madman
Super Moderator
ABSTRACT
Introduction: The hyper-catabolic state is a devastating pathophysiological response to severe injury, infection, or burns. Nandrolone decanoate (ND) is a potent anabolic steroid that has many clinical indications, but has not been investigated in burn injuries yet.
Patients and methods: A prospective randomized control study included 40 burned patients who were treated in the Burn unit from burn injuries ranged from 20 to 40%. Both groups are objectively assessed, clinically and laboratory during the treatment period till full recovery from burns’ injury. Recall assessment of the drug safety after many years is achieved.
Results: ND showed highly significant results supporting its use in combating catabolic insults in burns patients. Both clinical findings and laboratory findings are correlated and highly support the use of ND in burns as a new effective and safe long-lasting indication.
Conclusion: This study results showed preservation of lean body mass and protein partition, as well as the near-normal nitrogen balance in burn patients. The study proposes that nandrolone decanoate could be used in a safe and effective way to combat hypercatabolic impact in burn injury.
1. Introduction
Severe burn injury is usually followed by a profound hypermetabolic response which persists after injury up to 24 months. Burn patient experiences an ebb phase immediately after injury then passes through the flow phase. The Ebb phase lasts two to three days and decreases the metabolic rate and the cardiac output then the flow phase starts.
The “flow” phase is of a hyper-metabolic response due to the released hormones of stress; catecholamine, cortisol and glucagon [1].
The hyper-metabolic response is characterized by hyper-dynamic circulation with an increase in body temperature, oxygen and glucose consumption, CO2 production, glycogenolysis, proteolysis, and lipolysis. The response begins on the 5th-day post-injury and continues up to 9 months to one year. It causes erosion of lean body mass, muscle weakness, immuno-depression, poor wound healing, and major tissue breakdown. Inevitable gluconeogenesis results in nitrogen loss and lethal depletion of essential protein stores [2].
Hence methods to achieve normal nitrogen balance in severely burnt patients are required, because of an inevitable muscle breakdown and loss of lean body mass in spite of the nutritional support [3].
This fact led to the investigation of many non-pharmacological supports and pharmacological approaches to modulate the metabolic response [4].
Among used strategies is the use of hormonal therapy and anabolic steroids in order to achieve positive nitrogen balance. The growth hormone has a potent anabolic effect and improves wound healing, nitrogen balance, and decreases weight loss in hyper-metabolic patients suffering burns injury [5]. However, growth hormone is so expensive and has an aggressive diabetogenic effect, antibody reaction and might be associated with increased incidence of leukemia or other morbidities [5].
*Anabolic steroid hormones (ASHs) are used in major trauma and immunocompromised patients to stimulate appetite, increase muscle anabolism, protein synthesis and production of growth hormone and insulin-like growth factor [6]. They also enhance the immune system by triggering macrophages’ activity and cell-mediated immunity. They could improve the overall sense of wellbeing and eliminate the sense of fatigue [7].
The anabolic effect of steroid hormones is attributed to the process of re-uptake of the intracellular amino acid. ASH is converted by the enzyme 5a - reductase to 5a - dihydrotestosterone. Dihyderotestosterone binds to cytosol androgen receptors, initiating series of events leading to growth, differentiation, and synthesis of a variety of enzymes and other functional proteins [8].
Oxandrolone [9] is an oral anabolic steroid that showed a beneficial effect in combating muscle protein catabolism in burns, cachectic, critically injured adults, and children patients. However, oxandrolone is not widely available in many countries but nandrolone decanoate (ND) is widely available injections and used for variable indications [6,7,9].
Nandrolone decanoate (ND) is proved and used as a potent available anabolic steroid with minimal androgenic side effects. It is already used after major surgery and severe trauma but not yet investigated in burn injury.
Sincetheuseofthe growth hormone and oxandrolone are not applicable in many situations and countries, this study investigates the use of nandrolone decanoate (ND) in burn patients.
2. Pharmacological drug description
Nandrolone decanoate (ND) is an injectable anabolic preparation of testosterone analog. The pharmacologically active substance is nandrolone. The decanoate ester gives a three-week duration of action with 6 days half-life [10,11].
It affects the androgen receptors of the muscular tissue superior to testosterone as it binds better [10].
The liver is the pathway for the degradation of ND, where itis converted into inactive androsterone and etiocholanolone then both are conjugated then excreted into the urine [12,13] (Fig. 1).
7. Conclusion
Previous clinical studies have shown ND has been effective in treating many medical diseases. But this study proposes that nandrolone decanoate can be used with safety and efficacy to combat hyper-catabolic impact in burn injury.
