According to findings of a study in an issue of Pediatrics, preemies between 28-32 weeks of age are not harmed by a treatment option that is no longer used to help in maturing lungs. The concerned study revealed that babies’ brains remain virtually unaffected; a fact that overrules the previously believed fact that repeated courses of steroids in the womb may lead to brain damage.

From News-Medical.Net:

“The consensus in recent years has been to no longer give women in preterm labor more than one course of steroids because of possible adverse effects, but it means more babies are born needing ventilation,” said Sanjiv Amin, M.D., assistant professor of Pediatrics at the University of Rochester Medical Center and author of the study. “These findings may give us back a tool to help give these fragile babies a better chance of survival.”

Before concerns arose in 2000 about safety of multiple courses of steroids, many mothers in on-and-off preterm labor received several rounds before delivering. Now, when mothers go into preterm labor, obstetricians will often administer only a single course of steroids to help strengthen the baby’s lungs upon birth. But if the birth is successfully held off for more than seven days, the mother does not receive another course of medication and the baby’s lungs may not be protected.

It is important to note that many studies in the past have suggested that there are complications from multiple courses of dexamethasone, a steroid prepared with sulfur. This was the reason why doctors do not use dexamethasone anymore and have switched to sulfur-free steroids such as betamethasone.

It is believed that this study would provide new insights to further clinic studies in the same regard.

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Miguel Angel Hoyos, the 28-year-old Bolivian defender tested positive for the steroid dexamethasone after a World Cup qualifier in June.

Bolivian Football Federation spokesperson Javier Silva explained that the player was given the steroid dexamethasone after a head injury following a collision with Bolivia midfielder Ignacio Garcia. Hoyos later complained of dizziness and an urge to vomit.

Silva added that the South American Confederation (CSF) would decide whether Hoyos would be sanctioned or not.

This Wednesday, the matter was laid to rest as the South American confederation finally cleared Hoyos of doping.

Hoyos told reporters that he was confident that he did not take any drugs or substance to enhance his performance.

He hoped that the decision would provide clearance of his name, that the medication caused him to test positive in doping.

Two qualifiers for the FIFA World Cup remain next month. However, Bolivia lost all chances of reaching the 2010 World Cup Finals as they lost against Venezuela last June 6, 2009 with a score of 1-0.

The 2010 FIFA World Cup will be held in South Africa between June 11, 2010 and July 11, 2010. This will be the first time that the tournament will be hosted by an African nation.

From USA Today:

LA PAZ, Bolivia (AP) — Defender Miguel Angel Hoyos was cleared of a doping charge by the Bolivian Football Federation on Wednesday.

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If you are a diabetic and there is a need for you to undergo steroid therapy, your doctor should advise you on adjusting your diabetes therapy.

Steroids, particularly glucocorticoids can affect the glucose level in a person’s bloodstream. Glucocorticoids include hydrocortisone, prednisone, prednisolone, dexamethasone and betamethasone.

Since insulin is the only hormone that could overcome this effect, increase in insulin doses may be needed. The diabetic may also need to plan his meals or control his food intake since steroid can increase hunger.

Steroids can also make a non-diabetic increase their blood sugar levels. Steroids can make the liver produce sugar from substances such as proteins and fats. Steroids can also inhibit insulin release from the pancreas and its action in our body tissues.

The type of steroids and the form of administration can have various effects on sugar levels. Generally, inhaled and topical steroids have less effect on blood sugar levels compared to other types and routes of delivery.

Dosages also affect sugar levels. If steroids are given in low doses, it may have no effect on sugar levels, while moderate to higher doses can increase sugar levels significantly.

Fortunately, this effect is reversible. Once steroid therapy is stopped, blood sugar levels usually returns to normal.

From Caller:

CORPUS CHRISTI — The word steroids has become synonymous with sports and medicine. But these two associations could not be more different. The family of anabolic steroids abused by athletes is quite different than the family of glucocorticoid steroids that patients get.

