Steroid Group Research Articles

Efficacy of Oral Steroids for Acute Acoustic Trauma

Objective: This study aimed to study the effect of steroid treatment on new-onset sensorineural hearing loss (SNHL) in subjects presenting shortly after an audiometry-confirmed acute acoustic trauma (AAT) injury. Study Design: This is a case-control study. Methods: We identified healthy military personnel who presented with AAT injury to the Israeli Defense Forces Medical Corps Otolaryngology/Audiology Services during 2016–2020. Patients were nonrandomly allocated to a treatment arm, where they received steroids (prednisone, 1 mg/kg, 60 mg maximal daily dose), administered for either ≥7 days or <7 days, or to a control arm, in which no treatment was offered besides loud noise avoidance. Audiometries were conducted within 7 days following the AAT and within 1 month later. We compared changes in bone conduction (BC) and air conduction (AC) thresholds at 2–8 kHz. Results: Of the 263 enrolled subjects, 137 (52%) received steroids and 126 (48%) received no treatment. Subjects who were treated early (<24 h) with high-dose steroids and for ≥7 days demonstrated significantly better hearing outcomes, compared with the nontreatment group. Subjects in the steroids group demonstrated 13–14 dB average improvement in BC thresholds at 3 and 4 kHz (p = 0.001) and additional 7–8 dB average improvement in AC thresholds at 6 and 8 kHz, compared with the nontreatment group (p < 0.0001). These observations were more compelling in patients who initially presented with worse hearing losses (>35 dB). No statistically significant differences were observed in AC/BC pure tone average between the two groups. Conclusions: Early oral steroids are recommended in AAT injuries and were shown to improve hearing outcomes within 1 month.

Comparison of efficacy of Oral versus Intra-articular Corticosteroid Application in the treatment of Frozen Shoulder: An experimental study in rats.

The aim of this study was to compare clinical and histopathological effects of oral versus intraarticular corticosteroid application in a rat model of frozen shoulder. In this study, eighty adult Sprague-Dawley rats were used. The animals were divided into 5 equal groups. The frozen shoulder model was created by immobilizing animals' shoulders with internal fixation with sutures for 8 weeks. At the 8th week, sham (n: 16) and control (n: 16) groups were sacrificed to collect data for healthy and affected shoulders. Also, at the 8th week, 50 mg/ kg methylprednisolone was started for the oral treatment group, and a single dose of 0.5 mg/kg triamcinolone acetonide was injected for the intraarticular treatment group. The effect of additional steroid treatment was expected for 2 weeks, then all remaining treatment and natural course groups were sacrificed on the 10th week. After sacrification, specimens taken as "en bloc" scapulothoracic disarticulation were randomly divided into two groups for a range of motion measurement and histopathological examination. The control (frozen shoulder model) group's shoulder range of motion in all directions was lower than the sham (healthy) group (P < 0.01). Natural course and intraarticular steroid groups, compared to the frozen shoulder model showed a significant increase in the direction of abduction (P < 0.05). Also, it was found for treatment groups that in all directions the range of motion was not as good as the healthy values (P < 0.01). The intraarticular treatment group showed higher degrees of abduction compared to the natural course and oral steroid treatment groups (P < 0.01). Oral steroid treatment group's range of motion was not significantly better than the disease model and had no superiority to the natural course group (P > 0.05). Histopathologically, no statistically significant difference was observed between the groups for signs of frozen shoulder which was found in the immobilized group (P > 0.05). Histopathologically, immobilization was found to cause thickening of the capsule that cannot be resolved by treatment. (P < 0.05). In frozen shoulder disease, intraarticular steroid injection seems to be superior in increasing the range of motion than oral steroid treatment.

Steroidal alkaloid biosynthesis is coordinately regulated and differs among tomatoes in the red-fruited clade.

