Pros and Cons of Topical Steroids for Viral Conjunctivitis

Many physicians have found topical steroids to be helpful for patients with debilitating conjunctivitis. By reducing inflammation, steroids can bring dramatic improvement in patient comfort. However, others caution that steroids may delay resolution of the disease, prolonging the contagious course of the virus. In fact, studies in rabbit models have shown that topical steroids may prolong ocular shedding of adenovirus by several weeks.

Until recently, no well-designed human study has assessed the risks and benefits of topical steroids in the treatment of viral conjunctivitis. In a study by Wilkins and colleagues,3 111 patients with presumed viral conjunctivitis were randomly assigned to receive either preservative-free dexamethasone 0.1% or hydroxypropyl methylcellulose (the vehicle used by the Moorfields pharmacy for compounding topical dexam- ethasone) four times daily for 1 week. Statistically significantly more patients in the dexamethasone group (39 of 45) felt the drops to be helpful than in the vehicle group (30 of 43). No adverse events were seen in either group.

The decision to use steroids for the treatment of viral conjunctivitis is a personal one. Research has shown that, when used appropriately (ie, in cases where bacterial or herpetic infection has been ruled out and when used in short pulses), topical steroids can be beneficial to patients by ameliorating the symptoms for which they initially presented. Steroid use may somewhat prolong the length of the contagious period; however, many patients will gladly accept this so that they may begin to feel ocular relief.

Topical steroid drops should be used with great caution, as herpetic viral infection of the ocular surface is a common mimicker of adenoviral conjunctivitis, and unopposed steroid drops can promote viral replication and corneal scarring. Additionally, as noted above, multiple studies have demonstrated that topical steroids prolong the viral shedding period.2 The key to managing adenoviral conjunctivitis is to limit its spread. Patients with viral conjunctivitis who are treated with topical steroid drops may return to work or school while they are still in the contagious phase of the infection, and therefore have the potential to further increase the disease burden on the health care system.

Because the symptoms of adenoviral conjunctivitis may be severe, investigators have explored other treatment options for patients with symptomatic disease including a topical combination of dexamethasone 0.1% and povidoneiodine 0.4%.4 This novel formulation was compared with cidofovir 0.5%, a combination tobramycin-dexamethasone ophthalmic suspension (Tobradex; Alcon Laboratories, Inc., Fort Worth, Texas), and balanced salt solution in rabbit eyes. The combination topical dexamethasone 0.1% and povidoneiodine 0.4% was equally effective as cidofovir 0.5% in reducing viral titers and was the most efficacious in reducing clinical symptoms of adenovirus infection in rabbit eyes.

A dexamethasone/povidone-iodine combination drop is not yet commercially available, but other options are. Gordon et al demonstrated that topical ketorolac or diclofenac did not increase the viral shedding period and may be a safer alternative t topical steroids.5 More recently, during an epidemic of viral conjunctivitis in a military garrison in Karachi, Pakistan, 200 patients were randomly assigned to topical decongestant/antihistamine combination drops or to eye washing and cool compresses.6 Acute illness symptoms of eye watering, itching, burning, pain, and photophobia lasted a mean 4.91 days in the decongestant/ antihistamine drop and 7.86 days in the cool compresses group. 

Steroids and Viral Infections in Kids

Researchers have discovered the wheezing and steroids don't mix when it comes to children. Two studies show that steroids do not change the course of viral infections in children.

The researchers tested 700 children aged 10 months to 5 years old. The study showed that children stayed in hospital the same amount of time regardless if they had steroids or not from viral infections that caused wheezing.
At this time doctors treat wheezing from infections the same as they do in asthmatic children.
The study also showed that steroids didn't change the symptoms over the following seven days.

A second study compared the use of steroids and a placebo in 129 children aged 1 to 6. The children were given one of the two at the first sign of nasal congestion, sore throat or any other symptom that might show an upper respiratory tract infection was coming on. The children received the treatment for up to 10 days twice daily. The drug seemed to help.
Eighteen percent of the children in the placebo group had to have additional steroid drugs. The children that had used steroids needing the additional medication was at eight percent.
The children using steroids grew less though than the ones in the placebo group.

Steroids to Treat Arthritis

Steroids  are synthetic drugs that closely resemble cortisol, a hormone that your body produces naturally. Steroids work by decreasing inflammation and reducing the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions.

Corticosteroids are different from anabolic steroids, which some athletes use to build bigger muscles. Examples of corticosteroid medications include triamcinolone, cortisone, prednisone, and methylprednisolone.
How Are Steroids Given?

