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Int. arch. otorhinolaryngol. (Impr.) ; 26(1): 111-118, Jan.-Mar. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364913


Abstract Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged 2: 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups (p < 0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days (p = 0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days (p < 0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. Trial Registration database (NCT01457638 and NCT02231216).

Rev. chil. obstet. ginecol. (En línea) ; 87(1): 40-47, feb. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388708


Resumen El parto prematuro es la principal causa de morbimortalidad neonatal en Chile. Los prematuros tardíos, definidos como nacimientos entre 34 semanas con 0 días (34+0) y 36 semanas con 6 días (36+6) de gestación, representan el 70-80% de los prematuros y se asocian a baja morbilidad y excepcional mortalidad si se comparan con partos bajo 34 semanas, pero significativamente mayor al compararlos con partos de término. Los prematuros tardíos son el resultado de diversas condiciones obstétricas, tales como síndromes hipertensivos del embarazo, rotura prematura de membranas, colestasia intrahepática del embarazo y comorbilidad médica. El propósito de esta revisión es actualizar la información asociada a los prematuros tardíos y dar una visión de las tendencias en el uso de corticoides y el manejo expectante de la rotura prematura de membranas con el objetivo de disminuir las complicaciones en este grupo de prematuros.

Abstract Preterm delivery is the most important cause of neonatal morbidity and mortality in Chile. Late preterm, defined as deliveries between 34 +0 and 36+6-weeks accounts for 70-80% of preterm and is associated with non-severe morbidity and extremely low mortality when compared with deliveries below 34 weeks but significantly high when compared with full term babies. Late preterm deliveries are a result of several obstetric conditions, such a hypertensive disorder, premature rupture of membranes, intrahepatic cholestasis, and maternal medical comorbidities. The purpose of this review is to update the information associated with the risks of late preterm and to guide in the new trends in the application of steroid and expectant management for premature rupture of membranes in order to reduce the frequency of late preterm.

Humans , Female , Pregnancy , Infant, Newborn , Infant, Premature , Premature Birth/physiopathology , Premature Birth/therapy , Fetal Membranes, Premature Rupture , Risk Factors , Gestational Age , Adrenal Cortex Hormones/therapeutic use , Infant, Premature, Diseases/epidemiology
Arch. endocrinol. metab. (Online) ; 66(1): 77-87, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364306


ABSTRACT Adrenal steroid biosynthesis and its related pathology are constant evolving disciplines. In this paper, we review classic and current concepts of adrenal steroidogenesis, plus control mechanisms of steroid pathways, distribution of unique enzymes and cofactors, and major steroid families. We highlight the presence of a "mineralocorticoid (MC) pathway of zona fasciculata (ZF)", where most circulating corticosterone and deoxycorticosterone (DOC) originate together with 18OHDOC, under ACTH control, a claim based on functional studies in normal subjects and in patients with 11β-, and 17α-hydroxylase deficiencies. We emphasize key differences between CYP11B1 (11β-hydroxylase) and CYP11B2 (aldosterone synthase) and the onset of a hybrid enzyme - CYP11B1/CYP11B2 -, responsible for aldosterone formation in ZF under ACTH control, in "type I familial hyperaldosteronism" (dexamethasone suppressible). In "apparent MC excess syndrome", peripheral conversion of cortisol to cortisone is impaired by lack of 11β-hydroxysteroid dehydrogenase type 2, permitting free cortisol access to MC receptors resulting in severe hypertension. We discuss two novel conditions involving the synthesis of adrenal androgens: the "backdoor pathway", through which dihydrotestosterone is formed directly from androsterone, being relevant for the fetoplacental setting and sexual differentiation of male fetuses, and the rediscovery of C19 11-oxygenated steroids (11-hydroxyandrostenedione and 11-ketotestosterone), active androgens and important markers of virilization in 21-hydroxylase deficiency and polycystic ovaries syndrome. Finally, we underline two enzyme cofactor deficiencies: cytochrome P450 oxidoreductase which partially affects 21- and 17α-hydroxylation, producing a combined clinical/hormonal picture and causing typical skeletal malformations (Antley-Bixler syndrome), and PAPSS2, coupled to SULT2A1, that promotes sulfation of DHEA to DHEAS, preventing active androgens to accumulate. Its deficiency results in reduced DHEAS and elevated DHEA and androgens with virilization. Future and necessary studies will shed light on remaining issues and questions on adrenal steroidogenesis.

Humans , Male , Adrenal Hyperplasia, Congenital/metabolism , Hyperaldosteronism , Steroids , Cytochrome P-450 CYP11B2 , Androgens
Rev. chil. endocrinol. diabetes ; 15(3): 110-117, 2022. tab
Article in Spanish | LILACS | ID: biblio-1392449


La hiperglicemia y/o diabetes inducida por esteroides, se define como la elevación de la glicemia, causada por la acción de los fármacos glucocorticoideos, sobre el metabolismo de los carbohidratos, y presenta una prevalencia entre un 20% al 50%, en pacientes sin diabetes previa, existiendo mayor riesgo para esta patología en pacientes con diabetes pre-existente, obesidad, uso crónico de esteroides o en dosis altas, entre otros. El diagnóstico se rige por los criterios para diabetes en la mayoría de los casos. No obstante, existen casos en donde la hiperglicemia por esteroides es sub-diagnosticada. Su manejo se basa en el tratamiento farmacológico (antidiabéticos orales, subcutáneos e insulina) y no farmacológico (dieta y ejercicio), tomando en cuenta, el patrón glicémico, peso, edad, co-morbilidades, dosis, tipo y tiempo de uso de los esteroides. La relevancia de conocer como diagnosticar y tratar dicha patología, se debe al riesgo de ingreso hospitalario, de infección, de mala cicatrización y de mortalidad en casos no tratados. En vista del aumento del uso de glucocorticoides en la actualidad, se hace una revisión del abordaje terapéutico de la hiperglicemia y diabetes inducida por esteroides.

