Adrenal cortex hormones Research Papers (original) (raw)

Background: Shoulder pain is a very common presentation in primary care. Evidence of benefit for subacromial corticosteroid injection is inconclusive and confined largely to studies with short follow-up. We plan a large, definitive, primary-care-based trial to determine efficacy and safety in patients with rotator cuff tendinopathy, and conducted a pilot trial to explore feasibility. Methods: Six general practitioners (GPs) from Oxfordshire, UK underwent update training in assessing painful shoulders and injecting the subacromial space. Each then recruited patients aged 35 to 74 years from primary care complaining of shoulder pain lasting no more than 6 months. Eligible participants were randomized to receive either methylprednisolone acetate 40 mg with lidocaine 1% (total volume 1 ml), or lidocaine 1% alone (total volume 1 ml), injected into the subacromial space. The participants were blinded to treatment allocation. Feasibility outcomes were rates of recruitment, withdrawal, adherence to the protocol, completeness of follow-up, and success of patient masking. Clinical outcomes were the Oxford Shoulder Score (OSS) at baseline and at 4 and 12 weeks, and responses to three satisfaction questions at 2, 4 and 12 weeks. Outcome data were collected by postal questionnaires. Results: A total of 40 participants were randomized (80% of the target 50 participants) over 26 weeks giving an overall recruitment rate of 1.5 participants per week. Rates of follow-up were maintained to a high level for the full 12 weeks. Four participants requested a 'rescue' corticosteroid injection but no patients withdrew. The trial GPs gave high scores for their confidence that the patient had remained blinded to treatment allocation during the procedure. The OSS at 4 and 12 weeks and the responses to the satisfaction questions are reported. Conclusions: It is feasible to recruit participants with shoulder pain in the primary care setting for a blinded, randomized trial of corticosteroid injection. Online randomization of participants from the practice is also feasible, and postal questionnaires provide an effective means of gathering outcome data in this area of study. The lessons learned from this pilot will usefully inform the design of a large, definitive efficacy trial in primary care.

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- General Practice, Medicine, England, Pain Management

adverse effect that is not well known and characterised, although it was initially described more than 40 years ago. This study was conducted in order to characterise the important aspects of this adverse reaction, such as the role played by routes of corticosteroid administration, therapy duration, comedication, cumulative corticosteroid dose and underlying disease. Study design and methods: Published case reports of tendinopathies that were associated with corticosteroid use were identified by a comprehensive literature search using the databases MEDLINE, Pharm-line, EMBASE, ToxFile, Adis Inpharma, International Pharmaceutical Abstracts, Drug Information Fulltext and PASCAL. The reference lists of all pertinent articles were cross-referenced to retrieve additional cases. Spontaneous reports were requested from the Uppsala Monitoring Centre (the WHO Collaborating Centre for International Drug Monitoring). Information of published and spontaneous reports was analysed with regard to age, sex, underlying disease, individual corticosteroids, equivalent corticosteroid dose, latency time, cumulative dose, route of administration, comedication and type of tendinopathy. Results: We included and analysed 73 published case reports and case series involving 133 patients and 191 spontaneous reports of corticosteroid-associated tendinopathies. The proportion of women with tendinopathies was 50.8% and 41.0%, respectively. The mean age (± standard deviation) of patients with a tendinopathy was 50 ± 17 years and 61 ± 16 years, respectively. The predominant routes of administration were oral (33% of published cases and 47% of spontaneous cases) and intra-articular (35% of the published cases or parenteral (7% of the spontaneous cases). There were isolated cases of tendinopathy after inhaled or topical (i.e. ocular, cutaneous, nasal) corticosteroid use. Tendinopathies that were reported in the literature cases consisted mainly of tendon ruptures (93%), predominantly of the Achilles tendon. Of the spontaneous cases, 31% had a rupture and the remaining cases had a tendinitis or an unspecified tendon disorder. Conclusion: Oral and parenteral applications, especially intra-articular use, were the most prevalent routes of administration in cases with corticosteroid-associated tendinopathies. However, topical application has also been rarely associated with

