Podcasts about glucocorticoids

In today's episode, Dr. Rahul Damania and Dr. Pradip Kamat welcome their new co-host, Dr. Monica Gray. They'll dive into the topic of upper airway obstruction in children and explore a case involving a 12-month-old girl who presents with stridor and fever. Throughout the discussion, they delve into the underlying causes, possible diagnoses, and management strategies. Key takeaways include the significance of keeping the child calm, ensuring proper positioning, and utilizing treatments such as dexamethasone and Racemic epinephrine. They'll also touch on advanced therapies and serious infections like epiglottitis. The episode highlights the importance of recognizing stridor, knowing when to consider PICU admission, and the effectiveness of low-dose dexamethasone. Tune in to learn more!Show Highlights:Overview of upper airway obstruction in pediatric patientsCase presentation of a 12-month-old girl with stridor and feverDiscussion on the pathophysiology of stridor and its clinical significanceDifferential diagnoses for stridor, including croup, epiglottitis, and foreign body aspirationManagement strategies for upper airway obstruction, including stabilization and medicationImportance of calming the child and optimal positioning during treatmentUse of dexamethasone and racemic epinephrine in managing croupAdvanced therapies, such as Helios, for specific casesIndicators for pediatric intensive care unit (PICU) admissionKey clinical points and takeaways for healthcare professionals managing airway emergenciesReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 47 Otteson T, Richardson C, Shah J: Diseases of the upper Airway. Pages 524-535Rogers Textbook of Pediatric Intensive Care: Chapter 25; Ong May Soo Jacqueline, Tijssen J, Bruins BB and Nishisaki A: Airway management. Pages 341-365Reference: Asmundsson AS, Arms J, Kaila R, Roback MG, Theiler C, Davey CS, Louie JP. Hospital Course of Croup After Emergency Department Management. Hosp Pediatr. 2019 May;9(5):326-332. doi: 10.1542/hpeds.2018-0066. PMID: 30988017; PMCID: PMC6478427.Reference: Aregbesola A, Tam CM, Kothari A, Le ML, Ragheb M, Klassen TP. Glucocorticoids for croup in children. Cochrane Database Syst Rev. 2023 Jan 10;1(1):CD001955. doi: 10.1002/14651858.CD001955.pub5. PMID: 36626194; PMCID: PMC9831289.Previous Episode Mentioned:PICU Doc On Call Episode 80

What are topical steroids? Often prescribed for chronic skin conditions, I'll bet you've probably used them at some point during your treatment.Sure, they work quickly, but are they without side effects? To answer that question, we need to talk about glucocorticoids, which are hormones naturally produced by the adrenal glands as part of the stress response.Topical steroids fall under the glucocorticoids category, and due to those who've experienced something called topical steroid withdrawal, some people are described by physicians as “steroid phobic.”While there are serious downsides, glucocorticoids can have some incredible anti-inflammatory effects on various health conditions. That's why it's crucial for us to have a nuanced conversation about this!Dr. Luis Franco joins me to discuss everything you've wanted to know about topical steroids, types of glucocorticoids, and concerns about side effects from using topical steroids.Dr. Luis Franco is a Tenure-Track Investigator at the National Institute of Musculoskeletal and Skin Diseases (NIAMS). He was born in Colombia and grew up between Colombia, Brazil, Mexico, and the United States. He attended medical school in Colombia before returning to the United States, initially as a postdoctoral fellow at Duke University. Dr. Franco attended Baylor College of Medicine for specialty training in internal medicine and medical genetics. In 2014, he moved to the National Institute of Health (NIH).In This Episode:What are topical steroids versus glucocorticoids?Are topical steroids + glucocorticoids bad?Cortisone vs cortisol (and glucocorticoids examples by name)Side effects of glucocorticoidsWhat is topical steroid withdrawal?How glucocorticoids modulate your immune systemQuotes“Glucocorticoids exist naturally. They are hormones that are produced by our bodies. And they're produced by this very particular gland that's above our kidneys, that's called the adrenal gland or the suprarenal gland. And so our adrenal glands produce these chemicals called glucocorticoids. And those chemicals have many, many roles in biology and the one that is sort of best understood is that they are part of the stress response.”“I think the side effects that are important to know for topical glucocorticoids are one, something called skin atrophy, which is kind of a thinning of the skin that people notice when they've been applying glucocorticoids for a long time. Some people also notice little, kind of red, blood vessels that come up. These are called telangiectasias. These are like reddish blood vessels that become very visible on the skin of people who have used topical glucocorticoids.”LinksFind Dr. Franco onlineHealthy Skin Show ep. 344: NEW RESEARCH On Topical Steroid Withdrawal Symptoms + TSW Red Skin TriggerTopical Steroids Potency ChartImmune regulation by glucocorticoids can be linked to cell type–dependent transcriptional responsesGlucocorticoid-induced eosinopenia results from CXCR4-dependent bone marrow migration

Drs. Zachary Wallace and Michael Putman continue their induction therapy discussion in patients with ANCA-associated vasculitis, reviewing the use of glucocorticoids, avacopan, and plasma exchange.

In this CCO Nephrology podcast episode, hear from nephrologists Pietro Canetta, MD, MS, and Andy Bomback, MD, PhD, experts in clinical management and research on glomerular diseases as they discuss key updates in managing IgAN. Faculty highlight the importance of a comprehensive supportive care regimen to protect patients' kidneys and prevent progression of disease. In addition, they review the merits and place in therapy of novel and emerging therapies.  Topics include:Supportive care as the foundation of IgAN managementPlace in therapy for new and emerging agentsTargeted-release formulation of budesonideEndothelin receptor antagonists (eg, sparsentan)Factor B inhibitors (eg, iptacopan)The role of clinical trial involvementLearn more about IgA nephropathy with educational activities and resources here:  CME-certified text module with animated pathophysiology video and patient voice audio clipClinicalThought commentariesResources on IgAN from the American Kidney Fund

Many people take over-the-counter supplements for a variety of reasons, but it isn’t always clear what’s in those supplements. And while they may be intended to help, some may cause harm. In this episode, host Aaron Lohr talks with Kevin Wei, MD, from the University of Southern California/Los Angeles General Medical Center Internal Medicine Residency Program about the presence of glucocorticoids in some over-the counter supplements and why that may be a concern. Dr. Wei and colleagues presented an abstract at ENDO 2024 titled, “Characterizing the Physiological Side Effects of Over-the-Counter Arthritis Supplements.” Show notes are available at https://www.endocrine.org/podcast/enp88-glucocorticoids-in-supplements — for helpful links or to hear more podcast episodes, visit https://www.endocrine.org/podcast.

199.  In a patient that is receiving prolonged systemic glucocorticoid therapy, which of the following groups of adverse effects is most likely to be observed by the therapist? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.

Show notes at pharmacyjoe.com/episode899. In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. The post 899: Glucocorticoids Have No Role Reversing the Acute Symptoms of Anaphylaxis. Here’s Why: appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode899. In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. The post 899: Glucocorticoids Have No Role Reversing the Acute Symptoms of Anaphylaxis. Here’s Why: appeared first on Pharmacy Joe.

Knowing that glucocorticoids significantly increase the risk of fractures and is the most common cause of secondary osteoporosis, the use of the steroid has always been viewed as a doubled edged sword and “Bad for the Bones”. This week, we welcome Dr. Giovanni Adami, first author of Bone Loss in Inflammatory Rheumatic Musculoskeletal Disease Patients Treated with Low-Dose Glucocorticoids and Prevention by Anti-Osteoporosis Medications , whose goal for this study was to assess if a “safe” dose of glucocorticoids exists, with an attention focus on those with inflammatory rheumatic musculoskeletal diseases (iRMDs) to determine if a low enough dose of glucocorticoids can still reduce inflammatory burden and yet significantly reduce expected risk of fracture. 

Within this episode, Heidi Hadley delves into the close connection of your brain and immune system.  Within this episode, you will discover the very close connection and the importance of managing the state of your nervous system.TO PURCHASE THE 3 PART WORKSHOP, THE 3 PILLARS OF TOTAL SOMATIC EDUCATION, CLICK HERE.***Learn how to work intelligently and kindly with your soma.***TO LEARN MORE ABOUT HEIDI HADLEY:FREE PDF DOWNLOAD - FAQ GUIDE:https://totalsomatics.com/faq-answer-guide/ONLINE SHOP:https://totalsomatics.com/audio-instruction/TO LEARN MORE:https://TotalSomatics.comWAIT LIST:https://totalsomatics.com/join-now/FREE EBOOK:https://totalsomatics.com/free-ebook-somatics-what-is-it-how-can-it-help-me/LISTEN TO PAST PODCAST EPISODES:https://totalsomatics.com/podcast/*********TOTAL SOMATICS FREE CHALLENGE***********https://totalsomatics.com/total-somatics-free-challenge/************************************************************FREE WEBINAR:https://totalsomatics.com/free-total-somatics-webinar/Support the show

Episode 141: Adrenal Insufficiency BasicsFuture doctor Wilson explains how to recognize an acute adrenal insufficiency and explains how to treat it. Also, chronic adrenal insufficiency is explained. Dr. Arreaza adds comments about congenital adrenal hyperplasia.Written by Candace Wilson, MSIV, American University of the Caribbean. Comments by Hector Arreaza, MD.June 2, 2023.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction: After having seen patients with adrenal insufficiency when I did a rotation in ICU, I saw how important it is to be able to recognize it quickly to ensure that patients receive appropriate treatment as quickly as possible. Arreaza: AI is adrenal insufficiency but also AI stands for Artificial intelligence, so we had the idea to ask Chat GPT what are the adrenal glands and this is what we got: “The adrenal glands are small endocrine glands located on top of each kidney. They are small in size, but they play a vital role in producing and secreting essential hormones.” (end of quote)Glucocorticoids play an important role in the mobilization of energy reserves by increasing gluconeogenesis, glycogen synthesis, protein catabolism, lipolysis, appetite, and insulin resistance. Each adrenal gland is composed of two main parts: the outer region called the adrenal cortex and the inner region called the adrenal medulla. These two regions have distinct structures and functions.” The adrenal cortex has three zones, Zona glomerulosa (mineralocorticoids, mainly aldosterone), Zona fasciculata (cortisol), and Zona reticularis (androgens). Mineralocorticoids are a class of steroid hormones produced by the Zona glomerulosa of the adrenal gland that influence electrolyte and water balance through modifying renal absorption of sodium and potassium.Definition of AI: AI is “inadequate functioning of the adrenal glands”. Adrenal gland hormones: glucocorticoids, mineralocorticoids, and sex hormones.Primary vs. secondary adrenal insufficiency.Candace: Primary adrenal insufficiency is caused either by the abrupt destruction of the adrenal gland or by progressive destruction/atrophy, whereas secondary adrenal insufficiency is due to conditions that impair the hypothalamic-pituitary-adrenal axis leading to decreased ACTH production. Causes of primary adrenal insufficiency includes autoimmune adrenalitis (which is the most common cause in the US); infectious adrenalitis (tuberculosis being the most common cause worldwide); adrenal hemorrhage; infiltration of the adrenal gland by tumors, amyloidosis, or hemochromatosis; adrenalectomy; cortisol synthesis inhibitors (such as rifampin, fluconazole, phenytoin, ketoconazole); 21B-hydroxylase deficiency; and vitamin B5 deficiency. Fluconazole is commonly used to treat pulmonary cocci (Valley Fever in our community). What about secondary causes?Causes of secondary adrenal insufficiency include sudden discontinuation of chronic glucocorticoid therapy; stress (such as infection, trauma, or surgery) during prolonged glucocorticoid therapy; and hypopituitarism. Clinical presentation of adrenal crisis.Adrenal insufficiency can present acutely or chronically with more insidious symptoms. We will first discuss the acutemanifestation of adrenal insufficiency, also known as adrenal crisis. In any patient who demonstrates vasodilatory shock, unexplained severe hypoglycemia, or unexplained hyponatremia whether or not the patient is known to have adrenal insufficiency, adrenal crisis should be considered a possibility. Adrenal crisis is a life-threatening emergency that requires immediate medical treatment and can occur in either primary or secondary adrenal insufficiency, though it is most common in patients with primary adrenal insufficiency. The main feature of adrenal crisis is shock, but patients may also have vague symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma. In patients with adrenal crisis from primary adrenal insufficiency, volume depletion and hypotension are the major clinical features, resulting from mineralocorticoid deficiency. In contrast, the patients with adrenal crisis from secondary adrenal insufficiency (which is an isolated glucocorticoid deficiency) will have hypotension secondary to decreased vascular tone without volume depletion.Treatment of adrenal crisis.Signs of an adrenal crisis should be recognized quickly, and management should be started as quickly as possible. When adrenal crisis is suspected, do not wait for laboratory results before initiating treatment as this is a life-threatening medical emergency. After all necessary laboratory tests have been collected (including serum electrolytes, glucose, routine measurement of plasma cortisol and ACTH) and IV access has been established, infuse 2-3L of isotonic saline or 5% dextrose in isotonic saline as quickly as possible and give bolus of hydrocortisone 100mg IV followed by 50mg IV every 6 hours or 200mg/24 hours as a continuous IV infusion for the first 24hrs. The answer to many endocrine emergencies is IV fluids, in this case, you also add hydrocortisone and mineralocorticoids.Alternative glucocorticoids if hydrocortisone is unavailable include methylprednisolone and dexamethasone. While patient is hemodynamically unstable, it is important to frequently monitor vital signs and serum electrolytes to avoid iatrogenic fluid overload. When the patient has stabilized, continue IV isotonic saline at a slower rate for 24-48 hours, and for patients with primary adrenal insufficiency, begin mineralocorticoid replacement with fludrocortisone 0.1mg orally daily when saline infusion is stopped. If there is concern for infectious precipitating cause of the adrenal crisis, perform an extensive infectious workup. Addison's disease.Early symptoms of chronic adrenal insufficiency can be vague and nonspecific (such as fatigue, weight loss, and GI complaints), making the clinical diagnosis more difficult than acute adrenal insufficiency. Diagnosis must be confirmed with a thorough endocrine evaluation to determine the type and cause of the adrenal insufficiency, but treatment should be started before the diagnosis is established in acutely ill patients. Primary and secondary adrenal insufficiency shares some common clinical manifestations, such as fatigue, weight loss, anorexia, nausea, vomiting, abdominal pain, amenorrhea, diffuse myalgia, arthralgia, confusion, delirium, stupor, depression, psychosis, mania, anxiety, disorientation, and hallucinations.Clinical manifestations of indicative of primary adrenal insufficiency include orthostatic hypotension, salt craving, hyperpigmentation especially of areas not typically exposed to sunlight (such as palmar creases, mucous membrane of the mouth), vitiligo (though hyperpigmentation is more common), hypotension, and auricular calcifications. Lab findings.Laboratory results will show electrolyte disturbances (such as hyponatremia, hyperkalemia, and hypercalcemia), azotemia, normocytic anemia, eosinophilia, increased renin, normal anion gap metabolic acidosis, hypoglycemia, increased ACTH, low cortisol, low aldosterone, increased cortisol releasing hormone, and decreased DHEA-S.Clinical manifestations of secondary adrenal insufficiency is similar to those in primary adrenal insufficiency with the notable exceptions of: hypotension (which is less prominent than in primary AI), absence of dehydration, pale skin as opposed to hyperpigmentation. Laboratory results in secondary adrenal insufficiency will show normal aldosterone, sodium, potassium, and renin; decreased ACTH and cortisol; and increased cortisol-releasing hormone.Treatment of chronic adrenal insufficiency. Treatment of primary adrenal insufficiency focuses on replacing hypocortisolism with glucocorticoids and hypoaldosteronism with mineralocorticoids. In contrast, the treatment of secondary adrenal insufficiency focuses on the replacement of hypocortisolism with glucocorticoids without the need to supplement aldosterone. Short-acting glucocorticoids (such as hydrocortisone) are the preferred medication for treatment since they roughly mimic the normal diurnal rhythm. Intermediate-acting (such as prednisone or prednisolone) and long-acting glucocorticoids (such as dexamethasone) are acceptable alternatives, especially in patients who are non-compliant with multiple-day dose schedules or those with severe late-evening or early-morning symptoms, but due to variable inter-individual metabolism of dexamethasone, be cautious of over-treating patients. Whether the patient is receiving short-acting, intermediate-acting, or long-acting, ensure that patients receive the lowest glucocorticoid dose that relieves symptoms while avoiding signs and symptoms of glucocorticoid excess (such as weight gain, facial plethora, truncal obesity, osteoporosis, etc.).Summary: Primary = Glucocorticoids and mineralocorticoids. Secondary = Glucocorticoids. Glucocorticoids can be short, intermediate, and long-acting. What about mineralocorticoids?Fludrocortisone 0.1mg/day is the preferred agent for mineralocorticoid replacement in patients with primary adrenal insufficiency, though patients who are receiving hydrocortisone therapy in conjunction may require a lower dose of 0.05mg/day. Mineralocorticoid therapy may need to be increased during the summer due to salt loss in perspiration. As a reminder, aldosterone works by controlling the reabsorption of sodium and excretion of potassium. It influences water reabsorption. It is part of the renin-angiotensin-aldosterone system (RAAS) to maintain blood pressure. In addition, it is important that patients receive adequate education about their medical condition and causes, whether it is primary or secondary adrenal insufficiency, especially the maintenance of medication, adjustment during minor illnesses, and when to consult a clinician.Bottom line: Adrenal insufficiency can be acute or chronic, primary or secondary. In primary adrenal insufficiency, laboratory results will show electrolyte abnormalities, such as hyponatremia and hyperkalemia, with increased ACTH. Whereas in secondary adrenal insufficiency, electrolytes will be normal, and ACTH will be decreased. Both primary and secondary adrenal insufficiency require treatment with glucocorticoid, but a mineralocorticoid should be added in the setting of primary adrenal insufficiency. _________________________Conclusion: Now we conclude episode number 141, “Adrenal Insufficiency Basics.” We encourage you to recognize acute adrenal insufficiency promptly and start IV fluids and glucocorticoid stat. Candace reminded us that chronic adrenal insufficiency presents with vague and insidious symptoms, including hypotension, fatigue, weight loss, anorexia, hyperpigmentation of the skin, and even vitiligo. Make sure to include our colleagues from endocrinology if you have concerns.   This week we thank Hector Arreaza and Candace Wilson. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Nieman, L. K. (n.d.). Diagnosis of adrenal insufficiency in adults. UpToDate. https://www.uptodate.com/contents/diagnosis-of-adrenal-insufficiency-in-adults. Accessed June 2, 2023.Nieman, L. K. (2022, October 25). Clinical manifestations of adrenal insufficiency in adults. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-of-adrenal-insufficiency-in-adults . Accessed June 2, 2023.Nieman, L. K. (2022a, October 19). Treatment of adrenal insufficiency in adults. UpToDate. Treatment of adrenal insufficiency in adults - UpToDate. Accessed June 2, 2023.Royalty-free music used for this episode: "Latina Havana Boulevard." Downloaded on October 13, 2022, from https://www.videvo.net/ 