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Actress Lisa Ray, who has worked in many Indian and Hollywood movies, has been diagnosed with cancer. She recently revealed in her blog (lisaraniray.wordpress.com) that she is learning to face this disturbing fact and is quite hopeful of beating the ailment.

She says, “I was diagnosed with Multiple Myeloma on June 23rd. Started my first cycle of treatment July 2nd. Not long ago.”

When asked about her steroids and life in the wetsuit, Lisa remarked that she feels her skin getting stretched and move in ways that she has not felt before.

From Lisaraniray.wordpress.com:

In the industry I’m in, you could say, its motive alone that gives character to your acting.

So today with Velcade, Revlimid and other promising new treatments in the pipeline our survival rates are improving. But only with an ever expanding toolbox of treatments and awareness can this Cancer be beat. So I’m going to do everything I can to wrench the spotlight onto Myeloma and Cancer Awareness.

I believe it can be cured.

That’s the Dirty Realist in me.

So back to the ‘Yellow’ Diaries. And more on ‘Yellow’ and charging your yellow later…

On Steroids: you are HUNGRY ALL THE TIME.

When Dr. Ahmed Galal, my Warrior-Hematologist at Princess Margaret Hospital gave me my first cycle of meds, he capped his recommendation off with a charming gesture that meant: Beware of sweets.

Well. Sweet things aren’t the only temptation.

Every cycle of treatment, I’m on Dexamethasone for four days on, then four days off.

All her fans have been seen praying to the almighty for an early recovery for this actress of substance.

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The combination of lenalidomide and dexamethasone is effectual against multiple myeloma: this was a fact that was revealed after a study involving 353 patients with myeloma was conducted at 44 centers in the United States and Canada.

The study also found out that pairing a new thalidomide derivative with a steroid can considerably slowdown any further progression of multiple myeloma, which is an incurable bone marrow cancer. It was also revealed that this combination may also prove its worth to prolong lives of patients who have relapsed from previous treatments.

From News-Medical.Net:

“These trials highlight how large-scale cooperation in a team effort by myeloma investigators can quickly confirm benefits and introduce new active agents for patients with this disease,” Weber says. “We also owe a debt to the willing patients who participated in this study.”

Multiple myeloma is caused by formation of abnormal plasma cells, a type of white blood cell, in the bone marrow. These cells multiply rapidly, crowding out normal red and white blood cells and platelets. Tumors starting in the bone marrow may cause pain, and weaken bones predisposing them to fracture. In the United States about 20,000 people are diagnosed with multiple myeloma annually, and about 11,000 succumb to the disease each year.

Thalidomide, a breakthrough drug for multiple myeloma, is produced and marketed by Celgene Corporation as Thalomid(r). The company chemically altered thalidomide to make lenalidomide, known commercially as Revlimid(r), in hopes of reducing side effects and improving efficacy against the disease. The drugs attack both the malignant cells and the cellular environment that nurtures them.

It was remarked by lead author Donna Weber, M.D., Associate Professor in the Department of Lymphoma and Myeloma at The University of Texas M. D. Anderson Cancer Center that a combination of medical drugs may prove to be beneficial in ongoing treatment as a disease may become resistant to one drug.

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According to a team headed by Dana-Farber Cancer Institute investigators reported at the annual meeting of the American Society of Hematology, a new combo of Velcade with dexamethasone and lenalidomide can prove to be effective for patients who have been recently diagnosed with multiple myeloma.

The combination of these three drugs is effective for treating multiple myeloma patients who have relapsed after failing to respond to standard treatment therapies or after successful treatment.

From News-Medical.Net:

The three-pronged regimen of Velcade, lenalidomide (Revlimid) and dexamethasone – referred to as Rev/Vel/Dex – has achieved an overall response rate of 98 percent in 42 patients evaluated thus far in a Phase 1-2 trial, said Paul Richardson, MD, of Dana-Farber and the study’s principal investigator. He added that 52 percent of the patients had high quality responses (very good partial response or better), with 30 percent achieving complete response to date.

