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Sample records for antenatal steroid treatment

  1. Antenatal steroids and fluid balance in very low birthweight infants.

    Science.gov (United States)

    Dimitriou, G; Kavvadia, V; Marcou, M; Greenough, A

    2005-11-01

    To determine if insensible water loss (IWL) differed between infants exposed or not exposed antenatally to corticosteroids and to explore possible mechanisms for the early postnatal diuresis associated with antenatal steroid exposure. Retrospective analysis of prospectively collected data. Level three neonatal intensive care unit. Ninety six infants, median gestational age 27.5 weeks (range 23-33). Comparison of the IWL, urine output and osmolality, fluid input, electrolyte imbalance, respiratory illness severity (as assessed by surfactant requirement, maximum peak inspiratory pressure, and inspired oxygen concentration), and cardiovascular status (as assessed by inotrope requirement) between infants with antenatal corticosteroid exposure and gestational age matched controls. The infants exposed to antenatal steroids differed significantly from the controls in having both a lower IWL (p = 0.0135) and a higher urine output (p = 0.0036) on day 1, and fewer developed hyponatraemia (p = 0.027) on day 2. Fewer of those exposed to antenatal steroids required inotropes (p = 0.06), but their respiratory status was similar to that of the controls. Infants exposed to antenatal corticosteroids have a lower IWL. The results suggest that greater skin maturation, but also better perfusion rather than less severe respiratory status, explains the early diuresis in infants exposed to antenatal steroids.

  2. Assessing the potential impact of extending antenatal steroids to the late preterm period.

    Science.gov (United States)

    Souter, Vivienne; Kauffman, Ellen; Marshall, Alice J; Katon, Jodie G

    2017-10-01

    In 2016, guidance statements were issued by the Society for Maternal-Fetal Medicine and the American Congress of Obstetricians and Gynecologists about extending antenatal steroid use to selected late preterm singleton pregnancies. We sought to review antenatal steroid use prior to the 2016 guidance statements and assess the potential impact of these. This cohort study used chart-abstracted data from singleton deliveries from Jan. 1, 2012, through March 31, 2016, at 12 centers participating in the Obstetrics Clinical Outcomes Assessment Program, a quality initiative in Washington State. Pregnancies with missing gestation at delivery, fetal anomalies, or antepartum demise were excluded. Antenatal steroid use prior to the 2016 guidance was evaluated based on the percentage of early preterm deliveries (23 +0 -33 +6 weeks) and the percentage of all pregnancies that received antenatal steroids. Newborn complication rates were calculated for late preterm deliveries (34+0 +0 -36 +6 weeks), grouped by whether they would be potentially eligible or ineligible for antenatal steroids based on the 2016 guidance statements. The opportunity for antenatal steroids was missed in 21.8% (226/1034) of early preterm deliveries and of all those who received antenatal steroids, 32.2% (614/1908) delivered at term. Of preterm deliveries, 74% (n = 2942) were in the late preterm period. In all, 80% (n = 2363) of late preterm deliveries were potentially eligible for antenatal steroids and 60% of these (n = 1411) delivered at 36 weeks. The rate of respiratory complications in newborns delivering at 34 and 35 weeks was higher in the group potentially eligible for late preterm antenatal steroids compared to those in the ineligible group. Of those delivering at 36 weeks, no differences were detected in prevalence of respiratory complications by potential eligibility for antenatal steroids; however, compared with the ineligible group, those potentially eligible had a lower risk of neonatal

  3. Adjunctive steroid treatment

    DEFF Research Database (Denmark)

    Korshin, André; Køster-Rasmussen, Rasmus; Meyer, Christian N

    2007-01-01

    Our objective was to evaluate local guidelines regarding early steroid treatment in adult community acquired bacterial meningitis, and assess the actual treatment given and its correlation to clinical outcome. Patient outcome was obtained retrospectively from the medical records of 210 adults...... with petechial skin lesions, these were caused by pneumococci (15), meningococci (15), Staphylococcus aureus (1) and enterococci (1), and thus the presence of such lesions should not make the clinician abstain from early steroid treatment of bacterial meningitis. In conclusion, concordance with the new consensus...... of early steroid treatment was poor on a national basis, and better (41%) when adequate local guidelines were available. Early steroid treatment was associated with favourable outcome, and improved implementation of adequate guidelines may contribute to better patient outcome in bacterial meningitis....

  4. The efficacy of antenatal steroid therapy in preterm neonates in Shariati Hospital

    Directory of Open Access Journals (Sweden)

    Jamal A

    1996-07-01

    Full Text Available The newborn who is born before terms is a candidate for the development of idiopathic respiratory distress syndrome. The intense hypoxia and acidosis that ensue as the consequence of inadequate alveolar-capillary exchange of oxygen and carbon dioxid may prove fatal antenatal steroid therapy can affect RDS (Respiratory Distress Syndrom and its complications. The newborn before 34 weeks have a significantly lowered incidence of RDS and neonatal mortality from RDS with antenatal steroid therapy. In a retrospective study we compared 37 preterm infants whose mothers had received corticosteroids to 29 similar but untreated infants. The study showed that antenatal steroid therapy reduced neonatal mortality from RDS more than reducing the incidence of RDS and further it was concluded that this beneficial effect was more significant in female fetus than male fetus, but it was not significant statistically

  5. Antenatal steroids and risk of bronchopulmonary dysplasia: a lack of effect or a case of over-adjustment?

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    Gagliardi, Luigi; Bellù, Roberto; Rusconi, Franca; Merazzi, Daniele; Mosca, Fabio

    2007-07-01

    Although antenatal steroids reduce risk factors for bronchopulmonary dysplasia (BPD) in preterm infants, their effect on BPD is conflicting. We hypothesised that the lack of protective effect found in some studies could derive from over-adjustment during analysis, caused by controlling for factors intermediate in the causal pathway between treatment and outcome. We prospectively studied a cohort of infants 23-32 weeks gestation steroids. In univariable analysis, steroids were not significantly protective against BPD; some intermediate factors (mechanical ventilation, greater severity of illness as measured by Clinical Risk Index for Babies score, patent ductus arteriosus) were significantly positively associated with (i.e. were risk factors for) BPD (OR = 11.0, 1.55, 4.42, respectively, all P steroids (OR = 0.58, 0.92, and 0.58, respectively, all P steroid-treated infants had a lower risk of BPD (OR 0.59 [95% CI 0.36, 0.97], P = 0.036); male sex (OR = 2.08), late-onset sepsis (OR = 4.26), and birthweight (OR = 0.63 for 100 g increase) were also associated with BPD, all P effect of steroids disappeared; ventilation (OR = 3.03), increased illness severity (OR = 1.11), and patent ductus arteriosus (OR = 1.90) were significant risk factors. This study suggests that including variables that are potential mediators in the causal chain can obscure the ability to detect a protective effect of treatment. We observed such a phenomenon in our analyses of the relationship between antenatal steroids and BPD, suggesting that steroid effect is partly mediated through a reduction in the classical risk factors.

  6. Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth.

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    Mwansa-Kambafwile, Judith; Cousens, Simon; Hansen, Thomas; Lawn, Joy E

    2010-04-01

    In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour. However, although >1 million deaths due to preterm birth occur annually, antenatal steroids are not routine practice in low-income countries where most of these deaths occur. To review the evidence for and estimate the effect on cause-specific neonatal mortality of administration of antenatal steroids to women with anticipated preterm labour, with additional analysis for the effect in low- and middle-income countries. We conducted systematic reviews using standardized abstraction forms. Quality of evidence was assessed using an adapted GRADE approach. Existing meta-analyses were reviewed for relevance to low/middle-income countries, and new meta-analysis was performed. We identified 44 studies, including 18 randomised control trials (RCTs) (14 in high-income countries) in a Cochrane meta-analysis, which suggested that antenatal steroids decrease neonatal mortality among preterm infants (preterm babies currently receive little or no medical care. It is plausible that antenatal steroids may be of even greater effect when tested in these settings. Based on high-grade evidence, antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity, yet remains at low coverage in low/middle-income countries. If fully scaled up, this intervention could save up to 500 000 neonatal lives annually.

  7. Promoting antenatal steroid use for fetal maturation: results from the California Perinatal Quality Care Collaborative.

    Science.gov (United States)

    Wirtschafter, David D; Danielsen, Beate H; Main, Elliott K; Korst, Lisa M; Gregory, Kimberly D; Wertz, Andrew; Stevenson, David K; Gould, Jeffrey B

    2006-05-01

    The California Perinatal Quality Care Collaborative (CPQCC) was formed to seek perinatal care improvements by creating a confidential multi-institutional database to identify topics for quality improvement (QI). We aimed to evaluate this approach by assessing antenatal steroid administration before preterm (24 to 33 weeks of gestation) delivery. We hypothesized that mean performance would improve and the number of centers performing below the lowest quartile of the baseline year would decrease. In 1998, a statewide QI cycle targeting antenatal steroid use was announced, calling for the evaluation of the 1998 baseline data, dissemination of recommended interventions using member-developed educational materials, and presentations to California neonatologists in 1999-2000. Postintervention data were assessed for the year 2001 and publicly released in 2003. A total of 25 centers voluntarily participated in the intervention. Antenatal steroid administration rate increased from 76% of 1524 infants in 1998 to 86% of 1475 infants in 2001 (P < .001). In 2001, 23 of 25 hospitals exceeded the 1998 lower-quartile cutoff point of 69.3%. Regional collaborations represent an effective strategy for improving the quality of perinatal care.

  8. Does smoking in pregnancy modify the impact of antenatal steroids on neonatal respiratory distress syndrome? Results of the Epipage study.

    Science.gov (United States)

    Burguet, A; Kaminski, M; Truffert, P; Menget, A; Marpeau, L; Voyer, M; Roze, J C; Escande, B; Cambonie, G; Hascoet, J M; Grandjean, H; Breart, G; Larroque, B

    2005-01-01

    To assess the relation between cigarette smoking during pregnancy and neonatal respiratory distress syndrome (RDS) in very preterm birth, and to analyse the differential effect of antenatal steroids on RDS among smokers and non-smokers. A population based cohort study (the French Epipage study). Regionally defined births in France. A total of 858 very preterm liveborn singletons (27-32 completed weeks of gestation) of the French Epipage study were included in this analysis. The odds ratio for RDS in relation to smoking in pregnancy was estimated using a logistic regression to control for gestational age. The odds ratio for RDS in relation to antenatal steroids was estimated taking into account an interaction between antenatal steroids and cigarette smoking, using multiple logistic regression to control for gestational age, birthweight ratio, main causes of preterm birth, mode of delivery, and sex. The odds ratio for RDS in relation to smoking in pregnancy adjusted for gestational age (aOR) was 0.59 (95% confidence interval (CI) 0.44 to 0.79). The aOR for RDS in relation to antenatal steroids was 0.31 (95% CI 0.19 to 0.49) in babies born to non-smokers and 0.63 (95% CI 0.38 to 1.05) in those born to smokers; the difference was significant (p = 0.04). Cigarette smoking during pregnancy is associated with a decrease in the risk of RDS in very preterm babies. Although antenatal steroids reduce the risk of RDS in babies born to both smokers and non-smokers, the reduction is smaller in those born to smokers.

  9. Effect of Antenatal Steroids on Respiratory Morbidity of Late Preterm Newborns: A Randomized Controlled Trial.

    Science.gov (United States)

    Ontela, Vijaya; Dorairajan, Gowri; Bhat, Vishnu B; Chinnakali, Palanivel

    2018-01-22

    The objective of this article was to study the effect of antenatal dexamethasone on the respiratory morbidity of late preterm newborns. A randomized controlled trial, conducted in Obstetrics and Gynecology Department in collaboration with Neonatology department at JIPMER, India. In total, 155 women were studied in each group. Intention to treat analysis and per protocol analysis were done. Overall 31 (10%) newborns were admitted to intensive care unit. The composite respiratory morbidity (defined as respiratory distress syndrome and/or transient tachypnea of newborn) was observed in 64 (41.6%) infants in the study and 56 (36.2%) infants in the control group. On multivariable-adjusted analysis, use of steroids was not found to be associated with decrease in composite respiratory morbidity [adjusted relative risk 0.91 (95% confidence interval: 0.7-1.2)]. Antenatal dexamethasone does not reduce the composite respiratory morbidity of babies born vaginally or by emergency cesarean to women with late preterm labor. © The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  10. The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs.

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    Tingay, David G; Rajapaksa, Anushi; McCall, Karen; Zonneveld, Cornelis E E; Black, Don; Perkins, Elizabeth; Sourial, Magdy; Lavizzari, Anna; Davis, Peter G

    2016-06-01

    To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (Cdyn) in preterm lambs. Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH2O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth. All lambs then received the same management for 60-min with alveolar-arterial oxygen difference (AaDO2) and Cdyn measured at regular time points. Overall, the OLV strategy improved Cdyn and AaDO2 (all epochs except Surfactant) compared to SI (all P < 0.05; two-way ANOVA). Irrespective of strategy, Cdyn was better in the Steroid group in the first 10 min (all P < 0.05). Thereafter, Cdyn was similar to Steroid epoch in the OLV + Surfactant, but not SI + Surfactant group. OLV influenced the effect of steroid and surfactant (P = 0.005) on AaDO2 more than SI (P = 0.235). The antenatal state of the lung influences the type and impact of a recruitment maneuver at birth. The effectiveness of surfactant maybe enhanced using PEEP-based time-dependent recruitment strategies rather than approaches solely aimed at initial lung liquid clearance.

  11. Steroid Treatments Equally Effective Against Sudden Deafness

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    ... 6, 2011 Steroid Treatments Equally Effective Against Sudden Deafness Injecting steroids into the middle ear works just ... when it comes to restoring hearing for sudden deafness patients. This finding, the result of a large ...

  12. Neurodevelopmental outcome of extremely premature infants exposed to incomplete, no or complete antenatal steroids.

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    Chawla, Sanjay; Bapat, Roopali; Pappas, Athina; Bara, Rebecca; Zidan, Marwan; Natarajan, Girija

    2013-10-01

    To compare the neurodevelopmental outcomes at 18-22 months' corrected age of extremely premature infants exposed to a complete course, an incomplete course or no dose of antenatal steroids (ANS). Retrospective chart review of extremely premature (blindness or deafness and mental developmental index (MDI)/cognitive score ≥85. Neurodevelopmental impairment (NDI) was defined as any of the following: moderate or severe CP, MDI/cognitive score blindness. Patients were categorized into three groups: (A) no ANS; (B) incomplete course and (C) complete course of ANS. Outcome data were available for 134 (88%) patients of our cohort (n = 153). Severe intraventricular hemorrhage (IVH) was significantly lower and intact survival was higher in the complete ANS group (p < 0.01). On logistic regression, with gestational age, gender, maternal insurance and ANS exposure as covariates, an incomplete (versus complete) course of ANS (p = 0.006) and gestational age were significantly associated with lower intact survival at 18-22 months.: A complete course of ANS was associated with an increased likelihood of intact survival at a corrected age of 18-22 months among extremely premature infants, compared with an incomplete course. Follow-up studies should account for the differential benefit of complete versus incomplete course of ANS administration.

  13. HIV testing and treatment in the antenatal care setting.

    LENUS (Irish Health Repository)

    Coulter-Smith, S

    2012-02-01

    Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.

  14. HIV testing and treatment in the antenatal care setting.

    LENUS (Irish Health Repository)

    Coulter-Smith, S

    2010-01-01

    Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.

  15. Audit of antenatal steroid use in mothers of preterms admitted to a ...

    African Journals Online (AJOL)

    Background: Antenatal corticosteroids (ACS) are established as an effective method of reducing preterm morbidity and mortality. At the Korle Bu Teaching Hospital (KBTH), a tertiary referral centre in Ghana, it is recommended that a course of ACS should be given to mothers before delivery between 24 weeks to 34 weeks ...

  16. Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis

    International Nuclear Information System (INIS)

    Tomiyama, Takashi; Uchida, Kazushige; Matsushita, Mitsunobu; Ikeura, Tsukasa; Fukui, Toshiro; Takaoka, Makoto; Nishio, Akiyoshi; Okazaki, Kazuichi

    2011-01-01

    The efficacy of oral steroid therapy for autoimmune pancreatitis (AIP) is well known, and oral prednisolone treatment is most usually commenced at 30-40 mg/day, but there have been few reports about comparative studies of oral steroid therapy and steroid pulse therapy as the initial treatment for AIP. We studied the clinical course and image findings to estimate the utility of steroid pulse therapy for AIP, comparing it with oral steroid therapy. Laboratory and image findings were assessed retrospectively in 11 patients who received steroid pulse therapy, and the findings were compared to those in 10 patients who received conventional oral steroid therapy. Change in pancreatic size showed no significant difference between the therapies after 2 weeks of treatment. Significant improvement of lower bile duct strictures after 2 weeks of treatment and that of immunoglobulin values within 6 months were shown with both therapies. However, steroid pulse therapy showed significant improvement of γ-guanosine triphosphate (GTP) in 2 weeks and of alanine aminotransferase (ALT) in 2 and 8 weeks, compared with oral steroid therapy. Moreover, there was one patient in whom the lower bile duct stricture was not improved by oral steroid therapy, but it did show improvement with steroid pulse therapy. Initial steroid pulse therapy is a beneficial alternative to oral steroid therapy for the improvement of bile duct lesions. In future, the accumulation of a larger number of patients receiving steroid pulse therapy is needed, and prospective studies will be required. (author)

  17. Costs of hospitalization in preterm infants: impact of antenatal steroid therapy.

    Science.gov (United States)

    Ogata, Joice Fabiola Meneguel; Fonseca, Marcelo Cunio Machado; Miyoshi, Milton Harumi; Almeida, Maria Fernanda Branco de; Guinsburg, Ruth

    2016-01-01

    To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS). Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique. Of 220 patients that met the inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p=0.008). The survivors with gestational age <30 weeks showed a decrease in the total cost of 38% (p=0.008) and a 49% reduction of NICU length of stay (p=0.011). ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and <30 weeks of gestational age. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  18. Costs of hospitalization in preterm infants: impact of antenatal steroid therapy

    Directory of Open Access Journals (Sweden)

    Joice Fabiola Meneguel Ogata

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS. METHOD: Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique. RESULTS: Of 220 patients that met the inclusion criteria, 211 (96% charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU. In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p = 0.008. The survivors with gestational age <30 weeks showed a decrease in the total cost of 38% (p = 0.008 and a 49% reduction of NICU length of stay (p = 0.011. CONCLUSION: ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and <30 weeks of gestational age.

  19. Steroids

    Science.gov (United States)

    ... steroids (say: STARE-oydz), they often mean illegal anabolic steroids. Anabolic steroids are artificially produced hormones that are the same ... these is testosterone (say: tes-TOSS-tuh-rone). Anabolic steroids can be taken in the form of pills, ...

  20. Steroid plus antiviral treatment for Bell's palsy.

    Science.gov (United States)

    Kang, H M; Jung, S Y; Byun, J Y; Park, M S; Yeo, S G

    2015-05-01

    The effectiveness of antiviral agents for the treatment of Bell's palsy is uncertain. We evaluated whether a steroid with an antiviral agent (S + A group) provided better recovery outcomes than a steroid alone (S group) in patients with Bell's palsy. A total of 1342 patients diagnosed with Bell's palsy who visited the Kyung Hee Medical Center in Seoul, Korea, from 2002 to 2012 were included in this study. Patients in the S + A group were treated with prednisolone and antiviral agents (n = 569) and those in the S group with prednisolone alone (n = 773). Outcomes were measured using the House-Brackmann (HB) scale according to age, initial disease severity, electroneurography (ENoG) findings and underlying comorbidities. The rate of recovery (HB grades I and II) with initially severe Bell's palsy (HB grades V and VI) was higher in the S + A than in the S group (P = 0.001). However, the rates of recovery were similar with initially moderate palsy (HB grades II-IV) (P = 0.502). In patients classified according to age and ENoG-determined severity of palsy, the overall recovery rate was higher in the S + A than in the S group, but the differences were not statistically significant (P > 0.05 for both). The recovery rate without diabetes mellitus (DM) and hypertension (HTN) was higher in the S + A group than in the S group (P = 0.031). But in the patients with HTN and DM, the difference in recovery rates between the S + A and S groups was not statistically significant (P = 0.805). Treatment with a steroid plus antiviral agent resulted in significantly higher recovery rates than steroid therapy alone in patients with initially severe Bell's palsy and without either HTN or DM, and a nonsignificant trend towards higher recovery rates in all patients with Bell's palsy in this study. Antiviral agents may therefore help in the treatment of Bell's palsy. © 2014 The Association for the Publication of the Journal of Internal Medicine.

  1. Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids.

    Science.gov (United States)

    Chawla, Sanjay; Natarajan, Girija; Shankaran, Seetha; Pappas, Athina; Stoll, Barbara J; Carlo, Waldemar A; Saha, Shampa; Das, Abhik; Laptook, Abbot R; Higgins, Rosemary D

    2016-12-01

    Many premature infants are born without exposure to antenatal steroids (ANS) or with incomplete courses. This study evaluates the dose-dependent effect of ANS on rates of neonatal morbidities and early childhood neurodevelopmental outcomes of extremely premature infants. To compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no ANS or partial or complete courses of ANS. In this observational cohort study, participants were extremely premature infants (birth weight range, 401-1000 g; gestational age, 22-27 weeks) who were born at participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 2006 and December 2011. Data were analyzed between October 2013 and May 2016. Rates of death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined as the presence of any of the following: moderate to severe cerebral palsy, a cognitive score less than 85 on the Bayley Scales of Infant and Toddler Development III, blindness, or deafness. There were 848 infants in the no ANS group, 1581 in the partial ANS group, and 3692 in the complete ANS group; the mean (SD) birth weights were 725 (169), 760 (173), and 753 (170) g, respectively, and the mean (SD) gestational ages were 24.5 (1.4), 24.9 (2), and 25.1 (1.1) weeks. Of 6121 eligible infants, 4284 (70.0%) survived to 18- to 22-month follow-up, and data were available for 3892 of 4284 infants (90.8%). Among the no, partial, and complete ANS groups, there were significant differences in the rates of mortality (43.1%, 29.6%, and 25.2%, respectively), severe intracranial hemorrhage among survivors (23.3%, 19.1%, and 11.7%), death or necrotizing enterocolitis (48.1%, 37.1%, and 32.5%), and death or bronchopulmonary dysplasia (74.9%, 68.9%, and 65.5%). Additionally, death or neurodevelopmental impairment occurred in 68.1%, 54.4%, and 48.1% of

  2. Steroid-antivirals treatment versus steroids alone for the treatment of Bell’s palsy: a meta-analysis

    Science.gov (United States)

    Dong, Yabing; Zhu, Yong; Ma, Chuan; Zhao, Huaqiang

    2015-01-01

    Background: To illustrate whether the steroid-antivirals treatment could acquire a better recovery in patients with Bell’s palsy than the steroids alone treatment. Materials and methods: We conducted an exhaustive search over Pub med/Medline, Ovid, Elsevier search engines and the Cochrane library thereby collecting the randomized controlled trials in the treatment of patients with Bell’s palsy with steroid-antivirals and steroids. The qualities of relevant articles were assessed by GRADE, which was used to present the overall quality of evidence as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: Two investigators evaluated these papers independently, and resolved the disagreements by discussion. At last 8 eligible papers (1816 patients included: 896 treated with steroid-antivirals and 920 treated with steroids alone) match the criteria. Owing to the result (chi2 = 12.57, P = 0.08, I2 = 44%) presented by the formal test for heterogeneity, the fixed effect meta-analysis model was chosen. The facial muscle recovery between the steroids-antivirals group and the steroids alone group show significant differences (OR = 1.52, 95% CI: 1.20-1.94), while the statistical outcome of adverse effect shows no statistical significance (OR = 1.28, 95% CI: 0.71-2.31). Conclusions: The present meta-analysis indicates that the steroid-antivirals treatment could improve the recovery rate in patients with Bell’s palsy when comparing with the steroid alone treatment. Clinical significance: This meta-analysis showed that the steroid-antivirals treatment achieved the better outcomes in patients with Bell’s palsy. Clinicians should consider that steroid-antivirals therapy is an alternative choice for the patients with Bell’s palsy. PMID:25785012

  3. Steroid-antivirals treatment versus steroids alone for the treatment of Bell's palsy: a meta-analysis.

    Science.gov (United States)

    Dong, Yabing; Zhu, Yong; Ma, Chuan; Zhao, Huaqiang

    2015-01-01

    To illustrate whether the steroid-antivirals treatment could acquire a better recovery in patients with Bell's palsy than the steroids alone treatment. We conducted an exhaustive search over Pub med/Medline, Ovid, Elsevier search engines and the Cochrane library thereby collecting the randomized controlled trials in the treatment of patients with Bell's palsy with steroid-antivirals and steroids. The qualities of relevant articles were assessed by GRADE, which was used to present the overall quality of evidence as recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Two investigators evaluated these papers independently, and resolved the disagreements by discussion. At last 8 eligible papers (1816 patients included: 896 treated with steroid-antivirals and 920 treated with steroids alone) match the criteria. Owing to the result (chi(2) = 12.57, P = 0.08, I(2) = 44%) presented by the formal test for heterogeneity, the fixed effect meta-analysis model was chosen. The facial muscle recovery between the steroids-antivirals group and the steroids alone group show significant differences (OR = 1.52, 95% CI: 1.20-1.94), while the statistical outcome of adverse effect shows no statistical significance (OR = 1.28, 95% CI: 0.71-2.31). The present meta-analysis indicates that the steroid-antivirals treatment could improve the recovery rate in patients with Bell's palsy when comparing with the steroid alone treatment. This meta-analysis showed that the steroid-antivirals treatment achieved the better outcomes in patients with Bell's palsy. Clinicians should consider that steroid-antivirals therapy is an alternative choice for the patients with Bell's palsy.

  4. The effect of antenatal steroids on fetal lung maturation between the 34th and 36th week of pregnancy.

    Science.gov (United States)

    Balci, Osman; Ozdemir, Suna; Mahmoud, Alaa S; Acar, Ali; Colakoglu, Mehmet C

    2010-01-01

    To evaluate the effect of antenatal treatment with a single dose of betamethasone between the 34th and the 36th week of pregnancy on the maturation of fetal lung. To study 100 pregnant women in their 34th-36th week of pregnancy who were diagnosed as susceptible to have preterm delivery. Fifty patients did not receive betamethasone (group 1). The other 50 patients were administered 12 mg betamethasone in a single dose (group 2). Patients who delivered at least 24 h after the administration of betamethasone were included in this study. After delivery, the Apgar score and the development of respiratory distress syndrome (RDS) in the neonates were compared. Group 2 babies had better Apgar scores when compared to group 1, and the difference was statistically significant. Sixteen (32%) neonates of group 1 and 7 (14%) neonates of group 2 required resuscitation, and the difference was statistically significant (p = 0.032; OR = 0.34, 95% CI 0.12-0.93). RDS was detected in 8 newborns of group 1 and 2 of group 2. The difference was statistically significant (p = 0.046; OR = 0.21, 95% CI 0.04-1.08). The administration of a single dose of betamethasone to pregnant women in their 34th-36th week of pregnancy who are likely to have preterm delivery reduces RDS development. There is a need for larger studies to confirm these results. Copyright 2010 S. Karger AG, Basel.

  5. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only.

    Science.gov (United States)

    Gallucci, Massimo; Limbucci, Nicola; Zugaro, Luigi; Barile, Antonio; Stavroulis, Emmanouil; Ricci, Alessandro; Galzio, Renato; Masciocchi, Carlo

    2007-03-01

    To prospectively compare the clinical effectiveness of intraforaminal and intradiscal injections of a mixture of a steroid, a local anesthetic, and oxygen-ozone (O(2)-O(3)) (chemodiscolysis) versus intraforaminal and intradiscal injections of a steroid and an anesthetic in the management of radicular pain related to acute lumbar disk herniation. Medical Ethical Committee approval and informed consent were obtained. One hundred fifty-nine patients (86 men, 73 women; age range, 18-71 years) were included and were randomly assigned to two groups. Seventy-seven patients (group A) underwent intradiscal and intraforaminal injections of a steroid and an anesthetic, and 82 patients (group B) underwent the same treatment with the addition of an O(2)-O(3) mixture. Procedures were performed with computed tomographic guidance. An Oswestry Low Back Pain Disability Questionnaire was administered before treatment and at intervals, the last at 6-month follow-up. Patients and clinicians were blinded as to which treatment was performed. Results were compared with the chi(2) test. After 6 months, treatment was successful in 36 (47%) patients in group A and in 61 (74%) patients in group B. The difference was significant (P < .01). Intraforaminal and intradiscal injections of a steroid, an anesthetic, and O(2)-O(3) are more effective at 6 months than injections of only a steroid and an anesthetic in the same sites.

  6. Bell's Palsy: Treatment with Steroids and Antiviral Drugs

    Science.gov (United States)

    ... Drooping of a corner of the mouth • Difficulty smiling, frowning, or making other facial expressions • Twitching or ... no definite added improvement. If there is any benefit to adding an antiviral to steroid treatment, it ...

  7. Efficacy comparison of oral steroid, intratympanic steroid, hyperbaric oxygen and oral steroid + hyperbaric oxygen treatments in idiopathic sudden sensorineural hearing loss cases.

    Science.gov (United States)

    Alimoglu, Yalcin; Inci, Ender; Edizer, Deniz Tuna; Ozdilek, Alper; Aslan, Mehmet

    2011-12-01

    Idiopathic sudden sensorineural hearing loss is a rare disorder of unknown pathogenesis in which hearing is lost partially or totally. About 60 treatment modalities have been described. We aimed to compare the efficacy of hyperbaric oxygen, oral steroid, intratympanic steroid therapy and their combinations in idiopathic sudden sensorineural hearing loss patients. Files of patients who were followed up between 2004 and 2010 in our clinic were examined retrospectively. Patients were divided into four groups according to the therapy received: Oral steroid, oral steroid + hyperbaric oxygen, intratympanic steroid and hyperbaric oxygen. Treatment success was assessed by Siegel criteria and mean gains using pre-treatment and post-treatment audiograms. 217 patients and 219 ears were examined. The proportion of patients responding to therapy was the highest in the oral steroid + hyperbaric oxygen group with 86.88% (53/61) followed by the oral steroid group with 63.79% (37/58), the intratympanic steroid group with 46,51% (20/43) and the hyperbaric oxygen group with 43.85% (25/57). The proportion of patients who had complete recovery was the highest in the oral steroid + hyperbaric oxygen group with 42.6% (26/61) followed by the oral steroid group with 19.0% (11/58), the hyperbaric oxygen group with 17.5% (10/57) and the intratympanic steroid group with 11.6% (5/43). The oral steroid + hyperbaric oxygen group has the highest mean hearing gain among all groups (p sudden sensorineural hearing loss patients receiving oral steroid + hyperbaric oxygen combination therapy have a higher likelihood of recovery than patients receiving oral steroids, hyperbaric oxygen or intratympanic steroids alone.

  8. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women.

    Science.gov (United States)

    Henderson, Jennifer J; Hartmann, Peter E; Newnham, John P; Simmer, Karen

    2008-01-01

    The onset of copious milk secretion after birth is known as lactogenesis II. The objective of this study was to investigate the effect of preterm birth and antenatal corticosteroids on the timing of lactogenesis II after birth. Women who had received antenatal betamethasone treatment and were expressing for a preterm infant whose gestational age was lactogenesis II. The volume of milk was reduced further when antenatal corticosteroids were administered between 28 and 34 weeks' gestation and delivery occurred 3 to 9 days later. In view of the advantages of mothers' own milk, additional support with lactation is recommended for mothers of preterm infants, particularly those who have been treated with corticosteroids before the delivery.

  9. Antenatal glucocorticoid treatment and polymorphisms of the glucocorticoid and mineralocorticoid receptors are associated with IQ and behavior in young adults born very preterm

    NARCIS (Netherlands)

    Voorn, B. van der; Pal, S.M. van der; Rotteveel, J.; Finken, M.J.

    2015-01-01

    Context: Preterm survivors exhibit neurodevelopmental impairments. Whether this association is influenced by antenatal glucocorticoid treatment and glucocorticoid sensitivity is unknown. Objectives: To study the effects of antenatal glucocorticoid treatment and glucocorticoid receptor (GR) and

  10. Subcutaneous steroid injection as treatment for chalazion: prospective case series.

    Science.gov (United States)

    Ho, S Y; Lai, J S M

    2002-02-01

    To study the efficacy of subcutaneous steroid injection in the treatment of chalazion. Prospective consecutive case series. University teaching hospital, Hong Kong. Patients with chalazion presenting to the out-patient clinic of the Department of Ophthalmology at the Prince of Wales Hospital from January to June 1998. Size of the chalazion after steroid injection treatment. Forty-eight consecutive patients with chalazion were treated with injection of triamcinolone into the subcutaneous tissue around the lesion. In 43 (89.6%) patients, the lesion subsided completely. Twenty-six (54.2%) patients had lesions that subsided with one injection. The size and duration of the chalazion at presentation did not significantly affect the outcome of the treatment. Two patients developed depigmentation of the skin at the site of injection. No other major complications were encountered. Subcutaneous injection of the steroid triamcinolone acetonide appears to be a simple and effective treatment for chalazion. Further comparative clinical trials are indicated.

  11. Idiopathic urethritis in children: Classification and treatment with steroids.

    Science.gov (United States)

    Jayakumar, Sivasankar; Pringle, Kirsty; Ninan, George K

    2014-07-01

    Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 - 4) and report our experience with use of topical and oral steroids in IU. Retrospective data collection of all male children (0-16 years) diagnosed with IU over a period of 8 years between 2005 and 2012 at our institution. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management and outcomes. A total of 19 male children were diagnosed with IU. The median age of the patients was 13(7-16) years. Presenting symptoms included dysuria in 12; hematuria in 9; loin pain in 6; and scrotal pain in 2 patients. Both patients with scrotal pain had previous left scrotal exploration that revealed epididymitis. Serum C-reactive protein and Full blood count was tested in 15 patients and was within normal limits in all of them. Cystourethroscopy revealed urethritis of grade-I in 2; grade-II in 11; and grade-III in 3 patients. There were 3 patients with systemic symptoms from extra-urethral extension of inflammation (grade-IV). Mean follow up was 18.9(1-74) months. All patients had steroid instillation at the time of cystourethroscopy. Three patients with IU grade IV required oral steroids (prednisolone) in view of exacerbation of symptoms and signs despite steroid instillation. Complete resolution of symptoms and signs occurred in 18(94.7%) patients. Significant improvement in symptoms and signs was noted in 1(5.3%) patient who is still undergoing treatment. IU in male children can be successfully managed with steroid instillation, especially in grade I and II. Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment. In children with IU and extra-urethral symptoms (grade IV), oral steroids may be required.

  12. Idiopathic urethritis in children: Classification and treatment with steroids

    Directory of Open Access Journals (Sweden)

    Sivasankar Jayakumar

    2014-01-01

    Full Text Available Background: Idiopathic urethritis [IU] in children is of unknown etiology and treatment options are limited. We propose a classification for IU based on cystourethroscopy findings and symptoms (Grade 1 - 4 and report our experience with use of topical and oral steroids in IU. Materials and Methods: Retrospective data collection of all male children (0-16 years diagnosed with IU over a period of 8 years between 2005 and 2012 at our institution. Data was collected on patient demographics, laboratory and radiological investigations, cystourethroscopy findings, management and outcomes. Results: A total of 19 male children were diagnosed with IU. The median age of the patients was 13(7-16 years. Presenting symptoms included dysuria in 12; hematuria in 9; loin pain in 6; and scrotal pain in 2 patients. Both patients with scrotal pain had previous left scrotal exploration that revealed epididymitis. Serum C-reactive protein and Full blood count was tested in 15 patients and was within normal limits in all of them. Cystourethroscopy revealed urethritis of grade-I in 2; grade-II in 11; and grade-III in 3 patients. There were 3 patients with systemic symptoms from extra-urethral extension of inflammation (grade-IV. Mean follow up was 18.9(1-74 months. All patients had steroid instillation at the time of cystourethroscopy. Three patients with IU grade IV required oral steroids (prednisolone in view of exacerbation of symptoms and signs despite steroid instillation. Complete resolution of symptoms and signs occurred in 18(94.7% patients. Significant improvement in symptoms and signs was noted in 1(5.3% patient who is still undergoing treatment. Conclusions: IU in male children can be successfully managed with steroid instillation, especially in grade I and II. Grade III, will need steroid instillation but treatment of scarring and stricture will necessitate longer duration of treatment. In children with IU and extra-urethral symptoms (grade IV, oral

  13. Steroids

    Science.gov (United States)

    ... Drugs & Your Family Social Media: Understanding a Teen's World Signs of Drug Use What’s Happening in Your ... hostility Increased risk of heart disease, liver damage Addiction Read More about Steroids Be Informed. Search for information about a drug View Popular Searches: POT , HEROIN , METH Previous Pause ...

  14. Treatment of Fragile X Syndrome with a Neuroactive Steroid

    Science.gov (United States)

    2012-08-01

    has shown its efficacy in the treatment of partial seizures, infantile spasms and catamenial epilepsy [18,42]. However, this is the first time that...AD_________________ Award Number: W81XWH-11-1-0626 TITLE: Treatment of Fragile X Syndrome with a...2012 4. TITLE AND SUBTITLE Treatment of Fragile X Syndrome with a Neuroactive Steroid 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-11-1-0626 5c

  15. Treatment approaches in children with steroid sensitive nephrotic syndrome

    Directory of Open Access Journals (Sweden)

    Süleyman Kalman

    2011-09-01

    Full Text Available Pediatric nephrotic syndrome (NS is a chronic glomerular disorder, and if untreated, is associated with increased risk of life-threatening infectious, thromboembolism, lipid abnormalities, and malnutrition. The aim of the management of NS in children is to induce and maintain complete remission with resolution of proteinuria and edema without encountering serious adverse effects of therapy. Over 90% of cases in children with idiopathic NS and a majority of them will respond to steroid therapy. However, a substantial number of patients relapse frequently and become steroid dependent. The occurrence of frequent relapses necessitates clear therapeutic strategies in order to maintain sustained remission and minimize steroid toxicity. Numerous therapeutic regimens have been proposed utilizing steroid sparing agents such as alkylating agents, principally, cyclophosphamide and chlorambucil, calcineurin inhibitors namely cyclosporin A and an immunomodulatory drug, levamisole, with variable success and associated side-effects. Recently, mycophenolate mofetil (MMF, tacrolimus, the anti-CD20 antibody, rituximab, have emerged as new therapeutic options for the management of steroid dependent NS in a few uncontrolled clinical trials. It is therefore important that the benefits and risks of these agents are weighed before considering their use in the treatment of patients with NS.

  16. Nasal steroids as a possible treatment for Alzheimer's disease.

    Science.gov (United States)

    Lehrer, Steven; Rheinstein, Peter H

    2017-10-01

    Quite a number of experimental treatments, which are based on conventionally accepted understandings of Alzheimer's disease, have not yielded expected results. Therefore, conventionally accepted understanding of the mechanisms of the disease may be inadequate or even wrong. The characteristic amyloid plaques and tau tangles in the brain may be a result, not a cause. Alzheimer's disease is more likely the product of neuroinflammation and deranged brain wound healing. If so, a hypothesized treatment, intranasal glucocorticoids, might be effective. Long-term use of intranasal glucocorticoids (especially older generation steroids) for Alzheimer's treatment would potentially raise intraocular pressure, but newer intranasal steroids (fluticasone, triamcinolone, or budesonide) have a minimal effect on intraocular pressure because of their low bioavailability.

  17. Oral steroid treatment for idiopathic sudden sensorineural hearing loss

    Science.gov (United States)

    Chen, Wei T.; Lee, Jui W.; Yuan, Chien H.; Chen, Rong F.

    2015-01-01

    Objectives: To describe the efficacy of long-term oral steroids in idiopathic sudden sensorineural hearing loss (ISSHL), and to explore potential prognosis factors, the relationship of hearing recovery outcome, and the recovery time-course in ISSHL. Methods: In this retrospective study, we analyzed 215 cases diagnosed with idiopathic unilateral sudden deafness between January 2003 and December 2012 at a regional hospital in southern Taiwan. All of them received oral steroid therapy and were followed for at least 3 months. Results: Young age, the presence of no other disease (diabetes, hypertension, or cardiovascular disease), treatment within 7 days of the onset of ISSHL, mild hearing loss, and audiograms with ascending curves had a statistically significant better hearing recovery. The average pure-tone audiometry (PTA) was 67.8±23.9 dB initially, and was improved between one month (51.6±28.7 dB) and 2 months post treatment (49.7±28.6 dB). The average last-visit PTA was 49.9±29.2 dB. Conclusion: Approximately one third of patients had full recovery in hearing, one third had partial recovery, and approximately one third did not recover from hearing loss. In addition, the hearing level remained relatively stable following 2 months of treatment. More than 2 months of oral steroid therapy for ISSHL is not recommended because no additional benefits were evidenced. PMID:25737170

  18. Anabolic steroid-induced hypogonadism: diagnosis and treatment.

    Science.gov (United States)

    Rahnema, Cyrus D; Lipshultz, Larry I; Crosnoe, Lindsey E; Kovac, Jason R; Kim, Edward D

    2014-05-01

    To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management. Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria. Not applicable. Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS. History and physical examination followed by medical intervention if necessary. Serum testosterone and gonadotropin levels, symptoms, and fertility restoration. Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators. Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Treatment of phimosis with topical steroids and foreskin anatomy

    Directory of Open Access Journals (Sweden)

    Tatiana C. Marques

    2005-08-01

    Full Text Available OBJECTIVES: To correlate topical steroidal treatment of stenosed foreskin with the different degrees of glans exposure and the length of time the ointment is applied. MATERIALS AND METHODS: We studied 95 patients with phimosis, divided according to the degree of foreskin retraction. Group A presented no foreskin retraction, group B presented exposure of only the urethral meatus, group C presented exposure of half of the glans, and group D presented exposure of the glans, which was incomplete because of preputial adherences to the coronal sulcus. Patients were submitted to application of 0.05% betamethasone ointment on the distal aspect of the prepuce twice daily for a minimum of 30 days and a maximum of 4 months. RESULTS: Of 95 patients, 10 (10.52% abandoned the treatment and 15 patients in groups C and D were excluded from the study. Among the remaining 70 patients, only 4 patients (5.7% in group A did not obtain adequate glans exposure after treatment. In group A (38 patients, fully retractable foreskins were obtained in 19 patients (50% after 1 month of treatment. In group B (28 patients, fully retractable foreskins were obtained in 18 patients (64.2% after 1 month. CONCLUSIONS: Treatment was successful in 94.2% of patients, irrespective of the type of foreskin anatomy. The improvement may require several months of treatment. Patients with impossibility of urethral meatus exposure present around 10% treatment failure.

  20. The risk of osteoporosis in oral steroid treatment for nasal polyposis

    DEFF Research Database (Denmark)

    Winblad, L; Larsen, C G; Håkansson, K.

    2017-01-01

    BACKGROUND: Systemic glucocorticoids are often used in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), and osteoporosis is a well-known complication to steroid treatment, associated with significant morbidity. Nevertheless, the burden of steroid induced osteoporosis is unknown...... in patients with CRSwNP. We aimed to assess the risk of acquiring osteoporosis caused by oral steroids in patients with CRSwNP, and provide recommendations on future research and guidelines. METHODOLOGY: Cochrane Review Database, EMBASE, Ovid Medline, and PubMed were searched for studies including adult...... patients with CRSwNP treated with oral steroids. Outcomes were Bone Mineral Density (BMD) and prevalence of fractures in relation to dose and duration of oral steroids. In addition, we reviewed general guidelines for treatment with oral steroids. RESULTS: We identified two studies (n=243) that met...

  1. Steroid/Antiviral for the treatment of Bell's palsy: Double blind randomized clinical trial.

    Science.gov (United States)

    Khedr, Eman Mohamed; Badry, Reda; Ali, Anwer Mohamed; Abo El-Fetoh, Noha; El-Hammady, Dina Hatem; Ghandour, Abeer Mohamed; Abdel-Haleem, Ahmed

    2016-11-22

    A large number of patients with Bell's palsy fail to recover facial function completely after steroid therapy. Only a few small trials have been conducted to test whether outcomes can be improved by the addition of antiviral therapy. To evaluate the efficacy of treatment with steroid alone versus steroid + antiviral in a group of patients with moderately severe to severe acute Bell's palsy. Fifty eligible patients out of a total of 65 with acute onset Bell's palsy were randomized to receive the two treatments. Evaluation was performed before starting treatment, after 2 weeks of treatment and 3 months after onset, using the House and Brackmann facial nerve grading system (HB) and the Sunnybrook grading system.This study was registered with ClinicalTrials.gov, number NCT02328079. Both treatments had comparable demographics and clinical scores at baseline. There was greater improvement in the mean HB and Sunnybrook scores of the steroid + antiviral group in comparison to steroid group at 3 months. At the end of the 3rd month, 17 patients (68%) had good recovery and 8 patients (32%) had poor recovery in the steroid group compared with 23 patients (92%) and 2 (8%) respectively in the steroid and antiviral group (p = 0.034). The combination of steroid and antiviral treatment increases the possibility of recovery in moderately severe to complete acute Bell's palsy.

  2. Risk Factors for the Requirement of Antenatal Insulin Treatment in Gestational Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Mayu Watanabe

    2016-01-01

    Full Text Available Poor maternal glycemic control increases maternal and fetal risk for adverse outcomes, and strict management of gestational diabetes mellitus (GDM is recommended to prevent neonatal and maternal complications. However, risk factors for the requirement of antenatal insulin treatment (AIT are not well-investigated in the pregnant women with GDM. We enrolled 37 pregnant women with GDM and investigated the risk for AIT by comparing the patients with AIT (AIT group; n=10 and without insulin therapy (Diet group; n=27. The 1-h and 2-h plasma glucose levels and the number of abnormal values in 75 g OGTT were significantly higher in AIT group compared with Diet group. By logistic regression analysis, plasma glucose level at 1-h was significant predictor for AIT and the odds ratios were 1.115 (1.004–1.239 using forward selection method and 1.192 (1.006–1.413 using backward elimination method. There were no significant differences in obstetrical outcomes and neonatal complications. 1-h plasma glucose levels in 75 g OGTT are useful parameters in predicting the requirement for AIT in GDM. Both maternal and neonatal complications are comparable in GDM patients with and without insulin therapy.

  3. Gastroschisis with intestinal atresia--predictive value of antenatal diagnosis and outcome of postnatal treatment.

    Science.gov (United States)

    Ghionzoli, Marco; James, Catherine P; David, Anna L; Shah, Dimple; Tan, Aileen W C; Iskaros, Joseph; Drake, David P; Curry, Joseph I; Kiely, Edward M; Cross, Kate; Eaton, Simon; De Coppi, Paolo; Pierro, Agostino

    2012-02-01

    The purpose of this study is to evaluate (1) the predictive value of fetal bowel dilatation (FBD) for intestinal atresia in gastroschisis and (2) the postnatal management and outcome of this condition. A retrospective review of all gastroschisis cases diagnosed in our fetal medicine unit between 1992 and 2010 and treated postnatally in our center was performed. One hundred thirty cases had full postnatal data available. Intestinal atresia was found at surgery in 14 neonates (jejunum, n = 6; ileum, n = 3; ascending colon, n = 3; multiple, n = 2). Polyhydramnios and FBD were more likely in the atresia group compared with infants with no atresia (P = .0003 and P = .005, respectively). Fetal bowel dilatation had 99% negative predictive value (95% confidence interval, 0.9-0.99) and 17% positive predictive value (95% confidence interval, 0.1-0.3) for atresia. Treatment of intestinal atresia included primary anastomosis (n = 5), delayed anastomosis (n = 2), and stoma formation followed by anastomosis (n = 7). Infants with atresia had longer duration of parenteral nutrition, higher incidence of sepsis, and cholestasis compared with infants with no atresia (P = .0003). However, the presence of atresia did not increase mortality. Polyhydramnios and FBD are associated with atresia. Absence of FBD in gastroschisis excludes intestinal atresia. In our experience, atresia is associated with a longer duration of parenteral nutrition but does not influence mortality. These findings may be relevant for antenatal counseling. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Clinical manifestations and treatment response of steroid in pediatric Hashimoto encephalopathy.

    Science.gov (United States)

    Yu, Hee Joon; Lee, Jeehun; Seo, Dae Won; Lee, Munhyang

    2014-07-01

    Hashimoto encephalopathy is a steroid-responsive encephalopathy associated with elevated titers of antithyroid antibodies. Clinical symptoms are characterized by behavioral and cognitive changes, speech disturbance, seizures, myoclonus, psychosis, hallucination, involuntary movements, cerebellar signs, and coma. The standard treatment is the use of corticosteroids along with the treatment of any concurrent dysthyroidism. Other options are immunoglobulins and plasmapheresis. We described symptoms and outcomes on 3 teenage girls with Hashimoto encephalopathy. Presenting symptoms were seizure or altered mental status. One patient took levothyroxine due to hypothyroidism before presentation of Hashimoto encephalopathy. After confirmation of elevated antithyroid antibodies, all patients were treated with steroids. One patient needed plasmapheresis because of the lack of response to steroids and immunoglobulins. Hashimoto encephalopathy should be considered in any patient presenting with acute or subacute unexplained encephalopathy and seizures. Even though the use of steroids is the first line of treatment, plasmapheresis can rescue steroid-resistant patients. © The Author(s) 2013.

  5. Role of steroids in the treatment of bacterial keratitis

    Directory of Open Access Journals (Sweden)

    Palioura S

    2016-01-01

    Full Text Available Sotiria Palioura, Christopher R Henry, Guillermo Amescua, Eduardo C AlfonsoDepartment of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Bacterial keratitis can lead to severe visual impairment from corneal ulceration, subsequent scarring, and possible perforation. The mainstay of treatment is topical antibiotics, whereas the use of adjunctive topical corticosteroid drops remains a matter of debate. Herein, we review the rationale for and against the use of topical corticosteroids and we assess their effectiveness and safety in the published randomized controlled trials that have evaluated their role as adjunctive therapy for bacterial corneal ulcers. In the largest study to date, the Steroids for Corneal Ulcers Trial, topical corticosteroid drops were neither helpful nor harmful for the 500 participants as a whole. However, subgroup analyses suggested that topical corticosteroids may be beneficial upon early administration (within 2–3 days after starting antibiotics for more central corneal ulcers with poorer vision at presentation, for invasive Pseudomonas strains, and for non-Nocardia ulcers. These results are discussed within the limitations of the study.Keywords: topical corticosteroids, corneal ulcer, eye infection, antibiotic, endophthalmitis, perforation

  6. [Childhood steroid-dependent idiopathic nephrotic syndrome: Predictive factors for the need of immunosuppressive treatment].

    Science.gov (United States)

    Golay, M; Douillard, A; Nagot, N; Fila, M; Ichay, L; Dalla Vale, F; Tenenbaum, J; Morin, D

    2017-11-01

    More than half of the children with idiopathic nephrotic syndrome become steroid-dependent (or frequent relapsers) and will later require the use of complementary treatment aiming to reduce steroids' side effects and to limit the number of proteinuria relapses. It appears important to identify these children as early as possible in order to adapt their treatment. The aim of this study was to analyze the population of children, under 18 years of age, diagnosed between 1/01/2000 and 31/05/2015 with an idiopathic nephrotic syndrome and followed at the Montpellier University Hospital to search for criteria predictive of steroid-sparing agent use. In this retrospective study of children with idiopathic nephrotic syndrome, the exclusion criteria were primary steroid resistance and children with no proteinuria relapse after diagnosis. Eighty-four children (54 boys) were included in this study. The mean follow-up duration was 5.5 years (0.75-16). The mean age at diagnosis was 4.6 years. Sixty-five children (77%) received at least one steroid-sparing agent during their follow-up, within a mean 10 months after diagnosis. In these patients, the first relapse of the disease occurred earlier when compared with the children who were maintained on steroid alone (4 months vs 7 months; P<0.001). The use of methylprednisolone pulses to obtain a remission, the cumulative dose of steroid treatment, and the number of proteinuria relapses were also significantly correlated with the use of complementary immunosuppressive therapy. We found no predictive criteria of the use of steroid-sparing agents at diagnosis in our population of children. Nevertheless, with the steroid regimen used, the time within which the first proteinuria relapse occurred appears to be a significant criterion for the secondary use of a steroid-sparing agent. These data should be taken into account when choosing the treatment regimen. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Antenatal steroids and the IUGR fetus: are exposure and physiological effects on the lung and cardiovascular system the same as in normally grown fetuses?

    Science.gov (United States)

    Morrison, Janna L; Botting, Kimberley J; Soo, Poh Seng; McGillick, Erin V; Hiscock, Jennifer; Zhang, Song; McMillen, I Caroline; Orgeig, Sandra

    2012-01-01

    Glucocorticoids are administered to pregnant women at risk of preterm labour to promote fetal lung surfactant maturation. Intrauterine growth restriction (IUGR) is associated with an increased risk of preterm labour. Hence, IUGR babies may be exposed to antenatal glucocorticoids. The ability of the placenta or blood brain barrier to remove glucocorticoids from the fetal compartment or the brain is compromised in the IUGR fetus, which may have implications for lung, brain, and heart development. There is conflicting evidence on the effect of exogenous glucocorticoids on surfactant protein expression in different animal models of IUGR. Furthermore, the IUGR fetus undergoes significant cardiovascular adaptations, including altered blood pressure regulation, which is in conflict with glucocorticoid-induced alterations in blood pressure and flow. Hence, antenatal glucocorticoid therapy in the IUGR fetus may compromise regulation of cardiovascular development. The role of cortisol in cardiomyocyte development is not clear with conflicting evidence in different species and models of IUGR. Further studies are required to study the effects of antenatal glucocorticoids on lung, brain, and heart development in the IUGR fetus. Of specific interest are the aetiology of IUGR and the resultant degree, duration, and severity of hypoxemia.

  8. Antenatal Steroids and the IUGR Fetus: Are Exposure and Physiological Effects on the Lung and Cardiovascular System the Same as in Normally Grown Fetuses?

    Directory of Open Access Journals (Sweden)

    Janna L. Morrison

    2012-01-01

    Full Text Available Glucocorticoids are administered to pregnant women at risk of preterm labour to promote fetal lung surfactant maturation. Intrauterine growth restriction (IUGR is associated with an increased risk of preterm labour. Hence, IUGR babies may be exposed to antenatal glucocorticoids. The ability of the placenta or blood brain barrier to remove glucocorticoids from the fetal compartment or the brain is compromised in the IUGR fetus, which may have implications for lung, brain, and heart development. There is conflicting evidence on the effect of exogenous glucocorticoids on surfactant protein expression in different animal models of IUGR. Furthermore, the IUGR fetus undergoes significant cardiovascular adaptations, including altered blood pressure regulation, which is in conflict with glucocorticoid-induced alterations in blood pressure and flow. Hence, antenatal glucocorticoid therapy in the IUGR fetus may compromise regulation of cardiovascular development. The role of cortisol in cardiomyocyte development is not clear with conflicting evidence in different species and models of IUGR. Further studies are required to study the effects of antenatal glucocorticoids on lung, brain, and heart development in the IUGR fetus. Of specific interest are the aetiology of IUGR and the resultant degree, duration, and severity of hypoxemia.

  9. Potential adverse effects of antenatal melatonin as a treatment for intrauterine growth restriction: findings in pregnant sheep.

    Science.gov (United States)

    González-Candia, Alejandro; Veliz, Marcelino; Araya, Claudio; Quezada, Sebastian; Ebensperger, Germán; Serón-Ferré, María; Reyes, Roberto V; Llanos, Aníbal J; Herrera, Emilio A

    2016-08-01

    Intrauterine growth restriction is a condition in which the fetus has a birthweight and/or length melatonin acts as an umbilical vasodilator and a potent antioxidant that has not been evaluated in pregnancies under chronic hypoxia that induce fetal growth restriction. However, this neurohormone has been proposed as a pharmacologic therapy for complicated pregnancies. The aim of this study was to determine the effects of prenatal administration of melatonin during the last trimester of pregnancy on the biometry of the growth-restricted lambs because of developmental hypoxia. Further, we aimed to determine melatonin and cortisol levels and oxidative stress markers in plasma of pregnant ewes during the treatment. High-altitude pregnant sheep received either vehicle (n = 5; 5 mL 1.4% ethanol) or melatonin (n = 7; 10 mg/kg(-1)day(-1) in 5 mL 1.4% ethanol) daily during the last one-third of gestation. Maternal plasma levels of melatonin, cortisol, antioxidant capacity, and oxidative stress were determined along treatment. At birth, neonates were examined, weighed, and measured (biparietal diameter, abdominal diameter, and crown-rump length). Antenatal treatment with melatonin markedly decreased neonatal biometry and weight at birth. Additionally, melatonin treatment increased the length of gestation by 7.5% and shifted the time of delivery. Furthermore, the prenatal treatment doubled plasma levels of melatonin and cortisol and significantly improved the antioxidant capacity of the pregnant ewes. Our findings indicate that antenatal melatonin induces further intrauterine growth restriction but improves the maternal plasma antioxidant capacity. Additional studies should address the efficiency and safety of antenatal melatonin before clinical attempts on humans. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Steroid-induced femoral head osteonecrosis in immune thrombocytopenia treatment with osteochondral autograft transplantation.

    Science.gov (United States)

    Fotopoulos, Vasileios Ch; Mouzopoulos, George; Floros, Themistoklis; Tzurbakis, Matthaios

    2015-09-01

    Osteonecrosis of the femoral head is a devastating complication of steroid administration and has rarely been observed in the treatment of immune thrombocytopenia. The treatment of osteochondral defects in advanced stages of avascular necrosis (AVN), characterized by collapse of the subchondral bone, remains an unsolved burden in orthopedic surgery. In this report, we present a case of a 19-year-old female that was admitted in the Emergency Department with walking disability and painful hip joint movement due to steroid-induced femoral head osteonecrosis. Two years before she was diagnosed with immune thrombocytopenia, for which she received pulse steroid therapy with high dose of dexamethasone and underwent a splenectomy. This case report is the first to describe the use of osteochondral autograft transplantation as a treatment of steroid-induced AVN of the femoral head due to immune thrombocytopenia at the age of 19 years with very good clinical and radiological results 3 years postoperatively.

  11. Impact of the Integration of Water Treatment and Handwashing Incentives with Antenatal Services on Hygiene Practices of Pregnant Women in Malawi

    Science.gov (United States)

    Sheth, Anandi N.; Russo, Elizabeth T.; Menon, Manoj; Wannemuehler, Kathleen; Weinger, Merri; Kudzala, Amose C.; Tauzie, Blessius; Masuku, Humphreys D.; Msowoya, Tapona E.; Quick, Robert

    2010-01-01

    Access to safe drinking water and improved hygiene are important for reducing morbidity and mortality from diarrhea. We surveyed 330 pregnant women who participated in an antenatal clinic-based intervention in Malawi that promoted water treatment and hygiene through distribution of water storage containers, sodium hypochlorite water treatment solution, soap, and educational messages. Program participants were more likely to know correct water treatment procedures (62% versus 27%, P water treatment solution after free distribution (32% versus 1%, P water treatment and hygiene behaviors among pregnant women. Participants had high use of antenatal, delivery, and postnatal services, which could improve maternal and child health. PMID:21118942

  12. TREATMENT OF STEROID DEPENDENT ASTHMATICS WITH LOW DOSES OF CYCLOSPORINE

    Directory of Open Access Journals (Sweden)

    Stanislav Šuškovič

    2004-01-01

    Full Text Available Background. Asthmatics with glucocorticoid dependent asthma should be treated with systemic steroids. Cyclosporine is in many ways a potent anti-inflammatory drug. Cyclosporine is sometimes very effective in treating asthmatics and could allow us to lower the dose of oral steroid. In some randomized, double blind studies steroid dependent asthmatics were treated 12–36 weeks with cyclosporine in dose 5 mg/kg/day. We tried cyclosporine in steroid dependent asthmatics in shorter course and in lower dose.Methods. 13 steroid dependent asthmatics were in the first four weeks of the study treated by their own drugs (phase 1. Then they were for the next four weeks (phase 2 randomly and in double blind fashion treated with either cyclosporine (mean 1.7 mg/kg/day, SD 0.5, 6 patients – group 1 or by identical placebo (7 patients – group 2. To the patients in the group 2 serum concentration of cyclosporine was measured on the eight day of the study.Results. Morning peak expiratory flow (PEF raised significantly in group 1 (200 L/sec to 247 L/sec or for 23%. Patients in group1 had significantly less episodes of nocturnal asthma (2.2 episodes/night to 1.5 episodes/night or for 32%. In group 2 were not found any changes between first phase and second phase of the study. Steroid consumption did not change in any group. Mean serum concentration of cyclosporine in patients of group1 was 35.7 µg/L. We did not find any adverse effects of cyclosporine or placebo.Conclusions. Cyclosporine could have dangerous side effects, which are dependent on its serum concentration. So it should be administered in the lowest possible dose and for the most possible short period. In our study it was found that it is possible to successfully treat steroid dependent asthmatics with lower daily dose and for shorter time, than was found in other similar studies.

  13. Myeloid regeneration after whole body irradiation, autologous bone marrow transplantation, and treatment with an anabolic steroid

    International Nuclear Information System (INIS)

    Ambrus, C.M.; Ambrus, J.L.

    1975-01-01

    Stumptail monkeys (Macaca speciosa) received lethal whole-body radiation. Autologous bone marrow injection resulted in survival of the majority of the animals. Treatment with Deca-Durabolin, an anabolic steroid, caused more rapid recovery of colony-forming cell numbers in the bone marrow than in control animals. Both the Deca-Durabolin-treated and control groups were given autologous bone marrow transplantation. Anabolic steroid effect on transplanted bone marrow colony-forming cells may explain the increased rate of leukopoietic regeneration in anabolic steroid-treated animals as compared to controls

  14. [Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain].

    Science.gov (United States)

    Beyaz, Serbülent Gökhan

    A cross-sectional study. We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  15. Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain.

    Science.gov (United States)

    Beyaz, Serbülent Gökhan

    A cross-sectional study. We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  16. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.

    Science.gov (United States)

    Boyle, Rhianon; Hay-Smith, E Jean C; Cody, June D; Mørkved, Siv

    2012-10-17

    About a third of women have urinary incontinence and up to a 10th have faecal incontinence after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth both for prevention and the treatment of incontinence. To determine the effect of pelvic floor muscle training compared to usual antenatal and postnatal care on incontinence. We searched the Cochrane Incontinence Group Specialised Register, which includes searches of CENTRAL, MEDLINE, MEDLINE in Process and handsearching (searched 7 February 2012) and the references of relevant articles. Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial needed to include pelvic floor muscle training (PFMT). Another arm was either no PFMT or usual antenatal or postnatal care. Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. Three different populations of women were considered separately, women dry at randomisation (prevention); women wet at randomisation (treatment); and a mixed population of women who might be one or the other (prevention or treatment). Trials were further divided into those which started during pregnancy (antenatal); and those started after delivery (postnatal). Twenty-two trials involving 8485 women (4231 PFMT, 4254 controls) met the inclusion criteria and contributed to the analysis.Pregnant women without prior urinary incontinence (prevention) who were randomised to intensive antenatal PFMT were less likely than women randomised to no PFMT or usual antenatal care to report urinary incontinence up to six months after delivery (about 30% less; risk ratio (RR) 0.71, 95% CI 0.54 to 0.95, combined result of 5 trials).Postnatal women with persistent urinary incontinence (treatment) three months after delivery and who received

  17. Oral versus intravenous steroids for treatment of relapses in multiple sclerosis.

    Science.gov (United States)

    Burton, Jodie M; O'Connor, Paul W; Hohol, Marika; Beyene, Joseph

    2012-12-12

    This is an updated Cochrane review of the previous version published (Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006921. DOI: 10.1002/14651858.CD006921.pub2).Multiple sclerosis (MS), a chronic inflammatory and neurodegenerative disease of the central nervous system (CNS), is characterized by recurrent relapses of CNS inflammation ranging from mild to severely disabling.  Relapses have long been treated with steroids to reduce inflammation and hasten recovery.  However, the commonly used intravenous methylprednisolone (IVMP) requires repeated infusions with the added costs of homecare or hospitalization, and may interfere with daily responsibilities. Oral steroids have been used in place of intravenous steroids, with lower direct and indirect costs. The primary objective was to compare efficacy of oral versus intravenous steroids in promoting disability recovery in MS relapses Multiple Sclerosis and Rare Diseases of the Central Nervous System Group's Trials Register (January 2012), abstracts from meetings of the American Academy of Neurology (2008-2012), the European Federation of Neurological Sciences (2008-2012), the European Committee for Treatment and Research in Multiple Sclerosis and American Committee for Treatment and Research in Multiple Sclerosis (2008-2012) handsearching. No language restrictions were applied. Randomized or quasi-randomized trials comparing oral versus intravenous steroids for acute relapses (Multiple Sclerosis (OMEGA) trial and the "Efficacy and Safety of Methylprednisolone Per os Versus IV for the Treatment of Multiple Sclerosis (MS) Relapses" (COPOUSEP) trial, designed to address such limitations, are currently underway. The analysis of the five included trials comparing intravenous versus oral steroid therapy for MS relapses do not demonstrate any significant differences in clinical (benefits and adverse events), radiological or pharmacological outcomes. Based on the evidence, oral steroid therapy may be a

  18. Prevalence and treatment outcomes of routine Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis testing during antenatal care, Gaborone, Botswana.

