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Fulltext Global utilization of low-dose corticosteroids in severe sepsis and septic shock: a report from the PROGRESS registry

Beale R, Janes JM, Brunkhorst FM, Dobb G, Levy MM, Martin GS, et al.

Crit Care, 2010;14(3):R102.
PMID: 20525247 DOI: 10.1186/cc9044

INTRODUCTION: The benefits and use of low-dose corticosteroids (LDCs) in severe sepsis and septic shock remain controversial. Surviving sepsis campaign guidelines suggest LDC use for septic shock patients poorly responsive to fluid resuscitation and vasopressor therapy. Their use is suspected to be wide-spread, but paucity of data regarding global practice exists. The purpose of this study was to compare baseline characteristics and clinical outcomes of patients treated or not treated with LDC from the international PROGRESS (PROmoting Global Research Excellence in Severe Sepsis) cohort study of severe sepsis.
METHODS: Patients enrolled in the PROGRESS registry were evaluated for use of vasopressor and LDC (equivalent or lesser potency to hydrocortisone 50 mg six-hourly plus 50 microg 9-alpha-fludrocortisone) for treatment of severe sepsis at any time in intensive care units (ICUs). Baseline characteristics and hospital mortality were analyzed, and logistic regression techniques used to develop propensity score and outcome models adjusted for baseline imbalances between groups.
RESULTS: A total of 8,968 patients with severe sepsis and sufficient data for analysis were studied. A total of 79.8% (7,160/8,968) of patients received vasopressors, and 34.0% (3,051/8,968) of patients received LDC. Regional use of LDC was highest in Europe (51.1%) and lowest in Asia (21.6%). Country use was highest in Brazil (62.9%) and lowest in Malaysia (9.0%). A total of 14.2% of patients on LDC were not receiving any vasopressor therapy. LDC patients were older, had more co-morbidities and higher disease severity scores. Patients receiving LDC spent longer in ICU than patients who did not (median of 12 versus 8 days; P <0.001). Overall hospital mortality rates were greater in the LDC than in the non-LDC group (58.0% versus 43.0%; P <0.001). After adjusting for baseline imbalances, in all mortality models (with vasopressor use), a consistent association remained between LDC and hospital mortality (odds ratios varying from 1.30 to 1.47).
CONCLUSIONS: Widespread use of LDC for the treatment of severe sepsis with significant regional and country variation exists. In this study, 14.2% of patients received LDC despite the absence of evidence of shock. Hospital mortality was higher in the LDC group and remained higher after adjustment for key determinates of mortality.

Matched MeSH terms: Adrenal Cortex Hormones/administration & dosage*; Adrenal Cortex Hormones/pharmacology; Adrenal Cortex Hormones/therapeutic use*
A unilateral optic perineuritis in a teenager - A case report

Ameilia A, Shatriah I, Wan-Hitam WH, Yunus R

Brain Dev, 2015 Jun;37(6):635-7.
PMID: 25457086 DOI: 10.1016/j.braindev.2014.09.011

Optic perineuritis is an uncommon inflammatory disorder that involves optic nerve sheath. Numerous case reports have been published on optic perineuritis in adults, the majority of whom had bilateral presentation. There are limited data on optic perineuritis occurring in pediatric patients. We report a teenager who presented with a unilateral sign that mimicked the presentation of optic neuritis. The orbit and brain magnetic resonance imaging confirmed features of unilateral optic perineuritis. She was treated with a high dose of corticosteroids for 2weeks, and her final visual outcome was satisfactory. No signs of relapse were noted during follow-up visits.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Thyroid hormones and mortality risk in euthyroid individuals: the Kangbuk Samsung health study

Zhang Y, Chang Y, Ryu S, Cho J, Lee WY, Rhee EJ, et al.

J Clin Endocrinol Metab, 2014 Jul;99(7):2467-76.
PMID: 24708095 DOI: 10.1210/jc.2013-3832

CONTEXT: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear.
OBJECTIVE: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints.
SETTING AND DESIGN: A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records.
RESULTS: After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95, comparing the highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62, 95% confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints.
CONCLUSIONS: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.