“These may be some of the best response rates we’ve seen to date with up-front therapies, and although these are preliminary results, they are extremely promising,” Richardson said. The patients were previously untreated when they received the Rev/Vel/Dex combination.

Velcade is a “smart” drug known as a proteasome inhibitor that blocks the myeloma cells’ waste disposal system, creating an accumulation of toxic compounds that poison the cell. Revlimid is a chemical relative of thalidomide that affects several pathways in cancer cells, including immune mechanisms and blood vessel growth to tumors. Dexamethasone is a steroid hormone that counters inflammation and is used to treat hematologic malignancies such as myeloma. Studies leading to the trial of the three drugs in combination were carried out at Dana-Farber.

The findings are expected to offer much-awaited relief to patients with multiple myeloma, who have been expecting an effective treatment methodology for the last many years.

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Thalomid, which is also known as thalidomide, has been halted by drug company Celgene earlier than expected after the drug was shown to limit the progression of the blood cancer multiple myeloma.

It was revealed during the phase 3 trial of 270 patients that thalomid offers great benefits to patients who are suffering from blood cancer. These results prompted the decision that the trial patients not on this drug should also be given an opportunity to add thalomid to their treatment regimen.

From News-Medical.Net:

According to Celgene spokesman Brian Gill, Thalomid is currently the most widely prescribed drug for multiple myeloma.

It seems that while companies are not allowed to actively promote a drug for a condition for which it is not approved by regulators, doctors are allowed to prescribe it “off-label” for any disease.

Celgene is now chasing formal U.S. Food and Drug Administration approval for Thalomid to be used in multiple myeloma.

The FDA has however asked for updated safety information before allowing the drug to be marketed for treating newly diagnosed multiple myeloma.

Some of the side effects seen in the trial included insomnia, tremors and dizziness, and more than 10 percent of the Thalomid patients suffered deep vein thrombosis, compared with 1.7 percent of patients treated only with dexamethasone.

Pulmonary embolism occurred in 5.6 percent of Thalomid patients, compared with 1.7 percent of patients treated with dexamethasone alone.

Gill says the company is planning a wider commercial launch next year of both Thalomid and a successor drug, Revlimid, which was approved by the FDA in December for treating a group of blood disorders known as myelodysplastic syndromes.

Celgene has also recently sought approval from the FDA for Revlimid for the treatment of last-stage multiple myeloma.

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Children who were given the steroid dexamethasone after a tonsillectomy had less nausea and vomiting, but they also faced an increased risk of bleeding. According to a study, children will commonly feel postoperative nausea and vomiting in addition to pain and bleeding after the procedure. Despite clear information on dosing and side effects, researchers reported that dexamethasone is a standard practice at many institutions. Researchers believe that the increased bleeding with dexamethasone is due to impairment of wound healing.

Non-steroidal anti-inflammatory drugs have been used for pain relief but they also increase the risk of bleeding.

From Bio-Medicine:

“The clinical implication is that children undergoing [tonsillectomy] should not receive dexamethasone prophylactically unless an adequately designed, valid study has shown that our findings can be refuted,” said Dr. Martin R. Tramer, head of anesthesiology at Geneva University Hospitals in Switzerland.

Those taking the highest dose of dexamethasone had about seven times the risk of bleeding, the researchers reported.

In this trial, 215 children having elective tonsillectomies at a major teaching hospital in Switzerland were randomized to receive 0.05 milligrams per kilogram of dexamethasone, 0.15 mg/kg, 0.5 mg/kg, or a placebo.

But 4 percent of children in the placebo group and in the 0.15 mg/kg dexamethasone group experienced postoperative bleeding, compared to 11 percent of those taking the lowest dose of dexamethasone and 24 percent of those taking the highest dose.

