Steroid Preparations Research Articles

Difluoroboron Complexes as Versatile Precursors for Steroid Modification. Lumiestrone-Based Steroid Derivatives: Synthesis and Structural Studies.

A preparation method for steroid-based difluoroboron complexes has been developed using lumiestrone as a steroid example. Previously inaccessible lumiestrone-based difluoroboron complexes annulated at positions 16 and 17 of the D ring have been prepared. Such difluoroboron complexes may have large synthetic potential for heterofunctionalization of steroids at the D ring. An application of a borylation mixture Ac2O-BF3⋅OEt2 significantly simplify the preparation of steroid "dimers" bearing two estrone moieties connected at positions 2 and 2' via a linker. Crystal structures of key representatives have been determined by X-ray diffraction.

6437 Analysis of 17-OH-Progesterone (17OHP) and Androstenedione (A4) Profiles To Rationalise Biochemical Monitoring Of CAH Patients

Abstract Disclosure: N.R. Lawrence: None. N.P. Krone: None. J.F. Dawson: None. Z. Lang: None. W. Arlt: Advisory Board Member; Self; Diurnal. A. Brac de la Perriere: Research Investigator; Self; Diurnal. A.L. Hirschberg: Research Investigator; Self; Diurnal. A. Juul: Research Investigator; Self; Diurnal. D.P. Merke: Research Investigator; Self; Diurnal. J.D. Newell-Price: Research Investigator; Self; Diurnal. A. Prete: Research Investigator; Self; Diurnal. A.E. Taylor: None. A. Rees: Research Investigator; Self; Diurnal. N. Reisch: Research Investigator; Self; Diurnal. M. Stikkelbroeck: Research Investigator; Self; Diurnal. P.A. Touraine: Research Investigator; Self; Diurnal. G. Collins: None. R.J. Ross: Consulting Fee; Self; Diurnal. Background: There is no consensus on how to monitor biochemical control of CAH as excess ACTH overnight is common on standard therapy. Modified-release hydrocortisone (MRHC) gives potential for improved disease control and the need to understand this impact on disease monitoring.Aim: To define the relationship between 17OHP and A4, in healthy controls and CAH patients. Methods: Analysis of 24-hour 2-hourly 17OHP and A4 endocrine profiles in patients randomised to either standard treatment or MRHC (n=122, mean age 36.3 (SD 11.6) years, 78 female, 44 male) and a population of healthy controls (n=20, age 30.0 (12.3), 13 male, 7 female). Markers were regressed, cross correlated and assessed by Bayesian Change Point analysis using R. Results: Regressing the natural logarithms of 17OHP on A4, Bayesian multiple change point analysis converged on a stable changepoint equivalent to 17OHP of 4.5 nmol/L 149 ng/dl (95%, CI:4.2 to 4.7 nmol/L, Rhat < 1.008). Below the 17OHP change point A4 is proportionally lower than above, with no evidence of difference between sexes or steroid preparation. The relationship between 17OHP and A4 was different for healthy subjects, who for similar levels of A4 have lower levels of 17OHP than CAH patients in nmol/L (ng/dl): A4 of 1 (29) and 10 (286) associated with 17OHP 1.5 (50) and 8.8 (291) in healthy subjects’ vs 3.3 (109) and 71.2 (2353) in CAH patients, respectively. There was no consistent rhythm in either marker in healthy patients, shown by an autocorrelation function (ACF) that falls quickly to zero. ACF approaches zero more quickly in CAH patients on MRHC than those on standard therapy who more commonly exhibit a diurnal rhythm with an 0700hrs peak. There was no lag between markers, with cross-correlation function plots symmetrical. Conclusions: The relationship between 17OHP and A4 is different in CAH than healthy controls. In CAH, high A4 suggests poor control but a low A4 may still be associated with a raised 17OHP. In CAH patients, 17OHP concentrations within the healthy subject range are associated with A4 below levels seen in healthy subjects. When elevated in CAH patients, A4 and 17OHP rise and fall together with no lag; thus, A4 does not give more information on control over time. On MRHC the biomarkers show a reduced diurnal rhythm; therefore, individual measurements taken in clinic are more likely to reflect the daily average than measurements taken when on standard therapy. Presentation: 6/1/2024

Current advances in the treatment of myofascial pain syndrome with trigger point injections: A review.

