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Tran Cao, Dat, Ha Do Thi, Anh Pham Quynh i Chang Pham Thi Huyen. "Safety injection practice of clinical nurses in Ho Chi Minh city institute of traditional medicine in 2020". Journal of Health and Development Studies 06, nr 03 (30.06.2022): 134–42. http://dx.doi.org/10.38148/jhds.0603skpt22-060.
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Injection is a common technique and has an essential role in prevention and treatment. Safety injection practice had been instructed by the Ministry of Health in 2012 in order to enhance injecting quality. This was a cross-sectional study, had been implemented aimed to describing safety injection practice of clinical nurses in Ho Chi Minh City Institute of Traditional Medicine in 2020. The study recruited 55 clinical nurses and was implemented from June to November 2020. 495 injections, including 275 intramuscular injections (5 per nurse) and 220 intravenous ones (4 per nurse), were observed. Results showed that the percentage of safety injections were 54.3% (56.4% were intramuscular injections and 51.8% were intravenous ones). In each stage of the injecting process, the percentage of safety injections were around 66.4% to 100%. Recommendations to increase training for nurses and to focus inspection and supervision on often overlooked operations at each step of the process. Keywords: Safety injection, Nurse, Clinical nurse, Hospital
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Dao Phuoc Minh, Hien, Thuong Huynh Van i Chi Nguyen Thai Quynh. "Tuân thủ quy trình tiêm tĩnh mạch an toàn của nữ hộ sinh tại Khoa Sản, Bệnh viện đa khoa tỉnh Khánh Hoà năm 2023". Journal of Health and Development Studies 08, nr 02 (29.04.2024): 18–26. http://dx.doi.org/10.38148/jhds.0802skpt23-081.
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The study was implemented to describe midwives' compliance to safe intravenous injection procedures at the Department of Obstetrics and Gynecology, Khanh Hoa General Hospital 2023. This was a cross-sectional study, applying quantitative methods, conducted from November 2022 to September 2023, using safe injection procedure of the Ministry of Health (20 steps divided into 3 phases: before injection, during injection, and afterward) to observe 210 intravenous injections implemented by 70 midwives. Results: The percentage of safe intravenous injections was quite low, only 45.2%; in which, the compliance rate at pre-injection phase ranged from 61.4 - 100%; the compliance rate at the injecting phase is quite high from 98.1 - 100%; in the last phase, post-injection, compliance rate ranged from 91.9 - 100%. Less than 50% of intravenous injections were assessed for compliance with safety procedures. The Nursing Department needs to strengthen inspection and supervision of compliance with safe intravenous injection procedures by midwives at the unit and advise the hospital Board of Directors to promulgate regulations on rewards and punishments in the unit. Practicing safe injections in hospitals. Keywords: Intravenous injection, midwife.
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Smith, Rebecca L., Simeon J. West i Jason Wilson. "Using the BBraun BSmartTM Pressure Manometer to Prevent Unsafe Injection Pressures During Simulated Peripheral Nerve Blockade: A Pilot Study". Open Anesthesiology Journal 15, nr 1 (31.12.2021): 49–58. http://dx.doi.org/10.2174/2589645802115010049.
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Background: Peripheral nerve injury during regional anaesthesia may result from accidental intraneural placement of the needle, or forceful needle nerve contact. Intraneural injections are associated with increased resistance to injection, typically >15 psi. The BBraun BSmart™ is an inline mechanical manometer, offering a visual display of injection pressures. Objective: The primary objective of this study was to determine if using the BBraun BSmartTM manometer successfully prevents 90% of anaesthetists and anaesthetic assistants from injecting at pressures > 15 psi during simulated nerve block. Methods: This was a prospective observational study involving anaesthetists and anaesthetic assistants. Two 20 ml injections were performed by each participant, once when the BBraun BSmartTM manometer was obscured from view, and once with the manometer visible. A PendoTech PressureMATTMS recorded injection pressures. Results: 39 participants completed the study, with a total of 78 injections recorded. During the study, 32 peak pressures during the 78 procedures were recorded above the recommended upper limit of 15 psi, 41% of the total injections. The peak pressure rose above 15 psi in 24/39 (62%) injections when the BBraun Bsmart™ manometer was obscured, but only in 8/39 (21%) injections when the manometer was visible. Conclusion: The BBraun Bsmart™ manometer did not successfully prevent 90% of anaesthetists or anaesthetic assistants from injecting at unsafe pressures. However, using the BBraun BSmart™ did reduce the number of unsafe injection pressures generated by participants. When utilised in conjunction with PNS and ultrasound guidance, this may offer additional safety during peripheral nerve blockade.
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Huang, Ko-Jung, Cheng-Han Li, Ping-Kun Tsai, Chia-Chun Lai, Yu-Ren Kuo, Ming-Kun Hsieh i Ching-Wei Cheng. "Electromagnetic Force-Driven Needle-Free in Ovo Injection Device". Veterinary Sciences 9, nr 3 (21.03.2022): 147. http://dx.doi.org/10.3390/vetsci9030147.
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Needle-free injections are mainly used for administering human or mammalian vaccines or drugs. However, poultry vaccines, in ovo injections to embryos, subcutaneous injections to chickens, and intramuscular injections are administered using needle injections. This article presents a new needle-free in ovo injection device method that uses push-pull solenoids to eject liquid jets, mainly for embryonic eggs of chickens. Furthermore, our study investigated the suitable jet pressures for using this method and the post-injection hatching rates in 18-day-old embryonic eggs. Using this method, we could deliver the liquid to the allantoic and amniotic cavities or the muscle tissue through the egg membrane of the air chamber using a jet pressure of ~6–7 MPa or ~8 MPa. After injecting 0.25 mL of 0.9% saline into 18-day-old Lohmann breed layer embryonic eggs and specific pathogen-free (SPF) embryonic eggs at a jet pressure of ~7 MPa, we observed hatching rates of 98.3% and 85.7%, respectively. This study’s electromagnetic needle-free in ovo injection device can apply vaccine or nutrient solution injection for embryo eggs and serve as a reference for future studies on needle-free in ovo injection automation systems, jet pressure control, and injection pretreatment processes.
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Gundle, Kenneth R., Etasha M. Bhatt, Stephanie E. Punt, Viviana Bompadre i Ernest U. Conrad. "Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort". Open Orthopaedics Journal 11, nr 1 (31.05.2017): 486–92. http://dx.doi.org/10.2174/1874325001711010486.
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Background:Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC.Methods:Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center.Results:The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute.Conclusion:A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments.Level of Evidence:Level IV retrospective cohort study.
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Tsai, Yueh-Hsun, Guo-Shu Huang, Chi-Tun Tang, Fu-Chi Yang i Yi-Chih Hsu. "The Role of Power Doppler Ultrasonography in Caudal Epidural Injection". Medicina 58, nr 5 (22.04.2022): 575. http://dx.doi.org/10.3390/medicina58050575.
