Steroid Group Research Articles

The effects of oral steroid duration on stricture prevention after extensive endoscopic submucosal dissection for superficial esophageal cancer.

BackgroundEsophageal stricture is a major complication of endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer (SEC). Oral steroids have been used to prevent esophageal stricture in patients with more than 75% of the esophageal circumference resected. However, there are no established guidelines regarding the optimal duration of steroid use. This retrospective observational study aimed to compare the incidence of esophageal stricture according to the period of prophylactic oral steroid use and to identify the risk factors for esophageal stricture.MethodsEighty-one patients who were prescribed prophylactic steroid after undergoing ESD for SEC with more than 75% of esophageal circumference resected were enrolled. Patients were classified into the four-week steroid group (n=72) or eight-week steroid group (n=9) to compare the incidence of esophageal stricture. In addition, the patients were subdivided into those who developed esophageal stricture (n=24) and those who did not (n=57) to identify the risk factors for esophageal stricture.ResultsTwenty patients (27.8%) in the four-week oral steroid group and four patients (44.4%) in the eight-week oral steroid group developed esophageal stricture (P=0.44). The univariable analysis identified tumor size, longitudinal length of semi-circumferential resection, and proportion of circumferential resection as risk factors of esophageal stricture. The multivariable analysis identified the proportion of circumferential resection as an independent risk factor. After adjusting for the proportion of circumferential resection, the incidence of stricture was marginally higher in the eight-week steroid group [P=0.05; odds ratio (OR): 5.69; 95% confidence interval (CI): 1.01–32.15].ConclusionsEight weeks of oral steroid prophylaxis does not reduce the risk of stricture after extensive ESD more than four weeks of oral steroid prophylaxis. The proportion of circumferential resection is the strongest risk factor for stricture in patients with SEC undergoing ESD.

Management of checkpoint inhibitor toxicity and survival in patients with advanced melanoma.

9546 Background: Management of checkpoint-inhibitor-induced immune-related adverse events (irAEs) is primarily based on expert opinion. Recent studies have suggested detrimental effects of immunosuppressive treatment with anti-TNF on checkpoint-inhibitor efficacy. Methods: Advanced melanoma patients experiencing grade ≥3 irAEs after treatment with first-line ipilimumab-nivolumab between 2015 and 2021 were included from the Dutch Melanoma Treatment Registry. Progression-free survival (PFS), overall survival (OS) and melanoma-specific survival (MSS) were analyzed according to toxicity management regimen. A cox proportional hazards model was used to account for the confounders age, sex, performance status, lactate dehydrogenase, site of metastases and type of irAE. Results: Out of 771 ipilimumab-nivolumab treated patients, 350 were treated with immunosuppression for severe irAEs. Of these patients, 235 received steroids only and 115 received steroids with second-line immunosuppressants consisting of anti-TNF, mycophenolic acid, tacrolimus and other immunosuppressants. Median PFS was significantly longer for patients treated with steroids (11.3 months) than for patients treated with steroids and second-line immunosuppressants (5.4 months; HR 1.43; 95%CI 1.07-1.90; p = 0.01). Median OS was also significantly longer for the steroids group (46.1 months) than for the steroids and second-line immunosuppressants group (22.5 months; HR 1.64; 95%CI 1.16-2.32; p = 0.005). Results for MSS were similar (not reached versus 28.8 months; HR 1.70; 95%CI 1.16-2.49; p = 0.006). Median PFS, OS and MSS are shown in Table 1. After adjustment for potential confounders, patients treated with steroids + second-line immunosuppressants showed a non-significant trend towards a higher risk of progression (HRadj 1.40; 95%CI 1.00-1.97; p = 0.05), a higher risk of death (HRadj 1.54; 95%CI 1.03-2.30; p = 0.04) and of melanoma-specific death (HRadj 1.62; 95%CI 1.04-2.51; p = 0.032) compared to the steroids group. Conclusions: Second-line immunosuppression for irAEs is associated with impaired PFS, OS, and MSS in advanced melanoma patients treated with first-line ipilimumab-nivolumab, irrespective of being anti-TNF or other second-line immunosuppressants. These findings stress the importance of assessing the effects of differential irAE management strategies, not only in melanoma but also in other tumor types. [Table: see text]

