Steroid Dose Research Articles

Severe pediatric asthma therapy: Omalizumab-A systematic review and meta-analysis of efficacy and safety profile.

Omalizumab is the first biological therapy used to treat moderate-to-severe asthma and certainly the one with the highest number of publications. A systematic review and meta-analysis were performed to examine two critical outcomes of omalizumab therapy, asthma exacerbation rate, the reduction of the use of inhaled corticosteroids (ICS), and the improvement of the lung function as a secondary outcome using the following keywords in the MEDLINE database: "anti-IgE, severe asthma, children, and randomized controlled trial." We specifically selected papers that included moderate-to-severe asthma patients and collected data on children and adolescents. Four RCT studies (total number of patients = 1,239) were included in the analysis. The reported data on exacerbations showed an overall improvement in the exacerbation rate with a decreased use of inhaled steroids and some other minimal clinically important difference (MCID). Our systematic review confirms the known findings that omalizumab therapy decreases asthma exacerbation rate and reduces background therapy inhaled steroid dose. Therefore, add-on therapy with omalizumab shows a good efficacy and safety profile, thus proving to be a useful additional therapeutic option. https://www.crd.york.ac.uk/prospero/, identifier: CRD42023396785.

The incidence, risk factors, and outcome of new-onset diabetes among post-COVID-19 patients: A single-center study

Background: Coronavirus disease 2019 (COVID-19) infection may elevate the risk of hyperglycemia and other complications in patients with and without prior diabetes history. It is not clear whether the virus induces type 1 or type 2 diabetes or instead causes a novel form of diabetes. Precise mechanism of diabetes onset in COVID-19 patients remains unresolved. Aims and Objectives: The aims of this study were to know the incidence, risk factors, and outcome of new-onset diabetes among post-COVID-19 patients and association of disease severity and occurrence of new-onset diabetes in post-COVID-19 Patients. Materials and Methods: Patients age more than 18 years, not known diabetic, tested positive with rapid antigen test or reverse transcription polymerase chain reaction admitted to a tertiary care hospital were included in the present prospective observational study. The patients who developed new-onset diabetes during the 3 months follow-up and, the risk factors associated with new-onset diabetes are assessed. Patients with hemoglobin (HbA1c) >6.5% were diagnosed with new-onset diabetes. Results: Total 246 patients were non-diabetics at admission, at 1 week 188 were non-diabetics and 49 were diabetics, and nine were prediabetics. Patients were within the age range of 21–95 years with mean age of 49.46±17.02 years and male predominance (59.76%). Out of 188 non-diabetics, 19 (10.10%) developed new-onset diabetes, and 2 (1.06%) developed new-onset prediabetes after 3 months. Out of 49 diabetics, 19 (38.77%) became non-diabetic, 30 (61.22%) remained diabetic, and out of nine prediabetes 2 (22.22%) developed new-onset diabetes, 5 (55.55%) reversed to non-diabetic, and 2 (22.22%) remained prediabetic after 3 months. In total, from HbA1c at admission and 3 months, 51 subjects had new-onset diabetes (20.73%). Most common risk factors found with occurrence of new-onset diabetes were those on high dose of steroid (P=0.0001), family history of diabetes mellitus (DM) (P=0.001), over weight and obesity (P=0.0001), fungal infection (P=0.0001), and need of oxygen and intensive care unit requirement (P=0.0001). The patient with increased laboratory markers of inflammation such as ferritin, neutrophil leukocyte ratio, lactate dehydrogenase, and C-reactive protein D-dimer had strong association with occurrence of new-onset diabetes (P=0.0001). Conclusion: COVID-19 infection confers an increased risk for type 2 diabetes. Patients of all ages and genders had an elevated incidence and risk for occurrence of new-onset diabetes. Moreover, it was strongly associated with overweight and obesity, steroid dosage, and its duration, disease severity, positive family history of DM, and increased laboratory markers of inflammation. Hence, particular attention should be paid during the first 3 months after COVID-19 infection and patients need to be under follow-up for blood glucose monitoring.

