History Of Steroid Administration Research Articles

Steroids May Be Associated With Extensive Skeletal Muscle Uptake of 18F-FDG.

The possibility of steroid administration inducing the extensive skeletal muscle uptake (ESMU) of FDG in PET scans was investigated. From 8923 consecutive 18F-FDG PET/CT scans taken at our hospital, 23 scans (15 patients) met adult age and ESMU-positive inclusion criteria. Among the 15 patients, 13 with both ESMU-positive and -negative scans were examined for association with steroid administration. Extensive skeletal muscle uptake was associated with a history of steroid administration (χ2 test: P = 0.001). Notably, 20 ESMU-positive scans and 11 ESMU-negative scans were significantly different, with 0 to 95 days (median, 18.5 days) and 0 to 708 days (median, 319.0 days) since the last steroid administration, respectively (Mann-Whitney U test, P = 0.003). A significant correlation was observed between mean skeletal muscle SUVmax and the number of days since the last steroid administration (Spearman rank correlation coefficient, ρ = -0.501, P = 0.004). Specifically, the degree of ESMU tended to decrease over time, after steroid administration. From multiple regression analysis, the number of days since the last steroid administration was significantly associated with mean SUVmax (P = 0.007), but the blood glucose level was not significant (P = 0.204), revealing that the number of days since the last steroid administration was an independent risk factor. Multicollinearity was low (the variance inflation factor was 1.007 for both the number of days since the last steroid administration and blood glucose levels). Steroid administration within months before PET may be one cause of ESMU.

Clinical investigation of a unique type of hypothalamic adrenal insufficiency.

Hypothalamic adrenal insufficiency (AI) is a rare but distinct type of AI. The leading cause of hypothalamic AI is a secondary side-effect of exogenous steroid intake, particularly in large amounts and/or long-term periods. The next cause would be the effect of the tumor in the hypothalamic lesions. We show here 9 cases of hypothalamic AI without any disorder on imagings and a history of steroid administration. All patients had general fatigue; 7 patients (77.8%) had a history of hypoglycemia; 5 patients (55.6%) had a history of hypotension. None of the patients had hyponatremia, hyperkalemia, or eosinophilia. Their morning plasma adrenocorticotropic hormone (ACTH) value was low at 8.5 ± 4.2 pg/mL, and serum cortisol value was low at 4.5 ± 1.3 µg/dL. All patients demonstrated normal responses during the corticotropin-releasing hormone loading (CRH) test but inadequate responses during the insulin tolerance test (ITT). After hydrocortisone replacement therapy, their morning plasma ACTH and serum cortisol values were significantly recovered (P < .05). Moreover, more than half of the patients were fine after discontinuing hydrocortisone replacement therapy. These results indicate that this unique type of hypothalamic AI has a curable clinical course making hydrocortisone replacement therapy a novel therapeutic option.

IDF21-0421 High blood sugar as a risk factor for post COVID-19 rhino-orbital-cerebral mucormycosis

Background: Mucormycosis is an invasive fungal infection which is known to cause involvement of paranasal sinuses, orbits and brain. It occurs mainly in immunocompromised patients. The recent COVID-19 pandemic has led to a sudden upsurge of mucormycosis in COVID recovered patients in India leading to high mortality despite of antifungal therapy and surgical debridement. We studied the association of COVID-19 with diabetes with the use of steroids in the occurrence of this life-threatening infection. Aim: To study the epidemiological profile of post COVID-19 mucormycosis patients presenting to a tertiary care teaching hospital. Method: All patients more than 20 years of age, who got admitted with various complaints in the months of June and July, 2021 (with preceding history of COVID-19 within last 3 months) and diagnosed as one or the other forms of mucormycosis were included in the study. Risk factors for all were assessed. Results: Total 37 patients got admitted in mucor unit in two months (21 males, 16 females). Commonest age of presentation was between 51 to 60 years. After biopsy and imaging, 18 (48.65%) patients were diagnosed as rhino-orbital mucormycosis, 11 (29.73%) as rhino-orbital-cerebral mucormycosis and 8 (21.62%) as rhino-cerebral mucormycosis. Out of the 37 patients, 31 were known diabetics while rest 6 were recently diagnosed to present with high sugar. All these patients had a history of steroid administration during their COVID infection with poor blood sugar management and 17 patients also had history of taking oxygen therapy for their respiratory symptoms during the COVID illness. Discussion: There has been a steep rise in the cases of various types of mucormycosis after COVID-19 infection post-second wave in India. Almost all such patients have a common risk factor of uncontrolled blood sugar along with steroid use. A careful approach of strict sugar control with judicious use of steroids can minimise a lot of cases of this serious life-threatening infection.

CLINICAL PROFILE OF RHINO-OCULO-CEREBRAL MUCORMYCOSIS PATIENTS IN TERTIARY HEALTH CARE CENTRE.

BACKGROUND- The objective of this study was to determine the clinical prole and risk factors associated in the patients of mucormycosis. – It was a descriptive hospital-based study in conducte METHODS d in tertiary health care for a period of 5 months Detailed history, clinical examination, laboratory investigations were documented and SION score was calculated for each patient The study group consisted of 70 male (59%) and 49(41%) female, with mean age being 55 years RESULTS – 80 (67%) patients were known case of diabetes mellitus patients. 99 (83%) patients had history of covid 19 infection, while history of steroid administration was seen in 36 (6%) patients. Most common presenting symptom was facial, nasal followed by orbital complains. It was observed that patient with history of steroid intake had higher SION score compared to those who did not and showed a positive corelation between steroid administration and SION score(1) with p value being 0.043. Uncontrolled diabetes and over use of steroids in COVID CONCLUSION- management are two main risk factors associated with post covid 19 mucormycosis. A strong suspicion based on clinical features helps in early diagnosis and treatment and therefore a better outcome.

