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- ItemAcesso aberto (Open Access)Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality(Associação Paulista de Medicina - APM, 2003-01-01) Meneguel, Joice Fabíola [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Miyoshi, Milton Harumi [UNIFESP]; Peres, Clovis de Araujo [UNIFESP]; Russo, Regina Helena [UNIFESP]; Kopelman, Benjamin Israel [UNIFESP]; Camano, Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT: Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY: Cross-sectional. SETTING: A tertiary-care hospital. PARTICIPANTS: Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES: Analysis of maternal and newborn records. MAIN MEASUREMENTS: The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS: Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51) and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43). The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82). However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the protective effect in relation to death. With regard to other outcomes, antenatal corticosteroids reduced the incidence of intraventricular hemorrhage grades III and IV (OR: 0.28; 95% CI: 0.10-0.77). CONCLUSIONS: Antenatal corticosteroids were effective in the reduction of morbidity and mortality among premature newborns in the population studied, and therefore their use should be stimulated within our environment.
- ItemAcesso aberto (Open Access)Bone mineral density in juvenile systemic lupus erythematosus(Associação Brasileira de Divulgação Científica, 2002-10-01) Castro, Tania Caroline Monteiro de [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Szejnfeld, Vera Lucia [UNIFESP]; Castro, Charlles Heldan de Moura [UNIFESP]; Fisberg, Mauro [UNIFESP]; Gabay, M. [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)We evaluated spine bone mineral density (BMD) in Brazilian children with juvenile systemic lupus erythematosus (JSLE) in order to detect potential predictors of reduction in bone mass. A cross-sectional study of BMD at the lumbar spine level (L2-L4) was conducted on 16 female JSLE patients aged 6-17 years. Thirty-two age-matched healthy girls were used as control. BMD at the lumbar spine was measured by dual-energy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in patients and controls. Disease duration, mean daily steroid doses, mean cumulative steroid doses and JSLE activity measured by the systemic lupus erythematosus disease activity index (SLEDAI) were determined for all JSLE patients based on their medical charts. All parameters were used as potential determinant factors for bone loss. Lumbar BMD tended to be lower in the JSLE patients, however, this difference was not statistically significant (P = 0.10). No significant correlation was observed in JSLE girls between BMD and age, height, Tanner stage, disease duration, corticosteroid use or disease activity. We found a weak correlation between BMD and weight (r = 0.672). In the JSLE group we found no significant parameters to correlate with reduced bone mass. Disease activity and mean cumulative steroid doses were not related to BMD values. We did not observe reduced bone mass in female JSLE.
- ItemAcesso aberto (Open Access)Bone mineral density of Brazilian girls with juvenile dermatomyositis(Associação Brasileira de Divulgação Científica, 2005-02-01) Castro, Tania Caroline Monteiro de [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Szejnfeld, Vera Lucia [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Fonseca, A.s.m. da; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio Grande do Norte Departamento de PediatriaWe measured bone mineral density (BMD) in girls with juvenile dermatomyositis (JDM) considering multiple factors in order to determine if it could be used as a predictor of reduction in bone mass. A cross-sectional study of lumbar spine BMD (L2-L4) was conducted on 10 girls aged 7-16 years with JDM. A group of 20 age-matched healthy girls was used as control. Lumbar spine BMD was measured by dual-energy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in all patients and controls. Duration of disease and mean daily and cumulative steroid doses were calculated for all patients on the basis of their medical charts. JDM activity was determined on the basis of the presence of muscle weakness, cutaneous vasculitis and/or elevation of serum concentration of one or more skeletal muscle enzymes. Seven patients demonstrated osteopenia or osteoporosis. Lumbar BMD was significantly lower in the JDM patients than the age-matched healthy control girls (0.712 vs 0.878, respectively; Student t-test, P = 0.041). No significant correlation between BMD and age, height, Tanner stage, disease duration, corticosteroid use, or disease activity was observed in JDM girls, but a correlation was observed between BMD and weight (Pearson's correlation coefficient, r = 0.802). Patients with JDM may be at risk for a significant reduction in BMD that might contribute to further skeletal fragility. Our results suggest that reduced bone mass in JDM may be related to other intrinsic mechanisms in addition to steroid treatment and some aspects of the disease itself may contribute to this condition.