Characteristics and Treatment Methods of Bell’s Palsy in Patients Visiting Korean Medicine Hospitals From August 2018 to July 2021

Background: This study was designed to statistically analyze the data of patients who had Bell’s palsy (BP) who visited a Korean Medicine hospital in the last 3 years to determine the tendency or characteristics of their visit.Methods: This study retrospectively analyzed the medical records of 816 patients. Based on the data collected through medical records demographics, condition/disease, and therapeutic characteristics of the patients were analyzed using IBM SPSS Version 23.0.Results: Patients in their teens or younger, and 50s or older had a higher frequency of inpatient treatment, and 20s to 40s had a higher rate of outpatient treatment. The proportion of men who received steroid combination treatment was higher than women. The number of patients with BP, and the total treatment period of the patients has decreased every year. The total treatment period was shorter in the steroid group than the Korean medicine alone group. Inpatients were more likely to receive steroid combination therapy than outpatients. The proportion of patients who received steroid combination therapy was higher than patients with recurrence of BP. Patients with hypertension or diabetes had a higher rate of hospitalization and received more treatments than patients without the condition/disease.Conclusion: Visit characteristics and treatment methods preferred by patients with BP were identified. This research may help to establish a treatment model for BP in Korean Medicine institutions in the future.

Effectiveness of anabolic steroids in improving outcomes for post-operative hip fracture patients: A randomized controlled trial

BackgroundPost-operative elderly hip fracture patients require significant rehabilitation. Nandrolone is an anabolic steroid used to promote muscle growth. This study aims to examine the effect of nandrolone in improving rehabilitation and quality of life in elderly female patients with hip fractures undergoing hemiarthroplasty. MethodsThis is a double-blinded prospective randomized-controlled-trial consisting of female patients above the age of 65 with an isolated neck of femur fracture planned for a hip hemiarthroplasty. Participants were randomized into two arms of the study – 50 mg intramuscular nandrolone vs normal saline placebo administered on post-operative day 0, and weeks 2, 6 and 12. The participants were followed up across a 1-year period following the surgery. Clinical outcomes such as time taken to achieve rehabilitation milestones, distance of ambulation and thigh muscle girth, and functional scoring with SF-36 questionnaire were recorded at intervals of 2, 6 and 12 weeks, 6 months and 1 year following the surgery. ResultsThere were a total of 23 subjects with 11 in the steroid group and 12 in the placebo group. There was no significant difference in demographics and injury patterns between both groups. There was no significant difference for time taken to achieve various rehabilitation milestones and distance of ambulation. SF-36 scores on discharge and at 1-year follow-up mark were comparable. There was no difference in the complication rate between both groups. ConclusionIntra-muscular Nandrolone after hip surgery in elderly female patients does not result in short to mid-term improved rehabilitation or functional outcomes. Nandrolone did not result in increased short-term complications after hip surgery. Level of evidenceI.

Steroid treatment in the management of destructive thyrotoxicosis induced by PD1 blockade.

ObjectiveDestructive thyroiditis is the most common endocrine immune-related adverse event (iRAEs) in patients treated with anti-PD1/PD-L1 agents. Given its self-limited course, current guidelines recommend no treatment for this iRAE. Nevertheless, in patients with enlarged thyroid volume and a poor performance status, thyrotoxicosis may be particularly severe and harmful. The aim of the study is to evaluate if steroid treatment might be useful in improving thyrotoxicosis in subjects with a poor performance status.MethodsWe conducted a retrospective study, comparing the course of thyrotoxicosis of four patients treated with oral prednisone at the dosage of 25 mg/day (tapered to discontinuation in 3 weeks) and an enlarged thyroid volume to that of eight patients with similar thyroid volume who were left untreated.ResultsThe levels of thyroid hormones were lower in subjects treated compared to those untreated at time of 7, 14, 21, 28, 35, 42, 60 and 90 days (P < 0.05 at each time). The time to remission of thyrotoxicosis was 24 days in patients treated with steroids and 120 days in untreated patients (P < 0.001). At 6 months, the rate of evolution to hypothyroidism was similar in the two groups (4/4 in the steroid group vs 7/8 in the untreated group, P = 0.74) and no difference was found in tumor progression (P = 0.89).ConclusionsOur preliminary data suggest that in patients with a poor performance status experiencing a severe destructive thyrotoxicosis induced by PD-1 blockade, a short period of administration of oral prednisone is effective in obtaining a quick reduction of the levels of thyroid hormones.

