Use of Corticosteroids in Prenatal Treatment of Congenital Pulmonary Adenomatoid Malformation: Integrative Review / Uso de corticosteroides no tratamento pré-natal da malformação adenomatoide pulmonar congênita: Revisão integrativa

Abstract Objective To review data on the use of corticosteroids for the treatment of fetuses with high-risk congenital pulmonary adenomatoid malformation (CPAM). Methods Integrative review based on the literature available onMEDLINE and LILACS, including articles published until November, 2020. Results The initial search resulted in 87 articles, 4 of which were selected for analysis, with all of them being retrospective descriptive observational studies. In the group of fetuses that received only a single corticosteroid cycle, the hydrops resolution rate was 70%, and the survival rate was 83.8%. In fetuses treated with 2 or more cycles of corticosteroids, there was an improvement in the condition of hydrops or edema in a single body compartment in 47%, and survival of 81.8% of the fetuses. Conclusion The use of corticosteroids for the prenatal treatment of high-risk CPAM appears to be associated with an improvement in perinatal outcomes.

Resumo Objetivo Revisar os dados sobre o uso de corticoide no tratamento de fetos com malformação adenomatoide pulmonar congênita (MAPC) de alto risco. Métodos Revisão integrativa com base na literatura disponível no MEDLINE e LILACS, incluindo artigos publicados até novembro de 2020. Resultados A busca inicial resultou em 87 artigos, dos quais 4 foram selecionados para análise, todos tratando-se de estudos observacionais descritivos retrospectivos. No grupo de fetos que recebeu apenas um único ciclo de corticosteroide, a taxa de resolução da hidropsia foi de 70% e a taxa de sobrevida de 83,8%. Emfetos tratados com 2 ou mais ciclos de corticosteroides, houve melhora do quadro de hidropsia ou edema em um único compartimento corporal em 47% dos fetos e taxa de sobrevida de 81,8%. Conclusão O uso de corticosteroides para o tratamento pré-natal da MAPC de alto risco parece estar associado à melhora dos resultados perinatais.

Estudio comparativo de una asociación de diclofenac, betametasona y vitamina b12 (blokium b12®) con diclofenac (sin asociar) en el tratamiento de patología dolorosa de columna con compromiso neural / COMPARATIVE STUDY OF AN ASSOCIATION OF DICLOFENAC, BETAMETASONE AND VITAMIN B12 (BLOKIUM B12®) WITH DICLOFENAC (WITHOUT ASSOCIATION) IN THE TREATMENT OF PAINFUL SPINE PATHOLOGY WITH NEURAL COMMITMENT

El dolor lumbar bajo y el dolor cervical con o sin irradiación son causas muy comunes de consulta a los médicos generalistas en los países desarrollados. La discopatía aguda y el dolor por estenosis del canal espinal son los diagnósticos más frecuentes. La postura tradicional ha sido la de administrar antiinflamatorios no esteroideos (AINES) para estas lumbalgias o cervicalgias agudas. Cuando existe irradiación neural por compresión radicular es usual asociar al AINE un corticoide a baja dosis, así como un antineurítico, para lograr un mejor resultado. Con el objeto de documentar la utilidad de esta práctica habitual, efectuamos en 142 pacientes ambulatorios un estudio multicéntrico randomizado que compara la efectividad y la tolerancia de una asociación a dosis fija de diclofenac, betametasona y cianocobalamina administrada por vía oral versus la administración de diclofenac como monofármaco en el tratamiento de la patología dolorosa de la columna lumbar y cervical asociada a compresión neural. La asociación demostró ser más eficaz en controlar el dolor y mejorar la funcionalidad de los pacientes que la administración de diclofenac en forma aislada y se asoció a escasos efectos colaterales, principalmente digestivos

Low back pain and neck pain with or without radiation are very common causes of consultation with general practitioners in developed countries. Acute discopathy and pain due to spinal canal stenosis are the most frequent diagnoses. The traditional approach has been to administer non-steroidal antiinflammatory drugs (NSAIDs) for these acute low back or cervical pain. When there is neural radiation due to root compression, it is usual to associate a low-dose corticosteroid with the NSAID, as well as an antineuritic, to achieve a better result. In order to document the usefulness of this routine practice, we conducted a randomized multicenter study in 142 outpatients that compared the effectiveness and tolerance of a fixed-dose combination of diclofenac, betamethasone, and cyanocobalamin administered orally versus the administration of diclofenac as Monopharmaceutical in the treatment of painful pathology of the lumbar and cervical spine associated with neural compression. The association proved to be more effective in controlling pain and improving the functionality of patients than the administration of diclofenac in isolation and was associated with few side effects, mainly digestive

Hipo persistente tras inyección epidural de betametasona: a propósito de un caso / Persistent hiccups after epidural injection of betamethasone: a case report