KSQD 5-31-2023: Stress raises glucocorticoids and inflammation in the gut, thus causing irritable bowel syndrome; Mosquitos are attracted to terpenes in many soaps, but repelled by those with coconut oil; Editorial about gender selection and the altering of sexual development

Corticosteroids are a class of medications with well-studied effects on the immune system and some people living with ALS have reported benefits from them online. Here we review the pre-clinical and clinical data. We conclude that there is currently no clear evidence that steroids can slow ALS progression, and they can have many side effects.

Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR Cohort study  Dr Sara Muller (Keele University, UK) and Prof Samantha Hider (Keele University, UK) join Dr Sheilla Achieng to discuss a follow-up to the PMR cohort study, an inception cohort of 652 patients from English general practices who were diagnosed with PMR between 2012 and 2014. They identify the main findings from the follow-up and highlight that PMR is not always a time-limited condition. Read the full paper: Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR Cohort Study Want to find out more about polymyalgia rheumatica? Listen to this episode of our sister podcast, Talking Rheumatology Spotlight. Keywords: polymyalgia rheumatica, PMR, vasculitis, steroids, glucocorticoids, corticosteroids, prednisone, prednisolone, rheumatology.Thanks for listening to Talking Rheumatology Research! Join the conversation on Twitter using #TalkingRheumResearch, tweet us @RheumJnl, or find us on Instagram. Want to read more rheumatology research? Explore Rheumatology and Rheumatology Advances in Practice.

In this episode, we review the high-yield topic of Glucocorticoids from the Endocrine section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Managing Canine Arthritis 09/19/2011 If your dog experiences difficulty getting up, tires easily or seems stiff, arthritis may be the culprit. The most common type of canine arthritis is degenerative joint disease, or osteoarthritis, affecting one out of five adult dogs in the United Sates, the Arthritis Foundation recently reported. Osteoarthritis occurs when the cartilage protecting the bones of the joint is destroyed. The joint loses its cushion, causing friction between bones, leading to pain and decreased mobility in affected joints. Inflammation of the cartilage can also stimulate bony growths (spurs) to form around the joints. Since cartilage has no nerve supply, damage can progress with no outward symptoms until the joint is severely damaged and the lubricating fluid has lost its ability to protect the bone surfaces. Although any joint in a dog's body can be affected by arthritis, the most commonly affected joints are the hips, elbows, lower back, knees and wrists. The other less common type of arthritis affecting dogs is inflammatory joint disease, usually caused by an infection, such as bacterial or fungal infection, tick-borne disease and Rocky Mountain spotted fever. This type of arthritis can also be caused by an underlying defect in your dog's immune system, which may be hereditary. Factors contributing to a dog developing arthritis include aging, congenital joint disorders like hip dysplasia, osteochondrosis, elbow dysplasia, old injuries, repeated trauma to joints, activity levels in working and athletic dogs placing increased stress on joints, obesity, and metabolic diseases such as diabetes and Cushing's disease. Arthritis symptoms include stiffness, lameness, or limping after rest; appetite loss or unusual weight gain; inactivity and sleeping more; reluctance to walk, run or climb stairs; unusual urinating in the house; and irritability and other behavioral changes. A veterinarian can diagnose arthritis based on your dog's age, medical history, and a physical exam. X-rays of the joints may be necessary to determine severity of disease. Non-medical approaches to minimize arthritic aches and pains include: Weight control. If your dog is overweight, this puts added stresses on joints, causing greater joint damage and more severe arthritis. Helping your dog lose weight will help minimize further joint damage. A recent collaborative study between the Universities of Glasgow and Utrech found that weight loss among obese dogs with osteoarthritis dramatically improved lameness and mobility.  Food. The right mix of dietary fatty acids can do more than improve your dog's skin and coat. Research shows that eicosapentaenoic acid (EPA), an omega-3 fatty acid, can help reduce inflammation, help limit damage to cartilage and reduce the symptoms of arthritis in dogs. Ask your veterinarian for foods that provide high levels of EPA. Exercise. Light to moderate exercise helps keep stiff joints supple and mobile. The exact exercise requirements depend on the individual dog, with 15 to 20 minutes of exercise twice daily often recommended, rather than one long, 40-minute walk. Ideal is swimming, a low-impact activity that improves muscle mass without overstressing joints. Animal physical rehabilitation. Most academic centers and many large private practices have certified rehabilitators today. Rehabilitation therapy can include underwater treadmills, ultrasound therapy and electric stimulation. Like techniques used to help humans with arthritis, canine physical therapy utilizes applications of cold and heat, massage, stretching and range-of-motion exercises to maintain joint health and muscle strength. Rehabilitation can relieve pain and promote cartilage, tendon and ligament health. Natural over-the-counter treatments. Pills or food containing glucosamine and chondroitin sulfate or Omega fatty acids have shown to ease arthritis symptoms in dogs. Acupuncture and massage. Although controlled clinical studies are lacking, there are many anecdotal reports on the use of acupuncture to help relieve pain from hip dysplasia and degenerative joint disease in dogs. You can also gently massage your dog's painful joints to help restore blood flow. Medically managing canine arthritis is aimed at controlling pain, increasing mobility, slowing down joint degeneration and encouraging cartilage repair. Options include: Non-Steroidal Anti-Inflammatory Drugs. NSAIDs). Aspirin and many other modern and prescription medications like Rimadyl reduce pain and inflammation. Because of the side-effects associated with the use of anti-inflammatory drugs, many vets will choose to run a blood test to ensure that the liver and kidneys are in working order before initiating this treatment. Glucocorticoids (commonly known as steroids or cortisone). Given as tablets or injections, these drugs have a higher anti-inflammatory effect than NSAIDs, but long-term use may cause more obvious and serious side effects. Chondroprotectants. Helping protect cartilage as it attempts to repair itself, these drugs are increasingly popular in treating degenerative joint disease. This category includes the FDA-approved Adequan for management of degenerative joint disease in dogs, which works by inhibiting enzymes that contribute to cartilage destruction. Administered by intramuscular injection, studies show when puppies diagnosed with hip dysplasia were given Adequan before arthritic changes occurred, their radiographs showed significant improvement and development of degenerative joint disease was delayed. Surgery. If your dog's joints become severely damaged or if the pain is intense, your veterinarian may recommend surgery to reduce pain and improve movement and function. Among the different kinds of procedures for degenerative arthritis is arthroscopic surgery, which involves making small incisions through which the surgeon can clean cartilage debris from the joint. Other surgeries are aimed at repairing bone deformity, fusing joints or rebuilding part of a joint. Your dog may also undergo an operation to replace a damaged joint with an artificial joint. Preventing or delaying arthritis later in life can begin in puppyhood with these strategies: If you're buying a purebred puppy, choose a reliable breeder who should have X-rays taken of hips and elbows to prevent dogs with poor joint conformation from breeding. Don't let your puppy eat too much or over-exercise. Providing a wholesome diet with added calcium and omega 3 may also help delay or prevent arthritis. Providing a comfortable sleeping space for your puppy will help prevent him from laying in awkward positions and relieve unnecessary pressure on his joints.

In this episode, we review the high-yield topic of Glucocorticoids from the Endocrine section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbulletsIn --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

Dr Marwan Bukhari (Royal Lancaster Infirmary, UK) and Prof. Maarten Boers (Amsterdam UMC, The Netherlands) join Dr Ai Lyn Tan to discuss the effects of glucocorticoids on bone health. Their observational data suggest that glucocorticoids do not have the detrimental impact on bone health that we have come to expect – a rather controversial finding indeed.Read the paper: https://doi.org/10.1093/rap/rkab089The GLORIA trial discussed is available here: https://ard.bmj.com/content/81/7/925

Un nouvel épisode du pharmascope est maintenant disponible! Dans de ce 96ème épisode, Nicolas, Sébastien, Isabelle et leur invitée poursuivent leur discussion à propos de divers sujets associés au monde des allergies. Et oui, à la demande générale, on parle de calamine! Les objectifs pour cet épisode sont les suivants: Comparer l'efficacité de l'olopatadine 0,77% aux autres formulations disponiblesDiscuter de la littérature portant sur l'utilisation de calamine et d'acétate d'aluminium en démangeaisonDiscuter de l'utilisation de hautes doses d'antihistaminiques en contexte d'urticaireConseiller un patient sur l'application de corticostéroïdes topiquesReconnaître la littérature portant sur l'utilisation d'antihistaminiques, de corticostéroïdes et d'épinéphrine en anaphylaxie Ressources pertinentes en lien avec l'épisode Étude portant sur l'olopatadine 0,77%McLaurin E et coll. Pooled analysis of two studies evaluating efficacy and safety of olopatadine hydrochloride 0.77% in patients with allergic conjunctivitis. Clin Ophthalmol. 2017;11:1089-97. Étude portant sur la calamineMak MF et coll. Calamine lotion to reduce skin irritation in children with cast immobilisation. J Orthop Surg. 2013;21:221-5. Études portant sur les hautes doses d'antihistaminiques en urticaireFinn Jr AF et coll. A double-blind, placebo-controlled trial of fexofenadine HCl in the treatment of chronic idiopathic urticaria. J Allergy Clin Immunol. 1999;104:1071-8. Nelson HS et coll. Fexofenadine HCl is safe and effective for treatment of chronic idiopathic urticaria. Ann Allergy Asthma Immunol. 2000;84:517-22. Références portant sur la corticophobie topique et l'utilisation d'unités phalangettesLi AW et coll. Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review. JAMA Dermatol. 2017;153:1036-42. Eichenfield Lf, et coll. Translating Atopic Dermatitis Management Guidelines Into Practice for Primary Care Providers. Pediatrics (2015) 136 (3): 554–565. Diverses études et guide de pratique portant sur l'utilisation des traitements en anaphylaxieSheikh A et coll. H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review. Allergy. 2007;62:830-7. Nurmatov UB et coll. H2-antihistamines for the treatment of anaphylaxis with and without shock: a systematic review. Ann Allergy Asthma Immunol. 2014;112:126-31. Choo KJ et coll. Glucocorticoids for the treatment of anaphylaxis. Cochrane Database Syst Rev. 2012;2012:CD007596. Shaker MS et coll. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145:1082-123. De Silva D et coll. Diagnosing, managing and preventing anaphylaxis: Systematic review. Allergy. 2021;76:1493-506. Pruri”t”et Scorbu”t”Office québécois de la langue française. Banque de dépannage linguistique. La prononciation: Mots de terminant par un -t final précédé d'une voyelle. Gouvernement du Québec. Mars 2021.

