Glucocorticoids—All-Rounders Tackling the Versatile Players of the Immune System

Glucocorticoids regulate fundamental processes of the human body and control cellular functions such as cell metabolism, growth, differentiation, and apoptosis. Moreover, endogenous glucocorticoids link the endocrine and immune system and ensure the correct function of inflammatory events during tissue repair, regeneration, and pathogen elimination via genomic and rapid non-genomic pathways. Due to their strong immunosuppressive, anti-inflammatory and anti-allergic effects on immune cells, tissues and organs, glucocorticoids significantly improve the quality of life of many patients suffering from diseases caused by a dysregulated immune system. Despite the multitude and seriousness of glucocorticoid-related adverse events including diabetes mellitus, osteoporosis and infections, these agents remain indispensable, representing the most powerful, and cost-effective drugs in the treatment of a wide range of rheumatic diseases. These include rheumatoid arthritis, vasculitis, and connective tissue diseases, as well as many other pathological conditions of the immune system. Depending on the therapeutically affected cell type, glucocorticoid actions strongly vary among different diseases. While immune responses always represent complex reactions involving different cells and cellular processes, specific immune cell populations with key responsibilities driving the pathological mechanisms can be identified for certain autoimmune diseases. In this review, we will focus on the mechanisms of action of glucocorticoids on various leukocyte populations, exemplarily portraying different autoimmune diseases as heterogeneous targets of glucocorticoid actions: (i) Abnormalities in the innate immune response play a crucial role in the initiation and perpetuation of giant cell arteritis (GCA). (ii) Specific types of CD4+ T helper (Th) lymphocytes, namely Th1 and Th17 cells, represent important players in the establishment and course of rheumatoid arthritis (RA), whereas (iii) B cells have emerged as central players in systemic lupus erythematosus (SLE). (iv) Allergic reactions are mainly triggered by several different cytokines released by activated Th2 lymphocytes. Using these examples, we aim to illustrate the versatile modulating effects of glucocorticoids on the immune system. In contrast, in the treatment of lymphoproliferative disorders the pro-apoptotic action of glucocorticoids prevails, but their mechanisms differ depending on the type of cancer. Therefore, we will also give a brief insight into the current knowledge of the mode of glucocorticoid action in oncological treatment focusing on leukemia

Functional gastrointestinal disorders in Greek Children based on ROME III criteria: identifying the child at risk

Background: Functional gastrointestinal disorders (FGIDs) are a common, diverse group of disorders of unknown etiology, resulting in significant socieconomic burden. In this study, we aimed to assess the prevalence of FGIDs in children aged 6–18 years and examine their association with various demographic and socioeconomic parameters. Methods: This was a school-based, cross-sectional study approved by the relevant government authorities. Informed consent was obtained by the legal representatives of all children who participated. Diagnoses of FGIDs were based on the Greek official translation of the ROME-III questionnaire. Demographic and socioeconomic information were also collected. Key Results: A total of 1588 children (51.8% females, mean age: 12.9±2.8 years) were included. The overall prevalence of any-FGID was 23.1% (95% CI: 21.1–25.2). The most common FGIDs were functional constipation, n=231 (13.9%), abdominal migraine, n=84 (5.6%), aerophagia, n=58 (3.5%), and irritable bowel syndrome, n=48 (3.0%). Multiple logistic regression analysis on the probability of any-FGID identified physical exercise, TV-exposure, victimization, gender, parental educational level, number of children at home and number of adults at home as significant covariates for any-FGID in the final model. Conclusions and Inferences: FGIDs affect approximately 1 in 4 school-aged children in Greece. The following characteristics are associated with a higher probability of any-FGID: female gender, living in a non-nuclear household, victimization, lower parental education level, infrequent physical activity, and high television exposure. © 2016 John Wiley & Sons Lt

Developmental defects of enamel in first permanent molars associated with use of asthma drugs in preschool aged children: A retrospective case-control study

Aim: To investigate the association between the occurrences of developmental defects of enamel (DDE), in first permanent molars, and bronchodilators and/or corticosteroid intake for asthma-like episodic treatment at preschool age, in 6–12 year old children. Methods: Children of the case group (n = 70) were followed in the Paediatric Pulmonary Unit and the Unit of Allergology, Asthma and Inflammation at ‘Aghia Sofia’ Children’s Hospital, Athens, Greece and had used asthma drugs during their first 4 years of life. The control group (n = 70) consisted of healthy children who visited the Postgraduate Paediatric Dental Clinic, University of Athens. Information regarding demographic data, medical history, pregnancy, birth weight, duration of breastfeeding, mother’s smoking habits and antibiotic use at preschool age was obtained through a structured questionnaire. Details concerning asthma drugs used were extracted from medical records. The children in both groups underwent an oral examination under standard clinical conditions and all surfaces of first permanent molars were assessed for enamel defects using the modified DDE Index. Chi square statistics, Mann–Whitney U test, Spearman correlation coefficient and logistic regression analysis were used for statistical analysis of the data (p ≤ 0.05). Results: DDE were present in 24 children (34.3%) in the case group and only in 6 (8.6%) in the control, with the difference between the two groups being statistically significant (p < 0.001), while the estimated odds ratio was 5.56. Among the children with DDE in the case group, 41.6% had at least one hypoplastic molar with loss of enamel. The type of asthma drug, age at treatment onset and duration of drug use were not significantly associated with the severity or extent of DDE. Among the possible influential factors, gender was the only statistical significant factor. Conclusions: Children treated with asthma drugs for asthma-like episodes at a preschool age showed an overall increased risk for developing enamel defects in their first permanent molars. Severe hypoplastic lesions with loss of enamel was a frequent finding among affected molars. © 2017, European Academy of Paediatric Dentistry