Mg Of Betamethasone Research Articles

A case of chronic spontaneous urticaria with wheals lasting for more than a week.

Urticaria is characterized by the development of wheals which usually disappear within a day, and are not present beyond a few days. A 58-year-old man began to develop edematous, partially ring-shaped erythematous lesions accompanied by severe body itching without any particular cause, approximately 2 months before his first visit to our hospital. Each rash emerged as being about 5 mm in diameter, gradually enlarging over several days, and disappeared in up to 10 days. Despite oral treatment with several antihistamines and 10 mg of prednisolone, there was no improvement. Most eruptions disappeared without a trace, but the erythema that appeared on the palms left desquamation. The patient had a history of shellfish allergy, but otherwise no atopic diseases. Drug eruption was ruled out due to a lack of regular taking other medications. Histopathological findings of the skin lesions showed moderate lymphocytic and few eosinophilic infiltrates with edema, but no evidence of vasculitis. Despite the concomitant use of two second-generation antihistamines and montelukast, the rash did not improve. The symptoms began to improve following oral intake of 1.5 mg of betamethasone, which was tapered off with the addition of 150 mg of cyclosporin. The use of all medications was stopped at 4 months from the first visit without recurrence. Wheals of chronic spontaneous urticaria may last for longer than a week without apparent histopathological findings of vasculitis.

Under what conditions is the intra-articular steroid injection superior to nonsteroidal anti-inflammatory drugs for treating sacroiliac joint pain?

The purpose of this prospective study was to determine the conditions under which intra-articular injection therapy may be superior to nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with sacroiliac joint pain in the outpatient setting at our hospital. Patients with sacroiliac pain were divided into two groups: NSAID and the sacroiliac injection group. The NSAID group received 25 mg of indometacin orally once a day and 750 mg of naproxen orally once a day. In the sacroiliac injection group, 5 mg of betamethasone were injected into the sacroiliac joint. The patients' history of lumbar surgery, whether they had sacroiliitis, and the duration of pain were recorded. The patients' VAS (Visual analogue scale) scores at week 1 and month 1 were evaluated. VAS scores were decreased after the first week and first month in the sacroiliac injection group compared to the NSAID group (p<0.001). Sacroiliac steroid injection was found to be superior to NSAIDs in reducing VAS scores in patients with sacroiliitis, a history of lumbar surgery, and pain lasting more than 30 days (p<0.001). In patients without sacroiliitis, without a history of lumbar surgery, and with less than 30 days of pain, no difference was observed between the groups in reducing VAS scores at the end of the first month. In patients with sacroiliac joint pain, sacroiliac joint injection is superior to NSAIDs in pain relief in patients with pain for more than 30 days, those with MRI-diagnosed sacroiliitis, and those who have undergone lumbar surgery.

Chronic shoulder injury related to vaccine administration following coronavirus disease 2019 vaccination: a case report

BackgroundShoulder injury related to vaccine administration, defined as shoulder pain and limited range of motion occurring after administration in the upper arm, has been previously reported. The symptom resolved completely after treatment with oral nonsteroidal anti-inflammatory drugs or an intraarticular steroid injection, however there have been few reports of long-term symptoms following coronavirus disease 2019 vaccination. This case report describes a healthy, middle-aged, healthcare worker who developed post-vaccination subacromial–subdeltoid bursitis that lasted for more than 6 months after Pfizer–BioNTech coronavirus disease 2019 vaccination.Case presentationA 55-year-old Japanese woman with no significant medical history was vaccinated in the standard site, with the needle direction perpendicular to the skin. Within a few hours after the second vaccination, severe shoulder pain and limited range of motion appeared. Although shoulder range of motion improved, her shoulder pain did not improved for several months, and she consulted an orthopedic doctor 5 months later. Radiographs of her left shoulder did not provide helpful diagnostic information. High intensity in the subacromial–subdeltoid space was seen on short TI inversion recovery of magnetic resonance imaging, showing subacromial–subdeltoid bursitis. She was diagnosed with a shoulder injury related to vaccine administration. The patient was started on an oral anti-inflammatory drug, and the left subacromial space was injected with 2.5 mg of betamethasone with 3 ml of 1% lidocaine without epinephrine every 2 weeks. One month after starting this treatment, since her shoulder pain had not improved, the oral anti-inflammatory drug was switched to tramadol hydrochloride acetaminophen. However, 3 months after switching medication, the shoulder pain continued, and she worked so as to have minimal impact on her shoulder.ConclusionA case of subacromial–subdeltoid bursitis following a second dose of the Pfizer–BioNTech coronavirus disease 2019 vaccine that lasted many months is reported. Injection technique is a modifiable risk factor, the adverse effects of which could potentially be mitigated with appropriate and relevant training of healthcare providers. To prevent this type of case, the appropriate landmark, needle length, and direction should be confirmed.