Pulmonary Cryptococcosis and Pulmonary Fibrosis: A Complication of COVID-19 Pneumonia

Acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF) are increasinglyidentified as complications of coronavirus disease 2019 (COVID-19) infection, the latter being managed with taperingdose glucocorticoids. Studies have shown improved outcomes with steroid use in this subset of patients; however, the use of high doses of steroids predisposes these patients to developvarious complications such as opportunistic infections. The incidence of pulmonary cryptococcosis (PC) in patients with post-COVID-19 PF is not known. Here, we discuss a middle-aged male, with no pulmonary comorbidities, who developed PC secondary to the immunocompromised state from high-dose steroid use for the managementof post-COVID-19 PF.

MANAGEMENT AND FUNCTIONAL OUTCOME OF SARS COVID-19 INDUCED RHINO ORBITAL CEREBRAL MUCORMYCOSIS

Background: Rhino-orbital cerebral mucormycosis(ROCM) is an uncommon infection caused by the angiotropic fungus belonging to the order Mucorales and has high morbidity and mortality despite treatment. Rhino-orbital cerebral mucormycosis almost always occurs in immunocompromised hosts, including patients with uncontrolled diabetes mellitus, hematologic cancers, and solid organ or hematopoietic stem cell transplants. The suspicion or diagnosis of rhino-orbital cerebral mucormycosis triggers a medical as well as surgical emergency with the delay in treatment, increasing morbidity and mortality. Aim: 1.outcome of medical management 2.functional outcome and evaluation after medical management 3.complications of mucormycosis 4.outcome after surgical management Methods: 62 SARS covid-19 cases were evaluated who were diagnosed with rhino orbital cerebral mucormycosis.most of the patients presented with ptosis.proptosis.orbital cellulitis,decreased visual acuity,sluggishly reacting pupils, restricted extraocularmovemets.some patients were known diabetics and some diagnosed with diabetes after COVID 19 reovery.Retrobulbar Liposomal Amphotercin –B(3.5mg) was given to all patients for 10 alternate days and simultaneously patients received IV LIPOSOMAL AMPHOTERCIN 300mg OD for 10days renal function tests were monitored. 54 of them improved on day 5 of injection most patient Results: s visual acuity improved from CF –CF to CF>6mts, patients with perception of light didn't show any improvement in visual acuity but ptosis,proptosis,conjunctival congestion and chemosis was improved and 10 patients underwent exenteration. ROCM is seen Conclusion: in most SARS COVID 19 who were known diabetics or post covid -19 induced uncontrolled high sugars most patients received high dose of steroids during covid 19 treatment.most patient showed improvement of symptoms after retrobulbar IV Amphotericin 3.5mg and improvement is observed on MRI stages too and some patients underwent exenteration which prevented furthurer spread of infection

Hashimoto's Encephalopathy: Case Series and Literature Review.

To describe the clinical manifestations of Hashimoto's encephalopathy (HE) and discuss its pathogenesis in light of recent research. The pathogenesis of HE is uncertain. Available evidences point towards an autoimmune etiology due to vasculitis or other inflammatory process. Detection of thyroid antibodies - antithyroid peroxidase and anti-thyroglobulin are essential for diagnosis. Autoimmune encephalitis including Anti-IgLON5 disease needs to be excluded in suspected cases with appropriate tests for neuronal surface antibodies. Detection of thyroid autoantibodies is nonspecific, as these can be detected in some normal individuals and in other autoimmune diseases. In recent years, attention has turned to an aggressive form of Hashimoto's thyroiditis accompanied by elevated serum IgG4 levels in younger males with very high levels of thyroid antibodies. The role of the thyroid autoantibodies in the central nervous system (CNS) tissue damage remains unclear and these can act only as markers for diagnosis. Conversely, they have a role to play in determining the thyroid pathology - more glandular fibrosis associated with thyro-peroxidase antibody than with the thyroglobulin antibody. HE is a syndrome characterized by altered mental status, confusion, hallucinations, delusions, and sometimes seizures, in association with high serum anti-thyroid antibody concentration that is usually responsive to glucocorticoid therapy. Diagnosis requires the exclusion of other causes of encephalopathies and encephalitis including autoimmune encephalitis associated with neuronal surface antibodies and paraneoplastic ones. Diagnosis also is dependent on the demonstration of thyroid autoantibodies in serum. Since there is no direct pathophysiologic link between antithyroid antibodies, Hashimoto thyroiditis and the cerebral syndrome, the nomenclature HE could be misleading. The response to steroids led to a renaming of the syndrome to steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), though some cases do not respond to steroids. In recent years, attention has turned to an aggressive form of Hashimoto's thyroiditis accompanied by elevated serum IgG4 levels (IgG4-related disease). This is characterized by a higher incidence in men (5:1) than in women, onset at a younger age, more intense thyroid inflammation and higher antithyroid antibody titters. Such patients have excessive production of IgG4 + plasmacytes, which infiltrate various organs leading to their fibrosis and sclerosis, sometimes resulting in inflammatory tumors. HE is treated with corticosteroids along with treatment of the dysthyroid condition, if any. There are yet no guidelines regarding steroid dose and/or duration.