Matched MeSH terms: Thyroid Hormones/blood*
Fulltext The relationships between thyroid hormones and thyroid-stimulating hormone with lipid profile in euthyroid men

Chin KY, Ima-Nirwana S, Mohamed IN, Aminuddin A, Johari MH, Ngah WZ

Int J Med Sci, 2014;11(4):349-55.
PMID: 24578612 DOI: 10.7150/ijms.7104

Alteration in lipid profile is a common observation in patients with thyroid dysfunction, but the current knowledge on the relationship between lipids and thyroid hormone levels in euthyroid state is insufficient. The current study aimed to determine the association between thyroid hormones and thyroid-stimulating hormone (TSH) with lipid profile in a euthyroid male population.

Matched MeSH terms: Thyroid Hormones/blood*
Evaluation of medicinal interventions for the management of oral submucous fibrosis: a systematic review of the literature

Awan KH, Patil S, Habib SR, Pejcic A, Zain RB

J Contemp Dent Pract, 2014 Nov 1;15(6):812-7.
PMID: 25825114

Oral submucous fibrosis is a chronic, progressive scarring disease associated with both significant morbidity including pain and limited mouth opening and an increased risk for malignancy. This systematic review evaluated the different medicinal (i.e. nonsurgical) interventions available for the management of oral submucous fibrosis. An automated literature searches of online databases from January 1960 to December 2013 were performed and only studies with high level of evidence based on the guidelines of the Oxford Centre for evidence-based medicine were selected. Thirteen studies (3 randomized controlled trials and 10 clinical trials/controlled clinical trials) were included and drugs like steroids, hyaluronidase, human placenta extracts, chymotrypsin and collagenase, pentoxifylline, nylidrin hydrochloride, iron and multivitamin supplements including lycopene were used. There is a clear lack of evidence on the available drug treatment for oral submucous fibrosis and further high quality randomized controlled trials are needed to evaluate the different therapeutic agents.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Efficacy and safety of diphenylcyclopropenone among Chinese patients with steroid resistant and extensive alopecia areata

Luk NM, Chiu LS, Lee KC, Chau CT, Lee VW, Chang M, et al.

J Eur Acad Dermatol Venereol, 2013 Mar;27(3):e400-5.
PMID: 23057682 DOI: 10.1111/jdv.12009

BACKGROUND: Topical immunotherapy has recently been found useful in the treatment of chronic and extensive Alopecia Areata (AA).
OBJECTIVE: To evaluate the efficacy and safety of diphenylcyclopropenone (DPCP) use among Chinese patients with steroid resistant and extensive AA in our institute.
METHODS: The medical records of 31 Chinese patients treated with DPCP were analysed retrospectively. The efficacy, adverse effects, and relapse rate of DPCP treatment were reviewed.
RESULTS: Thirty-one (16 male, 15 female) Chinese patients with extensive, steroid resistant Alopecia Areata and a mean age of 28.9 years (SE 10.4) were treated. The mean age of onset was 17.8 years (SE 8.8) with an average disease duration of 11.2 years (SE 7.7). Ten patients had a history of atopy and 4 had a history of thyroid disease. Nail changes were found in 14 patients and a family history of AA was found in 2 patients. Thirteen patients (41.9%) had experienced total hair loss. Two patients abandoned the treatment due to severe side effects. Of the remaining 29 patients, 4 (13.8%), 7 (24.1%), 5 (17.2%), and 13 (44.8%) achieved >90% complete response, >50-90% partial response, >10-50% minimal response, and <10% no response hair regrowth, respectively. Adverse effects included pruritus, erythema, vesiculation, scaling, cervical lymphadenopathy, dyspigmentation and urticarial reactions. Relapse occurred (>25% hair loss) in 69.23% of patients after 18 months of follow up.
CONCLUSIONS: DPCP is an effective and tolerable treatment for Chinese patients with extensive, steroid resistant AA.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Fulltext Determination of trimester specific reference intervals for thyroid hormones during pregnancy in Malaysian women

Thevarajah M, Chew YY, Lim SC, Sabir N, Sickan J

Malays J Pathol, 2009 Jun;31(1):23-7.
PMID: 19694310 MyJurnal

To establish trimester specific reference intervals for thyroid hormones during pregnancy in Malaysian women.