    Science.gov (United States)

    Wynn, Adriane; Ramogola-Masire, Doreen; Gaolebale, Ponatshego; Moshashane, Neo; Sickboy, Ontiretse; Duque, Sofia; Williams, Elizabeth; Doherty, Klara; Klausner, Jeffrey D; Morroni, Chelsea

    2017-11-02

    Chlamydia trachomatis (CT) , Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) are curable, mostly asymptomatic, STIs that cause adverse maternal and perinatal outcomes. Most countries do not test for those infections during antenatal care. We implemented a CT, NG and TV testing and treatment programme in an antenatal clinic in Gaborone, Botswana. We conducted a prospective study in the antenatal clinic at Princess Marina Hospital in Gaborone, Botswana. We offered pregnant women who were 18 years or older and less than 35 weeks of gestation, CT, NG and TV testing using self-collected vaginal swabs. Testing was conducted using a GeneXpert® CT/NG and TV system. Those who tested positive were given directly observed antibiotic therapy and asked to return for a test of cure. We determined the prevalence of infections, uptake of treatment and proportion cured. The relationships between positive STI test and participant characteristics were assessed. We enrolled 400 pregnant women. Fifty-four (13.5%) tested positive for CT, NG and/or TV: 31 (8%) for CT, 5 (1.3%) for NG and 21 (5%) for TV. Among those who tested positive, 74% (40) received same-day, in person results and treatment. Among those who received delayed results (6), 67% (4) were treated. Statistical comparisons showed that being unmarried and HIV infected were positively association CT, NG and/or TV infection. Self-reported STI symptoms were not associated with CT, NG and/or TV infection. The prevalence of CT, NG and/or TV was high, particularly among women with HIV infection. Among women with CT, NG and/or TV infection, those who received same-day results were more likely to be treated than those who received delayed results. More research is needed on the costs and benefits of integrating highly sensitive and specific STI testing into antenatal care in Southern Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  19. Self-Treatment of Gynecomastia in Bodybuilders Who Use Anabolic Steroids. Case Reports.

    Science.gov (United States)

    Friedl, Karl E.; Yesalis, Charles E.

    1989-01-01

    Presents four case reports of bodybuilders whose self-administered anabolic steroid programs resulted in gynecomastia, and discusses treatment strategies advocated by some bodybuilders. The actual recommended treatment is complete cessation of drugs. By dispelling unfounded treatment methods, physicians might help discourage such drug use. (SM)

  20. Long-term Impact of Integration of Household Water Treatment and Hygiene Promotion with Antenatal Services on Maternal Water Treatment and Hygiene Practices in Malawi

    Science.gov (United States)

    Loharikar, Anagha; Russo, Elizabeth; Sheth, Anandi; Menon, Manoj; Kudzala, Amose; Tauzie, Blessius; Masuku, Humphreys D.; Ayers, Tracy; Hoekstra, Robert M.; Quick, Robert

    2013-01-01

    A clinic-based program to integrate antenatal services with distribution of hygiene kits including safe water storage containers, water treatment solution (brand name WaterGuard), soap, and hygiene education, was implemented in Malawi in 2007 and evaluated in 2010. We surveyed 389 participants at baseline in 2007, and found and surveyed 232 (60%) participants to assess water treatment, test stored drinking water for residual chlorine (an objective measure of treatment), and observe handwashing technique at follow-up in 2010. Program participants were more likely to know correct water treatment procedures (67% versus 36%; P water treatment and proper handwashing technique among program participants. PMID:23243106

  1. Setting the legal standard of care for treatment and evidence-based medicine: a case study of antenatal corticosteroids.

    Science.gov (United States)

    McMurtrie, Lachlan

    2006-11-01

    This article argues that liability for negligent medical treatment should be predicated upon a standard of care reflecting what is medically and scientifically reasonable. Legal science (jurisprudence) and medical science (evidence-based medicine) should be reconciled to improve patient care and outcomes. The use of antenatal corticosteroids in obstetrics during the 1990s illustrates how most jurisprudence for setting the standard of care for treatment is ill equipped to meet the fundamental aims of tort law. The proliferation of evidence-based medical practice provides a unique opportunity for the law to encourage best medical practice when setting the standard of care for treatment. It is argued that, eventually, the law should recognise clinical practice guidelines as the prima facie standard of care for treatment. This will provide legal certainty, appropriate medical practitioner accountability, and ultimately improve patient care and outcomes.

  2. The efficacy of rituximab in treatment of childhood steroid resistant and steroid dependent nephrotic syndrome: a systematic review and Meta-analysis

    Directory of Open Access Journals (Sweden)

    Hamid Mohammadjafar

    2013-05-01

    Full Text Available Corticosteroid resistant and dependent nephrotic syndrome in children is a challenge and there are some difficulties in treating such patients. We reviewed the current studies that evaluated therapeutic role of a relatively new immunosuppressive drug “rituximab” in reducing proteinuria and reduction of relapse rate in less than 16 year old patients with non-responsive or steroid dependent nephrotic syndrome. We searched Medline, Embase, web of science and Cochrane library with appropriate keywords and conducted the complete remission, relapse rate and the mean number of relapses 12 month after therapy on Meta-analysis. We put the data on two different subgroups; steroid resistant nephrotic syndrome and steroid dependent or frequent relapser nephrotic syndrome. In Steroid Resistant Nephrotic syndrome children, the complete remission was 0.27 (0.2- 0.34. In Steroid Dependent Nephrotic syndrome patients, the overall standard mean differences of mean number of relapses 12 mo after treatment in pooled four studies (56 cases was 2.63 (2.03, 3.24. In these dependent patients, the data on relapse rate after treatment pooled on 6 studies (162 cases and yield to the rate of 0.42 (0.15, 0.69 with the range of 0.09 to 0.83. In conclusion, Rituximab is a reasonable therapy for Steroid Dependent and Steroid Resistant Nephrotic syndrome children. In view of paucity of randomized data, we suggest to perform newer controlled multicenter studies

  3. C-Reactive Protein As a Marker for Initiating Steroid Treatment in Children With Orbital Cellulitis.

    Science.gov (United States)

    Davies, Brett W; Smith, Jesse M; Hink, Eric M; Durairaj, Vikram D

    2015-01-01

    To determine both the benefit of systemic steroids in pediatric patients with orbital cellulitis and to assess the usefulness of C-reactive protein (CRP) levels as a marker for starting steroids. Prospective, comparative interventional study. Pediatric patients aged 1 to 18 years admitted to a tertiary care children's hospital with a diagnosis of orbital cellulitis from October 2012 to March 2014 were included in the study. All patients were treated with intravenous antibiotics, and patients with subperiosteal abscess who met previously published criteria for surgical decompression underwent combined transorbital drainage and/or endoscopic sinus surgery. CRP was measured daily as a biomarker of inflammation, and when below 4 mg/dl, patients were started on oral prednisone 1 mg/kg per day for 7 days. Patients whose families did not consent to steroid treatment served as the control group. Patients were followed after discharge until symptoms resolved and all medications were discontinued. Thirty-one children were diagnosed with orbital cellulitis during the study period. Of these 31 children, 24 received oral steroids (77%) and 7 did not (23%). There were 19 males and 5 females in the steroid group with an average age of 8.1 years, and 6 males and 1 female in the nonsteroid group with an average age of 7.1 years (p = 0.618). Thirteen patients (54%) in the steroid group and 2 patients (29%) in the nonsteroid group underwent sinus surgery with or without orbitotomy (p = 0.394). The average CRP at the onset of steroid treatment was 2.8 mg/dl (range: 0.5-4). Patients who received oral steroids were admitted for an average of 3.96 days. In comparison, patients who did not receive steroids were admitted for an average of 7.17 days (p orbital cellulitis. Futhermore, this is the first study to suggest a standardized starting point (CRP ≤ 4 mg/dl) and dosing schedule (oral prednisone 1 mg/kg for 7 days) for children with orbital cellulitis. Patients who received

  4. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.

    Science.gov (United States)

    Woodley, Stephanie J; Boyle, Rhianon; Cody, June D; Mørkved, Siv; Hay-Smith, E Jean C

    2017-12-22

    About one-third of women have urinary incontinence and up to one-tenth have faecal incontinence after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both prevention and treatment of incontinence.This is an update of a review previously published in 2012. To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention or treatment of urinary and faecal incontinence in pregnant or postnatal women. We searched the Cochrane Incontinence Specialised Register (16 February 2017) and reference lists of retrieved studies. Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Review authors independently assessed trials for inclusion and risk of bias. We extracted data and checked them for accuracy. Populations included: women who were continent (PFMT for prevention), women who were incontinent (PFMT for treatment) at randomisation and a mixed population of women who were one or the other (PFMT for prevention or treatment). We assessed quality of evidence using the GRADE approach. The review included 38 trials (17 of which were new for this update) involving 9892 women from 20 countries. Overall, trials were small to moderate sized, and the PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Other than two reports of pelvic floor pain, trials reported no harmful effects of PFMT.Prevention of urinary incontinence: compared with usual care, continent pregnant women performing antenatal PFMT may have had a lower risk of reporting urinary incontinence in late pregnancy (62% less; risk ratio (RR) for incontinence 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; low-quality evidence). Similarly, antenatal PFMT

  5. Inhaled Steroids

    Science.gov (United States)

    ... including how oral steroids are used, what a 'steroid burst' is, and routine use and possible side effects. This information has been approved by Ronina Covar, MD and Ann Mullen, RN, MSN, CNS, AE-C (December 2012). Asthma Medications ... Long-Term Control Medications Anti-IgE Treatment Combination ...

  6. [Treatment of children with steroid-dependent nephrotic syndrome with rituximab].

    Science.gov (United States)

    Huang, Jianping; Du, Juan; Wang, Shuo; Xiao, Lili; Zhao, Xiaoyan

    2014-07-01

    To investigate the effects of rituximab (RTX) in children with steroid-dependent nephrotic syndrome. Five cases of children with steroid-dependent nephrotic syndrome seen from May 2012 to February 2013 in whom only steroid plus calcineurin inhibitor was effective and the disease recurred on reduction of dose were enrolled into this study, including 3 males and 2 females. Calcineurin inhibitors were stopped and steroids was changed to full dose. After the general condition improved, RTX was given at a dose of 375 mg/m(2), once a week for a total of three times for one course. After urine protein became negative for five days, the dose of steroid was changed to 2 mg/kg every other day, thereafter the dose was reduced by 5 mg per every 2 weeks, until discontinuation. After regular monitoring, when peripheral blood B cells were ≥ 3%, a second RTX was added. Urine protein was negative in 2-7 days in 5 patients after the first RTX treatment. Before treatment B lymphocytes in peripheral blood was 7.8% to 13.0% and after the first course of RTX treatment decreased to 0 in the first 6 to 8 months at the beginning of recovery, while in the first 7 to 10 months to 3.3%-6.1%, after a second RTX was given, B lymphocytes were reduced to 0, but in two cases (cases 1 and 3) B lymphocytes rose again at 16 and 17 months, in the first 17 and 18 months rose to 4.16% and 4.17%, RTX was given once again respectively. B lymphocytes were reduced to 0 again. Currently the 5 patients continued to be negative for urine protein, maintaining remission for 12 to 20 months.RTX infusion had no significant side effects, and side effects of steroid and calcineurin inhibitor disappeared. In children with steroid-dependent and only calcineurin inhibitor effective nephritic syndrome, relapse may still occur after improvement of nephrotic syndrome, after the first RTX treatment, regular monitoring of B lymphocytes, RTX supplementary treatment in advance can help discontinuation of steroids and

  7. Effect of sample pre-treatment on the determination of steroid esters in hair of bovine calves

    NARCIS (Netherlands)

    Aqai, P.; Stolker, A.A.M.; Lasaroms, J.J.P.

    2009-01-01

    The effect of three sample pre-treatment steps, washing, cutting and grinding on the determination of steroid esters in hair is studied. The study is performed by using hair samples obtained after pour-on application of steroid esters to bovine calves. After sample pre-treatment the hair is treated

  8. The role of steroid hormone supplementation in non-assisted reproductive technology treatments for unexplained infertility.

    Science.gov (United States)

    Quaas, Alexander M; Hansen, Karl R

    2016-12-01

    Fertility treatment strategies are evolving, with a more rapid transition to assisted reproductive technology (ART) treatments after unsuccessful non-ART treatments. This trend increases the potential importance of adjuvant treatments in non-ART cycles, such as steroid hormone supplementation. It has been established that success rates of ART treatments are increased with the use of luteal support with progesterone. In the setting of non-ART cycles, however, the evidence is less clear, and clinical practices vary widely between providers and clinics. In this review, we aimed to provide an overview of the current evidence for the use of steroid hormone supplementation, including progesterone for luteal support, estrogens, androgens, and mineralocorticoids, in the setting of non-ART treatments for ovulatory women. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  9. Increased stroke risk in Bell's palsy patients without steroid treatment.

    Science.gov (United States)

    Lee, C-C; Su, Y-C; Chien, S-H; Ho, H-C; Hung, S-K; Lee, M-S; Chou, P; Chiu, B C-H; Huang, Y-S

    2013-04-01

    To investigate the risk of stroke development following a diagnosis of Bell's palsy in a nationwide follow-up study. Information on Bell's palsy and other factors relevant for stroke was obtained for 433218 eligible subjects without previous stroke who had ambulatory visit in 2004. Of those, 897 patients with Bell's palsy were identified. Over a median 2.9 years of follow-up, 4581 incident strokes were identified. We estimated hazard ratios (HR) and 95% confidence intervals [CI] with Cox proportional hazard models adjusting for age, sex, co-morbidities, and important risk factors. Standardized incidence ratio of stroke amongst patients with Bell's palsy was analyzed. Compared with non-Bell's palsy patients, patients with Bell's palsy had a 2.02-times (95% CI, 1.42-2.86) higher risk of stroke. The adjusted HR of developing stroke for patients with Bell's palsy treated with and without systemic steroid were 1.67 (95% CI, 0.69-4) and 2.10 (95%, 1.40-3.07), respectively. Patients with Bell's palsy carry a higher risk of stroke than the general population. Our data suggest that these patients might benefit from a more intensive stroke prevention therapy and regular follow-up after initial diagnosis. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  10. Effectiveness of Antenatal Clinics to Deliver Intermittent Preventive Treatment and Insecticide Treated Nets for the Control of Malaria in Pregnancy in Mali: A Household Survey

    NARCIS (Netherlands)

    Hill, Jenny; Kayentao, Kassoum; Touré, Mahamoudou; Diarwara, Sory; Bruce, Jane; Smedley, James; Doumbo, Ogobara K.; ter Kuile, Feiko O.; Webster, Jayne

    2014-01-01

    Background: WHO recommends intermittent-preventive-treatment (IPTp) with sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) to prevent malaria in pregnancy in sub-Saharan Africa, however uptake remains unacceptably low. We evaluated the effectiveness of antenatal clinics (ANC) to

  11. Community-based distribution of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy improved coverage but reduced antenatal attendance in southern Malawi

    NARCIS (Netherlands)

    Msyamboza, K. P.; Savage, E. J.; Kazembe, P. N.; Gies, S.; Kalanda, G.; D'Alessandro, U.; Brabin, B. J.

    2009-01-01

    To evaluate the impact of a 2-year programme for community-based delivery of sulfadoxine-pyremethamine (SP) on intermittent preventive treatment during pregnancy coverage, antenatal clinic attendance and pregnancy outcome. Fourteen intervention and 12 control villages in the catchment areas of

  12. CoQ10 supplementation: a new treatment modality in steroid ...

    African Journals Online (AJOL)

    Cetin Dincel

    2014-08-09

    Aug 9, 2014 ... CoQ10 supplementation: a new treatment modality in steroid-resistant nephrotic syndrome with unknown molecular etiology. Dincel N1*, Ozdemir K2, Kara O.D2, Yılmaz E2, Gun Z.H3, Berdeli A4, Mir S2. 1Ankara Children Health and Research Hematology Oncology Education Research. Hospital,Ankara ...

  13. Strong topical steroid, NSAID, and carbonic anhydrase inhibitor cocktail for treatment of cystoid macular edema

    Directory of Open Access Journals (Sweden)

    Asahi MG

    2015-12-01

    Full Text Available Masumi G Asahi, Gabriela L Bobarnac Dogaru, Spencer M Onishi, Ron P GallemoreRetina Macula Institute, Torrance, CA, USA Purpose: To report the combination cocktail of strong steroid, non-steroidal anti-inflammatory drug (NSAID, and carbonic anhydrase inhibitor drops for treatment of cystoid macular edema. Methods: This is a retrospective case series of patients with cystoid macular edema managed with a topical combination of strong steroid (difluprednate, NSAID, and carbonic anhydrase inhibitor drops. The patients were followed with optical coherence tomography and fluorescein angiography. Results: In our six cases, resolution of the cystic edema with improvement in visual acuity was achieved with the use of a combination cocktail of drops. Leakage on fluorescein angiography and cystic edema on optical coherence tomography both responded to treatment with the topical cocktail of drops. Conclusion: A topical cocktail of strong steroid, NSAID, and carbonic anhydrase inhibitor drops are effective for managing cystoid macular edema. Further studies comparing this combination with more invasive treatments should be undertaken to determine the efficacy of this cocktail over other treatment options. Keywords: birdshot chorioretinopathy, diabetic macular edema, retinal vein occlusion

  14. Mycophenolate mofetil in treatment of childhood steroid-dependent nephrotic syndrome.

    Science.gov (United States)

    Jellouli, Manel; Fitouhi, Sonia; Abidi, Kamel; Hammi, Yousra; Naija, Ouns; Zarrouk, Chokri; Gargah, Tahar

    2016-03-01

    To establish the efficacy of mycophenolate mofetil (MMF) in steroid dependent nephrotic syndrome and to determine the predictive factors for a good response. retrospective hospital-based cohort study in the department of pediatric of Charles Nicolle hospital, between 2005 and 2012 included 30 children with steroid-dependent nephritic syndrome who were treated with MMF. A total of 30 patients (20 boys and 10 girls) were included. The mean age at the time of diagnosis was 5.45 years and treatment with MMF was performed at a mean age of 10.84 years. Side effects of steroid were found in 17 patients. Four patients had renal impairment (ciclotoxicity). The evolution of the disease was 5.45 years. The average rate of relapse was 1.75 relapses / year. The minimum dose of corticosteroids was 0.74 mg / kg / day. During MMF therapy, the average rate of relapse was 0.45 relapses / year (p<0.0001). The average residual steroid dose was 0.2 mg/kg/ day. Responding patients were younger at the onset of MMF (8.57 versus 12.83, p=0.009), had a short development period (3.75 vs 7.03 years, p=0.05), had not received cyclosporine (p=0.02). MMF allows steroid sparing and reduces the number of relapse. It is more effective than the patients are young, with short disease outcome and had not previously been treated with cyclosporine.

  15. Antenatal glucocorticoid treatment and polymorphisms of the glucocorticoid and mineralocorticoid receptors are associated with IQ and behavior in young adults born very preterm.

    Science.gov (United States)

    van der Voorn, Bibian; Wit, Jan M; van der Pal, Sylvia M; Rotteveel, Joost; Finken, Martijn J J

    2015-02-01

    Preterm survivors exhibit neurodevelopmental impairments. Whether this association is influenced by antenatal glucocorticoid treatment and glucocorticoid sensitivity is unknown. This study aimed to study the effects of antenatal glucocorticoid treatment and glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) polymorphisms on behavior and intelligence quotient (IQ). This study was part of the 19-year follow-up of the Project On Preterm and Small-for-gestational-age birth cohort. Multicenter study. Three hundred forty-four 19-year-olds born very preterm (gestational age IQ (digital Multicultural Capacity Test-intermediate level). Data were analyzed by linear regression and presented as regression coefficient (95% confidence interval [CI]). Sex ratio, GR (R23K; N363S) and MR (-2G/C; I180V) genotypes were equally distributed between treated and nontreated subjects. Independent of treatment, R23K carriers had improved IQ scores (β 9.3; 95% CI, 3.4 to 15.1) and a tendency toward more favorable total problem behavior scores (β -8.5; 95% CI, -17.3 to 0.2) ; -2G/C CC carriers had poorer IQ scores (β -6.2; 95% CI, -10.5 to -1.9); I180V carriers had more favorable internalizing behavior scores (β -2.0; 95% CI, -3.9 to -0.1). Antenatal glucocorticoid treatment was associated with more unfavorable behavior scores, especially internalizing behavior (β 2.4; 95% CI, 0.3 to 4.5). Interaction between GR and MR polymorphisms and antenatal glucocorticoid treatment was observed, with poorer IQ scores for exposed N363S carriers; poorer intellectual subdomain scores for exposed I180V-carriers; more favorable total problem behavior scores for exposed R23K carriers. Genetic variations in glucocorticoid sensitivity and antenatal glucocorticoid treatment are associated with IQ and behavior in young adult preterm survivors.

  16. [Effective immunosuppresive therapies including steroid pulse treatment for intramuscular hematoma in iliopsoas in acquired hemophilia].

    Science.gov (United States)

    Mohri, Hiroshi; Tanabe, Juichi; Takagi, Hiroshi; Murata, Takashi

    2007-12-01

    Acquired hemophilia is a life-threatening bleeding disorder by the development of autoantibody against factor VIII. The therapeutic approach relies on steroid, cyclophosphamide and/or cyclosporine. A 64-year-old man was referred to our hospital with extensive hematoma in both psoas muscles, severe anemia of 6.8 g/dl, prolonged activated partial thromboplastin time over 200 seconds, and factor VIII coagulation activity (FVIII: C) of 1.9%. A factor VIII inhibitor was detected at 118 Bethesda units (BU). The diagnosis of acquired hemophilia was made in the absence of a detectable cause. The inhibitor was IgG with a subclass of IgG4 and reacted with 72 kDa fragment of factor VIII light chain. Steroid pulse therapy following steroid treatment resulted in the resolution of acquired hemophila with marked and prolonged efficacy.

  17. Non-Operative Treatment Versus Steroid Injections in the Management of Unicameral Bone Cysts

    Directory of Open Access Journals (Sweden)

    WI Faisham

    2011-07-01

    Full Text Available The cases of nine patients with unicameral bone cysts were reviewed from two orthopaedic centres. In one hospital, five patients received serial steroid injections, and at the other hospital four patients were treated conservatively following fractures. In the steroid injection group, three cases were in the proximal femur and two in the proximal humerus. The five steroid injection patients showed radiological evidence of cyst healing within six months of treatment. Subsequently four of the patients showed a satisfactory radiological outcome after a year and complete resolution after 2 years. In the conservative group, all four cases were in the proximal humerus. Persistent cystic lesions were observed in all four patients and two was complicated by another fracture within six months.

  18. Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome.

    Science.gov (United States)

    Rocco, A G; Frank, E; Kaul, A F; Lipson, S J; Gallo, J P

    1989-03-01

    Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. The spinal interspace identified with the patients' pain complaint was the site of injection. For each treatment, patients were admitted to the Clinical Research Center for 24 h and their condition continuously monitored with a pulse oximeter and apnea monitor. Five to 7 patients in each group had pain relief for less than 1 month. No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.

  19. Association of Antenatal Depression Symptoms and Antidepressant Treatment With Preterm Birth.

    Science.gov (United States)

    Venkatesh, Kartik K; Riley, Laura; Castro, Victor M; Perlis, Roy H; Kaimal, Anjali J

    2016-05-01

    To evaluate the association of antenatal depression symptoms with preterm birth and small for gestational age (SGA). This was an observational cohort study conducted among women who completed Edinburgh Postnatal Depression Scale screening and delivered at 20 weeks of gestation or greater. The primary outcomes were preterm birth and an SGA neonate at birth (less than 10th percentile for gestational age); the primary predictor was an Edinburgh Postnatal Depression Scale antepartum score of 10 or greater, indicating symptoms of depression. Logistic regression models were used with and without consideration of antidepressant exposure during pregnancy. Among 7,267 women, 831 (11%) screened positive for depression. In multivariable analyses adjusting for maternal age, race, income, body mass index, tobacco use, lifetime diagnosis of major depression and anxiety, diabetes, hypertension, and preeclampsia, women who screened positive for depression experienced an increased risk of preterm birth (less than 37 weeks of gestation) (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) and very preterm birth (less than 32 weeks of gestation) (adjusted OR 1.82, 95% CI 1.09-3.02) as well as of having an SGA neonate (adjusted OR 1.28, 95% CI 1.04-1.58). In secondary analyses, among women who were treated with an antidepressant during pregnancy (19% of those who screened positive and 5% of those who screened negative), depressive symptoms were not associated with a significantly increased risk of preterm and very preterm birth or an SGA neonate. In a large cohort of women screened for depression antepartum, those with depressive symptoms had an increased likelihood of preterm and very preterm delivery as well having an SGA neonate. Such risk was not apparent among women who were treated with an antidepressant medication.

  20. Comparison of subacromial tenoxicam and steroid injections in the treatment of impingement syndrome.

    Science.gov (United States)

    Çift, Hakan; Özkan, Feyza Ünlü; Tolu, Sena; Şeker, Ali; Mahiroğulları, Mahir

    2015-01-01

    This study aims to assess and compare the efficacy of subacromial tenoxicam and steroid injections in treating patients with shoulder impingement syndrome. Forty patients having shoulder impingement syndrome with findings of rotator cuff tendinitis or subacromial bursitis on magnetic resonance imaging were included in the study. Patients were randomized into two subacromial injection groups: patients in the first group (10 males, 10 females; mean age 45.3 years; range 32 to 67 years) were administered 20 mg tenoxicam three times by weekly intervals, and patients in the second group (8 males, 12 females; mean age 46.5 years; range 29 to 73 years) were administered 40 mg methylprednisolone acetate just for once. Visual analog scale (VAS), active range of motion (ROM) of the shoulder joint, and Disabilities of Arm, Shoulder and Hand (DASH) questionnaire scores were evaluated at baseline, six weeks after treatment, and first year. Visual analog scale, DASH, and active ROM scores in both groups were statistically significantly improved. No statistically significant difference was detected between subacromial tenoxicam and steroid injections in terms of post-treatment VAS, DASH, and active ROM scores. Mean pre- and post-treatment VAS scores in tenoxicam group were 7.8 (range, 3-9) and 2.6 (range, 2-4), respectively. Mean pre- and post-treatment VAS scores in steroid group were 6.2 (range, 3-10) and 3.6 (range, 0-7), respectively. Mean pre- and post-treatment DASH scores in tenoxicam group were 59.4 (range, 45-80) and 14.7 (range, 8.3-25.8), respectively. Mean pre- and post-treatment DASH scores in steroid group were 56.7 (range, 33.3-85.8) and 18.1 (range, 0-69.2), respectively. Although the improvement in active ROM was higher in the steroid group, difference between two groups was not statistically significant. Both subacromial tenoxicam and steroid injections may be successfully used in the treatment of patients with impingement syndrome. Subacromial tenoxicam

  1. Water Treatment and Handwashing Behaviors among Non-Pregnant Friends and Relatives of Participants in an Antenatal Hygiene Promotion Program in Malawi

    Science.gov (United States)

    Russo, Elizabeth T.; Sheth, Anandi; Menon, Manoj; Wannemuehler, Kathleen; Weinger, Merri; Kudzala, Amose C.; Tauzie, Blessius; Masuku, Humphreys D.; Msowoya, Tapona E.; Quick, Robert

    2012-01-01

    Access to safe drinking water and improved hygiene are essential for preventing diarrheal diseases. To integrate hygiene improvement with antenatal care, free hygiene kits (water storage containers, water treatment solution, soap) and educational messages were distributed to pregnant women at antenatal clinics in Malawi. We assessed water treatment and hygiene practices of 275 non-pregnant friends and relatives of the hygiene kit recipients at baseline and follow-up nine months later to measure program impact on non-participants in the same communities. At follow-up, friends and relatives who did not receive kits or education were more likely than at baseline to purchase and use water treatment solution (25% versus 1%; P water treatment and hygiene behaviors among non-pregnant friends and relatives living in the same communities as hygiene kit recipients, suggesting that program benefits extended beyond direct beneficiaries. PMID:22556088

  2. Prevention of pulmonary hypoplasia and pulmonary vascular remodeling by antenatal simvastatin treatment in nitrofen-induced congenital diaphragmatic hernia

    Science.gov (United States)

    Makanga, Martine; Maruyama, Hidekazu; Dewachter, Celine; Da Costa, Agnès Mendes; Hupkens, Emeline; de Medina, Geoffrey; Naeije, Robert

    2015-01-01

    Congenital diaphragmatic hernia (CDH) has a high mortality rate mainly due to lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). Simvastatin has been shown to prevent the development of pulmonary hypertension (PH) in experimental models of PH. We, therefore, hypothesized that antenatal simvastatin would attenuate PPHN in nitrofen-induced CDH in rats. The efficacy of antenatal simvastatin was compared with antenatal sildenafil, which has already been shown to improve pathological features of PPHN in nitrofen-induced CDH. On embryonic day (E) 9.5, nitrofen or vehicle was administered to pregnant Sprague-Dawley rats. On E11, nitrofen-treated rats were randomly assigned to antenatal simvastatin (20 mg·kg−1·day−1 orally), antenatal sildenafil (100 mg·kg−1·day−1 orally), or placebo administration from E11 to E21. On E21, fetuses were delivered by cesarean section, killed, and checked for left-sided CDH. Lung tissue was then harvested for further pathobiological evaluation. In nitrofen-induced CDH, simvastatin failed to reduce the incidence of nitrofen-induced CDH in the offspring and to increase the body weight, but improved the lung-to-body weight ratio and lung parenchyma structure. Antenatal simvastatin restored the pulmonary vessel density and external diameter, and reduced the pulmonary arteriolar remodeling compared with nitrofen-induced CDH. This was associated with decreased lung expression of endothelin precursor, endothelin type A and B receptors, endothelial and inducible nitric oxide synthase, together with restored lung activation of apoptotic processes mainly in the epithelium. Antenatal simvastatin presented similar effects as antenatal therapy with sildenafil on nitrofen-induced CDH. Antenatal simvastatin improves pathological features of lung hypoplasia and PPHN in experimental nitrofen-induced CDH. PMID:25617377

  3. [Effect of antenatal spiramycin treatment on the frequency of retinochoroiditis due to congenital toxoplasmosis in a Colombian cohort].

    Science.gov (United States)

    Zuluaga, Liliana María; Hernández, John Camilo; Castaño, Carlos Felipe; Donado, Jorge Hernando

    2017-04-01

    Gestational toxoplasmosis is frequent and severe. There is still debate about the benefits of treatment against ocular manifestations in the newborn. Spiramycin treatment is used for this purpose, unfortunately prenatal diagnosis is sometimes delayed and pregnant women are not treated. To describe the relationship between treatment with spiramycin during pregnancy in mothers with gestational toxoplasmosis and development of ocular toxoplasmosis in newborns. We conducted a descriptive study of a case series. We evaluated a prospective cohort of patients diagnosed with gestational toxoplasmosis during three years at the Retinology Service at the Clínica Universitaria Bolivariana in Medellín. Gestational toxoplasmosis was found in 23 mothers; 15 (65%) were treated during pregnancy with 3 g per day of spiramycin, eight (35%) patients were untreated. In the treated group just one newborn developed ocular toxoplasmosis (6.6%), in contrast with five (62.5%) of the eight patients who did not receive treatment. These results suggest that pregnancy treatment reduces the relative risk of ocular toxoplasmosis in the newborn by 96% (95% CI: 33 - 100%). Only two (14%) of the patients who were evaluated, had nervous system involvement related to toxoplasmosis in CT scan or cerebral ultrasound. These two patients also developed ocular pathology and were diagnosed at the time of birth, so they did not received antenatal treatment. A protective effect was found against the ocular involvement in patients whose mother received treatment with spiramycin (OR=0.04;95% CI: 0.00-0.67), p<0.01 (Fisher's Exact Test).

  4. Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

    Science.gov (United States)

    Kamath-Rayne, Beena D; Rozance, Paul J; Goldenberg, Robert L; Jobe, Alan H

    2016-10-01

    The practice of antenatal corticosteroid administration in pregnancies of 24-34 weeks of gestation that are at risk of preterm delivery was adopted over 20 years after the first randomized clinical trial in humans. It is biologically plausible that antenatal corticosteroid in pregnancies beyond 34 weeks of gestation would reduce rates of respiratory morbidity and neonatal intensive care admission. Mostly guided by the results of a large multicenter randomized trial of antenatal corticosteroid in late preterm infants, the Antenatal Late Preterm Steroids Trial, the American Congress of Obstetricians and Gynecologists has released a practice advisory that the "administration of betamethasone may be considered in women with a singleton pregnancy between 34 0/7 and 36 6/7 weeks of gestation at imminent risk of preterm birth within 7 days." However, many unanswered questions about the risks and benefits of antenatal corticosteroids in this population remain and should be considered with the adoption of this treatment recommendation. This review of the literature indicates that the greatest effect is in the reduction of transient tachypnea of the newborn infant, which is a mostly self-limited condition. This benefit must be weighed against unanticipated outcomes, such as neonatal hypoglycemia, and unknowns about long-term neurodevelopmental follow up and metabolic risks. Amelioration of respiratory morbidity in late preterm infants does not preclude these infants from having other complications that are related to prematurity that require intensive care. Other possible morbidities of prematurity may be magnified if these babies no longer have respiratory symptoms. Conversely, if these late preterm babies no longer exhibit respiratory symptoms and "look good," they may be discharged before other morbidities of prematurity have resolved and be at risk for readmission. Furthermore, it is also important to ensure that unintended consequences are avoided to achieve a minor

  5. Environmental Stress and Atopic Dermatitis: Cure with Steroid-Free Treatment and Mutual Trust in a Good Life Style

    Science.gov (United States)

    Kimata, H.

    Atopic Dermatitis (AD) is a chronic inflammatory skin diseasewith severe itching. The exact causes for AD still remain to be elucidated. However, there are at least following 3 causes: 1) allergy, 2) bacterial infection, and 3) environmental stress. These 3 causes are mixed in AD, and consequently symptoms of AD are very complex. In addition, patients with AD are reluctant to take steroid ointment treatment. This is due to the fact that steroid is an anti-inflammatory and immunosuppressive drug. Thus steroid ointment treatment only temporally improved AD by reduction of inflammation, while it failed to cure bacterial infection. Patients had to apply steroid ointment for long-term, which caused many side effects, including enhancement of IgE production, aggravation of skin infection, and rebound phenomenon. Rebound was aggravation of symptoms upon cessation of steroid ointment use. Enhancement of IgE production augmented allergic responses, while aggravation of skin infecti on worsened skin symptoms. Collectively, lone-term use of steroid ointment complicated AD instead of cure. Patients with AD suffered from these side effects, and they did not trust steroid treatment. Recently, tacrolimus ointment was widely used instead of steroid ointment. However, tacrolimus was more potent immunosuppressive drug, and US FDA warned cancer concern. Therefore, steroid- and tacrolimus-free treatment was considered safer and ideal. Patients with AD were susceptible to stress, which worsened symptoms. Recently, new environmental stress emerged, and patients with AD were suffering from them. In this article, I describe the effect of environmental stress on allergic responses, and explain the details of cases of AD with steroid-free treatment and mutual trust, which resulted in cure of AD.

  6. Tacrolimus drug level and response to treatment in idiopathic childhood steroid resistant nephrotic syndrome

    International Nuclear Information System (INIS)

    Shah, S.S.; Hafeez, F.; Akhtar, N.

    2015-01-01

    The management of Steroid Resistant Nephrotic Syndrome (SRNS) is an uphill task for paediatric nephrologists as immunosuppressive agents are the mainstay of treatment in these patients. Tacrolimus is used along with steroids. This study is conducted to see the relationship between the tacrolimus dose, drug level and response in the management of SRNS. Methods: This quasi experimental study was conducted at The Childrens Hospital Lahore over a period of one year. Patients with SRNS of either sex and 1-10 years of age were included and those with secondary nephrotic syndrome were excluded. Tacrolimus was given at a dose of 0.05-0.1 mg/kg/day in 2 divided doses along with steroids. The follow-up was done for six months with proteinuria monitoring and tacrolimus drug levels done two weeks after initiation of treatment. Results: Out of 42 patients, 27 (64.3%) were males and 15 (35.7%) were females. The most common histological diagnosis observed was mesangio-proliferative glomerulonephritis in 30 (71.4%) patients. The tacrolimus trough level range was 0.5-15.20 ng/ml with a mean value of 4.68 ng/ml±2.85. Forty-one (97.6%) children showed complete response to treatment while one patient showed partial response. Conclusion: This study suggests that tacrolimus is an effective drug for treatment of SRNS in paediatric patients and there is no linear relationship between the drug dose, response and drug level. (author)

  7. TACROLIMUS DRUG LEVEL AND RESPONSE TO TREATMENT IN IDIOPATHIC CHILDHOOD STEROID RESISTANT NEPHROTIC SYNDROME.

    Science.gov (United States)

    Shah, Syed Sajid Hussain; Hafeez, Farkhanda; Akhtar, Naureen

    2015-01-01

    The management of Steroid Resistant Nephrotic Syndrome (SRNS) is an uphill task for paediatric nephrologists as immunosuppressive agents are the mainstay of treatment in these patients. Tacrolimus is used along with steroids. This study is conducted to see the relationship between the tacrolimus dose, drug level and response in the management of SRNS. This quasi experimental study was conducted at The Children's Hospital Lahore over a period of one year. Patients with SRNS of either sex and 1-10 years of age were included and those with secondary nephrotic syndrome were excluded. Tacrolimus was given at a dose of 0.05-0.1 mg/kg/day in 2 divided doses along with steroids. The follow-up was done for six months with proteinuria monitoring and tacrolimus drug levels done two weeks after initiation of treatment. Out of 42 patients, 27 (64.3%) were males and 15 (35.7%) were females. The most common histological diagnosis observed was mesangio-proliferative glomerulonephritis in 30 (71.4%) patients. The tacrolimus trough level range was 0.5-15.20 ng/ml with a mean value of 4.68 ng/ml ± 2.85. Forty-one (97.6%) children showed complete response to treatment while one patient showed partial response. This study suggests that tacrolimus is an effective drug for treatment of SRNS in paediatric patients and there is no linear relationship between the drug dose, response and drug level.

  8. Integrating Water Treatment into Antenatal Care: Impact on Use of Maternal Health Services and Household Water Treatment by Mothers—Rural Uganda, 2013

    Science.gov (United States)

    Matanock, Almea; Anderson, Tara; Ayers, Tracy; Likicho, Lilian; Wamimbi, Richard; Lu, Xin; Emeetai, Thomas; Kakande, Celia; Mutabazi, Miriam; Quick, Robert

    2016-01-01

    To increase maternal health service use and household water treatment (HWT), free water treatment kits were provided at first antenatal care (ANC) visits and free water treatment sachet refills were provided at follow-up ANC visits, delivery, and postnatal visits in 46 health facilities in rural Uganda. We evaluated the impact by surveying 226 women in the initiative (intervention group) and 207 women who received ANC before the initiative began (comparison group). There was no differences in the percentages of intervention and comparison group women with ≥ 4 ANC visits; however, a higher percentage of intervention group women reported treating their drinking water (31.7% versus 19.7%, P = 0.01), and had free chlorine residual in stored water (13.5% versus 3.4%, P = 0.02) than comparison group women. The intervention did not appear to motivate increased maternal health service use, but demonstrated improvements in HWT. PMID:27001758

  9. Antenatal corticosteroids impact the inflammatory rather than the antiangiogenic profile of women with preeclampsia.

    Science.gov (United States)

    Nayeri, Unzila A; Buhimschi, Irina A; Laky, Christine A; Cross, Sarah N; Duzyj, Christina M; Ramma, Wenda; Sibai, Baha M; Funai, Edmund F; Ahmed, Asif; Buhimschi, Catalin S

    2014-06-01

    Circulating antiangiogenic factors and proinflammatory cytokines are implicated in the pathogenesis of preeclampsia. This study was performed to test the hypothesis that steroids modify the balance of inflammatory and proangiogenic and antiangiogenic factors that potentially contribute to the patient's evolving clinical state. Seventy singleton women, admitted for antenatal corticosteroid treatment, were enrolled prospectively. The study group consisted of 45 hypertensive women: chronic hypertension (n=6), severe preeclampsia (n=32), and superimposed preeclampsia (n=7). Normotensive women with shortened cervix (preeclampsia cases were obtained before steroids and then serially up until delivery. A clinical severity score was designed to clinically monitor disease progression. Serum levels of angiogenic factors (soluble fms-like tyrosine kinase-1 [sFlt-1], placental growth factor [PlGF], soluble endoglin [sEng]), endothelin-1 (ET-1), and proinflammatory markers (IL-6, C-reactive protein [CRP]) were assessed before and after steroids. Soluble IL-2 receptor (sIL-2R) and total immunoglobulins (IgG) were measured as markers of T- and B-cell activation, respectively. Steroid treatment coincided with a transient improvement in clinical manifestations of preeclampsia. A significant decrease in IL-6 and CRP was observed although levels of sIL-2R and IgG remained unchanged. Antenatal corticosteroids did not influence the levels of angiogenic factors but ET-1 levels registered a short-lived increase poststeroids. Although a reduction in specific inflammatory mediators in response to antenatal steroids may account for the transient improvement in clinical signs of preeclampsia, inflammation is unlikely to be the major contributor to severe preeclampsia or useful for therapeutic targeting.

  10. Methotrexate in the treatment of steroid dependent asthma1

    Directory of Open Access Journals (Sweden)

    Derakhshan Deilami Gh

    2001-07-01

    Full Text Available Despite the role of oral corticosteroids in management of sever asthma, use of these drugs needs careful awareness of its many side effects. There are controversies about the role of methotrexate in lowering the need for corticosteroides in these patients. In this study an attempt has been made to determine methotrexate effects in corticosteroid dependent asthma. Six patients were entered in a double-blind placebo controlled crossover trial and randomly allocated to two groups. Each group got a 12 weeks course of treatment with 15 milligrams of methotrexate or placebo which thereafter was changed to the other regimen. In comparison with placebo, methotrexate caused a 62.5% less need for oral corticosteroid (P<0.01 and a 20% increase in FEV1 (P<0.05. We concluded that the use of low doses of oral methotrexate results in less need for oral corticosteroid in treatment of corticosteroid dependent asthma.

  11. Topical nasal steroid treatment does not improve CPAP compliance in unselected patients with OSAS.

    Science.gov (United States)

    Strobel, Werner; Schlageter, Manuel; Andersson, Morgan; Miedinger, David; Chhajed, Prashant N; Tamm, Michael; Leuppi, Jörg D

    2011-02-01

    Continuous positive airways pressure (CPAP) for treatment of obstructive sleep apnea (OSA) can produce troublesome nasal symptoms (i.e. congestion, rhinorrhea) that may reduce the compliance of CPAP. Topical nasal steroids are often prescribed to reduce these side effects, although scientific data are scarce supporting any benefits of this treatment for CPAP-induced nasal side effects. To study whether a topical nasal steroid can reduce CPAP-induced nasal symptoms and improve CPAP adherence during the initial phase of OSA treatment. A randomized, double-blinded, placebo-controlled study with fluticasone propionate 100 μg/nasal cavity twice daily Treatment was started 10 days prior to and continued throughout the first 4 weeks of CPAP. 63 patients who were selected for CPAP treatment participated. Nasal symptoms were recorded, nasal patency was assessed and lung function was measured with a peak flow meter. The patients' adherence to CPAP was recorded by the CPAP device. Total nasal symptoms increased from baseline to 4 wks after CPAP use for both nasal treatments (p < 0.05). No differences in total nasal symptoms between treatments were seen (p = 1), and no differences in nasal peak flow values after treatment were seen (p = 0.11). Moreover, there were no differences in CPAP use between the treatments. Fluticasone propionate as a nasal topical steroid does not reduce CPAP-induced unwanted nasal side effects, and has no beneficial effect on CPAP compliance during the first four weeks of treatment in unselected patients with OSAS. Copyright © 2010 Elsevier Ltd. All rights reserved.

  12. [Epidural injections of steroids in the treatment of patients with chronic sciatica in discopathy].

    Science.gov (United States)

    Popiołek, A; Domanik, A; Mazurkiewicz, G

    1991-01-01

    The authors tried to assess the effectiveness of the treatment with epidural steroid injections in cases with lumbar discopathy and chronic ischialgia++. Thirty patients were given one or two injections of Depo-Medrol or Polcortolon with added bupivacaine++ into the epidural space. The same number of patients were treated without such injections. Control examinations after 21 days showed greater and earlier improvement after Depo-Medrol . The results of Polcortolon were less evident. No side effects were observed.

  13. Oral anabolic steroid treatment, but not parenteral androgen treatment, decreases abdominal fat in obese, older men.

    Science.gov (United States)

    Lovejoy, J C; Bray, G A; Greeson, C S; Klemperer, M; Morris, J; Partington, C; Tulley, R

    1995-09-01

    To compare the effects of testosterone enanthate (TE), anabolic steroid (AS) or placebo (PL) on regional fat distribution and health risk factors in obese middle-aged men undergoing weight loss by dietary means. Randomized, double-blind, placebo-controlled clinical trial, carried out for 9 months with primary assessments at 3 month intervals. Due to adverse blood lipid changes, the AS group was switched from oral oxandrolone (ASOX) to parenteral nandrolone decaoate (ASND) after the 3 month assessment point. Thirty healthy, obese men, aged 40-60 years, with serum testosterone (T) levels in the low-normal range (2-5 ng/mL). Abdominal fat distribution and thigh muscle volume by CT scan, body composition by dual energy X-ray absorptiometry (DEXA), insulin sensitivity by the Minimal Model method, blood lipids, blood chemistry, blood pressure, thyroid hormones and urological parameters. After 3 months, there was a significantly greater decrease in subcutaneous (SQ) abdominal fat in the ASOX group compared to the TE and PL groups although body weight changes did not differ by treatment group. There was also a tendency for the ASOX group to exhibit greater losses in visceral fat, and the absolute level of visceral fat in this group was significantly lower at 3 months than in the TE and PL groups. There were significant main effects of treatment at 3 months on serum T and free T (increased in the TE group and decreased in the ASOX group) and on thyroid hormone parameters (T4 and T3 resin uptake significantly decreased in the ASOX group compared with the other two groups). There was a significant decrease in HDL-C, and increase in LDL-C in the ASOX group, which led to their being switched to the parenteral nandrolone decanoate (ASND) after 3 months. ASND had opposite effects on visceral fat from ASOX, producing a significant increase from 3 to 9 months while continuing to decrease SQ abdominal fat. ASND treatment also decreased thigh muscle area, while ASOX treatment

  14. Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

    Directory of Open Access Journals (Sweden)

    Joice Fabíola Meneguel

    Full Text Available CONTEXT: Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY: Cross-sectional. SETTING: A tertiary-care hospital. PARTICIPANTS: Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES: Analysis of maternal and newborn records. MAIN MEASUREMENTS: The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS: Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51 and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43. The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82. However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the

  15. Development of a Gene Therapy Virus with a Glucocorticoid-Inducible MMP1 for the Treatment of Steroid Glaucoma

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    Spiga, Maria-Grazia; Borrás, Teresa

    2010-01-01

    A glucocorticoid-inducible adenovirus vector overproduces active MMP1 only in the presence of dexamethasone. The overexpression degrades collagen type I and sets up the vector as a candidate for gene therapy treatment of steroid-induced hypertension.

  16. The effect of antenatal depression and selective serotonin reuptake inhibitor treatment on nerve growth factor signaling in human placenta.

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    Helena Kaihola

    Full Text Available Depressive symptoms during pregnancy are common and may have impact on the developing child. Selective serotonin reuptake inhibitors (SSRIs are the most prescribed antidepressant treatment, but unfortunately, these treatments can also negatively affect the behavioral development and health of a child during pregnancy. In addition, serotonin (5-HT exerts neurotrophic actions with thus far not fully known effects in the offspring. The neurotrophic growth factor (NGF is involved in neuronal cell survival and differentiation, and altered placenta levels have been found to increase the risk for pregnancy complications, similar to those found in women treated with SSRIs. We therefore investigated whether the NGF signaling pathway was altered in the placenta from women treated with SSRIs (n = 12 and compared them with placenta from depressed (n = 12 and healthy mothers (n = 12. Results from immunohistochemical stainings revealed that placental NGF protein levels of SSRI-treated women were increased in both trophoblasts and endothelial cells compared with depressed and control women. In addition, downstream of the NGF receptor TrkA, increased levels of the signaling proteins ROCK2 and phosphorylated Raf-1 were found in stromal cells and a tendency towards increased levels of ROCK2 in trophoblasts and endothelial cells in SSRI-treated women when compared to healthy controls. SSRI-treated women also displayed increased levels of phosphorylated ROCK2 in all placental cell types studied in comparison with depressed and control women. Interestingly, in placental endothelial cells from depressed women, NGF levels were significantly lower compared to control women, but ROCK2 levels were increased compared with control and SSRI-treated women. Taken together, these results show that the NGF signaling and downstream pathways in the placenta are affected by SSRI treatment and/or antenatal depression. This might lead to an altered placental function, although the

  17. Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature

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    Enrico Mazza

    2015-01-01

    Full Text Available Thyroidal pain is usually due to subacute thyroiditis (SAT. In more severe forms prednisone doses up to 40 mg daily for 2-3 weeks are recommended. Recurrences occur rarely and restoration of steroid treatment cures the disease. Rarely, patients with Hashimoto’s thyroiditis (HT have thyroidal pain (painful HT, PHT. Differently from SAT, occasional PHT patients showed no benefit from medical treatment so that thyroidectomy was necessary. We report three patients who did not show clinical response to prolonged high dose prednisone treatment: a 50-year-old man, a 35-year-old woman, and a 33-year-old woman. Thyroidectomy was necessary, respectively, after nine-month treatment with 50 mg daily, two-month treatment with 75 mg daily, and one-month treatment with 50 mg daily. The two women were typical cases of PHT. Conversely, in the first patient, thyroid histology showed features of granulomatous thyroiditis, typical of SAT, without fibrosis or lymphocytic infiltration, typical of HT/PHT, coupled to undetectable serum anti-thyroid antibodies. Our data (1 suggest that not only PHT but also SAT may show resistance to steroid treatment and (2 confirm a previous observation in a single PHT patient that increasing prednisone doses above conventional maximal dosages may not be useful in these patients.

  18. Early response of local steroid injection versus mini incision technique in treatment of carpal tunnel syndrome

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    Awan, A.S.; Khan, A.; Afridi, S.A.; Khan, R.S.

    2015-01-01

    Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the post-operative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. Methods: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups. Fifty-eight Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. Results: In this study mean age of the patients was 32.8 ± 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. Conclusion: The difference in pain after 1 month of the intervention was not statistically significant. (author)

  19. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid

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    Chang, Connie Y.; Kattapuram, Susan V.; Huang, Ambrose J.; Simeone, F.J.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital, Department of Radiology Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States)

    2017-01-15

    To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. Treatment success based on imaging was categorized as substantial (51-100 %), partial (1-50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications. Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence. (orig.)

  20. Rapid Involution of Pustules during Topical Steroid Treatment of Acute Generalized Exanthematous Pustulosis

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    Christiane Kley

    2017-04-01

    Full Text Available Acute generalized exanthematous pustulosis (AGEP is a dramatic generalized pustular rash of severe onset, which is considered a serious cutaneous adverse reaction to drugs. However, even though the clinical features are impressive and are often accompanied by systemic inflammation, it can be controlled quickly and safely by topical steroids subsequent to interruption of the offending drug. Here, we describe the management of a case and the evolution of the pustular rash. An elderly woman consulted with a generalized crop of 2–3 mm, nonfollicular pustules on erythematous background. In the 4 preceding weeks, she had been using amoxicillin/clavulanic acid for a bacterial implant infection and rivaroxaban. The clinical EuroSCAR criteria including the histology confirmed AGEP. Her medication was stopped and topical clobetasol propionate was used. Within 24 h, the development of new pustules ceased and the patient was discharged after 7 days of hospitalization with only a faint, diffuse erythema and focal desquamation remaining. This and many other cases in the literature suggest that topical steroids should be considered as a first-line treatment option, especially as systemic steroids themselves can sometimes induce generalized pustulosis.

  1. Study of Osteoarthritis Treatment with Anti-Inflammatory Drugs: Cyclooxygenase-2 Inhibitor and Steroids

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    Hongsik Cho

    2015-01-01

    Full Text Available Patients with osteoarthritis (OA, a condition characterized by cartilage degradation, are often treated with steroids, nonsteroidal anti-inflammatory drugs (NSAIDs, and cyclooxygenase-2 (COX-2 selective NSAIDs. Due to their inhibition of the inflammatory cascade, the drugs affect the balance of matrix metalloproteinases (MMPs and inflammatory cytokines, resulting in preservation of extracellular matrix (ECM. To compare the effects of these treatments on chondrocyte metabolism, TNF-α was incubated with cultured chondrocytes to mimic a proinflammatory environment with increasing production of MMP-1 and prostaglandin E2 (PGE2. The chondrocytes were then treated with either a steroid (prednisone, a nonspecific COX inhibitor NSAID (piroxicam, or a COX-2 selective NSAID (celecoxib. Both prednisone and celecoxib decreased MMP-1 and PGE-2 production while the nonspecific piroxicam decreased only the latter. Both prednisone and celecoxib decreased gene expression of MMP-1 and increased expression of aggrecan. Increased gene expression of type II collagen was also noted with celecoxib. The nonspecific piroxicam did not show these effects. The efficacy of celecoxib in vivo was investigated using a posttraumatic OA (PTOA mouse model. In vivo, celecoxib increases aggrecan synthesis and suppresses MMP-1. In conclusion, this study demonstrates that celecoxib and steroids exert similar effects on MMP-1 and PGE2 production in vitro and that celecoxib may demonstrate beneficial effects on anabolic metabolism in vivo.

  2. Clinical course of type 1 autoimmune pancreatitis patients without steroid treatment: a Japanese multicenter study of 97 patients.

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    Kubota, Kensuke; Kamisawa, Terumi; Hirano, Kenji; Hirooka, Yoshiki; Uchida, Kazushige; Ikeura, Tsukasa; Shiomi, Hideyuki; Ohara, Hirotaka; Shimizu, Kyoko; Arakura, Norikazu; Kanno, Atsushi; Sakagami, Junichi; Itoi, Takao; Ito, Tetsuhide; Ueki, Toshiharu; Nishino, Takayoshi; Inui, Kazuo; Mizuno, Nobumasa; Yoshida, Hitoshi; Sugiyama, Masanori; Iwasaki, Eisuke; Irisawa, Atsushi; Okazaki, Kazuichi; Kawa, Shigeyuki; Shimosegawa, Toru; Takeyama, Yoshifumi; Chiba, Tsutomu

    2018-02-12

    Sporadic autoimmune pancreatitis (AIP) cases showing remission without steroid treatment have been reported, however, the clinical course of these patients has not been clarified. This study sought to clarify the clinical course in AIP patients with hesitation for steroid treatment. We collected clinical data for AIP patients from high-volume centers in Japan. Data for AIP patients with and those without steroid treatment (steroid treatment vs. wait and see policy or W&S) were then compared. The primary point was the relapse-free survival rate (RFS) in patients with and those without steroid treatment, as determined using Kaplan-Meier curve. The secondary point was the identification of predictors of remission and risks of relapse in AIP patients without steroid treatment. There were 510 AIP patients in the steroid treatment group and 97 patients in the W&S group. Overall, 55.7% (54/97) of type 1 AIP patients in the W&S group experienced transient remission without steroid treatment. The W&S group had a significantly higher patient age and significantly lower incidences of jaundice, diffuse pancreas swelling, proximal-type sclerosing cholangitis, and stent placement and a lower remission rate than the steroid treatment group (each P < 0.05). The RFS reached a plateau at 10 years in both the W&S group (50%) and steroid treatment group (52.9%). As for the RFS (W&S vs. group with steroid), 89.4% vs. 74.4% within 3 years, 81.8% vs. 65.3% within 5 years, and 50% vs. 52.9% within 10 years (log-rank, P = 0.064). Female gender (OR 0.340, P = 0.027) and stent placement for jaundice (OR 4.552, P = 0.008) were identified as predictors of transient remission in the W&S group. New-onset diabetes mellitus (OR 8.333, P = 0.012) and the presence of extensive multi-organ involvement (OR 35, P = 0.006) were identified as risks of relapse in the W&S group. Some type 1 AIP patients without steroid treatment experience transient remission. These cases tend to have

  3. Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda

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    Mufubenga Patrobas

    2008-03-01

    Full Text Available Abstract Background To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Uganda improved the antenatal care package by including a strong commitment to increase distribution of insecticide-treated nets (ITNs and introduction of intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP as a national policy in 2000. This study assessed uptake of both ITNs and IPTp-SP by pregnant women as well as antenatal and maternity care use with the aim of optimizing their delivery. Methods 769 post-partum women were recruited from a rural area of central Uganda with perennial malaria transmission through a cross-sectional, community-based household survey in May 2005. Results Of the 769 women interviewed, antenatal clinic (ANC attendance was high (94.4%; 417 (57.7% visiting initially during the 2nd trimester, 242 (33.5% during the 3rd trimester and 266 (37.1% reporting ≥ 4 ANC visits. About 537 (71% and 272 (35.8% received one or ≥ 2 IPTp-SP doses respectively. Only 85 (15.8% received the first dose of IPTp-SP in the 3rd trimester. ITNs were used by 239 (31.3% of women during pregnancy and 314 (40.8% delivered their most recent pregnancy outside a health facility. Post-partum women who lacked post-primary education were more likely not to have attended four or more ANC visits (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2–9.3. Conclusion These findings illustrate the need to strengthen capacity of the district to further improve antenatal care and maternity services utilization and IPTp-SP uptake. More specific and effective community health strategies to improve effective ANC, maternity services utilization and IPTp-SP uptake in rural communities should be undertaken.

  4. Estimating Benzathine Penicillin Need for the Treatment of Pregnant Women Diagnosed with Syphilis during Antenatal Care in High-Morbidity Countries.

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    Melanie M Taylor

    Full Text Available Congenital syphilis continues to be a preventable cause of global stillbirth and neonatal morbidity and mortality. Shortages of injectable penicillin, the only recommended treatment for pregnant women and infants with syphilis, have been reported by high-morbidity countries. We sought to estimate current and projected annual needs for benzathine penicillin in antenatal care settings for 30 high morbidity countries that account for approximately 33% of the global burden of congenital syphilis.Proportions of antenatal care attendance, syphilis screening coverage in pregnancy, syphilis prevalence among pregnant women, and adverse pregnancy outcomes due to untreated maternal syphilis reported to WHO were applied to 2012 birth estimates for 30 high syphilis burden countries to estimate current and projected benzathine penicillin need for prevention of congenital syphilis.Using current antenatal care syphilis screening coverage and seroprevalence, we estimated the total number of women requiring treatment with at least one injection of 2.4 MU of benzathine penicillin in these 30 countries to be 351,016. Syphilis screening coverage at or above 95% for all 30 countries would increase the number of women requiring treatment with benzathine penicillin to 712,030. Based on WHO management guidelines, 351,016 doses of weight-based benzathine penicillin would also be needed for the live-born infants of mothers who test positive and are treated for syphilis in pregnancy. Assuming availability of penicillin and provision of treatment for all mothers diagnosed with syphilis, an estimated 95,938 adverse birth outcomes overall would be prevented including 37,822 stillbirths, 15,814 neonatal deaths, and 34,088 other congenital syphilis cases.Penicillin need for maternal and infant syphilis treatment is high among this group of syphilis burdened countries. Initiatives to ensure a stable and adequate supply of benzathine penicillin for treatment of maternal syphilis

  5. New insights into the role of sex steroid hormones in pregnancy: possible therapeutic approach by sex steroid hormones for the treatment of both preeclampsia and preterm labor.

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    Mizutani, S; Mizutani, E

    2015-03-01

    Fetal peptide hormones are essential for the development of fetus, which increase in accordance with pregnancy term. Concentration of these hormones within the feto-placental unit is normally higher than that of maternal circulation. Since these hormones are biologically active, the leakage of these hormones into the maternal circulation is regulated by degradation activity by placental aminopeptidases, in order to maintain the balance between carriage of pregnancy and onset of labor.Because the concentration of these hormones, being regulated by the amount of endogenous production and by physiological degradation by enzymes in the blood and tissue, the balance between production and degradation is a definitive element for maintaining normal gestation and term delivery.The changes of the balance between fetal angiotensin II (A-II) and vasopressin (AVP) andA-II and AVP degrading enzymes, between aminopeptidase A (APA) and placental leucine aminopeptidase( P-LAP) - in the placenta and maternal blood due to fetal stress such as hypoxia - are the provable causes of preeclampsia or preterm labor.Induction of APA and P-LAP by estradiol benzoate (E2) and progesterone (P) from placenta has been demonstrated. They are involved in the regulation of fetal peptide hormones via placental aminopeptidases in homeostasis of pregnancy.Recently it was shown that both APA and P-LAP could be potentially safe and effective drugs for preeclampsia and preterm labor. The authors' proposed sex steroid treatment with dose increasing manner by gestational week (sex steroid treatment) for severe preeclampsia and preterm labor could be candidates replacing conventional treatments. In light of lacking safe and effective medication, the proposed sex steroid treatment is worthwhile for the prospective controlled studies for the treatment of both preeclampsia and preterm labor. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Steroid-associated osteonecrosis: Epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview

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    Xin-Hui Xie

    2015-04-01

    Full Text Available Steroid-associated osteonecrosis (SAON is a common orthopaedic problem caused by administration of corticosteroids prescribed for many nonorthopaedic medical conditions. We summarised different pathophysiologies of SAON which have adverse effects on multiple systems such as bone marrow stem cells (BMSCs pool, bone matrix, cell apoptosis, lipid metabolism, and angiogenesis. Different animal models were introduced to mimic the pathophysiology of SAON and for testing the efficacy of both prevention and treatment effects of various chemical drugs, biological, and physical therapies. According to the classification of SAON, several prevention and treatment methods are applied at the different stages of SAON. For the current period, Chinese herbs may also have the potential to prevent the occurrence of SAON. In the future, genetic analysis might also be helpful to effectively predict the development of ON and provide information for personalised prevention and treatment of patients with SAON.

