Role Of Glucocorticosteroids Research Articles

Sepsis like a severe complication of autoimmune liver disease in gastroenterological patients

In article we present particular qualities of disease pattern and methods of treatment in patients with ulcer colitis associated with primary sclerosing cholangitis and autoimmune hepatitis. Course of disease was complicated by bacterial cholangitis, sepsis, multiple organ failure. There are described pathogenetic features of autoimmune livers and bowel illness. It was shown the role of bacterial translocation of microbes. There are described about differential diagnostic of primary and secondary cholangitis. Features of curing the patients are reminded in critical conditions are reviewed in article. There sketched role of glucocorticosteroids in critical care. Modern guidelines for the management the patients with overlap syndrome are highlighted. Patient D. was admitted to hospital in intensive care unit. There disease patterns of collapse, systemic inflammation response syndrome. The examination was established exacerbation of ulcer colitis complicated inflectional morbidity with sclerosing cholangitis and autoimmune hepatitis. This condition led to sepsis and multiple organ failure. Instead of intensive care there was a progressive deterioration until near death experience. Resuscitation procedure within 6 minutes were successful. Multiple areas of necrosis have developed on the limbs because of multiple organ failure and intensive vasopressors therapy. Glucocorticosteroids were prescribed in combination with antibacterial drugs were assigned because of ulcerative colitis’s exacerbation and cytolysis, regardless sepsis. On the thirtieth day of stay in hospital, the patient D. was transferred from the intensive care unit to the gastroenterology department, where the treatment was continued. Because of the cure signs of multiple organ failure, infectious complications, exacerbation of ulcerative colitis and primary sclerosing cholangitis were regressed. We supervise of patient.

Morphofunctional assessment of the gastric mucosa in patients with bronchial asthma

Summary. Morphological characteristics of gastric mucosa in patients with asthma of different severity with regard to corticosteroid therapy were described in this article. The aim of this study was to substantiate optimized standards of asthma treatment. Clinical and morphological investigations were conducted at the city clinical hospital № 31. We investigated all structural components of the gastric mucosa in biopsy specimens with light binocular microscopy and performed morphometric study of inflammatory infiltrates. As a result, several signs of protective effect of inhaled corticosteroids on gastric mucosa were found. We did not obtain any results that could confirm the key role of glucocorticosteroids in occurrence of gastrointestinal erosions in asthma patients. Therefore, prevention of erosive gastritis and other inflammatory gastrointestinal diseases in asthma patients should consider other risk factors besides glucocorticosteroid therapy and cover all stages of asthma.

Corticosteroids in severe pneumonia: Table 1—

The mortality rate in severe community- or hospital-acquired pneumonia is very high, ranging 20-50%. Despite advances in antimicrobial therapy and supportive measures, this rate has not changed in recent years, suggesting that other factors are also responsible for the poor outcome. An abnormal increase in the local and systemic inflammatory response is associated with poor outcome, and this occurs despite adequate antibiotic therapy. There is evidence that acute administration of corticosteroids decreases the inflammatory response and might decrease mortality in severe pneumonia. This has been shown in one small randomised controlled study, terminated prematurely due to 0% mortality in the intervention arm. In addition, an experimental study showed that glucocorticosteroids decrease lung inflammatory response and lung bacterial burden, confirming the results obtained through in vitro investigations. Although these results are promising and suggest a novel role of glucocorticosteroids in pneumonia, the inherent risks and potential side-effects of these drugs require further controlled clinical trials in order to better define the target population before their general use in clinical practice. Specifically, dosage, period of administration, titration, tapering and side-effects are some of the key questions that need to be investigated.

The Protective Role of Steroids in Ischemia-Reperfusion Injury of the Liver

Liver ischemia-reperfusion injury occurs in a number of clinical settings, including liver surgery, transplantation, and circulatory shock, leading to significant morbidity and mortality. There is a substantial evidence that hepatic ischemia-reperfusion injury results from an intense inflammatory response initiated by oxidative stress in the liver parenchyma during reperfusion. The anti-inflammatory effects of glucocorticosteroids (GCs) have been known for decades and have found extensive therapeutic use in a wide range of clinical situations associated with organ ischemia. Based on their biological effects, routine perioperative GCs administration has been advocated to reduce hepatic ischemic injury. However, the use of GCs in hepatic surgery remains controversial and clinical benefits are still uncertain. The aim of this review is to present the experimental and clinical evidence about the role of GCs in modulating hepatic ischemia-reperfusion injury.

