Corticosteroides

Background: Shoulder osteoarthritis (OA) is a painful condition in which movement of
the shoulder becomes restricted. Treatment is aimed at pain reduction and maintain
or improve functions. Intra-articular steroid injections have proven to be an effective
and cost-effective treatment option. However, long-term use can weaken the shoulder
tendons and cause histological changes. Recently, botulinum toxin has been evaluated
for the treatment of the chronic joint pain. Its injection into the painful shoulder joints
may inhibit the inflammatory mediators and the neuropeptide release which act on
articular nociceptors and produce pain.
Objective: The present study compared the efficacy of ultrasound-guided intra-articular
Botox and corticosteroid injections in glenohumeral joint in terms of reduction of pain
scores and enhancing range of movement in patients with shoulder OA.
Methodology: Fifty eligible patients with shoulder OA were randomly assigned to two
groups of Botox and corticosteroid (each with 25 patients). Ultrasound-guided intraarticular injections were randomly performed in all participants. Patients were evaluated in terms of effect on pre-procedure pain scores, range of abduction, internal rotation and external rotation, at 2 weeks and 12 weeks after injection. Two-way ANOVA and t-tests were utilized to analyze the data.
Results: The study results indicated that the injection of Botox and corticosteroid in
the shoulder joint cause reduction in pain and increased range of movements of the
patients with glenohumeral OA. Botox injection exerts more long-lasting effects in
comparison to the corticosteroid group. Mean pain scores were lower in Botox group in comparison to the steroid group (2.75 vs. 4.24); patients in the Botox group experienced more pain reduction at week-12 and more increase in range of abduction, internal rotation and external rotation.
Conclusion: It is concluded that intra-articular Botox injection can be more useful than
intra-articular steroid injection in terms of pain reduction and function improvement.
Key words: Osteoarthritis; Botulinum toxin; Pain management; Acetylcholine; Receptors, Cholinergic
Citation: Hashemi SM, Khamene SMH, Nabi BN, Ghasemi M. Effects of ultrasound guided intraarticular botox vs. corticosteroids for shoulder osteoarthritis. Anaesth
Pain & Intensive Care 2018;22(3):355-360

Los corticoides son fármacos muy usados en la práctica clínica habitual que, sin embargo, se asocian a frecuentes efectos adversos neuropsiquiátricos. Se describe el caso clínico de un varón de setenta y un años que desarrolló síntomas maníacos tras toma de corticoides y que fue tratado de forma satisfactoria con quetiapina. A partir de este caso, se realiza una revisión de la manía inducida por corticoides.

Autores: María Dolores Sánchez García, Beatriz Pecino Esquerdo y Enrique Pérez Martínez

Intracortical neural probes enable researchers to measure electrical and chemical signals in the brain. However, penetration injury from probe insertion into living brain tissue leads to an inflammatory tissue response. In turn, microglia are activated, which leads to encapsulation of the probe and release of pro-inflammatory cytokines. This inflammatory tissue response alters the electrical and chemical microen-vironment surrounding the implanted probe, which may in turn interfere with signal acquisition. Dexamethasone (Dex), a potent anti-inflammatory steroid, can be used to prevent and diminish tissue disruptions caused by probe implantation. Herein, we report retrodialysis administration of dexa-methasone while using in vivo two-photon microscopy to observe real-time microglial reaction to the implanted probe. Microdialysis probes under artificial cerebrospinal fluid (aCSF) perfusion with or without Dex were implanted into the cortex of transgenic mice that express GFP in microglia under the CX3CR1 promoter and imaged for 6 h. Acute morphological changes in microglia were evident around the microdialysis probe. The radius of microglia activation was 177.1 mm with aCSF control compared to 93.0 mm with Dex perfusion. T-stage morphology and microglia directionality indices were also used to quantify the microglial response to implanted probes as a function of distance. Dexamethasone had a profound effect on the microglia morphology and reduced the acute activation of these cells.

Cortisol has a long history of use in women at risk of having a
preterm birth, and has proven value in lung maturation [1]. This
seems crucial to increase the likelihood of survival of pretermers
[2]. However, a number of side-effects are known to arise from
such ante-natal corticosteroids. These include an increase in the
levels of blood pressure in childhood [3] and adulthood [4], with an
increased risk of later hypertension and associated disorders.
Prenatal corticosteroids are also associated with a decrease in the
levels of I.Q. [5] and some wider cognitive deficits [6]. Data also
suggests changes in the levels of emotional reactivity, linking to an
increased risk of psychiatric classification and perhaps in drug
abuse [7, 8].