  7. Successful Treatment of Primary Sclerosing Cholangitis with a Steroid and a Probiotic

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    Masaki Shimizu

    2012-05-01

    Full Text Available Primary sclerosing cholangitis (PSC is a serious disease that not only affects quality of life but can also have a significant effect on patient survival. The treatment for PSC is primarily supportive with the aim of controlling cholestatic symptoms and preventing complications. Ursodeoxycholic acid may induce biochemical improvements in affected patients; however, long-term pediatric studies to determine its possible benefits in young patients are lacking. Thus, the treatment of pediatric PSC remains a significant clinical challenge. We describe a patient with PSC and undetermined colitis who was treated with a combination of a steroid, salazosulfapyridine, and a probiotic. This treatment provided benefits both for PSC and the undetermined colitis. These findings suggest that bacterial flora and gut inflammation are closely associated with the pathogenesis of inflammatory bowel disease-related PSC. Suppression of bowel inflammation and maintenance of bacterial homeostasis may be important for treating PSC.

  8. Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment.

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    Park, Kui Young; Lee, Yohan; Hong, Ji Yeon; Chung, Won Soon; Kim, Myeung Nam; Kim, Beom Joon

    2017-05-01

    Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain. The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection. The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety. The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.

  9. Mycophenolate mofetil combined with steroids: New experiences in the treatment of idiopathic retroperitoneal fibrosis

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    Obrenčević Katarina

    2007-01-01

    Full Text Available Background/Aim. Idiopathic retroperitoneal fibrosis (IRF is an uncommon disease characterized by a retroperitoneal fibrotic tissue that often involve the ureters, leading to the obstructive nephropathy and variable impairment of renal function. Findings strongly suggest an autoimmune etiology. Surgery, medical treatment with immunosuppressive drugs, or a combination of both are proposed. The optimal treatment has not been established yet. The aim of this study was to present our experience with combined immunosuppressive therapy of IRF, steroids (S and mycophenolate mofetil (MMF. Methods. We prospectively followed four patients with IRF from January 2004 to December 2006. Three patients had an active disease with bilateral hydronephrosis. In the two of them acute renal failure was presented, and ureteral catheters were inserted in one in order to manage ureteral obstruction. One patient has came to our unit with a relapse of IRF and incipient chronic renal failure after the prior therapy with ureterolysis and immunosuppressive drugs (azathioprine and tamoxifen. All patients received steroids and MMF. Two patients were treated with intravenous methylprednisolone pulses (250 mg each, for three consecutive days, followed by oral prednisone 0.5 mg/kg/day. The other two patients received oral prednisone at the same dose. Prednisone was gradually tappered to a maintenance dose of 10 mg/kg/day. Simultaneously, all patients received MMF, initially 1 g/day with the increase to 2 g/day. Results. After four weeks of the therapy all symptoms disappeared, as well as a hydronephrosis with a decrease of erythrocyte sedimentation rate and Creactive protein (CRP to normal level in all patients. Three patients remain in remission untill the end of the follow up. One patient had a relapse because of stopping taking the therapy after six months. He was treated by oral prednisone 0.5 mg/kg/day, which was gradually decreased. After twelve weeks hydronephrosis

  10. Long-term treatment of childhood refractory and steroid dependent nephrotic syndrome with Cyclosporin A

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    Madani A

    2002-07-01

    Full Text Available Background: Cyclosporin A (CsA is now commonly used in the management of children with steroid-dependent and steroid resistant nephoitic syndrome. It has been reported to be effective in maintaining remission in 70-100 percent of patients with SDNS but somewhat SRNS 0-100 percent. The aim of this study was to evaluate the efficacy of long-term (CsA in children with refractory nephrotic syndrome (RNS and steroid dependent nephrotic syndrome (SDNS. Materials and Methods: The long-term effect of (CsA in 91 Iranian children aged 3 months to 11 years (54 with RNS and 37 with SDNS was assessed between 1984 and 1999. Eighty of 91 children received renal biopsy prior to introduction of (CsA, and the other 11 patients had not consent for kidney biopsy. If the patients did not show remission aftre receiving 3-6 months of (CsA, the medication was discontinued. Results: All patient were treated with (CsA in combination with low dose alternate day prednisolone. In children with RNS and SDNS, therapy with (CsA induced, remission in 25 of 54 (46.2 percent and 27 of 37 (73 percent respectively (P<0.02. Of the 32 patients with minimal change disease (MCD, 23 (72 percent responded to therapy, compared with 4 of 18 (22 percent with focal segmental glomerulosclerosis (FSGS (P<0.005. Twenty-four (48 percent of 50 who entered complete remission, had relapse 1-12 months after cessation of (CsA. The duration between the onset of nephrotic syndrome (NS and administration of (CsA and sexuality of patients had no effect in result of treatment. Side effects occurred in 25 patients (27.4 percent. No patients exhibited raised transaminases, 8 (8.7 percent of the children developed hirsutism, 7 (7.6 percent hypertension, 7 (7.6 percent gingival hyperplasia, (2.2 percent neurological toxicity and 1 (1 percent increase in serum creatinine. Conclusion: Our findings suggest that (CsA can be used to induce a complete remission in a significant proportion of patients with RNS and

  11. Use of androgenic anabolic steroids by patients under treatment for substance use disorder: case series

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    Julio Mario Xerfan do Amaral

    Full Text Available ABSTRACT The present study reports several case studies about the use of androgenic-anabolic steroids (AAS by patients under treatment for substance use disorder (SUD. Ten subjects were interviewed, two women and eight men, ranging from 25 to 43 years old. Regarding treatment regime, eight subjects were inpatients and two, outpatients. ASSIST-WHO and MINI-SUD scales and a semi-structured interview were used as research instruments. Seven subjects reported the use of AAS within fewer than twelve months from the interview date. Mental health professionals did not previously question none of the subjects were about the use of AAS. We discuss the efficacy of the chosen instruments to assess AAS use.

  12. Evaluation of the clinical efficiency of transforaminal epidural steroid injection in the treatment of sciatica

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    Gündoğdu Zafer

    2015-12-01

    Full Text Available Objective: Evaluation of clinical efficiancy of fluoroscopy-accompanied transforaminal epidural steroid injection in patients with symptomatic lumbar foraminal intervertebral disc herniation and foraminal stenosis. Methods: Fifty patients, who underwent fluoroscopic-guided epidural steroid injection between 19.12.2013 - 28.02.2014, were evaluated retrospectively. Pain levels of patients before the procedure, after 3 weeks and after 6 months were compared using visuel analog scale (VAS. Fifty percent or more decrease, less than 50% decrease and no change in VAS were evaluated as sufficient response, insufficient response and unresponsiveness, respectively. The patients were asked whether they would undergo this process again and “Yes”, “Maybe” and “No” answers were evaluated for patient satisfaction score. Results: In 50 patients (32 female, 18 male, average pain levels were found to be 8.4 (VAS 7-9, 4.3 (VAS 1-9 and 4.4 (VAS 0-9 before the procedure, 3 weeks after the procedure and 6 months after the procedure, respectively. While thirty-seven (74% of the patients were found to have sufficient response to treatment 3 weeks after the procedure, 10 (20% patients were found to have insufficient response. There was no response to treatment in 3 (6% patients. While thirty-five (70% of the patients were found to have sufficient response to treatment 6 months after the procedure, 10 (20% patients were found to have insufficient response. Six months after the procedure, there was no response to treatment in 5 patients (%10. Statistically significant improvement was observed when the pre and post-procedure VAS scores were compared. Forty (80% patients gave the answer “Yes” to the question whether they would undergo this procedure again. Conclusion: We found that fluoroscopic guided transforaminal epidural steroid injection is effective in pain relief in patients with lumbar foraminal intervertebral disc herniation and foraminalstenosis

  13. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women: a short version Cochrane review.

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    Boyle, Rhianon; Hay-Smith, E Jean C; Cody, June D; Mørkved, Siv

    2014-03-01

    Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth both for prevention and the treatment of incontinence. Effect of pelvic floor muscle training compared to usual antenatal and postnatal care on incontinence. Cochrane Incontinence Group Specialized Register; handsearching (searched February 7, 2012); the references of relevant articles. Randomized or quasi-randomized controlled trials in pregnant or postnatal women having pelvic floor muscle training (PFMT) versus no PFMT or standard care. Duplicate trial assessment, selection and data abstraction. Twenty-two trials involving 8,485 women. Continent pregnant women (prevention) who had intensive antenatal PFMT were less likely to report urinary incontinence up to 6 months after delivery (risk ratio (RR) 0.71, 95% CI 0.54-0.95). Incontinent postnatal women (treatment) who received PFMT were less likely to report urinary incontinence 12 months after delivery (RR 0.60, 95% CI 0.35-1.03). In a mixed population (women with and without incontinence symptoms in late pregnancy or after delivery), PFMT did not reduce incontinence rates after delivery. For women who are continent during pregnancy, PFMT may prevent urinary incontinence up to 6 months after delivery. The extent to which mixed prevention and treatment approaches to PFMT in the postnatal period are effective is less clear that is, offering advice on PFMT to all pregnant or postpartum women whether they have incontinence symptoms or not. There was little evidence about long-term effects for either urinary or fecal incontinence. © 2013 Wiley Periodicals, Inc.

  14. Treatment of steroid-resistant focal segmental glomerulosclerosis with rituximab: A case report and review of literature

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    Mohamed Hasham Varwani

    2017-01-01

    Full Text Available Various immunomodulating agents have been tried for the treatment of steroid-resistant focal segmental glomerulosclerosis (FSGS in the native kidney. A few case series and small studies have reported mixed results with the use of Rituximab for this indication. We report on the case of a 76-year-old male with steroid-resistant FSGS successfully treated with rituximab and remained in remission at the end of six months. A review of the literature highlights the paucity of data on this subject. We conclude that rituximab is a potentially useful treatment for steroid resistant FSGS and larger controlled studies are needed to further define its role in this setting.

  15. Antenatal glucocorticoid treatment alters Na+ uptake in renal proximal tubule cells from adult offspring in a sex-specific manner

    OpenAIRE

    Su, Yixin; Bi, Jianli; Pulgar, Victor M.; Figueroa, Jorge; Chappell, Mark; Rose, James C.

    2015-01-01

    We have shown a sex-specific effect of fetal programming on Na+ excretion in adult sheep. The site of this effect in the kidney is unknown. Therefore, we tested the hypothesis that renal proximal tubule cells (RPTCs) from adult male sheep exposed to betamethasone (Beta) before birth have greater Na+ uptake than do RPTCs from vehicle-exposed male sheep and that RPTCs from female sheep similarly exposed are not influenced by antenatal Beta. In isolated RPTCs from 1- to 1.5-yr-old male and femal...

  16. Comparison of two different steroid treatments with hyperbaric oxygen for idiopathic sudden sensorineural hearing loss.

    Science.gov (United States)

    Sevil, Ergun; Bercin, Sami; Muderris, Togay; Gul, Fatih; Kiris, Muzaffer

    2016-09-01

    The purpose of the study was to assess the efficacy of the association of intratympanic (IT) steroid and hyperbaric oxygen (HBO) therapy in patients presenting with idiopathic sudden sensorineural hearing loss (ISSNHL), and to compare this protocol with another consisting of intravenous (IV) steroid administration and HBO therapy. A total of 80 patients diagnosed with ISSNHL were included in this prospective trial. Patients were divided into three categories: a mild-to-moderate ISSNHL group with a pure-tone average (PTA) ≤60 decibels (dB), a severe ISSNHL group with a PTA of 60-80 dB, and a profound ISSNHL group with a PTA ≥81 dB. The first protocol consisted of 20 sessions of HBO therapy together with IV methylprednisolone 1 mg/kg body weight and a 10 mg taper every 3 days for 10 days. The second protocol consisted of HBO therapy for 20 sessions, together with an IT injection of dexamethasone at a dose of 4 mg/mL, 0.5-0.7 mL once a day for 7 consecutive days, performed 3 h before the HBO therapy. In the mild-to-moderate ISSNHL patients, the mean hearing gain and successful treatment rate was 19 (0-27) dB and 78.9 %, respectively in the IT + HBO treatment group, and 18 (3-44) dB and 70.5 % in the IV + HBO therapy group. In the severe ISSNHL patients, the mean hearing gain and successful treatment rate was 33 (1-54) dB and 81.8 %, respectively in the IT + HBO treatment group and 33.5 (7-57) dB and 58.2 % in the IV + HBO group. In the profound ISSNHL patients, the mean hearing gain and successful treatment rate was 36 (4-69) dB and 40 %, respectively in the IT + HBO therapy group, and 39.5 (0-92) dB and 72.7 % in the IV + HBO treatment group. The results demonstrated that patients with severe hearing loss success rate was superior in the group submitted to IT + HBO treatment, conversely IV + HBO therapy may be benefit for patients with profound hearing loss. Nevertheless, these clinical results were not statistically significant.

  17. [Treatment of syphilis during pregnancy: knowledge, practices and attitudes of health care professionals involved in antenatal care of the Unified Health System (SUS) in Rio de Janeiro City].

    Science.gov (United States)

    Domingues, Rosa Maria Soares Madeira; Lauria, Lilian de Mello; Saraceni, Valeria; Leal, Maria do Carmo

    2013-05-01

    This article seeks to evaluate knowledge, practices and attitudes of health care workers (HCW) involved in antenatal care in the Unified Health System (SUS) in Rio de Janeiro City (RJC) and to identify major barriers to the implementation of treatment for syphilis in pregnancy care protocols. A cross-sectional study was conducted with 102 HCW in antenatal care at SUS, corresponding to 70% of the eligible pool. Univariate and bivariate analysis were performed using SPSS version 16.0. A number of barriers were identified with respect to knowledge of and familiarity with the current protocols, difficulties related to DST management, relationship with patients and clinics organizational context, which were distinct according to the type of health unit. HCW who had greater access to training and technical manuals had a better performance, although the overall effect was discrete. Identifying barriers to adherence to health care protocols is essential to formulate intervention strategies. Access to protocols through training and technical manuals showed a discrete effect in the improvement of the care delivered to patients, pointing to the need of innovative ongoing education of HCW.

  18. Treatment of Anabolic-Androgenic Steroid Dependence: Emerging Evidence and Its Implications

    Science.gov (United States)

    Kanayama, Gen; Brower, Kirk J.; Wood, Ruth I.; Hudson, James I.; Pope, Harrison G.

    2010-01-01

    Currently, few users of anabolic-androgenic steroids (AAS) seek substance-abuse treatment. But this picture may soon change substantially, because illicit AAS use did not become widespread until the 1980s, and consequently the older members of this AAS-using population—those who initiated AAS as youths in the 1980s—are only now reaching middle age. Members of this group, especially those who have developed AAS dependence, may therefore be entering the age of risk for cardiac and psychoneuroendocrine complications sufficient to motivate them for substance-abuse treatment. We suggest that this treatment should address at least three etiologic mechanisms by which AAS dependence might develop. First, individuals with body-image disorders such as “muscle dysmorphia” may become dependent on AAS for their anabolic effects; these body-image disorders may respond to psychological therapies or pharmacologic treatments. Second, AAS suppress the male hypothalamic-pituitary-gonadal axis via their androgenic effects, potentially causing hypogonadism during AAS withdrawal. Men experiencing prolonged dysphoric effects or frank major depression from hypogonadism may desire to resume AAS, thus contributing to AAS dependence. AAS-induced hypogonadism may require treatment with human chorionic gonadotropin or clomiphene to reactivate neuroendocrine function, and may necessitate antidepressant treatments in cases of depression inadequately responsive to endocrine therapies alone. Third, human and animal evidence indicates that AAS also possess hedonic effects, which likely promote dependence via mechanisms shared with classical addictive drugs, especially opioids. Indeed, the opioid antagonist naltrexone blocks AAS dependence in animals. By inference, pharmacological and psychosocial treatments for human opioid dependence might also benefit AAS-dependent individuals. PMID:20188494

  19. Treatment of anabolic-androgenic steroid dependence: Emerging evidence and its implications.

    Science.gov (United States)

    Kanayama, Gen; Brower, Kirk J; Wood, Ruth I; Hudson, James I; Pope, Harrison G

    2010-06-01

    Currently, few users of anabolic-androgenic steroids (AAS) seek substance abuse treatment. But this picture may soon change substantially, because illicit AAS use did not become widespread until the 1980s, and consequently the older members of this AAS-using population - those who initiated AAS as youths in the 1980s - are only now reaching middle age. Members of this group, especially those who have developed AAS dependence, may therefore be entering the age of risk for cardiac and psychoneuroendocrine complications sufficient to motivate them for substance abuse treatment. We suggest that this treatment should address at least three etiologic mechanisms by which AAS dependence might develop. First, individuals with body image disorders such as "muscle dysmorphia" may become dependent on AAS for their anabolic effects; these body image disorders may respond to psychological therapies or pharmacological treatments. Second, AAS suppress the male hypothalamic-pituitary-gonadal axis via their androgenic effects, potentially causing hypogonadism during AAS withdrawal. Men experiencing prolonged dysphoric effects or frank major depression from hypogonadism may desire to resume AAS, thus contributing to AAS dependence. AAS-induced hypogonadism may require treatment with human chorionic gonadotropin or clomiphene to reactivate neuroendocrine function, and may necessitate antidepressant treatments in cases of depression inadequately responsive to endocrine therapies alone. Third, human and animal evidence indicates that AAS also possess hedonic effects, which likely promote dependence via mechanisms shared with classical addictive drugs, especially opioids. Indeed, the opioid antagonist naltrexone blocks AAS dependence in animals. By inference, pharmacological and psychosocial treatments for human opioid dependence might also benefit AAS-dependent individuals. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  20. The fate of pharmaceuticals, steroid hormones, phytoestrogens, UV-filters and pesticides during MBR treatment.

    Science.gov (United States)

    Wijekoon, Kaushalya C; Hai, Faisal I; Kang, Jinguo; Price, William E; Guo, Wenshan; Ngo, Hao H; Nghiem, Long D

    2013-09-01

    This study examined the relationship between molecular properties and the fate of trace organic contaminants (TrOCs) in the aqueous and solid phases during wastewater treatment by MBR. A set of 29 TrOCs was selected to represent pharmaceuticals, steroid hormones, phytoestrogens, UV-filters and pesticides that occur ubiquitously in municipal wastewater. Both adsorption and biodegradation/transformation were found responsible for the removal of TrOCs by MBR treatment. A connection between biodegradation and molecular structure could be observed while adsorption was the dominant removal mechanism for the hydrophobic (logD>3.2) compounds. Highly hydrophobic (logD>3.2) but readily biodegradable compounds did not accumulate in sludge. In contrast, recalcitrant compounds with a moderate hydrophobicity, such as carbamazepine, accumulated significantly in the solid phase. The results provide a framework to predict the removal and fate of TrOCs by MBR treatment. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  1. Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases.

    Science.gov (United States)

    Cavalié, Marine; Sillard, Laura; Montaudié, Henri; Bahadoran, Philippe; Lacour, Jean-Philippe; Passeron, Thierry

    2015-01-01

    Topical or intralesional corticosteroids are referred to as gold standard treatments for keloids. Recent studies showed that ablative fractional laser (AFL) treatment facilitates delivery of topical drug deeply into the skin by creating vertical channels. The objective of the present study was to assess the ablative erbium laser in fractionated mode, combined with topical high potent corticosteroid cream for treating resistant keloid scars. We conducted a retrospective study in the laser center of the Department of Dermatology (University Hospital of Nice, France), from January 2010 to June 2012, on patients with keloids who were resistant to a first-line of treatment. A 2940-nm ablative fractional erbium laser was used. Topical betamethasone cream was applied twice a day under occlusion with transparent film dressings. A total of 23 patients with 70 keloids were treated from January 2010 to June 2012. The median percentage of improvement was 50% (range -43 to 84). The mean follow-up was 8 months (range 3-18), and a recurrence was observed for eight lesions (22%). Although this observation warrants a prospective comparative evaluation, it supports the interest of the laser-assisted delivery of steroids for treating keloids scars. © 2014 Wiley Periodicals, Inc.

  2. Fate of steroid hormones and endocrine activities in swine manure disposal and treatment facilities.

    Science.gov (United States)

    Combalbert, Sarah; Bellet, Virginie; Dabert, Patrick; Bernet, Nicolas; Balaguer, Patrick; Hernandez-Raquet, Guillermina

    2012-03-01

    Manure may contain high concern endocrine-disrupting compounds (EDCs) such as steroid hormones, naturally produced by pigs, which are present at μgL(-1) levels. Manure may also contain other EDCs such as nonylphenols (NP), polycyclic aromatic hydrocarbons (PAHs) and dioxins. Thus, once manure is applied to the land as soil fertilizer these compounds may reach aquifers and consequently living organisms, inducing abnormal endocrine responses. In France, manure is generally stored in anaerobic tanks prior spreading on land; when nitrogen removal is requested, manure is treated by aerobic processes before spreading. However, little is known about the fate of hormones and multiple endocrine-disrupting activities in such manure disposal and treatment systems. Here, we determined the fate of hormones and diverse endocrine activities during manure storage and treatment by combining chemical analysis and in vitro quantification of estrogen (ER), aryl hydrocarbon (AhR), androgen (AR), pregnane-X (PXR) and peroxysome proliferator-activated γ (PPARγ) receptor-mediated activities. Our results show that manure contains large quantities of hormones and activates ER and AhR, two of the nuclear receptors studied. Most of these endocrine activities were found in the solid fraction of manure and appeared to be induced mainly by hormones and other unidentified pollutants. Hormones, ER and AhR activities found in manure were poorly removed during manure storage but were efficiently removed by aerobic treatment of manure. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Steroids in childhood epilepsy

    Directory of Open Access Journals (Sweden)

    Ramachandrannair Rajesh

    2006-01-01

    Full Text Available Treatment of epileptic encephalopathies can be very challenging as most anticonvulsant drugs fail to achieve good seizure control. Steroids are disease modifying as well as anticonvulsant in these conditions. Though steroids are accepted as the first-line treatment for infantile spasms, there are many unanswered questions with regard to the preparation, dose and duration of treatment. In this review a re-exploration of the literature is attempted. Putative mechanism of action of steroids in infantile spasms is also discussed. As steroids are being increasingly used in other epileptic encephalopathies and Rasmussen′s encephalitis, a brief discussion on the role of steroids in these conditions is attempted. The review ends with the discussion on newer neuroactive steroids in the management of epilepsy.

  4. Antenatal antioxidant treatment with melatonin to decrease newborn neurodevelopmental deficits and brain injury caused by fetal growth restriction.

    Science.gov (United States)

    Miller, Suzanne L; Yawno, Tamara; Alers, Nicole O; Castillo-Melendez, Margie; Supramaniam, Veena G; VanZyl, Niel; Sabaretnam, Tharani; Loose, Jan M; Drummond, Grant R; Walker, David W; Jenkin, Graham; Wallace, Euan M

    2014-04-01

    Fetal intrauterine growth restriction (IUGR) is a serious pregnancy complication associated with increased rates of perinatal morbidity and mortality, and ultimately with long-term neurodevelopmental impairments. No intervention currently exists that can improve the structure and function of the IUGR brain before birth. Here, we investigated whether maternal antenatal melatonin administration reduced brain injury in ovine IUGR. IUGR was induced in pregnant sheep at 0.7 gestation and a subset of ewes received melatonin via intravenous infusion until term. IUGR, IUGR + melatonin (IUGR + MLT) and control lambs were born naturally, neonatal behavioral assessment was used to examine neurological function and at 24 hr after birth the brain was collected for the examination of neuropathology. Compared to control lambs, IUGR lambs took significantly longer to achieve normal neonatal lamb behaviors, such as standing and suckling. IUGR brains showed widespread cellular and axonal lipid peroxidation, and white matter hypomyelination and axonal damage. Maternal melatonin administration ameliorated oxidative stress, normalized myelination and rescued axonopathy within IUGR lamb brains, and IUGR + MLT lambs demonstrated significant functional improvements including a reduced time taken to attach to and suckle at the udder after birth. Based on these observations, we began a pilot clinical trial of oral melatonin administration to women with an IUGR fetus. Maternal melatonin was not associated with adverse maternal or fetal effects and it significantly reduced oxidative stress, as evidenced by reduced malondialdehyde levels, in the IUGR + MLT placenta compared to IUGR alone. Melatonin should be considered for antenatal neuroprotective therapy in human IUGR. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Long-term repeated rituximab treatment for childhood steroid-dependent nephrotic syndrome.

    Science.gov (United States)

    Kim, Ji Hyun; Park, Eujin; Hyun, Hye Sun; Cho, Myung Hyun; Ahn, Yo Han; Choi, Hyun Jin; Kang, Hee Gyung; Ha, Il-Soo; Cheong, Hae Il

    2017-09-01

    Rituximab (RTX) can be used as a rescue therapy for steroid-dependent nephrotic syndrome (SDNS). However, the efficacy and safety of long-term, repeated use of RTX are not established. This study was conducted to assess the efficacy and safety of long-term, repeated RTX treatment in children. Eighteen consecutive child patients with SDNS who were treated with three or more cycles of RTX for one year or longer were recruited, and their medical records were retrospectively reviewed. The patients were followed for 4.7 ± 1.9 years and received 5.2 ± 2.3 cycles of RTX over 2.8 ± 1.1 years. Approximately 70% of the additional RTX cycles were administered due to recovery of B-cells without relapse. The relapse rate decreased from 3.4 ± 2.0 per year initially to 0.4 ± 0.8 per year at the third year after RTX treatment. Approximately 10% of the RTX infusions were accompanied by mild infusion reactions. Eight patients showed sustained remission without any oral medication after the last cycle of RTX, while 10 patients had one or more episodes of relapse after the last cycle of RTX. The relapse rate in the latter group decreased from 2.8 ± 1.5 per year before RTX treatment to 1.3 ± 0.8 per year after cessation of RTX treatment. No significant differences in clinical parameters were found between the two groups. This retrospective study showed that pre-emptive and long-term, repeated RTX treatment is relatively effective and safe in children with SDNS. However, well-designed prospective studies are needed to confirm these findings.

  6. Long-term repeated rituximab treatment for childhood steroid-dependent nephrotic syndrome

    Directory of Open Access Journals (Sweden)

    Ji Hyun Kim

    2017-09-01

    Full Text Available Background: Rituximab (RTX can be used as a rescue therapy for steroid-dependent nephrotic syndrome (SDNS. However, the efficacy and safety of long-term, repeated use of RTX are not established. This study was conducted to assess the efficacy and safety of long-term, repeated RTX treatment in children. Methods: Eighteen consecutive child patients with SDNS who were treated with three or more cycles of RTX for one year or longer were recruited, and their medical records were retrospectively reviewed. Results: The patients were followed for 4.7 ± 1.9 years and received 5.2 ± 2.3 cycles of RTX over 2.8 ± 1.1 years. Approximately 70% of the additional RTX cycles were administered due to recovery of B-cells without relapse. The relapse rate decreased from 3.4 ± 2.0 per year initially to 0.4 ± 0.8 per year at the third year after RTX treatment. Approximately 10% of the RTX infusions were accompanied by mild infusion reactions. Eight patients showed sustained remission without any oral medication after the last cycle of RTX, while 10 patients had one or more episodes of relapse after the last cycle of RTX. The relapse rate in the latter group decreased from 2.8 ± 1.5 per year before RTX treatment to 1.3 ± 0.8 per year after cessation of RTX treatment. No significant differences in clinical parameters were found between the two groups. Conclusion: This retrospective study showed that pre-emptive and long-term, repeated RTX treatment is relatively effective and safe in children with SDNS. However, well-designed prospective studies are needed to confirm these findings.

  7. Repurposing drugs for treatment of tuberculosis: a role for non-steroidal anti-inflammatory drugs.

    Science.gov (United States)

    Maitra, Arundhati; Bates, Sadé; Shaik, Monisha; Evangelopoulos, Dimitrios; Abubakar, Ibrahim; McHugh, Timothy D; Lipman, Marc; Bhakta, Sanjib

    2016-06-01

    The number of cases of drug-resistant Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), has risen rapidly in recent years. This has led to the resurgence in repurposing existing drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), for anti-TB treatment. Evidence from novel drug screening in vitro, in vivo, pharmacokinetic/pharmacodynamics analyses and clinical trials has been used for the preparation of this systematic review of the potential of NSAIDs for use as an adjunct in new TB chemotherapies. Certain NSAIDs have demonstrated inhibitory properties towards actively replicating, dormant and drug-resistant clinical isolates of M. tuberculosis cells. NSAIDs are a diverse class of drugs, which have reported off-target activities, and their endogenous antimicrobial mechanism(s) of action is still unclear. It is essential that clinical trials of NSAIDs continue, in order to assess their suitability for addition to the current TB treatment regimen. Repurposing molecules such as NSAIDs is a vital, low-risk strategy to combat the trend of rapidly increasing antibiotic resistance. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Gluten-free diet and steroid treatment are effective therapy for most patients with collagenous sprue.

    Science.gov (United States)

    Rubio-Tapia, Alberto; Talley, Nicholas J; Gurudu, Suryakanth R; Wu, Tsung-Teh; Murray, Joseph A

    2010-04-01

    Collagenous sprue (CS) is characterized by the presence of a distinctive band of subepithelial collagen deposition in the small bowel. We evaluated the clinical characteristics, treatments, and outcomes of patients with CS. Thirty patients with CS were identified at the 3 Mayo Clinic sites between 1993 and 2009. Clinical data from medical records were reviewed. The study cohort was 70% female (age range, 53-91 years). Most patients had severe diarrhea and weight loss. Hospitalization to treat dehydration was necessary in 16 (53%) patients. Associated immune-mediated diseases were noted in 70% of the patients; celiac disease was the most frequent. Other associated diseases were microscopic colitis, hypothyroidism, and autoimmune enteropathy. The median thickness of the layer of subepithelial collagen deposition in the small bowel was 29 mum (20-56.5 mum). Subepithelial collagen deposition in the colon or stomach was noted in 8 patients. A clinical response was observed in 24 (80%) patients after treatment with a combination of a gluten-free diet and immunosuppressive drugs. Histologic improvement was confirmed in 9 patients, with complete remission in 5. Two patients died (1 of complications of CS and 1 of another illness). Most patients with CS are treated effectively with a combination of gluten-free diet and steroids. CS is often associated with collagen deposition or chronic inflammation in other segments of the gastrointestinal tract as well as other immune-mediated disorders. Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

  9. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    International Nuclear Information System (INIS)

    Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

    2015-01-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment

  10. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    Energy Technology Data Exchange (ETDEWEB)

    Canyilmaz, Emine, E-mail: dremocan@ktu.edu.tr [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Canyilmaz, Fatih [Department of Orthopaedics and Traumatology, Yavuz Selim Bone Disease and Rehabilitation Hospital, Trabzon (Turkey); Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Uslu, Gonca Hanedan [Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon (Turkey); Aynaci, Osman [Department of Orthopaedics and Traumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey); Yoney, Adnan [Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon (Turkey)

    2015-07-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

  11. Past anabolic-androgenic steroid use among men admitted for substance abuse treatment: an underrecognized problem?

    Science.gov (United States)

    Kanayama, Gen; Cohane, Geoffrey H; Weiss, Roger D; Pope, Harrison G

    2003-02-01

    Recent reports suggest that anabolic-androgenic steroids (AAS) may cause mood disorders or dependence syndromes and may help to introduce some individuals to opioid abuse. At present, however, little is known about prior AAS use among men entering inpatient substance abuse treatment. We assessed lifetime AAS use in 223 male substance abusers admitted to a substance abuse treatment unit primarily for treatment of alcohol, cocaine, and opioid dependence. Subjects reporting definite or possible AAS use were then asked to participate in a detailed semistructured interview that covered demographics, drug use history, and symptoms experienced during AAS use and withdrawal, and whether AAS use had helped introduce the subject to other classes of drugs. Twenty-nine men (13%) reported prior AAS use, but this history was documented on physicians' admission evaluations in only 4 cases. Among 88 men listing opioids as their drug of choice, 22 (25%) acknowledged AAS use, versus only 7 (5%) of the other 135 men (p gym and subsequently first obtained opioids from the same person who had sold them AAS. Eighteen (75%) of the men interviewed reported that AAS were the first drugs that they had ever self-administered by injection, 4 (17%) reported severe aggressiveness or violence during AAS use, 1 (4%) attempted suicide during AAS withdrawal, and 5 (21%) described a history of AAS dependence. Prior AAS use appears to be common but underrecognized among men entering inpatient substance abuse treatment, especially those with opioid dependence. AAS use may serve as a "gateway" to opioid abuse in some cases and may also cause morbidity in its own right.

  12. Comparison of 2 and 4 Intratympanic Steroid Injections in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss.

    Science.gov (United States)

    Suzuki, Hideaki; Wakasugi, Tetsuro; Kitamura, Takuro; Koizumi, Hiroki; Do, Ba Hung; Ohbuchi, Toyoaki

    2018-04-01

    We studied the effect of intratympanic steroid administration with different total injection times on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). The subjects were 191 consecutive patients (192 ears) with ISSNHL (hearing level ≥40 dB, interval between onset and treatment ≤30 days). They received systemic prednisolone (100 mg followed by tapered doses) combined with intratympanic injection of dexamethasone (4 mg/ml). Intratympanic injection was performed 4 times (days 1, 2, 4, and 7) in 92 patients (92 ears) or 2 times (days 1 and 2) in 99 patients (100 ears). The hearing outcomes were evaluated at 1 week from the start of treatment and 1 to 2 months after the completion of treatment. There was no significant difference in hearing outcomes between the 4- and 2-injection groups at either time point. Multiple regression analysis also showed that the hearing level after treatment did not depend on the total number of intratympanic steroid injections. These results indicate that a protocol using only 2 intratympanic steroid injections exerts a sufficient effect on the hearing outcomes of ISSNHL. This simplified treatment protocol would be greatly beneficial to relieve the physical and mental stress of patients.

  13. Troubled social background of male anabolic-androgenic steroid abusers in treatment

    Directory of Open Access Journals (Sweden)

    Skarberg Kurt

    2007-07-01

    Full Text Available Abstract Background The aim of this study was to investigate the social background and current social situation of male abusers of anabolic-androgenic steroids (AAS. Methods We compared thirty-four AAS-abusing patients from an Addiction Centre (AC with two groups, 18 users and 259 non-users of AAS from a public gym in Orebro, Sweden. The study is based on semi-structured interviews and questionnaires. Results Histories of a troubled childhood as well as current social disadvantage were both more frequent among the AAS users. Users also reported poor relationships with their parents and almost half of them had experienced physical or mental abuse. The AC group's experiences from school were mostly negative, and included concentration problems, boredom and learning difficulties. Their current circumstance included abuse of other drugs, battering of spouses and other criminality such as assault, illegal possession of weapons and theft. Conclusion In conclusion, this study shows that abusers of AAS often have a troubled social background. This underlines the importance of making a thorough social assessment as a part of the treatment programme. The results of the study may help in directing appropriate questions relevant to the abuse of AAS.

  14. Troubled social background of male anabolic-androgenic steroid abusers in treatment.

    Science.gov (United States)

    Skarberg, Kurt; Engstrom, Ingemar

    2007-07-05

    The aim of this study was to investigate the social background and current social situation of male abusers of anabolic-androgenic steroids (AAS). We compared thirty-four AAS-abusing patients from an Addiction Centre (AC) with two groups, 18 users and 259 non-users of AAS from a public gym in Orebro, Sweden. The study is based on semi-structured interviews and questionnaires. Histories of a troubled childhood as well as current social disadvantage were both more frequent among the AAS users. Users also reported poor relationships with their parents and almost half of them had experienced physical or mental abuse. The AC group's experiences from school were mostly negative, and included concentration problems, boredom and learning difficulties. Their current circumstance included abuse of other drugs, battering of spouses and other criminality such as assault, illegal possession of weapons and theft. In conclusion, this study shows that abusers of AAS often have a troubled social background. This underlines the importance of making a thorough social assessment as a part of the treatment programme. The results of the study may help in directing appropriate questions relevant to the abuse of AAS.

  15. A Case of Systemic Lupus Erythematosus Presenting with an Acute Abdomen: Successful Treatment with Steroid

    Directory of Open Access Journals (Sweden)

    Haruka Fukatsu

    2014-01-01

    Full Text Available Abdominal pain continues to pose diagnostic challenges for emergency clinicians. A 56-year-old Japanese woman was referred to our hospital due to severe abdominal pain which presented as occasional epigastric pain five months before and intermittent abdominal pain. She had a past history of ileus twice, for both of which laparotomy was performed without an alimentary tract resection. The wall thickening with marked three-wall structure from terminal ileum to sigmoid colon was seen and bladder wall was irregularly thick and enhanced irregularly. Among the differential diagnosis of the acute abdomen, autoimmune diseases were suspected, especially lupus erythematosus and Henoch-Schönlein purpura. On the second day of admission, abdominal pain worsened. The results of examinations of antinuclear antibody, anti-double-stranded DNA antibody, ANCA, and the complements were not obtained at that time; however, we started 1-g steroid pulse treatment for three days with success. With the results obtained later, the patient was given a diagnosis of probable systemic lupus erythematosus (SLE. The present case shows that SLE can present with acute abdomen and should be included in the wide range of the differential diagnosis of acute abdomen.

  16. Epidural Steroid Injections for the Treatment of Cervical Radiculopathy in Elite Wrestlers: Case Series and Literature Review

    Science.gov (United States)

    Clark, Randy; Doyle, Matthew; Sybrowsky, Christian; Rosenquist, Richard

    2012-01-01

    Background Elite wrestlers place tremendous stress through their cervical spine. These athletes are at risk for cervical trauma and may develop radiculopathy from recurrent episodes of injury. Team physicians and athletic trainers are faced with the challenge of treating these injuries in such a way as to allow the athlete to safely and expeditiously return to competition. Epidural steroid injections can be a successful complement to a conservative treatment algorithm for these complex injuries. Study Design Case Series Methods Five upper-level NCAA collegiate wrestlers who experienced symptomatic cervical radiculopathy were identified from an archival review. The majority of the athletes had MRI evidence of cervical disc disease, with corresponding subjective complaints and physical examination findings including pain and weakness that precluded continued competition. All athletes were treated conservatively with initial activity modification, strengthening, rehabilitation, NSAIDs, and, ultimately, cervical epidural steroid injections. Results All five athletes successfully returned to competition without negative clinical sequelae or need for operative intervention. The athletes demonstrated subjective improvement in their symptoms and strength, and all were able to return to a high level of competition. The cervical epidural steroid injections were found to be safe, effective, and well tolerated in all of the athletes. Conclusions Elite wrestlers with cervical radiculopathy can be effectively and safely managed with a conservative regimen that includes cervical epidural steroid injections, which may allow them to continue to compete at a high level. PMID:23576942

  17. Avoiding the prenatal programming effects of glucocorticoids: are there alternative treatments for the induction of antenatal lung maturation?

    Science.gov (United States)

    Justus, Georgia; Sloboda, Deborah Magdalena; Henrich, Wolfgang; Plagemann, Andreas; Dudenhausen, Joachim Wolfram; Braun, Thorsten

    2015-09-01

    The long-term outcomes of antenatal glucocorticoids (GCs) vary between reports, and have generated controversy in terms of repeated and single-course events, causing irreversible effects on endocrine set points. This study aimed to assess the effects of alternative therapeutic agents other than synthetic glucocorticoid GC administration for fetal lung maturation. A review of literature from PubMed, EMBASE, Cochrane Library, and Google Scholar was conducted to assess the use of alternative therapies to synthetic GCs using recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). End points included the rates of respiratory distress syndrome (RDS), mRNA expression for pneumocyte type II, concentration of surfactant proteins in alveolar lavage, morphological differences, histological proof of lung maturation, and angiogenesis or quantification of the surfactant pool. In all 41 studies examined, we found that ambroxol showed positive effects on lung maturation, but it has yet to be analyzed with sufficient significance in humans. Interleukins and TNF-alpha produce accelerated lung maturation, but have only been evaluated in basic research/experimental studies. Growth factors promote structural and functional growth in all phases of lung maturation, but little is known about their reciprocal effects and exact mechanisms as therapeutics. Thyroid releasing hormone or vitamin A cause detrimental side effects or were less effective for lung maturation. The efficacy and safety of these alternative agents are differentiated and none up to now can be recommended as an alternative to GCs.

  18. Variables influencing delay in antenatal clinic attendance among ...

    African Journals Online (AJOL)

    A delay in deciding to seek antenatal care is predominant among pregnant teenagers in Lesotho. This subsequently leads to delay in reaching treatment and in receiving adequate treatment. Early antenatal care attendance plays a major role in detecting and treating complications of pregnancy and forms a good basis for ...

  19. Comparison of intermittent intratympanic steroid injection and near-continual transtympanic steroid perfusion as salvage treatments for sudden sensorineural hearing loss.

    Science.gov (United States)

    Chou, Yi-Fan; Chen, Peir-Rong; Kuo, Ian-Jiun; Yu, Szu-Hui; Wen, Yu-Hsuan; Wu, Hung-Pin

    2013-09-01

    The purpose of this study was to investigate whether near-continual transtympanic steroid perfusion is more effective than intermittent intratympanic steroid injection as a salvage therapy for idiopathic sudden sensorineural hearing loss. Case control study. We designed a case-control study consisting of 60 patients with sudden sensorineural hearing loss who did not respond well to systemic steroid therapy. From November 2008 to October 2010, we prospectively enrolled subjects for the transtympanic steroid perfusion therapy. We retrospectively collected data from age- and sex-matched patients who had undergone intratympanic steroid injection between January 2003 and October 2008. The audiological results of the two groups were compared. The presalvage pure tone threshold was 65.4 ± 13.5 dB in the transtympanic steroid perfusion group. After the therapy, the hearing threshold was improved by an average of 15.0 ± 9.7 dB, and 53.3% of subjects had improved by 10 dB or more. The speech discrimination score was improved from 12.6% ± 7.0% to 54.4 ± 6.4%. In the intratympanic steroid injection group, the presalvage pure tone threshold was 68.8 ± 16.0 dB. After the therapy, the hearing threshold was improved by an average of 10.7 ± 9.8 dB, and 43.3% of subjects had improved by 10 dB or more. The speech discrimination score was improved from 13.3 ± 6.0% to 46.4 ± 12%. The degree of hearing improvement was significantly greater in the transtympanic group. Both transtympanic steroid perfusion and intratympanic steroid injection can be used as salvage therapies for idiopathic sudden sensorineural hearing loss. Near-continual transtympanic steroid perfusions may provide better audiological results. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  20. External otitis and its treatment : is a group III steroid without antibiotics sufficent therapy? Experimental and clinical studies

    OpenAIRE

    Emgård, Per

    2005-01-01

    ABSTRACT External otitis and its treatment. Is a group III steroid without antibiotics sufficient therapy? – Experimental and clinical studies Per Emgård, Department of Otorhinolaryngology, University of Umeå and Ystad Hospital, Umeå and Ystad, Sweden External otitis is one of the most common ear, nose and throat (ENT) diagnoses in out-patient clinics. The clinical course of external otitis includes itching, pain, redness, swelling and effusion of the external auditory canal (EAC) with normal...

  1. Antenatal Dexamethasone Exposure in Preterm Infants Is Associated with Allergic Diseases and the Mental Development Index in Children

    Directory of Open Access Journals (Sweden)

    Wan-Ning Tseng

    2016-12-01

    Full Text Available Background: Antenatal steroid administration may benefit fetal lung maturity in preterm infants. Although some studies have shown that this treatment may increase asthma in childhood, the correlation between antenatal dexamethasone exposure and allergic diseases remains unclear. The purpose of this study is to investigate the association between antenatal dexamethasone and T cell expression in childhood allergic diseases. Methods: We recruited a cohort of preterm infants born at Kaohsiung Chang Gung Memorial Hospital between 2007 and 2010 with a gestational age of less than 35 weeks and body weight at birth of less than 1500 g. The status of antenatal exposure to steroids and allergic diseases were surveyed using a modified ISAAC questionnaire for subjects aged 2–5 years old. We analyzed Th1/Th2/Th17 expression of mRNA, cytokines (using the Magpix® my-system, and mental development index (MDI. Results: Among the 40 patients that were followed, the data showed that the antenatal dexamethasone exposure group (N = 24 had a significantly higher incidence of allergic diseases (75.0% vs. 18.8%, p < 0.0001 when compared to the non-dexamethasone exposure group (N = 16, especially with regard to asthma (41.7% vs. 0.0%, p = 0.003 and allergic rhinitis (58.3% vs. 18.8%, p = 0.013, but not atopic dermatitis. No statistical difference was observed in the mRNA expression levels of total white blood cell count between the dexamethasone exposure and non-exposure groups (p > 0.05. However, the asthma group had higher IL-5 levels (p = 0.009, and the MDI was shown to be significantly higher in the dexamethasone exposure group (90.38 ± 3.31 vs. 79.94 ± 3.58, p = 0.043 while no significant difference was found between the PDI of the two groups. Conclusions: Exposure to antenatal dexamethasone in preterm infants will increase their susceptibility to allergic diseases, particularly asthma and allergic rhinitis. Preterm infants’ exposure to antenatal

  2. Antenatal services for Aboriginal women: the relevance of cultural competence.

    Science.gov (United States)

    Reibel, Tracy; Walker, Roz

    2010-01-01

    Due to persistent significantly poorer Aboriginal perinatal outcomes, the Women's and Newborns' Health Network, Western Australian Department of Health, required a comprehensive appraisal of antenatal services available to Aboriginal women as a starting point for future service delivery modelling. A services audit was conducted to ascertain the usage frequency and characteristics of antenatal services used by Aboriginal women in Western Australia (WA). Telephone interviews were undertaken with eligible antenatal services utilising a purpose specific service audit tool comprising questions in five categories: 1) general characteristics; 2) risk assessment; 3) treatment, risk reduction and education; 4) access; and 5) quality of care. Data were analysed according to routine antenatal care (e.g. risk assessment, treatment and risk reduction), service status (Aboriginal specific or non-specific) and application of cultural responsiveness. Significant gaps in appropriate antenatal services for Aboriginal women in metropolitan, rural and remote regions in WA were evident. Approximately 75% of antenatal services used by Aboriginal women have not achieved a model of service delivery consistent with the principles of culturally responsive care, with few services incorporating Aboriginal specific antenatal protocols/programme, maintaining access or employing Aboriginal Health Workers (AHWs). Of 42 audited services, 18 Aboriginal specific and 24 general antenatal services reported utilisation by Aboriginal women. Of these, nine were identified as providing culturally responsive service delivery, incorporating key indicators of cultural security combined with highly consistent delivery of routine antenatal care. One service was located in the metropolitan area and eight in rural or remote locations. The audit of antenatal services in WA represents a significant step towards a detailed understanding of which services are most highly utilised and their defining characteristics

  3. Relationship of specific MRI findings to treatment outcomes in patients receiving transforaminal epidural steroid injections

    Energy Technology Data Exchange (ETDEWEB)

    Lechmann, Marco; Rosskopf, Andrea; Ehrmann, Christine; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [University of Zuerich, Department of Radiology, Orthopaedic University Hospital Balgrist, Zuerich (Switzerland)

    2016-12-15

    To determine whether specific MRI findings are related to outcomes after lumbar transforaminal epidural steroid injections (TFESI) and to assess the inter-rater reliability of imaging diagnosis. A prospective outcomes study on 156 consecutive patients with 1-month follow-up outcomes data and MRI within 3 months of TFESI was conducted. Pain levels (numerical rating scale) (NRS) were recorded prior to injection. Overall 'improvement' was determined using the Patients Global Impression of Change (PGIC) scale and NRS data were collected at three time points post injection. Two radiologists independently evaluated all images blinded to treatment outcome for reliability of diagnosis. The Chi-square test compared MRI findings for the senior radiologist to 'improvement'. NRS change scores were compared to MRI findings with the unpaired t-test or ANOVA. Kappa and percent agreement assessed inter-rater agreement of diagnosis. The only abnormality linked to 'improvement' (p = 0.03) and higher NRS change scores (p = 0.0001) at 1 month was the disc herniation morphology 'protrusion + sequestration'. Patients with degeneration by osteophytes (p = 0.034), grade 3 foraminal nerve root compression (p = 0.01) and foraminal/extraforaminal location of herniation (p = 0.014) also had higher 1 month NRS change scores. Reliability of diagnosis was 'fair' to 'substantial' depending on MRI findings. Patients with disc protrusion plus sequestration were significantly more likely to report overall improvement and more pain reduction at 1 month. Higher pain reduction was noted in patients with degeneration by osteophytes, grade 3 foraminal nerve root compression, or foraminal/extraforaminal disc herniation location. (orig.)

  4. Conservative treatment of lumbar disc herniation. Epidural steroid injection and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Ohmura, Munehisa; Sakanaka, Hideki; Wada, Eiji; Inaoka, Masahiro; Yonenobe, Sakuo [Kansai Rosai Hospital, Amagasaki, Hyogo (Japan)

    1996-01-01

    A study was made on the efficacy of the epidural injection of steroids in 65 patients of lumbar disc herniation. It was recognized that epidural steroids were effective in 49 cases (75 percent) and the effect was closely correlated with the prognosis of lumbar disc herniation. On follow-up MRI studies, a definite decrease in the size of the herniated nucleus pulposus was observed in six patients of the sequestration type: disappearance in five. No definite change was observed except for one patient in the protrusion type. (author).

  5. Assessment of the importance of sorption for steroid estrogens removal during activated sludge treatment

    DEFF Research Database (Denmark)

    Andersen, Henrik Rasmus; Hansen, Martin; Kjølholt, Jesper

    2005-01-01

    Distribution coefficients (Kd) between water and activated sludge particles (foc= 27.7±0.1%) were measured for the steroid estrogens (SE), estrone (E1), 17β-estradiol (E2) and 17α- ethinylestradiol (EE2) in batch experiments. Experimental concentration levels ranged ......Distribution coefficients (Kd) between water and activated sludge particles (foc= 27.7±0.1%) were measured for the steroid estrogens (SE), estrone (E1), 17β-estradiol (E2) and 17α- ethinylestradiol (EE2) in batch experiments. Experimental concentration levels ranged ...

  6. Impact of antenatal glucocorticosteroids on whole-genome expression in preterm babies.

    Science.gov (United States)

    Saugstad, Ola Didrik; Kwinta, Przemko; Wollen, Embjørg Julianne; Bik-Multanowski, Mirosław; Madetko-Talowska, Anna; Jagła, Mateusz; Tomasik, Tomasz; Pietrzyk, Jacek Józef

    2013-04-01

    To study the impact that using antenatal steroid to treat threatened preterm delivery has on whole-genome expression. A prospective whole-genome expression study was carried out on 50 newborn infants, delivered before 32 weeks gestation, who had been exposed to antenatal steroids, including 40 who had received a full antenatal steroid course. Seventy infants not exposed to antenatal steroids formed the control group. Microarray analyses were performed five and 28 days after delivery, and the results were validated by real-time PCR. The study was conducted between September 2008 and November 2010. Twenty thousand six hundred and ninety-three genes were studied in the infants' leucocytes. Thirteen were differentially expressed 5 days after delivery, but there were no differences at day 28. Four genes related to cancer or inflammation were up-regulated. Nine genes were down-regulated: six were Y-linked and associated with malignancies, graft-versus-host disease, male infertility and cell differentiation and three were associated with pre-eclampsia, oxidative stress and chloride/bicarbonate exchange. Seven gene pathways were up-regulated at day five and only one at day 28. These were associated with cell growth, cell cycle regulation, metabolism and apoptosis. Antenatal steroid therapy affects a limited number of genes and gene pathways in leucocytes in preterm babies at day five of life. The effect is short-lived, but long-term effects cannot be ruled out. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.

  7. Anabolic Steroids

    Science.gov (United States)

    Anabolic steroids are man-made substances related to male sex hormones. Doctors use anabolic steroids to treat some hormone problems in men, delayed ... from some diseases. Bodybuilders and athletes often use anabolic steroids to build muscles and improve athletic performance. Using ...

  8. Effect of maternal steroid on developing diaphragm integrity.

    Directory of Open Access Journals (Sweden)

    Yong Song

    Full Text Available Antenatal steroids reduce the severity of initial respiratory distress of premature newborn babies but may have an adverse impact on other body organs. The study aimed to examine the effect of maternal steroids on postnatal respiratory muscle function during development and elucidate the mechanisms underlying the potential myopathy in newborn rats. Pregnant rats were treated with intramuscular injections of 0.5 mg/kg betamethasone 7 d and 3 d before birth. Newborn diaphragms were dissected for assessment of contractile function at 2 d, 7 d or 21 d postnatal age (PNA, compared with age-matched controls. The expression of myosin heavy chain (MHC isoforms and atrophy-related genes and activity of intracellular molecular signalling were measured using quantitative PCR and/or Western blot. With advancing PNA, neonatal MHC gene expression decreased progressively while MHC IIb and IIx isoforms increased. Protein metabolic signalling showed high baseline activity at 2 d PNA, and significantly declined at 7 d and 21 d. Antenatal administration of betamethasone significantly decreased diaphragm force production, fatigue resistance, total fast fibre content and anabolic signalling activity (Akt and 4E-BP1 in 21 d diaphragm. These responses were not observed in 2 d or 7 d postnatal diaphragm. Results demonstrate that maternal betamethasone treatment causes postnatal diaphragmatic dysfunction at 21 d PNA, which is attributed to MHC II protein loss and impairment of the anabolic signalling pathway. Developmental modifications in MHC fibre composition and protein signalling account for the age-specific diaphragm dysfunction.

  9. Oral Steroids (Steroid Pills and Syrups)

    Science.gov (United States)

    ... to learn more about steroids? How are steroid pills and syrups used? Steroid pills and syrups are ... in the body; some more steroid medicines; important dosing considerations; and our research on steroids. Learn more ...

  10. Steroidal Saponins

    Science.gov (United States)

    Sahu, N. P.; Banerjee, S.; Mondal, N. B.; Mandal, D.

    The medicinal activities of plants are generally due to the secondary metabolites (1) which often occur as glycosides of steroids, terpenoids, phenols etc. Saponins are a group of naturally occurring plant glycosides, characterized by their strong foam-forming properties in aqueous solution. The cardiac glycosides also possess this, property but are classified separately because of their specific biological activity. Unlike the cardiac glycosides, saponins generally do not affect the heart. These are classified as steroid or triterpenoid saponins depending on the nature of the aglycone. Steroidal glycosides are naturally occurring sugar conjugates of C27 steroidal compounds. The aglycone of a steroid saponin is usually a spirostanol or a furostanol. The glycone parts of these compounds are mostly oligosaccharides, arranged either in a linear or branched fashion, attached to hydroxyl groups through an acetal linkage (2, 3). Another class of saponins, the basic steroid saponins, contain nitrogen analogues of steroid sapogenins as aglycones.

  11. Cyclosporine in the treatment of childhood idiopathic steroid resistant nephrotic syndrome: a single centre experience in Nigeria.

    Science.gov (United States)

    Ladapo, Taiwo Augustina; Esezobor, Christopher Imokhuede; Lesi, Foluso Ebunoluwa

    2016-01-01

    Children with steroid resistant nephrotic syndrome usually require treatment with second-line agents and calcineurin inhibitors such as cyclosporine are now recommended as initial therapy. These agents only recently become available in our environment and their impact on care is unknown. We reviewed the short-term treatment outcomes of their use in comparison with previous outcomes. Medical records of children managed for idiopathic steroid resistant nephrotic syndrome over a 5 year period were reviewed. Remission rates and improvement in renal function following use of various agents were compared. Of 103 children with idiopathic nephrotic syndrome, 25(24.3%) were steroid resistant, of whom 17 received additional medications. Full remission rate for cyclosporine was 70% (7/10). Remission rates prior to the availability of cyclosporine were 40% (2/5) for cyclophosphamide and 66% (2/3), (partial remission only) with enalapril, an angiotensin converting enzyme inhibitor used in combination with alternate day prednisolone. One child with cyclophosphamide resistance subsequently achieved remission with cyclosporine. Remission was not related to sex (p=0.96) , age (p=0.54) , serum albumin (p=0.37) or hypertension (p=0.43) but to serum cholesterol (p= 0.02) . The estimated glomerular filteration rate (eGFR) among children treated with cyclosporine ranged from 30-167 ml/min/1.73m 2 as follows: >90 (5); 60-89 (3); 30-59 (2) while the mean pre and post treatment eGFR in those with eGFR nephrotic syndrome.

  12. Treatment of a Recurrent Chest Wall Desmoid Tumor Using a CT-Guided Steroid Injection

    Energy Technology Data Exchange (ETDEWEB)

    Rhee, Sung Jung; Paik, Sang Hyun; Shin, Hwa Kyoon; Paik, Jai Soung; Lee, Eun Hye [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2012-06-15

    We report on a 41-year-old woman with a chest wall desmoid tumour who was successfully treated with a computed tomography (CT)-guided steroid injection. She presented with a palpable mass in the right upper chest wall and was treated by surgical excision and postoperative radiation therapy due to recurrence of the mass at the surgical site. At 20 months after the second operation, a recurrent mass was again detected in the anterosuperior portion of the previous surgical site on CT. We performed a CT-guided steroid injection weekly for 4 weeks by applying a mixture of 3 mL of triamcinolone acetonide (40 mg/mL) and 3 mL of 1% Lidocaine, administering 4-6 mL of the mixture, to the lesion. Six months later, CT showed a marked decrease in the size of the mass.

  13. [Successful treatment with intravenous steroid pulse therapy of a boy with recurrent idiopathic sixth nerve palsy].

    Science.gov (United States)

    Yamada, Keitaro; Kimizu, Tomokazu; Kimura, Sadami; Ikeda, Tae; Mogami, Yukiko; Yanagihara, Keiko; Suzuki, Yasuhiro

    2014-07-01

    A 3-year-old boy developed left-sided convergent strabismus one week after upper respiratory infection. All examinations, including analysis of cerebrospinal fluid, a tensilon test, and brain MRI, were negative. He was diagnosed with idiopathic sixth nerve palsy. His symptom resolved gradually with vitamin B12, and remitted completely three months after onset. At the age of 6 years, he experienced recurrence of left-sided sixth nerve palsy. After vitamin B12 failed, his symptom responded markedly to intravenous steroid pulse therapy starting on day 26 after relapse. He has been symptom-free for three years since the second remission. Steroid therapy might be effective, and should be considered in children with idiopathic sixth nerve palsy who do not show spontaneous remission.

  14. Intrathecal antitetanus serum (horse) with steroid in the treatment of neonatal tetanus.

    OpenAIRE

    Singh, A K; Bansal, A; Goel, S P; Agarwal, V K

    1980-01-01

    107 patients with neonatal tetanus were studied and the value of intrathecal antitetanus serum with steroid was noted. The mortality rate in a control group (68%) was significantly higher than that of the test group (37%). Furthermore, a delay in antitetanus serum administration was found to have a strong positive linear correlation with the mortality rate. In fact, the mortality rate for neonates who were given antitetanus serum 24 hours after the onset of convulsions was found to be as high...

  15. ROUTINE ANTENATAL SYPHILIS SCREENING IN SOUTH WEST ...

    African Journals Online (AJOL)

    serological screening in pregnancy and treatment with injectable penicillin, including the partner, as a routine part of antenatal care6. Ideally, this screening should be done during the first trimester or at the first ante- natal visit of the woman and again early in the third trimester, even in low- prevalence populations. There.

  16. Predictive value and utility of oral steroid testing for treatment of COPD in primary care: the COOPT study

    Directory of Open Access Journals (Sweden)

    Niels H Chavannes

    2009-11-01

    Full Text Available Niels H Chavannes1,2, Tjard RJ Schermer3, Emiel FM Wouters4, Reinier P Akkermans3, Richard PN Dekhuijzen5, Jean WM Muris2, Chris van Weel3, Onno CP van Schayck21Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands; 2Caphri Research Institute, Department of General Practice, Maastricht University, The Netherlands; 3Department of Primary and Community Care, Radboud University Nijmegen Medical Center, The Netherlands; 4Department of Pulmonary Diseases, University Hospital Maastricht, The Netherlands; 5Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center, The NetherlandsBackground: The oral prednisolone test is widely used to distinguish chronic obstructive pulmonary disease (COPD patients who might benefit from inhaled steroid treatment. Previous studies used selected patient groups that did not represent the large COPD population in primary care.Methods: The study included smokers and exsmokers with chronic bronchitis or COPD from primary care, who underwent prednisolone testing (30 mg for 14 days before randomization in a three-year follow-up randomized controlled trial (COOPT Study. Spirometry was performed before and after the test. Responders and nonresponders were classified according to international criteria. Effectiveness of inhaled fluticasone relative to placebo was compared in terms of health status (Chronic Respiratory Disease Questionnaire, exacerbations, and postbronchodilator forced expiratory volume in one second (FEV1, using repeated measurement analysis.Results: Two hundred eighty-six patients recruited from 44 primary care practices were randomized. Nine percent to 16% of the COPD population was classified as responder, depending on the international guideline criteria used. On average, responders did not reach the minimum clinically important difference in health status (0.29 points/year, P = 0.05, although a borderline significant effect of inhaled fluticasone

  17. Neuroactive steroid treatment in the model of focal cerebra ischemia in immature brain

    Czech Academy of Sciences Publication Activity Database

    Valeš, Karel; Uttl, L.; Vondráková, Kateřina; Druga, Rastislav; Kletečková, Lenka; Mikoška, M.; Syslová, K.; Kačer, P.; Stuchlík, Aleš; Vyklický ml., Ladislav; Kudová, Eva; Chodounská, Hana; Tsenov, Grygoriy

    2016-01-01

    Roč. 19, Suppl 1 (2016), s. 22-23 ISSN 1461-1457. [CINP World Congress of Neuropsychopharmacology /30./. 03.07.2016-05.07.2016, Seoul] R&D Projects: GA ČR(CZ) GBP304/12/G069; GA ČR(CZ) GA14-20613S; GA ČR(CZ) GAP303/12/1464; GA TA ČR(CZ) TE01020028 Institutional support: RVO:61388963 ; RVO:67985823 Keywords : neuroactive steroids * focal cerebral ischemia Subject RIV: CC - Organic Chemistry; FH - Neurology (FGU-C)

  18. Steroid osteopathy

    International Nuclear Information System (INIS)

    Conway, J.J.; Weiss, S.C.

    1984-01-01

    Patients receiving steroids or having disease processes which increase natural steroid production often demonstrate ''the classic x-ray changes'' of avascular necrosis of bone. Bone scintigraphy in these patients most frequently demonstrates an increased radionuclide localization. The literature suggests that the increased activity is related to healing of the avascular process. In a recent study of Legg-Calve-Perthes Disease (LCPD), 37 of the children had multiple studies and increased activity within the epiphysis during revascularization was extremely rare. Not only are the scintigraphic findings in steroid osteopathy dissimilar to that in healing LCPD, but the time interval for healing is much to short for that of a vascular necrosis and no patients demonstrated an avascular phase on bone scintigraphy. Of 15 children with renal transplants on steroid therapy, 9 demonstrated x-ray and clinical findings of osteopathy. In 8 of 9 instances, bone scintigraphy showed increased localization of radionuclide in the affected bone. Improvement or a return to normal occurred in those patients in whom steroids were discontinued. The following is a proposed mechanism for steroid osteopathy. Steroids affect the osteoblastic and osteoclastic activity of bone and weaken its internal structure. Ordinary stress produces microtrabecular fractures. Fractures characteristically stimulate reactive hyperemia and increase bone metabolism. The result is increased bone radiopharmaceutical localization. The importance of recognizing this concept is that steroid osteopathy is preventable by reducing the administered steroid dose. As opposed to avascular necrosis, bone changes are reversible

  19. Effect of oral testosterone treatment on serum concentrations of sex steroids gonadotrophins and prolactin in alcoholic cirrhotic men. Copenhagen Study Group for Liver Diseases

    DEFF Research Database (Denmark)

    Gluud, C; Bennett, Patrick; Svenstrup, Bo

    1988-01-01

    The aim of this study was to examine the serum concentrations of sex steroids and pituitary hormones in a randomly selected group of alcoholic cirrhotic men participating in a randomized, placebo-controlled study on the efficacy of oral testosterone treatment on the liver. Before treatment...

