Meta-analysis of the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates / 中华儿科杂志

Objective: To systematically evaluate the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates. Methods: Eight databases in either Chinese or English, including PubMed, the Cochrane Library, Embase, Medline, Scopus, CNKI, Wanfang and VIP, were searched to extract the studies on the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates published from the establishment of each database to December 2022. The Meta-analysis was performed using Stata 14.0 statistical software. Results: A total of 9 studies were included in this Meta-analysis, including 6 retrospective cohort studies, 2 prospective cohort studies and 1 randomized controlled trial (RCT) study, involving 9 143 premature infants. The Meta-analysis showed that prenatal steroid exposure increased the risk of late preterm neonatal hypoglycemia (RR=1.55, 95%CI 1.25-1.91, P<0.001). The similar correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates was all found in the following subgroups: North America (RR=1.57, 95%CI 1.37-1.80, P<0.001), enrolling pregnant women with gestational diabetes (RR=1.62, 95%CI 1.26-2.08, P<0.001), A-grade literature quality (RR=1.43, 95%CI 1.14-1.79, P=0.002), criteria for hypoglycemia ≤40 mg/dl (1 mg/dl=0.056 mmol/L, RR=1.49, 95%CI 1.28-1.73, P<0.001), sample size of 501-1 500 (RR=1.69, 95%CI 1.19-2.40, P=0.003) and >1 500 (RR=1.65, 95%CI 1.48-1.83, P<0.001), steroid injection dosage and frequency of 12 mg 2 times (RR=1.66, 95%CI 1.50-1.84, P<0.001), the time interval from antenatal corticosteroid administration to delivery of 24-47 h (RR=1.98, 95%CI 1.26-3.10, P=0.003), unadjusted gestational age (RR=1.78, 95%CI 1.02-3.10,P=0.043) and unadjusted birth weight (RR=1.80, 95%CI 1.22-2.66, P=0.003). Meta-regression results showed that steroid injection frequency and dose were the main sources of high heterogeneity among studies (P=0.030). Conclusion: Prenatal steroid exposure may be a risk factor for hypoglycemia in late preterm neonates.

Hiperglicemia y diabetes inducidas por esteroides / Hyperglycemia and steroid-induced diabetes

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.

Detecção de esteroides anabólicos androgênicos e seus produtos de biotransformação em dried urine spots por ionização por paper spray acoplada à espectrometria de massas (PS-MS) / Detection of anabolic androgenic steroids and its biotransformation products in dried urine spots by paper spray-mass spectrometry ionization (PS-MS)

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

Central serous chorioretinopathy risk factors in the mid-Euphrates region, Iraq

Central serous chorioretinopathy (CSC) is an ophthalmic disorder that often affects young male patients under psychological stres and is clinically characterized by blurring of vision, metamorphopsia, a visual abnormality in which normally straight lines appears curved, and micropsia, a visual abnormality in which objects appear smaller than normal. The annual incidence of the condition is not well recognized in our country. The objective of this cross-sectional study was to highlight the incidence rate of CSC in our community and to make an insight on possible associated risk factors. This cross-sectional study included 92 patients with vissual impairment that has been proved due to central serous chorioretinoplathy (CRC). The sample included 68 males and 24 females. The sample of CRC was all the available patients visiting ophthalmology unit at Al-Diwaniyah teaching hospital and at the ophthalmology unit at Medical Committee Instituion, both these health centers lie at Al-Diwaniyah province, mid-Euphrates region, Iraq. A rough estimation of the annual incidence of CRC in this mid-Euphrates region of Iraq was 3.5 per 100.000. Mean age of patients was 43.02 ± 4.71 years, and the disease was 2.83 times more common in males. The main possible risk factors are psychosocial stress and steroid therapy. CRC is common in our community, and the main possible risk factors are psychosocial stress, and steroid use and these associations need to be validated in a large longitudinal study or at least a case-control study

Síndrome de deprivación glucocorticoidea. A propósito de un caso / Glucocorticoid deprivation syndrome. Case presentation