Hyperglycemia and Steroid-induced Diabetes is defined as the elevation of glycemia caused by the action of glucocorticoid drugs on carbohydrate metabolism, with a prevalence between 20% and 50% in patients without Diabetes. Though, there is a greater risk of this pathology in patients with pre-existing Diabetes, Obesity, chronic use of steroids or in high doses, among others. In most cases, the diagnosis is governed by the criteria of Diabetes; however, there are cases where hyperglycemia Steroid-induced is under-diagnosed. Its management is based on pharmacological treatment (oral and subcutaneous hypoglycemic agents and insulin) and non-pharmacological treatment (diet and exercise), in accordance with the glycemic pattern, weight, age, co-morbidities, dose, type and the duration of the use of steroid. The relevance of knowing how to diagnose and treat this pathology is the risk of hospital admission, infection, poor healing and mortality in untreated cases. In view of the increased use of glucocorticoids nowadays, a review is made about the therapeutic approach to hyperglycemia and steroid-induced Diabetes.

Humans , Steroids/adverse effects , Diabetes Mellitus/chemically induced , Hyperglycemia/chemically induced , Risk Factors , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Glucocorticoids/adverse effects , Hyperglycemia/diagnosis , Hyperglycemia/therapy
Article in Chinese | WPRIM | ID: wpr-934368


Objective:This study explored the consistency of liquid chromatography-tandem mass spectrometry (LC-MS/MS) and immunoassay for the detection of steroid hormones. The diagnostic value of multiple steroid hormones in 21-hydroxylase deficiency (21-OHD) was investigated and the follow-up indicators were screened.Methods:This experimental group included 109 patients with typical 21-OHD who received standard treatment, and the control group included 94 normal children. 17-hydroxyprogesterone (17-OHP), androstenedione (Δ4-A), testosterone and cortisol were detected by immunoassay and LC-MS/MS method. At the same time, 16 other adrenal steroids were detected by LC-MS/MS method. The experimental group was divided into: (1) overtreatment group: 17OHP<4 ng/ml; (2) well controlled group: 4 ng/ml≤17-OHP<12 ng/ml; (3) poorly controlled group: 17-OHP≥12 ng/ml. The following studies were carried out. (1) The consistency of immunoassay and LC-MS/MS detection results was analyzed; (2) The serum concentrations of various steroid hormones in patients with 21-OHD and the control group were compared to explore the diagnostic value of multiple steroid hormones detection; (3) The concentration differences of 20 kinds of steroid hormones in 21-OHD patients with different therapeutic effects were compared to screen more valuable follow-up indicators.Results:(1) among the four indicators detected by LC-MS/MS and immunoassay, the consistency of T and 17-OHP was high. The concentrations of cortisol and Δ4-A determined by immunoassay were higher than those determined by LC-MS/MS. (2) Among the 20 kinds of steroid hormones secreted by adrenal gland detected by LC-MS/MS, 6 kinds of hormones were significantly higher and 6 kinds of hormones were significantly lower in 21-OHD patients compared with the control group, ,and 8 kinds of steroids showed no statistical difference. (3) 17-OHP decreased and 11-deoxycortisol increased in over-inhibition group, while 17-OHP, pregnenolone, progesterone, 17-hydroxypregnenolone, 21-deoxycortisol, Δ4-A and estrone increased in the poorly controlled group.Conclusions:LC-MS/MS can detect many kinds of steroid hormones at one time with better evaluate dimensions. During the follow-up, only 8 of the 20 hormones were closely related to the control status of patients, suggesting that unnecessary testing work could be reduced.

Bol. venez. infectol ; 32(2): 90-94, julio - diciembre 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1362827


La mucormicosis es una infección fúngica producida por hongos del orden Mucoral, que se desarrolla con mayor frecuencia en pacientes inmunocomprometidos, caracterizada por producir invasión de vasos sanguíneos con posterior trombosis e isquemia del área de lesión lo que produce manifestaciones rinocerebral, cutánea, gastrointestinal, diseminada y miscelánea. En la actualidad con el resurgimiento del Coronavirus y el uso desmedido de esteroides se ha evidenciado un incremento en los casos de Mucormicosis asociados a esta patología. Se presenta el caso de una paciente de 55 años de edad, quien recibió tratamiento para infección presuntiva por COVID-19 y que desarrolló manifestaciones clínicas de mucormicosis rino-orbito- cerebral

Mucormycosis is a fungal infection produced by fungi of the Mucoral order, which develops more frequently in immunocompromised patients, characterized by causing invasion of blood vessels with subsequent thrombosis and ischemia of the lesion area which produces rhinocerebral, cutaneous, gastrointestinal, disseminated manifestations and miscellaneous. At present, with the resurgence of the Coronavirus and the excessive use of steroids, there has been an increase in the cases of Mucormycosis associated with this pathology. The case of a 55- year-old patient is presented, who received treatment for presumptive infection by COVID-19 and who developed clinical manifestations of rhino-orbito-cerebral Mucormycosis, with subsequent mycological diagnosis

Rev. cuba. anestesiol. reanim ; 20(3): e717, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1351984