Physiologic effects of stress dose corticosteroids in in-hospital cardiac arrest (CORTICA): A randomized clinical trial

AimPostresuscitation hemodynamics are associated with hospital mortality/functional outcome. We sought to determine whether low-dose steroids started during and continued after cardiopulmonary resuscitation (CPR) affect postresuscitation hemodynamics and other physiological variables in vasopressor-requiring, in-hospital cardiac arrest. MethodsWe conducted a two-center, randomized, double-blind trial of patients with adrenaline (epinephrine)-requiring cardiac arrest. Patients were randomized to receive either methylprednisolone 40 mg (steroids group) or normal saline-placebo (control group) during the first CPR cycle post-enrollment. Postresuscitation shock was treated with hydrocortisone 240 mg daily for 7 days maximum and gradual taper (steroids group), or saline-placebo (control group). Primary outcomes were arterial pressure and central-venous oxygen saturation (ScvO2) within 72 hours post-ROSC. ResultsEighty nine of 98 controls and 80 of 86 steroids group patients with ROSC were treated as randomized. Primary outcome data were collected from 100 patients with ROSC (control, n = 54; steroids, n = 46). In intention-to-treat mixed-model analyses, there was no significant effect of group on arterial pressure, marginal mean (95% confidence interval) for mean arterial pressure, steroids vs. control: 74 (68–80) vs. 72 (66–79) mmHg] and ScvO2 [71 (68–75)% vs. 69 (65–73)%], cardiac index [2.8 (2.5–3.1) vs. 2.9 (2.5–3.2) L/min/m2], and serum cytokine concentrations [e.g. interleukin-6, 89.1 (42.8–133.9) vs. 75.7 (52.1–152.3) pg/mL] determined within 72 hours post-ROSC (P = 0.12–0.86). There was no between-group difference in body temperature, echocardiographic variables, prefrontal blood flow index/cerebral autoregulation, organ failure-free days, and hazard for poor in-hospital/functional outcome, and adverse events (P = 0.08–>0.99). ConclusionsOur results do not support the use of low-dose corticosteroids in in-hospital cardiac arrest.Trial Registration:ClinicalTrials.gov number: NCT02790788 (https://www.clinicaltrials.gov).

High-dose vs low-dose steroid in pregnancy patients with systemic lupus erythematosus and lupus nephritis: A systematic review and meta-analysis

Background: Management of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in pregnancy has been improving in recent decades. However, SLE can still lead to adverse pregnancy outcomes if not appropriately treated. Optimal dose of steroids, as one of the most commonly used for the treatment of SLE and LN in pregnancy is still a subject of debate. In this review, we determine the pregnancy outcomes in SLE and LN patients treated with low vs high doses of steroids. Methods: ProQuest, Pubmed, Science Direct, Scopus, and Web of Science were carefully searched for relevant studies published in English. A total of 2,596 studies were reviewed. We extracted the data from previous studies showing the use of steroids treatment in high-dose and low-dose related to pregnancy outcomes. We provide larger data about maternal (preterm rupture of membrane, fetal loss, pre-eclampsia, and flare up) and fetal outcomes (prematurity, small gestational age, low birth weight) receiving high vs low steroid in patients with SLE and LN in this systematic review and meta-analysis. Results: A total of 13 studies were included. Of these, one study discussed a group with LN and 12 other studies discussed SLE with related maternal and fetal outcomes. Maternal outcome in the group with low-dose steroid showed a lower risk of fetal loss (odds ratio (OR): 1.93; 95% confidence interval (CI) 1.01-3.70), but there were no differences in other maternal outcomes. The low-dose steroid group showed a better fetal outcome, with a lower risk of prematurity (OR: 3.06; 95% CI 1.98-4.71), small gestational age (OR: 2.63; 95% CI 1.15-6.00), and low birth weight (OR: 2.43; 95% CI 1.23-4.79). Conclusions: In pregnant patients with SLE or LN, high-dose steroids are associated with the high risk of fetal loss during pregnancy, preterm birth, small gestational age, and low birth weight.