Myofascial pain syndrome (MPS) caused by trigger points in muscles is a common cause of local or generalized pain, which is clinically common, has a high incidence, and has no specific cure. The most popular and widely used clinical method mainly targets the trigger point for treatment, i.e. trigger point injection (TPI) therapy. The injectable drugs mainly include glucose, saline, local anesthetics, botulinum toxin type A, platelet-rich plasma, platelet-poor plasma, steroid preparations, etc. This method is low cost and less invasive, and early clinical applications have shown good efficacy. In this paper, we have reviewed clinical research progress in treating MPS with TPI therapy.

Syntheses and medicinal chemistry of spiro heterocyclic steroids.

There is compelling evidence that incorporating a heterocyclic moiety into a steroid can alter its pharmacological and pharmacokinetic properties, driving intense interest in the synthesis of such hybrids among research groups. In this review, we present an overview of recent synthetic methodologies, spanning the period from 2000 to 2023, for the preparation of spiro heterocyclic steroids. The compounds surveyed encompass four-, five-, six-, and seven-membered heterocycles appended to various positions of steroidal backbones, with spirocycles containing oxygen, nitrogen, and sulfur atoms being predominant. The outlined synthetic procedures emphasize the pivotal steps for constructing the heterocycles, often accompanied by a detailed account of the overall synthesis pathway. The review encompasses innovative compounds, including bis-steroids linked by a spiro heterocycle and steroids conjugated to heterocyclic moieties containing three or more (hetero)cycles. Moreover, many compounds are accompanied by data on their biological activities, such as antiproliferative, antimalarial, antimicrobial, antifungal, steroid antagonist, and enzyme inhibition, among others, aimed at furnishing pertinent insights for the future design of more potent and selective drugs.

A Comparative Study of Post Operative Pain Following Tonsillectomy with Local Infilteration of Dexamethasone vs Triamcinolone.

Tonsillectomy till date continues to be the most frequently performed surgery by ENT surgeons, and with that comes the most challenging complication of post-tonsillectomy pain and its management that affects the patient morbidity and alters the hospital course. Various methods and techniques have been implicated in the post-operative pain management in patients undergoing tonsillectomy. To compare the post operative pain following local infiltration of Dexamethasone and Triamcinolone in patients undergoing Tonsillectomy. Total of 50 patients were selected and randomized into two groups- Group 1 and Group 2, who underwent local infiltration of Dexamethasone and Triamcinolone respectively to maintain uniformity. Baseline scoring (0h post operatively) and follow up scoring after 6h and 24h was done using the Visual Analogue Scale and were evaluated and documented as per their response to treatment. A significant reduction was observed in the severity of pain in both groups with an average reduction of mean score from 9.50 to 5.92 in Group 1 and from 9.04 to 3.90 in Group 2 at the end of 24h post-operatively. The mean score of Group 2 was greater and showed better improvements in VAS pain score and was statistically significant (p < 0.001). Usage of steroidal preparations locally during tonsillectomy helps combat the post-operative pain. Usage of Triamcinolone locally has proved beneficial in reducing the post-operative tonsillectomy pain.

A CROSS-SECTIONAL STUDY ON SELF-MEDICATION PRACTICES, PERCEPTION, AND ATTITUDES OF UNDERGRADUATE MEDICAL STUDENTS AT A GOVERNMENT TERTIARY CARE TEACHING HOSPITAL IN EASTERN INDIA