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Background and Objectives: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections, we used power Doppler ultrasonography (PDU) when injecting medications into the epidural space. Materials and Methods: This is a retrospective study that enrolled a total of 277 patients with refractory low back pain or degenerative disc from January 2019 to December 2019. The injectate flow of caudal epidural injections was examined with the assistance of PDU and confirmed by fluoroscopy. Four flow patterns were identified by PDU in our study: the “Earthworm sign,” the “Patch sign,” the ”Tubular sign” and the “Absent flow sign.” The accuracy of PDU in identifying intraepidural and intravascular injections was determined by fluoroscopy images recorded during each injection. Results: We evaluated 277 patients (mean age, 68.6 ± 13.2 years; 106 men). The “Patch sign” showed a sensitivity of 88.76% and a specificity of 80% in predicting epidural injection without intravascular injection. The “Earthworm sign” demonstrated a sensitivity of 70% and a specificity of 100% in detecting intravascular injection. The “Tubular sign” showed a specificity of 100% and a sensitivity of 9.4% in predicting successful epidural injection. The absence of a flow signal showed a sensitivity of 1.87% and a specificity of 90% in predicting successful epidural injection. Conclusions: Ultrasound-guided caudal epidural injection can accurately determine intraepidural and intravascular injections with the assistance of PDU and is thus a good alternative technique to fluoroscopy-guided caudal epidural injection.
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Strasburger, Christian J., Niki Karavitaki, Sylvère Störmann, Peter J. Trainer, Ilonka Kreitschmann-Andermahr, Michael Droste, Márta Korbonits i in. "Patient-reported outcomes of parenteral somatostatin analogue injections in 195 patients with acromegaly". European Journal of Endocrinology 174, nr 3 (marzec 2016): 355–62. http://dx.doi.org/10.1530/eje-15-1042.
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BackgroundLong-acting somatostatin analogues delivered parenterally are the most widely used medical treatment in acromegaly. This patient-reported outcomes survey was designed to assess the impact of chronic injections on subjects with acromegaly.MethodsThe survey was conducted in nine pituitary centres in Germany, UK and The Netherlands. The questionnaire was developed by endocrinologists and covered aspects of acromegaly symptoms, injection-related manifestations, emotional and daily life impact, treatment satisfaction and unmet medical needs.ResultsIn total, 195 patients participated, of which 112 (57%) were on octreotide (Sandostatin LAR) and 83 (43%) on lanreotide (Somatuline Depot). The majority (>70%) of patients reported acromegaly symptoms despite treatment. A total of 52% of patients reported that their symptoms worsen towards the end of the dosing interval. Administration site pain lasting up to a week following injection was the most frequently reported injection-related symptom (70% of patients). Other injection site reactions included nodules (38%), swelling (28%), bruising (16%), scar tissue (8%) and inflammation (7%). Injection burden was similar between octreotide and lanreotide. Only a minority of patients received injections at home (17%) and 5% were self-injecting. Over a third of patients indicated a feeling of loss of independence due to the injections, and 16% reported repeated work loss days. Despite the physical, emotional and daily life impact of injections, patients were satisfied with their treatment, yet reported that modifications that would offer major improvement over current care would be ‘avoiding injections’ and ‘better symptom control’.ConclusionLifelong injections of long-acting somatostatin analogues have significant burden on the functioning, well-being and daily lives of patients with acromegaly.
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Alnabulsi, Hussein, Rafiqul Islam, Izzat Alsmadi i Savitri Bevinakoppa. "An Innovative Method of Malicious Code Injection Attacks on Websites". Applied Data Science and Analysis 2024 (20.05.2024): 39–51. http://dx.doi.org/10.58496/adsa/2024/005.
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This paper provides a model to identify website vulnerability to Code Injection Attacks (CIAs). The proposed model identifies vulnerabilities to CIA of various websites, to check vulnerable to CIAs. The lack of existing models in providing checking against code injection has motivated this paper to present a new and enhanced model against web code injection attacks that uses SQL injections and Cross-Site Script (XSS) injections. This paper previews a self-checking protection model which enables web administrators to know whether their current protection program is adequate, or whether a website needs stronger protection against CIAs. The Automated Injection’s model is to check vulnerable to cod injection. The checking methodology consists of many intrusion methods that the attacker may use to launch code injection attacks. Methodology can give a high precision of CIA vulnerability checking for a website compared with other approaches (the minimum accuracy different between proposed approach and other approaches is 3.15%). CIAs can be a serious problem for vulnerable websites including stealing, deleting, or altering important data. Extensive experiments are conducted and compared with existing research [e.g. 1, 5, and 9] to study the effectiveness of the proposed model that can check whether a website is vulnerable to CIAs. The performance of the suggested approach has been tested on SQL injections and XSS injections. The studies showed that the detection rate of our model is 95.27%, and the false positive rate is 5.55%.
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Husseini, Jad S., F. Joseph Simeone, Steven J. Staffa, William E. Palmer i Connie Y. Chang. "Fluoroscopically guided lumbar spine interlaminar and transforaminal epidural injections: inadvertent intravascular injection". Acta Radiologica 61, nr 11 (12.02.2020): 1534–40. http://dx.doi.org/10.1177/0284185120903450.
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Background Inadvertent intravascular injection is a rare but catastrophic complication of lumbar epidural injections. Purpose To determine risk factors for inadvertent intravascular injection in fluoroscopically guided lumbar spine epidural injections. Material and Methods A total of 212 patients who presented for lumbar interlaminar or transforaminal injection were prospectively enrolled. Patient demographics, history of surgery, injection side, site and approach, and volume of contrast injected were recorded. Results There were 89 (42%) interlaminar and 123 (58%) transforaminal injections. For 36 (17%) patients, there had been surgery at the injected or adjacent lumbar level. There were 25 (12%) inadvertent intravascular injections, with an incidence of 2/93 (2%) for interlaminar and 23/119 (19%) for transforaminal injections. The patients with inadvertent intravascular injection were older ( P = 0.017) and had prior surgery at or adjacent to the level of injection ( P < 0.0001). Transforaminal approach had a higher intravasation rate than interlaminar injections, both when comparing the entire cohort ( P = 0.0001) and only patients without prior surgery ( P = 0.01). In multivariable logistic regression analysis, transforaminal injections (odds ratio [OR] 9.77, 95% confidence interval [CI] 2.14–44.6, P = 0.003) and prior surgery at or adjacent to the level of injection (OR 5.71, 95% CI 2.15–15.15, P < 0.001) were independently associated with increased risk of inadvertent intravascular injections. Conclusion Inadvertent intravascular injection occurred in 12% of our lumbar injection cohort and is more common with transforaminal injections, in older patients, and with prior lumbar surgery at or adjacent to the level of injection.
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Cholifah, Siti, Paramitha Amelia Kusumawardani i Miftahul Muslih. "Differences in fasting blood glucose levels in acceptors Progestin Injections and Combination Injections". Jurnal Ners dan Kebidanan Indonesia 8, nr 3 (19.11.2020): 247. http://dx.doi.org/10.21927/jnki.2020.8(3).247-252.