THE POTENCY OF CUCUMBER (CUCUMIS SATIVUS L.) PEEL EXTRACT AS ANTICHOLESTEROL

The liver has a very important role in the human body. However, these organ tissues are also very susceptible to be tissue damage. Fatty liver disease (steatosis) is a disease caused by high cholesterol. Physically, cholesterol is a yellowish subtance, lumps like wax, and is an arrangement of steroid groups. Non-alcoholic steatohepatitis (NASH) occurs due to excess cholesterol levels in the liver. Liver function can be affected as a result of liver damage. So, a hepatoprotector is needed. The flavonoid content of cucumber skin has potential as an anticholesterol. The purpose of this research is to analyze the ability of the ethanol extract of cucumber peel (Cucumis sativus L.) as a cholesterol lowering agents as indicated by the EC50 value. Maceration extraction method used in this study using 96% ethanol as solvent. Qualitative analysis of ethanolic extract of cucumber peel is known to have flavonoids, steroids, alkaloids as indicated by the appearance of color changes, and saponins which are indicated by the appearance of foam. Lieberman-burchad reagent was used for quantitative analysis of anticholesterol using a UV-Visible spectrophotometer. The analysis was carried out at a maximum wavelength of 665,0 nm with an incubation time of 15 minutes. The concentration variations of the extract used were between 25-150 with a range of 25 ppm. The results showed that the ethanolic extract of cucumber peel could potentially be an anticholesterol with the percentage reduction of 28.50%; 35.45%; 39.59%; 45.82%; 51.24%; and 55.12% at 5 variations of concentration. The EC50 value was achieved at a concentration of 122.04 ppm. &#x0D;

Management of adult diabetic patients of Bell’s palsy with and without steroid: experience from a tertiary care hospital

Background: Bell's palsy is the most common cause of lower motor neuron type facial nerve palsy and one of the most frequently encountered presentations in Department of Neurology. Initial treatment involves oral corticosteroids, possible antiviral drugs, protection of the eye from desiccation and physiotherapy. But in case of patients with Bell's palsy and diabetes mellitus (DM) decision of prescribing steroid is a major concern due to risk of hyperglycaemia and still a point of conflict. Aim of this study is to observe the outcome of diabetic patients with Bell's palsy with and without steroid therapy. Methods: This retrospective study was conducted from January 2017 to December 2020, in Department of Neurology of BIRDEM General Hospital, Shahbag, Dhaka, Bangladesh. During this period 50 adult diabetic patients with Bell's palsy were recruited retrospectively from hospital records according to inclusion criteria and divided into two groups depending upon the duration of symptoms and prescribing steroid. Group I consisted of patients with Bell's palsy who attended after 72 hours of onset of symptoms and was not prescribed steroid or antiviral drugs, whereas Group II included patients attending within 72 hours of onset of symptoms and received steroid and antiviral drugs. House-Brackmann (H-B) Grading system was used to assess the severity of facial dysfunction. Patients of Grade III and above were recruited in this study and during follow up Grade I and II were considered as recovered. All participants of Group II received prednisolone in divided doses of up to 60 mg for 5 days and then tapered over next 5 days along with the antiviral agents. Patients in the Group I were given supportive care. All patients of both the groups received physiotherapy for facial asymmetry and medication for eye care along with close monitoring and management of diabetes and other comorbidities. H-B Grades at onset, after 10 days, at the end of 1st and at 3rd month after facial paralysis were assessed. Recovery time and the number of patients who demonstrated improvement were compared between the groups. Results: Total 50 adult diabetic patients with Bell's palsy were included. Mean age at presentation was 48.5 ± 13.6 years, 44% were male and 56% female. Hypertension (HTN) was present in 50% cases. A total of 30 patients (60%) received oral steroid with anti-viral drugs and 20 (40%) received only supportive treatment. Significant statistical difference was observed with regard to H-B Grades, recovery time and number of patients between steroid group (Group II) in comparison to patients of non-steroid group (Group I) after 10 days (p 0.007), at 1st month ( p &lt;0.001) and at 3rd months (p &lt;0.001) after facial paralysis. Among comorbidities HTN (p 0.021), Glycated haemoglobin (HbA1c) (p 0.033) and High density lipoprotein (HDL) (p 0.005) contributed to the outcome. Conclusion: From the present study it is observed that patients with DM with Bell's palsy, the recovery of facial functions may be satisfactory with steroid therapy. Bangladesh Crit Care J March 2022; 10 (1): 33-37

Antenatal Corticosteroids to Asian Women Prior to Elective Cesarean Section at Early Term and Effects on Neonatal Respiratory Outcomes.