- by Stephan Krähenbühl
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- Risk assessment, Adolescent, Tendinopathy, Aged

anagement of asthma often focuses on "crisis intervention," meaning that the disease is addressed only when a problem occurs. Shifting emphasis to a preventive health model, which includes guided self-management, has been shown to reduce costs related to hospital admissions and visits to emergency departments. 1 Education about asthma is an integral part of the recommendations of most guidelines for the management of asthma. 2-4 There is no consensus on the best model for education about asthma. A review of publications from 1991 through 2004 showed that only half of the studies identified were randomized controlled trials and that many studies used patients as their own historic controls. 4 Given that a regression to the mean is commonly observed in the data of such studies, with improvements in asthma over time, the use of historic controls is not an acceptable means of defining the impact of education. The studies reviewed also varied greatly in the demographic characteristics of the participants, the professional qualifications of the educators used, the nature of the interventions, the outcomes measured, the time frames for measurement and the inclusion of medical care and other services. These variations make it difficult to compare results and make firm recommendations. 5-15 Programs of education about asthma are typically directed toward the learner and conducted using either a one-on-one, large-group or small-group format. The intervention may consist of self-directed educational material, lectures (i.e., a teacher-focused format) or group interaction (i.e., a learnerfocused format). Effective change in behaviour occurs when learners actively interact with the content to be learned, with the teacher and with each other. 16 Small groups of fewer than 10 members allow for an ideal level of interaction. Westberg and Jason 17 cite several compelling reasons for using small groups to promote learning. Learners are more likely to take ownership of their education and may be more engaged with

- by Wade Watson
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- Family, Quality of life, Asthma, Group Processes
- by Charles Maynard
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- Surgery, Research Design, Treatment, STEROIDS

Anti-diarrhoea1 drugs reduce the symptoms of diarrhoea (loose stool consistency, frequency of defecation and excessive stool weight) by effects on intestinal transit, mucosal transport or luminal contents. Opiates and opioids are the most useful anti-diarrhoea1 agents. Opiates have major effects on intestinal transit : pro-absorptive and anti-secretory effects are less well documented, but may be important for some of these drugs. Alpha-adrenergic agonists, somatostatin analogues and several other agents have had limited clinical use: these drugs may modify mucosal transport in addition to slowing transit. Adsorbents, bismuth and stool texture modifiers are used frequently by the public, but their efficacy is largely unproven. Oral rehydration solutions have had the greatest impact in saving lives and continue to be improved. Many new approaches to the treatment of diarrhoea are yet to be exploited.

- by Lawrence Schiller
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- Lithium, Diarrhea, Somatostatin, Morphine

The authors describe a clinical case of cutaneous candidiasis in a dog with dermatological lesions, characterized by persistent alopecia, crusts, ulcers and scales. Predisposing factors such as the use of corticosteroids, the concomitan presence of an autoimmune disease (pemphigus foliaceus) and an infection of ehrlichiosis caused by Ehrlichia canis were observed. Histopathological findings included signs of orthokeratotic hyperkeratosis, moderate follicular keratosis and light epidermic acanthosis. The reactive process included an infiltrative superficial dermatitis and a mural folliculitis with prevalent participation of macrophages and lymphocytes. The application of PCR-Restriction Enzyme Analysis (REA) method on cutaneous specimens in veterinary medicine is an extremely interesting diagnostic tool. Its use, together with other techniques, such as mycologic, cytologic and histological examinations, allowed us to identify Candida albicans as aetiological agent in this particular ...

- by Emanuele De Gasperis
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- Disease susceptibility, Dogs, Autoimmune diseases, Polymerase Chain Reaction

Background. Evidence from multiple trials demonstrates the efficacy of prophylactic ␤-blocker, amiodarone, and corticosteroid administration in reducing the incidence of postoperative atrial fibrillation. Despite this information, these interventions remain infrequently or inappropriately utilized. This study was designed to assess the frequency with which these prophylactic strategies are currently being used and to identify concerns and barriers to more widespread application. Methods. A link to an online survey was e-mailed to all practicing cardiac surgeons in Canada. Each surgeon was given a unique log-in identification number to complete the survey online through a secure web page. Results. Surveys were sent to 166 surgeons; 119 completed surveys (72%) were returned. Only 58% of respondents routinely use ␤-blockade for prophylaxis. For nonusers, 44% are unconvinced of the evidence for this practice. The routine use of amiodarone among surgeons was 19%. Of the remainder, 43% cited a perceived increased risk of complications as the reason for not using this therapy. An additional 29% considered the therapy was excessively complicated or time consuming. Corticosteroids were routinely used by only one surgeon. Major barriers to use of steroids were unconvincing evidence (76%), a perceived increased risk of wound infection (38%), and hyperglycemia (30%). Conclusions. Despite level 1 evidence, the use of ␤-blockers, amiodarone, and corticosteroids for prophylaxis of atrial fibrillation among Canadian surgeons remains less than expected. The results of this survey support the need for further clinical trials with robust and clinically relevant outcomes that may further influence surgeons to adopt this practice.