The Influence of Bolus of Methylprednisolone on Postorthognathic Surgery Symptoms: A Controlled Clinical Trial.

Despite improvements in maxillary and mandibular osteotomy, complications still result in around 20%. Post and intraoperative standard therapies, based on the use of betamethasone and tranexamic acid, could help to minimize the onset of side effects. The aim of the study was to compare the role of a supplementary bolus of methylprednisolone rather than the standard therapy in the onset of postoperative symptoms. The authors enrolled 10 patients, affected by class 2 and 3 Dentoskeletal, submitted to the institution for maxillomandibular repositioning osteotomy between October 2020 and April 2021. Patients were divided into 2 groups as follows: 5 patients (group A) received standard therapy consisting of the administration of 4mg of betamethasone, intraoperatively, and 1 g of tranexamic acid in 2 administrations. The remaining 5 patients (group B) received a supplementary bolus of 20mg methylprednisolone before the end of the surgery.All patients received, in the postoperative period, 4mg of betamethasone every 12 hours, for 3 days. Postoperative outcomes were evaluated with a questionnaire evaluating speaking discomfort, pain when swallowing, feeding discomfort, drinking discomfort, swelling, and ache. Each parameter was associated with a numeric rating scale ranging from 0 to 5. The authors observed that patients treated with a supplementary bolus of methylprednisolone (group B) had a statistically significant reduction of all postoperative symptoms as compared with patients of group A (*P < 0.05, **P<0.01 Fig. 1). The study highlighted that the additional bolus of methylprednisolone improved all of the 6 parameters investigated by the questionnaire submitted to patients, resulting in a faster recovery and improvement of the patient's compliance with surgery. Further studies with a larger population are needed to confirm preliminary results.

Neonatal Outcomes for Women at Risk of Preterm Delivery Given Half Dose Versus Full Dose of Antenatal Betamethasone: A Randomized, Multicentre, Double-blind, Placebo-Controlled, Non-inferiority Trial

ABSTRACT Antenatal corticosteroid administration to women at risk of preterm delivery is recommended worldwide because of their effectiveness in preventing respiratory distress syndrome, as well as in reducing the rate of necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death in preterm infants. However, the current usual dosage regimen of 2 injections of 12 mg of betamethasone (BMZ) 24 hours apart originated from preclinical experiments in the 1960s and has not been investigated in randomized clinical trials. These authors therefore designed a randomized trial for investigating whether a half dose of BMZ would be as effective as the standard full-dose regimen. The primary outcome was the need for exogenous surfactant within the first 48 hours of life. Secondary outcomes included the incidence and severity of respiratory disease, such as respiratory distress syndrome. This randomized, multicenter, double-blind placebo-controlled, noninferiority study was conducted in 37 perinatal centers in France. Pregnant women 18 years or older with singleton pregnancies at risk of delivery preterm (and already treated with dose 1 of antenatal BMZ before 32 weeks' gestation) were eligible to participate. Exclusion criteria included multiple pregnancy, having previously received full-dose antenatal corticosteroids, 4 cm or greater cervical dilation, cervical length of 20 mm or greater, fetal major malformations or chromosomal aberrations, or being unable to communicate fluently in French. Upon hospital admission after the first BMZ injection, women were provided information about the trial, and those who agreed were randomly assigned in a 1:1 ratio to receive either a saline placebo or the second intramuscular BMZ dose. A total of 3196 women participated, with 1597 in the half-dose group and 1599 in the full-dose group. In all, 30 fetuses were stillborn, 16 neonates were lost to follow-up, and 9 neonates died before evaluation, leaving 1567 neonates in the half-dose group and 1574 neonates in the full-dose group. In the intention-to-treat analysis, the primary outcome occurred in 313 (20%) of neonates in the half-dose group and 276 (17.5%) in the full-dose group (risk difference, 2.4%; 95% confidence interval [CI], 0.3–5.2); thus, noninferiority was not shown. The per-protocol analysis also did not show noninferiority (risk difference, 2.2%; 95% CI, −0.6 to 5.1). There were no differences in the rates of neonatal death, grade 3 to 4 intraventricular hemorrhage, stage ≥2 necrotizing enterocolitis, severe retinopathy of prematurity, or bronchopulmonary dysplasia. Between the 2 groups, all other secondary prematurity-associated outcomes were also similar. Strengths of the study included its large sample size and low loss-to-follow-up rate (0.5%), as well as consistent perinatal management approach through the Groupe de Recherche en Obstetrique et Gynecologie. However, the study also had limitations, such as the potential for the primary outcome to be considered a short-term surrogate only partially reflecting the overall severity of neonatal illness. The rate of the primary outcome observed in the study was also 2.5% lower than anticipated, which the authors attribute to the numbers of deliveries that occurred before 32 weeks' gestation and beyond 7 days following treatment. The number of births occurring within this window of time may limit the ability to demonstrate true differences between the 2 groups, meaning that the authors could not rule out the possibility of half-doses being inferior given higher preterm birth rates. In addition, long-term evaluation of the infants involved in the study via a follow-up evaluation at 5 years of age will be critical to determining the overall effect of BMZ dose reduction on neurological development. The authors concluded that this trial indicated the half-dose antenatal BMZ regimen did not meet criterion for noninferiority when compared with the currently recommended regimen in singleton pregnancies for preventing respiratory distress syndrome that requires exogenous intratracheal surfactant.

