Influence of methylprednisolone on the reversal time of sugammadex: a randomized clinical trial / Influência da metilprednisolona no tempo de reversão do sugammadex: estudo clínico randomizado

Abstract Background and objectives: Sugammadex is a modified gamma-cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway edema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium-induced moderate neuromuscular blockade in those who received intraoperative 1 mg kg-1 methylprednisolone or saline. Method: This single-centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear-nose-throat procedures (aged from 18 to 65, an ASA physical status I-II, a BMI less than 30 kg m-2, and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5 mL of saline, while the Methylprednisolone Group (Group M) received 1 mg kg-1 of methylprednisolone in 5 mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2 mg kg-1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study. Results: Median time to TOFr = 0.9 was for 130.00 s (range of 29-330) for Group C and 181.00 s (100-420) for Group M (p < 0.001). The differences between the two groups were statistically significant. Conclusion: When using 2 mg kg-1 of sugammadex to reverse rocuronium-induced neuromuscular blockade in patients who received 1 mg kg-1 of intraoperative methylprednisolone, demonstrated delayed recovery times.

Resumo Justificativa e objetivos: Sugammadex é uma gama-ciclodextrina modificada que reverte os efeitos de agentes de bloqueio neuromuscular aminoesteroides. Da mesma forma, algumas moléculas esteroides, como toremifene, ácido fusídico e flucloxacilina, podem ser encapsulados pelo sugammadex. A metilprednisolona, esteroide sintético usado geralmente para a profilaxia de edema de vias aéreas, também pode ser encapsulada pelo sugammadex. O objetivo do estudo foi comparar os tempos de recuperação do sugammadex na reversão de bloqueio neuromuscular moderado induzido pelo rocurônio em pacientes em que foi administrado 1 mg.kg-1 de metilprednisolona ou solução salina no período intraoperatório. Método: Este estudo prospectivo, randomizado, controlado, unicêntrico incluiu 162 pacientes adultos (idades de 18-65, ASA I-II, IMC abaixo de 30 kg.m-2, e não usando medicação esteroide) submetidos à anestesia geral para procedimento eletivo de otorrinolaringologia com propofol, remifentanil, rocurônio e sevoflurano. A monitorização neuromuscular foi realizada usando aceleromiógrafo calibrado. O grupo controle (Grupo C) recebeu 5 mL de solução salina, enquanto o grupo metilprednisolona (Grupo M) recebeu 1 mg.kg-1 de metilprednisolona em 5 mL de solução salina logo após a indução. Ao término da cirurgia, em relação à contagem do número de respostas à sequência de quatro estímulos (TOFc), dois pacientes mostraram recuperação espontânea e todos os pacientes receberam 2 mg.kg-1 de sugammadex. A recuperação da razão T4/T1 (TOFr) para 0,9 foi registrada nos dois grupos, e o desfecho primário do estudo foi o tempo estimado de recuperação, momento em que a razão TOFr alcançou o valor de 0,9 (TOFr = 0.9). Resultados: O tempo mediano para TOFr = 0,9 foi 130 s (29-330) para o Grupo C e 181s (100-420) para o Grupo M (p < 0,001). As diferenças entre os dois grupos foi estatisticamente significante. Conclusões: Pacientes que receberam 1 mg.kg-1 de metilprednisolona no intraoperatório apresentaram tempo de recuperação mais prolongado após o uso de 2 mg.kg-1 de sugammadex para reverter o bloqueio neuromuscular induzido pelo rocurônio.

Effects of aquaporin 4 and inward rectifier potassium channel 4 1 on medullospinal edema after methylprednisolone treatment to suppress acute spinal cord injury in rat

Abstract Purpose: To investigate the effects of aquaporin 4 (AQP4) and inward rectifier potassium channel 4.1 (Kir4.1) on medullospinal edema after treatment with methylprednisolone (MP) to suppress acute spinal cord injury (ASCI) in rats. Methods: Sprague Dawley rats were randomly divided into control, sham, ASCI, and MP-treated ASCI groups. After the induction of ASCI, we injected 30 mg/kg MP via the tail vein at various time points. The Tarlov scoring method was applied to evaluate neurological symptoms, and the wet-dry weights method was applied to measure the water content of the spinal cord. Results: The motor function score of the ASCI group was significantly lower than that of the sham group, and the spinal water content was significantly increased. In addition, the levels of AQP4 and Kir4.1 were significantly increased, as was their degree of coexpression. Compared with that in the ASCI group, the motor function score and the water content were significantly increased in the MP group; in addition, the expression and coexpression of AQP4 and Kir4.1 were significantly reduced. Conclusion: Methylprednisolone inhibited medullospinal edema in rats with acute spinal cord injury, possibly by reducing the coexpression of aquaporin 4 and Kir4.1 in medullospinal tissues.

