جستجوی مقالات مرتبط با کلیدواژه « glucocorticoids » در نشریات گروه « پزشکی »

The aim of the current study was to assess the effects of Nigella sativa essential oil on testicular toxicity in mice induced by dexamethasone.

Forty NMRI mice were randomly divided into four groups. The first group (Sham) received 1 ml per day of normal saline by intraperitoneal (i.p.) injection for 7 days. The second group (Control) received (i.p) injection of 5 mg/kg dexamethasone for 7 days. The third group (Dexa+ N.S 5 mg/kg) received dexamethasone (5 mg/kg) and gavaged 5 mg/kg N. sativa essential oil for 7 days. The fourth group (N.S 5 mg/kg) for 7 days was gavaged 5 mg/kg N. sativa. Histopathology of testis, spermatogenesis, and sperm fertility rate were assessed.

The results of histopathology assessments showed that in the third group, all histopathology criteria were decreased compared to the second group. The number of seminiferous tubules that had abnormal spermatogenesis in Johnsen’s score was slightly decreased in the third group compared to the second group. Furthermore, in the third group, embryo formation criteria were increased.

The data of this research demonstrate that N. sativa improves spermatogenesis defects and sperm fertility in mice treated with dexamethasone.

The effect of glucocorticoids on calcium balance and bone growth may lead to osteoporosis and currently glucocorticoid induced osteoporosis is one of the recognized types of osteoporosis. The present study aimed at evaluating the therapeutic effect of honey on dexamethasone-induced osteoporosis in rat model. Thirty-two male rats were randomly divided into four groups including dexamethasone receiving group, physiological serum receiving group, dexamethasone and honey receiving group, and dexamethasone and alendronate group. All rats were treated for 4 weeks. At the end of the treatment period, blood was collected and the changes in blood phosphorus, calcium and alkaline phosphatase (ALP) levels were compared on the first day. Animals were sacrificed and femurs were separated for histological evaluation, while specimens were obtained from the epiphysis and metaphysis. The positive effect of honey on prevention of osteoporosis was demonstrated, although there were no significant differences between groups regarding serum calcium. Histomorphometric parameters revealed the effective role of honey in prevention of dexamethasone-induced osteoporosis. Prescription of dexamethasone was illustrated to reduce the histomorphometric parameters of rat femur that caused osteoporosis. On the other hand, the administration of honey with dexamethasone could largely prevent more reduction for osteoporosis. Therefore, honey is suggested as a potential treatment for glucocorticoid-induced osteoporosis.

Nephrotic Syndrome (NS), common in the pediatric population is typically treated with high-dose glucocorticoid (GC). Long-term GC treatment in refractory cases results in osteoporosis susceptibility. Immunosuppressants adjuvant to GC, used to induce remission in steroid-resistant NS, have shown controversial effects on bone density. This study aims to evaluate and compare bone density in children with NS undergoing GC therapy for ≥2 years with or without immunosuppression using DEXA.

Twenty-three NS patients were enrolled in the study and underwent DXA scan. Demographic data and years of disease, and electrolytes including calcium, phosphorus, and vitamin D levels, as well as creatinine, Glomerular Filtration Rate (GFR), and albumin were documented.

DEXA scan showed low bone density in 4 out of 23 participants (17.4%), two of whom had scores lower than -2, which is indicative of osteoporosis, 2 of whom received cyclosporine and one received tacrolimus adjuvant therapy. Disease chronicity was significantly higher in children with lower whole-body Z-scores. Lower than normal vitamin D levels were detected in 68% of cases.

Our observations revealed a 2:1 ratio of cyclosporine to tacrolimus use in patients in Z-score <-1. We suggest that pediatric patients undergoing ≥2 years of GC therapy, especially in high doses or adjuvant to immunosuppressants, be screened for bone loss using DEXA scan for timely diagnosis and management. Furthermore, clinicians should be aware of the beneficial effects of vitamin D supplements in long-term GC therapy and evaluate their patients for vitamin D and calcium deficiency.

Hallux rigidus is one of the main etiologies of disability in the elderly. It is a degenerative disease of the first metatarsophalangeal joint causing restriction of movement as well as pain and swelling. This study was conducted to evaluate the effectiveness of methylprednisolone and dextrose prolotherapy in pain reduction and functional improvement of patients with hallux rigidus.

