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Dystrophinopathies are heritable muscle disorders caused by pathogenic variants in the DMD gene, leading to progressive muscle breakdown, proximal weakness, cardiomyopathy, and respiratory failure. Diagnosis and management are evolving areas of neuromuscular neurology. In this episode, Kait Nevel, MD, speaks with Divya Jayaraman, MD, PhD, an author of the article "Dystrophinopathies" in the Continuum® October 2025 Muscle and Neuromuscular Junction Disorders issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Jayaraman is an assistant professor of neurology and pediatrics in the division of child neurology at the Columbia University Irving Medical Center in New York, New York. Additional Resources Read the article: Dystrophinopathies Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today I'm interviewing Dr Divya Jayaraman about her article on dystrophinopathies, which she wrote with Dr Partha Ghosh. This article appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Divya, welcome to the podcast, and please introduce yourself to the audience. Dr Jayaraman: Thank you so much, Dr Nevel. My name is Divya, and I am an assistant professor of Neurology and Pediatrics at Columbia University Irving Medical Center, and also an attending physician in the Pediatric Neuromuscular program there. In that capacity, I see patients with pediatric neuromuscular disorders and also some general pediatric neurology patients and also do research, primarily clinical research and clinical trials on pediatric neuromuscular disorders. Dr Nevel: Wonderful. Thank you for sharing that background with us. To set us on the same page for our discussion, before we get into some more details of the article, perhaps, could you start with some definitions? What comprises the dystrophinopathies? What are some of the core features? Dr Jayaraman: So, the dystrophinopathies, I like that term because it is a smaller subset from the muscular dystrophies. The dystrophinopathies are a spectrum of clinical phenotypes that are all associated with mutations in the DMD gene on chromosome X. So, that includes DMD---or, Duchenne muscular dystrophy---, Becker muscular dystrophy, intermediate muscular dystrophy (which falls in between the two), dilated cardiomyopathy, asymptomatic hyperCKemia, and manifesting female carriers. In terms of the core features of these conditions, so, there's some variability, weakness being prominent in Duchenne and also Becker. The asymptomatic hyperCKemia, on the other hand, may have minimal symptoms and might be found incidentally by just having a high CK on their labs. They all will have some degree of elevated CK. The dilated cardiomyopathy patients, and also the Becker patients to a lesser degree, will have cardiac involvement out of proportion to skeletal muscle involvement, and then the manifesting carriers likewise can have elevated CK and prominent cardiac involvement as well as some milder weakness. Dr Nevel: Now that we have some definitions, for the practicing neurologists out there, what do you think is the most important takeaway from your article about the dystrophinopathies? Dr Jayaraman: I like this question because it suggests that there's something that, really, any neurologist could do to help us pick up these patients sooner. And the big takeaway I want everyone to get from this is to check the CK, or creatine kinase, level. It's a simple, cheap, easy test that anyone can order, and it really helps us a lot in terms of setting the patient on the diagnostic odyssey. And in terms of whom you should be thinking about checking a CK in, obviously patients who present with some of the classic clinical features of Duchenne muscular dystrophy. This would include young boys who have toe walking, as they're presenting, sign; or motor delayed, delayed walking. They may have calf hypertrophy, which is what we say nowadays. You might have seen calf pseudohypertrophy in your neurology textbooks, but we just say calf hypertrophy now. Or patients can often have a Gowers sign or Gowers maneuver, which is named after a person called Gowers who described this phenomenon where the child will basically turn over and use their hands on the floor to stand up, usually with a wide-based gait, and then they'll sort of march their hands up their legs. That's the sort of classic Gowers maneuver. There are modified versions of that as well. So, if anyone presents with this classic presentation, for sure the best first step is to check a CK. But I would also think about checking a CK for some atypical cases. For example, any boy with any kind of motor or speech delay for whom you might not necessarily be thinking about a muscle disorder, it's always good practice to check a CK. Even a boy with autism for whom you may not get a good clinical exam. This patient might present to a general pediatric neurology clinic. I always check a CK in those patients, and you'll pick up a lot of cases that way. For the adult folks in particular, the adult neurologist, a female patient could show up in your clinic with asymptomatic hyperCKemia. And I think it's an important differential to think about for them because this could have implications not just for their own cardiac risks, but also for their family planning. Dr Nevel: So, tell us a little bit more about the timing of diagnosis. Biggest takeaway: check a CK if this is anywhere on your radar, even if somewhat of an atypical case. Why is it so important to get kiddos started on that diagnostic odyssey, as you called it, early? Dr Jayaraman: This is especially important for kids because if they especially get a Duchenne muscular dystrophy diagnosis, you might be making them eligible for treatments that we've had for some time, and also treatments that were not available earlier that hinge on making that diagnosis. So, for example, people may be skeptical about steroids, but there's population data to suggest that initiation and implementation of steroids could delay the onset of loss of ambulation as much as three years. So, you don't want to deprive patients of the chance to get that. And then all the newer emerging therapies---which we'll be talking about later, I'm sure---require a Duchenne muscular dystrophy diagnosis. So, that's why it's so important to check a CK, have this on your radar, and then get them to a good specialist. Dr Nevel: I know that you alluded already, or shared a few of the kind of exam paroles or findings among patients with dystrophinopathy. But could you share with us a little bit more how you approach these patients in the clinic who are presenting with muscle weakness, perhaps? And how do you approach this or think about this in terms of ways to potentially differentiate between a dystrophinopathy versus another cause of motor weakness or delay? Dr Jayaraman: It's helpful to think through the neuraxis and what kinds of disorders can present along that neuraxis. A major differential that I'm always thinking about when I'm seeing a child with proximal