  20. Pharmacology of anabolic steroids.

    Science.gov (United States)

    Kicman, A T

    2008-06-01

    Athletes and bodybuilders have recognized for several decades that the use of anabolic steroids can promote muscle growth and strength but it is only relatively recently that these agents are being revisited for clinical purposes. Anabolic steroids are being considered for the treatment of cachexia associated with chronic disease states, and to address loss of muscle mass in the elderly, but nevertheless their efficacy still needs to be demonstrated in terms of improved physical function and quality of life. In sport, these agents are performance enhancers, this being particularly apparent in women, although there is a high risk of virilization despite the favourable myotrophic-androgenic dissociation that many xenobiotic steroids confer. Modulation of androgen receptor expression appears to be key to partial dissociation, with consideration of both intracellular steroid metabolism and the topology of the bound androgen receptor interacting with co-activators. An anticatabolic effect, by interfering with glucocorticoid receptor expression, remains an attractive hypothesis. Behavioural changes by non-genomic and genomic pathways probably help motivate training. Anabolic steroids continue to be the most common adverse finding in sport and, although apparently rare, designer steroids have been synthesized in an attempt to circumvent the dope test. Doping with anabolic steroids can result in damage to health, as recorded meticulously in the former German Democratic Republic. Even so, it is important not to exaggerate the medical risks associated with their administration for sporting or bodybuilding purposes but to emphasize to users that an attitude of personal invulnerability to their adverse effects is certainly misguided.

  1. A Prospective Study of Routine Screening of Hypothyroidism in Antenatal Patients and their Outcome with Levothyroxine Treatment

    Directory of Open Access Journals (Sweden)

    Manisha Sahu

    2017-10-01

    Full Text Available Introduction: Pregnancy with hypothyroidism is associated with significant maternal, fetal and neonatal complications. Early diagnosis and treatment can effectively reduce such complications. Aim: To find out the complications that can be prevented or reduced in severity in adequately treated hypothyroid pregnant women. Materials and Methods: Pregnant women attending obstetrics’ OPD upto 20 weeks were screened with serum Thyroid Stimulating Hormone (TSH and free Thyroxine FT4. Those having Subclinical Hypothyroidism (SCH, Overt Hypothyroidism (OH and pre pregnant women with hypothyroid were treated with levothyroxine as per consulting with endocrine unit. They were followed up till delivery and any adverse outcomes were documented such as Pregnancy Induced Hypertension (PIH, Pre Eclamptic Toxemia (PET, Abruption, Preterm Premature Rupture Of Membranes (PPROM, Low Birth Weight (LBW, oligohydramnios, Gestational Diabetes Mellitus (GDM, abortion, Intra Uterine Death (IUD, mode of delivery and Neonatal Intensive Care Unit (NICU admission were compared with similar complications documented among normal pregnant women excluding the treated hypothyroid during a period of one year study. Untreated or late trimester diagnosed hypothyroidism were excluded from study group. Results: Incidence of PIH, GDM, Oligohydramnios, PPROM, NICU admissions and caesarean section were higher among hypothyroid pregnant women though adequately treated than the control pregnant women. But incidence of LBW baby is less and no one had developed PET, Eclampsia or abruption among treated group. Comparing between SCH and OH incidence of PIH is almost equal in both while association of GDM is more in OH. A p-value for PIH, GDM, Oligohydramnios, PPROM developed in hypothyroid pregnant ladies which were calculated by Yates corrected Chi-Square and Fisher’s-exact test from open epic version 3.03a. A p-value is significant (<0.001 for PIH, GDM, PPROM and oligohydramnios but

  2. Effects of anabolic steroid treatment associated with physical training in adipose tissue of male Wistar rats

    Directory of Open Access Journals (Sweden)

    Marcela de Paiva Foletto

    2015-06-01

    Full Text Available Anabolic androgenic-steroids (AAS include a broad class of synthetic derivatives of testosterone, being nandrolone decanoate the most widely used in sports environment. The aim of this study was to evaluate the metabolic effects of nandrolone decanoate in sedentary and trained adult male rats. We established four experimental groups: sedentary control, sedentary treated, trained control and trained treated. The training had consisted of running on a treadmill for nine weeks. Treated animals received intramuscular injections of nandrolone decanoate (0.5 mg kg-1 during the last four weeks of physical training. The training time as the drug used were not sufficient to significantly reduce body weight gain, but caused a significative decrease on diameter of adipocytes and in the amount of adipose tissue stored, as well as decreased the plasma levels of glucose and total cholesterol.

  3. Myocardial fibrosis burden predicts left ventricular ejection fraction and is associated with age and steroid treatment duration in duchenne muscular dystrophy.

    Science.gov (United States)

    Tandon, Animesh; Villa, Chet R; Hor, Kan N; Jefferies, John L; Gao, Zhiqian; Towbin, Jeffrey A; Wong, Brenda L; Mazur, Wojciech; Fleck, Robert J; Sticka, Joshua J; Benson, D Woodrow; Taylor, Michael D

    2015-03-26

    Patients with Duchenne muscular dystrophy exhibit progressive cardiac and skeletal muscle dysfunction. Based on prior data, cardiac dysfunction in Duchenne muscular dystrophy patients may be influenced by myocardial fibrosis and steroid therapy. We examined the longitudinal relationship of myocardial fibrosis and ventricular dysfunction using cardiac magnetic resonance in a large Duchenne muscular dystrophy cohort. We reviewed 465 serial cardiac magnetic resonance studies (98 Duchenne muscular dystrophy patients with ≥4 cardiac magnetic resonance studies) for left ventricular ejection fraction (LVEF) and presence of late gadolinium enhancement (LGE), a marker for myocardial fibrosis. LVEF was modeled by examining LGE status, myocardial fibrosis burden (as assessed by the number of LGE-positive left ventricular segments), patient age, and steroid treatment duration. An age-only model demonstrated that LVEF declined 0.58 ± 0.10% per year. In patients with both LGE-negative and LGE-positive studies (n=51), LVEF did not decline significantly over time if LGE was absent but declined 2.2 ± 0.31% per year when LGE was present. Univariate modeling showed significant associations between LVEF and steroid treatment duration, presence of LGE, and number of LGE-positive left ventricular segments; multivariate modeling showed that LVEF declined by 0.93 ± 0.09% for each LGE-positive left ventricular segment, whereas age and steroid treatment duration were not significant. The number of LGE-positive left ventricular segments increased with age, and longer steroid treatment duration was associated with lower age-related increases. Progressive myocardial fibrosis, as detected by LGE, was strongly correlated with the LVEF decline in Duchenne muscular dystrophy patients. Longer steroid treatment duration was associated with a lower age-related increase in myocardial fibrosis burden. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley

  4. DEVELOPMENT OF AZATHIOPRINE-BASED TREATMENT REGIMEN FOR PATIENTS WITH STEROID RESISTANT PEMPHIGUS BASED ON ASSESSMENT OF MOLECULAR MECHANISMS AT THE POST-RECEPTOR LEVEL

    Directory of Open Access Journals (Sweden)

    O. Yu. Olisova

    2016-01-01

    Full Text Available Background: Autoimmune pemphigus is the most severe skin and mucous membranes disorders with production of IgG autoantibodies to desmogleins 1 and 3. Administration of systemic corticosteroids may help to abrogate active signs of pemphigus. However, some patients do not give an adequate response to systemic glucocorticosteroid monotherapy, as well as to their combination with immune suppressants and cytostatic agents. Aim: To develop an azathioprine-based treatment regimen for patients with autoimmune pemphigus resistant to steroids. Materials and methods: At the first step of development of a treatment regimen for patients with steroid-resistant pemphigus we analyzed retrospectively a clinical database on 23 patients who had been treated from 2000 to 2014 and whose treatment regimen included azathioprine, in addition to systemic glucocorticosteroids. At the second step, from 2013 to 2015, we assessed and treated with the azathioprine-based regimen 24 patients with autoimmune pemphigus, 14  of them being steroid resistant and 10, steroid sensitive (control group. To assess molecular mechanisms of steroid resistance at the post-receptor level (effect of prednisolone on incorporation of ³Н-uridine into lymphocyte mRNA, changes of intracellular levels of nuclear transcription factor NF-κB we used a  real-time polymerase chain reaction, radioisotope method and liquid scintillation radiometry. Results: At the first step, we developed an azathioprine-based treatment regimen for patients with steroid resistant autoimmune pemphigus. Initial dose of azathioprine was 150 mg daily. After achievement of response, the dose was decreased to 100 mg daily. When the dose of systemic glucocorticosteroids was decreased to 20  mg daily, the dose of azathioprine was decreased to 50 mg daily, thereafter steroid resistant patients were taking azathioprine at a dose of 50 mg daily from 3  months to 2.5  years. Investigation of molecular mechanisms

  5. Nifedipine versus atosiban in the treatment of threatened preterm labour (Assessment of Perinatal Outcome after Specific Tocolysis in Early Labour : APOSTEL III-Trial)

    NARCIS (Netherlands)

    van Vliet, Elvira O. G.; Schuit, Ewoud; Heida, Karst Y.; Opmeer, Brent C.; Kok, Marjolein; Gyselaers, Wilfried; Porath, Martina M.; Woiski, Mallory; Bax, Caroline J.; Bloemenkamp, Kitty W. M.; Scheepers, Hubertina C. J.; Jaquemyn, Yves; van Beek, Erik; Duvekot, Hans J. J.; Franssen, Maureen T. M.; Bijvank, Bas N.; Kok, Joke H.; Franx, Arie; Mol, Ben Willem J.; Oudijk, Martijn A.

    2014-01-01

    Background: Preterm birth is the most common cause of neonatal morbidity and mortality. Postponing delivery for 48 hours with tocolytics to allow for maternal steroid administration and antenatal transportation to a centre with neonatal intensive care unit facilities is the standard treatment for

  6. Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study.

    Science.gov (United States)

    Gharibo, Christopher G; Varlotta, Gerald P; Rhame, Ellen E; Liu, En-Chia James; Bendo, John A; Perloff, Michael D

    2011-01-01

    There is uncertainty in the literature over the relative effectiveness of lumbar epidural interlaminar (IL) steroid injection versus transforaminal (TF) steroid injection for lumbar radiculopathy. Most studies to date have been retrospective, or technically focused. To complete a randomized, blinded, prospective outcome study of the short-term benefit for IL versus TF epidural steroids for the treatment of subacute lumbar radicular pain. Prospective, randomized, blinded, subacute efficacy trial. Tertiary care pain management center, major metropolitan city, United States. After institutional review board approval, 42 age-matched patients with similar lower back pain and unilateral radicular symptoms were enrolled and randomized in a patient and evaluating physician blinded trial to IL or TF epidural steroids from 2007 through 2009. Prior to intervention and 10-16 days after injection, each participant was evaluated by questionnaire and physical exam by an independent physician. All injections were performed by the same physician. Thirty-eight participants completed the study, 18 in the IL group and 20 in the TF group. Four participants required a repeat injection, and 2 participants crossed over to the alternative injection type (IL to TF). Overall, physical exam, diagnostic testing, disability, activity, depression measures, and opioid pill use were similar between the 2 groups, both pre-injection baseline and post-injection improvement. In primary outcomes, the post-injection follow-up Numeric Rating Scale (NRS) was more greatly reduced in the TF group. The NRS decreased from 7.0 ± 1.9 to 3.9 ± 3.1 (mean values +/- standard deviation) in the IL group and 6.4 ± 2.1 to 1.7 ± 1.4 in the TF group. The Oswestry Disability Index was reduced from 37.5 ± 12.6 to 19.0 ± 16.7 in the IL group and 38.3 ± 6.4 to 21.6 ± 16.8 in the TF group. In secondary outcomes, the depression scale was reduced from 4.39 ± 3.22 to 2.28 ± 3.20 in the IL group and 4.10 ± 1.94 to 1

  7. Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study.

    Science.gov (United States)

    Fournier, Jean-Pascal; Sommet, Agnès; Bourrel, Robert; Oustric, Stéphane; Pathak, Atul; Lapeyre-Mestre, Maryse; Montastruc, Jean-Louis

    2012-11-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) are known to antagonize the effects of antihypertensive drugs, and these associations can lead to an increase in arterial blood pressure. However, the impact of NSAIDs on hypertension treatment management in large-scale populations remains poorly evaluated. We examined whether the introduction of NSAID into the treatment regimen would induce an intensification of hypertension treatment (defined as the introduction of a new antihypertensive drug). We conducted a cohort study involving 5,710 hypertensive subjects included in the French health insurance system database who had been treated and stabilized with their antihypertensive therapy and not exposed to any NSAID between 1 April 2005 and 1 April 2006. The maximum follow-up duration was 4 years. Adjusted hazard ratios (HR) for hypertension treatment intensification were 1.34 [95 % confidence interval (CI) 1.05-1.71] for NSAIDs in general, 1.79 (95 % CI 1.15-2.78) for diclofenac and 2.02 (95 % CI:1.09-3.77) for piroxicam. There were significant interactions between NSAIDs and angiotensin converting enzyme inhibitors (ACEIs; HR 4.09, 95 % CI 2.02-8.27) or angiotensin receptor blockers (ARBs; HR 3.62, 95 % CI 1.80-7.31), but not with other antihypertensive drugs. Exposure to NSAIDs leads to an intensification of hypertension treatment, especially in patients treated with ACEIs or ARBs. Renin-angiotensin system blockers should be avoided whenever NSAIDs are prescribed.

  8. Selection of non-steroidal anti-inflammatory drug and treatment regimen for sulfur mustard-induced cutaneous lesions.

    Science.gov (United States)

    Plahovinsak, Jennifer L; Buccellato, Matthew A; Reid, Frances M; Graham, John S

    2016-09-01

    The inflammatory process plays an important role in sulfur mustard (HD) injury and HD pathogenesis, suggesting that anti-inflammatory treatments applied as soon as possible following HD injury may reduce tissue damage and accelerate healing. This study used the HD dermal weanling swine model to investigate the efficacy of two non-steroidal anti-inflammatory drugs, capsaicin and diclofenac, when applied in combination with the steroid, clobetasol. The therapeutic regimen was also investigated with respect to initiation of treatment post-exposure, frequency and duration. Yorkshire-cross pigs were randomly assigned to experimental groups, corresponding to all combinations of treatment (capsaicin with clobetasol or diclofenac with clobetasol), onset time (1, 2 or 4 h post-exposure), treatment duration (1, 3 or 5 days) and frequency of applications (2, 3 or 4 per day). For each animal, two sites on the ventral abdomen were exposed to 400 μL of neat HD for 8 min to achieve superficial dermal (SD) lesions and two sites were exposed to 400 μL neat HD for 30 min to achieve deep dermal (DD) lesions. Each treatment regimen was tested against a SD and a DD injury. Untreated SD and DD lesion sites served as within-animal controls. Assessments, up to one week post-challenge, included digital photographs, clinical assessments (lesion size measurements and modified Draize scoring), transepidermal water loss (TEWL), reflectance colorimetry and histopathologic evaluations that included an estimate for depth of injury and wound healing parameters. Diclofenac plus clobetasol treatment resulted in significant reductions in lesion contracture and modified Draize scores, increased barrier function (decreased TEWL), and increased healing as determined by histopathology for both SD and DD injury when compared with untreated sites and sites treated with capsaicin plus clobetasol. An increased duration of treatment from 1 to 5 days was most commonly associated with decreased

  9. [Caudal epidural steroid injection in the treatment of chronic discogenic low back pain. Comparative, prospective and randomized study].

    Science.gov (United States)

    Cervera-Irimia, J; Tomé-Bermejo, F

    2013-01-01

    There is no consensus on the treatment of chronic low back pain of disc origin in the medical literature. The few prospective, randomized, controlled studies evaluating the effectiveness of caudal epidural steroid injections (CESI) have obtained contradictory results. The aim of this study is to evaluate the efficacy of CEI in reducing pain and improving the associated disability. This is a prospective, randomized, case-control study of a group of 46 patients with chronic low back disc pain. Patients were randomly allocated into 2 groups to either receive fluoroscopy guided CESI (CESI-group), or oral non-steroidal anti-inflammatory drugs (NSAID-group). All patients were clinically evaluated at 4, 12, and 24 weeks, and according to the indications of the Spanish Society for Study of Diseases of the Spine (GEER). Lumbar pain, measured by the visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ), did not improve significantly during follow-up in any of the two study groups (P>.05). Younger patients, women, patients with shorter duration of symptoms, low physical job demand, without leg pain, and sport-active, included in CESI-group showed a trend towards better results, but none reached statistical significance (P>.05). The present study has not demonstrated the superiority of CESI over NSAIDs in treating chronic low back pain of disc origin. While CESI could show some improvement in patients with degenerative lumbar disc disease, we consider it should be used with caution, informing patients about realistic expectations on the success of treatment. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  10. Effectiveness of antenatal clinics to deliver intermittent preventive treatment and insecticide treated nets for the control of malaria in pregnancy in Mali: a household survey.

    Directory of Open Access Journals (Sweden)

    Jenny Hill

    Full Text Available BACKGROUND: WHO recommends intermittent-preventive-treatment (IPTp with sulphadoxine-pyrimethamine (SP and insecticide-treated-nets (ITNs to prevent malaria in pregnancy in sub-Saharan Africa, however uptake remains unacceptably low. We evaluated the effectiveness of antenatal clinics (ANC to deliver two doses of IPTp and ITNs to pregnant women in Segou district, Mali. METHODS: We used household data to assess the systems effectiveness of ANC to deliver IPTp and ITNs to pregnant women and used logistic regression to identify predictors of ANC attendance, receipt of IPTp and ITN use during pregnancy, and the impact on community effectiveness. RESULTS: Of 81% of recently pregnant women who made at least one ANC visit, 59% of these attended during the eligible gestational age for IPTp. Of these, 82% reported receiving one dose of SP and 91% attended ANC again, of whom 66% received a second dose, resulting in a cumulative effectiveness for 2-dose IPTp of 29%, most of whom used an ITN (90%. Cumulative effectiveness of 2-dose SP by directly observed therapy (DOT was very low (6%. ITN use was 92%, and ANC was the main source (81%. Reported and ANC-card data showed some doses of SP are given to women in their first trimester. Women were less likely to receive two doses by DOT if they were married (OR 0.10; CI 0.03, 0.40, or lived <5 km from the health facility (OR 0.34; CI 0.14, 0.83. A high household person-LLIN ratio predicted low ITN use in pregnant women (OR 0.16; CI 0.04, 0.55. CONCLUSION: Our findings suggest poor adherence by health workers to provision of IPTp by eligible gestational age and DOT, contributing to low effectiveness of this strategy in this setting. ITN delivery and use among women was substantially higher. Efforts to improve health worker adherence to IPTp guidelines are needed to improve service delivery of IPTp.

  11. Treatment of vitiligo vulgaris with the combination therapy of topical steroid and vitamin D3 compound

    Directory of Open Access Journals (Sweden)

    Yoko Konishi

    2012-06-01

    Full Text Available We reported here two cases of vitiligo vulgaris successfully treated with the combination therapy of topical steroid and vitamin D3 compound and currently maintained by vitamin D3 analog without any adverse effects: skin atrophy, striae or telangiectasia on the exposed areas. The best-known mechanism of topical vitamin D3 analog is the enhancement of keratinocytes differentiation and anti-proliferative effects. Vitamin D3 analog is also reported to suppress T-cell mediated immunity, T-cell skin recruitment, and skin infiltration via down-regulating cutaneous lymphocyte antigen expression. Furthermore, vitamin D3 compounds are known to influence melanocyte maturation and differentiation and also to up-regulate melanogenesis. Autoreactive lymphocytes against melanocytes are one of the causes. Topical vitamin D3 analog may control vitiligo itself, however stronger immunosuppressive effects of topical corticosteroid may contribute to rapid re-pigmentation suppressing auto-reactive lymphocytes. The topical combination therapy is a simple, effective and safe option for vitiligo vulgaris in sun-exposed areas.

  12. Reduced glucose tolerance and insulin resistance induced by steroid treatment, relative physical inactivity, and high-calorie diet impairs the incretin effect in healthy subjects

    DEFF Research Database (Denmark)

    Hansen, K B; Vilsbøll, T; Bagger, J I

    2010-01-01

    The loss of incretin effect in patients with type 2 diabetes mellitus may be secondary to impaired glucose homeostasis. We investigated whether reduced glucose tolerance and insulin resistance induced by steroid treatment, relative physical inactivity, and high-calorie diet in healthy young males...

  13. The Potential of Mesenchymal Stromal Cells as Treatment for Severe Steroid-Refractory Acute Graft-Versus-Host Disease: A Critical Review of the Literature

    NARCIS (Netherlands)

    Munneke, J. Marius; Spruit, Melchior J. A.; Cornelissen, Anne S.; van Hoeven, Vera; Voermans, Carlijn; Hazenberg, Mette D.

    2016-01-01

    Acute graft-versus-host disease (GvHD) is a major complication after allogeneic hematopoietic stem cell transplantation which causes high morbidity and mortality among patients who do not respond to steroid treatment. Mesenchymal stromal cells (MSCs) have immune modulatory abilities and earned their

  14. Angina Bullosa Hemorrhagica with a Possible Relation to Dental Treatment, Diabetes Mellitus, Steroid Inhaler and Local Trauma: Report of 3 Cases

    Directory of Open Access Journals (Sweden)

    S M Ravi Prakash

    2010-01-01

    Full Text Available Angina bullosa hemorrhagica is a rare condition characterized by one or more blood filled blisters or bullae predominantly in the soft palate region caused either by local mucosal trauma, dental treatment, underlying systemic conditions or use of steroid inhalers. We report three cases of angina bullosa hemorrhagica with different etiological factors.

  15. Role of sphingosine 1-phosphate receptor expression in eosinophils of patients with allergic rhinitis, and effect of topical nasal steroid treatment on this receptor expression.

    LENUS (Irish Health Repository)

    Mackle, T

    2008-12-01

    Recent research has indicated that sphingosine 1-phosphate plays a role in allergy. This study examined the effect of allergen challenge on the expression of sphingosine 1-phosphate receptors on the eosinophils of allergic rhinitis patients, and the effect of steroid treatment on this expression.

  16. Quantitative Assessment of the T2 Relaxation Time of the Gluteus Muscles in Children with Duchenne Muscular Dystrophy: a Comparative Study Before and After Steroid Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hee Kyung; Laor, Tal; Wong, Brenda [Cincinnati Children' s Hospital Medical Center, Cincinnati (United States); Horn, Paul S. [University of Cincinnati, Cincinnati (United States)

    2010-06-15

    To determine the feasibility of using T2 mapping as a quantitative method to longitudinally follow the disease activity in children with Duchenne muscular dystrophy (DMD) who are treated with steroids. Eleven boys with DMD (age range: 5-14 years) underwent evaluation with the clinical functional score (CFS), and conventional pelvic MRI and T2 mapping before and during steroid therapy. The gluteus muscle inflammation and fatty infiltration were evaluated on conventional MRI. The histograms and mean T2 relaxation times were obtained from the T2 maps. The CFS, the conventional MRI findings and the T2 values were compared before and during steroid therapy. None of the patients showed interval change of their CFSs. On conventional MRI, none of the images showed muscle inflammation. During steroid treatment, two boys showed increased fatty infiltration on conventional MRI, and both had an increase of the mean T2 relaxation time (p < 0.05). The remaining nine boys had no increase in fatty infiltration. Of these, three showed an increased mean T2 relaxation time (p < 0.05), two showed no change and four showed a decreased mean T2 relaxation time (p < 0.05). T2 mapping is a feasible technique to evaluate the longitudinal muscle changes in those children who receive steroid therapy for DMD. The differences of the mean T2 relaxation time may reflect alterations in disease activity, and even when the conventional MRI and CFS remain stable.

  17. Quantitative Assessment of the T2 Relaxation Time of the Gluteus Muscles in Children with Duchenne Muscular Dystrophy: a Comparative Study Before and After Steroid Treatment

    International Nuclear Information System (INIS)

    Kim, Hee Kyung; Laor, Tal; Wong, Brenda; Horn, Paul S.

    2010-01-01

    To determine the feasibility of using T2 mapping as a quantitative method to longitudinally follow the disease activity in children with Duchenne muscular dystrophy (DMD) who are treated with steroids. Eleven boys with DMD (age range: 5-14 years) underwent evaluation with the clinical functional score (CFS), and conventional pelvic MRI and T2 mapping before and during steroid therapy. The gluteus muscle inflammation and fatty infiltration were evaluated on conventional MRI. The histograms and mean T2 relaxation times were obtained from the T2 maps. The CFS, the conventional MRI findings and the T2 values were compared before and during steroid therapy. None of the patients showed interval change of their CFSs. On conventional MRI, none of the images showed muscle inflammation. During steroid treatment, two boys showed increased fatty infiltration on conventional MRI, and both had an increase of the mean T2 relaxation time (p < 0.05). The remaining nine boys had no increase in fatty infiltration. Of these, three showed an increased mean T2 relaxation time (p < 0.05), two showed no change and four showed a decreased mean T2 relaxation time (p < 0.05). T2 mapping is a feasible technique to evaluate the longitudinal muscle changes in those children who receive steroid therapy for DMD. The differences of the mean T2 relaxation time may reflect alterations in disease activity, and even when the conventional MRI and CFS remain stable

  18. Risk factors for antenatal depression, postnatal depression and parenting stress

    OpenAIRE

    Leigh, Bronwyn; Milgrom, Jeannette

    2008-01-01

    Abstract Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite...

  19. The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment.

    Science.gov (United States)

    Taskaynatan, Mehmet Ali; Tezel, Kutay; Yavuz, Ferdi; Tan, Arif Kenan

    2015-01-01

    The aim of this retrospective study was to investigate the therapeutic effect of transforaminal epidural steroid injection in patients with chronic low back pain and radicular leg pain due to lumbar disc herniation. This study included 80 patients (32 female and 48 male; mean age: 45.8 years [range: 25-65 years]) that received fluoroscopically guided transforaminal epidural steroid injections for chronic radicular low back pain due to lumbar disc herniation. All of the patients had diagnostic MRI findings and did not respond to conservative treatment. All injections were performed by the same physician at the interventional pain unit of a tertiary hospital. The effectiveness of transforaminal epidural steroid injections was assessed via a standardized telephone questionnaire administered 2 years after the first injection. Mean duration of radicular low back pain was 24.50 ± 18.25 months. Most of the epidural injections were administered at the L5 and S1 levels. The most effective post-injection period was the first 5.11 ± 3.07 months. Mean duration of injection effect was 12.46 ± 7.24 months. The response rate to the epidural steroid injections was 72%. There was negative correlation between the duration of treatment effect and the duration of pre-treatment symptoms. Additionally, clinical improvement of radicular low back pain increased significantly as the duration of pre-treatment symptoms decreased. Based on the present findings, we think that transforaminal epidural steroid injections can be used as an alternative treatment for managing chronic radicular low back pain.

  20. Is there a difference in treatment outcomes between epidural injections with particulate versus non-particulate steroids?

    Energy Technology Data Exchange (ETDEWEB)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2017-04-15

    To compare the outcomes of patients after interlaminar computed tomography (CT)-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids. 531 consecutive patients were treated with CT-guided lumbar interlaminar epidural injections with steroids and local anaesthetics. 411 patients received a particulate steroid and 120 patients received a non-particulate steroid. Pain levels were assessed using the 11-point numerical rating scale (NRS) and overall reported 'improvement' was assessed using the Patients Global Impression of Change (PGIC) at 1 day, 1 week and 1 month post-injection. Descriptive and inferential statistics were applied. Patients receiving particulate steroids had statistically significantly higher NRS change scores (p = 0.0001 at 1 week; p = 0.0001 at 1 month). A significantly higher proportion of patients receiving particulate steroids reported relevant improvement (PGIC) at both 1 week and 1 month post injection (p = 0.0001) and they were significantly less likely to report worsening at 1 week (p = 0.0001) and 1 month (p = 0.017). Patients treated with particulate steroids had significantly greater pain relief and were much more likely to report clinically relevant overall 'improvement' at 1 week and 1 month compared to the patients treated with non-particulate steroids. (orig.)

  1. Is there a difference in treatment outcomes between epidural injections with particulate versus non-particulate steroids?

    International Nuclear Information System (INIS)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K.

    2017-01-01

    To compare the outcomes of patients after interlaminar computed tomography (CT)-guided epidural injections of the lumbar spine with particulate vs. non-particulate steroids. 531 consecutive patients were treated with CT-guided lumbar interlaminar epidural injections with steroids and local anaesthetics. 411 patients received a particulate steroid and 120 patients received a non-particulate steroid. Pain levels were assessed using the 11-point numerical rating scale (NRS) and overall reported 'improvement' was assessed using the Patients Global Impression of Change (PGIC) at 1 day, 1 week and 1 month post-injection. Descriptive and inferential statistics were applied. Patients receiving particulate steroids had statistically significantly higher NRS change scores (p = 0.0001 at 1 week; p = 0.0001 at 1 month). A significantly higher proportion of patients receiving particulate steroids reported relevant improvement (PGIC) at both 1 week and 1 month post injection (p = 0.0001) and they were significantly less likely to report worsening at 1 week (p = 0.0001) and 1 month (p = 0.017). Patients treated with particulate steroids had significantly greater pain relief and were much more likely to report clinically relevant overall 'improvement' at 1 week and 1 month compared to the patients treated with non-particulate steroids. (orig.)

  2. Antenatal glucocorticoids and neonatal inflammation-associated proteins.

    Science.gov (United States)

    Faden, Maheer; Holm, Mari; Allred, Elizabeth; Fichorova, Raina; Dammann, Olaf; Leviton, Alan

    2016-12-01

    To date, studies of the relationship between antenatal glucocorticoids (AGC) and neonatal inflammation in preterm newborns have been largely limited to umbilical cord blood specimens. To explore the association between exposure to antenatal glucocorticoids and concentrations of inflammation-related proteins in whole blood collected from very preterm newborns at multiple times during the first postnatal month. We measured the protein concentrations on postnatal day 1 (N=1118), day 7 (N=1138), day 14 (N=1030), day 21 (N=936) and day 28 (N=877) from infants born before the 28th week of gestation and explored the relationship between antenatal steroid receipt and protein concentrations in the highest and lowest quartiles. The creation of multinomial logistic regression models (adjusted for potential confounders) allowed us calculate odds ratios and 95% confidence intervals. Twenty of 420 assessments [21 (proteins)×2 (exposure levels: partial and full)×2 (quartile levels: top and bottom)×5 (days)] were statistically significant without any cohesive pattern. Among infants born before 28 weeks of gestational age, neither full, nor partial courses of antenatal glucocorticoids have a sustained anti-inflammatory effect. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Adrenal steroid hormone concentrations in dogs with hair cycle arrest (Alopecia X) before and during treatment with melatonin and mitotane.

    Science.gov (United States)

    Frank, Linda A; Hnilica, Keith A; Oliver, Jack W

    2004-10-01

    The purpose of the study was to evaluate intermediate adrenal steroid hormones (ISH) in neutered dogs with hair cycle arrest (Alopecia X) during treatment with melatonin, and to see if hair re-growth is associated with sex hormone concentrations within the normal ranges. Twenty-nine neutered, euthyroid, and normo-cortisolemic dogs were enrolled in the study (23 Pomeranians, three keeshonds, two miniature poodles, and one Siberian husky). Coat assessment and an ACTH stimulation test were performed pre-treatment and approximately every 4 months for a year post treatment. Melatonin was administered initially at 3-6 mg, every 12 h. Based on clinical progression, each dog was continued on the current dose of melatonin, given an increased dose of melatonin or changed to mitotane. Partial to complete hair re-growth occurred in 14/23 Pomeranians, and partial re-growth in 3/3 keeshond and 1/2 poodle dogs. A Siberian husky dog failed to re-grow hair. Fifteen dogs had partial hair re-growth at the first re-evaluation. Melatonin dosage was increased in eight dogs but only one had improved hair re-growth. On mitotane treatment, partial to complete hair re-growth was seen in 4/6 dogs and no re-growth in 2/6 dogs. No significant decrease in sex hormone concentrations were seen during melatonin or mitotane treatment. Concentrations of ISH in dogs with hair re-growth did not differ significantly from pre-treatment values. At the completion of the study, androstenedione, progesterone and 17-hydroxyprogesterone were still above reference ranges in 21, 64 and 36%, respectively, of dogs with partial to complete hair re-growth. In conclusion, 62% of dogs had partial to complete hair re-growth. However, not all dogs with hair re-growth had concentrations of ISH within the normal range.

  4. Low-dose maintenance steroid treatment could reduce the relapse rate in patients with type 1 autoimmune pancreatitis: a long-term Japanese multicenter analysis of 510 patients.

    Science.gov (United States)

    Kubota, Kensuke; Kamisawa, Terumi; Okazaki, Kazuichi; Kawa, Shigeyuki; Hirano, Kenji; Hirooka, Yoshiki; Uchida, Kazushige; Shiomi, Hideyuki; Ohara, Hirotaka; Shimizu, Kyoko; Arakura, Norikazu; Kanno, Atsushi; Sakagami, Junichi; Itoi, Takao; Ito, Tetsuhide; Ueki, Toshiharu; Nishino, Takayoshi; Inui, Kazuo; Mizuno, Nobumasa; Yoshida, Hitoshi; Sugiyama, Masanori; Iwasaki, Eisuke; Irisawa, Atshishi; Shimosegawa, Toru; Takeyama, Yoshifumi; Chiba, Tsutomu

    2017-08-01

    The effect of maintenance steroid treatment (MST) in reducing the risk of relapse in patients with autoimmune pancreatitis (AIP) remains under debate. The aim of this study was to validate the effect of MST on AIP administered in accordance with the 2010 Japanese consensus guidelines. The clinical data of patients with (n = 510) from 22 high-volume centers in Japan were studied. The primary endpoints were the relapse rates (RRs) in patients administered MST versus those not administered MST. The secondary endpoints were the optimal dose and duration of MST in terms of steroid toxicity and the predictors of relapse. The RRs were 10.0% within 1 year, 25.8% within 3 years and 35.1% within 5 years. The RR in the steroid therapy group reached a plateau at 42.7% at 7 years. In terms of the optimal dosage, the overall RR in the MST 5 mg/day group was 26.1%, which was significantly lower than that in the group which had discontinued steroid therapy (45.2%; p = 0.023) or was receiving MST at 2.5 mg/day (43.4%, p = 0.001). The RRs in the group receiving MST at ≥5 mg/day versus the patient group receiving MST at 5 mg/day were identified as predictors of relapse (OR 0.483; p = 0.001). The RR could continue to increase for 7 years even under MST. Based on our analysis of the side effects of steroid therapy, MST at 5 mg/day for 2 (total 4625 mg) to 3 (total 6425 mg) years might be a rational and safe therapeutic strategy in terms of keeping the RR to <30% while avoiding potential steroid toxicity.

  5. Moderate alcohol consumption in chronic form enhances the synthesis of cholesterol and C-21 steroid hormones, while treatment with Tinospora cordifolia modulate these events in men.

    Science.gov (United States)

    Kumari, Suman; Mittal, Ashwani; Dabur, Rajesh

    2016-10-01

    Chronic and heavy alcohol consumption disrupts lipid metabolism and hormonal balance including testosterone levels. However, studies doubt the relationship between moderate alcohol intake and sex hormone levels. Therefore, the aim of the present investigation was to establish the direct impact of chronic and moderate alcohol intake on cholesterol homeostasis and steroid hormone synthesis. Asymptomatic chronic and moderate alcoholics (n=12) without chronic liver disease and healthy volunteers (n=14) were selected for the study. Furthermore, effects of standardized water extract of Tinospora cordifolia (Willd) Mier. (Menispermaceae) (TCJ), a well reported anti-alcoholic herbal drug, on urinary steroids was studied. This study included four groups, i.e. a) healthy; b) healthy+TCJ; c) alcoholic; d) alcoholic+TCJ. The blood and urine samples from each group were collected on day 0 and 14 of the post-treatment with TCJ and analyzed. Alcoholic blood samples showed the significantly higher values of traditional biomarkers γ-GT and MCV along with cholesterol, LDL, TGL and urinary methylglucuronide compared to healthy. Qualitative analysis of steroids showed that moderate alcohol intake in a chronic manner increased the cholesterol synthesis and directed its flow toward C-21 steroids; shown by increased levels of corticosterone (2.456 fold) and cortisol (3.7 fold). Moreover, alcohol intake also increased the synthesis of estradiol and clearance rate of other steroids through the formation of glucuronides. Therefore, it decreased the synthesis and increased the clearance rate of testosterone (T) and androstenedione (A). Quantitative analysis confirmed decreased T/A ratio from 2.31 to 1.59 in plasma and 2.47 to 1.51 in urine samples of alcoholics. TCJ intervention normalized the levels of steroids and significantly improved the T:A ratio to 2.0 and 2.12 in plasma and urine. The study revealed that TCJ modulated lipid metabolism by inhibiting cholesterol and glucuronides

  6. Treatment of pruritus in mild-to-moderate atopic dermatitis with a topical non-steroidal agent.

    Science.gov (United States)

    Veraldi, Stefano; De Micheli, Paolo; Schianchi, Rossana; Lunardon, Luisa

    2009-06-01

    Atopiclair (Zarzenda) is a topical non-steroidal anti-inflammatory agent for the treatment of allergic diseases of the skin. Three main ingredients are contained in this product: glycyrrhetinic acid, telmesteine and Vitis vinifera extracts. Other ingredients include: allantoin, alpha-bisabolol, capryloyl glycine, hyaluronic acid, shea butter and tocopheryl acetate. Two previous randomized, double-blind, vehicle-controlled clinical studies provided evidence that Atopiclair is effective in the treatment of atopic dermatitis. This article presents an open, multicenter, sponsor-free, study on the anti-pruritic activity of this product in adult patients with mild-to-moderate atopic dermatitis. The Median Visual Analogue Scale (VAS) values were: at the start of the study (TO), median VAS was 48.5 mm; three weeks later (T1), median VAS was 34.1 mm (-14.4 mm from baseline); six weeks later (T2), median VAS was 24.6 mm (-23.9 mm from baseline). Statistical analysis revealed that differences between TO versus T1, TO versus T2 and T1 versus T2 were highly significant (p<0.001). Side effects (local burning) were relatively common, although mild in severity. On the basis of the results of this study, Atopiclair showed efficacy in relief of pruritus in adult patients with mild-to-moderate atopic dermatitis.

  7. Risk factors for antenatal depression, postnatal depression and parenting stress

    Directory of Open Access Journals (Sweden)

    Milgrom Jeannette

    2008-04-01

    Full Text Available Abstract Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them. Methods Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program 1. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26–32 weeks gestation. A subsample of these women (N = 161 also completed questionnaires at 10–12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI. Results Regression analyses identified significant risk factors for the three outcome measures. (1. Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2. Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3. Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator

  8. Risk factors for antenatal depression, postnatal depression and parenting stress.

    Science.gov (United States)

    Leigh, Bronwyn; Milgrom, Jeannette

    2008-04-16

    Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them. Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program 1. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26-32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10-12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI). Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors. Risk factor profiles for

  9. Pharmacology of anabolic steroids

    Science.gov (United States)

    Kicman, A T

    2008-01-01

    Athletes and bodybuilders have recognized for several decades that the use of anabolic steroids can promote muscle growth and strength but it is only relatively recently that these agents are being revisited for clinical purposes. Anabolic steroids are being considered for the treatment of cachexia associated with chronic disease states, and to address loss of muscle mass in the elderly, but nevertheless their efficacy still needs to be demonstrated in terms of improved physical function and quality of life. In sport, these agents are performance enhancers, this being particularly apparent in women, although there is a high risk of virilization despite the favourable myotrophic–androgenic dissociation that many xenobiotic steroids confer. Modulation of androgen receptor expression appears to be key to partial dissociation, with consideration of both intracellular steroid metabolism and the topology of the bound androgen receptor interacting with co-activators. An anticatabolic effect, by interfering with glucocorticoid receptor expression, remains an attractive hypothesis. Behavioural changes by non-genomic and genomic pathways probably help motivate training. Anabolic steroids continue to be the most common adverse finding in sport and, although apparently rare, designer steroids have been synthesized in an attempt to circumvent the dope test. Doping with anabolic steroids can result in damage to health, as recorded meticulously in the former German Democratic Republic. Even so, it is important not to exaggerate the medical risks associated with their administration for sporting or bodybuilding purposes but to emphasize to users that an attitude of personal invulnerability to their adverse effects is certainly misguided. PMID:18500378

  10. [Profile of prescription and adequacy of treatment with non-steroidal anti-inflammatory drugs in diabetic patients].

    Science.gov (United States)

    Navarro-Martínez, A; Vidal-Martínez, M; García-Rosa, I; Lázaro-Gómez, M J; Brotons-Román, J

    2015-01-01

    The aim of this study was to quantify and describe the prescription profile, as well as to assess the adequacy of treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in the diabetic population of a health district. This is a descriptive, cross-sectional study aimed at a target population of 2,795 diabetic patients. Data were collected from the computerised clinical records of a sample of 380 individuals. The adequacy of treatment was assessed using the recommendations proposed by the Spanish societies of Rheumatology, Cardiology and Gastroenterology. More than one-quarter (28%) of the diabetic patients received treatment with NSAIDs. The most commonly used ones were ibuprofen, naproxen, and dexketoprofen, with a defined daily dose per 1,000 inhabitants per day of 35.3, 17.2, and 13.2, respectively. In patients with a history of chronic kidney disease and cardiovascular high risk, fewer NSAIDs were prescribed, while they were used most frequently in patients with a risk for gastrointestinal adverse events. The prescription was considered adequate in 46.5% of diabetic patients. The main causes of inappropriate use were the inadequate prescription of NSAIDs (25.2%), and the use of any NSAID other than naproxen (20.6%). The most prescribed NSAIDs were those showing a low cardiovascular risk profile. Treatment with NSAIDs was inadequate in more than half of the patients. Risk factors for cardiovascular, and especially gastrointestinal, events must be considered in order to avoid its use when not indicated, as well as the use of any NSAIDs other than naproxen. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  11. Evolving strategy in treatment of infantile hemangiomas: from steroids to propranolol

    Directory of Open Access Journals (Sweden)

    Serhan Kupeli

    2016-06-01

    Full Text Available Infantile hemangiomas are the most common vascular tumors of the early childhood. Increased incidence of infantile hemangiomas can be attributed to widespread use of assisted reproductive technologies. Majority of hemangiomas in infantile age group resolve spontaneously and only a small proportion of the cases with infantile hemangiomas requires treatment. GLUT-ONE acronym (Giant infantile hemangiomas, Liver and/or other visceral organ involvement, Ulcerated or bleeding infantile hemangiomas, Threatening of life, Organ dysfunctioning infantile hemangiomas, Non-localized infantile hemangiomas, Esthetic/cosmetic compromise can help clinicians for the rapid decision of treatment. Corticosteroids have long been the mainstay treatment for hemangiomatous lesions but after the description of antiproliferative effect of propranolol on severe infantile hemangiomas in 2008, propranolol has been the preferred choice of treatment in many centers. Future studies should be directed to answer the questions regarding the optimal duration of propranolol treatment to overcome recurrences and clinical and histopathological characteristics of infantile hemangiomas that failed treatment with propranolol. [Cukurova Med J 2016; 41(2.000: 354-359

  12. Anabolic Steroids (For Teens)

    Science.gov (United States)

    ... Enter Search Term(s): Teens / Drug Facts / Anabolic Steroids Anabolic Steroids Street names: Gym Candy, Juice, Roids Print Expand All Revised March 2017 What are anabolic steroids? ©Shutterstock/ Dizain Also known as: Anabolic-androgenic Steroids, ...

  13. Treatment of hypergranulation tissue in burn wounds with topical steroid dressings: a case series

    Directory of Open Access Journals (Sweden)

    Jaeger M

    2016-08-01

    Full Text Available Marie Jaeger,1,* Moti Harats,1,* Rachel Kornhaber,2 Uri Aviv,1 Amir Zerach,1 Josef Haik1,3 1Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; 2School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia; 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *These authors contributed equally to this work. Abstract: Hypergranulation tissue (or also known as overgranulation may negatively influence burn wound healing time and contribute to recurrence of contractures in burn wounds and grafts. Subsequently, the treatment of hypergranulation tissue remains controversial and problematic. In this case series, we aimed to examine the feasibility and document the use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds. We report five cases where hypergranulation tissue developed following deep dermal/full-thickness burns. Initial burn wound treatment included necrotic tissue debridement, wound cleansing, and Flaminal®. All five cases underwent surgical debridement and split-skin ­grafting. Upon identification of hypergranulation tissue, hydrocortisone acetate 0.25% was applied ­topically as usual care for the treatment of hypergranulation tissue. All five patients had deep dermal/full-thickness burns with a total body surface area ranging from 22% to 61% and were aged from 3–41 years. All five cases developed hypergranulation tissue during their admission after debridement and split-thickness skin grafts. All patients showed an improvement in the treated areas with a complete regression of hypergranulation tissue and closure of the burn wounds. No clinically apparent local or systemic side effects of the treatment were observed. Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds

  14. Changes in body water distribution during treatment with inhaled steroid in pre-school children

    DEFF Research Database (Denmark)

    Heitmann, B L; Anhøj, Jacob; Bisgaard, A M

    2004-01-01

    . At the end of each treatment period body impedance and skin ultrasonography were measured. METHODS AND PROCEDURES: We measured changes in water content of the soft tissues by two methods. Skin ultrasonography was used to detect small changes in dermal water content, and bioelectrical impedance was used...... to assess body water content and distribution. MAIN OUTCOMES AND RESULTS: We found an increase in skin density of the shin from fluticasone as measured by ultrasonography (p = 0.01). There was a tendency for a consistent elevation of impedance parameters from active treatments compared to placebo although...... overall this effect was not statistically significant (0.1 generalized changes...

  15. Anti-tumor necrosis factor-a for the treatment of steroid-refractory acute graft-versus-host disease

    Directory of Open Access Journals (Sweden)

    M.C. Nogueira

    2007-12-01

    Full Text Available Allogeneic stem cell transplantation has been increasingly performed for a variety of hematologic diseases. Clinically significant acute graft-versus-host disease (GVHD occurs in 9 to 50% of patients who receive allogeneic grafts, resulting in high morbidity and mortality. There is no standard therapy for patients with acute GVHD who do not respond to steroids. Studies have shown a possible benefit of anti-TNF-a (infliximabfor the treatment of acute GVHD. We report here on the outcomes of 10 recipients of related or unrelated stem cell transplants who received 10 mg/kg infliximab, iv, once weekly for a median of 3.5 doses (range: 1-6 for the treatment of severe acute GVHD and who were not responsive to standard therapy. All patients had acute GVHD grades II to IV (II = 2, III = 3, IV = 5. Overall, 9 patients responded and 1 patient had progressive disease. Among the responders, 3 had complete responses and 6 partial responses. All patients with cutaneous or gastrointestinal involvement responded, while only 2 of 6 patients with liver disease showed any response. None of the 10 patients had any kind of immediate toxicity. Four patients died, all of them with sepsis. Six patients are still alive after a median follow-up time of 544 days (92-600 after transplantation. Considering the severity of the cases and the bad prognosis associated with advanced acute GVHD, we find our results encouraging. Anti-TNF-a seems to be a useful agent for the treatment of acute GVHD.

  16. The effect of steroid treatment on lipocortin immunoreactivity of rat brain.

    NARCIS (Netherlands)

    Go, K G; Haar, J G Ter; de Leij, Louis; Zuiderveen, F; Parente, L; Solito, E; Molenaar, W M

    Lipocortin-1, lipocortin-2 and lipocortin-5 were immunohistochemically assessed in rats. Apart from animals receiving no treatment, other animals received pretreatment with methylprednisolone, or the 21-aminosteroid U-74389F. Whereas Hpocortin immunoreactivity was absent in the greater part of the

  17. Barriers and facilitators to the implementation of antenatal syphilis screening and treatment for the prevention of congenital syphilis in the Democratic Republic of Congo and Zambia: results of qualitative formative research.

    Science.gov (United States)

    Nkamba, Dalau; Mwenechanya, Musaku; Kilonga, Arlette Mavila; Cafferata, Maria Luisa; Berrueta, Amanda Mabel; Mazzoni, Agustina; Althabe, Fernando; Garcia-Elorrio, Ezequiel; Tshefu, Antoniette K; Chomba, Elwyn; Buekens, Pierre M; Belizan, Maria

    2017-08-14

    The impact of untreated syphilis during pregnancy on neonatal health remains a major public health threat worldwide. Given the high prevalence of syphilis during pregnancy in Zambia and Democratic Republic of Congo (DRC), the Preventive Congenital Syphilis Trial (PCS Trial), a cluster randomized trial, was proposed to increase same-day screening and treatment of syphilis during antenatal care visits. To design an accepted and feasible intervention, we conducted a qualitative  formative research. Our objective was to identify context-specific  barriers and facilitators to the implementation of antenatal screening and treatment during pregnancy. Qualitative research included in-depth semi-structured interviews with clinic administrators, group interviews with health care providers, and focus groups with pregnant women in primary care clinics (PCCs) in Kinshasa (DRC) and Lusaka (Zambia). A total of 112 individuals participated in the interviews and focus groups. Barriers for the implementation of syphilis testing and treatment were identified at the a) system level: fragmentation of the health system, existence of ANC guidelines in conflict with proposed intervention, poor accessibility of clinics (geographical and functional), staff and product shortages at the PCCs; b) healthcare providers' level: lack of knowledge and training about evolving best practices, reservations regarding same-day screening and treatment; c) Pregnant women level: late enrollment in ANC, lack of knowledge about consequences and treatment of syphilis, and stigma. Based on these results, we developed recommendations for the design of the PCS Trial intervention. This research allowed us to identify barriers and facilitators to improve the feasibility and acceptability of a behavioral intervention. Formative research is a critical step in designing appropriate and effective interventions by closing the "know-do gap".

  18. Successful treatment of recurrent Henoch-Schönlein purpura nephritis in a renal allograft with tonsillectomy and steroid pulse therapy.

    Science.gov (United States)

    Yamakawa, Takafumi; Yamamoto, Izumi; Komatsuzaki, Yo; Niikura, Takahito; Okabayashi, Yusuke; Katsumata, Haruki; Kawabe, Mayuko; Katsuma, Ai; Mafune, Aki; Nakada, Yasuyuki; Kobayashi, Akimitsu; Koike, Yusuke; Miki, Jun; Yamada, Hiroki; Tanno, Yudo; Ohkido, Ichiro; Tsuboi, Nobuo; Yamamoto, Hiroyasu; Yokoo, Takashi

    2016-07-01

    We report a case of recurrent Henoch-Schönlein purpura nephritis (HSPN) treated successfully with a tonsillectomy and steroid pulse therapy in a kidney transplant patient. A 29-year-old woman was admitted to our hospital for an episode biopsy; she had a serum creatinine (S-Cr) of 1.0 mg/dL and 1.34 g/day proteinuria 26 months after kidney transplantation. Histological examination revealed increased amounts of mesangial matrix and mesangial hypercellularity with IgA deposition. Of note, one glomerulus showed focal endocapillary proliferation and tuft necrosis. We diagnosed active recurrent HSPN. Considering both the histological findings and refractory clinical course of the native kidney, she was treated for 3 consecutive days with steroid pulse therapy and a tonsillectomy. The patient's proteinuria decreased gradually to less than 150 mg/day 6 months later. A second biopsy 6 years after kidney transplantation showed an excellent response to treatment and revealed a marked reduction in both the mesangial matrix and mesangial hypercellularity, with trace IgA deposition. We conclude that a tonsillectomy and steroid pulse therapy appeared to be useful in this patient with active recurrent HSPN. This paper is the first to report a tonsillectomy and steroid pulse therapy as a therapeutic option for active recurrent HSPN. Further studies are needed to elucidate the efficacy and mechanisms of tonsillectomy with recurrent HSPN in kidney transplant patients. © 2016 Asian Pacific Society of Nephrology.

  19. Steroid-Sparing Effect of 0.1% Tacrolimus Eye Drop for Treatment of Shield Ulcer and Corneal Epitheliopathy in Refractory Allergic Ocular Diseases.

    Science.gov (United States)

    Miyazaki, Dai; Fukushima, Atsuki; Ohashi, Yuichi; Ebihara, Nobuyuki; Uchio, Eiichi; Okamoto, Shigeki; Shoji, Jun; Takamura, Etsuko; Nakagawa, Yayoi; Namba, Kenichi; Fujishima, Hiroshi

    2017-03-01

    To evaluate the effects of 0.1% topical tacrolimus alone or in combination with steroids for the treatment of shield ulcers and corneal epitheliopathy in patients with refractory allergic ocular diseases. Open cohort study. Patients with refractory allergic conjunctivitis epitheliopathy, shield ulcers, or corneal plaques (N = 791). The 791 patients were treated with topical tacrolimus alone or in combination with topical or oral steroids. The effectiveness of the treatments was determined by a corneal epitheliopathy score during the 3-month follow-up period. The clinical signs were rated on a 4-grade scale. Corneal epitheliopathy with no corneal staining was graded as 0, and shield ulcers or plaques were graded as 3, the highest grade. The effects of tacrolimus with and without topical steroids on the epitheliopathy scores were assessed after adjustments for the severity of the clinical signs and characteristics. Changes in the corneal epitheliopathy score. Adjusted mean epitheliopathy score at the baseline was 1.73 (95% confidence interval [CI], 1.65-1.81) for patients treated with tacrolimus alone, and this was significantly reduced by -0.93 at 1 month. The reduction of the score by topical and oral steroids was -0.02 for fluorometholone, 0.02 for betamethasone, and -0.02 for oral steroids, and these reductions were not significant compared with the reduction effect of topical tacrolimus alone at -0.93. The 238 patients with shield ulcer (score 3) were analyzed with adjustments, and the mean epitheliopathy score at 1 month was reduced to 1.38 with tacrolimus alone (95% CI, 1.24-1.51), 1.41 (95% CI, 1.26-1.56) with adjuvant fluorometholone, and 1.46 (95% CI, 1.32-1.61) with adjuvant betamethasone. No significant difference was observed in the adjunctive topical steroids. The presence of severe palpebral conjunctival symptoms, including giant papillae, was a significant resisting factor for topical tacrolimus. The significant effects of topical tacrolimus

  20. Mesenchymal stromal cells for treatment of steroid-refractory GvHD: a review of the literature and two pediatric cases

    Directory of Open Access Journals (Sweden)

    Wernicke Caroline M

    2011-08-01

    Full Text Available Abstract Severe acute graft versus host disease (GvHD is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. Human mesenchymal stromal cells (MSCs play an important role in endogenous tissue repair and possess strong immune-modulatory properties making them a promising tool for the treatment of steroid-refractory GvHD. To date, a few reports exist on the use of MSCs in treatment of GvHD in children indicating that children tend to respond better than adults, albeit with heterogeneous results. We here present a review of the literature and the clinical course of two instructive pediatric patients with acute steroid-refractory GvHD after haploidentical stem cell transplantation, which exemplify the beneficial effects of third-party transplanted MSCs in treatment of acute steroid-refractory GvHD. Moreover, we provide a meta-analysis of clinical studies addressing the outcome of patients with steroid-refractory GvHD and treatment with MSCs in adults and in children (n = 183; 122 adults, 61 children. Our meta-analysis demonstrates that the overall response-rate is high (73.8% and confirms, for the first time, that children indeed respond better to treatment of GvHD with MSCs than adults (complete response 57.4% vs. 45.1%, respectively. These data emphasize the significance of this therapeutic approach especially in children and indicate that future prospective studies are needed to assess the reasons for the observed differential response-rates in pediatric and adult patients.

  1. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis.

    Science.gov (United States)

    Cotton, Cary C; Erim, Daniel; Eluri, Swathi; Palmer, Sarah H; Green, Daniel J; Wolf, W Asher; Runge, Thomas M; Wheeler, Stephanie; Shaheen, Nicholas J; Dellon, Evan S

    2017-06-01

    Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective. We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive. In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  2. Antenatal Bartter Syndrome: A Review

    Directory of Open Access Journals (Sweden)

    Y. Ramesh Bhat

    2012-01-01

    Full Text Available Antenatal Bartter syndrome (ABS is a rare autosomal recessive renal tubular disorder. The defective chloride transport in the loop of Henle leads to fetal polyuria resulting in severe hydramnios and premature delivery. Early onset, unexplained maternal polyhydramnios often challenges the treating obstetrician. Increasing polyhydramnios without apparent fetal or placental abnormalities should lead to the suspicion of this entity. Biochemical analysis of amniotic fluid is suggested as elevated chloride level is usually diagnostic. Awareness, early recognition, maternal treatment with indomethacin, and amniocentesis allow the pregnancy to continue. Affected neonates are usually born premature, have postnatal polyuria, vomiting, failure to thrive, hypercalciuria, and subsequently nephrocalcinosis. Hypokalemia, metabolic alkalosis, secondary hyperaldosteronism and hyperreninaemia are other characteristic features. Volume depletion due to excessive salt and water loss on long term stimulates renin-angiotensin-aldosterone system resulting in juxtaglomerular hyperplasia. Clinical features and electrolyte abnormalities may also depend on the subtype of the syndrome. Prenatal diagnosis and timely indomethacin administration prevent electrolyte imbalance, restitute normal growth, and improve activity. In this paper, authors present classification, pathophysiology, clinical manifestations, laboratory findings, complications, and prognosis of ABS.

  3. Steroid-sparing effect and toxicity of dapsone treatment in giant cell arteritis

    Science.gov (United States)

    Ly, Kim Heang; Dalmay, François; Gondran, Guillaume; Palat, Sylvain; Bezanahary, Holy; Cypierre, Anne; Fauchais, Anne-Laure; Liozon, Eric

    2016-01-01

    Abstract Although a glucocorticoid (GC)-sparing strategy is needed for patients with giant cell arteritis (GCA) suffering from refractory disease or serious treatment-related complications, evidence of efficacy in this setting of immunosuppressive drugs and biotherapies is lacking. Herein, we evaluated the GC-sparing effects and tolerability of addition of dapsone (DDS) to prednisone therapy in patients with GCA. We retrospectively assessed data on 18 GCA patients who received DDS as a first-line treatment (DDS-1 group) and 52 patients who received it as a second- or third-line treatment for refractory GCA, with or without excessive GC-related toxicity (DDS-2 group). Of these 70 patients, 63 belonged to an inception cohort of 478 patients, whereas the remaining 7 were referred to our department for resistant GCA. In all, 52 patients were assessable for DDS efficacy. The baseline characteristics of the DDS-1 patients were similar to those of 395 GCA patients (control group) who received prednisone alone. DDS-1 patients had a more sustained decrease in GC dose with a lower mean prednisone dose at 12 months, and they comprised higher proportions who achieved GC withdrawal within the first year, who stopped prednisone treatment, and who recovered from GCA (P < 0.001 for each variable). Patients in the DDS-2 group achieved a mean rate of prednisone reduction of 65% and a prednisone dose reduction of 16.9 ± 13.3 mg/d. The monthly decreases in the prednisone dose were 2.4 and 1.25 mg in DDS-1 and DDS-2 patients, respectively. DDS-induced side effects were recorded in 44 (64%) assessable patients. These side effects led to lowering of the DDS dose by 25 mg/d in 11 (16%) patients and permanent cessation of DDS in 14 patients (20%), due to allergic skin rash in 7, agranulocytosis in 2, icteric hepatitis in 2, and excessive hemolysis in 2 patients. DDS is a potent GC-sparing agent in GCA that should be evaluated in prospective studies. However, DDS use should

  4. Non-Steroidal Anti-Inflammatory Drugs and Aspirin Therapy for the Treatment of Acute and Recurrent Idiopathic Pericarditis

    Directory of Open Access Journals (Sweden)

    Nicholas Schwier

    2016-03-01

    Full Text Available Aspirin (ASA and non-steroidal anti-inflammatory drugs (NSAIDs are a mainstay of therapy for the treatment of idiopathic pericarditis (IP. A comprehensive review consisting of pertinent clinical literature, pharmacokinetic, and pharmacodynamic considerations, has not been released in recent years. This review will facilitate the clinician’s understanding of pharmacotherapeutic considerations for using ASA/NSAIDs to treat IP. Data were compiled using clinical literature consisting of case reports, cohort data, retrospective and prospective studies, and manufacturer package inserts. ASA, ibuprofen, indometacin, and ketorolac relatively have the most evidence in the treatment of IP, provide symptomatic relief of IP, and should be tapered accordingly. ASA is the drug of choice in patients with coronary artery disease (CAD, heart failure (HF, or renal disease, but should be avoided in patients with asthma and nasal polyps, who are naïve to ASA therapy. Ibuprofen is an inexpensive and relatively accessible option in patients who do not have concomitant CAD, HF, or renal disease. Indometacin is not available over-the-counter in the USA, and has a relatively higher incidence of central nervous system (CNS adverse effects. Ketorolac is an intravenous option; however, clinicians must be mindful of the maximum dose that can be administered. While ASA/NSAIDs do not ameliorate the disease process of IP, they are part of first-line therapy (along with colchicine, for preventing recurrence of IP. ASA/NSAID choice should be dictated by comorbid conditions, tolerability, and adverse effects. Additionally, the clinician should be mindful of considerations such as tapering, high-sensitivity CRP monitoring, bleeding risk, and contraindications to ASA/NSAID therapy.

  5. Non-Steroidal Anti-Inflammatory Drugs and Aspirin Therapy for the Treatment of Acute and Recurrent Idiopathic Pericarditis

    Science.gov (United States)

    Schwier, Nicholas; Tran, Nicole

    2016-01-01

    Aspirin (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of therapy for the treatment of idiopathic pericarditis (IP). A comprehensive review consisting of pertinent clinical literature, pharmacokinetic, and pharmacodynamic considerations, has not been released in recent years. This review will facilitate the clinician’s understanding of pharmacotherapeutic considerations for using ASA/NSAIDs to treat IP. Data were compiled using clinical literature consisting of case reports, cohort data, retrospective and prospective studies, and manufacturer package inserts. ASA, ibuprofen, indometacin, and ketorolac relatively have the most evidence in the treatment of IP, provide symptomatic relief of IP, and should be tapered accordingly. ASA is the drug of choice in patients with coronary artery disease (CAD), heart failure (HF), or renal disease, but should be avoided in patients with asthma and nasal polyps, who are naïve to ASA therapy. Ibuprofen is an inexpensive and relatively accessible option in patients who do not have concomitant CAD, HF, or renal disease. Indometacin is not available over-the-counter in the USA, and has a relatively higher incidence of central nervous system (CNS) adverse effects. Ketorolac is an intravenous option; however, clinicians must be mindful of the maximum dose that can be administered. While ASA/NSAIDs do not ameliorate the disease process of IP, they are part of first-line therapy (along with colchicine), for preventing recurrence of IP. ASA/NSAID choice should be dictated by comorbid conditions, tolerability, and adverse effects. Additionally, the clinician should be mindful of considerations such as tapering, high-sensitivity CRP monitoring, bleeding risk, and contraindications to ASA/NSAID therapy. PMID:27023565

  6. The effects of sex steroid treatments on sexual differentiation in a unisexual lizard, Cnemidophorus uniparens (Teiidae).

