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Adulterants are often used to enhance, if not produce, the claimed effect of the product. Research indicates that mothers have an increased risk of breast cancer, daughters are at increased risk of clear cell adenocarcinoma and infertility, and sons are at increased risk of non-cancerous epididymal cysts. For many products, active ingredients have not been identified and the quantity needed to derive an effect has not been determined. Dietary supplement manufacturers are not legally required to use any standardization processes to ensure batch consistency of their products, nor is there any legal or regulatory definition for dietary supplement standardization. Use by Children Although dietary supplements are not necessary for most healthy children who consume a variety of foods,118 "many pediatric patients, especially those with chronic or recurrent conditions, use dietary supplements. Because it is not legally required, most dietary supplements have not been tested for safety or efficacy in children. The absorption, distribution, metabolism and excretion of dietary supplements differ in children and adults. In addition, "children may be particularly susceptible to the effects of dosing variations [because] of their smaller size and different capacity for detoxifying chemicals. Health Benefit Echinacea and chamomile, both used for respiratory disturbances, were the most frequently used herbs in a 2001 study of patients seen in the pediatric emergency department at the New York Methodist Hospital in Brooklyn. This adjuvant use could be dangerous because "antioxidants, such as Vitamins C and E, can reduce the effectiveness of chemotherapy [and because] children receiving anti-cancer medications-including cisplatin and anthracyclines-are especially susceptible to cardiac, neurological, and renal impairment. Enhancing Physical Appearance or Athletic Performance In one study American adolescents reported a higher prevalence of overweight than any of the European countries or Israel. Additionally, adolescents with eating disorders frequently use herbal supplements to control their weight. Advertisements for PediaLoss claimed that "children can enjoy their favorite foods but with slower absorption of carbohydrates and faster and safer fat burning without using stimulants. Creatine monohydrate (creatine) is one of the most popular dietary supplements used by male and female college athletes. The National Federation of State High School Associations warns coaches and school staff not to recommend or distribute any supplements to athletes, and lists creatine as a harmful substance. Although these alternatives "cannot meet the legal definition of a dietary supplement because they are not intended to supplement the diet, promote health or reduce the risk of disease,"157 some manufacturers market herbal products as safe sources of a natural high or euphoric feeling. The Partnership for a Drug Free America defines herbal ecstasy as a combination of herbs that are legal, inexpensive, and marketed as a natural high. Department of Health and Human Services161 selects herbs and active or toxic ingredients found in some herbs for study. These studies focus on characterization of potential adverse health effects, including reproductive toxicity, neurotoxicity, and immunotoxicity, as well as those associated with acute high dose exposure and chronic exposure to lower doses. Studies also look for possible herb/herb and herb/drug interactions and contraindications such as age and pregnancy. Aristolochic acid is found in all members of the aristolochia family of botanicals. Aristolochia plants and plant parts are often used as ingredients in traditional Chinese medicines. Often, because the Chinese names for different plants are similar, Aristolochia plants are substituted for other plants including stephania. Regulatory agencies in countries including Canada, France, Germany, Switzerland, and the United Kingdom have taken actions ranging from advising consumers about the potential risks of kava use to banning the sale of kava-containing products. Other dietary supplements, including comfrey, can endanger consumers long after they stop using the product. Teas, tablets, tinctures and lotions made from the root and leaves of the herb have been used for hundreds of years as blood purifiers, antiasthmatic agents, and ulcer remedies. A more common, current use of the herb is as an ingredient in oral anti-inflammatory supplements. In December 2003, Health Canada issued a statement advising consumers not to ingest products made with comfrey because they may contain the liver toxin echimidine. While some dietary supplements are proven to have beneficial health effects, others are known to cause serious harm.