Oxidative stress of crystalline lens in rat menopausal model / O estresse oxidativo do cristalino em modelo de rata na menopausa

ABSTRACT Purpose: To evaluate lenticular oxidative stress in rat menopausal models. Methods: Forty Wistar female albino rats were included in this study. A total of thirty rats underwent oophorectomy to generate a menopausal model. Ten rats that did not undergo oophorectomy formed the control group (Group 1). From the rats that underwent oophorectomy, 10 formed the menopause control group (Group 2), 10 were administered a daily injection of methylprednisolone until the end of the study (Group 3), and the remaining 10 rats were administered intraperitoneal streptozocin to induce diabetes mellitus (Group 4). Total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) measurements of the crystalline lenses were analyzed. Results: The mean OSI was the lowest in group 1 and highest in group 4. Nevertheless, the difference between the groups was not statistically significant in terms of OSI (p >0.05). The mean TOS values were similar between the groups (p >0.05), whereas the mean TAC of group 1 was significantly higher than that of the other groups (p <0.001). Conclusions: Our results indicate that menopause may not promote cataract formation.

RESUMO Objetivo: Avaliar o estresse oxidativo lenticular em modelos de ratas na menopausa. Métodos: Quarenta ratos albinos femininos tipo Wistar foram incluídos neste estudo. Trinta ratas foram submetidas à ooforectomia para gerar o modelo de menopausa e 10 ratas formaram o grupo controle (Grupo 1). Dentre as ratas ooforectomizadas, 10 formaram o grupo controle menopausa (Grupo 2), 10 ratas receberam injeção diária de metilprednisolona até ao final do estudo (Grupo 3) e 10 ratas receberam estreptozotocina por via intraperitoneal para induzir diabetes mellitus (Grupo 4). O estado oxidante total (TOS), a capacidade total antioxidante (TAC) e as medições do índice de estresse oxidativo (OSI) dos cristalinos foram analisados. Resultados: A média de OSI foi menor no grupo 1 e maior no grupo 4. Todavia, a diferença entre os grupos não foi estatisticamente significativa (p>0,05). Os valores médios TOS foram semelhantes entre os grupos (p>0,05), enquanto a média de TAC grupo 1 foi mais elevada do que nos outros grupos ( p<0,001). Conclusões: Nossos resultados indicam que a menopausa podem não promover a formação de catarata.

Análisis histopatológico del cartílago articular expuesto a metilprednisolona, ropivacaína y ácido hialurónico en un modelo animal de osteoartrosis / Histopathological analysis of the articular cartilage exposed to methylprednisolone, ropivacaine and hyaluronic acid in an animal model of osteoarthrosis

La osteoartrosis es un padecimiento del aparato locomotor con una prevalencia elevada y en crecimiento, paralela al envejecimiento de la población. La infiltración intraarticular de sustancias para aliviar la sintomatología de la osteoartrosis es una práctica común en el consultorio médico de los especialistas que atienden esta enfermedad. Aunque la sintomatología mejora con la infiltración de anestésicos locales, corticoesteroides y suplementos viscosantes, es aún incierto el efecto que estas sustancias tienen sobre la integridad del cartílago articular. Este estudio explora a nivel macroscópico e histológico el efecto de la infiltración de ropivacaína, metilprednisolona y ácido hialurónico sobre el cartílago articular en un modelo de osteoartrosis química en conejos (n=24). Nuestros resultados indican que en los grupos infiltrados con metilprednisolona (n=8) y ropivacaína (n=8) la estructura del cartílago articular presento alteraciones más severas con respecto a su grupo control, además de una disminución importante en la síntesis de matriz extracelular. En el grupo infiltrado con ácido hialurónico (n=8), las alteraciones macroscópicas e histológicas del cartílago articular mejoraron con respecto a su grupo control, presentando una estructura integra y síntesis de matriz extracelular normal.

