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Methods A prospective randomized study including 40 patients in steroid and 42 patients in HA group. At six months HA was significantly better than a steroid.
Conclusion The HA seems to be better for pain relief and functionality in the short and mid-term periods. Introduction Osteoarthritis OA is the most common cause of knee pain and a leading cause of disability globally.
It is a progressive disorder caused by gradual loss of articular cartilage. Many mechanical and biochemical factors have been suggested as the responsible causes for cartilage destruction leading to OA. Cytokines and various growth factors GF may also play a role in the regulation of catabolic and anabolic process in the pathophysiology of knee OA.
Various conservative treatment modalities including both pharmacological and the non-pharmacological modalities are recommended in clinical guidelines.
A total of 82 patients knees of both the sexes with a unilateral or bilateral knee pain of more than three months were selected for this study. All of these patients were randomized by computer generated random number table and were given steroid or HA accordingly.
Our bilateral knee pain cases were symptomatic for both knee from beginning of study and both knee was injected simultaneously. Forty patients 68 knees were included in the steroid group.
Mercer and colleagues reported a prospective randomized trial of aminoglutethimide Cytadren, mg twice daily vs hydrocortisone 20 mg twice daily in advanced breast cancer. All patients were postmenopausal and had experienced disease progression on tamoxifen. Of 61 patients entered into the trial, 56 were included in the analysis.
Although this difference was not statistically significant, it does serve as evidence that corticosteroids have activity in breast cancer. The authors did not report on clinical benefit. Prostate Cancer: Hormone therapy is well established in the treatment of prostate cancer.
However, progressive disease after failure of hormone therapy is a difficult problem for patients in this setting. Tannock and colleagues from the Princess Margaret Hospital in Toronto have reported their experience with prednisone in the treatment of hormone-refractory disease.
In an informative study, these investigators prospectively treated 37 men with symptomatic bone metastases with 7.
Pain scores were assessed by three different measures at monthly intervals. Responses did not correlate with alkaline or acid phosphatase measures, but did appear to correlate with suppression of adrenal androgens. Although the median duration of response was only slightly more than 4 months, the investigators concluded that there was improvement in quality of life with little toxicity or expense.
These investigators have now reported on the superiority of the combination of mitoxantrone and prednisone as palliation for a similar group of patients; however, this therapy was not associated with a survival advantage. Some patients will opt not to receive chemotherapy, although corticosteroids alone may be beneficial. Sartor and colleagues assessed the effects of prednisone, 10 mg twice daily, on Prostate-Specific Antigen PSA in 29 men with progressive, hormone-refractory prostate cancer.
Twenty-six of the patients were symptomatic. The median progression-free survival was 2 months; however, median overall survival was The duration of symptom control and any correlation with PSA measurements were not reported, but would be of interest as patients lived an average of 10 months beyond the development of progressive disease 5. When taken by mouth every day, these pills inhibit female fertility. They were first approved for contraceptive use in the United States in , and are a very popular form of birth control.
They are currently used by more than million women worldwide and by almost 12 million women in the United States.
Medical Use: Combined oral contraceptive pills should be taken at the same time each day. If one or more tablets are forgotten for more than 12 hours, contraceptive protection will be reduced. Most brands of combined pills are packaged in one of two different packet sizes, with days marked off for a 28 day cycle. For the pill packet, a pill is consumed daily for three weeks, followed by a week of no pills. A woman on the pill will have a withdrawal bleed sometime during the placebo week, and is still protected from pregnancy during this week.
There are also two newer combination birth control pills Yaz 28 and Loestrin 24 Fe that have 24 days of active hormone pills, followed by 4 days of placebo. Placebo Pills: The placebo pills allow the user to take a pill every day; remaining in the daily habit even during the week without hormones. Failure to take pills during the placebo week does not impact the effectiveness of the pill, provided that daily ingestion of active pills is resumed at the end of the week.
The withdrawal bleeding that occurs during the break from active pills was thought to be comforting, as a physical confirmation of not being pregnant. The withdrawal bleeding is also predictable; as a woman goes longer periods of time taking only active pills, unexpected breakthrough bleeding becomes a more common side effect.
Less Frequent Placebos: If the pill formulation is monophasic, it is possible to skip withdrawal bleeding and still remain protected against conception by skipping the placebo pills and starting directly with the next packet.
It will not, however, increase the risk of getting pregnant. Starting in , women have also been able to use a three-month version of the Pill. Seasonique is another version in which the placebo week every three months is replaced with a week of low-dose estrogen. A version of the combined pill has also been packaged to completely eliminate placebo pills and withdrawal bleeds. Perfect use or method effectiveness rates only include people who take the pills consistently and correctly.
Actual use, or typical use effectiveness rates are of all COCP users, including those who take the pills incorrectly, inconsistently, or both. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.
The perfect use pregnancy rate of COCPs is 0.
Several factors account for typical use effectiveness being lower than perfect use effectiveness: Mistakes on the part of those providing instructions on how to use the method Mistakes on the part of the user Conscious user non-compliance with instructions. For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or by mistake not take the pill one day, or simply not go to the pharmacy on time to renew the prescription.