- by Joel Price
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- Cardiology, Medicine, Prevention, Probability
- by Chris Patterson
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- Pediatrics, Decision Making, Asthma, Adolescent

Pemphigus is a group of potentially life-threatening diseases characterized by cutaneous and mucosal blistering. There is a fairly strong genetic background to pemphigus with linkage to HLA class II alleles. Certain ethnic groups, such as Ashkenazi Jews and those of Mediterranean origin, are especially liable to pemphigus. Pemphigus vulgaris (PV), the most common and important variant, is an autoimmune blistering disease characterized by circulating pathogenic IgG antibodies against desmoglein 3 (Dsg3), about half the patients also having Dsg1 autoantibodies. Oral lesions are initially vesiculobullous but readily rupture, new bullae developing as the older ones rupture and ulcerate. Biopsy of perilesional tissue, with histological and immunostaining examinations, is essential to the diagnosis. Serum autoantibodies to either Dsg1 or Dsg3 are best detected by both normal human skin and monkey esophagus or by enzyme-linked immunosorbent assay (ELISA). Before the introduction of cortico...

- by Stephen Challacombe
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- Dentistry, Medicine, Ethnic Groups, PEMPHIGUS VULGARIS
- by Joseph Damiani
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- Adolescent, Child, Differential Diagnosis, Clinical Sciences

Asthmatics hospitalised because of influenza A infection are less likely to require intensive care or die compared with nonasthmatics. The reasons for this are unknown. We performed a retrospective analysis of data on 1520 patients admitted to 75 UK hospitals with confirmed influenza A/H1N1 2009 infection. A multivariable model was used to investigate reasons for the association between asthma and severe outcomes (intensive care unit support or death). Asthmatics were less likely than nonasthmatics to have severe outcome (11.2% versus 19.8%, unadjusted OR 0.51, 95% CI 0.36-0.72) despite a greater proportion requiring oxygen on admission (36.4% versus 26%, unadjusted OR 1.63) and similar rates of pneumonia (17.1% versus 16.6%, unadjusted OR 1.04). The results of multivariable logistic regression suggest the association of asthma with outcome (adjusted OR 0.62, 95% CI 0.36-1.05; p50.075) are explained by pre-admission inhaled corticosteroid use (adjusted OR 0.34, 95% CI 0.18-0.66) and earlier admission (f4 days from symptom onset) (adjusted OR 0.60, 95% CI 0.38-0.94). In asthmatics, systemic corticosteroids were associated with a decreased likelihood of severe outcomes (adjusted OR 0.36, 95% CI 0.18-0.72). Corticosteroid use and earlier hospital admission explained the association of asthma with less severe outcomes in hospitalised patients.

- by Peter Openshaw
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- Asthma, Adolescent, Medicine, Comorbidity

We report a case of severe contact urticaria with systemic involvement resembling an anaphylactic reaction, following the application of a topical corticosteroid. This was caused by hexylene glycol, an excipient in the formulation. Glycols are widely used in cosmetics, foods and topical and systemic drugs. In particular, glycols are present in many topical drugs used by dermatologists. To our knowledge, this is the first case in the literature of a potentially life-threatening immediate-type reaction in the context of a contact urticaria syndrome due to hexylene glycol. The classification of contact urticaria syndrome and the allergenic potential of glycols are reviewed. Dermatologists should be aware of the contact urticaria syndrome and of the increasing use of glycols in topical drug formulation in order to identify possible adverse reactions.

- by Andreas Bircher
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- Dermatology, Drug Use, Case Report, Anaphylaxis

Pharmacologic therapy of aphakic cystoid macular edema (ACME) in the past has included the use of topical, periocular, and systemic corticosteroids as well as inhibitors of prostaglandin synthesis. Preliminary studies have suggested a beneficial effect of systemic corticosteroids on ACME, although it has been said that this effect is temporary and that recurrences are common. To date, no adequate therapeutic or prophylactic trial of topical, periocular, or systemic corticosteroids for ACME has been performed. Several elegant clinical trials have been done to study the effects of indomethacin, a prostaglandin (PG) synthesis inhibitor, on the incidence of ACME. It seems likely that topical, and perhaps systemic, indomethacin is effective in reducing the incidence of angiographically proved ACME. To date, however, no trial has demonstrated a sustained effect of topical or systemic PG synthesis inhibitors on ACME or visual acuity. Further studies of the role of PG synthesis inhibitors (especially topical agents) in the therapy of ACME are necessary. In addition, further efforts should be made to determine the efficacy of the use of PG synthesis inhibitors in combination with corticosteroids.