Osteoarthritis is a musculoskeletal condition with a high prevalence, increasing with the aging of population. The intraarticular infiltration of substances to relieve the symptoms of osteoarthritis is a common practice in medical practice. Although symptoms improved with the infiltration of local anesthetics, corticosteroids and supplements, it is still uncertain what effect these substances have on the integrity of articular cartilage. This study explores the macroscopic and histological effects of infiltration of Ropivacaine, Methylprednisolone and Hyaluronic Acid on articular cartilage in a model of chemical osteoarthritis in rabbits (n=24). Our results indicate that in the infiltrated groups with Methylprednisolone (n=8) and Ropivacaine (n=8) the structure of articular cartilage present more severe alterations with respect to its control group and an important decrease in the synthesis of extracellular matrix. In-group infiltrated with hyaluronic acid (n=8), macroscopic and histological changes of articular cartilage improved with respect to its control group, presenting a normal structure and normal extracellular matrix synthesis.

Efeitos da metilprednisolona na atividade inflamatória e estresse oxidativo nos pulmões de ratos com morte cerebral / Effects of methylprednisolone on inflammatory activity and oxidative stress in the lungs of brain-dead rats

OBJETIVO: Avaliar os efeitos da administração sistêmica precoce e tardia de metilprednisolona nos pulmões em um modelo de morte encefálica em ratos. MÉTODOS: Vinte e quatro ratos Wistar machos foram anestesiados e randomizados em quatro grupos (n = 6 por grupo): sham, somente morte encefálica (ME), metilprednisolona i.v. (30 mg/kg) administrada 5 min após a morte encefálica (MP5) e 60 min após a morte encefálica (MP60). Os grupos ME, MP5 e MP60 foram submetidos à morte encefálica por insuflação de um balão no espaço extradural. Todos os animais foram observados e ventilados durante 120 min. Foram determinadas variáveis hemodinâmicas e gasométricas, relação peso úmido/seco, escore histológico, thiobarbituric acid reactive substances (TBARS, substâncias reativas ao ácido tiobarbitúrico), atividade de superóxido dismutase (SOD) e de catalase, assim como contagem diferencial de células brancas, proteína total e nível de desidrogenase lática no LBA. A atividade da mieloperoxidase, peroxidação lipídica e níveis de TNF-α foram avaliados no tecido pulmonar. RESULTADOS: Não foram observadas diferenças significativas nas variáveis hemodinâmicas e gasométricas, relação peso úmido/seco, análises do LBA, escore histológico, SOD, mieloperoxidase e catalase entre os grupos. Os níveis de TBARS foram significativamente maiores nos grupos MP5 e MP60 do que nos grupos sham e ME (p < 0,001). Os níveis de TNF-α foram significativamente menores nos grupos MP5 e MP60 do que no grupo ME (p < 0,001). CONCLUSÕES: Neste modelo de morte cerebral, a administração precoce e tardia de metilprednisolona apresentou efeitos semelhantes sobre a inflamação e a peroxidação lipídica no tecido pulmonar.

OBJECTIVE: To evaluate the effects that early and late systemic administration of methylprednisolone have on lungs in a rat model of brain death. METHODS: Twenty-four male Wistar rats were anesthetized and randomly divided into four groups (n = 6 per group): sham-operated (sham); brain death only (BD); brain death plus methylprednisolone (30 mg/kg i.v.) after 5 min (MP5); and brain death plus methylprednisolone (30 mg/kg i.v.) after 60 min (MP60). In the BD, MP5, and MP60 group rats, we induced brain death by inflating a balloon catheter in the extradural space. All of the animals were observed and ventilated for 120 min. We determined hemodynamic and arterial blood gas variables; wet/dry weight ratio; histological score; levels of thiobarbituric acid reactive substances (TBARS); superoxide dismutase (SOD) activity; and catalase activity. In BAL fluid, we determined differential white cell counts, total protein, and lactate dehydrogenase levels. Myeloperoxidase activity, lipid peroxidation, and TNF-α levels were assessed in lung tissue. RESULTS: No significant differences were found among the groups in terms of hemodynamics, arterial blood gases, wet/dry weight ratio, BAL fluid analysis, or histological score-nor in terms of SOD, myeloperoxidase, and catalase activity. The levels of TBARS were significantly higher in the MP5 and MP60 groups than in the sham and BD groups (p < 0.001). The levels of TNF-α were significantly lower in the MP5 and MP60 groups than in the BD group (p < 0.001). CONCLUSIONS: In this model of brain death, the early and late administration of methylprednisolone had similar effects on inflammatory activity and lipid peroxidation in lung tissue.

