Methylprednisolone Sodium Succinate Research Articles

ANAPHYLAXIS TREATMENT OR TRIGGER? A CASE REPORT OF REACTION TO DIPHENHYDRAMINE AND STEROIDS AS PREMEDICATIONS

Introduction Anaphylaxis affects 1.6%-5.1% of adults. Treatment with epinephrine is generally effective, and supplementary medications can be used for prevention/treatment of anaphylactoid symptoms. Common adjuncts include corticosteroids and antihistamines. Radiocontrast is necessary for evaluation of certain conditions and cannot always be avoided even with history of reaction. While underlying mechanisms of contrast reactions are not well-understood, premedication with corticosteroids/antihistamines can often be used for prevention of reactions. Case Description 64-year-old male with DM2, hemodialysis-dependent ESRD, and known contrast reactions presented for routine fistulogram and experienced severe anaphylaxis 10 minutes post-administration of IV premedications (methylprednisolone/diphenhydramine), prior to contrast administration. Anaphylaxis resolved after epinephrine, albuterol, and fluids, and he was referred to Allergy for identification of offending agents. Prick/intradermal testing to various steroids/antihistamines was performed. Testing was positive to IV methylprednisolone succinate, IV hydrocorticone succinate, and IV diphenhydramine. Patient has since tolerated PO prednisone, loratadine, and fexofenadine. Discussion Our patient may have anaphylaxed to steroid, succinate, and/or diphenhydramine. Negative testing to prednisolone and prednisone-tolerance make succinate a more likely culprit than steroid, but further testing/challenge is needed to elucidate. Regarding antihistamines, this is one of few reports of reaction/positive testing to diphenhydramine with concurrent negative testing/tolerance to loratadine and fexofenadine. Adjunct therapies for prevention/treatment of allergic reactions can occasionally trigger anaphylaxis. These medications should therefore be included in anaphylaxis workup. Allergy testing may help predict tolerability of alternative agents when similar medications are needed. Given limited reports in the literature, further studies are needed to better determine reliability of testing for these agents and cross-reactivity between them.

Synthesis of poly (amidoamine) (PAMAM) dendrimer-based chitosan for targeted drug delivery and cell therapy

Introduction: In the current study we designed a sophisticated drug delivery nanoparticle to control the methylprednisolone succinate delivery rate and affect the cancer cell growth in culture condition. Materials and methods: Magnetic nanoparticles were synthesized through co-precipitation method. Fe3O4 was first prepared via co-precipitation method and then its surface was functionalized with polyamidoamine (PAMAM) nanodendrimer. PAMAM synthesis trait was detected via FT-IR and SEM methods. Methylprednisolone drug was loaded on PAMAM@Fe3O4 and its effect against cancer cell lines was studied. In order to slow down drug release rate from nanoparticles, PAMAM@Fe3O4 were coated with trimethylchitosan (TMC) after drug loading. Performance of PAMAM@Fe3O4@TMC nanoparticles loaded with mmethylprednisolone, were evaluated against two cell lines to detect the cytotoxic and apoptotic effects by invert light scanning microscopy, immunoassay, and LDH cytotoxicity Kit. Results: According to SEM, image size of Fe3O4 was 4.79-6.37nm, which is smaller than nanodendrimer (6.30-43.67 nm). FT-IR spectrum for ester bond Methylacrylate @ Ethylendiamin was obtained to be 1720-1730 cm-1. FT-IR Spectrums 600 cm-1, 1000 cm-1 belong to Fe3O4, and Fe3O4@ NH2. Also, trimethyl chitosan coated Nanoparticle @ Drug, smearing trimethyl chitosan with Glutaraldehyde, created cross link between TMC monomer at low drug doses in each complete nanoparticle, gave confidence drug side effect, therefore, this nanoparticle could be safe for future cancer therapy. Conclusion: The results showed that drug delivery via PAMAM@Fe3O4 nanoparticle reduces cell viability in vitro condition.

