Steroid Group Research Articles

Role of Steroids in Reducing Recurrence of Urethral Stricture after Direct Vision Internal Urethrotomy

Background: Recurrence of urethral strictures is the most frequent and bothersome complication, with majority of stricturesrecurring after optical internal urethrotomy. The objective of this study was to establish the role of oral steroid therapy after direct vision internal urethrotomy (DVIU) in minimizing recurrence of urethral stricture.
 Methodology: It was a randomized controlled trial carried out at Armed Forces Institute of Urology, Rawalpindi from January 2018 to March 2021. A total of 180 male patients with urethral stricture of ≤2 cm were included. Patients with traumatic stricture, post-anastomotic urethroplasty strictures, neurogenic bladder and history of steroid intake were excluded. Patients were randomly categorized into two groups i.e. Group A patients were given oral prednisolone (6 mg tablet twice daily for 4 weeks) while group B was control group. Patients were followed up to 12 months for recurrence of stricture.
 Results: The mean age of patients in group A was 44.38 ± 8.03 years while in group B was 46.64 ± 6.66 years. The mean length of stricture in group A was 0.93 ± 0.26 cm and in group B was 0.95 ± 0.27 cm. Recurrence of stricture was seen in 18 (20.0%) patients in group A (oral steroids group) and 42 (46.67%) patients in group B (no oral steroids) with p-value of 0.0001.
 Conclusion: Oral prednisolone therapy after internal urethrotomy waseffective in decreasing the rate of recurrence of urethral stricture.
 Keywords: Oral, Recurrence, Steroid, Urethral Stricture.

Comparison of Surgery and Local Steroid Injections for the Treatment of Carpal Tunnel Syndrome

Background: There is no consensus about the optimum treatment or treatment algorithm for carpal tunnel syndrome (CTS). In previous randomized studies that compared open carpal tunnel release and local steroid injections (LSIs), the two most used nonconservative treatments, conflicting results were found. Objective: The objective of the study was to compare the efficacies of surgery and LSI in the treatment of CTS. Subjects and Methods: A randomized, controlled clinical trial was conducted with 80 patients who were clinically diagnosed as having idiopathic CTS. The requirements for enrollment were awakening from sleep due to nocturnal paresthesia and a diagnosis to be confirmed through electrodiagnostic tests. Patients were randomly assigned to the surgery and the steroid groups. Assessments were performed at baseline and 1, 3, 6, and 12 months after initial treatment. The primary outcome measure was the improvement of awakening from sleep. Results: A total of 80 patients were enrolled in the study. Thirty-six patients were assigned to the surgery group and 44 to the steroid group. None of our patients were lost to follow-up. Fourteen out of the 44 patients in the steroid group and all 36 patients in the surgery group had a successful outcome at the 12-month assessment. Success rates in the steroid group at 1, 3, 6, and 12 months were 77.3%, 61.4%, 45.5%, and 31.8%, respectively. When the injection group was evaluated separately, LSI was found more successful in mild cases and unilateral cases. Conclusion: Surgery should be chosen for the treatment of moderate-to-severe idiopathic CTS, but LSI may be used for mild cases. The historical-objective scale may predict which patient will benefit from which treatment.

Steroid Drugs as an Adjunct for Reducing the Incidence of Proliferative Vitreoretinopathy after Rhegmatogenous Retinal Detachment Surgery: A Meta-Analysis of Randomized Controlled Studies

