Browsing by Subject "Hydrocortisone"

Now showing 1 - 7 of 7
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    A Case Series of Persistent SARS-CoV-2 Infection in Immunocompromised Pediatric Patients
    (Hindawi, 2023-05-16) Ahmed, Mohamed Y.; Taylor, Jane B.; Aneja, Rajesh K.; Wang, Qian; Williams, John V.; Pediatrics, School of Medicine
    Diagnosis and management of SARS-CoV-2 infection in immunocompromised patients are extremely challenging. These patients can have atypical clinical courses, and there is a paucity of data regarding clinical features, diagnostic findings, and the safety and efficacy of available therapeutic agents used to treat COVID-19 in these patients. In this case series, we report atypical COVID-19 presentations in 4 immunocompromised pediatric patients who were admitted with acute respiratory failure after an initial diagnosis of COVID-19 a few weeks earlier. All patients included in this cohort showed persistent worsening respiratory symptoms for several weeks before hospital presentation. While they manifested common COVID-19 sequelae, they also had rare COVID-19-related pathognomonic and radiographic features developed along their hospital course. Multiple therapeutic agents were used in their COVID-19 management, including corticosteroids, remdesivir, and monoclonal antibodies. All three patients who have received concurrent therapy with remdesivir, hydrocortisone, and monoclonal antibodies survived, and only one patient died as a direct complication of COVID-19 ARDS with secondary pulmonary mucormycosis. Our outcomes suggest the potential benefit of remdesivir use in combination with hydrocortisone and monoclonal antibodies in the management of severe COVID-19 ARDS in this group, as well as the importance of close surveillance and early administration of broad empirical antimicrobial and antifungal coverage if clinically indicated in this high-risk population.
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    Association of Time of First Corticosteroid Treatment with Bronchopulmonary Dysplasia in Preterm Infants
    (Wiley, 2021) Cuna, Alain; Lagatta, Joanne M.; Savani, Rashmin C.; Vyas-Read, Shilpa; Engle, William A.; Rose, Rebecca S.; DiGeronimo, Robert; Logan, J. Wells; Mikhael, Michel; Natarajan, Girija; Truog, William E.; Kielt, Matthew; Murthy, Karna; Zaniletti, Isabella; Lewis, Tamorah R.; Children’s Hospitals Neonatal Consortium (CHNC) Severe BPD Focus Group; Pediatrics, School of Medicine
    Objective: To evaluate the association between the time of first systemic corticosteroid initiation and bronchopulmonary dysplasia (BPD) in preterm infants. Study design: A multi-center retrospective cohort study from January 2010 to December 2016 using the Children's Hospitals Neonatal Database and Pediatric Health Information System database was conducted. The study population included preterm infants <32 weeks' gestation treated with systemic corticosteroids after 7 days of age and before 34 weeks' postmenstrual age. Stepwise multivariable logistic regression was used to assess the association between timing of corticosteroid initiation and the development of Grade 2 or 3 BPD as defined by the 2019 Neonatal Research Network criteria. Results: We identified 598 corticosteroid-treated infants (median gestational age 25 weeks, median birth weight 760 g). Of these, 47% (280 of 598) were first treated at 8-21 days, 25% (148 of 598) were first treated at 22-35 days, 14% (86 of 598) were first treated at 36-49 days, and 14% (84 of 598) were first treated at >50 days. Infants first treated at 36-49 days (aOR 2.0, 95% CI 1.1-3.7) and >50 days (aOR 1.9, 95% CI 1.04-3.3) had higher independent odds of developing Grade 2 or 3 BPD when compared to infants treated at 8-21 days after adjusting for birth characteristics, admission characteristics, center, and co-morbidities. Conclusions: Among preterm infants treated with systemic corticosteroids in routine clinical practice, later initiation of treatment was associated with a higher likelihood to develop Grade 2 or 3 BPD when compared to earlier treatment.
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    Diagnosis of adrenal insufficiency in eosinophilic esophagitis: The importance of timing of cortisol measurements in interpreting low-dose adrenocorticotropic hormone stimulation testing
    (Elsevier, 2016-07) Schoelwer, Melissa J.; Nebesio, Todd D.; Pediatrics, School of Medicine
    Comment on Adrenal Insufficiency after Chronic Swallowed Glucocorticoid Therapy for Eosinophilic Esophagitis. [J Pediatr. 2016]
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    Differential effects of hydrocortisone, prednisone, and dexamethasone on hormonal and pharmacokinetic profiles: a pilot study in children with congenital adrenal hyperplasia
    (BioMed Central, 2016) Nebesio, Todd D.; Renbarger, Jamie L.; Nabhan, Zeina M.; Ross, Sydney E.; Slaven, James E.; Li, Lang; Walvoord, Emily C.; Eugster, Erica A.; Department of Pediatrics, IU School of Medicine
    BACKGROUND: Little is known about the comparative effects of different glucocorticoids on the adrenal and growth hormone (GH) axes in children with congenital adrenal hyperplasia (CAH). We sought to compare the effects of hydrocortisone (HC), prednisone (PDN), and dexamethasone (DEX) in children with classic CAH and to investigate a potential role of pharmacogenetics. METHODS: Subjects were randomly assigned to three sequential 6-week courses of HC, PDN, and DEX, each followed by evaluation of adrenal hormones, IGF-1, GH, and body mass index (BMI). Single nucleotide polymorphism (SNP) analysis of genes in the glucocorticoid pathway was also performed. RESULTS: Nine prepubertal subjects aged 8.1 ± 2.3 years completed the study. Mean ACTH, androstenedione, and 17-hydroxyprogesterone (17-OHP) values were lower following the DEX arm of the study than after subjects received HC (p ≤ 0.016) or PDN (p ≤ 0.002). 17-OHP was also lower after HC than PDN (p < 0.001). There was no difference in IGF-1, GH, or change in BMI. SNP analysis revealed significant associations between hormone concentrations, pharmacokinetic parameters, and variants in several glucocorticoid pathway genes (ABCB1, NR3C1, IP013, GLCCI1). CONCLUSIONS: DEX resulted in marked adrenal suppression suggesting that its potency relative to hydrocortisone and prednisone was underestimated. SNPs conferred significant differences in responses between subjects. Although preliminary, these pilot data suggest that incorporating pharmacogenetics has the potential to eventually lead to targeted therapy in children with CAH.