Egyptian pediatric clinical practice adapted guidelines: evidence-based [2] steroid-resistant nephrotic syndrome (SRNS) 2022

BackgroundNephrotic syndrome is one of the most common chronic kidney diseases in children. Steroid sensitive type (SSNS) constitutes about 85–90%, whereas steroid-resistant type (SRNS) only 15–20% (Mickinney et al. Pediatr Nephrol 16:1040-1044, 2001). While MCD is the most common histopathology in SS type, children with SRNS have MCD, mesangial proliferative glomerulonephritis, or focal and segmental glomerulosclerosis (FSGS) (International Study Kidney Disease in children, Kidney Int 20;765-771, 1981). SRNS is defined as those who do not show remission after 6 weeks and standard dose of oral steroids ± 3 IV MPD doses (Trautmann et al. Pediatr Nephrol 35:1529-1561, 2020).ObjectivesThese national adapted guidelines aim to frame evidence-based recommendations adopted or adapted from the IPNA 2020, KDIGO 2021, and Japanese 2014 de novo guidelines for diagnosis and management of nephrotic children to be presented in two manuscripts: (1) steroid sensitive (SSNS) and (2) steroid-resistant nephrotic syndrome (SRNS).MethodologyFormulation of key questions was followed with a review of literature guided by our appraised guidelines using AGREE plus appraisal tool. Virtual monthly meetings all through the year 2021 were activated for reviewing and validation of final adaptation evidence-based draft, considering all comments of external reviewers including KDIGO assigned reviewer.DiscussionRationale behind the selection of adopted statements and tailoring of others to suit our local facilities, expertise, and our local disease profile was discussed in the text with reasons.ConclusionThe provided guidelines aim to optimize patient care and outcome and suggest research areas lacking validated research recommendations.

Assessing the impact of usage of steroids among newly detected diabetes patients in a study among covid-19 patients across India

Background: There is a bidirectional relationship between COVID-19 and diabetes. New-onset diabetes and severe metabolic complications of pre-existing diabetes in patients with COVID-19 have been observed. Steroids are medications used for treatment of several diseases, including COVID-19. Its pharmacological action increases blood glucose and poses additional challenges in the management. Aim: To study the impact of steroids on newly detected diabetes patients with a history of COVID-19 in a cohort group. Method: 2263 patients from 15 different sites across India were analysed following a specific eligibility criterion. The patients were segregated into three groups - No steroids, Low steroids [less than or equal to the median dose (50mg)], and High steroids [greater than the median dose (50mg)]. Two-way Analysis of Variance (ANOVA) test was used to test the relationship between Diabetes status and Steroid usage. Results: The steroid dosage for the management of COVID-19 in the Newly-Detected Diabetes (NDD) group received higher doses of steroids. All steroid doses were adjusted and standardized to prednisolone 5mg. The average maximum doses of steroids used in the management of COVID-19 for NDD was 86.6 mg/day. Within the NDD group, those who received a lower steroid dose had a higher HRCT score as compared to the No steroid and High steroid groups. Also, amongst all patients who did not receive steroids for management of COVID-19, NDD had a statistically higher HRCT score. Conclusion: The prevailing hypothesis that increased application of steroids causes diabetes-like disease spectrums in patients recovering from COVID-19. The findings however require reconsidering steroid usage as the leading cause of COVID-induced diabetes.

