Steroids Associated With Reduced Mortality in Adults with Sepsis

MedicalResearch.com Interview with:

Dr. Jianguo Xu, MD West China Hospital, Sichuan University Chengdu, Sichuan, China

West China Hospital Sichuan University

Dr. Jianguo Xu, MD
West China Hospital, Sichuan University
Chengdu, Sichuan, China

MedicalResearch.com: What is the background for this study?

Response: Since the mid-20th century, corticosteroids have been used as adjuvant therapy in the context of sepsis. Although evaluated in numerous randomized clinical trials and meta-analyses, both the safety and efficacy of corticosteroids remain controversial.

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Quadrupling Inhaled Steroids May Abort Some Asthma Attacks

MedicalResearch.com Interview with:
“Asthma Inhaler” by NIAID is licensed under CC BY 2.0Timothy Harrison, MBBS, BSc, FRCP, MD, MSc
Professor and Honorary Consultant
Faculty of Medicine & Health Sciences
University of Nottingham

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Self management plans are recommend for patients with asthma but previous studies have shown that doubling the dose of inhaled steroids when asthma starts deteriorating is ineffective at preventing the development of an exacerbation.

This study shows that quadrupling the dose is effective and in a real-life setting can reduce severe exacerbations by about 20%

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Oral vs IV Steroids for Acute Optic Neuritis

MedicalResearch.com Interview with:

Sarah A. Morrow MD, MS, FRCPC Associate Professor of Neurology Department of Clinical Neurological Sciences University of Western Ontario (Western)

Dr. Morrow

Sarah A. Morrow MD, MS, FRCPC
Associate Professor of Neurology
Department of Clinical Neurological Sciences
University of Western Ontario (Western)

MedicalResearch.com: What is the background for this study?

Response: Acute demyelinating optic neuritis, which presents with loss of vision and painful eye movements, is common in multiple sclerosis (MS) occurring 50% of persons with MS. High dose (≥ 1g) corticosteroids administered through an IV became the standard of practice after the landmark Optic Neuritis Treatment Trial as IV administration. However, in that study the IV dose of corticosteroids was much higher (1 gram daily) than the oral dose (1 mg/kg). Thus, it is not clear if IV administration is still better if equivalent doses are used orally. Oral administration is much more convenient for patients and less expensive, and previous studies showed that it is preferred by patients.

In this study, we asked the following question: are high dose (≥ 1000mg) IV corticosteroids superior to equivalent doses of oral corticosteroids for the acute treatment of optic neuritis?

We randomly assigned fifty-five cases of acute optic neuritis to 1000mg IV methylprednisolone or 1250mg oral prednisone daily for three days and compared recovery of their vision over the next 6 months.  Continue reading

How Do Steroids Affect Patients in Septic Shock?

MedicalResearch.com Interview with:

hospital bed CDC image

CDC image

Bala Venkatesh, MBBS, MD(Int.Med), FRCA, FFARCSI, MD(UK), FCICM
Director of Intensive Care, Wesley Hospital
Pre-eminent specialist, Princess Alexandra Hospital
Professor of Intensive Care,University of QLD
Honorary Professor, University of New South WalesProfessorial Fellow, The George Institute for Global Health

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Whether hydrocortisone reduces mortality in patients with septic shock is unclear. The uncertainty about the efficacy of glucocorticoids in reducing mortality in patients with septic shock has resulted in widespread variation in clinical practice

In the results published in the New England Journal of Medicine the investigators found steroids not only reduced the duration of septic shock, they also led to less blood transfusions, and the time spent on life support therapy in intensive care. However, the use of steroids did not lead to fewer deaths overall compared to placebo.

Some of the findings are consistent with previous research whilst other results add new information that will inform clinicians.

Our results show there is still a lot to learn about septic shock which kills up to half of those affected in some parts of the world. There are undoubtedly many other contributors to survival which we don’t yet understand.  Continue reading

Atopic Dermatitis: IF Used At All, Systemic Steroids Should Be Short Term Bridge To Other Therapies

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Systemic corticosteroids are commonly used as systemic treatments for atopic dermatitis. However, few studies assessed the efficacy and safety of systemic corticosteroids in atopic dermatitis. This systematic review sought to summarize the available evidence for their use in atopic dermatitis.

Overall, 52 reviews and 12 studies were included in this systematic review. Most studies suffered from small sample size, low quality. In one of the only randomized-controlled trials performed, systemic corticosteroids were less effective than cyclosporine and led to more rebound flares. There were numerous safety and tolerability concerns with both short and long-term treatment with systemic corticosteroids. One study found that even short-term use of systemic corticosteroids was associated with increased sepsis, venous thromboembolism and fractures.

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No Link Found Inhaled Steroids and Bone Fractures in Asthmatic Children

MedicalResearch.com Interview with:
“Asthma” by Michael Havens is licensed under CC BY 2.0Teresa To, PhD
Biostatistics, Design and Analysis
Scientific Director
The Hospital for Sick Children
Dalla Lana School of Public Health, University of Toronto
Institute for Clinical Evaluative Sciences
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We studied asthma prescription drug use in Ontario children aged 2 to 18 years with physician diagnosed asthma between 2003 and 2014.