A randomized double-blind control trial was designed with the inclusion of 32 patients assigned to the two groups. Group one received a mixture of 1 cc methylprednisolone 40 mg with 1 cc lidocaine 2% while the second group received a combination of 1 cc dextrose 50% with 1 cc lidocaine 2%. Standard questionnaires, including visual analog scale (VAS) and Manchester-Oxford foot questionnaire (MOXFQ) were completed by all patients at baseline and 1, 4, and 8 weeks after injections.

Both groups revealed significant improvement in VAS and MOXFQ scores 1, 4, and 8 weeks post-injection with no difference between the two groups in the follow-up.

Both corticosteroid injections and prolotherapy are effective in pain reduction and functional improvement in patients with hallux rigidus but neither is superior to the other.

The primary immune responses to CoV-19 are inter-individual variability against this virus. Studies on the neuro-immune system demonstrate that interactions in these communication pathways can be a reason for several psychiatric disorders and immune-mediated diseases. Stress-related behaviors are significant in the psycho-immune interactions, and even stress-related factors such as socioeconomic status can also play a vital role in these interactions. A literature review on the topic was carried out, and 150 articles were included. Catecholamine and glucocorticoids are stress neurohormones. Noradrenaline as signaling molecules, through macrophages, can be an essential stimulus for cytokine secretion. Glucocorticoids, by both pro-and anti-inflammatory roles in specific conditions, can inhibit the elevation of the inflammatory response by inhibiting the pro-inflammatory macrophage activation and also enhance the anti-inflammatory activity in monocyte/macrophage populations the further eliminate. Stress with this flawed amplification feedback system can disrupt immune homeostasis (cytokine storm) in the patient with COVID-19. This investigation showed that there is a strong link between psycho-neuroendocrine-immune axis organizations against respiratory viral infections during the COVID-19 epidemic. The stress cascade must be responsible for meeting the body's hemostatic challenges in the necessary physiological and metabolic interactions. The motivation of the stress system leads to behavioral/physical variations that are strangely consistent in their qualitative presentation. These variations must be generally adaptive and increase the chances of the individual's survival. In coronavirus respiratory disease, identifying people with acute/chronic psychosocial stress is of particular importance for providing prompt care as soon as possible, as scheduling intervention appears to be an essential factor in reducing stress and hospitalization rate in the intensive care unit (ICU).

The emerging disease of COVID-19 was announced as a pandemic in 2020, with wide prevalence worldwide. After the duration of the pandemic of the disease, reports based on the invasion of Aspergillus into patients' lungs with COVID-19 and their hospitalization in ICU were published by the researchers, which attracted the attention of other researchers to perform such studies. In this review, PubMed, ScienceDirect, Scopus, Springer, Wiley, ProQuest, Sid, Cochrane, and the search engine Google Scholar were searched for publications by the keywords include COVID-19, Aspergillus, SARS-CoV-2, Invasive pulmonary aspergillosis, fungal and viral co-infection or a combination of them. The data were extracted and descriptively discussed. Not many studies have been performed on the association between aspergillosis and COVID-19. However, although the results of the studies suggest some possible causes of these concomitant infections like underlying diseases and prolonged mechanical ventilation, they also recommend further studies. Since the diagnosis of common fungal and viral infections is difficult, the concurrent incidence of these two infections in patients becomes a therapeutic challenge. Accordingly, this issue increased the mortality rate in this group of patients, especially in those hospitalized in ICU. According to the recently performed studies, various problems, including underlying diseases and difficult diagnostic methods of some dangerous diseases like invasive aspergillosis, are discussed in patients with COVID-19.

Glucocorticoids are pivotal components of immunosuppressive regimens in solid organ transplantations. This study aimed to assess the possible association between the ER22/23EK, N363S, and Bcl1 polymorphisms, and short-term clinical outcomes, including acute rejection and delayed graft function (DGF), in kidney transplantation recipients.

A case-control study was conducted in a two-year period on adults with transplanted kidneys, comprised of subjects without rejection (n=50, control) and those with documented rejection within one year after transplantation (n=50, case), between April 2017 and September 2018, in Shiraz, Iran. Demographic characteristics and clinical and paraclinical findings were gathered. The genotyping of the ER22/23EK, N363S, and Bcl1 polymorphisms was carried out via polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The association between the genotypes and DGF as well as rejection types was evaluated using either the Chi square test or Fisher exact test. A stepwise logistic regression analysis was conducted to determine the independent factors of acute rejection within the first year after transplantation.