Investigation of the potential of leukoreduction filters in the creation of anti-inflammatory compound

BackgroundSome viruses such as SARS, SARS-CoV-2, and MERS cause an imbalance in immune responses and leads to an acute inflammatory reaction named cytokine storm. In this situation, an anti-inflammatory component can modulate the immune system and decrease mortality. The aim of this study was investigate the potential of leukoreduction filters (LRFs) in creating an anti-inflammatory compound. Materials and methodsIn this experimental study, firstly optimal dose of the anti-inflammatory drug was obtained through LRFs treatment with 0.1 mg, 0.4 mg, 0.6 mg of Betamethasone. Then inflammatory and anti-inflammatory cytokine in gene and protein level was evaluated. In the next step, LRFs were categorized into treatment 1, treatment 2, control assay, and control groups and treated with the optimal dose of the drug. Finally, the obtained compound was investigated for the concentration of IL1, IL6, and TNF-α as inflammatory and IL4, IL1Ra, and IL10 as anti-inflammatory cytokines. ResultsThe results of the current study showed that the concentration of 0.4 mg of Betamethasone lead to a significant increase of anti-inflammatory cytokine in gene and protein levels. The results also showed that the Betamethasone treated groups (treatment1) causes a significant increase in the secretion of anti-inflammatory cytokine compares to the control while inflammatory cytokine remained at the control level. ConclusionThe results showed that under influence of anti-inflammatory drug treatments the production and secretion of anti-inflammatory cytokines can be induced in LRFs.

A rare form of intoxication: acute methyl ethyl ketone peroxide poisoning.

We report two suicidal cases of acute methyl ethyl ketone peroxide (MEKP) poisoning. A woman in her late 60s suffered from oral mucosal erosion, functional impairment of the heart, liver and other organs, pulmonary inflammation, elevated inflammatory markers, pleural effusion, hypoproteinemia and metabolic acidosis after oral administration of approximately 50 mL of MEKP. After admission, the patient was administered hemoperfusion four times, 8 mg of betamethasone for 6 days and symptomatic support. Hemoperfusion had an obvious effect on the treatment of oral MEKP poisoning. After discharge, the patient developed progressive dysphagia and secondary esophageal stenosis. Supplementary feeding was administered with a gastrostomy tube after the patient was completely unable to eat. A man in his mid-40s developed oropharyngeal mucosal erosion, bronchitis and esophageal wall thickening after oral administration of 40 ml MEKP. After receiving total gastrointestinal dispersal, 80 mg of methylprednisolone was administered for 7 days, and symptomatic supportive treatment was provided. Slight dysphagia was observed after discharge, and there was no major effect on the quality of life. Patients with acute oral MEKP poisoning should be followed up regularly to observe its long-term effects on digestive tract corrosion and stenosis.