Anti-inflammatory agents and immunomodulators are key components to treating patients who are severely or critically ill due to a COVID-19 infection.In this episode, Vikramjit Mukherjee, MD, discusses the role and timing of these treatment options, including:High-titer convalescent plasmaCorticosteroidsInterleukin-6 inhibitors (eg, tocilizumab)Janus kinase inhibitors (eg, baricitinib)Presenter:Vikramjit Mukherjee, MDAssistant Professor of MedicineDivision of Pulmonary, Critical Care, & Sleep MedicineNew York University School of MedicineDirector, Medical Intensive Care UnitBellevue HospitalNew York, New York Review the downloadable slidesets at: https://bit.ly/35NNb7QLink to full program: https://bit.ly/35SrxQ0

Glucocorticoids can do a lot of harm over time. In this episode, John Stone, MD, MPH, walks us through the Glucocorticoid Toxicity Index (GTI), a validated tool to measure steroid toxicity over time that we'll be seeing more of in the future. Intro :11 Stone introduction :26 About the GTI 1:13 Professional development opportunities for rheumatologists 2:32 The interview 4:27 What is the GTI, how did it come about and how do you think rheumatologists now and in the future will be utilizing it? 5:28 What are the difficulties in measuring steroid toxicities in trials? 10:58 How did you go about putting this instrument together? 13:04 What makes up the GTI? 19:11 Can you explain the Cumulative Worsening Score and the Aggregate Improvement Score? 20:53 Walk us through a patient coming in and being evaluated for the GTI 25:49 What's the future of the GTI in your opinion? 30:32 Do you think the GTI is going to be something that can eventually be used in day-to-day clinical practice? 33:42 Thank you, Dr. John Stone 34:43 John Stone, MD, MPH, is director of clinical rheumatology at Massachusetts General Hospital. Disclosures: Brown reports no relevant financial disclosures. Stone is one of the experts who developed the Glucocorticoid Toxicity Index.  We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum

Metabolic resuscitation is an adjunctive therapy for sepsis and septic shock, which consists of a combination of vitamin C, glucocorticoids, and vitamin B1 or their components. Recently, there has been considerable interest in this treatment. However, due to the wide range of combinations of its components, there is no evidence for the effectiveness of this therapy. To fill this gap, a network meta-analysis (NMA) and component NMA was conducted. This analysis summarised the available evidence concerning these therapies and determined any incremental effect of each component when added to sepsis treatment. In the following podcast, Dr Fuji explains the methodology employed and details the study results. Original paper: https://doi.org/10.1007/s00134-021-06558-0 (Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis.) Speakers: Tomoko FUJII. Intensive Care Unit, Jikei University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 (JP). Australian and New Zealand Intensive Care Research Centre. Inès LAKBAR. Service Anesthésie - Réanimation Pr LEONE - AP-HM - Hôpital Nord - Marseille (FR).

Glucocorticoids and CV risk in RA: Drs. Aurelie Najm and Jon Giles Might Tofacitinib Reduce Malignancy Risk with Patients with RA? Dr. Jonathan Kay Rheumatic Diseases Can Take your Breath Away: Dr.Janet Pope Best of PsA Day 4 (Tuesday): MACE in PsA:  Dr. Rachel Tate Predicting Progression from Psoriasis to PsA: Dr. Robert Chao David Liew Interview Dr. Seoyoung Kim About Tofacitinib and Malignancy Risk. Third Time's the Charm - COVID Vaccination While on Rituximab: Dr. Yuz Yusof Can We Stop Medication in Systemic JIA? Dr. Bella Mehta Day 4 SpA Highlights - Pregnancy in SpA and Drug Monitoring: Dr. Robert Chao

Glucocorticoids and CV risk in RA: Drs. Aurelie Najm and Jon Giles Might Tofacitinib Reduce Malignancy Risk with Patients with RA? Dr. Jonathan Kay Rheumatic Diseases Can Take your Breath Away: Dr.Janet Pope Best of PsA Day 4 (Tuesday): MACE in PsA: Dr. Rachel Tate Predicting Progression from Psoriasis to PsA: Dr. Robert Chao David Liew Interview Dr. Seoyoung Kim About Tofacitinib and Malignancy Risk. Third Time's the Charm - COVID Vaccination While on Rituximab: Dr. Yuz Yusof Can We Stop Medication in Systemic JIA? Dr. Bella Mehta Day 4 SpA Highlights - Pregnancy in SpA and Drug Monitoring: Dr. Robert Chao

On this week's SciFiles, your hosts Chelsie and Daniel interview Nick Chargo. Nick's research is focused on preventing osteoporosis by changing the composition of the bacteria in the gut. Menopause is a well-known cause of osteoporosis, but the bone loss also occurs as a side effect of some diseases and medications. One phenomenon associated with conditions that cause osteoporosis is gut bacterial changes (aka dysbiosis). The main goal of Nick's project is to understand how dysbiosis leads to bone loss and how to prevent it. He is specifically studying glucocorticoid-induced osteoporosis. Glucocorticoids are anti-inflammatory drugs used chronically to treat many conditions including rheumatoid arthritis, COPD, asthma, and inflammatory bowel disease to name a few, and are the second leading cause of osteoporosis. The lab he works in has shown that changing the gut bacteria composition by supplementing the diet with either pre- or probiotics can prevent osteoporosis. Probiotics are “good” bacteria that improve the health of the host while prebiotics are compounds that essentially feed the probiotic bacteria. Importantly, both are natural and confer little to no side effects while effectively preventing bone loss in various models of dysbiosis-induced osteoporosis. Overall, Nick's research will explore new avenues to improve the treatment and prevention of glucocorticoid-induced osteoporosis. If you're interested in talking about your MSU research on the radio or nominating a student, please email Chelsie and Danny at scifiles@impact89fm.org. Check The Sci-Files out on Twitter, Facebook, Instagram, LinkedIn, and YouTube! 

During this episode, Lynora Saxinger, MD, FRCPC, CTropMed, updates listeners on the latest Emergency Use Authorizations and guideline recommendations for optimal clinical management of COVID-19. Gain practical insights on patient identification, risk stratification, and treatment.Key points include:Treatment of COVID-19 can be broken into antiviral and immune-modulating therapiesEach agent should be used at the correct disease stage to maximize benefitAntiviral medications and mAbs show the greatest promise early during COVID-19, before the host immune response is mountedPassive immunization with mAbs can prevent infection and severe disease—and mortality—if given early to hospitalized personsOperational challenges to using these medications exist, but given the epidemic of unvaccinated persons, these treatments become increasingly relevant to reduce burden on healthcare systemsPresenter:Lynora Saxinger, MD, FRCPC, CTropMedCochair, Scientific Advisory Group  Alberta COVID-19 Emergency Coordination Centre  Associate ProfessorDivision of Infectious DiseasesDepartment of Medicine  University of AlbertaEdmonton, Alberta, CanadaContent based on an online CME program supported by an educational grant from Gilead Sciences, Inc.Follow along with the slides at:https://bit.ly/3BxQKtD Link to full program:https://bit.ly/3BwzdlC

Show notes at pharmacyjoe.com/episode640. In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. The post 640: Why Glucocorticoids Have No Role Reversing the Acute Symptoms of Anaphylaxis appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode640. In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. The post 640: Why Glucocorticoids Have No Role Reversing the Acute Symptoms of Anaphylaxis appeared first on Pharmacy Joe.

Eric Kuelker Ph.D. R.Psych. discusses reliable but little-known research linking cancer and heart disease to traumatic life events and stress. It turns out that psychotherapy and relationship repair reduces the chances of cancer and factors like marriage extend life more than medical treatments do. This may extend it down to the cellular level.Eric's website is https://psychologicalinjuryindex.com/References:Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. Aug;2(8):e356-e366. https://pubmed.ncbi.nlm.nih.gov/29253477/Roberts AL, Huang T, Koenen KC, Kim Y, Kubzansky LD, Tworoger SS. (2019) Post-traumatic stress disorder is associated with increased risk of ovarian cancer: A prospective and retrospective longitudinal cohort study. Cancer Res. Oct 1;79(19): 5113-5120. https://pubmed.ncbi.nlm.nih.gov/31488422/ Lu D, Sundström K, Sparén P, Fall K, Sjölander A, Dillner J, Helm NY, Adami HO, Valdimarsdóttir U, Fang F. (2016). Bereavement is associated with an increased risk of HPV infection and cervical cancer: An epidemiological study in Sweden. Cancer Res. Feb 1;76(3): 643-51. https://pubmed.ncbi.nlm.nih.gov/26634926/Flaherty RL, Owen M, Fagan-Murphy A, Intabli H, Healy D, Patel A, Allen MC, Patel BA, Flint MS. (2017) Glucocorticoids induce production of reactive oxygen species/reactive nitrogen species and DNA damage through an iNOS mediated pathway in breast cancer. Breast Cancer Res. Mar 24;19(1):35. https://pubmed.ncbi.nlm.nih.gov/28340615/ Morath J, Moreno-Villanueva M, Hamuni G, Kolassa S, Ruf-Leuschner M, Schauer M, Elbert T, Bürkle A, Kolassa IT. (2014) Effects of psychotherapy on DNA strand break accumulation originating from traumatic stress. Psychotherapy and Psychosomatics. 83(5):289-97. https://pubmed.ncbi.nlm.nih.gov/25116690/ Bellis MA, Hughes K, Ford K, Ramos Rodriguez G, Sethi D, Passmore J. (2019) Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Health. Oct;4(10): e517-e528. https://pubmed.ncbi.nlm.nih.gov/31492648/Ziegler C, Richter J, Mahr M, Gajewska A, Schiele MA, Gehrmann A, Schmidt B, Lesch KP, Lang T, Helbig-Lang S, Pauli P, Kircher T, Reif A, Rief W, Vossbeck-Elsebusch AN, Arolt V, Wittchen HU, Hamm AO, Deckert J, Domschke K. (2016). MAOA gene hypomethylation in panic disorder: Reversibility of an epigenetic risk pattern by psychotherapy. Transl Psychiatry. Apr 5;6(4):e773. doi: 10.1038/tp.2016.41 https://pubmed.ncbi.nlm.nih.gov/27045843/Roberts S, Lester KJ, Hudson JL, Rapee RM, Creswell C, Cooper PJ, Thirlwall KJ, Coleman JR, Breen G, Wong CC, Eley TC. (2014). Serotonin transporter [corrected] methylation and response to cognitive behavior therapy in children with anxiety disorders. Transl Psychiatry. Sep 16;4(9):e444. https://pubmed.ncbi.nlm.nih.gov/25226553/Roberts S, Keers R, Breen G, Coleman JRI, Jöhren P, Kepa A, Lester KJ, Margraf J, Scheider S, Teismann T, Wannemüller A, Eley TC, Wong CCY. (2019). DNA methylation of FKBP5 and response to exposure-based psychological therapy. Am J Med Genet B Neuropsychiatr Genet. Mar;180(2):150-158. https://pubmed.ncbi.nlm.nih.gov/30334356/Levy-Gigi E, Szabó C, Kelemen O, Kéri S. (2013). Association among clinical response, hippocampal volume, and FKBP5 gene expression in individuals with posttraumatic stress disorder receiving cognitive behavioral therapy. Biol Psychiatry. Dec 1;74(11): 793-800. doi: 10.1016/j.biopsych.2013.05.017 https://pubmed.ncbi.nlm.nih.gov/23856297/Quidé Y, Witteveen AB, El-Hage W, Veltman DJ, Olff M. (2012). Differences between effects of psychological versus pharmacological treatments on functional and morphological brain alterations in anxiety disorders and major depressive disorder: A systematic review. Neurosci Biobehav Rev. Jan;36(1): 626-44. https://pubmed.ncbi.nlm.nih.gov/21963442/Bossini L, Santarnecchi E, Casolaro I, Koukouna D, Caterini C, Cecchini F, Fortini V, Vatti G, Marino D, Fernandez I, Rossi A, Fagiolini A. (2017). Morphovolumetric changes after EMDR treatment in drug-naïve PTSD patients. Riv Psichiatr. Jan-Feb;52(1): 24-31. https://pubmed.ncbi.nlm.nih.gov/28287194/Aizer AA, Chen MH, McCarthy EP, et al. Marital status and survival in patients with cancer. (2013) J Clin Oncol. 31: 3869‐3876. https://pubmed.ncbi.nlm.nih.gov/24062405/Mirosevic S, Jo B, Kraemer HC, Ershadi M, Neri E, Spiegel D. (2019). "Not just another meta-analysis": Sources of heterogeneity in psychosocial treatment effect on cancer survival. Cancer Med. Jan;8(1): 363-373. https://pubmed.ncbi.nlm.nih.gov/30600642/https://www.health.harvard.edu/heart-health/the-genetics-of-heart-disease-an-updateLevin M (2019) The Computational Boundary of a “Self”: Developmental Bioelectricity Drives Multicellularity and Scale-Free Cognition. Front. Psychol. 10:2688. https://pubmed.ncbi.nlm.nih.gov/31920779/ See acast.com/privacy for privacy and opt-out information.

