Steroid users cheat fans, game, and themselves

A strong statement on performance enhancing drugs was issued by DeMaurice Smith, the NFLPA Chief, in the wake of the suspension handed down to Texans LB Brian Cushing.

It was remarked by Smith, "Sport is at its best when fans can witness great achievements under the rules of fair play. Players who break those rules cheat the game, cheat the fans and cheat themselves. The players want a clean game as well as a clean process for enforcing those rules. We intend to address both in the collective bargaining process to make the system better."

From Content.usatoday.com:

NFLPA chief DeMaurice Smith issued a strong statement about performance-enhancing drugs on Tuesday in the wake of the suspension handed down to Texans LB Brian Cushing.

Smith said the NFLPA is committed to keeping the game free from steroids and other performance-altering substances and chastised players who break the league's policy on such substances as cheaters.

The NFL suspended Cushing for four games though the allegations were denied by the Texans LB.

GCA patients can expect extended relief

Patients suffering from giant cell arteritis (GCA) can expect to finally have some relief coming their way with a study offering hope and a practical treatment option for them.

Researchers from Emory University and the Mayo Clinic said that recently diagnosed GCA patients can considerably taper off use of an oral steroid and these patients also relapsed less in the following year with just three days of a high-dose intravenous steroid.

From Sciencedaily.com:

Faced with these ineffective new agents and with the limitations and drawbacks of the current treatment, Dr. Goronzy and Dr. Weyand turned to animal models. After implanting inflamed arteries into mice, they observed the effect of different doses of steroids on the inflammation. "We learned that the doses of steroids, although already high, really didn’t take away the disease," says Dr. Weyand. "But if we increased the dose to very high levels, we could then eradicate the inflammation."

Equipped with those initial results, they designed a double-blind human study to examine whether a brief period of pulsing with high-dose intravenous steroids soon after diagnosis could reduce the long-term need for prednisone and improve patient recovery.

As the article and an accompanying editorial report, the research showed extremely positive long-term results. Those patients who had been given the initial high dosage had fewer relapses of the disease (21, as compared to 37 relapses). Seventy-one percent were also able to reduce their daily dose of prednisone to 5 milligrams after a year of treatment (compared to only 15 percent in the control group), avoiding the need for long-term steroids.

This study was published in an issue of the journal Arthritis & Rheumatism. The research was funded by the National Institutes of Health, the Dana Foundation, the Mayo Foundation and the National Institutes of Health General Clinical Research Center.

Steroid therapies can be avoided after transplant

The use of modern immunosuppressive drugs can help in maintaining kidney function along with eliminating the need for steroid therapy as early as one week following a transplant surgery.

It was remarked by Steve Woodle, MD, chief of UC’s transplant surgery division, principal investigator and designer of the study that eliminating a daily dose of steroids after a transplant minimizes chronic health conditions that are common to kidney transplant recipients.

From Sciencedaily.com:

Steroids have long been the primary source of morbidity and complications following successful kidney transplantation,” Woodle says. “This study demonstrates that elimination of even small, daily prednisone (pred-ne-zone) doses does not compromise results while minimizing weight gain, diabetes and bone complications.”
Corticosteroids were the first anti-rejection drug used in transplant patients, dating back to the first transplant surgeries over 50 years ago.
Traditionally patients who have undergone organ transplantation have required life-long steroid treatments given in combination with other drugs that help suppress the body’s immune system and allow the transplanted organ to function properly.
However, the steroid treatment—given as the oral drug, prednisone—can cause serious side effects including cardiovascular disease, high cholesterol and blood pressure, weight gain, diabetes, bone weakness and cataracts.

The study also involved researchers from the University of Wisconsin; the University of Utah; the Methodist Hospital, Houston; and Weill Cornell Medical College and was funded by Astellas Pharma U.S., Inc.

Kidney transplant patients can benefit from abstinence

When certain immunosuppressive drugs are withdrawn after kidney transplantation, patients can experience prolonged survival and save a significant amount of money when compared to patients on these medications for life.