Background: Common measures of adherence to prescribed medications derived from administrative databases reflect both patients’ and physicians’ behavior, even if the measures are often interpreted as reflecting only the patient's adherence. Adherence to inhaled corticosteroids (ICSs) has been shown to be low among patients with asthma. Objective: To develop a new measure of patients’ adherence adjusted for prescription patterns and to evaluate the extent to which the low use of ICSs in asthma is due to patients’ nonadherent or suboptimal prescribing practices. Methods: The new measure of adherence, called the proportion of prescribed days covered (PPDC), is defined as the ratio of the total days’ supply dispensed to the total days’ supply prescribed during the study period. The PPDC is a modification of an existing adherence measure, the proportion of days covered (PDC). The PPDC and PDC for ICSs, therapy that should be prescribed for chronic daily use to patients with persisten...

- by Sylvie Perreault
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- Medication Adherence, Treatment, Asthma, Adhesion

In this review we focused on steroid metabolomics in human fetuses and newborns and its role in the physiology and pathophysiology of human pregnancy and subsequent stages of human life, and on the physiological relevance of steroids influencing the nervous systems with regards to their concentrations in the fetus. Steroid profiling provides valuable data for the diagnostics of diseases related to altered steroidogenesis in the fetal and maternal compartments and placenta. We outlined a potential use of steroid metabolomics for the prediction of reproductive disorders, misbalance of hypothalamic-pituitary-adrenal axis, and impaired insulin sensitivity in subsequent stages of human life. A possible role of steroids exhibiting a non-genomic effect in the development of gestational diabetes and in the neuroprotection via negative modulation of AMPA/kainate receptors was also indicated. Increasing progesterone synthesis and catabolism, declining production of tocolytic 5␤-pregnane steroids, and rising activities of steroid sulfotransferases with the approaching term may be of importance in sustaining pregnancy. An increasing trend was demonstrated with advancing gestation toward the production of ketones (and 3␤-hydroxyl groups in the case of 3␣-hydroxy-steroids) was demonstrated in the fetus on the expense of 3␣-hydroxy-, 17␤-hydroxy-, and 20␣-hydroxy-groups weakening in the sequence C17, C3, and C20. There was higher production of active progestogen but lower production of active estrogen and GABAergic steroids with the approaching term. Rising activities of placental CYP19A1 and oxidative isoforms of HSD17B, and of fetal CYP3A7 with advancing gestation may protect the fetus from hyperestrogenization. This article is part of a Special Issue entitled 'Pregnancy and Steroids'.

- by Martin Hill
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- Biology, Medicine, Fetal development, Brain
- by Bethanee Schlosser
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- Dermatology, Medicine, Clinical Sciences, Estrogens

Dentists are aware of contraindications to the use of vasoconstrictors in patients with cardiovascular diseases. However, there are some other noncardiac conditions we should know. This article discusses the absolute contraindications to the use of vasoconstrictors in patients with a history of hyperthyroidism, diabetes, allergy to sulfites, asthma, and pheochromocytoma.

- by Jean-paul Goulet
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- Asthma, Drug interactions, Heart Failure, Hypertension

Corret inhaler technique is recommended by guidelines for optimum asthma care. The objective of the study is to determine real life predictors of correct pressurized metered dose inhaler (pMDI) technique in Asthma and COPD patients. Two hundred eight adult patients aged 18+ from respiratory outpatients (69.2%) and the community on regular pMDI for a diagnosis of Asthma (78.9%) or COPD, were recruited. A questionnaire containing 31 possible predictors was administered and pMDI technique with or without spacer was observed by trained researchers on 12 point steps, of which 4 were considered critical. 23.1% of patients had no errors in inhaler technique and 32.2% had no critical errors. Patients had a median of 10 correct steps (IQR9-11), and 3(IQR2-4) correct critical steps. Using binary logistic regression the predictors of 10 correct steps were, other healthcare professional (pharmacist, nurse, physiotherapist) explained OR 3.73(1.63-8.54, p = 0.001), male gender 2.70(1.35-5.39, ...