    Science.gov (United States)

    Billy, A J; Crews, D

    1986-02-01

    Cnemidophorus uniparens is a parthenogenetic unisexual species of lizard in which each individual develops as a female, making it a unique animal model for the study of sexual differentiation. In one study, administration of exogenous testosterone before and/or after hatching influenced the development of the gonads, the accessory reproductive ducts, the renal sex segment of the mesonephric kidney, and the femoral glands, a secondary sex character. Testosterone treatment also affected the cross-sectional area of the gonad and the proportions of cortical and medullary tissues present in the developing gonad. The oviducts and femoral glands of testosterone-treated individuals were hypertrophied; the collecting tubules of the kidney of these animals contained granules, an androgen-dependent, sexually dimorphic character in squamate reptiles. In another study, testosterone, dihydrotestosterone, or estradiol were administered to C. uniparens embryos. No treatment effects on gonadal development were detected on the day of hatching. However, estradiol, but not testosterone and dihydrotestosterone, stimulated development of the oviducts. Taken together these studies suggest that androgen aromatization may play a role in sexual differentiation in lizards.

  7. [Epidermolysis bullosa acquisita complicated by esophageal stenosis. Endoscopic treatment with thermoplastic dilators and intralesional steroid injection].

    Science.gov (United States)

    Moura, E G; Couto-Júnior, D S; Alvarado-Escobar, H; da Costa-Martins, B; Sallum, R A; Artifon, E L; Sakai, P

    2011-01-01

    Epidermolysis bullosa acquisita (EBA) is a rare auto-immune dermatologic disease, produced by auto-antibodies against colagen VII. We report a 44 years old male patient with EBA diagnosed 15 years before, who presented with progressive disphagia, being diagnosed an esophageal involvement of EBA. The patient was submitted to endoscopic treatment with thermoplastic bougie dilation and intralesional corticosteroid injection. The patient improved clinically with recovery of nutritional status. Esophageal involvement in EBA is very rare and its reason is still unknown. Endoscopic approach must be cautiously performed with the use of small diameter endoscopes, small caliber dilators, intralesional injection of corticosteroid and enteral tube in order to minimize the risks of complications, as well as esophageal rest from food trauma and better reparatory molding of the epithelium.

  8. Prognostic accuracy of antenatal neonatology consultation.

    Science.gov (United States)

    Kukora, S; Gollehon, N; Weiner, G; Laventhal, N

    2017-01-01

    Neonatologists provide antenatal counseling to support shared decision-making for complicated pregnancies. Poor or ambiguous prognostication can lead to inappropriate treatment and parental distress. We sought to evaluate the accuracy of antenatal prognosticaltion. A retrospective cohort was assembled from a prospectively populated database of all outpatient neonatology consultations. On the basis of the written consultation, fetuses were characterized by diagnosis groups (multiple anomalies or genetic disorders, single major anomaly and obstetric complications), assigned to five prognostic categories (I=survivable, IIA=uncertain but likely survivable, II=uncertain, IIB=uncertain but likely non-survivable, III non-survivable) and two final outcome categories (fetal demise/in-hospital neonatal death or survival to hospital discharge). When possible, status at last follow-up was recorded for those discharged from the hospital. Prognostic accuracy was assessed using unweighted, multi-level likelihood ratios (LRs). The final cohort included 143 fetuses/infants distributed nearly evenly among the three diagnosis groups. Over half (64%) were assigned an uncertain prognosis, but most of these could be divided into 'likely survivable' or 'likely non-survivable' subgroups. Overall survival for the entire cohort was 62% (89/143). All but one of the fetuses assigned a non-survivable prognosis suffered fetal demise or died before hospital discharge. The neonatologist's antenatal prognosis accurately predicted the probability of survival by prognosis group (LR I=4.56, LR IIA=10.53, LR II=4.71, LR IIB=0.099, LR III=0.040). The LRs clearly differentiated between fetuses with high and low probability of survival. Eleven fetuses (7.7%) had misalignment between the predicted prognosis and outcome. Five died before discharge despite being given category I or IIA prognoses, whereas six infants with category IIB or III prognoses survived to discharge, though some of these were

  9. The effectiveness of oxymetazoline plus intranasal steroid in the treatment of chronic rhinitis: A randomised controlled trial.

    Science.gov (United States)

    Thongngarm, Torpong; Assanasen, Paraya; Pradubpongsa, Panitan; Tantilipikorn, Pongsakorn

    2016-03-01

    The recommended drug for moderate to severe chronic rhinitis is intranasal steroids (INS). However, nasal congestion could be refractory and need additional treatments. We sought to explore the benefit of oxymetazoline (Oxymet) plus INS on nasal congestion without inducing rhinitis medicamentosa. We performed a 60-week, randomised, double-blind clinical trial in 50 patients, 18 years of age or greater, with chronic rhinitis who had used INS and cetirizine and still had nasal congestion. Subjects were randomised to receive 2 sprays of 0.05% Oxymet in each nostril twice daily or placebo for 4 weeks. All patients received 2 sprays of budesonide (100 μg/spray) in each nostril twice daily and 10 mg cetirizine once daily from entry throughout the study. Nasal symptom scores, nasal peak inspiratory flow (NPIF) and Rhinoconjunctivitis Quality of Life (Rcq) scores were measured. Oxymet significantly reduced nasal congestion in subjects with chronic rhinitis compared with placebo on the day of 15-28 and 29-42. In subjects with allergic rhinitis, nasal congestion scores in the Oxymet group were significantly reduced compared with those in the placebo group on days 4-7, days 8-14, days 15-28 and days 29-42. In the Oxymet group, post hoc analysis showed that subjects with allergic rhinitis significantly improved their nasal congestion scores compared to non-allergic individuals (N, allergic/non-allergic = 18/7, p < 0.05). The combination of INS and Oxymet was not associated with rhinitis medicamentosa. The combination of INS and Oxymet provides additional benefit compared to INS monotherapy in relieving nasal congestion in subjects with chronic rhinitis and allergic rhinitis without developing rhinitis medicamentosa.

  10. Assessment of coverage of preventive treatment and insecticide-treated mosquito nets in pregnant women attending antenatal care services in 11 districts in Mozambique in 2011: the critical role of supply chain.

    Science.gov (United States)

    Salomão, Cristolde; Sacarlal, Jahit; Gudo, Eduardo Samo

    2017-05-25

    Malaria during pregnancy is associated with poor maternal and pregnancy outcome and the World Health Organization recommends the administration of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) and distribution of insecticide-treated mosquito nets (ITNs) to all pregnant women attending antenatal care (ANC) services. This study was conducted with the aim to assess the uptake of IPTp and ITNs in pregnant women attending ANC services and correlate with ANC attendance and frequency of stock-outs in 22 health facilities Mozambique. A cross-sectional study was conducted between July and December 2011 in 22 health units in 11 districts situated in 11 provinces in Mozambique. Two health facilities were selected per district (one urban and one rural). Data were collected by reviewing logbooks of antenatal consultations as well as from monthly district reports. During the period under investigation, a total of 23,524 pregnant women attended their 1st antenatal care visits, of which 12,775 (54.3%) and 7581 (32.2%) received one and two doses of IPTp, respectively. In regard to ITNs, a total of 16,436 (69.9%) pregnant women received ITNs. Uptake of IPTp and ITNs by pregnant women at ANC services was higher in southern Mozambique and lower in districts situated in the northern part of the country. Stock-outs of SP and ITNs were reported in 50.0% (11/22) and 54.5% (12/22) of the health facilities, respectively. Coverage of IPTp and ITN in health facilities with stock-outs of SP and ITNs was much lower as compared to health facilities with no stock-outs. Altogether, data from this study shows that coverage of the 2nd dose of IPTp, as well as ITNs, was low in pregnant women attending ANC services in Mozambique. In addition, this data also shows that stock-outs of SP and ITNs were frequent and led to lower coverage of IPTp and ITN, representing a serious barrier for the accomplishment of targets. In conclusion, this study recommends that

  11. The potential importance of steroids in the treatment of autistic spectrum disorders and other disorders involving mercury toxicity.

    Science.gov (United States)

    Geier, Mark R; Geier, David A

    2005-01-01

    Autism is a neurodevelopmental disorder that according to the Centers for Disease Control and Prevention (CDC) affects 1 in 150 children in the United States. Autism is characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movements, and sensory dysfunction. Recently emerging evidence suggests that mercury, especially from childhood vaccines, appears to be a factor in the development of the autistic disorders, and that autistic children have higher than normal body-burdens of mercury. In considering mercury toxicity, it has previously been shown that testosterone significantly potentates mercury toxicity, whereas estrogen is protective. Examination of autistic children has shown that the severity of autistic disorders correlates with the amount of testosterone present in the amniotic fluid, and an examination of a case-series of autistic children has shown that some have plasma testosterone levels that were significantly elevated in comparison neurotypical control children. A review of some of the current biomedical therapies for autistics, such as glutathione and cysteine, chelation, secretin, and growth hormone, suggests that they may in fact lower testosterone levels. We put forward the medical hypothesis that autistic disorders, in fact, represents a form of testosterone mercury toxicity, and based upon this observation, one can design novel treatments for autistics directed towards higher testosterone levels in autistic children. We suggest a series of experiments that need to be conducted in order to evaluate the exact mechanisms for mercury-testosterone toxicity, and various types of clinical manipulations that may be employed to control testosterone levels. It is hoped by devising therapies that address the steroid hormone pathways, in addition to the current treatments that successful lower heavy metal body-burdens of mercury, will work synergistically to improve clinical outcomes. In light of the fact that

  12. Unilateral striae distensae of the knee after a steroid injection for the treatment of Osgood-Schlatter disease.

    Science.gov (United States)

    Wise, Kelsey; Warren, Donald; Diaz, Lucia

    2017-03-15

    We report a 12-year-old girl with new diagnosisof right knee Osgood-Schlatter who developedhorizontal purple striae below the right tibial tubercletwo months after a right knee intra-articular steroidinjection. She is the second reported case of unilaterallocalized striae after an intra-articular steroid injectionand the first with triamcinalone as the corticosteroid.

  13. Unilateral striae distensae of the knee after a steroid injection for the treatment of Osgood-Schlatter disease

    OpenAIRE

    Wise, Kelsey; Warren, Donald; Diaz, Lucia

    2017-01-01

    We report a 12-year-old girl with new diagnosisof right knee Osgood-Schlatter who developedhorizontal purple striae below the right tibial tubercletwo months after a right knee intra-articular steroidinjection. She is the second reported case of unilaterallocalized striae after an intra-articular steroid injectionand the first with triamcinalone as the corticosteroid.

  14. Efficacy of hyaluronic acid or steroid injections for the treatment of a rat model of rotator cuff injury.

    Science.gov (United States)

    Yamaguchi, Takeshi; Ochiai, Nobuyasu; Sasaki, Yu; Kijima, Takehiro; Hashimoto, Eiko; Sasaki, Yasuhito; Kenmoku, Tomonori; Yamazaki, Hironori; Miyagi, Masayuki; Ohtori, Seiji; Takahashi, Kazuhisa

    2015-12-01

    This study evaluated dorsal root ganglia from C3-C7, analyzed gait, and compared the expression of calcitonin gene-related peptide (CGRP) which was a marker of inflammatory pain in a rat rotator cuff tear model in which the supraspinatus and infraspinatus tendons were detached; comparisons were made to a sham group in which only the tendons were exposed. Fluorogold was injected into the glenohumeral joint 21 days after surgery in both groups, and saline, steroids, or hyaluronic acid was injected into the glenohumeral joint in the rotator cuff tear group 26 days after surgery. The proportions of CGRP-immunoreactive neurons were higher and the gait parameters were impaired in the rotator cuff tear group compared to in the sham group. However, the CGRP expression was reduced and the gait was improved with steroid or hyaluronic acid injection compared to saline, suggesting that both hyaluronic acid and steroid injections suppressed of inflammation which thought to be provided pain relief. While there were no significant differences, the suppression of CGRP expression and the improved gait after hyaluronic acid and steroid injections suggested that both methods were effective for rat rotator cuff tear model. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  15. R & D of an Innovative Composite Scaffold Incorporated with Phytoestrogenic Icaritin for Treatment of Steroid-associated Osteonecrosis Lesion in Rabbits

    Science.gov (United States)

    Xie, Xinhui

    Bone defect is a common orthopaedic problem caused by many pathologic disorders such as tumor, trauma or metabolic diseases, including osteonecrosis (ON). ON is a disabling clinical condition characterized by the death of osteocytes, aggregation of marrow fat cells, a decrease in activity of bone marrow stem cells (BMSCs) pool, and degeneration of trabecular bone matrix, which affect more frequently young adults that usually leads to bone and articular cartilage destruction in joints, especially in hip and knee. High dose of steroid is one of the risk factors associated with ON, which sometimes is used for treatment of some medical conditions such as systemic lupus erythematosus (SLE), organ transplantation, asthma, rheumatologic arthritis (RA), and severe acute respiratory syndrome (SARS). Core decompression has been efficacious for treatment of early ON stages when the necrotic lesion is still small in size. However, ON lesion, weakens the cancellous bone within and adjacent to the necrotic region. Thus orthopaedic challenges in repair for steroid-associated ON lesion after core decompression may include the impaired osteogenic potential of stem-cell-pool under the influence of pulsed steroid and lack of platform for bone or/and neovascularization ingrowth after removal of large size necrotic bone. The proposed strategies for treatment of steroid-associated ON lesion are to provide biocompatible scaffold with required structure to fill the defect area after core decompression and osteogenic stimulator facilitating the repair of ON lesion. Previous works show that the PLGA (poly-lactic glycolic acid) and TCP (tricalcium phosphate) have good biocompatibility, osteoconduction and biodegradation to be used in bone defect repair, however no significant osteopromotive effects. Many endogenous factors are osteopromotive and also eventually osteoinductive, such as bone morphogenic proteins (BMPs). As an extraneous molecular, Icaritin, a small molecule derived from

  16. [Cost-effectiveness analysis of celecoxib versus non-selective non-steroidal anti-inflammatory drug therapy for the treatment of osteoarthritis in Spain: A current perspective].

    Science.gov (United States)

    De Lossada, A; Oteo-Álvaro, Á; Giménez, S; Oyagüez, I; Rejas, J

    2016-01-01

    To assess the cost-effectiveness of celecoxib and non-selective non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis in clinical practice in Spain. A decision-tree model using distribution, doses, treatment duration and incidence of GI and CV events observed in the pragmatic PROBE-designed «GI-Reasons» trial was used for cost-effectiveness. Effectiveness was expressed in terms of event averted and quality-adjusted life-years (QALY) gained. QALY were calculated based on utility decrement in case of any adverse events reported in GI-Reasons trial. The National Health System perspective in Spain was applied; cost calculations included current prices of drugs plus cost of adverse events occurred. The analysis was expressed as an incremental cost-effectiveness ratio per QALY gained and per event averted. One-way and probabilistic analyses were performed. Compared with non-selective non-steroidal anti-inflammatory drugs, at current prices, celecoxib treatment had higher overall treatment costs €201 and €157, respectively. However, celecoxib was associated with a slight increase in QALY gain and significantly lower incidence of gastrointestinal events (p<.001), with mean incremental cost-effectiveness ratio of €13,286 per QALY gained and €4,471 per event averted. Sensitivity analyses were robust, and confirmed the results of the base case. Celecoxib at current price may be considered as a cost-effective alternative vs. non-selective non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis in daily practice in the Spanish NHS. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Treatment of steroid-induced osteonecrosis of the femoral head using porous Se@SiO2 nanocomposites to suppress reactive oxygen species

    Science.gov (United States)

    Deng, Guoying; Niu, Kerun; Zhou, Feng; Li, Buxiao; Kang, Yingjie; Liu, Xijian; Hu, Junqing; Li, Bo; Wang, Qiugen; Yi, Chengqing; Wang, Qian

    2017-03-01

    Reducing oxidative stress (ROS) have been demonstrated effective for steroid-induced osteonecrosis of the femoral head (steroid-induced ONFH). Selenium (Se) plays an important role in suppressing oxidative stress and has huge potential in ONFH treatments. However the Se has a narrow margin between beneficial and toxic effects which make it hard for therapy use in vivo. In order to make the deficiency up, a control release of Se (Se@SiO2) were realized by nanotechnology modification. Porous Se@SiO2 nanocomposites have favorable biocompatibility and can reduced the ROS damage effectively. In vitro, the cck-8 analysis, terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) stain and flow cytometry analysis showed rare negative influence by porous Se@SiO2 nanocomposites but significantly protective effect against H2O2 by reducing ROS level (detected by DCFH-DA). In vivo, the biosafety of porous Se@SiO2 nanocomposites were confirmed by the serum biochemistry, the ROS level in serum were significantly reduced and the curative effect were confirmed by Micro CT scan, serum Elisa assay (inflammatory factors), Western blotting (quantitative measurement of ONFH) and HE staining. It is expected that the porous Se@SiO2 nanocomposites may prevent steroid-induced ONFH by reducing oxidative stress.

  18. Effect of long-term treatment with steroid hormones or tamoxifen on the progesterone receptor and androgen receptor in the endometrium of ovariectomized cynomolgus macaques

    Directory of Open Access Journals (Sweden)

    Cline J Mark

    2003-02-01

    Full Text Available Abstract The progesterone receptor (PR and androgen receptor (AR belong to the nuclear receptor superfamily. Two isoforms of PR (A and B have been identified with different functions. The expression of AR, each isoform of PR and their involvement in long-term effects on the endometrium after hormonal replacement therapy (HRT or tamoxifen (TAM treatment is not known. The aims of this study were to determine PR(A+B, PRB and AR distribution by immunohistochemistry in the macaque (Macaca fascicularis endometrium. Ovariectomized (OVX animals were orally treated continuously for 35 months with either conjugated equine estrogens (CEE; medroxyprogesterone acetate (MPA; the combination of CEE/MPA; or TAM. Treatment with CEE/MPA tended to down-regulate PR in the superficial glands, but increased it in the stroma. TAM treatment increased both the PR and PRB levels in the stroma. Overall, less than 20% of the cells were positive for the PRB isoform and less variation was observed after steroid treatment. AR was found in the stroma, mainly distributed in the basal layer of the endometrium in the OVX and steroid treated groups, but was absent in the TAM treated group. No AR was found in the glandular epithelium. The present data show that long-term hormone treatment affects the PR level, and also the ratio between PRA and PRB in the endometrium.

  19. Postnatal Imaging of Antenatal Hydronephrosis

    Directory of Open Access Journals (Sweden)

    David M. Kitchens

    2009-01-01

    Full Text Available Radiologic imaging of the newborn detected prenatally with hydronephrosis should follow a systematic approach. Upper and lower urinary tract imaging should be performed in most cases in order to determine the etiology and gauge the use of future imaging. An overview of renal ultrasound, voiding cystourethrography, renal scintigraphy, and magnetic resonance urography in the setting of antenatal hydronephrosis are discussed.

  20. Dead Sea salt irrigations vs saline irrigations with nasal steroids for symptomatic treatment of chronic rhinosinusitis: a randomized, prospective double-blind study.

    Science.gov (United States)

    Friedman, Michael; Hamilton, Craig; Samuelson, Christian G; Maley, Alexander; Wilson, Meghan N; Venkatesan, T K; Joseph, Ninos J

    2012-01-01

    Intranasal steroids are 1 of the most frequently prescribed medications for the treatment of chronic rhinosinusitis (CRS), and saline irrigations are commonly used as an adjunct to medical therapy. We aimed to compare the efficacy of Dead Sea salt (DSS) irrigations and DSS nasal spray vs saline irrigations and topical nasal steroid spray in the treatment of symptoms of CRS. A total of 145 symptomatic adult patients without acute infection were initially enrolled and 114 completed the study. Patients completed a Sino-Nasal Outcomes Test 20 (SNOT-20) survey (primary outcome metric) and underwent endonasal examination, acoustic rhinometry, and smell testing (secondary outcome metrics). Patients were randomized to 2 groups. The experimental group (n = 59) self-administered hypertonic DSS spray and DSS irrigation; the control group (n = 55) self-administered fluticasone spray and hypertonic saline irrigation and spray. Patients and staff were blinded to group assignment. Outcomes were reassessed at 4 weeks. The 2 groups were homogeneous with respect to pretreatment primary and secondary outcome metrics. Dropout rates were 30% in the DSS group and 36.6% in the control group. Both groups showed significant improvement in mean SNOT-20 scores following treatment; however, the degree of improvement was not significantly different between groups (p = 0.082). There were no significant changes in secondary outcome metrics between the 2 groups. For patients with CRS, treatment with DSS irrigations and sprays appears as effective for symptom reduction as a combination of hypertonic saline irrigations and sprays and a topical steroid spray. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

  1. Joint Mobilization and Stretching Exercise vs Steroid Injection in the Treatment of Plantar Fasciitis: A Randomized Controlled Study.

    Science.gov (United States)

    Celik, Derya; Kuş, Gamze; Sırma, Serkan Önder

    2016-02-01

    This study compared the effectiveness of joint mobilization combined with stretching exercises (JM&Str) vs steroid injection (SI) in the treatment of plantar fasciitis (PF). A total of 43 patients (mean age, 45.5 ± 8.5 years; range, 30-60 years; 23 females) with PF were randomly assigned to receive either JM&Str (n = 22) or SIs (n = 21). JM&Str was applied 3 times per week for 3 weeks for a total of 9 visits. The SI group received 1 injection at baseline. The patients' functional scores were assessed using the Foot and Ankle Ability Measure (FAAM), and pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were captured at baseline and at 3-week, 6-week, 12-week, and 1-year follow-ups. The primary aim was examined using a mixed-model analysis of variance (ANOVA). Pairwise comparisons were performed to examine differences between the baseline and follow-up periods using Bonferroni equality at an alpha level of 0.05. Age, sex, body mass index, and dorsiflexion range of motion did not significantly impact pain relief or functional outcome (P > .05) at the 3-, 6- or 12-week follow-ups compared to baseline. Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups (P < .05) at the 3-, 6-, and 12-week follow-ups compared to baseline. However, at the 12-week and 1-year follow-ups, pain and functional outcomes were significantly improved in only the JM&Str group (P = .002). The overall group-by-time interaction was statistically significant for both FAAM (P = .001; F = 7.0) and VAS (P = .001; F = 8.3) scores. Between-group differences favored the SI group at the 3-week (P = .001, P = .001), 6-week (P = .002, P = .001), and 12-week (P = .008, P = .001) follow-ups for pain relief and functional outcomes. However, no significant differences (P = .62, P = .57) were detected in the measured outcomes at the 1-year follow-up. Our study demonstrated that while both groups achieved significant

  2. [Treatment of nausea and vomiting with 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatinantagonists, benzodiazepines and cannabinoids in palliative care patients : a systematic review].

    Science.gov (United States)

    Benze, G; Geyer, A; Alt-Epping, B; Nauck, F

    2012-09-01

    Various recommendations exist for the treatment of nausea and vomiting in palliative care but only few studies and even less systematic reviews look into antiemetic therapy for patients receiving palliative care. This systematic review aims to analyze the current evidence for antiemetic treatment with 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatin analogs, benzodiazepines and cannabinoids in palliative care patients with far advanced cancer not receiving chemotherapy or radiotherapy, acquired immune deficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), progressive heart failure, amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Results regarding evidence of treatment with prokinetic and neuroleptic agents will be published separately. The electronic databases PubMed and EmBase were systematically searched for studies (published 1966-2011) dealing with antiemetic therapy in palliative care and electronic retrieval was completed by manual searching. Studies with patients undergoing chemotherapy or radiotherapy, pediatric studies and studies published in languages other than English or German were excluded. Studies addressing therapy with 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatin analogs, benzodiazepines or cannabinoids were identified and selected for this systematic review. In the general search 75 relevant studies were found. Of those 36 addressed 5HT3 receptor antagonists, steroids, antihistamines, anticholinergics, somatostatin analogs, benzodiazepines and cannabinoids, 13 considered 5HT3 receptor antagonists, 10 somatostatin antagonists, 9 steroids, 5 cannabinoids, 4 anticholinergics, 1 antihistamines and none benzodiazepines. Furthermore six systematic reviews exist. Evidence for any drug used as an antiemetic is low. Concerning 5HT3 receptor antagonists data are insufficient for recommendations on the treatment of patients with AIDS and MS due to

  3. Do freequent Antenatal Care Visits ensure access and adherence to ...

    African Journals Online (AJOL)

    Do freequent Antenatal Care Visits ensure access and adherence to Intermittent preventive treatment of Malaria in pregnancy in an Urban Hospital in South West Nigeria? ... Respondents were enrolled over a period of three months in a secondary healthcare facility within 24 hours of delivery. Demographic details, delivery ...

  4. Prevalence and Determinants of Early Antenatal Care Visit among ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Antenatal care (ANC), which is given to pregnant women, is widely used for prevention, early diagnosis and treatment of general medical and .... of Ethiopia. The town has 9 kebeles - the smallest administrative units in Ethiopia. There are two hospitals (one government and one private), two health centers, ten private clinics,.

  5. Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study.

    Science.gov (United States)

    Vallely, Lisa M; Toliman, Pamela; Ryan, Claire; Rai, Glennis; Wapling, Johanna; Gabuzzi, Josephine; Allen, Joyce; Opa, Christine; Munnull, Gloria; Kaima, Petronia; Kombuk, Benny; Kumbia, Antonia; Kombati, Zure; Law, Greg; Kelly-Hanku, Angela; Wand, Handan; Siba, Peter M; Mola, Glen D L; Kaldor, John M; Vallely, Andrew J

    2017-12-29

    Papua New Guinea (PNG) has among the highest estimated prevalences of genital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG. Women attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses. 1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%-21%) and positive predictive value (PPV) (7%-37%), but high specificity (76%-89%) and moderate negative predictive value (NPV) (55%-86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, 'vaginal discharge syndrome' had moderate to high sensitivity (72%-78%) and NPV (62%-94%), but low specificity (26%-33%) and PPV (8%-38%). 'Lower abdominal pain syndrome' had low sensitivity (26%-41%) and PPV (8%-23%) but moderate specificity (66%-68%) and high NPV (74%-93%) among women attending WWC, and moderate-high sensitivity (67%-79%) and NPV (62%-86%) but low specificity (26%-28%) and PPV (14%-33%) among SHC attendees. The performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent

  6. Adolescent Steroid Use.

    Science.gov (United States)

    Office of Inspector General (DHHS), Washington, DC.

    The study focused on non-medical steroid use by adolescents according to data obtained from the National Institute on Drug Abuse, professional literature, 30 key informants knowledgeable in steroid issues, and 72 current or former steroid users. The findings indicated: (1) over 250,000 adolescents, primarily males, used or have used steroids, and…

  7. The Inhaled Steroid Treatment As Regular Therapy in Early Asthma (START) study 5-year follow-up: effectiveness of early intervention with budesonide in mild persistent asthma

    DEFF Research Database (Denmark)

    Busse, William W; Pedersen, Søren; Pauwels, Romain A

    2008-01-01

    BACKGROUND: The Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study enrolled 7241 patients aged 5 to 66 years with recent-onset, mild persistent asthma to assess early intervention with the inhaled corticosteroid budesonide on long-term asthma control. OBJECTIVE: The open......-label phase of the START study was included to determine the effect on lung function and asthma control of adding budesonide to the reference group patients who had not initially received inhaled corticosteroids. METHODS: Patients were randomized to double-blind treatment with budesonide, 200 mug (those aged...... asthma therapy for 3 years, after which all patients received 2 years of open-label treatment with budesonide once daily. RESULTS: During the full 5-year study period, postbronchodilator FEV(1) percent predicted decreased, irrespective...

  8. Fluoroscopically-guided transforaminal epidural steroid injection for the treatment of sciatica due to herniated nucleus pulposus

    International Nuclear Information System (INIS)

    Liu Xiao; Wang Jianhui; Duan Zhaohui; Xu Zhitao; Shu Xiaomin; Qiu Ronghua

    2009-01-01

    Objective: To discuss the therapeutic benefit of fluoroscopically-guided lumbar transforaminal epidural steroid injections (TFESI) in treating patients with sciatica due to a herniated nucleus pulposus. Methods: From October 2004 to November 2007, fluoroscopically-guided lumbar TFESI as performed in 79 patients (41 males and 38 females with a mean age of 45.75 years,ranged from 20 to 70 years) with sciatica due to a herniated nucleus pulposus. Patients had a symptomatic course of disease from 8 weeks to 22 years and showed no response to conservative treatment. The diagnosis was confirmed by computed tomography or magnetic resonance imaging. TFESI was performed at patient's request. Additional injections, up to 3 times, were given with an interval of 7 or 10 days. The injection medicine consisted of 25 mg of prednisolone acetate and (9-14) ml of 0.5% lidocaine. Patients were evaluated by an independent observer and received questionnaires before the initial injection and at 6,12 months after TFESI. Questionnaires included an eleven points visual analog scale (VAS) and a five points patient satisfaction scale. A successful outcome required a patient satisfaction scale score of 3 (very good) or 4(excellent) and a reduction on the VAS score of 2 or more points after TFESI. Pain relief was classified as 'excellent' when the pain was completely resolved or diminished by 5 points or more, as 'good' when a diminution of pain was 2 points or more, as 'fair' and 'poor' when a diminution of pain was 1 point or less, or even an increase in pain. Results: Twenty-nine patients received single injection, 22 patients received two, 15 patients received three and 13 patients received four times of injection, with a mean of 1.96 times per patient. The mean VAS scores were 6.5(ranged 3.5-9.5) before and 3.8(ranged 0-9.5) 6 months after the procedure. Pain relief was graded as excellent in 35 patients (44.3%), good in 26 patients(32.9%), fair in 10 patients(12.7%), and poor in 8

  9. [Prevention of preterm birth complications by antenatal corticosteroid administration].

    Science.gov (United States)

    Schmitz, T

    2016-12-01

    To evaluate short- and long-term benefits and risks associated with antenatal administration of a single course of corticosteroids and the related strategies: multiple and rescue courses. The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Antenatal administration of a single course of corticosteroids before 34 weeks of gestation is associated in the neonatal period with a significant reduction of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) and death (LE1), and in possibly childhood with a reduction of cerebral palsy and increased psychomotor development index and intact survival (LE3). However, this treatment is associated with alterations of the HPA axis response persisting until 8 weeks after birth (LE2) and possibly with insulin resistance in adulthood (LE3). Antenatal corticosteroid administration after 34 weeks is associated, with high number needed to treat, with reduced respiratory morbidity (LE2), with no significant effect on neurological (LE2) or digestive (LE2) morbidities. Because of a very favourable benefit/risk balance, antenatal administration of a single course of corticosteroids is recommended for women at risk of preterm delivery before 34 weeks (grade A). The minimum gestational age for treatment will depend on the threshold chosen to start neonatal intensive care in maternity units and perinatal networks (Professional consensus). After 34 weeks, evidences are not consistent enough to recommend systematic antenatal corticosteroid treatment (grade B), however, a course might be indicated in the clinical situations associated with the higher risk of "severe" RDS, mainly in case of planned cesarean delivery (gradeC). In case of imminent preterm birth, pre-empting the second betamethasone injection is not recommended (gradeC), because this policy might be associated with increased rates of

  10. Histopathological and Morphometric Evaluation in the Testis and Epididymis of Adult Rats Submitted To A Recovery Period after Treatment with Anabolic Steroid, Alcohol and/or Nicotine

    Directory of Open Access Journals (Sweden)

    Bianca Ribeiro de Souza

    2017-09-01

    Full Text Available Objective: Frequently, reproductive toxic substances such as androgenic anabolic steroids, alcohol and nicotine are used in association by adolescents and adults, in an indiscriminate manner. This study investigated the testicular and epididymal tissue of adult rats submitted to a recovery period after treatment with anabolic steroid, alcohol and /or nicotine. Materials and Methods: The animals (n=42 were divided into three control groups simulating the drugs administration routes (CI: distilled water, oral; CII: saline solution, subcutaneous; CIII: water and saline solution and groups treated with a testosterone esters mixture (T: 7.5 mg/kg body weight - b.w., subcutaneous, alcohol (AL: 3.5 g/kg b.w. of ethanol 25%, oral, nicotine (N: 2.0 mg/kg b.w., subcutaneous, and co-administration of these three substances (T/AL/N. After 15 consecutive days of treatment (once a day, the animals were kept for 30 days in recovery. At the end of this period, the testes and epididymides were collected, weighed and processed for histological and morphometric analysis by light microscope. Results: All groups treated with toxic substances presented histopathological changes in testes and epididymis after the recovery period. There was a significant decrease (p [J Interdiscip Histopathol 2017; 5(3.000: 92-98

  11. Assessing recovery of in vitro steroid production in male rainbow darter (Etheostoma caeruleum) in response to municipal wastewater treatment plant infrastructure changes.

    Science.gov (United States)

    Marjan, Patricija; Van Der Kraak, Glen J; MacLatchy, Deborah L; Fuzzen, Meghan L M; Bragg, Leslie M; McMaster, Mark E; Tetreault, Gerald R; Servos, Mark R

    2018-02-01

    The present study examined in vitro 11-ketotestosterone and testosterone production by the testes of rainbow darter (Etheostoma caeruleum) collected from selected reference sites and downstream of 2 municipal wastewater treatment plants (MWWTPs; Waterloo and Kitchener) on the central Grand River (Ontario, Canada), over a 6-yr period (2011-2016). The main objective was to investigate if infrastructure upgrades at the Kitchener MWWTP in 2012 resulted in a recovery of this response in the post-upgrade period (2013-2016). Two supporting studies showed that the fall season is appropriate for measuring in vitro sex steroid production because it provides stable detection of steroid patterns, and that the sample handling practiced in the present study did not introduce a bias. Infrastructure upgrades of the Kitchener MWWTP resulted in significant reductions in ammonia and estrogenicity. After the upgrades, 11-ketotestosterone production by MWWTP-exposed fish increased in 2013 and it continued to recover throughout the study period of 2014 through 2016, returning to levels measured in reference fish. Testosterone production was less sensitive and it lacked consistency. The Waterloo MWWTP underwent some minor upgrades but the level of ammonia and estrogenicity remained variable over time. The production of 11-ketotestosterone and testosterone in rainbow darter below the Waterloo MWWTP was variable and without a clear recovery pattern over the course of the present study. The results of the present study demonstrated that measuring production of sex steroids (especially 11-ketotestosterone) over multiple years can be relevant for assessing responses in fish to environmental changes such as those resulting from major infrastructure upgrades. Environ Toxicol Chem 2018;37:501-514. © 2017 SETAC. © 2017 SETAC.

  12. Basiliximab treatment for steroid-resistant rejection in pediatric patients following liver transplantation for acute liver failure.

    Science.gov (United States)

    Shigeta, Takanobu; Sakamoto, Seisuke; Uchida, Hajime; Sasaki, Kengo; Hamano, Ikumi; Kanazawa, Hiroyuki; Fukuda, Akinari; Kawai, Toshinao; Onodera, Masafumi; Nakazawa, Atsuko; Kasahara, Mureo

    2014-12-01

    An IL-2 receptor antagonist, basiliximab, decreases the frequency of ACR in liver transplant (LT) recipients as induction therapy. The aim of this study was to evaluate the effectiveness of basiliximab against SRR as rescue therapy in pediatric LT patients with ALF. Forty pediatric ALF patients underwent LT between November 2005 and July 2013. Among them, seven patients suffering from SRR were enrolled in this study. The median age at LT was 10 months (6-12 months). SRR was defined as the occurrence of refractory rejection after more than two courses of steroid pulse therapy. Basiliximab was administered to all patients. The withdrawal of steroids without deterioration of the liver function was achieved in six patients treated with basiliximab therapy without patient mortality, although one patient developed graft loss and required retransplantation for veno-occlusive disease. The pathological examinations of liver biopsies in the patients suffering from SRR revealed severe centrilobular injuries, particularly fibrosis within one month after LT. We demonstrated the effectiveness and safety of rescue therapy consisting of basiliximab for SRR in pediatric LT recipients with ALF. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Narrowband UVB treatment is highly effective and causes a strong reduction in the use of steroid and other creams in psoriasis patients in clinical practice.

    Directory of Open Access Journals (Sweden)

    John Foerster

    Full Text Available Narrowband NB-UVB phototherapy (NB-UVB is an effective treatment for psoriasis, as demonstrated by clinical trials. However, due to required infrastructure and need for treatment attendance opinions on the value of offering this treatment in routine practice vary. AIMS: To provide high quality large-scale and long-term data on the efficacy of NB-UVB for psoriasis under real-world conditions in order to assist in management decisions.The following resources were employed: (1 complete and prospectively recorded prescription drug records for a population of 420,000 marked by low demographic mobility, (2 prospectively recorded clinical treatment outcomes for all NB-UVB treatment episodes occurring in the local population; (3 complete dermatology electronic treatment records of all psoriasis patients, allowing cross-validation of diagnoses and treatment records. Using these data sets, we analysed all first-ever initial NB-UVB treatment episodes occurring over 79 months (n = 1749 for both clinical outcomes and the effect of NB-UVB on the use of topical treatments for psoriasis.Around 75% of patients both achieved a status of "clear/minimal disease" and used fewer topical treatments. NB-UVB treatment led to a strong reduction for both steroid creams (25% and psoriasis-specific topicals, e.g. vitamin-D products (30% during the 12-month period following NB-UVB treatment. The effects measured were specific as no effect of NB-UVB was noted on drug prescriptions unrelated to psoriasis. Results were independent of individuals administering and/or scoring treatment, as they were highly similar between four geographically separate locations.NB-UVB treatment is highly effective and leads to a remarkable reduction in the need for topical cream treatments for a period of at least 12 months.

  14. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease - effect of age, gender, disc pathology and multi-segmental changes

    Energy Technology Data Exchange (ETDEWEB)

    Oder, Bernhard; Loewe, Maria; Reisegger, Michael; Thurnher, Siegfried A. [Hospital Brothers of St. John of God, Department of Radiology and Nuclear Medicine, Vienna (Austria); Lang, Wilfried [Hospital Brothers of St. John of God, Department of Neurology, Vienna (Austria); Ilias, Wilfried [Hospital Brothers of St. John of God, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Vienna (Austria)

    2008-09-15

    Oxygen-ozone nucleolysis (ONL) is a new, minimally invasive procedure for the treatment of discogenic low back pain with or without radicular symptoms. The aim of the present study was to determine associations between the morphology of the basic disease, patient-specific factors and the outcome of the treatment. Six hundred and twelve patients not responding to conservative therapy were divided into five groups (disc bulging, disc herniation, postoperative patients, osteochondrosis, others) and subjected to nucleolysis with ozone and to periradicular infiltration with steroids and local anaesthesia. The success of treatment was assessed by means of a visual analog pain scale (VAS) and the Oswestry Disability Index (ODI). A significant reduction in the VAS was registered after 2 and 6 months (from 8.6 to 5.4 and 6.0; p<0.001) in all patient groups; an excellent therapy response (VAS below 3.0) was achieved by about a third of the patients. A significant improvement in ODI was registered in all patients (46 to 31; p<0.001), most pronounced in the herniation group (25.5, p=0.015). Patients below 50 years had significantly better values in the VAS and ODI score 6 months after treatment. Final VAS and ODI scores for patients with a single diseased segment were 4.2 and 28.0, in two affected segments 6.5 and 32 and in three segments 6.7 and 38.5 (p<0.001 and p=0.051). ONL with periradicular steroid therapy might exert a functional and sustained analgesic effect in patients with degenerative changes in the lumbar spine not responding to conservative therapy and was most effective below 50 years with disc herniation in one segment. (orig.)

  15. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease - effect of age, gender, disc pathology and multi-segmental changes

    International Nuclear Information System (INIS)

    Oder, Bernhard; Loewe, Maria; Reisegger, Michael; Thurnher, Siegfried A.; Lang, Wilfried; Ilias, Wilfried

    2008-01-01

    Oxygen-ozone nucleolysis (ONL) is a new, minimally invasive procedure for the treatment of discogenic low back pain with or without radicular symptoms. The aim of the present study was to determine associations between the morphology of the basic disease, patient-specific factors and the outcome of the treatment. Six hundred and twelve patients not responding to conservative therapy were divided into five groups (disc bulging, disc herniation, postoperative patients, osteochondrosis, others) and subjected to nucleolysis with ozone and to periradicular infiltration with steroids and local anaesthesia. The success of treatment was assessed by means of a visual analog pain scale (VAS) and the Oswestry Disability Index (ODI). A significant reduction in the VAS was registered after 2 and 6 months (from 8.6 to 5.4 and 6.0; p<0.001) in all patient groups; an excellent therapy response (VAS below 3.0) was achieved by about a third of the patients. A significant improvement in ODI was registered in all patients (46 to 31; p<0.001), most pronounced in the herniation group (25.5, p=0.015). Patients below 50 years had significantly better values in the VAS and ODI score 6 months after treatment. Final VAS and ODI scores for patients with a single diseased segment were 4.2 and 28.0, in two affected segments 6.5 and 32 and in three segments 6.7 and 38.5 (p<0.001 and p=0.051). ONL with periradicular steroid therapy might exert a functional and sustained analgesic effect in patients with degenerative changes in the lumbar spine not responding to conservative therapy and was most effective below 50 years with disc herniation in one segment. (orig.)

  16. Prematuridad extrema y uso materno de corticoides antenatal

    Directory of Open Access Journals (Sweden)

    Ramón Acosta Díaz

    2000-12-01

    Full Text Available Con el objetivo de evaluar el uso de corticoides antenatal en las madres con amenaza de parto pretérmino y el efecto sobre los recién nacidos prematuros extremos, se realizó un estudio prospectivo, longitudinal, y analítico entre todos los niños nacidos vivos con edad gestacional menor de 31 semanas y peso inferior a 1 500 g, ocurridos en el Hospital Ginecoobstétrico Provincial Docente "Justo Legón Padilla" de Pinar del Río, desde enero de 1997 hasta julio de 1998. Se estudiaron los 53 niños con estas características. Los datos que se obtuvieron se depositaron en base de datos; para el procesamiento estadístico, se aplicó la prueba de chi cuadrado, con un nivel de significación de p In order to evaluate the antenatal use of adrenal cortex hormones in mothers with preterm delivery threat and its effect on extreme premature infants, it was conducted a prospective, longitudinal and analytical study among the live births with gestational age under 31 weeks and a weight lower than 1 500 g registered at "Justo Legón Padilla" Provincial Gynecoobstetric Teaching Hospital, in Pinar del Río, from January, 1997, to July, 1998. 53 children with these characteristics were studied. The collected data were entered in databases. The chi square test with a level of significance of p<0.05 was used for the statistical processing. Steroids were administered to 32 mothers. A statistically significant reduction of the hyaline membrane disease, the use of ventilation, the complications and mortality was observed with the antenatal use of maternal adrenal cortex hormones. There were no statistically significant differences between the study and the control group as regards sex, mean gestational age (29.0/28.9 weeks and weights (1207.9/1180.0 g.

  17. Antenatal diagnosis of congenital deafness.

    Science.gov (United States)

    Isaacson, G

    1988-01-01

    Advances in the field of antenatal diagnosis have made possible the detection of profound sensorineural hearing loss prior to birth. Fetal motion in response to sound and auditory evoked potential testing can determine the presence of fetal hearing in the third trimester of pregnancy. Imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging hold promise for the diagnosis of some forms of congenital deafness in the second trimester fetus. The methods by which congenital deafness soon may be diagnosed and the implications for the otologist are discussed.

  18. Influence of CYP2C9 and COX-2 Genetic Polymorphisms on Clinical Efficacy of Non-Steroidal Anti-Inflammatory Drugs in Treatment of Ankylosing Spondylitis.

    Science.gov (United States)

    Wang, Yu; Yi, Xiao-Dong; Lu, Hai-Lin

    2017-04-12

    BACKGROUND The aim of this study was to evaluate the relationships of CYP2C9 and COX-2 genetic polymorphisms with therapeutic efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in treatment of ankylosing spondylitis (AS). MATERIAL AND METHODS We enrolled 130 AS inpatients and outpatients in the Arthritis and Rheumatism Department of Peking University First Hospital and 106 healthy people getting routine check-ups between September 2013 and July 2014. CYP2C9 and COX-2 genetic polymorphisms were detected by PCR-RFLP. All AS patients underwent medical treatment and 12-week follow-up treatment. Score differences of BASDAI, ASAS20, ASAS50, and ASAS70 for AS patients with different genotypes before and after treatment were compared. RESULTS In terms of COX-2-1290A/G and -1195G/A gene polymorphism genotype and allele frequency, the case group and control group were obviously different (all P0.05). AS patients had improved BASDAI, ASAS20, ASAS50, and ASAS70 scores after they received NSAID treatment (all Ptreatment of AS and COX-2 gene -1290A/G and -1195G/A polymorphism were associated (all P0.05). CONCLUSIONS COX-2-1290A/G and -1195G/A polymorphism may increase AS risk and they both can be considered as biological indicators for prediction of efficacy of NSAIDs in treatment of AS.

  19. Group antenatal care: new pedagogic method for antenatal care--a pilot study.

    Science.gov (United States)

    Wedin, Kathe; Molin, Johan; Crang Svalenius, Elizabeth L

    2010-08-01

    to investigate how women who attended group antenatal care experienced the information they received, compared with women who attended traditional antenatal care, and their satisfaction with the form of care. The aim was also to determine the effect of group antenatal care on women's social networks compared with traditional antenatal care. a pilot study with an intervention group (group antenatal care) and a control group (traditional antenatal care). Both groups were selected through informed choice. A questionnaire and a follow-up telephone call, using a structured questionnaire, were used to evaluate both groups. for each woman who had chosen to be in the intervention group, two women who had chosen traditional antenatal care were selected from the same antenatal clinic and given the same questionnaire. 35/45 (77%) women in the intervention group returned a completed questionnaire, compared with 40/85 (48%) women in the control group. There was little difference in satisfaction with information between the two groups, and overall satisfaction was high. at six months post partum, the women who attended group antenatal care still met others from the group more regularly than the women who attended traditional antenatal care. group antenatal care is well accepted by women, and can better utilise midwives' time. Copyright 2008 Elsevier Ltd. All rights reserved.

  20. Determinants of Antenatal Care Use in Ghana

    NARCIS (Netherlands)

    Overbosch, G.B.; Nsowah-Nuamah, N.N.N.; van den Boom, G.J.M.; Damnyag, L.

    2004-01-01

    The paper investigates the determinants of antenatal care use in Ghana. In particular, we study how economic factors affect the demand for antenatal care and the probability that the number of visits falls below the recommended number of four. Estimation results from a nested three-level multinomial

  1. Are Steroids Worth the Risk?

    Science.gov (United States)

    ... by passing laws controlling steroid distribution. How Do Anabolic Steroids Work? Anabolic steroids stimulate muscle tissue to grow and "bulk up" ... effect of naturally produced testosterone on the body. Anabolic steroids can remain in the body anywhere from a ...

  2. Drug Facts: Anabolic Steroids

    Science.gov (United States)

    ... the menstrual cycle enlarged clitoris deepened voice In teens: stunted growth (when high hormone levels from steroids signal to the body to stop bone growth too early) stunted height (if teens use steroids before their growth spurt) Some of ...

  3. Geographic Variation in Epidural Steroid Injection Use in Medicare Patients

    OpenAIRE

    Friedly, Janna; Chan, Leighton; Deyo, Richard

    2008-01-01

    Background: The rates of epidural steroid injections have increased dramatically over time, with conflicting evidence regarding the efficacy of epidural steroid injections for the treatment of various low-back pain disorders. Given the uncertainty about their role, we sought to evaluate the geographic variation in the use of epidural steroid injections for low back pain within the United States. We also sought to determine whether greater rates of epidural steroid injections are associated wi...

  4. Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol

    Directory of Open Access Journals (Sweden)

    Althabe Fernando

    2012-09-01

    Full Text Available Abstract Background Preterm birth is a major cause of neonatal mortality, responsible for 28% of neonatal deaths overall. The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful perinatal intervention to reduce neonatal mortality in resource rich environments. The effect of antenatal steroids to reduce mortality and morbidity among preterm infants in hospital settings in developed countries with high utilization is well established, yet they are not routinely used in developing countries. The impact of increasing antenatal steroid use in hospital or community settings with low utilization rates and high infant mortality among premature infants due to lack of specialized services has not been well researched. There is currently no clear evidence about the safety of antenatal corticosteroid use for community-level births. Methods We hypothesize that a multi country, two-arm, parallel cluster randomized controlled trial to evaluate whether a multifaceted intervention to increase the use of antenatal corticosteroids, including components to improve the identification of pregnancies at high risk of preterm birth and providing and facilitating the appropriate use of steroids, will reduce neonatal mortality at 28 days of life in preterm newborns, compared with the standard delivery of care in selected populations of six countries. 102 clusters in Argentina, Guatemala, Kenya, India, Pakistan, and Zambia will be randomized, and around 60,000 women and newborns will be enrolled. Kits containing vials of dexamethasone, syringes, gloves, and instructions for administration will be distributed. Improving the identification of women at high risk of preterm birth will be done by (1 diffusing recommendations for antenatal corticosteroids use to health providers, (2 training health providers on identification of women at high risk of preterm birth, (3 providing reminders to health providers on the use of the kits, and

  5. Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol.

    Science.gov (United States)

    Althabe, Fernando; Belizán, José M; Mazzoni, Agustina; Berrueta, Mabel; Hemingway-Foday, Jay; Koso-Thomas, Marion; McClure, Elizabeth; Chomba, Elwyn; Garces, Ana; Goudar, Shivaprasad; Kodkany, Bhalchandra; Saleem, Sarah; Pasha, Omrana; Patel, Archana; Esamai, Fabian; Carlo, Waldemar A; Krebs, Nancy F; Derman, Richard J; Goldenberg, Robert L; Hibberd, Patricia; Liechty, Edward A; Wright, Linda L; Bergel, Eduardo F; Jobe, Alan H; Buekens, Pierre

    2012-09-19

    Preterm birth is a major cause of neonatal mortality, responsible for 28% of neonatal deaths overall. The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful perinatal intervention to reduce neonatal mortality in resource rich environments. The effect of antenatal steroids to reduce mortality and morbidity among preterm infants in hospital settings in developed countries with high utilization is well established, yet they are not routinely used in developing countries. The impact of increasing antenatal steroid use in hospital or community settings with low utilization rates and high infant mortality among premature infants due to lack of specialized services has not been well researched. There is currently no clear evidence about the safety of antenatal corticosteroid use for community-level births. We hypothesize that a multi country, two-arm, parallel cluster randomized controlled trial to evaluate whether a multifaceted intervention to increase the use of antenatal corticosteroids, including components to improve the identification of pregnancies at high risk of preterm birth and providing and facilitating the appropriate use of steroids, will reduce neonatal mortality at 28 days of life in preterm newborns, compared with the standard delivery of care in selected populations of six countries. 102 clusters in Argentina, Guatemala, Kenya, India, Pakistan, and Zambia will be randomized, and around 60,000 women and newborns will be enrolled. Kits containing vials of dexamethasone, syringes, gloves, and instructions for administration will be distributed. Improving the identification of women at high risk of preterm birth will be done by (1) diffusing recommendations for antenatal corticosteroids use to health providers, (2) training health providers on identification of women at high risk of preterm birth, (3) providing reminders to health providers on the use of the kits, and (4) using a color-coded tape to measure

  6. The clinical characteristics and non-steroidal treatment for radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy

    International Nuclear Information System (INIS)

    Ogo, Etsuyo; Komaki, Ritsuko; Abe, Toshi; Uchida, Masafumi; Fujimoto, Kiminori; Suzuki, Gen; Tsuji, Chiyoko; Suefuji, Hiroaki; Etou, Hidehiro; Hattori, Chikayuki; Watanabe, Yuko; Hayabuchi, Naofumi

    2010-01-01

    Purpose: A rare and unique occurrence of radiation-induced pulmonary injury was observed outside the tangential field for early breast cancer treatment. The findings appeared to be idiopathic and were termed radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome. The goal of this study was to report and determine the incidence, analyze the characteristics of the pulmonary lesions on the images and also investigate the treatment methods. Materials and methods: A retrospective analysis was conducted of 616 consecutive patients that underwent breast-conserving therapy (BCT) from January 1992 to December 2008. The patients were observed at least one year after radiotherapy for BCT. Radiotherapy was administered by 4 MV photons in all patients. The patients underwent chest X-rays periodically. If the BOOP syndrome was found, chest computed tomography (CT) were conducted to identify the characteristics of the pulmonary lesion outside the radiation field. Results: The incidence of the radiation-induced BOOP syndrome was 12 patients (1.9%). Six of them had fever and cough, 6 had no symptoms. The pulmonary lesions were classified into four patterns on chest CT. Progression of the pulmonary lesions observed on chest X-ray were classified into three patterns. BOOP syndrome appeared within 5.6 months after radiotherapy and completely disappeared within 12 months after its onset. Their clinical conditions were not severe and these pulmonary lesions disappeared gradually without use of steroids in our institution. There was no death caused by BOOP syndrome. Conclusions: Although the incidence of BOOP syndrome and its associated prognosis are not significant, this clinical condition must be carefully followed using diagnositic imaging in order to not over administer steroids.

  7. Antenatal stress: An Irish case study.

    LENUS (Irish Health Repository)

    Carolan-Olah, Mary

    2013-05-16

    score between the different age groups (F4,68=1.68, P=0.16), living arrangements (F4,67=2.30, P=0.068) or usual occupations (F4,68=1.25, P=0.3). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:: this study found high levels of antenatal stress, anxiety, and depressive symptoms in a low risk pregnant population, in an economically impacted region in Ireland. These findings have implications for fetal development and maternal health during pregnancy and in the post partum. Further studies are important to confirm rates and should be conducted over a longer time frame with data collected at more than one point in time, such as mid and late pregnancy. If findings are confirmed, early recognition and treatment of stress, anxiety and depressive symptoms is important to ameliorate some of the harmful effects of these conditions.

  8. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease--effect of age, gender, disc pathology and multi-segmental changes.

    Science.gov (United States)

    Oder, Bernhard; Loewe, Maria; Reisegger, Michael; Lang, Wilfried; Ilias, Wilfried; Thurnher, Siegfried A

    2008-09-01

    Oxygen-ozone nucleolysis (ONL) is a new, minimally invasive procedure for the treatment of discogenic low back pain with or without radicular symptoms. The aim of the present study was to determine associations between the morphology of the basic disease, patient-specific factors and the outcome of the treatment. Six hundred and twelve patients not responding to conservative therapy were divided into five groups (disc bulging, disc herniation, postoperative patients, osteochondrosis, others) and subjected to nucleolysis with ozone and to periradicular infiltration with steroids and local anaesthesia. The success of treatment was assessed by means of a visual analog pain scale (VAS) and the Oswestry Disability Index (ODI). A significant reduction in the VAS was registered after 2 and 6 months (from 8.6 to 5.4 and 6.0; p herniation group (25.5, p = 0.015). Patients below 50 years had significantly better values in the VAS and ODI score 6 months after treatment. Final VAS and ODI scores for patients with a single diseased segment were 4.2 and 28.0, in two affected segments 6.5 and 32 and in three segments 6.7 and 38.5 (p lumbar spine not responding to conservative therapy and was most effective below 50 years with disc herniation in one segment.

  9. Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Arindam Kumar Hazra

    2016-01-01

    Full Text Available Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP. Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. Methods: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg through caudal route either using ultrasound guidance (Group U, n = 25 or fluoroscopy guidance (Group F, n = 25. Pre-procedural visual analogue scale (VAS score and Oswestry Disability Index (ODI were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS score and ODI at the 2nd week and again at the end of 1st and 2nd month. Results: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively,P< 0.001. Significant reduction in VAS score and ODI (clinical improvement was noted in the follow-up time points and comparable between the groups at all time points. Conclusion: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores remains comparable between both the techniques.

  10. Radioimmunoassay of steroid hormones

    International Nuclear Information System (INIS)

    Hampl, R.; Starka, L.

    1976-01-01

    A list is given of steroids currently determined using the RIA method based on the reversible interaction of labelled and non-labelled steroids within the binding points of specific antibodies. Steroids do not have the properties of antigens, and antibodies are therefore obtained from conjugates of steroid derivatives with macromolecules where the steroid has the function of hapten. The most important synthetic methods of preparing the given derivatives are listed, and questions of the relation of the specificity of the antiserum and the structure of the respective derivative are discussed, the basic data characterizing the antiserum (titre, affinity and specificity) are described and methods are given used for measuring these variables. The technical aspects of RIA and the differences between the RIA determination of steroids and of other substances are given. The Amersham Radiochemical Centre antigens, kits and steroid hormones are recommended for use. (L.O.)

  11. Gonadotropins in the Russian Sturgeon: Their Role in Steroid Secretion and the Effect of Hormonal Treatment on Their Secretion.

    Directory of Open Access Journals (Sweden)

    Svetlana Yom-Din

    Full Text Available In the reproduction process of male and female fish, pituitary derived gonadotropins (GTHs play a key role. To be able to specifically investigate certain functions of Luteinizing (LH and Follicle stimulating hormone (FSH in Russian sturgeon (Acipenser gueldenstaedtii; st, we produced recombinant variants of the hormones using the yeast Pichia pastoris as a protein production system. We accomplished to create in vitro biologically active heterodimeric glycoproteins consisting of two associated α- and β-subunits in sufficient quantities. Three dimensional modelling of both GTHs was conducted in order to study the differences between the two GTHs. Antibodies were produced against the unique β-subunit of each of the GTHs, in order to be used for immunohistochemical analysis and to develop an ELISA for blood and pituitary hormone quantification. This detection technique revealed the specific localization of the LH and FSH cells in the sturgeon pituitary and pointed out that both cell types are present in substantially higher numbers in mature males and females, compared to immature fish. With the newly attained option to prevent cross-contamination when investigating on the effects of GTH administration, we compared the steroidogeneic response (estradiol and 11-Keto testosterone (11-KT in female and males, respectively of recombinant stLH, stFSH, and carp pituitary extract in male and female sturgeon gonads at different developmental stages. Finally, we injected commercially available gonadotropin releasing hormones analog (GnRH to mature females, and found a moderate effect on the development of ovarian follicles. Application of only testosterone (T resulted in a significant increase in circulating levels of 11-KT whereas the combination of GnRH + T did not affect steroid levels at all. The response pattern for estradiol demonstrated a similar situation. FSH levels showed significant increases when GnRH + T was administered, while no changes

  12. Imatinib mesylate for the treatment of steroid-refractory sclerotic-type cutaneous chronic graft-versus-host disease.

    Science.gov (United States)

    Baird, Kristin; Comis, Leora E; Joe, Galen O; Steinberg, Seth M; Hakim, Fran T; Rose, Jeremy J; Mitchell, Sandra A; Pavletic, Steven Z; Figg, William D; Yao, Lawrence; Flanders, Kathleen C; Takebe, Naoko; Sarantopoulos, Stefanie; Booher, Susan; Cowen, Edward W

    2015-06-01

    Sclerotic skin manifestations of chronic graft-versus-host disease (ScGVHD) lead to significant morbidity, including functional disability from joint range of motion (ROM) restriction. No superior second-line therapy has been established for steroid-refractory disease. Imatinib mesylate is a multikinase inhibitor of several signaling pathways implicated in skin fibrosis with in vitro antifibrotic activity. We performed an open-label pilot phase II trial of imatinib in children and adults with corticosteroid-refractory ScGVHD. Twenty patients were enrolled in a 6-month trial. Eight received a standard dose (adult, 400 mg daily; children, 260 mg/m(2) daily). Because of poor tolerability, 12 additional patients underwent a dose escalation regimen (adult, 100 mg daily initial dose up to 200 mg daily maximum; children, initial dose 65 mg/m(2) daily up to 130 mg/m(2) daily). Fourteen patients were assessable for primary response, improvement in joint ROM deficit, at 6 months. Primary outcome criteria for partial response was met in 5 of 14 (36%), stable disease in 7 of 14 (50%), and progressive disease in 2 of 14 (14%) patients. Eleven patients (79%), including 5 with partial response and 6 with stable disease, demonstrated a positive gain in ROM (range of 3% to 94% improvement in deficit). Of 13 patients with measurable changes at 6 months, the average improvement in ROM deficit was 24.2% (interquartile range, 15.5% to 30.5%; P = .011). This trial is registered at http://clinicaltrials.gov as NCT007020689. Published by Elsevier Inc.

  13. [Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications].

    Science.gov (United States)

    2017-01-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) are a broad class of non glucocorticoid drugs which are extensively used in anti-inflammatory, analgesic, and antipyretic therapies. However, NSAIDs may cause many side effects, most commonly in gastrointestinal(GI) tract. Cardiovascular system, kidney, liver, central nervous system and hematopoietic system are also involved. NSAID-induced GI side effects not only endanger the patients' health, increase mortality, but also greatly increase the cost of medical care. Therefore, how to reduce GI side effects is of particular concern to clinicians. The Chinese Rheumatism Data Center(CRDC) and Chinese Systemic Lupus Erythematosus Treatment and Research Group(CSTAR) compose a "Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications" , as following: (1) GI lesions are the most common side effects of NSAIDs. (2) NSAID-induced GI side effects include gastritis, esophagitis, gastric and duodenal ulcers, bleeding, perforation and obstruction. (3) With the application of capsule endoscopy and small intestinal endoscopy, growing attention is being paid to the NASID-induced small intestine mucosa damage, which is mainly erosion and ulcer. (4) Risk factors related to NSAID-induced GI ulcers include: Helicobacter pylori (Hp) infection, age> 65 years, past history of GI ulcers, high doses of NSAIDs, multiple-drug combination therapy, and comorbidities, such as cardiovascular disease and nephropathy.(5) GI and cardiovascular function should be evaluated before using NSAIDs and gastric mucosal protective agents. (6) The risk of GI ulcers and complications caused by selective cyclooxygenase-2 (COX-2) inhibitors is less than that of non-selective COX-2 inhibitors. (7)Hp eradication therapy helps to cure GI ulcers and prevent recurrence when Hp infection is positive in NSAID-induced ulcers. (8) Proton pump inhibitor (PPI) is the first choice for the

  14. Steroid-sparing effect of mycophenolate mofetil in the treatment of a subepidermal blistering autoimmune disease in a dog : clinical communication

    Directory of Open Access Journals (Sweden)

    P.J. Ginel

    2010-05-01

    Full Text Available A 7-year-old female Cocker spaniel-cross was referred with an 8-month history of mucocutaneous erosive dermatitis. On physical examination, skin lesions affected the eyelids and periocular area, lips and vulva. Lesions were symmetrical with small diffuse superficial ulcers, haemorrhagic crusts, adherent purulent exudation in haired skin, and alopecia with hyperpigmentation and scarring. Histopathologic evaluation showed multiple, non-intact dermoepidermal junction vesicles and ulceration associated with a dermal lichenoid infiltrate. Immunohistochemistry showed strong to moderate reactivity in the dermoepidermal junction for the antibodies directed against canine IgG, human IgG lambda light chains and C3, respectively. A diagnosis of autoimmune subepidermal blistering dermatosis was made. Treatment with oral prednisone at 2 mg/kg and mycophenolate mofetil (MMF at 20 mg/kg twice daily was initiated and after 4 weeks the ulcers and erosions were cured. During the rest of treatment, MMF was maintained at 10 mg/kg twice daily and prednisone could be tapered to 0.25 mg/kg once every other day without recurrences. In conclusion, this case report shows that MMF was well tolerated and might be effective as steroid-sparing agent in the long-term treatment of this autoimmune subepidermal blistering disease.

  15. Differential Effects of Clinical Doses of Antenatal Betamethasone on Nephron Endowment and Glomerular Filtration Rate in Adult Sheep

    OpenAIRE

    Zhang, Jie; Massmann, G. Angela; Rose, James C.; Figueroa, Jorge P.

    2009-01-01

    Antenatal steroid administration is associated with alterations in fetal kidney development and hypertension. However, a causal relationship between nephron deficit and hypertension has not been established. In this study, we measured nephron number, renal function, and blood pressure in sheep exposed antenataly to betamethasone. Pregnant sheep were given 2 betamethasone doses (0.17 mg/kg) or vehicle at 80 and 81 days gestational age and allowed to deliver at term. Data were obtained from a f...