- ItemSomente MetadadadosDensidade Mineral Óssea de Pacientes Portadores de Glomerulopatias em Uso Crônico de Corticóides(Universidade Federal de São Paulo (UNIFESP), 2001) De Deus, Rogério Barbosa [UNIFESP]; Heilberg, Ita Pfeferman [UNIFESP]
- ItemAcesso aberto (Open Access)Efeitos da betametasona sobre os fetos e placentas da rata albina(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2001-03-01) Souza, Eduardo de [UNIFESP]; Simões, Manuel de Jesus [UNIFESP]; Camano, Luiz [UNIFESP]; Kulay Júnior, Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: to analyze the effect of betamethasone on the pregnancy of rats. Methods: thirty pregnant rats were divided into three groups of ten animals each. Group I -- the animals received betamethasone IM (1 mg/kg body weight, in 0.5 ml distilled water) on the 11th, 12th, 18th and 19th day of pregnancy. Group II -- the rats received distilled water (0.5 ml) IM on the 11th, 12th, 18th and 19th day of pregnancy. Group III - the rats did not receive any drug or vehicle. The animals were weighed on days 0, 7, 14 and on the 20th of pregnancy, and on the last day of weighing, the animals were sacrificed. The number of implantations, resorptions, fetuses, placentas, malformations, maternal and fetal mortality as well as the weight of the fetuses and placentas were obtained and analyzed. Results: our results show that the rats treated with betamethasone gained significantly less weight. Their fetuses had an average weight of 3.2 g compared with 3.75 g in the control group. The results regarding placental weight were 0.36 g vs 0.48 g, respectively. All these differences were statistically significant. Conclusions: betamethasone had a negative effect on the gain of weight of matrices, fetuses and placentas when administered repeatedly and continuousy after the second half of pregnancy.
- ItemSomente MetadadadosEffects of corticosteroid, montelukast and iNOS inhibition on distal lung with chronic inflammation(Elsevier B.V., 2013-01-15) Ribas Souza, Flavia Castro; Gobbato, Nathalia Brandao; Maciel, Rafaela Guerra; Prado, Carla Maximo [UNIFESP]; Martins, Milton Arruda; Leick, Edna A.; Calvo Tiberio, Iolanda F. L.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)We evaluated the effects of anti-iNOS (1400W - W) associated with leukotriene antagonist (montelukast - M) or corticosteroid (dexamethasone - D) on distal lung of guinea pigs (GP) with chronic pulmonary inflammation.Methods: GP were inhaled with ovalbumin (OVA-2x/week/4 weeks), treated with M (OVAM), D (OVAD) and/or W (OVAW, OVADW, OVAMW) and distal lungs were evaluated by morphometry.Results: Isolated treatments were not sufficient to reduce all parameters. in OVADW, all parameters were reduced with greater reduction in elastic fibers, TIMP-1, IL-4, IL-5, IFN-gamma and PGF2-alpha compared with OVAD (p<0.05). OVAMW potentiated the reduction of actin, elastic fibers, TIMP-1, IL-4, IL-5, TGFbeta, IFN-gamma, iNOS, and PGF2-alpha to a greater extent than OVAM (p<0.05). A reduction of TIMP-1, IL-4, IL-5, TGF-beta, IFN-gamma and iNOS was observed in OVADW compared with OVAMW (p<0.05).Conclusions: Although anti-iNOS paired with montelukast or dexamethasone yields better results than isolated treatments, the most effective pairing for controlling inflammation, oxidative stress and remodeling in this asthma model was found to be corticosteroids and anti-iNOS. (C) 2012 Published by Elsevier B.V.
