Adam Vasser of Los Altos, California, was an active kid with a flair for baseball until one day when his heart was attacked by a mysterious virus requiring a need for a heart transplant. He underwent steroid treatment in the long term for preventing rejection of transplant leaving him to lead his life with osteonecrosis, an excruciating knee disorder.

Now at 23 and undergoing 15 knee and heart surgeries, he is back to play baseball again, all due to a new technique known as cellular grafting.

From News-Medical.Net:

The new surgical technique involves transplanting cellular material from the pelvic area into the knee. Two years after surgery, Goodman said, all three patients had returned to nearly normal activity and knee function with no complications.

“It’s a fairly simple procedure,” said Goodman, the Robert L. and Mary Ellenburg Professor in Surgery at the Stanford University School of Medicine.

Osteonecrosis of the knee is a rare disorder. When it occurs in young people, it’s most often the result of steroid therapy and is called secondary osteonecrosis. The bones in the knee start to die from a loss of blood supply, leading to severe pain, progressive arthritis and eventually the need for artificial joint replacement.

“Many patients do OK without surgical treatment,” Goodman said. “With those patients, I wait and prescribe pain medication.” But for young patients who still have a lifetime of activity ahead of them, Goodman wanted alternatives.

The 60-minute surgery, known as osteoprogenitor cellular grafting, involved scooping out the dead bone and thereafter filing the space in with a new cellular matter. It was theorized by Goodman that use of bone cells is better than using traditional bone grafting for these kinds of cases. A longer-term follow-up study with a larger number of patients was recommended by Goodman, an orthopedic surgeon Stuart Goodman, MD, PhD.

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According to new results from a comprehensive childhood asthma study, asthmatic children who benefited from steroid drugs are unable to experience the same results after discontinuing the usage.

The findings of this study came from the Childhood Asthma Management Program (CAMP) clinical trial in which more than 1,000 children were treated for mild-to-moderate asthma. Children were divided into three groups in which one group received twice-daily budesonide and an inhaled corticosteroid medication, the second group received a placebo and the third group received nedocromil (an inhaled non-steroid medication). All the three groups also received albuterol, a bronchodilator, and oral corticosteroids for treating asthma symptoms.

From News-Medical.Net:

Inhaled corticosteroids such as budesonide have been shown to be the most effective form of anti-inflammatory treatment for asthma by controlling symptoms and improving pulmonary function. Results from the original CAMP trial showed that using budesonide twice daily led to fewer hospitalizations and urgent care visits, fewer days in which additional asthma medications were needed and a reduced need for albuterol, a fast-acting drug for relief of acute asthma symptoms. Using nedocromil twice daily reduced urgent care visits and courses of oral steroids for severe symptoms, but did not affect the number of hospitalizations, symptoms or airway responsiveness.

Although the patients had fewer symptoms five years after stopping the daily medication, Strunk cautions that doesn’t mean that they can stop using asthma medications altogether or that their asthma is cured.

In another part of the follow-up study, the involved researchers had a close look at the long-term side effects of the steroid therapy on bone density, fracture rate, and growth.

The study is expected to provide deep insights to the medical fraternity to formulate new plans for treating asthma, which is considered to affect more than 150,000 people in the United States alone.

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Pneumonia patients can recover faster when steroids are administered in conjunction with antibiotics when compared against those recovering with antibiotics alone, according to a study by scientists from the UT Southwestern Medical Center.

The study suggested that use of steroids with antibiotics can prove to be a very effective option when it comes to treating inflammation in the lungs of a pneumonia patient. This study was headed by Dr. Robert Hardy, Study’s Senior Author & Associate Professor of Internal Medicine and Pediatrics.

From News-medical.net:

Adding corticosteroids to traditional antimicrobial therapy might help people with pneumonia recover more quickly than with antibiotics alone, UT Southwestern Medical Center scientists have found.

Unlike the anabolic steroids used to bulk up muscle, corticosteroids are often used to treat inflammation related to infectious diseases, such as bacterial meningitis. Used against other infectious diseases, however, steroid therapy has been shown to be ineffective or even harmful.