The finding was disclosed in a study that appeared in an issue of the Journal of the American Society Nephrology (JASN).

From Medicalnewstoday.com:

Sirolimus, in combination with steroids, is currently the only immunosuppressive treatment regimen that is approved for use when calcineurin inhibitors are withdrawn. Therefore, Dr. Earnshaw's group compared treatments containing sirolimus plus steroids versus treatments that maintained the use of calcineurin inhibitors.
The researchers' decision-analytic model, using data published in the literature and reported by the US transplant registry, assumed that within the first 12 months following transplant surgery, sirolimus plus steroid therapy is associated with a greater risk of kidney allograft rejection than regimens that continue to use calcineurin inhibitors. Other commonly used regimens include a calcineurin inhibitor such as cyclosporine or tacrolimus, plus mycophenolate mofetil and steroids. In this particular study, it was assumed that in the absence of induction therapy a total of 21.8% of patients taking sirolimus plus steroids experienced acute rejection within one year of transplantation, compared with 19.0% of patients taking cyclosporine plus mycophenolate mofetil and steroids, and 17.1% of patients taking tacrolimus plus mycophenolate mofetil and steroids.
However, it was revealed that overall, treatment with sirolimus plus steroids may be more efficacious and less costly than regimens that continued to use calcineurin inhibitors. Specifically, withdrawal of calcineurin inhibitors may prolong patients' lives and improve their kidney function.

Wyeth Pharmaceuticals in Collegeville, PA, provided funding for this analysis.

Asthma drug combo or increase in steroid doses can bring improvement

Children with asthma and continuing to experience the disease symptoms and making use of use of low-dose inhaled corticosteroids can find benefit by or adding one of two asthma drugs or increasing the dosage.

Results of the study, called BADGER (Best ADd-on therapy Giving Effective Responses) can help physicians in predicting, in a better way, as to which of the options would help a patient the most.

From Sciencedaily.com:

Surprisingly, researchers determined several factors that had no influence on a drug's effectiveness, including age, gender, allergies, bronchodilator response, recent exacerbations or several other tests.

"We used a few complicated and expensive tests we thought would help us determine which drug would be better, but they didn't help, so we can avoid these tests," says Strunk, the Donald Strominger Professor of Pediatrics at Washington University School of Medicine.

Although 98 percent of patients in the study showed improvement on at least one of the step-up options, there were still 120 asthma exacerbations, or attacks, among the 165 patients that required treatment with prednisone, a corticosteroid commonly used after an exacerbation that prevents the release of inflammatory substances in the body. Bacharier says that indicates none of these treatments provide perfect asthma control.

"There may not be an ideal therapy for every patient, but these step-up treatments allow for improved asthma control and outcomes over leaving them on low-dose steroids alone," Bacharier says.

Robert C. Strunk, M.D., and Leonard B. Bacharier, M.D., both Washington University pediatric asthma specialists at St. Louis Children's Hospital, were coauthors on the study, published online March 2, 2010, by the New England Journal of Medicine.

Anti-aging hormones of little to no use and pose dangers

Dr. Thomas T. Perls, an associate professor of medicine at Boston University School of Medicine, an eminent medical authority, condemned the usage of anti-aging hormones in wake of the American Medical Association's (AMA) Council on Science and Public Health's recently released report "The use of hormones for "anti-aging": a review of efficacy and safety".

Perls said that risks associated with anti-aging hormones greatly outweigh the benefits (little or no benefits) and must be avoided.