Matched MeSH terms: Thyroid Hormones/blood*
Fulltext Post viral acute multifocal posterior placoid pigment epithiopathy in a teenage child

Nga AD, Ramli N, Mimiwati Z

Med J Malaysia, 2009 Jun;64(2):176-8.
PMID: 20058585 MyJurnal

We report a rare case of a young boy presenting with bilateral blurring of vision following a viral like illness. Fundus examination revealed multiple pale cream-coloured lesions scattered across the posterior pole of both eyes. Fundus fluorescein angiography showed characteristic features of early hypofluorescence and late hyperfluorescence, further confirming the diagnosis of acute posterior placoid pigment epitheliopathy (AMPPPE). He was treated with topical steroids for the accompanying mild anterior uveitis. He had a prompt visual recovery with no adverse sequelae.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Standardized quassinoid-rich Eurycoma longifolia extract improved spermatogenesis and fertility in male rats via the hypothalamic-pituitary-gonadal axis

Low BS, Das PK, Chan KL

J Ethnopharmacol, 2013 Feb 13;145(3):706-14.
PMID: 23261482 DOI: 10.1016/j.jep.2012.11.013

Eurycoma longifolia Jack, a small Simaroubaceae tree, known locally as 'Tongkat Ali' is popularly used as a sexual tonic in traditional medicine for aphrodisiac activity and improvement of fertility and male libido.

Matched MeSH terms: Hormones/metabolism
Response of exhaled nitric oxide to inhaled corticosteroids in patients with stable COPD: A systematic review and meta-analysis

Lim CS, Rani FA, Tan LE

Clin Respir J, 2018 Jan;12(1):218-226.
PMID: 27328740 DOI: 10.1111/crj.12518

INTRODUCTION: To our knowledge, no meta-analysis has investigated the response of FeNO levels to corticosteroid treatment in ex-smokers with chronic obstructive pulmonary disease (COPD).

OBJECTIVES: This meta-analysis assessed the potential role of fraction of exhaled nitric oxide (FeNO) as a biomarker for corticosteroid response in ex-smokers with stable COPD.

METHODS: Medline, Cochrane, EMBASE, Google Scholar databases were searched until November 5, 2014 using the following terms: corticosteroid, chronic obstructive pulmonary disease, COPD, nitric oxide, NO, exhaled nitric oxide. Only randomized controlled trials (RCT) or two-arm prospective studies were included. The primary outcome measure was FeNO before and after treatment with inhaled corticosteroids (ICS) in ex-smokers with COPD. Sensitivity analysis was also performed.

RESULTS: Five studies were included in the analysis with a total of 171 COPD patients. All five studies included 125 ex-smokers and two of these also included 46 current smokers. There was a significant decrease of FeNO in ex-smoking COPD patients following inhaled corticosteroid treatment (-7.51, 95% CI: -11.51 to -3.51; P =0.003); and in a population of subjects that included both smokers and ex-smokers (-1.99, 95% CI: -3.41 to -0.56; P =0.006).

CONCLUSION: Our findings indicate that FeNO levels significantly decreased with corticosteroid treatment in ex-smokers with COPD. Additional studies are required to evaluate whether concurrent smoking has significant effect on FeNO response to ICS.

Matched MeSH terms: Adrenal Cortex Hormones/administration & dosage*
Fulltext Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery?

Ngeow WC, Lim D

Adv Ther, 2016 Jul;33(7):1105-39.
PMID: 27287853 DOI: 10.1007/s12325-016-0357-y

INTRODUCTION: The use of corticosteroids to reduce the post-operative sequelae of lower third molar surgery, namely pain, swelling and trismus, has been well studied by many researchers over the past 6 decades. This study reviewed the reported outcome of corticosteroids used in controlling the above sequalae after third molar surgery.
MATERIALS AND METHODS: A PubMed, Medline, EMBASE and Google search was undertaken of all controlled clinical trials on the effects of corticosteroids on pain, swelling and trismus after lower third molar surgery. The review was limited to studies published over the last 10 years (2006-2015).
RESULTS: Of the 46 initially retrieved articles, 34 were finally included. Eleven studies compared the effect of 2 similar (but different dose) or different group of corticosteroids. Thirty-one studies reported the effects of corticosteroids on all sequale, 2 reported the outcome on swelling and trismus and another 1 on swelling and pain only. In 16 of the studies, corticosteroid use resulted in significant reductions in pain after third molar removal. Twenty-two out of 29 studies reported reduced swelling against negative control while 18 out of 25 studies reported improved mouth opening. Fourteen studies reported the benefit of corticosteroids on all 3 sequelae, with 71.4% resulted from the use of methylprednisolone.
CONCLUSION: Although there are some conflicting effects, the results of this analysis shows in general the benefits derived from short-term use of corticosteroids in relation to pain, swelling and trismus following third molar surgical extraction, with no side effects observed.
FUNDING: This work was supported by the University of Malaya's High Impact Research grant UM.C/625/1/HIR/MOHE/05.

