Oral steroids for acute back pain

Narrative: Chronic obstructive pulmonary disease (COPD), a term that encompasses both patients diagnosed with chronic bronchitis and emphysema, is an obstructive lung disease in many cases caused by years of tobacco smoking. It is thought that patients with COPD ‘exacerbation’ (increased shortness of breath or change in their chronic cough and sputum) may benefit from steroids, presumably by reducing the inflammatory response that accompanies the exacerbation.

Benefits: 10 studies contributed data for this Cochrane analysis, representing 1051 patients. There was no statistically significant difference in the mortality of subjects who received systemic steroids compared to placebo. In regards to treatment failure, the review found a NNT of 10 (% reduction). Interestingly, no benefit was found in analysis of studies with steroids for less than 72 hours. The reductions in treatment failure were recorded from studies including both admitted and outpatient/Emergency Department patients.

Harms: Corticosteroids can cause multiple side effects, and some studies evaluated harms, though this was inconsistent across studies. When harms were pooled, there was an absolute risk increase of % for patients receiving steroids (NNH = 7) though this includes some harms that are not patient-oriented (high blood sugars) as well as some that are patient-oriented (diarrhea).

Endotracheal intubation and ventilation for impending respiratory failure:
Intubation and mechanical ventilation can be life-saving interventions but their use in paediatric patients with asthma have been associated with significant adverse effects. Up to 26% of children intubated due to asthma have complications, such as pneumothorax or impaired venous return, and cardiovascular collapse because of increased intrathoracic pressure [31] . Mechanical ventilation during an asthma exacerbation is associated with increased risk of death and should be considered as a last resort and only in conjunction with the support of a paediatric ICU specialist.

The doctor may suggest hospitalization simply because it may be necessary to break the cycle of chronic inflammation, or other problems that are exacerbating the illness. Frequently, five or six days of vigorous in-hospital treatment care can result in a dramatic clearing of the eczema. Food tests, allergy skin testing, and the development of an outpatient therapy plan can all be done during the hospitalization. Unfortunately, getting approval from insurers is often difficult. During an acute flare the number of 15-20 minute baths must be increased to three or four per day. Besides hydrating the skin, baths also increase the penetration of topical medication up to ten-fold if the medicine is applied immediately after the bath. Wet wraps after baths may also help hydration and medicinal penetration. Bedtime wet wraps are most practical, and can be done with elasticized gauze followed by ace bandages or double pajamas. (The first pair of pajamas is worn damp but not soaking wet, and a second pair of dry pajamas is worn over them. For a tighter fit, sometimes a plastic sauna suit is used instead of the dry pajamas.) For feet and hands, socks can be used. Additional blankets or increased room heat may be necessary during this three to seven days to prevent chilling.

About 35-50% of humans possess C. albicans as part of their normal oral microbiota . [5] With more sensitive detection techniques, this figure is reported to rise to 90%. [6] This candidal carrier state is not considered a disease, since there are no lesions or symptoms of any kind. Oral carriage of Candida is pre-requisite for the development of oral candidiasis. For Candida species to colonize and survive as a normal component of the oral microbiota, the organisms must be capable of adhering to the epithelial surface of the mucous membrane lining the mouth. [19] This adhesion involves adhesins (., hyphal wall protein 1 ), and extracellular polymeric materials (., mannoprotein). [13] Therefore, strains of Candida with more adhesion capability have more pathogenic potential than other strains. [6] The prevalence of Candida carriage varies with geographic location, [6] and many other factors. Higher carriage is reported during the summer months, [6] in females, [6] in hospitalized individuals, [6] in persons with blood group O and in non-secretors of blood group antigens in saliva. [6] Increased rates of Candida carriage are also found in people who eat a diet high in carbohydrates, people who wear dentures, people with xerostomia (dry mouth), in people taking broad spectrum antibiotics, smokers, and in immunocompromised individuals (., due to HIV/AIDS, diabetes, cancer, Down syndrome or malnutrition ). [13] Age also influences oral carriage, with the lowest levels occurring in newborns, increasing dramatically in infants, and then decreasing again in adults. Investigations have quantified oral carriage of Candida albicans at 300-500 colony forming units in healthy persons. [20] More Candida is detected in the early morning and the late afternoon. The greatest quantity of Candida species are harbored on the posterior dorsal tongue, [13] followed by the palatal and the buccal mucosae. [20] Mucosa covered by an oral appliance such as a denture harbors significantly more candida species than uncovered mucosa. [20]

Oral steroids for acute back pain

oral steroids for acute back pain

About 35-50% of humans possess C. albicans as part of their normal oral microbiota . [5] With more sensitive detection techniques, this figure is reported to rise to 90%. [6] This candidal carrier state is not considered a disease, since there are no lesions or symptoms of any kind. Oral carriage of Candida is pre-requisite for the development of oral candidiasis. For Candida species to colonize and survive as a normal component of the oral microbiota, the organisms must be capable of adhering to the epithelial surface of the mucous membrane lining the mouth. [19] This adhesion involves adhesins (., hyphal wall protein 1 ), and extracellular polymeric materials (., mannoprotein). [13] Therefore, strains of Candida with more adhesion capability have more pathogenic potential than other strains. [6] The prevalence of Candida carriage varies with geographic location, [6] and many other factors. Higher carriage is reported during the summer months, [6] in females, [6] in hospitalized individuals, [6] in persons with blood group O and in non-secretors of blood group antigens in saliva. [6] Increased rates of Candida carriage are also found in people who eat a diet high in carbohydrates, people who wear dentures, people with xerostomia (dry mouth), in people taking broad spectrum antibiotics, smokers, and in immunocompromised individuals (., due to HIV/AIDS, diabetes, cancer, Down syndrome or malnutrition ). [13] Age also influences oral carriage, with the lowest levels occurring in newborns, increasing dramatically in infants, and then decreasing again in adults. Investigations have quantified oral carriage of Candida albicans at 300-500 colony forming units in healthy persons. [20] More Candida is detected in the early morning and the late afternoon. The greatest quantity of Candida species are harbored on the posterior dorsal tongue, [13] followed by the palatal and the buccal mucosae. [20] Mucosa covered by an oral appliance such as a denture harbors significantly more candida species than uncovered mucosa. [20]

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