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Wednesday 26, May 2010

  Diabetic retinopathy can be slowed down by steroid injections

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Diabetic retinopathy can be slowed down by steroid injectionsPatients suffering from diabetic retinopathy, a complication of diabetes that can cause vision loss and blindness, can finally have some relief coming their way.

According to a report in the December issue of Archives of Ophthalmology, one of the JAMA/Archives journals, injecting triamcinolone (corticosteroid) directly into the eye can slow down the disease progression.

From Sciencedaily.com:

Corticosteroids have been shown to interfere with the creation of new blood vessels, possibly by reducing the production of compounds that spur their growth, the authors note. However, steroids are also associated with other eye diseases.

“Use of this intravitreal [injected into the eye] corticosteroid preparation to reduce the likelihood of progression of retinopathy is not warranted at this time because of the increased risk of glaucoma and cataract associated with intravitreal steroid use,” the authors write. “Any treatment to be used routinely to prevent proliferative diabetic retinopathy likely needs to be relatively safe because the condition already can be treated successfully and safely with panretinal photocoagulation. Nevertheless, further investigation with regard to the role of pharmacotherapy for reduction of the incidence of progression of retinopathy appears to be warranted.”

This finding was disclosed by Neil M. Bressler, M.D., of Johns Hopkins University School of Medicine, Baltimore, and colleagues in the Diabetic Retinopathy Clinical Research Network.

Saturday 22, May 2010

  Herbal creams for treating eczema may include steroids

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Herbal creams for treating eczema may include steroidsScientists from the Royal Hallamshire Hospital, Sheffied, UK, have found that ‘herbal creams’ used to treat eczema may have steroids in them. It is worth noting here that patients using steroids in the long run can experience permanent damages.

The scientists called for strict regulations of herbal medicines to treat eczema after found that most of these medicines included steroids.

From MedicalNewsToday.com:

Eczema can be controlled by using corticosteroid creams (prescription only). However, many people do not like them because of their long-term effects (there can be permanent skin damage, growth retardation in children and hormonal disruption during milestones of a child’s development).

As a result, many people have resorted to herbal medicines.

Dr. Helen Ramsay (Royal Hallamshire Hospital, Sheffied, UK) has said that patients are getting steroids from ‘natural, herbal products’.

They tested 24 creams and found that 20 of them had ‘powerful, or very powerful steroid drugs‘ (in varying concentrations).

One product called ‘Wau Wau’ was found to be a pharmaceutical steroid brand mixed in a paraffin base. The instructions on the packet told the patient to apply it all over – there was no minimum age. If a parent followed the instruction on their 4-year-old, the child would be receiving 135 grams a week of cream. The child would be exposed to dangerous levels of steroids.

The researchers also found that these creams were more expensive than standard prescription charges (in the UK).

This is an unfortunate state of affairs. Three years ago a similar study found 80% of natural creams had power steroids in them. So, no progress at all has been made to protect patients.

This finding is expected to provide invaluable insights to medical practitioners treating patients suffering from eczema.

Monday 17, May 2010

  Continuing steroid doses associated with cerebral palsy

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Continuing steroid doses associated with cerebral palsyRepeated courses of a corticosteroid called betamethasone that is used for improving the survival of unborn premature babies could possibly increase the risk of cerebral palsy in those children.

This finding was revealed as part of results from a multi-center study, which was funded by the National Institutes of Health and led by Ronald Wapner, M.D., professor of obstetrics and gynecology, Columbia University Medical Center and attending obstetrician and gynecologist at NewYork-Presbyterian Hospital/Columbia.

From Sciencedaily.com:

Up until the year 2000, obstetrician-gynecologists frequently repeated the course of steroids every week, up to 10 to 11 times, in women who remained pregnant after the first course. A NIH panel that year, concerned with the lack of safety data for this practice, suggested multiple courses should be strictly reserved for patients enrolled in clinical trials.

In one of the first such trials to examine the long-term effects of the treatment on the children, women who remained pregnant a week after the initial course of corticosteroids were randomly assigned to weekly courses of corticosteroids or placebo until their babies were born.