La analgesia epidural mediante inyección de corticoides es un procedimiento frecuente en las unidades de dolor. A pesar de ser una técnica con bajo índice de complicaciones, se ha descrito la aparición de hipo persistente tras la intervención. Se presenta como caso clínico el primer episodio publicado en España y sexto en el mundo de hipo persistente por betametasona administrada mediante inyección epidural, acompañado de una recapitulación sobre la definición de esta entidad y su etiología, fisiopatología, manejo e incidencia en pacientes a tratamiento con corticoides orales y epidurales. Debido a la duración, impacto en la calidad de vida y necesidad de tratamiento sintomático, se considera el caso más grave publicado hasta la fecha.(AU)

Epidural analgesia by corticosteroid injection is a common procedure in pain units. Despite being a technique with a low rate of complications, the appearance of persistent hiccups after the intervention has been described. We present as a clinical case the first episode published in Spain and the sixth in the world of persistent hiccups due to betamethasone administered by epidural injection, accompanied by a summary of the definition of this entity and its aetiology, pathophysiology, management and incidence in patients treated with oral and epidural corticosteroids. Due to its duration, impact on quality of life and need for symptomatic treatment, it is considered the most severe case published to date.(AU)

Utilidad de la betametasona en la prevención del dolor postoperatorio en cirugía de hernia discal lumbar / Usefulness of betamethasone in the prevention of postoperative pain in lumbar disc herniation

RESUMEN Introducción: el empleo de corticoesteroides es una estrategia eficaz para reducir el dolor postoperatorio. Objetivo: determinar la utilidad de la betametasona en la prevención del dolor postoperatorio en pacientes intervenidos por hernia discal lumbar. Métodos: se realizó un estudio cuasi-experimental en 100 pacientes intervenidos por hernia discal lumbar en el Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro¼, de la provincia de Villa Clara, durante el período de abril de 2013 a diciembre de 2015. Se dividieron en un grupo control y en un grupo estudio; previo a la incisión quirúrgica, se les administró diclofenaco 75 mg endovenoso y 8 mg de betametasona (solo en el grupo estudio). Resultados: el 70 % de los pacientes eran masculinos, y la edad media fue 45,99 años. En el grupo estudio el tiempo de aparición del dolor () y su intensidad, a las 4, 8 y 24 horas, fue significativamente menor que en el grupo control (pα< 0,010, pα< 0,001 y <0,001); el 48 % de los pacientes pudieron levantarse sin dolor, 32 % menos requirieron analgesia de rescate, y el grado de satisfacción fue significativamente mejor. Conclusiones: la administración de betametasona antes de la incisión quirúrgica resultó muy útil en la prevención del dolor postoperatorio en los pacientes intervenidos de hernia discal lumbar.

ABSTRACT Introduction: use of corticosteroids is an effective strategy to reduce postoperative pain. Objective: to determine usefulness of betamethasone in the prevention of postoperative pain in patients operated for lumbar disc herniation. Methods: a quasi-experimental study was carried out in 100 patients operated for lumbar disc herniation at "Arnaldo Milián Castro" Clinico-Surgical University Hospital, in Villa Clara province from April 2013 to December 2015. They were divided into a control group and a study one; prior to surgical incision, intravenous diclofenac 75mg and betamethasone 8mg were administered (only in the study group). Results: 70% of the patients were male, and the mean age was 45.99 years. In the study group, the time of onset of pain () and its intensity, at 4, 8 and 24 hours, was significantly lower than in the control group (pα <0.010, pα <0.001 and <0.001); 48% of the patients were able to get up without pain, 32 % less required rescue analgesia, and the degree of satisfaction was significantly better. Conclusions: administration of betamethasone before surgical incision was very useful in the prevention of postoperative pain in patients operated for lumbar disc herniation.

Patient and Physician Satisfaction with Calcipotriol and Betamethasone Dipropionate Aerosol Foam in the Treatment of Plaque Psoriasis on the Body. / Satisfacción del paciente y el médico con la espuma en aerosol de calcipotriol y dipropionato de betametasona para el tratamiento de la psoriasis vulgar en el cuerpo.

BACKGROUND AND OBJECTIVE: Calcipotriol and betamethasone dipropionate (Cal/BD) aerosol foam is more effective in the treatment of plaque psoriasis than earlier formulations incorporating this combination of active ingredients. The aim of this study was to evaluate patient and physician satisfaction with Cal/BD aerosol foam in the treatment of plaque psoriasis on the body. MATERIAL AND METHODS: Retrospective observational study of 446 patients with plaque psoriasis affecting no more than 30% of the body surface area who had received treatment with Cal/BD aerosol foam for 4 weeks. The patients rated their satisfaction with the treatment using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) and the physicians on a 5-point Likert scale. RESULTS: Patients were highly satisfied with Cal/BD aerosol in terms of its ability to treat their condition (84%), relieve their symptoms (84.4%), and act rapidly (82.8%). With respect to convenience, the patients gave high ratings to ease of use (91.8%), ease of planning (93.9%), and ease of following instructions (89.9%). Global satisfaction was also high, with 85% of patients expressing that they were satisfied, very satisfied, or extremely satisfied with the treatment. Of the physicians, 85.7% stated that they were quite or very satisfied with the treatment. CONCLUSION: Both patients and physicians expressed high satisfaction with the use of Cal/BD aerosol foam for the treatment of plaque psoriasis on the body.