This exploratory study aimed to evaluate the effects of antenatal corticosteroids in singleton pregnancies of Asian women prior to elective cesarean section (CS) at early term on neonatal respiratory outcomes. Methods: This is a pilot and pragmatic randomized trial conducted at a university hospital in Malaysia. Women with singleton pregnancies planned for elective CS between 37+0 and 38+6 weeks gestation were randomly allocated into the intervention group, where they received two doses of IM dexamethasone 12 mg of 12 h apart, 24 h prior to surgery OR into the standard care, control group, and both groups received the normal routine antenatal care. The primary outcome measures were neonatal respiratory illnesses, NICU admission and length of stay. Results: A total of 189 patients were recruited, 93 women in the intervention group and 96 as controls. Between the steroid and control groups, the mean gestation at CS was similar, 266.1 ± 3.2 days (38 weeks) vs. 265.8 ± 4.0 days (37+6 weeks), p = 0.53. The mean birthweight of infants was 3.06 ± 0.41 kg vs. 3.04 ± 0.37 kg, p = 0.71. Infants with respiratory morbidities were primarily due to transient tachypnea of newborn (9.7% vs. 6.3%), and congenital pneumonia (1.1% vs. 3.1%) but none had respiratory distress syndrome. Only four infants required NICU admission (2.2% vs. 3.1%, p = 0.63). Their average length of stay was not statistically different; 3.5 ± 2.1 days vs. 5.7 ± 1.5 days, p = 0.27. Conclusions: Elective CS at early term before 39 weeks was associated with a modest overall incidence of neonatal respiratory illness (10.1%) in this Asian population. Antenatal dexamethasone did not diminish infants needing respiratory support, NICU admission and length of stay.

Use of systemic steroids during pulmonary exacerbations in children and adolescent with Cystic fibrosis.

To determine the role of systemic steroids in cystic fibrosis patients and its effects on pulmonary exacerbation in children and adolescents. The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from January 2015 to December 2019 of cystic fibrosis patients aged 3-18 years hospitalised with pulmonary exacerbations. The patients were divided into systemic steroid group A and non-systemic steroid group B. Patients in group A received parenteral steroids during acute exacerbation of cystic fibrosis in the first two weeks of admission, while those in group B did not receive systemic steroids. Length of hospital stay and number of days on oxygen support were compared between the groups. Data was analysed using SPSS 22. Of the 124 patient charts evaluated, 84(67.7%) were included; 40(47.6%) in group A and 44(52.4%) in group B. There were no significant differences between the groups related to age, age at diagnosis, weight, height, and pulmonary exacerbations (p>0.05). Group A had significantly fewer days on oxygen support compared to group B (p<0.001), but there was inter-group difference in mean length of hospital stay (p=0.53). Systemic steroid usage during hospitalisation for acute exacerbation of cystic fibrosis was associated with decreased duration of oxygen requirement with standard treatment.

Evaluation of the outcomes of intraoperative subconjunctival injection of triamcinolone acetonide at the surgical site after pterygium excision using bare-sclera technique and mitomycin C

Purpose To determine the role of the intraoperative triamcinolone acetonide application after pterygium excision using bare-sclera technique and mitomycin C (MMC). Patients and methods This prospective randomized clinical study included 80 patients (80 eyes) who had primary pterygium and was done at the Alpha Center of Ophthalmology. In total, 40 eyes were treated by excision with bare-sclera technique with MMC combined with intraoperative subconjunctival triamcinolone-acetonide injection (group I) (steroid group), and the other 40 eyes were treated by excision with bare-sclera technique with MMC alone (group II) (control group). All patients were subjected to complete ophthalmic evaluation preoperatively and were followed up for 6 months postoperatively. The postoperative conjunctival inflammation rate at 1 week was the primary outcome measure, while the rate of pterygium recurrence 6 months postoperatively and intraocular pressure (IOP) was the secondary outcome measure. No complications developed intraoperatively or postoperatively. Results The postoperative conjunctival inflammation was significantly higher in group II (45%) than group I (12.5%) (P=0.001). The recurrence rate of pterygium 6 months postoperative in group I was 7.5%, while in group II was 17.5%, which was statistically insignificant (P=0.176). The mean IOP 6 months postoperative in group I was 14.2±1.9, and in group II was 13.6±1.7, which was statistically insignificant (P=0.172). Pyogenic granuloma developed in one (2.5%) eye in group I and two (5%) eyes in group II. Conclusion After pterygium excision using the technique of bare sclera and MMC, the intraoperative subconjunctival injection of triamcinolone acetonide at the surgical site was found to be beneficial in reducing the incidence of postoperative conjunctival inflammation without elevation of the IOP and decreasing the recurrence rate of the pterygium.