One puzzling aspect of the findings is that the lower and higher doses of dexamethasone had higher levels of bleeding than the middle dose.

Bleeding is of particular concern after tonsillectomies because the wound is not sewn up or covered and is exposed to food, air and saliva. A large blood supply courses through the area and, if hemorrhaging occur, manual compression is next to impossible. That means surgery becomes the only option.

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Steroids help to reduce inflammation, but University of Illinois scientists suggest they also could be used to reverse a loss of myelin – a major problem in multiple sclerosis and other demyelinating diseases and injuries associated with the central and peripheral nervous systems.

Treatment of MS already includes the use of steroids, because they relieve inflammation and speed remission. However, new findings indicate that the steroids dexamethasone and progesterone actually signal the initiation and dramatically increase the rate of myelin synthesis.

From Bio-Medicine:

“I think this work is very important in that it helps clarify the signals that are responsible for the synthesis of myelin,” said Jonah R. Chan, a doctoral student in the department of biochemistry and neuroscience program at the University of Illinois.

Myelin is a white substance made of fat and proteins that form in a protective spiral sheath around the axon of nerve fibers. The sheath is a vital component of the body’s efficient and rapid nerve-communication system.

“Steroids seem to be very important in regulating the initiation and synthesis,” said Michael Glaser, professor of biochemistry and lead investigator of the project. “They had been implicated as having a role in the overall process, but not for enhancing the actual synthesis. It is our hope that this line of work will lead to a line of treatment for nerve injuries and demyelinating diseases.”

Their findings provided the first live look at the signals initiating myelin formation in live cells, Glaser said.

What causes a loss of myelin – demyelination – in MS cases is not known, but is believed to be the result of an abnormal immune response to bacteria and viruses. When myelin fails to form, it jeopardizes nerve communications leading to altered sensations and other complications. Demyelination is a focal point of research around the world.

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During the 50th Annual Meeting of the American Society of Hematology in San Francisco, CA, four studies pertaining to treatment and survival results for individuals with varying forms of thrombocytopenia were presented.

The studies reported on the latest combination therapy for previously incurable idiopathic thrombocytopenic purpura (ITP), an investigational oral treatment for chronic ITP, a new therapeutic platelet transfusion medical approach after chemotherapy & autologous stem cell transplantation, and a low-dose platelet transfusion strategy for patients suffering from hypoproliferative thrombocytopenia.

From News-Medical.Net:

The studies featured in the press conference will report on a new combination therapy for previously untreated idiopathic thrombocytopenic purpura (ITP), an investigational oral treatment for chronic ITP, a low-dose platelet transfusion strategy for patients with hypoproliferative thrombocytopenia, and a new therapeutic platelet transfusion approach following high-dose chemotherapy and autologous stem cell transplantation.

“We have some very exciting data on novel therapeutic approaches to minimize bleeding episodes in patients with platelet disorders,” said press conference moderator Kenneth Kaushansky, MD, 2008 President of the American Society of Hematology and Helen M. Ranney Professor and Chair of the Department of Medicine at the University of California, San Diego School of Medicine. “The results of these studies will likely transform the way hematologists treat and manage these conditions, ultimately resulting in improvements in overall patient outcomes such as reducing bruising and unnecessary bleeding that can result if left untreated.”

It was revealed during the study that adding rituximab (an immunotherapy drug) to dexamethasone (a steroid) is highly effective in the treatment of idiopathic thrombocytopenic purpura (ITP).

It was remarked by press conference moderator Kenneth Kaushansky, MD, 2008 President of the American Society of Hematology and Helen M. Ranney Professor and Chair of the Department of Medicine at the University of California, San Diego School of Medicine that there has been a collection of effective data to reduce bleeding episodes in patients suffering from platelet disorders.

These studies are expected to transform the treatment methodologies of hematologists in an aim to bring great improvements in overall patient outcomes.

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