Introducción: La administración epidural de esteroides constituye un pilar del tratamiento del dolor radicular cervical y lumbosacro. Objetivo: Describir los mecanismos fisiológicos y características farmacológicas de los corticosteroides utilizados en el tratamiento del dolor, así como las complicaciones derivadas de la administración epidural de esteroides particulados. Métodos: Se realizó una revisión no sistemática de la literatura en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID y el buscador académico Google Scholar, en los meses de julio a septiembre del año 2020. Desarrollo: Los corticoides utilizados en la medicina del dolor son derivados de la prednisolona. Estos se clasifican en particulados (de depósito, de suspensión) o no particulados (de dilución), en función de la presencia o ausencia de un componente molecular sólido (moléculas tipo éster, insolubles en agua). Los fármacos más empleados son la dexametasona, betametasona, triamcinolona y metilprednisolona. Conclusiones: La administración epidural de esteroides particulados está relacionada con la incidencia de complicaciones graves, aunque poco frecuentes, como paraplejía, tetraplejía, infarto de la médula espinal, hemorragia y edema cerebral. La evidencia disponible muestra una efectividad analgésica similar a los compuestos no particulados. Por lo tanto, no se recomienda su utilización rutinaria durante el abordaje del espacio epidural(AU)

Introduction: Epidural administration of steroids is a cornerstone for the treatment of cervical and lumbosacral radicular pain. Objective: To describe the physiological mechanisms and pharmacological characteristics of the corticosteroids used for pain treatment, as well as the complications derived from the epidural administration of particulate steroids. Methods: A nonsystematic review of the literature was carried out, from July to September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID and the academic search engine Google Scholar. Development: The corticoids used in pain medicine are derived from prednisolone. These are classified into particulate (deposit, suspension) or non-particulate (dilution), depending on the presence or absence of a solid molecular component (ester-type molecules, insoluble in water). The most commonly used drugs are dexamethasone, betamethasone, triamcinolone, and methylprednisolone. Conclusions: The epidural administration of particulate steroids is related to the incidence of serious, although infrequent, complications, such as paraplegia, tetraplegia, spinal cord infarction, hemorrhage and cerebral edema. Available evidence shows analgesic effectiveness similar to that of non-particulate compounds. Therefore, its routine usage is not recommended during the managment of the epidural space(AU)

Humans , Male , Female , Dexamethasone , Prednisolone , Adrenal Cortex Hormones , Analgesics , Quadriplegia
Medicina UPB ; 40(2): 75-79, 13 oct. 2021. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1342235


Los antibióticos y analgésicos han sido descritos frecuentemente como las principales causas de toxicidad hepática. Los esteroides anabólicos se han relacionado también con alteraciones en sistemas como el cardiovascular o el hepático; en este último causan colestasis, carcinoma hepatocelular, hiperplasia regenerativa nodular y sangrado de varices, secundario a hipertensión portal. Es importante entonces considerar los esteroides anabólicos como factores de riesgo para hepatotoxicidad. Se presenta el primer caso en Colombia y uno de los pocos en Latinoamérica, de colestasis asociada únicamente al uso de estanozolol. Se trata de un paciente de 21 años, en tratamiento con el medicamento para incrementar la masa muscular, que presentó compromiso hepático de tipo colestásico. Se descartaron otras posibles causas de ictericia, mediante la escala CIOMS/RUCAM se llegó a establecer causalidad entre el consumo de estanozolol y la colestasis. El objetivo de este reporte es hacer una descripción no reportada en la literatura colombiana y poco común en la literatura mundial.

Antibiotics and pain relievers have been frequently described as the main causes of liver toxicity. Anabolic steroids have also been linked to alterations in systems such as cardio-vascular or liver. In the latter, they seem to cause cholestasis, hepatocellular carcinoma, nodular regenerative hyperplasia and variceal bleeding secondary to portal hypertension. It is important to consider them as factors associated with hepatotoxicity. The first case in Colombia and one of the few in Latin America of cholestasis associated only to the use of Stanozolol is presented in a 21-year-old patient under treatment with the drug to increase muscle mass. The patient presented with cholestatic liver involvement. Other possible causes of jaundice were ruled out. From the CIOMS / RUCAM scale, causality was established between the consumption of Stanozolol and cholestasis. The objective of this case is to report a case not found in Colombian literature and little reported in world literature.

Antibióticos e analgésicos têm sido frequentemente descritos como as principais causas de toxicidade hepática. Os esteroides anabolizantes também têm sido relacionados a alterações em sistemas como cardiovasculares ou hepáticos; neste último, causam colestase, carcinoma hepatocelular, hiperplasia nodular regenerativa e sangramento varicoso, secundário à hipertensão portal. Portanto, é importante considerar os este-roides anabolizantes como fatores de risco para hepatotoxicidade. O primeiro caso é apresentado na Colômbia e um dos poucos na América Latina, de colestase associada apenas ao uso de estanozolol. Paciente de 21 anos, em tratamento com fármaco para aumento de massa muscular, apresentou acometimento hepático colestático. Outras possíveis causas de icterícia foram descartadas, a escala CIOMS / RUCAM estabeleceu causalidade entre o consumo de estanozolol e colestase. O objetivo deste relatório é fazer uma descrição não relatada na literatura colombiana e rara na literatura mundial

Humans , Stanozolol , Anabolic Agents , Cholestasis , Testosterone Congeners , Jaundice , Liver
Braz. j. biol ; 81(3): 537-543, July-Sept. 2021. graf
Article in English | LILACS | ID: biblio-1153387


