for impaired growth.
The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and predominantly manifests with respiratory symptoms. However, it may have a wide range of complications, including hematological complications. Several studies demonstrated that patients with COVID-19 exhibit a wide range of complex abnormalities of the coagulation system. We report the case of a 22-year-old man who presented to our emergency department with a cough and fever for one week. His vital signs were normal. Since the patient was young and mildly symptomatic, he was offered the option of home isolation for seven days. Two weeks later, the patient presented to the emergency department complaining of sudden shortness of breath that was associated with chest pain. The oxygen saturation was 92% on room air. The patient underwent computed tomography pulmonary angiography. The scan showed a centric filling defect in the main right and left pulmonary arteries representing pulmonary embolism. Further, the scan showed a thrombus in the inferior vena cava that was the source of bilateral pulmonary embolism. The patient was admitted to the intensive care unit. He received full anticoagulation with heparin. After recovery, he underwent a thrombophilia screen, which yielded normal findings. The present case demonstrated that thromboembolic events may develop even after the recovery from mild COVID-19 pneumonia. In the appropriate clinical settings, physicians should maintain a high index of suspicion of coagulopathy in any patient with recent COVID-19 pneumonia. Further studies are needed to determine the indication and duration of the thromboprophylaxis following the recovery from COVID-19.
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