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The other rare diseases may for instance be rare infectious diseases, rare cancers or rare auto-immune diseases. The 30 million Europeans and 25 million Americans suffering from a rare disease coincide with six to eight per cent of the total population. However today we still miss reliable quantitative data for the burden of disease even if it is generally known that people with a rare disease can suffer significantly. The authors concluded that inborn errors of metabolism constitute a highly heterogeneous category of rare diseases, representing a relevant cause of morbidity and mortality in childhood. For some monogenetic rare diseases not only the burden for the patients themselves but also in some regions the burden for the society is significant, like for thalassemia and sickle cell anaemia. One estimate that in European countries, one out of 500 children are diagnosed with cancer before the age of 15. First estimate of the rare cancer burden is that about 4 300 000 patients are living today in the European Union with a diagnosis of a rare cancer, 24% of the total cancer prevalence. The research focus is not only on groups of rare diseases, but also on the burden of specific rare diseases, like scleroderma and immune thrombocytopenic purpura. Ten rare diseases were selected with a Delphi approach to run a representative pilot survey in eight European countries. Results and deliverables will be shared with relevant stakeholders, like patient associations, policy makers and medical community and is anticipated to stimulate the future comparability and monitoring of rare diseases care in Europe. An appropriate and internationally recognised rare disease classification system is critical in making rare diseases more visible in health information systems and consequently provide reliable epidemiological data from existing and future databases. Potentially, such a system will not only generate reliable prevalence/incidence data, but also constitute a useful basis for further research into the natural history and aetiology of rare diseases. It will also allow the evaluation of the economic burden of the disease, and monitoring of clinical effectiveness of therapies and measuring the quality of care. Moreover, as reliable prevalence data has to be provided to regulatory authorities in order to obtain an orphan designation, increased availability of such data for all rare diseases could represent an important preparatory step in facilitating orphan drug development. It is intended to be used in electronic health records to code the health status of patients; but as system designed to be comprehensive for common occurences it has some shortcomings when it comes to rare diseases. Representing a group of 5 000-8 000 complex and heterogeneous conditions makes the description of a specific control strategy for rare diseases extremely difficult if not impossible. The control strategy for a specific rare disease depends on the nature of the disease (genetic or non-genetic), the knowledge obtained for a specific disease, translation of this knowledge into an effective treatment, diagnostic or preventive tool or some other kind of healthcare innovation. Moreover, various socio-economic and demographic factors also play an important role. In general, a large group of rare diseases have to be managed through care alone, because no therapy is available. Another group of rare diseases are managed through existing medical treatment combined with care. Finally, with new therapies becoming available a growing group of rare diseases are managed through some form of intervention. For several (mono)genetic rare diseases prenatal and/or newborn screening is possible. In case of the general population, many countries screen newborns for certain metabolic defects. In this way early diagnosis of the defect can lead to early intervention and preventive care. Despite important technological progress that could facilitate newborn population screening a high variability exist between countries/regions in the type and number of diseases screened. This is mainly due to the lack of data on the cost effectiveness and the ethical implications of the screening strategies. An effective control strategy for a single disease will depend on a combination of three strategies: an effective early diagnosis, the development of optimal care including preventive care and the availibility of a drug or another therapeutic interventions. As explained in the examples below, the importance gained by each strategy will vary per disease. This inherited metabolic disease is characterized by an inability of the body to utilize the essential amino acid, phenylalanine, due to a deficiency of the enzyme phenylalanine hydroxylase. Without this enzyme, phenylalanine and other biochemical products accumulate in the 6. The excess phenylalanine is toxic to the central nervous system, and results in mental retardation and other neurological problems when left untreated. When a very strict diet is begun within the first few weeks of life and is well-maintained, affected children can expect normal development and a normal life span.
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Oral prednisone is used in the interim to stabilize the patient and control the active inflammatory process until the immunomodulatory agent takes effect. Prednisone is subsequently tapered and the patient maintained on the systemic immunomodulatory agent. If the initial combination of therapy is ineffective after several months, the patient will be switched to a different agent such as cyclophosphamide. The methotrexate is stopped and the oral prednisone increased in the crossover period. The microbes may be detected within the biopsied limbal conjunctiva vessels by immunoprobing. Treatment with topical steroids and systemic antiviral agent is normally effective. Staphylococcal Marginal Keratitis these local hypersensitivity responses to microbial antigens may represent the most common form of peripheral cornea infiltrates and ulceration often in association with longstanding Staphylococcal blepharoconjunctivitis. Usually the infiltrates are separated from the limbus by a distinct lucid interval of clear, noninvolved cornea. The direction of spread of the lesion is concentric with the limbus, rather than centrally