Puncture technologies in the treatment of pain syndrome caused by sacroiliac joint dysfunction

Sacroiliac joint (SIJ) dysfunction is a cause of low back pain in 10–30% of cases. In 1993, the International Association for the Study of Pain (IASP) defined the following set of diagnostic criteria necessary to diagnose SIJ dysfunction: 1) the presence of pain in the areas characteristic of SIJ lesions, with special attention to pain in the Fortin area projection, with possible different types of radiation; 2) positive pain provocation tests for a SIJ lesion; 3) reduced pain after intra-articular anesthetic injection; 4) the lack of a specific nature of the lesion (fracture, inflammation, tumor, etc.). Injection of 0.5–2.5 ml of solution of an anesthetic (bupivacaine, lidocaine) and 20–40 mg of triamcinolone or 5 mg of betamethasone (1 ml) into the SIJ area is used as interventional technologies. More prolonged analgesia involves radiofrequency denervation (RFD) of the SIJ, in which needles with electrodes are placed in the projection of the nerves that innervate the SIJ, and their local thermal destruction is performed. The effectiveness of RFD of SIJ requires further investigation.

Efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and QOL in patients with OSF

ObjectivesTo assess the efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and quality of life (QOL) in patients with oral submucous fibrosis. Study designSixty patients were divided in 4 groups; group A received 8 mg of betamethasone, group B received 3000 IU of hyaluronidase, group C received the combination of betamethasone and hyaluronidase and group D received saline injections biweekly for 5 weeks. Patients were also assessed using QOL questionnaire. ResultsMouth opening and oral burning of the four groups for final visit, using the pretreatment opening as a covariate showed significant difference for group A, B, C. ConclusionBetamethasone and hyaluronidase injections appears to be a viable option to increase mouth opening with reduction in burning sensation

Effect of cocktail therapy after arthroscopic rotator cuff repair: a randomized, double-blind trial

We investigated the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR). We evaluated 128 shoulders undergoing ARCR and used block randomization to divide patients into 2 groups in this double-blind trial: The cocktail group received 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 mg of epinephrine, 2 mg of betamethasone, and saline solution to a total of 42 mL, whereas the control group received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL. Postoperatively, one of the drug mixtures was injected into the glenohumeral joint, subacromial bursa, suprascapular nerve, and anterior, middle, and posterior parts of the deltoid muscle according to the treatment group. We recorded patients' visual analog scalescores preoperatively and at 4, 8, 16, 24, and 48 hours postoperatively; the number of patients using postoperative diclofenac suppositories and buprenorphine hydrochloride; the number of patients experiencing nausea; the number of patients with infection and delayed wound healing as adverse effects; the surgery time; the retear rate; and passive shoulder range of motion. The cocktail group constituted 64 shoulders (50.0%), with 39 men (60.9%)and 25 women (39.1%); the mean age was 64.2 ± 10.2 years. The control group constituted 64 shoulders (50.0%), with 41 men (64.1%) and 23 women (35.9%); the mean age was 65.2 ± 7.5 years. We found no significant difference in age or sex between the 2 groups. There was also no significant difference in rotator cuff tear size or surgery time between the 2 groups. The visual analog scale scores at 8, 16, and 24 hours postoperatively were significantly lower in the cocktail group. The number of patients using suppositories was also significantly lower in the cocktail group. The number of patients receiving buprenorphine injections tended to be lower in the cocktail group, but the difference was not significant. Nausea occurred in 6.3% of patients in the cocktail group and 15.6% in the control group, but the difference was not significant. No infection or delayed wound healing occurred in either group. There was no significant difference in the retear rate between the 2 groups. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group than in the control group. We compared cocktail therapy and ropivacaine after ARCR and found no difference in results except for VAS score at 8, 16, and 24 hours postoperatively and frequency of postoperative suppository use without an apparent risk of infection or a detrimental effect on tendon healing.