Effect of methylprednisolone on perivascular pulmonary edema, inflammatory infiltrate, VEGF and TGF-beta immunoexpression in the remaining lungs of rats after left pneumonectomy

Pneumonectomy is associated with high rates of morbimortality, with postpneumonectomy pulmonary edema being one of the leading causes. An intrinsic inflammatory process following the operation has been considered in its physiopathology. The use of corticosteroids is related to prevention of this edema, but no experimental data are available to support this hypothesis. We evaluated the effect of methylprednisolone on the remaining lungs of rats submitted to left pneumonectomy concerning edema and inflammatory markers. Forty male Wistar rats weighing 300 g underwent left pneumonectomy and were randomized to receive corticosteroids or not. Methylprednisolone at a dose of 10 mg/kg was given before the surgery. After recovery, the animals were sacrificed at 48 and 72 h, when the pO2/FiO2 ratio was determined. Right lung perivascular edema was measured by the index between perivascular and vascular area and neutrophil density by manual count. Tissue expression of vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-β) were evaluated by immunohistochemistry light microscopy. There was perivascular edema formation after 72 h in both groups (P = 0.0031). No difference was observed between operated animals that received corticosteroids and those that did not concerning the pO2/FiO2 ratio, neutrophil density or TGF-β expression. The tissue expression of VEGF was elevated in the animals that received methylprednisolone both 48 and 72 h after surgery (P = 0.0243). Methylprednisolone was unable to enhance gas exchange and avoid an inflammatory infiltrate and TGF-β expression also showed that the inflammatory process was not correlated with pulmonary edema formation. However, the overexpression of VEGF in this group showed that methylprednisolone is related to this elevation.

Glomerulonefritis rapidamente progresiva en el niño: análisis de la casuística de un quinquenio 2004-2009: [revisión] / Rapidly progressive glomerulonephritis in children: analysis of the data of a five-year period 2004-2009: [review]

La glomerulonefritis rápidamente progresiva (GNRP) es una entidad poco frecuente; el diagnóstico precoz es importante con fines terapéuticos y pronósticos. El objetivo del presente trabajo es reportar la casuística del GNRP en el Servicio de Nefrología del Hospital de Niños "Jorge Lizarraga" entre enero 2004 y enero 2009. Estudio retrospectiva y descriptivo con la revisión de las historias clínicas de 8 pacientes con edades entre 3-13 años. Seis pacientes correspondieron al sexo femenino. La edad promedio fue de 11 ± 3.5 años. La mayoría presentó un foco infeccioso previo con mayor frecuencia en piel (6 casos), y en faringe un caso. Las manifestaciones clínicas y los hallazgos de laboratorio se caracterizaron por: edema, hipertensión, hematuria, retención azoada progresiva, proteinuria e hipocomplementaria. Se realizó biopsia renal en todos los casos, observandose glomerulonefritis proliferativa endo y extracapilar en 6 casos y glomerulonefritis membranoprolirativa en 2 casos. La terapéutica se basó en tratar la infección y el fallo renal agudo. Se aplicaron pulsos de metilprednisolona a todos los pacientes y 6 pacientes ameritaron diálisis peritoneal. Seis pacientes sobrevivieron (2 egresaron con función renal normal y 4 progresaron a enfermedad renal crónica) y 2 pacientes fallecieron. La GNRP es una condición que se presenta esporadicamente; su evolución depende de la severidad del compromiso renal, extensión de las lesiones histopatológicas y precocidad en la terapéutica farmacológica y dialítica. La mayoría de los pacientes sobrevive, un porcentaje importante progresa a enfermedad renal crónica, lo cual eventualmente amerita terapia substitutiva con dialisis y trasplante renal.