Objectives: Self-medication (SM) is common in India. It is of greater significance when practiced by medical students as they going to be medical practitioners in the future. This study was conducted to assess the pattern of SM practices, perceptions, and attitudes among students pursuing 2nd-year professional MBBS in a tertiary medical college in the year 2019. Methods: This study was a cross-sectional one based on a questionnaire. It was conducted among the 2nd-year undergraduate (MBBS) medical students in a tertiary care medical college in West Bengal, India. Results: Out of 199 students approached, 198 consented to the study and filled in the supplied study questionnaire. Thirteen incomplete questionnaires were excluded and the remaining 185 were analyzed. It was found that 81.6% (151/185) respondents practiced SM. The most common ailments for seeking SM were fever 66.2% (100/151), followed by cough cold, and sore throat 55.0% (84/151), diarrhea/nausea, and vomiting 40.4% (61/151). The most common drug used for SM was paracetamol 73.51% (111/151), followed by H1 antihistaminics and proton pump inhibitors. A small percentage of students used topical preparations of steroids, analgesics, antibiotics, and antifungals as well. Among the common reasons for seeking SM, 72.2% (109/151) felt that their illness was mild and 57% (86/151) preferred it as they had prior experience. Conclusion: Our study showed that SM is commonly practiced among the students of this institution. Therefore, medical teachers need to try even more to generate adequate awareness among the students about inherent risks of SM.

Prevalence of nandrolone preparations with endogenous carbon isotope ratios in Australia.

Nandrolone and its prohormones, including 19-norandrost-4-ene-3,17-dione and 19-norandrost-4-ene-3β,17β-diol, are anabolic steroids forbidden at all times in sports according to the World Anti-Doping Code Prohibited List and its metabolite 19-norandrosterone (19NA) is the preferred urinary target compound to identify their abuse. In recent years, an increasing number of 19NA isotope ratio mass spectrometry (IRMS) cases have arisen that, based on the initial testing procedure, were likely to result in an adverse analytical finding but were concluded negative after IRMS analysis. The current study was therefore set up to gain a better insight on the prevalence of nandrolone preparations with endogenous carbon isotope ratio values in Australia. Suitable workplace (non-athlete) urine samples that had previously been reported positive for 19NA were identified and analysed on IRMS. A total of 82% of the samples that were analysed were reported with enriched carbon isotope ratios of 19NA (i.e., 19NA greater than -26‰). This indicates that there is a high prevalence of nandrolone-containing anabolic androgenic steroid preparations in Australia that have 'endogenous' carbon isotope ratios which reduces the ability to identify exogenous nandrolone.

P951 Efficacy and safety of tofacitinib for the treatment of moderate- severe ulcerative colitis in biologic naïve patients

Abstract Background To assess the rates of clinical response at week 8, biochemical response, steroid-free clinical remission, endoscopic healing and safety data at week 26 of tofacitinib in biologic naive patients with moderate-severe ulcerative colitis (UC). Methods This was a retrospective analysis of prospectively collected data extracted from the notes of biologic naïve patients with moderate-severe UC who were treated with tofacitinib in the last 3 years in 5 Greek IBD centers and who had a follow up of at least 26 weeks after initiation of treatment. Tofacitinib was administered at a dose of 10 mg bid for 8 or 16 weeks followed by a maintenance dose of 5mg bid thereafter. Week-8 or -16 clinical response was defined as the reduction in the partial Mayo score of at least 2 points, without concomitant use of any steroid preparation [budesonide, prednis(ol)one, or methylprednisolone]. Steroid free clinical remission at week 26 was defined as a partial Mayo score of ≤1 points without concomitant use of any steroid preparation. Biochemical response at week 26 was defined as any reduction in fecal calprotectin or plasma C-reactive protein concentrations as compared to their baseline levels.Mucosal healing at week 26 was defined as Mayo endoscopic sub-score of ≤1. A safety list of all reported adverse events was completed. Treatment discontinuation due to adverse events was considered as treatment failure, whereas patients needing escalation of the maintenance dose were also considered as non-responders. Results Overall, 41 patients (26 males), aged (mean, SD) 35.2 (12.7) years and disease duration of mean (SD) 6.5 (4.8) years were included. UC was extensive in 22, left-sided in 17, and proctitis in 2 patients. Clinical response was seen in 31 (75.6%) and 34 (82.9%) patients at week 8 and 12 respectively.Biochemical response and steroid free clinical remission at week 26 were seen in 35 (85.4%) patients. Endoscopic healing was seen in 29 (70.7%) patients. Adverse events,which did not lead to treatment discontinuation, occurred in 5 patients (hyperlipidemia n=3, elevated liver enzymesn=1, herpes zoster n=1). Conclusion In this retrospective real-world ongoing cohort study, tofacitinib demonstrated clinical response at week 8 or 16 and steroid free clinical remission at week 26 in more than 75% of biologic naïve patients with moderate-severe UC with a good safety profile.