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<em>Efforts to limit and regulate birth spacing as a goal to create quality families and healthy families, the government encourages people to use contraceptives as birth control. One of these contraceptives is injection contraception. Injecting contraception is the most widely used contraceptive tool by the people of Indonesia, is considered effective, practical, but has several side effects, the most worrying is that it affects blood glucose. Blood glucose levels in the human body that increase more than normal can be a symptom of diabetes mellitus. The purpose of this study is to determine differences in blood glucose levels in progestin injection and combined injection contraceptive acceptors. Observational research design using a cross sectional approach. The study population was all injectable acceptors. Samples were taken that met the inclusion criteria, namely respondents were willing to be examined, there was no history of diabetes mellitus (DM), less than 40 years of age, acceptors of at least 6-8 hours fasting. Sampling was carried out using consecutive sampling techniques totaling 50 acceptors (25 progestin injection acceptors, 25 combined injection acceptors). Data were analyzed by Witney mann test using α = 0.05. The results showed the mean fasting blood glucose for progestin injection acceptors was higher than for combination injections, the test results P = 0.008 <α = 0.05. The conclusions of the study show that there are significant differences in blood glucose levels in progestin-injecting acceptors and this combination means that progestin-injecting contraceptives have a higher impact on increasing fasting blood sugar levels compared with combined injection contraception. Suggestions for health workers to control blood glucose injector acceptors at acceptors who experience high glucose levels are recommended to replace non-hormonal contraceptive methods.</em>
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Heidbüchel, Katharina, Jessica Raabe, Lisa Baldinger, Werner Hagmüller i Ralf Bussemas. "One Iron Injection Is Not Enough—Iron Status and Growth of Suckling Piglets on an Organic Farm". Animals 9, nr 9 (4.09.2019): 651. http://dx.doi.org/10.3390/ani9090651.
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Suckling piglets cannot satisfy their demand for the essential trace element iron from sows’ milk alone, which is poor in iron. Therefore, iron is usually supplemented by injecting 200 mg iron (as iron dextran) on day 3 post natum. However, the longer suckling period in organic pig herds leads to iron intake from feed starting later. We hypothesized that one iron injection is not enough for organically reared piglets, and that a second and third injection would improve their iron status and growth. On an organically certified experimental farm, 288 piglets from 32 litters were allocated to three treatments with one iron injection on day 3, two injections on day 3 and 14 and three injections on day 3, 14 and 21 post natum, respectively. One injection resulted in the lowest hematocrit and serum iron levels until day 28 post natum and the lowest daily weight gains until weaning, while piglets receiving two or three iron injections did not differ from each other. Based on these observations, we conclude that one iron injection is not enough to ensure adequate iron supply and unimpaired growth of organically reared piglets, and additional iron supply is necessary.
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Slone, Tyler, Michael Ciesa, Ania Bartholomew, Nicholas A. Cheney i Brian C. Clark. "Efficacy of Fluoroscopically Guided Corticosteroid Injections for Foot and Ankle Pain". Foot & Ankle Orthopaedics 7, nr 1 (styczeń 2022): 2473011421S0045. http://dx.doi.org/10.1177/2473011421s00453.
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Category: Midfoot/Forefoot; Ankle; Ankle Arthritis; Hindfoot; Lesser Toes Introduction/Purpose: Arthritis of the foot and ankle can severely hamper quality of life resulting in decreased mobility and functionality. Conservative treatment can involve corticosteroid injections into affected joint spaces. Fluoroscopic guided injections provide confirmation that the injection was successfully applied within the appropriate joint space. Due to this, they can be of diagnostic value and result in more accurate injection placement. Current literature focuses on ultrasound guided injections and does not fully address the efficacy of fluoroscopic injections. Objective: Assess and determine overall efficacy of fluoroscopically guided corticosteroid injections including the degree and period of relief provided. Methods: We retrospectively reviewed patient charts from 2016 through 2020 of patients that received fluoroscopically guided corticosteroid injections in foot or ankle joints. 224 injections were reviewed, gathering responses to percent relief, days of relief, pre-/post-injection VAS pain score and efficacy of repeat injections. Additionally, Kellgren-Lawrence arthritis scale vs pain relief were analyzed. Results: Analysis limited by incomplete patient response. 24/83 (28.9%) injections provided less than 2 weeks of relief while 59/83 (71.1%) injections averaged 109.49 +- 72.03 days of pain relief. Of 127 responses, post-injection relief at first follow up had an average VAS reduction of 2.87 +- 3.17 with 70.38 +- 30.8 % improvement. 40 subjects with repeat injections had 109.41 +- 64.96 days of relief per injection. No significant correlation was found between joint injected or degree of arthritis and percent improvement. Conclusion: Fluoroscopic guided injections are an effective conservative option providing prolonged but varying relief of 3-4 months irrespective of the specific joint or degree of arthritis. Repeat injections show similar efficacy. In contrast to ultrasound guided injections, fluoroscopy provides additional diagnostic and therapeutic value. This can be beneficial if the injections fail and the patient must progress to surgery. Future prospective studies could directly compare different injections modalities and further analyze efficacy for specific diagnoses.
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Bhatia, Padma, Harshima Sawlani i Rajesh Tarachandani. "A study to assess and develop injection administration skill in medical undergraduates of GMC, Bhopal". International Journal Of Community Medicine And Public Health 6, nr 1 (24.12.2018): 390. http://dx.doi.org/10.18203/2394-6040.ijcmph20185278.
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Background: Injections are one of the vital route of drug administration in emergency medical practice. WHO has estimated that out of 12 billion injections administered worldwide annually 50% are unsafe and 75% are unnecessary. Despite of humungous efforts medical students still lack the confidence in injecting drugs due to stress for post graduation selection. The objectives of the study were to assess the knowledge of students regarding administration of I.M. and I.V. injections; to make students confident and skilful about administration of I.M. and I.V. injections and to assess the proportion of students who can skilfully administer I.V. and I.M. before and after this intervention.Methods: This was a Quasi experimental study carried out on 150 students of junior final medical students of GMC Bhopal for a period of three months.Results: Out of effective 136 students, 93.4% had ever seen I.M./ I.V. administration. 29.4% have administered I.M. and 16.9% I.V. injection ever. A significant increase in knowledge regarding I.M. and I.V. administration technique is observed following interventional training of the participants. Significant gain in self confidence among the students was perceived.Conclusions: There was a convincing increase in skillful knowledge and self-confidence for parenteral injection technique among medical undergraduates.
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Rodik, Tristan, i Brendon McDermott. "Platelet-Rich Plasma Compared With Other Common Injection Therapies in the Treatment of Chronic Lateral Epicondylitis". Journal of Sport Rehabilitation 25, nr 1 (luty 2016): 77–82. http://dx.doi.org/10.1123/jsr.2014-0198.