Nigella sativa L. as immunomodulator and preventive effect on renal tissue damage of lupus mice induced by pristane

IntroductionNigella sativa L. is an herbal plant with Thimoquinone as the main therapeutic properties. This plants has been shown to cure for various diseases and affected the immune system by modulating cytokines and T regulatory cell (Treg) sot that able to prevent renal injury in several diseases, but studies on Systemic Lupus Erythematous are still rare. ObjectiveThis study aimed to investigate immunomodulation and preventive effects of Nigella sativa L. on renal tissue damage in Pristane induced Lupus (PIL)-mice model. MethodsThis true experimental study included 48 female Balb/C mice, 38 mice were injected pristane intraperitoneally and waited 16 weeks to become lupus model. Only 30 mice met the Systemic Lupus International Collaborating Clinics criteria. Ten healthy mice were used as control, 30 PIL mice model divided into 3 groups (placebo, steroid, Nigella sativa L.). At the end of 28 days of treatment, the mice were sacrificed to take a blood sample and kidney organ to evaluate the injury histopathologically. ResultsThe results showed that the cytokine expression Interleukin (IL) (IL-17, IL-6, IL-23) in the Nigella sativa L. group was the lowest. The highest absolute number of Tregs was the steroid group followed Nigella sativa L. group. Renal injury assessed histopathologically showed the Nigella sativa L. group was the lowest and almost close to normal. ConclusionThis study indicate that Nigella sativa L. has an immunomodulatory effect and can prevent kidney injury PIL-treated mice. We suggest that Nigella sativa L. may need to be considered for further research on its use as a complementary supplement in lupus patients.

Evaluation of the Pharmaceutical Properties of Clobetasol Propionate Ointments and Base Stability of the Mixture with Heparinoid Oil Based Creams

Clobetasol propionate ointment (CLPO) formulations have been classified as members of the "strongest" steroidal efficacy group, with eight of these formulations currently marketed in Japan. Evaluations of pharmaceutical properties of each formulation revealed three classification types: droplet dispersion type containing propylene glycol (PG) and surfactant, type with surfactant but not PG, and other types. These rheological properties were diverse, with no correlation found between viscosity and ointment type. However, when CLPO and six types of heparinoid oil-based cream (HPOC) formulation mixtures were stored at 37℃, a liquid layer was observed starting at 24 h for one CLPO formulation in which polyoxyethylene hydrogenated castor oil 40 was used as a surfactant out of the four droplet-dispersion type ointments and two low-viscosity HPOC formulations. In contrast, one other type of CLPO formulation that contained a surfactant with polysorbate 80, but not PG, exhibited a liquid layer for all of HPOC formulations. This suggests that CLPO formulations that contain a surfactant with a high hydrophilic-lipophilic balance value are likely to generate a liquid layer for mixtures containing HPOC formulation. The present results demonstrate that not only the pharmaceutical properties of the eight CLPO formulations differ from one another, but also that the stabilities of HPOC formulation mixtures are significantly different. Therefore, pharmacists need to focus on inactive as well as active pharmaceutical ingredients to select formulations that patients will want to use, in addition to successfully treating their pathological conditions.