weakness is spinal muscular atrophy, which is a genetic anterior horn cell disorder that can also present in this age group. And some of the key differences there would be things like reflexes. So, you should have dropped reflexes in spinal muscular atrophy. In DMD, surprisingly, they might have preserved Achilles reflexes even if their patellar reflexes are lost. It may only be much later that they go on to lose their Achilles reflex. So, if you can get an Achilles reflex, that's quite reassuring, and if you cannot, then you need to be thinking about spinal muscular atrophy. They can both have low muscle tone and can present quite similarly, including with proximal weakness, and can even have neck flexion weakness. So, this is an important distinction to make. The reason for that is, obviously there are treatments for both conditions, but for spinal muscular atrophy, timing is very, very important. Time is motor neurons, so the sooner you make that diagnosis the better. Other considerations would be the congenital muscular dystrophies. So, for those that they tend to present a lot younger, like in infancy or very early on, and they can have much, much higher CKS in that age range than a comparable Duchenne or Becker muscular dystrophy patient. They can also have other involvement of the central nervous system that you wouldn't see in the dystrophinopathies, for example. My mnemonic for the congenital muscular dystrophies is muscle-eye-brain disease, which is one of the subtypes. So, you think about muscle involvement, eye involvement, and brain involvement. So, they need an ophthalmology valve. They can have brain malformations, which you typically don't see in the dystrophinopathies. I think those are some of the major considerations that I have. Obviously, it's always good to think about the rest of the neuraxis as well. Like, could this be a central nervous system process? Do they have upper motor neuron signs? But that's just using all of your exam tools as a neurologist. Dr Nevel: Yeah, absolutely. So, let's say you have a patient in clinic and you suspect they may have a dystrophinopathy. What is your next diagnostic step after your exam? Maybe you have an elevated CK and you've met with the patient. What comes next? Dr Jayaraman: Great question. So, after the CK, my next step is to go to genetics. And this is a bit of a change in practice over time. In the past we would go from the CK to the muscle biopsy before genetic testing was standard. And I think now, especially in kids, we want to try and spare them invasive procedures where possible. So, genetic testing would be the next step. There are a few no-charge, sponsored testing programs for the dystrophinopathies and also for some of the differential diagnosis that I mentioned. And I think we'll be including links to websites for all of these in the final version of the published article. So, those are a good starting point for a genetic workup. It's really important to know that, you know, deletions and duplications are a very common type of mutation in the DMD gene. And so, if you just do a very broad testing, like whole exome, you might miss some of those duplications and deletions. And it's important to include both checking for duplications and deletions, and also making sure that the DMD gene is sequenced. So always look at whatever genetic test you're ordering and making sure that it's actually going to do what you want it to do. After genetics, I think that the sort of natural question is, what if things are not clear after the genetics for some reason? We still use biopsy in this day and age, but we save it for those cases where it's not entirely clear or maybe the phenotype is a little bit discordant from the genotype. So, for mutations that disrupt the reading frame, those tend to cause Duchenne muscular dystrophy, whereas mutations that preserve the reading frame tend to cause Becker muscular dystrophy. There are some important exceptions to this, which is where muscle biopsy can be especially helpful in sorting it out. So, for example, there are some early mutations early in the DMD gene where, basically, they find an alternate start codon or an initiation codon to continue with transcription and translation. So, you end up forming a largely functional, somewhat truncated protein that gives you more of a milder Becker phenotype. On the other hand, you can have some non-frameshift or inframe mutations that preserve the reading frame, but because they disrupt a very key domain in the protein that's really crucial for its function, you can actually end up with a much more severe Duchennelike phenotype. So, for these sorts of cases, you might know a priori you're dealing with them, but might just be a child who is who you think has DMD has a mutation that's showed up on testing. There isn't enough in the literature to point you one way or another, but they look maybe a little milder than you would expect. That would be a good kid to do a biopsy in because there are treatment decisions that hinge on this. There are treatments that are only for Duchenne that someone with a milder phenotype would not be eligible for. Dr Nevel: So, that kind of stepwise approach, but maybe not all kids need a muscle biopsy is what I'm hearing from you. If it's a mutation that's been well-described in the literature to be fitting with Duchenne, for example. Dr Jayaraman: Absolutely. Dr Nevel: So, after you confirm the diagnosis through genetic testing---and let's say, you know, whether or not you do a muscle biopsy or not, after you know the diagnosis is a dystrophinopathy---how do you counsel the families and your patients? What are the most important points to relay to families, especially in that initial phase where the diagnosis is being made? Dr Jayaraman: This is a lot of what we do in pediatric neurology in general, right? So, I actually picked up this approach from the pediatric hematology oncology specialists at Boston Children's. They had this concept of a day-zero conversation, which is the day that you disclose the life-changing diagnosis or potentially, at some point, terminal diagnosis to a family. And some of the key components of that are a not beating around the bush, telling them what the diagnosis is, and then letting them have whatever emotional response they're going to have in the moment. And you may not get much further than that, but honestly, you want them to take away, this is what my child has. I did not do anything to cause this, nor could I have done anything to prevent this. Because often for these genetic conditions, there's a lot of guilt, a lot of parental guilt. So, you want to try and assuage that as much as possible. And then to know that they're not going to be alone on this journey; that, you know, they don't have to have it all figured out right then, but we can always come back and answer any questions they have. There's going to be a whole team of specialists. We're going to help the family and the kid manage this condition. Those are sort of my big takeaways that I