If started at any other time in the menstrual cycle, COCPs provide effective contraception only after 7 consecutive days use of active pills, so a backup method of contraception must be used until active pills have been taken for 7 consecutive days. COCPs should be taken at approximately the same time every day. Drug Interactions: Some drugs reduce the effect of the Pill and can cause breakthrough bleeding, or increased chance of pregnancy.
These include drugs such as rifampicin, barbiturates, phenytoin and carbamazepine. In addition cautions are given about broad spectrum antibiotics, such as ampicillin and doxycycline, which may cause problems "by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel".
Combined hormonal contraceptives, including COCPs, inhibit follicular development and prevent ovulation as their primary mechanism of action. Progestogen negative feedback decreases the pulse frequency of gonadotropin-releasing hormone GnRH release by the hypothalamus, which decreases the release of follicle-stimulating hormone FSH and greatly decreases the release of Luteinizing Hormone LH by the anterior pituitary.
Decreased levels of FSH inhibit follicular development, preventing an increase in estradiol levels. Progestogen negative feedback and the lack of estrogen positive feedback on LH release prevent amid-cycle LH surge. Inhibition of follicular development and the absence of a LH surge prevent ovulation.
Estrogen was originally included in oral contraceptives for better cycle control to stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding , but was also found to inhibit follicular development and help prevent ovulation.
Estrogen negative feedback on the anterior pituitary greatly decreases the release of FSH, which inhibits follicular development and helps prevent ovulation.
Other possible secondary mechanisms may exist. For instance, the brochure for Bayer's YAZ mentions changes in the endometrial effects that reduce the likelihood of implantation of an embryo in the uterus. Such a secondary mechanism would occur if breakthrough ovulation were to occur and result in a post-fertilization effect.
One example isendometrial effects that prevent implantation of an embryo in the uterus. A scientific analysis of the available studies on this issue concluded "that good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some degree on postfertilization effects. However, there are insufficient data to quantitate the relative contribution of postfertilization effects.
Some physicians and patients consider such a mechanism to be abortifacient. Other scientists point out that the possibility of fertilization during COCP use is very small. From this, they conclude that endometrial changes are unlikely to play an important role, if any, in the observed effectiveness of COCPs. Subsequently, the frequency of such postfertilization mechanisms is a controversial topic and currently unresolved.
Formulations: Oral contraceptives come in a variety of formulations. The main division is between combined oral contraceptive pills, containing both estrogen and progestins and progestin only pills. Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progestin changes from 1 week to the next. Non-contraceptive uses: The hormones in "the Pill" can also be used to treat other medical conditions, such as polycystic ovary syndrome PCOS , endometriosis, adenomyosis, menstruation-related anemia and painful menstruation dysmenorrhea.
In addition, oral contraceptives are often prescribed as medication for mild or moderate acne. The pill can also induce menstruation on a regular schedule for women bothered by irregular menstrual cycles or disorders where there is dysfunctional uterine bleeding.
In addition, the Pill provides some protection against breast growth that is not cancer, ectopic pregnancy, vaginal dryness and menopause-related painful intercourse. Ever since this discovery, corticosteroids have been used to treat a great variety of diseases where inflammation not infection and not cancer is the major problem, from arthritis to psoriasis to asthma.
To treat the inflammation of asthma within the bronchial tubes, steroids can be taken in tablet or liquid form or by inhalation. Occasionally, steroids are given by injection or in hospitalized persons directly into the veins intravenous infusion.
Taken as tablets, liquid, injection, or intravenous infusion, the steroid medication travels in the blood and is carried throughout the body, including to the bronchial tubes. Used in this way, steroids have their most powerful effects, both for the good relieving asthmatic symptoms and for the bad undesirable side effects.
On the other hand, modern steroid medications inhaled on the bronchial tubes from pressurized canisters act directly on these tubes; almost no medication is carried into the bloodstream. Although not as powerful in their immediate effects, steroids by inhalation are better suited for long-term use in the treatment of inflamed bronchial tubes because they are free of major undesirable side effects. Examples of steroids in tablet form are prednisone Brand name: Deltasone and prednisolone Brand-name: Medrol.
A Short Course of Steroids: Steroids taken in tablet or liquid form "oral steroids" are usually prescribed for asthma that has become difficult to control by any other means; they are the most effective treatment available for a severe "attack" of asthma. Most often, they are prescribed for a short period of time: a short course may be as brief as days or as long as weeks.
They are stopped when the asthma has gotten better and other treatments suffice to keep it under control. Longer periods of treatment and continuous treatment with oral steroids are generally avoided except for the most difficult-to-control asthma because of the undesirable side effects that often develop with prolonged oral steroid treatment. As a rough guide, we consider less than 20 milligrams abbreviated "mg" of prednisone a low dose, 20 to 30 mg a moderate dose, and 40 to 60 mg a high dose of oral steroids.
When rapid relief from an asthma attack is needed, a high dose will often be recommended initially, followed by a gradual reduction in dose on successive days until the oral steroids are stopped: a "steroid taper.
There is no single schedule of oral steroid dosing that is right for all asthma attacks in all patients. Effects of a Short Steroid Course: The beneficial effects of oral steroids are usually evident within several hours.