The study population consisted of 64 men and 36 women. The frequency of mutated alleles was 0.32 for G (Bcl1), 0.02 for S (N363S), and 0.065 for A (ER22/23EK). There was no significant association either between the studied polymorphisms and acute rejection or between the Bcl1 (P=0.17), N363S (P=0.99), and ER22/23EK (P=0.99) genotypes and DGF. The length of hospital stay after kidney transplantation was slightly more in N363N and ER22/23EK wild allele carriers. However, this difference was not statistically significant.

Our data suggested no statistically significant association between the genotypes of the studied polymorphisms and early clinical outcomes after kidney transplantation.

The outbreak of the novel SARS-COV-2 and its following complications has caused an almost unprecedented chaos throughout the world in recent years. Although a series of vaccines have been proposed recently in order to reduce the risk of mortality and mor-bidity of this disease, an ultimate and reliable cure has yet to be discovered. One of the major complications of Covid-19 is the outburst of a series of inflammatory responses in the respiratory system of the patients, which eventually causes a hypoxemic pneu-monitis and accounts for most of the Covid-19 patients’ mortality. It is suggested that a group of inflammatory cytokines such as different interleukins are responsible for this complication, therefore drugs which can influence this system may be useful in reducing this exaggerated inflammatory response which is dubbed the ‘cytokine storm’. In this article we review potential treatment options for reducing the inflammatory re-sponse and discuss some clinical trials and case reports related to the drugs interfering with responsible interleukins in order to quench the cytokine storm.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus which has led to a pandemic. There is no approved treatment for coronavirus disease 2019 (COVID-19). Over time, physicians came to understand that in some severe patients, glucocorticoids could be considered as a second line treatment option. As there are a limited number of reports addressing the use of glucocorticoids (GCs) in patients with moderately severe COVID-19, this article presents the results in patients who referred to our national team and received glucocorticoids as part of their medication. This descriptive and prospective study iincludes 35 clinically-diagnosed moderate to severe COVID-19 cases in outpatient and inpatient settings. Patients received intravenous dexamethasone, oral prednisolone, and pulsed methylprednisolone. Demographic data, clinical signs and symptoms, laboratory and chest CT findings of patients were recorded. On average Men comprised 60% of this group of patients. On admission Lymphocyte counts were depleted in a majority of patients (54.3%). Shortness of breath, O2 sat, and respiratory rate improved 48 to 72 hours after administration of glucocorticoids. Almost all patients had favorable clinical courses were improved during treatment with glucocorticoids, except one who had superimposed bacterial and candida infection. CT scan findings showed bilateral peripheral patchy infiltrations with ground glass opacities as the dominant pattern of lung involvement (60%). One patient was admitted to the intensive care unit. The results of our study showed that the administration of glucocorticoids in the early stages of COVID-19 disease is not only effective, but is also safe and prevents the progression of the disease.

Shoulder pain is the third most common type of musculoskeletal disorder and rotator cuff (RC) tendinopathy is the most frequent diagnosis. Ultrasound is the most preferable guidance tool for diagnostic and interventional purposes. The aim of this study is to compare the effectiveness of the prolotherapy injection with corticosteroid injection in patients with RC dysfunction.

Thirty to sixty‑five‑year‑old patients with chronic RC disease were divided into two groups. Ultrasound‑guided dextrose prolotherapy of supraspinatus tendon was done for one group and ultrasound‑guided corticosteroid injection in the subacromial bursa was done for the other groups. Visual analog scale (VAS) and Shoulder Pain and Disability Index (SPADI) were evaluated for both groups at baseline, 3 and 12 weeks after injections.

Thirty‑three patients were included in the result. Both the groups showed significant improvement in VAS and SPADI scores in 3 and 12 weeks after injections compared with preinjection times with no difference between two groups neither in 3 weeks nor in 12 weeks after injections.

Both ultrasound‑guided dextrose prolotherapy and CS injections are effective in the management of RC‑related shoulder pain in both short‑term and long‑term with neither being superior to the other. Therefore, prolotherapy may be a safe alternative therapy instead of corticosteroid injection due to lack of its side effects.

Nephrotic syndrome is one of the most common glomerular diseases in children who are also at risk of metabolic bone diseases. In this study the effect of supplementary use of vitamin D3 was assessed on serum levels of vitamin D3 in patients with nephrotic syndrome receiving steroid therapy.

Thirty children with nephrotic syndrome were included in this study. After obtaining blood samples to measure 25(OH) D levels, all patients were supplemented with daily doses of Vitamin D for one month. Serum 25(OH) D level was checked again, and these patients were supplemented for another month if they had been recognized with deficiency at the last check.