Development of machine learning models for detection of vision threatening Behçet’s disease (BD) using Egyptian College of Rheumatology (ECR)–BD cohort

BackgroundEye lesions, occur in nearly half of patients with Behçet’s Disease (BD), can lead to irreversible damage and vision loss; however, limited studies are available on identifying risk factors for the development of vision-threatening BD (VTBD). Using an Egyptian college of rheumatology (ECR)-BD, a national cohort of BD patients, we examined the performance of machine-learning (ML) models in predicting VTBD compared to logistic regression (LR) analysis. We identified the risk factors for the development of VTBD.MethodsPatients with complete ocular data were included. VTBD was determined by the presence of any retinal disease, optic nerve involvement, or occurrence of blindness. Various ML-models were developed and examined for VTBD prediction. The Shapley additive explanation value was used for the interpretability of the predictors.ResultsA total of 1094 BD patients [71.5% were men, mean ± SD age 36.1 ± 10 years] were included. 549 (50.2%) individuals had VTBD. Extreme Gradient Boosting was the best-performing ML model (AUROC 0.85, 95% CI 0.81, 0.90) compared with logistic regression (AUROC 0.64, 95%CI 0.58, 0.71). Higher disease activity, thrombocytosis, ever smoking, and daily steroid dose were the top factors associated with VTBD.ConclusionsUsing information obtained in the clinical settings, the Extreme Gradient Boosting identified patients at higher risk of VTBD better than the conventional statistical method. Further longitudinal studies to evaluate the clinical utility of the proposed prediction model are needed.

Association between preoperative hematologic markers and aggressive behavior in meningiomas

IntroductionMeningiomas have varying degrees of aggressive behavior. Some systemic hematologic makers are associated with malignancy, but their value in predicting aggressive meningioma behavior is not fully understood. ObjectiveTo evaluate the association between preoperative markers such as neutrophil-lymphocyte ratio (NLR), neutrophil-monocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), and diagnostic and prognostic factors including WHO grade, proliferation index, presence of edema on preoperative MRI, and tumor recurrence. MethodsA retrospective review of patients treated between 2000 and 2019 with a preoperative complete blood count (CBC) differential lab draw before intracranial meningioma resection was conducted. All preoperative steroid dosages were converted to dexamethasone equivalents. Primary outcomes included presence/absence of perilesional edema, WHO grade, Ki-67/MIB-index, and recurrence. Univariate and multivariable regression analyses were conducted. ResultsA total of 209 meningioma patients were included. Of these, 143 (68 %) were WHO grade I, 61 (29 %) grade II and 5 (2 %) were grade III. Recurrence was reported in 19 (9.1 %) tumors. No hematologic markers were associated with recurrence. In separate multivariable logistic analyses, no biomarkers were associated with perilesional edema or WHO grade. MLR was associated with higher MIB-index (p = 0.018, OR 6.57, 95 % CI 1.37–30.91). ConclusionMost hematologic markers were not associated with meningioma invasiveness, grade, proliferative index, or aggressiveness. Preoperative MLR was associated with high proliferation index in patients undergoing surgery for intracranial meningioma. Higher MLR could be a surrogate for meningioma proliferation and has potential to be used as an adjunct for risk-stratifying meningiomas.

Postnatal corticosteroids and developmental outcomes in extremely preterm or extremely low birth weight infants: The Victorian Infant Collaborative Study 2016-17 cohort.

Systemic postnatal corticosteroids are used to treat or prevent bronchopulmonary dysplasia (BPD) in extremely preterm (EP) or extremely low birth weight (ELBW) infants but are associated with long-term harm. We aimed to assess the relationship between cumulative postnatal corticosteroid dose and neurodevelopmental outcomes. Longitudinal cohort study of all EP/ELBW livebirths in Victoria, Australia 2016-2017. Perinatal data were collected prospectively. Neurodevelopmental assessment was performed at 2 years' corrected age. Linear and logistic regression were used to determine relationships between cumulative corticosteroid dose and neurodevelopment, adjusted for gestational age, birth weight, sex and major intraventricular haemorrhage. Seventy-six EP/ELBW infants received postnatal corticosteroids to treat or prevent BPD, 62/65 survivors were seen at 2 years. Median (IQR) cumulative postnatal corticosteroid dose was 1.36 (0.92-3.45) mg/kg dexamethasone equivalent. Higher cumulative corticosteroid dose was associated with increased odds of cerebral palsy, adjusted OR (95% CI) 1.47 (1.04, 2.07). Higher cumulative corticosteroid dose was also associated with lower cognitive and motor developmental scores, however, this weakened after adjustment for confounding variables: cognitive composite score adjusted coefficient (95% CI) -1.3 (-2.7, 0.1) and motor composite score adjusted coefficient (95% CI) -1.3 (-2.8, 0.2). Higher cumulative postnatal corticosteroid dose in EP/ELBW infants is associated with increased odds of cerebral palsy at 2 years' corrected age. Adequately powered studies are needed to assess the independent effects of cumulative steroid dose on neurodevelopmental outcomes.

