The risk of stridor and reintubation in selected high-risk patients can be minimized to a considerable extent by administering steroids at least four hours before extubation, as per a recent report.

Dr. Samir Jaber from University of Montpellier I in France and colleagues conducted a quantitative meta-analysis of seven studies for identifying the effectiveness of prophylactic steroid therapy in inhibiting reintubation and post-extubation stridor. It is noteworthy to remember that this identification process took the at-risk populations and steroid administration regimen into account.

It was suggested during the study that the prophylactic steroid therapy is still controversial in both selected and non-selected patients when it comes to preventing post-extubation stridor and reintubation.

From Medscape.com:

Administration of steroids at least 4 hours before planned extubation significantly reduced the risk for reintubation, but not for stridor, the researchers note, and later administration of steroids did not decrease the risk for reintubation or stridor.

The investigators conclude: “The present meta-analysis suggests, first that the beneficial effect of steroids to prevent post-extubation stridor and reintubation were observed in the subgroup of patients with a high risk to develop post-extubation stridor, as identified by the cuff-leak test, and second that steroid treatment before a planned extubation decreases the risk of reintubation only if intravenous steroid administration was performed at least 4 hours before planned extubation.”

“The benefit of steroid remains unclear when patients are not selected,” they conclude.

It was indicated during the study that reintubation risk in trials enrolling high-risk patients was minimized with steroid treatment but the minimized risk was not well-defined when the conducted trials did not select patients for reintubation risk.

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Boys with Duchenne muscular dystrophy who were previously unable to walk on their own for long can now have a sigh of relief. According to a recent study, daily steroid treatment allows them to walk on their own and minimize the risk of scoliosis to a considerable extent.

The results were part of a study that was published in the May 8, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology.

From News-Medical.Net:

For the study, researchers reviewed records of 143 boys seen at the Ohio State University Muscular Dystrophy Clinic in Columbus. Of the group, 75 had been treated with corticosteroids for an average of eight years and the rest of the boys had never been treated or had received a brief dose of steroids.

The study found boys who were treated with daily steroids walked by themselves 3.3 years longer than the untreated boys and had a lower rate of scoliosis, 31 percent compared to 91 percent.

“Previous studies have shown steroids improve strength and function in Duchenne muscular dystrophy, but this is the first study to show the long-term impact and how treated boys are able to walk longer on their own,” said study author Wendy King, PT, with the Department of Neurology at Ohio State University Medical Center, and member of the American Academy of Neurology.

It was remarked that the benefits of steroids come at a cost of side effects and it is best to weigh the benefits and risk of steroid treatments before making any decision. The study is expected to bring smiles on the faces of patients and parents of these patients who have been long expecting a cure for this disorder.

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According to experts from Scotland, Bell’s Palsy that is a syndrome causing muscles on one side of the face to become paralyzed, is now curable by a new kind of steroid treatment. It is worth noting here that Bell’s Palsy tends to affect the facial nerve that is used by the humans to smile and close their eyes.

It was found by researchers at the Dundee University that treating this disorder with prednisolone at an early stage can cure some people in as fast as three months besides offering a 95 percent chance of complete recovery in a matter of nine months.

From News-Medical.Net:

The new study says that the relatively cheap steroid prednisolone was the “best treatment” and offered “significantly” better recovery rates than the anti-viral agent acyclovir, which they say “has little benefit”.

Professor Frank Sullivan, the director of the Scottish School of Primary Care at the university, and his team examined about 500 sufferers and he says the new treatment offers a significant improvement in how Bell’s Palsy is dealt with and will make a real difference to patients.

Professor Sullivan says the study gives clear-cut evidence that early treatment with steroids offers by far the best results for complete recovery.

The study was led by Dundee University, with support from other Scottish universities at Aberdeen, Edinburgh and Glasgow and GP services around the country.

The findings have been published in the New England Journal of Medicine.

It is believed that every one out of 60 people are affected by Bell’s Palsy at one point of their lifetime and this treatment option can open doors of new and improvised treatment option for this disorder.