Introduction: The efficacy and influence of steroids for reducing the incidence of proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) surgery remain controversial. Systematic review and meta-analysis were conducted to explore the effect of steroids versus placebo on risk of PVR. Methods: We searched PubMed, Embase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs), assessing the effect of steroid drugs as an adjunct for reducing the incidence of PVR after RRD surgery. This meta-analysis was performed using the random-effect model. Data were extracted by two reviewers independently; the quality of RCTs was assessed by the Cochrane risk-of-bias tool. We calculated risk ratio (RR) and the 95% confidence intervals (CIs) of all outcomes and plotted on forest plots. I2 accessed using the χ2 test was applied to quantify the degree of heterogeneity. Results: Four RCTs involving 478 patients (478 eyes) are included in the meta-analysis. There was no significant difference in the incidence of PVR recurrence between steroid groups and control groups (RR: 0.87, 95% CI: 0.70–1.08, p = 0.19). However, the incidence of recurrent PVR was lower in the steroid group (RR: 0.67, 95% CI: 0.46–0.99, p = 0.04) than in the control group when only PVR grades A and B were taken into consideration. Besides, steroids could significantly reduce the incidence of macular edema after surgery (RR: 0.64, 95% CI: 0.47–0.88, p = 0.007). The steroid group and control group had comparable outcomes of retinal reattachment rate and reoperation rate after primary surgery. Additionally, there was no significant difference of the incidence of epiretinal membrane, and the incidence of surgery required by epiretinal membrane. Conclusion: This meta-analysis reveals that RRD surgery combined with steroid drugs administration could significantly reduce the recurrence in PVR grade A and B subgroup, as well as the incidence of macular edema after surgery.

High-dose Steroids Versus Standard Treatment for Myasthenic Crisis

Background: Previous literature revealed the possible benefit of high-dose steroids in myasthenic crises. Steroids are more economical than standard therapy, especially in resource-poor settings. More data are therefore needed about the utility of steroids for the myasthenic crisis. Objective: The outcomes were compared between standard therapy (intravenous immunoglobulin [IVIg] or plasmapheresis [PLEX]) and high-dose steroid (intravenous methylprednisolone) for the myasthenic crisis. The primary outcome was the length of hospital stay. The secondary outcomes were the length of intubation, intensive care unit stay, readmission rate due to crisis, posttreatment muscle score, and mortality. Methodology: This study was a single-center, longitudinal, 12-year retrospective study. Sixty-five patients were analyzed. A comparison of means was made between the outcomes of the two groups. Regression analysis was done for hospital stay and intubation outcomes. Side effects of treatment were determined. Results: Shorter hospital stay (P = 0.001), shorter intubation length (P = 0.000), and shorter intensive care (P = 0.000) were observed in the steroid group. Mortality (P = 0.187) and muscle score (P = 0.281) were comparable between the two groups. There was a trend toward lesser readmission (P = 0.097) and longer time to readmission (P = 0.069) in the standard therapy group. The IVIg group had arrhythmias, hypotension, headache, renal impairment, and hypomagnesemia. The PLEX group had hypotension and lower limb pain. The steroid group had hyperglycemia, insomnia, infection, stomach upset, facial flushing, myopathy, and sudden death. No acute worsening of the myasthenia crisis was seen in all patients in the steroid arm. Conclusion: Data on hospital stay, intensive care days, and intubation length were better with high-dose steroids. Mortality and motor outcomes were comparable between the two groups. Readmission rates due to crisis were lower in the standard therapy group.

Steroid hormone signaling: What we can learn from insect models.

Ecdysteroids are a group of steroid hormones in arthropods with pleiotropic functions throughout their life history. Ecdysteroid research in insects has made a significant contribution to our current understanding of steroid hormone signaling in metazoans, but how far can we extrapolate our findings in insects to other systems, such as mammals? In this chapter, we compare steroid hormone signaling in insects and mammals from multiple perspectives and discuss similarities and differences between the two lineages. We also highlight a few understudied areas and remaining questions of steroid hormone biology in metazoans and propose potential future research directions.

The influence of steroid therapy of complications of infectious mononucleosis on the course of Epstein-Barr virus hepatitis.