RESUMEN El síndrome de deprivación glucocorticoidea es el cuadro clínico resultante de la suspensión de la administración exógena de esteroides, aplicados por tiempo prolongado, independientemente de la vía de administración. Provoca la frenación del eje hipotálamo-hipófisis-suprarrenal y por ende disminuye la producción y secreción de corticotropina. Paciente femenina de 54 años de edad, con esteroides como tratamiento prolongado. Al retirarlo comenzó con pérdida de peso y dificultad para caminar, además de hipotensión ortostática, sufrió caída brusca al piso con pérdida de conocimiento. Fue llevada al hospital y no se constató pulsos periféricos ni tensión arterial, que no resolvió totalmente con el uso enérgico de fluidos endovenosos. Se mantuvo sin regular parámetros normales, se reevaluó como un síndrome de depravación corticoidea y se le impuso tratamiento con prednisona, mejorando paulatinamente. Los síndromes asociados a la retirada de corticoidesaparecen por el empleo de dosis altas, o retirada brusca de la corticoterapia prolongada. Al conjunto de síntomas y signos que aparecen cuando no se consigue tolerar la retirada de glucocorticoides, ante la ausencia de enfermedad subyacente para la cual fueron indicados estos medicamentos, y con un eje hipotálamo-hipófisis-suprarenal (HHS) no suprimido se le considera un síndrome de retirada de corticoides. A pesar de la gravedad, la frecuencia e importancia de este efecto secundario, en ocasiones no se repara en él, por lo que es imprescindible valorar los tratamientos indicados y reevaluar periódicamente los tratamientos crónicos indicados.

ABSTRACT The glucocorticoide deprivation symptom is the clinical symptom resulting from stoping the exogenous administration of steroids that were used for a long time, in spite of the administration way. It restrains the hypothalamus-pituitary-adrenal axis and therefore reduces corticotropine production and secretion. This is the case of a female patient, aged 54 years, with a continued steroid treatment. When stoping it, she began to lose weight and presented difficulties for walking. Besides orthostatic hypotension, she abruptly fell to the ground losing conciousness. She was carried to the hospital and there were not found periferal pulses nor arterial tension, a problem that was not solved by the active use of endovenous fluids. She kept on without regulating normal parameters, and was re-evaluated as a corticoid deprivation symptom and treated with prenisone. She gradually got better. The syndromes asociated to corticod deprivation begin due to the usage of high doses, or due to the abrupt withdrawal of a long corticotherapy. The whole of the symptoms appearing when corticoid withdrawal is not tolerated, in the absence of the underlying disease against which these medicines were indicated, and with a non-suppressed hypothalamus-pituitary-adrenal axis, is considered as a syndrome of corticoide withdrawal. In spite of its seriousness, of the frequency and importance of this secundary effect, sometimes it is not noticed; therefore it is essential to evaluate the indicated treatments and periodically reevaluate the treatments ordered for chronic diseases.

Risk factors for cytomegalovirus disease in systemic lupus erythematosus (SLE): a systematic review

Abstract Background: Cytomegalovirus (CMV) is an opportunistic pathogen causing reactivation and disease in Systemic Lupus Erythematosus (SLE) patients. This study aims to systematically review the literature for risk factors associated with CMV disease in SLE patients, in order to identify those more susceptible to CMV infection during their treatment. Methods: A systematic review was conducted on 4 different search engines and via hand search until May 2017. Studies were included after quality assessment via the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (HTA KMET). Results: Two studies on CMV disease were included. Elevated CMV viral load, higher steroid doses, use of immunosuppressants and disease duration were the most commonly associated risk factors for CMV disease. Conclusion: High CMV viral loads, longer SLE disease duration and higher steroid doses were associated with CMV disease. Further studies studying the risk of treatment drugs and role of interventions in the development of CMV infection are needed.