Combined intrastromal injection of ganciclovir and depot betamethasone for the management of nummular keratitis: Case series. / Inyección intraestromal combinada con ganciclovir y betametasona de depósito para el manejo de la queratitis numular: serie de casos.

Nummular keratitis is an inflammatory process of the cornea that is characterised by multiple sub-epithelial deposits, for which a variety of therapeutic approaches have been proposed. A retrospective review was performed using the medical records of patients diagnosed with nummular keratitis and treated with a combined intrastromal injection of ganciclovir and depot betamethasone between the years 2009 and 2017. A total of 21 eyes of 16 patients were finally included. Upon termination of the treatment, 18 eyes (85.71%) were asymptomatic. This improvement was maintained during a mean follow-up time of 22.90 months. Depot betamethasone mixed with ganciclovir by intrastromal application is a good alternative for the treatment of nummular keratitis.

Betametasona fosfato para la prevención de Síndrome de Dificultad Respiratoria (SDR) del recién nacido de pretérmino / Betamethasone phosphate for the prevention of Respiratory Distress Syndrome (RDS) in the preterm newborn

RESUMEN Introducción: El estándar para inducción de madurez pulmonar en fetos con riesgo de nacer prematuramente es la administración de 12 mg de betametasona acetato/fosfato por dos veces espaciada cada 24 horas. El uso establecido en algunos hospitales públicos en Chile es con dos dosis de 12 mg betametasona fosfato aunque no existen estudios publicados sólo con betametasona fosfato sobre la incidencia de Síndrome de Distress Respiratorio (SDR). Objetivo: Evaluar efecto de betametasona en su forma fosfato como tratamiento antenatal para inducción de madurez fetal pulmonar en la incidencia SDR debido a membrana hialina en prematuros menores de 34 semanas de edad gestacional. Comparar el efecto de betametasona fosfato con el efecto publicado de betametasona acetato/fosfato. Material y método: Análisis de incidencia de SDR en prematuros nacidos en Hospital Padre Hurtado entre 24+0 y 34+0 semanas que recibieron betametasona fosfato para madurez pulmonar y aquellos que no la recibieron. Resultados: De 1.265 neonatos estudiados, 722 completaron dos dosis (57,5%); 436 sólo una dosis (34,5%) y 107 (8,5%) no recibieron corticoides antenatales. La incidencia de SDR debido a membrana hialina en el grupo con dos dosis fue 8,7%, una dosis 25,3% y 32,7% en los no tratados (p<0,001). Para SDR severo las incidencias fueron 6,7%, 12,6% y 16,8% respectivamente (p<0,001). Conclusiones: Inducción de madurez fetal pulmonar con betametasona fosfato en dos dosis de 12 mg IM separadas por 24 horas otorga una reducción significativa de incidencia de SDR semejante a la publicada con betametasona acetato/fosfato en iguales dosis.

ABSTRACT The standard for induction of lung maturity in fetuses at risk of being born prematurely is the administration of 12 mg of betamethasone acetate/phosphate two doses separated by 24 hours. The established use in some public hospitals in Chile is with two doses of 12 mg betamethasone phosphate although there are no studies published with betamethasone phosphate alone on the incidence of respiratory distress syndrome (RDS). Objective: To evaluate the effect of betamethasone in its phosphate form as antenatal treatment for the induction of fetal lung maturity in the incidence of RDS due to hyaline membrane in preterm infants less than 34 weeks of gestational age. To compare the effect of betamethasone phosphate with the published effect of betamethasone acetate/phosphate. Material and method: Analysis of the incidence of RDS in preterm infants born at Hospital Padre Hurtado between 24 + 0 and 34 + 0 weeks who received betamethasone phosphate for lung maturity and those who did not receive it. Results: Of 1,265 infants studied, 722 completed two doses (57.5%); 436 only one dose (34.5%) and 107 (8.5%) did not receive antenatal corticosteroids. The incidence of RDS due to hyaline membrane in the group with two doses was 8.7%, one dose 25.3% and 32.7% in the untreated ones (p <0.001). For severe RDS, incidences were 6.7%, 12.6% and 16.8% respectively (p <0.001). Conclusions: Induction of fetal lung maturity with betamethasone phosphate in two doses of 12 mg IM separated by 24 hours gives a significant reduction in the incidence of RDS similar to that published with betamethasone acetate/phosphate in equal doses.

Update on Topical Treatments for Psoriasis: The Role of Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam. / Actualización del tratamiento tópico en psoriasis: aportación de la combinación de calcipotriol y dipropionato de betametasona en espuma.

Topical agents are the first-line treatment for mild and moderate psoriasis, but factors such as frequency of administration, organoleptic properties, and the limited short term results can reduce treatment adherence and effectiveness. Innovations in topical treatments are linked not only to the discovery of new molecules, but also to the reformulation of existing active ingredients based on improvements to administration, organoleptic properties, bioavailability, and ease of use. Calcipotriol and betamethasone dipropionate aerosol foam is a new formulation in which the active ingredients are dissolved in a mixture of volatile propellants that evaporate quickly, leaving a supersaturated solution of calcipotriol and betamethasone dipropionate that enhances penetration into the epidermis. In this article, we take a look at the new calcipotriol and betamethasone dipropionate aerosol formulation and briefly review the main evidence supporting the use of topical treatments for psoriasis.

