DOCSLIB.ORG

Patient Perceptions of Glucocorticoid Side Effects: a Cross-Sectional Survey of Users in an Online Health Community

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Patient Perceptions of Glucocorticoid Side Effects: a Cross-Sectional Survey of Users in an Online Health Community PEER REVIEW HISTORY BMJ Open: first published as 10.1136/bmjopen-2016-014603 on 3 April 2017. Downloaded from BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf) and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. ARTICLE DETAILS TITLE (PROVISIONAL) Patient perceptions of glucocorticoid side effects: a cross-sectional survey of users in an online health community. AUTHORS Costello, Ruth; Patel, Rikesh; Humphreys, Jennifer; McBeth, John; Dixon, Will VERSION 1 - REVIEW REVIEWER Russell, Anthony Univ Alberta,Canada REVIEW RETURNED 14-Oct-2016 GENERAL COMMENTS An interesting approach with unexpected answers. REVIEWER Michele Iudici Past address: Rheumatology Unit Second University of Naples, Italy REVIEW RETURNED 15-Nov-2016 http://bmjopen.bmj.com/ GENERAL COMMENTS The authors report an online cross-sectional survey aiming to identify the GC-related adverse events most important to patients. They analyzed data from 604 patients and reported the ranks for each side effect, without providing any additional analysis that can make the paper more interesting and appealing for the readers. For example they do have data on the number and time of pills intake on October 1, 2021 by guest. Protected copyright. per day. It would be interesting to investigate if patient's perception of some AEs could be related to these parameters (evening intake and sleep disturbances...intake during meals and digestive symptoms...). Moreover, authors could also in deepen analyze how the experience of an AEs impacts on patient's perception. I wuold be prone to think that the experience of a vertebral fracture could absolutely change my point of view on this AE and the same can happens for the others. So, I would suggest to make a subanalysis taking into account the patient's history of GC-AEs occurrence. Another point I think the authors should underline is that this kind of exercise could be flawed by difference in patient's educational levels. They should acknowledge this in the text. REVIEWER Adrian Loerbroks BMJ Open: first published as 10.1136/bmjopen-2016-014603 on 3 April 2017. Downloaded from University of Düsseldorf, Germany REVIEW RETURNED 21-Nov-2016 GENERAL COMMENTS Costello and colleagues examined which potential side effects of glucocorticoid (GC) use may matter most to patients. Doing so, they conducted an online survey among individuals reporting current or recent GC use. The most important side effects from patients’ perspectives were weight gain, insomnia and a “moon face”. Overall, this study provides interesting findings as it illustrates how patient perceptions of the salience of GC side effects may differ from those of clinicians. Further, the authors adopted a novel approach to data collection (i.e. recruitment through a social online network). The study suffers from a number of limitations though, which the authors partly acknowledged, but which should be presented more explicitly in my view. Also, additional analyses may be of interest. Those points and additional suggestions are detailed below. Specific comments: 1. I recommend adding to the introduction why your research aim matters. You mention this in the discussion (e.g. patient perceptions of side effects will likely affect adherence), but I would do so early on. 2. Does you study make a novel contribution in light of what is currently known (study 8-10)? 3. In my view your findings could be affected by selection bias in at least two ways: 1) selection due to imperfect participation (as you acknowledged and as reflected by the very low response rate) and 2) selection due to your sampling choice (e.g. even if 100% had participated, those http://bmjopen.bmj.com/ using such social networks may differ from patients who do not). I suggest acknowledging in particular the latter selection process more explicitly. 4. It would be of interest to learn how exactly you obtained and used clinicians’ and patients’ feedback in the construction of the questionnaire measuring potential GC side effects. Especially, the approach to account for patient views needs to be presented in greater detail, because I wondered whether you had been able to on October 1, 2021 by guest. Protected copyright. identify and consider potential patient misconceptions about GC side effects. In the field of asthma research, it has been observed for instance that patients may be concerned about developing „tolerance“ /addiction with regard to some drugs (e.g. Hyland et al., Clnical Therapeutics 2004). Possibly, the same holds true for GC, but has not been measured. 5. What was the distribution of responses to the items in block 6? 