Abstract Anabolic substances have been increasingly used by bodybuilders and athletes with the goal of improving performance and aesthetics. However, this practice has caused some concern to physicians and researchers because of unknowledge of consequences that the indiscriminate and illicit use of these substances can cause. Thus, this study analyzed the effects of two commercially available anabolic steroids (AS), Winstrol Depot® (Stanozolol) and Deposteron® (Testosterone Cypionate), in the neuronal density of limbic, motor and sensory regions on the cerebral cortex and in CA1, CA2, CA3 regions of the hippocampus. A total of 60 Swiss mice were used (30 males and 30 females), separated into three groups: control and two experimental groups, which received the AAS. From each brain, homotypic and semi-serial samples were taken in frontal sections from areas established for the study. The results showed that females treated with testosterone cypionate presented a reduction in all regions tested and the ones treated with Stanozolol showed a decrease in some hippocampal areas. Regarding male animals, stanozolol led to a decrease in neuron number in one hippocampal region. These data allow us to conclude that supra-physiological doses of steroids used in this study, can cause considerable damage to nervous tissue with ultrastructural and consequently behavioral impairment. These changes could interfere with the loss of physical yield and performance of athletes and non-athletes and may cause irreparable damage to individuals making irresponsible use of anabolic steroids.

Resumo As substancias anabólicas tem sido cada vez mais utilizadas por fisiculturistas e atletas com o objetivo de melhorar o desempenho e a estética. No entanto, essa prática tem causado algumas preocupações aos médicos e pesquisadores, devido ao desconhecimento das consequencias que o uso indiscriminado e ilícito dessas substâncias podem causar. Diante disso, este estudo analisou os efeitos de dois esteroides anabolizantes (EA) comercialmente disponíveis, Winstrol Depot® (Stanozolol) e Deposteron® (cipionato de testosterona), na densidade neuronal das regiões corticais límbica, motora e sensitive bem como das áreas CA1, CA2, CA3 do hipocampo. Foram utilizados 60 camundongos Swiss (30 machos e 30 fêmeas), separados em três grupos: controle e dois grupos experimentais, que receberam o EA. De cada cérebro, foram coletadas amostras homotípicas e semi-seriadas em cortes frontais das áreas estabelecidas para o estudo. Os resultados mostraram que as fêmeas tratadas com cipionato de testosterona apresentaram uma redução em todas as regiões analisadas já as fêmeas tratadas com Stanozolol mostraram uma diminuição em algumas áreas do hipocampo. Em relação aos animais machos, o stanozolol levou a uma diminuição na densidade neuronal em uma região do hipocampo. Estes dados nos permitem concluir que doses supra fisiológicas de esteroides utilizadas neste estudo podem causar danos consideráveis ao tecido nervoso com comprometimento ultraestrutural e consequentemente comportamental. Essas alterações podem interferir na perda de rendimento físico e no desempenho de atletas e não atletas e podem causar danos irreparáveis a indivíduos que fazem uso irresponsável destes EA.

Animals , Male , Female , Rabbits , Anabolic Agents/adverse effects , Stanozolol/adverse effects , Testosterone Congeners , Hippocampus , Neurons
Rev. colomb. cir ; 36(3): 438-445, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1254238


Introducción. La mastitis granulomatosa crónica es una enfermedad inflamatoria poco frecuente y con mayor incidencia en el sexo femenino. Su sintomatología y su presentación clínica causan gran ansiedad tanto en el paciente como en el personal médico, debido a su comportamiento similar al de la patología mamaria maligna. No hay una etiología clara ni un manejo terapéutico definido. El objetivo de este estudio fue determinar las características clínico-patológicas, el tratamiento y la evolución de las pacientes con mastitis granulomatosa, durante el periodo de estudio. Métodos. Estudio retrospectivo en el que se revisaron las historias clínicas de pacientes con diagnóstico y manejo de trastorno inflamatorio de la mama no especificado (N61X), entre enero de 2010 y diciembre de 2019. Se encontraron 236 pacientes, se excluyeron 176 por no cumplir con el diagnóstico de mastitis granulomatosa crónica o por no tener un seguimiento adecuado. Se evaluaron las características sociodemográficas, clínicas y de evolución, comparando la respuesta que se obtuvo con cada tratamiento. Resultados. Se incluyeron 60 pacientes femeninas que presentaron manifestaciones variadas. El 38,3 % (n=23) recibieron manejo antibiótico, el 30 % (n=18) fue tratado con corticoides, el 8,3 % (n=5) recibió antibióticos más corticoides y se realizó manejo expectante en el 16,6 % (n=10). El 6,6 % (n=4) de los pacientes fueron llevados a cirugía. Discusión. La mejor respuesta y la menor tasa de recidiva se encontró en las pacientes que fueron sometidas a observación y en aquellas que recibieron corticoides

Introduction. Chronic granulomatous mastitis is a rare inflammatory disease with a higher incidence in females. Its symptoms and its clinical presentation cause great anxiety both in the patient and in the medical personnel, due to its behavior similar to that of malignant breast disease. There is no clear etiology or defined therapeutic management. The objective of this study was to determine the clinical-pathological characteristics, treatment and evolution of the patients with granulomatous mastitis, during the study period. Methods. Retrospective study in which the medical records of patients with diagnosis and management of unspecified inflammatory disorder of the breast (N61X) were reviewed, between January 2010 and December 2019. Two-hundred-thirty-six patients were found, 176 were excluded for not complying with the diagnosis of chronic granulomatous mastitis or for not having an adequate follow-up. The sociodemographic, clinical and evolution characteristics were evaluated, comparing the response obtained with each treatment. Results. Sixty female patients who presented varied manifestations were included, of which 38.3% (n=23) received antibiotic treatment, 30% (n=18) were treated with steroids, 8.3% (n=5) received antibiotics plus steroids, expectant management was performed in 16, 6% (n = 10), and 6.6% (n=4) of the patients were taken to surgery.Discussion. The best response and the lowest recurrence rate were found in patients who were observed and in those who received steroids