Debate on the oncologic potential of sex steroid preparations

Background. Thanks to numerous worldwide studies, the significant contribution of the hormonal component to the oncological risks of the organs of the female reproductive system is beyond doubt. Of great interest is the analysis of world research on the oncological potential of hormonal drugs, namely COCs and MGT, since this issue continues to be one of the most complex and controversial.&#x0D; Aim. This study aimed to contribution of hormonal factors to the development of cancer of the female reproductive system, namely breast, cervical, endometrial and ovarian cancers.&#x0D; Materials and Methods. The study was conducted on the basis of the Center of Gynecology and Reproductive Technologies of the FSAU “National Medical Research Center “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation, the Department of Oncogynecology of the University Clinical Hospital No. 4 of the I.M. Sechenov First Moscow State Medical University. The analysis of medical documentation for the period from January 2015 to December 2021 was carried out. The study included 1842 patients with verified oncological disease of the female reproductive system, who had a history of taking hormonal drugs of the following pharmacological groups: hormonal contraceptives, menopausal hormone therapy drugs. The age of all patients ranged from 26 to 83 years (mean age 51.98±10.3 years). The control group consisted of 611 patients without oncological diseases, who have a history of indications for taking hormonal drugs of these pharmacological groups.&#x0D; Results. When assessing the effect of the duration of MGT intake on the risk of developing breast cancer, it was found that MGT intake for a total of more than 6 years was associated with a higher risk of developing breast cancer (HR 1.18; CI 1.02–1.36; p 0.001). Using the Wald method, we found that the probability of developing breast cancer is associated with a BMI of more than 25 kg/m2 and long-term intake of combined MGT for a total of more than 6 years. When assessing the effect of the duration of MGT intake on the risk of developing RTM, it was found that MGT intake for a total of more than 6 years was associated with a higher risk of developing RTM (HR 1,432; CI 1,172–1,750; p 0.001). Using the Wald method, we found that the probability of developing RTM is associated with the presence of a BMI of more than 25 kg/m2, prolonged MGT intake for a total of more than 6 years and the presence of endometrial hyperplastic processes, adenomyosis, hypertension in the anamnesis. When assessing the effect of the duration of COC intake on the risk of developing breast cancer, it was found that taking COC for a total of more than 7 years was associated with a higher risk of developing breast cancer (HR 1.68; CI 1.1–2.5; p=0.010). According to the Wald method, it was revealed that the probability of developing breast cancer is associated with the presence of HPV type 16, a BMI of more than 25 kg/m2 and prolonged intake of COCs for a total of more than 7 years. When assessing the effect of the duration of MGT intake on the risk of developing PC, it was found that MGT intake for a total of more than 9 years was associated with a higher risk of developing PC (HR 1.65; CI 1.2–2.3; p=0.010). Using the Wald method, we found that the probability of developing RYA is associated with the presence of a BMI of more than 25 kg/m2, MGT intake and the presence of endometrial hyperplastic processes in the anamnesis.&#x0D; Conclusions. With prolonged use of sex steroids, there is a tendency to increase the risk of developing cancer of the female reproductive system. Careful follow-up and limitation of the duration of taking sex steroids in risk groups will reduce carcinogenic risks.

Nasal sprays: commonly used medications that are often misunderstood.

Sinonasal inflammatory disease is very common and all clinicians who care for these patients should understand the topical treatment options available. This article reviews the utility and application of steroidal, saline, decongestant, antihistamine and anticholinergic preparations for the treatment of sinonasal disease, with a particular focus on evidence-based guidelines for use in both specialist and non-specialist healthcare settings.

Non-specialized care of skin disorders: a cross-sectional survey of new patients attending dermatology clinic in a tertiary hospital in Jos, Northcentral Nigeria.