This week join your patient co-hosts, Tiffany Westrich-Robertson, CEO of the International Foundation for Autoimmune and Autoinflammatory Arthritis (AiArthritis), and recurring 2021 patient co-host Deb Constien as they welcome two special guests to the table for a new episode of our Special Series on COVID-19. They are joined today by two practicing adult rheumatologists: Dr. Al Kim ("Al") of the Washington University School of Medicine and Dr. Jeff Sparks ("Jeff") of the Harvard School of Medicine *.  This debrief they focus on sessions that involved communication and office visit needs (patient side and rheumy side), as well as shared-decision making and the evolution of visits to include discussions on comorbidities (and multi-morbidities).  The rheumies also update us on COVID-19 vaccinations and new research.  Jeff received an abstract award at the conference for his research on COVID-19 disease outcomes for patients taking immunosuppressant medications and Al is doing research, led by Washington University, tracking vaccine response in autoimmune patients.  Shared decision making about therapeutic plans, including vaccination, is the other hot topic for the day! The rheumies and our co-hosts dish about the topics on patients' minds including antibodies, boosters, and next steps. And Tiffany gives a special thank you to Janssen Pharmaceuticals for investing in the organizations new initiative to prepare patients to engage in shared decision making about COVID-19 and vaccines.    This special episode was recorded during a EULAR 2021 debrief. You can watch the entire, unedited video recording (that also includes Katie and Patrice) HERE.  While there, watch all of our EULAR 2021 content on our YouTube Channel. *Actually, at minute marker 20 in the full video, Al and Jeff zoom-bombed our patient-led debrief, the first time non-patient stakeholders were invited to the table for this series. But it was about rheumy communication, so why not?!    Now, if you are a patient, a parent of a juvenile patient, or any other stakeholder (doctor, nurse, researcher, industry representative, or other health services person) - are you ready to join the conversation? It's your turn to pull up a seat. Join our new AiArthritis Voices program, where people living with AiArthritis diseases and other stakeholders who we need 'at the table' to solve problems that impact education, advocacy, and research sign up to have a voice in our initiatives. By signing up, you'll get notified of opportunities to be more involved with this show - including submitting post-episode comments and gaining insider information on future show topics. JOIN TODAY!   AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/talkshow. Find us on Twitter, Instagram, or Facebook (@ifAiArthritis) or email us (podcast@aiarthritis.org) to have your seat at the table.   Episode 63: COVID-19, Vaccinations, Shared-Decision Making, & Rheumy Communications 01:37 - Tiffany welcomes listeners. 03:12 - Tiffany is joined today by recurring co-host Deb and rheumatologists Dr Al Kim and Dr Jeff Sparks. 05:16 - Today's episode will focus on COVID-19 vaccinations and new research on COVID-19, as well as the launch of a new AiArthritis initiative to promote shared decision making regarding COVID-19 vaccinations. 07:47 - Thank you to Johnson & Johnson for funding our work on this important initiative.  09:01 - Jeff explains his award-winning research abstract presented at EULAR 2021. 10:33 - Jeff's research found that COVID-19 patients who were taking Rituximab and JAK inhibitors prior to diagnosis had more severe disease courses compared to patients who were not treated with these drugs or were treated with different DMARD or Biologics. 10:58 - This is especially interesting because some trials have shown that JAK inhibitors can be effective in treating COVID-19 in patients who were not taking immunosuppressant medications prior to diagnosis. 13:19 - COVID-19 is a unique disease in that it creates a second stage inflammatory state where immunosuppressants can be helpful in preventing death and facilitating recovery. 13:48 - Research from Yale shows that a patient's ability to produce antibodies effectively in the early stage of the disease is crucial to preventing the more serious form of the disease, so patients taking immunosuppressants have an increased risk of developing severe COVID even though these drugs are helpful in treating the disease in the second stage. 15:32 - AiArthritis (in conjunction with EULAR PARE) just launched the Pathway of Patient Engagement in Rheumatology Research, which features Jeff's research abstract. 16:32 - What should patients be preparing for before their rheumatology appointments as new information about COVID-19 and vaccines continues to develop? 17:00 - Al still thinks that testing patients for antibodies doesn't make sense because antibody status is not actionable information from the rheumatologist's perspective. 17:47 - Prophylactic monoclonal antibodies are substantially restricted because they have only been approved under an Emergency Use Authorization by the FDA, so your rheumatologist cannot just prescribe them for you because your vaccine did not yield COVID-19 antibodies. 18:05 - Booster shots for COVID-19 have also not been approved by the FDA yet, so some patients are lying about their vaccination status to get a second set of shots.  Please note that neither AiArthritis nor the rheumatologists appearing in this episode recommend this course of action. 22:21 - Rituximab is generally considered to be a very safe drug, but it elevates risk for patients with COVID-19. 23:06 - This raises questions for doctors about whether they should continue prescribing it in light of the risk that patients may be facing from COVID-19. 23:15 - It will be very important for patients to engage in shared decision making with regard to drugs that elevate COVID-19 risks. 24:11 - Special thanks to Janssen Pharmaceuticals for their support in funding our work on promoting shared decision and helping patients with regard to COVID-19 vaccination decisions. 26:36 - To watch the entirety of this conversation, check out our EULAR debrief video #6 on our YouTube Channel. 26:55 - If you are interested in going to conferences with us, find out how you could attend a conference with us at aiarthritis.org/conferences. 27:11 - You can also find any of our previous podcast episodes at aiarthritis.org/talkshow. 27:17 - Please consider donating at aiarthritis.org because we need your support to keep this show and all of our initiatives moving forward. 27:54 - Tiffany thanks listeners for their support.   Links discussed in this debrief: 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis - https://ard.bmj.com/content/early/2021/06/13/annrheumdis-2021-220249 Exploring intentional medication non-adherence in patients with systemic lupus erythematosus: the role of physician-patient interactions - https://pubmed.ncbi.nlm.nih.gov/33604502/ Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry - https://pubmed.ncbi.nlm.nih.gov/34049860/ Glucocorticoids and B Cell Depleting Agents Substantially Impair Immunogenicity of mRNA Vaccines to SARS-CoV-2 - https://www.medrxiv.org/content/10.1101/2021.04.05.21254656v2.full.pdf Learn more about the Pathway of Patient Engagement in Rheumatology Research: www.rheumactioncouncil.org/pathway   Be sure to check out our top-rated show on Feedspot!  

Editor's Summary by Gregory Curfman, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the June 1, 2021 issue.

In this episode of ARA Audio Rheum, ARA President Prof. Catherine Hill talks to Prof. Liana Fraenkel. Prof. Fraenkel is the principal investigator of the 2020 ACR Guidelines for pharmacological management of rheumatoid arthritis (RA). In this podcast they discuss the contemporary role of methotrexate and glucocorticoids in RA.