The purpose of the study was to characterize the differences in the course of Epstein-Barr virus (EBV) primary infection-induced hepatitis between patients treated with steroids due to complications of infectious mononucleosis (IM) and those not receiving such therapy. We analyzed the changes in the activity of liver enzymes and differences in abdominal ultrasound results. The study was based on reviewing the medical records of children hospitalized for primary EBV infection at the Department of Children's Infectious Diseases, Medical University of Warsaw, Regional Hospital of Infectious Diseases in Warsaw, between August 2017 and March 2023. The study population was divided into two groups: patients treated with steroids (Group 1) and children not receiving steroids (Group 2). Significant differences were obtained for alanine aminotransferase activity only in the first week of IM (205.34 ±115.40 vs. 288.82 ±170.16 IU/l for Group 1 and 2, respectively; p = 0.024), and for aspartate aminotransferase in the first (170.63 ±159.47 vs. 218.85 ±128.22 IU/l for Group 1 and 2, respectively; p = 0.009) and the third week (151.09 ±138.57 vs. 235.50 ±170.27 IU/l for Group 1 and 2, respectively; p = 0.016). The analysis of the results of laboratory tests for the diagnosis of cholestasis (γ-glutamyl transferase and total serum bilirubin concentrations with fractions) did not show significant differences between the groups. Our results indicated that the two cohorts of patients may differ in the course of hepatitis associated with primary EBV infection, especially at the beginning of the disease, when the laboratory features of hepatitis were less pronounced in children treated with steroids.

Efficacy of antiviral therapy in the treatment of peripheral facial paralysis: a tertiary institution experience

Objective: For the treatment of peripheral facial paralysis, the superiority of the use of steroid alone and the use of steroid + antiviral over each other has not been clarified in the literature. In this study, the efficacy of using steroid treatment alone and using a combination of steroid+antiviral treatment in patients we followed up with peripheral facial paralysis in our clinic was questioned retrospectively. It was aimed to clarify the efficacy and superiority of steroid alone and steroid+antiviral therapy in patients with peripheral facial paralysis. Materials and Methods: One hundred and ten patients who received only steroids and 62 patients who received combination therapy were included in the study. Age, gender, regular drug use, smoking, previous history of facial paralysis, comorbid diseases, initial stage of the disease (House-Brackman/HB staging), treatment protocol and response to treatment were recorded from the files examined. Patients with HB stage ≤2 at the 6th month follow-up were considered to have responded well or completely to the treatment. Results: When the group receiving only steroid treatment and the group receiving steroid + antiviral treatment were compared in terms of age, chronic drug use, gender, and previous facial paralysis, no statistically significant difference was observed. The groups were compared in terms of response to treatment, 88.2% improvement was observed in the steroid group (HB stage ≤2), and 91.9% improvement was observed in the combined treatment group. No statistically significant difference was observed (p=0.605). Conclusion: For the treatment of peripheral facial paralysis, the superiority of steroid use alone and combined antiviral + steroid use has not been proven. In the light of the literature, it is recommended that the patient be treated with steroids at the earliest stage.

ISOLATION AND BIOLOGICAL ACTIVITY OF THE GORGONIAN EXTRACT FROM MALUKU

Isolation and biological activity of gorgonians from the Maluku Sea have been carried out. Isolation using n-hexane: ethanol (1:1) solvent resulted in 3 crude extracts from all parts (HEL), axial (HEA), and skin (HEK) of gorgonians. Analyzed crude extracts using LC-MS/MS and tested biological activity with an evaluation of the antioxidant and antibacterial activity. The compounds obtained from the gorgonian extract were derived from sesquiterpenes, phenol lipids, terpenoids, aldehydes, and steroid groups. An antioxidant test assessed DPPH radical-scavenging activity with results between 31,688 - 40,916 %. In addition, the antibacterial activity was tested by disc diffusion against two human pathogenic bacteria Escherichia coli IFO 3301, Salmonella typhimurium IFO 12529, Bacillus subtilis IFO 13719, and Staphylococcus aureus IFO 13276. All extracts showed positive results in most of the tests.