Humans , General Surgery , Mastitis , Adrenal Cortex Hormones , Granulomatous Mastitis , Fibrocystic Breast Disease , Anti-Bacterial Agents
Rev. invest. clín ; 73(1): 31-38, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1289742


ABSTRACT Background: Secondary immune thrombocytopenia (ITP) is a heterogeneous and unpredictable disease associated with various underlying conditions. Objective: The objective of the study was to investigate clinical evolution and chronicity predictors in secondary ITP. Methods: Patients treated at an academic medical center during 2008-2019 were stratified by age as children <16 years and adults >16 years. Responses to steroids, intravenous immunoglobulin G (IVIG), rituximab, and eltrombopag were classified as response (R) and complete response (CR). Risk factors for chronic ITP were determined by multiple regression with uni- and multi-variate analysis. Results: Eighty-three patients were included, 37 children and 46 adults. The most frequent associated conditions were infections 53%, systemic lupus erythematosus (SLE) 24%, thyroid disease 9.6%, and Evans syndrome 3.6%. Response to first-line treatment in the whole cohort was 94%; CR 45.7%; and R 50.6%. Initial response to steroids alone was 91.3% (n = 21/23), rituximab plus high-dose dexamethasone (HDD) 93.3% (n = 14/15); children receiving IVIG alone 100% (n=12/12); and eltrombopag in adults 100% (n = 3/3). Relapse was documented in 19.4% of children and 34% of adults, at a median time of 15 and 2 months, respectively; 30.4% of adults (15.2% from the miscellaneous group, 10.9% SLE-associated, and 4.3% infection-associated) and 18.9% of children followed a chronic course; age ≥10 years and platelets ≥20 × 109/L were risk factors for chronic ITP in children. Conclusion: Evolution was heterogeneous: a better and more sustained response was documented in the infections group compared to SLE or the miscellaneous group. (REV INVEST CLIN. 2021;73(1):31-8)

Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Referral and Consultation , Chronic Disease , Retrospective Studies , Treatment Outcome , Hematology
Article in Chinese | WPRIM | ID: wpr-912458


Low ionizability and poor chemical instability make some target analytes not suitable for direct LC-MS/MS analysis. To improve the detection performance, chemical derivation is frequently imported. However, such technology involves multiple disciplines such as laboratory medicine, organic chemistry and separation science. At present, it′s still a challenge for general application of chemical derivatization in routine clinical laboratories in our country. This article summarizes the key scientific connotation of chemical derivatization in the detection of vitamins, steroids, neurotransmitters and therapeutic drugs, and describes the derivatization approaches for development of chemical mass spectrometry in the future.

Med. lab ; 25(3): 569-580, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1343146


La glomerulonefritis rápidamente progresiva mediada por complejos inmunes (GMNRP II) es un síndrome clínico caracterizado por el rápido deterioro de la función renal asociado a hematuria, edemas y oliguria. Histológicamente se manifiesta como una glomerulonefritis crescéntica, con la presencia de depósitos granulares en la inmunofluorescencia. Aunque es una enfermedad rara, es grave y puede evolucionar a una enfermedad renal crónica, por lo cual es fundamental su identificación temprana. A continuación, se presenta una revisión sobre este tipo de glomerulonefritis, con énfasis en su etiología y en las opciones terapéuticas existentes en la actualidad

Rapidly progressive immune complex-mediated glomerulonephritis (RPGNMN II) is a clinical syndrome characterized by severe deterioration of renal function associated with hematuria, edema, and oliguria. It is histologically characterized as a crescentic glomerulonephritis, with the presence of granular deposits on immunofluorescence. Although it is a rare condition, it is a potentially serious disease that may progress to chronic renal disease, therefore its early identification is essential. Here we present a review of this form of glomerulonephritis, with emphasis on its etiology and the currently available therapeutic options

Glomerulonephritis , Purpura , IgA Vasculitis , Steroids , Biopsy , ISCOMs , Glomerulonephritis, IGA , Kidney Failure, Chronic
Rev. bras. oftalmol ; 80(3): e0010, 2021. graf
Article in English | LILACS | ID: biblio-1280122


ABSTRACT Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition of unknown etiology that can affect the eye. The most common ocular manifestation related to VKH is bilateral diffuse uveitis associated to exudative retinal detachment. Although these patients respond well to steroid pulse therapy, we report a case of a 44-year-old female patient presenting bilateral exudative retinal detachment and clinical diagnosis of VKH, who did not respond to the first cycle of 3-day pulse therapy with methylprednisolone. The exudation was reabsorbed only after a second cycle of steroid therapy.

RESUMO A doença de Vogt-Koyanagi-Harada é inflamatória e de etiologia desconhecida, podendo afetar o olho. A manifestação ocular mais comum relacionada à doença de Vogt-Koyanagi-Harada é a uveíte difusa bilateral associada ao descolamento exsudativo da retina. Embora esses pacientes respondam bem à pulsoterapia com esteroides, relatamos um caso de paciente de 44 anos que apresentou descolamento exsudativo bilateral da retina com diagnóstico clínico de doença de Vogt-Koyanagi-Harada que não respondeu ao primeiro ciclo de pulsoterapia de 3 dias com metilprednisolona. A exsudação apenas reabsorveu após uma segunda rodada de terapia com esteroides.