Compound found in some vegetables may reduce diabetes-related kidney damage Phenethyl isothiocyanate, derived from watercress and other cruciferous vegetables, shows benefits Al-Maarefa University (Saudi Arabia), April 27, 2021 New research conducted in rats suggests a compound that gives some cruciferous vegetables their pungent taste could help to reverse kidney problems associated with diabetes.  It is estimated that about one-quarter of people with diabetes will eventually develop diabetic nephropathy, a gradual loss of kidney function eventually requiring dialysis. The condition is a leading cause of chronic kidney disease in the U.S. and is also associated with a high risk of heart disease. There is currently no cure.  For the new study, researchers assessed the effects of phenethyl isothiocyanate (PEITC) in rats with diabetic nephropathy. PEITC is found in several types of vegetables but is most concentrated in watercress.  "Our study provides, for the first time, evidence that PEITC might be effective as a naturally occurring agent to reverse serious kidney damage in people with diabetes," said lead study author Mohamed El-Sherbiny, PhD, a postdoctoral fellow at AlMaarefa University in Riyadh, Saudi Arabia. "Our study introduces mechanistic evidence of how PEITC might manage kidney injury associated with diabetes by targeting multiple interconnected pathways involved in diabetic nephropathy, including inflammation, glycation and oxidative status." El-Sherbiny will present the research at the American Association for Anatomy annual meeting during the Experimental Biology (EB) 2021 meeting, held virtually April 27-30.  Previous studies have suggested sulforaphane, a related compound in cruciferous vegetables, also helps reduce diabetes-associated kidney damage. The new study bolsters the evidence that eating more vegetables containing these compounds could help people with diabetes to stave off kidney problems.  "PEITC seems to manage one of the most serious and painful diabetic complications. Luckily, PEITC is naturally present in many dietary sources, importantly watercress, broccoli, turnips and radish," said El-Sherbiny.  Since the research was conducted in animal models, further studies will be needed to confirm the findings and understand how the results could translate to new treatments or dietary recommendations for people with diabetes.   Eating probiotic foods helps improve bone health in women Kyung Hee University (South Korea), April 23, 2021 A recent study by researchers at Kyung Hee University (KHU) in South Korea presents a good example of how powerful probiotics are and how they can be used for medicinal purposes. The researchers examined the effects of probiotics on vaginosis caused by the bacterium, Gardnerella vaginalis, and osteoporosis induced by ovariectomy. They reported that probiotics, specifically, anti-inflammatory bacteria isolated from kimchi, caused significant improvements in female mice with the above-mentioned conditions. The researchers discussed their findings in an in an article published in the Journal of Medicinal Food. Probiotics from fermented food offer substantial benefits for women Bacterial vaginosis (BV) is a type of inflammation caused by the overgrowth of bacterialike G. vaginalis, which naturally reside in the vagina. Normally, good bacteria outnumber bad bacteria and keep them in check; but certain activities, such as frequent douching or unprotected sex, can disrupt the microbial balance in the vagina and promote the growth of bad bacteria. Osteoporosis, also called “porous bone,” is a disease characterized by either the loss of too much bone in the body, a decreased formation of bone, or both. These events cause the bones to become weak and more likely to break from a fall, a minor bump or even from sneezing. According to statistics, osteoporosis is more common in women, with one in three over the age of 50 experiencing bone fractures because of it, while only one in five men experience the same. Genetics and age can play a part in osteoporosis development, along with low calcium intake, thyroid problems, inflammatory conditions and the use of corticosteroid medications. In their study, the team from KHU noted that the excessive expression of tumor necrosis factor-a (TNF-a), a signaling protein (cytokine) secreted by inflammatory cells, is known to aggravate BV and osteoporosis. To determine if probiotics can influence the expression of TNF-a and alleviate these conditions, they isolated anti-inflammatory Lactobacillus plantarum NK3 and Bifidobacterium longum NK49 from kimchi as well as from human fecal samples. They then tested the effects of these good bacteria in female mice with BV and osteoporosis. The researchers reported that oral gavage of NK3 alone or in combination with NK49 significantly alleviated GV-induced vaginosis and decreased GV population in the vagina. The probiotics also inhibited the activation of NF-kB, a transcription factor that increases the production of inflammatory cytokines, and TNF-a expression in the vagina and uterus of the female mice. The researchers also found that treatment with NK3 alone or in combination with NK49 alleviated ovariectomy-induced osteoporosis and obesity. Moreover, it increased blood calcium, phosphorus and osteocalcin levels, as well as suppressed weight gain. NK3 and/or NK49 treatment also reduced TNF-a expression and NF-kB activation in the colon and restored optimal gut microbiota composition. Based on these findings, the researchers concluded that the probiotics present in fermented foods like kimchi can alleviate BV and osteoporosis by reducing inflammation and regulating gut microbial composition.     Chronic stress may reduce lifespan in wild baboons, according to new multi-decadal study Duke University, April 21, 2021 Female baboons may not have bills to pay or deadlines to meet, but their lives are extremely challenging. They face food and water scarcity and must be constantly attuned to predators, illnesses and parasites, all while raising infants and maintaining their social status. A new study appearing April 21 in Science Advances shows that female baboons with high life-long levels of glucocorticoids, the hormones involved in the 'fight or flight' response, have a greater risk of dying than those with lower levels. Glucocorticoids are a group of hormones that help prepare the body for a challenge. While these hormones have many functions in the body, persistently high levels of glucocorticoids in the bloodstream can be a marker of stress. To understand the relationship between stress responses and survival, scientists studied 242 female baboons in Amboseli National Park, in Kenya. For more than 20 years, they measured glucocorticoid levels in the baboons' feces, a task that drew upon one of the world's largest collections of data from a wild primate population. Females with higher levels of glucocorticoids in their feces, either due to more frequent exposure to different types of challenges, or more intense stress responses, tended to die younger. The researchers then used these real values of hormone levels and risk of death to simulate a comparison between females that lived at opposite ends of the stress spectrum. The model showed that a hypothetical female whose glucocorticoid levels were kept very elevated would die 5.4 years sooner than a female whose glucocorticoid levels were kept very low. If they reach adulthood, female baboons have an expected lifespan of about 19 years, so 5.4-years represents a 25% shorter life. Five years more life can also represent enough time to raise one or two more infants. The team's simulations represent extreme values that are unlikely to be maintained throughout the females' lives, said Fernando Campos, an assistant professor at the University of Texas San Antonio and lead author of the study. Nonetheless, the link between exposure to stress-associated hormones and survival is clear. "Whether it's due to your environment or your genes or something that we are not measuring, having more glucocorticoids shortens your life," said Susan Alberts, a professor of biology and chair of evolutionary anthropology at Duke and senior author on the paper. The variation in glucocorticoid levels observed by Campos, Alberts, and their team shows that some females have it worse than others. Glucocorticoid levels may vary due to environmental factors, such as growing up in very hot and dry years, social factors, such as living in an unusually small or large group, and individual differences, such as being pregnant more often. "Those are the things we know about," said Alberts, "there's a whole bunch of horrible things that happen to animals that we just can't measure." "Whatever is exposing you to the glucocorticoids is going to shorten your life," Alberts said. "The more hits you get, the worse your outcome." Glucocorticoids play all sorts of vital roles in our bodies. They regulate our immunity, help our bodies access energy from sugars and fats, and modulate metabolic reactions to prepare the body for a challenge. But being constantly prepared for a challenge has high costs: maintenance processes get shut down, and fight or flight processes stay active for longer. Over time, these effects accumulate. "This chronic activation of the stress response leads to a caustic downstream physiological environment of not enough immune system, and not enough attention to maintenance," said Alberts. Associations between stress and survival are extremely difficult to test in a natural scenario. They require very frequent data collection for a very long period of time, in this case through the Amboseli Baboon Research Project, which was launched in 1971. Amboseli females are followed daily from birth to death, their activity is monitored, big events in their lives are recorded, and their feces are periodically collected. "In my lab we have one of the largest collections of primate behavioral data in the world," said Alberts, "and also one of the biggest primate poop collections." More than 14,000 fecal samples were used in this study. Poop is a very valuable, if slightly smelly, repository of information. By measuring hormone levels in feces rather than in blood or saliva, researchers avoid handling and stressing the animals, which could influence hormone levels. "People have long hypothesized that glucocorticoids play a role in how long you live," said Campos, "but to our knowledge this is the first direct evidence that chronic exposure to glucocorticoids strongly predicts survival in wild primates."   Smoking cannabis significantly impairs vision, study finds Smoking cannabis significantly impairs vision but many users are unaware of it University of Granada (Spain), April 15, 2021 A study carried out by the University of Granada indicates that smoking cannabis significantly alters key visual functions, such as visual acuity, contrast sensitivity, three-dimensional vision (stereopsis), the ability to focus, and glare sensitivity Yet, more than 90% of users believe that using cannabis has no effect on their vision, or only a slight effect A group of researchers from the Department of Optics of the University of Granada (UGR) has studied the effects of smoking cannabis on various visual parameters compared to the effect that the users themselves perceive the drug to have on their vision. This study, led by Carolina Ortiz Herrera and Rosario González Anera, has been published in the journal Scientific Reports. Its main author, Sonia Ortiz Peregrina, explains that cannabis use is on the rise despite being an illegal drug. According to the national Survey on Alcohol, Drugs and Other Addictions in Spain 2019-2020, cannabis use nationally has increased since 2011, with 37% of Spanish adults having used this drug at some time. Approximately 10% consumed it in the last year.  In this study, which had the approval of the Human Research Ethics Committee of the UGR (ref. 921/CCEIH/2019), an exhaustive visual trial was conducted on 31 cannabis users, both when they had not consumed any substance in advance and also when they were under the effect of the drug. The researchers also studied the participants' perception of the visual effects of having consumed this drug. The results showed that, following consumption, visual aspects such as visual acuity, contrast sensitivity, three-dimensional vision (stereopsis), the ability to focus, and glare sensitivity significantly worsened. Despite this, not all subjects reported a worsening of their vision after smoking cannabis. Indeed, 30% reported that their vision had not suffered at all, while 65% responded that it had worsened only slightly. The authors note that the visual parameter that could be most strongly linked to users' perception of the visual effect is contrast sensitivity. The study found a negative effect on all of the visual parameters evaluated, with the effect of cannabis on some of the parameters being analysed for the first time in this research. These results, together with the lack of awareness that the participants presented about the visual impairment caused by smoking cannabis, indicate the need to carry out awareness-raising campaigns, as this visual deterioration can pose a danger when performing everyday tasks.   Poor iodine levels in pregnancy poses risks to fetal intellectual development   University of South Australia, April 23, 2021 A growing number of young Australian women are at increased risk of having children born with impaired neurological conditions, due to poor iodine intake. Dietary changes, including a growing trend towards the avoidance of bread and iodised salt, as well as a reduced intake of animal products containing iodine can contribute to low iodine levels. A small pilot study undertaken by the University of South Australia (UniSA) comparing iodine levels between 31 vegan/plant-based participants and 26 omnivores has flagged the potential health risk. Urine samples showed iodine readings of 44 ug/L in the plant-based group, compared to the meat eaters' 64 ug/L level. Neither group came close to the World Health Organization's recommended 100 grams per liter. Participants from both groups who chose pink or Himalayan salt instead of iodised salt had severely deficient iodine levels, averaging 23 ug/L. The findings have been published in the International Journal of Environmental Research and Public Health. While the study was undertaken in South Australia, it builds evidence on a 2017 US study (1) that found nearly two billion people worldwide were iodine deficient, resulting in 50 million experiencing clinical side effects. UniSA research dietitian Jane Whitbread says adequate iodine is essential for fetal intellectual development. "Mild to moderate iodine deficiency has been shown to affect language development, memory and mental processing speeds," Ms Whitbread says. "During pregnancy, the need for iodine is increased and a 150mcg supplement is recommended prior to conception and throughout pregnancy. Unfortunately, most women do not take iodine supplements before conceiving. It is important to consume adequate iodine, especially during the reproductive years." Dietary sources of iodine include fortified bread, iodized salt, seafoods including seaweeds, eggs, and dairy foods. Concerns about the link between poor iodine status and impaired neurological conditions in newborns prompted the mandatory fortification of non-organic bread with iodised salt in 2009 in Australia. It has since been reported that women who consume 100g of iodine-fortified bread every day (approximately three pieces) have five times greater chance of meeting their iodine intake compared to women who don't consume that much. The average amount of bread consumed by women in this study was one piece of bread. The growing preference of Himalayan salt over iodized table salt may also be problematic, Ms Whitbread says. A quarter of women in the study reported using the pink salt which contains an insignificant level of iodine. Another issue is that plant-based milks have low levels of iodine and are not currently fortified with this nutrient. Neither group met the estimated average requirement (EAR) for calcium. The vegan/plant-based group also did not reach the recommended levels for selenium and B12 without supplementation, but their dietary intake of iron, magnesium, vitamin C, folate and fibre was higher than the meat eaters. This reflects the inclusion of iron-rich soy products, wholemeal foods, legumes, and green leafy vegetables in their diet. The researchers recommended that both new salts and plant milks be fortified with iodine as well as a campaign to raise awareness about the importance of iodine in the diet, especially for women in their reproductive years. They also called for a larger study sample to determine iodine status of Australian women.   Taking vitamin D could lower heart disease risk for people with dark skin Racial disparities in heart disease may be linked to vitamin D deficiency Penn State University, April 26, 2021 New research suggests a simple step could help millions of people reduce their risk of heart disease: make sure to get enough vitamin D. Elucidating linkages between skin pigmentation, vitamin D and indicators of cardiovascular health, the new study, combined with evidence from previous research, suggests vitamin D deficiency could contribute to the high rate of heart disease among African Americans.  "More darkly-pigmented individuals may be at greater risk of vitamin D deficiency, particularly in areas of relatively low sun exposure or high seasonality of sun exposure," said S. Tony Wolf, PhD, a postdoctoral fellow at the Pennsylvania State University and the study's lead author. "These findings may help to explain some of the differences that we see in the risk for developing blood vessel dysfunction, hypertension and overt cardiovascular disease between ethnic groups in the United States. Although there are many factors that contribute to the development of hypertension and cardiovascular disease, vitamin D supplementation may provide a simple and cost-effective strategy to reduce those disparities." Wolf noted that the need for vitamin D supplementation depends on a variety of factors, including where you live, how much time you spend in the sun, your skin pigmentation and your age.  Wolf will present the research at the American Physiological Society annual meeting during the Experimental Biology (EB) 2021 meeting, held virtually April 27-30.  Melanin, which is more concentrated in darker skin, is known to inhibit the process our bodies use to make vitamin D in the presence of sunlight. As a result, darkly pigmented people may make less vitamin D, potentially leading to vitamin D deficiency. For the study, Wolf and colleagues measured skin pigmentation, vitamin D and the activity of nitric oxide in the small blood vessels beneath the skin in 18 heathy adults of varying skin tones. Nitric oxide is important for blood vessel function, and reduced nitric oxide availability is thought to predispose an individual to the development of hypertension or cardiovascular disease. Previous studies suggest vitamin D helps to promote nitric oxide availability.  Study participants with darker skin had lower levels of vitamin D and lower nitric oxide availability. In addition, the researchers found that lower levels of vitamin D were related to reduced nitric oxide-mediated blood vessel function. The results align with those of a separate study by the same research group, which found that vitamin D supplementation improved blood vitamin D levels and nitric oxide-mediated blood vessel function in otherwise healthy, young African American adults. "Vitamin D supplementation is a simple and safe strategy to ensure vitamin D sufficiency," said Wolf. "Our findings suggest that promoting adequate vitamin D status in young, otherwise healthy adults may improve nitric oxide availability and blood vessel function, and thereby serve as a prophylactic to reduce risk of future development of hypertension or cardiovascular disease."   Men's loneliness linked to an increased risk of cancer University of Eastern Finland, April 27, 2021 A recent study by the University of Eastern Finland shows that loneliness among middle-aged men is associated with an increased risk of cancer. According to the researchers, taking account of loneliness and social relationships should thus be an important part of comprehensive health care and disease prevention. The findings were published in Psychiatry Research. "It has been estimated, on the basis of studies carried out in recent years, that loneliness could be as significant a health risk as smoking or overweight. Our findings support the idea that attention should be paid to this issue," Project Researcher Siiri-Liisi Kraav from the University of Eastern Finland says.  The study was launched in the 1980s with 2,570 middle-aged men from eastern Finland participating. Their health and mortality have been monitored on the basis of register data up until present days. During the follow-up, 649 men, i.e. 25% of the participants, developed cancer, and 283 men (11%) died of cancer. Loneliness increased the risk of cancer by about ten per cent. This association with the risk of cancer was observed regardless of age, socio-economic status, lifestyle, sleep quality, depression symptoms, body mass index, heart disease and their risk factors. In addition, cancer mortality was higher in cancer patients who were unmarried, widowed or divorced at baseline.  "Awareness of the health effects of loneliness is constantly increasing. Therefore, it is important to examine, in more detail, the mechanisms by which loneliness causes adverse health effects. This information would enable us to better alleviate loneliness and the harm caused by it, as well as to find optimal ways to target preventive measures."     How exercise and the simple act of moving your body can improve mental health   University of Toronto, April 26, 2021 Whether running around a track or simply stretching in your living room, physical activity can go a long way toward making you happier. Catherine Sabiston, a professor in the University of Toronto's Faculty of Kinesiology & Physical Education, says the positive impact of exercise on mental health is well-documented. "There is uncontested evidence that physical activity is conducive to mental health," she says. For example, Sabiston co-authored a study in the Journal of Sport and Exercise Psychology that adolescents who consistently participated in team sports during high school reported lower depression levels in early adulthood. A Canada Research Chair in physical activity and mental health, Sabiston directs a lab that studies the connections between physical activity and mental health, developing and evaluating interventions to promote physical activity and mental wellness among people who are at risk of inactivity and mental health problems. The lab also runs a six-week program called MoveU.HappyU that provides customized coaching and training aimed at reducing the stress and anxiety of students in the lab through physical movement. She recently spoke with U of T News about why it's important to stay active during the pandemic—and how to feel good doing it. How closely connected are physical activity and mental health? Symptoms of mental illness such as anxiety and depression can impede physical activity and vice versa. When you are experiencing symptoms, you may also encounter feelings of low self-worth and an inability to be motivated. It's very hard to find a type of physical activity that you can engage in when you lack interest in most things. Many of the symptoms tied to mental illness are also barriers to physical activity. On the flip side, there is uncontested evidence that physical activity is conducive to mental health. Physical activity prevents some forms of mental illness, and, for individuals who have been diagnosed with mental illness, physical activity can help reduce those symptoms and improve their quality of life. It holds its own weight in comparison to all other forms of treatment for mental illness, including psychotherapy and even medication. Physical activity is a potential adjunct to any other form of preventative or treatment-focused therapy. How exactly does exercise lift our mood? There are a number of mechanisms at play, including physical activity effects that are tied to our brain activity and brain chemistry. Physical activity increases our body temperature. When we are warmer, we are given the sense that we are comfortable and cared for. Also, from a historical perspective, we know that humans were naturally much more active in the past than we are now. So, physical activity brings us closer to that core level of movement that human bodies are meant to be. Moreover, physical activity can mimic mental health symptoms such as anxiety. When you exercise, you may sweat or feel your heart racing. That mimics the feeling of panic, so by engaging in exercise, you are producing a similar physical effect that can make you more accustomed to those symptoms. Exercise also provides you with an opportunity, whether for two minutes or 20, to break away from your usual routines or worries. This escape can help people better cope with their symptoms while experiencing a sense of purpose or accomplishment. In fact, feelings of mastery and accomplishment are also specific ways that physical activity impacts mental health. Small goals and activities inherent to physical activity offer plenty of opportunities for positive feedback, feeling successful and achieving, which helps stave off symptoms of mental illness. Finally, physical activity is something you can partake in outdoors, which has a potentiating effect on mental health. That allows you to see other people, even if you are not interacting with them, and feel a sense of connectedness. What are some ways people can stay active and motivated during the pandemic? We want to dispel the myth that physical activity is just running, biking and lifting weights. Physical activity can be any movement where your heart is increasing its work capacity and your body is moving. In "MoveU.HappyU," we coach students on day-to-day strategies for how to maintain a level of physical activity. Because the program is virtual now, we have trained students who are currently all over the world. Some students who had never spoken to their families about their mental health struggles are now actually having their whole families join in on the physical activities. The physical activity you are doing should be something that you enjoy. If you don't enjoy it, you're not going to continue to do it. We also want people to engage in physical activity to improve function rather than appearance. It's important to uncouple the relationship between physical activity for weight and body-size reasons and move towards physical activity for enjoyment and fun reasons. If it's fun, you are more likely to do it, and more likely to do it leads to more benefits. Do you have any tips for people looking to boost physical activity at home? There are many ways you can innovate physical activity to make it more varied, even when you are stuck in the same place. The best part of physical activity is thinking about the endless possibilities of ways your body can move. If you are purposeful about it, physical activity can be integrated into your everyday routines: Set aside time as you would if you were going to the gym or commuting. Mark it in your calendar or set an alarm to give you an actual reminder. Use your phone or a pedometer to measure your step count. Having something that measures how many steps you're taking gives you a baseline: If you know you walked a certain number of steps on day one, you can add five additional steps on day two. That way you'll have a tangible goal for increasing movement. Consciously link items or places in your home to short bouts of movement. For example, if you use the toaster oven every morning, make a habit of doing squats while you're waiting for your bread. Or when you are wheeling from one room to another, add some extra distance. When you're outside, use aspects of your environment to change up your physical activity. You can change the intensity of your walking or wheeling, for instance, each time that you pass a lamppost or see a blue car. Make it fun to change up the intensity, type, and timing of your activities. Create movement challenges for yourself and your friends, family, colleagues, or students. Set goals for taking a certain number of steps or finishing a certain number of arm raises each day. Making physical activity more like a game is a proven strategy for increasing movement—and enjoying it.    