  16. Antenatal management of the expectant mother and extreme preterm infant at the limits of viability.

    LENUS (Irish Health Repository)

    Khan, R

    2012-01-31

    We explored the opinions of healthcare providers on the antenatal management and outcome of preterm delivery at less than 28 weeks gestation. An anonymous postal questionnaire was sent to health care providers. The response rate was 55% (74% Obstetrician, 70% neonatologist). Twenty four weeks is the limit at which most would advocate intervention. At 23 weeks 67% of neonatologists advocate antenatal steroids. 50% of all health care providers advocate cardiotocographic monitoring at 24 weeks gestation. Written information on survival and long-term outcome is provided by 8% of the respondents. Neonatologists (50%) were more likely than obstetrician (40%) to advocate caesarean section at 25 weeks. We conclude that 24 weeks is the limit at which most would advocate intervention. Significant variation exists both between and within each health care group at less than 25 weeks. Establishment and provision of national outcome data may aid decision making at the limits of viability.

  17. Antenatal education in the transition to motherhood

    OpenAIRE

    Burley, Suzanne Elizabeth

    2003-01-01

    This thesis explores the relationship between antenatal education and the transition to motherhood, focusing on the pre-natal expectations and postnatal experiences of a small sample of first-time mothers in Plymouth. The aims of the study were 1) to investigate the style and content of statutory and voluntary sector antenatal classes in the Plymouth area. 2) To investigate factors affecting non-attendance, including non-attenders' perceptions of them. 3) To examine the role of...

  18. Antenatal hypnosis training and childbirth experience

    DEFF Research Database (Denmark)

    Werner, Anette; Uldbjerg, Niels; Zachariae, Robert

    2013-01-01

    Childbirth is a demanding event in a woman's life. The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience.......Childbirth is a demanding event in a woman's life. The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience....

  19. Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy – a single-centre experience

    International Nuclear Information System (INIS)

    Henkenberens, C.; Janssen, S.; Lavae-Mokhtari, M.; Leni, K.; Meyer, A.; Christiansen, H.; Bremer, M.; Dickgreber, N.

    2016-01-01

    To assess efficacy of our single-centre experience with inhalative steroids (IS) in lung cancer patients with symptomatic radiation pneumonitis (RP) grade II. Between 05/09 and 07/10, 24 patients (female, n = 8; male, n = 16) with lung cancer (non-small cell lung carcinoma [NSCLC]: n = 19; small cell lung cancer [SCLC]: n = 3; unknown histology: n = 2) and good performance status (ECOG ≤1) received definitive radiotherapy to the primary tumour site and involved lymph nodes with concurrent chemotherapy (n = 18), sequential chemotherapy (n = 2) or radiation only (n = 4) and developed symptomatic RP grade II during follow-up. No patient presented with oxygen requiring RP grade III. The mean age at diagnosis was 66 years (range: 50–82 years). Nine patients suffered from chronic obstructive pulmonary disease (COPD) before treatment, and 18 patients had a smoking history (median pack years: 48). The mean lung dose was 15.5 Gy (range: 3.0–23.1 Gy). All patients were treated with IS. If a patient’s clinical symptoms did not significantly improve within two weeks of IS therapy initiation, their treatment was switched to oral prednisolone. All 24 patients were initially treated with a high dose IS (budesonide 800 μg 1-0-1) for 14 days. Of the patients, 18 showed a significant improvement of clinical symptoms and 6 patients did not show significant improvement of clinical symptoms and were classified as non-responders to IS. Their treatment was switched to oral steroids after two weeks (starting with oral prednisolone, 0.5 mg/kg bodyweight; at least 50 mg per day). All of these patients responded to the prednisolone. None of non-responders presented with increased symptoms of RP and required oxygen and / or hospitalization (RP grade III). The median follow-up after IS treatment initiation was 18 months (range: 4–66 months). The median duration of IS treatment and prednisolone treatment was 8.2 months (range: 3.0–48.3 months) and 11.4 months (range: 5.0–44

  20. Efficacy and safety of tanezumab monotherapy or combined with non-steroidal anti-inflammatory drugs in the treatment of knee or hip osteoarthritis pain.

    Science.gov (United States)

    Schnitzer, Thomas J; Ekman, Evan F; Spierings, Egilius L H; Greenberg, H Scott; Smith, Michael D; Brown, Mark T; West, Christine R; Verburg, Kenneth M

    2015-06-01

    To evaluate whether subjects with knee or hip osteoarthritis (OA) pain on non-steroidal anti-inflammatory drugs (NSAIDs) received greater benefit when tanezumab monotherapy replaced or was coadministered with NSAIDs. Subjects (N=2700) received intravenous tanezumab (5 or 10 mg) or placebo every 8 weeks with or without oral naproxen 500 mg twice daily or celecoxib 100 mg twice daily. Efficacy was assessed as change from baseline to week 16 in three co-primary endpoints: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, WOMAC Physical Function and Patient's Global Assessment (PGA) of OA. Safety assessments included adverse events, physical and neurological examinations, laboratory tests and vital signs. Although all tanezumab treatments provided significant improvements in WOMAC Pain and Physical Function over either NSAID alone, only tanezumab+NSAIDs were significant versus NSAIDs with PGA and met the prespecified definition of superiority. Combination treatment did not substantially improve pain or function over tanezumab monotherapy. Adverse event frequency was higher with tanezumab than with NSAIDs and highest with combination therapy. Higher incidence of all-cause total joint replacements occurred with tanezumab+NSAID versus tanezumab monotherapy or NSAIDs. Rapidly progressive OA incidence was significantly greater versus NSAID in all tanezumab groups except tanezumab 5 mg monotherapy. Subjects receiving partial symptomatic relief of OA pain with NSAIDs may receive greater benefit with tanezumab monotherapy. While only coadministration of tanezumab with NSAIDs met the definition of superiority, combination treatment did not provide important benefits over tanezumab monotherapy; small differences in efficacy were negated by treatment-limiting or irreversible safety outcomes. NCT00809354. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Efficacy of Non-steroidal Anti-inflammatory Drugs for the Treatment of Acute Puerperal Metritis in Dairy Cows

    Directory of Open Access Journals (Sweden)

    Alina Pohl

    2017-08-01

    Full Text Available Background: Acute puerperal metritis (APM is a potentially life threatening, painful disease and is often treated with third-generation cephalosporins (Machado et al., 2014; Stojkov et al., 2015. An increasing antibiotic resistance is well documented and associated with decreasing clinical efficacy, animal welfare and economic consequences (Thomson et al., 2004. Hence, there is the need to evaluate alternative therapies to antibiotics.Objective: The objective of this study was to assess the efficacy of ketoprofen for the treatment of APM compared with ceftiofur hydrochloride.Materials and Methods: A total of 610 dairy cows from 6 farms in Germany were enrolled. Inclusion criteria was a rectal temperature (RT ≥ 39.5 °C and a reddish-brown fetid vaginal discharge within the first 10 DIM. Cows meeting the inclusion criteria were randomly allocated to treatment with ketoprofen (3 mg/kg of body weight, n = 300 or treatment with ceftiofur (1 mg/kg of body weight, n = 310, both administered on 3 consecutive days. Rectal temperature was recorded daily for a period of 7 days after enrollment. Cows that showed RT ≥ 39.5 °C on day 4 to 7 after inclusion received an extended treatment (extT with ceftiofur for 3 (ketoprofen group or 2 (ceftiofur group more days. Between 21 and 40 DIM cows were examined with the metricheck device and vaginal discharge was categorized on a 5-point scale according to the presence of pus.Results: A total of 52 cows (35 from ketoprofen group, 17 from ceftiofur group were excluded from analysis due to missing protocol compliance (n = 37 or concurrent disease (n = 15. Cows initially treated with ketoprofen had higher odds of extT than cows treated with ceftiofur (61% vs 31%, OR 3.47, P < 0.01, n = 558. Occurrence of purulent vaginal discharge (PVD was similar for both treatment groups. However, cows with extT had 2.12 (P < 0.01, n = 438 times the odds of PVD than cows without extended treatment. Treatment group did not affect

  2. Adjunctive treatment of decompression illness with a non-steroidal anti-inflammatory drug (tenoxicam) reduces compression requirement.

    Science.gov (United States)

    Bennett, M; Mitchell, S; Dominguez, A

    2003-01-01

    We report a randomized trial examining adjunctive administration of the NSAID, tenoxicam, to divers suffering with DCI. 180 subjects were graded for severity on admission and randomized according to a stratified random number schedule. Subjects were recompressed and treatment continued daily until symptom stabilization or complete resolution. Tenoxicam 20 mg or a placebo preparation was administered at the first air break during the initial recompression and continued daily for seven days. The subjects were assessed using a recovery status score at the completion of treatment and at 4-6 weeks. The proportion of patients with mild residual symptoms at discharge and final follow-up was not significantly different (discharge placebo 30% versus tenoxicam 37%, P=0.41; six weeks placebo 20% versus tenoxicam 17%, P=0.58). There was a significant reduction in the number of treatments required to achieve discharge (median treatments placebo 3, tenoxicam 2, P=0.01). 61% of patients in the tenoxicam group required less than 3 compressions, versus 40% in the placebo group (P=0.01, RRR 33 % [95%CI 9%-56%], NNT=5 [95%CI 3-18]). There was no evidence of increased complications of treatment in the tenoxicam group. When given this NSAID, patients with DCI require fewer hyperbaric oxygen (HBO2) sessions to achieve a standard clinical end-point and there is likely to be an associated cost saving.

  3. Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery

    Directory of Open Access Journals (Sweden)

    H. Hakan Poyrazoğlu

    2016-04-01

    Full Text Available Background: Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α playing an active role in this process. Aims: This research was to investigate the effects of preoperative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery. Study Design: Controlled clinical study. Methods: This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF; at the 5th minute of cross-clamping (Per TNF; 2 hours after termination of cardiopulmonary bypass (Post TNF; and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF. Results: The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05. The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05. Conclusion: There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect

  4. Mind Over Matter: Anabolic Steroids

    Science.gov (United States)

    ... Guide and Series / Anabolic Steroids Mind Over Matter: Anabolic Steroids Print Order Free Publication in: English Spanish Download ... to build muscle faster. The Brain's Response to Anabolic Steroids Hi, my name's Sara Bellum. Welcome to my ...

  5. Steroids in neuroinfection

    Directory of Open Access Journals (Sweden)

    Ronaldo Abraham

    2013-09-01

    Full Text Available The consequences of inflammatory response are primarily responsible for morbimortality in bacterial meningitis. Early use of steroids in these cases can reduce mortality and hearing loss and improve functional outcome without causing significant side effects. The formal recommendation towards pneumoccocal meningitis is being extended to other forms of Bacterial Meningitis. The same thought can be applied to tuberculous meningitis. In neurocysticercosis and neuroschistosomiasis steroids are more useful than parasiticides in most cases. Despite the evidence favoring the use of steroids in herpes simplex encephalitis, it is not sufficient to definitely support such indication. Among the opportunistic infections that affect AIDS patients, neurotoxoplasmosis and progressive multifocal leukoencephalopaty are those most often considered for the use of steroids; steroids are safe to use, but no definite benefit could be demonstrated in both conditions.

  6. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial.

    Science.gov (United States)

    Lakemeier, Stefan; Lind, Marcel; Schultz, Wolfgang; Fuchs-Winkelmann, Susanne; Timmesfeld, Nina; Foelsch, Christian; Peterlein, Christian D

    2013-07-01

    Lumbar facet joint degeneration is a source of chronic low back pain, with an incidence of 15% to 45% among patients with low back pain. Various therapeutic techniques in the treatment of facet-related pain have been described in the literature, including intraarticular lumbar facet joint steroid injections and radiofrequency denervation. In this study, we compared the effectiveness of intraarticular facet joint steroid injections and radiofrequency denervation. Our randomized, double-blind, controlled study included patients who received intraarticular steroid infiltrations in the lumbar facet joints (L3/L4-L5/S1) and patients who underwent radiofrequency denervation of L3/L4-L5/S1 segments. The inclusion criteria were based first on magnetic resonance imaging findings showing hypertrophy of the facet joints L3/L4-L5/S1 and a positive response to an intraarticular test infiltration of the facet joints L3/L4-L5/S1 with local anesthetics. The primary end point was the Roland-Morris Questionnaire. Secondary end points were the visual analog scale and the Oswestry Disability Index. All outcome assessments were performed at baseline and at 6 months. Fifty-six patients were randomized; 24 of 29 patients in the steroid injection group and 26 of 27 patients in the denervation group completed the 6-month follow-up. Pain relief and functional improvement were observed in both groups. There were no significant differences between the 2 groups for the primary end point (95% confidence interval [CI], -3 to 4) and for both secondary end points (95% CI for visual analog scale, -2 to 1; 95% CI for Oswestry Disability Index, -18 to 0). Intraarticular steroid infiltration or radiofrequency denervation appear to be a managing option for chronic function-limiting low back pain of facet origin with favorable short- and midterm results in terms of pain relief and function improvement, but improvements were similar in both groups.

  7. Cardiac profile of asymptomatic children with Becker and Duchenne muscular dystrophy under treatment with steroids and with/without perindopril.

    Science.gov (United States)

    Mavrogeni, Sophie; Giannakopoulou, Aikaterini; Papavasiliou, Antigoni; Markousis-Mavrogenis, George; Pons, Roser; Karanasios, Evangelos; Noutsias, Michel; Kolovou, Genovefa; Papadopoulos, George

    2017-07-24

    To evaluate cardiovascular function in boys with Duchenne (DMD) and Becker (BMD) muscular dystrophy, using cardiac magnetic resonance (CMR). This is a single point cross sectional study of twenty-four boys with genetically ascertained DMD, and 10 with BMD, aged 10.5 ± 1.5 years (range 9-13), were prospectively evaluated by a 1.5 T system and compared with those of age-sex matched controls. The DMD patients were divided in 2 groups. Group A (N = 12) were under treatment with both deflazacort and perindopril, while Group B (n = 12) were under treatment with deflazacort, only. BMD patients did not take any medication. Biventricular function was assessed using a standard SSFP sequence. Late gadolinium enhancement (LGE) was assessed from T1 images taken 15 min after injection of 0.2 mg/Kg gadolinium DTPA using a 3D-T1-TFE sequence. Group A and BMDs were asymptomatic with normal ECG, 24 h ECG recording and echocardiogram. Group B were asymptomatic but 6/12 had abnormal ECG and mildly impaired LVEF. Their 24 h ECG recording revealed supraventricular and ventricular extrasystoles (all at 12-13 yrs). LV indices in Group A and BMD did not differ from those of controls. However, LV indices in Group B were significantly impaired compared with controls, Group A and BMDs (p < 0.001). An epicardial LGE area = 3 ± 0.5% of LV mass was identified in the posterolateral wall of LV only in 6/12 patients of Group B, but in not in any BMD or Group A. Children with either BMD or DMD under treatment with both deflazacort and perindopril present preserved LV function and lack of LGE. However, further large scale multicenter studies are warranted to confirm these data, including further CMR mapping approaches.

  8. Steroid induced diabetes mellitus in patients receiving prednisolone ...

    African Journals Online (AJOL)

    Introduction: Steroids are a useful component of combination chemotherapy or as a single agent in the treatment of haematological disorders even though there are adverse effects associated with its use. Methods: We report four patients who developed diabetes mellitus (DM) during treatment with steroids for ...

  9. Number and timing of antenatal HIV testing

    DEFF Research Database (Denmark)

    Nguyen Thi Thuy, Hanh; Gammeltoft, Tine; Rasch, Vibeke

    2011-01-01

    ABSTRACT: BACKGROUND: HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary...... repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been...... scaled up to reach first level health facilities. METHODS: A cross-sectional community-based study was conducted among 1108 recently delivered mothers through face-to-face interviews following a structured questionnaire that focused on socio-economic characteristics, experiences of antenatal care and HIV...

  10. Maintenance treatment with esomeprazole following initial relief of non-steroidal anti-inflammatory drug-associated upper gastrointestinal symptoms: the NASA2 and SPACE2 studies

    Science.gov (United States)

    Hawkey, Christopher J; Talley, Nicholas J; Scheiman, James M; Jones, Roger H; Långström, Göran; Næsdal, Jorgen; Yeomans, Neville D

    2007-01-01

    Non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 (COX-2) inhibitors, cause upper gastrointestinal (GI) symptoms that are relieved by treatment with esomeprazole. We assessed esomeprazole for maintaining long-term relief of such symptoms. Six hundred and ten patients with a chronic condition requiring anti-inflammatory therapy who achieved relief of NSAID-associated symptoms of pain, discomfort, or burning in the upper abdomen during two previous studies were enrolled and randomly assigned into two identical, multicentre, parallel-group, placebo-controlled studies of esomeprazole 20 mg or 40 mg treatment (NASA2 [Nexium Anti-inflammatory Symptom Amelioration] and SPACE2 [Symptom Prevention by Acid Control with Esomeprazole] studies; ClinicalTrials.gov identifiers NCT00241514 and NCT00241553, respectively) performed at various rheumatology, gastroenterology, and primary care clinics. Four hundred and twenty-six patients completed the 6-month treatment period. The primary measure was the proportion of patients with relapse of upper GI symptoms, recorded in daily diary cards, after 6 months. Relapse was defined as moderate-to-severe upper GI symptoms (a score of more than or equal to 3 on a 7-grade scale) for 3 days or more in any 7-day period. Esomeprazole was significantly more effective than placebo in maintaining relief of upper GI symptoms throughout 6 months of treatment. Life-table estimates (95% confidence intervals) of the proportion of patients with relapse at 6 months (pooled population) were placebo, 39.1% (32.2% to 46.0%); esomeprazole 20 mg, 29.3% (22.3% to 36.2%) (p = 0.006 versus placebo); and esomeprazole 40 mg, 26.1% (19.4% to 32.9%) (p = 0.001 versus placebo). Patients on either non-selective NSAIDs or selective COX-2 inhibitors appeared to benefit. The frequency of adverse events was similar in the three groups. Esomeprazole maintains relief of NSAID-associated upper GI symptoms in patients taking continuous

  11. Non-steroidal anti-inflammatory drugs for the treatment of pain and immobility-associated osteoarthritis: consensus guidance for primary care

    Directory of Open Access Journals (Sweden)

    Adebajo Ade

    2012-03-01

    Full Text Available Abstract Background Osteoarthritis is a common presentation in primary care, and non-selective non-steroidal anti-inflammatory drugs (sometimes also referred to as traditional NSAIDs or tNSAIDs and selective cyclo-oxygenase 2 inhibitors (COX-2 inhibitors are commonly used to treat it. The UK's National Institute for Health and Clinical Excellence (NICE recommends taking patient risk factors into account when selecting a tNSAID or a COX-2 inhibitor, but GPs have lacked practical guidance on assessing patient risk. Methods A multi-disciplinary group that included primary care professionals (PCPs developed an evidence-based consensus statement with an accompanying flowchart that aimed at providing concise and specific guidance on NSAID use in osteoarthritis treatment. An open invitation to meet and discuss the issue was made to relevant healthcare professionals in South Yorkshire. A round table meeting was held that used a modified nominal group technique, aimed at generating opinions and ideas from all stakeholders in the consensus process. A draft developed from this meeting went through successive revisions until a consensus was achieved. Results Four statements on the use of tNSAIDs and COX-2 inhibitors (and an attached category of evidence were agreed: 1 tNSAIDs are effective drugs in relieving pain and immobility associated with osteoarthritis. COX-2 inhibitors are equally effective; 2 tNSAIDs and COX-2 inhibitors vary in their potential gastrointestinal, liver, and cardio-renal toxicity. This risk varies between individual treatments within both groups and is increased with dose and duration of treatment; 3 COX-2 inhibitors are associated with a significantly lower gastrointestinal toxicity compared to tNSAIDs. Co-prescribing of aspirin reduces this advantage; 4 PPIs should always be considered with a tNSAID and with a COX-2 inhibitor in higher GI risk patients. An accompanying flowchart to guide management was also agreed. Conclusions

  12. Effects of Antenatal Betamethasone and Dexamethasone in Preterm Neonates

    Directory of Open Access Journals (Sweden)

    Chen-Yu Chen

    2005-09-01

    Conclusion: In our study, no significant differences between antenatal betamethasone and dexamethasone were found in complications of preterm neonates. Incomplete courses of antenatal corticosteroids were associated with an increased incidence of RDS compared with complete courses.

  13. Tritiumlabelling of steroids

    International Nuclear Information System (INIS)

    Wagner, H.

    1986-01-01

    The present paper gives a survey of the preparation of specific tritium labelled steroids of high and highest activity (up to 58 Ci/mM and 2150 GBq/mM, resp.) using the method of catalytic tritiation. It concerns steroids of all classes - androstanes, estratrienes, norandrostanes and progesterones - labelled in different positions of all the four possible rings of the steroid skeleton. The tritium labelled products have been applied in many research laboratories of the GDR and also been exported abroad. (author)

  14. Oral steroid contraception.

    Science.gov (United States)

    Sech, Laura A; Mishell, Daniel R

    2015-11-01

    Oral steroid contraception is a popular method of family planning worldwide. Over the past several decades, this method of contraception has changed significantly by decreasing the estrogen dose, changing the progestin component, and reducing the hormone free interval. Despite the popularity of oral steroid contraception, there has been much criticism regarding the associated risks of venous thromboembolism and stroke. Despite these established, yet uncommon risks, oral steroid contraception has many important health benefits. This review highlights the available formulations of oral contraceptives along with their evidence-based associated risks and benefits. Highlights regarding future directions for development of novel oral contraceptives are also addressed.

  15. Anabolic-androgenic steroid treatment induces behavioral disinhibition and downregulation of serotonin receptor messenger RNA in the prefrontal cortex and amygdala of male mice.

    Science.gov (United States)

    Ambar, G; Chiavegatto, S

    2009-03-01

    Nandrolone is an anabolic-androgenic steroid (AAS) that is highly abused by individuals seeking enhanced physical strength or body appearance. Supraphysiological doses of this synthetic testosterone derivative have been associated with many physical and psychiatric adverse effects, particularly episodes of impulsiveness and overt aggressive behavior. As the neural mechanisms underlying AAS-induced behavioral disinhibition are unknown, we investigated the status of serotonergic system-related transcripts in several brain areas of mice receiving prolonged nandrolone administration. Male C57BL/6J mice received 15 mg/kg of nandrolone decanoate subcutaneously once daily for 28 days, and different sets of animals were used to investigate motor-related and emotion-related behaviors or 5-HT-related messenger RNA (mRNA) levels by real-time quantitative polymerase chain reaction. AAS-injected mice had increased body weight, were more active and displayed anxious-like behaviors in novel environments. They exhibited reduced immobility in the forced swim test, a higher probability of being aggressive and more readily attacked opponents. AAS treatment substantially reduced mRNA levels of most investigated postsynaptic 5-HT receptors in the amygdala and prefrontal cortex. Interestingly,the 5-HT(1B) mRNA level was further reduced in the hippocampus and hypothalamus. There was no alteration of 5-HT system transcript levels in the midbrain. In conclusion,high doses of AAS nandrolone in male mice recapitulate the behavioral disinhibition observed in abusers. Furthermore, these high doses downregulate 5-HT receptor mRNA levels in the amygdala and prefrontal cortex. Our combined findings suggest these areas as critical sites for AAS-induced effects and a possible role for the 5-HT(1B) receptor in the observed behavioral disinhibition.

  16. C-Reactive Protein Levels at Diagnosis of Acute Graft-versus-Host Disease Predict Steroid-Refractory Disease, Treatment-Related Mortality, and Overall Survival after Allogeneic Hematopoietic Stem Cell Transplantation

    DEFF Research Database (Denmark)

    Minculescu, Lia; Kornblit, Brian Thomas; Friis, Lone Smidstrups

    2018-01-01

    , and their prognosis is especially poor. There is experimental evidence that coexisting inflammation aggravates aGVHD. Because C-reactive protein (CRP) is a systemic inflammatory marker, we aimed to investigate whether plasma CRP concentrations at the diagnosis of aGVHD can predict the risk of failing first-line......-refractory disease. In these patients, plasma CRP concentration at diagnosis ranged between higher in patients who developed steroid-refractory disease compared with those who responded to high-dose corticosteroid therapy (odds ratio, 1.50; 95% confidence interval, 1.18-1.93......Acute graft-versus-host disease (aGVHD) remains a cause of excessive morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Primary treatment consists of high-dose corticosteroids, but a small group of patients develop steroid-refractory disease...

  17. Pattern and Determinants of Antenatal Booking at Abakaliki ...

    African Journals Online (AJOL)

    Background: Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and ...

  18. Acceptability of focused antenatal care by pregnant Nigerian women ...

    African Journals Online (AJOL)

    Context: In 2002, the World Health Organization (WHO) proposed "Focused Antenatal Care (FANC)"model for developing countries and it is aimed at addressing some of the challenges associated with the traditional model of antenatal care and to improve the quality of antenatal care services rendered. Despite its wide ...

  19. Perceived cost in the utilization of antenatal care services by ...

    African Journals Online (AJOL)

    Perceived cost in the utilization of antenatal care services by pregnant women in Abeokuta South. ... An adequate reproductive health education campaign is advocated to improve on the utilization of antenatal care services. Training and retraining of antenatal care service provider and legislation to entrench the regular ...

  20. Health care providers' knowledge and practice of focused antenatal ...

    African Journals Online (AJOL)

    ... observational checklist were the instruments for data collection. Findings revealed poor knowledge of concept, components, timing of visits on focused antenatal care and non compliance with the guidelines for the practice of focused antenatal care, because of health workers lack of knowledge on focused antenatal care.

  1. Factors Influencing Antenatal Care Service Utilization in Hadiya Zone

    African Journals Online (AJOL)

    Analysis was done using SPSS for windows version 16. RESULT: This study revealed that antenatal care service utilization in the study area was 86.3%. However, from those who attended antenatal care service 406 (68.2%) started antenatal care visit during the second trimester of pregnancy and significant proportion 250 ...

  2. Antenatal care and pregnancy outcome in Ghana, the importance of ...

    African Journals Online (AJOL)

    The antenatal characteristics of 503 pregnant women attending maternal and child health clinics in Accra were studied to ascertain the influence of antenatal care on pregnancy outcome. Gestation age of first antenatal care attendance, duration of nutrients supplementation during pregnancy, infant birth-weight and level of ...

  3. Factors associated with delayed antenatal care attendance in Malawi

    African Journals Online (AJOL)

    Background: Antenatal care has been identified as pivotal to improving maternal and child health in Malawi. Though Malawian women consistently seek antenatal care, they rarely do so during their first trimester. The purpose of this study was to identify barriers to antenatal care uptake among Malawian women. This article ...

  4. The prevalence of glucose intolerance among antenatal clients at ...

    African Journals Online (AJOL)

    Objectives: To determine the prevalence of and associated factors for glucose intolerance among antenatal clients at Kenyatta National Hospital at 24-36 weeks of gestation. Design: Cross-sectional analytical study. Setting: Kenyatta National Hospital antenatal clinic. Subjects: One hundred and two (102) antenatal mothers ...

  5. Expectant management of preterm preeclampsia in Indonesia and the role of steroids.

    Science.gov (United States)

    Ernawati; Gumilar, Erry; Kuntoro; Soeroso, Joewono; Dekker, Gus

    2016-01-01

    To present the outcome of expectant management of preterm preeclampsia in Indonesia, and the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal outcome. Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration of dexamethasone for fetal lung maturation, patients were randomized to receive 25 mg MP group IV for the first week, decreasing to 12.5 mg during 2nd week and continued till birth, or matching IV placebo treatment (PL group). Prolongation of entry to delivery interval served as primary outcome measurement. The average time gained with expectant management was almost 14 days. However, there was no difference of mean time interval between entry to delivery between the PL (13.8 days) and MP (13.7 days) groups. Antenatal ongoing treatment with IV MP also did not improve maternal and/or perinatal outcome and might be associated with a higher risk for severe maternal infections--in particular tuberculosis. Expectant management of preterm preeclampsia is a realistic option in a major Indonesian perinatal referral center. Steroids (outside the use for fetal lung maturation) should not be used in the expectant management of preterm preeclampsia in Indonesia.

  6. ABUSE OF STEROID PRESCRIPTION- A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Shilpashri

    2017-10-01

    Full Text Available Corticosteroids are widely used and highly effective in treatment for number of conditions like immunological condition inflammation, systemic lupus erythematosus, chronic obstructive pulmonary disease, cancer and chronic pain conditions. Steroid-induced psychiatric disturbances appear in 3 to 6% of patient on treatment. Glucocorticoid is one of the most cause of avascular necrosis, affects hip joint, and other joints.

  7. Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

    Directory of Open Access Journals (Sweden)

    Kessy Flora

    2011-05-01

    Full Text Available Abstract Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker

  8. Sociodemographic factors influencing adherence to antenatal iron ...

    African Journals Online (AJOL)

    Sociodemographic factors influencing adherence to antenatal iron supplementation recommendations among pregnant women in Malawi: Analysis of data from ... Focusing on education interventions that target populations with low rates of iron supplement intake, including campaigns to increase the number of women who ...

  9. Prevalence of Antenatal Depressive Symptoms and Associated

    African Journals Online (AJOL)

    GB

    2017-01-01

    Jan 1, 2017 ... ABSTRACT. BACKGROUND: Antenatal depression is one of the common problems during pregnancy with a magnitude of 20% to 30% globally. It can negatively endanger women's and off springs lives. As there are scarce reports on this area in Northern Ethiopia, it is important to carry out different studies ...

  10. Prevalence of antenatal depressive symptoms and associated ...

    African Journals Online (AJOL)

    Background: Antenatal depression is one of the common problems during pregnancy with a magnitude of 20% to 30% globally. It can negatively endanger women's and off springs lives. As there are scarce reports on this area in Northern Ethiopia, it is important to carry out different studies that explore the magnitude of the ...

  11. Obstetric outcomes and antenatal access among adolescent ...

    African Journals Online (AJOL)

    T Govender

    Background: Pregnancy among adolescents in South Africa is a growing concern as it may be associated with adverse socio- economic and health impacts. Timeous initiation and optimal utilisation of antenatal care (ANC) services is imperative to ensure positive pregnancy outcomes. However, this is not always possible ...

  12. Up-regulated dipeptidyl-peptidase IV (CD26) on monocytes was unaffected by effective DMARD treatment in early steroid and DMARD-naive rheumatoid arthritis

    DEFF Research Database (Denmark)

    Ellingsen, Torkell Juulsgaad; Hansen, I; Thorsen, J

    2012-01-01

    To study the CD26 density on monocytes and CD4+ T-lymphocytes in steroid and DMARD-naïve, early rheumatoid arthritis (RA) patients and to analyse for correlations with disease activity, including long-term radiographic progression....

  13. Newborn bloodspot screening for cystic fibrosis: What do antenatal and postnatal women know about cystic fibrosis?

    Science.gov (United States)

    Fitzgerald, C; Linnane, B; Heery, E; Conneally, N; George, S; Fitzpatrick, P

    2016-07-01

    The Republic of Ireland has one of the highest reported incidences of cystic fibrosis (CF) in the world (1/1353) with an estimated carrier rate of 1/20. No cure exists, however there have been significant advances in available treatments. Newborn bloodspot screening (NBS) for CF was added to the NBS programme in Ireland in July 2011. Little is known about antenatal or postnatal women's knowledge about CF. This was a cross-sectional study of 662 antenatal (≥36weeks gestation) and 480 postnatal women (post NBS). Women were asked to self-complete a questionnaire including 14 CF knowledge questions. Among the respondents significantly more postnatal than antenatal women were aware that CF is included on the NBS (81.8% vs 63.5%; pdiagnosis. Copyright © 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

  14. Childbirth and parenting preparation in antenatal classes.

    Science.gov (United States)

    Barimani, M; Forslund Frykedal, K; Rosander, M; Berlin, A

    2018-02-01

    to describe topics (1) presented by midwives' during antenatal classes and the amount of time spent on these topics and (2) raised and discussed by first-time parents and the amount of time spent on these topics. qualitative; data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach, i.e., conventional, summative, and directed analyses. 3 antenatal courses in 2 antenatal units in a large Swedish city; 3 midwives; and 34 course participants. class content focused on childbirth preparation (67% of the entire antenatal course) and on parenting preparation (33%). Childbirth preparation facilitated parents' understanding of the childbirth process, birthing milieu, the partner's role, what could go wrong during delivery, and pain relief advantages and disadvantages. Parenting preparation enabled parents to (i) plan for those first moments with the newborn; (ii) care for/physically handle the infant; (iii) manage breastfeeding; (iv) manage the period at home immediately after childbirth; and (v) maintain their relationship. During the classes, parents expressed concerns about what could happened to newborns. Parents' questions to midwives and discussion topics among parents were evenly distributed between childbirth preparation (52%) and parenting preparation (48%). childbirth preparation and pain relief consumed 67% of course time. Parents particularly reflected on child issues, relationship, sex, and anxiety. Female and male participants actively listened to the midwives, appeared receptive to complex issues, and needed more time to ask questions. Parents appreciated the classes yet needed to more information for managing various post-childbirth situations. while midwifery services vary among hospitals, regions, and countries, midwives might equalise content focus, offer classes in the second trimester, provide more time for parents to talk to each other, allow time in the course plan for parents to bring up new

  15. Anabolic steroid induced hypogonadism in young men.

    Science.gov (United States)

    Coward, Robert M; Rajanahally, Saneal; Kovac, Jason R; Smith, Ryan P; Pastuszak, Alexander W; Lipshultz, Larry I

    2013-12-01

    The use of anabolic androgenic steroids has not been traditionally discussed in mainstream medicine. With the increased diagnosis of hypogonadism a heterogeneous population of men is now being evaluated. In this larger patient population the existence of anabolic steroid induced hypogonadism, whether transient or permanent, should now be considered. We performed an initial retrospective database analysis of all 6,033 patients who sought treatment for hypogonadism from 2005 to 2010. An anonymous survey was subsequently distributed in 2012 to established patients undergoing testosterone replacement therapy. Profound hypogonadism, defined as testosterone 50 ng/dl or less, was identified in 97 men (1.6%) in the large retrospective cohort initially reviewed. The most common etiology was prior anabolic androgenic steroid exposure, which was identified in 42 men (43%). Because of this surprising data, we performed an anonymous followup survey of our current hypogonadal population of 382 men with a mean±SD age of 49.2±13.0 years. This identified 80 patients (20.9%) with a mean age of 40.4±8.4 years who had prior anabolic androgenic steroid exposure. Hypogonadal men younger than 50 years were greater than 10 times more likely to have prior anabolic androgenic steroid exposure than men older than 50 years (OR 10.16, 95% CI 4.90-21.08). Prior anabolic androgenic steroid use significantly correlated negatively with education level (ρ=-0.160, p=0.002) and number of children (ρ=-0.281, phypogonadism and anabolic steroid induced hypogonadism is the most common etiology of profound hypogonadism. These findings suggest that it is necessary to refocus the approach to evaluation and treatment paradigms in young hypogonadal men. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. On-site screening for syphilis at an antenatal clinic | Delport | South ...

    African Journals Online (AJOL)

    Objective. To determine the validity, predictive value and accuracy of the rapid plasma reagin card test performed on site to diagnose active syphilis in pregnant women so that immediate treatment can be offered to prevent congenital syphilis. Design. Open, descriptive study. Setting. Antenatal clinic, Mamelodi Hospital, ...

  17. Stigma and Attitudes towards Antenatal Depression and Antidepressant Use during Pregnancy in Healthcare Students

    Science.gov (United States)

    Gawley, Laura; Einarson, Adrienne; Bowen, Angela

    2011-01-01

    Depression in pregnancy or antenatal depression (AD) occurs in approximately one in five women, with potentially deleterious effects to the mother and fetus. People are encouraged to get treatment for depression; however, pregnant women can experience stigma when they reach out for help with depression. Research indicates that healthcare…

  18. The prevalence of glucose inTolerance among anTenaTal clienTs ...

    African Journals Online (AJOL)

    2011-09-09

    Sep 9, 2011 ... Exclusion criteria: Clients who had pre-gestational diabetes mellitus, those already diagnosed with glucose intolerance in the current pregnancy or in previous pregnancy, clients who did not consent and clients on medications for chronic treatment. Sampling frame: This consisted of antenatal mothers.

  19. Homicide and Associated Steroid Acute Psychosis: A Case Report

    Directory of Open Access Journals (Sweden)

    G. Airagnes

    2011-01-01

    Full Text Available We report the case of an old man treated with methylprednisolone for chronic lymphoid leukemia. After two months of treatment, he declared an acute steroid psychosis and beat his wife to death. Steroids were stopped and the psychotic symptoms subsided, but his condition declined very quickly. The clinical course was complicated by a major depressive disorder with suicidal ideas, due to the steroid stoppage, the leukemia progressed, and by a sudden onset of a fatal pulmonary embolism. This clinical case highlights the importance of early detection of steroid psychosis and proposes, should treatment not be stopped, a strategy of dose reduction combined with a mood stabilizer or antipsychotic treatment. In addition have been revised the risks of the adverse psychiatric effects of steroids.

  20. Assessment of two complementary liquid chromatography coupled to high resolution mass spectrometry metabolomics strategies for the screening of anabolic steroid treatment in calves

    International Nuclear Information System (INIS)

    Dervilly-Pinel, Gaud; Weigel, Stefan; Lommen, Arjen; Chereau, Sylvain; Rambaud, Lauriane; Essers, Martien; Antignac, Jean-Philippe; Nielen, Michel W.F.; Le Bizec, Bruno

    2011-01-01

    Anabolic steroids are banned in food producing livestock in Europe. Efficient methods based on mass spectrometry detection have been developed to ensure the control of such veterinary drug residues. Nevertheless, the use of 'cocktails' composed of mixtures of low amounts of several substances as well as the synthesis of new compounds of unknown structure prevent efficient prevention. New analytical tools able to detect such abuse are today mandatory. In this context, metabolomics may represent new emerging strategies for investigating the global physiological effects associated to a family of substances and therefore, to suspect the administration of steroids. The purpose of the present study was to set up, assess and compare two complementary mass spectrometry-based metabolomic strategies as new tools to screen for steroid abuse in cattle and demonstrate the feasibility of such approaches. The protocols were developed in two European laboratories in charge of residues analysis in the field of food safety. Apart from sample preparation, the global process was different in both laboratories from LC-HRMS fingerprinting to multivariate data analysis through data processing and involved both LC-Orbitrap-XCMS and UPLC-ToF-MS-MetAlign strategies. The reproducibility of both sample preparation and MS measurements were assessed in order to guarantee that any differences in the acquired fingerprints were not caused by analytical variability but reflect metabolome modifications upon steroids administration. The protocols were then applied to urine samples collected on a large group of animals consisting of 12 control calves and 12 calves administrated with a mixture of 17β-estradiol 3-benzoate and 17β-nandrolone laureate esters according to a protocol reflecting likely illegal practices. The modifications in urine profiles as indicators of steroid administration have been evaluated in this context and proved the suitability of the approach for discriminating anabolic

  1. Assessment of two complementary liquid chromatography coupled to high resolution mass spectrometry metabolomics strategies for the screening of anabolic steroid treatment in calves

    Energy Technology Data Exchange (ETDEWEB)

    Dervilly-Pinel, Gaud, E-mail: laberca@oniris-nantes.fr [ONIRIS, Ecole nationale veterinaire, agroalimentaire et de l' alimentation Nantes-Atlantique, Laboratoire d' Etude des Residus et Contaminants dans les Aliments (LABERCA), Atlanpole - La Chantrerie, BP 40706, Nantes F-44307 (France); Weigel, Stefan; Lommen, Arjen [RIKILT - Institute of Food Safety, Wageningen UR, P.O. Box 230, 6700 AE Wageningen (Netherlands); Chereau, Sylvain; Rambaud, Lauriane [ONIRIS, Ecole nationale veterinaire, agroalimentaire et de l' alimentation Nantes-Atlantique, Laboratoire d' Etude des Residus et Contaminants dans les Aliments (LABERCA), Atlanpole - La Chantrerie, BP 40706, Nantes F-44307 (France); Essers, Martien [RIKILT - Institute of Food Safety, Wageningen UR, P.O. Box 230, 6700 AE Wageningen (Netherlands); Antignac, Jean-Philippe [ONIRIS, Ecole nationale veterinaire, agroalimentaire et de l' alimentation Nantes-Atlantique, Laboratoire d' Etude des Residus et Contaminants dans les Aliments (LABERCA), Atlanpole - La Chantrerie, BP 40706, Nantes F-44307 (France); Nielen, Michel W.F. [RIKILT - Institute of Food Safety, Wageningen UR, P.O. Box 230, 6700 AE Wageningen (Netherlands); Wageningen University, Laboratory of Organic Chemistry, Wageningen (Netherlands); Le Bizec, Bruno [ONIRIS, Ecole nationale veterinaire, agroalimentaire et de l' alimentation Nantes-Atlantique, Laboratoire d' Etude des Residus et Contaminants dans les Aliments (LABERCA), Atlanpole - La Chantrerie, BP 40706, Nantes F-44307 (France)

    2011-08-26

    Anabolic steroids are banned in food producing livestock in Europe. Efficient methods based on mass spectrometry detection have been developed to ensure the control of such veterinary drug residues. Nevertheless, the use of 'cocktails' composed of mixtures of low amounts of several substances as well as the synthesis of new compounds of unknown structure prevent efficient prevention. New analytical tools able to detect such abuse are today mandatory. In this context, metabolomics may represent new emerging strategies for investigating the global physiological effects associated to a family of substances and therefore, to suspect the administration of steroids. The purpose of the present study was to set up, assess and compare two complementary mass spectrometry-based metabolomic strategies as new tools to screen for steroid abuse in cattle and demonstrate the feasibility of such approaches. The protocols were developed in two European laboratories in charge of residues analysis in the field of food safety. Apart from sample preparation, the global process was different in both laboratories from LC-HRMS fingerprinting to multivariate data analysis through data processing and involved both LC-Orbitrap-XCMS and UPLC-ToF-MS-MetAlign strategies. The reproducibility of both sample preparation and MS measurements were assessed in order to guarantee that any differences in the acquired fingerprints were not caused by analytical variability but reflect metabolome modifications upon steroids administration. The protocols were then applied to urine samples collected on a large group of animals consisting of 12 control calves and 12 calves administrated with a mixture of 17{beta}-estradiol 3-benzoate and 17{beta}-nandrolone laureate esters according to a protocol reflecting likely illegal practices. The modifications in urine profiles as indicators of steroid administration have been evaluated in this context and proved the suitability of the approach for

  2. Response of Vancomycin according to Steroid Dosage in Pediatric Patients with Culture-Proven Bacterial Meningitis.

    Science.gov (United States)

    Lee, Shin Ae; Kim, Jin Kyu; Jo, Dae Sun; Kim, Sun Jun

    2017-12-01

    This study aimed to evaluate the efficacy of combined vancomycin and steroid therapy for the treatment of culture-proven bacterial meningitis in pediatric patients. We identified a total of 86 pediatric patients with culture-positive cerebrospinal fluid who were treated at our facility between 2005 and 2015. Ten of these patients (5 boys and 5 girls) received first-line treatment with vancomycin as the initial form of therapy. All cultured bacteria were sensitive to vancomycin. We retrospectively analyzed these cases to examine the relationship between concomitant steroid dosage and antibiotic treatment effectiveness. Nine of the 10 patients included in our analysis received steroid treatment. Of these, 3 received high-dose steroid therapy and 6 received low-dose steroid therapy. Five patients did not respond to vancomycin, including all 3 patients in the high-dose steroid group and 2 patients in the low-dose steroid group. Our analysis confirmed that the response rate to vancomycin treatment was significantly reduced in accordance with steroid dosage (P = 0.035). Patients who did not to respond to vancomycin with concomitant high-dose steroid administration improved clinically after the substitution of vancomycin with teicoplanin. The use of steroids, especially in high doses, may impair the effectiveness of vancomycin for treating bacterial meningitis in pediatric patients. Physicians should be cautious when administering concomitant steroid therapy and should carefully monitor the steroid dosage. Copyright © 2017 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy

  3. Antenatal cytogenetic testing in Havana, Cuba.

    Science.gov (United States)

    Méndez-Rosado, Luis A; Quiñones, Olga; Molina, Odalys; González, Nereida; del Sol, Marylin; Maceiras, Luanda; Bravo, Yomisleidy

    2014-01-01

    INTRODUCTION Antenatal cytogenetic testing was started in Havana in 1984, as a diagnostic option for fetal chromosome complement. The techniques applied are amniocyte culture, chorionic villus sampling, cordocentesis and fluorescence in situ hybridization in interphase cells. OBJECTIVE Describe the results of antenatal cytogenetic testing in the cytogenetic laboratory of the Cuba's National Medical Genetics Center in Havana, from 1984 through 2012. METHODS A retrospective descriptive study was carried out of the 22,928 pregnant women who had antenatal testing with conclusive results during the period 1984-2012. Information was obtained from laboratory databases for four antenatal diagnostic techniques. Variables studied were: antenatal diagnostic method, indications for genetic testing, type of chromosomal abnormality detected and couple's decision concerning pregnancy continuation if hereditary disease was diagnosed. Results were reported in absolute numbers and percentages. RESULTS Overall positivity was 2.8% (641 cases). Of the total, 20,565 samples were from amniocyte culture (558 positive cases, 2.7%); 1785 chorionic villus sampling (38 positive, 2.1%); 407 cord blood culture (28 positive, 6.9%); and 171 fluorescence in situ hybridization in interphase cells (17 positive, 9.9%). Advanced maternal age was the predominant indication for amniocyte culture and chorionic villus sampling. Positivity was higher for the two less frequently used methods, cordocentesis (6.9% positivity) and fluorescence in situ hybridization (9.9%). The predominant chromosomal abnormality was Down syndrome, with 45.4% of cases detected (291/641; 279 pure lines and 12 mosaic trisomies), followed by Edward syndrome with 12% (77/641, 71 pure lines and 6 mosaics) and Patau syndrome 4.7% (30/641, 27 pure lines and 3 mosaics). Sexual aneuploidy with pure lines affected 6.9% of cases (44/641) and with mosaicism 4.7% (30/641). Structural chromosomal abnormalities were detected in 22.5% of cases

  4. Epidural steroid injection for lumbosacral radiculopathy

    International Nuclear Information System (INIS)

    Sung, Mi Sook

    2006-01-01

    Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections

  5. Epidural steroid injection for lumbosacral radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Mi Sook [The Catholic University of Korea, Pucheon (Korea, Republic of)

    2006-06-15

    Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections.

  6. [Peroral and transdermal application of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of regional musculoskeletal pain syndromes].

    Science.gov (United States)

    Hodinka, László; Bálint, Géza; Budai, Erika; Géher, Pál; Papp, Renáta; Somogyi, Péter; Szántó, Sándor; Vereckei, Edit

    2017-12-01

    In this review the available evidences regarding the most frequently applied medication (peroral and transdermal non-steroidal anti-inflammatory agents) for the most frequent musculoskeletal complaints (regional pain syndromes) have been collected for the appropriate medical professionals who are most frequently faced with these conditions (general practitioners, rheumatologists, orthopedics, occupational and sports medicine experts). The special population at risk (with repeated and high energy overuse because of occupational or sport activities) and the pathology of their syndromes are identified. Mode of action, pharmacological properties of the non-steroidal anti-inflammatory drugs and the unwanted effects of their application especially in infants and elderly are highlighted. Recommendations of the general and specific pain management guidelines have been selected and listed in the review. Orv Hetil. 2017; 158(Suppl. 3): 3-30.

  7. Pulse cyclophosphamide therapy for steroid-resistant focal segmental glomerulosclerosis in children

    International Nuclear Information System (INIS)

    Al-Salloum, Abdullah A.

    2004-01-01

    In children, steroid-resistant nephritic syndrome due to focal segmental glomerulosclerosis (FSGS) is frequently a progressive condition resulting in end-stage renal disease (ESRD). We report the response of 15 patients with steroid resistant FSGS to treatment with intravenous pulse cyclophosphamide (IVCP) and oral prednisone after 4 years of follow up. 5 patients had initial steroid resistance and 10 patients had late steroid resistance. All patients were treated with IVCP at a dose of 500 mg/m/day for four weeks followed by 40/mg/m on alternate days for 4 weeks and then tapered over next 4 weeks. All patients with initial resistance to steroids showed no response to IVCP and continued to be steroid resistant. 3 developed CRF during the observation period. The other 10 patients with late steroid resistance responded to IVCP but all were steroid dependent at the end of observation period. 5 could not be weaned from steroids during the IVCP period. The other 5 patients achieved relatively prolonged remission (7 months to 24 months), but eventually become steroid dependent. 67% of the steroid resistant FSGS become steroid dependent. Patient with initial steroid resistance did not respond to IVCP. We no correlation between IgM deposition and the response to therapy. The side effects of IVCP were negligible. Beneficial therapy for initial steroid-resistant FSGS remains to be determined. (author)

  8. Radioimmunoassay of anabolic steroids

    International Nuclear Information System (INIS)

    Hampl, R.; Stranska, I.; Starka, L.; Picha, J.; Chundela, B.

    1978-01-01

    Alternative antisera against 17 α-methyltestosterone and 19-nortestosterone were raised and used for radioimmunoassay of anabolic steroids. Tritiated compounds were used as radioligands. The RIA method suitable for doping control is proposed for 17 α-alkylated anabolic steroids in both plasma and urine, using qoat antiserum against methyltestosterone-3-carboxymethyloxime-BSA. Sensitivity of the method was expressed as least amount of nonradioactive methandienone which, when added to normal urine or plasma, caused statistically significant decrease of measured supernatant radioactivity at 99% level. The amounts from 50 to 500 pg were tested, each in eight parallel determinations. The amounts of 100 pg for plasma and 200 pg for urine met these criteria. The respective coefficients of variation did not depend on the amount of steroid added in this range. They averaged 4.60% for plasma and 4.95% for urine, respectively. (T.I.)

  9. Dynamic Contrast Enhanced MRI Can Monitor the Very Early Inflammatory Treatment Response upon Intra-Articular Steroid Injection in the Knee Joint: A Case Report with Review of the Literature

    DEFF Research Database (Denmark)

    Boesen, Mikael; Kubassova, Olga; Cimmino, Marco A

    2011-01-01

    Dynamic contrast-enhanced MRI in inflammatory arthritis, especially in conjunction with computer-aided analysis using appropriate dedicated software, seems to be a highly sensitive tool for monitoring the early inflammatory treatment response in patients with rheumatoid arthritis. This paper gives...... a review of the current knowledge of the emerging technique. The potential of the technique is demonstrated and discussed in the context of a case report following the early effect of an intra-articular steroid injection in a patient with rheumatoid arthritis flare in the knee....

  10. Antenatal embolization of a large placental chorioangioma: a case report

    Directory of Open Access Journals (Sweden)

    Babic Inas

    2012-07-01

    Full Text Available Abstract Introduction A chorioangioma is the most common benign tumor of the placenta. The majority of pregnancies with chorioangiomas are asymptomatic. Pregnancies with large chorioangiomas are associated with maternal and fetal complications, such as growth restriction, cardiomegaly, congestive heart failure, fetal anemia, thrombocytopenia, nonimmune hydrops and intrauterine fetal death. There are several modalities of treatment published to date with various results. Our case was the third such case report published on the successful treatment with antenatal embolization of the feeding vessel of the chorioangioma. To the best of our knowledge, there have been no published cases about antenatal treatment of placental chorioangiomas in Saudi Arabia, or any other Gulf state. Case presentation We describe the case of a 28-year-old Arab woman diagnosed at 22 weeks of gestation with a chorioangioma. A glue material - enbucrilate (Histoacryl - was used for embolization of the feeding vessel. Intrauterine fetal blood transfusions were performed twice, as a treatment for fetal anemia. The fetus developed heart failure at 30 weeks of gestation. A Cesarean section was performed and the outcome was a live baby with right ventricular hypertrophy. The baby was admitted to our neonatal intensive care unit and discharged at 42 days following birth in a stable condition,with follow-up with our cardiology team. Conclusion In this case, we found that intrauterine embolization of the feeding vessel of a chorioangioma with Histoacryl was a valid treatment option that carried a small risk considering the good pregnancy outcome.

  11. EFFECT OF THYROID DYSFUNCTION IN ANTENATAL MOTHERS

    Directory of Open Access Journals (Sweden)

    Anasooya Parail Sankaran

    2016-12-01

    Full Text Available BACKGROUND The aim of the study is to study the effect of thyroid dysfunction in antenatal mothers in Alappuzha one of the coastal areas in South Kerala over a period from January 2012 to January 2015. MATERIALS AND METHODS It is a descriptive study of the effect of thyroid dysfunction among pregnant ladies attending OBG Department in Government Medical College, Alappuzha, a rural medical college at coastal areas of Kerala over a period of 3 years. RESULTS The incidence is found to be maximum in the coastal area, i.e. 84.9%, but p-valve 0.625 is not statistically significant. Thyroid disorder is mostly seen in primigravida (57.8% and between the age of 20 and 25 yrs. (43.2% and the most commonly seen disorder among is subclinical hypothyroidism (73.7% (p valve <.005, which is statistically significant. There is significant increase in maternal complications like preeclampsia, (RR-8.54, p-value 0.014 recurrent abortion (RR-91.13, p-value 0.000, prolonged period of infertility (RR-55.16, p-value 0.000, anaemia (RR-11.37, p-value 0.003 is seen in subclinical hypothyroidism. The foetal complications seen are oligamnios (7.8%, MSAF (9.2%, foetal distress (12.1%, PROM (5.1% and FGR (10.9%. The neonates were admitted in NICU in view of NEC (1.5%, NNJ (24.1%, MAS (6.9%, TTNB (9.5% and HIE (2.9%. CONCLUSION The present study is intended to study the maternal and foetal effects of thyroid dysfunction. After the study, we concluded that there are many adverse maternal, foetal and neonatal effects in pregnancies complicated with thyroid dysfunction. In coastal area, the disease has got a high prevalence and hence there is a need for proper screening and early diagnosis. Proper treatment options are given to the patient.

  12. Is antenatal antibody screening worthwhile in Chinese?

    Science.gov (United States)

    Wong, K F; Tse, K T; Lee, A W; Mak, C S; So, C C

    1997-06-01

    A total of 1997 pregnant women were screened during their first antenatal visit for irregular antibodies for the prevention of haemolytic disease of the newborn. Patient sera were tested against a panel of group O screen cells including one with the expression of Miltenberger determinants GP.Mur. 17 women (0.85%) had irregular antibodies of which four were of potential clinical significance, including one with anti-D, two with anti-E and one with anti-D, anti-E and anti-G. Although antenatal antibody screening is mandatory in Western populations, our results suggest that this may not be necessary in the Chinese population except for those who are Rh D-negative or who have a history of haemolytic disease of the newborn.

  13. The role of steroids in the management of uveitic macular edema

    NARCIS (Netherlands)

    de Smet, Marc D.; Julian, Karina

    2010-01-01

    Purpose. To review the role of steroids in the management of uveitic macular edema. Methods. Review of recent literature on the physiopathology of macular edema and clinical trials involving steroids as main treatment of uveitic macular edema. Results. The steroid-glucocorticoid receptor complex

  14. Antenatally detected solid tumour of kidney

    Science.gov (United States)

    Panda, Shasanka Shekhar; Mandelia, Ankur; Gupta, Devendra Kumar; Singh, Amit

    2014-01-01

    Congenital renal tumours are rare and usually benign. Polyhydramnios is the most common mode of presentation. Although most cases have been diagnosed postnatally, with advances in imaging technology, an increasing number of cases are being detected on antenatal scans. We describe a case of solid tumour of kidney detected in the second trimester of pregnancy and managed by surgery in the postnatal period. PMID:24526198

  15. [Diagnosis and treatment with steroids for patients with Duchenne muscular dystrophy: experience and recommendations for Mexico. Administración del Patrimonio de la Beneficencia Pública. Asociación de Distrofia Muscular de Occidente].

    Science.gov (United States)

    Vázquez-Cárdenas, Norma A; Ibarra-Hernández, Francisco; López-Hernández, Luz B; Escobar-Cedillo, Rosa E; Ruano-Calderón, Luis A; Gómez-Díaz, Benjamín; García-Calderón, Noemí; Carriedo-Dávila, M Fernanda; Rojas-Hurtado, Liliana G; Luna-Padrón, Emilia; Coral-Vázquez, Ramón M

    2013-11-16

    Duchenne muscular dystrophy is a severe, debilitating and progressive disease that affects 1 in 3,500 live male births in the world. The diagnosis should be confirmed by genetic testing to identify the mutation in the DMD gene or muscle biopsy and immunostaining to demonstrate the absence of dystrophin. Although up to now continues to be an incurable disease, this does not mean it has no treatment. Treatment should be multidisciplinary, looking for the functionality of the patient and avoiding or correcting complications, mainly cardio-respiratory and skeletal. Many proposals have been evaluated and implemented with the aim of improving the quality of life for these patients. The long-term steroids have shown significant benefits, such as prolonging ambulation, reduce the need for spinal surgery, improve cardiorespiratory function and increase survival and the quality of life. This document presents the recommendations based on the experience of the working group and experts worldwide on the diagnosis and treatment with steroids for patients with Duchenne muscular dystrophy.

  16. Steroid injections - tendon, bursa, joint

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007678.htm Steroid injections - tendon, bursa, joint To use the sharing features on this page, please enable JavaScript. A steroid injection is a shot of medicine used to ...

  17. Ultrasound guided local steroid injection versus extracorporeal ...

    African Journals Online (AJOL)

    Nayera Saber

    2011-12-17

    Dec 17, 2011 ... injection;. Plantar fascia thickness;. Mayo clinic scoring system. Abstract Objective: This study was conducted to compare and evaluate the therapeutic effects of ultrasound guided local steroid injection versus medium frequency shock wave therapy in plantar fasciitis treatment among Egyptian population.

  18. Antenatal and intrapartum prediction of shoulder dystocia.

    Science.gov (United States)

    Gupta, Manish; Hockley, Christine; Quigley, Maria A; Yeh, Peter; Impey, Lawrence

    2010-08-01

    To (1) develop algorithms to calculate the risk of shoulder dystocia at individual deliveries; (2) evaluate screening for shoulder dystocia. Retrospective analysis of 40284 consecutive term cephalic singleton pregnancies using a 'train and test' method. Four models were derived using logistic regression and tested (birthweight alone; birthweight and other independent antenatal variables; birthweight and all independent antenatal and intrapartum variables; and all independent variables excluding birthweight). Shoulder dystocia occurred in 240 deliveries (0.6%). Birthweight was the most important risk factor although 98 cases (41%) occurred in babies weighing shoulder dystocia of >10%. Although the antenatal model had high predictability (area under curve 0.89), it was no better than birthweight alone and had a sensitivity of 52.4%. Where birthweight was excluded, prediction of shoulder dystocia was poor. Antepartum and labour calculation of the risk of shoulder dystocia is possible. Whilst greatly hindered by the inaccuracy of estimating weight, it allows due weight to be given to factors which may already be influencing clinical practice. However, shoulder dystocia cannot be predicted with sufficient accuracy to allow universal screening. Copyright 2010. Published by Elsevier Ireland Ltd.

  19. Topical steroid addiction in atopic dermatitis

    Directory of Open Access Journals (Sweden)

    Fukaya M

    2014-10-01

    Full Text Available Mototsugu Fukaya,1 Kenji Sato,2 Mitsuko Sato,3 Hajime Kimata,4 Shigeki Fujisawa,5 Haruhiko Dozono,6 Jun Yoshizawa,7 Satoko Minaguchi8 1Tsurumai Kouen Clinic, Nagoya, 2Department of Dermatology, Hannan Chuo Hospital, Osaka, 3Sato Pediatric Clinic, Osaka, 4Kimata Hajime Clinic, Osaka, 5Fujisawa Dermatology Clinic, Tokyo, 6Dozono Medical House, Kagoshima, 7Yoshizawa Dermatology Clinic, Yokohama, 8Department of Dermatology, Kounosu Kyousei Hospital, Saitama, Japan Abstract: The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome. Keywords: topical steroid addiction, atopic dermatitis, red burning skin syndrome, rebound, corticosteroid, eczema

  20. Functionalization of new PN ligands with steroids

    International Nuclear Information System (INIS)

    Jimenez, H.; Volkert, W.A.; Singh, P.R.; Ketring, A.R.; Katti, K.V.

    1993-01-01

    Efforts are currently underway to radiolabel steroids for possible imaging and treatment of breast cancer. The authors are exploring the ligating properties of phosphorus hydrazides to anchor radionuclides of diagnostic and therapeutic use (e.g. 99m Tc or 186 Re/ 188 Re) to estrogen and progesterone steroids which abound around breast tumor cells. The phenolic ring of estrone undergoes nucleophilic reaction with the pentavalent trichloro phosphorus sulfide (or oxide) in the presence of a weak base such as Et 3 N or pyridine. The chlorines were then substituted with hydrazine to produce the phosphorus attached steroid ligands in excellent yields. These ligands formed stable complexes with the metals at the open-quotes non-tracerclose quotes (Pd(II) and Re) and open-quotes tracerclose quotes ( 99m Tc and 109 Pd) levels. The alcohol functionalities as in 11-hydroxy progesterone and protected estradiol were also utilized with the use of a strong base LiN(SiMe 3 ) 2 and KH. Carbonyl containing steroid such as pregnenolone was directly added to a bishydrazido phosphine chelate by Schiff base coupling in a dean stark set-up. For estrone, which contains a hindered ketone, one hydrazone unit was first formed before the phosphorus chloride was introduced. C-O-P bond formation was also achieved from enolates of these ketones. By applying 2 eq of LDA or BuLi, α C-P bonding was accomplished. Structures and reactivities of these phosphorus hydrazide bound steroids are discussed

  1. Efficacy of steroidal vs non-steroidal agents in oral lichen planus: a randomised, open-label study.

    Science.gov (United States)

    Singh, A R; Rai, A; Aftab, M; Jain, S; Singh, M

    2017-01-01

    This study compared the therapeutic efficacy of steroidal and non-steroidal agents for treating oral lichen planus. Forty patients with clinical and/or histologically proven oral lichen planus were randomly placed into four groups and treated with topical triamcinolone, oral dapsone, topical tacrolimus or topical retinoid for three months. Pre- and post-treatment symptoms and signs were scored for each patient. Patients in all treatment groups showed significant clinical improvement after three months (p 0.05) and for topical retinoid vs topical tacrolimus (p > 0.05). Non-steroidal drugs such as dapsone, tacrolimus and retinoid are as efficacious as steroidal drugs for treating oral lichen planus, and avoid the side effects associated with steroids.

  2. Selective amine catalysed steroidal dimerization

    Indian Academy of Sciences (India)

    steroid dimers in which carbon atoms comprise a ben- zene nucleus.6 A standard colour test for the presence of cholesterol is the formation of a green colour in concentrated sulphuric acid, and this was shown to be due to a polyenyl steroidal dimer carbocation.7–9 Many dimeric and oligomeric steroids exhibit interesting.

  3. Selective amine catalysed steroidal dimerization

    Indian Academy of Sciences (India)

    of cholesterol is the formation of a green colour in concentrated sulphuric acid, and this was shown to be due to a polyenyl steroidal dimer carbocation.7–9 Many dimeric and oligomeric steroids exhibit interesting micellular, detergent and liquid crystal behaviour.10,11. Most of the steroidal dimmers are also well-known.

  4. Anabolic Steroids...What's the Hype?...

    Science.gov (United States)

    Landry, Gregory L.; Wagner, Lauris L.