- by Martin Balzan
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- Asthma, Malta, Checklist, Patient Compliance

Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the risk of vertebral fragility fractures. Good practice in the care of those with DMD requires prevention of these adverse effects. Treatments to increase bone mineral density include bisphosphonates and vitamin D and calcium supplements, and in adolescents with pubertal delay, testosterone. Bone health management is an important part of lifelong care for patients with DMD. To assess the effects of interventions to prevent or treat osteoporosis in children and adults with DMD taking long-term corticosteroids; to assess the effects of these interventions on the frequency of vertebral fragility fractures and long-bone fractures, and on quality of life; and to assess adverse events. On 12 September 2016, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus to identi...

- by Mike Shields
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- Vitamin D, Calcium, Adolescent, Vibration
- by Esen Özkaya
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- Immunology, Vitamins, Minerals, Medicine

Corticosteroids are widely used in modern medicine but can result in troubling psychiatric side-effects. Physicians and other medical professionals should be aware of the potential for these side-effects, possible means of prevention, and efficacious treatments. Herein, we review adult case report data published during the past quarter-century on adverse corticosteroid-induced psychiatric effects, and present a case of corticosteroid-induced psychotic depression. PubMed and PsychLit databases were searched using the terms 'corticosteroids', 'steroids', and the generic names of corticosteroid medications with terms for psychiatric symptoms or syndromes, including psychosis, mania, hypomania, depression, apathy, anxiety, panic, depersonalization, delirium, confusion, hallucinations, delusions, paranoia, cognitive impairment and dementia. Fifty-five cases and a number of clinical trials investigating the incidence and treatment of these psychiatric symptoms and syndrome...

- by Lorrin Koran
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- Cognitive Science, Psychiatry, Depression, Hallucinations
- by joseph daniel
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- Weight Loss, Chronic Disease, Musculoskeletal pain, Platelet Rich Plasma

Biliary atresia (BA) remains an enigmatic disease with a degree of etiologic heterogeneity. A number of variants can be defined clinically, and these include the syndromic group (typically BA splenic malformation), cystic BA, and cytomegalovirus (CMV) IgM ϩve associated BA. The remainder, and still the largest group, may be termed isolated BA. There is a wide variation in incidence across the globe from 1 in 5000 in Taiwan to 1 in 20,000 live births in Northern Europe, although the reasons for such a disparity remain obscure. Management remains primarily surgical with an attempt to restore bile flow by resection of extrahepatic biliary remnants and a reconstruction portoenterostomy (the Kasai procedure), reserving liver transplantation for those where this fails or complications of chronic liver disease supervene. Clearance of jaundice to normal values has been achieved in 40%-55% of cases in large series from around the world, with an expectation of 5-year native liver survival of similar proportions.

- by Mark Davenport
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- Spleen, Outcome, Liver Transplantation, Prognosis

Objective: To determine whether systemic corticoste- roids are of benefit to patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Methods: An English-language search of MEDLINE (1966 to February 2002) and the Cochrane Library and a bibliographic review was performed to identify pub- lished clinical trials of systemic corticosteroid adminis- tration in acute exacerbations of COPD. All relevant En-

- by Kenneth Chapman
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- English language, Clinical Trial, Prednisolone, Aged

A 2007 American College of Physicians guideline addressed pharmacologic options for low back pain. New evidence and medications have now become available. To review the current evidence on systemic pharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Ovid MEDLINE (January 2008 through November 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Randomized trials that reported pain, function, or harms of systemic medications versus placebo or another intervention. One investigator abstracted data, and a second verified accuracy; 2 investigators independently assessed study quality. The number of trials ranged from 9 (benzodiazepines) to 70 (nonsteroidal anti-inflammatory drugs). New evidence found that acetaminophen was ineffective for acute low back pain, nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed, duloxetine was effectiv...

- by Andrea Skelly
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- Chronic Pain, Low back pain, Benzodiazepines, Acute Pain
- by Sandra Pekic Djurdjevic
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- Magnetic Resonance Imaging, Medicine, Differential Diagnosis, Lancet

Background: Neurosarcoidosis (NS) is a relatively rare neurologic disorder for which no accepted treatment guidelines are available. Treatment with corticosteroids has been described as the primary means of controlling progressive symptoms. However, some physicians have recently advocated early intervention with alternative immunosuppressive therapies in patients who present with disabling symptoms. Objective: To investigate our experience during the last decade regarding alternative immunosuppressive treatments, including corticosteroids and alternative therapies, in patients with NS.