The tomato (Solanum spp.) clade of Solanaceae features a unique assortment of cholesterol-derived steroidal alkaloids. However, little quantitative data exists reporting the profile and concentration of these alkaloids across diverse fruit germplasm. To address the lack of knowledge regarding the chemical diversity, concentration, and genetic architecture controlling tomato steroidal alkaloids, we quantitatively profiled and genotyped two tomato populations representing diversity in the red-fruited clade. We grew 107 genetically diverse fresh market, processing, landrace, and wild tomato in multiple environments. Nine steroidal alkaloid groups were quantified using ultra-high performance liquid chromatography tandem mass spectrometry. The diversity panel and a biparental population segregating for high alpha-tomatine were genotyped to identify and validate quantitative trait loci (QTL) associated with steroidal alkaloids. Landraces and wild material exhibited higher alkaloid concentrations and more chemical diversity. Average total content of steroidal alkaloids, often dominated by lycoperoside F/G/esculeoside A, ranged from 1.9 to 23.3 mg 100 g-1 fresh wt. across accessions. Landrace and wild cherry accessions distinctly clustered based on elevated concentrations of early or late-pathway steroidal alkaloids. Significant correlations were observed among alkaloids from the early and late parts of the biosynthetic pathway in a species-dependent manner. A QTL controlling multiple, early steroidal alkaloid pathway intermediates on chromosome 3 was identified by genome-wide association studies (GWAS) and validated in a backcross population. Overall, tomato steroidal alkaloids are diverse in the red-fruited clade and their biosynthesis is regulated in a coordinated manner.

Association between Preoperative Steroids and Outcomes in Patients Undergoing Pancreaticoduodenectomy using the National Surgical Quality Improvement Program

BackgroundA national study analyzing the association between preoperative steroid use and outcomes after pancreatic resections is lacking. The purpose of this study is to evaluate the association between preoperative steroids and outcomes after pancreaticoduodenectomy using a national database. Materials and MethodsA retrospective analysis of patients undergoing pancreaticoduodenectomy was performed using the National Surgical Quality Improvement Program (NSQIP) database (2014–2019). In addition, we utilized propensity score matching to compare patients on preoperative steroids to those who were not. Outcomes measured included 30-day complications and mortality, need for readmission, a prolonged hospital length of stay, delayed gastric emptying, and pancreatic fistula. ResultsAfter propensity score matching, there were 438 patients in the steroid group and 876 patients in the no steroid group. There was no difference in pancreatic fistula (23.8% vs. 21.7%; p-0.3), delayed gastric emptying (21.1% vs.20.1%; p-0.06), major complications (31.8% vs. 30.1%; p-0.1), and mortality (3.5% vs. 3.2%; p-0.6) between the two groups. ConclusionGlucocorticoids did not reduce the incidence of overall complications, postoperative fistula, and delayed gastric emptying following pancreaticoduodenectomy.

Ultrasound-Guided Nerve Hydrodissection With 5% Dextrose 4 Weeks After Steroid Injection in Treatment of Carpal Tunnel Syndrome: A Retrospective Study.

ObjectiveTo investigate the efficacy and safety of ultrasound-guided nerve hydrodissection (HD) with 5% dextrose (D5W) as add-on therapy after corticosteroid injection in carpal tunnel syndrome (CTS), and provide a novel strategy.MethodsIn this retrospective study, patients with CTS who received ultrasound-guided nerve HD with D5W as add-on therapy after corticosteroid injection (combination group) were enrolled. Patients who received corticosteroid injection without add-on therapy (steroid group) were recruited as the control group. Ultrasound-guided nerve HD with D5W was performed 4 weeks after corticosteroid injection. Treatment effectiveness were assessed by visual analog scale (VAS) and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). The assessment was performed at baseline and 4, 8, and 12 weeks after corticosteroid injection. In addition, adverse events were recorded in this study.ResultsA total of 49 patients and 62 wrists meeting the criteria were included, with 24 patients and 31 wrists in the steroid group and 25 patients and 31 wrists in the combination group. Compared with baseline data, both groups showed greater improvement in VAS, BCTQs (BCTQ severity), and BCTQf (BCTQ function) at 4, 8, and 12 weeks follow-up. VAS, BCTQs, and BCTQf scores at baseline and week 4 were comparable between steroid group and combination group. Compared with steroid group, combination group exhibited a significant reduction in VAS, BCTQs, and BCTQf at 8- and 12-week follow-up (P ≤ 0.01). No adverse event occurred in any group.ConclusionsOur results showed that ultrasound-guided nerve HD with D5W as add-on therapy after corticosteroid injection was efficacious and safe in CTS, and combination therapy is more beneficial than corticosteroid monotherapy in the improvement of symptoms and function at 8- and 12-week follow-up.

Tocilizumab for COVID-19: A systematic review and meta-analysis of randomized controlled trials.