Steroids can be given topically (cream or ointment), by mouth (orally), or by injection. When injected, they can be given into a vein or muscle, directly into a joint or bursa (lubricating sac between certain tendons and the bones beneath them) or around tendons and other soft tissue areas.
How Do Steroids Work?

Steroids decrease inflammation and reduce the activity of the immune system. Inflammation is a process by which the body's white blood cells and chemicals protect the body against infection and foreign organisms such as bacteria and viruses.

In certain diseases, however, the body's defense system (immune system) doesn't function properly and is overactive. This may cause inflammation to work against the body's own tissues and cause tissue damage. Inflammation is characterized by redness, warmth, swelling and pain.

Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells.
What Conditions Are Treated With Steroids?

Steroids are used to treat a variety of conditions in which the body's defense system malfunctions and causes tissue damage. Steroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle). They may also be used selectively to treat inflammatory conditions such as rheumatoid arthritis, lupus, Sjögren's syndrome, or gout.
What Are the Benefits of Steroids?

When inflammation threatens to damage critical body organs, steroids can be organ saving and, in many instances, life-saving. For example, they may help prevent the progression of kidney inflammation, which can lead to kidney failure in people who have lupus or vasculitis. For these people, steroid therapy may eliminate the need for kidney dialysis or transplant.

Low doses of steroids may provide significant relief from pain and stiffness for people with conditions including rheumatoid arthritis. Temporary use of higher doses of steroids may help a person recover from a severe flare-up of arthritis.

How Do I Know If Steroid Treatment Is Right for Me?

The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, your overall health, and other drugs you are taking. Your doctor also will make sure you understand the potential benefits and risks of steroids before you start taking them. 

Management of HIV in Pregnancy

HIV infection in young children most commonly arises as a result of mother-to-child transmission (MTCT). It is thought that only 1.5-2% of MTCT occurs transplacentally during pregnancy. The vast majority occurs due to maternofetal transmission of blood during parturition or postnatal breast-feeding.

All pregnant women are recommended screening for HIV infection, syphilis, hepatitis B and rubella in every pregnancy at their booking antenatal visit. If a woman declines an HIV test, this should be documented in the maternity notes, her reasons should be sensitively explored and screening offered again at around 28 weeks.

A negative maternal HIV test at booking does not preclude neonatal infection - maternal infection and seroconversion can occur at any time during pregnancy and lactation. This is well-documented in countries with a high prevalence of HIV and has been seen in the UK.

Risk of mother-to-child transmission (MTCT)

This is increased with:

    Higher levels of maternal viraemia.
    HIV core antigens.
    Lower maternal CD4 count.
    Primary HIV Infection occurring during pregnancy.
    Chorioamnionitis.
    Co-existing other sexually transmitted disease (and malaria - possibly).
    Invasive intrapartum procedures, eg fetal scalp electrodes, forceps, ventouse.
    Rupture of membranes (especially if delivery is more than 4 hours after the membranes ruptured).
    Vaginal delivery.
    Preterm birth
    Female babies more likely to be infected early (transplacental/perinatal routes).
    Advanced maternal age.
    The firstborn of twins (born to an HIV-infected mother).

Factors that decrease risk of transmission are:

    Higher levels of neutralising HIV antibody.
    Elective Caesarean section.
    Zidovudine (ZDV)
    Less invasive monitoring and intrapartum procedures.

Management

Mother-to-child transmission (MTCT) of HIV infection can be greatly reduced through early diagnosis of maternal HIV infection.

    Pregnant women should be offered screening for HIV early in pregnancy because appropriate antenatal interventions can reduce MTCT of HIV infection.
    Interventions to reduce MTCT of HIV during the antenatal period include antiretroviral therapy, elective Caesarean section delivery and avoidance of breast-feeding after delivery.
    These interventions can reduce the risk of mother-to child HIV transmission from 25-30% to less than 1%.
    All pregnant women who are HIV-positive should be screened and appropriately treated for genital infections during pregnancy. This should be done as early as possible in pregnancy and repeated at about 28 weeks.
    Presentation with symptoms or signs of pre-eclampsia, cholestasis or other signs of liver dysfunction during pregnancy may indicate drug toxicity, and early liaison with HIV physicians is essential.

Drug therapy

Women who require HIV treatment for their own health should take highly active antiretroviral therapy (HAART) and continue treatment postpartum. They may also require prophylaxis against pneumocystic pneumonia (PCP), depending on their CD4 lymphocyte count.

Women already taking HAART and/or PCP prophylaxis before pregnancy should not discontinue their medication.