Calcineurin inhibitor in corneal transplantation

Objective: To evaluate the long-term efficacy and safety of topical calcineurin inhibitor, tacrolimus 0.003% suspension for the management of steroid-induced ocular hypertension post-penetrating keratoplasty [PK]

Design: A Retrospective Study

Setting: Magrabi Aseer Eye Hospital, Khamis Mushait, Saudi Arabia

Method: Twenty primary keratoplasties [primary PK] performed between 1 January 2012 and 31 December 2015 were included in the study. Prednisolone was replaced with tacrolimus 0.003% suspension after intraocular pressure [IOP] elevation. Primary outcome measure was immunologic graft rejection episodes and secondary outcome measures were pre and postoperative best-corrected visual acuity [BCVA]

Result: Twenty patients with keratoconus were included in the study; 12 [60%] were males and the mean age was 27 years

There were no reports of graft rejection or patients requiring glaucoma surgery

Tacrolimus was well tolerated; however, all patients reported a mild transient burning sensation in the eye during application. At the final follow-up, tacrolimus was tapered for all patients

Conclusion: Topical tacrolimus 0.003% suspension is an effective second-line immunosuppressant for the management of primary, normal-risk corneal grafts in patients who are steroid responders

Estrongiloidiasis crónica y uso prolongado de corticoides / Chronic strongyloidiasis and extended use of corticoids

La infección causada por Strongyloides stercoralis puede permanecer asintomática o con síntomas ligeros en humanos por varios años. Sin embargo, algunos individuos inmunodeprimidos, entre ellos los pacientes tratados con esteroides por tiempo prolongado, pueden presentar hiperinfección con altas tasas de mortalidad. El objetivo es reportar por primera vez en Cuba el caso de una paciente con síntomas de estrongiloidiasis crónica asociada al uso de esteroides orales. Se trata de una paciente de 63 años, asmática con síntomas de estrongiloidiasis crónica y riesgo de hiperinfección por el uso de esteroides orales por tiempo prolongado. Se describen las manifestaciones clínicas y los análisis complementarios. Se discuten los factores predisponentes para la adquisición inicial y el desarrollo de la enfermedad. El laboratorio confirmó la presencia de larvas rabditoides de Strongyloides stercoralis en las heces de la paciente. Aunque existen evidencias de casos fatales de pacientes con strongiloidiasis asociada al uso prolongado de esteroides en la literatura internacional, hay escasez de esos reportes en Cuba. Adicionalmente, es probable que el diagnóstico y el tratamiento oportunos, hayan contribuido a evitar complicaciones fatales en esta paciente(AU)

The infection caused by Strongyloides stercoralis may remain asymptomatic or with slight symptoms in humans for decades. However, immunocompromised patients, particulary those receiving long-term steroid therapy, may face hyperinfection resulting in high mortality rates. The objective was to present the first report in Cuba about a patient with chronic strongyloidiasis associated to use of oral steroids. Here is a 63 years-old asthmatic woman, who showed chronic strongyloidiasis symptoms and hyperinfection risk due to the long-term use of oral steroids. The symptoms and physical examination were described as well as various diagnostic tests. Predisposing factors for the onset and development of the disease were discussed. Laboratory diagnosis confirmed the presence of Strongyloides stercoralis rabditoid larvae in the patient's feces. Although there has been evidence of fatal cases with chronic strongyloidiasis associated with long-term use of steroids in the international literature, such reports are rare in Cuba. Additionally, it is likely that timely diagnosis and treatment have contributed to avoid fatal complications in this patient(AU)

Morphometric study of the corpus cavernosum after anabolic androgenic steroid administration in pubertal and adult rats

PURPOSE: To evaluate the penile morphological modifications of pubertal and adult rats chronically treated with supra-physiological doses of anabolic androgenic steroids. METHODS: Forty-eight male Wistar rats were distributed into four groups: two control groups, 105- and 65-day-old (C105 and C65, respectively) injected with peanut oil (vehicle); and two treated groups, 105- and 65-day-old (T105 and T65, respectively) injected with nandrolone decanoate at a dose of 10 mg Kg-1 of body weight. The rats were injected once a week for eight weeks. The rats were then killed and their penises were processed for histomorphometric analyses. The mean of each parameter was statistically compared. RESULTS: A corpus cavernosum reduction of 12.5% and 10.9% was observed in the T105 and T65 groups, respectively, when compared with their respective control groups. The cavernosum smooth muscle surface density diminished by 5.6% and 12.9% in the T65 and T105 groups, respectively, when compared with their controls. In contrast, the sinusoidal space increased by 17% in the T105 group and decreased by 9.6% in the T65 group. CONCLUSION: The use of supra-physiological doses of AAS promotes structural changes in the rat penis, by altering the proportions of corpus cavernosum tissues, in both pubertal and adult treated animals. .