Evaluation of the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean

Background: Compared with vaginal delivery, early-term cesarean section (CS) is associated with an increased risk of neonatal respiratory morbidity. Given the role of steroids in lung maturation in preterm labor, few studies have investigated their effects on early-term delivery. Therefore, this study aimed to investigate the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean (37–38 weeks and 6 d).Methods: This randomized clinical trial was conducted in Mahdieh Hospital in Tehran in 2017. Women with single pregnancy who were candidates for planned elective CS in 37–38 weeks and 6 d of gestation were randomly assigned to either betamethasone group (intramuscular injection of 12 mg of betamethasone in two doses with an interval of 24 h from the 37th week of gestation) or control group (routine treatment). Then, neonatal respiratory morbidities, hospitalization in NICU, and its cause and duration were recorded and compared between the two groups.Results: Of all, 16 neonates (7%) suffered from one or more respiratory morbidities, and there was no significant difference between the betamethasone and control groups (six cases (6%) and 10 cases (9%), respectively, p = .299). There was also no significant difference between betamethasone and control groups in terms of the frequency of respiratory morbidities at the gestational age of 37 and 38 weeks (p > .05). Grunting, retraction, or nasal flaring was the most common respiratory morbidity that was observed in 13 neonates (6%). We observed the need for CPAP in three neonates (1%), respiratory distress syndrome (RDS) in three neonates (1%), transient tachypnea of the newborn (TTN) in two neonates (1%), need for resuscitation at birth in one neonate (0.5%), and apnea in one neonate (0.5%). There was no significant difference between the two groups in terms of respiratory morbidities (p > .05). A total of 17 neonates (8%) were admitted to NICU; the number of neonates admitted to NICU was significantly lower in betamethasone group than in the control group (three neonates (7.2%) and 14 neonates (12.7%), respectively, p = .005). Respiratory distress in 11 neonates (5%), sepsis in two neonates (1%), and other cases in four neonates (2%) were the main reasons for NICU admission. The prevalence of respiratory distress, as a cause for admission, was significantly lower in the betamethasone group (p = .005).Conclusion: The findings of this study showed that intramuscular injection of 12 mg of betamethasone in two doses, with an interval of 24 h, after 37 weeks of gestation in women undergoing early-term CS did not have a significant effect on respiratory morbidities in neonates. However, it decreased the frequency of admission to NICU, especially admission due to respiratory distress; it could indicate that the respiratory morbidities were less severe in betamethasone group than in the control group.

Evaluation of the effect of antenatal betamethasone on neonatal respiratory morbidities in late preterm deliveries (34–37 weeks)

Background: Since late preterm neonates (34–36 weeks) are more at risk of respiratory morbidities, the present study was conducted to evaluate the effect of antenatal betamethasone on neonatal respiratory morbidities in women with late preterm delivery.Methods: This randomized clinical trial was performed on 240 women with single pregnancy that was at high risk of late preterm delivery (34–37 weeks). The patients were randomly assigned to either betamethasone (intramuscular injection of 12 mg of betamethasone in two doses with an interval of 24 hours) or the control group. The two groups were compared with each other in terms of respiratory morbidities, NICU admission and its cause and duration, hospitalization in the neonatal ward for more than 6 hours, and the duration of hospitalization.Results: Of all, 79 neonates (33%) had one or more respiratory morbidities. The observed morbidities in the betamethasone group were significantly less prevalent than those in the control group (19 neonates (16%) and 60 neonates (50%), respectively, p < .001). The most frequently observed respiratory morbidity was needed for oxygen for more than an hour (34 infants, 14%). The need for oxygen for more than an hour, the need for continuous positive airway pressure (CPAP), respiratory distress syndrome (RDS), and the need for surfactant were significantly less observed in betamethasone group than in the control group. A total of 43 neonates (18%) were admitted to NICU and then hospitalized in the neonatal ward; the number of admitted neonates were significantly lower in the betamethasone group than in the control group (11 neonates (9%) and 32 neonates (27%), respectively, p < .001). Moreover, 15 neonates (6%) were admitted to the neonatal ward and there were no significant differences between the betamethasone and control groups (10 neonates (8%) and 5 neonates (4%), respectively, p = .182). Totally, 58 neonates (24%) were hospitalized; the number of hospitalized neonates was significantly lower in the betamethasone group than in the control group (21 neonates (18%) and 37 neonates (31%), respectively, p = .016).Conclusion: The results of this study showed that the antenatal administration of betamethasone in late preterm delivery (34–37 weeks) can improve respiratory morbidities and decrease the frequency of NICU admission.

The Use of Feathers from Racing Pigeons for Doping Control Purposes.