The effective treatment modalities for severe coronavirus disease 2019 (COVID-19) are needed. As the primary cause of mortality is a hyperinflammatory state, the interleukin-6 antagonist tocilizumab has been used in multiple clinical studies. We conducted this systematic review and meta-analysis to estimate the effectiveness of tocilizumab in reduction of mortality due to COVID-19.A systematic search of the Pubmed and Embase databases was performed to extract randomized controlled trials (RCTs) regarding the use of tocilizumab therapy for COVID-19. An overall pooled mortality analysis was performed, and odds ratios were reported. Cochrane risk of bias assessment tool was used to assess the risk of bias. Heterogeneity was assessed using the I2 statistic. Nine RCTs, including 6489 patients, were selected for meta-analysis. Seven trials reported 28-day mortality, and one trial each reported 21-day and 30-day mortality. There were 846 deaths among 3358 participants in the steroid group while 943 deaths among 3131 patients randomized to the control group (random-effects odds ratio 0.87, 95% confidence interval 0.73-1.03, p=0.11). There was some heterogeneity among the trials as the I2 value was 15%, with a p-value of 0.31. There was a reduction in the need for ICU admission in the tocilizumab group. A higher risk of secondary infections was noted in the tocilizumab group (fixed-effects odds ratio 0.72, 95% confidence interval 0.55-0.95, p=0.02). This meta-analysis of RCTs demonstrated that the use of tocilizumab was not associated with a reduction in all-cause mortality in patients with COVID-19 and had higher odds of secondary infections.

Effect of Antenatal Dexamethasone in Late Preterm Period on Neonatal Hypoglycemia: A Prospective Cohort Study from a Developing Country.

This study compared the risk of hypoglycemia within 72 h of life in infants with and without exposure to antenatal dexamethasone in the late preterm period (34-366/7 week's gestational age). This prospective cohort study was conducted in a tertiary care neonatal unit of Eastern India from May 2021 to November 2021. Babies in the exposed group received at least one dose of antenatal dexamethasone in the late preterm period between 7 days before delivery and birth. 'Complete course' of antenatal steroid was defined as four doses of injection dexamethasone at 12 h intervals and <4 doses were considered as 'Partial course'. Primary outcome was incidence of hypoglycemia within 72 h of life, defined as whole blood glucose <45 mg/dl. Total 298 infants (98 in control, 134 in partial and 66 in complete group) were assessed for final outcome. No significant difference in outcomes were seen in the exposed group compared to unexposed group. However, incidence of hypoglycemia within 72 h (complete vs. partial p= 0.008, complete vs. control p=0.005) and 12 h of life (complete vs. partial p=0.013, complete vs. control p=0.013) was significantly less in complete steroid group. Logistic regression analysis revealed complete course of antenatal corticosteroid significantly decreased the risk of hypoglycemia [adjusted odds ratio, 95% confidence interval (CI) 0.15 (0.03-0.69), p=0.015]. Number needed to be exposed for one additional benefit was 7 (95% CI, 6.35-22.14). Complete course of dexamethasone administered to mothers at risk of late preterm delivery reduces risk of neonatal hypoglycemia within 72 h of life.

Efficacy of Intra Articular Steroid Injection and Platelet Rich Plasma in Patients with Osteoarthrithis

Objective: To compare the efficacy of intra-articular steroid injection and Platelet rich plasma in patients with Osteoarthrithis. Methodology: A randomized controlled trail study was conducted at Rheumatology Division of the Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad after the acceptance of synopsis from  . A total of 122 adult patients with unilateral or bilateral osteoarthritis of knee and were randomized into two treatment groups. In Group I, patients received intra-articular steroid injections and in Group II, patients received platelet rich plasma (PRP). WOMAC score was calculated at baseline and was subsequently assessed after 06 weeks and 3 months. Results: Age and gender distribution and mean WOMAC and VAS scores were similar in both groups at baseline (p&gt;0.05).  At six weeks, mean WOMAC score in steroid group was 32.1 ± 24.1 and it was 24.9 ± 21.3 in PRP group (P=0.084). Mean VAS in steroid group was 4.5 ± 2.5 and it was 3.9 ± 2.6 in PRP group (P=0.0.158). At three months, mean WOMAC score in steroid group was 39.1 ± 24.3 SD and it was 27.1 ± 21.9 SD in PRP group (P=0.005). At three months, mean VAS in steroid group was 5.6 ± 2.6 and it was 4.1 ± 2.7 in PRP group (P=0.003). Conclusions: The study outcomes were better in patients treated with PRP as compared to intra-articular steroid injection. Mean WMOAC and VAS scores were significantly lower after three months in PRP group as compared to steroid group.