Association between the use of a baby's bottle and pacifier and the absence of breastfeeding in the second six months of life / Associação entre o uso de mamadeira e de chupeta e a ausência de amamentação no segundo semestre de vida

Introduction: The World Health Organization recommends breastfeeding for two years or more and advises against bottle feeding and pacifier use. Objective: Investigate the association between bottle feeding and pacifier use, and breastfeeding in the second half-year of life. Methods: Survey in a municipality of Rio de Janeiro state, in 2006, interviewing those responsible for 580 children aged 6-11 months. Bottle feeding and pacifier use, and variables which in the bivariate analysis were associated with the outcome 'absence of breastfeeding' (≥ 0.20), were selected for multiple analysis. Adjusted prevalence ratios were obtained by a Poisson regression model. Results: 40% of the children 6-11 months were not being breastfed, 47% used a pacifier and 57% used a bottle. Pacifier use (PR = 3.245; CI95%: 2.490-4.228) and bottle feeding (PR = 1.605; CI95%: 1.273-2.023) were shown to be strongly associated with the outcome, and also with: mother's low schooling (PR = 0.826; CI95%: 0.689-0.990); low birth weight (PR = 1.488; CI95%: 1.159-1.910); mother not being the baby carer (PR = 1.324; CI95%: 1.080-1.622); and increasing age of the baby in days (PR = 1.004; CI95%: 1.002-1.006). Conclusions: The use of pacifiers and bottles can reduce continued breastfeeding. Stronger discouragement of these artifacts should be adopted in public health policies. .

A OMS preconiza a amamentação por 2 anos ou mais e contraindica o uso de chupeta e mamadeira. O objetivo deste estudo foi investigar a associação entre esse uso e o aleitamento materno no 2º semestre de vida, por meio de inquérito. Foi conduzido em município do estado do Rio de Janeiro, em 2006, entrevistando acompanhantes de 580 crianças de 6 a 11 meses. O uso da chupeta e da mamadeira e variáveis, que na análise bivariada se associaram ao desfecho "ausência do aleitamento materno" (≥ 0,20), foram selecionadas para análise múltipla. Razões de prevalência ajustadas foram obtidas por modelo de regressão de Poisson com variância robusta. Não estavam sendo amamentadas 40% das crianças de 6 a 11 meses, 47% usavam chupeta e 57% mamadeira. O uso de chupeta (RP = 3,245; IC95%: 2,490-4,228) e da mamadeira (RP = 1,605; IC95%: 1,273-2,023) mostraram-se fortemente associados ao desfecho, além da: baixa escolaridade materna (RP = 0,826; IC95%: 0,689-0,990), baixo peso ao nascer (RP = 1,488; IC95%: 1,159-1,910), mãe não ser o acompanhante do bebê (RP = 1,324; IC95%: 1,080-1,622), e idade crescente do bebê em dias (RP = 1,004; IC95%: 1,002-1,006). O uso de chupetas e mamadeiras pode prejudicar a amamentação continuada. O desestímulo a estes artefatos deve ser reforçado no âmbito das políticas públicas de nutrição e saúde.

Side effects of steroid use in patients with traumatic spinal cord injury / Efeitos colaterais do uso de esteroides em pacientes com lesão medular traumática / Efectos secundarios del uso de esteroides en pacientes con lésion medular traumática

OBJECTIVE: Indicate and identify potential complications in our unit associated with the use of steroids in patients over 16 years of age with traumatic acute spinal cord injury managed with NASCIS II, III scheme compared with patients with the same characteristics who did not receive this management. METHODS: To conduct a research study with reports of cases and controls in patients over 16 years of age and with an established diagnosis of acute spinal cord injury, treated definitively in our unit, performing the comparison of evolutionary process between those treated with steroids and those who were not, based on the development of a data collection sheet with several variables.. The results were encoded, tabulated and analyzed. RESULTS: A total of 30 patients were analyzed from January to December 2012 and it was found that 16% of the patients managed with the steroid scheme required admission to the intensive care unit, 40% developed hospital-acquired pneumonia, 17% had urinary tract infection, 3% progressed to respiratory failure and 20% of this group had gastrointestinal bleeding. CONCLUSIONS: It was concluded that steroid management is not a risk-free therapy and the recommendation is to make a direct assessment of the potential benefit to its use in relation to the possible complications that can ensue before choosing this option in patients with traumatic spinal cord injury. .