or peripherally. If the lesions are left untreated, epithelial breakdown and eventual ulceration occurs. The natural course of the lesion however is benign, and healing usually occurs in 2 to 4 weeks. Vascularized corneal pannus directed to the ulcer site may bridged the lucid interval after healing. Microbial culture of the lid margins will yield Staphylococcus aureus in the majority of cases. Gram and Giemsa stains of the corneal scrapings usually show neutrophils but no bacteria. Treatments of the acute lesions with mild topical steroids usually cause rapid resolutions of symptoms. A combination of lid hygiene and topical antibodies is used to treat the blepharitis and prevent recurrences. The ulceration begins as grayish infiltration in the perilimbal cornea usually in the interpalpebral fissure. Characteristically the central wall of the ulcer is undermined leading to an overhanging advancing edge of an epithelial effect (Figure 3). It is a diagnosis of exclusion, since many conditions can present somewhat similarly. Figure 3 the ulceration first spreads circumferentially and then centrally, ultimately subsiding after the entire cornea has been involved typically over a period of 4 to 18 months. Treatment might involve initial aggressive topical steroid therapy with prophylactic antibiotics, followed by conjunctival resection, ulcer debridement, application of tissue adhesive to thinned areas with soft contact lens application and subsequent treatment with predinosolone phosphate 1% four times daily. It is usually painless, with only minor or no episodes of acute inflammation and the corneal epithelium remains intact. The thinning usually begins superiorly, (Figure 4) and progresses circumferentially but minimally centrally. Associated lipid deposition at the edge of fine superficial vessels may be evident. Advanced systemic involvement is usually apparent at the time of ocular involvement. Treatment is initially with systemic steroids combined with methotrexate (5-25mg once weekly), reserving agents such as cyclophosphamide for therapeutic failures, drug intolerance and rapidly progressive disease. It is usually bilateral and classically associated with an adjacent necrotizing scleritis (Fig7). It is in part a diagnosis of exclusion resting on clinical signs and on histopathologic demonstration of nongranulomatosis vasculitis of medium and small arteries. The treatment of choice is combination of systemic corticosteroid and cyclophosphamide. Local surgical therapy may temporarily retard progession of the ulcer until immunosuppression takes effect.
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In a previous article we described a phenomenon called the internal disc derangement. I refer you to that article to describe the phenomena of internal disc derangement. In brevity a disc derangement, occurs when a portion nuclear material moves into a weakened area or a tear in the disc and the nuclear material becomes entrapped causing severe back pain. The derangement represents an entrapped nuclear fragment in a tear or zone of the annular wall. Some patients that experience such an episode can then remain completely asymptomatic for months or even years between episodes. A patient with an internal disc deragement may or may not have a positive discogram. That is a very important distinction between the annular tear patient and the internal disc derangement patient. In the case of the annular tear or fissure patient, the tear extends into the periphery of the disc as seen in the picture to the right. When an annular tear has extended to the outer annulus it can stimulate the region of the disc most sensitive to pressure and pain. If one were to inject a contrast material under pressure in this disc the solution injected into the disc will travel right through the tear and exert pressure on the outer fibers of the annulus or leak out of the tear when the test is performed. In addition this will stimulate or replicate the usual pain the 8 individual has been experiencing. Many patients with a history of periodic derangements can eventually progress to a tear. An individual may have no history of derangement and experience a tear with a lifting incident or injury. Many annular tear patients may not experience the same locking sensations that the derangement patient has and typically is not noted to have the "antalgic" position that is so common in the derangement patient. They may have an annular tear that causes a dull constant pain that increase with activity and they could also experience periodic acute episodes of pain with associated antalgic posture when a portion of the nucleus shifts within the disc becomes trapped in the tear. Technically speaking a patient who has periodic acute pain from a disc derangement has an annular tear of fissure. But the tear is in the internal sections of the annular rings it not cause continuous pain like the annular fissure patient. One would think that once the disc becomes so dehydrated with extensive degeneration that there would be no way they could have episodes of acute pain with the associated shifted posture so common to the internal disc derangement. I have seen many patients with significant degenerative disc disease still have these derangement episodes. Even in some discs that have undergone significant degeneration and "dehydration" there can still be left over fragments of hydrated nucleus in the middle that can move around. If this piece of viable nucleus shifts along the fissures of the disc it can get trapped and you have acute pain simulating a derangement. You could have a history of these derangements for years and then as the disc dehydrates it stiffens. When this occurs the nucleus no longer mobile within the disc and will not shift positions in the disc. Once this occurs, from that point on you may have very little problems with you back! Once they started using the new fiberobtic scopes and laser procedures they have identified these viable fragments of nucleus within a degenerated disc exactly as described. Remember this is not the case with everyone and it takes a physician acting as a medical detective to sort this out. Types of annular tears and fissures: There are a number of different types of annular disruptions or tears. The tear can also occur in a circumferential fashion better known as a "rim tear".