- ItemAcesso aberto (Open Access)Effects of the corticosteroids in the lesions by radiofrequency on rats' thigh in different age groups(Sociedade Brasileira de Cardiologia - SBC, 2010-08-01) Okada, Mieko [UNIFESP]; Araújo, Sérgio de [UNIFESP]; Franco, Marcello Fabiano de [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Fenelon, Guilherme [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: The corticosteroids limit the late growth of the lesions by radiofrequency (RF) on the rats' infants' thighs, but the effects on the pubescent and adult rats are unknown. OBJECTIVE: Evaluate the effects of the corticosteroids in the healing of the lesions by RF on the rats' thighs muscles in different age groups. METHODS: Ablation was performed on the thigh muscle of 30 rats (1 lesion per animal): infants (30 days old, weight 73 g, n = 10), pubescents (60 days old, weight 230 g, n = 10) and 10 adults (90 days old, 310 g, n = 10), subdivided in control and treated groups, that received Hydrocortisone (10 mg/kg IM post-RF) and Betametasone (3.5 mg/kg IM, twice a week, for 29 days). The rats were sacrificed 60 days after the ablation for hystopathological and planimetric analysis with specified software (ImageJ®). RESULTS: In the infant, pubescent and adult groups, the weight gain in the follow up did not differ between the control and the treated ones. In the control group, the lesions of the infants and pubescents were superior (p = 0.01) to the adults'. The treatment reduced the size of the lesion in the infants (5.58+0.61 mm² vs 4.02+0.23 mm²; p < 0.01) and pubescents (5.20+0.47 mm² vs 4.16+0.48 mm²; p < 0.01), but not in the adults (4.44+0.50 mm² vs 4.79+0.53 mm², p = NS). Infant and pubescent treated groups presented lower collagen deposition and less fibrotic bands invading the healthy tissue from the central fibrosis area, and forming lesions with remarkably more reduced dimensions than their controls. There were no differences in the adult groups. CONCLUSION: The corticosteroids seem to reduce the late growth of lesion, in addition to attenuate the fibrotic proliferation in the infant and pubescent rats.
- ItemSomente MetadadadosImpact of corticosteroids on late growth of radiofrequency lesions in infant pigs: histopathological and electroanatomical findings(Oxford Univ Press, 2011-01-01) Arfelli, Elerson [UNIFESP]; Araujo, Sergio de [UNIFESP]; Okada, Mieko [UNIFESP]; Nascimento, Thais [UNIFESP]; Santos, Luis Felipe N. dos [UNIFESP]; Franco, Marcello [UNIFESP]; Paola, Angelo A. V. de [UNIFESP]; Fenelon, Guilherme [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Aims Corticosteroids attenuate late growth of radiofrequency (RF) lesions in the thigh muscle of infant rats. We sought to assess the impact of these drugs on the late growth of RF lesions in immature swine myocardium and to determine the electroanatomical mapping (EAM) characteristics of these lesions.Methods and results Radiofrequency (60 degrees C; 60 s) lesions were created in the right atrium (n = 2) and ventricle (n = 2) of 14 piglets (age 65 days; weight 5 kg) and 3 adults. Piglets were divided into: controls (n 7) and treated (n 7), receiving hydrocortisone (10 mg/kg iv after RF) and prednisone (1 mg/kg/day) for 29 days. After 8 months, animals were sacrificed for histological analysis. in four piglets, endocardial and epicardial voltage EAM were performed.In infant groups, the dimensions of atrial (11 +/- 5 vs. 13 +/- 7 mm) and ventricular (12 +/- 3 vs. 11 +/- 3 mm) lesions were similar. in adults, atrial (6 +/- 1 mm) and ventricular (6 +/- 1 mm) lesions were smaller. in controls, ventricular lesions depicted dense fibrosis and multiple strands of fibrous tissue extending from the lesion into normal muscle. Treated piglets revealed scars exhibiting less dense fibrosis with predominance of fibroadipose tissue and less collagen proliferation. Large atrial and ventricular low-voltage areas corresponding to the macroscopic lesions were identified in all animals.Conclusion Radiofrequency lesions in infant pigs reveal late growth and invasion of normal muscle by intense collagen proliferation. Corticosteroids do not prevent late enlargement of the lesions but modulate the fibrotic proliferation. the expressive growth of the lesion may generate low-voltage areas detectable by EAM.