6. As the authors stated, the ranking of the importance of side effects may partly reflect their prevalence. It would be of interest, in this context, to re-run analyses while excluding those individuals who report to actually suffer from the respective symptom (item set #6 in your questionnaire). In my view, such analyses would be a more valid representation of real life scenarios related to the prescription of GC: Patients may decide not to use GC because of concerns about potential and anticipated side-effects (that are thus not yet experienced). 7. Another shortcoming of your study is that you only inquired after conditions and symptoms that are attributed to GC use. As a result, it remains elusive what proportion of the sample suffered from BMJ Open: first published as 10.1136/bmjopen-2016-014603 on 3 April 2017. Downloaded from particular complaints irrespectively of GC treatment. For instance, a reasonable proportion of your respondents (aged 50+) may have suffered for hypertension and may therefore have ranked this side effect unimportant. However, these cases are probably only partly captured by the items in block #6, which related hypertension to GC treatment. I suggest mentioning this limitation in the discussion section. VERSION 1 – AUTHOR RESPONSE Response to reviewers Thank you to the reviewers for their helpful comments. We have responded to each of the reviewer’s comments below: Reviewer 2: The authors report an online cross-sectional survey aiming to identify the GC-related adverse events most important to patients. They analyzed data from 604 patients and reported the ranks for each side effect, without providing any additional analysis that can make the paper more interesting and appealing for the readers. For example they do have data on the number and time of pills intake per day. It would be interesting to investigate if patient's perception of some AEs could be related to these parameters (evening intake and sleep disturbances...intake during meals and digestive symptoms...). Moreover, authors could also in deepen analyze how the experience of an AEs impacts on patient's perception. I wuold be prone to think that the experience of a vertebral fracture could absolutely change my point of view on this AE and the same can happens for the others. So, I would suggest to make a subanalysis taking into account the patient's history of GC-AEs occurrence. Another point I think the authors should underline is that this kind of exercise could be flawed by difference in patient's educational levels. They should acknowledge this in the text. http://bmjopen.bmj.com/ Response: Thank you for your helpful suggestions. Although we have the usual time per day of steroid administration, we do not have the number of pills per day so we did not feel we could conduct any additional analysis around this, though it is an interesting area. We have added stratification of scores by both experience and community group. Thank you for the suggestion to look at the impact of prior experience of GC-associated side effects and how this influenced scoring. We had in fact done this analysis for a conference presentation post-submission and it revealed some interesting on October 1, 2021 by guest. Protected copyright. findings. Prior experience of a side effect did increase the importance of that side effect to respondents. The results are tabulated in table 4, with the following text summarising the results on page 11: “When stratified by prior experience, participants who had previously experienced the side effect of interest reported higher median scores, with smaller IQRs. The side effects most important to those who had experienced them were diabetes, eye disease and CVD, all scoring a median of 10. The side effects most important to those who had not experienced them were reduced bone strength, CVD and eye disease (Table 4, figure S2). Although weight gain had the highest rank overall, it was ranked only fourth in those who had and who hadn’t experienced it prior to completing the survey, with median scores and IQRs of 9 (7-10) and 6 (2-9), respectively. The most commonly experienced side effects were, in order, weight gain, round face, insomnia, changes in mood, skin changes and indigestion, all of which were experienced by over half of the 604 respondents.” We added stratification by community to give an indication of the effect of dose on the perception of side effects and this showed community rankings were mainly similar except for the PMR/GCA community. The results are tabulated in Table 3, with the following text at the bottom of page 9: “When stratified by community group the rankings remained similar to the overall rankings for all BMJ Open: first published as 10.1136/bmjopen-2016-014603 on 3 April 2017. Downloaded from communities except the PMRGCAUK community group, where the side effects most important to respondents were eye disease, CVD and insomnia, with weight gain fourth (Table 3).” The reasons for the difference by prior experience and by community are discussed in the first paragraph of the discussion (page 12): “It is known that oral GCs have many side effects, but few studies have investigated which matter the most to patients.
