Higher Steroid Hormone Levels in Pregnancy Can Cause Autism in Children

Researchers exploring the causes of autism have linked higher levels of steroid hormones in the womb during early fetal development to autism spectrum disorder.

These hormones, which play a key phase in brain development at three to four months of pregnancy, may also explain why the condition is far more common among males than females, they said.

But it was too early to say whether higher hormone levels were a cause of autism, the team wrote, and cautioned against hormone screening or treatment based on their preliminary findings.

Scientists at the University of Cambridge in Britain and Denmark's Statens Serum Institute analyzed hormone levels among nearly 20,000 stored samples of amniotic fluid, which surrounds the fetus in the uterus.

The team measured levels of four "sex" steroid hormones -- testosterone, progesterone, 17-alpha-hydroxy-progesterone and androstenedione -- which are known to play a role in brain development.

They also looked at a fifth hormone, cortisol, which is a marker of stress.

The researchers found higher hormone levels in the amniotic fluid in 128 males who were later diagnosed with autism spectrum disorder.

All autistic subgroups were found to have the signature: Asperger syndrome, classic autism or a category called unspecified pervasive developmental disorder.

"This is one of the earliest non-genetic biomarkers that has been identified in children who go on to develop autism," said Simon Baron-Cohen, a University of Cambridge professor.

"We previously knew that elevated prenatal testosterone is associated with slower social and language development, better attention to detail and more autistic traits.

"Now, for the first time, we have also shown that these steroid hormones are elevated in children clinically diagnosed with autism. Because some of these hormones are produced in much higher quantities in males than in females, this may help us explain why autism is more common in males."

It was not known what causes the higher steroid levels in the first place, and the team cautioned against using the findings as a tool to screen for autism.

Nor should drugs be used to block steroid hormones.

"This could have unwanted side effects and may have little to no effect," said Baron-Cohen.

Only males were tested in the first phase of research. The next step will be to see if a similar telltale exists for females.

"Steroid hormones are particularly important because they exert influence on the process of how instructions in the genetic code are translated into building proteins," co-researcher Craig Brierley said in an email exchange with AFP.

The study appeared in the journal Molecular Psychiatry.

The cause of autism, a complex neurodevelopmental disorder characterized by social withdrawal, is considered to be roughly split between genetic and environmental factors, according to a study last month in the Journal of the American Medical Association (JAMA).

Steroids Ineffective and Possibly Harmful in Pediatric Liver Disease

Treating infants with high doses of steroids fails to improve medical outcomes in the end-stage pediatric liver disease biliary atresia and leads to earlier onset of serious adverse events, says a new study.

Researchers say the clinical trial involving 14 sites provides new evidence on a growing controversy in the medical community - whether treating infants with steroids to augment surgery improves outcomes.

The results from this clinical trial differ from previous reports of a benefit from steroid therapy on bile drainage or survival in biliary atresia. Although it cannot be excluded some small potential benefit from steroid treatment, observed no statistical differences in two-year survival between patients receiving steroid treatment after surgery and those receiving placebo. Children receiving steroids during the study also developed serious adverse events more quickly, raising a potential increase in risks associated with steroid therapy.

Biliary atresia is the leading cause of pediatric liver transplantation in the world. The disease accounts for about 50 percent of transplants in children and 10 percent of transplants at any age. It results from inflammation and rapid accumulation of connective tissues that obstruct and restrict bile ducts from draining. The condition then manifests as cholestatic jaundice in the first few weeks after birth.

At diagnosis, the primary treatment is the hepatoportoenterostomy (HPE, the Kasai procedure) - a surgical procedure that removes the diseased bile ducts and gallbladder and connects an intestinal loop directly to the liver to restore bile drainage. Study authors point out that some clinicians suggest steroid treatment after surgery may help prevent additional fibrosis and improve bile drainage. The current study - called START (Steroids in Biliary Atresia Randomized Trial) - was designed to provide rigorous medical data to help answer that question.

The study involved 140 infants with a median age of 2.3 months. The initial study was conducted between September 2005 and February 2011, with follow up ending in January 2013.

Researchers report that in 70 children treated with steroids, bile drainage was not significantly different six months post-surgery compared to 70 children who received placebo after surgery. Of the 70 who received steroids, 41 of 70 patients (58.6 percent) had improved bile drainage. Of 70 patients who did not receive steroids, 34 of 70 (48.6 percent) had improved bile drainage.