- ItemSomente MetadadadosParticipation of corticosteroids and effects of indomethacin on the acute inflammatory response of rats fed n-6 or n-3 polyunsaturated fatty acid-rich diets(Kluwer Academic/plenum Publ, 2003-02-01) Wohlers, Marta [UNIFESP]; Nascimento, Claudia Maria da Penha Oller do [UNIFESP]; Xavier, Roberta Araújo Navarro [UNIFESP]; Ribeiro, Eliane Beraldi [UNIFESP]; Silveira, Vera Lucia Flor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)We have previously shown that both n-3 (fish oil) and n-6 (soybean oil) PUFA-rich diets reduce carrageenan-induced paw edema in rats. the present study evaluated the role of corticosteroids, and the effect of indomethacin on this response. Basal (pre-carrageenan) levels of corticosterone were elevated in both lipid diets compared to the chow diet. During inflammation, corticosterone levels increased to a similar extent in the chow and lipid diets. With 2.0 mg/kg indomethacin, edema was reduced in the chow diet and the n-3 diet, while it was not changed in the n-6 diet. in contrast, the 16.6 mg/kg dose of indomethacin induced a mild increase in edema in the chow diet but a pronounced edema increase in the lipid diets. the increase in corticosterone levels induced by carrageenan was either reduced (chow) or completely abolished (lipids) by the treatment with the higher dose of indomethacin, compared to both the control (untreated) group, and the lower dose of indomethacin. These data indicate that both acute inflammation and the response to an antiinflammatory drug were attenuated by n-3 or n-6 PUFA-rich diets. They also showed that indomethacin can have anti- or proinflammatory properties reflecting the extent of the corticosterone inhibition by indomethacin.
- ItemSomente MetadadadosRetinal and Ocular Toxicity in Ocular Application of Drugs and Chemicals - Part II: Retinal Toxicity of Current and New Drugs(Karger, 2010-01-01) Penha, Fernando Marcondes [UNIFESP]; Rodrigues, Eduardo Buchele [UNIFESP]; Maia, Mauricio [UNIFESP]; Furlani, Bruno de Alburquerque [UNIFESP]; Regatieri, Caio Vinicius Saito [UNIFESP]; Melo, Gustavo Barreto de [UNIFESP]; Magalhães, Octaviano [UNIFESP]; Manzano, Roberta [UNIFESP]; Farah, Michel Eid [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Aims: Retinal pharmacotherapy has gained great importance for the treatment of various retinal diseases. An increasing number of drugs have been constantly released into the market, especially for wet age-related macular disease and diabetic macular edema. in this review, the issues concerning the toxicity of current and new classes of drugs are discussed. Methods: An extensive search of the literature was performed to review various aspects of drug toxicity in retinal pharmacotherapy. the different major classes of drugs, such as corticosteroids, antibiotics, antimetabolites, antineoplastic agents, monoclonal antibodies (mAbs), nonsteroidal anti-inflammatory drugs, enzymes, fibrinolytics, miscellaneous anti-inflammatory and antiangiogenic agents, as well as toxicity unrelated to the drug were identified and discussed. Results: Corticosteroids like fluocinolone, dexamethasone or triamcinolone at low dose cause little damage to the retina, but at high doses signs of toxicity have been well documented. Complications like cataract and glaucoma are quite common with corticosteroids. Aminoglycosides showed differences in the type and doses associated with toxic reactions, thereby the following order of toxicity can be described (from most toxic to least toxic): gentamicin > netilmicin = tobramycin > amikacin = kanamycin. Vancomycin at the usual dose of 1 mg is not toxic to the retina, while further studies are necessary in order to clarify the safety of new-generation quinolones. 5-Fluorouracil has been shown to be nontoxic to the retina after an injection of 2.5 mg in animals. mAbs like ranibizumab and bevacizumab were demonstrated to be safe to the retina in cell culture, animals and humans at high doses. the exact biocompatibility of nonsteroidal anti-inflammatory agents like diclofenac needs further evaluation. Preservatives like benzyl alcohol and changes in pH or osmolarity exert an influence on the toxic effects of intravitreally applied drugs. Conclusions: A great number of drugs are now used mainly intravitreally without relevant retinal toxicity. Copyright (C) 2010 S. Karger AG, Basel
- ItemAcesso aberto (Open Access)Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2016) Kosugi, Eduardo Macoto [UNIFESP]; Moussalem, Guilherme Figner [UNIFESP]; Simoes, Juliana Caminha [UNIFESP]; Felici de Souza, Rafael de Paula e Silva [UNIFESP]; Chen, Vitor Guo [UNIFESP]; Neto, Paulo Saraceni [UNIFESP]; Mendes Neto, Jose Arruda [UNIFESP]Introduction: Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. Objective: To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. Methods: Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1 mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. Results: Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p = 0.006) and Lund-Kennedy mean scores (8.8-5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. Conclusion: High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores. (C) 2015 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.