Video auf YouTube: youtube.de/Medizinmensch Bei einer Vaskulitis attackiert das Immunsystem die Blutgefäße im eigenen Körper. Kleine Blutgefäße sind lebensnotwendig für das Funktionieren wichtiger Organe im Körper (Niere, Lunge, Nerven) doch die genauen Auswirkungen können sehr unterschiedlich sein. Das Ergebnis: eine Vaskulitis wie z.B. eine ANCA assoziierte Vaskulitis (AAV) kann eine Vielzahl von mysteriös erscheinenden Symptomen verursachen. Manche Patienten plagen lange unerklärliche Schmerzen, werden oft nicht ernst genommen bis die korrekte Diagnose nach Wochen, Monaten, oder gar Jahren gestellt wird. In diesem Video besprechen wir anhand eines Fallbeispiels Anzeichen einer AAV, wie diese seltene Krankheit behandelt wird, und was über die Entstehung bekannt ist. Glossar: Assoziiert: In Verbindung stehend (aber nicht notwendigerweise ursächlich) ANCA: Anti-Neutrophile cytoplasmatische Antikörper. Eiweiße die gegen Bestandteile von Immunzellen, den sogenannten neutrophilen Granulozyten, binden; ein charakteristisches Merkmal von ANCA-assoziierter Vaskulitis und hilft bei der Einteilung dieser Erkrankungen Avacopan: Neues Medikament für ANCA-Vaskulitis vasculum (lat.): (kleines) Gefäß Granulomatose mit Polyangiitis (GPA): Eine Form einer ANCA assoziierte Vaskulitis (AAV), früher Wegener Granulomatose (M. Wegener genannt) Vaskulitis (Mehrzahl: Vaskulitiden): Eine Entzündung der Blutgefäße Palpabel: Tastbar Palpable Purpura: Tastbare, purpurne Hautveränderung. Ein Anzeichen u.a. einer Vaskulitis der kleinen Blutgefäße Rituximab: Therapeutischer Antikörper der B Zellen attackiert; häufig eingesetzt bei Autoimmunerkrankungen -itis: Medizinische Endung für "Entzündung" Meine Website: https://medizinmensch.de Kaffee spenden: https://buymeacoffee.com/Medizinmensch Weitere Videos von mir (Playlists): Autoimmunerkrankungen: https://bit.ly/MM-Autoimmunerkrankungen Blutwerte erklärt: https://bit.ly/MM-Blutwerte Coronavirus & Covid-19: https://bit.ly/MM-Corona Gicht & Pseudogicht: https://bit.ly/MM-Gicht Medizin leicht erklaert: https://bit.ly/MM-Medizin-erklaert Quellen und Links: Keine Sterblichkeitsreduktion oder geringeres Nierenversagen mit Plasmaaustausch bei ANCA Vaskulitis: Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis (The New England Journal of Medicine 2020) https://www.nejm.org/doi/full/10.1056/nejmoa1803537 Avacopan zur Behandlung ANCA-assoziierter Vaskulitis: Avacopan for the Treatment of ANCA-Associated Vasculitis (NEJM 2021) https://www.nejm.org/doi/full/10.1056/nejmoa2023386 Über die Assoziation zwischen Bildungserfolg und die Anzahl der Bücher im Haushalt eines Kindes: 'Freakonomics': What Makes a Perfect Parent? https://abcnews.go.com/WNT/story?id=1633286&page=1 Merk-würdiges Medizinwissen für Alle. Abonniere jetzt und erhalte neue Folgen, jeden Medizin-Mittwoch. Folge direkt herunterladen

Stress is no stranger to human existence. It’s a normal part of living and functioning in a gravitational state on this planet. But, as Buddha said, “be moderate in all things.” Too much of anything, on a chronic basis, can eventually be deleterious to one’s health.Hungarian-born Hans Selye MD, Ph.D, the “so-called” father of stress research, developed and implemented his famous concept, “General Adaptive Syndrome (GAS),” a response of the body based on the demands placed on it. The body’s three stage response – alarm, resistance, exhaustion – manifest, as follows, notes Medicalnewstoday.com.“At the alarm reaction stage, a distress signal is sent to a part of the brain called the hypothalamus. The hypothalamus enables the release of hormones called glucocorticoids. Glucocorticoids trigger the release of adrenaline and cortisol, which is a stress hormone. The adrenaline gives a person a boost of energy” – at cost of raising the heart rate, blood pressure, and blood sugar.The control mechanism is the autonomic nervous system (ANS) – sympathetic nervous system (SNS) - fight or flight system - and the parasympathetic nervous (PNS) - relaxation or recovery response – all affecting heart rate variability (HRV), what happens between heart beats (R-R interval), resulting from an elevation in the hormone cortisol.During the resistance stage, which is controlled by the PNS, “the body tries to counteract the physiological changes that happened during the alarm reaction stage,” notes the website.If the stress gets under control, then the heart rate and blood pressure begin to return to normal. However, if the stressor remains, the body will stay in a state of alert, and stress hormones continue to be produced.Should the stressor or situation become protracted, then the body goes into the final stage of GAS – exhaustion – depleting its energy resources by continually trying – eventually failing to recover from the initial alarm reaction stage.Symptoms may manifest in the form of fatigue, depression, anxiety, and a feeling of the inability to cope. That’s when long-term stress may trigger the start of cardiovascular disease, type 2 diabetes, colitis, and other such stress-inflammatory conditions.According to research – Magnesium Status and Stress: The Vicious Circle Concept Revisited – which appeared in the January 2021 issue of the online, peer-reviewed journal Nutrients, “magnesium is a naturally occurring calcium channel blocker, is involved in the maintenance of electrolyte balance (e.g., regulation of sodium–potassium ATPase activity), and plays a key role in membrane excitability.”Magnesium, the second most abundant intracellular essential mineral, is a cofactor in hundreds of enzyme processes – specifically protein and nucleic acid synthesis, regulation of metabolic pathways, neuronal transmission, neuromuscular function, and normalization of cardiac rhythm.The adult human body contains roughly from 21 to 28 grams of magnesium – with 50–60% being stored in the bones, while the remainder is distributed in soft tissues such as muscles.The study authors, from various medical facilities and universities in France, comment that, “magnesium is also an essential component of the extracellular fluid (ECF) and the cerebrospinal fluid (CSF) in the central nervous system,” with, “only 1% of the total magnesium is extracellular and 0.3% of this circulates in serum in three different forms: Free (unbound; 60%), which represents the biologically active form; albumin-bound (30%); or in a complex with other ions (10%).”Read the rest on MaxWellNutrition.com.

This episode covers glucocorticoids!

▪好獸醫來讀書單元由台灣禮藍動保公司ELANCO獨家贊助 ▪ 第二季每週一中午12點播出，十個主題新知說給你聽 簡介： 免疫調節的溶血性貧血（IMHA）是狗最常見的血液學疾病。雖然已經進行了多年的研究，但這疾病發生時仍持續導致大量的發病和死亡。最近，美國獸醫內科學院（ACVIM）小組制定了犬貓IMHA診斷和IMHA管理指南。根據現有的最佳證據所提供的診斷及治療建議，但仍然缺乏能夠支持大多數病例治療的大型隨機臨床試驗結果。貓咪IMHA的因為案例很少，本篇治療主要著重在狗的部分。本篇治療策略和ACVIM的建議差不多，重點會在對急診和重症監護（ECC）中更為常見的急性和重症病患的管理建議。另外，也進一步討論了新興的療法和未來的治療趨勢。 重點整理： ▪犬免疫調節的溶血性貧血（IMHA）的支持療法，包括輸血和抗血栓藥物，是最大化患者生存時間的重要關鍵。 ▪Glucocorticoids醣皮質醇與另一種免疫抑製藥物，例如azathioprine、cyclosporine或mycophenolate mofetil等藥物合用，仍然是治療犬IMHA的主要手段或方式。 ▪藥物治療監測可以提高cyclosporine和mycophenolate mofetil的實用性，並使安全性最大化。 ▪犬IMHA的新興療法包括新型藥物製劑和治療性血漿置換。 ▪未來的治療方法可能包括了抗CD20的單株抗體以及補體激活抑製劑等。 官方網址www.wondervet.com.tw▫請主持人喝杯咖啡☕ https://pay.firstory.me/user/ck4fgb04n698h0804wzdkaycj Powered by Firstory Hosting

Aging and chronic stress can obtain activation of CNS-resident microglia and astrocytes, that produce type 1 interferons (T1 IFNs) which signal through the heterodimeric IFN-α/β receptor (IFNAR) where receptor binding of T1 IFNs activates the JAK/STAT thus inducing IFN-stimulated genes (ISGs) which mediate both pro- and anti-inflammatory functions depending upon the cellular micro-environment. Now consider how aging is linked to elevated & activated leukocyte counts and it becomes clear that this is a patho-biochemical phenocopy to T cell acute lymphoblastc leukaemia (T-ALL) where signaling through Notch, Jak/Stat, PI3K/Akt/mTOR, and MAPK are shared. IL7-induced glucocorticoid resistance is diagnostic of certain subtypes of T-ALL and this is also associated with the senescence associated secretory phenotype of aging-linked morbidity and mortality. Finally, consider that chronic CNS stress leads to increased glucocorticoid production leading to a suppression of cell adhesion protein thus corrupting synaptic plasticity, memory re-formation, and cognitive acuity while promoting sarcopenia by stimulating proteasomal removal of contractile proteins and inhibiting the PI3-kinase/Akt pathway. Glucocorticoids also prevent IL-2 synthesis and secretion thus causing immune suppression by blocking T cell activation. J Neuroinflammation. 2019; 16: 236. Cytokine & Growth Factor Reviews, 22 Apr 2017, 35:85-96 --- Support this podcast: https://anchor.fm/dr-daniel-j-guerra/support

In this week's episode, Brad speaks to the large body of research that has been done in the exercise immunology field and the great promise the field has to uncover with future research focal points. He highlights Dr. Richard Simpson PHD's article Titled: Exercise, Immunity, and the COVID-19 Pandemic. Dr. Simpson's research interests are concerned with the effects of aging, stress and exercise on the immune system. He is an associate professor in the Departments of Nutritional Sciences, Pediatrics and Immunobiology at the University of Arizona. You can read it in it's entirety here. https://www.acsm.org/blog-detail/acsm-blog/2020/03/30/exercise-immunity-covid-19-pandemic. It is a good read that lays out in layman's terms the impact that exercise has on our immune function. Simpson writes in his blog, "Having higher age and sex-adjusted scores for cardiorespiratory fitness and performing regular exercise of moderate- to vigorous-intensity exercise that fall within ACSM (American College of Sports Medicine) guidelines has been shown to improve immune responses to vaccination, lower chronic low-grade inflammation, and improve various immune markers in several disease states including cancer, HIV, cardiovascular disease, diabetes, cognitive impairment and obesity. The ongoing COVID-19 pandemic has raised a lot of questions regarding how exercise can protect us from infection by boosting immunity.” The blog also goes on to highlight: “Compounding this problem are the known negative effects of social isolation and confinement on immunity. Glucocorticoids such as cortisol are elevated during periods of isolation and confinement and can inhibit many critical functions of our immune system. When we are stressed, the ability of our T-cells to multiply in response to infectious agents is markedly reduced, as is the ability of certain effector lymphocytes (e.g., NK-cells and CD8+ T-cells) to recognize and kill cells in our body that have become cancerous or have been infected with viruses. It is also vitally important that our immune cells maintain their ability to redeploy so that they may ‘patrol' vulnerable areas in or body (e.g., the upper respiratory tract and the lungs) to prevent viruses and other pathogens from gaining a foothold. This process is also important to minimize the impact of the virus and to expedite viral resolution should we become infected. Brad gives tips to improving your cardiorespiratory fitness by getting your heart rate within 50-65% of your target heart rate max for 30-45 minutes for 3-5x/wk if not all days. If you are not sure how to calculate this, see the SportSquire Episode, The Benefits of Training Within Your Different Target Heart Rates. Brad continues to encourage the SportSquire Community to explore, engage, and learn as this is foundational to empowering real behavioral change on your wellness journey. He encourages those who are interested to look into some of the scholarly articles to read about the progressive research findings specifically related to Exercise Immunology. I hope you find this as a PROACTIVE tool during this time and meet your knowledge with your action! Be well!