Comparison of the Efficacy of Intra-articular Platelet-rich Plasma with Intra-articular Steroid in the Management of Pain due to Sacroiliac Joint Dysfunction

Background: Platelet-rich plasma (PRP) has proved to be beneficial due to its remodeling property in various conditions in the past. When given intra-articularly, it may also provide adequate analgesia in low back pain. Aims: This study was aimed to compare the efficacy between intra-articular sacroiliac joint (SIJ) injection of PRP and steroid in the management of SIJ dysfunction pain. Materials and Methods: This prospective, randomized parallel group study was conducted for 24 months period at a tertiary care hospital. A total of 50 patients above 18 years were included in the study and allocated into two groups (n = 25) by computer randomization. Patients in the respective group received sacroiliac intra-articular injection of either autologous PRP or triamcinolone (steroid). For the primary outcome, the Numerical Rating Scale Score was recorded preprocedure and postprocedure at the 24 h, 1st, 3rd, and 6th month. The need for any rescue analgesia or repeat injection during the study period was considered the secondary outcome. Results: At the 1st, 3rd, and 6th month postprocedure, 100%, 88%, and 76% of patients, respectively, obtained significant pain relief after injection of PRP. In contrast, at 3rd and 6th month postprocedure, only 20% and 28%, respectively, had short-term pain relief in the steroid group. Conclusions: Single intra-articular injection of PRP provides significant pain relief and functional improvement in patients with SIJ pain.

Comparison of Ultrasound-Guided Steroid and Platelet-Rich Plasma (PRP) Injection in Patients with Carpal Tunnel Syndrome

Objective: Imaging-guided injection treatments can yield effective results in patients with mild-to-moderate carpal tunnel syndrome (CTS) resistant to conservative methods. Methods: Patients who presented with typical median nerve entrapment findings for at least 3 months, were diagnosed with mild-moderate CTS electrophysiologically, and underwent ultrasound-guided steroid and PRP injection were included in the study. Visual analog scale (VAS) scores, Boston Carpal Tunnel Questionnaire (Functional status scale (FSS) and Symptom severity scale (SSS) parameters) scores were recorded in the pre-procedure, 1st month and 6th month controls of the patients. Sonographically, median nerve cross-sectional area (CSA) measurements were recorded at pre-procedure and post-procedure 1st and 6th month controls. Results: In 27 patients (21 women, 6 men), 40 median nerve injections (9 patients right, 5 patients left, 13 patients bilateral) were evaluated. In all patients, CSA, VAS, FSS, and SSS scores were significantly lower at 1 month and 6 months after the procedure than before the procedure. (p=0.000, p=0.000, p=0.000, P=0.000, respectively). While the VAS scores were found to be significantly lower in the steroid group than in the PRP group at 1 month (p=0.04), there was no significant difference between the two groups in terms of CSA, FSS, and SSS scores (p=0.1, p=0.5, p=0.8, respectively). At 6 months, CSA, VAS, FSS, and SSS scores were significantly lower in the PRP group compared to the steroid group (p=0.000, p=0.000, p=0.000, p=0.000 respectively). Conclusion: In mild-to-moderate carpal tunnel syndrome, steroid injections applied under ultrasonography guidance of the median nerve are effective for a short time, and PRP injections are a superior and safe option to steroids for long-term efficacy.

Isolation of steroids from n-hexane extract of the stems of Miliusa velutina Dun Hook. f. et. Thoms

Miliusa velutina (Dun) Hook. f. et. Thoms belongs to the Na family (Annonaceae). In folklore, M.velutina is widely used as a traditional medicine to treat inflammation, scabies, antiseptic, hemostatic, and antibacterial, in addition to being used to kill parasites and as a natural insecticide. Some research on its chemical constituents showed that there are groups of phenols, alkaloids, flavonoids, steroids, acetogenin, sesquiterpenoids, and lactones along with diverse biological activities that help cure cancer, antifungal, antibacterial, antimalarial, antioxidant, antidiabetic. However, in Vietnam, there have not been many studies on M. velutina, so this study was conducted with the aim of investigating the chemical constituents of the M. velutina, somehow providing more data related to the plant. By column chromatography method with thin layer chromatography with different solvent systems from n-hexane extract, five steroids were isolated. The chemical structure of the compounds was elucidated from 1D and 2D-NMR spectroscopic data combined with literature data showing that five steroids were obtusifolione (1), β-sitosterol (2), stigmasterol (3), stigmastan-3-one (4), stigmast-4-en-3-one (5). Among them, three compounds (1), (4) and (5) are first known to exist in the M. velutina.