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Clinical Scenario:Lateral epicondylitis (LE) is a relatively common pathology capable of producing chronic debilitation in a variety of patients. A newer treatment for orthopedic conditions is platelet-rich plasma (PrP) local injection.Focused Clinical Question:Is PrP a more appropriate injection therapy for LE than other common injections such as corticosteroid or whole blood?Summary of Key Findings:Four studies were included: 1 randomized controlled trial (RCT), 2 double-blind RCTs, and 1 cohort study. Two studies involved comparisons of PrP injection to corticosteroid injection. One of the studies involved a 2-y follow-up while another involved a 1-y follow-up. Another study involved the comparison of PrP injection with whole-blood injection with a 6-mo follow-up. The final study included a PrP-injection group and control group. The 2 studies involving PrP vs corticosteroid injections with 2-y and 1-y follow-ups both favored PrP over corticosteroid injection in terms of pain reduction and function increases. The third study favored PrP injections over whole-blood injections at 6 mo regarding pain reduction. All studies demonstrated significant improvements with PrP over comparison injections or no injection.Clinical Bottom Line:PrP injections provide more favorable pain and function outcomes than whole blood and corticosteroid injections for 1–2 y after injection.Strength of Recommendation:Consistent findings from RCTs suggest level 1b evidence in support of PrP injection as a treatment for LE.
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Payne, R., D. W. Corson, A. Fein i M. J. Berridge. "Excitation and adaptation of Limulus ventral photoreceptors by inositol 1,4,5 triphosphate result from a rise in intracellular calcium." Journal of General Physiology 88, nr 1 (1.07.1986): 127–42. http://dx.doi.org/10.1085/jgp.88.1.127.
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Single pressure injections of 1-10 pl of inositol 1,4,5 triphosphate (IP3) or inositol 4,5 bisphosphate [I(4,5)P2] excite Limulus ventral photoreceptors by inducing rapid bursts of inward current. After excitation by IP3, responses to subsequent injections of IP3 or light flashes are often reversibly diminished (adapted). Single injections of IP3 and I(4,5)P2 are effective at concentrations in the injecting pipette of 20 microM to 1 mM. Single injections of inositol 1,4 bisphosphate are ineffective at concentrations of 100-500 microM. Excitation by IP3 or I(4,5)P2 is accompanied by a rise in intracellular free calcium, as indicated by aequorin luminescence. Prior injection of calcium buffer solutions containing 100 mM EGTA greatly diminishes the total charge transferred across the plasma membrane during excitation by IP3 or I(4,5)P2, which suggests that a rise in Cai is necessary for excitation by the inositol polyphosphates. Adaptation of the response to light by IP3 is also abolished by prior injection of EGTA. In the same cells, the response to brief light flashes is slowed and diminished in amplitude by the injection of calcium buffer, but the charge transferred during the response is not significantly diminished. This suggests that light has access to a pathway of excitation in the presence of EGTA that is not accessible to intracellularly injected IP3.
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Follin, Cecilia, i Sven Karlsson. "Attitudes and preferences in patients with acromegaly on long-term treatment with somatostatin analogues". Endocrine Connections 5, nr 4 (lipiec 2016): 167–73. http://dx.doi.org/10.1530/ec-16-0038.
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Introduction Patients with acromegaly can be treated with surgery, medical therapy and/or radiation therapy. For the patients not being cured with surgery, treatment with somatostatin analogues (SSAs) is the primary therapy. SSA can be taken by self- or partner-administered injections in addition to being given by a nurse at a clinic. The aim was to assess if patients with acromegaly prefer self-injections and to investigate their attitudes towards long-term medical therapy. Method All patients in the southern medical region of Sweden with a diagnosis of acromegaly and treated with SSA were eligible for the study (n = 24). The study is based on a questionnaire asking about the patients’ attitudes and preferences for injections with SSA, including their attitudes towards self-injection with SSA. Results The patients’ (23 included) median age was 68.5 years and the patients had been treated with SSA for 13 (1–38) years. One patient was currently self-injecting. All of the other patients were receiving injections from a nurse at a clinic. Three patients preferred self-injections, one preferred partner injections and 19 patients did not prefer self- or partner injections. The most frequent arguments to not preferring self-injections were ‘feeling more secure with an educated nurse’ and ‘preferring regular contact with a specialised nurse’. Conclusion Patients with acromegaly prefer regular contact with the endocrine team to the independence offered by self-injections. These findings might mirror the patients’ desires for continuity and safety. We need to address patients’ concerns regarding injections with SSA and support them in their choices.
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Spencer, Mark, Matthew Hall, Allison Schafer i Lauren E. Geaney. "Clinical Outcomes of Posterior Tibial Tendon Sheath Ultrasound-Guided Corticosteroid Injections". Foot & Ankle Orthopaedics 7, nr 4 (październik 2022): 2473011421S0095. http://dx.doi.org/10.1177/2473011421s00952.
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Category: Ankle; Basic Sciences/Biologics; Sports Introduction/Purpose: The treatment of progressive collapsing foot deformity (PCFD) typically begins with nonoperative management including physical therapy, bracing, nonsteroidal anti-inflammatory medications, and activity modifications. Surgical intervention is not typically performed until nonoperative treatment has failed. Corticosteroid injections into the posterior tibial tendon sheath (PTTS) is a burgeoning nonoperative treatment modality for PCFD. The purpose of our study was to assess the safety of ultrasound-guided corticosteroid injections into the posterior tibial tendon sheath for posterior tibialis tendon tendinopathy. Secondary outcomes include duration of pain relief, amount of pain relief, need for repeat injections and progression to surgery. Methods: We retrospectively reviewed all patients in our electronic medical record who underwent a PTTS steroid injection between 2015 to 2020 for the diagnosis of posterior tibial tendon dysfunction, and/or posterior tibialis tendon insufficiency, and/or ankle pain. Demographic information was obtained from the patient record in addition to MRI data, clinical response to injection based on follow up visits, number of total injections, and progression to surgery. Thirty-eight posterior tibial tendon sheath ultrasound-guided injections in 33 patients met criteria during the 5 year study period. Results: Thirty-three patients were included in the study with 38 injections. Two patients (6.1%) had 3 posterior tibial tendon injections, one patient (3%) had 2 injections, and the rest had only a single injection yielding a total of 38 injections included in the study. Eighteen of 38 (47%) injections yielded good or better pain relief. Seven of 33 patients (21%) progressed to surgery. There were no reported complications with the 38 performed injections. Conclusion: Ultrasound-guided corticosteroid injections into the posterior tibial tendon sheath is a safe nonoperative treatment modality for posterior tibialis tendon tendinopathy. The efficacy of the injection appears highly variable with 47% of injections yielding 'good' or better clinical results. When evaluating BMI, obese patients (BMI >= 30.0) were found to have a more sustained response to injection (P = 0.029) and more pain relief (P = 0.049) compared to non-obese patients.
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Kuo, Dr Hann-Chorng. "Repeated Onabotulinumtoxin-A Injections Provide Better Results than Single Injection in Treatment of Painful Bladder Syndrome". Pain Physician 1;16, nr 1;1 (14.01.2013): E15—E23. http://dx.doi.org/10.36076/ppj.2013/16/e15.