Welcome to Physiology by Physeo (an InsideTheBoards podcast)! This show brings together some of the best boards-relevant content for physiology and pathophysiology from three innovative platforms: Physeo, InsideTheBoards, and Med School Phys. Having gone through the grind of med school ourselves, we understand the fast-paced lifestyle you're living right now, so our aim is to help the listener learn while on-the-go. By listening to our show, you'll be one step closer to slaying the USMLE. This episode is from the "Lost" Final Physiology by Physeo Series. In the episode, Dr. Greg Rodden explains why steroids, specifically glucocorticoids, can't do everything despite having broad-ranging effects. Discounted Physeo Subscription for InsideTheBoards listeners Head over to Physeo's Website and sign up for a subscription. Use the code ITB25 to receive 25% off your subscription. Keep calm and watch Physeo. Legal Stuff InsideTheBoards and Physeo are not affiliated with the NBME, USMLE, COMLEX, NBOME or any professional licensing body. InsideTheBoards fully adheres to the policies on irregular conduct outlined by the aforementioned credentialing bodies.  All information, content, and materials published by this podcast are for informational purposes only and are NOT intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider. Please consult your healthcare provider regarding personal medical decisions.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.11.293217v1?rss=1 Authors: CABEZA, L., RAMADAN, B., GIUSTINIANI, J., HOUDAYER, C., PELLEQUER, Y., GABRIEL, D., FAUCONNET, S., HAFFEN, E., RISOLD, P.-Y., FELLMANN, D., BELIN, D., PETERSCHMITT, Y. N. Abstract: Anxio-depressive symptoms as well as severe cognitive dysfunction including aberrant decision-making (DM) are documented in neuropsychiatric patients with hypercortisolaemia. Yet, the influence of the hypothalamo-pituitary-adrenal (HPA) axis on DM processes remains poorly understood. As a tractable mean to approach this human condition, adult male C57BL/6JRj mice were chronically treated with corticosterone (CORT) prior to behavioural, physiological and neurobiological evaluation. The behavioural data indicate that chronic CORT delays the acquisition of contingencies required to orient responding towards optimal DM performance in a mouse Gambling Task (mGT). Specifically, CORT-treated animals show a longer exploration and a delayed onset of the optimal DM performance. Remarkably, the proportion of individuals performing suboptimally in the mGT is increased in the CORT condition. This variability seems to be better accounted for by variations in sensitivity to negative rather than to positive outcome. Besides, CORT-treated animals perform worse than control animals in a spatial working memory (WM) paradigm and in a motor learning task. Finally, Western blotting neurobiological analyses show that chronic CORT downregulates glucocorticoid receptor expression in the medial Prefrontal Cortex (mPFC). Besides, corticotropin-releasing factor signalling in the mPFC of CORT individuals negatively correlates with their DM performance. Collectively, this study describes how chronic exposure to glucocorticoids induces suboptimal DM under uncertainty in a mGT, hampers WM and motor learning processes, thus affecting specific emotional, motor, cognitive and neurobiological endophenotypic dimensions relevant for precision medicine in biological psychiatry. Copy rights belong to original authors. Visit the link for more info

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.02.280065v1?rss=1 Authors: Westrick, S. E., van Kesteren, F., Boutin, S., Lane, J. E., McAdam, A. G., Dantzer, B. Abstract: Environmental factors experienced during development can affect the physiology and behavior of offspring. Maternal glucocorticoids (GCs) may convert environmental cues experienced by the mother into a cue triggering adaptive developmental plasticity in offspring. In North American red squirrels (Tamiasciurus hudsonicus), females exhibit increases in GCs when conspecific density is elevated, and selection favors more aggressive and perhaps more active mothers under high density conditions. We experimentally elevated maternal GCs during gestation or early lactation to test the hypothesis that elevated maternal GCs cause shifts in offspring aggression and activity that may prepare them for high density conditions. When offspring were weaned, we measured two behavioral traits (activity and aggression) using a standardized behavioral assay. Because maternal GCs may influence offspring hypothalamic-pituitary-adrenal (HPA) axis activity and HPA axis activity may in turn affect offspring behavior, we also measured the impact of our treatments on offspring HPA axis activity (adrenal reactivity and negative feedback) and the association between offspring HPA axis activity and behavior. Increased maternal GCs during lactation, but not gestation, only slightly elevated activity levels in offspring. Offspring aggression, adrenal reactivity, and negative feedback did not differ between GC-treated and control groups. Offspring with higher adrenal reactivity did exhibit lower aggression, but the relationship between adrenal reactivity and aggression was not affected by treatment with maternal GCs. These results suggest maternal GCs during gestation or early lactation alone may not be a sufficient cue to produce changes in behavioral and physiological stress responses in offspring in natural populations. Copy rights belong to original authors. Visit the link for more info

In this podcast, Dr. Paul Studenic speaks to Dr. Sofia Ramiro and Prof. Robert Landewé both engaged in clinical work in the Zuyderland Medical Center in the south of the Netherlands about their clinical study evaluating systemic glucocorticoids and Il-6 blockade as second-line treatment for COVID-19-associated cytokine storm syndrome. They tell the story of the set-up of a peculiar trial using historical patients treated with supportive care as controls to the ‘experimental' treatment strategy during these unprecedented times of March and April 2020. Link to article: https://ard.bmj.com/content/79/9/1143 Link to EULAR press release: https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_42291DEB-50E5-49AE-5726D0FAAA83A7D4/eular_glucocorticoids_and_il_6_receptor_can_reduce_covid19_css_related_hospital_mortality_(002).pdf

In this podcast, Dr. Paul Studenic speaks to Dr. Sofia Ramiro and Prof. Robert Landewé both engaged in clinical work in the Zuyderland Medical Center in the south of the Netherlands about their clinical study evaluating systemic glucocorticoids and Il-6 blockade as second-line treatment for COVID-19-associated cytokine storm syndrome. They tell the story of the set-up of a peculiar trial using historical patients treated with supportive care as controls to the ‘experimental’ treatment strategy during these unprecedented times of March and April 2020. Link to article: https://ard.bmj.com/content/79/9/1143 Link to EULAR press release: https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_42291DEB-50E5-49AE-5726D0FAAA83A7D4/eular_glucocorticoids_and_il_6_receptor_can_reduce_covid19_css_related_hospital_mortality_(002).pdf

It's been an important week with big developments in potential COVID-19 vaccines; News on how steroid therapy may help some COVID patients; There's results from the Actemra trial in COVID pneumonia patients; News that sputum samples may be just as effective as nasopharyngeal samples for detecting sars-cov-2; And  researchers have linked vaccination to reduced risks of Alzheimer disease.

What is the most important agent for anaphylaxis? What other treatments are only considered as adjuncts? How should I give these agents? Find out this week as we review updated anaphylaxis treatment guidelines published in April 2020! References:Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis- a 2020 practice parameter update, systematic review, and grading of recommendations, assessment, development, and evaluation (GRADE) analysis. J Allergy Clin Immunol 2020; 146 (4): 1082-1123

With COVID-19 and the question of whether glucocorticoids could be beneficial, this episode digs into the data on the use of glucocorticoids in the setting of infections, from pneumonia and septic arthritis, to meningitis and septic shock. Intro :11 In this episode :25 The first published case series of patients with serious infection 6:45 Otolaryngologic infections 7:43 Pneumonia, malaria and flu 8:26 Cortisone in strep throat 9:22 Major severe infections 11:26 A review article 12:12 Specific organ systems 13:25 Dexamethasone for bacterial meningitis 25:28 Septic shock 26:19 Dearth of data on glucocorticoids for influenza 32:10 Summary and take-home 35:19 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Annane D, et al. JAMA. 2002;288:862-871. Annane D, et al. N Engl J Med. 2018;378:809-818. Bennett IL, et al. JAMA. 1963;183:462-465. Blum CA, et al. Lancet. 2015;385:1511-1518. de Gans J, van de Beek D. N Engl J Med. 2002;347:1549-1556. Dellinger RP, et al. Crit Care Med. 2013;41:580-637. Fogel I, et al. Pediatrics. 2015;136:e776. Hahn EO, et al. J Clin Invest. 1951;30:274-281. Hartman FA, Merle Scott WJ. Proc Soc Exp Biol and Med. 1931;28:478-479. Hinshaw LB, et al. J Surg Res. 1980;28:151-170. Nedel WL, et al. World J Crit Care Med. 2016;5:89-95. Odio CM, et al. Pediatr Infect Dis J. 2003;22:883-888. Perla D, Marmorston J. Endocrinology. 1940;27:368-374. Stern A, et al. Cochrane Database Syst Rev. 2017;12:doi:10.1002/14651858.CD007720.pub3 Venkatesh B, et al. N Engl J Med. 2018;378:797-808. Wenner WF, Cone AJ. Arch Otolaryngol. 1934;20:178-187. Whitehead KW, Smith C. Proc Soc Expert Biol and Med. 1932;29:672-673. Wysenbeek AJ, et al. Ann Rheum Dis. 1998;57:687–690.  Zhou Y, et al. Sci Rep. 2020;10:https://doi.org/10.1038/s41598-020-59732-7.

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a rare form of vasculitis that primarily affects the small blood vessels. Individuals diagnosed with EGPA commonly have a history of asthma and/or allergies. Inflammation associated with EGPA can lead to injury in multiple organ systems, including the sinuses, lungs, gastrointestinal system, heart, and kidneys. Early diagnosis and treatment are critical when managing EGPA to improve patient outcomes and reduce symptom burden. Education is needed to provide clinicians with the latest information regarding optimal diagnostic and management strategies, including newer steroid-sparing therapy options. In this CME podcast series, experts will provide guidance on differentiating EGPA from related vasculitides or eosinophilic conditions, highlight recent clinical data, and discuss therapeutic advancements. Transcript available here: https://tinyurl.com/EGPA4-4

Plasma Exchange and Glucocorticoids in Severe ANCA-Associated VasculitisSummary on NephJCCast:Joel TopfSwapnil HiremathSamira FaroukJennie LinJordy CohenShow Notes:55th ERS-EDTA Congress, late breaking and high impact trials. June 2018The CJASN Review recommended by JennieMEPEX studyC5a antagonist, Avacopan in ANCA-Associated VasculitisThe fragility index as described in JAMA SurgeryMichael Walsh looks at the Fragility Index in 399 trials in medical literatureThe EVOLVE trial of Cinacalcet. Age-adjusted HR results in statistically significant results for primary outcome, but was not defined as the primary endpoint. Patients were one year older in the cinacalcet group; older age known to increase mortality in dialysis patients. Wiki Journal Club.Ron Falk and his irresponsible editorial.Cochrane Systematic Review and Meta-analysis of Anti‐cytokine targeted therapies for ANCA‐associated vasculitisNephMadness is now in full swing at the AJKDblog!

Today we have the venerable EBM guru Dr. Brian Locke on the show to talk PLEX and DEX. Does plasma exchange for ANCA-vasculitis really work? Do steroids make any difference in patients with ARDS? Also, have you ever wondered which Hogwarts house your medical specialty belongs to? Plasma Exchange and Glucocorticoids for ANCA-Vasculitis Dexamethasone for Acute Respiratory Distress SyndromeThe Sorting Hat of Medicine: Why Hufflepuffs Wear Stethoscopes and Slytherins Carry ScalpelsMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

¡Gracias por escuchar!Para empezar el año, este episodio lo dedicaré a hablar de como la composición corporal influye sobre la eficacia y eventos adversos asociados al uso de glucocorticoides.Agradezco su continuada atención a este podcast y les recuerdo que se pueden suscribir a el en iTunes, Spotify o usando su gestor de podcasts favorito. Como siempre su retroalimentación es bienvenida y les pido amablemente dejen su calificación a este y otros episodios en iTunes.Estas son algunas de las referencias consultadas para este episodio:van der Goes, M. C. et al. Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann. Rheum. Dis. 69, 1015–1021 (2010).Konijn, N. P. et al. The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis. Rheumatology (Oxford) http://dx.doi.org/10.1093/ rheumatology/kew221 (2016).Buttgereit, F., Smolen, J. S., Coogan, A. N. & Cajochen, C. Clocking in: chronobiology in rheumatoid arthritis. Nat. Rev. Rheumatol. 11, 349–356 (2015).Arvidson, N. G., Gudbjornsson, B., Larsson, A. Hallgren, R. The timing of glucocorticoid administration in rheumatoid arthritis. Ann. Rheum. Dis. 56, 27–31 (1997).Cutolo, M. Glucocorticoids and chronotherapy in rheumatoid arthritis. RMD Open 2, e000203 (2016).Smith-Ryan, A. E. et al. Validity and reliability of a 4-compartment body composition model using dual energy X-ray absorptiometry-derived body volume. Clin. Nutr. http://dx.doi.org/10.1016/j. clnu.2016.05.006 (2016).Summers, G. D., Metsios, G. S., Stavropoulos- Kalinoglou, A. & Kitas, G. D. Rheumatoid cachexia and cardiovascular disease. Nat. Rev. Rheumatol. 6, 445–451 (2010).Walsmith, J. & Roubenoff, R. Cachexia in rheumatoid arthritis. Int. J. Cardiol. 85, 89–99 (2002).Arshad, A., Rashid, R. & Benjamin, K. The effect of disease activity on fat-free mass and resting energy expenditure in patients with rheumatoid arthritis versus noninflammatory arthropathies/soft tissue rheumatism. Mod. Rheumatol. 17, 470–475 (2007).Elkan, A. C., Hakansson, N., Frostegard, J., Cederholm, T. & Hafstrom, I. Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res. Ther. 11, R37 (2009).

In today's VETgirl online veterinary continuing education podcast, we will be reviewing a treatment that is often a bit controversial -; steroids! In particular, we will look at the use of steroids in the treatment of acute pancreatitis in dogs. Steroids may appear attractive to use in this inflammatory disease since glucocorticoids impart anti-inflammatory affects in the body. Glucocorticoids may theoretically improve pancreatic blood flow and in critically ill patients with refractory blood pressure concerns, glucocorticoids are sometimes used to treat suspected (or confirmed) CIRCI. But with the possibility of eliciting negative side effects from steroid use, owing to their unwanted gastrointestinal tract side effects and their immunomodulatory effects, are they worth the risk in treating these patients?

In today's VETgirl online veterinary continuing education podcast, we will be reviewing a treatment that is often a bit controversial -; steroids! In particular, we will look at the use of steroids in the treatment of acute pancreatitis in dogs. Steroids may appear attractive to use in this inflammatory disease since glucocorticoids impart anti-inflammatory affects in the body. Glucocorticoids may theoretically improve pancreatic blood flow and in critically ill patients with refractory blood pressure concerns, glucocorticoids are sometimes used to treat suspected (or confirmed) CIRCI. But with the possibility of eliciting negative side effects from steroid use, owing to their unwanted gastrointestinal tract side effects and their immunomodulatory effects, are they worth the risk in treating these patients?

Show Notes for November 2019 – Episode 36 Detection of Various Microplastics in Human stool – Annals of int Med Herpes Zoster in Tofacitinib: Risk is Further Increased with Glucocorticoids but not Methotrexate – Arthritis Care Res Fatty Liver Disease Caused by High-Alcohol-Producing Klebsiella pneumoniae  – Cell Incidence of and Risk Factors for  Hepatic Encephalopathy in a Population-Based… Continue reading GI Pearls – November 2019 – Episode 36 Gastroenterology Literature Review

In this episode, the Edifice of Trust host, Victor Bolles, discusses how low socio-economic status and poverty affects the brain development in children and what to do about it.