want them to get. Dr Nevel: Right. And that segues into my next question, which is, who is part of that team? I know that these teams that help take care of people with dystrophinopathies and other muscle disorders can be very large teams that span multiple specialists. Can you talk a little bit more about that for this group of patients? Dr Jayaraman: Of course. So, the neuromuscular neurologist, really, our role is in coordinating the diagnosis, the initiation of any disease-specific treatments, and coordinating care with a whole group of specialists. So, we're sort of at the center of that, but everyone else is equally important. So, the other specialists include physical therapists; occupational therapists; rehab doctors or physiatrists; orthotists who help with all of the many braces and other devices that they might need, wheelchairs; pulmonology, of course, for managing the respiratory manifestations of this. It becomes increasingly important over time, and they are involved early on to help monitor for impending respiratory problems. Cardiac manifestations, this is huge and something that you should be thinking about even for your female carriers, the mother of the patient you're seeing in the clinic, or your patient who comes to adult clinic with asymptomatic hyperCKemia. if you end up making a diagnosis of DMD carrier for those patients, or if you make a Becker diagnosis, the cardiac surveillance is even more important because the cardiac involvement can be out of proportion to the skeletal muscle weakness. And of course, extremely important for the Duchenne patients as well. Endocrinologists are hugely important because in the course of treating patients with steroids, we end up giving them a lot of iatrogenic endocrinologic complications. Like they might have delayed puberty, they might have loss of growth, of height; and of course metabolic syndrome. So, endocrinology is hugely important. They're also important in managing things like fracture prevention, osteoporosis, prescribing bisphosphonates if necessary. Nutrition and GI are also important, not just later on when they might need assistance to take in nutrition, whether that's through tube feeds, but also earlier on when we're trying to manage the weight. Orthopedics, of course, for the various orthopedic complications that patients develop. And then finally, a word must be said for social work and behavioral and mental health specialists, because a lot of this patient population has a lot of mental health challenges as well. Dr Nevel: After you give the diagnosis, you've counseled the patient and families and you've had those kind of initial phase discussions, the day-zero discussion, when you start getting into discussions or thoughts about management, disease-specific medication. But what are the main categories of the treatment options, and maybe how do you kind of approach deciding between treatment options for your patients? Dr Jayaraman: So, there are two broad categories that I like to think about. So, one is the oral corticosteroids and oral histone deacetylase, or HDAC inhibitors, which share the common characteristic that they are non-mutation specific. And within corticosteroids, patients now have a choice between just Prednisone or Prednisolone, or Deflazacort or Vermilion. The oral HDAC inhibitors are newly FDA-approved as a nonsteroidal therapy in addition to corticosteroids in DMD patients above six years of age. I would say we're in the early phase of adoption of this in clinical practice. And then the other big category of treatment options would be the genetic therapies as a broad bucket, and this would include gene therapy or gene replacement therapy, of which the most famous is the microdystrophin gene therapy that was FDA-approved first on an accelerated approval basis for ages four to eight, and then a full approval in that age group as well as an accelerated approval for all comers, essentially, with DMD. This is obviously controversial. Different centers approach this a bit differently. I think our practice at our site has been to focus on the ambulatory population, just thinking about risk versus benefit, because the risks are not insignificant. So really this is something that should be done by experienced sites that have the bandwidth and the wherewithal to counsel patients through all of this and to manage complications as they arise with regular monitoring. And then another class that falls within this broader category would be the Exon-skipping therapies. So as the name suggests, they are oligonucleotides that cause an Exon to be skipped. The idea is, if there is a mutation in a particular Exon that causes a frame shift, and there's an adjacent Exon that you can force skipping of, then the resulting protein, when you splice the two ends together, will actually allow restoration of the reading frame. I think the picture I want to paint is that there's a wide range of options that we present to families, not all of which everyone will be eligible for. And they all have different risk profiles. And I really think the choice of a particular therapy has to be a risk-benefit decision and a shared decision-making process between the physician and the family. Dr Nevel: What is going on in research in this area? And what do you think will be the next big breakthrough? I know before we started the recording you had mentioned that there's a lot of things going on that are exciting. And so, I'm looking forward to hearing more. Dr Jayaraman: Of course. So, I'll be as quick as I can with this. But I mentioned that next-generation Exon skipping therapies, I think the hope is that they will be better at delivering the Exon skipping to the target tissue and cells and that they might be more efficacious. I'm also excited about next-generation gene therapies that might target muscle more specifically and hopefully reduce the off-target effects, or combination use of gene therapies with other immunosuppressive regimens to improve the safety profile and maybe someday allow redosing, which we cannot do currently. Or potentially targeting the satellite cells, which are the muscle stem cells, again, to improve the long term durability of these genetic therapies. Dr Nevel: That's great, thank you for sharing. Thank you so much for talking to me today about your article. I really enjoyed learning more about the dystrophinopathies. Today I've been interviewing Dr Divya Jayaraman about her article on the dystrophinopathies, which she wrote with Dr Partha Ghosh. This article appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Please be sure to check out the Continuum Audio episodes from this and other issues. Also, please read the Continuum articles for more details than what we were able to get to today during our discussion. Thank you, as always, so much to the listeners for joining us today, and thank you, Divya, for sharing all of your knowledge with us today. Dr Jayaraman: Thank you so much for having me on the podcast. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

