Kentucky Derby’s beloved I Want Revenge sustained a bad ankle on April 7. On April 10, the colt’s right front fetlock was X-rayed, and on April 14, an ultrasound was conducted on it, according to testimony and veterinarian bills. The next day, I Want Revenge was injected in his right front digital sheath with hyaluronic acid and Vetalog, a corticosteroid.

However, according to his owner, David Lanzman, the trauma was only observed for the first time on the day of the derby.

On two occasions, veterinarians have testified, I Want Revenge’s ankle was injected with what amounted to new transmission fluid. The second time was just four days before the Derby and was done at the request of his trainer, Jeff Mullins. Irrespective of the consequence of the , the treatments are a striking illustration of how the use, and overuse, of legal medications have placed America’s thoroughbred population at ever greater chance of injury.

There is a developing concern inside the veterinary community that overmedication — with drugs like corticosteroids, anti-inflammatory that can have severe consequences — and inattentive supervision are part of the reason the United States has the world’s worst fatality rate for purebreds.

From  New York Times:

Five months after the Kentucky Derby favorite I Want Revenge was scratched the morning of the race with a bad ankle, his owners are embroiled in a lawsuit that has exposed the fault lines of administering legal drugs to America’s thoroughbreds.

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Last September 29, 2009, in a meeting held in Louisville, Kentucky, the Racing Medication and Testing Consortium (RMTC) board of directors has accredited the formation of a committee to supervise the implementation of the Drug Testing Initiative (DTI) Task Force recommendations on quality assurance and laboratory accreditation programs for U.S. horse racing drug testing laboratories.

At the board meeting, issues such as the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) and how they may affect pre-race exams by regulatory veterinarians were tackled. Dr. Tom David of the Louisiana State Racing Commission and chairman of the ARCI Racing Regulatory Veterinarian Committee explained the examining veterinarian’s interest over current NSAID and corticosteroid policies. RMTC Scientific Advisory Committee was previously appointed with the job of reexamining all existing research on NSAIDs, particularly phenylbutazone.

The RMTC Scientific Advisory Committee has noted different options for consideration in future recommendations on the administration times and threshold concentrations for NSAIDs.

The RMTC previously announced that it was carrying out research on corticosteroids commonly used in racing and the board was updated on the status of that project. A copy of Dr. Soma’s study and Dr. David’s remarks can be found at the RMTC website.

From Harness Link:

At the board meeting, other integrity issues were also discussed in depth, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) and how they may affect pre-race examinations by regulatory veterinarians. Dr. Tom David of the Louisiana State Racing Commission and chairman of the ARCI Racing Regulatory Veterinarian Committee explained the examining veterinarian’s concern over current NSAID and corticosteroid policies.

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Budesonide, a form of corticosteroid, used in asthma and nasal polyps, has been found to be effective in treating symptoms of chronic rhinosinusitis.

Rhinosinusitis is a new classification of sinusitis referring to the inflammation of the sinuses including the nose. A sinusitis is considered chronic if it persists for 12 weeks or more. It may occur with nasal polyps but there are cases without.

According to Neil Sachnadani, BS, and colleagues at the Washington University School of Medicine in St. Louis, a nasal wash containing budesonide and saline solution can improve clinical symptoms of rhinosinusitis.

The study was conducted by giving the participants a nasal wash with 0.25 mg budesonide in 5 ml saline solution. The participants have to apply the nasal wash in each nostril for 30 days. They were also made to answer a set of questionnaires relating to their symptoms and related quality of life. This was done before and after the study period.

A standard method of testing used was consyntropin injections. It stimulates the release of cortisol by the adrenal glands. This is to determine the adrenal response after budesonide therapy.

All participants reported some form of relief after therapy. Researchers also found that adrenal responses remained normal even after budesonide therapy. This indicates that budesonide is effective in treating rhinosinusitis without suppressing the adrenal function of the body.

From Eurekalert:

A nasal wash containing the corticosteroid budesonide appears to reduce symptoms of chronic rhinosinusitis without suppressing the function of the adrenal glands, a known complication of this type of drug that would indicate absorption throughout the whole body, according to a report in the March issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

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According to a research conducted by Dr. Matthew Thompson of the University of Oxford, corticosteroids in combination with antibiotics can effectively and rapidly treat pain and inflammation associated with sore throat than with antibiotics alone.

The study involved adults and children who all had symptoms of sore throat. They were given both corticosteroids and antibiotics. Results showed that those who received this combination therapy had total pain relief after 24 hours than those who received placebo. Effects on pain, however, were less evident after 48 hours. This led the researchers to conclude that a single dose of corticosteroid is enough to alleviate pain associated with sore throat.

Furthermore, researchers observed that this positive effect was only evident among adult patients and those receiving oral corticosteroids. After numerous trials, it was also found that simple painkillers and corticosteroids exhibit similar effects.

The authors concluded that pain relief can be effectively achieved by using corticosteroid in conjunction with antibiotics. It can reduce the average time to pain relief. However, there were some limitations to the study. Further research needs to be conducted on the effects of corticosteroids independent of antibiotics. Possible harmful effects on the use of steroids in sore throat were also not established.

According to Medical News Today:

A study just published on bmj.com reports that when treating adults with severe sore throat, a single dose of corticosteroid drugs together with antibiotics can alleviate pain more rapidly and effectively than with antibiotics alone.