Given the paucity of skin health specialists in Nigeria and the low level of awareness amongst its populace, patients seek for care for skin related disorders from different sources and are given a variety of remedies before accessing specialist care. This study was aimed at describing outlets visited and medication received by patients with skin disorders prior to attending the dermatology outpatient clinic in JUTH. This was a cross sectional study conducted over one year. Information on socio-demography, sources and medication received prior to presentation was obtained and analysed using SPSS 23. The male: female ratio among 166 consenting new patients was 1:1.4. Prior to presentation patients sought care most frequently from Health facilities (68.1%), Patent medicine vendors-PMV (30.7%) and Traditional healers (21.7%). Overall, different steroid preparations were the most commonly used medications (56.6%) across all age groups with fixed combination preparations most frequently used (32.5%). Unconventional substances reportedly used by patients for skin disorders were urine, toothpaste, tomatoes, salt, water in which a life catfish had been kept and fats from a dead dog. Only 21.1% of the patients did not use any medication prior to presentation. There is need to increase capacity in the care of common skin diseases at all levels of the health care system to decrease patronage of unconventional providers. Raising awareness of the general public on the potential dangers of inappropriate treatment of skin diseases and strengthen referral system is imperative to reduce the burden of skin diseases in the country.

Topical Corticosteroid-Induced Iatrogenic Cushing Syndrome in an Adolescent: A Case Report

Cushing syndrome (CS) is an endocrinological disorder characterized by increased blood cortisol level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. Iatrogenic Cushing syndrome is the most common form of Cushing syndrome. The vast majority of cases are due to oral or parenteral steroid preparations, which are commonly prescribed for pulmonary, renal, hematological or autoimmune diseases. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamo-pituitory-adrenal (HPA) axis, which is less common than that of oral or parenteral route. Iatrogenic CS due to the overuse of topical corticosteroids is rarely reported. There are only few cases that reported young children having Cushing syndrome secondary to misuse of topical corticosteroids.

Lateral Stenosis of External Auditory Canal Secondary to Corrosive acid Injury: A Rare Case Report and Review of Literature.

Acquired external auditory canal (EAC) stenosis is an uncommon condition with an incidence of 0.6 in 100,000 population. Road traffic accidents and otology surgeries are the frequently reported causes for it to occur. The high rate of restenosis makes this condition difficult to manage. A 50 year old lady presented with history of accidental instillation of acid in her left ear at 6 months of age by the care giver. The patient developed stenosis of left EAC with hearing loss. Examination revealed pin point stenosis of left EAC. Puretone audiogram revealed a moderately severe conductive hearing loss. Computed tomogram showed soft tissue lesion obliterating the entire EAC and extending into the middle ear and antrum. Intra operatively only the cartilaginous EAC was stenosed. Surgical excision of the fibrotic scar with a tympanomastoidectomy and wide meatoplasty was done. Regular post operative aural toileting, packing with merocele strips and application of topical antibiotic -steroid preparations was done. 6 months post-surgery a patent EAC and healed tympanic membrane was achieved. In this report, we present a rare case of lateral EAC stenosis secondary to corrosive acid injury, highlighting the surgical steps, post operative care and surgical outcomes. A limited review of literature is also presented.

Characteristics of morphological changes in the skin of patients with allergodermatoses during long-term external application of fluorined steroids