OBJETIVO: Sinalizar e identificar possíveis complicações em nossa unidade, associadas ao uso de esteroides em pacientes com mais de 16 anos de idade com lesão medular aguda manejados com esquema NASCIS II, III em comparação com pacientes com as mesmas características que não receberam esse tratamento. MÉTODOS: Realizar um estudo de investigação com relato de casos e controles em pacientes com mais de 16 anos de idade e com diagnóstico estabelecido de lesão medular traumática aguda, tratados de maneira definitiva em nossa unidade, realizando a comparação do processo evolutivo intra-hospitalar entre os que foram tratados com esteroides e os que não foram, com base na elaboração de uma folha de captura com diversas variáveis. Os resultados foram codificados, tabulados e analisados. RESULTADOS: Um total de 30 pacientes foi analisado no período de janeiro a dezembro de 2012, verificando que dos pacientes tratados com o esquema de esteroides, 16% precisaram de internação em terapia intensiva, 40% desenvolveram pneumonia hospitalar, 17% apresentaram infecção do trato urinário, 3% evoluíram para insuficiência respiratória e 20% deste grupo apresentaram sangramento gastrintestinal. CONCLUSÕES: Conclui-se que o manejo com esteroides não é uma terapia livre de riscos e se recomenda realizar uma avaliação direta do possível benefício do uso dessa medicação com relação às possíveis complicações que podem sobrevir antes de escolher essa opção em pacientes com lesão medular traumática. .

OBJETIVO: Señalar y determinar las posibles complicaciones en nuestra unidad asociadas al uso de esteroides en pacientes mayores de 16 años de edad con lesión medular aguda manejados con esquema NASCIS II, III en comparación con pacientes bajo las mismas características que no recibieron este manejo. MÉTODOS: Realizar un estudio de investigación con reporte de casos y controles en pacientes con diagnostico establecido de lesión medular aguda traumática en mayores de 16 años tratados de manera definitiva en nuestra unidad, realizando una comparativa en el proceso evolutivo intrahospitalario entre aquellos que fueron manejados con esteroides y aquellos que no lo fueron en base a la elaboración de una hoja de captura con diversas variables. Los resultados fueron codificados, tabulados y analizados. RESULTADOS: Se analizó un total de 30 pacientes en el periodo de Enero a Diciembre de 2012 encontrando que aquellos pacientes manejados con esquema de esteroides, un 16% requirieron atención en terapia intensiva, 40% desarrollaron neumonía intrahospitalaria, 17% presentaron infección de vías urinarias, un 3% cursó con falla respiratoria y 20% de este grupo presentaron sangrado de tubo digestivo. CONCLUSIONES: Se concluye que el manejo con esteroides no es una terapia libre de riesgo y se hace la recomendación de realizar una evaluación directa del posible beneficio que puede otorgar este manejo contra las potenciales complicaciones a desarrollar antes de elegir esta opción en pacientes con lesión medular traumática. .

Low-dose steroid-induced tumor lysis syndrome in a hepatocellular carcinoma patient

Tumor lysis syndrome is rare in hepatocellular carcinoma (HCC), but it has been reported more frequently recently in response to treatments such as transcatheter arterial chemoembolization (TACE), radiofrequency thermal ablation (RFTA), and sorafenib. Tumor lysis syndrome induced by low-dose steroid appears to be very unusual in HCC. We report a patient with hepatitis-C-related liver cirrhosis and HCC in whom tumor lysis syndrome occurred due to low-dose steroid (10 mg of prednisolone). The patient was a 90-year-old male who presented at the emergency room of our hospital with general weakness and poor oral intake. He had started to take prednisolone to treat adrenal insufficiency 2 days previously. Laboratory results revealed hyperuricemia, hyperphosphatemia, and increased creatinine. These abnormalities fulfilled the criteria in the Cairo-Bishop definition of tumor lysis syndrome. Although the patient received adequate hydration, severe metabolic acidosis and acute kidney injury progressed unabated. He finally developed multiple organ failure, and died 3 days after admission. This was a case of tumor lysis syndrome caused by administration of low-dose steroid in a patient with HCC.