The clinical utility of steroids in facial trauma: A retrospective study of 638 patients

AbstractGlucocorticosteroids reduce post‐operative swelling, trismus and pain after third molar extraction, maxillofacial trauma and orthognathic surgery. Steroids may affect immune system and retard wound healing. However, the use of steroids may or may not lead to infection. Patients were divided into two groups based on steroid therapy. The minimum follow‐up was for 6 months. Independent t‐test and chi‐square statistics were used for quantitative and categorical data respectively. A p &lt; 0.05 was considered significant at 95% confidence interval. A total of 638 patient records were divided into two groups; group A (steroid group) and group B (non‐steroid group). After 6 months 45% of group A patients and 2% of group B patients had infection (p value‐0.077). The mean duration of analgesic requirement in group A was 3.9 ± 1.5 days compared to 4.4 ± 2.1 days in group B (p = 0.01). Oedema was present in 9% of patients in group A compared to 12.5% in group B after 1 week (p &lt; 0.0001). The mean VAS score at 1 week was 0.03 ± 0.18 in group B compared to 0 in group A (p &lt; 0.001). Use of steroids does not increase the risk of infection. It significantly reduces the duration of analgesic requirement with the reduction in oedema and pain.

EVALUATION OF PTEN AND PI3K/AKT EXPRESSIONS IN STANOZOLOL-TREATED RAT KIDNEYS

Objective: Stanozolol is an anabolic androgenic steroid (AAS) that is widely used by teenagers and athletes in bodybuilding, sports, and athletics. The potential effects of stanozolol in kidney functions have not been defined. In this study we investigated the expression of tumor suppressor protein phosphatase and tensin homolog (Pten) and mRNA levels of phosphatidylinositol 4,5-bisphosphate 3 kinase (Pi3k) and the protein kinase B (Akt1) signaling pathway in rat kidneys treated by stanozolol. Material and Method: Rats were randomized to 5 groups as control, solvent control, steroid (stanozolol), solvent-exercise, and steroid-exercise. Subcutaneous injection of stanozolol (5 mg/kg) was applied for 28 days and swimming exercise was performed 20 min/day, 5 days/week in exercise groups. Expression of PTEN was evaluated by immunohistochemistry. Also, Pten, Pi3k, and Akt1 mRNA expressions were analyzed via RT-PCR. Results: Mesangial cells and renal tubules in the control, solvent control, and solvent exercise groups showed strong (+++) PTEN reactivity against weak PTEN reactivity in the steroid group. Moderate PTEN reactivity was detected in cells of the steroid exercise group. Pten mRNA expression was significantly decreased, and Pi3k and Akt1 mRNA expression were significantly increased in the steroid group versus other groups (p&lt;0.001). Pten expression showed increase while Pi3k and Akt1 expression showed decrease with exercise treatment (p&lt;0.05). Conclusion: Our findings suggest that AAS usage may inhibit PTEN expression in kidneys, which can be associated with increased Pi3k and Akt1 mRNA levels. Exercise performed with AAS usage can be protective on stanozolol-exposed kidneys due to increased levels of PTEN expression and decreased levels of Pi3k and Akt1.