Out of 30 children, 60% were male and 40% were female with a mean age of 6.91 ± 3.34 years. Before intervention, 70% of patients had severe vitamin D deficiency, and 26.7% had mild to moderate deficiency, and none of the patients had normal serum levels of 25-(OH)-D. After one month, only one patient gained normal levels which was not statistically significant (P=0.500). After two months of intervention, 12 patients escaped deficiency but still exhibited insufficient levels followed by 8 people with deficiency, and 10 patients reached normal values which was statistically significant (P=0.002). The mean level of 25(OH) D was 8.277±0.84 ng/ mL rising to 14.364±1.14 ng/mL after two months (P=0.001).

This study showed a high incidence of vitamin D deficiency in the children with nephrotic syndrome warranting routine surveillance of vitamin D serum levels in these patients. Daily doses of vitamin D in the first month of onset of the disease was insufficient. We suggest that children may benefit from routine measurement of their serum vitamin D from diagnosis and later in follow-up visits so an individual strategy for vitamin D supplementation could be given

Vitamin D level varies according to the geographic location. This study was conducted to evaluate Vitamin D level in the serumsamples of Systemic lupus erythematosus (SLE) patients from the Iranian population and determine its association with SLE diseaseactivity index (SLEDAI), sun exposure, smoking, photosensitivity, sun protector cream use, and drug regimen. In this crosssectional study, 200 patients were included. The patient’s data were obtained using a questionnaire. The enzyme-linkedimmunosorbent assay (ELISA) technique was used to determine Vitamin D level in the serum samples of the patients. The studypopulation was comprised of 27 (13.5%) males and 173 (86.5%) females, with a mean age of 38.46 ± 13.24 years. The serumlevel of Vitamin D was 13.62 ± 3.22 ng/ml in the patients. Vitamin D deficiency was observed in 104 (52%) patients. There wasa statistically positive correlation between vitamin D level and duration of sun exposure (CC = 0.57, P = 0.004). A statisticallysignificant negative correlation was seen between vitamin D level and SLEDAI (CC = -0.41, P = 0.013).Vitamin D level was significantly (P = 0.030) lower in the SLE patients with photosensitivity. SLE patients using sunprotector cream had significantly (P = 0.002) lower level of Vitamin D. Patients receiving glucocorticoid drugs hadsignificantly (P = 0.001) lower levels of Vitamin D in comparison to the patients not receiving glucocorticoids. Vitamin D isinvolved in the disease activity of SLE patients. It is important to include vitamin D supplementation in the drug regimen of SLEpatients, especially when it includes glucocorticoids.

Corticosteroids are widely used in many medical problems; therefore, they are easily available in all types of pharmacies. Because of their dramatic response and different available formulations, the non-prescription use of these drugs is high, even though there are many side effects related to their use. The present study evaluates and compares the data reported by FDA, main health insurance organizations and pharmaceutical companies that distribute the corticosteroids.

This descriptive correlational, cross-sectional study was designed to assess the prevalence, distribution pattern, per capita prescription and non-prescription consumption of 11 high-consumption corticosteroids in private and public pharmacies of Khuzestan province throughout 2016.

The results indicated that the highest distribution of corticosteroids is related to private pharmacies. Among the cities of Khuzestan, the highest rate of non-prescription use of corticosteroids was in Haftkel city, and the lowest was in Andika city. Among the drugs, prednisolone 5 mg tablets and dexamethasone 5 mg tablets have the highest per capita prescription and non-prescription consumption in Khuzestan province, respectively.

According to the results of this study, the per capita consumption of corticosteroids is high, and the pharmacies seem to dispense these drugs widely. Therefore accurate recording of the distribution and dispense of corticosteroids by FDA on a monthly and annual basis is crucial. It is necessary to increase the supervision of drug companies that provide the supply of corticosteroids.

Elective cesarean section (ECS) increases neonatal respiratory complications like transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS). This pilot study examined the effect of antenatal steroids on the prevention of respiratory problems in full-term neonates born via ECS.

This experimental study was carried out on full-term neonates (39-42 weeks) born by ECS to the mothers admitted to Babol Clinic Hospital, northern, Iran in 2016. The intervention group received betamethasone (12 mg, intramuscular, once a day) for 2 days before ECS plus conventional care, but the control group received only conventional care. The rate of respiratory complication and the admission rate of the newborn ward and neonatal intensive care unit (NICU) were compared between two groups.

Overall, 200 full-term neonates (100 neonates in the experimental group and 100 neonates in the control group) were enrolled. Nine neonates (9%) in the experimental group and 8 neonates (8%) in the control group had TTN (P=0. 64), and one (1%) neonate in the experimental group and one neonate (1%) in the control group had RDS (P=1).