Prevalence of Metabolic Syndrome and its components in a Brazilian sample of pemphigus patients

BACKGROUND: Pemphigus foliaceus and pemphigus vulgaris are endemic in the northeastern region of São Paulo State, Brazil. They are treated mainly with systemic corticosteroids, which may provoke osteoporosis; atherosclerosis, higher blood pressure, insulin resistance, glucose intolerance, hyperlipidemia and abdominal obesity. These side effects of corticoids also constitute criteria for the diagnosis of metabolic syndrome. OBJECTIVE: The prevalence of metabolic syndrome and each component of metabolic syndrome in Pemphigus foliaceus and pemphigus vulgaris groups was compared with Brazilian casuistic samples. METHODS: Data of 147 patients (pemphigus foliaceus 48.9% and pemphigus vulgaris 51.1%) were compiled from medical records regarding metabolic syndrome and its components, and included in the analysis. RESULTS: There was no significant difference regarding the prevalence of metabolic syndrome in pemphigus groups compared with the Brazilian casuistic samples. The analysis of each component of metabolic syndrome showed a higher prevalence of: higher blood pressure in male subjects with pemphigus vulgaris, and in pemphigus foliaceus in both genders; diabetes mellitus in both genders for pemphigus vulgaris and pemphigus foliaceus; obesity in females for pemphigus vulgaris and pemphigus foliaceus, and hypertriglyceridemia in both genders for pemphigus vulgaris and pemphigus foliaceus groups that were statistically significant compared to the Brazilian reports. Furthermore, the study noted a higher incidence of cardiovascular events in both genders in pemphigus foliaceus and pemphigus vulgaris groups than in Brazilian casuistic samples. CONCLUSION: The components of metabolic syndrome are more numerous in pemphigus when compared with Brazilian casuistic samples. Future studies are necessary to assure that metabolic syndrome may be associated with pemphigus per se, including a greater casuistic sample of patients who have not ...

The prostate after administration of anabolic androgenic steroids: a morphometrical study in rats

Purpose Many adverse effects have been associated with abuse of anabolic-androgenic steroids (AAS), including disorders of the urogenital tract. The objective of this study is to analyze the morphological modifications in the prostate ventral lobe of pubertal and adult rats chronically treated with AAS, using morphometric methods. Materials and Methods: We studied 39 male Wistar rats weighing between 400 g and 550 g. The rats were divided into four groups: (a) control rats, with 105 days of age (C105) (n = 7); (b) control rats with 65 days of age (C65) (n = 9), injected only with the vehicle (peanut oil); (c) treated rats, with 105 days of age (T105) (n = 10) and (d) treated rats with 65 days of age (T65) (n = 13). The treated rats were injected with nandrolone decanoate at a dose of 10 mg.Kg-1 body weight. The steroid hormone and the vehicle were administered by intramuscular injection once a week for eight weeks. The rats were killed at 161 days of age (C105 and T105) and 121 days of age (C65 and T65) and the ventral prostate lobe was dissected and processed for histology. The height of the acinar epithelium, the surface densities of the lumen, epithelium and stroma were observed with X400 magnification using an Olympus light microscope coupled to a Sony CCD video camera, and the images transferred to a Sony monitor KX14-CP1. The selected histological areas were then quantified using the M42 test-grid system on the digitized fields. The data were analyzed with the Graphpad software. To compare the quantitative data in both groups (controls and treated) and the outcomes, Student's t-test was used (p < 0.05 was considered significant). Results: The weight (p < 0.001) and volume (p = 0.004) of the prostate ventral lobe showed differences between C65 and T65 groups and between C105 and T105 groups. The epithelium height showed no difference between groups C65 and T65 (p = 0.8509), but the T105 group showed an increase of 32% compared ...