In a study available online and in a future issue of the Journal of Infectious Diseases, researchers at UT Southwestern show that mice infected with a type of severe bacterial pneumonia and subsequently treated with steroids and antibiotics recovered faster and had far less inflammation in their lungs than mice treated with antibiotics alone.

It was also remarked during the study that a combination of steroids and antibiotics is one of the best available therapy options for patients during asthma (M pneumoniae infection) attack. Researchers also said that while antibiotics are good options for killing the bug, steroids are good for treating inflammation in the lungs.

The findings of this study were supported by the National Institutes of Health.

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According to a research conducted at the National Jewish Medical and Research Center, black teenagers with asthma are three times more resistant to steroids than their white counterparts.

Joseph Spahn, M.D., a pediatric allergist and director of the Immunopharmacology Lab at National Jewish, said that studies have revealed that African-American children are more prone to be resistant to asthma steroid therapy than white children.

The study suggested that inhaled steroids can be one of the best and most effective ways when it comes to controlling asthma in an effective manner.

From News.Bio-Medicine.Org:

“Our results suggest that children with steroid-resistant asthma are more likely to be African-American, to have required treatment with oral steroids at an earlier age and to require larger amounts of oral steroids for only marginal control of their asthma,” said Joseph Spahn, M.D., a pediatric allergist and director of the Immunopharmacology Lab at National Jewish.

Other recent epidemiological studies have shown that blacks with asthma are sicker and have a higher mortality rate than whites with asthma. Doctors at National Jewish now are trying to determine whether blacks have a more vigorous immune response to airway inflammation–which means that higher doses of steroids must be used to control inflammation–or a poor response to steroids secondary to a genetic resistance to the drugs.

“The theory is that with ongoing airway inflammation you get worsening asthma and diminished steroid sensitivity,” Dr. Spahn said.

This study of 164 teen-agers treated at National Jewish also showed that 25 percent of the group was steroid resistant. Children with less than a 15 percent improvement in lung function following a “burst” of inhaled steroids–high doses over seven days–were considered steroid resistant.

“Twenty-five percent of the kids admitted to National Jewish have steroid-resistant asthma, which is much greater than anyone thought,” Dr. Spahn said.

Further studies are under pipeline to determine whether or not black teens even have a more vigorous immune response to airway inflammation.

The study was published in the Journal of Allergy and Clinical Immunology.

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According to pediatric oncologists at Brenner Children’s Hospital, part of Wake Forest University Baptist Medical Center, children who are exposed to chicken pox and have been treated with steroids have a more severe case of the virus.

As per the study, children who are undergoing steroid treatments for ailments like childhood leukemia are at a greater risk of contracting a more severe form of chicken pox, which can eventually lead to death.

From News-Medical.Net:

Steroids are a common and highly successful treatment for many childhood cancers, McLean said.

“We just need to make sure we don’t mix the two,” he added. “Steroids and the chicken pox virus don’t go together. They are a bad combination.”

Chicken pox is usually mild, but it can be serious and even life threatening. In 1995, a chickenpox vaccine was developed to help prevent the spread of the virus. Prior to the widespread use of the varicella vaccine, approximately 12,000 people were hospitalized for chicken pox each year in the United States and 100 died as a result of the disease, according to the Centers for Disease Control and Prevention.

“Since the introduction of the vaccine, the incidence of varicella has decreased steadily. We hope one day to eradicate the disease all together,” McLean said. “I strongly encourage any parent whose child has not had chicken pox to get that child vaccinated.”

Thomas McLean, a pediatric oncologist at Brenner Children’s Hospital, remarked that children are tested for chicken pox before steroid treatment can be prescribed for them. In cases where chicken pox is seen, McLean recommends waiting till the incubation period has passed before giving the go-ahead for steroid therapy.

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According to a new study by researchers at UC, the use of modern immunosuppressive drugs can eliminate the need for a steroid therapy as early as a week after a transplant surgery without an impact on maintenance of kidney function.

It was remarked by Steve Woodle, MD, Chief of UC’s transplant surgery division, principal investigator and designer of the study, that chronic health conditions that are common to kidney transplant recipients can be reduced through elimination of a daily dose of steroids.