Introduction: The hyper-catabolic state is a devastating pathophysiological response to severe injury, infection, or burns. Nandrolone decanoate (ND) is a potent anabolic steroid that has many clinical indications, but has not been investigated in burn injuries yet.
Patients and methods: A prospective randomized control study included 40 burned patients who were treated in the Burn unit from burn injuries ranged from 20 to 40%. Both groups are objectively assessed, clinically and laboratory during the treatment period till full recovery from burns’ injury. Recall assessment of the drug safety after many years is achieved.
Results: ND showed highly significant results supporting its use in combating catabolic insults in burns patients. Both clinical findings and laboratory findings are correlated and highly support the use of ND in burns as a new effective and safe long-lasting indication.
Conclusion: This study results showed preservation of lean body mass and protein partition, as well as the near-normal nitrogen balance in burn patients. The study proposes that nandrolone decanoate could be used in a safe and effective way to combat hypercatabolic impact in burn injury.
1. Introduction
Severe burn injury is usually followed by a profound hypermetabolic response which persists after injury up to 24 months. Burn patient experiences an ebb phase immediately after injury then passes through the flow phase. The Ebb phase lasts two to three days and decreases the metabolic rate and the cardiac output then the flow phase starts.
The “flow” phase is of a hyper-metabolic response due to the released hormones of stress; catecholamine, cortisol and glucagon [1].
The hyper-metabolic response is characterized by hyper-dynamic circulation with an increase in body temperature, oxygen and glucose consumption, CO2 production, glycogenolysis, proteolysis, and lipolysis. The response begins on the 5th-day post-injury and continues up to 9 months to one year. It causes erosion of lean body mass, muscle weakness, immuno-depression, poor wound healing, and major tissue breakdown. Inevitable gluconeogenesis results in nitrogen loss and lethal depletion of essential protein stores [2].
Hence methods to achieve normal nitrogen balance in severely burnt patients are required, because of an inevitable muscle breakdown and loss of lean body mass in spite of the nutritional support [3].
This fact led to the investigation of many non-pharmacological supports and pharmacological approaches to modulate the metabolic response [4].
Among used strategies is the use of hormonal therapy and anabolic steroids in order to achieve positive nitrogen balance. The growth hormone has a potent anabolic effect and improves wound healing, nitrogen balance, and decreases weight loss in hyper-metabolic patients suffering burns injury [5]. However, growth hormone is so expensive and has an aggressive diabetogenic effect, antibody reaction and might be associated with increased incidence of leukemia or other morbidities [5].
*Anabolic steroid hormones (ASHs) are used in major trauma and immunocompromised patients to stimulate appetite, increase muscle anabolism, protein synthesis and production of growth hormone and insulin-like growth factor [6]. They also enhance the immune system by triggering macrophages’ activity and cell-mediated immunity. They could improve the overall sense of wellbeing and eliminate the sense of fatigue [7].
The anabolic effect of steroid hormones is attributed to the process of re-uptake of the intracellular amino acid. ASH is converted by the enzyme 5a - reductase to 5a - dihydrotestosterone. Dihyderotestosterone binds to cytosol androgen receptors, initiating series of events leading to growth, differentiation, and synthesis of a variety of enzymes and other functional proteins [8].
Oxandrolone [9] is an oral anabolic steroid that showed a beneficial effect in combating muscle protein catabolism in burns, cachectic, critically injured adults, and children patients. However, oxandrolone is not widely available in many countries but nandrolone decanoate (ND) is widely available injections and used for variable indications [6,7,9].
Nandrolone decanoate (ND) is proved and used as a potent available anabolic steroid with minimal androgenic side effects. It is already used after major surgery and severe trauma but not yet investigated in burn injury.
Sincetheuseofthe growth hormone and oxandrolone are not applicable in many situations and countries, this study investigates the use of nandrolone decanoate (ND) in burn patients.
2. Pharmacological drug description
Nandrolone decanoate (ND) is an injectable anabolic preparation of testosterone analog. The pharmacologically active substance is nandrolone. The decanoate ester gives a three-week duration of action with 6 days half-life [10,11].
It affects the androgen receptors of the muscular tissue superior to testosterone as it binds better [10].
The liver is the pathway for the degradation of ND, where itis converted into inactive androsterone and etiocholanolone then both are conjugated then excreted into the urine [12,13] (Fig. 1).
7. Conclusion
Previous clinical studies have shown ND has been effective in treating many medical diseases. But this study proposes that nandrolone decanoate can be used with safety and efficacy to combat hyper-catabolic impact in burn injury.