When researchers compared survival rates between the steroid/non-steroid groups at age 24 months, 58.7 percent of children in the steroid group survived compared to 59.4 percent in the placebo group.

The percent of children who experienced serious safety events was relatively the same between the steroid group (81.4 percent) and non-steroid group (80 percent), but children who received steroids had an earlier time to onset for those events. Serious safety events occurred with 30 days post-surgery in 37.2 percent of children who received steroid treatment, versus 19 percent in the placebo group.

Potential serious safety events the authors pointed to included complications such as immunosuppression, associated risk of infection, poor wound healing, hyperglycemia, gastrointestinal bleeding, poor growth, and inadequate response to routine immunizations.

The Use of Human Growth Hormone in the treatment of HIV / AIDS

HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immune deficiency syndrome). The HIV retrovirus may be passed from one person to another when infected blood, semen, vaginal secretions or other bodily fluids come in contact with an uninfected person's broken skin or mucous membranes. People with HIV have what is called HIV infection and are fit and well. Some of these people will develop AIDS as a result of their HIV infection.

Growth hormone is a popular bodybuilding and performance enhancing aid, and the use of recombinant human growth hormone (rHGH, or simply GH) to treat various conditions in HIV infection has been debated with excitement for years. Indeed it is licensed for the treatment of wasting syndrome in advanced stages of AIDS. GH is also a commonly used bodybuilding and performance enhancing drug, which can be purchased on the black market; used to help both muscle anabolism / strength and reduction in body fat levels. Both of these applications have possible significance in the treatment of HIV.

Other than in the treatment of wasting disease, results from the studies using rHGH to treat body changes associated with HIV and/or drugs used to treat HIV have been very favourable. One which has been studied extensively is the use of rHGH in reducing HIV-associated adipose redistribution syndrome (HARS). However, the positive effects of HGH treatment in HIV may be more direct. Several studies have proposed that rHGH may bolster the immune system in ways that might improve clinical outcomes in HIV.

Let's look at each of the possible treatment benefits of rHGH in HIV in turn:

HIV-associated adipose redistribution syndrome (HARS)
HARS is a type of lipodystrophy (abnormal distribution of body fat), where there is accumulation of excess truncal fat and visceral adipose tissue, as opposed to regular gynoid (glutes and hips) or android (abdomen) deposition. This is observed in HIV infected people, moreso as virus load increases. Although not a debilitating condition in itself (indeed extra body fat can prolong life if followed by wasting), HARS is unpleasant for the individual, giving reduced confidence in body image; another negative aspect of the disease.

rHGH therapy has been shown to significantly reduce HARS, leading to an improved body image, and significant improvement in psychological well-being. Numerous studies have demonstrated the benefits of this, leading to rHGH being licesenced for the treatment of HARS in some countries. It should also be noted that improvement in psychological well-being could also contribute to a positive clinical outcome, in that it reduces the effects of wasting.

Acute Infections
HIV patients are often more prone to acute infections which may take longer to clear up than in non-HIV individuals. Sometimes these can be associated with poor appetite and weight loss. rHGH therapy may curb rapid weight loss often associated with acute infections in HIV positive people and may also reduce length of infection. Far more research is needed here though.

Fasting lipid profile
HIV patients have been shown to have elevated serum lipids, and dyslipidaemia, i.e. high LDL (bad) cholesterol and low HDL (good) cholesterol with raised total cholesterol and triglycerides. This is associated with anti-HIV drug treatment especially later on in infection. This does increase risk of cardiovascular diseases, and rHGH treatment may improve lipid profiles.

Bone Building
HIV patients may have loss of bone density associated with wasting. Both treatment with rHGH and growth hormone releasing factor (GHRF) have indicated improved bone mass in HIV patients (Koutkia et al 2005).

Side effects of rHGH treatment
Although we have focused on the promising benefits for rHGH treatment in HIV infection, consideration of possible side effects is important in ensuring an informed decision can be made. Side effects of rHGH therapy include possible joint pain (arthralgia), abnormal growth of the body's extremities and impaired glucose intolerance, increasing the risk of type 2 diabetes.