We found that:

  1. Currently in Ontario, nearly 50% of children with asthma did not fill a prescription for an inhaled corticosteroid during the study period, despite these medications being considered the gold-standard for asthma management.
  2. Our findings did not show clinically important association between inhaled corticosteroids and fracture among children with asthma.
  3. However, systemic corticosteroids (oral or injection) are associated with higher fracture risk in children with asthma (17% higher risk).

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Abuse of Anabolic Steroids May Impair Insulin Resistance For Years After Discontinuation

MedicalResearch.com Interview with:
Jon Rasmussen, MD, PhD fellow
Department of Internal Medicine
Herlev Hospital, Denmark

MedicalResearch.com: What is the background for this study?

Response: Abuse of anabolic androgenic steroids has become highly prevalent among young men involved in recreational strength training. A recent meta-analysis estimated that approximately 18% of young men involved recreational strength training abuse anabolic steroids.

Well-known adverse effects following abuse of anabolic steroids include hypogonadism (For those who have interest, we have recently published a paper concerning this issue, it can be read and downloaded at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161208).

Yet, we have a poor understanding on the adverse effects these compounds might have on the metabolism and insulin sensitivity.

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Steroids May Improve Outcomes For Community-Acquired Pneumonia

Reed A.C. Siemieniuk, MD Department of Clinical Epidemiology & Biostatistics Ontario CanadaMedicalResearch.com Interview with:
Reed A.C. Siemieniuk, MD
Department of Clinical Epidemiology & Biostatistics
Ontario Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Siemieniuk: Local and cytokine-mediated systematic inflammatory responses help clear bacterial pathogens in community-acquired pneumonia (CAP), but often they can also cause harm. Pneumonia is the most common cause of the acute respiratory distress syndrome (ARDS), an often fatal inflammatory complication. Two randomized trials were published earlier this year, each of which suggested the possibility of  benefit from adjunctive corticosteroid therapy. We decided to perform a systematic review and meta-analysis, taking all available data into consideration.

Corticosteroids may be effective for reducing the incidence of ARDS by 6%, the need for mechanical ventilation by 5%, and mortality by 3% (all moderate confidence). They also reduce time to clinical stability and time to discharge by approximately 1 day (high confidence).

For an interactive summary of findings table that shows the study’s findings, please see: http://isof2.epistemonikos.org/#/finding/550bc6acf30d0c43083e63a0.

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Role of Steroids Post Tonsillectomy Explored

MedicalResearch.com Interview with:
Sayaka Suzuki, MD
Department of Clinical Epidemiology and Health Economics, School of Public Health, Faculty of Medicine, Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo, Japan

Medical Research: What are the main findings of the study?

Dr.  Suzuki: We found a slight increase in the risk of severe bleeding requiring surgery for hemostasis in children who were administrated intravenous steroid on the day of tonsillectomy.

Physicians should carefully make a decision to use steroids, taking into account patients’ choice under being well informed on the risks and benefits of steroid use.
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How Does Prednisone Affect TB Infections in Patients With and Without HIV?

Bongani M. Mayosi, M.B., Ch.B., D.Phil. Department of Medicine, Old Groote Schuur Hospital Cape Town, South AfricaMedicalResearch.com Interview with:
Bongani M. Mayosi, M.B., Ch.B., D.Phil.
Department of Medicine, Old Groote Schuur Hospital
Cape Town, South Africa

Medical Research: What are the main findings of this study?

Dr. Mayosi: In those with definite or probable tuberculous pericardial effusion:

(1)       Prednisolone for 6 weeks and Mycibacterium indicus pranii  for three months had no significant effect on the combined outcome of death from all causes, cardiac tamponade requiring pericardiocentesis or constrictive pericarditis.
(2)      Both therapies were associated with an increased risk of HIV-associated malignancy.
(3)       However, use of prednisolone reduced the incidence of constrictive pericarditis and hospitalization.
(4)       The beneficial effects of prednisolone on constriction and hospitalization were similar in HIV-positive and HIV-negative patients

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Inflammatory Bowel Disease: Call to Standardize Perioperative Steroids

Elizabeth C. Wick, MD Assistant Professor,Department of Surgery The Johns Hopkins Hospital, Baltimore, MarylandMedicalResearch.com Interview with:
Elizabeth C. Wick, MD
Assistant Professor,Department of Surgery
The Johns Hopkins Hospital, Baltimore, Maryland

 

MedicalResearch.com: What are the main findings of the study?

Dr. Wick: The main finding is the high variability in physician practice for prescribing steroids and the lack of clear guidance as to best practice in the literature.
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Preterm Infants and Effects of Antenatal Steroids

Dr. Elizabeth V. Asztalos, MD, M.Sc., FRCPC Sunnybrook Health Sciences Centre 2075 Bayview Ave., Room M4 230 Toronto, ON M4N 3M5MedicalResearch.com Interview with:
Dr. Elizabeth V. Asztalos, MD, M.Sc., FRCPC
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Room M4 230
Toronto, ON M4N 3M5

 

MedicalResearch.com What are the main findings of the study?

Answer: This study was focused to see if there were differences in the main neurodevelopmental outcomes of children whose mothers had participated in the original MACS trial. We found that there were no differences in the main outcomes of the trial as it related to the aspects of death and/or developmental. Continue reading