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Background: Onabotulinumtoxin-A (BoNT-A) is effective for the treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). However, long-term follow-up does not show successful outcome after a single injection. Objectives: To evaluate the efficacy and safety of repeated intravesical BoNT-A injections for treatment of IC/PBS and compare the success rates among patient groups receiving different injection numbers. Study Design: Prospective interventional study. Setting: Tertiary medical center. Methods: Intravesical injection of 100 U of BoNT-A was performed in 81 patients every 6 months for up to 4 times or until patients’ symptoms significantly improved. Patients who received a single injection served as active controls. Measured parameters included O’LearySant symptom indexes (ICSI) and problem indexes (ICPI), visual analogue score (VAS) for pain, voiding diary variables, urodynamic parameters, maximal bladder capacity under anesthesia, glomerulation grade, and global response assessment. Multiple measurements and KaplanMeier analysis were used for comparison of consecutive data and success rates among groups. Results: Among 81 patients, 20 received single injections, 19 received 2 injections, 12 received 3 injections, and 30 received 4 injections. The mean (± standard deviation) of ICSI, ICPI, total scores, VAS, functional bladder capacity, and daytime frequency all showed significant improvement after repeated BoNT-A treatment with different injections. Significantly better success rates were noted in patients who received 4 repeated injections (P = 0.0242) and 3 injections (P = 0.050), compared to those who received a single injection. However, there was no significant difference of long-term success rates among patients who received 2, 3, and 4 injections. Limitations: Lack of placebo control group is the main limitation. Conclusion: Repeated intravesical BoNT-A injections were safe and effective for pain relief and they increased bladder capacity and provided a better long-term success rate than a single injection did for treatment of IC/PBS. Key words: Botulinum toxin, IC/PBS, Intravesical treatment
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Daulay, Meirina, i Kasih Purwati. "HUBUNGAN PENGGUNAAN KB SUNTIK DEPO PROVERA 3 BULAN TERHADAP KADAR Hb PADA WUS WANITA USIA SUBUR DI BPM (BIDAN PRAKTEK MANDIRI) NUNI NURAENI KELURAHAN PADASUKA CIOMAS KABUPATEN BOGOR". Zona Kedokteran: Program Studi Pendidikan Dokter Universitas Batam 9, nr 2 (2.07.2020): 80–87. http://dx.doi.org/10.37776/zked.v9i2.294.
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Family Planning is an acronym for Family Planning which was formed by the government to reduce the number of people using contraception, but some contraceptives have side effects namely bleeding, headache, nausea, menstrual disorders, weakness/fatigue, and vaginal discharge. This study was an observational analytic study with a cross-sectional design. Samples were all users of 3 months Depo Provera Injecting KB injection at BPM Nuni Nuraeni, Padasuka Ciomas, Bogor Regency in 2018. Statistical tests used chi-square. The results of univariate analysis showed WUS using Depo Provera injections 3 months 49 (65.3%) and WUS who did not use Depo Provera injections 3 months 26 (34.7%), WUS who used 3 months Depo Provera injectable KB obtained that Hb levels were normal 43 (57.3%) and whereas WUS who used KB injections Depo Provera 3 months found that Hb levels were not normal 32 (42.7%). In the Bivariate analysis, based on the results of the Chi-Square Statistical Test with a significance limit α = 0.05 and 95% CI obtained Ï value = 0.26 α> 0.05 (Prevalence Rate = 3,300). This shows that there is no relationship between the use of 3 months Depo Provera injecting contraception to Hb levels in WUS at BPM Nuni Nuraeni. Thus the hypothesis which states that there is a relationship between the use of 3 months Depo Provera injecting contraception with Hb levels in WUS is rejected. From the results of the study it can be concluded that there is no relationship between the use of a 3-month injection of Depo Provera injections with Hb levels in WUS at BPM Nuni Nuraeni, Padasuka Ciomas, Bogor Regency.
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English, J. M., O. B. Toon i M. J. Mills. "Microphysical simulations of sulfur burdens from stratospheric sulfur geoengineering". Atmospheric Chemistry and Physics Discussions 12, nr 1 (25.01.2012): 2517–58. http://dx.doi.org/10.5194/acpd-12-2517-2012.
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Abstract. Recent microphysical studies suggest that geoengineering by continuous stratospheric injection of SO2 gas may be limited by the growth of the aerosols. We study the efficacy of SO2, H2SO4 and aerosol injections on aerosol mass and optical depth using a three-dimensional general circulation model with sulfur chemistry and sectional aerosol microphysics (WACCM/CARMA). We find increasing injection rates of SO2 in a narrow band around the equator to have limited efficacy while broadening the injecting zone as well as injecting particles instead of SO2 gas increases the sulfate burden for a given injection rate, in agreement with previous work. We find that injecting H2SO4 gas instead of SO2 does not discernibly alter sulfate size or mass, in contrast with a previous study using a plume model with a microphysical model. However, the physics and chemistry in aircraft plumes, which are smaller than climate model grid cells, need to be more carefully considered. We find equatorial injections increase aerosol optical depth in the Northern Hemisphere more than the Southern Hemisphere, potentially inducing regional climate changes. We also find significant perturbations to tropospheric aerosol for all injections studied, particularly in the upper troposphere and near the poles, where sulfate burden increases by up to 100 times. This enhanced burden could have implications for tropospheric radiative forcing and chemistry. These results highlight the need to mitigate greenhouse gas emissions through means other than geoengineering, and to further study geoengineering before it can be seriously considered as a climate intervention option.
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Lewis, Emma, Khalid Merghani, Iain Robertson, Jonathon Mulford, Ben Prentice, Ronnie Mathew, Peter Van Winden i Kathryn Ogden. "The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial". Bone & Joint Journal 104-B, nr 6 (1.06.2022): 663–71. http://dx.doi.org/10.1302/0301-620x.104b6.bjj-2021-1109.r2.
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Aims Platelet-rich plasma (PRP) intra-articular injections may provide a simple and minimally invasive treatment for early-stage knee osteoarthritis (OA). This has led to an increase in its adoption as a treatment for knee OA, although there is uncertainty about its efficacy and benefit. We hypothesized that patients with early-stage symptomatic knee OA who receive multiple PRP injections will have better clinical outcomes than those receiving single PRP or placebo injections. Methods A double-blinded, randomized placebo-controlled trial was performed with three groups receiving either placebo injections (Normal Saline), one PRP injection followed by two placebo injections, or three PRP injections. Each injection was given one week apart. Outcomes were prospectively collected prior to intervention and then at six weeks, three months, six months, and 12 months post-intervention. Primary outcome measures were Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol five-dimension five-level index (EQ-5D-5L). Secondary outcomes included visual analogue scale for pain and patient subjective assessment of the injections. Results A total of 102 patients were recruited. The follow-up period was 12 months, at intervals of six weeks, 12 weeks, six months, and 12 months. KOOS-Total significantly improved in all groups at these time intervals compared to pre-injection. There was an improvement in EQ-5D-5L index scores in saline and single injection groups, but not in the multiple injection group. Comparison of treatment groups showed no additional beneficial effect of single or multiple PRP injections above that displayed in the saline injection group. Subjective patient satisfaction and recommendation of treatment received demonstrated a similar pattern in all the groups. There was no indication of superiority of either single or multiple PRP injections compared to saline injections. Conclusion There is no evidence that single or multiple PRP had any additional beneficial effect compared to saline injection up to 12 months, follow-up after treatment of early stage symptomatic OA of the knee. Cite this article: Bone Joint J 2022;104-B(6):663–671.
