Use Of Steroids In Patients Research Articles

Glucocorticoid use in patients with preterm premature rupture of the fetal membranes

Antenatal glucocorticoid use in patients with preterm premature rupture of membranes (PPROM) is controversial. The majority of prospective, randomized studies on antenatal glucocorticoid use evaluate the effect of this intervention on preterm infants delivered due to multiple, diverse etiologies, only one of which is PPROM [corrected]. These studies present a variety of conflicting conclusions; meta-analysis indicates a potential benefit of steroids in the reduction of RDS, intraventricular hemorrhage, and mortality. Meta-analysis of studies specifically evaluating pregnancies complicated by PPROM demonstrates a significant reduction in RDS; however, this effect is primarily due to the work of a single author with a potentially atypical study population [corrected]. The remaining studies fail to show a benefit of steroids. The strongest argument for steroid use in patients with PPROM is extrapolation of data from studies of patients delivered preterm due to a variety of etiologies, not just PPROM. While such an extrapolation is currently recommended by the NIH Consensus Development Panel, it may be premature to assume that the same pathophysiological mechanisms and the same propensity for benefit from steroids occur in these different populations. Further studies are necessary before glucocorticoids can be confidently recommended in pPROM.

Antenatal steroid therapy before 33 weeks' gestation

OBJECTIVE: The purpose of this study was to determine those factors influencing contemporary antenatal steroid use in pregnancies delivered prior to 33 weeks of gestation. METHOD: We analyzed the clinical circumstances of 86 consecutive patients who delivered prior to 33 weeks of gestation and compared the 20 women who received dexamethasone prior to delivery with the remaining 66 untreated cases. RESULT: Known risk factors for preterm delivery (e.g. prior preterm birth, n = 17; prior admission and tocolysis during the index pregnancy, n = 15) did not discriminate between treated and untreated subsets. Premature membrane rupture ( 3 20 vs. 34 66 ; P < 0.01) and documented preterm labor ( 1 20 vs. 23 66 P < 0.01 ) were more common in the untreated cohort and a shorter mean interval from admission to delivery was also observed (2.8 vs 11.2 days). However, a full course of steroids would have been possible in 22 66 untreated women, since delivery was delayed for at least 36 h in these patients. CONCLUSION: These observations reflect the fact that many preterm births cannot be anticipated, even among hospitalized patients. We would therefore suggest that universal steroid treatment be considered for all women with documented preterm labor prior to 33 weeks of gestation. Initiation of steroid therapy at the referral center, (prior to maternal transport) should also be considered. Since both premature membrane rupture and early gestational age (24–28 weeks') confounded many of these cases, steroid use in patients with these circumstances should be reevaluated.

High-dose intravenous methylprednisolone therapy associated with osteonecrosis in patients with systemic lupus erythematosus.

Osteonecrosis is related to the use of steroids in patients with systemic lupus erythematosus (SLE); its association with the use of 'pulses' of methylprednisolone (PMP) is not clear at present. In a retrospective analysis of 190 patients with SLE we found that 19% of 36 patients treated with PMP had osteonecrosis compared with 6% of 154 patients without that treatment (P < 0.04). Risk factors associated with osteonecrosis were PMP treatment, cushingoid appearance, steroid doses > or = 40 mg/day during the first month of treatment, a ratio of steroid dose in grams/year > or = 12, hematuria and proteinuria. In a stepwise regression model, when cushingoid appearance was excluded, PMP became the only significant factor (P = 0.045). We conclude that osteonecrosis can be considered a long-term complication of PMP treatment in SLE patients.

The Effects of Steroids in the Treatment of Typhoid Fever

The results are presented of the treatment of 99 infants and children with initially Uncomplicated typhoid fever. The effect of addition of steroids to the chloramphenicol treatment and usual therapeutic regime is discussed. The rapid relief of fever and toxicity, noted eleswhere, was confirmed. This changed our treatment from a mostly inpatient to a mostly outpatient basis, such as is particularly useful, when possible, for hospitals in overcrowded, underdeveloped areas. The striking reduction in mortality and morbidity in steroid-treated patients warrants further investigation. Caution is recommended in the use of steroids in patients with history of fever for 2 weeks or more, as most typhoid perforations occur in the third week.

The Place of Steroids in Pulmonary Disease

Although the clinical significance of the adrenal glands was first reported by Addison in 1855, comparatively little was known of its physiology until Selye showed its relationship to the “stress mechanism.” Further studies by Hench, et, al., proved clinically the relationship of cortisone in inflammatory and allergic reactions. Even at present, the corticosteroid preparations are clearly labeled as being contra-indicated in patients with active tuberculosis. This is due to the adverse affects first noted in early animal experiments13 and in humans in whom cortisone caused an exacerbation of a previously unknown or quiescent tuberculosis. Reports in the literature recently by various investigators4#{176} tend to show that the corticosteroids can be given safely with occasional dramatic results in active tuberculosis as long as anti-tuberculous therapy is being simultaneously administered. This is especially true in fulminating tuberculosis such as miliary and tuberculous meningitis. This paper, therefore, will seem paradoxical, for it will tend to condemn a treatment where it ‘has been previously advocated and advocate a treatment where it has previously been condemned. Following the excellent results obtained in the treatment of rheumatoid arthritis,’0 bronchial asthma, inflammatory and allergic dermatitis, and eye conditions, its use has expanded to rheumatic fever, nephrosis, lupus eryithematosis and other collagen diseases, blood dyscrasias, etc. The first portion of this presentation will discuss cases of reactivated tuberculosis seen by the authors in patients receiving the corticosteroids for a variety of conditions. The reasons for reactivation and possible methods of prevention will also be discussed. The second portion will review the results obtained by the use of steroids in patients with acute and chronic tuberculosis, who also were receiving antituberculous therapy. While it may be true that the number of reactivated tuberculosis cases is comparatively small in proportion to the general usage of the steroids, nevertheless they are being seen with increased frequency by chest