From Sciencedaily.com:

“Steroids have long been the primary source of morbidity and complications following successful kidney transplantation,” Woodle says. “This study demonstrates that elimination of even small, daily prednisone (pred-ne-zone) doses does not compromise results while minimizing weight gain, diabetes and bone complications.”

Corticosteroids were the first anti-rejection drug used in transplant patients, dating back to the first transplant surgeries over 50 years ago.

Traditionally patients who have undergone organ transplantation have required life-long steroid treatments given in combination with other drugs that help suppress the body’s immune system and allow the transplanted organ to function properly.

However, the steroid treatment—given as the oral drug, prednisone—can cause serious side effects including cardiovascular disease, high cholesterol and blood pressure, weight gain, diabetes, bone weakness and cataracts.

Woodle said that the risk of rejection episodes in patients was marginally increased with an early steroid discontinuation process. He hopes that even this minor risk of increased rejection combined with long-term gains would not change much with development of new drugs and modern anti-rejection drugs.

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Scientists from the Imperial College, London have found the reason why lungs of smokers are resistant to steroid treatment along with finding a solution to this resistance.

Chronic Obstructive Pulmonary Disease (COPD) - ‘smoker’s lung’, or chronic bronchitis and emphysema - presently affects 6 percent population of the United Kingdom and is considered to be the fourth most common death cause in the land of the Queen.

It is seen that steroids are normally very effective in the treatment of inflammatory ailments such as COPD but some COPD patients do not respond as per expectations to steroid therapy.

From News-Medical.Net:

Professor Peter Barnes and his colleagues discovered that steroids act as a ‘molecular bridge’ to recruit HDAC2 to the appropriate genes where it can act to switch them off.

The London researchers found that in COPD, levels of HDAC2 are very low compared to normal cells, so that the steroids have no effect in switching off the activated inflammatory genes.

They then found that in lung cells in vitro, and in rats, low doses of a cheap and widely available drug raised the levels of HDAC2 and broke the steroid resistance.

The first stages of clinical trials to test low doses of this drug, theophylline, in COPD patients are now underway. If successful, this may lead to a change in the treatment of COPD and other severe inflammatory diseases that do not respond well to steroid therapy.

Professor Peter Barnes commented, ‘COPD kills tens of thousands of people in the UK every year and currently we can only treat the symptoms, not the underlying problem of inflammation of the lungs. Our work has finally provided an explanation for steroid resistance in COPD, and has allowed us to identify ways to combat this.

Professor Peter Barnes and his colleagues found out that steroid are effective in playing an active role for acting as a molecular bridge in the recruitment of Histone Deacetylase 2 (HDAC2), an enzyme, to the relevant genes where it can switch them off.

They also discovered that levels of HDAC2 were very low compared to normal cells in the COPD patients. This means that the steroids are no longer potent enough to have any effect in switching off the activated inflammatory genes. In this direction, a new steroid has been found that can raise the levels of HDAC2 and break the resistance of steroids.

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As per a research conducted at the National Jewish Medical and Research Center, black teenagers are three times more likely than their white counterparts to have steroid-resistant asthma.

Joseph Spahn, M.D., a pediatric allergist and director of the Immunopharmacology Lab at National Jewish, remarked that research revealed that the African-American Children were more likely to be resistant to steroid therapy for treating asthma than their white counterparts.

As per other recent epidemiological studies, black teens with asthma are found to be sicker and have a higher mortality rate than white teens with asthma.

The study suggested that inhaled steroids can be one of the best and most effective ways to control asthma.

From News.Bio-Medicine.Org:

“Our results suggest that children with steroid-resistant asthma are more likely to be African-American, to have required treatment with oral steroids at an earlier age and to require larger amounts of oral steroids for only marginal control of their asthma,” said Joseph Spahn, M.D., a pediatric allergist and director of the Immunopharmacology Lab at National Jewish.

Other recent epidemiological studies have shown that blacks with asthma are sicker and have a higher mortality rate than whites with asthma. Doctors at National Jewish now are trying to determine whether blacks have a more vigorous immune response to airway inflammation–which means that higher doses of steroids must be used to control inflammation–or a poor response to steroids secondary to a genetic resistance to the drugs.