Management of the adverse effects of cancer immunotherapy with a focus on the respiratory and nervous systems

Background: The incidence of adverse toxic reactions to immunotherapy using immune checkpoint inhibitors is 2-10% in the respiratory system and 3.9% to 12% in the neurologic system. The severity of adverse effects increases when combined immunotherapeutic agents are administered.Current Concepts: In cases of high-grade toxicity, it is important to discontinue immunotherapy immediately. In cases of grade 3 to 4 toxicity, immunosuppressive corticosteroid therapy is the first-line treatment. Short-term steroid treatment does not affect anti-tumor efficacy. It is thus necessary to use steroids for an appropriate period then carefully taper the steroid dose to prevent recurrence. If no improvement is achieved within 48-72 hours after the administration of steroids, it is essential to initiate multidisciplinary treatment involving related departments and add immunosuppressive drugs. If the patient is administrated immunotherapy again, it may be necessary to permanently discontinue the immunotherapy depending on the toxicity grade that first occurred.Discussion and Conclusion: The primary goals for effective management of immunotherapy-related adverse events are early recognition of symptoms and immediate treatment.

C1q Nephropathy in a 2-Year-Old Boy: A Case Report

<i>Background</i>: C1q nephropathy occurs when C1q is significantly deposited in the mesangial region and systemic lupus erythematosus can be excluded as a diagnosis. <i>Clinical Description</i>: A case of a 2-year-old boy who was diagnosed with steroid-resistant C1q nephropathy. As he was initially managed as a case of idiopathic nephrotic syndrome, prednisolone was administered. However, as his condition did not improve with steroid treatment, other causes for nephrotic were considered, including infections. As it was initially refractory to steroid treatment, a cytomegalovirus infection was strongly considered. Based on the histological findings, C1q deposition was noted in the mesangium, which confirmed the diagnosis of C1q nephropathy. Cyclosporine A was initiated, which resulted in complete remission from the disease. When administering high doses of steroids, it is necessary to recognize the risk of infection. <i>Conclusion</i>: C1q nephropathy is considered to be a heterogeneous disease group from the clinicopathological point of view. In order to treat established C1q nephropathy, it is necessary to clarify the pathological significance of C1q deposition in glomeruli. As it was initially refractory to steroid treatment, CMV infection was strongly considered. When administering high doses of steroids, it is necessary to recognize the risk of infection.

Rhino-orbital mucormycosis in a Mexican patient with COVID-19: Case report

A variety of bacterial and fungal co-infections may be attributed to the coronavirus disease 2019 (COVID-19), particularly in people who already have a medical condition such diabetes mellitus or those who received large dosages of steroids. We described a 52-year-old diabetic man who was receiving high doses of dexamethasone and antibiotics while receiving ambulatory care for COVID-19 pneumonia. His anterior rhinoscopy revealed a necrotic scab, and a sample confirmed Mucor spp. He underwent surgery and was given amphotericin as a result of the severity of the condition, palpebral ptosis, and right ocular palsy he was experiencing. The patien ́s progression was satisfactory. pre-existing diabetes mellitus, previous steroid and antimicrobial use, as well as SARS-CoV-2 infection are some of the risk factors associated with Mucor spp. infection. Prompt detection of mucormycosis is important in the management of these affected patients.