A fungal epidemic amidst a viral pandemic: Risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis in India

ABSTRACT Purpose To study the risk factors for development of COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) during the COVID-19 pandemic in India. Methods Multi-centric retrospective case-control study conducted from October 2020 to May 2021. Cases comprised of consecutive patients of COVID-19-associated ROCM (CA-ROCM) presenting at the participating ophthalmic institutes. Controls comprised of COVID-19-positive or COVID-19-recovered patients who did not develop ROCM. Comparative analysis of demographic, COVID-19 infection, treatment parameters and vaccination status between cases and controls performed. Clinical and imaging features of CA-ROCM analyzed. Results There were 179 cases and 361 controls. Mean age of presentation in cases was 52.06 years (p = .001) with male predominance (69.83%, p = .000011). Active COVID-19 infection at the time of presentation of ROCM (57.54%, p < .0001), moderate to severe COVID-19 (p < .0001), steroid administration (OR 3.63, p < .00001), uncontrolled diabetes (OR 32.83, p < .00001), random blood sugar >178 mg/dl were associated with development of CA-ROCM. Vaccination showed a protective effect (p = .0049). In cases with intracranial or cavernous sinus extension there was history of steroid administration (OR 2.89, p = .024) and orbital apex involvement on imaging (OR 6.202, p = .000037) compared to those with only rhino-orbital disease. Conclusion Male gender, active COVID-19 infection, moderate or severe COVID-19, uncontrolled diabetes, steroid administration during COVID-19 treatment are risk factors for developing rhino-orbital-cerebral mucormycosis. Vaccination is protective. Random blood sugar of >178 mg/dl in COVID-19 positive or recovered patients should warrant close observation and early detection of ROCM. Presence of ophthalmoplegia, blepharoptosis at first clinical presentation and orbital apex involvement on imaging are associated with intracranial extension in ROCM.

Early repair of necrotic lesion of the femoral head after high-degree posterior rotational osteotomy in young patients-a study evaluated by volume measurement using magnetic resonance imaging.

We investigated the repair of femoral head necrosis with extensive necrotic lesions treated by high-degree posterior rotational osteotomy (HDPRO) in young adults and adolescents (mean age; 30.8 years) using magnetic resonance imaging (MRI). HDPRO was performed on 72 hips from 66 cases, and of those, 60 hips from 60 cases were included in this study for data analysis. All cases had extensive collapsed lesion preoperative anteroposterior radiographs. In total, 34 hips were male and 26 were females. In total, 19 had a history of steroid administration, 11 had a previous femoral neck fracture, 7 had no particular etiologic factor, and 4 had a followed slipped capital femoral epiphysis. Antero-inferior viable areas were transferred to the loaded portion below the acetabular roof by this operation. The mean posterior rotational angle was 118.5°. MRI was taken after 1 month, 6 months and 1-year post-operatively. Post-operative necrotic lesion volume compared with the preoperative necrotic lesion volume was defined as lesion volume ratio (%). The reduction of necrotic volume was observed over time, and at 1 year post-operatively, it was 19.4% for patients in their teens, 35.3% for those in twenties, 42.8% for those in their thirties and 59.5% for those in their forties. From this study, we concluded that the extensive necrotic lesions decreased in size within a short period after HDPRO in young patients.

G.P.163: Clinical features of Duchenne muscular dystrophy aged over 40 years

In the muscular dystrophy wards of 27 hospitals in Japan, of which 26 belong to the National Hospital Organization, and the other is the National Center of Neurology and Psychiatry, there are 733 patients diagnosed as Duchenne muscular dystrophy (DMD). Among them, 119 patients are 40 years and older. To elucidate their clinical feature, we made survey of their condition and medical treatment. Questionnaire includes results of gene analysis, muscle biopsy findings, time of loss of ambulation, respiratory condition, nutrition, treatment for cardiomyopathy, steroid therapy, and history of spinal fusion. Information of 79 patients was obtained. Among them, we analyzed data of 48 patients diagnosed based on loss of ambulation before 12 years old and gene analysis or muscle biopsy findings showing negative immunostaining of Dystrophin. Their age ranged from 40.2 to 51.0 years old (mean 43.7). Age of introduction of mechanical ventilation ranged from 15 to 40 years old (mean 24). Present respiratory conditions were non-invasive ventilation in 25 patients, and tracheal intermittent positive pressure ventilation in 23. Thirty-five patients preserved oral nutritional supply function, and others supplied with tube feeding. Ejection fraction of echocardiography ranged from 6 ∼ 69% (mean 46 n = 35), and the level of brain natriuretic peptide from 5.7 to 519 pg/ml (mean 52.9, n = 33). Medication for cardiomyopathy was as follows; 16 cases of beta-blocker, 25 angiotensin converting enzyme inhibitor, 21 diuretics, and 17 digitalis. Fourteen cases were administered more than 3 agents, whereas 9 no medication for cardiomyopathy. Three cases were administered steroid presently. Except them, there was no history of steroid administration. No spinal fusion was done in patients. Progress in multidisciplinary medical care for respiratory failure, cardiomyopathy, nutritional problems, and other related factors has extended the lifespan of DMD patients.