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Choi, Ja Young, Seung Ki Kim i Eun Sook Park. "The Effect of Botulinum Toxin Injections on Gross Motor Function for Lower Limb Spasticity in Children with Cerebral Palsy". Toxins 11, nr 11 (8.11.2019): 651. http://dx.doi.org/10.3390/toxins11110651.
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The aim of this study was to investigate the use of botulinum toxin type A (BoNT-A) injections and their efficacy on gross motor function for lower limb spasticity in children with spastic cerebral palsy (CP). This retrospective study included 919 injection occasions from 591 children with CP who received a lower limb BoNT-A injection between 2006 and 2016. The Gross Motor Function Measure (GMFM-88), the Modified Ashworth Scale, and the Modified Tardieu Scale were administered before and after injections. Injections were predominantly administered to children under the age of 6 years. The most common muscle injection site was the calf muscle for dynamic foot deformity. The second most commonly injected muscle was the hip adductor among 2–3 year olds and the hamstring muscle among 4–6 year olds. Distal injections were predominantly administered to high-functioning children, whereas proximal injections were typically administered to low-functioning children. Multilevel injections were mostly administered to midfunctioning children. GMFM-88 scores significantly increased post-injection for both high- and low-functioning groups. Younger age at injection and distal injection type were associated with larger improvements on the GMFM-88 at both short- and midterm follow-up. The target muscles for injection varied depending on gross motor functioning and age. Younger age at injection and distal injection type were significantly related with greater gain in gross motor function.
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Kishore, Kamal, Daniel S. McGowan i Kurt A. Hanebrink. "Iatrogenic Retinal Penetration from Intravitreal Injections". Case Reports in Ophthalmology 12, nr 1 (12.04.2021): 248–53. http://dx.doi.org/10.1159/000512695.
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We present 2 cases of iatrogenic retinal penetration from intravitreal (IVT) injections in a retrospective noncomparative case series of 2 patients. The first patient, an 81-year-old Caucasian male, developed dense vitreous hemorrhage soon after receiving an IVT bevacizumab injection for macular edema from central retinal vein occlusion. A 25-g vitrectomy 1 week later showed a retinal hole surrounded by fresh hemorrhages in the same quadrant as the IVT injection. The second patient, an 87-years-old male, developed a retinal detachment after 28 injections of anti-VEGF medications for neovascular AMD. A peripheral round hole was observed during vitrectomy without any lattice degeneration in the same quadrant as prior IVT injections. Both eyes were pseudophakic, had normal axial lengths, and received injections without measuring the injection site. Retinal penetration from IVT injections can result in serious sight-threatening complications. Measuring the injection site from the limbus should be part of safe IVT injection technique.
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Giuliano, François, Pierre Denys i Charles Joussain. "Safety and Effectiveness of Repeated Botulinum Toxin A Intracavernosal Injections in Men with Erectile Dysfunction Unresponsive to Approved Pharmacological Treatments: Real-World Observational Data". Toxins 15, nr 6 (5.06.2023): 382. http://dx.doi.org/10.3390/toxins15060382.
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Intracavernosal injections of botulinum toxin A (BTX/A ic) may be effective for difficult-to-treat erectile dysfunction (ED). This is a retrospective case series study of the effectiveness of repeated off-label BTX/A ic (onabotulinumtoxinA 100U, incobotulinumtoxinA 100U or abobotulinumtoxinA 500U) in men with ED and insufficient response to phosphodiesterase type 5 inhibitors (PDE5-Is) or prostaglandinE1 intracavernosal injections (PGE1 ICIs), defined as an International Index of Erectile Function-Erectile Function domain score (IIEF-EF) < 26 on treatment. Further injections were performed on patients’ requests, and the files of men who underwent at least two injections were reviewed. The response to BTX/A ic was defined as the achievement of the minimally clinically important difference in IIEF-EF adjusted to the severity of ED on treatment at baseline. Out of 216 men treated with BTX/A ic and PDE5-Is or PGE1-ICIs, 92 (42.6%) requested at least a second injection. The median time since the preceding injection was 8.7 months. In total, 85, 44 and 23 men received, respectively, two, three and four BTX/A ic. The overall response rate was 77.5%: 85.7% in men with mild ED, 79% for moderate ED and 64.3% for severe ED on treatment. The response increased with repeated injections: 67.5%, 87.5% and 94.7%, respectively, after the second, third and fourth injections. Post-injection changes in IIEF-EF were similar across injections. The time from injection to request for a further injection varied little. Four men reported penile pain at the time of injection (1.5% of all injections), and one experienced a burn at the penile crus. Repeated BTX/A injections combined with PDE5-Is or PGE1-ICIs produced an effective and durable response, with acceptable safety.
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Plessl, Daniel, Robert Summey, Oliver Joseph, Oleg Uryasev, John P. McNamara i Apostolos Paul Dallas. "FEASIBILITY OF ULTRASOUND-GUIDED ULNAR NERVE INJECTIONS AT THE CUBITAL TUNNEL USING A LATERAL-TO-MEDIAL APPROACH". Journal of Musculoskeletal Research 17, nr 01 (marzec 2014): 1450002. http://dx.doi.org/10.1142/s021895771450002x.
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Purpose: Describe an alternative approach to perform ultrasound-guided injections into the cubital tunnel as a pilot study for cubital tunnel syndrome (CTS) treatment feasibility. Methods: The ulnar nerve was visualized bilaterally on four non-embalmed cadaveric models which were placed in a supine position. To image the cubital tunnel, the subject's elbow was examined in external rotation with the elbow angle at approximately 40° flexion (full elbow extension is considered 0°). The ultrasound transducer was placed transverse to the condylar groove along the medial epicondyle-olecranon axis and the ulnar nerve was identified. Methylene blue 0.35 mL was injected into the ulnar nerve perineural space under ultrasound guidance in a lateral-to-medial approach. Post-injection incisions were made to expose the underlying ulnar nerve and examine the injection sites. Injections were considered accurate if the ulnar nerve perineural space was dyed, and were considered precise if the injection was localized without damaging the ulnar collateral artery. Results: Dissection revealed that the ulnar nerves were covered with dye from the cubital tunnel inlet to outlet. 8-of-8 (100%) injections were accurate; 8-of-8 (100%) injections were precise. Conclusion: This pilot study shows that a lateral-to-medial approach to injecting the cubital tunnel under ultrasound guidance is accurate and precise. The clinical efficacy of such a procedure using corticosteroids should be examined through clinical trials and the results should be compared to other techniques used for treating CTS.