Spinal epidural arteriovenous fistula with nerve root enhancement mimicking myeloradiculitis: a case report

BackgroundGadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculitis. We report a patient who was initially diagnosed with neurosarcoid myeloradiculitis due to spinal nerve root enhancement, mildly inflammatory cerebrospinal fluid, and pulmonary granulomas, who ultimately was found to have an extensive symptomatic SDAVF.Case presentationA 52-year-old woman presented with a longitudinally extensive spinal cord lesion with associated gadolinium enhancement of the cord and cauda equina nerve roots, and mild lymphocytic pleocytosis. Pulmonary lymph node biopsy revealed non-caseating granulomas and neurosarcoid myeloradiculitis was suspected. She had rapid and profound clinical deterioration after a single dose of steroids. Further work-up with spinal angiography revealed a thoracic SDAVF, which was surgically ligated leading to clinical improvement.ConclusionsThis case highlights an unexpected presentation of SDAVF with nerve root enhancement and concurrent pulmonary non-caseating granulomas, leading to an initial misdiagnosis with neurosarcoidosis. Nerve root enhancement has only rarely been described in cases of SDAVF; however, as this case highlights, it is an important consideration in the differential diagnosis of non-inflammatory causes of longitudinally extensive myeloradiculopathy with nerve root enhancement. This point is highly salient due to the importance of avoiding misdiagnosis of SDAVF, as interventions such as steroids or epidural injections used to treat inflammatory or infiltrative mimics may worsen symptoms in SDAVF. We review the presentation, diagnosis, and management of SDAVF as well as a proposed diagnostic approach to differentiating SDAVF from inflammatory myeloradiculitis.

The effect of disease-modifying antirheumatic drugs on sleep and quality of life in older patients with rheumatoid arthritis.

The sleep quality is worse in rheumatoid arthritis (RA) patients than in healthy controls and it is more difficult to achieve a satisfactory quality of life after treatment with age. Our aim is to assess the quality of life and sleep in elderly onset RA patients and to analyze the effect of disease-modifying agents on sleep and quality of life. Thirty-four older patients with RA patients and 30 healthy controls are included in the study. Sleep quality was evaluated with the Pittsburg sleep quality index and quality of life with Short Form-36. Parametric/non-parametric tests and Spearman/Pearson correlation analysis were applied for the data according to the distribution. While the rate of poor sleep quality before treatment was 67.6%, the rate was 26.5% after treatment. There was a statistically significant difference before and after treatment in terms of subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and scores for sleep disturbance. The mean steroid dose and Disease Activity Score-28 were higher in patients with poor sleep quality than in patients with good sleep quality. Patients with poor sleep quality had lower mean physical function, pain, general health, social function, emotional role difficulties, and energy/vitality values than patients with good sleep quality. Both sleep and quality of life improved after treatment in older patients with RA patients. In older patients, it should be regularly evaluated in terms of sleep and quality of life and appropriate treatment should be provided.

STUDY OF EFFECT OF ANTENATAL STEROIDS ON MECHANICALLY VENTILATED LOW BIRTH WEIGHT NEONATES WITH RESPIRATORY DISTRESS ADMITTED TO NEONATAL INTENSIVE CARE UNIT(NICU)

Background: Low birth weight (LBW) is dened as a birth weight of less than 2.5kg as per World Health Organization (WHO)1. Low birth weight (LBW) is a major public health problem in developing countries including India. In India, 30-35% of babies are LBW and more than half of them are full term babies2. Reduction of low birth weight forms an important contribution to the Millennium Development Goal (MDG) for reducing child mortality3. Corticosteroids administration before anticipated preterm births is one of the most important antenatal therapies available to improve neonatal outcomes. Corticosteroids alter the structural and biochemical physiology of neonates, like surfactant production and lung maturation and thus reduces the requirement and duration of mechanical ventilation. Aims And Objectives: 1.To know the effect of antenatal steroids in minimizing the duration of ventilation in LBW neonates 2.To know the effect of antenatal steroids on assisting in early extubation of LBW neonates. All Low birth weight neonates &lt;2.5 kg who were intubated and on vent Inclusion Criteria: Exclusion Criteria: ilator support. 1.Major congenital anomalies 2.Extubated as a part of withdrawal of care. This Materials And Methods: study was a Prospective Observational Study and was conducted in Rajarajeswari Medical College and Hospital, Bangalore for a duration of 18 months between January 2021 and June 2022.SAMPLE SIZE: n=54, Sample size calculated using considering 95% condence interval and 10% precision. All the parameters Results: i.e., birth weight, gestational age, gender, presence of maternal comorbidities, surfactant and antenatal steroids showed signicant association with number of days of mechanical ventilation in the study. This study was conducted Conclusion: to study the effect of antenatal steroids on mechanical ventilation in low-birth-weight neonates admitted to neonatal intensive care unit and it was found that antenatal steroids had signicant effect on duration of mechanical ventilation; this study has also recognized the factors involved in prolonging the days of mechanical ventilation such as prematurity, doses of antenatal steroids received, low birth weight, lower gestational ag . Recognising such factors can help in preventing complications among the newborns thereby reducing the number of days of mechanical ventilation

Comparison of high-versus low-dose corticosteroid administration on post-tonsillectomy outcomes.

