Systemic effects of epidural methylprednisolone injection on glucose tolerance in diabetic patients

ABSTRACT: BACKGROUND: Several studies have shown that in diabetic patients, the glycemic profile was disturbed after intra-articular injection of corticosteroids. Little is known about the impact of epidural injection in such patients. The goal of this study was double, at first comparing the glycaemic profile in diabetic patients after a unique injection of 80 mg of acetate methylprednisolone either intra-articular or epidural and secondly to compare the amount of systemic diffusion of the drug after both procedures. METHODS: Seventeen patients were included. Glycemic changes were compared in 9 diabetic patients following intra-articular (4 patients) and epidural injections (5 patients). Epidural injections were performed using the sacral route under fluoroscopic control in patients with lumbar spinal stenosis. Diabetes control had to stable for more than 10 days and the renal function to be preserved. Blood glucose was monitored using a validated continuous measuring device (GMS, Medtronic) the day before and for two days following the injection. Results were expressed in the form of daily glycemic profiles and as by mean, peak and minimal values +/ SD. The urinary excretion of methylprednisolone after the 2 routes of injection was analyzed in 8 patients (4 in each group). Urine samples were cropped one hour before the injections, then 4 times during the first day and 3 times a week for 2 weeks. The measurements included the free and conjugated fraction RESULTS: The glycaemic profile remains unchanged with no significant changes in the group of the 5 diabetic patients receiving epidural injections. On the other end, the average peak and mean values were enhanced up to 3 mmol/l above baseline two days after the infiltration in the groups of the 4 diabetic patients infiltrated intra-articular. The mean urinary excretion of the steroid was about ten times higher in the intra-articular versus epidural group: 7000 ng/ml versus 700 ng/ml. Looking at each individual there were marked differences especially after intra-articular injections. CONCLUSION: This is the first study to show that a single epidural steroid injection of 80 mg depot methylprednisolone had no effect on the glycemic control in diabetic patients. The absence of glycemic control changes correlated well with the very low urinary excretion of the drug after epidural injection. Trial registration NCT01420497

Global patterns of care in advanced stage mycosis fungoides/Sezary syndrome: a multicenter retrospective follow-up study from the Cutaneous Lymphoma International Consortium

ABSTRACT Background Advanced-stage mycosis fungoides (MF)/Sezary syndrome (SS) patients are weighted by an unfavorable prognosis and share an unmet clinical need of effective treatments. International guidelines are available detailing treatment options for the different stages but without recommending treatments in any particular order due to lack of comparative trials. The aims of this second CLIC study were to retrospectively analyze the pattern of care worldwide for advanced-stage MF/SS patients, the distribution of treatments according to geographical areas (USA versus non-USA), and whether the heterogeneity of approaches has potential impact on survival. Patients and methods This study included 853 patients from 21 specialist centers (14 European, 4 USA, 1 each Australian, Brazilian, and Japanese). Results Heterogeneity of treatment approaches was found, with up to 24 different modalities or combinations used as first-line and 36% of patients receiving four or more treatments. Stage IIB disease was most frequently treated by total-skin-electron-beam radiotherapy, bexarotene and gemcitabine; erythrodermic and SS patients by extracorporeal photochemotherapy, and stage IVA2 by polychemotherapy. Significant differences were found between USA and non-USA centers, with bexarotene, photopheresis and histone deacetylase inhibitors most frequently prescribed for first-line treatment in USA while phototherapy, interferon, chlorambucil and gemcitabine in non-USA centers. These differences did not significantly impact on survival. However, when considering death and therapy change as competing risk events and the impact of first treatment line on both events, both monochemotherapy (SHR = 2.07) and polychemotherapy (SHR = 1.69) showed elevated relative risks. Conclusion This large multicenter retrospective study shows that there exist a large treatment heterogeneity in advanced MF/SS and differences between USA and non-USA centers but these were not related to survival, while our data reveal that chemotherapy as first treatment is associated with a higher risk of death and/or change of therapy and thus other therapeutic options should be preferable as first treatment approach