- by Carol Chieffe
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- Cognitive Science, Nonparametric Statistics, Magnetic Resonance Imaging, Treatment

Crohn ' s disease (CD) is associated with substantial psychosocial burden and increased risks for mental health disorders. This retrospective cohort study compared the risks of developing anxiety disorders and depression and incidences of psychotropic medication use between young CD patients and matched CD-free controls. METHODS: Medical claims, prescription drug claims, enrollment, and demographic data for patients < 18 years diagnosed with CD were obtained from the MarketScan database (1 January 2000-30 June 2006). Each CD patient was matched with fi ve CD-free controls based on exact age, sex, and months of health plan enrollment. Incidence rates and risks of developing anxiety disorders and depression and psychotropic medication use in the 6 months after the index date were compared, as were risks of developing persistent anxiety or depression (receiving medical services related to a diagnosis of anxiety or depression or psychotropic therapy for > 1 year). RESULTS: After adjustment for patient characteristics, the risks of developing anxiety disorders (hazard ratio (HR) [95 % confi dence interval (CI)] = 2.28 [1.65-3.17]) and depression (HR [95 % CI] = 1.74 [1.35-2.25]) after CD diagnosis were signifi cantly greater for the CD cohort (N = 2,144) than for CD-free controls (N = 10,720). Patients with CD also had greater risks of developing persistent anxiety and persistent depression (HR [95 % CI] = 4.35 [2.22-8.50] and 2.75 [1.73-4.38], respectively). CONCLUSIONS: Compared with matched CD-free controls, young patients with CD had signifi cantly greater risks of developing anxiety disorders and depression, were more likely to receive psychotropic treatments, and had signifi cantly greater risks of developing persistent anxiety and depression.

- by Annie Guerin
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- Anxiety Disorders, Depression, Health insurance, Adolescent

Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operatio...

- by Prathap Tharyan
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- India, Tuberculosis, Government Agencies, guidelines as topic

Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults. A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations. When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming ''uncontrolled'' or that remains ''uncontrolled'' despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided. Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

- by M. Gaga
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- Asthma, International Cooperation, Comorbidity, Immunoglobulin E

Alcoholism results in about 2.5 million deaths annually worldwide, representing 4% of all mortality. Most of this mortality is from alcoholic liver disease (ALD). ALD includes alcoholic steatosis, alcoholic hepatitis, and alcoholic cirrhosis, in order of increasing severity. This work reviews this clinically important subject, with a focus on informing clinicians of recent advances in therapy to reduce the currently high mortality from alcoholic hepatitis and alcoholic cirrhosis.

- by Mitchell Cappell
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- Treatment Outcome, Liver Transplantation, Risk factors, Clinical Sciences

Introduction: The association of gender with health status (HS) response to long-term oxygen therapy (LTOT) in very severe COPD is unclear. The aims of this study were: (1) to compare dyspnea perception and HS between male and female with very severe COPD at baseline and (2) to provide a prospective assessment of HS response to LTOT, according to gender. Patients and methods: Hypoxemic COPD (n=97, age: 65.5±9.6 years, 53% males) were enrolled in a prospective longitudinal study over 12 months or until death. St. George's Respiratory Questionnaire (SGRQ) and baseline dyspnea index (BDI) were assessed. Results: At baseline, HS impairment and dyspnea sensation were similar between genders. After 12 months of LTOT, women presented improvement in symptom (64.1±20.6 versus 40.6±22.9; P<.0001) and total SGRQ scores. Men also showed improvement in symptoms after 12 months (62.7±23.3 versus 49.6±22.8; P<.0005); however, they presented deterioration of activity, impact, and total scores during the study period, with markedly decline of activity domain (68.5±20.0 versus 75.9±16.9; P=.008). BDI did not show significant difference by gender over the study period. Conclusions: Our results show that the HS course in very severe COPD patients differs according to gender, as females show greater response longitudinally to LTOT.

- by Liciana Silveira
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- Brazil, Medicine, Comorbidity, Prospective studies

The article will also be published in Critical Care Medicine. * Sponsor of 2004 guidelines; ** Sponsor of 2008 guidelines but did not participate formally in revision process; *** Members of the 2007 SSC Guidelines Committee are listed in... more

- by Charles Sprung
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- Nursing, Medicine, Critical Care, Critical Care Medicine