Impact of low-dose dexamethasone on pregnancy outcome in type A PCOS women candidate for IVF/ICSI using the gonadotropinreleasing hormone antagonist protocol

Objective. Evaluation of the efficacy of low-dose dexamethasone on ovarian response and pregnancy outcome in infertile patients with type A polycystic ovarian syndrome (PCOS). Patients and methods. The study included infertile patients with type A PCOS who were candidates for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) using a fixed GnRH antagonist protocol. The patients were randomized into two groups: a low-dose steroid group of 80 women with type A PCOS undergoing a trial of IVF/ICSI who received two tablets of 0.5 mg dexamethasone every evening from the first day of gonadotropin administration till the night before oocyte retrieval with a GnRH antagonist controlled ovarian hyperstimulation (COH), and a placebo group of 80 women with type A PCOS undergoing IVF/ICSI who received two tablets of placebo from the first day of gonadotropin administration until the night of oocyte retrieval. Results. In the low-dose dexamethasone group, the duration of stimulation was statistically significantly shorter, and there were significantly fewer stimulation ampoules; however, E2 levels on the day of ovulation induction, fertilization rate, and the number of retrieved M2 and fertilized oocytes were significantly higher compared to the placebo group. On the other hand, there was no significant difference between both groups regarding the incidence of ovarian hyperstimulation syndrome (OHSS) and the rate of embryo transfer. Conclusion. Dexamethasone improves embryo quality and pregnancy rate; additionally, it minimizes the number of gonadotropin ampoules used for stimulation. Thus, we suggest the use of dexamethasone in women with PCOS undergoing IVF/ICSI treatment. Key words: low-dose dexamethasone; type A PCOS; IVF/ICSI; antagonist protocol

Efficacy of Oral versus Intratympanic Steroids in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A 1-year Randomized Control Trial

Background: Sudden sensorineural hearing loss (SSNHL) is a common otologic emergency, with hearing loss of 30 dB or greater at three contiguous frequencies, and an abrupt onset within 3 days or fewer, with no recognizable cause. Aims and Objectives: In this study, the efficacy of intratympanic (IT) injections of dexamethasone are compared with oral prednisolone and the behaviour of the different audiometric curves in response to both the steroid therapies in studied. Materials and Methods: Patients presenting with SSNHL to the Department of ENT, Head and Neck Surgery at Government Multi Speciality Hospital, Chandigarh, were subjected to routine tests. Informed written consent was taken from each patient, and cases meeting the selection criteria were included in the study. Pure-tone audiometry was done before starting treatment. Patients were randomly assigned into two groups based on their enrollment number. Those in Group 1 were treated with three doses of 0.3–0.6 mL IT injections of dexamethasone (4 mg/mL) on alternate days and those in Group 2 received OP 1 mg/kg/day with tapering doses. Pure-tone audiogram (PTA) will be repeated after 2 weeks, 4 weeks, and 8 weeks from the first dose. Results: In the IT dexamethasone group, the pretreatment PTA was 61.05 dB while the posttreatment PTA was 37.45 dB. The hearing gain was 23.6 dB. In the oral steroid group, pretreatment PTA was 66.79 while posttreatment PTA was 47.36 dB. The hearing gain was 19.43 dB. The hearing gain in both the groups was statistically significant; however, there was no statistical difference between the two in terms of superiority of efficacy (P > 0.05). Conclusion: The treatment of SSNHL still remains a challenge among the otologists. The present study establishes that the efficacy of IT steroids was as good as the oral steroid therapy for the management of SSNHL as both the modalities showed significant hearing improvement. Hence, IT steroid can be used as a first-line therapy in patients with. Our study also uncovered the fact that patients who come with shorter duration of onset recover quickly compared to those patients who delay their treatment. Hence, IT steroid can be used as a primary modality of treatment instead of a salvage therapy in the selected group of patients.