The study, performed by members of the NIH-sponsored Maternal-Fetal Medicine Network followed a total of 556 infants at the Morgan Stanley Children’s Hospital of NewYork-Presbyterian Hospital/Columbia and 12 other sites around the country, and found that by ages two to three, the two groups of children were physically and neurologically identical, except that six out of 248 children who received multiple courses of corticosteroids had been diagnosed with cerebral palsy, compared to only 1 out of 238 children in the placebo group. The mothers of all six children with cerebral palsy in the corticosteroid group had received four or more courses of the drug.

This research was supported by the National Institute of Child Health and Human Development of the National Institutes of Health and the study results were published in an issue of the New England Journal of Medicine.

Tuesday 11, May 2010

  Single steroid dose can do wonders for treating sore throat

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Single steroid dose can do wonders for treating sore throatA study published on bmj.com has reported that a single dose of corticosteroid drugs together with antibiotics can be used for alleviating pain and this treatment is more effective than with antibiotics alone. However, it was not indicated that this finding holds equally good for children with sore throat.

Dr Matthew Thompson at the University of Oxford and collaborators expected the premise that corticosteroids can successfully ease sore throat symptoms because of their anti-inflammatory effects.

From MedicalNewsToday.com:

The results of eight trials were analyzed. They compared corticosteroids to placebo in adults or children. Overall, 743 patients were involved in the trial, including 369 children and 374 adults. They all had symptoms of severe sore throat.

In order to reduce partiality, variations in study feature and quality were considered.

Results showed patients given corticosteroids together with antibiotics were three times more likely to report total clearing up of pain after 24 hours than patients given placebo. After 48 hours the effect on pain was less evident. According to the authors, this indicates that a single dose of corticosteroids may be sufficient.

In addition, corticosteroids reduced the average time to pain relief by about six hours. But, the researchers specify that considerable effects were observed only in adult patients and only in those receiving oral corticosteroids. After assessing the trials, it was apparent that the use of simple painkillers made no difference.

The authors explain: “These findings suggest that, in patients with severe sore throat, pain can be reduced and resolution hastened by use of corticosteroids in conjunction with antibiotic therapy.” They write in conclusion: “These results may also help to prevent antibiotic use, particularly in the context of delayed prescribing. Future research should focus on the effect of corticosteroids independent of antibiotics.”

It was acknowledged by an associated editorial that steroids can minimize pain in the first day but the editorial cautioned about lack of information on the possible harmful effects.

Saturday 01, May 2010

  Research findings presented on asthma

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Research findings presented on asthmaResearchers examining inhaled steroids and children suffering from asthma, as well as asthma and obesity have presented their findings from the National Heart, Lung, and Blood Institute (NHLBI) Asthma Clinical Research Networks at the American Thoracic Society 2007 International Conference in San Francisco.

Wayne Morgan, M.D., of the University of Arizona Health Sciences Center in Tucson, presented new data at the ATS meeting, said that asthma can be controlled but cannot be eliminated.

From Sciencedaily.com:

A second presentation on the PEAK study looked at whether there are ways to predict which high-risk children will do poorly with their asthma. “Some children outgrow their asthma and some maintain their asthma, and PEAK found that inhaled steroids didn’t change that course. However, these high-risk children do respond to inhaled steroids, but if you take them off, they tend to do worse,” says researcher Theresa Guilbert, M.D., Assistant Professor of Pediatrics at the University of Wisconsin-Madison and lead author of The New England Journal of Medicine article. “We know that if children have certain characteristics such if they’re male, have allergy, or have eczema that they tend to do poorly over time.”

A third study from NHLBI’s Asthma Clinical Research Network looked at the impact of overweight and obesity on asthma severity and response to asthma therapy. The study used data from the NHLBI on approximately 1,200 people with asthma.