Intraoperative steroids have been shown to decrease post-tonsillectomy morbidity; however, optimal dosing of corticosteroids is unknown. This study evaluates the effects of high-versus low-dose dexemethasone administration (0.5mg/kg vs. 0.1mg/kg) on post-tonsillectomy outcomes. Nonrandomized controlled study. Academic Medical Center. Pediatric patients undergoing tonsillectomy at the University of Michigan between 2017 and 2018 were identified. Uncomplicated patients between 1 and 18 years who received dexamethasone during their operation were included. Patients were categorized by high- or low-dose dexamethasone administration and outcomes assessed included revisits within 30 days for pain, vomiting/dehydration, and post-operative bleeding. The number of postoperative phone calls was also assessed. A total of 1641 patients were included in the study. No significant differences in steroid group outcomes were observed regarding vomiting (1.65% vs 1.7%, p=0.618), bleeding (1.09% vs 1.3%, p=0.579), pain (1.64% vs 0.62%, p=0.141), other morbidities (3.83% vs 3.57%, p=0.493) or post-operative phone calls (10.6% vs 9.9%, p=0.81). Post-tonsillectomy bleeding was higher for infectious etiology versus sleep disordered breathing (p=0.005); however, no rate differences for vomiting or pain were noted. Controlling for indication, no differences in hospital return rates were seen between steroid groups. No statistically significant differences in post-tonsillectomy outcome measures were observed based on administration of either high- or low-dose dexamethasone. With no observed outcome differences related to steroid dosing, we transitioned to routine use of low-dose dexamethasone for tonsillectomy and adenoidectomy.

Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study.

Immunocompromised patients may be at higher risk of mortality if hospitalised with Coronavirus Disease 2019 (COVID-19) compared with immunocompetent patients. However, previous studies have been contradictory. We aimed to determine whether immunocompromised patients were at greater risk of in-hospital death and how this risk changed over the pandemic. We included patients > = 19 years with symptomatic community-acquired COVID-19 recruited to the ISARIC WHO Clinical Characterisation Protocol UK prospective cohort study. We defined immunocompromise as immunosuppressant medication preadmission, cancer treatment, organ transplant, HIV, or congenital immunodeficiency. We used logistic regression to compare the risk of death in both groups, adjusting for age, sex, deprivation, ethnicity, vaccination, and comorbidities. We used Bayesian logistic regression to explore mortality over time. Between 17 January 2020 and 28 February 2022, we recruited 156,552 eligible patients, of whom 21,954 (14%) were immunocompromised. In total, 29% (n = 6,499) of immunocompromised and 21% (n = 28,608) of immunocompetent patients died in hospital. The odds of in-hospital mortality were elevated for immunocompromised patients (adjusted OR 1.44, 95% CI [1.39, 1.50], p < 0.001). Not all immunocompromising conditions had the same risk, for example, patients on active cancer treatment were less likely to have their care escalated to intensive care (adjusted OR 0.77, 95% CI [0.7, 0.85], p < 0.001) or ventilation (adjusted OR 0.65, 95% CI [0.56, 0.76], p < 0.001). However, cancer patients were more likely to die (adjusted OR 2.0, 95% CI [1.87, 2.15], p < 0.001). Analyses were adjusted for age, sex, socioeconomic deprivation, comorbidities, and vaccination status. As the pandemic progressed, in-hospital mortality reduced more slowly for immunocompromised patients than for immunocompetent patients. This was particularly evident with increasing age: the probability of the reduction in hospital mortality being less for immunocompromised patients aged 50 to 69 years was 88% for men and 83% for women, and for those >80 years was 99% for men and 98% for women. The study is limited by a lack of detailed drug data prior to admission, including steroid doses, meaning that we may have incorrectly categorised some immunocompromised patients as immunocompetent. Immunocompromised patients remain at elevated risk of death from COVID-19. Targeted measures such as additional vaccine doses, monoclonal antibodies, and nonpharmaceutical preventive interventions should be continually encouraged for this patient group. ISRCTN 66726260.