From Sciencedaily.com:

There have always been nostrums and potions peddled for eternal youth. Most recently these have been what some entrepreneurs call "bio-identical" or "all-natural" hormones. What they mean by these terms varies from substances made from vegetables -- such as soy or yams, which some claim have estrogen-like effects to, more commonly, drugs that are exactly the same as hormones prescribed by endocrinologists for specific diseases. Dr. Perls remarked: "The terms bio-identical or all-natural, particularly in the case of the drugs prescribed by endocrinologists, misleadingly convey a sense of safety to the gullible customer. Arsenic is all-natural to, and it even has some medical uses, but it is anything but safe."
"The AMA's review of the risks and benefits of these hormones in the setting of anti-aging and athletic enhancement is very important given its inclusion of the consensus and position statements of the key professional medical societies as well as the federal agencies that guard public health." states Dr. Perls in the editorial.
The editorial summarizes the AMA's assessment for each of the purported anti-aging hormones and essentially the bottom line of his argument is that in terms of anti-aging, the risks of these hormones out-weigh the little or no benefit. Dr. Perls denounces the marketing of these hormones, particularly growth hormone and anabolic steroids (anabolic steroids are variations of testosterone), for anti-aging. He also provides guidelines for spotting "red flags of quackery" and basic advice that physicians can lend to their patients in their pursuit of healthy aging.

Efforts of the AMA in evaluating the benefits and risks of growth hormone, testosterone, estrogen and DHEA for anti-aging were welcomed by Dr. Perls.

Improved survival and less rejection possible with drug regimen

A new drug combination can be effective for reducing incidences of rejection in liver transplant patients than present day treatment options, according to Transplant surgeons at Thomas Jefferson University Hospital in Philadelphia.

Basiliximab, a monoclonal antibody, as part of a group of drugs that included a standard anti-rejection agent (tacrolimus), and low doses of steroids was used by a team of surgeons, led by Ignazio Marino, M.D., director of the Division of Liver Transplantation and Hepato-biliary Surgery at Thomas Jefferson University Hospital.

From Sciencedaily.com:

Tacrolimus is a drug that suppresses the immune system by inhibiting an enzyme (calcineurin) crucial for T-cell proliferation, which is important in the immune process. The Jefferson surgeons' trial marks the first time anyone had evaluated the effectiveness and safety of basiliximab and tacrolimus to suppress the immune system to prevent the body's rejection of a liver.

"We think we have much less toxicity in the short term because we use less tacrolimus," he says. They also expect less toxicity in the long term as well because they used fewer steroids. As a result, he says, they expect fewer complications associated with long-term steroid use, which includes hypertension, osteoporosis and diabetes.

Dr. Marino has also discovered that basiliximab may affect hepatitis C virus (HCV) recurrence. "We also suspect that the recurrence of HCV is lower, though we don't have enough data to confirm this," he says. Typically, immunosuppressed liver transplant patients experience high rates of HCV recurrences, Dr. Marino notes, because the virus has fewer restrictions on its growth. Perhaps, he says, the anti-IL2 monoclonal has some mechanism affecting the replication of the HCV.

Dr. Marino, who is also professor of surgery at Jefferson Medical College of Thomas Jefferson University and the interim director of the Division of Transplantation at Thomas Jefferson University Hospital, remarked that adding basiliximab results in significant reduction of rejection rate to 12 percent.

Use of steroids in long run minimize lymphoma risk in Rheumatoid Arthritis

The risk of rheumatoid arthritis (RA) related lymphoma is considerably minimized when treatment involving oral steroids is followed for a period of two years or more. The finding was revealed in data presented at EULAR 2007, the Annual European Congress of Rheumatology, in Barcelona, Spain.

The data further disclosed that the benefits of steroids are in easy reach irrespective of when the steroids were first administered in course of the disease.

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From MedicalNewsToday.com:

The study involved 378 patients with rheumatoid arthritis-associated lymphoma identified from the Swedish Hospital Register and the Cancer Register compared with 378 individually matched RA controls, i.e. patients with RA but without lymphoma.
Using data on steroid treatment type and duration along with inflammatory load collected from cases and controls, information on lymphoma type (where observed) was also collected. The lymphoma tissues were obtained from the pathology laboratories and were reclassified according to the most recent lymphoma classification, the World Health Organization classification.
Interestingly, researchers also compiled information on the duration of RA at initiation of steroid treatment. In this study there was no correlation observed between protective function and length of RA at onset of steroidal treatment. The protective effect was identical in those starting steroid treatment the first five years after onset of RA and in those starting later (relative risk 0.6; 0.3-0.9). Steroid treatment outcome was not associated with the presence of the Epstein-Barr virus in the lymphomas.
These results build on those of a previously published study that reported that orally prescribed and intra-articular (administered within the joint or joint cavity) steroids protect the individual from the development of malignant (actively cancerous) lymphomas in a dose responsive manner.