ЛІКУВАННЯ СОБАК З УРАХУВАННЯМ ОСОБЛИВОСТЕЙ ПАТОГЕНЕЗУ ХРЕБЕТНО-СПИННОМОЗКОВИХ ТРАВМ

ЛІКУВАННЯ СОБАК З УРАХУВАННЯМ ОСОБЛИВОСТЕЙ ПАТОГЕНЕЗУ ХРЕБЕТНО-СПИННОМОЗКОВИХ ТРАВМ

Pig tracheal patchy xenotransplantation in the dog

A long-segmental tracheal lesion is difficult to repair by tracheal allotransplantation due to the lack of a well-defined blood supply for blood vessel anastomosis. The donor trachea needs to be revascularized within a well-vascularized soft tissue flap for several months to allow successful trachea allotransplantation. To date, xenotransplantation using the wild-type or genetically modified pig has been widely studied. The object of this study was to evaluate the feasibility of a small-sized (2×2cm) wild-type pig tracheal patchy in a dog tracheal defect model before trying a long-segment tracheal defect model and using a genetically modified pig as a donor in dog xenotransplantation. Three healthy beagle dogs (8-9kg) were used as recipients, and one pig (20kg) was used as the donor. A pig cartilaginous tracheal patchy (2×2cm half tube) was sutured to the tracheal resected site in each dog. Antithymocyte globulin (2.5mg/kg infusion, D0 and 1), tacrolimus (4.5mg/kg, twice a day for 2months), and methylprednisolone sodium succinate (1mg/kg, IV, for 2days and tapering) were administered for immunosuppression. The levels IL-2 and IFN-γ in the serum were measured at D0, 7, and 28. Tracheoscopy was performed at D28, 60, and 90. The recipients were sacrificed at D90, and the expression of dog and pig genes in the graft was evaluated by PCR. Histopathological examination of the graft was conducted. All of the dogs survived without complications during the experimental period. Their IL-2 and IFN-γ levels were significantly increased at D7 after transplantation compared to D0 and D28 (P<0.05). The pig tracheal patchy site was open, and no stenosis was observed until D90 on tracheoscopy, when pale mucosa erosion was observed; there was also remnant suture material at D28. However, the tracheal patchy sites gradually became similar to normal mucosa at D60 and 90. The expression of pig genes was detected in the graft by PCR. Normal epithelium and CD3 cells were observed in the histological examination at D90. In this study, our data suggest that the pig tracheal patchy can be successfully engrafted into the trachea of dog, although erosion of mucosa on the graft was seen at D30, in spite of the discordant species.

A comparative study of lignocaine with methylprednisolone in reducing pain of propofol injection

Background: Propofol is an anaesthetic drug (an induction agent) which is given to induce and maintain anaesthesia. The present study was conducted to compare lignocaine with methylprednisolone in reducing pain of propofol injection. Materials and methods: The present study was conducted on 40 patients of both genders undergoing elective surgery. Patients were divided into 2 groups of 20 each. Group I patients received pre-treatment with lignocaine (20 mg of 2% solution diluted to 2 ml with distilled water), and group II patients received pre-treatment with methylprednisolone sodium succinate (125 mg diluted into 2 ml of distilled water). Pain on propofol injection was evaluated by four-point verbal rating scale. Results: It was seen that 34 patients in group I and 35 in group II had pain score 1, 4 in group I and 2 in group II had 2 and 2 in group I and 3 in group II had score 3. The difference was significant (P< 0.05). Conclusion: Methylprednisolone found to be equally effective in reducing pain of propofol injection when compared with lignocaine.

Spinal Cord Injuries in Dogs Part II: Standards of Care, Prognosis and New Perspectives

Abstract Severe spinal cord injuries (SCI), causing physical handicaps and accompanied by many serious complications, remains one of the most challenging problems in both, human and veterinary health care practices. The central nervous system in mammals does not regenerate, so the neurological deficits in a dog following SCI persists for the rest of its life and the affected animals display an image of permanent suffering. Diagnostics are based on: neurological examination, plain x-rays of vertebral column, x-rays of the vertebral column following intrathecal administration of a water-soluble contrast medium (myelography), x-rays of the vertebral column following epidural administration of a contrast medium (epidurography), computed tomography (CT) and/or magnetic resonance imaging (MRI). Currently, only limited therapeutic measures are available for the dogs with SCIs. They include: the administration of methylprednisolone sodium succinate (MPSS) during the acute stage; early spinal cord decompression; stabilisation of vertebral fractures or luxations; prevention and treatment of complications, and expert rehabilitation. Together with the progress in the understanding of pathophysiologic events occurring after SCI, different therapeutic strategies have been instituted, including the local delivery of MPSS, the utilisation of novel pharmacological agents, hypothermia, and stem/precursor cell transplantation have all been tested in the experimental models and preclinical trials with promising results. The aim of this review is the presentation of the generally accepted methods of diagnostics and management of dogs with SCIs, as well as to discuss new therapeutic modalities. The research strategy involved a PubMed, Medline (Ovid), Embase (Ovid) and ISI Web of Science literature search from January 2001 to December 2017 using the term “spinal cord injury”, in the English language literature; also references from selected papers were scanned and relevant articles included.