https://ivdi.org/inv Ready to elevate your veterinary dental skills? Request an invite to the Veterinary Dental Practitioner Program. -------------------------------------------------------------------------

Prednisolone is a corticosteroid that is often used in pediatrics. Hyperglycemia, insomnia, and GI upset are relatively common adverse effects. Ibuprofen is a commonly used OTC pain reliever. It is classified as an NSAID and can increase GI bleed risk and exacerbate heart failure. Aceon is the brand name for perindopril. ACE inhibitors are well known to cause drug induced cough and will cause hyperkalemia. Trazodone is classified as an antidepressant but is frequently used to treat insomnia because of its sedative properties. Pioglitazone is an oral anti-diabetes medication that should be avoided in patients with heart failure.

Drs Sandhya Srinivas and Heather Cheng discuss PARP inhibitors, clinical trials, and germline vs somatic testing for patients with prostate cancer, as well as the optimal time for this testing. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988734). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Germline Testing in Prostate Cancer: When and Who to Test https://pubmed.ncbi.nlm.nih.gov/34669358/ Germline and Somatic Mutations in Prostate Cancer for the Clinician https://pubmed.ncbi.nlm.nih.gov/31085765/ Genetic and Genomic Testing for Prostate Cancer: Beyond DNA Repair https://pubmed.ncbi.nlm.nih.gov/37207301/ Genome-Wide Association Study of Prostate Cancer-Specific Survival https://pubmed.ncbi.nlm.nih.gov/26307654/ Inherited DNA-Repair Gene Mutations in Men With Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/27433846/ NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Prostate Cancer https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf PARP Inhibitors in Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/37168382/ Rucaparib in Men With Metastatic Castration-Resistant Prostate Cancer Harboring a BRCA1 or BRCA2 Gene Alteration https://pubmed.ncbi.nlm.nih.gov/32795228/ Olaparib for Metastatic Castration-Resistant Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/32343890/ Abiraterone and Olaparib for Metastatic Castration-Resistant Prostate Cancer https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200043 Rucaparib or Physician's Choice in Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/36795891/ FDA Approves Olaparib With Abiraterone and Prednisone (or Prednisolone) for BRCA-Mutated Metastatic Castration-Resistant Prostate Cancer https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-olaparib-abiraterone-and-prednisone-or-prednisolone-brca-mutated-metastatic-castration Niraparib and Abiraterone Acetate for Metastatic Castration-Resistant Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/36952634/ Talazoparib Plus Enzalutamide in Men With First-line Metastatic Castration-Resistant Prostate Cancer (TALAPRO-2): A Randomised, Placebo-Controlled, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/37285865/

Drs Sandhya Srinivas and Rana R. McKay discuss bone health and survivorship, including risk factors and potential side effects with androgen deprivation therapy in patients with prostate cancer. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988732). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Metastases in Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/29661810/ Do Dietary Calcium and Vitamin D Matter in Men With Prostate Cancer? https://pubmed.ncbi.nlm.nih.gov/29765146/ Zoledronic Acid: A Review of Its Use in the Management of Bone Metastases and Hypercalcaemia of Malignancy https://pubmed.ncbi.nlm.nih.gov/12558465/ Denosumab in Osteoporosis https://pubmed.ncbi.nlm.nih.gov/24289327/ Alpha Emitter Radium-223 and Survival in Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/23863050/ Effect of Longer-Interval vs Standard Dosing of Zoledronic Acid on Skeletal Events in Patients With Bone Metastases: A Randomized Clinical Trial https://pubmed.ncbi.nlm.nih.gov/28030702/ The Prevention of Fragility Fractures in Patients With Non-Metastatic Prostate Cancer: A Position Statement by the International Osteoporosis Foundation https://pubmed.ncbi.nlm.nih.gov/29088899/ Decreased Fracture Rate by Mandating Bone Protecting Agents in the EORTC 1333/PEACEIII Trial Combining Ra223 With Enzalutamide Versus Enzalutamide Alone: An Updated Safety Analysis. https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.5002 Addition of Radium-223 to Abiraterone Acetate and Prednisone or Prednisolone in Patients With Castration-Resistant Prostate Cancer and Bone Metastases (ERA 223): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/30738780/