Cirugía fetal en tumores pulmonares mediante escleroterapia

Microcystic fetal lung tumors or masses such as the congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (SBP) are rare congenital pathologies, diagnosed by ultrasound during prenatal assessment, with a high mortality rate of 95% as a consequence of prenatal complications due to hydrops and postnatal death from pulmonary hypoplasia. Minimally invasive therapies using sclerosing agents are positioned among the low cost and highly effective techniques for such pathologies. Methodology: We conducted a prospective, randomized, blind clinical study in 17 pregnant women with diagnosis of fetal microcystic CCAM or hybrid lesion (CCAM + SBP), who were treated with betamethasone or polidocanol. Alternative therapy was employed in case of failure of the initial procedure. Results: In four (44.4%) of the nine cases treated with betamethasone, the alternative therapy of sclerosis with polidocanol was required for treatment due to fetal compromise. Involution of the lung lesion and the hydropic condition was faster and progressive with percutaneous sclerotherapy compared to the maternal steroid effect. Perinatal results were also more satisfactory in the group with polidocanol (91.7%) than in the group with the steroid (60%). Conclusions: Percutaneous sclerotherapy with polidocanol was found efficacious for CCAM and hybrid lesion treatment, with faster and more efficient resolution of the pathology in cases resistant to previously administered steroid therapy.

Las tumoraciones o masas pulmonares fetales microquísticas, tales como la malformación adenomatoidea quística congénita (CCAM, por sus siglas en inglés) y el secuestro bronco pulmonar (SBP), representan patologías congénitas poco frecuentes, diagnosticadas por ultrasonido durante la evaluación prenatal, con un alto índice de mortalidad de 95% como consecuencia de las complicaciones prenatales por hidropesía y fallecimiento posnatal debido a hipoplasia pulmonar. Las terapias de mínima invasión usando agentes esclerosantes han tomado posicionamiento entre las técnicas de bajo costo y alta efectividad para dichas patologías. Metodología. Se realizó un estudio clínico prospectivo, aleatorio, ciego, en 17 embarazadas con diagnóstico de CCAM microquística o de lesión híbrida (CCAM +SBP) tratadas con betametasona o con polidocanol, optando por la terapia alternativa en caso de fallar la técnica inicial. Resultados. En 4/9 (44,4%) de los 9 casos tratados con betametasona se requirió la terapia alternativa de esclerosis con polidocanol para la resolución del cuadro, que comprometía el estado fetal. La involución de la lesión pulmonar y del cuadro hidrópico fue más rápida y progresiva con la escleroterapia percutánea en comparación con el efecto esteroideo materno. Los resultados perinatales fueron asimismo más satisfactorios en el grupo con polidocanol (91,7%) que en el grupo con el esteroide (60%). Conclusiones. Se comprobó la eficacia de la escleroterapia percutánea con polidocanol para el tratamiento de la CCAM y de lesión híbrida, con resolución más rápida y eficaz de la patología en los casos donde existía resistencia a la terapia esteroidea previamente administrada.

Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double-blind, randomized and controlled clinical trial / Associação entre desloratadina e prednisolona no tratamento de crianças com sintomas agudos de rinite alérgica: ensaio clínico duplo-cego, randomizado e controlado

Abstract Introduction: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. Objective: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. Methods: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12] ≥ 6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n = 105; three daily doses) or desloratadine plus prednisolone (n = 105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. Results: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14% × 8.57%, respectively). Conclusion: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.

Resumo Introdução: A associação entre anti-histamínicos e corticosteroides orais é frequentemente empregada no tratamento de sintomas agudos de rinite alérgica. Objetivo: Avaliar a segurança e eficácia da associação desloratadina + prednisolona no tratamento de sintomas agudos de crianças (2-12 anos) com rinite alérgica e compará-las com as da associação dexclorfeniramina + betametasona. Método: Crianças com rinite alérgica persistente moderada/grave e sintomáticas (escore de sintomas nasais [0-12] ≥ 6) foram alocadas de modo duplo-cego e randômico para receber dexclorfeniramina + betametasona (n = 105; três doses diárias) ou desloratadina + prednisolona (n = 105; dose única seguida por duas de placebo) por 7 dias. No início e no fim da avaliação foram obtidos: escore de sintomas nasais, escore de sintomas extranasais, pico de fluxo inspiratório nasal, bioquímica sanguínea e eletrocardiograma. Do total, 96 crianças do grupo dexclorfeniramina + betametasona e 98 do grupo desloratadina + prednisolona concluíram o protocolo. Resultados: Os dois grupos foram iguais com relação ao escore de sintomas nasais, escore de sintomas nasais extranasais e pico de fluxo inspiratório nasal iniciais e finais. Observou-se queda de 76,4% e 79,1% nos escores para escore de sintomas nasais, de 86,0% e 79,2% para escore de sintomas extranasais, assim como incremento de 25,2% e de 24,3% para o pico de fluxo inspiratório nasal para os grupos desloratadina + prednisolona e dexclorfeniramina + betametasona, respectivamente. Não houve alterações significativas da bioquímica sanguínea. Taquicardia sinusal foi a alteração do eletrocardiograma mais encontrada, mas sem significância clínica. Sonolência foi significantemente mais referida entre os tratados com dexclorfeniramina + betametasona do que entre os desloratadina + prednisolona (8,57% × 17,14%, respectivamente). Conclusão: A associação desloratadina + prednisolona foi capaz de controlar efetivamente os sintomas agudos de rinite em crianças, melhorou sintomas e a função nasal. Na comparação com a associação dexclorfeniramina + betametasona, demonstrou ação clínica semelhante, mas com menor incidência de eventos adversos e maior comodidade posológica.