Mizoribine combined with steroids and dietary sodium restriction on the treatment of primary membranous nephropathy: a prospective study.

We aimed to initially explore the efficiency and safety of mizoribine (MZR) combined with steroids and dietary sodium restriction on the treatment of primary membranous nephropathy (MN) compared with cyclophosphamide (CPM)-based steroids. Patients with primary MN were enrolled. According to the therapy, they were divided into theMZR combined with steroids and dietary sodium restriction group (N = 30) and CPM-based steroids group (N = 30). Both groups were followed up for 1year to monitor safety and efficacy. Compared with the CPM-based steroids group, theMZR combined with steroids and dietary sodium restriction group had significantly lower daily sodium intake, serum sodium, blood pressure (BP), and 24h urine protein (all P < 0.05). Conversely, plasma albumin and complete remission rate in the MZR group were higher at the 12th follow-up (40.39 ± 5.14g/L vs. 37.63 ± 5.40g/L; 86.67% vs. 66.67%; all P < 0.05). These two groups showed similar adverse events rates (20.00% vs. 26.67%, P = 0.54). This study demonstrates that MZR combined with steroids and dietary sodium restriction is superior to CPM-based steroids in terms of completeremission and 24h urine protein in patients with primary MN.

C-Reactive Protein Levels during High Dose Steroid Treatment for COVID-19 Pneumonia

Objectives: Inflammation is the main cause of systemic damage in SARS-COV2 infections. Steroid treatment has been shown to reduce mortality in COVID-19. However, there is no index to monitor treatment responses to steroids. Here, we evaluated the validity of serial C-reactive-protein (CRP) follow-up for predicting the outcome in the patients receiving steroid therapy. Material and methods: In our retrospective cohort study, four hundred twenty-five patients were included. All patients received dexamethasone 6 mg/day or equivalent dose of steroid as much as needed with the onset of hypoxia (SaO2 ≤ 93%). We divided patients into two groups according to outcome (deceased/discharged). We then compared demographic, clinical and laboratory features between the groups. Lastly, we evaluated the thresholds of CRP decline associated with COVID-19 associated mortality at 3th, 5th days and at the end of treatment. Results: COVID 19 associated mortality rate of the cohort was 6.1% (26/425). In multivariate analysis, in which survival was evaluated, parameters related to death due to COVID-19 in the steroid group were high NEWS-2 score (0.82, CI 95 % 0.68-0.97, p=0.02), increased Charlson comorbidity index (0.68,CI 95% 0.51-0.90,p= 0.007) and absolute CRP level at the end of treatment (0.97,CI 95%, p&lt;0.001). In addition, cut-off levels of CRP reduction related to COVID-19-associated mortality during steroid therapy were found as follows: less than 33% (sensitivity 75%, specificity 64.1%) on day 3, less than 43.5% (sensitivity 81.8%, specificity 70.8%) on day 5 and less than 55% at the end of the treatment (sensitivity 80.7%, specificity 71.8%). Conclusions: Serial CRP measurement from the third day of steroid therapy can be used to predict mortality in COVID-19 patients receiving steroids.

COPD Exacerbation-Related Pathogens and Previous COPD Treatment.