Rapidly progressive glomerulonephritis (RPGN) is a rate entity; early diagnosis is important for adequate and prompt treatment. The objetive of this paper is to report the casuistic of RPGN in the Department of Nephrology of the Hospital de Niños "Jorge Lizarraga" between January 2004 and January 2009. Retrospective and descriptive study collecting data of the medical records of 8 pantients, ages 3-13 years. Six patients were females and the average for age was 11 ± 3.5 years. The majority presented a previous infection (skin in 6 and pharynx in 1). Clinical manifestations and laboratory findings were: edema hypertensión, hematuria, progressive azotemic retentions, proteinuria and hypocomplementemia. Renal biopsy was performed in all patients with the following results: endo and extracapillary proliferative glomerulonephritis in 6 cases and membranoproliferative glomerulonephritis in 2. Therapeutic measures were aimed to the treatment of infection acute renal failure. Methylprednisolone boluses were indicated in all patients, 6 patients were submitted to peritoneal dialysis. Six patients survived (2 with normal renal function and 4 with progression to chronic kidney disease), and 2 died. RPGN is a condition that occurs sporadically: its evolution depends of the severity of renal involvement, the extension of histological lesions and the precocity with which pharmacological and dialytic treatment are installed. Most patients survive but a significant number progresss to chronic kidney disease.

Effects of methylprednisolone and ganglioside GM-1 on a spinal lesion: a functional analysis

OBJECTIVES: The pharmacological effects of methylprednisolone (MP) and ganglioside GM-1 on spinal injuries have been thoroughly investigated, but only a few studies have evaluated the interaction between these two drugs. METHODS: Twenty-four Wistar rats were subjected to contusive injury of the spinal cord produced by the NYU system. These animals were divided into four groups: group I was injected with MP; group II was injected with GM-1; group III was injected with MP together with GM-1; and group control received physiological serum. The animals were evaluated with regard to their recovery of locomotive function by means of the BBB test on the second, seventh and fourteenth days after receiving the contusive injury to the spinal cord. They were sacrificed on the fourteenth day. RESULTS: This study demonstrated that the MP and GM-1 groups presented functional results that were better than those of the control group, although the enhanced recovery of group II (GM-1) relative to the control group was not statistically significant (p>0.05). The most notable recovery of locomotive function was observed in the group that received MP alone (p<0.05). The group that received MP together with GM-1 presented results that were better than those of the control group (p<0.05). CONCLUSION: Administration of methylprednisolone alone or with GM-1 was shown to be effective for recovery of locomotive function. Combined administration of these drugs resulted in better outcomes than administration of methylprednisolone alone.

Response of the growth plate of uremic rats to human growth hormone and corticosteroids

Children with chronic renal failure in general present growth retardation that is aggravated by corticosteroids. We describe here the effects of methylprednisolone (MP) and recombinant human growth hormone (rhGH) on the growth plate (GP) of uremic rats. Uremia was induced by subtotal nephrectomy in 30-day-old rats, followed by 20 IU kg-1 day-1 rhGH (N = 7) or 3 mg kg-1 day-1 MP (N = 7) or 20 IU kg-1 day-1 rhGH + 3 mg kg-1 day-1 MP (N = 7) treatment for 10 days. Control rats with intact renal function were sham-operated and treated with 3 mg kg-1 day-1 MP (N = 7) or vehicle (N = 7). Uremic rats (N = 7) were used as untreated control animals. Structural alterations in the GP and the expression of anti-proliferating cell nuclear antigen (PCNA) and anti-insulin-like growth factor I (IGF-I) by epiphyseal chondrocytes were evaluated. Uremic MP rats displayed a reduction in the proliferative zone height (59.08 ± 4.54 vs 68.07 ± 7.5 æm, P < 0.05) and modifications in the microarchitecture of the GP. MP and uremia had an additive inhibitory effect on the proliferative activity of GP chondrocytes, lowering the expression of PCNA (19.48 ± 11.13 vs 68.64 ± 7.9 percent in control, P < 0.0005) and IGF-I (58.53 ± 0.96 vs 84.78 ± 2.93 percent in control, P < 0.0001), that was counteracted by rhGH. These findings suggest that in uremic rats rhGH therapy improves longitudinal growth by increasing IGF-I synthesis in the GP and by stimulating chondrocyte proliferation.