“This type of study provides extremely rich data in terms of the participants’ height, weight and asthma severity, allowing us to more precisely evaluate the relationship between body mass and asthma severity,” says researcher E. Rand Sutherland, M.D., M.P.H., Assistant Professor of Medicine at the National Jewish Medical and Research Center in Denver. “We can also look at how obesity modifies the response to therapy.”

Two of these presentations consisted of new research findings from the Prevention of Early Asthma in Kids (PEAK) study, which is examining the effect of inhaled corticosteroid therapy on asthmatic children.

Wednesday 28, Apr 2010

  Coping strategies offered for relief from summer allergens

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Coping strategies offered for relief from summer allergens  Allergy sufferers can finally have some respite as springtime mountain cedars and tree pollens have generally subsided but summertime is here.

Dr. David Khan, associate professor of internal medicine at UT Southwestern Medical Center, said limiting outdoor exposure during peak times, closing the windows, air conditioning, and mask wearing can help people avoid allergies to a significant extent.

From Sciencedaily.com:

Prescription antihistamines can offer more potency and be less sedating than over-the-counter measures, Dr. Khan said.

Corticosteroid anti-inflammatory nasal sprays can be used regularly, often once a day, and are generally safe and effective. These are not the same as anabolic steroids that athletes sometimes abuse and for which some school systems now test.

Antihistamines, decongestants and corticosteroids, however, do no more than depress symptoms. “Although you’ll be reducing the effect of the allergic reaction, you’ll still be just as allergic at the end of the day,” Dr. Khan said.

Shots are the most effective medical treatment, he said, actually making allergy sufferers less allergic.

Even though heat does not influence pollen amount in the air, it does stimulates the formation of ground-level ozone that can exacerbate symptoms of allergy.

Sunday 25, Apr 2010

  Steroids superior to antihistamines for treating allergies

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Steroids superior to antihistamines for treating allergiesResearchers from the University of Chicago have demonstrated that corticosteroid-based nasal sprays are superior to antihistamines when used “as needed” for treating seasonal allergies.

The finding, which was published in the November 26 issue of the Archives of Internal Medicine, suggests that the present guidelines and prescription patterns flavoring the usage of antihistamines as the first-line treatment to treat mild or moderate allergies need to be changed.

From Sciencedaily.com:

Antihistamines can block the actions of histamines if taken in advance but they have no impact on the late response. Intranasal steroids inhibit the late response and prevent priming.

Antihistamines,” explained Naclerio, “taken once symptoms have already appeared, arrive too late to block the early response and have little effect on the late response. Corticosteroids taken when symptoms begin can prevent the late response and inhibit priming, which makes the patient more sensitive to subsequent contacts.”

“Our study,” he added, “demonstrates the greater importance of the late response compared to the immediate response.”

The authors emphasize that continuous medication use is more effective than sporadic use in response to symptoms but acknowledge that few patients comply with those instructions.

In light of their findings, they suggest revising the current guidelines so that “intranasal corticosteroids should become the first-line treatment for seasonal allergies. They should now be recommended for regular use in patients with severe disease,” said Naclerio, “and for as-needed use in patients with mild disease.”

Robert Naclerio, M.D., chief of otolaryngology-head and neck surgery at the University of Chicago and director of the study, said more people will be benefited and health costs will be reduced by changing the present guidelines to match patient practice.

Saturday 24, Apr 2010

  High doses of steroids can lead to improvement in asthmatic children

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High doses of steroids can lead to improvement in asthmatic childrenChildren who are suffering from asthma and report continued symptoms while using low-dose inhaled corticosteroids can expect benefit from increasing the doses or adding one of two asthma drugs, as per a new study by researchers at Washington University School of Medicine and other institutions.

The study called BADGER (Best ADd-on therapy Giving Effective Responses) could allow physicians to predict which of the available options will help a patient the most.

From Sciencedaily.com:

To treat children whose asthma is not well controlled while using low-dose inhaled corticosteroids, the National Heart, Lung, and Blood Institute (NHLBI) guides physicians to try one of three additional, or step-up, treatments: doubling the dosage of the inhaled corticosteroid or adding a long-acting beta antagonist (LABA) or a leukotriene receptor antagonist (LTRA) to the inhaled corticosteroid treatment.

