“This is probably the most controversial topic in acute lung injury and ARDS,” Dr. Pastores of the department of anesthesiology and critical care medicine at Memorial Sloan-Kettering Cancer Center, New York, said at the annual meeting of the American College of Chest Physicians.

From Familypracticenews.com:

He went on to note that physicians should give steroids in conjunction with infection surveillance, “avoiding neuromuscular blockers if you can, and being concerned about the phenomenon of rebound inflammation if you stop steroids abruptly.”

Inhaled nitric oxide has also been studied as a nonventilatory strategy in ALI/ARDS. A Cochrane review of 13 randomized, controlled trials involving 1,303 patients found no significant effect with this approach in overall mortality, but did show a transient improvement in oxygenation in the first 24 hours. The review also found that inhaled nitric oxide had no significant effect on duration of ventilation, ventilator-free days, and ICU and hospital length of stay. An increased risk of renal impairment among adults was also noted (Cochrane Database Syst. Rev. 2010 Oct. 23 [doi:10.1002/14651858.CD002787.pub2]).

“An important piece of this study was that [the researchers] did regular infection surveillance with regular bronchoscopies, and they avoided the use of neuromuscular blockers,” said Dr. Pastores, who is also professor of medicine and anesthesiology at Cornell University in New York.

“A larger study examining only severe corneal ulcers is needed to confirm this supposition,” Nisha R. Acharya, MD, of the University of California San Francisco, and co-authors wrote. “To our knowledge, this is the first large randomized controlled trial to provide evidence regarding the safety and efficacy of the use of corticosteroids in the treatment of bacterial corneal ulcers.”

From Medpagetoday.com:

Use of topical steroids to treat corneal ulcers has remained controversial for decades, owing to a lack of data to provide a definitive answer. The clinical rationale lies in steroids‘ potential to reduce immune-mediated damage and in evidence of efficacy in some systemic bacterial infections.

In an effort to resolve the uncertainty, investigators in the U.S. and India conducted the Steroids for Corneal Ulcers Trial (SCUT). They enrolled 500 patients, primarily from India, with culture-positive bacterial corneal ulcers, who had been using topical moxifloxacin for 48 hours.

Patients were randomized to 1% prednisolone phosphate or placebo in addition to moxifloxacin. They were followed for three months.

The primary endpoint was best spectacle-corrected visual acuity at the end of the study. Secondary outcomes included adverse events; infiltrate/scar size; rigid contact lens-corrected visual acuity at three weeks, three months, and 12 months; time to resolution of epithelial defect; and best spectacle-corrected visual acuity at three weeks and 12 months.

The study was supported by the National Eye Institute and Alcon/Novartis provided the moxifloxacin used in the study.

The finding was presented by a research presented at the American Society for Bone and Mineral Research (ASBMR) 2011 Annual Meeting.

From Medscape.com:

Corticosteroids are known to be toxic to osteoblasts, and the drugs are typically given in exceptionally high doses after kidney transplants, potentially causing substantial bone loss, said coauthor Thomas L. Nickolas, MD, from Columbia University Medical School in New York City.

“Kidney transplant patients typically initially get very high intravenous doses of corticosteroids that are tapered down to a high oral dose, then to a small oral dose, by 6 months, but it is in that first 6 months after transplantation when the majority of bone loss occurs,” he explained.

Studies show that the bone loss at the lumbar spine and the hip during that initial 6 months posttransplantation can range from 2% to as much as 10%, he said.

The study was supported by the Doris Duke Charitable Foundation.

“There may be several reasons for our findings; It is possible that some children are genetically less responsive to steroids,” says researcher Gregory Sawicki, M.D. of Children’s Hospital in Boston.

From Sciencedaily.com:

Several studies of adults with asthma have suggested that even rigorous use of inhaled steroids doesn’t lead to well controlled asthma in all adults, Dr. Sawicki noted. “But this issue hasn’t been looked at closely in children,” he said. “Further studies are needed to see what is different about children who don’t respond to steroids, to see if there is a way to predict whether a child will respond to inhaled steroids.”

Of the 914 children in the study, inhaled steroids were recommended for 435 who had persistent asthma, meaning they had symptoms on a regular basis. Among children who weren’t recommended for inhaled steroid treatment, most reported well-controlled asthma. Among those recommended for inhaled steroid treatment, 44% reported consistently using the medicine; 35% said they intermittently used the medicine and 21% said they didn’t use it at all.

“The majority of children with mild asthma are less likely to have symptoms as they get older and may not need to be on daily steroids,” Dr. Sawicki said. “The flip side is that if a child has poor asthma control, the parents and doctor need to make sure the child is adhering to their inhaled steroid treatment. But variation in response to inhaled steroids, as other medications, is well described.”