The First Principles of Croup that can get you through your paediatrics rotation: what is it, what do you do about it, and what type of barking cough do you hear? === Other Links === Check out our new website ⁠⁠⁠⁠1pm.wiki⁠⁠⁠⁠ for the ⁠⁠⁠⁠Notion document⁠⁠⁠⁠, free Anki flashcards, and podcast episodes. Check out our Instagram: ⁠⁠⁠⁠https://www.instagram.com/firstprinciplesofmedicine/⁠⁠⁠⁠ Recorded 15 March 2023 Co-hosts: Jay Cheyyur, JT Yeung⁠⁠⁠⁠⁠ & Adian Izwan⁠⁠⁠⁠⁠ feat. Alex Truong. Produced by Rushil D'Cruz & Adian Izwan. If you have any ideas or feedback, comment on this Notion document, or shoot us an email at ⁠⁠⁠⁠hello@1pm.wiki⁠⁠⁠⁠ *** We're really excited to be collaborating with Becky from Becky's notes, a UK based resource, to produce infographics for our visual learners out there. Becky's notes brings together all the key topics medical students need to know in a readily available place, reviewed by specialists in the field. These visually striking notes are a refreshing change from all the boring textbooks. You can check her out on Instagram at @beckysnotes01 and get her books at ⁠⁠⁠⁠https://linktr.ee/Beckysnotes⁠⁠⁠⁠ === Timestamps === (01:10) What is Croup? (01:35) Anatomy & physiology (03:58) Airway diameter (04:36) Top viruses (07:53) Signs & symptoms (09:11) Stridor (11:38) Examination (15:37) Exam summary (15:53) Severity of Croup (21:38) Severity summary  (22:19) Investigations (24:47) Management (26:15) Dexamethasone vs Prednisolone (34:50) Management summary (35:24) Complications (36:13) Differentials (38:16) Three key takeaways  

Epilepsy is a frequent co-morbidity in those with autism spectrum disorder (ASD). Maria Augusta Montenegro, M.D., Ph.D., discusses how cognitive abilities, motor deficit, and other associated symptoms can be factors, how epilepsy can be diagnosed, and recommended treatment options. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Show ID: 38389]

Epilepsy is a frequent co-morbidity in those with autism spectrum disorder (ASD). Maria Augusta Montenegro, M.D., Ph.D., discusses how cognitive abilities, motor deficit, and other associated symptoms can be factors, how epilepsy can be diagnosed, and recommended treatment options. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Show ID: 38389]

Epilepsy is a frequent co-morbidity in those with autism spectrum disorder (ASD). Maria Augusta Montenegro, M.D., Ph.D., discusses how cognitive abilities, motor deficit, and other associated symptoms can be factors, how epilepsy can be diagnosed, and recommended treatment options. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Show ID: 38389]

Epilepsy is a frequent co-morbidity in those with autism spectrum disorder (ASD). Maria Augusta Montenegro, M.D., Ph.D., discusses how cognitive abilities, motor deficit, and other associated symptoms can be factors, how epilepsy can be diagnosed, and recommended treatment options. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Show ID: 38389]

Epilepsy is a frequent co-morbidity in those with autism spectrum disorder (ASD). Maria Augusta Montenegro, M.D., Ph.D., discusses how cognitive abilities, motor deficit, and other associated symptoms can be factors, how epilepsy can be diagnosed, and recommended treatment options. Series: "Autism Tree Project Annual Neuroscience Conference" [Health and Medicine] [Show ID: 38389]

I mentioned prednisolone to prednisone conversion in this podcast. Please go check out Pyrls.com for a free steroid conversion downloadable PDF with a free account! On this episode, I discuss prednisolone (Orapred, Pediapred) pharmacology, adverse effects, practice pearls, and drug interactions. Prednisolone is a systemic corticosteroid that can cause insomnia, elevations in blood sugars, and numerous effects if used long-term. CYP3A4 is an important enzyme in the breakdown of prednisolone. Inhibitors or inducers may raise or lower drug levels respectively.

This Podcast summarises the article 'Penetration of topically administered dexamethasone disodium phosphate and prednisolone acetate into the normal equine ocular fluids' by Hermans et al.

In this podcast Francesca Beccati discusses bone stress injuries and fatigue fractures of the pelvis in endurance horses, and Hanneke Hermans discusses penetration of topically administered dexamethasone disodium phosphate and prednisolone acetate into the normal equine ocular fluids.

In this episode, we talk to Milap Sandhu, PT, PhD about Acute Intermittent Hypoxia and drug-induced neuromodulation and the results of his recent paper: Sandhu MS,Gray E, Kocherginsky M, Jayaraman A, Mitchell GS, Rymer WZ. Prednisolone pretreatment enhances intermittent hypoxia-induced plasticity in persons with chronic incomplete spinal cord injury. Neurorehabil Neural Repair. 2019;33:911-921. The Spinal Cord Injury Special Interest Group is part of the Academy of Neurologic Physical Therapy - www.neuropt.org.