Humans , Female , Adult , Retinal Detachment/drug therapy , Methylprednisolone/therapeutic use , Uveomeningoencephalitic Syndrome/drug therapy , Adrenal Cortex Hormones/therapeutic use , Pulse Therapy, Drug/methods , Glucocorticoids/therapeutic use
São Paulo; s.n; s.n; 2021. 142 p. tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-1378940


Os esteroides anabólicos androgênicos (EAA) são utilizados clinicamente para tratar diferentes doenças, porém propagou-se o uso não terapêutico por atletas de elite e fisiculturistas, com o intuito de aumentar a massa muscular e melhorar o desempenho físico. O uso de substâncias ergogênicas, como fármacos estimulantes e narcóticos analgésicos no esporte, foi proibido em 1967 pelo International Olympic Committee (COI), mas somente em 1976 os EAA entraram para a lista de substâncias proibidas. O uso de EAA está associado a diversos efeitos adversos, principalmente cardiovasculares, neuroendócrinos e distúrbios psiquiátricos, além de dislipidemia, elevação dos marcadores inflamatórios e disfunção endotelial. As análises toxicológicas constam como a maneira mais eficaz de minimizar o doping no esporte. O material é fornecido pelo atleta durante as competições ou treinamentos e previne que os competidores alcancem vantagem competitiva devido ao uso de EAA. A utilização de métodos para amostragem alternativos tem ganhado força, devido à necessidade de técnicas mais práticas que utilizam pouco volume de amostra e possuem facilidade de armazenamento. O dried urine spots é um método no qual pequenas amostras de urina são aplicadas em papéis de filtro para análises qualitativas ou quantitativas. Ele se caracteriza por ser uma técnica rápida, fácil, simples e barata para a coleta, armazenamento e distribuição, além de minimizar os riscos de infecção, podendo ser utilizado na rotina. A técnica de paper spray (PS-MS) foi desenvolvida a partir da relevância de métodos como o dried blood spots por proporcionar análises mais rápidas, apresenta alta especificidade, capacidade de analisar diferentes analitos simultaneamente, baixo limite de detecção e dispensa a necessidade de reagentes específicos. Sendo assim, neste trabalho foi desenvolvido e validado o método de screening de EAAs em dried urine spots por ionização por paper spray acoplada à espectrometria de massas. O método apresentou limites de detecção entre 2-15ng/mL e presença de três interferentes endógenos. Os dez analitos de interesse deste estudo são estáveis por 150 dias em temperatura ambiente. Dessa forma, a análise de EAAs em dried urine spots por PS-MS demonstra grande potencial para se tornar um método alternativo no monitoramento rápido de drogas de abuso

Anabolic androgenic steroids (AAS) are used clinically to treat different diseases, but non-therapeutic use has spread among elite athletes and bodybuilders, with the aim of increase muscle mass and improve physical performance. The International Olympic Committee (IOC) banned the use of ergogenic substances, such as stimulating drugs and analgesic narcotics in sports, in 1967, but only in 1976, AAS were included on the list of prohibited substances. The use of AAS is associated with several adverse effects, mainly cardiovascular, neuroendocrine and psychiatric disorders, in addition to dyslipidemia, elevated inflammatory markers and endothelial dysfunction. Toxicological analyzes are the most effective approach to minimize doping in sport. The material is provided by the athlete during competitions or training and prevents competitors from achieving a competitive advantage due to the use of AAs. The use of alternative sampling methods has gained strength, due to the need for more practical techniques that use low sample volume and can be easily storage. Dried urine spots are a method, which a small amount of urine samples is applied to filter papers for qualitative or quantitative analysis. It is characterized by being a fast, easy, simple and inexpensive technique for collection, storage and distribution, in addition to minimizing the risks of infection, and can be used in the routine. The paper spray technique (PS-MS) was developed based on the relevance of methods such as dried blood spots for providing faster analysis, high specificity, ability to analyze different analytes simultaneously, low detection limit and for eliminating the need for specific reagents. Therefore, this work developed and validated a screening method for AAS in dried urine spots by paper spray-mass spectrometry ionization. The method provided detection limits between 2-15ng/mL and the presence of three endogenous interferents. The ten analytes of interest in this study are stable for 150 days at room temperature. Thus, the analysis of AAS in dried urine spots by PS-MS demonstrates great potential to become an alternative method for the rapid monitoring of drugs of abuse

Mass Spectrometry/instrumentation , Sports/classification , Steroids/adverse effects , Drug-Related Side Effects and Adverse Reactions , Athletes/classification , Performance-Enhancing Substances , Pharmaceutical Preparations/analysis , Illicit Drugs/adverse effects , Substance-Related Disorders , Doping in Sports/prevention & control , Evaluation Studies as Topic , Physical Functional Performance , Narcotics/adverse effects
Acta cir. bras ; 36(5): e360507, 2021. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1278110


ABSTRACT Purpose To evaluate the immediate and late effects of nandrolone on femur morphology of rats. Methods Twenty-eight animals with 20 weeks of age were divided into four groups: C28, control animals that were euthanized eight weeks after the experiment started; C40, control animals euthanized 20 weeks after the experiment started; T28, treated animals receiving nandrolone during eight weeks and euthanized immediately after the treatment period; and T40, animals treated during eight weeks and euthanized 12 weeks after the end of the treatment. Treated animals received nandrolone decanoate during eight weeks and control groups received peanut oil by intramuscular injection. After euthanasia, femurs were removed, dissected, weighted and measured by digital pachymeter. Results The T40 group presented an increase on distal epiphysis diameter when compared to C40 group. There was no difference between treated and control groups in relation to body and femur absolute weight, relative weight and length of femur. There was also no difference in relation to diameter of proximal epiphysis and diameter of diaphysis among the groups. Conclusions Nandrolone decanoate does not produce significant effect on femur, exception on its distal extremity at late period. The effects of such drug may depend on the time after administration.