Local combined with systemic glucocorticoid treatment of young and middle-aged patients with severe and profound hearing loss

Objective:To investigate the clinical effect of local combined with systemic glucocorticoid injection on young and middle-aged patients with severe and profound hearing loss. Method:Ninety-three cases of young and middle-aged patients with severe and profound hearing loss admitted to our hospital from May 2013 to May 2017 were retrospectively analyzed. Patients were divided into two groups according to the different treatment. Forty-six cases in control group were treated with systemic injection of glucocorticoids.Forty-seven cases in observation group were treated with local administration combined with systemic glucocorticoid therapy. The efficacy, changes of average hearing threshold and the incidence of adverse reactions were evaluated.Result:The total effective rate in the observation group was 68.09%, which was significantly higher than that in the control group (45.65%,P<0.05).After treatment, the average hearing thresholds in the observation groups of 0.5,1.0,2.0 and 4.0kHz were(35.77±13.28)dB HL,(39.71±14.09)dB HL, (32.99±10.73)dB HL and (30.17±9.29)dB HL respectively,which were significantly higher than that in the control group(26.30±14.03)dB HL,(25.14±13.28)dB HL,(20.54±9.27)dB HL,and (20.98±8.71)dB HL(P<0.05).Among all the patients received systemic injection of dexamethasone sodium phosphate injection,there was no other complications were found except for one patient whose blood pressure instability was relieved after treatment stopping. In the observation group, intratympanic methylprednisolone sodium succinate did not cause serious complications such as tympanic cavity infection and perforation of the tympanic membrane on the basis of systemic injection.While in the observation group,one case complained of earache and one case complained of a slight burning sensation in the ear, and both of them eased after rest.Conclusion:Local combined with systemic glucocorticoid treatment of young and middle-aged patients with severe and profound hearing loss can significantly improve the efficiency and increase the average hearing threshold changes at 0.5,1.0,2.0 and 4.0 kHz,and there was no serious adverse reactions.

Nebulization of Cyclic Arginine-Glycine-(D)-Aspartic Acid-Peptide Grafted and Drug Encapsulated Liposomes for Inhibition of Acute Lung Injury.

Acute lung injury (ALI) is a fatal syndrome in critically ill patients. It is characterized by lung edema and inflammation. Numerous pro-inflammatory mediators are released into alveoli. Among them, interleukin-1beta (IL-1β) causes an increase in solute permeability across the alveolar-capillary barrier leading to edema. It activates key effector cells (alveolar epithelial and endothelial cells) releasing inflammatory chemokines and cytokines. The purpose of the study was to demonstrate that nebulized liposomes inhibit ALI in vivo. In vivo ALI model was simulated through intra-tracheal instillation of IL-1β solution (100μg/mL in PBS, pH7.2, 200μL) in male Sprague-Dawley rats. Various formulations were tested in ALI induced rats. These formulations include plain liposomes (PL), methylprednisolone sodium succinate solution (MPS solution), cRGD-peptide grafted liposomes (LcRGD) and methylprednisolone sodium succinate encapsulated and cRGD-peptide grafted liposomes (MPS-LcRGD). Formulations were nebulized in vivo in rats using micro-pump nebulizer. Liposome formulations exhibited higher levels of drug concentration in lungs. The physicochemical parameters demonstrated that the liposome formulations were stable. On the basis of aerodynamic droplet-size, nebulized formulations were estimated to deposit in different regions of respiratory tract, especially alveolar region, Among the formulations, MPS-LcRGD caused significant reduction of edema, neutrophil infiltration and inflammation biochemical marker levels. From the results, it can be inferred that nebulization of targeted liposomes had facilitated spatial and temporal modulation of drug delivery resulting in alleviation of ALI.

Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids

Intravenous (IV) administration of corticosteroids is the standard of care in the treatment of acute optic neuritis. However, it is uncertain whether a bioequivalent dose of corticosteroid administered orally, which may be more cost-efficient and convenient for patients, is as effective as IV administration in the treatment of acute optic neuritis. To determine whether recovery of vision following treatment of acute optic neuritis with a high-dose IV corticosteroid is superior to that with a bioequivalent dose of an oral corticosteroid. This single-blind (participants unblinded) randomized clinical trial with 6-month follow-up was conducted at a single tertiary care center in London, Ontario, Canada. Participants were enrolled from March 2012 to May 2015, with the last participant's final visit occurring November 2015. Patients 18 to 64 years of age presenting within 14 days of acute optic neuritis onset, without any recovery at time of randomization and without history of optic neuritis in the same eye, were screened. Inclusion criteria included best-corrected visual acuity (BCVA) of 20/40 or worse and corticosteroids deemed required by treating physician. In total, 89 participants were screened; 64 were eligible, but 9 declined to participate. Thus, 55 participants were enrolled and randomized. Primary analysis was unadjusted and according to the intention-to-treat principle. Participants were randomized 1:1 to the IV methylprednisolone sodium succinate (1000-mg) or oral prednisone (1250-mg) group. Primary outcome was recovery of the latency of the P100 component of the visual evoked potential at 6 months. Secondary outcomes were the P100 latency at 1 month and BCVA as assessed with Early Treatment Diabetic Retinopathy Study letter scores on the alphabet chart and scores on low-contrast letters at 1 and 6 months. Of 55 randomized participants, the final analyzed cohort comprised 23 participants in the IV and 22 in the oral treatment groups. The mean (SD) age of the cohort was 34.6 (9.5) years, and there were 28 women (62.2%). At 6 months' recovery, P100 latency in the IV group improved by 62.9 milliseconds (from a mean [SD] of 181.9 [53.6] to 119.0 [16.5] milliseconds), and the oral group improved by 66.7 milliseconds (from a mean [SD] of 200.5 [67.2] to 133.8 [31.5] milliseconds), with no significant difference between groups (P = .07). Similarly, no significant group difference was found in the mean P100 latency recovery at 1 month. For BCVA, recovery between the groups did not reach statistical significance at 1 month or 6 months. In addition, improvements in low-contrast (1.25% and 2.5%) BCVA were not significantly different between treatment groups at 1 or 6 months' recovery. This study finds that bioequivalent doses of oral corticosteroids may be used as an alternative to IV corticosteroids to treat acute optic neuritis. clinicaltrials.gov Identifier: NCT01524250.

Efficacy of Intraoperative, Single-Bolus Corticosteroid Dose to Prevent Postoperative Respiratory Complication after Transhiatal Esophagectomy

Introduction: Esophageal cancer is among the most common malignancies. Hospital mortality in the past decade reduced; but its morbidity is still high. Pulmonary complications are the most common complications after esophageal resection. In this study we examined the effect of steroids administration during surgery to reduce postoperative morbidity with a focus on respiratory complications.Material and Methods: Patients with esophageal cancer who underwent transhiatal esophagectomy, randomly divided into two groups to thirty patients: The intervention group (received 125mg methylprednisolone sodium succinate). After surgery, patients admitted in the ICU for a day. Oral feeding initiated on day 7th and patients discharged home on the day 8th or 9th.Postoperative complications included anastomotic fistula, wound infection in the neck and abdomen and pulmonary complications. We analyzed pulmonary complications included pneumonia, Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) occurred before the seventh day. The leukocyte counts and CRP levels measured on the 2nd and 7th days after surgery.Results: 60 patients enrolled in the study. Incidence of ARDS, ALI and pneumonia in the control group was 3, 5 and 2 and in steroid group 1, 1 and 1 respectively. CRP levels and blood leukocyte count was similar in two groups on the second day but seventh day values and difference between the two levels between the second and seventh days were significantly different between the two groups (p<0.001).Conclusion: Intraoperative single dose corticosteroids are effective in preventing pulmonary complications after transhiatal esophagectomy. Methylprednisolone reduced the increase in CRP levels after surgery and decreased blood leukocyte count more in postoperative period.

Early and late preventive effect of Nigella sativa on the bleomycin-induced pulmonary fibrosis in rats: An experimental study.