Load more

Recommended publications
  • Hypertensive Encephalopathy As the Initial Manifestation of Cushing's
    The Journal of Medical Research 2016; 2(6): 144-145 Case Report Hypertensive encephalopathy as the initial manifestation JMR 2016; 2(6): 144-145 November- December of Cushing’s syndrome ISSN: 2395-7565 © 2016, All rights reserved Alagoma Iyagba*1, Arthur Onwuchekwa1 www.medicinearticle.com 1 Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria Abstract A 65-year old lady was rushed into the accident and emergency department with a two-day history sudden onset severe generalized throbbing headache associated with restlessness, irritability, irrational talk, projectile vomiting and loss of consciousness of three hours duration. On examination, she had moon face, buffalo hump, and truncal obesity with body mass index was 45.84kg/m2. Her blood pressure was 190/120 mmHg. Serum cortisol done at 0800 hrs the next day was elevated with a value of 511 ng/ml. 1 mg overnight dexamethasone was 148 ng/ml. The diagnosis of hypertension secondary to Cushing’s syndrome should be strongly considered in any hypertensive obese patients regardless of age with typical ‘cushingoid facies’. An assessment of serum cortisol in such patients would be beneficial in diagnosing this condition and optimizing treatment outcomes. Keywords: Cushing’s, Hypertension, Encephalopathy. INTRODUCTION Cushing’s syndrome is the constellation of a large group of signs and symptoms resulting from prolonged pathologic hypercortisolism caused by excessive adrenocorticotropic hormone (ACTH) secretion by tumors in the pituitary gland or elsewhere, or by ACTH-independent cortisol secretion from adrenal tumors[1]. It is one of the endocrine causes of hypertension with profound cardiovascular and neurological effects.
    [Show full text]
  • Chapter 13. Secondary Hypertension
    Hypertension Research (2014) 37, 349–361 & 2014 The Japanese Society of Hypertension All rights reserved 0916-9636/14 www.nature.com/hr GUIDELINES (JSH 2014) Chapter 13. Secondary hypertension Hypertension Research (2014) 37, 349–361; doi:10.1038/hr.2014.16 OVERVIEW AND SCREENING approximately 5–10% of hypertensive patients,984,985 and it is the most Hypertension related to a specific etiology is termed secondary frequent in endocrine hypertension. In addition, frequent etiological hypertension, markedly differing from essential hypertension, of factors for secondary hypertension include renal parenchymal hyper- which the etiology cannot be identified, in the condition and tension and renovascular hypertension. A study reported that sleep therapeutic strategies. Secondary hypertension is often resistant hyper- apnea syndrome was the most frequent factor for secondary hyper- tension, for which a target blood pressure is difficult to achieve by tension.517 The number of patients with secondary hypertension standard treatment. However, blood pressure can be effectively may further increase with the widespread diagnosis of sleep apnea reduced by identifying its etiology and treating the condition. There- syndrome. fore, it is important to suspect secondary hypertension and reach an Generally, the presence of severe or resistant hypertension, juvenile appropriate diagnosis. hypertension and the rapid onset of hypertension suggest the possi- Frequent etiological factors for secondary hypertension include bility of secondary hypertension. In such hypertensive patients, a close renal parenchymal hypertension, primary aldosteronism (PA), reno- inquiry on medical history, medical examination and adequate vascular hypertension and sleep apnea syndrome. Renal parenchymal examinations must be performed, considering the possibility of hypertension is caused by glomerular diseases, such as chronic secondary hypertension.