Anabolic Agents/pharmacology , Nandrolone , Femur , Nandrolone Decanoate
Article in Chinese | WPRIM | ID: wpr-879156


The chemical constituents from the stems and leaves of Morinda citrifolia were isolated and purified by column chromatography methods with silica gel, ODS, Sephadex LH-20 and preparative high performance liquid chromatography(HPLC). The structures of the isolated compounds were identified by physicochemical properties and spectroscopic analysis, as well as comparisons with the data reported in literature. 17 compounds were isolated from the 90% ethanol extract of the stems and leaves of M. citrifolia, and were identified as 9,10-dihydroxy-4, 7-megastigmadien-3-one(1), 5,12-epoxy-6,9-hydroxy-7-megastigmen-3-one(2), fukinone(3), β-eudesmol(4), sarmentol F(5), 4, 5-dihydroblumenol A(6), 3-hydroxy-β-ionone(7), aristol-8-en-1-one(8), ergosta-7-en-3β-ol(9), ergosta-7-ene-3β,5α,6β-triol(10),(22E)-5α,8α-epidioxyergosta-6,22-dien-3β-ol(11), olivil(12), 4-epi-larreatricin(13), chushizisin Ⅰ(14), rabdosia acid A(15), glycerol monolinoleate(16) and(9Z,12Z,15Z)-2,3-dihydroxypropyl octadeca-trienoate(17). All compounds were isolated from M. citrifolia for the first time. All isolated compounds were evaluated for their anti-rheumatoid arthritis activities via examining their inhibitory activities on the proliferation of synoviocytes in vitro using MTS met-hod. Compounds 1-11 showed significant anti-rheumatoid arthritis activities, displaying the inhibitory effects on the proliferation of MH7 A synovial fibroblast cell with the IC_(50) values ranging from(38.69±0.86) to(203.45±1.03) μmol·L~(-1).

Cell Proliferation , Chromatography, High Pressure Liquid , Molecular Structure , Morinda , Synoviocytes
Case reports (Universidad Nacional de Colombia. En línea) ; 6(2): 156-164, July-Dec. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1149199


ABSTRACT Introduction: Myositis is a rare complication of extra-articular anabolic steroid injections, while osteitis has not been reported as an adverse effect from this cause. This case report provides information about imaging findings of these two entities. Case presentation: A 37-year-old male, bodybuilder, presented pain and edema in the left gluteal region, associated with functional limitation, 5 days after receiving an intramuscular anabolic steroid injection (stanozolol). The man underwent an ultrasound scan and magnetic resonance imaging of the pelvis with contrast, which allowed making the diagnosis of myositis of the left gluteus maximus and osteitis of the iliac bone. The patient was treated with piperacillin-tazobactam and vancomycin for 10 days, without complications. No surgical management was required. Conclusion: Myositis is a rare complication of anabolic steroid injections and the pathophysiological mechanism of this substance is unknown. Osteitis, on the other hand, is an even rarer complication and, to the best of our knowledge, this is the first known case associated with this cause. Given the findings, the myositis reported herein has an infectious nature; however, further studies are required to demonstrate the actual causal association.

RESUMEN Introducción. La miositis es una complicación muy rara de las inyecciones extraarticulares de esteroides anabólicos y la osteítis no ha sido reportada como efecto adverso por esta causa. El presente reporte de caso aporta información sobre los hallazgos imagenológicos de estos dos tipos de inflamaciones. Presentación del caso. Paciente masculino de 37 años, dedicado al fisicoculturismo, quien cinco días después de recibir una inyección de estano-zolol presentó dolor y edema en la región glútea izquierda asociados a limitación funcional. El sujeto asistió a consulta por este motivo y se le realizó una ecografía y una resonancia magnética contrastada de pelvis, cuyos resultados permitieron diagnosticarle miositis del glúteo mayor izquierdo y osteítis del hueso ilíaco. Se indicó tratamiento con piperacilina-tazobactam y vancomicina por 10 días y no se requirió manejo quirúrgico dado que se obtuvieron buenos resultados. Conclusión. La miositis es una complicación rara de las inyecciones de esteroides anabólicos en donde el mecanismo fisiopatológico de estas sustancias es incierto. Por su parte, la osteítis es una complicación aún más rara de la cual se presenta el primer caso conocido por esta causa. Dados los hallazgos se plantea que la miositis reportada es de tipo infecciosa; sin embargo, se requieren estudios adicionales que demuestren la asociación causal real.

Arq. bras. oftalmol ; 83(6): 543-546, Nov.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1153071


ABSTRACT Central giant cell granuloma is a rare osseous tumor affecting young patients with anatomical and functional compromise of the maxilla and mandible. Steroid injection therapy constitutes a less invasive treatment modality for disease control in selected cases. Retinal ischemia is a reported complication of multiple medical procedures, including dental interventions, and may lead to loss of vision with poor prognosis. We report a case of retinal arteriolar ischemic disease following central giant cell granuloma management with local injected corticosteroids.

RESUMO O granuloma central de células gigantes é um tumor ósseo raro que afeta pacientes jovens com comprometimento anatômico e funcional da maxila e mandíbula. A terapia com injeção de esteroides constitui uma modalidade de tratamento menos invasiva para o controle da doença em casos selecionados. A isquemia retiniana é uma complicação relatada em vários procedimentos médicos, incluindo intervenções odontológicas, e pode levar à perda da visão com mau prognóstico. Relatamos um caso de doença isquêmica arteriolar da retina após o tratamento com granuloma central de células gigantes com corticosteroides injetados locais.