Antenatal corticosteroid administration to the mothers before ECS with gestational ages of 39-42 weeks does not reduce the incidence of respiratory complications.  Thus, further studies are needed to determined its effects in gestational age group more than 39 weeks.

Endothelial cell (EC) apoptosis plays a critical role in the physiological and pathological vascular regression, remodeling, and angiogenesis. There are several therapeutic agents such as glucocorticoids (GCs), which could influence EC apoptosis, causing coagulation events. Due to the paradoxical effects of GCs on cellular apoptosis, the aim of the current study was to investigate the dose and time in which GCs could initiate and terminate in vitro cellular apoptosis.

Dexamethasone (DEXA) was serially diluted 10-folds for 8 serial concentrations (from 1 mM to 0.1 nM) added to cultured human umbilical vein endothelial cells (HUVECs). The cytotoxic effects of DEXA on HUVEC were tested with a rapid colorimetric test using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay. Apoptotic assays based on quantitative polymerase chain reaction was performed for Bax and Bcl-2 genes and terminal deoxynucleotidyl transferase dUTP nick end labeling assay.

DEXA at the concentration of 1 µM showed significant cytotoxic effects, more intense anti-apoptotic effects in lower concentrations (1 nM to 100 nM), and anti-apoptotic effects with less intensity in higher concentrations (10 µM to 1 mM). Six hours of treatment by 1 µM of DEXA was estimated as the initial time of DEXA that could remarkably induce HUVECs apoptosis. The maximum significant increase of apoptosis was detected 24 hours after treatment with DEXA.

Our findings suggested that GCs can influence cellular apoptosis in a dose- and time-dependent manner.

We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV).

An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI).

Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections.

There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.

Leishmaniasis is a vector-borne disease caused by Leishmania species. The transcription factor (NF-κB) activates and the innate immune system starts working when this parasite attacks macrophages. In addition, glucocorticoids increase nitric oxide (NO) and INFγ leads to the apoptosis of the cell by inhibiting the NF-κB activity. The aim of this study was the in vitro investigation of the effects of the glucocorticoids on Leishmania major amastigotes.

Leishmania major was produced in a massive volume. Then, promastigotes penetrated into macrophages and converted to amastigotes by adding promastigotes to the J774 mouse macrophage cell line and providing appropriate conditions. Next, the infected macrophages with L. major parasite were treated with different concentrations of prednisolone and mometasone. After 24 and 48 hours, the effect of the drugs was evaluated based on the average number of amastigotes in the infected macrophages. In addition, the amount of NO and the mean interleukin 12 (IL-12) level secreted by the infected macrophages treated with different concentrations of drugs were measured by Griess reagent and ELISA reader, respectively.

The average number of amastigotes in the infected macrophages treated with different concentrations of the drug was significantly different from the control group. Further, the amount of NO and the mean level of IL-12 secreted by infected macrophages had a direct and significant relationship with different concentrations of drugs, but the results of Tukey post hoc test showed that the reduction in the number of promastigotes was not time-dependent.

In general, prednisolone and mometasone stimulated macrophages increased the IL-12 levels and NO secretion and finally decreased the number of parasites in infected macrophages.

Systemic lupus erythematosus (SLE) is an autoimmune disease with chronic inflammatory immune response. Current therapies mostly rely on glucocorticoids which are accompanied by side-effects and mostly fail to achieve a favorable remission. Th17 subpopulation of T cells is increased in exacerbated SLE as IL-17 cytokine is overexpressed. However, IL-17 is reported to be resistant to glucocorticoids in various disorders. Here, we evaluated the plasma level of IL-17 among newly diagnosed and under-treatment SLE patients to understand the effect of glucocorticoids on Th17 response.  A total of 40 female SLE patients and 20 age- and sex- matched normal subjects were enrolled. IL-17 plasma level was evaluated using ELISA cytokine assay and analyzed with previously obtained IL-10, IFN-γ, and GILZ levels. Our findings revealed that IL-17 was overexpressed among under-treatment SLE patients. There was a significant correlation between IL-17 and IFN-γ and significant reverse correlations between IL-17, IL-10, and GILZ levels. IL-17 was not significantly correlated with the disease activity. According to the role of IL-17 in tissue injury and the fact that glucocorticoids are not successful in preventing organ damages in SLE, the overexpressed IL-17 in response to therapies could be introduced as an underlying reason.