However, physicians often find it difficult to predict which step-up treatment might work best for a particular child. So the researchers in the five-center, NHLBI-funded Childhood Asthma Research and Education (CARE) Network used a novel triple-crossover, double-blind approach to determine if the treatments improved asthma symptoms, and if so, which treatment might work best.

Robert C. Strunk, M.D., and Leonard B. Bacharier, M.D., both Washington University pediatric asthma specialists at St. Louis Children’s Hospital, were coauthors on the study, published online March 2, 2010, by the New England Journal of Medicine and presented the same day at the American Academy of Allergy, Asthma and Immunology’s annual meeting in New Orleans.

Saturday 24, Apr 2010

  Risk of pneumonia can increase dramatically with inhaled corticosteroids

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Risk of pneumonia can increase dramatically with inhaled corticosteroidsA great sense of caution has been recommended by lung disease experts at John Hopkins when it comes to prescribing inhaled corticosteroid drugs to patients with chronic obstructive pulmonary disease (COPD).

This caution call was made after evidence was found suggesting that a widely used anti-inflammatory medication increases the risk of pneumonia by a full third.

It was remarked by the researchers that it is not clear why the corticosteroid treatment increases the risk but it is suspected that it is because corticosteroids suppress the immune system.

From Sciencedaily.com:

In breaking down the overall rise in risk, the researchers found that in people taking the highest possible dose of each inhaled corticosteroid, there was a 46 percent increase in risk for pneumonia. Infection risk nearly doubled in those who had less than 40 percent normal lung function, as opposed to those whose lungs were stronger.

Drummond says the absence of an overall difference in death rates between users and non-users of corticosteroids was likely due to the short-term follow-up of three years or less across all of the studies.

Fan says further research is needed to identify precisely which groups benefit long-term and which ones do not from inhaled corticosteroids, and to see if there is a link between higher risk and death.

He notes that COPD kills more than 120,000 Americans every year and is expected to become the nation’s third leading cause of death in the United States by 2020, ahead of stroke and behind heart disease and cancers.

Funding for this latest study was provided by The Johns Hopkins Hospital’s General Clinical Research Center.

Pulmonologist M. Brad Drummond, M.D., M.H.S., led the study and was supported by Eddy Fan, M.D.; other researchers involved in this study, conducted solely at Hopkins, were Elliott Dasenbrook, M.D., M.H.S.; Marshall Pitz, M.D., M.H.S., now at the University of Manitoba, in Winnipeg, Canada; and David Murphy, M.D.

Friday 16, Apr 2010

  Steroid injections helpful for slowing down diabetes-related complications

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Steroid injections helpful for slowing down diabetes-related complicationsAccording to findings reported in the December issue of Archives of Ophthalmology, one of the JAMA/Archives journals, injecting triamcinolone directly into the human eye has the ability to considerably slow down the progression of diabetic retinopathy.

Proliferative diabetic retinopathy is a condition in which new blood vessels are formed on the optic disc or another retina component.

From Sciencedaily.com:

Corticosteroids have been shown to interfere with the creation of new blood vessels, possibly by reducing the production of compounds that spur their growth, the authors note. However, steroids are also associated with other eye diseases.

“Use of this intravitreal [injected into the eye] corticosteroid preparation to reduce the likelihood of progression of retinopathy is not warranted at this time because of the increased risk of glaucoma and cataract associated with intravitreal steroid use,” the authors write. “Any treatment to be used routinely to prevent proliferative diabetic retinopathy likely needs to be relatively safe because the condition already can be treated successfully and safely with panretinal photocoagulation. Nevertheless, further investigation with regard to the role of pharmacotherapy for reduction of the incidence of progression of retinopathy appears to be warranted.”

This study was conducted by Neil M. Bressler, M.D., of Johns Hopkins University School of Medicine, Baltimore, and colleagues in the Diabetic Retinopathy Clinical Research Network and involved 840 eyes of 693 participants having macular edema.

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