The article presents the results of studies of the effect of applying topical fluorinated glucocorticosteroids in combination with ceramides on the barrier function of the skin of experimental animals with allergic dermatoses (guinea pigs). The purpose of the work: substantiation of the inclusion of ceramides in the base of topical fluorinated steroid preparations for the treatment of allergic dermatoses by studying the morphological changes in the skin of guinea pigs after the application of the indicated means of various compositions. Materials and methods. Histological research was carried out on outbred guinea pigs of the same sex and condition (74 individuals). The animals were divided into separate groups depending on the applied drugs. The following combinations of drugs and, accordingly, guinea pigs were selected, which were divided as follows: IC – intact control (15 animals); O – base application (14); OC – base containing ceramides (15); FSt/kr – fluorinated steroids of strong action (betamethasone) (16); FStK/kr – fluorinated steroids of strong action (betamethasone) + ceramides (14). Results. In order to study the traumatic effect of topical steroids on the skin and the possibility of preventing morphological (atrophic) disorders, an experimental study of the morphology of the skin of guinea pigs was carried out on a model of atrophy caused by long-term (14 days) application of topical fluorinated steroids of various compositions. Applying the foundation to animals led to some thickening of the epidermal layer, while the morphology of the epidermis and the skin itself was not disturbed. The addition of ceramides led to the acceleration of proliferative processes and the development of proliferative acanthosis. Changes induced by betamethasone were noted mainly in the epidermis in the form of local atrophy of the epidermal layer. The addition of ceramides to a potent fluorinated steroid to some extent smoothed out the negative effects of the corticosteroid hormone. The average thickness of the epithelial layer increased by 2 times compared to the thickness of the epithelial layer of animals of the FSt/kr group and even slightly exceeded the indicators of intact animals. Vacuolar dystrophy of the cells of the spinous and granular layers occurred in all animals of the FStK/kr group. Lymphoid infiltration of the dermis, parakeratosis and acantholysis were not noted. Conclusions. The results of an experimental study of the effect of topical fluorinated steroids of different composition on the skin of guinea pigs indicate the existence of differences between the drugs in terms of their degree of action on the intensity and development of pathological processes in experimental animals. A comparison of the effect on the skin of classic topical steroids and those additionally containing ceramides indicates the possibility of preventing the traumatic effect of hormones, which is especially important for patients with filaggrin gene mutations.

An ayurvedic management of Tamakshwasa with special reference to bronchial asthma: A case study

Bronchial asthma is a chronic inflammatory disease of respiratory tract with airway hyper responsiveness producing symptoms such as wheezing, cough and dyspnea. Exposure to the dust, smoke, respiratory infections, new dietic preparation, stress and change in climate are some of the causative factors of Bronchial Asthma. In Modern medicine there is no permanent cure for asthma, only symptoms can be. If it is left untreated or not treated in time,it is fatal in nature. Although various studies have been performed across the globe in last few decades and some good drugs are discovered. Due to changes in life style and change in environment, mainly pollution, study shows clear indication that the prevalence of Shwasa (Bronchial Asthma) has increased significantly in all age groups. Tamakshwasa is of 5 types of Shwasa , which is said to be Kashtasadhya or Yapya by Madhavnidan. Presently, nebulization is the fastest way of relieving the symptom of Shwaskashtata in Bronchial Asthma, for which bronchodilator and steroidal preparations are widely used. But they have some ill effects when used for prolonged period. A 40-year-old female having increase in symptoms of Shortness of breath, Expiratory wheezes, Chest pressure sensation, Patient had taken allopathic medicine for 1 month, but she had no satisfactory relief. Shaman and Shodhan as ApunarbhavChikitsa is given. Significant improvement observed in subjective and objective parameters.

Flushing After Lumbar Epidural Steroid Injection with Dexamethasone.

Epidural steroid injections are an accepted treatment for low back pain and radicular symptoms. While epidural steroid injections are routinely performed without complications, side effects can be seen, including flushing. Flushing has been studied using various steroid preparations, including dexamethasone, but at significantly higher doses. This was a prospective cohort study that examines the rate of flushing in ESIs with a lower dose (4mg) of dexamethasone. Subjects undergoing lumbar epidural steroid injection were asked about the presence of flushing following the procedure prior to discharge and again at 48h after. A total of 80 participants received fluoroscopically guided interlaminar and transforaminal epidural injections. All participants received 4mg of dexamethasone. Of the 80 subjects, 52 were female, and 28 were male. Seventy-one underwent a transforaminal epidural injection and 9 underwent an interlaminar epidural injection. Four (5%) subjects experienced flushing-1 subject experienced immediate post-procedural flushing and 3 experienced flushing within 48h. All 4 subjects (100%) were female. All 4 subjects received transforaminal injections (100%). There is a gap of knowledge about the flushing after lumbar epidural steroid injection with dexamethasone. Flushing is a known and common side effect of epidural steroid injections, varying in frequency based on type of steroid as well as dose. We found 5% incidence in flushing reaction with 4mg of dexamethasone.