    [Show full text]
  • HEMADY (Dexamethasone Tablets), for Oral Use Chronic Use
    HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use • Gastrointestinal Perforation: Avoid use in active or latent peptic ulcers, HEMADYTM safely and effectively. See full prescribing information for diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative HEMADY. colitis, since they may increase the risk of a perforation. (5.7) • Osteoporosis: Increased risk; monitor for changes in bone density with HEMADY (dexamethasone tablets), for oral use chronic use. (5.8) Initial U.S. Approval: 1958 • Behavioral and Mood Disturbances: May include euphoria, insomnia, mood swings, personality changes, severe depression, and psychosis. --------------------------- INDICATIONS AND USAGE -------------------------­ Monitor for signs and symptoms and manage promptly. (5.10) HEMADY is a corticosteroid indicated in combination with other anti­ • Kaposi’s Sarcoma: Kaposi’s sarcoma has been reported to occur in patients myeloma products for the treatment of adults with multiple myeloma. (1) receiving corticosteroid therapy, most often for chronic conditions. (5.11) • Embryo-Fetal Toxicity: Can cause fetal harm. Advise females of ----------------------- DOSAGE AND ADMINISTRATION ---------------------­ reproductive potential of the potential risk to a fetus. (5.13, 8.1) Recommended Dosage: 20 mg or 40 mg orally once daily, on specific days depending on the protocol regimen. (2) ------------------------------ ADVERSE REACTIONS ----------------------------­ The most common adverse reactions are
    [Show full text]
  • Cholesterol (Precursor of Steroid Hormones)
    Unit IV – Problem 5 – Biochemistry: Biosynthesis of Steroid Hormones & Steroid Hormone Receptor - Cholesterol (precursor of steroid hormones): It is composed of 27 carbons with four rings and a hydroxyl group (-OH) attached at carbon 3 and is found in cell membrane (why?) → to regulate membrane fluidity and permeability. Cholesterol from diet will be packaged in chylomicrons (in the gut) to be transported into lymph and then into plasma. Cholesterol is synthesized de novo (from scratch) in the cytosol of the liver. - Steroid Hormones: The rate-limiting irreversible step in steroid hormone synthesis is represented by the conversion of cholesterol into pregnenolone (which contains 21 carbons) via the enzyme desmolase. How to name steroids? 21 carbons: pregnanes (pregnenolone). 19 carbons: androstanes (testosterone). 18 carbons: estranges (estrogen). - Classes of steroid hormones: Mineralocorticoids: from zona glomerulosa of adrenal cortex. Glucocorticoids: from zona fasciculate of adrenal cortex. Androgens: from testes and zona reticularis of adrenal cortex. Estrogens and progestogens: from ovaries and placenta. - Synthesis of steroid hormones: Enzyme Sex Mineralocorticoids Cortisol Labs Presentation deficiency hormones XY: Hypertension, 17α- pseudohermaphroditism ↑ ↓ ↓ hypokalemia and hydroxylase XX: lack secondary ↓DHT sexual development Hypotension, Infancy: salt wasting; hyperkalemia, ↑ 21- childhood precocious ↓ ↓ ↑ renin activity and ↑ hydroxylase puberty; XX: 17- virilization hydroxyprogesterone ↓ aldosterone, ↑ 11- 11β- Hypertension (low deoxycorticosterone ↓ ↑ XX: virilization hydroxylase renin) (results in ↑ BP) - Glucocorticoids (natural): Synthesized in zona fasciculate of adrenal cortex. Regulated by: Corticotrophin-releasing hormone (CRH) which is secreted from the hypothalamus and then stimulating the anterior pituitary gland to produce adrenocorticotropic hormone (ACTH) which in turn will enhance the synthesis of cortisol from zona fasciculata. Functions of cortisol (BIG FIB): ↑ Blood pressure.