¿Afecta el tratamiento con corticoides en los periodos prenatal y posnatal el neurodesarrollo del recién nacido prematuro?

Introducción. Los glucocorticoides, ampliamente utilizados en el periodo perinatal, pueden asociarse con efectos adversos en el neurodesarrollo. Objetivo. Analizar los resultados del tratamiento con corticoides en el periodo prenatal y en el posnatal en el neurodesarrollo de una cohorte de recién nacidos de muy bajo peso. Materiales y métodos. Se hizo un estudio prospectivo de cohortes en los recién nacidos de muy bajo peso hospitalizados en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel entre el 2008 y el 2013. Se comparó el neurodesarrollo entre aquellos que no recibieron tratamiento prenatal con corticoides y quienes recibieron el esquema completo (dos dosis de 12 mg de betametasona) o el incompleto (una dosis). También, se compararon los resultados en el neurodesarrollo de los recién nacidos que no recibieron tratamiento posnatal y aquellos que sí (dexametasona sistémica a partir de la primera semana de vida). Se evaluó la función motora, la neurosensorial y la cognitiva, así como los trastornos de conducta durante los dos primeros años de vida. Resultados. Se analizaron 225 recién nacidos de muy bajo peso; 83,6 % de las madres había recibido tratamiento prenatal con corticoides (esquema incompleto: 24 %; esquema completo: 59,6 %). Durante el periodo posnatal solamente el 13,3 % había recibido dexametasona sistémica. El seguimiento neurológico se llevó a cabo en 194 neonatos. En el análisis de regresión logística no se detectó que el tratamiento prenatal no el posnatal se asociara con más trastornos neurológicos, ni hubo diferencias significativas entre quienes recibieron el esquema completo y los que recibieron el incompleto durante el periodo prenatal. Conclusión. Los resultados de este estudio no pudieron demostrar que el tratamiento perinatal con corticoides se asociara con peores resultados en el neurodesarrollo en recién nacidos de muy bajo peso.

Introduction: Glucocorticoids, widely used in the perinatal period, may be associated with adverse neurodevelopmental effects. Objectives: To analyze neurodevelopmental outcomes in a cohort of very low birth weight newborns treated with antenatal and/or postnatal corticosteroids. Materials and methods: This was a prospective cohort study in which we included all very low birth weight babies admitted to the neonatal intensive care unit of a tertiary hospital between 2008 and 2013. We compared the neurodevelopment among very low birth-weight newborns who did not receive prenatal corticosteroid therapy and those who received a complete course (two doses of 12 mg betamethasone) and an incomplete course (one dose), and between those who did not receive postnatal corticosteroid therapy and those who received it (systemic dexamethasone after the first week of life). Motor, neurosensory and cognitive functions, as well as behavior disorders during the first two years of age were evaluated. Results: A total of 225 very low birth weight newborns were analyzed; 83.6% received prenatal corticosteroid therapy (24% incomplete treatment schedule and 59.6% complete schedule). Only 13.3% received systemic dexamethasone during the postnatal period. Neurological monitoring was performed in 194 infants. Logistic regression analysis did not detect an association between prenatal and postnatal corticosteroid therapy and more neurological disorders, and no significant differences were found among those who received complete and incomplete courses of prenatal corticosteroid therapy. Conclusion: These results did not demonstrate an association between perinatal corticosteroid therapy and worse neurodevelopmental outcomes in very low birth weight newborns.

¿Afecta el tratamiento con corticoides en los periodos prenatal y posnatal el neurodesarrollo del recién nacido prematuro? / Does corticosteroid treatment during the pre and postnatal periods affect the neurodevelopmental outcome of premature newborns?