EVALUATION OF PTEN AND PI3K/AKT EXPRESSIONS IN STANOZOLOL-TREATED RAT KIDNEYS

Objective: Stanozolol is an anabolic androgenic steroid (AAS) that is widely used by teenagers and athletes in bodybuilding, sports, and athletics. The potential effects of stanozolol in kidney functions have not been defined. In this study we investigated the expression of tumor suppressor protein phosphatase and tensin homolog (Pten) and mRNA levels of phosphatidylinositol 4,5-bisphosphate 3 kinase (Pi3k) and the protein kinase B (Akt1) signaling pathway in rat kidneys treated by stanozolol. Material and Method: Rats were randomized to 5 groups as control, solvent control, steroid (stanozolol), solvent-exercise, and steroid-exercise. Subcutaneous injection of stanozolol (5 mg/kg) was applied for 28 days and swimming exercise was performed 20 min/day, 5 days/week in exercise groups. Expression of PTEN was evaluated by immunohistochemistry. Also, Pten, Pi3k, and Akt1 mRNA expressions were analyzed via RT-PCR. Results: Mesangial cells and renal tubules in the control, solvent control, and solvent exercise groups showed strong (+++) PTEN reactivity against weak PTEN reactivity in the steroid group. Moderate PTEN reactivity was detected in cells of the steroid exercise group. Pten mRNA expression was significantly decreased, and Pi3k and Akt1 mRNA expression were significantly increased in the steroid group versus other groups (p&lt;0.001). Pten expression showed increase while Pi3k and Akt1 expression showed decrease with exercise treatment (p&lt;0.05). Conclusion: Our findings suggest that AAS usage may inhibit PTEN expression in kidneys, which can be associated with increased Pi3k and Akt1 mRNA levels. Exercise performed with AAS usage can be protective on stanozolol-exposed kidneys due to increased levels of PTEN expression and decreased levels of Pi3k and Akt1.

Presence of multilobular necrosis on liver biopsy identifies corticosteroid responsiveness in acute indeterminate hepatitis.

Treatment of patients with severe indeterminate hepatitis (IAH) is an unmet need. Corticosteroids are often used in the management of these patients but criteria for the selection of patients for this intervention are arbitrary. The aims of this study were to analyse the clinical and pathological features of patients with IAH to define predictors of corticosteroid responsiveness. This study included consecutive patients with acute indeterminate hepatitis admitted to a single hospital and underwent a liver biopsy. The clinical manifestation and histopathological features of steroid and non-steroid groups were compared and their relationship with corticosteroids response was evaluated. Forty-eight patients were included, 24 (50%) recovered and the other half underwent liver transplantation or died within 3-months. Of the 48 cases, 24 received corticosteroids (initial dose of 45±12mg prednisolone). Corticosteroids were initiated 2.7±3.8days after admission. Liver biopsy was performed 2-days (median, IQR 1-3) after admission. Fifteen (62.5%) patients receiving corticosteroids survived without transplantation compared with 9 (37.5%) that did not receive steroids (P=.149). In those with multilobular necrosis, 50% reduction in the death/transplantation rate was observed after steroid treatment (P=.018). In patients without multilobular necrosis and with or without perivenulitis, corticosteroids did not impact the outcome. Response to corticosteroids was independent of the MELD score. The presence of multilobular necrosis on liver biopsy helps identify a subgroup of IAH cases who may benefit from the administration of corticosteroids.

When to start tacrolimus ointment for vernal keratoconjunctivitis? A proposed treatment protocol.

The aim of this study was to compare treatment regimens of tacrolimus and of topical steroids for VKC and suggest a treatment protocol according to our clinical experience. This retrospective, nonrandomized case series enrolled 85 patients with VKC. Patients were classified clinically according to severity (mild, moderate, severe) and were treated according to a suggested protocol. Analysis was made according to treatment received: tacrolimus ointment as first line treatment (tacrolimus 1st line), tacrolimus ointment after topical steroid drops treatment (tacrolimus 2nd line) and topical steroid drops or artificial tears alone (topical steroid and tears group). Significant improvements in clinical signs and symptoms were achieved under tacrolimus treatment 14months in the moderate group and 5months in the severe group. The longest duration of treatment was for tacrolimus 2nd line group (p = 0.031) and the mean number of visits in the clinic was the highest. The mean number of topical treatments per day was higher in the topical steroid and tears group (2.6 times) than in the two tacrolimus groups (1.3 times for both). The mean time needed to achieve disease remission or relief did not differ between the tacrolimus 1st line and 2nd line groups. Tacrolimus treatment is effective and safe for VKC. Tacrolimus as 1st line treatment may be preferred for severe cases, for faster disease remission compared to tacrolimus as 2nd line treatment; and with fewer topical treatments per day compared to topical steroids.

Clinical Characteristics of COVID-19: Use of Steroids in Mostly Unvaccinated COVID-19 Patients Before the Omicron Variant.