Different Doses of Lumbar Epidermal Methylprednisolone Injection and their effect on Pain Control and Blood Glucose Level in Diabetic patients

Background: Frequency of diabetes mellitus is high between people suffering from lumbar spinal degenerative sickness Despite the fact that injection of steroid in epidural space are recognised to rise the glycaemic Blood amount postoperatively, therefore it is inquiry that decrease dose of methylprednisolone (40mg) cannot rise blood glycaemic level as compare to higher dose of methylprednisolone (80mg) and their effect on pain management of patients. Aim: To evaluate 2 common doses (80mg &amp; 40mg) of methylprednisolone effects which is given through Epidural lumbar route, on glycaemic Blood level and pain management of diabetes mellitus patients to determine an adequate epidural steroid dose. Methods: This was an observational prospective study was conduct at Department of Anaesthesia Hayatabad Medical Complex Peshawar in June 2022. Overall 110 Diabetes mellitus patients were participated. They acquired lumbar epidural, methylprednisolone for spinal stenosis radiculopathy or failed back surgery syndrome. Methylprednisolone dose were given to patients, either 80mg (Group A) or 40 mg (Group B) was determined clinically after the procedure type. Results: HbA1c level was noted in group A 6.21mmol/L while in group B 6.52 mmol/L (p =0.991). The increase in fasting blood glucose (FBG) were greater significantly A Group than in B Group on post procedure day (PPD)1,2&amp;3 (PPD1: 179 mg/dL A Group Vs 146mg/dL in B Group ), (PPD2: 221 mg/dL in A Group Vs 152mg/dL in B Group ) &amp; (PPD3: 202mg/dL in A Group Vs 175mg/dL in B Group ). Fasting blood glucose incidence was &gt;180mg/dL were greater in A Group than in B Group on post procedure day 1&amp;2 (PPD1: A Group=11 vs B Group=5) and (PPD2: A Group=13 Vs B Group= 4). Conclusion: Methylprednisolone increase dose 80mg rise FBG and PDG greater than a decrease dose 40mg with no effect on pain management, employment status, or clinical outcome. Thus, it is recommended that methylprednisolone 40mg will b given rather than 80mg in diabetes mellitus patients with respect to pain management and blood glycaemic level Keywords: Epidural methylprednisolone, back pain, blood glucose.

Efficacy of low carbohydrate diet (LCD) on obesity and alcohol intake from bio-psycho-social points of view

Background: There is a bidirectional relationship between COVID-19 and diabetes. New-onset diabetes and severe metabolic complications of pre-existing diabetes in patients with COVID-19 have been observed. Steroids are medications used for treatment of several diseases, including COVID-19. Its pharmacological action increases blood glucose and poses additional challenges in the management. Aim: To study the impact of steroids on newly detected diabetes patients with a history of COVID-19 in a cohort group. Method: 2263 patients from 15 different sites across India were analysed following a specific eligibility criterion. The patients were segregated into three groups - No steroids, Low steroids [less than or equal to the median dose (50mg)], and High steroids [greater than the median dose (50mg)]. Two-way Analysis of Variance (ANOVA) test was used to test the relationship between Diabetes status and Steroid usage. Results: The steroid dosage for the management of COVID-19 in the Newly-Detected Diabetes (NDD) group received higher doses of steroids. All steroid doses were adjusted and standardized to prednisolone 5mg. The average maximum doses of steroids used in the management of COVID-19 for NDD was 86.6 mg/day. Within the NDD group, those who received a lower steroid dose had a higher HRCT score as compared to the No steroid and High steroid groups. Also, amongst all patients who did not receive steroids for management of COVID-19, NDD had a statistically higher HRCT score. Conclusion: The prevailing hypothesis that increased application of steroids causes diabetes-like disease spectrums in patients recovering from COVID-19. The findings however require reconsidering steroid usage as the leading cause of COVID-induced diabetes.