Did you spend that extra leap year day in February keeping up with the medical literature? No? No problem, we've got you covered with a fresh look at the month's most relevant and interesting Gen Med articles.--------------------------- Get in touch! @JournalSpotting or journalspotting@gmail.comWe'd love to hear from you: what you thought of the show, what you would like to hear, and if you have any articles that you would like us to share with the general medicine world! A wise man at your ARCP once said: "It didn't happen unless you've filled in a feedback form". (But seriously, we'd love to hear what you think!) --------------------------- In this month's episode: …NELSON sails the high seas of lung cancer screening…de Koning, Harry J et al. “Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial.” The New England journal of medicine  https://pubmed.ncbi.nlm.nih.gov/31995683/…the rise and rise of the NOAC… Inohara, Taku et al. “Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation.” https://pubmed.ncbi.nlm.nih.gov/31911503/ Kuno, Toshiki et al. “Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Hemodialysis.” Journal of the American College of Cardiology https://pubmed.ncbi.nlm.nih.gov/31976865/ …why we should all brush up on our drug side effect monitoring… Savage, Rachel D et al. “Evaluation of a Common Prescribing Cascade of Calcium Channel Blockers and Diuretics in Older Adults With Hypertension.” JAMA internal medicinehttps://pubmed.ncbi.nlm.nih.gov/32091538/ …Surely there's more to it than just steroids?... Dobler, Claudia C et al. “Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis.” Annals of internal medicine. https://pubmed.ncbi.nlm.nih.gov/32092762/ …when the question is steroids, might metformin be the answer?...Pernicova, Ida et al. “Metformin to reduce metabolic complications and inflammation in patients on systemic glucocorticoid therapy” The lancet. Diabetes & endocrinology https://pubmed.ncbi.nlm.nih.gov/32109422/ …to scope or not to scope for dyspepsia…Sonnenberg, Amnon et al. “Low Prevalence of Helicobacter pylori-Positive Peptic Ulcers in Private Outpatient Endoscopy Centers in the United States.” The American journal of gastroenterology https://pubmed.ncbi.nlm.nih.gov/31972622/ ***Irrelevantly relatively relevant articles*** Urinary Auto-brewery Syndrome: A Case Report https://pubmed.ncbi.nlm.nih.gov/32092761/Sex rations & societal stress https://pubmed.ncbi.nlm.nih.gov/32127345/ ***Other bits***Piers Morgan vs. Gregg's  https://www.youtube.com/watch?v=Jj2x_NE_TNQBjork's 4th album: https://www.youtube.com/watch?v=OnjWKA0JsJo&list=PL1BCBDDA394C775CLSHTM Viral Podcast

QD Clinic - Lessons from the clinic Review of the HOPE study - Prednisolone in Hand OA Features Dr. Jack Cush YouTube: https://youtu.be/rM3Ta3ARURY

This randomised, double-blind, placebo-controlled trial by Kroon et al has demonstrated a substantial improvement in painful hand OA with signs of inflammation following six weeks of low-dose prednisolone.

Question 1:  Karen from North Carolina, 0-12:25 Hello Dr. Berne.  First, I want to thank you for all of the wonderful, hopeful and extremely helpful information you give out to all of us who have eye disease. I look forward to listening to every one of your podcasts. Six weeks ago I was diagnosed with an eye virus and Meibomian gland dysfunction. (I had a cold for 2 weeks and also got something in my eye which I rubbed and should not have). I was prescribed a combo steroid/antibiotic eyedrop one drop q.i.d. for 10 days. This did not seem to help as the clear little bubbles were still in my eye and my eye was pink. A month later I went for a second opinion, and was diagnosed with 2+ nodular episcleritis and conjunctival lymphangiectasia. I was prescribed Prednisolone 1% one drop t.i.d. for 7 days. This helped as I did not feel like I had something in my eye anymore and the redness went away. I had a one week follow-up appt and the inflammation was much improved, but still have the lymph bubbles. The eye doctor told me to continue the Prednisolone one drop b.i.d. for another 2 weeks.  Personally, I do not want to continue with the Prednisolone drops for another 2 weeks. I have lattice degeneration, myopia, cataracts, dry eye, ocular migraines, vitreous syneresis, and photopsia. I take every one of the supplements you recommend for eyes along with ones to support the liver and eat a good diet. I have been rebounding, using eye compresses, drinking eyebright tea and using eyebright homeopathy pellets, and putting lemon essential oil on my neck to try to help the lymphangiectasia. I use Similasan eyedrops as well. Today I am going to start with hexane free organic castor oil eye drops.  I wanted to know if you have any further recommendations to help get rid of the little clear lymph bubbles. Also, of note, they do seem to get smaller and move around just a little, look as though they are going away, and then they pop back up again. There are usually 3-4 of them.   Thank you SO VERY MUCH for your consideration for answering my questions. God Bless You For All That You Do!!!!  Question 2:  Tracy from California, 12:30-24:23.   Dr Berne I  have an ocular immune disease I was shocked to read on the pemphagus site that spirulina  as well as  well as echinacea actually  increases the autoimmunity I was drinking a green powder from a reputable company and noticed spirulina was an ingredient   Also I was told by my doc not to have more than 500  mg vitamin c as  that can also have an adverse reaction I am of course doing an integrative approach but after consulting with functional doctor and I don't need medication.   What do you suggest?