Matched MeSH terms: Adrenal Cortex Hormones/administration & dosage*
Pregnenolone metabolites in rat testis: endogenous concentrations, and intracellular distribution in whole testes during incubation in vitro

Pertiwi AK, Kwan TK, Gower DB

J Steroid Biochem Mol Biol, 2002 Aug;81(4-5):363-7.
PMID: 12361726

The intracellular movements of pregnenolone in rat testes were investigated. Whole testes were incubated in the presence or absence of pregnenolone (2.5mM) in the medium for 120 min (in some studies 30, 60, and 90 min). The testes were homogenised, subcellular fractions prepared and analysed in quadruplicate for steroid content by gas chromatography-mass spectrometry with selected ion monitoring. Quantification of pregnenolone and 11 of its metabolites, obtained from non-incubated whole testes, provided values for endogenous amounts. Pregnenolone was the only steroid of quantitative importance found initially in the mitochondrial fraction but was subsequently found in the microsomal fraction, where metabolism occurred. Identification and quantification of metabolites indicated that both classical pathways for testosterone production were operating, with the 4-en-3-oxosteroid pathway predominating. By 120 min, virtually all pregnenolone metabolites, including pregnenolone itself, were found in the cytosol, consistent with an overall movement from mitochondria to endoplasmic reticulum to cytosol.

Matched MeSH terms: Gonadal Steroid Hormones/metabolism
Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study

Lai CK, De Guia TS, Kim YY, Kuo SH, Mukhopadhyay A, Soriano JB, et al.

J Allergy Clin Immunol, 2003 Feb;111(2):263-8.
PMID: 12589343

Few data on asthma management are available for the Asia-Pacific region.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Fulltext Adult varicella pneumonia that responded to combined acyclovir and steroid therapy

Lau LG

Med J Malaysia, 1999 Jun;54(2):270-2.
PMID: 10972042

We describe a case of adult chickenpox which was complicated by severe varicella pneumonia, mild hepatitis and thrombocytopenia. The hepatitis and the thrombocytopenia were asymptomatic clinically and were diagnosed on biochemistry and blood count results. These eventually improved without specific interventions. The pneumonia, however, deteriorated rapidly despite the early commencement of oxygen supplementation, acyclovir and antibiotic. Subsequently, systemic corticosteroid therapy was initiated and the patient was ventilated in the intensive care unit. The patient eventually recovered.

Matched MeSH terms: Adrenal Cortex Hormones/administration & dosage*
Fulltext New therapies for acute respiratory distress syndrome (ARDS):--a review

Reddy VG

Med J Malaysia, 1999 Mar;54(1):132-45.
PMID: 10972019

Acute respiratory distress syndrome (ARDS) has been associated with high mortality. Improved understanding of the pathophysiology, recognition of precipitating events and improved management has decreased the mortality over the years. Mechanical ventilation is still the corner stone of the management of the disease. It is well recognised that high tidal volumes and airway pressures increase the morbidity, hence the need to use alternative modes of ventilation like pressure control with or without inverse ratio ventilation. Extracorporeal membrane oxygenation is still experimental and not easily available, whereas prone position to improve oxygenation is simple and inexpensive. The concept of pathological oxygen dependency and therapy aimed at supranormal values has failed to improve survival. Restricting the fluids to prevent further oedema formation in an already wet lung has improved the survival rate. Nitric oxide and surfactant have failed to produce desirable effect in large studies. Pharmacological support to inhibit inflammation with non steroidal anti-inflammatory drugs, antifungal agents, prostaglandin and corticosteroids have all failed. Interestingly corticosteroid rescue treatment in the late phase of ARDS has shown promise. Antiendotoxin and anticytokine studies which began with much enthusiasm is yet to produce desirable results.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Fulltext Idiopathic sudden sensorineural hearing loss. University hospital experience

