Steroid complications

Displacement of an allylic halide is complicated by side reactions involving migration of the double bond. A good example is the reaction of 7a-bromo-3 -acetoxy-A -steroids (201) which gives, besides the expected... 

When in the late 1940 s the remarkable therapeutic effects of the glucocorticoids cortisone and hydrocortisone were discovered, new raw materials had to be developed to produce these complicated molecules, and new synthetic methods devised to convert either a 20-ketopregnane or 21-acetoxy-20-ketopregnane to the dihydroxyacetone side-chain characteristic of these corticoids. This latter challenge produced some extremely useful new organic chemical reactions, many of which have wider application outside of steroids. 

Halogenation of steroid 3-ketones can lead to complicated mixtures by virtue of the fact that the kinetic enol leads to 3 halo products, whereas the thermodynamic product is that halogenated at the 4 position. Carefully controlled reaction of the 5a-androstanolone with chlorine thus leads to the 2a-chloro derivative (29). Reaction of that intermediate with O(p-nitrophenyl)-hydroxylamine affords the androgenic agent ni stremine acetate (30). ... 

Polycyclic compounds are common in nature, and many valuable substances have fused-ring structures. For example, steroids, such as the male hormone testosterone, have 3 six-membered rings and 1 five-membered ring fused together. Although steroids look complicated compared with cyclohexane or decalin, the same principles that apply to the conformational analysis of simple cyclohexane lings apply equally well (and often better) to steroids. 

Corticosteroids a chronic painless myopathy associated with the long-term use of corticosteroids is a particularly common example of drug-induced muscle disorder. It is almost certain that mild cases are overlooked because steroids are so frequently used to treat inflammatory myopathies such as polymyositis. Fluorinated steroids are particularly frequently implicated, and the incidence of drug-induced muscle disease is dose and time-related. The presence of muscle weakness can even complicate topical steroid therapy. Corticosteroid-induced myopathy is mediated via intramuscular cytosolic steroid receptors. The steroid-receptor complexes inhibit protein synthesis and interfere with oxidative phosphorylation. The myopathy is associated with vacuolar changes in muscle, and the accumulation of cytoplasmic glycogen and mitochondrial aggregations. 

The steric bulk of steroid structures prevents their use as the only organic side group present. However, mixed-substituent polymers that contain both steroidal side groups and amino acid ester or other cosubstituent units can be readily synthesized. If a saturated A ring is present in the steroid, linkage to the polymer chain is complicated by side reactions that result from dehydration of the steroid (chlorophosphazenes are powerful dehydrating agents). 

Mononeuropathy multiplex (MM) is an infrequent complication that can occur in early HIV infection, because of dysimmune or vasculitic mechanisms (Gherardi et al. 1989 Chamonard et al. 1993 Bradley and Verma 1996 Schifitto et al. 1997 Mahadevan et al. 2001). Seroconversion-related MM has been described in a case report (Sngimoto et al. 2006). Most of these patients have a good prognosis as symptoms resolve spontaneously and treatment may not be necessary. In others, treatment has focused on intravenous immunoglobulin, judicious short-term use of steroids, and a combination of zidovudine and plasmapheresis (Chamouard et al. 1993 Cohen et al. 1993 Bradley and Verma 1996 Schifitto et al. 1997). 

Megraud F, Lamouliatte H. The treatment of refractory Helicobacter pylori infection. Aliment Pharmacol Ther 2003 17 1333-1343. Silverstein FE, Graham DY, Senior IR, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving non-steroidal anti-inflammatory drugs a randomized, double-blind, placebo-controlled trial. Ann Intern Med 1995 123 241-249. 

Peripheral neuropathy is the most common complication reported in type 2 DM. This complication generally presents as pain, tingling, or numbness in the extremities. The feet are affected more often than the hands and fingers. A number of treatment options have been tried with mixed success. Current options include pregabalin, gabapentin, low-dose tricyclic antidepressants, duloxetine, venlafaxine, topiramate, non-steroidal anti-inflammatory drugs, and topical capsaicin. 