Purpose: To our knowledge, there is no published information on the efficacy of epidural steroid injections for the treatment of lumbar disc herniation in an athletic population. The purpose of this study was to evaluate the efficacy of epidural corticosteroid injection for treatment of lumbar disc herniation in a group of National Football League (NFL) players. Methods: We retrospectively reviewed the records of all NFL players who underwent an epidural steroid injection at our institution for incapacitating pain secondary to an acute lumbar disc herniation (confirmed on magnetic resonance imaging) from 2003 to 2010. Our primary outcome was success of the injection, defined as return to play. The secondary outcome of the study was to evaluate risk factors for failure of this treatment approach. Results: Seventeen players had a total of 37 injections for 27 distinct lumbar disc herniation episodes from 2003 to 2010. The success rate of returning an athlete to play for a given episode of disc herniation was 89% (24 of 27 episodes) with an average loss of 2.8 practices (range = 0-12) and 0.6 games (range = 0-2) after the injection. Four players required a repeat injection for the same episode. Three of these four players ultimately failed conservative management and required surgical intervention. Risk factors for failing injection therapy included sequestration of the disc herniation on magnetic resonance imaging (P = 0.01) and weakness on physical examination (P = 0.002). There were no complications reported. Conclusions: In this highly selective group of professional athletes, our results suggest that epidural steroid injections are a safe and effective therapeutic option in the treatment of symptomatic lumbar disc herniation.

- by Frank Cammisa
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- Treatment Outcome, Medicine, Low back pain, Football

Introduction The prevalence of bronchopulmonary dysplasia (BPD), one of the most frequently occurring complications following preterm birth, is increasing due to increased survival of preterm infants. Methods Systematic literature review. Conclusion The etiology is multifactorial, with prematurity being a prerequisite for the development of BPD. Over time, there have been many different and new treatment modalities, some of them have reduced the severity of the disease, but none of them have been able to impact upon the increasing incidence of BPD.

- by Dorthe Jeppesen
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- Vitamins, Birth Weight, Vitamin A, Pregnancy
- by Alexis Narvaez-Rojas, M.D.
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- Adolescent, Electrocardiography, Hypertension, Cocaine

Learning objectives: Readers will learn the importance of psychiatric symptomatology with corticosteroid drug therapy, especially when combined with other medications. Data Sources: A brief history of corticosteroid use over the last five decades was complied utilizing MEDLINE and PSYCHOINFO as sources of information which include peer-reviewed research articles, case studies, and relevant reviews in English. Conclusion: Corticosteroids are routinely prescribed for a variety of allergic and immunologic illnesses. Psychiatric side effects from corticosteroids include mania, depression and mood disturbances. Psychiatric symptoms usually occur within the first two weeks of corticosteroid therapy and seem to be dose related. Treatment with lithium or antipsychotics may be helpful. Physicians should carefully monitor patients for psychiatric and cognitive side effects of corticosteroid use.

- by David Khan
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- Immunology, Bipolar Disorder, Delusions, Hallucinations
- by Timothy Moss
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- Cognitive Science, Carbon Dioxide, Aging, Birth Weight

This ECCO Topical Review of the European Crohn's and Colitis Organisation [ECCO] focuses on the role of environmental factors with respect to the development of inflammatory bowel disease [IBD] as well as their influence on the course of established IBD. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.

- by Colm O'Morain
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- Biomarkers, Drug interactions, Europe, Infection

Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 49 systematic reviews, RCTs, or observational studies that met our inclusio...

- by John O'Dowd
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- Bioinformatics, Life Sciences, Treatment Outcome, Biomedical Research

Background. Long-term use of corticosteroids is associated with considerable morbidity, including cardiovascular and metabolic adverse effects. Methods. This study evaluated the long-term efficacy and safety of two steroid-free regimens compared with a triple immunosuppressive therapy in renal transplant recipients. This was a 3-year follow-up to a 6-month, open-label, randomized, multicenter study. Results. Data from 3 years were available for 421 (93.3%) of 451 patients in the original intent-to-treat population (143 tacrolimus/basiliximab [Tac/Bas], 139 tacrolimus/mycophenolate mofetil [Tac/MMF], and 139 tacrolimus/MMF/ The original 6-month ATLAS study and statistical analyses were supported by Astellas Pharma Europe, Staines, UK. B.K.K. has received lecture fees and honoraria from Astellas, Novartis, Teva, and Wyeth; served on advisory/safety boards for Astellas, Bristol-Myers Squibb, Novartis, Teva, and Wyeth; received research grants from Astellas and Novartis; and participated in clinical trials sponsored by Astellas, Bristol-Myers Squibb, Novartis, Roche, and Wyeth. J.-P.S. has received research grants from Novartis, Astellas, Roche, Wyeth, Fresenius, and Genzyme. B.B. participated in studies sponsored by Astellas, Bristol-Myers Squibb, Genzyme, Novartis, Roche, and Wyeth. B.K. participated in clinical trials sponsored by Astellas and Novartis. S.S. participated in advisory boards and received fees from Novartis, Bristol-Myers Squibb, and Bellco. M.C. has served on advisory boards for Astellas, Bristol-Myers Squibb, and Roche and participated in clinical trials sponsored by Astellas, Novartis, Roche, and