Pulmonary fibhrosis is a disease of the connective tissues in the respiratory system. Nigella sativa has been used for the treatment of pulmonary diseases like asthma. This study investigated the early and late preventive effect of methanolic extract of N. sativa on a bleomycin- induced pulmonary fibrosis model. This study was carried out using 52 rats. Pulmonary fibrosis was induced by a single endotracheal injection of bleomycin (5 mg/kg). Extract of N. sativa (500 mg/kg per day) or methylprednisolone succinate (4 mg/kg per day) was injected intraperitoneally in two periods (i.e. days 1-14 as early preventive group and days 15-28 days as late preventive group). The lung tissues were histologically examined at the end of each period and inspected for the amount of hydroxyproline and biomarkers of oxidative stress. The pulmonary inflammation and fibrosis were significantly decreased in groups treated with methylprednisolone and N. sativa extract compared to bleomycin group in both early and late prevention groups (p<0.001). The hydroxyproline concentration in pulmonary tissue was significantly decreased in N. sativa and methylprednisolone groups compared to the bleomycin group in both prevention groups (p<0.001). Significant reductions in lipid peroxidation (p<0.001) and increases in catalase activity were also observed in N. sativa and methylprednisolone groups compared to bleomycin group. This study suggested that N. Sativa extract is effective for early and late prevention of pulmonary fibrosis and inflammation. However, more studies are needed to identify its anti-inflammatory and anti-fibrotic mechanisms in the respiratory system.

Self-assembled nanoformulation of methylprednisolone succinate with carboxylated block copolymer for local glucocorticoid therapy.

A new self-assembled formulation of methylprednisolone succinate (MPS) based on a carboxylated trifunctional block copolymer of ethylene oxide and propylene oxide (TBC-COOH) was developed. TBC-COOH and MPS associated spontaneously at increased concentrations in aqueous solutions to form almost monodisperse mixed micelles (TBC-COOH/MPS) with a hydrodynamic diameter of 19.6 nm, zeta potential of -27.8 mV and optimal weight ratio ∼1:6.3. Conditions for the effective formation of TBC-COOH/MPS were elucidated by comparing copolymers and glucocorticoids with different structure. The micellar structure of TBC-COOH/MPS persisted upon dilution, temperature fluctuations and interaction with blood serum components. TBC-COOH increased antiradical activity of MPS and promoted its intrinsic cytotoxicity in vitro attributed to enhanced cellular availability of the mixed micelles. Intracellular transportation and hydrolysis of MPS were analyzed using optimized liquid chromatography tandem mass spectrometry with multiple reaction monitoring which showed increased level of both MPS and methylprednisolone in neuronal cells treated with the formulated glucocorticoid. Our results identify TBC-COOH/MPS as an advanced in situ prepared nanoformulation and encourage its further investigation for a potential local glucocorticoid therapy.

Досвід оперативного лікування собак при зміщеннях міжхребцевих дисків

Досвід оперативного лікування собак при зміщеннях міжхребцевих дисків

Use of glucocorticoids in patients with COPD exacerbations in China: a retrospective observational study.

Background:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common in patients with underlying moderate to severe COPD and are associated with increased health and economic burden. International and Chinese guidelines recommend using glucocorticoids for the management of AECOPD because glucocorticoid therapy has been shown to benefit clinical outcomes. However, only scant data are available for current status of glucocorticoid therapy in hospitalized AECOPD patients in China. The aim of the study was to identify current use of glucocorticoids for the treatment of AECOPD in China.Methods:This retrospective, multicenter, noninterventional study evaluated the treatment pattern of AECOPD in patients hospitalized from January 2014 to September 2014 at 43 sites (41 tertiary hospitals and two secondary hospitals) in China. The endpoints of the study were the percentage of patients receiving glucocorticoids by different routes of administration, doses and duration, mortality, and the mean length of hospitalization.Results:A total of 4569 patients (90.17%) received glucocorticoids for AECOPD treatment. A combination of nebulized and systemic route was most frequently used (40.51%), followed by using nebulized route alone (38.00%), systemic route alone (15.45%), and inhaled route other than nebulization (6.04%). Furthermore, the most commonly prescribed glucocorticoids of the nebulized, intravenous, inhaled (other than nebulized) and oral route was budesonide (69.4%), methylprednisolone sodium succinate (45.31%), fluticasone propionate (19.54%), and prednisone acetate (11.90%), respectively. The in-hospital mortality rate was 1.24% and the mean length of hospitalization was 12.22 ± 6.20 days (± SD).Conclusions:Our study was the first study of the treatment pattern of glucocorticoids in the management of hospitalized AECOPD patients in China. Data indicates that there is a gap in the implementation of international guidelines for the treatment of AECOPD in China. Further studies are warranted to clarify the appropriate glucocorticoids strategy for the management of AECOPD to determine the optimal route of administration, dose and duration, and resulting clinical outcomes.