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According to a new study on early steroid withdrawal following transplantation of liver, a higher incidence of rejection and a lower incidence of intolerance to glucose necessitating treatment for diabetes happen.

This first double-blind placebo-controlled study was conducted to examine the effects of early steroid elimination. The results of this study on early steroid withdrawal appeared in an issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS).

From News-Medical.Net:

“Although the incidence of acute rejection in the placebo group was increased, it was easily controlled in most of the cases and did not affect long-term graft histology or survival,” the authors note, adding that the increase may ultimately be acceptable if steroids could be eliminated. However, the main goal of steroid elimination is to reduce metabolic complications and this study showed no difference in cholesterol or hypertension, with a trend toward a decreased incidence of diabetes in the placebo group.

The authors conclude: “Indeed, while there are many arguments in favor of corticosteroid withdrawal beyond 3 months posttransplantation, in terms of safety and efficacy, our study demonstrates that earlier withdrawal at day 14 is not completely safe in terms of rejection, but seems efficient in terms of improvement of glucose tolerability,” which could decrease long-term mortality due to cardiovascular disease.

The study is expected to offer a new paradigm to individuals and scientists who were previously finding a way out from the concerning issue of early steroid withdrawal.

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A steroid nasal spray is far effective than antihistamine pills when it comes to quashing symptoms of allergy as per a recent study.

During the study, it was revealed that Flonase, nasal spray fluticasone, helps in relieving allergy symptoms far better than Claritin, antihistamine loratadine. Fluticasone is a corticosteroid preparation that fights against symptoms of allergy by minimizing the level of inflammation that happens in the nose when an individual is exposed against allergy triggers such as dust mites.

From Bio-Medicine.org:

Using a steroid nasal spray to quash allergy symptoms may work better than antihistamine pills. Researchers say that when used on an “as-needed”, rather than daily basis, the nasal spray fluticasone (Flonase) relieves allergy symptoms such as runny nose, sneezing and congestion more effectively than the antihistamine loratadine (Claritin).

Dr. Robert M. Naclerio and his colleagues at the University of Chicago in Illinois remarked that patients with seasonal allergies are always advised to take steroid nasal sprays or antihistamines on a daily basis but they tend to overrule the advice.

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Patients who have low levels of adrenal are supposed to be weaned off early from ICU if they are given a supplement of hydrocortisone before extubation is attempted.

Study was conducted on 93 critically ill patients, 91.4% of the 70 with relative adrenal insufficiency who received hydrocortisone infusions were successfully weaned from a ventilator, compared with 68.8% of those who received a saline placebo.

This stress dose corticosteroid supplementation with adrenal insufficiency led to a significantly higher success rate for ventilator weaning. Functional adrenal insufficiency was related to subnormal corticosteroid production during critical illness, particularly septic shock, in the absence of structural defects in the hypothalamic-pituitary-adrenal axis.

From med page today:

ICU patients with adrenal insufficiency stand a better chance of being weaned off a ventilator more rapidly if they are treated with hydrocortisone before extubation is attempted.

“In this study, stress dose corticosteroid supplementation before extubation of patients with adrenal insufficiency led to a significantly higher success rate for ventilator weaning and a shorter weaning duration than in the placebo group,” they wrote.

“The successful ventilator weaning percentage was significantly higher (p = 0.035) in the adequate adrenal reserve group (88.4%) and in the stress dose hydrocortisone treatment group (91.4%) than in the placebo group (68.6%),” the authors wrote.

The patients were given regular corticosteroids before or during the admission. Patients with adrenal insufficiency were given 50 mg intravenous hydrocortisone every six hours during the weaning period. Studies showed that 32 of 35 patients taking hydrocortisone were successfully taken off ventilators, compared with 24 of 35 in the control group. Among the 20 patients with adequate adrenal reserves, 20 of 20 patients were taken off ventilator, but three failed after extubation.

Studies conclude that the weaning period was shorter in the hydrocortisone treatment group than in the placebo group. They also noted that “No significant adverse effects were observed in the corticosteroid treatment group.”

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Several weeks ago it was Chinese dairy products contaminated with industrial chemical melamine that had caught international attention. Now, another Chinese product has been getting publicity – very bad publicity – since it has been discovered to be tainted with a potentially hazardous ingredient.

A skin cream, which has been used to treat eczema in babies, was discovered to contain clobetasol propionate, a steroid hormone. The Miaoling Medical Technology Group, manufacturer of the product, said it had recalled and stopped production of the cream.

Clobetasol, technically a corticosteroid, is  used in medicines prescribed for dermatologic and gynecologic treatments. Although the hormone is used to treat skin disorders, it is not recommended to be used on children under 12 years old.

Among the side effects of this hormone include changes in blood sugar and Cushing’s syndrome, an endocrine disorder characterized by rapid weight gain often referred to as central obesity and a ‘moon face’.

The packaging of the cream stated that it only contained 25 natural ingredients and clostebol was not listed as one of these ingredients.

According to AFP report, the company’s license is likely to be revoked.

A report published in Xiaoxiang Morning News in central China said that an eight-month-old girl in Changsha, the capital of Hunan province, had appeared to menstruate after being given the cream for seven months. Doctors there said the hormone was the cause.

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