Esteroides androgénicos anabolizantes: consecuencias en el hombre / Anabolic androgenic steroids: consequences in the man

El abuso de Esteroides Androgénicos Anabolizantes (EAA) se ha convertido en una práctica frecuente en hombres. Deportistas de alto rendimiento y fisicoculturistas eran los usuarios más frecuentes de este tipo de fármacos, sin embargo, en los últimos 10 años se ha observado una preocupante prevalencia de abuso en hombres jóvenes y usuarios de gimnasios con el fin simplemente de mejorar su aspecto físico. Muchas veces este tipo de fármacos son adquiridos al margen de la legalidad, promocionados en internet, sin la supervisión médica, necesaria al sostener una terapia hormonal. La autoadministración de EAA en altas dosis guarda implicancias negativas poco conocidas o inadvertidas por lo usuarios. Dentro de estas destacan las consecuencias andrológicas propias del abuso de estas sustancias como son la disfunción sexual, alteraciones reproductivas, metabólicas y psicógenas. El objetivo de esta revisión es acercar el conocimiento actual sobre los riesgos e implicancias en el hombre del abuso de los EAA.

Anabolic Androgenic Steroid (EAA) Abuse has turned into a common practice upon men. High performance sportsmen and body builders were the most common users of these drugs, but in the last 10 years there has been a worrying prevalence of abuse in young men and fitness studio users with the aim of obtaining better physical aspect. Many times these drugs are bought at the margins of legality, promoted in Internet, without the medical supervision needed for hormonal therapy. Self-administration of EAA in high doses has negative effects that may be not known or unnoticed by users. Some of them are Sexual Dysfunction, reproductive, metabolic or psychological alterations. The purpose of this revision is to come closer to today’s knowledge of the risks of abuse of EAA in men.

model to predict short-time asthma morbidity: what could be the explanatory factors?

There is an increase in the worldwide prevalence, morbidity and mortality of asthma. Therefore, study of the possible factors related to the burden of this disorder could help the health providers to introduce effective initiatives and reduce adverse consequences due to this condition. This study was designed to investigate any relationship between asthma morbidity with inhaler technique and other probable explanatory factors in asthmatic patients. An observational, cross-sectional study was designed in which asthmatic patients referring to the outpatient respiratory clinic of the Shaheed Labbafinezhad hospital were entered the study using a non-probability sampling method. Their demographic, socio-economic, medical and medication history, inhaler technique [using a 10-step check list], as well as short-term morbidity index [in the past 4 weeks using the .Tone's morbidity questionnaire] were determined and recorded in organized data collection forms. These data were entered the Excel and SPSS [version 17.0] worksheets and analyzed using appropriate statistical tests. A step-by-step analysis method was used in order to find out any relationship between possible explanatory factors and the morbidity index of the patients. 199 adult asthmatic patients [94 male and 105 female] with mean +/- SD age of 54.29 +/- 15.52 years enrolled the study. In the first step of data analysis only 5 factors out of 20 explanatory factors were eligible to be included in the multivariate analysis leading to the final predictive model. In the multivariate regression analysis, 2 out of 5 factors could remain in the final model, which were [history of systemic steroid usage] and [age] [p=0.007, r=0.32]. So that, patients with a positive history of systemic steroid use and those with a younger age had higher asthma morbidity rate. The observed positive relationship between history of systemic steroid usage and asthma morbidity remarks the importance of asthma control in the primary care level and highlights its role on patient's quality of life. Possible reasons leading to a higher morbidity rate in younger asthmatic patients should be evaluated in the future studies

Post-LASIK interface fluid syndrome caused by steroid drops

Interface fluid syndrome after laser in situ keratomileusis [LASIK] is a rare but visually threatening postoperative complication. In this case series we present 8 post-LASIK eyes that developed interface fluid syndrome after prolonged steroid use. Patients presented with signs mimicking diffuse lamellar keratitis [DLK] that worsened with steroid treatment. Slit-lamp examination revealed corneal haze and an optically clear fluid-filled space between the flap and stroma. The IOP was high in all cases. Topical steroids were stopped and replaced with topical and systemic anti-glaucoma medications resulting in a dramatic improvement in visual acuity

Esteroides epidurales: consideraciones sobre los nuevos casos de meningitis infecciosa en Estados Unidos y revisión de sus indicaciones terapéuticas / Epidural steroids: considerations regarding the new cases of infectious meningitis in the United States and a review of their therapeutic indications

La administración de esteroides epidurales es ampliamente utilizada para el manejo del dolor lumbar. Recientemente hemos presenciado la aparición de infecciones del neuroeje en Estados Unidos debido a la contaminación de los envases fabricados por una farmacia de formulación “magistral” en Nueva Inglaterra. Este hecho nos ha obligado a preguntarnos sobre la utilidad y riesgos de esta terapia. El propósito de este artículo es presentar una revisión de la evidencia disponible que sustenta el uso de inyecciones epidurales de esteroides y los riesgos asociados...