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    Expensive Egos: Narcissistic Males Have Higher Cortisol
    (PLOS, 2012-01-23) Reinhard, David A.; Konrath, Sara H.; Lopez, William D.; Cameron, Heather G.
    Background Narcissism is characterized by grandiosity, low empathy, and entitlement. There has been limited research regarding the hormonal correlates of narcissism, despite the potential health implications. This study examined the role of participant narcissism and sex on basal cortisol concentrations in an undergraduate population. Methods and Findings Participants were 106 undergraduate students (79 females, 27 males, mean age 20.1 years) from one Midwestern and one Southwestern American university. Narcissism was assessed using the Narcissistic Personality Inventory, and basal cortisol concentrations were collected from saliva samples in a laboratory setting. Regression analyses examined the effect of narcissism and sex on cortisol (log). There were no sex differences in basal cortisol, F (1,97) = .20, p  = .65, and narcissism scores, F (1,97) = .00, p  = .99. Stepwise linear regression models of sex and narcissism and their interaction predicting cortisol concentrations showed no main effects when including covariates, but a significant interaction, β = .27, p = .04. Narcissism was not related to cortisol in females, but significantly predicted cortisol in males. Examining the effect of unhealthy versus healthy narcissism on cortisol found that unhealthy narcissism was marginally related to cortisol in females, β = .27, p = .06, but significantly predicted higher basal cortisol in males, β = .72, p = .01, even when controlling for potential confounds. No relationship was found between sex, narcissism, or their interaction on self-reported stress. Conclusions Our findings suggest that the HPA axis is chronically activated in males with unhealthy narcissism. This constant activation of the HPA axis may have important health implications.
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    Studies of adrenal sterol metabolism
    (1965) Lloyd, Burr Jackson
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    Therapy Dogs for Anxiety in Children in the Emergency Department: A Randomized Clinical Trial
    (American Medical Association, 2025-03-03) Kelker, Heather P.; Siddiqui, Huma K.; Beck, Alan M.; Kline, Jeffrey A.; Emergency Medicine, School of Medicine
    Importance: Prior evidence suggests that the use of therapy dogs in emergency care reduces anxiety in adults, but no trial has tested the use of therapy dogs in emergency care of children. Objective: To examine whether adjunctive use of therapy dogs in standard child-life therapy reduces child-reported and parent-reported child anxiety in a pediatric emergency department (ED). Design, setting, and participants: This randomized clinical trial was conducted from February 1, 2023, to June 30, 2024, at an academic pediatric ED. Children (aged 5-17 years) with suspected moderate to high anxiety were included. Intervention: All participants received standard child-life therapy, and the intervention group was randomly assigned to have exposure to a therapy dog and handler for approximately 10 minutes. Main outcomes and measures: Anxiety was measured using the 0- to 10-point FACES scale (with 0 indicating no anxiety and 10 indicating very severe anxiety) and salivary cortisol concentrations. Measurements were obtained at baseline (T0), 45 minutes (T1), and 120 minutes (T2) for both child and parents. Results: A total of 80 patients (mean [SD] age, 10.9 [3.8] years; 45 [56%] female) were enrolled (40 in the control group and 40 in the intervention group). At T0, the mean (SD) FACES scores were 5.4 (2.8) for child report and 6.4 (2.4) for parent report; the means were not different between groups. From T0 to T1, child-reported anxiety changed by a mean (SD) of -1.5 (3.4) points in the control group vs -2.7 (2.5) points in the intervention group (P = .02, Mann-Whitney U test); similarly, mean (SD) parent-estimated child anxiety changed by -1.8 (2.7) points in the control group vs -3.2 (2.3) points in the intervention group (P = .008). A total of 9 children (23%) in the control group had a greater than 2.5-point decrease in FACES score vs 18 (46%) in intervention group (P = .04, Fisher test). At T2, mean (SD) child-reported FACES scores decreased to 3.6 (3.4) points in the control group and 3.0 (2.7) points in the intervention group (P = .70). A total of 14 control participants (35%) received ketamine, midazolam, lorazepam, or droperidol vs 7 (18%) in the intervention group (P = .08, Fisher test). Child and parent salivary cortisol decreased from T0 to T1 in both groups but was not different between groups. Parental salivary cortisol was significantly consistently higher than their children's salivary cortisol (P < .001, unpaired t test, for comparisons of child vs parent at T0 and T1 in both groups). Conclusions and relevance: This study of adjunctive use of therapy dogs in standard child-life therapy found a modest but significantly greater reduction in both child-reported and parental-reported child anxiety in the pediatric ED for the intervention vs control group. These findings support the use of therapy dogs to help reduce pain and anxiety without the use of chemical or physical constraint.