    [Show full text]
  • Cushings Disease
    put together by Alex Yartsev: Sorry if i used your images or data and forgot to reference you. Tell me who you are. [email protected] Cushings Disease History of Presenting Illness - weight gain, BUFFALO HUMP with supraclav fat pads, moon face, central obesity - purple stretch marks , HEADACHE, POLYURIA, NOCTURIA, GALACTORHHOEA? - easy bruising , Changes in pigmentation?? DARKER? Acanthisis Nigricans? - skin thinning . It can only be ACTH SECRETING ADENOMA!! - irregular menses hirsutism . - difficulty climbing stairs, getting out of a low chair, and raising their arms. - Depression CUSHINGOID FEATURES WITH HIRSUITISM AND - cognitive dysfunction VIRILISATION? BUT NO PIGMENT CHANGES?? - emotional lability Think about an ADRENAL CARCINOMA!! - bone disease (fractures) - STOMACH ULCERS from corticosteroid excess - Appetite Gain! ACUTELY cortisol excess causes EUPHORIA - Exacerbation of diabetes CHRONICALLY cortisol excess causes DEPRESSION - Hypokalemia (weakness ) - hypernatremia ELECTROLYTES ALL WRONG? MUCH ACNE, FLORID HYPERTENSION, OEDEMA, HIGH GLUCOSE, …BUT : NO FAT REDISTRIBUTION? ACUTE ONSET? Sounds like an ECTOPIC NEOPLASTIC SOURCE Differential Diagnoses - Hypothalamic disease (too much CRH) - Primary Cushing Disease (ACTH-secreting pituitary adenoma) - Adrenal cortisol-secreting adenoma - Ectopic Neoplastic Source of cortisol eg. lung cancer ( disease of decrepit old men) - Use + Abuse of corticosteroid medication - Hypercortisolism secondary to alcoholism - Depression - Hypothyroidism ~ADRENAL CRISIS~ - Hypoadrenalism
    [Show full text]
  • High Blood Pressure: Secondary Hypertension
    High Blood Pressure: Secondary Hypertension What is secondary hypertension? Blood pressure is the force of the blood on the artery walls as the heart pumps blood through the body. High blood pressure caused by a disease or another known medical problem is called secondary hypertension. Most cases of secondary hypertension are caused by kidney or hormonal problems. Normal blood pressure ranges up to 120/80 ("120 over 80") but blood pressure can rise and fall with exercise, rest, or emotions. The pressures are measured in millimeters of mercury. The upper number (120) is the pressure when the heart pushes blood out to the rest of the body (systolic pressure). The bottom number (80) is the pressure when the heart rests between beats (diastolic pressure). • Healthy blood pressure is less than 120/80. • Pre-high blood pressure (prehypertension) is from 120/80 to 139/89. • Stage I high blood pressure ranges from 140/90 to 159/99. • Stage II high blood pressure is over 160/100. If repeated checks of your blood pressure show that it is higher than 140/90, you have hypertension. If you have prehypertension and other health problems, such as diabetes, you need treatment. How does it occur? Many medical conditions, diseases, and medicines can cause secondary hypertension, including: • narrowing of the arteries in the kidneys • narrowing of the aorta, a large blood vessel that supplies blood to the lower body • several types of kidney disease • excess secretion of a hormone called aldosterone from the adrenal gland • tumor of the adrenal gland • Cushing's syndrome, a disorder in which there is too much corticosteroid hormone in the blood • medicines such as estrogen and oral contraceptives • abuse of drugs such as amphetamines, alcohol, or diet pills • pregnancy.
    [Show full text]
  • Budesonide Prolongs Time to Relapse in Ilealand
    82 Gut 1996; 39: 82-86 Budesonide prolongs time to relapse in ileal and ileocaecal Crohn's disease. A placebo controlled one year study Gut: first published as 10.1136/gut.39.1.82 on 1 July 1996. Downloaded from R L6fberg, P Rutgeerts, H Malchow, C Lamers, A Danielsson, G Olaison, D Jewell, 0 0stergaard Thomsen, H Lorenz-Meyer, H Goebell, H Hodgson, T Persson, C Seidegard Abstract Corticosteroids are the most efficacious Background and Ains-To evaluate the medical treatment for active Crohn's disease efficacy and safety of the topical cortico- (CD)' with remission rates of 50 to 80 per cent steroid budesonide, given in an oral con- reported after short or intermediate courses of trolled release formulation for treatment.2A Well known adverse effects (for maintenance ofremission in patients with example, acne, moon face, hirsutism, buffalo ileal and ileocaecal Crohn's disease (CD). hump) and systemic side effects (that is, impact Patients and Methods-Out of 176 patients on adrenal gland function, hypertension, with active CD who had achieved remis- impaired glucose tolerance) make continued sion (CD activity index score s,S0) after 10 conventional corticosteroid treatment with high weeks' treatment with either budesonide or doses inadvisable. Some patients achieving prednisolone, 90 were randomised to remission with the use of corticosteroids, how- continue with once daily treatment of6 mg ever, may benefit from longterm treatment with budesonide, or 3 mg budesonide or placebo low doses (<7.5 mg/day) of prednisolone or for up to 12 months in a double blind, similar. In the European Cooperative CD multicentre trial.