Effects of Methylprednisolone on the Neural Conduction of the Motor Evoked Potentials in Spinal Cord Injured Rats

Methylprednisolone (MP), a glucocorticoid steroid, has an anti-inflammatory action and seems to inhibit the formation of oxygen free radicals produced during lipid peroxidation in a spinal cord injury (SCI). However, the effects of MP on the functional recovery after a SCI is controversial. The present study was conducted to determine the effects of MP on the recovery of neural conduction following a SCI. A SCI was produced using the NYU spinal cord impactor. A behavioral test was conducted to measure neurological disorders, and motor evoked potentials (MEPs) were recorded. According to the behavioral test, using BBB locomotor scaling, MP-treated animals showed improved functional recoveries when compared to salinetreated animals. MEP latencies in the MP-treated group were shortened when compared to those in the control group. Peak amplitudes of MEPs were larger in the MP-treated group than those in the control group. The thresholds of MEPs tended to be lower in the MP-treated group than those in the control group. These results suggest that MP may improve functional recovery after a SCI.

Soluble P-and E- selectins and ultrastructural evaluation of canine liver after reperfusion with methylprednisolone and prostaglandin E 1

Ischemia reperfusion injury [IRI] is a multifactorial process that may be the main underlying factor in critical phases faced during and after liver transplantation. This work evaluates the effect of methylprednisolone [MP] and prostaglandin El [PGE1] on IRI of the liver of dogs at the ultrastructural level together with the assessment of soluble P-and E- selectin levels. Three groups of dogs [9 each] were subjected to 60 min ischemia followed by 30 min reperfusion with the appropriate solution according to the group. Group I, the control untreated group was flushed with Ringer's solution, group II was administered 10 mg/kg MP 24 hours before the procedure and with induction of anaesthesia, and group III was flushed with PGE1 in Ringer's solution at a rate of 0.02 microg/kg/min. Liver specimens were collected before ischemia, after ischemia and after reperfusion and were processed for the preparation of ultrathin sections for electron microscopic examination. Corresponding venous blood samples were harvested, centrifuged and serum was processed for the estimation of soluble P-and E- selectins by enzyme immunoassay, together with alanine and aspartate aminotransferases. Electron microscopic [EM] examination of liver ultrathin sections revealed that the morphological structure of hepatocytes and endothelial lining of hepatic sinusoids were well preserved in the group treated with PGE1. Hepatic ultrastructure was much altered in MP treated group showing necrotic and degenerative changes. The control untreated group disclosed bleb formation of hepatocytic membrane with increased leukocyte infiltration. Soluble P-and E- selectin levels were significantly elevated in the control group, near to pre-ischemic level in PGE1 group and showed a persistent elevation in MP group. Serum transaminases [AST and ALT] were significantly elevated in both control and MP groups as compared to their corresponding pre-ischemic levels. Yet, in PGE1 group, their values were comparable to the pre-ischemic ones. This work confirms the hepatoprotective effect of PGE1 in IR injury. The PGE1 impact on preserving the subcellular structure of hepatic sinusoids is crucial and may be mainly attributed to its biological properties. We presume that P-and E- selectins are greatly implicated in the mechanism of IR and may be an important therapeutic target by specific monoclonal antibodies

Intra-articular methylprednisolone acetate in the management of chronic arthritis in children king Hussein medical center experience

Intraarticular steroid injection in Juvenile Idiopathic arthritis [JIA] has been recently introduced into pediatric rheumatology practice. Much of the evidence supporting its use based on open, non-controlled studies. Patients and methods: We prospectively evaluated the impact of a single intraarticular injection of Methylprednisolone acetate on control of inflammatory arthritis of knee joints in a group of 24 children [30 joints] with Juvenile Idiopathic Arthritis who failed to respond satisfactory to Non-Steroidal Anti-inflammatory Drugs[NSAIDs] with or without slow acting anti-inflammatory drugs. Adverse effects were also evaluated. The study was carried out at the pediatric immunology clinic at King Hussein medical Center [KHMC] between December 1999 to June 2003. Patients aged between 1.5 to 10 years with a mean of 3.39 years. The median duration of follow-up was 24 months. We achieved a significant restoration of the extension function of most joints injected. The mean duration of effect was 18 months for oligoarthritis, and 24 months for juvenile psoriatic arthritis and enthesitis related arthritis compared with 6.75 months for other subtypes. All patients with oligoarthritis who were on oral steroid have discontinued this treatment. This effect was partial or not seen in other subtypes. Relapse rate was higher in patients with systemic- and polyarthritis subtypes. The favorable outcome did not correlate with age, sex or disease duration. The beneficial effect of the injections did not correlate with the presence of antinuclear antibodies [ANA] or ESR. Local adverse effects were few and self-limited with no evidence of systemic toxicity. Intraarticular injection of methylprednisolone acetate appears to be effective, rapid and not associated with significant adverse effects in oligoarthritis, Juvenile Psoriatic arthritis and Enthesitis related arthritis subtypes. On contrary it was found to be less effective in systemic and polyarthritis subtypes