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Park, Min Soo, i Seung Joon Lee. "Comparison of Intravitreal Bevacizumab and Aflibercept Injections for Central Serous Chorioretinopathy". Journal of the Korean Ophthalmological Society 62, nr 7 (15.07.2021): 957–62. http://dx.doi.org/10.3341/jkos.2021.62.7.957.
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Purpose: We examined differences in the treatment effects of intravitreal bevacizumab injections and intravitreal aflibercept injections in patients with central serous chorioretinopathy. Methods: This retrospective analysis included 51 eyes of 49 patients who received intravitreal anti-vascular endothelial growth factor agent injections after initial diagnosis with central serous chorioretinopathy. The patients were divided into two groups: one received an intravitreal bevacizumab injection, and another one received an intravitreal aflibercept injection. Patients with no reaction to treatment or a worsened condition, received repeat treatment with the same therapy. After treatment, patients were monitored for >3 months. Data were collected regarding best- corrected visual acuity (BCVA), subfoveal choroidal thickness, injection number, and treatment duration. Results: Both intravitreal bevacizumab injections and intravitreal aflibercept injections led to significant differences in BCVA (p < 0.0001, p = 0.001) and subfoveal choroidal thickness (p < 0.0001, p = 0.011), compared between before and after treatment. However, no differences between groups were observed in mean change of BCVA or subfoveal choroidal thickness. In addition, there were no differences between groups in injection number and treatment duration. Conclusions: In patients with central serous chorioretinopathy, both intravitreal bevacizumab injections and intravitreal aflibercept injections are effective treatment methods. There were no differences between the two medicines in terms of functional and anatomical recovery, or the injection number and treatment duration.
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Middleton, T., L. Turner, C. Fennell, S. Savkovic, V. Jayadev, A. J. Conway i D. J. Handelsman. "Complications of injectable testosterone undecanoate in routine clinical practice". European Journal of Endocrinology 172, nr 5 (maj 2015): 511–17. http://dx.doi.org/10.1530/eje-14-0891.
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ObjectiveInjectable testosterone undecanoate (TU) was marketed within the last decade, but its complications in routine clinical practice are not well defined.Design and methodsProspective observational study of consecutive TU injections in an Andrology Clinic to estimate the incidence of i) immediate cough/syncope due to pulmonary oil microembolisation (POME), ii) post-injection haematoma and iii) the prevalence of secondary polycythaemia.ResultsIn 3022 injections given to 347 patients over 3.5 years, POME was observed after 56 injections (66% mild, 19% severe; 40% with onset before injection completed) in 43 patients. The incidence of 19 (95% CI 14–24) per 1000 injections did not differ between three experienced nurse injectors, but recurrences were more frequent than by chance. No post-injection haematoma was reported including after 269 injections to men taking antiplatelet, anticoagulant or both drugs (upper 95% confidence limit 1%) with 56 not withholding drugs prior to TU administration (upper 95% confidence limit 5.4%). Mean haematocrit was 0.44±0.04 (s.d.) with 25 (7%) >0.50, 14 (4%) >0.52 and 3 (1%) >0.54.ConclusionTU injections produce a low incidence of POME with injections by experienced nurses, but recurrence is more frequent than by chance. Post-injection haematoma was not observed even among men using anticoagulant and/or antiplatelet drugs, and polycythaemia was a minor problem rarely requiring treatment other than optimising inter-injection interval.
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Laakso, Anton, Hannele Korhonen, Sami Romakkaniemi i Harri Kokkola. "Radiative and climate effects of stratospheric sulfur geoengineering using seasonally varying injection areas". Atmospheric Chemistry and Physics 17, nr 11 (14.06.2017): 6957–74. http://dx.doi.org/10.5194/acp-17-6957-2017.
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Abstract. Stratospheric sulfur injections have often been suggested as a cost-effective geoengineering method to prevent or slow down global warming. In geoengineering studies, these injections are commonly targeted to the Equator, where the yearly mean intensity of the solar radiation is the highest and from where the aerosols disperse globally due to the Brewer–Dobson Circulation. However, compensating for greenhouse gas-induced zonal warming by reducing solar radiation would require a relatively larger radiative forcing to the mid- and high latitudes and a lower forcing to the low latitudes than what is achieved by continuous equatorial injections. In this study we employ alternative aerosol injection scenarios to investigate if the resulting radiative forcing can be targeted to be zonally more uniform without decreasing the global the mean radiative forcing of stratospheric sulfur geoengineering. We used a global aerosol–climate model together with an Earth system model to study the radiative and climate effects of stratospheric sulfur injection scenarios with different injection areas. According to our simulations, varying the SO2 injection area seasonally would result in a similar global mean cooling effect as injecting SO2 to the Equator, but with a more uniform zonal distribution of shortwave radiative forcing. Compared to the case of equatorial injections, in the seasonally varying injection scenario where the maximum sulfur production from injected SO2 followed the maximum of solar radiation, the shortwave radiative forcing decreased by 27 % over the Equator (the latitudes between 20° N and 20° S) and increased by 15 % over higher latitudes. Compared to the continuous injections to the Equator, in summer months the radiative forcing was increased by 17 and 14 % and in winter months decreased by 14 and 16 % in Northern and Southern hemispheres, respectively. However, these forcings do not translate into as large changes in temperatures. The changes in forcing would only lead to 0.05 K warmer winters and 0.05 K cooler summers in the Northern Hemisphere, which is roughly 3 % of the cooling resulting from solar radiation management scenarios studied here.
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Ruan, Tiffany, Troy B. Puga, Elisa Chaparro, Karson Schroeder, Robert Tyler i Gautam Desai. "Effects of patient education on knee joint injections and the impact on patient care and satisfaction in rural Guatemala". International Journal of Research in Orthopaedics 9, nr 4 (29.06.2023): 633–47. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20231983.
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Background: As the rates of osteoarthritis increase among the elderly population across the world, the number of intra-articular corticosteroid injections has also steadily increased. The objective of this research study was to compare the ratings of anxiety level, pain level, and education about glucocorticoid injections between the group who received expansive education about joint injections and the group who received minimal education about joint injections. Methods: Each participant was given a pre-injection survey allowing them to rate their anxiety level, pain level, prior education level on knee injections, and duration and severity of symptoms. Each participant completed a post-injection survey following the procedure. Rating data were analyzed using a paired t-test to compare each of the groups to themselves and unpaired t-tests were used to compare the two groups. Demographic and survey data were analyzed using Fisher’s exact test. Results: Statistical significance was noted when a paired t-test was run between pain levels before and after the knee injection was administered in group A and between pain levels before and after the knee injection was administered in group B (p<0.001). A paired t-test also showed statistical significance when comparing the educational levels before and after the knee injection was administered in group A (p=0.04). Conclusions: This research study showed that increased education on corticosteroid knee injections prior to the procedure demonstrated increased education on corticosteroid knee injections after the injection and decreased pain levels following the injection in participants with osteoarthritis in rural Guatemala.