Study author Dr Eva Baecklund of Uppsala University Hospital, Sweden, remarked that steroid treatment in the long run could reduce the risk of malignant lymphomas (cancer in the immune system) in patients with severe rheumatoid arthritis.

Children with bronchiolitis do not benefit from treatment with popular steroid

Treatment involving a common steroid, dexamethasone, is not beneficial for young children suffering from bronchiolitis as per a recent study by DMC Children's Hospital of Michigan.

It was disclosed in the study that dexamethasone-based treatment is not effective when it comes to improving the associated disease symptoms or reducing incidents of hospitalization.

The findings of this research study appeared in an issue of the New England Journal of Medicine.

From News-Medical.Net:

Bronchiolitis is the leading cause of hospitalization for infants in the United States and accounts for more than 100,000 admissions each year. Hospital charges associated with the disease exceed $700 million annually. According to Dr. Mahajan, prescribing dexamethasone is a common practice among emergency room physicians and pediatricians to treat acute bronchiolitis. "Corticosteroids are commonly used to treat bronchiolitis although evidence of their effectiveness is limited." The findings of this study resolve controversy from prior research and are expected to help guide treatment for the most common cause of infant hospitalization.
Given the results of this study, though there is really no best treatment for children, researchers now can concentrate on finding better treatment and better preventative strategies.
DMC Children's Hospital of Michigan treats 500-600 patients annually for bronchiolitis. Hospital length of stay, later medical visits or admissions, and adverse events were also evaluated in the study.
The study lead investigators note that glucocorticoid medications still play an important role in other respiratory illnesses of childhood, such as asthma and croup. They point out these medications are not the androgenic steroids sometimes abused by athletes, and that the side effects seen with long-term steroid use are not a risk in the short-course treatments used for croup and asthma attacks.

Prashant Mahajan, M.D., M.P.H, M.B.A, DMC Children's Hospital vice chief of pediatric emergency medicine and associate professor of pediatrics and emergency medicine at Wayne State University School of Medicine was a lead co- investigator in this nationwide study involving 600 infants between the age of 2-12 months.

Low sperm count found associated with excess of prenatal testosteroneLow sperm count found associated with excess of prenatal testosterone

According to a study, exposure to excess of sex steroids such as testosterone during fetal development can lead to reduced sperm count and motility.

It was remarked by Professor Sergio Recabarren of the University of Concepcion in Chillan, Chile and lead author of the study that most sperm count disorders originate during fetal life.

From Sciencedaily.com:

Prenatal exposure to excess sexual steroids can occur in two ways, said Dr. Recabarren. First, the exposure may be a product of increased sexual steroids in the maternal environment due to a hormonal condition such as polycystic ovary syndrome. Second, humans are exposed to several industrial pollutants which can act as steroid mimics, causing the body to inhibit or accelerate native steroid production.

In this study, researchers treated pregnant sheep with 30 mg testosterone propionate twice weekly from days 30 to 90 of pregnancy and with 40 mg testosterone propionate from days 90 to 120 of pregnancy. They found a

--> significant reduction in body weight, scrotal circumference, and sperm count in male sheep born to these mothers compared with control sheep.

"While this research involved sheep, it can certainly be argued that in humans, exposure to an excess of sexual steroids during fetal development could constitute a potential risk factor that may conduct to a low sperm count," said Dr. Recabarren.

Other researchers on this study were Pedro Rojas-Garcia, Monica Recabarren, and Victor Alfaro of the University of Concepcion in Chillan, Chile; Rosita Smith and Teresa Sir-Petermann of the University of Chile in Santiago; and Vasantha Padmanabhan of the University of Michigan in Ann Arbor.