“In addition to issues of medication adherence and inability to completely control for differences in underlying asthma, severity can never be completely ruled out,” Sawicki said.

Testosterone enanthate helps sportsmen by improving the levels of intense muscle growth, muscle mass, stamina, and performance besides promoting maximum fat loss and increased recovery from intense strength training.

Commonly administered via intramuscular or subcutaneous injections, testosterone enanthate is used for a period of 6-8 weeks and has an active life of 14-15 days. This steroid has an anabolic/androgenic ratio of 100:100 and can be detected over 2-3 months.

The recommended dose of testosterone enanthate for men is 300-2000 mg per week; women are not advised to make use of this testosterone derivative. In order to reap optimum benefits during a steroid cycle, testosterone enanthate can be stacked with Anavar, Clenbuterol, Dianabol, Deca Durabolin, Primobolan, and Equipoise. The drug is not meant to be used by individuals allergic to any ingredient in Testosterone Enanthate or suffering from prostate or breast cancer; its use is also not recommended for pregnant or breast-feeding women. It should not be used in a combination with carbamazepine, corticosteroids (eg, prednisone), macrolide immunosuppressants (eg, tacrolimus), or oxyphenbutazone.

Lupus

The biological rationale as to why large doses of corticosteroids (steroids) administered over several weeks can be of great help to lupus patients was revealed by researchers at the UT Southwestern Medical Center.

From News-Medical.Net:

Unlike the anabolic steroids athletes sometimes use illegally to bulk up muscle, corticosteroids are routinely used to treat inflammation in lupus patients. The drugs, however, can cause undesirable side effects including weight gain and acne when taken over long periods of time.

In a study published in a recent issue of Nature, researchers at UT Southwestern and other institutions show in blood cells that giving very high doses of intravenous corticosteroids early and frequently in the course of the disease is more effective at killing the cells that drive lupus than giving the standard limited intravenous steroids followed by high doses of oral corticosteroids over a period of months. The cells used came from lupus patients as well as from animal models of lupus.

Dr. Marilynn Punaro, professor of pediatrics at UT Southwestern and co-author of the study, remarked that administration of high doses of steroids in the preliminary stages and on a regular basis could greatly help in high steroid doses at a later point of time.

It is was disclosed by the study that administration of steroids could be effective for reducing the use of inhalers besides revealing that such benefits can hold good for a period of three weeks.

From News-Medical.Net:

This updated finding was drawn after reviewing data in six trials that together involved 374 people.

Between 12% and 16% of people who are discharged from hospital after having an asthma attack have a relapse within two weeks. “There is considerable debate about the best way of treating people who have asthma attacks, including the dose, method of delivery and timing of delivery of corticosteroids. Our research found clear evidence that people who arrived at a hospital with acute asthma and were well enough to be discharged benefited from the addition of corticosteroid therapy,” says lead author Professor Brian Rowe, who works at the University of Alberta, in Edmonton, Canada.

Carol Spooner, the review colleague, said that the use of systematic corticosteroids for treating outpatients after getting discharged from the hospital after asthma attack is strongly endorsed by the systematic review.

The drug is presently used for easing down drug and alcohol abuse symptoms and can prove to be an effective drug for Crohn’s disease, as per a Pilot study by Penn State College of Medicine.

From News-Medical.Net:

Typical treatment for Crohn’s involves using steroids or corticosteroids, which suppress the immune system and can have other toxic side effects. Treatment is often time-intensive and expensive, as well.

“This is a novel approach to treating a common disease, and it’s simple, it’s safe, and it costs far less than current standards of treatment,” Smith said. “We don’t yet know the exact mechanisms involved in how it works, but we’re working on that as well.”

Smith initiated the study using a Dean’s Feasibility Grant — a program designed to encourage investigators to design trials in their area of expertise and seek outside funding. The National Institutes of Health (NIH) recently awarded the College of Medicine $500,000 for the team to continue the study.

Jill P. Smith, a gastroenterology specialist and researcher at the College of Medicine and Penn State Milton S. Hershey Medical Center in Los Angeles at the National Association of Gastroenterologists annual Digestive Diseases Week conference, presented the findings.

A combination of steroids and antibiotics could be one of the best ways to provide relief to patients suffering with pneumonia, as per the study. The combination holds good even in 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.

Dr. Robert Hardy, Study’s Senior Author & Associate Professor of Internal Medicine and Pediatrics, said that clinical trials will soon start for confirming findings of the study.

Results of the study suggest that there is a significant effect of low-dose macrolide therapy on the frequency of exacerbation, and severity with moderate to severe COPD, according to lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator.

From News-Medical.Net:

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. “In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class,” wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. “Balancing benefit against harm could pose a dilemma for which there might be no clear answers.”

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

The study results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine, which is published by the American Thoracic Society.