Uncovering the seasonal brain: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) as a biochemical approach for studying seasonal social behaviors

Many animals show pronounced changes in physiology and behavior across the annual cycle, and these adaptations enable individuals to prioritize investing in the neuroendocrine mechanisms underlying reproduction and/or survival based on the time of year. While prior research has offered valuable insight into how seasonal variation in neuroendocrine processes regulates social behavior, the majority of these studies have investigated how a single hormone influences a single behavioral phenotype. Given that hormones are synthesized and metabolized via complex biochemical pathways and often act in concert to control social behavior, these approaches provide a limited view of how hormones regulate seasonal changes in behavior. In this review, we discuss how seasonal influences on hormones, the brain, and social behavior can be studied using liquid chromatography-tandem mass spectrometry (LC-MS/MS), an analytical chemistry technique that enables researchers to simultaneously quantify the concentrations of multiple hormones and the activities of their synthetic enzymes. First, we examine studies that have investigated seasonal plasticity in brain-behavior interactions, specifically by focusing on how two groups of hormones, sex steroids and nonapeptides, regulate sexual and aggressive behavior. Then, we explain the operations of LC-MS/MS, highlight studies that have used LC-MS/MS to study the neuroendocrine mechanisms underlying social behavior, both within and outside of a seasonal context, and discuss potential applications for LC-MS/MS in the field of behavioral neuroendocrinology. We propose that this cutting-edge technology will provide a more comprehensive understanding of how the multitude of hormones that comprise complex neuroendocrine networks affect seasonal variation in the brain and behavior.

Fitokimia dan Aktivitas Antioksidan Ekstrak Temu Blenyeh (Curcuma purpurascens Blumae)

Temu blenyeh (Curcuma purpurascens Bl) is a species of curcuma that is still rarely studied. Temu blenyeh is thought to have antioxidant activity so that it can reduce free radical activity. The purpose of this study was to screen phytochemicals and to determine the antioxidant activity of temu blenyeh extract using the 2,2-Diphenyl-2-picrylhydrazyl (DPPH) method. Temu blenyeh extract was macerated with 96% ethanol solvent, then its antioxidant activity was tested using the 2,2-Diphenyl-2-picrylhydrazyl (DPPH) method at a maximum wavelength of 515.8 nm and using vitamin C as a comparison. group of flavonoid compounds, alkaloids, tannins, saponins, triterpenoids and steroids. While the results of the antioxidant activity of temu blenyeh extract are in the very weak category with an IC50 of 458,888ppm and vitamin C with an IC50 of 3,294 ppm.

PECULIARITIES OF THE SPECTRAL CHARACTERISTICS OF BRASSINOSTEROIDS OF THE 24-EPIBRASSINOLIDE AND 6-DEOXO-24-EPITHEASTERONE SERIES IN NMR SPECTRA IN DEUTEROPYRIDINE AND DEUTEROCHLOROFORM

Assignment of signals of the nuclei of hydrogen and carbon atoms in a group of steroids belonging to the group of 6-deoxo-24-epiteasterone and 24-epibrassinolide has been fulfilled using the two-dimensional Nuclear magnetic resonance spectroscopy methods. The effect of solvents on the chemical shift has been&#x0D; studied.

Role of Oral Steroids in The Treatment of Carpal Tunnel Syndrome

Objective: To compare the efficacy of oral steroids and intracarpal steroids in treating carpal tunnel syndrome.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Neurology department, Allied Hospital, Faisalabad Pakistan, from Jul to Dec 2020.&#x0D; Methodology: Patients of either gender, &gt;18 years of age having carpal tunnel syndrome were included and divided into two groups. The oral steroids group received 20mg Prednisone tablets for two weeks and 2cc 0.9% Saline injection locally in the carpal tunnel on the affected hand by a neurologist. Intracarpal steroids group received 40mg Methylprednisolone locally in the carpal tunnel on the affected hand and placebo tablets for two weeks. Global symptom score was calculated at baseline and four weeks of treatment. Nerve conduction studies were conducted at baseline and four weeks of treatment.&#x0D; Result: A total of 106 patients were included in the study. There was a statistically significant improvement in the oral steroids group and intracarpal steroids group at four weeks follow up in mean sensory conduction velocity, mean global symptom score, mean motor conduction velocity and mean sensory latency (p&lt;0.05). There was no statistically significant difference in the efficacy of oral Prednisone and intracarpal Methyl prednisone in the groups (p-value 0.579).&#x0D; Conclusion: Oral steroids and intracarpal steroids are effective as conservative treatment of carpal tunnel syndrome in decreasing symptoms on global symptom score (GSS) and improving the nerve conduction parameters of carpal tunnel syndrome.