If patients have a severe subepithelial infiltration, a topical steroid may be required. However, topical steroids may cause serious ocular complications and may worsen herpetic conjunctivitis, which has symptoms similar to viral conjunctivitis. Additionally, the period of virus shedding may be prolonged by up to 50% by topical prednisolone. Only ophthalmologists should prescribe topical steroids.10... 

Campath) hypotension prolonged immunosuppression (resulting in infectious complications) during treatment. Premedicate with acetaminophen, diphenhydramine, with or without a steroid to alleviate infusion-related reactions. Subcutaneous dosing may lessen acute toxicity. Initially 3 mg/day as a 2-hour infusion, increase to 1 0 mg/day, then 30 mg/day as tolerated. 

Antibodies have and likely will find additional use in transplantation-related medicine. In general, cell-mediated immunological mechanisms are responsible for mediating rejection of transplanted organs. In many instances, transplant patients must be maintained on immunosuppressive drugs (e.g. some steroids and, often, the fungal metabolite cyclosporine). However, complications may arise if a rejection episode is encountered that proves unresponsive to standard immunosuppressive therapy. Orthoclone OKT-3 was the first monoclonal antibody-based product to find application in this regard. 

The use of glucocorticoids for tuberculous meningitis remains controversial. The administration of steroids such as oral prednisone, 60 to 80 mg/ day (1 to 2 mg/kg/day in children), or 0.2 mg/kg/day of IV dexametha-sone, tapered over 4 to 8 weeks, improves neurologic sequelae and survival in adults and decrease mortality, long-term neurologic complications, and permanent sequelae in children. 

The analysis of steroid sexual hormones and related synthetic compounds in WW, soil, sludge, and sediment samples is a challenging task. This is due to both the complex environmental matrices and the requirement of low detection limits. Therefore, the use of complicated, time- and labor-consuming analytical procedures is necessary. 

Ocular complications following local or systemic administration of steroids include glaucoma, cataracts, adverse influence on specific ocular infections, pseudotumor cerebri, ptosis, mydriasis, subjective visual complaints, visual field defects, systemic absorption of the topical medication, conjunctival and palpebral petechiae, epithelial punctate keratitis, and, possibly, corneal and scleromalacia. ... 

A variety of endogenous and synthetic steroids have now been demonstrated to alter neuronal activity. Paul and Purdy (1992) proposed that this group of neurosteroids be named neuroactive steroids, a nomenclature defining their activity. Further complicating this terminology, some authors more generally define neurosteroids both as neuroactive compounds produced de novo in the nervous system and as those steroids derived from circulating precursors, which are metabolized to neuroactive compounds in the nervous system. 

Nitrophenyl)ethylene glycol was used to protect simple aldehydes and ketones, as well as some steroids. Acetals were prepared under acid catalysis, leading, in the case of chiral carbonyl compounds to diaste-reoisomers. The photochemical removal of the protecting group was in several instances complicated by the instability of some carbonyl derivatives to irradiation at 350 nm otherwise, yields were in the range of 83-90% (see Scheme 19). 

Here is a bit of a complication there is a lot of individual variation in the sense of human olfaction. Not everything smells the same to everyone. This holds both for the intensity of the perceived smeU as well as for its quality pleasant, floral, skunky, sweaty, or no odor at all. Andreas Keller has recently demonstrated that some significant part of this individual variation in the sense of smell derives from genetic variation in human odorant genes. Specifically, two single nucleotide polymorphisms (SNPs), leading to two amino acid substitutions in an odorant receptor, have dramatic affects on the perception of the odor of androstenone, a steroid derived from testosterone. 

Mesangiocapillary glomerulonephritis can occur as a complication of many diseases, such as SEE or as a primary disease. Treatment of the primary disease with steroids, immunosuppres-sives and antiplatelet agents have been attempted with unimpressive results. 

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