Mechanism of Neuroprotection Against Experimental Spinal Cord Injury by Riluzole or Methylprednisolone.

Any spinal cord injury carries the potential for persistent disability affecting motor, sensory and autonomic functions. To prevent this outcome, it is highly desirable to block a chain of deleterious reactions developing in the spinal areas immediately around the primary lesion. Thus, early timing of pharmacological neuroprotection should be one major strategy whose impact may be first studied with preclinical models. Using a simple in vitro model of the rat spinal cord it is possible to mimic pathological processes like excitotoxicity that damages neurons because of excessive glutamate receptor activation due to injury, or hypoxic/dysmetabolic insult that preferentially affects glia following vascular dysfunction. While ongoing research is exploring the various components of pathways leading to cell death, current treatment principally relies on the off-label use of riluzole (RLZ) or methylprednisolone sodium succinate (MPSS). The mechanism of action of these drugs is diverse as RLZ targets mainly neurons and MPSS targets glia. Even when applied after a transient excitotoxic stimulus, RLZ can provide effective prevention of secondary excitotoxic damage to premotoneurons, although not to motoneurons that remain very vulnerable. This observation indicates persistent inability to express locomotor activity despite pharmacological treatment conferringsome histological protection. MPSS can protect glia from dysmetabolic insult, yet it remains poorly effective to prevent neuronal death. In summary, it appears that these pharmacological agents can produce delayed protection for certain cell types only, and that their combined administration does not provide additional benefit. The search should continue for better, mechanism-based neuroprotective agents.

Safety of intrathecal route: focus to methylprednisolone acetate (Depo-Medrol) use.

Complications of the intrathecal route may cause potential toxicity related to the medicaldevice and properties of theadministered drugand/or excipient. A description of clinical and histological effects of polyethylene glycol and miripirium after Depo-Medrol injection, and the adverse reactions of particulate methylprednisolone acetate was conducted. The safety of theintrathecal route with excipients,label and off-label drugs is discussed. A bibliographicsearch inMedline, Google, and Cochrane database from 1940 to June 2016 was performed. The keywords included 'intrathecal methylprednisolone acetate', 'miripirium', 'myristyl-gamma-picolinium', 'side effects', 'intrathecal Depo-Medrol', 'polyethylene glycol', and 'intrathecal devices' used individually or in combination. Adverse reactions have been reported with this intrathecal administration route such as arachnoiditis, bladder dysfunction, headache, meningitis. Some pharmaceutical excipients have been associated with specific toxicity issues and with allergic and anaphylaxis reactions. Additives of methylprednisolone acetate formulations suchas polyethylene glycol and miripirium chloride can be neurotoxic when injected intrathecally. Polyethylene glycol-an antimicrobial agent widely used in pharmaceutical drugs-has been associated with cardiovascular, hepatic, respiratory, and CNS toxicity. Intrathecal methylprednisolone acetate (Depo-Medrol)therapy seems not fully safe due to reported adverse events. The use of other forms of corticosteroid therapy free from excipientsshould be emphasized such as soluble methylprednisolone sodium succinate.

Anaphylactic shock with methylprednisolone sodium succinate in a child with short bowel syndrome and cow\u2019s milk allergy

BackgroundMedications with methyl-prednisolone sodium succinate containing lactose, which potentially contains traces of cow’s milk proteins (CMP), could cause allergic reactions or compromise treatment of acute allergic reactions in sensitized patients.Case presentationWe describe the unusual case of a one-year-old child affected by short bowel syndrome and history of severe cow’s milk allergy (CMA) and anaphylactic reaction due to intravenous administration of methyl-prednisolone sodium succinate (Solu-Medrol 40 mg, Pfizer). He was admitted to our hospital for severe respiratory failure and was initially treated with methyl-prednisolone (Urbason 40 mg, Sanofi Aventis), then with methyl-prednisolone sodium succinate (Solu-Medrol 40 mg, Pfizer). After the intravenous administration of second steroid, immediate anaphylaxis was recorded and treatment was stopped. Antihistamine and epinephrine were required and symptom resolution occurred.ConclusionChildren who are highly sensitive to milk may have severe allergic reactions also after exposure to CMP through a different administration route than the oral one. Patients who have food allergies need to pay particular attention to the prescription of drugs and their formulation.