Epidural steroid injections are widely used in the treatment of low back pain. In the United States, we have recentlywitnessed an outbreak of neuraxial infections, likely due to contaminated steroids made by a compounding pharmacy in New England. This has forced us to question the utility and risks of this therapy. The following article presents a review of the available evidence supporting the use of steroid injections for low back pain, as well as the associated risks...

Gonadal steroids levels and vitellogenesis in the formation of oocytes in Prochilodus lineatus (Valenciennes) (Teleostei: Characiformes)

The objective of this study was to obtain information about the possible mechanisms related to poor reproductive performance in tropical rheophilic fish. To that effect, cages (Cs) and earthen ponds (EPs) were used as experimental systems to provide unsuitable and suitable conditions, respectively, for curimbatá (Prochilodus lineatus) breeders. Fish were maintained under experimental conditions for 18 months, and during this period females were randomly sampled every two months for biometric analysis (n=30), blood (n=5/sampling) and ovary (n=5/sampling). After this period EPs females (EPFs) and Cs females (CFs) were submitted to the induced breeding experiments. The results showed that rearing curimbatá for such long time in a cage at this stocking density, reduces its growth, plasma E2 levels and vitellogenesis. During vitellogenesis, the mean plasma estradiollevels of CFs were three times lower than those of EPFs (P<0.01). CFs presented poorer results than EPFs for all the examined parameters of reproductive performance. Taken together these data showed that the reduced estradiol levels during vitellogenesis (and the consequently less intense transition from the previtellogenic to vitellogenic phase) and reduced amounts of yolk are mechanisms associated with the formation of low quality oocytes and shortened and delayed breeding season in this species. Moreover, our data showed that the onset of vitellogenesis (six months before the spawning season) must be considered as a key period related to the formation of oocytes of good quality, and adequate management should be provided throughout the year.

Este estudo teve como objetivo gerar informações básicas sobre os possíveis mecanismos relacionados com os resultados desfavoráveis obtidos com o desempenho reprodutivo em peixes reofílicos tropicais. Para isso tanques-rede (Cs) e viveiros escavados (EPs) foram utilizados como sistemas experimentais para propociar respectivamente condições inadequadas e adequadas para reprodutores de Prochilodus lineatus. Os peixes foram mantidos por 18 meses em viveiros escavados (EPs) e tanques-rede (Cs), e durante este período, foram aleatoriamente coletados a cada dois meses para análise biométrica (n=30), coleta de sangue (n=5/tratamento) e amostragem do ovário (n=5/tratamento). Após este período as fêmeas mantidas em EPs (EPFs) e as fêmeas mantidas em Cs (CFs) foram submetidas aos experimentos de reprodução induzida. Os resultados mostraram que manter curimbatás por este período em Cs, na densidade de estocagem utilizada, reduz seu crescimento, níveis plasmáticos de E2 e vitelogênese. Durante a vitelogênese, os níveis plasmáticos de estradiol das CFs foram três vezes menores do que os das EPFs (P <0,01). As CFs apresentaram resultados inferiores aos das EPFs para todos os parâmetros analisados de desempenho reprodutivo. Em conjunto, estes dados mostram que os níveis reduzidos de estradiol durante a vitelogênese (bem como o consequente atraso na transição da fase previtelogênica para a vitelogênica) e as quantidades reduzidas de vitelo são mecanismos associados com a formação de ovócitos de baixa qualidade; redução e atraso na época de desova nesta espécie. Além disso, nossos dados mostraram que o início da vitelogênese (seis meses antes da época de desova) é um período-chave para formação de ovócitos de boa qualidade, e o manejo adequado deve ser aplicado durante todo o ano.