    Antiretroviral therapy is given to prevent MTCT and to prevent maternal disease progression. The optimal regimen is determined on a case-by-case basis.
    Zidovudine (ZDV) is indicated for use in pregnancy for prevention of MTCT of HIV but single-agent ZDV therapy which does not suppress plasma viraemia to undetectable levels may allow the emergence of resistant virus.
    Potent combinations of three or more antiretroviral drugs (HAART) have now become the standard of care. Women with advanced HIV should be treated with a HAART regimen. The start of treatment should be deferred until after the first trimester, if possible, and should be continued after delivery.
    For women who do not require HIV treatment for their own health, HAART should be initiated between 20 and 28 weeks and discontinued at delivery. If they have a plasma viral load of less than 10,000 copies/ml and are prepared to be delivered by elective Caesarean section, an acceptable alternative is ZDV monotherapy initiated between 20 and 28 weeks, given orally, 250 mg twice daily, and intravenously started four hours before beginning the Caesarean section, continuing until the umbilical cord has been clamped. ZDV is usually administered orally to the neonate for four to six weeks.
    Combination antiretroviral therapy maximises the chance of preventing transmission and represents optimal therapy for the mother but may increase the risk of drug toxicity to the fetus.
    The use of antiretrovirals to reduce MTCT has resulted in resistant mutations and, in the Paediatric AIDS Clinical Trials Group Protocol, 15% of the women developed nevirapine-resistant mutations by 6 weeks' postpartum.

In sub-Saharan Africa, access to services is improving. In 2008, 45% of HIV-infected pregnant women received antiretroviral treatment compared with 9% in 2004. 

Prevention of Viral Diseases

   Viral diseases are among those which spread from one person to another. Illness develops when a virus enters the body, invades healthy cells and replicates itself. At times, a virus can mutate itself during the replication process, making it more difficult for the body to fight. Viruses depend on other living organisms to survive and are hard to remove once in the body. Few medications fight viruses, making the body's immune system the best protection against infection.

    Viruses range in severity, making some life threatening conditions. Viruses have several groups in which they are categorized based on shape, behaviors and other common characteristics. For instance, the picornaviruses group includes the rhino-viruses which cause the common cold, or the papovaviruses which includes the papilloma virus known to women as HPV. More serious viruses such as HIV and Hepatitis C fall into groups of viruses known to generate their own DNA, enabling them to replicate themselves repeatedly within the body.

    Transmission
    Viruses are transmitted from one person to another through touching, breathing, bites and contact with body fluids (saliva, blood, semen or excrement). The most common form of transmission is by inhaling droplets of a virus in the air you breathe. Shared objects such as spoons, cups, door knobs and pencils that have been exposed can carry droplets of a virus from person to person. Insects and animals can transmit viruses by biting a human or another animal.
    Direct contact with body fluids can cause virus transmission, but only when certain conditions are met. Direct contact requires a significant amount of body fluid to be present, the person to have direct contact with the fluid, have a point of entry for the virus to enter into the body (cuts, scrapes, eyes, mouth) and be susceptible to the virus.

    Effects
    Viruses cause illness and discomfort for the sufferer, many of them are often temporary and usually non-life threatening. Effects of viruses can include symptoms such as dehydration, nausea, vomiting, high fever and weakness. Viruses such as Influenza cannot be cured with medication, but their effects can be kept under control until it finally disappears.
    Viruses, such as strains of Hepatitis, HIV and herpes, do not disappear. Their effects are felt throughout a lifetime for the person infected, sometimes resulting in death.

    Prevention
    Following simple steps can greatly reduce the risk of contracting a virus. Use bandages to cover scrapes, cuts or open sores at all times. Do not eat, drink, touch your mouth, nose or eyes before washing your hands and avoid handling pens, pencils or other items that belong to others. Never drink from someone else's beverage containers or eat from another persons soiled utensils. Frequent hand washing is highly recommended with soap and warm running water or an alcohol based sanitizing hand gel.

    Cleaning
    Bleach based products are extremely effective in killing 99.9% of germs and viruses in, and around, the home. If the cost of bleach based cleansers is an issue, 1 1/2 cups of chlorine bleach to a gallon of fresh water will clean with the same effectiveness. You may add a few drops of dish detergent to the mixture for a soapy consistency.
    Regular cleaning is recommended for door handles, bathroom sinks, toilets and toothbrush holders in an effort to reduce the chances of contracting a strain of flu or the common cold.

Sterols Have The Potential To Stabilize The Immune System And Protect From Numerous Diseases

Sterols present in plants are referred to as phytosterols and are present in small quantities in numerous fruits and vegetables. Sterols are similar in structure to the cholesterol present in animal cells.
However, sterols offer better benefits than the cholesterol obtained from animal cells and are proven to reduce the levels of ‘bad’ cholesterol in the body. It is now being proposed that sterols have the potential to stabilize the immune system and protect one from numerous diseases and health conditions. It is believed that sterols, along with improvement in cholesterol levels also help prevent many infections.