Professor Nash interviews Professor Curtis about his recent paper: Herpes zoster in Tofacitinib: Risk is Further Increased with Glucocorticoids but not Methotrexate

In which your exhausted 35-year-old host squeezes his last ounce of corporate Luau Week zest into a twenty-minute Sunday night microrant that features a social cameo from Expatriate Act guest #2 Enam Amegbeto, a tribute to your host's anthropological mancrush, Dr. Robert Sapolsky, and concludes with an unlikely proposal for world peace through oafishness.

Have you been packing on the pounds? This is Judy Gaman and this is your Stay Young Medical Minute.  It is a known fact that stress can lead to weight gain.  A new study from the journal Cell Metabolism explains why.  Stress leads to inflammation in the body.  Glucocorticoids, a steroid hormone, are released in response to the inflammation.  When under long term stress, this hormone signals the creation of fat cells.  Continuous stress can eventually lead to excessive weight gain and other health problems.  If your stress levels are through the roof, try exercising, meditating, or breathing exercises to keep tension at a safe level.  If you are still unable to control your stress, talk to your doctor.  This Stay Young Medical Minute is brought to you by Executive Medicine of Texas, a leader in preventative and proactive medicine. Learn why patients from around the globe trust Executive Medicine of Texas to their health. Visit EMTexas.com that's EMTexas.com Read the study! Thank you for listening to the Staying Young Medical Minute! With all the mixed messages on health, you need information that you can use and that you can trust. Listen in as the experts discuss all topics health related. It's time to STAY YOUNG and stay healthy! Each week we tackle a topic and often with leading scientists, best-selling authors, and even your favorite celebrities! As a listener of our show, your input is important to us. Please take a moment to fill out this quick survey so we can serve you better - Survey For more information on The Staying Young Show, please visit our website, and subscribe to the show in iTunes, Stitcher, or your favorite podcast app. You can also reach out to our host, Judy Gaman on www.judygaman.com for book purchasing, and speaking opportunities in your area!  

Prof Nash interviews Prof Fleischmann about his recent paper: Effect of Discontinuation or Initiation of Methotrexate or Glucocorticoids on Tofacitinib Efficacy in Patients with Rheumatoid Arthritis: A Post Hoc Analysis

In this interview, Dr. Kathryn Hibbert reviews the biology underlying the effects of various fluids on the body and how sepsis disrupts the body’s natural response to corticosteroids. We also discuss the major points from these four new papers in the March 1, 2018 issue of NEJM and prior literature to get you up to speed on the evidence behind practice.

The last lesson covered how insulin, glucagon, and allosteric regulators from within the liver ensure that the liver only engages in gluconeogenesis when it can and when it needs to. This lesson focuses on an additional layer of regulation: cortisol. Cortisol is the principal glucocorticoid in humans. Glucocorticoids are steroid hormones produced by the adrenal cortex that increase blood glucose. Cortisol has multiple actions on the liver, muscle, adipose, and pancreas that all converge on making glucose more available to the brain. Among them, it increases movement of fatty acids from adipose to the liver, which provide the energy for gluconeogenesis, and the movement of amino acids from skeletal muscle to the liver, which provide the building blocks for gluconeogenesis. Cortisol serves both to antagonize insulin, thereby acutely increasing gluconeogenesis, and to increase the synthesis of gluconeogenic enzymes, which amplifies all other pro-gluconeogenic signaling and increases the total capacity for gluconeogenesis. In fact, even the day-to-day regulation of gluconeogenesis by glucagon is strongly dependent on normal healthy levels of cortisol in the background. Since gluconeogenesis is an extremely expensive investment with a negative return, it makes sense that the body would regulate it as a stress response, and thus place it under control by cortisol. This raises the question of whether carbohydrate restriction increases cortisol. Several studies are reviewed in this lesson that indicate that 1) there may be an extreme level of carbohydrate restriction that always increases cortisol, and 2) carbohydrate restriction definitely increases cortisol in some people. It may be the case that other stressors in a person’s “stress bucket” determine whether and how strongly the person reacts to carbohydrate restriction with elevated cortisol. For the full episode, go to chrismasterjohnphd.com/mwm/2/31 Sign up for MWM Pro for early access to content, enhanced keyword searching, self-pacing tools, downloadable audio and transcripts, a rich array of hyperlinked further reading suggestions, and a community with a forum for each lesson.

This episode features Dr. Scott Manaker, discussing the UpToDate What’s New topic on the lack of benefit of glucocorticoids in severe sepsis (starts at 01:07); and Dr. Joel Palefsky, discussing the UpToDate Practice Changing UpDate regarding updated guidelines for HPV vaccination in young adolescents (starts at 14:56). Dr. Sandy Falk hosts.

Alessandro Ferretti joins us to discuss blood glucose, ketones, ketogenic diets, and of course how it all relates to health, performance and Heart Rate Variability. We also cover some useful topics such as how to use HRV for food sensitivity testing, how to establish a personal glucose baseline and when best to measure blood glucose, and ideal ketone thresholds for exercise and training. -- topics listed below HRV Educational Resources: https://hrvcourse.com/ep-7 Leave a quick review: https://elitehrv.com/review-ep-7 (Thanks in advance!) TOPICS: * 24/7 HRV, ketones, glucose monitoring * Food sensitivity testing with HRV and the % changes to look for to identify offending foods * Correlations between blood glucose and HRV * “Normal” vs. healthy blood glucose levels * How to establish a personal glucose baseline * When to measure blood glucose (two key times) * Nutrient timing * Glucocorticoids and the inflammatory response * Substrate efficiency during exercise * GLUT4 * Cortisol resistance * “Pseudo paleo” * Low carb vs. ketogenic diet * What is a ketogenic diet, really? * The dangers of doing ketogenic diet incorrectly * What are ketones? * Becoming fat adapted * Phases of ketogenesis * Ideal ketone thresholds for exercise & training * Ketoacidosis * How the brain uses ketones * Breath vs. blood vs. urine ketones * Type 1 and type 2 diabetes * Acetyl acetate and beta hyrdoxybuterate * Gluten cross-reactivity * Fungal infections in the gut * 24/7 continuous monitoring vs. snapshot morning HRV measurements * Comparing the foot print of various life stressors * The individuality of the sympathetic response * Timing recovery for optimal performance HRV Educational Resources: https://hrvcourse.com/ep-7 Leave a quick review: https://elitehrv.com/review-ep-7 (Thanks in advance!) Guest: Alessandro Ferretti http://AlessandroFerretti.co.uk Host: Jason Moore http://twitter.com/jasonmooreme --

Brian Feldman explains how a secreted protease inhibits diet- and glucocorticoid-induced differentiation of adipocytes.

Can steroid therapies drive you crazy? Two leading neuropsychiatrists share their dramatic and startling findings that yes, certain glucocorticoids such as prednisone can lead to erratic and self-destructive behavior, especially in women. Dr. Lewis Judd of UC San Diego and Dr. Sherwood Brown of the University of Texas, along with an international roster of co-authors, recently published this eye-opening research in The American Journal of Psychiatry and discuss their work here with Nick Binkley, President of the Diana Foundation. [Health and Medicine] [Show ID: 28521]

Can steroid therapies drive you crazy? Two leading neuropsychiatrists share their dramatic and startling findings that yes, certain glucocorticoids such as prednisone can lead to erratic and self-destructive behavior, especially in women. Dr. Lewis Judd of UC San Diego and Dr. Sherwood Brown of the University of Texas, along with an international roster of co-authors, recently published this eye-opening research in The American Journal of Psychiatry and discuss their work here with Nick Binkley, President of the Diana Foundation. [Health and Medicine] [Show ID: 28521]

Editor's Audio Summary by Mary McGrae McDermott, MD, Contributing Editor, the Journal of the American Medical Association, for the June 05, 2013 issue

ACL injuries. Situational awareness. Energy field therapy. Olfaction. Rotton odor and lung disorders. Probiotics and UT and yeast infections. Glucocorticoids and mental disorders. Traditional Chinese Medicine (TCM), Western Perspective, Integrative and Functional Medicine. Live streaming. The Balancing Point health radio talk show about Traditional Chinese Medicine, supplements, nutrition, and more.  Host Dr. John Nieters, acupuncturist [...]Read More »

Background: Endocannabinoids (ECs) are rapidly acting immune-modulatory lipid-signaling molecules that are important for adaptation to stressful and aversive situations. They are known to interact with glucocorticoids and other stress-responsive systems. Maladaptation to acute or chronic stress represents a major risk factor for the development of psychiatric disorders. In the present study, we administered stress doses of hydrocortisone in a prospective, randomized, placebo-controlled double-blind study in patients undergoing cardiac surgery (CS) to examine the relationship between the use of glucocorticoids, plasma EC levels, and the occurrence of early postoperative cognitive dysfunction (delirium) and of later development of depression. Methods: We determined plasma levels of the ECs anandamide and 2-arachidonoylglycerol (2-AG) in CS patients of the hydrocortisone (n=56) and the placebo group (n=55) preoperatively, at postoperative day (POD) 1, at intensive care unit discharge, and at 6 months after CS (n=68). Postoperative delirium was diagnosed according to Diagnostic and Statistical Manual of the American Psychiatric Association IVth Edition (DSM-IV) criteria, and depression was determined by validated questionnaires and a standardized psychological interview (Structured Clinical Interview for DSM-IV). Results: Stress doses of hydrocortisone did not affect plasma EC levels and the occurrence of delirium or depression. However, patients who developed delirium on POD 1 had significantly lower preoperative 2-AG levels of the neuroprotective EC 2-AG (median values, 3.8 vs. 11.3 ng/ml; p=0.03). Preoperative 2-AG concentrations were predictive of postoperative delirium (sensitivity=0.70; specificity=0.69; cutoff value=4.9 ng/ml; receiver operating characteristic curve area=0.70; 95% confidence interval=0.54-0.85). Patients with depression at 6 months after CS (n=16) had significantly lower anandamide and 2-AG levels during the perioperative period. Conclusions: A low perioperative EC response may indicate an increased risk for early cognitive dysfunction and long-term depression in patients after CS. Glucocorticoids do not seem to influence this relationship.

Current guidelines recommend glucocorticoids and splenectomy as standard 1(st) and 2(nd) line treatments for chronic immune thrombocytopenia (ITP). We sought to find out how German ITP-patients are treated with respect to these guidelines. Members of a patient support association ≥18 years with a self-reported history of chronic ITP>12 months were surveyed with a web-based questionnaire. 122 questionnaires were evaluated. 70% of patients had chronic ITP for more than 5 years and 20% an average platelet count of ≤30·10(9)/L. 41% of the patients reported haematomas or petechiae more than once or twice and up to 12 times or more per year and 17% oropharyngeal and nasal bleeds. 11% had been admitted to hospital during the last 12 months. 88% had received or currently receive glucocorticoids, 27% were splenectomised. IVIG had been given to 55%, rituximab to 22%, anti-D to 12%, ciclosporin to 7%, while complementary and alternative medical treatments had been used by 36%. 50 women responded to questions concerning pregnancy. 14 (28%) had been advised not to become pregnant. 23 reported pregnancies and 10 (44%) required treatment for their ITP during pregnancy. Glucocorticoids are the most common therapy for chronic ITP but complementary and alternative treatments already come second and less than ⅓ of patients are splenectomised. This and the frequent use of complementary medicines suggests patients' dissatisfaction with conventional approaches. Many patients receive off-label therapies. There is a major need for adequate counselling and care for pregnant ITP-patients.

Topical glucocorticoids have always been considered first-line drugs for inflammatory diseases of the skin and bronchial system. Applied systemically, glucocorticoids are used for severe inflammatory and immunological diseases and the inhibition of transplant rejection. Owing to the progress in molecular pharmacology, the knowledge of the mechanism of action has increased during the last years. Besides distinct genomic targets, which are due to the activation of specific cytoplasmatic receptors resulting in the (trans-) activation or (trans-) repression of target genes, there are non-genomic effects on the basis of the interference with membrane-associated receptors as well as with membrane lipids. In fact, various glucocorticoids appear to differ with respect to the relative influence on these targets. Thus, the extended knowledge of glucocorticoid-induced cellular signalling should allow the design and development of even more specifically acting drugs-as it has been obtained with other steroids, e.g. estrogens for osteoporosis prevention. Copyright (C) 2005 S. Karger AG, Basel.

Glucocorticoid hormones suppress the secretion of ACTH evoked by secretagogues such as CRF and arginine vasopressin. In this study, we investigated the effects of glucocorticoids on ACTH release induced by oxytocin (OT) and on intracellular free calcium ion levels in corticotropes prepared from the adenohypophyses of female Wistar rats. Pulsatile additions of physiological concentration of OT (10 nM) to superfused anterior pituitary cells caused pulsatile ACTH release about 4-fold above basal secretion with similar peak amounts of ACTH during subsequent OT pulses. Exposure of the cells to corticosterone (100 nM) or to a selective glucocorticoid receptor agonist RU 28362 (100 nM) for 30 min suppressed OT-stimulated but not basal ACTH release by approximately 60%. Inhibition gradually disappeared during subsequent pulses of OT in the absence of corticosterone. Pretreatment with the selective antagonist RU 38486 (1 microM) completely blocked the inhibitory effect of corticosterone on OT-induced ACTH secretion. Changes in free cytosolic calcium levels in single cultured pituitary cells were measured using the calcium indicator Fura-2. OT caused calcium transients in corticotropes, which were identified by immunocytochemistry. They responded in a similar manner to a second OT stimulus when preincubated for 30 min with corticosterone (1 microM) or with RU 28362 (1 microM). Our data indicate that glucocorticoids, via glucocorticoid receptors, rapidly inhibit OT-stimulated ACTH secretion by corticotropes without affecting intracellular calcium transients due to OT. Therefore, we conclude that rapid inhibition of ACTH release by glucocorticoids interferes with cellular signal transduction beyond the step of calcium mobilization.