The development of accurate and reliable analytical methodologies to detect the abuse of doping agents in sport animals is crucial to ensure their welfare, as well as to support continuing social acceptance of these sports. The detection of doping agents in racing pigeons is difficult, especially owing to the disadvantages and limitations of obtaining samples from conventional matrices. The present study aimed to develop and validate an analytical methodology combining a two-step extraction procedure (liquid-liquid extraction and solid-phase extraction) in feathers from racing pigeons with analysis by liquid chromatography tandem mass spectrometry (LC-MS-MS) that enabled the simultaneous detection of a beta-agonist drug (clenbuterol) and three corticosteroids (prednisolone, betamethasone and budesonide). The method was validated concerning linearity (with coefficients of determination always higher than 0.99), accuracy (87.3-112.4%), precision (repeatability and intermediate precision coefficient of variation (CV%) always below 15%), recovery (71.6-98.2%), limits of detection (0.24-0.52 ng/g) and quantification (0.79 and 0. 1.74 ng/g) and specificity. The applicability of the method was performed using feathers from pigeons administered orally with a daily dose of 0.075 mg of betamethasone. The drug was administered during 60 days and successive analyses of feathers were performed, at the end of the administration protocol and also after ceasing the oral administration of the drug, for a three weeks period.

Comparison between two doses of betamethasone administration with 12 hours vs. 24 hours intervals on prevention of respiratory distress syndrome: a randomised trial

The purpose of the present study was to compare the effect of a two-dose administration of betamethasone with 12 hours interval vs. 24 hours interval on neonatal respiratory distress syndrome (RDS). The study was performed as a randomised clinical trial on 201 pregnant women with a gestational age of 26–34 weeks. In one group 12 mg of betamethasone every 12 hours for two doses and in the other group 12 mg of betamethasone every 24 hours for two doses were prescribed intramuscularly. There were no significant differences between the two groups according to maternal age, parity, gravidity, BMI, neonatal sex, need to surfactant, NICU admission, NICU stay, neonatal death, neonatal sepsis and Apgar score at minutes 1 and 5, but the gestational age at the beginning of the study and delivery receiving complete course of betamethasone and neonatal weight were lower in 24 hours group. RDS, necrotising enterocolitis, intra-ventricular haemorrhage and chorioamnionitis were more in the 24 hours’ group. Multiple regression analysis showed that RDS and IVH (p = .022, RR = 0.07, CI95% 0.006–0.96 and p = .013; RR = 0.9, CI95% 0.1–0.89, respectively) were more in the 24 hours group and neonatal death (p = .034, RR = 4.7, CI95% 1.07–16.2) and NEC (p = 0.038, RR = 2.5, CI95% 1.7–3.7), were more in the 12 hours group. In conclusion, it seems that 12 hours interval betamethasone therapy may be considered as an alternative treatment in the case of preterm labour for acceleration of lung maturity; however, it is suggested that more studies should be performed on this issue and various morbidities.IMPACT STATEMENTWhat is already known on this subject: Administration of a single course of corticosteroids in all women with a gestational age of 24–34 weeks of pregnancy who are at risk for preterm labour and delivery has been recommended. The accepted regimen by National Institutes of Health (NIH) is an injection of betamethasone for two doses with 24 hours interval.What do the results of this study add: Twelve hours interval betamethasone therapy may be considered as an alternative treatment in the cases of preterm labour for acceleration of lung maturity.What are the implications of these findings for clinical practice and/or further research: Prescription of two doses (complete regimen) is more important than the interval between two doses for obtaining the maximum effect in a preterm birth.

Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain

Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called “Alcock syndrome.” Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy. Case Presentation: We present a case of a 51-year-old woman with 5 years of worsening right groin and vulva pain. Various medication trials only lead to limited improvement in pain. The first diagnostic right pudendal nerve block was done using 3 mL of 0.25% bupivacaine with 6mg of betamethasone using a transgluteal technique and a target of the right ischial spine; this procedure resulted in ~8 hours of &gt; 50% pain relief. The patient was then referred for MR neurography of the lumbosacral plexus. This study revealed increased signal of the right pudendal nerve at the ischial spine and in the pudendal canal, findings consistent with the clinical picture of PN. Six weeks after the initial block, the patient underwent a second right transgluteal pudendal nerve block, utilizing 3 mL of 0.25% bupivacaine with 40 mg of triamcinolone acetonide; this procedure resulted in ~8 hours of 100% pain relief. Satisfied with these results the patient decided to undergo pudendal nerve PRF ablation for possible long-term relief. For this therapeutic procedure, a right transgluteal approach was again utilized. PRF ablation was performed for 240 seconds at 42° Celsius. Following this ablation the patient reported at least 6 weeks of significant (&gt; 50%) pain relief. Discussion and Conclusion: In this paper we presented a case of successful treatment of PN with PRF ablation and detection of pudendal neuropathy on MR neurography. We believe that transgluteal PRF ablation for PN might be an effective, minimally invasive option for those patients that have failed conservative management. MR neurography employed in this case is not only helpful in confirming the diagnosis of PN but could also be useful in ruling out other causes of pelvic pain, such as genitofemoral neuropathy, endometriosis, adenomyosis, or pelvic mass lesion. To conclude, transgluteal PRF ablation can serve as a viable treatment option for mitigating symptoms of pudendal neuropathy and MR neurography is useful in confirming a clinically suspected diagnosis of PN. Key words: Pelvic pain, pudendal neuralgia, MR neurography, pulsed radiofrequency ablation, transgluteal technique, Alcock canal syndrome