Modelling the adsorption and controlled release of drugs from the pure and amino surface-functionalized mesoporous silica hosts

Several mesoporous silica materials with different structures were investigated as matrices for controlled drug delivery. The aim of this study is correlating the textural and surface chemical properties of these materials with the adsorption and delivery of the drug model methylprednisolone sodium succinate. The materials were synthetized according to different protocols, and employing both cationic and non-ionic surfactants. Additionally, the functionalization of the materials' surface with 1-[3-(trimethoxysilyl)propyl]diethylenetriamine (DT) was accomplished to study the synergistic effect of the incorporation of amine groups and textural properties on the loading and delivery of drug. The thermodynamics and dynamic adsorption behavior of these materials were determined and fitted to several isotherms models to provide information about the drug adsorption processes. The maximum adsorption capacities of the raw silica supports were correlated with the pore size and the results indicated that the drug adsorption ability improved as the material pore size increases. Moreover, it is observed that the drug adsorption on materials with mesoporous size higher than 10 nm are very close to the theoretical saturation capacity. Regarding amino-modified materials, isotherms models confirmed that the factor governing the adsorption process were mainly the electrostatic interactions, hydrogen bonding and/or hydrophobic-hydrophilic interactions between the drug moieties and amino-functionalized silica surfaces, and in a lesser degree the textural properties of the support. Furthermore, the kinetics of the drug release from these materials functionalized with amino groups were also modelled to finally obtain a correlation between the adsorption and release drug cargo from the host pure and surface-functionalized materials.

Lessons learned from administration of high-dose methylprednisolone sodium succinate for acute pediatric spinal cord injuries.

OBJECTIVE Methylprednisolone sodium succinate (MPSS) has been studied as a pharmacological adjunct that may be given to patients with acute spinal cord injury (ASCI) to improve neurological recovery. MPSS treatment became the standard of care in adults despite a lack of evidence supporting clinical benefit. More recently, new guidelines from neurological surgeon groups recommended no longer using MPSS for ASCI, due to questionable clinical benefit and known complications. However, little information exists in the pediatric population regarding MPSS use in the setting of ASCI. The aim of this paper was to describe steroid use and side effects in patients with ASCI at the authors' Level 1 pediatric trauma center in order to inform other hospitals that may still use this therapy. METHODS A retrospective chart review was conducted to determine adherence in ordering and delivery according to the guideline of the authors' institution and to determine types and frequency of complications. Inclusion criteria included age < 17 years, blunt trauma, physician concern for ASCI, and admission for ≥ 24 hours or treatment with high-dose intravenous MPSS. Exclusion criteria included penetrating trauma, no documentation of ASCI, and incomplete medical records. Charts were reviewed for a predetermined list of complications. RESULTS A total of 602 patient charts were reviewed; 354 patients were included in the study. MPSS was administered in 59 cases. In 34 (57.5%) the order was placed correctly. In 13 (38.2%) of these 34 cases, MPSS was administered according to the recommended timeline protocol. Overall, only 13 (22%) of 59 patients received the therapy according to protocol with regard to accurate ordering and administration. Among the patients with ASCI, 20 (55.6%) of the 36 who received steroids had complications, which was a significantly higher rate than in those who did not receive steroids (8 [24.2%] of 33, p = 0.008). Among the patients without ASCI, 10 (43.5%) of the 23 who received steroids also experienced significantly more complications than patients who did not receive steroids (50 [19.1%] of 262, p = 0.006). CONCLUSIONS High-dose MPSS for ASCI was not delivered to pediatric patients according to protocol with a high degree of reliability. Patients receiving steroids for pediatric ASCI were significantly more likely to experience complications than patients not receiving steroids. The findings presented, including complications of steroid use, support removal of high-dose MPSS as a treatment option for pediatric ASCI.

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate.

Introduction:The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI).Methods:A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.”Results:The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI”; (2) “We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option”; and (3) “We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI.”Conclusions:These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.