- by Bernhard Banas
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- Kidney transplantation, Risk assessment, Biopsy, Europe

Chronic persistent neck pain with or without upper extremity pain is common in the general adult population with prevalence of 48% for women and 38% for men, with persistent complaints in 22% of women and 16% of men. Multiple modalities of treatments are exploding in managing chronic neck pain along with increasing prevalence. However, there is a paucity of evidence for all modalities of treatments in managing chronic neck pain. Cervical epidural injections for managing chronic neck pain are one of the commonly performed interventions in the United States. However, the literature supporting cervical epidural steroids in managing chronic pain problems has been scant. A systematic review of cervical interlaminar epidural injections for cervical disc herniation, cervical axial discogenic pain, cervical central stenosis, and cervical postsurgery syndrome. To evaluate the effect of cervical interlaminar epidural injections in managing various types of chronic neck and upper extremity pai...

- by Manohar Sharma
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- Chronic Pain, Medicine, Neck Pain, Arm

State of latency, well known for several herpesviruses, has been proposed for equine herpesvirus-3 (EHV-3) and supported by epidemiological observations. No detailed assessment about reactivation, patterns of excretion and reexcretion has been formally reported. An experimental reactivation study by corticosteroid treatment in previously naturally infected horses was therefore carried out. Two polo mares with clinical and virologically confirmed history of equine coital exanthema were injected with dexamethasone and prednisolone on 3 successive days. Clinical signs, body temperature and clinical samples for virological and serological studies were obtained daily. Mares did not show any systemic clinical signs or hyperthermia. EHV-3 shedding, seroconversion and the presence of a small lesion were observed in one of the mares under study 2 weeks after corticosteroid treatment. The results demonstrate that this virus exhibits a latency-reactivation behaviour similar to that of other alpha herpesviruses. Reactivation of latency may have an important bearing on the appearance of clinical signs in mares and/or stallions during the breeding season without the actual evidence of transfer from mare to stallion or vice versa.

- by Julio Oriol
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- Biological Sciences, Dexamethasone, Polymerase Chain Reaction, Horses

Background-The risks for infants and young children receiving inhaled corticosteroid (ICS) therapy are largely unknown. Recent clinical studies indicate that ICS therapy in pre-school children with symptoms of asthma result in decreased symptoms without influencing the clinical disease course, but potentially affect postnatal growth and development. The current study employs a primate experimental model to identify the risks posed by ICS therapy.

- by Michelle Fanucchi
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- Immunology, Asthma, Child, Infant

Asthma is now widely recognized as a chronic inflammatory condition ofthe airways that requires early pharmacological treatment and long-term management. Anti-inflammatory agents, particularly inhaled corticosteroids, are currently the most effective long-term preventative medication. Moreover, early intervention with inhaled corticosteroids plays an important role in airway remodelling. Despite significant advances in the understanding ofasthma and its

- by Alon Tal
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- Respiratory Medicine, Early Intervention, Asthma, Treatment Outcome

El lupus eritematoso sistémico (LES) se asocia con diversos eventos adversos en el embarazo como parto prematuro, pre-eclampsia y pérdidas gestacionales. Gracias a los avances terapéuticos el pronóstico del embarazo en mujeres con LES ha mejorado. Además de las complicaciones relacionadas con el embarazo, las mujeres con LES tienen un alto riesgo de complicaciones médicas durante la gestación como hipertensión, enfermedad renal, síndrome antifosfolípido, diabetes pregestacional o actividad lúpica, las cuales afectan el curso de la enfermedad y empeoran los resultados del embarazo. El embarazo aumenta la probabilidad de recaídas del LES. Aunque no es posible predecir cuándo se presentará una recaída en una paciente, esta es más probable si la enfermedad ha permanecido activa en los seis meses previos a la concepción.

- by Peter-Andrew Schwarz
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- Immunology, Kidney diseases, Medicine, High risk pregnancy

Ultrasound examination is a recognized advanced tool in the diagnosis of many sport-related overuse injuries. This article illustrates a new indication for ultrasound examination: the diagnosis of iliopsoas tendinitis and its treatment by... more

- by Lars Bolvig
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- Soccer, Medicine, Tendinopathy, Hip