Impact of Systemic Steroids on Posttonsillectomy Bleeding

To review the incidence and extent of peri-electrode edema after DBS and to clarify the effect of postoperative use of steroids on the peri-electrode edema. This retrospective cohort study included 250 patients who underwent bilateral subthalamic nucleus (STN) DBS surgery with intact MRI within 1 month after DBS surgery. Patients were divided into steroid and non-steroid groups, based on postoperative steroids use. The occurrence and extent of peri-electrode edema were compared between the two groups, and other associated factors were analyzed using univariate and multivariate methods. Peri-electrode edema >1 cm3 in at least one hemisphere was reported in 215 (86.00%) patients. The mean volume of peri-electrode edema observed in the steroid group was significantly smaller than in the non-steroid group (8.09 ± 8.47 cm3 vs 17.10 ± 16.90 cm3 , p < 0.001). In the steroid group, 104 (32.91%) of the 316 implanted electrodes present with edema less than 1 cm3 , whereas in the non-steroid group, only 27 (14.67%) of the 184 implanted electrodes present with edema less than 1 cm3 (p < 0.001). Multivariate analysis indicated that lesser peri-electrode edema was significantly associated with postoperative steroids use and general anesthesia. Peri-electrode edema is common after DBS surgery, and postoperative steroids use reduces the occurrence and extent of peri-electrode edema.

Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults

OBJECT Anterior cervical discectomy and fusion (ACDF) is an effective procedure for the treatment of cervical radiculopathy and/or myelopathy; however, postoperative dysphagia is a significant concern. Dexamethasone, although potentially protective against perioperative dysphagia and airway compromise, could inhibit fusion, a generally proinflammatory process. The authors conducted a prospective, randomized, double-blinded, controlled study of the effects of steroids on swallowing, the airway, and arthrodesis related to multilevel anterior cervical reconstruction in patients who were undergoing ACDF at Albany Medical Center between 2008 and 2012. The objective of this study was to determine if perioperative steroid use improves perioperative dysphagia and airway edema. METHODS A total of 112 patients were enrolled and randomly assigned to receive saline or dexamethasone. Data gathered included demographics, functional status (including modified Japanese Orthopaedic Association myelopathy score, neck disability index, 12-Item Short-Form Health Survey score, and patient-reported visual analog scale score of axial and radiating pain), functional outcome swallowing scale score, interval postoperative imaging, fusion status, and complications/reoperations. Follow-up was performed at 1, 3, 6, 12, and 24 months, and CT was performed 6, 12, and 24 months after surgery for fusion assessment. RESULTS Baseline demographics were not significantly different between the 2 groups, indicating adequate randomization. In terms of patient-reported functional and pain-related outcomes, there were no differences in the steroid and placebo groups. However, the severity of dysphagia in the postoperative period up to 1 month proved to be significantly lower in the steroid group than in the placebo group (p = 0.027). Furthermore, airway difficulty and a need for intubation trended toward significance in the placebo group (p = 0.057). Last, fusion rates at 6 months proved to be significantly lower in the steroid group but lost significance at 12 months (p = 0.048 and 0.57, respectively). CONCLUSIONS Dexamethasone administered perioperatively significantly improved swallowing function and airway edema and shortened length of stay. It did not affect pain, functional outcomes, or long-term swallowing status. However, it significantly delayed fusion, but the long-term fusion rates remained unaffected. Clinical trial registration no.: NCT01065961 (clinicaltrials.gov).

EFFECT OF CORTICOSTEROIDS ON NOSOCOMIAL INFECTIONS IN PATIENTS WITH COVID-19, A SYSTEMATIC REVIEW OF RANDOMIZED CLINICAL TRIALS

Effects of preoperative steroids on morbidity and mortality after transsternal thymectomy are analyzed. There were 620 transsternal thymectomies for myasthenia gravis performed in the period 1973-2002. There were 547 patients with nonthymomatous myasthenia, including 17 patients submitted to repeated thymectomy (rethymectomy) and 46 patients with thymoma. There were 522 upper median sternotomies performed in the period 1973-1997 and 98 complete median sternotomies performed in the period 1998-2002 (74 patients without thymoma, 7 thymomas and 17 rethymectomies). One hundred and seventeen of these 620 patients were taking steroids preoperatively. The impact of steroids use on postoperative respiratory insufficiency (ventilator), need for tracheostomy, superficial wound dehiscence, superficial wound suppuration, sternal dehiscence and mortality was analyzed. The rate of morbidity and mortality in the steroids and the no-steroids groups included respiratory insufficiency necessitating the use of a ventilator in 46/503 patients from the no-steroids group (9.1%) and 8/117 patients from the steroids group (6.8%; P = 0.4260), need for tracheostomy in 14/503 patients from the no-steroids group (2.8%) and 3/117 patients from the steroids group (2.6%; P = 9054). Complications with wound healing (including sternal dehiscence, superficial wound dehiscence and superficial wound suppuration) occurred in 47/503 (9.3%) patients from the no-steroids group and in 1/117 (0.9%) patient from the steroids group (P = 0.0023) The overall complications rate was 30.6% (154/503) in the no-steroids group and 11.1% (13/117) in the steroids group (P = 0.0001). Mortality rate in the no-steroids group was 0.4% (2/503 patients) and none in the steroids group. Morbidity in patients with complete sternotomy was low, respiratory insufficiency in three patients (3.1%), and superficial wound suppuration in one patient (1.0%), no other morbidity and no mortality. Changing morbidity in periods 1973-1980, 1981-1990 and 1991-2002 is analyzed. Preoperative use of steroids for transsternal thymectomy in patients with myasthenia gravis had no negative impact on morbidity and mortality, conversely, the results in patients taking steroids were better, with significant difference of results regarding the overall complication rates and the overall complication rates of wound healing.