We evaluated whether the pathogens identified during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) are associated with the COPD medications used in the 6 months before AE-COPD. We collected the medical records of patients diagnosed with AE-COPD at 28 hospitals between January 2008 and December 2019 and retrospectively analyzed them. Microorganisms identified at the time of AE-COPD were analyzed according to the use of inhaled corticosteroid (ICS) and systemic steroid after adjusting for COPD severity. We evaluated 1177 patients with AE-COPD and available medication history. The mean age of the patients was 73.9 ± 9.2 years, and 83% were males. The most frequently identified bacteria during AE-COPD were Pseudomonas aeruginosa (10%), followed by Mycoplasma pneumoniae (9.4%), and Streptococcus pneumoniae (5.1%), whereas the most commonly identified viruses were rhinovirus (11%) and influenza A (11%). During AE-COPD, bacteria were more frequently identified in the ICS than non-ICS group (p = 0.009), and in the systemic steroid than non-systemic steroid group (p < 0.001). In patients who used systemic steroids before AE-COPD, the risk of detecting Pseudomonas aeruginosa was significantly higher during AE-COPD (OR 1.619, CI 1.007−2.603, p = 0.047), but ICS use did not increase the risk of Pseudomonas detection. The risk of respiratory syncytial virus (RSV) detection was low when ICS was used (OR 0.492, CI 0.244−0.988, p = 0.045). COPD patients who used ICS had a lower rate of RSV infection and similar rate of P. aeruginosa infection during AE-COPD compared to patients who did not use ICS. However, COPD patients who used systemic steroids within 6 months before AE-COPD had an increased risk of P. aeruginosa infection. Therefore, anti-pseudomonal antibiotics should be considered in patients with AE-COPD who have used systemic steroids.

The Potential of Nyamplung Seed Oil (Calophyluminophyllum L.) as a Source of Natural Antioxidants

Indonesia has many plants that have the potential as raw materials for medicines and cosmetics, one of which is Calophylluminophyllum which in Indonesian is called the Nyamplung plant. Nyamplung seeds have a high oil content of 73% and have the potential as a source of active compounds. In this study, we looked at the content of active compounds as antioxidants from Nyamplung seed oil produced from the press and press process with degumming. The resulting Nyamplung seed oil contains compounds from the phenolic and steroid groups. Component analysis showed that Nyamplung seed oil contained as many as 20-25 compounds with the highest content being cis-13-Octadecenoic acid, Octadecanoic acid, n-Hexadecanoic acid, cis-Vaccenic acid. Nyamplung seed oil has potential as a source of antioxidants because it has an IC50 value of 50 µg/mL, namely 41.37 µg/mL for oil from the press process and 46.59 µg/mL for oil from the press process with degumming. Keywords: Nyamplung Seed Oil, Extraction, Degumming, Antioxidants

Risk analysis of musculoskeletal pain intervention using corticosteroid during COVID-19 pandemic: a cohort study

Most international bodies recommended against musculoskeletal steroid injection during the COVID-19 pandemic, fearing that the immunosuppressive effects of the steroid could worsen COVID-19 infection, thus prolonging the suffering of patients with severe musculoskeletal disease. The authors' aim is to analyze the risk of COVID-19 infection after musculoskeletal injections. This is a retrospective study of patients who visited a sports medicine clinic and received musculoskeletal steroid injections between January 1, 2020 and February 28, 2021. The collected data was compared with the national COVID-19 registry to identify positive COVID-19 patients. The patients were only considered positive for COVID-19 following corticosteroid injection within 3 months after injection. Out of 502 steroid injections; 79.7% (n = 400) received a single injection in one day, 19.1% (n = 96) received steroid injections at 2 sites in one day, and 1.2% (n = 6) received steroid injections at 3 sites in one day. Using the Fisher's exact test, there was no statistically significant association of COVID-19 infection between the steroid group and control group (relative risk, 1.44; 95% confidence interval, 0.9-23.1, P = 0.654). Only one patient contracted mild COVID-19 with no post COVID complications. The authors recommend the use of musculoskeletal steroid injections in clinically indicated situation without having increased risk of COVID-19.