Comparative study between epidural methylprednisolone and indomethacin in chronic low back pain patients using P300

Thirty patients were included in this study and divided into two equal groups: Group I received 80 mg methylprednisolone [MTP] epidurally and group II received 2 mg lyophilized, preservative-free indomethacin [INM] epidurally. Another dose of the drug was given after two weeks. The values of absolute peak latencies and amplitudes of P300 were recorded before [baseline] and after two weeks of the first injection as well as after two weeks of the second injection in both groups. The intensity of pain was also recorded using a 10-cm visual analog scale [VAS]. The study concluded that INM administered epidurally is a good alternative to MTP whenever corticosteroids are contraindicated in chronic low back pain patients

Effect of sodium carboxymethylcellulose and methylprednisolone on the healing of jejunal anastomoses in rats

Sodium carboxymethylcellulose (SCMC) has been effective in reducing adhesion formation and corticosteroids reduce the inflammatory process. The objective of this study was to define the intraperitoneal (ip) effects of SCMC combined with intramuscular (im) methylprednisolone on peritoneal adhesion formation and on jejunal anastomosis healing in rats. Twenty Wistar rats (200-350 g) were divided into four groups (N = 5): groups I and III (controls) 5 and 21 days of treatment before sacrifice, respectively; groups II and IV (experimental groups) 5 and 21 days of treatment, respectively. SCMC (1 percent) was infused into the abdominal cavity and methylprednisolone (10 mg kg-1 day-1) was injected im daily from the day before surgery for animals of groups II and IV. All rats were submitted to a jejunal anastomosis. Sections of the anastomosis were prepared for routine histopathological analysis. The abdominal adhesion of group IV was less intense when compared with group III (P<0.0008). Anastomotic resistance was higher in groups II and IV when compared with groups I and III, respectively (P<0.05). There was no histological difference between groups I and II (exuberant granulation tissue on the serosal surface). Group III presented little peritoneal fibrinous tissue, with numerous thick collagen fibers. Group IV presented extensive although immature young fibrous tissue with rare thick collagen fibers. Sodium carboxymethylcellulose combined with corticosteroids seemed to diminish peritoneal adhesion but did not reduce anastomotic resistance

Evaluación prospectivas del corticoide epidural para el tratamiento del síndrome radicular secundario a HNP lumbar / Prospective analysis of the epidural steroids for the treatment of radicular pain caused by lumbar disc herniation

Se hace un análisis prospectivos de 141 pacientes portadores de un síndrome radicular lumbar, que fueron incluidos en un grupo de estudio con criterios de inclusión estrictos a los cuales se les administró una dosis única de 80 mg de metilprednisolona en el espacio epidural con técnica interlaminar por un anestesista calificado. El seguimiento mínimo fue de 6 meses con una media de 3 años. La edad promedio de los pacientes fue de 46 años (15-63). Las hernias discales fueron clasificados de acuerdo al: nivel, localización y tamaño. La efectividad del procedimiento fue evaluada en términos de desaparición del cuadro radicular y del test de extensión con pierna extendida (TEPE). En un periodo de seguimiento a corto plazo, el 39 por ciento de los pacientes experimentaron un alivio completo de la sintomalogía post infiltración, pero después de un seguimiento a mayor plazo (6 meses), este porcentaje disminuyó a un 26 por ciento del total de 141 pacientes que fueron incluidos en este estudio. Se obtuvieron mejores resultados con las hernias discales; las hernias de situación medial tienen mejores resultados en comparción con otras localizaciones (51 por ciento) y finalmente las hernias tipo A (pequeñas) responden mejor (43 por ciento) en relación con otros tamaños. Las hernias discales LA-L5 del tipo A y en situación medial, tienen en general los mejores resultados. Los peores resultados se obtuvieron con hernias del nivel L3-L4 y definitivamente ningún paciente portador de hernias del tamaño C respondió adecuadamente al procedimiento. Las complicaciones del método fueron mínimas