Violence in the Lives of Rural, Southern, and Poor White Women

Poor White single mothers and their children in non-urban communities in the American South experience high levels of domestic violence. We report selected findings from a life history study among White, low-income, unmarried mothers in South Carolina. Here, we examine how domestic violence in both childhood and adulthood may inhibit asset development by diminishing low-income single mothers’ accumulation of human and social capital, thus compromising their well-being as adults and parents.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Estudo clínico da eficácia do bloqueio anestésico radicular transforaminal no tratamento da radiculopatia lombar Estudio clínico de la eficacia del bloqueo anestésico radicular transforaminal en el tratamiento de la radiculopatía lumbar Clinical study on the efficacy of transforaminal radicular block in lumbar radiculopathy treatment

OBJETIVO: O objetivo deste estudo é avaliar a eficácia da injeção transforaminal nos pacientes com dor radicular devido à hérnia de disco ou estenose foraminal lombar por meio de estudo prospectivo randomizado. MÉTODOS: Foram avaliados 61 pacientes com quadro de radiculopatia nos membros inferiores. Esses pacientes foram divididos em dois grupos escolhidos aleatoriamente. Desses, 32 foram submetidos à injeção de corticosteroides e 29 foram submetidos à injeção salina. O período de acompanhamento foi de 12 meses. Para avaliar os resultados aplicamos a Escala Analógica Visual de Dor (EAV) e o Índice Oswestry (ODI). RESULTADOS: Houve melhora significativa da intensidade de dor (p < 0,001) na primeira semana nas escalas EAV e ODI, em ambos os grupos estudados (corticosteroides e solução salina). Na observação após o terceiro mês, os dois grupos apresentaram resultados semelhantes. O uso do bloqueio transforaminal evidenciou-se um método eficaz para o tratamento da dor radicular aguda, e sem melhora da patologia se considerado a longo prazo. CONCLUSÃO: O bloqueio transforaminal é um excelente método com alta evidência para tratar a crise de dor radicular e ciática a curto prazo (menor que três meses), porém moderado a longo prazo (maior que seis meses).<br>OBJETIVO: El presente estudio tuvo como objetivo evaluar la eficacia de la inyección transforaminal en pacientes con dolor radicular, debido a la hernia discal lumbar o estenosis foraminal, mediante un estudio prospectivo y aleatorizado. MÉTODOS: Se analizó un total de 61 pacientes con cuadro de radiculopatía en miembros inferiores. Estos pacientes fueron divididos en dos grupos seleccionados al azar. De ellos, 31 fueron sometidos a inyecciones de corticoides y a 29 se les aplicaron inyecciones de suero fisiológico. El período de seguimiento fue de 12 meses. Para evaluar los resultados se les aplicó la Escala Visual Analógica del dolor (EAV) y el Índice de Oswestry (ODI, sigla en inglés). RESULTADOS: Hubo una mejora significativa en la intensidad del dolor (p <0,001) en la primera semana según las escalas VAS y ODI, en ambos grupos estudiados (corticosteroides y solución salina). La observación después del tercer mes, en ambos grupos, mostró resultados similares. El uso del bloqueo transforaminal mostró un método eficaz para el tratamiento del dolor radicular agudo, y no hubo mejoría en la enfermedad en el largo plazo. CONCLUSIÓN: El bloqueo transforaminal es un excelente método, con alta evidencia, para hacer frente a la crisis de dolor radicular y la ciática en el corto plazo (menos de 3 meses), pero tiene efecto moderado en el largo plazo (más de 6 meses).<br>OBJECTIVE: To assess the efficacy of corticosteroid injections in patients with sciatica due to lumbar disc herniation or lumbar foraminal stenosis by a prospective randomized study. METHODS: There were analyzed 61 patients with sciatica due to lumbar disc degeneration. These patients were divided into two groups randomly chosen to radicular blocks with saline solution or corticosteroids. Thirty-one of these patients were submitted to corticosteroids radicular block and 29 patients were submitted to saline solution radicular block with a follow-up of 12 months. Outcomes were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI). RESULTS: Statistical analysis showed improvement in pain reduction (p < 0.001) in the first week on ODI and VAS in the group with corticosteroid radicular block in comparison to the group with saline solution; however no statistical differences were observed after three months of follow-up. The transforaminal root block presents a good method for treatment of acute sciatica and showed no improvement in a long-term-follow-up. CONCLUSION: Transforaminal root block is an excellent method with high evidence to treat sciatica in short-term follow-up, but for long-term (more than six months) follow-up is just moderate