    [Show full text]
  • View a Copy of This Licence, Visit
    Fushimi et al. BMC Endocrine Disorders (2021) 21:163 https://doi.org/10.1186/s12902-021-00818-2 CASE REPORT Open Access Concurrence of overt Cushing’s syndrome and primary aldosteronism accompanied by aldosterone-producing cell cluster in adjacent adrenal cortex: case report Yoshiro Fushimi, Fuminori Tatsumi, Junpei Sanada, Masashi Shimoda, Shinji Kamei, Shuhei Nakanishi, Kohei Kaku, Tomoatsu Mune and Hideaki Kaneto* Abstract Background: Various adrenal disorders including primary aldosteronism and Cushing’s syndrome lead to the cause of hypertension. Although primary aldosteronism is sometimes complicated with preclinical Cushing’s syndrome, concurrence of overt Cushing’s syndrome and primary aldosteronism is very rare. In addition, it has been drawing attention recently that primary aldosteronism is brought about by the presence of aldosterone-producing cell cluster in adjacent adrenal cortex rather than the presence of aldosterone-producing adenoma. Case presentation: A 67-year-old Japanese female was referred to our institution due to moon face and central obesity. Based on various clinical findings and data, we diagnosed this subject as overt Cushing’s syndrome and primary aldosteronism. Furthermore, in immunostaining for cytochrome P450 (CYP) 11B1, a cortisol-producing enzyme, diffuse staining was observed in tumorous lesion. Also, in immunostaining for CYP11B2, an aldosterone- producing enzyme, CYP11B2 expression was not observed in tumorous lesion, but strong CYP11B2 expression was observed in adjacent adrenal cortex, indicating
    [Show full text]
  • What Is Secondary Hypertension?
    Secondary Hypertension The Primary Care Perspective Stephen Koesters, MD Assistant Professor of Clinical Medicine Department of Pediatrics Division of General Medicine The Ohio State University’s Wexner Medical Center What Is Hypertension (JNC 7) 1 What is Hypertension • For Children/Adolescents: – Average SBP/DBP >/= 95th percentile for age, gender, and height. – “Prehypertension” is >/= 90th percentile – 3 separate readings on 3 separate viitisits. – Incidence appears to be increasing over time. What is Essential/Primary Hypertension • HTN with no identifiable cause • Often develops gradually over years • Much of HTN still falls in this category - up to 85% in many reports. • Likely a complex interaction between multiple risk factors/causes in many cases. 2 What is Secondary Hypertension? • Meets Criteria for HTN • Results from an identifiable, potentially correctable cause • Accounts for significant number of Resistant HTN cases • Estimated to account for 5-15% of cases of HTN • Prevalence of hypertension in adults between 20-30% (50-70 million people). Conservatively, probably 3-5 million people in U.S. affected. Associations with Hypertension • Family History – first degree relatives • Race – more common in African Americans • Physical Inactivity • Dyslipidemia • Obesity • Vitamin D deficiency 3 Unclear Association with HTN • Caffeine – May cause short spike in BP – No sustained effect noted – May be more significant in older/overweight • Stress/Anxiety/Type A – Clearly causes short-term increases – Unclear if sustained stress can truly cause HTN When to Suspect Secondary HTN • Early age of onset – Young adult without family history or risk factors – Onset prior to puberty • Severe or resistant HTN – Remember – fewer than 50% of patients well controlled on a single medication • Acute onset or change in control when previously stable • Malignant/End-organ changes • Abnormal exam findings (e.g.