“The theory is that with ongoing airway inflammation you get worsening asthma and diminished steroid sensitivity,” Dr. Spahn said.

This study of 164 teen-agers treated at National Jewish also showed that 25 percent of the group was steroid resistant. Children with less than a 15 percent improvement in lung function following a “burst” of inhaled steroids–high doses over seven days–were considered steroid resistant.

“Twenty-five percent of the kids admitted to National Jewish have steroid-resistant asthma, which is much greater than anyone thought,” Dr. Spahn said.

Further Studies are being conducted to determine whether or not the black teens have a more vigorous immune response to airway inflammation.

It is estimated that only 1/10th of a percent of the 15 million asthma patients in the United States are resistant to steroids while there are approximately 5 million children fighting against asthma in the United States.

The study was published in the Journal of Allergy and Clinical Immunology. It is the first one to examine steroid-resistant asthma in children.

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Lead author Andrew Jones, MD, of the department of intensive care, Guy’s and St. Thomas’ Hospital, London, United Kingdom, in a recent interview, said that relying solely on ACTH (Adrenocorticotropic Hormone) may eliminate some patients who could have benefited from steroids.

At the 33rd Critical Care Congress, it was revealed that the measurement of baseline cortisol seems to be a critical factor in the identification of sepsis patients who may have gained some benefits from steroid therapy.

From Docguide.com:

Dr. Jones and colleagues analyzed medical records of 97 patients who underwent ACTH stimulation followed by hydrocortisone treatment during an 8-month period. Hydrocortisone was infused at 200 mg/24 hours.

The investigators identified the patients’ ACTH non-responder (NR)/responder (R) status as well as vasopressor status on initiation of steroids and at 24 and 48 hours.

Considering only response to ACTH stimulation, significant reductions in vasopressor dose was seen in both NR and R groups at 24 (NR: P < .01; R: P = .01) and 48 hours (NR: P < .01; R: P < .01) after the introduction of hydrocortisone. There were no differences in vasopressor levels between the groups at any time.

However, when baseline cortisol level was considered (< or > 25 mcg/dL), again significant reductions in vasopressor levels were seen in both groups, he said.

Moreover, at 24 and 48 hours after the initiation of hydrocortisone, noradrenaline levels were lower in subjects whose baseline cortisol was < 25 mcg/dL (P = .02; P = .01).

These findings have given strength to claims of many researchers that steroid therapy can be helpful in treating sepsis patients over a period of time. They have been welcomed by the medical world, all over the world and seem to infuse a new ray of hope in patients suffering from sepsis.

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According to a study by the UT Southwestern Medical Center Scientists, steroids can aid recovery for a pneumonia patient in a quicker manner than with antibiotics alone.

It was also revealed in the study that body health of a pneumonia patient can be restored in an effective manner when steroids are used with antibiotics as against usage of antibiotics alone. It was remarked that while antibiotics are used for killing the bug, steroids can be used in conjunction with them to treat inflammation in the lungs. The findings clearly suggested that individuals with pneumonia are expected to be in a better state of health when they take antibiotics with steroids.

The findings also suggested that usage of antibiotics in a combination with steroids can be used as an effective therapy for a patient in the midst of an asthma attack (M pneumoniae infection).

From News-medical.net:

Adding corticosteroids to traditional antimicrobial therapy might help people with pneumonia recover more quickly than with antibiotics alone, UT Southwestern Medical Center scientists have found.

Unlike the anabolic steroids used to bulk up muscle, corticosteroids are often used to treat inflammation related to infectious diseases, such as bacterial meningitis. Used against other infectious diseases, however, steroid therapy has been shown to be ineffective or even harmful.

In a study available online and in a future issue of the Journal of Infectious Diseases, researchers at UT Southwestern show that mice infected with a type of severe bacterial pneumonia and subsequently treated with steroids and antibiotics recovered faster and had far less inflammation in their lungs than mice treated with antibiotics alone.

This study that was headed by Dr. Robert Hardy, Study’s Senior Author & Associate Professor of Internal Medicine and Pediatrics, indicated possibilities that clinic trials would soon be taking place to confirm these findings. The National Institutes of Health supported findings of this study.

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