- Waardenburg syndrome type 1
- Glycogenosis type III
- Ptosis coloboma trigonocephaly
- Hereditary macrothrombocytopenia
- Osteolysis hereditary multicentric
- Mount Reback syndrome
- Transverse myelitis
- Schwannoma, malignant
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During the same time period, 21,747 Tennesseans died from lung cancer, resulting in an age-adjusted mortality rate of 58. White women had higher incidence and mortality rates than black women, but black men had higher incidence and mortality rates than white men. Cancer Incidence and Mortality, Lung and Bronchus, By Year, Tennessee 2010-2014 90. Black men are disproportionately affected by this disease compared to white men; black men experience a mortality rate that is roughly two and a half times higher compared to white men. It should be noted that the Taskforce is currently in the process of updating this recommendation. During the same time period, 2,840 prostate cancer deaths were reported, giving an age-adjusted mortality rate of 20. Thus, fewer men undergoing prostate cancer screening may mean that fewer men will be diagnosed with prostate cancer in the short term. Cancer Stage, Prostate, By Race, Tennessee, 2010-2014 100% 80% Percent 60% 40% 20% 0% 0. Early diagnosis of prostate cancer is believed to contribute to a low mortality-to-incidence ratio. Female breast cancer incidence rates remained relatively stable over the 5-year period covered by this report. It appears that both breast cancer incidence and mortality may have reached a plateau during 2013 and counts may be starting to decrease though additional years of decreasing counts will be needed before confirming this potential decreasing trend. Furthermore, it is important to note that black women are more likely than white women to be diagnosed with breast cancer in the late stages (i. Early detection and effective treatment options contributed to the low mortality-to-incidence ratio of breast cancer (0. The Taskforce provided a grade of "C" for screening mammography for women 40-49 years of age. During the same time period, 4,467 Tennessee women died from breast cancer, giving an age-adjusted mortality rate of 22. Black women had statistically significantly higher breast cancer mortality rates than white women; however, note that incidence rates between the two races are not statistically significantly different. Cancer Incidence and Mortality, Female Breast By Year, Tennessee, 2010-2014 Age-Adjusted Rate per 100,000 140. Cancer Stage, Female Breast, By Race, Tennessee, 2010-2014 100% 80% 60% 40% 20% 18. It should also be noted Tennesseans who died of colorectal cancer died on average 7. Black men and women experience statistically significantly greater incidence and mortality rates for colorectal cancer compared to white men and women. Regular colorectal cancer screening can identify lesions before they become cancer and find colorectal cancer early, when it is highly curable. The screening methodology for colorectal cancer recommended by most healthcare professionals is the colonoscopy and sigmoidoscopy. During the same time period, 5,985 Tennesseans died of colorectal cancer, resulting in an age-adjusted mortality rate of 16. Cancer Incidence and Mortality, Colon and Rectum, By Year, Tennessee, 2010-2014 50. The decrease in the colorectal cancer mortality may be partially explained by the increase in colorectal screening over the past 15 years. It should be noted Tennesseans, who died of melanoma skin cancer, died on average 10 years earlier than expected. During the same time period, white Tennesseans experienced incidence rates that are about twenty-six times higher than black individuals. However, black individuals experience a much higher mortality-incidence ratio for this disease, i. This is at least partially attributable to the fact that black individuals are almost three times more likely than white individuals to be diagnosed at late stages and this was statistically significant. During the same time period, 1,118 melanoma skin cancer patients died, resulting in an age-adjusted mortality rate of 3. White Tennesseans had significantly higher melanoma skin cancer incidence and mortality rates than blacks regardless of gender.