Question 1:  Karen from North Carolina, 0-12:25 Hello Dr. Berne.  First, I want to thank you for all of the wonderful, hopeful and extremely helpful information you give out to all of us who have eye disease. I look forward to listening to every one of your podcasts. Six weeks ago I was diagnosed with an eye virus and Meibomian gland dysfunction. (I had a cold for 2 weeks and also got something in my eye which I rubbed and should not have). I was prescribed a combo steroid/antibiotic eyedrop one drop q.i.d. for 10 days. This did not seem to help as the clear little bubbles were still in my eye and my eye was pink. A month later I went for a second opinion, and was diagnosed with 2+ nodular episcleritis and conjunctival lymphangiectasia. I was prescribed Prednisolone 1% one drop t.i.d. for 7 days. This helped as I did not feel like I had something in my eye anymore and the redness went away. I had a one week follow-up appt and the inflammation was much improved, but still have the lymph bubbles. The eye doctor told me to continue the Prednisolone one drop b.i.d. for another 2 weeks.  Personally, I do not want to continue with the Prednisolone drops for another 2 weeks. I have lattice degeneration, myopia, cataracts, dry eye, ocular migraines, vitreous syneresis, and photopsia. I take every one of the supplements you recommend for eyes along with ones to support the liver and eat a good diet. I have been rebounding, using eye compresses, drinking eyebright tea and using eyebright homeopathy pellets, and putting lemon essential oil on my neck to try to help the lymphangiectasia. I use Similasan eyedrops as well. Today I am going to start with hexane free organic castor oil eye drops.  I wanted to know if you have any further recommendations to help get rid of the little clear lymph bubbles. Also, of note, they do seem to get smaller and move around just a little, look as though they are going away, and then they pop back up again. There are usually 3-4 of them.   Thank you SO VERY MUCH for your consideration for answering my questions. God Bless You For All That You Do!!!!  Question 2:  Tracy from California, 12:30-24:23.   Dr Berne I  have an ocular immune disease I was shocked to read on the pemphagus site that spirulina  as well as  well as echinacea actually  increases the autoimmunity I was drinking a green powder from a reputable company and noticed spirulina was an ingredient   Also I was told by my doc not to have more than 500  mg vitamin c as  that can also have an adverse reaction I am of course doing an integrative approach but after consulting with functional doctor and I don't need medication.   What do you suggest?

Ebony,Stan and Vicky speak about side effects they felt when taking Prednisolone to alleviate MS attack...Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, cancers, adrenocortical insufficiency, high blood calcium, rheumatoid arthritis, dermatitis, eye inflammation, asthma, and multiple sclerosis. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/victoriouschats214/support

In this episode I cover giant cell arteritis.If you want to follow along with written notes on giant cell arteritis go to https://zerotofinals.com/medicine/rheumatology/giantcellarteritis/ or the rheumatology section in the Zero to Finals medicine book.This episode covers the definitions, associations, complications, features, diagnosis and management of giant cell arteritis. We also cover long term steroids.The audio in the episode was expertly edited by Harry Watchman.

In this episode I cover polymyalgia rheumatica.If you want to follow along with written notes on polymyalgia rheumatica go to https://zerotofinals.com/medicine/rheumatology/pmr/ or the rheumatology section in the Zero to Finals medicine book.This episode covers the definitions, associations, features, diagnosis and management of polymyalgia rheumatica. We also cover long term steroids.The audio in the episode was expertly edited by Harry Watchman.

Fennesz / Beat Pharmacy / Adrian Corker / Leafcutter John / Dust-e-1 / Sote / Unbroken Dub and more....

Fennesz / Beat Pharmacy / Adrian Corker / Leafcutter John / Dust-e-1 / Sote / Unbroken Dub and more....

In this episode I cover acute asthma.If you want to follow along with written notes on asthma go to https://zerotofinals.com/medicine/respiratory/acuteasthma/ or find the respiratory section in the Zero to Finals medicine book.This episode covers the pathophysiology, triggers, presentation, diagnosis and management of acute asthma. The audio in the episode was expertly edited by Harry Watchman.

In this Episode we are listening to Ilkka from Finland.  He talks about how AS threatened his career as a musician.  He was once on 10 different types of medication including Motifene Dual, Salazopyrin, Prednisolone, Somacand and now he is off them all for well over a year.  His career is thriving and he is healthier than ever.  I look forward to surfing with this guy one day.If you would like to get a hold of me (Michael Eisner the host) feel free to email me at eisner00@gmail.com  

Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the August 22, 2017 issue  

In this Audio Summary Adam shares the evidence around whether hydrolysed diets reduce gastro-intestinal symptoms in dogs with chronic enteropathy. Read the full Knowledge Summary here. Audio Summaries are a free resource that enables vets and vet nurses to access and digest relevant and up-to-date evidence quicker and easier! A time-saving way to make better and faster evidence-based decisions.  