    This pamphlet uses a question-and-answer format to examine the use and abuse of anabolic steroids. It begins by explaining that all steroids are not anabolic steroids and that anabolic steroids are those used specifically to build muscles quickly. Medical uses of anabolic steroids are reviewed; how people get steroids, how they take them, and…

  5. Radioimmunoassay of steroid hormone

    International Nuclear Information System (INIS)

    Murakami, Tadashi

    1975-01-01

    Low acid pepsin treated gamma-globulin was applied to ammonium sulfate salting out method, which was a method to separate bound fraction from free one in radioimmunoassay of steroid hormone, and the effect of the separation and the standard curve were examined. Pepsin treated gamma-globulin was prepared in pH 1.5 to 5.5 and then the pepsin was completely removed. It had an effect to accelerate the precipitation in radioimmunoassay of steroid hormone labelled with 3 H. The effect of pepsin treated gamma-globulin to adhere free steroid hormone and to slat out bound one was compared with that of human gamma-globulin. Pepsin treated gamma-globulin, which was water soluble, could easier reach its optimal concentration, and the separation effect was better than human gamma-globulin. The standard curve of it was steeper, particularly in a small dose, and the reproducibility was also better. It could be applied not only to aldosterone and DOC, but also to the steroid hormones, such as progesterone and DHEA, and it seemed suitable for routine measurement method. (Kanao, N.)

  6. Steroids: A Timeless Fascination

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 9; Issue 2. Steroids: A Timeless Fascination - Cholesterol and its Bio-products. S Hari Prasad. General Article Volume 9 Issue 2 February 2004 pp 80-84. Fulltext. Click here to view fulltext PDF. Permanent link:

  7. Steroids facing emotions

    NARCIS (Netherlands)

    Putman, P.L.J.

    2006-01-01

    The studies reported in this thesis have been performed to gain a better understanding about motivational mediators of selective attention and memory for emotionally relevant stimuli, and about the roles that some steroid hormones play in regulation of human motivation and emotion. The stimuli used

  8. Microbial biotransformation of bioactive and clinically useful steroids and some salient features of steroids and biotransformation.

    Science.gov (United States)

    Sultana, Nighat

    2018-01-19

    Steroids are perhaps one of the most widely used group of drugs in present day. Beside the established utilization as immunosuppressive, anti-inflammatory, anti-rheumatic, progestational, diuretic, sedative, anabolic and contraceptive agents, recent applications of steroid compounds include the treatment of some forms of cancer, osteoporosis, HIV infections and treatment of declared AIDS. Steroids isolated are often available in minute amounts. So biotransformation of natural products provides a powerful means in solving supply problems in clinical trials and marketing of the drug for obtaining natural products in bulk amounts. If the structure is complex, it is often an impossible task to isolate enough of the natural products for clinical trials. The microbial biotransformation of steroids yielded several novel metabolites, exhibiting different activities. The metabolites produced from pregnenolone acetate by Cunning hamella elegans and Rhizopus stolonifer were screened against tyrosinase and cholinesterase showed significant inhibitory activities than the parent compound. Diosgenin and its transformed sarsasapogenin were screened for their acetyl cholinesterase and butyryl cholinesterase inhibitory activities. Sarsasapogenin was screened for phytotoxicity, and was found to be more active than the parent compound. Diosgenin, prednisone and their derivatives were screened for their anti-leishmanial activity. All derivatives were found to be more active than the parent compound. The biotransformation of steroids have been reviewed to a little extent. This review focuses on the biotransformation and functions of selected steroids, the classification, advantages and agents of enzymatic biotransformation and examines the potential role of new enzymatically transformed steroids and their derivatives in the chemoprevention and treatment of other diseases. tyrosinase and cholinesterase inhibitory activities, severe asthma, rheumatic disorders, renal disorders and

  9. [Related factors to lack of implementation of antenatal corticosteroids].

    Science.gov (United States)

    Corona-Gutiérrez, América Aime; Olivares-Ramírez, Araceli; Fajardo-Dueñas, Sergio

    2015-10-01

    Despite the known benefits of antenatal corticosteroids therapy its use in clinical practice is not generalized. To identify factors related to antenatal corticosteroids non administration. Cross-sectional and descriptive study that included patients admitted to Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", who had indication for antenatal corticosteroids therapy but did not receive it. Variables: antenatal corticosteroids therapy prescription, factors related to antenatal corticosteroids therapy non administration and lapsed time between diagnosis and birth. Antenatal corticosteroids therapy were not prescribed in 79 (94%) of 84 patients. Main related factors were imminent birth and severe maternal complication. The longer amount of time from diagnosis to birth was before hospitalization (91 vs. 9%, p <0.0005). The biggest and best opportunity for the administration of inducers of fetal lung maturity is during prenatal care, when cases with increased risk of preterm birth are detected.

  10. [Risk of fatal/non-fatal events in patients with previous coronary heart disease/acute myocardial infarction and treatment with non-steroidal anti-inflammatory drugs].

    Science.gov (United States)

    Muñoz Olmo, L; Juan Armas, J; Gomariz García, J J

    2017-09-04

    Primary Care is the fundamental axis of our health system and obliges us to be consistent with our prescriptions. The non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk and increased risk of all causes of death, as well as acute myocardial infarction (AMI) in patients with a previous myocardial infarction. Pain and cardiac patient management are 2 basic pillars in our daily activity, and we must know the limitations of NSAIDs in patients with established cardiovascular risk. We present a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The objective is to determine the relationship between the consumption of different NSAIDs and the fatal and non-fatal events among patients with known coronary disease. This is a review of the scientific literature with primary interest in the role of NSAIDs and cardiovascular risk. The literature review was conducted in PubMed search engines like Tripdatabase and with certain keywords. Of the 15 original papers found, 9 did not correspond completely to the central focus, so the approach was decided from 6 original articles from the past 5 years, which address the central focus of increased cardiovascular risk found (fatal and non-fatal events) in patients with prior cardiovascular disease or AMI being prescribed NSAIDs for any reason. The risk of fatal/non-fatal events in each of the studies is expressed by the odds ratio (OR)/hazard ratio (HR), defined as the probability of an event occurring. A moderate risk was observed for ibuprofen. It increases the risk of acute coronary syndrome after 5 years of cardiovascular event, especially in the 2nd year (OR 1.63; 95% CI 1.42-1.87). It also increases the risk of stroke (HR 1.23; 95% IC 1.10-1.38). Cyclo-oxygenase-2 inhibitors were the third risk group, after nabumetone and diclofenac. Celecoxib increases risk from the 14th day of treatment (HR 2.3; 95% CI 1.79-3.02), having an OR

  11. Antenatal pertussis vaccination: Are we implementing best evidence into practice?

    Science.gov (United States)

    Krishnaswamy, Sushena; Wallace, Euan; Buttery, Jim; Giles, Michelle

    2016-12-01

    Maternal immunisation is the most effective strategy to reduce infant morbidity and mortality from pertussis infection, and is now standard of care in many countries, including Australia. However, uptake cannot be guaranteed unless the barriers to implementing programs locally are understood. Education and resources for antenatal care providers, embedding vaccination within antenatal care, and provision of culturally appropriate information for pregnant women are integral to a successful antenatal vaccination program. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  12. An assessment of antenatal care among Syrian refugees in Lebanon.

    Science.gov (United States)

    Benage, Matthew; Greenough, P Gregg; Vinck, Patrick; Omeira, Nada; Pham, Phuong

    2015-01-01

    After more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and family planning behaviors and practice among pregnant Syrian refugees in various living conditions and multiple geographic areas of Lebanon. A field-based survey was conducted between July and October 2013 in 14 main geographic sites of refugee concentration. The assessment evaluated antenatal services among a non-randomized sample of 420 self-identified pregnant Syrian refugee women that included demographics, gestational age, living accommodation, antenatal care coverage, antenatal care content, antenatal health behaviors, antenatal health literacy, and family planning perception and practices. In total, 420 pregnant Syrian refugees living in Lebanon completed the survey. Of these, 82.9% (348) received some antenatal care. Of those with at least one antenatal visit, 222 (63.8%) received care attended by a skilled professional three or more times, 111 (31.9%) 1-2 times, and 15 (4.3%) had never received skilled antenatal care. We assessed antenatal care content defined by blood pressure measurement, and urine and blood sample analyses. Of those who had received any antenatal care, only 31.2% received all three interventions, 18.2% received two out of three, 32.1% received one out of three, and 18.5% received no interventions. Only (41.2%) had an adequate diet of vitamins, minerals, and folic acid. Access, content and health behaviors varied by gestational age, type of accommodation and location in Lebanon. Standards of antenatal care are not being met for pregnant Syrian refugee women in

  13. Women's education level, antenatal visits and the quality of skilled antenatal care: a study of three African countries.

    Science.gov (United States)

    Babalola, Stella

    2014-02-01

    Many pregnant women in Africa who access professional antenatal care do not receive all the WHO-recommended components of care. Using Demographic and Health Survey (DHS) data from Kenya, Malawi and Nigeria, this study assesses the relationship of education level with the quality of antenatal care received and highlights how the number of antenatal visits mediates this relationship. The results show that a large proportion of the effect of education level on quality of care is direct, while only a small portion is mediated through the number of antenatal visits. Efforts to improve pregnancy outcomes for under-privileged women should focus on removing structural barriers to access, strengthening the technical and interpersonal skills of providers, and addressing providers' biases and discriminatory practices towards these women. Such efforts should also seek to empower underprivileged women to insist on quality antenatal care by explaining what to expect during an antenatal visit.

  14. Glucocorticoid Receptors and the Pattern of Steroid Response in ...

    African Journals Online (AJOL)

    CD3+) expression of glucocorticoid receptors (GCR) and the response to glucocorticoid treatment in children with idiopathic nephrotic syndrome (NS). The aim of the current study is to determine whether steroid responsiveness is dependent on ...

  15. Lithium exposure during pregnancy: outcomes for women who attended a specialist antenatal clinic.

    Science.gov (United States)

    Frayne, Jacqueline; Nguyen, Thinh; Mok, Tabitha; Hauck, Yvonne; Liira, Helena

    2017-06-15

    Lithium treatment in pregnancy represents a significant dilemma for women and treating health professionals alike. The complexity of risk-benefit analysis is impacted by limited information. A cohort study of 33 women with severe mental illness, who were prescribed lithium at any time during the pregnancy, and gave birth between December 2007 and January 2015 at a specialist antenatal clinic in Western Australia. A descriptive comparison for women who continued lithium throughout pregnancy, and those who ceased on discovery of pregnancy was undertaken examining demographic, obstetric, neonatal and psychiatric variables. Women who were prescribed lithium, irrespective of whether they continued or discontinued the medication represented a high risk group obstetrically, with high rates of smoking overall (33%) medical comorbidities (54%) and antenatal complications (88%). Preconception counseling occurred in 33% of the cohort but increased the likelihood of continuing lithium in pregnancy (p = .007). Compared to those who ceased lithium, women who remained on lithium through the pregnancy had increased rates of fetal ultrasound abnormalities such as abdominal circumference >90th % (p = .005). Psychiatric relapses through the antenatal and immediate postpartum period appeared to be due to a combination of factors. Pregnant women with severe mood disorders treated with lithium are a vulnerable, high-risk obstetric population who would benefit from preconception counseling, regular antenatal care in a tertiary center, delivery with neonatal pediatric support and experienced psychiatric management.

  16. THE ROLE OF STEROID HORMONES IN LEARNING AND MEMORY

    Directory of Open Access Journals (Sweden)

    Cristian Gurzu

    2006-08-01

    Full Text Available Sufficient evidence has accumulated since the 1970s to support the hypothesis that gonadal steroids can influence processes that allow an organism to learn and remember new information. Although this conclusion quickly leads to exciting implications for our understanding of cognitive function and for the treatment of cognitive disability, it also raises questions regarding the nature, mechanism, and significance of the steroid modulation of learning and memory. In order to support the case that a steroid plays a meaningful role in cognition, several central issues must be addressed : adaptative value (the proposed effect of the steroid on learning and memory should have adaptive value to the organism; strenght of effect (empirical data supporting the role of the steroid in learning and memory should be sufficiently robust in magnitude and replicability; neural substrate (anatomical and physilogical substrates should exist to support the actions of the steroid on learning and memory ; and nonmnemonic processes (processes other than those directly mediating steroid effects on learning and memory systems should be identified (23. Sufficient evidence has accumulated since the 1970s to support the hypothesis that gonadal steroids can influence processes that allow an organism to learn and remember new information. Although this conclusion quickly leads to exciting implications for our understanding of cognitive function and for the treatment of cognitive disability, it also raises questions regarding the nature, mechanism, and significance of the steroid modulation of learning and memory. In order to support the case that a steroid plays a meaningful role in cognition, several central issues must be addressed : adaptative value (the proposed effect of the steroid on learning and memory should have adaptive value to the organism; strenght of effect (empirical data supporting the role of the steroid in learning and memory should be sufficiently robust

  17. Effect of antenatal corticosteroids on postmortem brain weight of preterm babies.

    Science.gov (United States)

    Murphy, D J

    2001-07-01

    To investigate the effects of single and repeated courses of antenatal corticosteroids on brain growth in very preterm babies. Retrospective study of 110 very preterm babies delivered at a single University Teaching Hospital between 1992 and 1999 who had a full necropsy including detailed examination of the brain. Mean brain weight did not differ significantly between babies who received corticosteroids and those who did not 160 vs. 157 g, (p=0.82), nor was there a difference between mean brain weight of stillborn or liveborn babies in relation to steroid use 164 vs. 159 g, (p=0.84) and 156 vs. 152g (p=0.81). There was no apparent dose-response relationship between the total number of doses of corticosteroids or timing since the first dose of corticosteroids and brain weight, p=0.95 and p=0.87. Single and multiple courses of antenatal corticosteroids had no significant effect on brain growth in babies delivered preterm who died but long-term follow-up studies are required to evaluate the functional neurological outcome of surviving children.

  18. Ante-natal ionising radiation and cancer

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This editorial comments on the latest reports of the Oxford Survey of Childhood Cancer (now based on Birmingham). With 14759 pairs, the latest survey is over 10-fold larger than the 1958 report and the calculation of fatal childhood cancer rate at one case in 990 ante-natal radiographic examinations is rather larger than the early estimates, in spite of the fetal radiation dose having been halved and the cure rate for childhood leukemia being much improved. Comments are made on the comparisons with bomb survivors, and on the much increased fatal cancer incidence after first trimester radiography. (UK)

  19. Do assisted-reproduction twin pregnancies require additional antenatal care?

    Science.gov (United States)

    Jauniaux, E; Ben-Ami, I; Maymon, R

    2013-02-01

    obviously at higher risk of perinatal complications than singletons due to a natural increase in the incidence of fetal anomalies, antenatal disorders and obstetric and neonatal complications associated with the development of two fetuses instead of one. Overall, our review indicates that some antenatal complications are more frequent in assisted-conception twin pregnancies than in spontaneous twin pregnancies but their prevalence is low and thus their impact on the morbidity and mortality of an individual assisted-conception twin pregnancy is limited. Assisted reproduction treatment has become available to older women with pre-existing maternal medical conditions such as chronic hypertension and diabetes. The increased obstetrical risks in this population must be considered prior to attempts at assisted conception, and the transfer of more than one embryo should be avoided in women with a pre-existing maternal medical condition. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Anabolic steroids and head injury.

    Science.gov (United States)

    Mills, James D; Bailes, Julian E; Turner, Ryan C; Dodson, Sean C; Sakai, Jun; Maroon, Joseph C

    2012-01-01

    The suggestion has been made that neurological changes seen in the syndrome of chronic traumatic encephalopathy may be due to exogenous anabolic steroid use rather than traumatic brain injury. To determine whether administration of anabolic steroids alters the pathophysiology of traumatic brain injury. Sixty adult male Sprague-Dawley rats and a linear acceleration model of traumatic brain injury were used. Experimental groups were (1) preinjury anabolic steroids, (2) preinjury placebo carrier, (3) anabolic steroids without injury, (4) no steroids and no injury, (5) postinjury placebo carrier, and (6) postinjury anabolic steroids. Following a 30-day recovery, rats were euthanized, and brainstem white matter tracts underwent fluorescent immunohistochemical processing and labeling of β-amyloid precursor protein (APP), a marker of axonal injury. Digital imaging and statistical analyses were used to determine whether anabolic steroid administration resulted in a significant change in the number of injured axons. There was no statistically significant difference in number of APP-positive axons by immunohistochemical analysis between respective anabolic steroid and placebo groups. Using a standard acceleration-deceleration model of mild traumatic brain injury, we have shown successful visualization of traumatically injured axons with antibody staining of APP. Our results indicate no statistically significant effect of anabolic steroids on the number of APP-positive axons. With the use of this model, and within its limitations, we see no adverse effect or causative role of anabolic steroid administration on the brain following mild traumatic brain injury using APP counts as a marker for anatomic injury.

  1. Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study.

    Science.gov (United States)

    Cho, Jae-Heung; Nam, Dong-Hyun; Kim, Ki-Tack; Lee, Jun-Hwan

    2014-02-01

    To investigate the feasibility and sample size required for a full-scale randomised controlled trial of the effectiveness of acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) for chronic neck pain compared with acupuncture or NSAID treatment alone. A total of 45 patients with chronic neck pain participated in the study. For 3 weeks the acupuncture with NSAIDs treatment group took NSAIDs (zaltoprofen, 80 mg) daily while receiving acupuncture treatment three times a week. The acupuncture treatment group received treatment three times a week and the NSAID treatment group took NSAIDs daily. The primary outcomes were to determine the feasibility and to calculate the sample size. As secondary outcomes, pain intensity and pain-related symptoms for chronic neck pain were measured. With regard to enrolment and dropout rates, 88.2% of patients consented to be recruited to the trial and 15.6% of participants were lost to follow-up. The sample size for a full-scale trial was estimated to be 120 patients. Although preliminary, there was a significant change in the visual analogue scale (VAS) for neck pain intensity between the baseline measurement and each point of assessment in all groups. However, there was no difference in VAS scores between the three groups. This pilot study has provided the feasibility and sample size for a full-scale trial of acupuncture with NSAIDs for chronic neck pain compared with acupuncture or NSAID treatment alone. Further research is needed to validate the effects of acupuncture with NSAIDs.

  2. Preoperative High-Dose Steroid Has Long-Term Beneficial Effects for Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    Syuichi Tetsuka

    2013-01-01

    Full Text Available Previous studies addressing preoperative steroid treatment have revealed that control of myasthenia gravis (MG with steroids prior to surgery appeared to stabilize postoperative status. The purpose of our study was to clarify the clinical benefits of the preoperative programmed high-dose steroid treatment on the long-term outcomes of MG patients. We retrospectively reviewed the records of 171 MG patients who were followed up after undergoing thymectomy in our hospital between 1988 and 2006. One hundred and thirteen patients in the programmed treatment group had received preoperative steroid treatment, while 58 patients received no steroid treatment during the preoperative period. Clinical remission, which was defined as the achievement of the modified pharmacologic remission (PR for at least 1 year, and clinical benefits were compared between the two groups. With regard to the remission after thymectomy, Kaplan-Meier life-table curves for patients in the preoperative steroid treatment group versus those for patients in the no steroid preoperative treatment group revealed a significantly higher probability of the PR in the preoperative steroid treatment group (log-rank test, P<0.01. This study might be the first, as per our knowledge, to indicate that preoperative programmed high-dose steroid treatment has long-term beneficial effects for MG patients.

  3. Impact of proton pump inhibitor treatment on gastrointestinal bleeding associated with non-steroidal anti-inflammatory drug use among post-myocardial infarction patients taking antithrombotics

    DEFF Research Database (Denmark)

    Schjerning Olsen, Anne-Marie; Lindhardsen, Jesper; Gislason, Gunnar H

    2015-01-01

    STUDY QUESTION: What is the effect of proton pump inhibitors (PPIs) on the risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with non-steroidal anti-inflammatory drugs (NSAIDs)? METHODS: This was a nationwide cohort study based on linked...... plus antithrombotic therapy was estimated using adjusted time dependent Cox regression models. STUDY ANSWER AND LIMITATIONS: The use of PPIs was independently associated with decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated...... gastrointestinal bleeds occurred. The crude incidence rates of bleeding (events/100 person years) on NSAID plus antithrombotic therapy were 1.8 for patients taking PPIs and 2.1 for those not taking PPIs. The adjusted risk of bleeding was lower with PPI use (hazard ratio 0.72, 95% confidence interval 0.54 to 0...

  4. Antenatal care service utilization and associated factors in Metekel ...

    African Journals Online (AJOL)

    socioeconomic and some obstetric factors have been stated by few studies in other areas, the factors associated with low utilization of Antenatal care in Metekel Zone are not well assed before. Therefore, the objective of this study was to assess the status of Antenatal care service utilization and associated factors among ...

  5. Pattern of Family Planning Methods used by Antenatal Patients in ...

    African Journals Online (AJOL)

    This study aimed at assessing the pattern of family planning methods used by antenatal patients at Federal Medical Centre, Owo, Ondo State, Nigeria. The study was conducted between December,2007 and February,2008 at the antenatal clinic of the hospital. Ethical clearance was obtained from the Ethical committee of ...

  6. Perception of prenatal services by antenatal clinic attendees in a ...

    African Journals Online (AJOL)

    It has also been recognised that most women who registered for antenatal care in a particular health institution, do not go back to the same centre to deliver when in labour. Skilled attendant delivery is very low in Nigeria. While many reasons can be adduced for this health seeking behaviour, antenatal care satisfaction is ...

  7. Influence of pregnancy perceptions on patterns of seeking antenatal ...

    African Journals Online (AJOL)

    Maternal mortality remains a challenge in Sub-Saharan Africa including Uganda. Antenatal Care (ANC) is one of the recommended measures to improve maternal and child health. However, the influence of pregnancy definition and perception on patterns of seeking regular and timely antenatal care among women in the ...

  8. Antenatal care services utilization among women of reproductive ...

    African Journals Online (AJOL)

    Methods: A cross-sectional study was carried out between September and October 2013 among 425 women of reproductive age using a multi-stage sampling technique. Results: Almost all the respondents (93.9%) were aware of antenatal care services. A good proportion of the mothers (90.1%) used antenatal services, ...

  9. Seroprevalence of hepatitis B virus among antenatal attendees at ...

    African Journals Online (AJOL)

    Abstract. Background: Pregnant women infected with hepatitis B virus (HBV) can transmit the infection to their fetuses and newborns. Despite the above, screening of antenatal attendees is not yet done as a routine in many Nigerian Hospitals that offer antenatal services, inclusive of University of Abuja Teaching Hospital.

  10. Prevalence and factors associated with late antenatal care visit ...

    African Journals Online (AJOL)

    Flora

    Conclusion: Late first antenatal clinic visit was high in Lushoto, and was highly associated with unmarried and unemployment status. Therefore, provision of continuous health education and community sensitization on the importance of timely seeking ANC services should be strengthened. Keywords: pregnancy, antenatal ...

  11. Utilisation of antenatal and maternity services by mothers seeking ...

    African Journals Online (AJOL)

    Background: Utilisation of antenatal and maternity services is an important maternal health indicator. Increasing the proportion of mothers who are cared for in health facilities during pregnancy, childbirth and puerperium reduces the health risks to mothers and their children. Objective: To determine the utilisation of antenatal ...

  12. Prevalence Of HIV Infection Among Antenatal Attendees At Uyo ...

    African Journals Online (AJOL)

    This retrospective study was conducted at the maternity unit of the University of Uyo Teaching Hospital Uyo. The aim was to determine the prevalence of HIV infection among pregnant women receiving antenatal care in the center. The voluntary counselling and testing register, the partner notification and antenatal clinic ...

  13. HIV Prevalence amongst Clients Attending Antenatal Clinic at the ...

    African Journals Online (AJOL)

    One hundred and ten (42%) booked in the 3 trimester while only 34 (13%) booked in the 1 trimester. HIV seroprevalence is high amongst antenatal women in Makurdi and intervention strategies should be scaled up for prevention of vertical transmission of the virus. Keywords: HIV prevalence,Antenatal Clinic, Makurdi.

  14. Utilisation of Antenatal Services at the Provincial Hospital, Mongomo ...

    African Journals Online (AJOL)

    Utilisation of Antenatal Services at the Provincial Hospital, Mongomo, Guinea Equatoria. AAG Jimoh. Abstract. This prospective study was carried out to evaluate the utilisation of antenatal care at the Provincial Specialist Hospital, Mongomo, Guinea Equatoria, paying close attention to the confounding factors affecting ...

  15. Factors associated with late antenatal care attendance in selected ...

    African Journals Online (AJOL)

    Background: Despite antenatal care services being provided free of charge or sometimes at a minimal cost in Zambia, only 19% of women attend antenatal care by their fourth month of pregnancy, as recommended by World Health Organization (WHO). An estimated 21% of pregnant women in urban and 18% in rural ...

  16. Antenatal care visits and pregnancy outcomes at a Kenyan rural ...

    African Journals Online (AJOL)

    Background: The goal of antenatal care (ANC) is to improve maternal and neonatal outcomes. Fewer ANC visits in focused antenatal care (FANC) model can affect maternal and perinatal outcomes in low income settings where the number ANC visits are often low. Objective: To determine the number of ANC visits and their ...

  17. Antenatal Care Services Utilization among Women of Reproductive ...

    African Journals Online (AJOL)

    Satisfaction received from antenatal and delivery services was also higher in the urban settings (p= 0.000). Conclusion: Rural-urban differences exist in the utilization of antenatal care services, with a higher proportion of urban women utilizing these services. Increased health education of women, especially in the rural ...

  18. Perception of prenatal services by antenatal clinic attendees in a ...

    African Journals Online (AJOL)

    DR ADDAH A.O

    2015-09-30

    Sep 30, 2015 ... not go back to the same centre to deliver when in labour. Skilled attendant delivery is very low in Nigeria. While many reasons can be adduced for this health seeking behaviour, antenatal care satisfaction is one of them. We decided to study how satisfied are the antenatal subjects at the Federal Medical ...

  19. Pattern and Determinants of Antenatal Booking at Abakaliki ...

    African Journals Online (AJOL)

    for pregnant women to enable them attain and maintain a state of good health throughout pregnancy and to improve ... subsidization of cost of medical services will help in reversing the trend of late antenatal booking. Keywords: Abakaliki, Antenatal booking, .... Artisan/fashion/ design. 10 (2.9). 3 (30). 7 (70). Civil servant.

  20. Awareness of family planning amongst antenatal patients in a ...

    African Journals Online (AJOL)

    Aim: This study aimed at determining the awareness about family planning amongst pregnant women presenting to the antenatal clinic of Federal Medical Centre, Owo, Ondo State, Nigeria. Methodology: The study was conducted between December, 2007 and February, 2008 at the antenatal clinic of the hospital. Ethical ...

  1. Knowledge and attitudes of pregnant women towards antenatal care ...

    African Journals Online (AJOL)

    Health knowledge is one of the key factors enabling pregnant women to be aware of their rights and health status in order to seek appropriate antenatal health care services. The primary aim of this study was to explore pregnant women`s knowledge and attitudes towards antenatal care services at Tshino village, Vhembe ...

  2. The Prevalence of Osteoporosis among Antenatal Clinic Attendees ...

    African Journals Online (AJOL)

    Introduction: Osteoporosis is a global public health problem characterized by reduction of bone mineral density (BMD). This study aimed to assess the prevalence of osteoporosis among antenatal clinic attendees in a rural Southeastern hospital. Material and Methods: This was a cross‑sectional study of booking. Antenatal ...

  3. Gender preferences among antenatal women: a cross-sectional ...

    African Journals Online (AJOL)

    Background: A balanced sex ratio is essential for a stable society. Objective: The main objective of the present research was to study the perceptions of women attending the antenatal care (ANC) facility regarding their gender preferences and family composition. Method: In this cross-sectional study 132 antenatal women ...

  4. Reasons Given by Pregnant Women for Late Initiation of Antenatal ...

    African Journals Online (AJOL)

    2010-06-01

    Jun 1, 2010 ... no advantages in booking for antenatal care in the first three months of pregnancy. This seems to be because antenatal care is viewed primarily as curative rather than preventive in the study population. Research is needed to determine the best approaches for health education programmes to correct the ...

  5. Influence of Antenatal Care on the Haematocrit Value of Pregnant ...

    African Journals Online (AJOL)

    Context: Antenatal care is generally believed to influence the outcome of any pregnancy. Haematocrit values are important in the assessment of anaemia in pregnancy. A good antenatal care is expected to be associated with good haematocrit values, prevent anaemia in pregnancy, and result in an overall good pregnancy ...

  6. Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice.

    OpenAIRE

    Musheke Maurice; Bond Virginia; Merten Sonja

    2013-01-01

    Background: Couple HIV testing has been recognized as critical to increase uptake of HIV testing, facilitate disclosure of HIV status to marital partner, improve access to treatment, care and support, and promote safe sex. The Zambia national protocol on integrated prevention of mother-to-child transmission of HIV (PMTCT) allows for the provision of couple testing in antenatal clinics. This paper examines couple experiences of provider-initiated couple HIV testing at a public antenatal clinic...

  7. The Central Effects of Androgenic-anabolic Steroid Use.

    Science.gov (United States)

    Mędraś, Marek; Brona, Anna; Jóźków, Paweł

    2018-02-21

    : Millions of men use androgenic-anabolic steroids (AAS) to stimulate muscle growth and improve physical appearance. Although 1 out of 3 people who uses androgenic-anabolic steroids develops a steroid use disorder, the effects of the drugs on the central nervous system and the psyche are still not well understood. Although most addictive substances improve mood immediately after administration, AAS exert less pronounced euphoric effects. Instead, they are primarily taken for the delayed gratification of increased muscle mass. Withdrawal from AAS may lead to a range of somatic and psychiatric symptoms, and, in many cases, comprehensive treatment supervised by an endocrinologist and a psychiatrist is required.

  8. Anabolic-androgenic steroid increases running endurance in rats.

    Science.gov (United States)

    Van Zyl, C G; Noakes, T D; Lambert, M I

    1995-10-01

    The study was designed to determine whether treatment with an anabolic-androgenic steroid enhances running performance in rats by increasing their freely chosen training distance. Forty male Long-Evans rats were randomly divided into either a sedentary control group or an exercising group caged in specially designed running wheels in which the rats were able to run spontaneously. After 4 wk, both groups were further subdivided into two groups receiving either 0.5-mg Durabolin (nandrolone phenylpropionate) (im) or 0.5-mg saline, every second day. After 8 wk, running distance was similar in both exercising groups. Rats receiving the anabolic-androgenic steroid ran 41% longer during the test of submaximal running endurance compared to the trained rats receiving saline (P sedentary rats receiving the anabolic-androgenic steroid. After 4 wk of training, the maximal sprinting speed increased by 29% in trained rats. There was no further increase in maximal sprinting speed after an additional 4 wk of training and treatment with either anabolic-androgenic steroid or saline treatment. Therefore, rats that train spontaneously while being treated with an anabolic-androgenic steroid had increased submaximal running endurance compared with trained rats treated with saline, despite the similar voluntary training distance and skeletal muscle oxidative capacity between the two groups. The mechanism by which treatment with an anabolic-androgenic steroid, combined with training, enhances submaximal running performance could not be identified and needs to be addressed in future studies.

  9. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

    OpenAIRE

    Leary, Joyce; Swislocki, Arthur

    2013-01-01

    Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a...

  10. Cervical epidural hematoma: Following interlaminar cervical epidural steroid injection

    Directory of Open Access Journals (Sweden)

    Dwarkadas Kanhayalal Baheti

    2015-01-01

    Full Text Available Cervical epidural steroid injection is a common procedure performed for patients with cervical radiculopathy. Cervical epidural hematoma is a rare but known complication of Intervention Pain Treatment Procedure (IPTP in healthy patients without coagulopathy. We report a case of cervical epidural hematoma as a complication of cervical epidural steroid injection in an elderly patient with cervical radiculopathy; resulting in right upper limb motor sensory deficit. Patient responded to conservative management and surgery was not performed since symptoms progressively improved.

  11. Iatrogenic Cushing's Syndrome After Topical Steroid Therapy for Psoriasis

    OpenAIRE

    Sah?p, Birsen; Cel?k, Mehmet; Ayturk, Semra; Kucukarda, Ahmet; Mert, Onur; D?ncer, Nejla; Guld?ken, S?bel; Tugrul, Armagan

    2016-01-01

    Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing′s syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing′s syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with ...

  12. Steroid-Functionalized Titanocenes: Docking Studies with Estrogen Receptor Alpha

    Directory of Open Access Journals (Sweden)

    Li Ming Gao

    2016-11-01

    Full Text Available Estrogen receptor alpha (ERα is a transcription factor that is activated by hormones, with 17β-estradiol being its most active agonist endogenous ligand. ERα is also activated or inactivated by exogenous ligands. ER is overexpressed in hormone-dependent breast cancer, and one of the treatments for this type of cancer is the use of an ER antagonist to halt cell proliferation. We have previously reported four steroid-functionalized titanocenes: pregnenolone, dehydroepiandrosterone (DHEA, trans-androsterone, and androsterone. These steroids have hormonal activity as well as moderate antiproliferative activity, thus these steroids could act as vectors for the titanocene dichloride to target hormone-dependent cancers. Also, these steroids could increase the antiproliferative activity of the resulting titanocenes based on synergism. In order to elucidate which factors contribute to the enhanced antiproliferative activity of these steroid-functionalized titanocenes, we performed docking studies between ERα and the titanocenes and the steroids. The binding affinities and type of bonding interactions of the steroid-functionalized titanocenes with ERα are herein discussed.

  13. Teens and Steroids: A Dangerous Combo

    Science.gov (United States)

    ... FDA Consumer Health Information Español The abuse of anabolic steroids can cause both temporary and permanent injury to ... the dangers of steroid use. Q: What are anabolic steroids and how many teens use them? A: They ...

  14. Teaching antenatal counseling skills to neonatal providers.

    Science.gov (United States)

    Stokes, Theophil A; Watson, Katie L; Boss, Renee D

    2014-02-01

    Counseling a family confronted with the birth of a periviable neonate is one of the most difficult tasks that a neonatologist must perform. The neonatologist's goal is to facilitate an informed, collaborative decision about whether life-sustaining therapies are in the best interest of this baby. Neonatologists are trained to provide families with a detailed account of the morbidity and mortality data they believe are necessary to facilitate a truly informed decision. Yet these complicated and intensely emotional conversations require advanced communication and counseling skills that our current fellowship-training strategies are not adequately providing. We review educational models for training neonatology fellows to provide antenatal counseling at the threshold of viability. We believe that training aimed at teaching these skills should be incorporated into the neonatal-perinatal medicine fellowship. The optimal approaches for teaching these skills remain uncertain, and there is a need for continued innovation and outcomes-based research. Published by Elsevier Inc.

  15. Antenatal Diagnosis of an XXX Female

    Science.gov (United States)

    Krone, Lawrence R.; Prichard, Lorraine L.; Bradshaw, Christy L.; Jones, Oliver W.; Peterson, Raymond M.; Dixson, Barbara K.

    1975-01-01

    This report describes the first antenatal diagnosis of an XXX female. Over 150 postnatal cases of XXX females have been described. There is no specific phenotype associated with the sex chromosome abnormality and most such persons are fertile. The frequency of XXX females in mental institutions is 3.9 per 1,000 female subjects whereas the frequency in consecutive newborn infants is 1.1 per 1,000 newborns. Chi-square analysis shows this difference cannot be due to chance. On the other hand, data from consecutive newborn studies suggest that intellectual development in XXX newborns is within normal range. Available evidence favors normal development in XXX female infants although the risk for developmental disabilities may be higher for the XXX than for the XX infant. ImagesFigure 1. PMID:1154778

  16. Advances in microbial steroid biotransformation.

    Science.gov (United States)

    Mahato, S B; Garai, S

    1997-04-01

    Microbial biotransformations of various steroids are reviewed. Developmental studies on hydroxylation, carbon-carbon bond cleavage, enzymatic catalysis in nonaqueous solvents, use of cyclodextrin medium, cell immobilization, and new microbial reactions are highlighted. Various steroid substrates, their metabolites and the microorganisms used for the transformations are compiled covering the literature for the period 1992-1995.

  17. Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression.

    Science.gov (United States)

    Dennis, Cindy-Lee; Allen, Kim

    2008-10-08

    Although pregnancy was once thought of as a time of emotional well-being for many women, conferring 'protection' against psychiatric disorders, a recent meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester to a high of 12.8% in the second trimester. Due to maternal treatment preferences and potential concerns about fetal and infant health outcomes, non-pharmacological treatment options are needed. To assess the effects, on mothers and their families, of non-pharmacological/psychosocial/psychological interventions compared with usual antepartum care in the treatment of antenatal depression. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007), the Cochrane Collaboration Depression Anxiety and Neurosis Group's Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (January 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 3), MEDLINE (1966 to January 2007), EMBASE (1980 to January 2007) and CINAHL (1982 to January 2007). We scanned secondary references and contacted experts in the field to identify other published or unpublished trials. All published, unpublished and ongoing randomised controlled trials of non-pharmacological/psychosocial/psychological interventions to treat antenatal depression. All review authors independently participated in the evaluation of methodological quality and data extraction. . We included one US three-armed randomised controlled trial in this review, incorporating 61 outpatient antenatal women who met Diagnostic and Statistical Manual for Mental Disorders-IV criteria for major depression. Maternal massage, compared to non-specific acupuncture (control group), did not significantly decrease the number of women diagnosed with clinical depression immediately post-treatment (one trial, n = 38; risk ratio (RR) 0.80, 95% confidence interval (CI) 0.25 to 2

  18. Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria

    Directory of Open Access Journals (Sweden)

    Adekanle DA

    2008-04-01

    Full Text Available Introduction: Antenatal care is concerned mainly with prevention, early diagnosis and treatment of general medical and pregnancy associated disorders. For it to be meaningful, early booking is recommended, however, late booking is still a major problem.Objective: To determine the prevalence of late booking in our environment and factors related to it.Methodology: A descriptive cross-sectional study using structured interviewer assisted questionnaires.Results: Mean gestational age at booking was 20.3±6.2 weeks. Prevalence of late entry to antenatal care was 82.6%. Maternal education and age remained significant factors influencing late booking.Conclusion: Late booking is still a major problem in this part of the world. Public enlightenment, health education coupled with women empowerment would be helpful in reducing the problem

  19. Impact of animal manure separation technologies on steroid hormone distribution

    DEFF Research Database (Denmark)

    Hansen, Martin; Popovic, Olga; Björklund, Erland

    2015-01-01

    water treatment processes. However more recently, it has been revealed that agricultural practices also may add to the environmental burden of steroid hormones. So far, research activities have mainly focused on steroid estrogens, but also androgens, progestagens and glucocorticoids, expressed......When steroid hormones are emitted into the environment, they may have harmful effects on the reproduction system of aquatic life. Until now, research has primarily focused on human excretion, demonstrating that steroid hormones reach the aquatic environment due to insufficient removal in waste...... in the vertebrate steroidogenesis, may occur at substantial levels in animal manure and should be addressed. In agricultural practices the animal manure can be applied to the soil as raw manure, but also as a solid or liquid manure fraction, since current livestock production facilities utilizes a recently...

  20. The antenatal diagnosis of cephalothoracopagus Janiceps conjoined twins.

    Science.gov (United States)

    Ramadani, H M; Johnshrud, N; al Nasser, M; Rayes, O

    1994-02-01

    A case of cephalothoracopagus conjoined twins (Janiceps twins) is presented. The abnormality was detected antenatally by the use of ultrasonography and confirmed postnatally, clinically and by computed tomography (CT scan).

  1. Perceptions of pregnant adolescents on the antenatal care received ...

    African Journals Online (AJOL)

    Perceptions of pregnant adolescents on the antenatal care received at Ndirande Health Centre in Blantyre, Malawi. Maria Chifuniro Chikalipo, Linda Nyondo Mipando, Rabecca Chikondi Ngalande, Sadandaula Rose Muheriwa, Ursula Kalimembe Kafulafula ...

  2. Incidence of nevirapine-associated hepatitis in an antenatal clinic ...

    African Journals Online (AJOL)

    based highly active antiretroviral therapy at a dedicated antenatal antiretroviral clinic between July 2004 and December 2006. Results. Three hundred and ninety women were included in the analysis. Median age was 29 (interquartile range (IQR)

  3. Perceived Factors Influencing the Choice of Antenatal Care and ...

    African Journals Online (AJOL)

    Perceived Factors Influencing the Choice of Antenatal Care and Delivery Centres among Childbearing Women In Ibadan North South-Western, Nigeria. EE Ewa, CJ Lasisi, SO Maduka, AE Ita, UW Ibor, OA Anjorin ...

  4. Iatrogenic Cushing's Syndrome After Topical Steroid Therapy for Psoriasis.

    Science.gov (United States)

    Sahıp, Birsen; Celık, Mehmet; Ayturk, Semra; Kucukarda, Ahmet; Mert, Onur; Dıncer, Nejla; Guldıken, Sıbel; Tugrul, Armagan

    2016-01-01

    Glucocorticoids are used for the treatment of many diseases, such as inflammatory, allergic, autoimmune, and neoplastic diseases. They can be used in the form of topical, oral, inhalable, rectal, and intra-articular agents. Many topical steroid-related iatrogenic Cushing's syndrome cases affecting especially children have been reported in the literature. Topical steroid-related Cushing's syndrome is rarely seen in adults. In this report, we present the case of a 32-year-old male patient with iatrogenic Cushing's syndrome related to long-term clobetasol propionate treatment for psoriasis. In the context of such treatment, the glucocorticoid withdrawal problem has to be overcome. At present there is no consensus on steroid withdrawal. Patients on long-term glucocorticoid treatment must be evaluated for potential adverse effects and withdrawal symptoms by their physician and their endocrinologist.

  5. Prevalence of antenatal depressive symptoms among women in Sabah, Malaysia.

    Science.gov (United States)

    Mohamad Yusuff, Aza Sherin; Tang, Li; Binns, Colin W; Lee, Andy H

    2016-01-01

    To investigate the prevalence of antenatal depression and to assess whether the common risk factors identified in previous studies were applicable to women in Sabah, Malaysia. A prospective cohort study of 2072 women was conducted in Sabah during 2009-2010. Participants were recruited at 36-38 weeks of gestation to complete a self-administered questionnaire regarding their demographic, socioeconomic and health characteristics. The presence of depression was assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale. The prevalence of antenatal depression was 13.8% [95% confidence interval (CI) 12.3%, 15.3%]. Women who were happy with the pregnancy [odds ratio (OR) 0.43, 95% CI 0.21, 0.89] and those with a planned pregnancy (OR 0.45, 95% CI 0.33, 0.60) were less likely to suffer from antenatal depression. Pregnant mothers who were taking oral contraceptives before pregnancy (OR 1.63, 95% CI 1.20, 2.22) and women who experienced antenatal anxiety (OR 3.17, 95% CI 2.35, 4.26) appeared to have an increased risk of antenatal depression. A substantial proportion of women suffered from antenatal depression in Sabah, Malaysia. Screening and culturally tailored intervention programs targeting vulnerable subgroups of women in the early stage of pregnancy are recommended to deal with the problem.

  6. Topical steroid-damaged skin

    Directory of Open Access Journals (Sweden)

    Anil Abraham

    2014-01-01

    Full Text Available Topical steroids, commonly used for a wide range of skin disorders, are associated with side effects both systemic and cutaneous. This article aims at bringing awareness among practitioners, about the cutaneous side effects of easily available, over the counter, topical steroids. This makes it important for us as dermatologists to weigh the usefulness of topical steroids versus their side effects, and to make an informed decision regarding their use in each individual based on other factors such as age, site involved and type of skin disorder.

  7. Are Steroids a Beneficial Adjunctive Therapy in the Immunosuppressed Patient with Herpes Simplex Virus Encephalitis?

    Directory of Open Access Journals (Sweden)

    Karlo J. Lizarraga

    2013-03-01

    Full Text Available Few reports describe the reactivation of latent herpes simplex virus causing encephalitis (HSVE in patients undergoing brain radiation therapy and a concomitant steroid regimen. The role for steroid use in the treatment of patients with HSVE has not been fully elucidated. We report the case of a female patient immunosuppressed by steroids and brain radiation who developed HSVE and responded to acyclovir and dexamethasone.

  8. COMPARATIVE STUDY OF EFFICACY OF FERROUS SULPHATE AND CARBONYL IRON IN ANEMIA OF ANTENATAL WOMEN

    Directory of Open Access Journals (Sweden)

    Radhika

    2015-03-01

    Full Text Available Iron deficiency anemia is the most common and important public health problem all over the world in the risk group of antenatal women. Research is going on to improve the iron status of the pregnant women with different forms of iron available. In this regard, Carbonyl Iron is showing promising results in improving the red cell mass with better compliance. 120 antenatal women were recruited in this study. The study comprised of 6weeks for each patient. They were given Carbonyl Iron 100 mg/day and FeS04 100gm/day . Before and after treatment all the baseline and specific investigations were one. Results were tabulated, comparison and significance were tested by unpaired student ’s’ test and their 'p' value was calculated. Results were shown graphically also. Carbonyl Iron showed improvement in hemoglobin, PCV and better than ferrous Sulphate (P <0.001. Incidence of side effects were less with Carbonyl Iron than Ferrous Sulphate, better compliance was seen with Carbonyl Iron. In conclusion, the present study s howed that Carbonyl Iron had better efficacy and safety in the management of Iron deficiency anemia in antenatal women than ferrous Sulphate

  9. Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Andreas Kuznik

    2013-11-01

    Full Text Available Untreated syphilis in pregnancy is associated with adverse clinical outcomes for the infant. Most syphilis infections occur in sub-Saharan Africa (SSA, where coverage of antenatal screening for syphilis is inadequate. Recently introduced point-of-care syphilis tests have high accuracy and demonstrate potential to increase coverage of antenatal screening. However, country-specific cost-effectiveness data for these tests are limited. The objective of this analysis was to evaluate the cost-effectiveness and budget impact of antenatal syphilis screening for 43 countries in SSA and estimate the impact of universal screening on stillbirths, neonatal deaths, congenital syphilis, and disability-adjusted life years (DALYs averted.The decision analytic model reflected the perspective of the national health care system and was based on the sensitivity (86% and specificity (99% reported for the immunochromatographic strip (ICS test. Clinical outcomes of infants born to syphilis-infected mothers on the end points of stillbirth, neonatal death, and congenital syphilis were obtained from published sources. Treatment was assumed to consist of three injections of benzathine penicillin. Country-specific inputs included the antenatal prevalence of syphilis, annual number of live births, proportion of women with at least one antenatal care visit, per capita gross national income, and estimated hourly nurse wages. In all 43 sub-Saharan African countries analyzed, syphilis screening is highly cost-effective, with an average cost/DALY averted of US$11 (range: US$2-US$48. Screening remains highly cost-effective even if the average prevalence falls from the current rate of 3.1% (range: 0.6%-14.0% to 0.038% (range: 0.002%-0.113%. Universal antenatal screening of pregnant women in clinics may reduce the annual number of stillbirths by up to 64,000, neonatal deaths by up to 25,000, and annual incidence of congenital syphilis by up to 32,000, and avert up to 2.6 million

  10. ANABOLIC ANDROGENIC STEROIDS AND DEPENDENCE

    Directory of Open Access Journals (Sweden)

    IHSAN SARI

    2010-12-01

    Full Text Available Anabolic androgenic steroids are used for sportive, cosmetic, therapeutic and occupational reasons and there are many side effects reported (George, 2005; Nieminen et al., 1996; O'Sullivan et al., 2000. Prevalence of anabolic steroids’ use also indicates the importance of this topic. Moreover, it is now known that use of anabolic steroids could lead to dependence which could be psychological or/and physiological (Copeland et al., 2000. It isimportant to know about all aspects of anabolic steroids including dependence. Therefore, this study has attempted to give an insight into use of anabolic steroids and dependence. The discussion will focus on prevalence, reasons, and side effects of use and physiological and psychological dependence

  11. The radioimmunoassay of steroid glucuronides

    International Nuclear Information System (INIS)

    Chaudhri, B.

    1980-07-01

    A radioimmunoassay method for steroid glucuronides in which the second carboxylated group has been introduced into the steroid structure and used to attach the hapten to the protein. The unequivocal attachment through the second group, rather than through the glucuronide is achieved by leaving the glucuronide protected as its triacetyl methyl-ester (g.a.m.e.) until after the hapten has been coupled to the protein. The hapten, immunogens and antisera to costrone-3-glucuronide have been prepared using a 17-carboxymethyloxime bridge. The antisera raised to these immunogens have been characterised for their ability to discriminate between the free steroid and the steroid glucuronide, and evaluated for use in immunoassay. (author)

  12. Do oral steroids aid recovery in children with Bell's palsy?

    Science.gov (United States)

    Ismail, Abdul Qader; Alake, Oluwaseyi; Kallappa, Chetana

    2014-10-01

    There is growing evidence that steroids are not beneficial for treatment of paediatric patients with Bell's palsy. To investigate, we conducted a retrospective longitudinal study examining notes of 100 children, over 12 years coded for facial nerve palsy. Of the 79 diagnosed with Bell's palsy, all recovered, and for 46 patients we had data on interval from onset of symptoms to resolution (median duration in treated group = 5 weeks, range = 39; median duration in untreated group = 6 weeks, range = 11; P = .86). From our results, we conclude that all children with Bell's palsy recovered, with or without steroid treatment, with no statistically significant difference in symptoms duration. Complications of unresolved Bell's palsy can have important long-term functional and psychosocial consequences. Therefore, we need further research on use of steroids in children with complete/severe cases; it would be a shame to omit treatment due to "absence of evidence" rather than "evidence of absence." © The Author(s) 2013.

  13. Antenatal nephromegaly and propionic acidemia: a case report.

    Science.gov (United States)

    Bernheim, Ségolène; Deschênes, Georges; Schiff, Manuel; Cussenot, Isabelle; Niel, Olivier

    2017-03-30

    Propionic acidemia (PA) is a rare but severe recessive autosomal disease, presenting with non specific signs in the first years of life. Prenatal diagnosis is invasive (amniocentesis) and limited to suspect cases. No screening test has been described, in particular no correlations between prenatal sonography and PA have been documented so far. We report the case of a boy with fetal bilateral nephromegaly and hyperechogenic kidneys, along with neonatal acute kidney injury; no etiology could be found in the first months of life. At 3 months of life, he presented with tachypnea and altered mental status, which lead to the diagnosis of PA. The renal ultrasound at 8 months of life, after a symptomatic treatment of PA had been initiated, showed a regression of the renal abnormalities. This case describes PA as a novel cause of large and hyperechogenic kidneys in the antenatal period. It suggests that, when confronted to fetal nephromegaly, hyperechogenic kidneys and risk factors of metabolic disease such as consanguineous parents, PA should be considered, and a prenatal test should be proposed.

  14. Effect of anabolic steroids on skeletal muscle mass during hindlimb suspension

    Science.gov (United States)

    Tsika, R. W.; Herrick, R. E.; Baldwin, K. M.

    1987-01-01

    The effect of treatment with an anabolic steroid (nandrolone decanoate) on the muscle mass of plantaris and soleus of a rats in hindlimb suspension, and on the isomyosin expression in these muscles, was investigated in young female rats divided into four groups: normal control (NC), normal steroid (NS), normal suspension (N-sus), and suspension steroid (sus-S). Steroid treatment of suspended animals (sus-S vs N-sus) was found to partially spare body weight and muscle weight, as well as myofibril content of plantaris (but not soleus), but did not modify the isomyosin pattern induced by suspension. In normal rats (NS vs NC), steroid treatment did enhance body weight and plantaris muscle weight; the treatment did not alter isomyosin expression in either muscle type.

  15. Lymphocyte-depleting induction and steroid minimization after kidney transplantation: A review.

    Science.gov (United States)

    Naesens, Maarten; Berger, Stefan; Biancone, Luigi; Crespo, Marta; Djamali, Arjang; Hertig, Alexandre; Öllinger, Robert; Portolés, José; Zuckermann, Andreas; Pascual, Julio

    Steroid minimization after kidney transplantation has become more widely practiced as transplant clinicians seek the potential benefits such as reduced cardiovascular risk factors, improved growth in pediatric patients, and improved compliance with the immunosuppression regimen. Steroid avoidance (i.e. no steroids after the first week) is generally favored compared to later withdrawal. Induction therapy is routine in this setting, frequently rabbit antithymocyte globulin (rATG, Thymoglobulin®) or off-license use of alemtuzumab. Direct comparisons of steroid minimization regimens versus standard steroid regimens are rare. However, the available data show that the risk of acute rejection is low when rATG or alemtuzumab induction is given to support steroid-avoidance regimens after kidney transplantation. Steroid avoidance may be inadvisable in patients at high immunological risk or at risk of recurrent glomerular disease. Steroid withdrawal after day 8 may be possible without additional risk of rejection in patients given rATG induction, but while encouraging, the data are too sparse for firm conclusions. In summary, steroid avoidance may be beneficial for patients after renal transplantation, with the potential to avoid or reduce steroid-related comorbidities. Whilst depleting induction therapy could be the treatment of choice, results of prospective randomized, controlled studies are eagerly awaited. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Preparation of directly iodinated steroid hormones and related directly halogenated compounds

    International Nuclear Information System (INIS)

    Sahadevan, V.

    1981-01-01

    The preparation of directly iodinated radioactive steroid hormones is described for use in radioimmunoassays or radiolocalization and treatment of human breast tumours. The radioactive iodinated steroid hormone is prepared by reacting a parent steroid hormone with an alkali metal iodide containing radioactive 123 I, 125 I, 130 I or 131 I in the presence of hydrogen peroxide or chloramine-T. The parent steroid hormones include the adrenal corticosteroids, the estrogens, the progestogens, the progestins and the diuretic and antidiuretic agents. The radioactive iodinated steroid hormone is prepared by iodinating the parent steroid hormone directly on the cyclopentanophenanthrene nucleus. The radioactive iodinated steroid hormones have the same antigenicity and receptor site specificity as the parent steroid hormone. The invention is illustrated by 1) the method of iodination of estradiol-17β, 2) results for the percentage labelling of several steroids and steroid hormones, 3) results for the radioimmunoassay of 125 I-estradiol and 4) results for the binding of directly iodinated estradiol-17β in an estrogen receptor assay of human breast cancer. (U.K.)

  17. Steroid - induced rosacea: A clinical study of 200 patients

    Directory of Open Access Journals (Sweden)

    Yasmeen J Bhat

    2011-01-01

    Full Text Available Background: Topical corticosteroids were first introduced for use in 1951. Since then uncontrolled use (abuse has caused many different reactions resembling rosacea - steroid dermatitis or iatrosacea. Multiple pathways including rebound vasodilatation and proinflammatory cytokine release have been proposed as the mechanism for such reactions. Aim: The aim was to study the adverse effects of topical steroid abuse and the response to various treatment modalities. Materials and Methods: Two hundred patients with a history of topical steroid use on face for more than 1 month were studied clinically and various treatments tried. Results: The duration of topical corticosteroid use varied from 1 month to 20 years with an average of 19.76 months. Majority of patients were using potent (class II topical steroids for trivial facial dermatoses. The common adverse effects were erythema, telangiectasia, xerosis, hyperpigmentation, photosensitivity, and rebound phenomenon. No significant change in laboratory investigations was seen. Conclusion: A combination of oral antibiotics and topical tacrolimus is the treatment of choice for steroid-induced rosacea.

  18. Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy.

    Science.gov (United States)

    Nedelka, Tomas; Nedelka, Jiri; Schlenker, Jakub; Hankins, Christopher; Mazanec, Radim

    2014-01-01

    Lumbar facet joints (FJ) is a common source of low back pain and contributes approximmately on one third of chronic low back pain. Medial branch radiofrequency neurotomy is considered as a gold standard in the treatment of facet joint pain. Corticosteroid injections have also presented effect in FJ pain. As an interventional procedures, they carry not-negligible risk of possible complications including infection, damage to nerve root or medial branch structures. Shockwave therapy (SWT) is a non-invasive method for treatment of various musculoskeletal disorders. Its effect is based on transduction of mechanical energy, transferred to cascade of various biochemical processes in target tissue. Its efficacy was proved in the treatment of different painful conditions. The efficacy of SWT was not yet studied in FJ pain. Aim of our work was to compare the efficacy of SWT against interventional treatment procedures - radiofrequency neurotomy and corticosteroid FJ injections. A retrospective study was done on 62 selected patients with unilateral chronic lumbar facet pain. There were 32 women and 30 men, divided into SWT group, corticosteroid injections group radiofrequency group. Nociceptive and neuropathic pain intensity and severity of pain were measured. Shockwave therapy had shown better longterm results compared to FJ injections group and little inferior efficacy compared to RMBN. We did not observe any adverse effects and complications in SWT group. Moreover, in SWT and RMBN groups, significant longterm improvement in daily activities limitation, was observed. SWT appears to be a safe and perspective option in the treatment of FJ pain with negligible side effects.

  19. The correlation between fecal calprotectin, simple clinical colitis activity index and biochemical markers in ulcerative colitis during high-dose steroid treatment

    DEFF Research Database (Denmark)

    Theede, Klaus; Kiszka-Kanowitz, Marianne; Nielsen, Anette Mertz

    2014-01-01

    OBJECTIVE: Monitoring active ulcerative colitis (UC) is essential for making correct and timely treatment decisions. The current monitoring is based on symptom scores and biochemical markers, among which the role of fecal calprotectin (FC) is debated. The aims were to assess the development in FC...... colitis activity index (SCCAI) were assessed before the initiation of treatment, as well as on days 2, 6, 13, and 27. The one-year follow-up data were retrospectively obtained. RESULTS: All patients had significant decreasing levels of FC (-1014 mg/kg, p = 0.0061), CRP (-10 mmol/l, p = 0.0313), and SCCAI...

  20. Evaluation of preventive and therapeutic activity of novel non-steroidal anti-inflammatory drug, CG100649, in colon cancer: Increased expression of TNF-related apoptosis-inducing ligand receptors enhance the apoptotic response to combination treatment with TRAIL.

    Science.gov (United States)

    Woo, Jong Kyu; Kang, Ju-Hee; Jang, Yeong-Su; Ro, Seonggu; Cho, Joong Myung; Kim, Hwan-Mook; Lee, Sang-Jin; Oh, Seung Hyun

    2015-04-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) have been suggested as the potential new class of preventive or therapeutic antitumor agents. The aim of the present study was to evaluate the antitumor activity of the novel NSAID, CG100649. CG100649 is a novel NSAID dual inhibitor for COX-2 and carbonic anhydrase (CA)-I/-II. In the present study, we investigated the alternative mechanism by which CG100649 mediated suppression of the colon cancer growth and development. The anchorage‑dependent and -independent clonogenic assay showed that CG100649 inhibited the clonogenicity of human colon cancer cells. The flow cytometric analysis showed that CG100649 induced the G2/M cell cycle arrest in colon cancer cells. Animal studies showed that CG100649 inhibited the tumor growth in colon cancer xenograft in nude mice. Furthermore, quantitative PCR and FACS analysis demonstrated that CG100649 upregulated the expression of TNF-related apoptosis-inducing ligand (TRAIL) receptors (DR4 and DR5) but decreased the expression of decoy receptors (DcR1 and DcR2) in colon cancer cells. The results showed that CG100649 treatment sensitized TRAIL‑mediated growth suppression and apoptotic cell death. The combination treatment resulted in significant repression of the intestinal polyp formation in APCmin/+ mice. Our data clearly demonstrated that CG100649 contains preventive and therapeutic activity for colon cancer. The present study may be useful for identification of the potential benefit of the NSAID CG100649, for the achievement of a better treatment response in colon cancer.

  1. Combination treatment of extensive and recalcitrant alopecia areata with oral and topical steroids with topical minoxidil: An open-label study of efficacy and safety in pediatric patients

    Directory of Open Access Journals (Sweden)

    Vivek Kumar Dey

    2016-01-01

    Conclusion: Finding an effective and safe treatment regimen for AA, especially in children is difficult. Our regimen allows for more rapid lowering of oral doses with maintaining the cosmetic response and minimizing the side effects. Therefore, a trial course of this regiment would seem to be a reasonable approach for nearly hopeless but highly motivated pediatric patients of extensive and recalcitrant AA.

  2. Eculizumab treatment in a patient with hematopoietic stem cell transplantation-associated thrombotic microangiopathy and steroid-refractory acute graft versus host disease

    Directory of Open Access Journals (Sweden)

    Cristina Fernández

    2015-12-01

    Full Text Available A 30-year-old man with acquired aplastic anemia underwent an HLA-identical bone marrow transplant. He developed a grade III acute graft versus host disease (GVHD refractory to various lines of treatment. On post-transplant day 196, he was diagnosed with stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA and he received treatment with eculizumab 900 mg iv weekly for 4 doses followed by a single dose of 1200 mg 2 weeks later. After the first dose of eculizumab, the patient ceased to require transfusions and a progressive improvement in analytical parameters for microangiopathy was observed until their complete normalization. Coinciding with the improved of HSCT-TMA, the patient presented a clear response to his acute GVHD with disappearance of the diarrhea and bilirubin normalization. He was discharged eight weeks after the start of treatment. Unfortunately, one month later, the patient was readmitted for a GVHD relapse and he died two weeks later by an acute respiratory distress syndrome. In our case, the rapid clinical and analytical response to early treatment with eculizumab supports the implication of the complement in HSCT-TMA and suggests that the drug has a beneficial effect when used as coadjuvant therapy in acute GVHD.

  3. The effect of antenatal education in small classes on obstetric and psycho-social outcomes

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Axelsen, Solveig Forberg; Andersen, Stig Krøger

    2014-01-01

    The aims of antenatal education contain both outcomes related to pregnancy, birth and parenthood. Both content and methods of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small...... number of participants, may differ from the effect of other forms of antenatal education. The latest Cochrane review, assessed as up-to-date in 2007, concluded that the effect of antenatal education for childbirth or parenthood or both remains largely unknown. This systematic review and meta......-analysis aims to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes....

  4. Efficacy of photodynamic therapy or low level laser therapy against steroid therapy in the treatment of erosive-atrophic oral lichen planus.

    Science.gov (United States)

    Mirza, Sana; Rehman, Navedur; Alrahlah, Ali; Alamri, Wa'ad Rafa; Vohra, Fahim

    2018-03-01

    The efficacy of photodynamic therapy (PDT) or low level laser therapy (LLLT) in the treatment of oral lichen planus (OLP) is debatable. The aim of this study was to compare the effects of PDT, LLLT or topical corticosteroid application in the treatment of erosive-atrophic OLP. Forty-five adult patients with erosive-atrophic biopsy-proven OLP on the tongue or buccal mucosa (size ≤3 cm) were randomly divided into three groups. Group-1: patients receiving PDT topical application of 50 μl toluidine blue (1 mg/ml) with micropipette and after 10 min treated by laser irradiation using GaAlAs laser (630 nm, 10 mW/cm 2 , continuous wave, spot size: 1 cm 2 ); Group-2: patients receiving LLLT using diode laser (630 nm, 10 mW, continuous wave, spot size: 1 cm 2 ); and Group-3: patients receiving topical corticosteroid applications consisting of dexamethasone (0.5 mg in 5 ml water) mouthwash for 5 min. Demographic data, type, and severity of the lesions and pain were recorded before and after treatment and then at the 1 year follow-up. There was a significant difference in sign score changes before and after the treatment in the PDT group (p = 0.03), LLLT group (p = 0.04) and in the control group (p = 0.02). There was a statistically significant difference between group-1 (p = 0.001) and group-2 (p = 0.001) against group-3 before and after treatment. Mean amount of improvement in pain was significantly greater in the control group in comparison with the PDT and LLLT groups (p < 0.001). The efficacy index of the PDT group improved significantly more than the LLLT (p = 0.001) and corticosteroid groups (p = 0.001). Within the limits of the present RCT, it is indicated that PDT and LLLT are effective in the treatment of erosive-atrophic forms of OLP in adult patients. However, further comparative clinical trials are needed to obtain strong conclusions in this regard. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Impact of proton pump inhibitor treatment on gastrointestinal bleeding associated with non-steroidal anti-inflammatory drug use among post-myocardial infarction patients taking antithrombotics

    DEFF Research Database (Denmark)

    Schjerning Olsen, Anne-Marie; Lindhardsen, Jesper; Gislason, Gunnar H

    2015-01-01

    gastrointestinal bleeds occurred. The crude incidence rates of bleeding (events/100 person years) on NSAID plus antithrombotic therapy were 1.8 for patients taking PPIs and 2.1 for those not taking PPIs. The adjusted risk of bleeding was lower with PPI use (hazard ratio 0.72, 95% confidence interval 0.54 to 0.......95) regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. The main limitation of the study is its observational non-randomised design. The results suggest that PPI treatment probably has a beneficial effect regardless of underlying gastrointestinal risk and that when NSAIDs cannot...... of NSAID, and type of PPI used. FUNDING, COMPETING INTERESTS, DATA SHARING: AMSO has received a grant from the Danish Council of Independent Research (grant 12-132760). GHG is supported by an unrestricted research scholarship from the Novo Nordisk Foundation....