Efficacy of Betamethasone Oral Mini-Pulse Therapy in the Treatment of Lichen Planus

Lichen planus (LP) is a common inflammatory disorder that affects the skin, mucous membranes, nails and hair. There are various modalities of treatment but none is curative. Betamethasone oral mini-pulse (OMP) therapy has been used effectively and safely in vitiligo, alopecia areata and lichen planus. We sought to evaluate the efficacy and safety of Betamethasone OMP in patients with lichen planus. This prospective study was carried out among patients with lichen planus fulfilling the inclusion criteria, attending the skin and VD outpatient department of Dhaka Medical College Hospital, Dhaka Bangladesh over a period of 6 months from January 2005 to June 2005. A total of 20 patients with lichen planus diagnosed clinically and confirmed by histopathological examination were selected randomly for this study. Among them both male and female were in equal number. The study subjects were treated with 5 mg of Betamethasone orally on 2 consecutive days per week, for 3 months. Treatment response and side effects were monitored 4 weekly. The response was good in 60% and fair in 40% and there was no excellent response. This study indicates that further prospective placebo controlled studies are needed to clarify the efficacy of oral Betamethasone in lichen planus.Faridpur Med. Coll. J. Jul 2015;10(2): 47-49

Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study.

Though recommended for pregnant women at risk of preterm birth to improve perinatal outcomes, antenatal corticosteroid (ACS) treatment can cause maternal hyperglycemia, especially in cases of glucose intolerance. A standardized protocol for preventing hyperglycemia during ACS treatment remains to be established. We herein retrospectively investigated the time-dependent changes in insulin dose required for maternal glycemic control during ACS treatment in gestational diabetes (GDM). Twelve singleton pregnant women with GDM who received 12 mg of betamethasone intramuscularly twice 24 hours apart were included in this analysis. Of those, eight also received ritodrine hydrochloride for preterm labor. The blood glucose levels were maintained at 70-120 mg/dL with continuous intravenous infusion of insulin and nothing by mouth for 48 hours after the first betamethasone administration. After the first dose of betamethasone, the insulin dosage needed for glycemic control gradually increased and reached a maximum (6.6 ± 5.8 units/hr) at 10 hours, then, decreased to 4.1 ± 1.5 units/hr at 24 hours. Similar changes in the insulin requirement were found after the second betamethasone dose (the maximum insulin dosage: 5.5 ± 1.6 units/hr at 9 hours following the second administration). Women treated with ritodrine hydrochloride needed more insulin, than those without ritodrine hydrochloride treatment (130.8 ± 15.0 vs. 76.8 ± 15.2 units/day, respectively, p < 0.05). Our data indicated that the requirement for insulin is highest 9-10 hours after each dose of betamethasone. When GDM is treated with ACS, levels of blood glucose should be carefully monitored, especially in patients treated with ritodrine hydrochloride.

Increased Dose of Betamethasone for Transforaminal Epidural Steroid Injections Is Not Associated with Superior Pain Outcomes at 4 Weeks