Resumen Introducción. Los glucocorticoides, ampliamente utilizados en el periodo perinatal, pueden asociarse con efectos adversos en el neurodesarrollo. Objetivo. Analizar los resultados del tratamiento con corticoides en el periodo prenatal y en el posnatal en el neurodesarrollo de una cohorte de recién nacidos de muy bajo peso. Materiales y métodos. Se hizo un estudio prospectivo de cohortes en los recién nacidos de muy bajo peso hospitalizados en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel entre el 2008 y el 2013. Se comparó el neurodesarrollo entre aquellos que no recibieron tratamiento prenatal con corticoides y quienes recibieron el esquema completo (dos dosis de 12 mg de betametasona) o el incompleto (una dosis). También, se compararon los resultados en el neurodesarrollo de los recién nacidos que no recibieron tratamiento posnatal y aquellos que sí (dexametasona sistémica a partir de la primera semana de vida). Se evaluó la función motora, la neurosensorial y la cognitiva, así como los trastornos de conducta durante los dos primeros años de vida. Resultados. Se analizaron 225 recién nacidos de muy bajo peso; 83,6 % de las madres había recibido tratamiento prenatal con corticoides (esquema incompleto: 24 %; esquema completo: 59,6 %). Durante el periodo posnatal solamente el 13,3 % había recibido dexametasona sistémica. El seguimiento neurológico se llevó a cabo en 194 neonatos. En el análisis de regresión logística no se detectó que el tratamiento prenatal no el posnatal se asociara con más trastornos neurológicos, ni hubo diferencias significativas entre quienes recibieron el esquema completo y los que recibieron el incompleto durante el periodo prenatal. Conclusión. Los resultados de este estudio no pudieron demostrar que el tratamiento perinatal con corticoides se asociara con peores resultados en el neurodesarrollo en recién nacidos de muy bajo peso.

Abstract Introduction: Glucocorticoids, widely used in the perinatal period, may be associated with adverse neurodevelopmental effects. Objectives: To analyze neurodevelopmental outcomes in a cohort of very low birth weight newborns treated with antenatal and/or postnatal corticosteroids. Materials and methods: This was a prospective cohort study in which we included all very low birth weight babies admitted to the neonatal intensive care unit of a tertiary hospital between 2008 and 2013. We compared the neurodevelopment among very low birth-weight newborns who did not receive prenatal corticosteroid therapy and those who received a complete course (two doses of 12 mg betamethasone) and an incomplete course (one dose), and between those who did not receive postnatal corticosteroid therapy and those who received it (systemic dexamethasone after the first week of life). Motor, neurosensory and cognitive functions, as well as behavior disorders during the first two years of age were evaluated. Results: A total of 225 very low birth weight newborns were analyzed; 83.6% received prenatal corticosteroid therapy (24% incomplete treatment schedule and 59.6% complete schedule). Only 13.3% received systemic dexamethasone during the postnatal period. Neurological monitoring was performed in 194 infants. Logistic regression analysis did not detect an association between prenatal and postnatal corticosteroid therapy and more neurological disorders, and no significant differences were found among those who received complete and incomplete courses of prenatal corticosteroid therapy. Conclusion: These results did not demonstrate an association between perinatal corticosteroid therapy and worse neurodevelopmental outcomes in very low birth weight newborns.

Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double-blind, randomized and controlled clinical trial.

INTRODUCTION: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. OBJECTIVE: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. METHODS: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12]≥6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n=105; three daily doses) or desloratadine plus prednisolone (n=105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. RESULTS: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14%×8.57%, respectively). CONCLUSION: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.

Characteristics of particulate and non-particulate corticosteroids. Indications for their use in chronic pain treatments. / Características de los corticoides particulados y no particulados. Condicionantes para su uso en el tratamiento del dolor crónico.

Corticosteroids been used frequently in pain treatments since the middle of last century (1952). Due to a review of the complications as a result of their application in epidural injections, the United States of America Food and Drug Administration (FDA) issued an «alert controversy¼ requesting that a warning label should be added to injectable corticosteroids, where risks must be described (loss of sight, brain damage, paralysis and death) when administering by this route. It must be mentioned that there are different types of corticosteroids with diverse characteristics, which as a result, may produce different side-effects. Due to the aforementioned developments, the controversies that have arisen, and the lack of well-conducted studies on the use of steroids in epidural injections, we must begin by reviewing their indications in different pain conditions.

Síndrome Hellp en embarazos pretérmino: evidencia fisiopatológica para uso de corticoides anteparto / Hellp syndrome in preterm pregnancies: pathophysiologic evidence for antepartum use of corticosteroids

El uso de corticoides anteparto podría atenuar el proceso inflamatorio del síndrome HELLP en embarazos pretérmino permitiendo mejorar los desenlaces materno-neonatales. Objetivo: identificar los beneficios materno-neonatales del uso de corticoides preparto en embarazos pretérmino complicados con HELLP mediante una revisión de la literatura. Metodología: se realizó una revisión entre julio y septiembre del 2013 que incluyó ensayos clínicos, en inglés o español sobre la utilidad de los corticoides anteparto en embarazos pretérmino complicados con síndrome HELLP y las repercusiones materno-fetales de su uso. Resultados: se revisaron cuatro ensayos clínicos que incluyeron 248 embarazos que comparaban el uso de dexametasona, betametasona o prednisolona con el placebo encontrándose potenciales beneficios como la prolongación del embarazo, la reducción de exacerbaciones y la reducción de necesidad de transfusiones en esta población. Conclusiones: la corticoterapia podría ser útil en la estabilización de pacientes preparto entre las 48 a 72 horas para garantizar el traslado a centros de mayor complejidad, en la reducción de recurrencias del síndrome HELLP en el manejo expectante en embarazos pretérmino y en la reducción de transfusiones; sin embargo son necesarios más estudios para evaluar sus indicaciones...