Background: The use of anabolic androgenic steroids (AAS) like Nandrolone Decanoate (ND) for enhancing physical performance and muscle growth is prevalent among athletes and non-athletes. However, the adverse effects of AAS on organ systems, particularly the kidney and heart, have been a growing concern within the medical and scientific community. Previous studies have highlighted the potential nephrotoxic and cardiotoxic effects of these substances, necessitating further research to elucidate the extent of organ damage. Objective: This study aims to investigate the histopathological effects of ND on the kidney and heart tissues of Rattus norvegicus and to draw comparisons with control groups to assess the severity of organ damage. Methods: A total of 15 Rattus norvegicus were divided into three groups: a control group, an olive oil group (positive control), and a steroid group (ND treated). The animals were housed under controlled conditions with a 12-hour light/dark cycle at 23±2°C. The steroid and olive oil groups received 50mg/ml intramuscular injections of ND and olive oil, respectively, twice weekly for six weeks. Following treatment, the animals were euthanized, and their kidney and heart tissues were extracted for histological examination. Tissues were fixed in 10% formalin, processed, and stained with Hematoxylin and Eosin (H&amp;E) for microscopic evaluation. Results: Histological analysis revealed significant alterations in the ND-treated group compared to controls. Kidney tissues from the ND group exhibited tubular dilation, epithelial degeneration, and necrosis with a noticeable increase in Bowman's space and vascular congestion. Quantitatively, tubular atrophy and degeneration were observed in 80% of the ND-treated animals, compared to none in the control and olive oil groups. Heart tissues in the ND group showed evidence of myocardial fibrosis and necrosis, with myocardial fibrosis observed in 70% of the steroid-treated animals, significantly higher than the control groups. Conclusion: The administration of Nandrolone Decanoate in Rattus norvegicus significantly impacts kidney and heart histology, underscoring the potential health risks associated with AAS use. These findings contribute to the growing body of evidence on the nephrotoxic and cardiotoxic effects of steroids, emphasizing the need for caution and further research in human healthcare to develop safer therapeutic alternatives.

Efficacy of Closed Continuous Lumbar Drainage on the Treatment of Postcraniotomy Meningitis: A Retrospective Analysis of 1062 Cases.

Do Perioperative Systemic Corticosteroids Improve Cochlear Implant Hearing Preservation Outcomes?

The efficacy of pharmacological interventions in sciatica is limited and the use of systemic steroids is still controversial. We aimed at evaluating the efficacy and tolerance of systemic steroids in sciatica. A systematic literature search was performed in the Medline, Embase and Cochrane databases until February 2010. Randomized placebo-controlled trials evaluating the efficacy and the tolerance of systemic steroids in sciatica were included. Efficacy and tolerance were assessed using the relative risk (RR) and 95% CI with the inverse variance method (RR > 1 means that the event is more likely to occur in the steroid group). We explored the heterogeneity between the studies using subgroup analysis. Seven studies (383 patients) were included. The difference in the rate of responders between both groups was not statistically significant (RR = 1.22, 95% CI 0.96, 1.56). The rate of adverse events was 13.3% for the patients in the steroid group and 6.6% for the placebo group (RR = 2.01, 95% CI 1.06, 3.80). The number needed to harm was 20 (95% CI 10, ∞). Twenty (15.3%) patients in the steroid group and seven (5.7%) patients in the placebo group underwent surgery. A trend towards a higher requirement for spinal surgery was observed in the steroid group (RR = 1.14, 95% CI 0.74, 1.75). The methodological quality slightly influenced the results. We did not find any publication bias. Steroid efficacy is not superior to the placebo in sciatica, but it has more side effects. The tolerance : efficacy ratio indicates against the use of systemic steroids in sciatica.