BackgroundGlucocorticoids are one of the current standard agents for moderate to severe coronavirus disease 2019 (COVID-19) treatment based on the RECOVERY trial. Data on the real clinical application of steroids for COVID-19 are scarce and will help guide the optimal use of steroids. We described the current prescription pattern of steroids for COVID-19 and investigated the factors related to specific practices.MethodsAll adults aged ≥ 19 years who were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction and admitted to one of 3 study hospitals from 8 December 2020 to 30 June 2021 were enrolled. Demographic and clinical data, including medications and oxygen therapy, were retrospectively collected from electronic medical records. The severity of comorbidities and COVID-19 were measured. The subjects were divided into steroid and nonsteroid groups, and the steroid group was then subdivided into standard and higher/longer groups.ResultsAmong a total of 805 patients, 217 (27.0%) were treated with steroids. The steroid group showed a higher rate of oxygen therapy (81.1% vs. 2.7%), more concomitant use of remdesivir (77.4% vs. 1.4%) or antibiotics (79.3% vs. 4.3%), and a higher proportion of high risk according to National Early Warning Score-2 score (30.0% vs. 0.9%) or severe risk according to National Institute of Allergy and Infectious Disease Ordinal Scale score (81.1% vs. 2.7%) than the nonsteroid group. The mortality of the steroid group was 4.6%. In the steroid group, 82.5% received a standard or lower dose of steroids within ten days, and 17.5% (38/217) received a higher or longer dose of steroids. Multivariate analysis showed that initial lymphopenia (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.89–0.99) and high level of lactate dehydrogenase (LDH) (aOR, 1.00; 95% CI, 1.00–1.01) were independent risk factors for higher doses or longer steroid use.ConclusionThe dose and duration of steroids were in line with current guidelines in 82.5% of COVID-19 patients, but the outliers may need tailored therapy according to surrogate markers, such as initial lymphopenia or high level of LDH.

Role of Corticosteroids in Tubercular Pleural Effusion: A Prospective Interventional Study from a Tertiary Care Teaching Hospital, Telangana, India

Introduction: Tuberculosis is a major public health problem in majority of the developing countries. Pleural effusion develops when fluid accumulates between the parietal and visceral pleura. Aim: To evaluate the efficiency of corticosteroids in rapid clinical and radiological resolution of TPE. Also to study the recurrence of pleural effusion and find incidence of pleural fibrosis in patients treated with corticosteroids. Materials and Methods: This prospective interventional study was conducted at Government Chest Diseases and TB hospital (tertiary care teaching hospital), Telangana, India, from October 2014 to October 2016. Total 80 patients with TPE were divided into two groups. Steroid group (n=40), patients received standard Antitubercular Treatment (ATT) that was alternate day regimen along with prednisolone 0.75 mg/kg body weight per day for 2 weeks there after tapering of the dose done every 2nd weekly in next 4 weeks. Non steroid group (n=40), patients received standard ATT alone that was alternate day regimen under Directly Observed Treatment Short course (DOTS) therapy based on Revised National TB Control Programme (RNTCP) guidelines respectively. All patients were followed in the Outpatient Department at the end of second, fourth, sixth, 24th week. At every follow-up visit, history obtained from patients regarding symptoms and chest radiographs for comparison of reabsorption of pleural fluid between two groups. At the end of treatment ultrasound of the chest was performed to confirm the presence of pleural thickening seen on chest radiograph. Descriptive measures obtained included as mean and standard deviation. The association between two categorical variables done by using Chi-square test. The p-values&lt;0.05 was considered as statistically significant. Results: There was early initiation of symptomatic relief in patients treated with steroid group as compared to non steroid group (p-value &lt;0.001). Average duration for symptomatic relief in steroid group was 3.42 days (range 1-7 days) and in non steroid group 8.3 days (range 1-42 days). There was significant difference between two groups in duration taken for symptomatic relief (p-value &lt;0.001). Conclusion: Results of the present study suggest that corticosteroids still play some role in the treatment of TPE. Addition of the corticosteroids to the standard ATT exerts more rapid relief of clinical symptoms. The rapidity in pleural fluid absorption is not influenced significantly by adding corticosteroids to the ATT. There was no recurrence of pleural effusion after addition of corticosteroids to ATT. The incidence of pleural thickening was not influenced by steroids.

Are short course corticosteroids as effective as longer course in determining days of oxygen requirement and hospital stay in patients with moderate COVID-19 disease?