Comparison of a Preservative-free Non-steroidal Anti-inflammatory Drug and Preservative-free Corticosteroid after Uneventful Cataract Surgery: A Randomized Control Trial

Background: Cataract is considered as a main cause of blindness around the world along with glaucoma and macular degeneration. Now, surgery remains the only effective treatment option of cataracts and cataract surgery is one of the most frequently accomplished surgeries in the field of ophthalmic arena. This study aimed to compare the effects of NSAIDs with those of steroids for the management of inflammation after uneventful cataract surgery.&#x0D; Methods: This study was a prospective randomized control trial, conducted at the Department of Cataract in National Institute of Ophthalmology and Hospital, Dhaka, from 01 February 2021- 30 January 2022. A total of 194 patients were randomly allocated into two groups by lottery. The patients of NSAID group was prescribed bromfenac sodium hydrate 0.1% to apply two times a day in 1 eye, whereas the steroid group was treated with Dexamethasone 0.1%, 4 times per day for 4 weeks after the surgery.&#x0D; Results: The mean age of the patients in NSAID and steroid group were 71.10 (± 8.55) years and 72.09 (± 8.64) years respectively. The male female ratio of each group was 33:64. The change in inflammation grade of the anterior from postoperative day 1 to week 8 in the NSAID group was -1.25 ± 1.30 and in the steroid group -1.25 ± 1.32 which shows a significant reduction in both eyes (p &lt;0.001). Comparing the changes from preoperative to week 1 and preoperative to week 8 showed central corneal thickness in the NSAID group was also significantly less than that in the steroid group (8.87 ± 22.46 and 29.48± 46.60 vs. 4.74 ± 31.75 and 8.76 ± 40.95 mm) (p&lt;0.05). Comparing the changes from postoperatively to week 1 and postoperatively to week 8, the NSAID group had lower conjunctival hyperemia -0.09± 0.53 and -0.19 ± 0.54 vs. the steroid group had higher conjunctival hyperemia 0.08 ± 0.64 and -0.20 ± 0.53.&#x0D; Conclusion: NSAIDs like nepafenac 0.1%, bromfenac 0.09%, and ketorolac 0.5% are proven to be a good alternative to steroids which has a corresponding level of anti-inflammatory activity like Dexamethasone 0.1% for controlling postoperative ocular inflammation among patients going through cataract surgery.&#x0D; J. Natl. Inst. Ophthalmol. 2022;5(1):10-15

The Effect of Adding Corticosteroid to the Periarticular Injection Cocktail for Pain Control after Total Hip and Total Knee Arthroplasty: A Double-Blinded Randomized Clinical Trial.

The impact of periarticular corticosteroid injection for pain control after total joint arthroplasty (TJA) is controversial. The present study aimed to investigate this controversy in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). A total of 42 THA and 42 TKA patients were included in this study. The patients of each group were randomly allocated into group A (cocktail+Depo-Medrol) and group B (cocktail alone). The outcome measures were a Visual Analog Scale (VAS) for pain at five different time points for both THA and TKA, as well as the knee range of motion (ROM) and straight leg raise (SLR) for the TKA group only. Patients were followed for three months to observe infection, wound complications, and any venous thromboembolic event. In the THA group, the preoperative VAS, 12, 24, 48, and 72h postoperative VAS were not statistically different between groups A and B (P=0.49, P=0.5, P=0.96, P=0.15, and P=0.11, respectively). In the TKA group, the preoperative VAS, 12, 24 48h, and 72h postoperative VAS were not statistically different between groups A and B (P=1.0, P=0.47, P=0.82, P=0.92, P=0.5, respectively). The mean scores of knee range of motion and ability to perform SLR were not significantly different between TKA patients in the steroid and non-steroid groups (P=0.18 and P=0.58, respectively). The only observed complication was one surgical site infection in the non-steroid group of the TKA. The obtained results did not support the benefit of including a steroid (Depo-Medrol) in the periarticular injection cocktail for pain control after the THA and TKA.