Amin JM

Med J Malaysia, 1993 Dec;48(4):407-9.
PMID: 7514259

Thirty patients with idiopathic sudden sensorineural hearing loss who presented to the University Hospital between January 1985 to January 1992 are presented. The combined regime of bed rest, intravenous dextran 40, vasodilator and steroid therapy produced good improvement in 63.4% of patients. Unfavourable prognostic factors were found to be, hearing loss of more than two weeks duration, vertigo and bilateral hearing loss.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Fulltext Protein energy malnutrition, thyroid hormones and goitre among Malaysian Aborigines and Malays

Osman A, Khalid BAK, Tan TT, Wu LL, Ng ML

Asia Pac J Clin Nutr, 1992 Mar;1(1):13-20.
PMID: 24323000

The relationship between malnutrition, goitre and thyroid hormones was studied among Aborigines and Malays in Ulu Langat, Malaysia. Fifty Aborigines aged >=7years were selected randomly for anthropometric, clinical and hormonal assessment. Fifty Malays of similar age from the nearby Malay village were chosen as controls. The Aborigines had a higher prevalence of malnutrition and goitre compared to the Malays. The prevalence of goitre was 26.5% amongst Aborigines and 19.6% among the Malays. All the nutritional indexes measured were significantly different between the two communities, especially among females. The differences corresponded to significant differences in levels of thyroid-stimulating hormone (TSH) measured using a highly sensitive TSH assay. By univariate analysis the increase in TSH corresponded to the decrease in body mass index (BMI). On the other hand, no association was found between BMI and goitres. No thyroid autoantibodies were detected and all subjects were clinically euthyroid and had normal thyroxine and triidothyronine levels. However, consumption of cassava conferred a four-fold risk of developing goitres. The high prevalence of goitres in malnourished subjects in this region which is not known to be iodine deficient could be due to cassava consumption.

Matched MeSH terms: Thyroid Hormones*
Fulltext Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever

Leong KW, Srinivas P

Med J Malaysia, 1993 Sep;48(3):369-72.
PMID: 8183156

A case of prolonged thrombocytopenia following dengue haemorrhagic fever in a 15 year old boy is reported. The mechanism was presumed to be immunological and he responded dramatically to oral prednisolone.

Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use*
Dengue virus infection: epidemiology, pathogenesis, clinical presentation, diagnosis, and prevention

Kautner I, Robinson MJ, Kuhnle U

J Pediatr, 1997 Oct;131(4):516-24.
PMID: 9386651
Matched MeSH terms: Adrenal Cortex Hormones/therapeutic use
Thyroid hormones and autoantibodies in pregnant patients with thyroid diseases

Goh KH, Ng ML, Roslan BA, Tan TT, Nasri BN, Khalid BA

Ann Acad Med Singap, 1993 Jul;22(4):539-43.
PMID: 8257054

Serum concentrations of thyroid stimulating hormone (TSH) and thyroid autoantibodies in pregnant patients with thyroid disease at various stages of pregnancy were determined by in-house ELISAs. In normal pregnancy, serum TSH levels were significantly elevated (p < 0.05) from 13 weeks of gestation. The normal reference ranges for TSH for the second (0.6-5.0 mIU/l) and third trimester (0.6-5.6 mIU/l) were significantly higher (p < 0.05; p < 0.01 respectively) compared to 0.4-4.5 mIU/l for the first trimester. In pregnant thyroid patients, serum TSH levels correlated highly (p < 0.001) to T4 (r = 0.740), FT4I (r = 0.683) and MicAb (microsomal antibodies) (r = 0.825) but weaker (p < 0.01) to T3 (r = -0.512), FT3I (r = 0.520) and TgAb (thyroglobulin antibodies) (r = 0.618). Thus, measurement of TSH with the highly sensitive ELISA (enzyme linked immunosorbent assay) would form a useful first line test for thyroid dysfunction in pregnancy while measurement of thyroid autoantibodies would aid in the diagnosis of autoimmune hypothyroidism.

Matched MeSH terms: Thyroid Hormones/blood*

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