The use of antepartum corticosteroids may attenuate the inflammatory process of HELLP syndrome in preterm pregnancies allowing improved maternal and neonatal outcomes. Objective: identifying maternal and neonatal benefits of using corticosteroids in antepartum preterm pregnancies complicated by HELLP through a review of the literature. Methodology: A review was conducted between July and September 2013, including clinical trials in English or Spanish about the usefulness of antepartum corticosteroids in preterm pregnancies complicated by HELLP syndrome and fetal-maternal repercussions of its use. Results: four clinical trials involving 248 pregnancies comparing the use of dexamethasone, betamethasone or prednisolone with placebo were reviewed, potential benefits as prolonging pregnancy, reducing exacerbations and reduced need for transfusions in this population was found. Conclusions: corticosteroid herapy may be useful in stabilizing antepartum patients between 48-72 hours to ensure the move to more complex centers, in reducing recurrence of HELLP syndrome, in expectant management in preterm pregnancies and reducing transfusion need; however, more studies are needed to assess this indications...

[Preauricular injection of betamethasone depot and acyclovir for the treatment of acute herpes zoster ophthalmicus]. / Inyección preauricular de betametasona de depósito y aciclovir para el tratamiento del herpes zóster oftálmico agudo.

CLINICAL CASES: Several treatments have been described for the management of patients with herpes zoster ophthalmicus (HZO). However, the progress of these patients is usually slow, and many of them develop postherpetic neuritis (PHN). In the present paper, three clinical cases are presented, in which a significant symptomatic improvement was obtained by using a preauricular injection of a mixture of betamethasone depot combined with acyclovir. PHN did not develop in any of them. DISCUSSION: The preauricular injection of betamethasone depot and acyclovir could be a good alternative for the management of HZO.

Cambios hemodinámicos por doppler en fetos con retardo del crecimiento intrauterino de 26-34 semanas a 24 y 48 horas de la administración materna de betametasona / Hemodynamic changes detected by doppler between 26-34 weeks pregnancies with iugr 24 and 48 hours after betamethasone administration

Identificar cambios en el índice de pulsatilidad (IP) de las arterias umbilical y cerebral media después de aplicar betametasona en pacientes con retardo del crecimiento intrauterino (RCIU) entre 26 y 34 semanas. Métodos: 22 pacientes hospitalizadas con embarazos únicos entre las 26 y 34 semanas asociadas con RCIU, con indicación de maduración pulmonar que no se encontraban en trabajo de parto, recibieron protocolo completo de maduración, toma de doppler fetoplacentario inicial y a las 24 y 48 horas. Resultados: 68,2% presentaron trastorno hipertensivo del embarazo, 81,8% (n:18) negaron enfermedad crónica asociada, no se documentaron anomalías fetales mayores ni se sospechó infección fetal. El promedio del IP de la arteria umbilical al ingreso fue 1,62 (DE 0,41) y de la cerebral media 1,97 (DE 0,61). En el doppler de 48 horas se observaron cambios del IP en la umbilical (p =0.0079) y la cerebral media (p=0.0149), respecto al basal. Conclusiones: en RCIU entre las semanas 26 y 34 hay variaciones con significación estadística del IP en el doppler de las arterias umbilical y cerebral media que no siempre se asociaron con cambios en la estadificación del doppler actual y no tienen importancia clínica. La hipertensión gestacional asociada puede ser un factor de confusión. Palabras clave: cambios hemodinámicos, doppler, retardo del crecimiento intrauterino, betametasona. Abreviaturas: IP, índice de pulsatilidad: RCIU, retardo en el crecimiento intrauterino...

To identify changes in the pulsatility index (PI) of the umbilical and middle cerebral arteries after betamethasone administration in pregnancies at 26-34 gestational weeks with intrauterine growth retardation (IUGR). Methods: the study comprised 22 hospitalized women with singleton pregnancies at 26- 34 weeks with IUGR, not in labor, with indication of fetal lung maturity enhancement who received a complete treatment protocol and an initial fetoplacental Doppler repeated after 24 and 48 hours. Results: pregnancy-induced hypertension was present in 68.2%, 81.8% (n: 18) denied having an associated chronic illness, no major fetal anomalies or suspicion of fetal infection were documented. The average PI of the umbilical artery at admission was 1.62 (SD 0.41) and of the middle cerebral artery 1.97 (SD 0.61). PI changes observed in the Doppler performed after 48 hours were (p =0.0079) in the umbilical artery and (p=0.0149) in the middle cerebral artery, compared with baseline PI. Conclusions: there are statistically significant variations of Doppler PI in the umbilical and middle cerebral arteries in IUGR between week 26 and 34 which were not always related with changes of current Doppler stages and have no clinical importance. The associated gestational hypertension may constitute a confounding factor...

[Intra-lesional injection of betamethasone for the treatment of symptomatic pinguecula]. / Infiltración intralesional de betametasona como tratamiento de la pinguecula sintomática.

CLINICAL CASES: The pinguecula is a degenerative lesion which is usually asymptomatic, except when it is associated with an inflammatory reaction. We present 2 clinical cases of patients that had symptomatic pinguecula, in which intra-lesional betamethasone in depot form was used as treatment, obtaining a significant clinical improvement. DISCUSSION: The administration of intra-lesional betamethasone in depot form may be a good alternative for the treatment of the symptomatic pinguecula.

