21-amino glucocorticoid steroids, such as methylprednisolone, are commonly prescribed to treat this condition, but their usage is associated with potential side effects ( Haberkamp 1999 ; Stokroos 1996b ; Thurmond 1998 ). The specific action of steroids in the cochlea is uncertain but their use has been based on their ability to decrease inflammation and oedema. However, there are a wide range of side effects relating to short-term steroid use including glucose intolerance, hypertension, adrenal suppression, gastrointestinal bleeding and altered mental states. There are currently insufficient clinical data to indicate the prevalence of side effects from short, sharp courses of steroid usage. The duration of steroid usage for the treatment of ISSHL is very short (only about two weeks) compared with regimens used to treat chronic disease. The potential side effects from very short, sharp courses of steroids are therefore fewer than those from longer-term use.
We have also noted that 24-hour urinary estrogens can be a sensitive monitor of liver detoxification capability. Elevated urinary estrogens in normally-cycling women may indicate a history of exposure to liver stresses such as excessive environmental organic chemicals. Interventions intended to improve liver function result in a gradual normalization of the abnormal estrogen levels. Thus, measurement of urinary estrogens can give insight into other aspects of physiology. This phenomenon is also noted in peri- or post-menopausal women who have previously taken Premarin, and have switched to triple-estrogen replacement with less-than-optimal symptom relief.
Background: The management of steroid resistant nephrotic syndrome (SRNS) is quite difficult in paediatric patients. Not only the remission is difficult but also these patients are at risk of progression to end stage renal disease (ESRD). The goal of treatment is either to achieve complete remission or even partial remission as it is the most important predictor of disease outcome. Methods: This study was conducted at The Children’s Hospital, Lahore from February 2014 to May 2015. The SRNS patients of either sex between ages of 1–12 years were included with histology showing mesangioproliferative glomerulonephritis (MesangioPGN), focal segmental glomerulosclerosis (FSGS) or minimal change disease (MCD). Patients were given different immunosuppressant drugs and steroid 30 mg/m 2 alternate day therapy on case to case basis and kept on regular follow up to check for response and adverse effects. Results: Total of 105 patients included, 63 (60%) male and 42 (40%) female patients. The age ranges from to 12 years, mean age of years and SD of ±. Tacrolimus was the most common drug used 43 (41%) patients followed by cyclosporine in 38 (%) patients, while Mycophenolate mofetil (MMF) was prescribed in 21 (20%) patients. Complete response was in 96 (%) initially while partial response was seen in 8 (%) patients. On follow up, 92 (%) patients showed complete response and partial response was in 5 (%) patients. Cushingoid features and hypertrichosis were the most common adverse effect seen. Conclusion: Steroid resistant nephrotic syndrome can be managed well with various immunosuppressant drugs and steroids but treatment should be individualized according to clinical presentation, disease histology and cost/social factors.