28. International perspectives on the current practice of acute spinal cord injury management: results of a global survey

Steroids are often administered at the time of transcatheter arterial chemoembolization (TACE), a standard treatment of hepatocellular carcinoma (HCC), with the expectation of preventing postembolization syndrome. Here we investigated the precise effects of steroids on TACE. We prospectively enrolled 144 HCC patients from 10 hospitals who underwent TACE. Three hospitals used steroids (steroid group, n=77) and the rest did not routinely use steroids (control group, n=67). The occurrence of adverse events and the algetic degree at 1-5 days post-treatment were compared between the groups. Fever (grades 0-2) after TACE was significantly less in the steroid group (56/21/0) compared to the control group (35/29/3, p=0.005, Cochran-Armitage test for trend). The suppressive effect of steroids against fever was prominent in females (p=0.001). Vomiting (G0/G1/ G2-) was also less frequent in the steroid group (70/5/2) versus the control group (53/10/3), but not significantly (p=0.106). The algetic degree and the grade of hematological adverse events, including hyperglycemia, did not differ between the groups. We conclude that the administration of steroids was useful for the prevention of adverse events after TACE in patients with HCC.

Non-Warfarin Oral Anticoagulants in Heparin-Induced Thrombocytopenia

Introduction: The efficacy and influence of steroids for reducing the incidence of proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) surgery remain controversial. Systematic review and meta-analysis were conducted to explore the effect of steroids versus placebo on risk of PVR. Methods: We searched PubMed, Embase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs), assessing the effect of steroid drugs as an adjunct for reducing the incidence of PVR after RRD surgery. This meta-analysis was performed using the random-effect model. Data were extracted by two reviewers independently; the quality of RCTs was assessed by the Cochrane risk-of-bias tool. We calculated risk ratio (RR) and the 95% confidence intervals (CIs) of all outcomes and plotted on forest plots. I2 accessed using the χ2 test was applied to quantify the degree of heterogeneity. Results: Four RCTs involving 478 patients (478 eyes) are included in the meta-analysis. There was no significant difference in the incidence of PVR recurrence between steroid groups and control groups (RR: 0.87, 95% CI: 0.70–1.08, p = 0.19). However, the incidence of recurrent PVR was lower in the steroid group (RR: 0.67, 95% CI: 0.46–0.99, p = 0.04) than in the control group when only PVR grades A and B were taken into consideration. Besides, steroids could significantly reduce the incidence of macular edema after surgery (RR: 0.64, 95% CI: 0.47–0.88, p = 0.007). The steroid group and control group had comparable outcomes of retinal reattachment rate and reoperation rate after primary surgery. Additionally, there was no significant difference of the incidence of epiretinal membrane, and the incidence of surgery required by epiretinal membrane. Conclusion: This meta-analysis reveals that RRD surgery combined with steroid drugs administration could significantly reduce the recurrence in PVR grade A and B subgroup, as well as the incidence of macular edema after surgery.

Tonsillectomy in children is a common procedure to treat obstructive sleep apnea and other respiratory conditions. However, it is associated with postoperative complications, including bleeding, pain, and postoperative nausea and vomiting. Non-steroidal anti-inflammatory drugs are often used for pain management, but their effects on postoperative bleeding risk remains controversial. This meta-analysis aims to evaluate the impact of NSAIDs on postoperative bleeding and PONV in children undergoing tonsillectomy by synthesizing evidence from RCTs. This study was conducted strictly in accordance with the PRISMA guidelines. After a thorough search of databases such as CNKI, Wanfang, Sinomed, PubMed, Embase, and the Cochrane Library, 26 randomized controlled trials were eventually included. Meta-analysis was performed using STATA software, and the impact on postoperative bleeding and postoperative nausea and vomiting was evaluated by relative risk (RR) and 95% confidence interval (CI). A total of 26 randomized controlled trials were included in the meta-analysis, involving 2717 pediatric patients. The risk of total postoperative bleeding [1.19, 95% CI (0.9, 1.58)], primary bleeding [RR=1.13, 95% CI (0.77-1.65)], and secondary bleeding [RR=1.36, 95% CI (0.86-2.14)] was not significantly affected by the use of NSAIDs during the perioperative period. Subgroup analysis showed that different types of NSAIDs and administration methods did not significantly increase the risk of postoperative bleeding. In addition, NSAIDs significantly reduced the incidence of PONV [RR=0.78, 95% CI (0.67-0.92)]. In conclusion, this study has not identified any correlation between the application of NSAIDs and an elevated risk of bleeding after tonsillectomy in children. It lends support to the notion that these drugs can serve as an effective alternative for analgesia after tonsillectomy in children, which helps to cut down the usage of opioid drugs and consequently mitigate their associated adverse effects. However, more high-quality RCTs are necessary to further confirm these results and refine postoperative management guidelines.

Background:Juvenile idiopathic arthritis (JIA) is the commonest chronic inflammatory arthritis in children. Its prevalence is 1/1000. The clinical presentation, prognosis, and response to treatment are very heterogeneous. The knees, ankles,...