Presentaciones farmacológicas optativas para el paciente pediátrico / Pharmacological presentations for pediatric patients

Para la administración de algunos medicamentos utilizados con poca frecuencia en niños, no se dispone de una presentación farmacológica adecuada en el comercio. Es necesariopor lo tanto conocer las alternativas a las que puede recurrir para lograr una buena y efectiva utilización de productos como metilprednisolona, ranitidina e hidrato de cloral. A continuación se revisa someramente la farmacología de estos medicamentos y su presentación ideada para pacientes pediátricos como prescripción magistral (presentaciones formuladas a solicitud del médico) disponibles en Chile. Es importante conocer la estabilidad de cada una de las presentaciones, para informar adecuadamente al personal de salud o a los familiares

Efeito da metilprednisolona sobre a tensäo anastomótica jejunal / Effect of methylprednisolone on jejunal anastomotic tension

O retardo cicatricial é uma das principais complicaçöes da corticoterapia. Com o propósito de avaliar o papel dos corticóides no processo cicatricial da parede intestinal, foram estudados 40 ratos submetidos a anastomoses jejunais. Os animais operados foram divididos em quatro grupos (n=10). Dois grupos receberam, por via intraperitoneal, metilprednisona (1o mg/Kg) e os outros dois (controles) receberam soluçäo a 0,9 por cento. Os ratos que receberam corticoides apresentaram decréscimo ponderal e menor resistência tênsil nas anastomoeses do que os controles. Em três animais que recebram metildinisolona ocorreu fístula no local da anastomose. A avaliaçäo histológica mostrou fibrose cicatricial mais tênue no grupo submetido à metilprednisolona. Os Resultados deste estudo indicam um possível retardo cicatricial nos ratos tratados com corticóides, bem como menor grau de resistência tênsil da área cicatricial e maior número de complicaçöes pós-operatórias

Efecto de la metilprednisolona sobre la cardiotoxicidad producida por la adriamicina en conejos: estudio electrocardiografico, enzimatico e histopatológico / Methylprednisolone effects on cardiotoxicity produced by adryamicin in rabbits: electrocardiography, enzymatic and hystopathologic study

La adriamicina (ADR) es un agente antineoplásico de amplio espectro y de gran eficacia, pero tiene el inconveniente de producir toxicidad cardíaca aguda y crónica. La metilprednisolona ha mostrado conferir protección miocárdica en modelos isquémicos, anóxicos y en miocardiopatía por adriamicina en ratas. El objetivo del presente trabajo fue valorar el efecto de la metilprednisolona sobre las manifestaciones de cardiotoxicidad producida por adriamicina. En este estudio se utilizó el conejo como modelo experimental y un esquema de administración de ADR cada 3 semanas por 5 veces a una dosis total de 55 mg/m2. Los resultados mostraron daño miocárdico: a) detectado in vivo por la presencia de infradesnivel del segmento ST y elevación sérica de CPK-MB. Estos cambios se iniciaron post 1ra dosis acumulativa; b) corroboración por estudio histológico, por la presencia de diversos grados de miocitolisis, vacuolización, fragmentación de fibras, edema intestinal, tumefacción celular, fibrosis y atrofia focal de fibras; todas estas lesiones de localización preferente en pared libre de ventrículo izquierdo y septum, se ubicaron principalmente en el subendocardio. La metilprednisolona previno significativamente las modificaciones electrocardiográficas, enzimáticas e histopatológicas producidas por el efecto cardiotóxico de la adriamicina. De los mecanismos patogénicos incriminados en la miocardiopatía por adriamicina, la interferencia en la síntesis proteica parece jugar un rol importante y decisivo. Esto se basa en el hecho de que los corticoesteroides, estimulando la síntesis proteica, organizan el efecto de la adriamicina..