The concepts of allostatic load and overload, i.e. a dramatic increase in the allostatic load that predisposes to disease, have been extensively described in the literature. Here, we show that rats engaging in active offensive response (AOR) behavioral strategies to chronic predator scent stress (PSS) display less anxiety behavior and lower plasma cortisol levels versus rats engaging in passive defensive response (PDR) behavioral strategies to chronic PSS. In the same chronic PSS paradigm, AOR rats also have higher lactate and lower glutamate levels in amygdala but not in control-region hippocampus versus PDR rats. The implications of these findings for regulation of allostatic and stress responses, and post-traumatic stress disorder (PTSD) are discussed.

Introduction
Hydrogen sulfide (H2S) is a fundamental biological endogenous gas-mediator in the respiratory system. It regulates pivotal patho-physiological processes such as oxidative stress, pulmonary circulation, airway tone and inflammation.
Objectives
We herein describe the design and synthesis of molecular hybrids obtained by the condensation of several corticosteroids with different hydrogen sulfide releasing moieties.
Methods
All the molecules are characterized for their ability to release H2S both via amperometric approach and using a fluorescent probe. The chemical stability of the newly synthesized hybrid molecules has been investigated at differing pH values and in human serum.
Results
Prednisone-TBZ hybrid (compound 7) was selected for further evaluations. The obtained results from the in vitro and in vivo studies clearly show evidence in favor of the anti-inflammatory properties of the released H2S.
Conclusions
The protective effect on airway remodeling makes the hybrid Prednisone-TBZ (compound 7) as a promising therapeutic option in reducing allergic asthma symptoms and exacerbations.

Entamoeba histolytica is one of the most important enteric pathogens affecting people worldwide, causing the diarrheal disease amebic colitis. Fulminant amebic colitis is an uncommon but life threatening complication that may ensue. High rates of colonization with E. histolytica burden many developing countries, and travelers are at risk of acquisition of infection when they visit endemic areas. Corticosteroids are an invaluable group of broadly prescribed anti-inflammatory medications, but have been identified as a risk factor for the development of fulminant amebic colitis. Our comprehensive report highlights the frequent misdiagnosis of amebic colitis and the high morbidity and mortality associated with fulminant disease. Improved awareness of this condition among medical providers is needed, so that infection with E. histolytica can be considered in both patients presenting with symptoms of colitis and patients with asymptomatic colonization prior to the administration of corticosteroids. This study points to the need to continue efforts to develop both a vaccine that can prevent amebic colitis and innovative life- and bowel-saving adjuncts for the treatment of fulminant amebic colitis through an improved understanding of host responses to infection with E. histolytica.

Glucocorticoid hormones are known to influence widely interconnected brain networks, thereby enhancing the consolidation of memory of several types of training experiences. In this network, the dorsal stri-atum plays an important role in transforming goal-directed behavior into habitual behavior. Many studies have shown that the dorsolateral striatum (DLS) enables the formation of stimulus–response associations that are needed for procedural learning. In contrast, the dorsomedial striatum (DMS) is predominantly involved in influencing goal-directed behaviors via interactions with the dorsal hippocampus and medial prefrontal cortex. To date, most studies that have supported a functional dissociation of the dorsal striatum in memory have focused on the behavioral deficits produced by lesions or temporary inactivation of different striatal regions. Few studies have investigated the effect of pharmacological activation of the DMS in modulating memory of distinct kinds of spatial navigation. Therefore, in the present study corticosterone (CORT) was administered into the DMS immediately after training on either a place or cue water-maze task to investigate possible effects on the consolidation of spatial and procedural memory. Our findings indicate that CORT (5, 10 and 20 ng) enhanced 24-h retention of place training, without affecting retention of cue training. However, CORT administration after place and cue training did not shift the selection from a procedural to a spatial navigation strategy in a place-cue competition test. These findings support the functional heterogeneity of the dorsal striatum and suggest that the DMS can modulate the consolidation of allocentric spatial information via glucocorticoid action.

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. 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). 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 re...