Background: In past 2 years, COVID-19 pandemic has affected the health care system adversely. World statistics showed a huge rise in the incidence of this highly infectious disease. Abnormal and unregulated immune response was found to be the key deciding factor for the outcome of this disease. A lot of studies showed a promising role if corticosteroids as immunosuppressant agents. They reduce morbidity and mortality in patients with moderate-to-severe COVID-19 disease. However, steroid therapy comes with a huge concern in form of their adverse effects, especially on prolonged use. Optimum duration of steroid therapy is not standardized. Aim and Objectives: The present study was carried out to determine days of oxygen requirement and duration of hospital stay in patients receiving short course steroid vis-à-vis long course steroid therapy. Materials and Methods: A retrospective observational study was conducted in tertiary care teaching hospital after prior permission of the Institutional Ethics Committee. All patients diagnosed as having moderate COVID-19 illness with age group of 18–80 years with minimum 03 days of 6 mg dexamethasone or other equivalent steroid administration were included in the study. Patients who were living with HIV/AIDS, cancer, hepatic and renal illness, ischemic and other valvular diseases, and chronic pulmonary diseases affecting oxygenation status were excluded from the study. A total of 203 study participants were enrolled during study period (68 in short course while 135 in long course steroid group). Data were enrolled in predesigned structured and validated case record form. Results: Short course steroid therapy was found more frequent in &lt;60 years of age. Mean and SD of days of oxygen administration were (4.36 vs. 8.88) and (2.15 vs. 3.43) in short course and long course steroid therapy, respectively. Oxygen requirement for ≥7 days was in (10, 7.41%) patients and (45, 66.18%) patients in short course steroid group and long course steroid group, respectively. Mean and standard deviation of duration of hospital stay were (6.64, 2.87) and (11.9, 4.03) in short course and long course steroid group, respectively. Hospital stay for more than 9 days was (20, 14.81%) and (47, 69.12%) in short course and long course steroid group, respectively. Conclusion: A positive association was found between duration of hospital stay and long course steroid therapy and was statistically significant. Similarly, a positive association between days of oxygen requirement and long course steroid therapy was found and again it was statistically significant. The study findings indicated that short course steroid therapy was found to be more effective in treatment outcome of COVID-19 illness as far as the duration of hospital stay and oxygen administration parameters are concerned.

Outcomes of Transcatheter Aortic Valve Replacement in Patients Treated With Systemic Steroids.

Chronic steroid therapy is associated with higher vascular complication rates in patients undergoing transcatheter aortic valve replacement (TAVR). The effect of corticosteroids on aortic annular complications has not been directly assessed in this population. A retrospective analysis of 1095 patients undergoing transfemoral TAVR was performed. Patients treated with chronic steroids at the time of the procedure (n = 99) were compared with those who received no steroids (n = 992). The primary outcome included a composite of aortic annular complications, defined as a combination of aortic annular rupture, aortic dissection/perforation, and left ventricular perforation. The primary outcome was significantly higher in the steroid group (4.0% vs 0.5%; P<.01). This finding was primarily driven by higher rates of acute annular rupture in the steroid group (2.0% vs 0.2%; P=.04). Steroid use was associated with higher rates of intraoperative cardiac arrest (5.1% vs 1.5%; P=.03), device capture/retrieval (4.0% vs 0.8%; P=.01), and emergent conversion to open heart surgery (4.0% vs 0.6%; P<.01). There were no differences with respect to in-hospital mortality, stroke, myocardial infarction, need for permanent pacemaker, bleeding complications, minor vascular complications, hospital length of stay, hospital 30-day readmission, or 30-day echocardiographic findings. Additionally, within the steroid group, there were no significant differences between balloon-expandable vs self-expanding TAVR prostheses with respect to composite aortic annular complications. Chronic steroid therapy increases the risk of aortic annular complications in patients undergoing TAVR, with detrimental consequences including intraoperative cardiac arrest and conversion to open heart surgery. Steroid use should be considered in patient selection and determination of procedural technique for TAVR.

Effects of postnatal hydrocortisone on cytokine profile in extremely preterm infants.

