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    In addition to the mentioned side effects several others have been reported. In both males and females acne are frequently reported, as well as hypertrophy of sebaceous glands, increased tallow excretion, hair loss, and alopecia. There is some evidence that anabolic steroid abuse may affect the immune system, leading to a decreased effectiveness of the defense system. Steroid use decreases the glucose tolerance, while there is an increase in insulin resistance. These changes mimic Type II diabetes. These changes seem to be reversible after abstention from the drugs.

    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]

    In a double-blind randomized controlled trial that evaluated the emergency department treatment of migraine in 66 patients, the combination of IV prochlorperazine (10 mg) and IV diphenhydramine ( mg) was significantly more effective than subcutaneous sumatriptan (6 mg) for the reduction of pain intensity at 80 minutes or time of discharge [ 78 ]. Diphenhydramine was used with prochlorperazine to prevent akathisia and dystonic reactions. However, the possibility of migraine benefit from diphenhydramine cannot be completely discounted. A high drop-out rate upon attempted telephone contact at 72 hours precluded meaningful assessment of headache recurrence, although none of the enrolled patients returned to the emergency department with complaint of headache.

    With this current update, a total of five eligible studies (215 patients) were identified. Only one outcome , the proportion of patients with Expanded Disability Status Scale (EDSS) improvement at four weeks, was common to three trials, while two trials examined magnetic resonance imaging (MRI) outcomes. The results of this review shows there is no significant difference in relapse recovery at week four ( MD -, 95% confidence interval (95% CI ), to , P = ) nor differences in magnetic resonance imaging (MRI) gadolinium enhancement activity based on oral versus intravenous steroid treatment. However, only two of the five studies employed more current and rigorous methodological techniques, so these results must be taken with some caution. The Oral Megadose Corticosteroid Therapy of Acute Exacerbations of Multiple Sclerosis (OMEGA) trial and the "Efficacy and Safety of Methylprednisolone Per os Versus IV for the Treatment of Multiple Sclerosis (MS) Relapses" (COPOUSEP) trial , designed to address such limitations, are currently underway.

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  • Citation tools Download this article to citation manager Bush Andrew , Grigg Jonathan , Saglani Sejal . Managing wheeze in preschool children BMJ 2014; 348 :g15
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    Oral steroids for acute back pain

    oral steroids for acute back pain

    In a double-blind randomized controlled trial that evaluated the emergency department treatment of migraine in 66 patients, the combination of IV prochlorperazine (10 mg) and IV diphenhydramine ( mg) was significantly more effective than subcutaneous sumatriptan (6 mg) for the reduction of pain intensity at 80 minutes or time of discharge [ 78 ]. Diphenhydramine was used with prochlorperazine to prevent akathisia and dystonic reactions. However, the possibility of migraine benefit from diphenhydramine cannot be completely discounted. A high drop-out rate upon attempted telephone contact at 72 hours precluded meaningful assessment of headache recurrence, although none of the enrolled patients returned to the emergency department with complaint of headache.

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