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Measurement given in hundredths of millimeters should be rounded to the nearest tenth. Definition Ulceration is the formation of a break on the skin or on the surface of an organ. Primary tumor ulceration has been shown to be a dominant independent prognostic factor, and if present, changes the pT stage from T1a to T1b, T2a to T2b, etc. There must be a statement that ulceration is not present to code 0 Coding Instructions and Codes Note 1: Physician statement of microscopically confirmed ulceration (e. Note 4: Code 9 if there is microscopic examination and there is no mention of ulceration. If there is more than one pathology report for the same melanoma at initial diagnosis and different mitotic counts are documented, code the highest mitotic count from any of the pathology reports. The Allred Score is calculated by adding the Proportion Score and the Intensity Score, as defined in the tables below. The Allred score combines the percentage of positive cells (proportion score) and the intensity score of the reaction product in most of the carcinoma. If there are no results prior to neoadjuvant treatment, code the results from a post-treatment specimen. Note 3: the Allred system looks at what percentage of cells test positive for hormone receptors, along with how well the receptors show up after staining (this is called "intensity"). If assays are performed on more than one specimen and any result is interpreted as positive, code as 1 Positive/elevated. Note 8: If the test results are presented to the hundredth decimal, ignore the hundredth decimal. Note 7: If the test results are presented to the hundredth decimal, ignore the hundredth decimal. Recent studies indicate that these tests may also be helpful in planning treatment and predicting recurrence in node positive women with small tumors. For the Breast cases, there are 2 data items that record information on Multigene testing. It tests a sample of the tumor (removed during a biopsy or surgery) for a group of 50 genes. The test can help women and their doctors decide if extending hormonal therapy 5 more years (for a total of 10 years of hormonal therapy) would be beneficial. The Breast Cancer Index reports two scores: how likely the cancer is to recur 5 to 10 years after diagnosis and how likely a woman is to benefit from taking hormonal therapy for a total of 10 years. Knowing if the cancer has a high or low risk of recurrence can help women and their doctors decide if chemotherapy or other treatments to reduce risk after surgery are needed. Coding Instructions and Codes Note 1: Physician statement of the Multigene Signature Results can be used to code this data item. Note 2: Multigene signatures or classifiers are assays of a panel of genes from a tumor specimen, intended to provide a quantitative assessment of the likelihood of response to chemotherapy and to evaluate prognosis or the likelihood of future metastasis. Note 6: For Mammaprint, EndoPredict, and Breast Cancer Index, only record the risk level. The results may be used clinically to evaluate benefits of radiation therapy following surgery. Intermediate Risk: Recurrence Score result between 18 and 30: the patient has a tumor that is in the middle of the risk spectrum reflecting that biology is continuous and not all patients have a low or a high recurrence risk, assuming 5 years of hormonal therapy is given. High risk: Recurrence Score result greater than or equal to 31: the patient has a high risk of distant recurrence, assuming 5 years of hormonal therapy and is likely to benefit from chemotherapy. Code 0 1 2 6 7 8 9 Description Low risk (recurrence score 0-38) Intermediate risk (recurrence score 39-54) High risk (recurrence score greater than or equal to 55) Not applicable: invasive case Test ordered, results not in chart Not applicable: Information not collected for this case (If this item is required by your standard setter, use of code 8 will result in an edit error. Note 2: the Oncotype Dx-Invasive recurrence score is reported as a whole number between 0 and 100. Note 3: Record only the results of an Oncotype Dx-Invasive recurrence score in this data item. Note 5: Staging for Breast cancer now depends on the Oncotype-Dx-Invasive recurrence score. Note 2: the Oncotype Dx Risk Level-Invasive test stratifies scores into low, intermediate, and high risk of distant recurrence. If no ipsilateral axillary nodes are examined, or if an ipsilateral axillary lymph node drainage area is removed but no lymph nodes are found, code X9.
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Longitudinal erythronychia can be observed with distal matrix and nail bed involvement. However, if distal chipping is a problem, several coats of clear nail hardener may be applied as needed. In young children, a 6- to 12-week trial of high potency topical steroid can be tried first. Fortunately, it is non-scarring and gradually resolves along with the selflimited skin rash. There is also a high spontaneous mutation rate and mosaic or localized forms are reported. Acral involvement including nail disease may be the first manifestation during childhood. The nails display longitudinal red and white bands that extend through the nail bed from the distal matrix. The plates are thin and will frequently be fissured with "v" shaped notches at the distal-free edge (Figure 8. Greasy flat-topped warty papules are seen on the dorsum of the hands, but they become much more confluent in the seborrhea areas of the chest and back in older teens and adults. Most desquamating vesicular lesions are in the flexures and can spread by a positive Nikolsky sign. Longitudinal white bands of the fingernails may occur initially before the disease is fully expressed. Juvenile Xanthogranuloma Juvenile xanthogranuloma is a benign proliferative (non-Langerhan cell) histiocytic disorder that may be present at birth or develops in the first 6 months of life. These lesions have a characteristic yellow color and may be single, giant, agminated, or widely disseminated. If the diagnosis is doubtful, a small biopsy will demonstrate lipid-laden macrophages and Touton giant cells. Granuloma Annulare Granuloma annulare is a common, self-limited asymptomatic skin disorder characterized by small dermal inflammatory papules that are usually arranged in "ring-like" configurations distributed over the hands, feet, digits, arms, and legs. In addition, there are no systemic associations in children who are frequently affected with this presumed reactive, hypersensitivity disorder. The nail unit may be secondarily affected and is reported in one case of disseminated perforating disease. Clinically, the disorder is characterized by fevers and scaly violaceous cheeks, nose, ears, fingers, and toes that reflect a leukocytoclasitic vasculitis and a microthrombotic angiopathy. One of the earliest signs of this condition is nail fold capillary loop tortuosity and loss. Dystrophic nail changes precede gangrene and auto-amputation and are present in all children described till date. They are commonly restricted to one extremity; however, bilateral involvement of fingers on both hands is possible. Veillonella Infection of the Newborn Forty-two epidemics of subungual infection were described by Sinniah et al. The number of fingers affected in per patient ranged from 1 to 10; the thumbs were less frequently involved than other digits, and the toenails were spared altogether. Three stages were identified: in the first stage, a small amount of clear fluid appears under the center of the nail along with mild inflammation at the distal end of the finger.