Corticosterone in thin-billed prion Pachyptila belcheri chicks: diel rhythm, timing of fledging and nutritional stress

Glucocorticosteroids (GCs) of the hypothalam-pituitary-adrenal axis play a role in association with both stressful events and daily life processes. However, relatively little is known about the role of GCs in relation to daily and seasonal life processes in animals in the wild. In this paper, we present data on basal levels of plasma corticosterone CORT in chicks of a pelagic seabird, the thin-billed prion, Pachyptila belcheri, during two predictable changes in demands, the daily activity pattern and the preparation for fledging. By comparing chicks fed recently with unfed chicks, we test how GC levels are modified according to nutritional condition. In accordance with their nocturnal feeding rhythm, chicks had a clear daily rhythm with increased CORT secretion at night, but CORT levels during the active phase were also highly elevated in unfed chicks compared with fed chicks. Close to fledging, chicks rapidly increased basal CORT levels, and again unfed chicks had higher levels than fed chicks, although the age effect here was stronger than the effect of recent feeding. The present data thus support the hypothesis that GC levels are adjusted to life stages with predictable changes in demands, but food availability and/or internal energy stores also affect the level to which GCs increase.

Lipid malabsorption persists after weaning in rats whose dams were given GLP‐2 and dexamethasone

Glucagon-like peptide-2 (GLP-2) enhances intestinal growth and absorption in mature animals, and glucocorticosteroids (GC) increase the sugar and lipid uptake in adult animals. However, the role of GC and GLP-2 in the ontogeny of lipid absorption is unknown. We hypothesized that GLP-2 and the GC dexamethasone (DEX), when administrated to rat dams during pregnancy and lactation, would enhance lipid uptake in the offspring. Rat dams were treated in the last 10 d of pregnancy and during lactation with GLP-2 [0.1 microg/g/d subcutaneous (sc)], DEX (0.128 microg/g/d sc), GLP-2 + DEX, or a placebo. Sucklings were sacrificed at 19-21 d of age, and weanlings were sacrificed 4 wk later. Lipid uptake was assessed using an in vitro ring uptake method. Although DEX and GLP-2 + DEX increased the jejunal mass, the jejunal lipid uptake was unchanged. In contrast, GLP-2, DEX, and GLP-2 + DEX reduced the ileal lipid uptake in suckling and weanling rats. This reduction was not due to alterations in intestinal morphology or to changes in fatty acid-binding protein abundance, but it was partially explained by an increase in the effective resistance of the intestinal unstirred water layer. In sucklings, DEX dramatically reduced the jejunal lipid uptake to levels similar to those seen in weanlings, such that the normal ontogenic decline in lipid uptake was not observed. Giving dams GLP-2 or DEX during pregnancy and lactation reduced lipid uptake in the offspring, and this persisted for at least 1 mon. The impact this may have on the nutritional well-being of the animal in later life is unknown.

Glucocorticosteroids in Allergic Inflammation: Clinical Benefits in Allergic Rhinitis, Rhinosinusitis, and Otitis Media

Allergic rhinitis, rhinosinusitis, and otitis media are among the most common health problems encountered in general practice. Although frequently trivialized, they affect the quality of life, represent a significant socioeconomic burden, and are associated with some serious complications. In addition, allergic rhinitis, rhinosinusitis, and otitis media are often considered as comorbidities. These disorders involve an inflammatory process of the respiratory mucosa of the nose, paranasal sinuses, or middle ear. Because of their well-known anti-inflammatory effects, the role of glucocorticosteroids in the management of these three disorders has been questioned, evaluated, and, in some cases, established.