Abstract 70: High dose intravenous therapy augments complete anterior pituitary hormoanl recovery in primary autoimmune hypophysitis

Background: Glucocorticoid treatment of primary autoimmune hypophysitis (PAH) is well established; however, dose, route, and recovery predictors are not well-defined.Aims: Systematic review of published literature for use of glucocorticoids as first line of management in PAH- to analyze treatment protocol, baseline and post-treatment clinical, hormonal, and radiological features.Results: 152 cases (females-69.8%; age-41±13.9 years) with PAH [(94-oral steroid group (OSG); 58-intravenous steroid group (IVSG)] were included. Clinical recovery [headache, 79% vs.97%; visual deficits, 58% vs.90%; cranial nerve palsy, 50% vs.87%] between OSG and IVSG were comparable. Complete anterior pituitary hormonal (APH) recovery was significantly higher in IVSG (39.02% vs.20.89%, p=0.04) predominantly due to corticotroph axis recovery (56.7% vs. 27.3%), whereas recovery of other APH axes were not different. Persistent APH deficit was higher in OSG (52.2% vs. 29.3%, p=0.02). Radiologically, regression of pituitary enlargement (72% vs. 64%) and resolution of stalk thickening (76% vs. 64%) between groups was not different. Trend towards lesser recurrence in IVSG (19.3% vs. 32.9%) was seen. Prednisolone equivalent dose (mg)/day was significantly higher in IVSG [30 (24-65) vs. 136 (73-136)] with similar treatment duration (weeks) [8 (8-20) vs. 10 (6-10)]. Reported major adverse effects did not differ between groups. DI predicted poor hormonal recovery in IVSG, while no other parameter affected recovery.Conclusion: High-dose pulse IVS leads to better APH recovery and may decrease recurrence. Preserving the cortisol axis prevents long-term hormone replacement and adrenal crisis in future.

Early intervention with anti-fibrotic pirfenidone is effective than corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients

Background: The COVID-19 pandemic caused by SARS-CoV-2 has made nearly 120 million people sick with more than 2 million dead. Many survivors of severe COVID-19 are experiencing post-COVID complications beyond 4 weeks from the disease onset. The decrease in lung function and pulmonary fibrosis are the serious manifestations of COVID-19. The burden of even a relatively mild fibrotic change could have considerable morbidity and mortality, especially in the elderly and those with comorbidities. Aim: To evaluate the effect of early intervention with anti-fibrotic pirfenidone and corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients. Methods: This randomised open-label pilot trial was conducted was conducted at Government Medical College, Srinagar for evaluating the role of anti-fibrotic drugs in preventing post-COVID pulmonary fibrosis. In this study, 60 patients with severe COVID-19 infection were screened and randomised into two groups, one receiving anti-fibrotic drug– pirfenidone (n = 17) and other receiving corticosteroids (n = 19). The study participants were evaluated at the baseline and after 6 ± 1 week using 6-min walk test, spirometry and high-resolution computed tomography (HRCT). Results: The mean (±standard deviation [SD]) age of the pirfenidone and steroid group was 64.16 ± 11.36 and 67.19 ± 13.32 (P = 0.929), respectively. There were no significant differences in clinically relevant baseline characteristics at the time of enrolment in the two treatment groups. The initial CT severity score was 14.84 ± 4.031 and 14.81 ± 4.722 (P = 0.400) in pirfenidone and corticosteroids groups. The mean (±SD) baseline forced expiratory volume in the first second (FEV1) in pirfenidone and corticosteroid was 73.32 ± 18.10 and 71.71 ± 17.92 (P = 0.670), while FEV1/forced vital capacity was 95.89 ± 23.40 and 90.00 ± 21.09 (P = 0.920), respectively, between the two groups. The final fibrosis score was 115.52 ± 12.32 and 138.22 ± 43.90 (P = 0.004) in the pirfenidone and corticosteroids groups, respectively. At the 6th week, the proportion of patients who had died was less in the pirfenidone group as compared in the corticosteroid group (02 patients [11.76%] in the pirfenidone group vs. 08 patients [42.10%] P &lt; 0.001). Conclusion: Pirfenidone, an anti-fibrotic agent, has a better outcome than corticosteroids in preventing post-COVID pulmonary fibrosis without serious adverse effects. Our study concludes that early initiation of pirfenidone therapy in patients with severe COVID-19 infection, especially those at higher risk like the elderly and those with co-morbidities has a better treatment and survival outcome compared to corticosteroids.