Effect of chronic cortisone use in rats strain susceptible to ligature-induced periodontitis / Efeito do uso crônico da cortisona em ratas de linhagem susceptível à periodontite induzida por ligadura

Objective: The present study assessed the effect of prolonged betamethasone use in ligature-induced periodontitis in adult Fischer-344 rats. Methods: Thirty-six Fisher rats were randomly assigned to three groups: group B (betamethasone); group S (sham) and group C (control). The animals in group B were given intramuscular betamethasone daily, those in group S were given saline injections daily, and those in group C were not submitted to any intervention. The interventions lasted 60 days, and all groups were submitted to the same environmental conditions. Tendays after starting the injections, periodontal disease was induced in the animals from groups B and S by tying a sterile silk suture threadaround the upper right second molar. Fifty days later, all animals were sacrificed and the connective tissue attachment level (Jac-E) and boneloss (Jac-O) were measured. Results: Jac-E and Jac-O of groups B and S were not significantly different, but they differed significantly from those of group C. Conclusion: Prolonged use of betamethasone did not affect the progression of induced periodontitis in rats.

Objetivo: Avaliar o efeito do uso prolongado da betametasona na periodontite induzida por ligadura, em ratas adultas da linhagem Fischer-344. Métodos: Selecionou-se trinta e seis ratas Fisher, as quais foram divididas aleatoriamente em três grupos: grupo B (betametasona); grupo S (soro) e grupo C (controle). Os animais do grupo B receberam injeções diárias intramuscular de betametasona, o grupo S recebeu injeções diárias de soro fisiológico e o grupo C foi mantido sem nenhuma intervenção. Estes procedimentos duraram 60 dias. Os três grupos foram mantidos nas mesmas condições ambientais. Decorridos dez dias a partir do início das injeções, os animais dos grupos B e S foram submetidos a indução da doença periodontal, através da colocação do fio de seda em volta do segundo molar superior direito. Ao final do período experimental (50 dias) os animais foram submetidos à eutanásia. O nível de inserção histológica (Jac-E) e perda óssea histológica (Jac-O) foram mensurados.Resultados: Entre os grupos B e S, não houve diferenças estatisticamente significativas para Jac-E e Jac-O. Entretanto, notaram-se diferenças significativas em ambos os parâmetros avaliados quando o grupo C foi comparado aos grupos B e S. Conclusão: Pode-se concluir que o uso prolongado de betametasona não modificou a progressão de periodontite induzida.

Aplicación de farmacopuntura en afecciones dolorosas del hombro / Application pharmacopuncture in painful affections of the shoulder

Se realizó un estudio experimental, tipo ensayo clínico controlado, en el período comprendido entre enero del 2007 hasta enero del 2008, con el fin de comparar la respuesta al tratamiento con farmacopuntura en el hombro doloroso con respecto al bloqueo del nervio supraescapular y proponer un algoritmo de tratamiento. La muestra quedó constituida por 60 pacientes, los cuales fueron aleatorizados y divididos en dos grupos, a uno se le realizó bloqueo del nervio supraescapular con betametasona y lidocaína al 2 por ciento en dosis habituales y al otro grupo se les aplicó farmacopuntura con pequeñas dosis de betametasona diluida con agua para inyección. El tratamiento fue aplicado dos veces por semana y hasta seis sesiones como máximo. Se evaluaron semanalmente por un equipo de trabajo teniendo en cuenta el criterio del paciente según la escala visual análoga, según criterio médico basado en el examen clínico, explorándose el dolor, la limitación de la movilidad articular y el balance funcional . Se observó una evolución satisfactoria más rápida en los pacientes tratados con farmacopuntura. El tratamiento con farmacopuntura en el hombro doloroso es de alta eficacia frente al bloqueo del nervio supraescapular.

We carried out an experimental, longitudinal and prospective study, at the Provincial Centre for the Development of Natural and Traditional Medicine Dr Mario E Dihigo, during the period from January 2007 to January 2008, with the objective of treating the increased incidence of patients with painful affections of the shoulder, requiring in many cases the usage of long, risk treatments, with results not always satisfactory. The sample was formed by 60 patients who were randomized and divided in two groups. A blockade of the supraescapular nerve with betamethasone and lidocain 2 per cent in habitual doses was applied to one group; the second one received pharmacopuncture with low doses of betamethasone diluted in water for injection. The treatment was applied 2 times a week and up to the maximum of 6 sessions. They were evaluated weakly for a working group, taking into account the patient's criteria according to the visual analogous scale, according to the medical criteria based on the clinical examination looking for pain, joint mobility limitation and functional balance. Among the studied patients there was a predominance of the female sex beginning from the third and fourth decades of life. Tendinitis of the rotator cuff was the most frequent diagnosis. There was a faster satisfactory recovery in patients treated with pharmacopuncture. Pharmacopuncture therapy in painful shoulder is of higher efficacy than the blockade of the supraescapular nerve.