  6. Trend in asthma severity in steroid naive asthmatic children in Benin ...

    African Journals Online (AJOL)

    Objective: To determine the trend in severity of asthma in steroid naive children, in an era when steroid use in the treatment of asthma was uncommon. Materials and Methods: Case notes of patients managed for asthma from 1985 to 1995 and age 5 - 16 years were retrieved and reviewed (these case notes are usually ...

  7. Indications for intra-articular steroid in osteoarthritis of the ankle and ...

    African Journals Online (AJOL)

    The results of treatment with intra-articular steroid in an unselected group of patients with osteo-arthritis of the ankle and metatarsophalangeal joint of the big toe are described. From the results of this trial it is possible to lay down indications for the use of intra-articular steroid in these conditions. In the ankle joint it is ...

  8. Effects of kinesiotaping versus non-steroidal anti-inflammatory drugs and physical therapy for treatment of pes anserinus tendino-bursitis: A randomized comparative clinical trial.

    Science.gov (United States)

    Homayouni, Kaynoosh; Foruzi, Shima; Kalhori, Fereshte

    2016-09-01

    Pes anserinus tendino-bursitis is a condition caused by repetitive friction over the bursa or direct trauma to knee joint and it presents with proximal medial tibial pain and swelling. The aim of this study is to determine the effects of kinesiotaping in comparison with naproxen and physical therapy in treatment of pes anserinus tendino-bursitis. In a randomized comparative clinical trial 56 patients with clinical diagnosis of pes anserinus tendino-bursitis were randomly assigned to kinesiotaping and naproxen/physical therapy (28 patients in each group). Kinesiotaping on the tender area in the form of space-correction (lifting) technique was used and repeated for three times with a one-week interval. Another group received naproxen (250mg TID for 10 days) and ten sessions of daily physical therapy. The visual analog scale (VAS) was used for evaluation of pain. The depth of swelling of the area was measured with sonography before and after treatment. Wilcoxon signed ranks test has been used for determining the influence of interventions on pain (VAS) and swelling scores in each group. The ANCOVA (Analysis of covariance) test was applied for comparing the influence of interventions on VAS and swelling scores after adjustment for co-variables. At end of the study, 27 patients remained in the kinesiotaping group and 19 patients in naproxen/physical therapy group. Treatment with kinesiotaping significantly decreased the pain (P=0.0001) and swelling scores (P=0.0001) in comparison with naproxen/physical therapy after adjustment for baseline characteristics. Kinesiotaping was safe without any complications except for a mild local skin irritation in one patient. Kinesiotaping is more effective than naproxen plus physical therapy in reduction of pain and swelling in patients with pes anserinus tendino-bursitis. www.ClinicalTrials.gov identifier is NCT01680263.

  9. Effect of oral testosterone treatment on serum concentrations of sex steroids gonadotrophins and prolactin in alcoholic cirrhotic men. Copenhagen Study Group for Liver Diseases

    DEFF Research Database (Denmark)

    Gluud, C; Bennett, Patrick; Svenstrup, Bo

    1988-01-01

    than 0.01) higher median serum concentrations of oestrone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin. The patients were randomized to treatment with either oral micronized testosterone (200 mg t.d.s.) or placebo for a median duration of 1 year. In the placebo group (n......, but no significant changes were observed regarding serum oestradiol and prolactin concentrations. Both LH and FSH concentrations decreased significantly (P less than 0.05) in the testosterone-treated group when compared with concentrations at entry and concentrations in the placebo group....

  10. Ongoing treatment with non-steroidal anti-inflammatory drugs at time of admission is associated with poorer prognosis in patients with first-time acute myocardial infarction

    DEFF Research Database (Denmark)

    Lamberts, Morten; Fosbøl, Emil L; Olsen, Anne-Marie S

    2013-01-01

    was significantly increased in patients receiving rofecoxib (hazard ratio [HR] 1.15; CI 1.04-1.27), celecoxib (HR 1.13; CI 1.01-1.26), diclofenac (HR 1.12; CI 1.04-1.20) or any NSAID use (HR 1.05; CI 1.02-1.09). No association was found for naproxen or ibuprofen. CONCLUSION: Ongoing treatment with NSAIDs...... and in particular the cyclooxygenase-2-selective inhibitors rofecoxib, celecoxib, and diclofenac is associated with worsened prognosis in patients admitted with first-time MI....

  11. Steroid-sparing effect and toxicity of dapsone treatment in giant cell arteritis: A single-center, retrospective study of 70 patients.

    Science.gov (United States)

    Ly, Kim Heang; Dalmay, François; Gondran, Guillaume; Palat, Sylvain; Bezanahary, Holy; Cypierre, Anne; Fauchais, Anne-Laure; Liozon, Eric

    2016-10-01

    Although a glucocorticoid (GC)-sparing strategy is needed for patients with giant cell arteritis (GCA) suffering from refractory disease or serious treatment-related complications, evidence of efficacy in this setting of immunosuppressive drugs and biotherapies is lacking. Herein, we evaluated the GC-sparing effects and tolerability of addition of dapsone (DDS) to prednisone therapy in patients with GCA. We retrospectively assessed data on 18 GCA patients who received DDS as a first-line treatment (DDS-1 group) and 52 patients who received it as a second- or third-line treatment for refractory GCA, with or without excessive GC-related toxicity (DDS-2 group). Of these 70 patients, 63 belonged to an inception cohort of 478 patients, whereas the remaining 7 were referred to our department for resistant GCA. In all, 52 patients were assessable for DDS efficacy. The baseline characteristics of the DDS-1 patients were similar to those of 395 GCA patients (control group) who received prednisone alone. DDS-1 patients had a more sustained decrease in GC dose with a lower mean prednisone dose at 12 months, and they comprised higher proportions who achieved GC withdrawal within the first year, who stopped prednisone treatment, and who recovered from GCA (P < 0.001 for each variable). Patients in the DDS-2 group achieved a mean rate of prednisone reduction of 65% and a prednisone dose reduction of 16.9 ± 13.3 mg/d. The monthly decreases in the prednisone dose were 2.4 and 1.25 mg in DDS-1 and DDS-2 patients, respectively. DDS-induced side effects were recorded in 44 (64%) assessable patients. These side effects led to lowering of the DDS dose by 25 mg/d in 11 (16%) patients and permanent cessation of DDS in 14 patients (20%), due to allergic skin rash in 7, agranulocytosis in 2, icteric hepatitis in 2, and excessive hemolysis in 2 patients. DDS is a potent GC-sparing agent in GCA that should be evaluated in prospective studies. However, DDS use should be

  12. Systematic review of the cost effectiveness of prophylactic treatments in the prevention of gastropathy in patients with rheumatoid arthritis or osteoarthritis taking non-steroidal anti-inflammatory drugs

    Science.gov (United States)

    van Dieten, H. E M; Bos, I.; van Tulder, M. W; Lems, W.; Dijkmans, B.; Boers, M.

    2000-01-01

    A systematic review on the cost effectiveness of prophylactic treatments of non-steroidal anti-inflammatory drug (NSAID) induced gastropathy in patients with osteoarthritis or rheumatoid arthritis was conducted. Two reviewers conducted the literature search and the review. Both full and partial economic evaluations published in English, Dutch, or German were included. The criteria list published in the textbook of Drummond was used to determine the quality of the economic evaluations. The methodological quality of three randomised controlled trials (RCTs) in which the economic evaluations obtained probability estimates of NSAID induced gastropathy and adverse events was assessed by a list of internal validity criteria. The conclusions were based on a rating system consisting of four levels of evidence.
  Ten economic evaluations were included; three were based on RCTs. All evaluations studied misoprostol as prophylactic treatment: in one evaluation misoprostol was studied as a fixed component in a combination with diclofenac (Arthrotec). All economic evaluations comprised analytical studies containing a decision tree. The three trials were of high methodological quality. Nine economic evaluations were considered high quality and one economic evaluation was considered of low methodological quality. There is strong evidence (level "A") that the use of misoprostol for the prevention of NSAID induced gastropathy is cost effective, and limited evidence (level "C") that the use of Arthrotec is cost effective. Although the levels of evidence used in this review are arbitrary, it is believed that a qualitative analysis is useful: quantitative analyses in this field are hampered by the heterogeneity of economic evaluations. Existing criteria to evaluate the methodological quality of economic evaluations may need refinement for use in systematic reviews.

 PMID:11005773

  13. Evaluation of antenatal risk factors lit Cape Verde.

    Science.gov (United States)

    Wessel, H; Bergstrorn, S; Cnattingius, S; Dupret, A; Reitmaier, P

    1996-08-01

    The prevalence of antenatal risk factors and their association with adverse pregnancy outcome were prospectively studied in the county of Praia, Cape Verde. Of 4693 women registering for antenatal care, 8% were randomly selected from October 1991 through December 1992. Eventually 358 women were observed until puerperium when a physical examination and a structured interview took place. Three out of four women of the cohort were exposed to risk factors according to the existing risk classification in Praia, and 9% presented high risk factors. Thirty two percent of the cohort faced adverse pregnancy outcomes. Adverse pregnancy outcomes were significantly increased among women who presented high risk factors, but 82% of all adverse outcomes occurred among other women. The antenatal risk classification investigated cannot be considered an effective tool for detection of women at risk of adverse pregnancy outcome.

  14. Antenatal maternal education for improving postnatal perineal healing for women who have birthed in a hospital setting.

    Science.gov (United States)

    O'Kelly, Sonia M; Moore, Zena Eh

    2017-12-04

    The female perineum becomes suffused and stretched during pregnancy, and further strain during vaginal childbirth contributes to approximately 85% of women experiencing some degree of trauma to the perineal region. Multiple factors play a role in the type and severity of trauma experienced, including parity, delivery method, and local practices. There is ongoing debate about best midwifery practice to reduce perineal trauma. Once perineal trauma has occurred, treatment also varies greatly, depending on its degree and severity, local practice and customs, and personal preference. In order to optimise wound-healing outcomes, it is important that wounds are assessed and managed in an appropriate and timely manner. A perineal wound may cause significant physical and/or psychological impact in the short or long term, however little evidence is available on this subject.Antenatal education serves to prepare women and their partners for pregnancy, delivery and the postpartum period. The delivery of this education varies widely in type, content, and nature. This review examined antenatal education which is specifically tailored towards perineal care and wound healing in the postnatal period via formal channels. Appropriate patient education positively impacts on wound-healing rates and compliance with wound care. Risk factors that contribute to the breakdown of wounds and poor healing rates may be addressed antenatally in order to optimise postnatal wound healing. It is important to assess whether or not antenatal wound-care education positively affects perineal healing, in order to empower women to incorporate best practice, evidence-based treatment with this important aspect of self-care in the immediate postnatal period. To evaluate the effects of antenatal education on perineal wound healing in postnatal women who have birthed in a hospital setting, and who have experienced a break in the skin of the perineum as a result of a tear or episiotomy, or both. We searched

  15. Mid-Childhood Bone Mass After Exposure to Repeat Doses of Antenatal Glucocorticoids: A Randomized Trial.

    Science.gov (United States)

    McKinlay, Christopher J D; Cutfield, Wayne S; Battin, Malcolm R; Dalziel, Stuart R; Crowther, Caroline A; Harding, Jane E

    2017-05-01

    Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity, but could have adverse effects on skeletal development. We assessed whether exposure to repeat antenatal betamethasone alters bone mass in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids. Women were randomized to a single dose of betamethasone or placebo, ≥7 days after an initial course of glucocorticoids, repeated each week that they remained at risk for preterm birth at glucocorticoids does not alter bone mass in mid-childhood. Copyright © 2017 by the American Academy of Pediatrics.

  16. Midwives' views on appropriate antenatal counselling for congenital anomaly tests: Do they match clients' preferences?

    NARCIS (Netherlands)

    Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van

    2014-01-01

    OBJECTIVE: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. DESIGN: a comparative (midwives versus clients) questionnaire survey.

  17. Midwives' views on of appropriate antenatal counselling for congenital anomaly tests: do they match clients' preferences?

    NARCIS (Netherlands)

    Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van

    2014-01-01

    Objective: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. Design: a comparative (midwives versus clients) questionnaire survey.

  18. Anti-androgenic effects of S-40542, a novel non-steroidal selective androgen receptor modulator (SARM) for the treatment of benign prostatic hyperplasia.

    Science.gov (United States)

    Nejishima, Hiroaki; Yamamoto, Noriko; Suzuki, Mika; Furuya, Kazuyuki; Nagata, Naoya; Yamada, Shizuo

    2012-10-01

    Selective androgen receptor modulators (SARMs) would provide alternative therapeutic agent for androgen-related diseases. We identified a tetrahydroquinoline (THQ) derivative, 1-(8-nitro-3a, 4, 5, 9b-tetrahydro-3H-cyclopenta[c]quinolin-4-yl) ethane-1, 2-diol (S-40542) as a novel SARM antagonist. Affinity for nuclear receptors of S-40542 was evaluated in receptor-binding studies. Androgen receptor (AR) transcriptional activity of S-40542 was investigated by luciferase reporter assay in DU145AR cells. Normal and benign prostatic hyperplasia (BPH) model rats were repeatedly treated with S-40542 and flutamide. The tissue weights of prostate and levator ani muscle as well as blood levels of testosterone and luteinizing hormone were measured. S-40542 bound to the AR with high affinity. S-40542 at relatively high concentrations increased the transcriptional activity. This agent also showed a concentration-dependent AR antagonistic action in the presence of 1 nM 5α-dihydrotestosterone. Repeated treatment with S-40542 and flutamide decreased dose-dependently the weights of the prostate to a similar extent. In contrast, the tissue weight-reducing effect by S-40542 treatment on the levator ani muscle was much weaker than that of flutamide. S-40542 had little effect on the blood level of testosterone and luteinizing hormone, whereas flutamide increased the level of both hormones. Furthermore, S-40542 decreased dose-dependently prostate weight of BPH rats. The current results indicate that S-40542 possesses the prostate-selective SARM activity, suggestive of clinical benefit against benign prostate hyperplasia. THQ compounds may be useful for the research of mode of action of SARMs and for the development of safe SARM antagonists. Copyright © 2012 Wiley Periodicals, Inc.

  19. Steroids for Treating Cancer (For Parents)

    Science.gov (United States)

    ... and the health risks they incur from abusing anabolic steroids — drugs that were originally intended for people with ... that he or she will not be taking anabolic steroids, but rather corticosteroids . Corticosteroids are made from a ...

  20. Quality Management of Steroid Hormone Assays

    Science.gov (United States)

    Middle, Jonathan G.

    This chapter describes the principles and practices of quality management of the steroid hormone in clinical laboratory service, and the assessment of the quality of that service by the author's EQA programme (UK NEQAS for Steroid Hormones).

  1. Determination of steroids in manure and soil

    DEFF Research Database (Denmark)

    Hansen, Martin; Björklund, Bengt Erland; Halling-Sørensen, Bent

    A genuine analytical method to determine native steroids (pregnenolone, progesterone, dehydroepiandrosterone, androstenedione, testosterone, dihydrotestosterone, estrone, 17b-estradiol, and 17a-estradiol) and one anthropogenic steroid (ethynylestradiol) in environmental solid samples is presented...

  2. Steroids in adults with acute bacterial meningitis: a systematic review

    NARCIS (Netherlands)

    van de Beek, Diederik; de Gans, Jan; McIntyre, Peter; Prasad, Kameshwar

    2004-01-01

    Bacterial meningitis is uncommon but causes significant mortality and morbidity, despite optimum antibiotic therapy. A clinical trial in 301 patients showed a beneficial effect of adjunctive steroid treatment in adults with acute community-acquired pneumococcal meningitis, but data on other

  3. Steroid implants and markers of bone turnover in steers | Knetter ...

    African Journals Online (AJOL)

    Thirty-two crossbred yearling steers were given one of four treatments to determine whether these markers of bone turnover could be detected and reflect steroid-induced bone maturity in the periphery: non-implanted controls; 25.7 mg estradiol-17β (E2); 120 mg trenbolone acetate (TBA); or 120 mg TBA and 24 mg E2 (T+E) ...

  4. The effect of steroidal contraceptives on liver enzymes and serum ...

    African Journals Online (AJOL)

    This study assessed the influence of steroidal contraceptives on liver enzymes and serum total protein using 48 adult female rats in four groups -A as control and B, C and D as tests. The animals were further divided into two subgroups - treatment (A1 - D1; n=6 each) and reversal (A2 - D2; n=6 each). Groups A1&A2 ...

  5. the effect of steroidal contraceptives on liver enzymes and serum ...

    African Journals Online (AJOL)

    2015-10-31

    Oct 31, 2015 ... This study assessed the influence of steroidal contraceptives on liver enzymes and serum total protein using 48 adult female rats in four groups -A as control and B, C and D as tests. The animals were further divided into two subgroups - treatment (A1 - D1; n=6 each) and reversal (A2 - D2; n=6 each).

  6. Inter-laboratory exercise on steroid estrogens in aqueous samples

    DEFF Research Database (Denmark)

    Heath, E.; Kosjek, T.; Andersen, Henrik Rasmus

    2010-01-01

    matrices. As the main task three steroid estrogens. 17 alpha-ethinylestradiol, 17 beta-estradiol and estrone were determined in four spiked aqueous matrices' tap water, river water and wastewater treatment plant influent and effluent using GC-MS and LC-MS/MS Results were compared and discussed according...... to the analytical techniques applied, the accuracy and reproducibility of the analytical methods and the nature of the sample matrices. Overall, the results obtained in this inter-laboratory exercise reveal a high level of competence among the participating laboratories for the detection of steroid estrogens...

  7. Androgen - secreting steroid cell tumor of the ovary

    Directory of Open Access Journals (Sweden)

    Paras Ratilal Udhreja

    2014-01-01

    Full Text Available Steroid cell tumors (SCTs, not otherwise specified of the ovary are rare subgroup of sex cord tumors, which account for less than 0.1% of all ovarian tumors and also that will present at any age. The majority of these tumors produce steroids with testosterone being the most common. A case of a 28-year-old woman who presented with symptoms of virilization is reported. Although SCTs are generally benign, there is a risk for malignant transformation. Surgery is the most important and hallmark treatment.

  8. Gestational age at initiation of antenatal care in a tertiary hospital ...

    African Journals Online (AJOL)

    Gestational age at initiation of antenatal care in a tertiary hospital, Southwestern Nigeria. ... care is still prevalent in our environment. Therefore, pregnant women should be adequately informed about the concept of early antenatal registration. Keywords: Antenatal care, gestational age, initiation, Nigeria, Southwestern ...

  9. Audit of antenatal care at a community health centre in Tshwane ...

    African Journals Online (AJOL)

    Objective: Few studies document the level of compliance with antenatal care protocols in primary health care in South Africa. The aim of this study was to conduct an audit of antenatal care at a community health centre in Tshwane North subdistrict in order to measure the level of compliance of maternity staff with antenatal ...

  10. Antenatal HIV Screening and Treatment in South Africa: Social ...

    African Journals Online (AJOL)

    Très récemment, les fonctionnaires et les membres du parti politique au pouvoir, au mépris de l\\'ancienne politique, ont accepté que les médicaments antirétroviraux soient donnés aux femmes enceintes séropositives. Le tissu social de la société sud africaine est remarquablement différent de celui des pays occidentaux.

  11. Esophageal lipomatosis: another consequence of the use of steroids

    International Nuclear Information System (INIS)

    Bogaert, J.; Rosseel, F.; Verhaegen, S.; Verschakelen, J.

    2000-01-01

    After we incidentally found on CT extensive esophageal fat accumulations in a patient with long-term use of steroids, we prospectively evaluated during a 6-month period all CT studies of the chest for esophageal lipomatosis and related the findings to the possible use of steroids. The diagnosis of esophageal fat on CT was made by density measurements or if too small for reliable density measurements by comparison with mediastinal fat. In 21 of 1320 exclusively older male patients the diagnosis of esophageal lipomatosis was definite in 7 and likely in 14 patients. All fat accumulations were located in the upper third of the esophagus (mean length 22 ± 6 mm) and presented ring-like (n = 10), irregular (n = 3), or as a horseshoe sparing the posterior border (n = 8). In 20 patients there was an unequivocal history of steroid treatment. Associated centripetal fat infiltration was found in 11 patients. None of the patients had swallowing problems. Prolonged use of steroids, either orally or inhalationally administered, is associated with esophageal lipomatosis. The predisposition for the upper esophagus might be related to the presence of striated muscle cells in this part of the esophagus; moreover, inhalational steroid therapy may adversely affect the upper esophagus. (orig.)

  12. MicroRNA profiling in mucosal biopsies of eosinophilic esophagitis patients pre and post treatment with steroids and relationship with mRNA targets.

    Directory of Open Access Journals (Sweden)

    Shaolei Lu

    Full Text Available The characterization of miRNAs and their target mRNAs involved in regulation of the immune process is an area of intense research and relatively little is known governing these processes in allergic inflammation. Here we present novel findings defining the miRNA and mRNA transcriptome in eosinophilic esophagitis (EoE, an increasing recognized allergic disorder.Esophageal epithelial miRNA and mRNA from five paired biopsies pre- and post-treatment with glucocorticosteroids were profiled using Taqman and Affymetrix arrays. Validation was performed on additional paired biopsies, untreated EoE specimens and normal controls. Differentially regulated miRNAs and mRNAs were generated, within which miRNA-mRNA target pairs with high predicted confidence were identified.Compared to the post-glucocorticoid treated esophageal mucosa, of all the 377 miRNA sequences examined, 32 miRNAs were significantly upregulated and four downregulated in the pre-treated biopsies. MiR-214 was the most upregulated (150 fold and miR-146b-5b, 146a, 145, 142-3p and 21 were upregulated by at least 10 fold. Out of 12 miRNAs chosen for validation by qRT-PCR, five (miR-214, 146b-5p, 146a, 142-3p and 21 were confirmed and 11 shared the same trend. When the expression of the 12 miRNAs in the EoE mucosa was compared to unrelated normal mucosa, six (miR-214, 146b-5p, 146a, 21, 203, and 489 showed similar significant changes as in the paired samples and 10 of them shared the same trend. In the same five pairs of samples used to profile miRNA, 311 mRNAs were down-regulated and 35 were up-regulated in pre-treated EoE mucosa. Among them, 164 mRNAs were identified as potential targets of differentially regulated miRNAs. Further analysis revealed that immune-related genes, targeted and non-targeted by miRNAs, were among the most important genes involved in the pathogenesis of EoE.Our findings add to the accumulating body of data defining a regulatory role for miRNA in immune and allergic

  13. Iatrogenic Cushing's syndrome in children following nasal steroid.

    Science.gov (United States)

    Oluwayemi, Isaac Oludare; Oduwole, Abiola Olufunmilayo; Oyenusi, Elizabeth; Onyiriuka, Alphonsus Ndidi; Abdullahi, Muhammad; Fakeye-Udeogu, Olubunmi Benedicta; Achonwa, Chidozie Jude; Kouyate, Moustapha

    2014-01-01

    Cushing syndrome is a hormonal disorder caused by prolonged exposure of body tissue to cortisol. We report two cases of iatrogenic Cushing's syndrome in two Nigerian children following intranasal administration of aristobed-N (Betamethasone + Neomycin) given at a private hospital where the children presented with feature of adenoidal hypertrophy. Two months into treatment children were noticed to have developed clinical and laboratory features of iatrogenic Cushing's syndrome with critical adrenal suppression. Serum cortisol (at presentation): 1(st) patient: 12nmol/L (reference range 240-618), 2(nd) 1.69nmol/L. Serum cortisol (3 months after weaning off steroid): 343.27 nmol/L (within normal range for the first patient; second patient newly presented and has just begun steroid weaning off process. The serum cortisol level one month into weaninig off process was 128 nmol/L). Unsupervised topical steroid administration in children can cause adrenal suppression with clinical features of Cushing's syndrome.

  14. Effects of non-steroidal anti-inflammatory drug treatments on cognitive decline vary by phase of pre-clinical Alzheimer disease: findings from the randomized controlled Alzheimer's Disease Anti-inflammatory Prevention Trial.

    Science.gov (United States)

    Leoutsakos, Jeannie-Marie S; Muthen, Bengt O; Breitner, John C S; Lyketsos, Constantine G

    2012-04-01

    We examined the effects of non-steroidal anti-inflammatory drugs on cognitive decline as a function of phase of pre-clinical Alzheimer disease. Given recent findings that cognitive decline accelerates as clinical diagnosis is approached, we used rate of decline as a proxy for phase of pre-clinical Alzheimer disease. We fit growth mixture models of Modified Mini-Mental State (3MS) Examination trajectories with data from 2388 participants in the Alzheimer's Disease Anti-inflammatory Prevention Trial and included class-specific effects of naproxen and celecoxib. We identified three classes: "no decline", "slow decline", and "fast decline", and examined the effects of celecoxib and naproxen on linear slope and rate of change by class. Inclusion of quadratic terms improved fit of the model (-2 log likelihood difference: 369.23; p < 0.001) but resulted in reversal of effects over time. Over 4 years, participants in the slow-decline class on placebo typically lost 6.6 3MS points, whereas those on naproxen lost 3.1 points (p-value for difference: 0.19). Participants in the fast-decline class on placebo typically lost 11.2 points, but those on celecoxib first declined and then gained points (p-value for difference from placebo: 0.04), whereas those on naproxen showed a typical decline of 24.9 points (p-value for difference from placebo: <0.0001). Our results appeared statistically robust but provided some unexpected contrasts in effects of different treatments at different times. Naproxen may attenuate cognitive decline in slow decliners while accelerating decline in fast decliners. Celecoxib appeared to have similar effects at first but then attenuated change in fast decliners. Copyright © 2011 John Wiley & Sons, Ltd.

  15. Anabolic steroids for treating pressure ulcers.

    Science.gov (United States)

    Naing, Cho; Whittaker, Maxine A

    2017-06-20

    Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers. Anabolic steroids are considered because of their ability to stimulate protein synthesis and build muscle mass. Comprehensive evidence is required to facilitate decision making, regarding the benefits and harms of using anabolic steroids. To assess the effects of anabolic steroids for treating pressure ulcers. In March 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Published or unpublished randomised controlled trials (RCTs) comparing the effects of anabolic steroids with alternative treatments or different types of anabolic steroids in the treatment of pressure ulcers. Two review authors independently carried out study selection, data extraction and risk of bias assessment. The review contains only one trial with a total of 212 participants, all with spinal cord injury and open pressure ulcers classed as stage III and IV. The participants were

  16. Adolescents and Steroids: A User Perspective.

    Science.gov (United States)

    Office of Inspector General (DHHS), Washington, DC.

    Anabolic-androgenic steroids ("steroids") are synthetic derivatives of the natural male hormone testosterone. They were first used non-medically by elite athletes seeking to improve performance. More recently, however, steroid use has filtered down to high school and junior high school levels. The purpose of this study was to describe…

  17. Excreted steroids in vertebrate social communication.

    Science.gov (United States)

    Doyle, Wayne I; Meeks, Julian P

    2018-03-08

    Steroids play vital roles in animal physiology across species, and the production of specific steroids is associated with particular internal biological functions. The internal functions of steroids are, in most cases, quite clear. However, an important feature of many steroids -- their chemical stability -- allows these molecules to play secondary, external roles as chemical messengers after their excretion via urine, feces, or other shed substances. The presence of steroids in animal excretions has long been appreciated, but their capacity to serve as chemosignals has not received as much attention. In theory, the blend of steroids excreted by an animal contains a readout of its own biological state. Initial mechanistic evidence for external steroid chemosensation arose from studies of many species of fish. In sea lampreys and ray-finned fishes bile salts were identified as potent olfactory cues and later found to serve as pheromones. Recently, we and others have discovered that neurons in amphibian and mammalian olfactory systems are also highly sensitive to excreted glucocorticoids, sex steroids, and bile acids, and some of these molecules have been confirmed as mammalian pheromones. Steroid chemosensation in olfactory systems, unlike steroid detection in most tissues, is performed by plasma membrane receptors, but the details remain largely unclear. In this review, we present a broad view of steroid detection by vertebrate olfactory systems, focusing on recent research in fishes, amphibians, and mammals. We review confirmed and hypothesized mechanisms of steroid chemosensation in each group and discuss potential impacts on vertebrate social communication. Copyright © 2018 the authors.

  18. Sex steroids and lipoprotein metabolism

    NARCIS (Netherlands)

    Gevers Leuven, J.A.

    1994-01-01

    Lipoprotein metabolism is involved in atherogenesis. Female sex-hormones have substantial effects on both lipoprotein metabolism and the vessel wall. Cholesterol, one of the major lipids in lipoproteins, is both the substrate for, and the target of, the steroidal sex hormones.

  19. The radioimmunoassay of steroid glucuronides

    International Nuclear Information System (INIS)

    Chaudhri, R.

    1980-07-01

    A modified radioimmunoassay for steroid glucuronides is described. A second carboxylated group is introduced into the steroid structure and used to attach the hapten to the protein. The unequivocal attachment through the second group, rather than through the glucuronide is achieved by leaving the glucuronide protected as its triacetyl methylester until after the hapten has been coupled to the protein. Subsequently, the glucuronide can be exposed by mild alkaline hydrolysis or alternatively, the protected immunogen can be injected into the rabbits, leaving the animals to deprotect the hapten. The hapten, immunogens and antisera to oestrone-3-glucuronide have been prepared using a 17-carboxymethyloxime bridge. The hapten, immunogen and antisera to pregnanediol-3 α - glucuronide have also been prepared using a 6 β - hemisuccinoxy bridge. A study has been made of the reactive properties of the 6 β-hydroxyl group and its effect on the stereo-specificity of reduction of 4-ene and the 3-oxo group and on the reactivity of the 3 α-hydroxyl group. The antisera raised to these immunogens have been characterised for their ability to discriminate between the free steroid and the steroid glucuronide, and evaluated for use in immunoassay. (author)

  20. Recent advances in steroid radioimmunoassay

    International Nuclear Information System (INIS)

    Jeffcoate, S.L.

    1977-01-01

    The advances since 1974 in the techniques of measuring steroid molecules by radioimmunoassay are reviewed in this paper. They are considered under the following headings: preparation and use of antisera; preparation and use of tracers; preparation of biological samples before assay; dispensing of the reagents in the assay; separation of free and bound radioactivity; counting and data processing; quality control and standardization. (orig.) [de

  1. Sundhedspolitik på steroider

    DEFF Research Database (Denmark)

    Christiansen, Ask Vest

    2012-01-01

    Danmark er det land i verden der har valgt den måske mest drastiske metode til bekæmpelse af brug af anabole androgene steroider (AAS) i fitness- og styrketræningsmiljøerne. Ikke pga. oplysningskampagnerne, samarbejdet med SKAT eller at AAS er ulovlige. Der hvor Danmark skiller sig ud er ved brugen...

  2. Steroid and sterol hormone action

    Energy Technology Data Exchange (ETDEWEB)

    Spelsberg, T.C.; Kumar, R.

    1987-01-01

    This book contains 21 selections. Some of the titles are: Estrogen control of vitellogenin gene transcription and mRNA stability; Inhibition of glucocorticoid receptor conversion to the DNA-binding state and inhibition of subunit dissociation; Steroid regulation of rRNA synthesis; Messenger RNA-S14 as a model of thyroid hormone action at the hepatocellular level; and The oxysterol receptor.

  3. Steroid profiling in doping analysis

    NARCIS (Netherlands)

    Kerkhof, Daniël Henri van de

    2001-01-01

    Profiling androgens in urine samples is used in doping analysis for the detection of abused steroids of endogenous origin. These profiling techniques were originally developed for the analysis of testosterone, mostly by means of the ratio of testosterone to epitestosterone (T/E ratio). A study was

  4. factors affecting antenatal care service utilization in yem special ...

    African Journals Online (AJOL)

    jhon

    BACKGROUND: worldwide, about half a million women die every year in connection with pregnancy and childbirth, 99% of which occurs in low and middle income countries. Antenatal care provides an opportunity to deliver different services which are important in improving maternal survival. The objective of this study was ...

  5. Routine antenatal syphilis screening in South West Nigeria - a ...

    African Journals Online (AJOL)

    Background: Untreated maternal syphilis is strongly associated with adverse birth outcomes, especially in women with high titre syphilis. The WHO recommends routine serological screening in pregnancy. Some workers have advised a reappraisal of this practice, having demonstrated low sero-prevalence in their antenatal ...

  6. pathways utilized for antenatal health seeking among women in the ...

    African Journals Online (AJOL)

    2015-03-01

    Mar 1, 2015 ... 1 Department of Population, Family and Reproductive Health, University of Ghana School of Public Health,. P. O. Box LG 13 Legon, Accra, Ghana, ... hemorrhage, hypertensive diseases, and a high burden of infectious morbidity.4 .... When asked to chronicle the places they had sought antenatal care, it was ...

  7. Antenatal clinical pelvimetry in primigravidae and outcome of labour ...

    African Journals Online (AJOL)

    Method: A retrospective study of clinical pelvimetry and outcome of labour in primigravidae. Results: The total number of primigravidae included in the study was 268 and of these, 74 were adjudged to have adequate pelvis at antenatal clinical pelvimetry. The APGAR scores at one and five minutes were significantly higher ...

  8. Prevalence and factors associated with late antenatal care visit ...

    African Journals Online (AJOL)

    The objective of this study was to determine the prevalence and factors associated with late antenatal booking among pregnant women in Lushoto district of north-eastern Tanzania. Methods: This hospital based cross sectional study involved pregnant women and was conducted in August-September 2015. A standardized ...

  9. Prevalence of malaria parasitaemia in the booking antenatal (ANC ...

    African Journals Online (AJOL)

    We studied 270 patients attending the booking antenatal clinic recruited for three months in the Lagos State University Teaching Hospital (LASUTH), Nigeria. Each patient was screened for malaria parasites using Giemsa's stain of thick and thin blood films on 2 ml venous blood. Parameters on the age, parity, gestation at ...

  10. Pattern and Determinants of Antenatal Booking at Abakaliki ...

    African Journals Online (AJOL)

    E‑mail: researchdivision2@gmail.com. Reference. 1. Onoh R, Umeora O, Agwu U, Ezegwui H, Ezeonu P,. Onyebuchi A. Pattern and determinants of Antenatal Booking at Abakaliki Southeast Nigeria. Ann Med Health Sci Res. 2012;2:169‑75. Access this article online. Quick Response Code: Website: www.amhsr.org. DOI:.

  11. Factors associated with delayed Antenatal Care attendance in Malawi

    African Journals Online (AJOL)

    SITWALA COMPUTERS

    15,16 school, and to be stigmatized. The stigma and shame of an unwanted pregnancy influenced delaying antenatal care. Despite the small sample size, our study reveals that unplanned or unwanted pregnancies were one of the factors associated with delayed ANC attendance. This was especially apparent if the woman ...

  12. Prevalence and antenatal determinants of orofacial clefts in Benin ...

    African Journals Online (AJOL)

    The prevalence and antenatal determinants of cleft lip and palate were determined. Result: Cleft lip and palate were often encountered in clinical practice in Benin City with a prevalence of 1.35%. The results showed that orofacial clefts were commoner in females and that the combined unilateral cleft lip and palate was the ...

  13. Determinants of condom use among antenatal clinic attendees in ...

    African Journals Online (AJOL)

    Conclusion: The reported prevalence of ever use of a condom amongst antenatal clinic attendees is low and inconsistent especially among HIV positive women. Deliberate effort should be used to ensure condom access, availability and correct and consistent use of condoms by women in all sexual acts.

  14. health care providers' knowledge and practice of focused antenatal ...

    African Journals Online (AJOL)

    order to ensure safe pregnancy, labour and puerperium. Qualitative antenatal services are care given to pregnant women by a skilled .... ANC card.” “I paid particular attention to all new clients and those referred by TBAs and probed to know reasons why they left the TBAs”. “I used their ANC card to document their personal.

  15. Determinants of Home Delivery among Women attending Antenatal ...

    African Journals Online (AJOL)

    USER

    Unskilled home delivery is a threat to maternal and child health. In northern Nigeria, many pregnant women attend antenatal care but opt to deliver at home despite knowing the potential consequences. An institutional delivery, helps reduce various complications during childbirth, and therefore decreases the rates of ...

  16. Gender preferences among antenatal women: a cross-sectional ...

    African Journals Online (AJOL)

    Keywords: Gender preferences; family composition; antenatal women; coastal South India. DOI: http://dx.doi.org/10.4314/ahs.v15i2.31 ... Gender bias, even when not disastrous, may still generate greater debility among surviving .... in America and the Caribbean (with the exception of. Bolivia) along with several Southeast ...

  17. Determinants of Home Delivery among Women attending Antenatal ...

    African Journals Online (AJOL)

    The study concluded that, pregnant women are aware of the importance of antenatal care and, do deliver at home due to behavioural, sociocultural and religious preferences. To combat the maternal mortality in this region, values and beliefs of the women and families should be put into cognizance. Additionally, healthcare ...

  18. Intentions of Registered Antenatal Clinic Patients About Utilizing ...

    African Journals Online (AJOL)

    Background: Nigeria bears a sizeable proportion of the global HIV burden; mother to child transmission as a major contributor and prevention of mother to child transmission the hope for a HIV-free generation. Objective: To find evaluate how booked antenatal attendees intend to utilize the labour and delivery services of the ...

  19. Cash Transfers to Increase Antenatal Care Utilization in Kisoro ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    University of Michigan, Ann Arbor, MI, USA1; Kisoro District Hospital, Kisoro, Uganda2; Albert Einstein College of Medicine,. Bronx, NY, USA3. *For correspondence: Email: chavkahn@med.umich.edu; phone: 1-201-394-9637. Abstract. The World Health Organization recommends four antenatal visits for pregnant women in ...

  20. Factors contributing to non-compliance with the standard antenatal ...

    African Journals Online (AJOL)

    Background: Non-compliance with at least four standard antenatal care (ANC) visits is a critical public health problem. In Rwanda, the proportion of pregnant women who follow the four ANC remains relatively low (43.9%) although it has relatively increased. Objectives: To assess the level of knowledge of selected pregnant ...

  1. determinants of first antenatal care visit by pregnant women

    African Journals Online (AJOL)

    2014-09-01

    Sep 1, 2014 ... September 2014. EAsT AFRICAN MEDICAL JOURNAL. 317. East African Medical Journal Vol. 91 No. 9 September 2014. DETERMINANTS OF FIRST ANTENATAL CARE VISIT BY PREGNANT WOMEN AT COMMUNITY BASED. EDUCATION, RESEARCH AND SERVICE SITES IN NORTHERN UGANDA.

  2. Patterns of Antenatal Care Seeking Behavior in South East Nigeria ...

    African Journals Online (AJOL)

    that appropriate antenatal care (ANC) is important in reducing maternal morbidity and mortality, there is limited information on inequities on ANC seeking pattern among the pregnant women in Nigeria. Aim: The study was designed to explore inequities due to age, education, and socioeconomic status (SES) of women of ...

  3. Antenatal Deep Vein Thrombosis with an Underlying Thrombophilia ...

    African Journals Online (AJOL)

    Antenatal Deep Vein Thrombosis with an Underlying Thrombophilia. Emmanuel K Srofenyoh, Ali Samba, Enyonam Y Kwawukume. Abstract. Deep vein thrombosis (DVT) can cause severe morbidity in the puerperium and, less commonly, during pregnancy. A woman who developed DVT as a result of thrombophilia was ...

  4. Game-based online antenatal breastfeeding education: A pilot.

    Science.gov (United States)

    Grassley, Jane S; Connor, Kelley C; Bond, Laura

    2017-02-01

    The aim of this study was to evaluate the effect of the Healthy Moms intervention on antenatal breastfeeding self-efficacy and intention and to determine the feasibility of using an online game-based learning platform to deliver antenatal breastfeeding education. The Internet has potential for improving breastfeeding rates through improving women's access to antenatal breastfeeding education. Twelve computer-based breastfeeding education modules were developed using an online learning platform. Changes in participants' breastfeeding self-efficacy and intention pre- and post-intervention were measured using descriptive statistics and a one-way ANOVA. Of the 25 women submitting the pretest, four completed zero quests; seven, orientation only; eight, one to six breastfeeding quests; and six, 10 to 12 breastfeeding quests. No significant differences in breastfeeding self-efficacy and intention were found among the groups. Online antenatal breastfeeding education is feasible; however, further research is warranted to determine if it can affect breastfeeding outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Contraceptive‑seeking Behavior of Women Attending Antenatal ...

    African Journals Online (AJOL)

    Contraceptive‑seeking Behavior of Women Attending Antenatal Care in a Developing Country: A Veritable Tool for Slowing Population Growth. ... Background: The use of modern contraceptives has been embraced by developed nations as a means of achieving controlled growth rate. Nigeria, Africa's most populous nation ...

  6. Gestational Age At First Antenatal Attendance In Sagamu, Western ...

    African Journals Online (AJOL)

    This study was a carried out to determine to the gestation age first antenatal attendance at our centre and find out factors that influence it, with the aim of making suggestions that will encourage early booking for ANC Subjects and Methods: A cross – sectional study was carried out amongst pregnant women that came to ...

  7. Placenta accreta: MRI antenatal diagnosis and surgical correlation.

    Science.gov (United States)

    Ha, T P; Li, K C

    1998-01-01

    We describe a case of a placenta previa accreta that was diagnosed antenatally by MRI with subsequent surgical confirmation. We show the advantages of ultrafast MRI single shot (SS) fast spin echo (FSE) techniques for accurate diagnosis with minimal scan time and fetal motion artifacts.

  8. Attitude and perceptions of women on routine antenatal ultrasound ...

    African Journals Online (AJOL)

    Attitude and perceptions of women on routine antenatal ultrasound examination in Nnewi, South East, Nigeria. ... Journal of Biomedical Investigation ... at Nnamdi Azikiwe University Teaching Hospital, Nnewi to determine the attitude and perceptions of pregnant women towards routine ultrasound examination in pregnancy.

  9. Audit of antenatal services in primary healthcare centres in Jos ...

    African Journals Online (AJOL)

    Introduction: Maternal mortality remains a big challenge in developing countries including Nigeria where the figures are amongst the highest in the world. The Nigerian government's response in providing primary healthcare centres (PHCs) in all local government areas is commendable but access to quality antenatal care is ...

  10. Seroprevalence of rubella antibodies among antenatal patients in ...

    African Journals Online (AJOL)

    Objectives: To determine the seroprevalence of rubella virus infection among antenatal patients aged between 15 and 45 years in the Western Cape province of South Africa, in order to provide data to determine the need for vaccination to protect women of childbearing age. Design: A cross-sectional study. Setting Virology ...

  11. Upright or dorsal? childbirth positions among antenatal clinic ...

    African Journals Online (AJOL)

    These positions such as kneeling and squatting were the norm for childbirth in indigenous Nigerian custom. However, westernization has largely replaced them with supine positions. Objective: This study was conducted to compare the knowledge, attitude and experience regarding childbirth positions between antenatal ...

  12. Prevalence of malaria at booking among antenatal clients in a ...

    African Journals Online (AJOL)

    Administrator

    2Institute for Advanced medical Research and Training, College of Medicine, Ibadan, Nigeria. 3Department of Obstetrics ... MATERIALS AND METHODS. We used a cross sectional ... all part of routine care in the. Prevalence of malaria at booking among antenatal clients in a secondary health care facility in Ibadan, Nigeria ...

  13. Induced abortion among women attending antenatal clinics in ...

    African Journals Online (AJOL)

    Objectives: Unsafe abortion is a public health concern because of its impact on maternal morbidity and mortality. The objective of this study was to document on induced abortion in Yaounde, Cameroon. Design: Cross-sectional study. Setting: Six antenatal clinics in Yaounde, Cameroon. Methods: Women attending ...

  14. Antenatal prevention of mother to child transmission of HIV

    African Journals Online (AJOL)

    infected and 370,000 children died due to HIV. The vast majority of children ac- quired HIV through vertical transmission from mother to child.1. During 2006 the sero-positive HIV prevalence amongst women attending antenatal clinics in the public health sector within South Africa was 29.1%.2. The province with the lowest ...

  15. Antenatal glucocorticoids: where are we after forty years?

    Science.gov (United States)

    McKinlay, C J D; Dalziel, S R; Harding, J E

    2015-04-01

    Since their introduction more than forty years ago, antenatal glucocorticoids have become a cornerstone in the management of preterm birth and have been responsible for substantial reductions in neonatal mortality and morbidity. Clinical trials conducted over the past decade have shown that these benefits may be increased further through administration of repeat doses of antenatal glucocorticoids in women at ongoing risk of preterm and in those undergoing elective cesarean at term. At the same time, a growing body of experimental animal evidence and observational data in humans has linked fetal overexposure to maternal glucocorticoids with increased risk of cardiovascular, metabolic and other disorders in later life. Despite these concerns, and somewhat surprisingly, there has been little evidence to date from randomized trials of longer-term harm from clinical doses of synthetic glucocorticoids. However, with wider clinical application of antenatal glucocorticoid therapy there has been greater need to consider the potential for later adverse effects. This paper reviews current evidence for the short- and long-term health effects of antenatal glucocorticoids and discusses the apparent discrepancy between data from randomized clinical trials and other studies.

  16. Toxoplasmosis among pregnant women attending antenatal clinic in ...

    African Journals Online (AJOL)

    Toxoplasmosis is a neglected tropical protozoan disease of public health importance. This study estimated the seroprevalence of toxoplasmosis and the associated risk factors among pregnant women attending the antenatal clinic in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. Two hundred and ...

  17. Antenatal Care and Skilled Birth Attendance in Three Communities ...

    African Journals Online (AJOL)

    This study assessed antenatal care (ANC) coverage, place of delivery and use of skilled birth assistants in three communities in Kaduna State, Nigeria. The sample included 332 women who had delivered within two years of the survey. ANC attendance rates were high, with 76.2% of women reporting at least one visit, and ...

  18. Antenatal corticosteroid use in preterm birth at Kenyatta National ...

    African Journals Online (AJOL)

    Background: Preterm birth causes about 75% of neonatal deaths that are not attributable to congenital malformations. Antenatal corticosteroids (ACS) given to mothers at risk of preterm birth reduce the incidence/severity of RDS, intraventricular haemmorhage, necrotizing enterocolitis and neonatal deaths. The WHO ...

  19. Utilization of antenatal care services among teenagers in Ethiopia: A ...

    African Journals Online (AJOL)

    Background: Teenaged women suffer from a disproportionate share of reproductive health problem. The purpose of this study was to estimate the utilization of antenatal care (ANC) services among teenagers (13-19 years) during delivery in Ethiopia. Methodology: Raw data collected from all part of the country on child ...

  20. Socio-demographic determinants of antenatal clinic utilization in a ...

    African Journals Online (AJOL)

    Socio-demographic determinants of antenatal clinic utilization in a Nigerian university teaching hospital. ... CONCLUSION:Among other social factors female education improved women's ability to take decisions on reproductive matters. Poor education and low socioeconomic status not only increase women's vulnerability ...

  1. Skilled antenatal care service utilization and its association with the ...

    African Journals Online (AJOL)

    Background: In response to high maternal and perinatal morbidities and mortalities in Ethiopia, "Women's Health Development Army" was established to enhance utilization of skilled maternity services including antenatal care (ANC). However, its effect on skilled ANC service utilization is not well measured. Our study was ...

  2. Clients satisfaction of antenatal care services in public and private ...

    African Journals Online (AJOL)

    Background: Antenatal care involves screening for health and socioeconomic conditions likely to increase the possibility of specific adverse pregnancy outcomes, providing therapeutic interventions known to be effective and educating pregnant women about planning for safe birth. Quality and customer service have been ...

  3. perception and satisfaction with quality of antenatal care services ...

    African Journals Online (AJOL)

    particularly for ethical reasons4. Women's perceptions of antenatal visits significantly influence their assessment of quality of services that are provided5. As a result of this new focus, measurement of customer satisfaction has become equally important in assessing system performance. Patient satisfaction has traditionally ...

  4. Perceptions of pregnant adolescents on the antenatal care received ...

    African Journals Online (AJOL)

    2018-03-25

    Mar 25, 2018 ... Two major themes emerged from the findings: a) caring b) motivation for attending antenatal care. .... childbirth as narrated in the quote below. ... quotes below. “The care we received I can say the reception was good. I heard that when you come to this clinic they will touch your abdomen, ask you to.

  5. Determinants Of Antenatal Care Services Utilization In Emevor ...

    African Journals Online (AJOL)

    The difference is not significant (P > 0.05). A majority of the women who attained secondary education (69%), post-secondary education (96%), those whose husbands had secondary education (69%), postsecondary education (82%) and those who had income-yielding occupations (72%) utilized ante-natal care services.

  6. Bacterial Vaginosis in Antenatal Patients in Abakaliki, Nigeria.

    African Journals Online (AJOL)

    (92.5%) did not have BV. The antenatal complications observed among these 80 participants include: malaria, epistaxis, mumps, polyhydramnios and pregnancy induced hypertension. Table 3 shows the distribution of these complications among those with and those without bacterial vaginosis. It can be seen that one out of ...

  7. Polyhydramnios, Transient Antenatal Bartter's Syndrome, and MAGED2 Mutations

    NARCIS (Netherlands)

    Laghmani, Kamel; Beck, Bodo B.; Yang, Sung-Sen; Seaayfan, Elie; Wenzel, Andrea; Reusch, Bjorn; Vitzthum, Helga; Priem, Dario; Demaretz, Sylvie; Bergmann, Klasien; Duin, Leonie K.; Goebel, Heike; Mache, Christoph; Thiele, Holger; Bartram, Malte P.; Dombret, Carlos; Altmueller, Janine; Nuernberg, Peter; Benzing, Thomas; Levtchenko, Elena; Seyberth, Hannsjoerg W.; Klaus, Guenter; Yigit, Goekhan; Lin, Shih-Hua; Timmer, Albert; de Koning, Tom J.; Scherjon, Sicco; Schlingmann, Karl P.; Bertrand, Mathieu J. M.; Rinschen, Markus M.; de Backer, Olivier; Konrad, Martin; Koemhoff, Martin

    2016-01-01

    BACKGROUND Three' pregnancies with male offspring in one family were complicated by severe polyhydramnios and prematurity. One fetus died; the other two had transient massive salt-wasting and polyuria reminiscent of antenatal Bartter's syndrome. METHODS To uncover the molecular cause of this

  8. Barriers to uptake of antenatal maternal screening tests in Senegal

    NARCIS (Netherlands)

    Koster, W.; Ondoa, P.; Sarr, A.M.; Sow, A.L.; Schultsz, C.; Sakande, J.; Diallo, S.; Pool, R.

    2016-01-01

    Background: Evidence exists that selective antenatal maternal screening tests contribute to the reduction of maternal morbidity and mortality. However, data are lacking on coverage with the complete set of recommended tests. The study aimed to identify barriers to uptake of the complete set of tests

  9. Determinants of antenatal care, institutional delivery and postnatal ...

    African Journals Online (AJOL)

    Results: Overall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births. Factors that consistently predict the utilization of the three MCH services are maternal and husband's level education, place of residence, wealth level and parity. Antenatal ...

  10. Is antenatal screening for rubella and cytomegalovirus justified?

    African Journals Online (AJOL)

    Abstract Altogether 2 250 asymptomatic pregnant women attending an antenatal clinic were investigated for serological evidence of past exposure to rubella and cytomegalovirus (CMV) as well as for active primary infection or reinfectionJreactivation. Only. 7 (0,3%) active rubella infections were diagnosed, none of them ...

  11. Quality of Antenatal care services in eastern Uganda: implications ...

    African Journals Online (AJOL)

    Good quality Antenatal Care (ANC) provides opportunity to detect and respond to risky maternal conditions. This study assessed quality of ANC services in eastern Uganda with a goal of benchmarking implications for interventions. Methods Data was collected from 15 health facilities in Eastern Uganda to establish capacity ...

  12. Implementing focussed antenatal care in sub-Saharan Africa: an ...

    African Journals Online (AJOL)

    A SWOT Analysis framework was used to assess the situational analysis of antenatal care programmes in sub-Saharan Africa while the Walt and Gilson policy analysis triangle was used to analyse the feasibility of introducing the new WHO ANC model into the sub-region. The content of the WHO model may need to be ...

  13. The association of maternal social factors and antenatal care with ...

    African Journals Online (AJOL)

    Zinc is a crucial micronutrient in early childhood survival and the development of innate and acquired immunity. The objective is to determine the relationship between of maternal social class and antenatal care to serum zinc level in newborns in a tertiary and a rural hospital. It is prospective study using questionnaires on ...

  14. Attitude To Caesarean Section Amongst Antenatal Clients In Ibadan ...

    African Journals Online (AJOL)

    This was a cross-sectional study carried out on 372 clients receiving antenatal care at a rural, suburban and urban centres, in order to assess the acceptance of caesarean delivery amongst them and the factors influencing their attitude. Caesarean section was acceptable to 65.7%. Many respondents will refuse the surgery, ...

  15. Developmental reprogramming of reproductive and metabolic dysfunction in sheep: native steroids vs. environmental steroid receptor modulators

    Science.gov (United States)

    Padmanabhan, Vasantha; Sarma, Hiren N.; Savabieasfahani, Mozhgan; Steckler, Teresa L.; Veiga-Lopez, Almudena

    2014-01-01

    The inappropriate programming of developing organ systems by exposure to excess native or environmental steroids, particularly the contamination of our environment and our food sources with synthetic endocrine disrupting chemicals that can interact with steroid receptors, is a major concern. Studies with native steroids have found that in utero exposure of sheep to excess testosterone, an estrogen precursor, results in low birth weight offspring and leads to an array of adult reproductive / metabolic deficits manifested as cycle defects, functional hyperandrogenism, neuroendocrine / ovarian defects, insulin resistance, and hypertension. Furthermore, the severity of reproductive dysfunction is amplified by excess postnatal weight gain. The constellation of adult reproductive and metabolic dysfunction in prenatal testosterone-treated sheep is similar to features seen in women with polycystic ovary syndrome. Prenatal dihydrotestosterone treatment failed to result in similar phenotype suggesting that many effects of prenatal testosterone excess are likely facilitated via aromatization to estradiol. Similarly, exposure to environmental steroid imposters such as bisphenol A (BPA) and methoxychlor (MXC) from days 30-90 of gestation had long-term but differential effects. Exposure of sheep to BPA, which resulted in maternal levels of 30-50 ng/ml BPA, culminated in low birth-weight offspring. These female offspring were hypergonadotropic during early postnatal life and characterized by severely dampened preovulatory LH surges. Prenatal MXC-treated females had normal birth weight and manifested delayed but normal amplitude LH surges. Importantly, the effects of BPA were evident at levels, which approximated twice the highest levels found in human maternal circulation of industrialized nations. These findings provide evidence in support of developmental origin of adult reproductive and metabolic diseases and highlight the risk posed by exposure to environmental endocrine

  16. Quality and uptake of antenatal and postnatal care in Haiti.

    Science.gov (United States)

    Mirkovic, Kelsey R; Lathrop, Eva; Hulland, Erin N; Jean-Louis, Reginald; Lauture, Daniel; D'Alexis, Ghislaine Desinor; Handzel, Endang; Grand-Pierre, Reynold

    2017-02-02

    Despite improvement, maternal mortality in Haiti remains high at 359/100,000 live births. Improving access to high quality antenatal and postnatal care has been shown to reduce maternal mortality and improve newborn outcomes. Little is known regarding the quality and uptake of antenatal and postnatal care among Haitian women. Exit interviews were conducted with all pregnant and postpartum women seeking care from large health facilities (n = 10) in the Nord and Nord-Est department and communes of St. Marc, Verrettes, and Petite Rivière in Haiti over the study period (March-April 2015; 3-4 days/facility). Standard questions related to demographics, previous pregnancies, current pregnancy, and services/satisfaction during the visit were asked. Total number of antenatal visits were abstracted from charts of recently delivered women (n = 1141). Provider knowledge assessments were completed by antenatal and postnatal care providers (n = 39). Frequencies were calculated for descriptive variables and multivariable logistic regression was used to explore predictors of receiving 5 out of 10 counseling messages among pregnant women. Among 894 pregnant women seeking antenatal care, most reported receiving standard clinical service components during their visit (97% were weighed, 80% had fetal heart tones checked), however fewer reported receiving recommended counseling messages (44% counselled on danger signs, 33% on postpartum family planning). Far fewer women were seeking postnatal care (n = 63) and similar service patterns were reported. Forty-three percent of pregnant women report receiving at least 5 out of 10 counseling messages. Pregnant women on a repeat visit and women with greater educational attainment had greater odds of reporting having received 5 out of 10 counseling messages (2 nd visit: adjusted odds ratio [aOR] =1.70, 95% confidence interval [CI]: 1.09-2.66; 5+ visit: aOR = 5.44, 95% CI: 2.91-10.16; elementary school certificate: a

  17. Understanding delayed access to antenatal care: a qualitative interview study

    Science.gov (United States)

    2014-01-01

    Background Delayed access to antenatal care ('late booking’) has been linked to increased maternal and fetal mortality and morbidity. The aim of this qualitative study was to understand why some women are late to access antenatal care. Methods 27 women presenting after 19 completed weeks gestation for their first hospital booking appointment were interviewed, using a semi-structured format, in community and maternity hospital settings in South Yorkshire, United Kingdom. Interviews were transcribed verbatim and entered onto NVivo 8 software. An interdisciplinary, iterative, thematic analysis was undertaken. Results The late booking women were diverse in terms of: age (15–37 years); parity (0–4); socioeconomic status; educational attainment and ethnicity. Three key themes relating to late booking were identified from our data: 1) 'not knowing’: realisation (absence of classic symptoms, misinterpretation); belief (age, subfertility, using contraception, lay hindrance); 2) 'knowing’: avoidance (ambivalence, fear, self-care); postponement (fear, location, not valuing care, self-care); and 3) 'delayed’ (professional and system failures, knowledge/empowerment issues). Conclusions Whilst vulnerable groups are strongly represented in this study, women do not always fit a socio-cultural stereotype of a 'late booker’. We report a new taxonomy of more complex reasons for late antenatal booking than the prevalent concepts of denial, concealment and disadvantage. Explanatory sub-themes are also discussed, which relate to psychological, empowerment and socio-cultural factors. These include poor reproductive health knowledge and delayed recognition of pregnancy, the influence of a pregnancy 'mindset’ and previous pregnancy experience, and the perceived value of antenatal care. The study also highlights deficiencies in early pregnancy diagnosis and service organisation. These issues should be considered by practitioners and service commissioners in order to promote

  18. MicroRNA and mRNA Expression Changes in Steroid Naïve and Steroid Treated DMD Patients.

    Science.gov (United States)

    Liu, Da Zhi; Stamova, Boryana; Hu, Shengyong; Ander, Bradley P; Jickling, Glen C; Zhan, Xinhua; Sharp, Frank R; Wong, Brenda

    2015-09-22

    Duchenne Muscular Dystrophy (DMD) is a recessive X-linked form of muscular dystrophy. Steroid therapy has clinical benefits for DMD patients, but the mechanism remains unclear. This study was designed to identify mRNAs and microRNAs regulated in Duchenne Muscular Dystrophy patients prior to and after steroid therapy. Genome wide transcriptome profiling of whole blood was performed to identify mRNAs and microRNAs regulated in DMD patients. The data show many regulated mRNAs and some microRNAs, including some muscle-specific microRNAs (e.g., miR-206), that were significantly altered in blood of young (age 3-10) DMD patients compared to young controls. A total of 95 microRNAs, but no mRNAs, were differentially expressed in older DMD patients compared to matched controls (age 11-20). Steroid treatment reversed expression patterns of several microRNAs (miR-206, miR-181a, miR-4538, miR-4539, miR-606, and miR-454) that were altered in the young DMD patients. As an example, the over-expression of miR-206 in young DMD patients is predicted to down-regulate a set of target genes (e.g., RHGAP31, KHSRP, CORO1B, PTBP1, C7orf58, DLG4, and KLF4) that would worsen motor function. Since steroids decreased miR-206 expression to control levels, this could provide one mechanism by which steroids improve motor function. These identified microRNA-mRNA alterations will help better understand the pathophysiology of DMD and the response to steroid treatment.

  19. Anabolic steroids for rehabilitation after hip fracture in older people.

    Science.gov (United States)

    Farooqi, Vaqas; Berg, Maayken E L van den; Cameron, Ian D; Crotty, Maria

    2016-01-01

    Hip fracture occurs predominantly in older people, many of whom are frail and undernourished. After hip fracture surgery and rehabilitation, most patients experience a decline in mobility and function. Anabolic steroids, the synthetic derivatives of the male hormone testosterone, have been used in combination with exercise to improve muscle mass and strength in athletes. They may have similar effects in older people who are recovering from hip fracture. To examine the effects (primarily in terms of functional outcome and adverse events) of anabolic steroids after surgical treatment of hip fracture in older people. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (10 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013 Issue 8), MEDLINE (1946 to August Week 4 2013), EMBASE (1974 to 2013 Week 36), trial registers, conference proceedings, and reference lists of relevant articles. The search was run in September 2013.Selection criteria: Randomized controlled trials of anabolic steroids given after hip fracture surgery, in inpatient or outpatient settings, to improve physical functioning in older patients with hip fracture.Data collection and analysis: Two review authors independently selected trials (based on predefined inclusion criteria), extracted data and assessed each study's risk of bias. A third review author moderated disagreements. Only very limited pooling of data was possible. The primary outcomes were function (for example, independence in mobility and activities of daily living) and adverse events, including mortality. We screened 1290 records and found only three trials involving 154 female participants, all of whom were aged above 65 years and had had hip fracture surgery. All studies had methodological shortcomings that placed them at high or unclear risk of bias. Because of this high risk of bias, imprecise results and likelihood of publication bias

  20. The lived experiences of rural women diagnosed with the human immunodeficiency virus in the antenatal period.

    Science.gov (United States)

    Fords, Genevieve Marion; Crowley, Talitha; van der Merwe, Anita S

    2017-12-01

    In South Africa, pregnant women are diagnosed with human immunodeficiency virus (HIV) at antenatal clinics and simultaneously initiated on antiretroviral treatment (ART). An HIV diagnosis together with the initiation of ART has an emotional impact that may influence how pregnant women cope with pregnancy and their adherence to a treatment plan. The aim of the study was to explore the lived experiences of women diagnosed with HIV in the antenatal period in a rural area in the Eastern Cape province of South Africa. A qualitative approach with a descriptive phenomenological design was utilised. The study applied purposive sampling to select participants from a local community clinic in the Eastern Cape. Ten semistructured interviews were conducted, transcribed and analysed using Colaizzi's framework. Four themes formed the essential structure of the phenomenon being investigated: a reality that hits raw, a loneliness that hurts, hope for a fractured tomorrow and support of a few. Although the participants had to accept the harsh reality of being diagnosed with HIV and experienced loneliness and the support of only a few people, they had hope to live and see the future of their children. Women diagnosed with HIV during pregnancy are ultimately concerned with the well-being of their unborn children, and this concern motivates their adherence to ART. Women's lived experiences are situated in their unique sociocultural context, and although some known challenges remain, counselling and support strategies need to be informed by exploring context-specific issues and involving the local community.