Humans , Female , Adolescent , Bone Neoplasms , Adrenal Cortex Hormones , Ischemia/chemically induced , Bone Neoplasms/drug therapy , Granuloma, Giant Cell , Granuloma, Giant Cell/drug therapy , Mandible
Dolor ; 30(72): 10-13, nov. 2020. tab
Article in Spanish | LILACS | ID: biblio-1362051


Introducción: El dolor lumbar es uno de los principales motivos de consulta en diferentes escenarios clínicos; entre las causas más frecuentes de dolor lumbar se encuentra el canal lumbar estrecho, discopatía y radiculopatías, por lo que se han establecido diferentes modalidades de tratamiento que incluyen medidas invasivas, como las inyecciones de esteroides epidurales vía caudal. Objetivo: Evaluar la mejoría del dolor lumbar después de la aplicación de esteroides epidurales caudales no particulados en la población con dolor crónico lumbar bajo secundario a canal lumbar estrecho, discopatía y radiculopatía lumbar de un hospital en Bogotá, Colombia. Metodología: Se realizó un estudio observacional retrospectivo en el que se evaluó la reducción del dolor, en pacientes con diagnóstico de dolor lumbar crónico secundario a canal lumbar estrecho, radiculopatía, discopatía, mediante escala visualanáloga del dolor EVA seis meses después de la aplicación de dexametasona 8 mg vía epidural caudal en 147 pacientes en un período de 2 años. Resultados: Se evaluaron 147 pacientes con dolor lumbar crónico, de los cuales 58.32% eran mujeres y 47.76% hombres, con edades entre 44 y 77 años, de los cuales 50% eran mayores o igual a 65 años y 75% mayor o igual a 77 años. En la evaluación inicial del dolor lumbar, se encontró que el 50% de los pacientes tenían una EVA inicial mayor o igual a 8/10 y el 75% informó un EVA inicial 10/10. Se encontró que el canal lumbar estrecho fue la principal causa de dolor lumbar en el 53,06% de los pacientes, seguido de la enfermedad del disco lumbar el 49,66% y en el tercer lugar, los pacientes con radiculopatía lumbar correspondieron al 19.73% de la población. Sobre la mejoría del dolor de una manera particular, se encontró una mayor reducción del dolor en pacientes con enfermedad de disco lumbar 48,21%, seguido de estrecho canal lumbar estrecho 41,37% y radiculopatías lumbares 33,3%. En el análisis comparativo por patología aislada, la intervención no presentó una mejora considerable, sin embargo, cuando más de una de las entidades estudiadas coexistieron en el mismo paciente, hubo una mejoría significativa del dolor, por lo que en el 66,5% de los pacientes diagnosticados con un canal lumbar estrecho y radiculopatía, la mejoría de la lumbalgia y la radiculopatía disminuyó, de la misma forma que los pacientes que presentaron discopatía y radiculopatía tuvieron un alivio del dolor del 66% y, finalmente, aquellos con discopatía y canal lumbar estrecho, 60% tuvieron una reducción del dolor después del procedimiento. Conclusión: La aplicación de esteroides no particulados vía epidural caudal proporciona una mejora sintomática significativa en un porcentaje considerable de pacientes sometidos al procedimiento, especialmente en aquellos que tienen más de una de las causas de dolor lumbar crónico expuesta, por lo que se constituye en una medida invasiva de tratamiento efectivo para el dolor lumbar en este tipo de pacientes.

Introduction: Low back pain is one of the main reasons for consultation in different clinical scenarios; among the most frequent causes of low back pain is the narrow lumbar canal, discopathy and radiculopathies, which is why different modalities have been established of treatment including invasive measures such as injections of epidural steroids caudal via. Objective: To evaluate the improvement of lumbar pain after application of non-particulate caudal epidural steroid via in the population with chronic low lumbar pain in the narrow lumbar canal, discopathy and lumbar radiculopathy of a military hospital in Bogotá, Colombia. Methodology: A retrospective observational study was performed in which the pain reduction measured by visual analogous scale of pain VAS was evaluated six months after the application of dexamethasone 8 mg caudal epidural via in 147 patients in a period of 2 years Results: 147 patients with chronic low back pain were evaluated, of which 58.32% were women and 47.76% men, with ages between 44 and 77 years, of which 50% were greater than or equal to 65 years and 75 % greater than or equal to 77 years. Concerning the initial evaluation of lumbar pain, it was found that 50% of the patients had an initial VAS greater than or equal to 8/10 and 75% reported an initial VAS 10/10. Regarding the prevalence of causes of low back pain in the evaluated patients, it was found that the narrow lumbar canal was the main cause in 53.06% of the patients, followed by lumbar disc disease 49.66% and in the third place patients with lumbar radiculopathy corresponded 19.73% of the population. About pain improvement in a particular way, greater pain reduction was found in patients with lumbar disc disease 48.21%, followed by narrow lumbar canal 41.37% and lumbar radiculopathies 33.3%. In the comparative analysis due to isolated pathology, the intervention did not present a considerable improvement, however, when more than one of the entities studied coexisted in the same patient, there was a significant improvement in pain, thus 66.5% of the patients diagnosed with a canal. Narrow lumbar and radiculopathy improved, in the same way those patients who presented with discopathy and radiculopathy 66% had relief of pain and finally those with discopathy and narrow lumbar canal 60% had pain reduction after the procedure. Conclusion: The application of non-particulate steroid via caudal epidural provides significant symptomatic improvement in a considerable percentage of patients undergoing the procedure, especially in those who have more than one of the causes of chronic low back pain exposed and evaluated, thus being able to constitute an invasive measure of effective treatment for low back pain in this type of patients.

Humans , Male , Female , Adult , Middle Aged , Aged , Steroids/administration & dosage , Injections, Epidural , Low Back Pain/drug therapy , Steroids/therapeutic use , Pain Measurement , Retrospective Studies , Treatment Outcome , Low Back Pain/etiology