Systemic hydrocortisone administration has been widely used in preterm infants who are at risk of bronchopulmonary dysplasia (BPD). However, the effects of hydrocortisone on cytokine profiles have not been examined. We aimed to investigate the effects of postnatal hydrocortisone treatment on serum cytokine levels in extremely preterm infants. This is a retrospective study of 29 extremely preterm infants born at <28 weeks of gestational age. We obtained serum from blood samples collected during an early phase (5-20 days) and a late phase (28-60 days) after birth. We measured the levels of proinflammatory cytokines (tumor necrosis factors α and β, interleukin (IL)-1β, and IL-6), T-helper (Th) 1 cytokines (interferon-γ, IL-2, and IL-12p70), Th2 cytokines (IL-4, IL-5, and IL-10), Th17 cytokine IL-17A, and chemokine IL-8. The cytokine levels between the early and late phases were compared between infants who received postnatal hydrocortisone and those who did not. Thirteen infants (45%) received systemic hydrocortisone treatment at a median age of 15 days (IQR: 10.0-21.5) after birth due to respiratory deterioration. The percentage of BPD was higher in the steroid group than in the non-steroid group (P = 0.008). The ratio of IL-6 for the late-to-early phase was significantly lower in the steroid group than in the non-steroid group (P = 0.04). The concentration of the other cytokines remained unchanged between the phases. Although the postnatal hydrocortisone treatment provided for respiratory deterioration did not prevent the BPD development, hydrocortisone treatment might suppress IL-6 overproduction in extremely preterm infants.

IDENTIFICATION OF CHEMICAL COMPOUNDS AND ANTIBACTERIAL ACTIVITY TEST OF Kirinyuh LEAF EXTRACT (Chromolaena odorata L.) FROM Ie Seum GEOTHERMAL AREA, REGENCY OF ACEH BESAR, INDONESIA

This research aims to identify and compare the chemical components of Chromolaena odorata leaf extract grown in the geothermal and outer areas of the geothermal source site. The antibacterial activity of the plant extracts was also identified. The plant materials were collected from the Ie Seum Geothermal area and Blangkrueng region, approximately 31 km from the geothermal area. All samples were extracted using three different solvents: ethanol, nhexane, and ethyl acetate. A phytochemical test was performed to identify the secondary metabolites, volatile components were identified using GC-MS, and the inhibition zone method was used to assess the antibacterial activity of the extracts against S. aureus. The ethanol extract and ethyl acetate from both areas contained phenolic, flavonoid, and steroid, while the n-hexane extracts from both areas’ steroid groups were identified. In addition, GCMS data revealed that the plant material sample from the geothermal contained more chemical constituents compared to the sample from the geothermal outer area. The extract from geothermal also shows better antibacterial activity against S. aureus, and statistical analysis indicates a significant difference in antibacterial activity among solvents and between the origin of the samples.

The effect of steroids used in the treatment of coronavirus disease 2019 on infections in intensive care.

Objective:Cytokine storm in coronavirus disease 2019 (COVID-19) patients causes lung damage and acute respiratory distress syndrome (ARDS). Immunomodulators such as steroids are widely used to control this situation. This study investigates the effectiveness of steroids used in COVID-19 patients, and their effects on secondary infections, morbidity, and mortality.Methods:Data were obtained by retrospectively scanning the files of patients in our hospital’s intensive care unit clinic during the three peak periods.Results:Between the steroid and non-steroid groups, there was no statistically significant difference in reproductive rates. These rates were 49.7% and 43.2%, respectively. Reproductive rates among steroid types were determined as 25 (56.8%) in the Methylprednisolone group, 18 (69.2%) (Highest) in the Dexamethasone + Methylprednisolone group, and 54 (43.2%) (Lowest) in the Dexamethasone group. Steroid treatment duration was effective on reproduction. Steroids cause more infections, especially after invasive procedures (Tracheal intubation, central venous catheter, etc.). In the groups with and without tracheal aspirate steroids, the growth rates were 71 (76.3%) and 32 (54.2%) respectively. There was no difference in mortality between the groups.Conclusion:Cytokine storm causes lung damage and ARDS. Steroids can be useful in controlling this hyper-inflammatory situation. However, increased secondary infections, an important side effect of steroids, increase mortality. Steroids more often cause these infections, especially in patients undergoing invasive Strict adherence to infection control measures during steroid treatment will reduce this risk. In conclusion, while steroids reduce mortality by controlling the hyper-inflammatory picture, they also increase mortality with increased secondary infections. Preventing infections enables success with steroids.