Caution is also advised against using over-the-counter or faddy internet products that claim to contain human growth hormone. Some of them claim to contain plant-derived growth hormone, others claim to contain cow or goat growth hormone, and still others claim to contain substances that increase the body's production of GH. There is no evidence that any of these products contain either a relevant product or a dose needed to induce the types of effects seen in studies. Over-the-counter and internet sales of these 'growth hormone' products are a major source of health fraud.

Certainly rHGH has shown benefits in treating wasting syndrome in advanced stages of HIV disease or AIDS, and its approval as a treatment for body lipodystrophy is encouraging. However, it's important that larger studies confirm these early findings. They can tell us whether or not increases in thymus size and CD4+ cell numbers, associated with rHGH use, ultimately benefit people living with HIV and result in better quality of life and longer life. Treatment with GH in HIV is encouraging and exciting, but far more research is still required.

How to Protect the Liver During Anabolic Steroid Use

Liver harm from anabolic steroids comes principally or entirely from alkylated anabolic steroids. Where the steroids are non-alkylated and estradiol levels remain normal, there’s almost never harm to the liver from steroid use.

Example non-alkylated steroids are testosterone, Masteron, trenbolone, boldenone (Equipoise), nandrolone (Deca Durabolin), and Primobolan.

Keeping liver safety in mind, an effective cycle should have one or more of these steroids as the base, or even as the entirety of the cycle.

About 350-700 mg/week of a steroid stack, though, may be an alkylated compound. The most common alkylated steroids are Dianabol, Anadrol, oxandrolone (Anavar), and Winstrol.

Alkylated steroid use is preferably limited to only six weeks at a time, though of course many who go longer don’t suffer lasting harm. However, sustained use of oral anabolic steroids absolutely can cause undetected formation of scar tissue in the liver. This effect can be cumulative, as the scar tissue does not heal. And thoroughly excellent gains can be achieved without “pushing” the 6-week rule.

If cycle length is greater than 6 weeks, then appropriate amounts of testosterone can substitute for the orals. I replace Anadrol or Winstrol with testosterone on a milligram for milligram basis. I replace Dianabol on a three-to-two basis, or in other words, 50 mg/day Dianabol is replaced by about 75 mg/day of testosterone.

Oxandrolone, on the other hand, is replaced with Masteron on a three-to-two basis, or trenbolone on a two-to-three basis.

Each period of alkylated steroid use should be followed by about twice as much time not using alkylated steroids, or longer.

Estradiol preferably will be kept in the normal range, or not much above it, as elevated estradiol is slightly liver toxic. In and of itself estradiol toxicity is not greatly important, but in combination with alkylated steroid use, it adds to the toxicity.

Obviously hepatotoxic drugs and excessive alcohol use should be avoided, as should heavy use of NSAID’s, aspirin, or acetaminophen. Cautious use is fine.

In terms of supplementation for liver health, lecithin may be taken in amounts such as 3-7 g/day together with B vitamins. With regard to milk thistle, steroid-induced cholestasis results from reduced activity of the bile salt export pump, and silymarin and silibinin (components of milk thistle) act at this point and can partially block the adverse effects of steroids. However, cheap milk thistle products don’t provide much of these substances.

Liver protection supplementation may safely be omitted when the above principles are followed. Supplementation shouldn’t be a license to use alkylated steroids less carefully.

Steroids and Cancer Treatments

When you hear the word steroid you may think of "roid rage" and muscle-bound gym rats with shrunken testicles. But if your doctor prescribed steroids as part of your treatment for cancer or another serious illness, don't worry. It's not "that" kind of steroid.
Your doctor is actually talking about cortisol, a form of steroid that your body produces naturally. It's different from anabolic steroids, which are the illegal muscle-building kind.

How Steroids Help

Although the cortisol-type steroids prescribed for cancer treatment are different from anabolic steroids, you still need to take them under the close supervision of your doctor or medical specialist.
You'll probably get a manmade version of the natural steroid cortisol, such as:

• cortisone
• hydrocortisone
• prednisone
• methylprednisolone
• dexamethasone

These can help with your treatment in a variety of ways:

• reduce nausea associated with chemotherapy and radiation
• kill cancer cells and shrink tumors as part of chemotherapy
• decrease swelling
• reduce allergic reactions (before transfusions, for example)
• lessen headaches caused by brain tumors

Sometimes, your doctor will recommend steroid treatments just to help you sleep, eat, and feel better.
Doctors can prescribe steroids for cancer treatment several ways:

• by injection
• through an intravenous (IV) drip
• in liquid or pill form
• as a cream

Steroids used in medical treatments can have some side effects, although they're not as extreme as the side effects from anabolic steroids. Talk to your doctor and ask questions if you're worried.
You may not have any side effects. But if you do, don't worry — they'll only last as long as you're taking the steroids. When you stop your treatment, things will return to normal.
Some of the more common side effects of steroid treatments include:

• increased appetite
• weight gain, often in unfamiliar places, like your cheeks or the back of your neck
• mood swings
• stomach upset or ulcers
• osteoporosis (weaker bones)
• vision problems
• higher blood pressure
• increased blood sugar. Sometimes, people develop diabetes temporarily. If you already have diabetes, you'll need to monitor your blood sugar levels more closely.
• for girls, irregular menstruation (missed or late periods)

Less common side effects include bruising more easily, difficulty fighting infections, acne flare-ups, and increased facial hair.
If you develop several of these symptoms, you have a condition called Cushing syndrome. Sometimes it gets better if you make changes in the way you take the steroids. If you're having problems with these side effects, talk to your doctor.
Remember, you may not have any side effects. If you do, you'll probably find that they're overshadowed by the benefits of the treatment. But check with your doctor about ways to make them easier to live with.

How Excess Weight Affects Your Health

If you’re carrying many extra pounds, you face a higher-than-average risk of a whopping 50 different health problems. These health conditions include the nation’s leading causes of death—heart disease, stroke, diabetes, and certain cancers—as well as less common ailments such as gout and gallstones. Perhaps even more compelling is the strong link between excess weight and depression, because this common mood disorder can have a profound, negative impact on your daily life.

A Harvard study that combined data from more than 50,000 men (participants in the Health Professionals Follow-up Study) and more than 120,000 women (from the Nurses’ Health Study) revealed some sobering statistics about weight and health.

The volunteers provided their height and weight, as well as details on their diets, health habits, and medical histories. Researchers tracked the volunteers over more than 10 years. They noted the occurrence of illnesses and compared those developments with each subject’s body mass index (BMI)—an estimate of an individual’s relative body fat calculated from his or her height and weight).

Obesity increased the risk of diabetes 20 times and substantially boosted the risk of developing high blood pressure, heart disease, stroke, and gallstones. Among people who were overweight or obese, there was a direct relationship between BMI and risk: the higher the BMI, the higher the likelihood of disease.

Weight and depression

Do people gain weight because they’re depressed, or do they become depressed because they’re overweight? A review of 15 studies found evidence that both scenarios are likely true. The study, published in 2010 in the Archives of General Psychiatry, found that obese people have a 55% higher risk of developing depression over time compared with people of normal weight. Here are some reasons why obesity may increase risk of depression:

    Both conditions appear to stem (at least in part) from alterations in brain chemistry and function in response to stress.
    Psychological factors are also plausible. In our culture, thin equals beautiful, and being overweight can lower self-esteem, a known trigger for depression.
    Odd eating patterns and eating disorders, as well as the physical discomfort of being obese, are known to foster depression.

The study also found that depressed people have a 58% higher risk of becoming obese. Here are some reasons why depression may lead to obesity:

    Elevated levels of the stress hormone cortisol (common in people with depression) may alter substances in fat cells that make fat accumulation, especially in the belly, more likely, according to one theory.
    People who feel depressed often feel too blue to eat properly and exercise regularly, making them more prone to gain weight.
    Some medications used to treat depression cause weight gain.


Weight, heart disease, and stroke

Some of the most common problems seen in people who carry excess weight, such as high blood pressure and unhealthy levels of cholesterol and other fats in the blood, tend to occur together. Both can lead to concurrent health problems—namely, heart disease and stroke.

High blood pressure is about six times more common in people who are obese than in those who are lean. According to the American Heart Association, 22 pounds of excess weight boosts systolic blood pressure (the first number in a reading) by an average of 3 millimeters of mercury (mm Hg) and diastolic blood pressure (the second number) by an average of 2.3 mm Hg, which translates to a 24% increase in stroke risk.

A 2007 study in Archives of Internal Medicine examined the connection between weight and heart disease by pooling results from 21 different studies involving more than 300,000 people. The study found:

    Being overweight boosted the risk of heart disease by 32%
    Obesity increased the risk by 81%

Although the adverse effects of overweight on blood pressure and cholesterol levels could account for 45% of the increased heart disease risk, even modest amounts of excess weight can increase the odds of heart disease independent of those well-known risks, the authors concluded.