The immune system performs a wide range of functions that as a whole help in preventing infections and diseases in the human body. Supplementations of various plant products have been associated with an improvement in function in the immune system. Plant sterols which were initially being promoted for benefits on serum blood cholesterol levels are now being researched and studied for the effects on the human immune system.

The T-lymphocytes have a number of associated cells that are grouped as T-helper cells to aid in the function of identifying and destroying harmful microorganisms and their toxic products. These T-helper cells have been reported to fight directly against the viruses and other microorganisms to prevent the occurrence of infections. Further, T-cells may also act against cancer cells and prevent progression and spreading. Studies have reported that nutrients such as plant sterols do have an influence on the number and function of such helper cells that are quite essential for the prevention of infections.Proper regulation of immune cells is important in enhancing the actions of the immune system while protecting the body against autoimmune reactions and responses.
Sterols Benefits on the Immune System and Medical Studies
One of the benefits of regulation of the immune system was noted in patients suffering from asthma. Asthma results from the abnormal increase in the response of the immune system to minor stimuli. Administration of plant sterols were noted to regulate the actions of the T-helper cells, thereby reducing the release of several chemicals (histamines) responsible for the inflammation of cells of the lungs and the throat. Dr. Miller concludes that the administration of plant sterols does have an effect on the immune system and can be used as additional mode of therapy while treating individuals suffering from asthma.

A compound produced from a combination of plant sterols was tested on individuals suffering from HIV infection in South Africa. HIV is known for its suppression on the immune system and the study demonstrated promising results. The administration of sterol compounds was notably associated with an increase in the T-cell counts along with other benefits such as improvement in general health, decrease in the number of viruses present in the body, weight gain and reduction in skin irritations.

The results obtained from these studies have confirmed the effects of anabolic steroids on the immune system. Therefore, it can be concluded that plant sterols may boost the immune system and protect the body against infections and other disorders.

How to Manage the Most Common Respiratory Infection - the Cold

The common cold is known as one of the most prevalent infections worldwide. It is estimated that the average person contracts two to four colds per year. It has people running to drug stores and reaching for pharmaceuticals, causing further imbalance in the body, not to mention wasting money and resources. However, given a proper understanding of how the common cold works, people are able to prevent or treat this ailment in the most beneficial, and natural of ways.
A cold is classified as an upper respiratory infection (URI) and exhibits a collection of symptoms. The most common include nose and throat irritations, like a runny or stuffy nose and cough.

Colds are caused by viruses, not bacteria. Viruses and bacteria are as different as computers and elephants. Although they have some things in common, viruses generally do not respond to measures that work on bacteria. Therefore, using anti-bacterial soaps or antibiotics, which are both intended for bacteria, is useless. Viruses are not alive in the typical sense that a cell is, therefore, we cannot 'kill' them. The best way to deal with viruses is to limit our exposure to them and have our body's immune system "disassemble" them.

Over the counter cold medications do not cure colds, they just suppress the symptoms. It is; therefore, prudent to know that going out to buy typical cold medications, anti-bacterial soaps or drugs like antibiotics, is generally a waste of money and further damage to health. The best thing we can do to manage, alleviate or decrease the chances of a cold is work on boosting our immune system - and not just when a cold strikes, but year round.

Enhance your immune system
The best way to manage a cold is to not get it in the first place. This is possible by adopting optimally healthy lifestyle habits. Eating a diet based on whole, natural plant food is key. Fruits, vegetables, herbs and spices offer the most natural vitamins, minerals and antioxidants to protect and strengthen our immune system. Additionally, drinking enough pure water, having regular movement, effective stress relief, exposure to fresh air and sun for optimal vitamin D levels are of key importance as well.

Rest, hydrate and 'nutrate'
When a cold strikes, the best thing we can do first for our body is to rest. This means allowing yourself to take a day or two off of work. It is the very message the cold is trying to send us - take a break. Rest helps our bodies do what they does best, offering a most efficient and quick recovery.

Next, hydrate your body with water. Well lubricated tissues are less likely to be attacked by viruses and water helps to cleanse, as well as optimize all functions.

Finally, 'nutrate' your body by ingesting lots of high quality nutrition. This is the time to avoid all processed, junk and fast food completely, and instead take in pure nutrient-dense foods from whole, natural, plant foods. Boosting nutrient levels with supplements such as vitamins C and D and zinc is also beneficial.