It was also concluded during the study that relatively cheap steroid prednisolone was a far better option than the anti-viral agent acyclovir.

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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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According to a study published in an issue of Pediatrics, steroids possess the ability to considerably minimize damage to heart in children with Kawasaki’s disease.

The new finding addresses a knowledge gap as the present guidelines from the American Academy of Pediatrics state that concrete evidence for steroid treatment is still lacking and recommendations are been made for the standard treatment of Kawasaki’s via aspirin and intravenous immunoglobulin (IVIG).

From News-Medical.Net:

“This gap in knowledge led us to examine the benefits of steroids more closely. We looked at research worldwide and were surprised to find eight solid clinical trials showing the value of steroids in significantly reducing heart damage in children with Kawasaki’s disease. Steroids, when combined with aspirin and IVGB, reduced the odds of developing inflammation of the heart blood vessels by half,” said Stephen Aronoff, MD, lead author of the meta-analysis and Temple University School of Medicine professor and chair of pediatrics.

Aronoff was of the view that a presently underway multi-center study will be able to provide any further evidence of benefits of steroid treatment for Kawasaki’s disease, which is considered to be one of the leading causes of acquired heart disease in children inflaming the blood vessels leading to the heart.

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Scientists from the Imperial College, London have claimed that they are just one the verge of finding an amicable solution to one of the most common and fatal diseases in the UK - smokers lung - in relation to difficulties in treating it with a steroid treatment. In this regard, clinical trials of a potential therapy have already begun.

Chronic Obstructive Pulmonary Disease (COPD) – chronic bronchitis and emphysema, or ‘smoker’s lung’ - is responsible for affecting approximately 6 percent of UK’s population.

From News-Medical.Net:

Steroids would normally be effective at treating inflammatory diseases such as COPD. However, COPD patients do not respond to steroid therapy. This is a major clinical problem due to the prevalence of the disease and the fact that it gets progressively worse.

Inflammation is caused by cells producing certain chemical signals. They do this by ‘switching on’ specific genes. Switching these genes off – and stopping inflammation – requires an enzyme called Histone Deacetylase 2 (HDAC2).

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 and his colleagues found that steroids act a ‘molecular bridge’ in the recruitment of HDAC2 to the concerned genes where it can possibly act to switch them off. It was further found that low doses of theophylline can raise the levels of HDAC2 and break the resistance of steroids.

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According to a new study, children who take steroid drugs for nephrotic syndrome do not suffer bone loss, which is a common side-effect of steroid treatment methodologies in adults.

Childhood nephrotic syndrome, which is believed to affect 3 out of 100,000 children, is one of the most common chronic kidney ailments in children. Though it does not impair functions of kidney, it weakens the human body’s ability to remove salt and water from the blood to cause swelling in the legs, belly, and around the eyes.

From News-Medical.Net:

“Unlike other childhood diseases treated with steroid drugs, such as inflammatory bowel disease or juvenile rheumatoid arthritis, nephrotic syndrome resolves quickly when treated,” said pediatric nephrologist Mary B. Leonard, M.D., of The Children’s Hospital of Philadelphia, lead author of the study. “We specifically chose steroid-sensitive nephrotic syndrome because we are able to isolate the drug’s effects on bones, without having an underlying systemic disease simultaneously affecting the bones.”

The team led by Dr. Leonard compared 60 children and adolescents with steroid-sensitive nephrotic syndrome to 195 healthy children. Specialized X- ray measurements showed no signs of osteoporosis, a loss in bone mass, among the nephrotic syndrome patients. The study appeared in the August 26 New England Journal of Medicine.

The researchers made adjustments for body mass index, an important consideration, since 38 percent of the children in the nephrotic syndrome sample were obese (in contrast, only 16 percent of the control subjects were obese, a proportion consistent with the general pediatric population). The disproportionate obesity among children with nephrotic syndrome disappears after the patients discontinue steroid treatments.