CsA in frequently relapsing nephrotic syndrome in children (categorical outcomes). Kidney biopsy is necessary to exclude secondary causes of nephrotic syndrome, and assess the extent of interstitial and glomerular fibrosis. Quantification of proteinuria is essential, since this provides the comparison for subsequent treatment responsiveness. Consequently, we have elected to utilize one of the commonly used definitions of resistance, i. Steroids may be continued for an additional 4 weeks, totaling 12 weeks, while awaiting histopathology results. Results of the biopsy are also often used to explain to both patient and family why there has not been a response to therapy, and that the prognosis is likely to be substantially altered from the initial one. Both cyclosporine and corticosteroids have a direct effect on the podocyte cytoskeleton,107 in addition to their immunemodulating properties, indicating these agents may have multiple beneficial mechanisms of action in nephrotic syndrome. There is low-quality evidence that tacrolimus has a similar impact on proteinuria control and may improve adherence to treatment, based upon lower risk for hypertrichosis and gingival hyperplasia compared to cyclosporine. The risk for kidney failure is significantly greater for patients who fail to achieve a partial or complete remission with any single or combination therapy. The 69% cumulative complete and partial remission was significantly better than the 0-16% remission in the control arms of these randomized studies. In this trial, the frequency of nephrotoxicity, hypertension, and diabetes mellitus were not different between cyclosporine and tacrolimus. The only difference in these agents was in the side-effect profile of hypertrichosis (95% vs. Extension of therapy beyond 12 months to prevent relapse is common practice; however, the impact of this approach on relapse risk, long-term kidney function, and risk for nephrotoxicity has not been established. A low-dose corticosteroid is recommended here to be consistent with the majority of clinical trials. Because only a minority of those randomized to methylprednisolone actually received that agent, the study is of very low quality. The corticosteroid pulse therapy induced a 34% complete remission and 13% partial remission with no significant difference between methylprednisolone and dexamethasone treatment groups. The study did not demonstrate a significant difference between the treatment arms (see Table 5). The study was halted at week 12 according to predefined stopping rules, due to the significant difference between the combined complete and partial remission rates of 60% in cyclosporine group and 17% in the cyclophosphamide group (P o0. Options are provided without prioritization, and include oral corticosteroids, a return to the previously effective immunosuppressant agent, or the selection of an alternate immunosuppressant agent to avoid potential toxicity. Investigation of treatment options is needed for patients with nephrotic syndrome associated with genetic mutations. Supplementary Table 9: Meta-analyses and systematic reviews on steroid-resistant nephrotic syndrome in children. Cyc treatment in children with steroid-resistant nephrotic syndrome (categorical outcomes). Cyc treatment in children with steroid-resistant nephrotic syndrome (continuous outcomes). CsA treatment in children with steroid-resistant nephrotic syndrome (categorical outcomes). CsA treatment in children with steroid-resistant nephrotic syndrome (continuous outcomes). Disease Definitions Definitions of proteinuria outcomes are as listed in Table 10, Chapter 6. There is only low-quality evidence to define the optimal dose and duration of corticosteroids in adults, but a high dose until remission is achieved followed by a slow taper to minimize relapse is usually prescribed.