Neurosteroids in the Hippocampus: Neuronal Plasticity and Memory

The hippocampus, which is critically involved in learning and memory processes, is known to be a target for the neuromodulatory actions of steroid hormones produced by the adrenal glands and gonads. Much of the work of B.S. McEwen and collaborators has focused on the role of glucocorticosteroids and estrogen in modulating hippocampal plasticity and functions. In addition to hormones derived from the endocrine glands, cells in the hippocampus may be exposed to locally synthesized neurosteroids, including pregnenolone, dehydroepiandro-sterone and their sulfated esters as well as progesterone and its reduced metabolites. In contrast to hormones derived from the circulation, neurosteroids have paracrine and/or autocrine activities. In the hippocampus, they have been shown to have trophic effects on neurons and glial cells and to modulate the activity of a variety of neurotransmitter receptors and ion channels, including type A gamma-aminobutyric acid, N-methyl-D-aspartate and sigma receptors and N- and L-type Ca2+ channels. There is accumulating evidence that some neurosteroids, in particular pregnenolone sulfate, have strong influences on learning and memory processes, most likely by regulating neurotransmission in the hippocampus. However, the hippocampus is not the only target for the mnesic effects of neurosteroids. Associated brain regions, the basal nuclei of the forebrain and the amygdaloid complex, are also involved. Some neurosteroids may thus be beneficial for treating age- or disease-related cognitive impairments.

Clinical Applications of Pharmacologic Therapies for Spinal Cord Injury

We review the evidence supporting the role of glucocorticosteroids, trilazad, and GM1 ganglioside in spinal cord injury and provide our critique of the published studies, along with our recommendations for pharmacologic therapy for this complex and difficult problem.

Role of glucocorticosteroids in the treatment of infectious diseases.

The role of glucocorticosteroids in the management of infectious diseases in man remains controversial, although experimental data obtained both in in vitro systems and in experimental infections in animals provide evidence of a beneficial effect of such treatment. Their use in the treatment of Pneumocystis carinii pneumoniae and severe typhoid fever seems indicated. A beneficial effect on the treatment of bacterial meningitis needs to be confirmed. Sufficient data are now available that argue against steroid treatment in septic shock. However, new treatment modalities such as monoclonal antibodies against endotoxin and inflammatory mediators are currently being developed to modulate infectious inflammation. This could also bring a renaissance of the role of glucocorticosteroids in the treatment of infectious diseases.

Role of Glucocorticosteroids in the Regulation of Pancreatic Amylase Synthesis

Both adrenalectomy and chemically induced diabetes mellitus cause a marked decrease of pancreatic amylase activity in rats, but it is unknown whether these effects are the result of a direct or indirect mechanism. The synthesis of various pancreatic enzymes has been studied in isolated pancreatic acini from sham-operated, castrated, and adrenalectomized animals as well as in animals that have been both adrenalectomized and castrated. Protein synthesis was measured by pulse labeling of acini with [35S]methionine followed by either trichloroacetic acid precipitation of total protein and counting or by SDS-PAGE and autoradiography, and additionally by in vitro translation of extracted pancreatic RNA using rabbit reticulocytes. Adrenalectomy resulted in a 70% reduction of amylase activity per milligram of acinar protein as a result of a decrease in amylase synthesis. This reduction in amylase synthesis is a consequence of a decrease in the amount of mRNA coding for amylase. After adrenalectomy, plasma concentrations of the following were reduced compared to controls: corticosterone to 0.45%, insulin to 11%, and glucose to approximately 66%. Addition of glucose to the drinking water caused an increase in insulin and plasma glucose, but this was not followed by an increase in amylase activity. We postulate that corticosterone directly regulates amylase synthesis in the rat pancreas.

Inhibition of antibody synthesis by histamine in concanavalin A-treated mice: the possible role of glucocorticosteroids.

Administration of histamine (50 mg/kg) to BALB/C mice injected with concanavalin A (Con A) (100 micrograms, i.v.) 24 hr previously, results in a marked decrease in antibody synthesis to sheep red blood cells (SRBC) injected 2 hr later. This phenomenon occurs with nonimmunosuppressive doses of Con A and is strain-specific. It does not take place in the response to the T-independent antigen polyvinylpyrrolidone (PVP) or if histamine is administered after the antigen. Adoptive transfer of normal syngeneic cells at the same time as antigen does not reverse this effect. Excess suppressor cell generation was excluded by co-cultivation of treated spleen cells with normal cells in vitro and by determining their antibody response to SRBC 5 days later. 2-Methylhistamine, a histamine type 1 (H1) receptor agonist, mimicks the effect of histamine whereas dimaprit, a histamine type 2 (H2) receptor agonist, does not. Because histamine interaction with H1 receptors causes the release of adrenocorticotropic hormone (ACTH), we examined the effects of ACTH and corticosterone in this system and found that both could mimick the effect of histamine. These results suggest that the interaction of histamine with H1 receptors causes the release of glucocorticosteroids that may interfere with either Con A-activated T helper cell function or macrophage processing of T-dependent antigen.