Innovative therapy for progressive IgA nephropathy with the oral encapsulated steroid preparation Nefecon®

Innovative therapy for progressive IgA nephropathy with the oral encapsulated steroid preparation Nefecon®

Experience in the treatment of otitis external contaminated with bacterial infection and yeast Malassezia in dogs with signs of food allergy

The aim of the study was to develop a treatment regimen for otitis externa with contamination by bacterial infection and yeast fungi of the genus Malassezia in dogs with signs of food allergy without the use of steroid preparations. The study was conducted on nine dogs of dwarf breeds aged from six months to two years with a clinically and laboratory confirmed diagnosis of otitis externa complicated by bacterial and yeast contamination. As a result of cytological examination of smears prepared from earwax and smears-prints taken from the area of interdigital spaces, the presence of cocci and yeast fungi in various ratios was revealed in the studied animals. At the same time, bacterial microflora (coccoid forms) prevailed in four animals, fungal microflora prevailed in three, and the ratio of cocci and fungi in two animals was 1:1. The animals were prescribed therapy, including the use of self-prepared ear drops based on the preparations "Baitril 5.0%" and "Clotrimazole 1.0%", a course of 14 days with preliminary cleaning of the external auditory passages with specialized veterinary lotions based on glycyrine.It was found that the developed treatment regimen for otitis externa with contamination by bacterial infection and yeast fungi of the genus Malassezia in dogs with signs of food allergy is effective. The fundamental difference between this scheme and common treatment regimens is the absence of steroid drugs in its composition, which often lead to undesirable side reactions of the body.

Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how.

Despite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpretation of GH peaks are still a matter of debate worldwide. Diagnostic workup is even more problematic in short children with slow growth and delayed sexual development: they often exhibit low GH peaks under GHST, which often normalize as puberty progresses. Consequently, this transient suboptimal response to GHST may result in GH overtreatment, carrying both health and economic concerns. Considering the complex and bound link between GH axis and sex steroids, the use of sex steroid priming prior to GHST might be helpful in peripubertal setting. However, its use is still controversial. There is no consensus regarding patient selection, timing, dose, and preparation of sex steroids. In this review, we aim to overview the use of sex steroid priming in clinical practice, highlighting the need to develop appropriate guidelines in order to overcome diagnostic pitfalls in peripubertal age.

64 HIGH-DOSE STEROIDS IN HAEMATOLOGICAL MALIGNANCY: A RED FLAG FOR BONE HEALTH

Abstract Background Bone-protective treatment should always be considered when commencing glucocorticoid therapy in individuals at high risk of fracture, as outlined in recent guidelines (National Osteoporosis Guideline Group, July 2018). Despite this, many patients receive high dose glucocorticoids (&amp;gt;7.5mg/kg/day or equivalent for &amp;gt;3 months) during treatment of haematological malignancy without formal assessment of bone health. Methods Twenty-five patients with Non-Hodgkin’s Lymphoma (NHL) on high dose steroid chemotherapy protocols were retrospectively assessed. The inclusion criterion was defined as any patient commenced on a cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) containing protocol from 1/8/2020 to 1/8/21. Data was collected from electronic and written patient records. Information regarding patient age, diagnosis, steroid preparation and dose, presence of risk factors for osteoporosis and calcium and vitamin D prescriptions were collected. Radiological imaging was reviewed to assess for the occurrence of fragility fractures. Each patient had a FRAX® score calculated to assess fracture risk. Results The mean age of patients studied was 67 years and equally distributed between males and females. All patients had NHL. 32% (n=25) of patients were identified to be at high risk for fracture (FRAX® score &amp;gt;20% ten-year probability of major osteoporotic fracture). 16% had already established fragility fractures prior to commencing steroid treatment. 28% of patients were females over the age of 70 years. Only 12% of patients received vitamin D and calcium supplementation. No patient commenced bone protection therapy. Conclusion Omission of bone health assessment prior to high dose glucocorticoid treatment is prevalent in haematological malignancy and places patients at risk of significant morbidity. Patients are not routinely considered for protective measures including calcium and vitamin D supplementation and bone protection therapy. A simple risk-assessment tool and education to staff and patients prior to glucocorticoid therapy could significantly improve practice in this area. It is now planned to introduce routine risk assessment for this cohort of patients, with re-audit following implementation.