    [Show full text]
  • Corticosteroid Therapy in Inflammatory Bowel Diseases This Publication Is Sponsored by the Falk Foundation E.V
    The informed patient Corticosteroid therapy in inflammatory bowel diseases This publication is sponsored by the Falk Foundation e.V. The information herein represents the independent opinion of the author and does not necessarily reflect the opinion and recommendations of the Falk Foundation e.V. Not all products discussed may have a licence or indication in your country. Please consult your doctor regarding your country’s specific prescribing information. If you get any side effects, talk to your Doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more infor- mation on the safety of medicines. Publisher For further information please contact DR FALK PHARMA UK LTD Bourne End Business Park Cores End Road Bourne End Bucks SL8 5AS, UK © 2017 Falk Foundation e.V. 5th edition 2017 (UK) All rights reserved. (Bu80e 10-6/2010) U2 The informed patient Corticosteroid therapy in inflammatory bowel diseases Prof. Dr. Tilo Andus 1 Author: Prof. Dr. Tilo Andus Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und internistische Onkologie Krankenhaus Bad Cannstatt Klinikum Stuttgart Prießnitzweg 24 70374 Stuttgart Germany 2 The informed patient Contents Page Introduction 5 The natural role and regulation of corticosteroids in the body 7 • Anti-inflammatory properties of corticosteroids 12 • The effect of corticosteroids on metabolism 12
    [Show full text]
  • Secondary Causes of Obesity
    REVIEW Secondary causes of obesity Jocelyne G Karam & While the rising epidemic of obesity is primarily attributed to sedentary lifestyle, poor Samy I McFarlane† dietary habits and the aging of the population, secondary causes of obesity generally go †Author for correspondence undetected and untreated. These include endocrinological disorders, such as Cushing’s State University of New York, Division of Endocrinology, syndrome, polycystic ovary syndrome, hypogonadism and hypothyroidism, as well as Diabetes and Hypertension, genetic, syndromic and drug-related obesity. We present an overview of the major Department of Medicine, disorders associated with obesity, highlighting the pathophysiologic mechanisms and Box 50 Health Science Center at Brooklyn Kings County discussing diagnostic and treatment strategies that are most helpful to practicing Hospital Center, physicians in recognizing and treating these generally underdetected and 450 Clarkson Avenue, undertreated disorders. Brooklyn, NY 11203, USA Tel.: +1 718 270 3711; Fax: +1 718 270 6358; During the past few decades, prevalence of obes- recognized by physicians and specific therapeutic Email: smcfarlane@ downstate.edu ity has dramatically increased in the Western strategies should be planned in conjunction with world, including the USA where obesity has cur- diet and exercise. rently reached epidemic proportions. A compar- In this review, we provide the readers with a ison of data from two National Health and general overview of the secondary causes of obesity, Nutrition Examination Surveys (NHANES) has highlighting the pathophysiology, the clinical diag- shown that among US adults, the prevalence of nosis and the therapeutic options of each disorder. obesity increased from 15% (in the 1976–1980 Obesity is a state of excessive body weight asso- survey) to 32.9% (in the 2003–2004 survey) [1].
    [Show full text]
  • A Cross-Sectional Survey of Users in an Online Health Community
    Open Access Research BMJ Open: first published as 10.1136/bmjopen-2016-014603 on 3 April 2017. Downloaded from Patient perceptions of glucocorticoid side effects: a cross-sectional survey of users in an online health community Ruth Costello,1 Rikesh Patel,1 Jennifer Humphreys,1 John McBeth,1,2 William G Dixon1,2,3 To cite: Costello R, Patel R, ABSTRACT et al Strengths and limitations of this study Humphreys J, . Patient Objectives: To identify the side effects most perceptions of glucocorticoid important to glucocorticoid (GC) users through a ▪ side effects: a cross-sectional This survey used a novel recruitment method, survey of a UK online health community survey of users in an online through an online social network for health, health community. BMJ Open (Healthunlocked.com). which resulted in over 600 UK respondents who 2017;7:e014603. Design: Online cross-sectional survey. were taking glucocorticoids for a variety of doi:10.1136/bmjopen-2016- Setting: Participants were recruited through conditions. 014603 Healthunlocked.com, an online social network for ▪ Only a few studies have previously investigated health. which glucocorticoid side effects are most ▸ Prepublication history and Participants: Adults who were currently taking GCs, important to patients. additional material is or had taken GCs in the past month. ▪ The sample was mainly female and over 50 years available. To view please visit Method: Responders scored the importance of listed of age, which may represent bias in the type of the journal (http://dx.doi.org/ side effects from 1 to 10, with 10 being of high people who participate in studies.
    [Show full text]