Compared with people of normal weight, overweight people face a 22% higher risk of stroke. For those who are obese, the increased risk rises to 64%, according to a 2010 report in the journal Stroke, which pooled results from 25 studies involving more than two million people.

Weight and diabetes

Overweight and obesity are so closely linked to diabetes, experts have coined the term “diabesity” to describe the phenomenon. About 90% of people with type 2 diabetes (the most common form of the disease) are overweight or obese. The incidence of diabetes rose dramatically—by nearly 65%—from 1996 to 2006.

A high blood sugar level, the hallmark of diabetes, is one of the features of metabolic syndrome. If untreated or poorly controlled, diabetes can lead to a number of grave health problems, including kidney failure, blindness, and foot or leg amputations. Diabetes is currently the seventh leading cause of death in the United States.


Weight and cancer

Some experts believe that obesity ranks as the second leading cause of cancer death, after cigarette smoking.

A study by the American Cancer Society, published in The New England Journal of Medicine, followed more than 900,000 people for 16 years. The study showed a link between excess body weight and many different cancers. Some of the findings:

    Among people ages 50 and older, overweight and obesity may account for 14% of all cancer deaths in men and 20% of all cancer deaths in women.
    In both men and women, higher BMIs were associated with a higher risk of dying from cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, or kidney.
    In men, excess weight also increased the risk of dying from stomach or prostate cancer.
    In women, deaths from cancer of the breast, uterus, cervix, or ovary were elevated in women with higher BMIs.

A 2008 review article in The Lancet reached similar conclusions. Part of the problem may lie in the fact that people who are very overweight are less likely to have cancer screening tests such as Pap smears and mammograms.

A report in The International Journal of Obesity showed that the larger the woman, the more likely she was to delay getting a pelvic exam, largely because of negative experiences with doctors and their office staff. In men, screening tests such as prostate exams may be physically difficult if people are very overweight, particularly if they tend to store fat in their hips, buttocks, or thighs.

Weight and lifespan

Being overweight or obese can make just getting around a challenge. Compared with people at a healthy weight, those carrying extra pounds have a harder time walking a quarter-mile, lifting 10 pounds, and rising from an armless chair. The burden of these problems appears to be greater than in years past, probably because people are now obese for a greater portion of their lives, experts speculate.

And because excess weight plays a role in so many common and deadly diseases, overweight and obesity can cut years off your life. A New England Journal of Medicine study that followed more than half a million 50- to 71-year-olds for a decade found an increase of 20% to 40% in death rates among people who were overweight at midlife. Among obese people, the death rate was two to three times as high.

A 2010 study in the same journal, which pooled findings from 19 studies that followed nearly 1.5 million white adults 19 to 84 years old for a similar period of time, found that the risk of death increased along with body size, ranging from 44% higher for those who were mildly obese to 250% higher for those with a BMI of 40 to 50.

Procedures for Determining the Level of Utilization of Health Personnel and Healthcare.

In determining the level of utilization of health personnel and health care, resource planning, allocation and the evaluation of the appropriateness, medical needs and efficiency of health care service and procedures must be carefully analysed. Such analysis is of very important for health care institutions to ensure effective and

efficient patient care delivery.

Today, patient medical records include a large number of entries related to patient conditions along with treatments and procedures received. Utilization analysis based on such observational data collected through normal course of care delivery and carried out in a systematic manner can be leveraged to improve care delivery in many ways.

Two areas in particular have attracted significant attention recently. The first is the notion of hot spotting, which is the ability to identity in a timely manner patients who are heavy users of the system and their patterns of use, so that targeted intense intervention and follow up programs can be put in place to address their needs and change the existing, potentially ineffective, utilization pattern. The second is anomaly detection, where the goal is to identify utilization patterns that are unusual given patients’ clinical characteristics, including both underutilization and overutilization. The former may indicate a gap in medical service that if left unaddressed could result in further deterioration of patient’s condition leading to situations requiring more costly and less effective interventions. The latter incurs unnecessary cost and waste of precious healthcare resources that could have been directed towards cases in real need.

Estimates have put the waste caused by overutilization at more than 30% of the total medical cost and this has been confirmed by real world medical management experiences.