Background: Fluoroscopically guided transforaminal epidural steroid injections (FG-TFESIs) have been shown to provide both immediate and long-term improvement in patients’ selfreported pain. Administration of the lowest possible dose of epidural betamethasone is desired to minimize side effects while maintaining efficacy. We hypothesize that a 3 mg or a 6 mg dose of betamethasone will demonstrate equivalent analgesic properties. Objectives: To compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone for use in FG-TFESI. Study Design: Retrospective evaluation. Setting: Academic outpatient pain center. Methods: One hundred fifty-eight patients underwent FG-TFESI for lumbar back pain between 2012 and 2013. Depending on the date of service, a dose of 3 mg or a dose of 6 mg betamethasone was used in the single level unilateral TFESI. Opioid consumption and NRS-11- 11 pain score were analyzed pre-procedurally and at a clinic visit 4 weeks post-procedurally. Results: Changes in numerical rating scale (NRS-11-11) pain score (-1.21 + 2.61 vs. -0.81 + 2.40 respectively, P = 0.17) and changes in opioid consumption as measured in oral morphine equivalents (-2.94 + 16.4 mg vs. -2.93 + 14.8 mg, P = 0.17) were statistically equivalent between both groups. Intergroup sub-analysis of those with &gt; 50% reduction in baseline NRS-11-11 pain score was not different (15.2% vs. 34%, P = 0.56), and the proportion with a VRS pain score &lt; 3 were similar (24.5% vs. 23.8%, P = 0.92). Limitations: Potential selection bias inherent with study design. Conclusions: Reduction in NRS-11-11 pain scores and narcotic usage at 4 weeks after FG-TFESI were statistically equivalent between patients who received 3 mg or 6 mg of betamethasone, suggesting that a lower steroid dose has similar analgesic efficacy. IRB Number: Cedars-Sinai Medical Center Institutional Review Board Pro00031594 Key words: Low back pain, radiculitis, steroids, epidural, transforaminal epidural steroids, chronic pain management

Evaluating the Interleukin 17 Serum Level in Psoriatic Patients from the Eastern Egyptian Population

Objectives: Cytokines released by T helper 17 (Th17) cells maintain psoriatic inflammation. The aim of the study was to determine the serum level of IL-17 in psoriatic patients and to evaluate the effect of the local treatment on the IL-17 level. Materials and Methods: Ninety subjects from both sexes with ages ranging from 20-40 years old were instructed to apply 0.64 mg of Betamethasone Dipropionate (equivalent to 0.5 mg (0.05%) of Betamethasone) and 30 mg (3%) of salicylic acid ointment twice per day for three weeks. For scalp psoriasis, patients were advised to use 0.64 mg of Betamethasone Dipropionate, equivalent to 0.5 mg (0.05%) of Betamethasone and 20 mg (2%) of Salicylic acid lotion twice per day for three weeks. Serum IL-17 concentrations were determined by ELISA on day 0 and day 21. Psoriasis area severity score index (PASI) was evaluated. Results: A statistically significant higher level of IL-17 (p 0.05) in psoriasis area severity score index (PASI) in patients after treatment was observed. Further analysis indicated that there was no significant correlation between serum IL-17 level and PASI Score before therapy.

P17.02: Fetal thymus and steroid treatment: the effect of prenatal therapy on sonographic measurements

Ultrasound (US) studies of fetal thymus size in utero are reported in physiological and in complicated pregnancies. In literature, the effect of prenatal steroid treatment on the fetal immune system and thymus size is demonstrated. The aim of the study is to determine if there is an US anatomical change in fetal thymus correlated to administration of prenatal steroids. The study population [n = 6 pregnant women attending for programmed Caesarean section (CS) near term] was compared to a control group (n = 7) with similar maternal and fetal characteristics [gestational age (±1 week), maternal age, body mass index (BMI), parity and mean percentile of estimated fetal weight (EFW)]. In the study group two doses of 12 mg of betamethasone were administered at 24 hours intervals within 7 days before delivery. The patients underwent a detailed US evaluation to assess fetal biometry, EFW and thymic diameter and circumference within 48 hours before delivery. Neonatal outcomes (Apgar score, birthweight, neonatal infection up to 7 days post-delivery) were also recorded for the study. US measurements of thymic transverse diameter and perimeter of the study group were significantly reduced than controls, 18% and 19%, respectively (p < 0.05). A reduction of thymic perimeter was also confirmed considering birthweight (perimeter/birthweight ratio; p < 0.05). No statistical evidence was obtained when we considered the diameter/birthweight ratio (p = ns). No statistical differences were reported considering neonatal outcomes. Despite of restricted number of cases, our results show an evident influence of steroid prenatal administration on fetal thymus size. Moreover, rectifying by birthweight, is evident only a reduction of thymus circumference. This is a preliminary study that could open up the possibility to investigate the correlation of fetal thymic function and its anatomical change.