See the original written post, Down With the Sickness. If you are enjoying the content; words, audio or video, please share or subscribe at the bottom of the page. Excerpt: My five year old has roid rage. She was prescribed Prednisolone for a cough last week. The cough is still around but now it’s a little […]

In this edition of the EVJ podcast, Jonathon Cheetham discusses their paper, entitled 'Transoesophageal ultrasound and computer tomographic assessment of the equine cricoarytenoid dorsalis muscle: Relationship between muscle geometry and exercising laryngeal function' and Isabelle Kern discusses their paper 'Bacteraemia before, during and after tooth extraction in horses in the absence of antimicrobial administration'. These papers have been made free to access for 3 months.

Happy new year! In our first episode of 2016, Amol, general internal medicine resident at the University of Toronto, talk about his 10 favourite papers of 2015. Rate us on iTunes! Follow us on Twitter @roundstable. The Papers 1. Teixobactin, a new antibiotic:  http://www.nature.com/nature/journal/v517/n7535/full/nature14098.html 2. Modified Valsalva manoeuvre: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961485-4/abstract 3. Prednisolone or pentoxifylline for alcoholic ... The post Amol’s 10 Favourite Papers of 2015 appeared first on Healthy Debate.

Happy new year! In our first episode of 2016, Amol, general internal medicine resident at the University of Toronto, talk about his 10 favourite papers of 2015. Rate us on iTunes! Follow us on Twitter @roundstable. The Papers 1. Teixobactin, a new antibiotic:  http://www.nature.com/nature/journal/v517/n7535/full/nature14098.html 2. Modified Valsalva manoeuvre: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2961485-4/abstract 3. Prednisolone or pentoxifylline for alcoholic ...The post Amol's 10 Favourite Papers of 2015 appeared first on Healthy Debate.

Amol and Nathan want you to understand the following: 1. A large randomized evaulation of a quality improvement intervention demonstrated a modest but significant reduction in rates of cesarean-section in Quebec. 2. A large double-blind randomized-controlled-trial of over 1100 patients showed that pentoxifylline is not beneficial in the treatment of alcoholic hepatitis and prednisolone may have mild ... The post Summer Replay 2: Reducing c-sections and prednisolone vs. pentoxifylline for alcoholic hepatitis appeared first on Healthy Debate.

Amol and Nathan want you to understand the following: 1. A large randomized evaulation of a quality improvement intervention demonstrated a modest but significant reduction in rates of cesarean-section in Quebec. 2. A large double-blind randomized-controlled-trial of over 1100 patients showed that pentoxifylline is not beneficial in the treatment of alcoholic hepatitis and prednisolone may have mild ...The post Summer Replay 2: Reducing c-sections and prednisolone vs. pentoxifylline for alcoholic hepatitis appeared first on Healthy Debate.

Amol and Nathan want you to understand the following: 1. A large randomized evaulation of a quality improvement intervention demonstrated a modest but significant reduction in rates of cesarean-section in Quebec. 2. A large double-blind randomized-controlled-trial of over 1100 patients showed that pentoxifylline is not beneficial in the treatment of alcoholic hepatitis and prednisolone may have mild ...The post A Hippocratic Dilemma: Reducing rates of c-sections and prednisolone vs. pentoxifylline for alcoholic hepatitis. appeared first on Healthy Debate.

Amol and Nathan want you to understand the following: 1. A large randomized evaulation of a quality improvement intervention demonstrated a modest but significant reduction in rates of cesarean-section in Quebec. 2. A large double-blind randomized-controlled-trial of over 1100 patients showed that pentoxifylline is not beneficial in the treatment of alcoholic hepatitis and prednisolone may have mild ... The post A Hippocratic Dilemma: Reducing rates of c-sections and prednisolone vs. pentoxifylline for alcoholic hepatitis. appeared first on Healthy Debate.

An interview with Ivo N. van Schaik, MD, PhD, about pulsed high-dose dexamethasone versus standard prednisolone treatment for chronic inflammatory demyelinating polyradiculoneuropathy (PREDICT study): a double-blind, randomized, controlled trial. Interviewed by Ted Burns, MD and Robert Pascuzzi, MD.

An interview with Ivo N. van Schaik, MD, PhD, about pulsed high-dose dexamethasone versus standard prednisolone treatment for chronic inflammatory demyelinating polyradiculoneuropathy (PREDICT study): a double-blind, randomized, controlled trial. Interviewed by Ted Burns, MD and Robert Pascuzzi, MD.

An interview with Ivo N. van Schaik, MD, PhD, about pulsed high-dose dexamethasone versus standard prednisolone treatment for chronic inflammatory demyelinating polyradiculoneuropathy (PREDICT study): a double-blind, randomized, controlled trial. Interviewed by Ted Burns, MD and Robert Pascuzzi, MD.

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Thu, 1 Jan 1970 12:00:00 +0100 https://epub.ub.uni-muenchen.de/8795/1/8795.pdf Müller, O. A.; Kluge, F.; Gerb, A. C.; Boss, M.; Scriba, Peter Christian