“While steroids tend to make children shorter and heavier than healthy children, increased weight is associated with an increase in bone mass,” said co-author Babette Zemel, Ph.D., of the Nutrition Center at Children’s Hospital. Specifically, whole-body measurements of bone mineral content were higher in children with nephrotic syndrome than in healthy children.

Dr. Leonard said that the findings of this report can be used to assure parents and doctors about steroid treatments for helping children with nephrotic syndrome as steroids do not enhance their risk of osteoporosis.

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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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A new study of the University of Michigan’s Kresge Hearing Research Institute revealed that patients who are suffering from deafness due to an immune system attack can be treated with steroids.

Deafness caused by an immune system attack, which is also known as autoimmune sensorineural hearing loss or AISNHL, can be treated by diagnosing accurately with steroid treatment about the mysterious hearing loss and finding the next course of action for treatment of deafness.

As per Thomas Carey, Ph.D., senior author, professor and a distinguished research scientist at the U-M Medical School and department chair in the School of Dentistry, this study strongly suggested that accurate prediction can be given for who all we regain their hearing abilities with steroid treatment after a direct test for antibodies.

From News-Medical.Net:

Researchers at U-M have been studying IESCA for several years in animals and have found that it may be a main target of the immune system’s deafening attack on the inner ear.

IESCA is found in the supporting cells that help make up the organ of Corti, a tiny but crucial structure inside the cochlea, or inner ear.

It is here, inside the organ of Corti, that the ultra-sensitive hair cells are found.

Their movement in response to vibrations creates the nerve signals that are fed to the brain and interpreted as sounds and speech.

It has been seen that damage to the organ of Corti and hair cells, whether due to immune system attack, loud noise, trauma or medications, can diminish or destroy hearing.

By developing a monoclonal antibody, called KHRI-3, that attaches to IESCA in the inner ear, and can be detected in living animal systems and cell cultures, it has allowed the researchers to study IESCA’s role in hearing loss in animal models, and show that damage to the inner ear caused by antibodies to IESCA can destroy hearing.

The KHRI-3 antibody creates a staining pattern that resembles a line of tiny wine glasses when it binds to IESCA in the organs of Corti of guinea pigs.

The U-M has patent applications pending in the U.S. and overseas, but Carey says the development of a clinical test for patient antibody to IESCA will take time.

Carey commented that almost all of the patients who were a part of the study nearly improved with steroid treatment after being made to suffer sudden hearing loss due to an attack of the immune system.

The study was funded by the Deafness Research Foundation, the National Institutes of Health, the Ruth and Lynn Townsend Fund, a gift from the Holden Foundation, and the Autoimmune Sensorineural Hearing Loss Research Fund.

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According to a report, the risks of reintubation and stridor in selected high-risk patients can be reduced when steroids are administered to them at least four hours before extubation.

Dr. Samir Jaber from University of Montpellier I in France and colleagues conducted a quantitative meta-analysis of seven studies with an aim to identify the effectiveness of prophylactic steroid therapy for preventing reintubation and post-extubation stridor. This identification took into account the at-risk populations and the steroid administration regimen.

However, it was revealed that prophylactic steroid therapy with an aim to prevent post-extubation stridor and reintubation is still controversial in both selected and non-selected patients.

From Medscape.com:

Administration of steroids at least 4 hours before planned extubation significantly reduced the risk for reintubation, but not for stridor, the researchers note, and later administration of steroids did not decrease the risk for reintubation or stridor.

The investigators conclude: “The present meta-analysis suggests, first that the beneficial effect of steroids to prevent post-extubation stridor and reintubation were observed in the subgroup of patients with a high risk to develop post-extubation stridor, as identified by the cuff-leak test, and second that steroid treatment before a planned extubation decreases the risk of reintubation only if intravenous steroid administration was performed at least 4 hours before planned extubation.”

“The benefit of steroid remains unclear when patients are not selected,” they conclude.

The study indicated that the risk of reintubation in trials that enrolled high-risk patients got reduced with steroid treatment. But, the risk reduction was not completely well-defined when the conducted trials did not select patients for reintubation risk.

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