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Kang, Jin, i Gyeong Cheon. "Demonstration of Subretinal Injection Using Common-Path Swept Source OCT Guided Microinjector". Applied Sciences 8, nr 8 (2.08.2018): 1287. http://dx.doi.org/10.3390/app8081287.
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In this paper, we present the development of a handheld common-path swept source optical coherence tomography (CP-SSOCT) guided microinjector system and demonstrated its utility by precisely injecting fluorescein dye in the subretinal layer of ex vivo bovine eyes. The system enables precise subretinal injection with micron-level injection depth control. This was achieved by using a high-resolution CP-SSOCT distal sensor and signal processing using a graphics-processing unit (GPU), which made a real-time smart motion control algorithm possible. The microinjector performance was first evaluated using a gelatin phantom in terms of its ability for dynamic depth targeting and injection depth. This is followed by using an ex vivo bovine eye model to perform multiple consecutive subretinal injections of fluorescein dye. The results validated the OCT guided injector’s ability to precisely guide and lock in the needle tip to the target depth during injection. The ex vivo evaluation tests demonstrate that an OCT-guided injector can consistently guide the injecting needle to the desired depth and is able to maintain the position with 9.38 μm average root mean square error during the injections.
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Pearl, Craig, Brendan Moxley, Andrew Perry, Nagi Demian i Cyndie Dallaire-Giroux. "Management of Trigeminal Neuralgia with Botulinum Toxin Type A: Report of Two Cases". Dentistry Journal 10, nr 11 (3.11.2022): 207. http://dx.doi.org/10.3390/dj10110207.
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Trigeminal neuralgia is a chronic pain condition associated with sharp, shock-like pain in one or more divisions of the trigeminal nerve. For patients who do not respond well to pharmacotherapy, there is growing evidence that Botulinum toxin type A injections into the trigeminal ganglion provide pain relief for several weeks up to several months at a time. One option is to administer injections into the trigeminal ganglion in Meckel’s cave by inserting a needle through the Pterygopalatine Fossa using fluoroscopy to guide and confirm the proper needle placement. However, there is evidence that Botulinum toxin travels across nerve synapses; thus, injecting directly into the trigeminal ganglion may not be necessary. We present two patients with a confirmed diagnosis of trigeminal neuralgia who were treated by injecting Botulinum toxin type A intraorally into the mental foramen which resulted in 6 months or longer of pain relief. Injections into the mental foramen are much easier to administer than those administered directly into the trigeminal ganglion, and both patients treated with this technique experienced comparable results to what can be expected from traditional fluoroscopy-guided botulinum toxin injections. Though more research is needed, these cases potentially imply that a less-invasive injection may be sufficient in managing trigeminal neuralgia-related pain.
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Belhassen, S., i I. Saliba. "Intratympanic steroid injection as a salvage treatment for sudden sensorineural hearing loss". Journal of Laryngology & Otology 128, nr 12 (17.11.2014): 1044–49. http://dx.doi.org/10.1017/s0022215114002710.
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AbstractObjective:To determine the efficacy of intratympanic methylprednisolone injections for treating sudden sensorineural hearing loss.Method:A retrospective chart review was performed to identify patients suffering from sudden sensorineural hearing loss with no recovery after oral steroids. Patients were given up to three intratympanic methylprednisolone injections at one-week intervals. They were classified according to their functional hearing class, remission was monitored and potential factors affecting prognosis were analysed.Results:Intratympanic injections provide effective salvage therapy for sudden sensorineural hearing loss (p = 0.039). Changes in pure tone average and speech discrimination score were analysed following intratympanic methylprednisolone injections. The pure tone average reached a plateau after the second injection; however, the speech discrimination score improved until after the third injection. Hearing improvement after intratympanic injections mainly occurred at low frequencies. The interval between symptoms appearing and intratympanic injections starting was not significantly associated with remission (p = 0.680).Conclusion:A delay between symptom onset and the first intratympanic methylprednisolone injection does not seem to affect prognosis.
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Zhang, Kaibo, Jiang Yu, Jian Li i Weili Fu. "The Combined Intraosseous Administration of Orthobiologics Outperformed Isolated Intra-articular Injections in Alleviating Pain and Cartilage Degeneration in a Rat Model of MIA-Induced Knee Osteoarthritis". American Journal of Sports Medicine 52, nr 1 (styczeń 2024): 140–54. http://dx.doi.org/10.1177/03635465231212668.
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Background: Intra-articular (IA) platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) injections have shown efficacy and safety in treating osteoarthritis (OA). However, the effectiveness and mechanisms of combined intraosseous (IO) administration of these orthobiologics have yet to be explored. Purpose/Hypothesis: The purpose of this study was to evaluate the effect on pain, cartilage, synovium/infrapatellar fat pad (IFP), and subchondral bone in rat knee OA, comparing isolated IA with combined IA and IO (IA+IO) injections of PRP or BMAC. It was hypothesized that combined injections would be superior to sole IA injections. Study Design: Controlled laboratory study. Methods: A total of 48 rats were divided into 6 groups: sham (only joint puncture during OA induction with IA+IO saline injection treatment) and 5 groups with OA induction, control (IA+IO saline injection), PRP (IA PRP+IO saline injection), BMAC IA (IA BMAC+IO saline injection), PRP IA+IO (IA+IO PRP injection), and BMAC IA+IO (IA+IO BMAC injection). OA was induced by IA injection of monosodium iodoacetate (MIA). Rats were administered different orthobiologics according to their grouping 3 weeks after the MIA injection. Pain changes were evaluated using the weightbearing ratio assay at weeks 3, 4, 5, 7, and 9 after OA induction. Rats were euthanized at week 9 for gross, radiological, histological, immunohistochemical, and immunofluorescence assessments of cartilage, synovium, and subchondral bone. Results: Compared with the control group, all orthobiologics injection groups had reduced joint pain. Compared with IA injection, IA+IO injections provided superior pain relief by suppressing calcitonin gene-related peptide and substance P in both the synovium/IFP and subchondral bone. IA+IO injections slowed the progression of subchondral bone lesions by inhibiting CD31hiEmcnhi vessel formation and excessive osteoclast and osteoblast turnover while preserving subchondral bone microarchitecture, slowing cartilage degeneration. However, IA+IO injections did not outperform isolated IA injections in reducing synovitis and synovium/IFP fibrosis. Compared with PRP, BMAC exhibited superior inhibition of pain-related mediators, but no significant differences were observed in synovitis suppression, infrapatellar fat pad fibrosis, and subchondral bone protection. Conclusion: IA+IO injections of orthobiologics were more effective in relieving pain, slowing cartilage degeneration, and inhibiting abnormal vascularization and remodeling compared with isolated IA injections. BMAC showed superior pain relief in the synovium/IFP and subchondral bone compared with PRP. Further research is needed to optimize PRP and BMAC components for enhanced efficacy in OA management. Clinical Relevance: Our findings contribute to advancing the understanding of pain relief mechanisms and support the endorsement of IO injection of orthobiologics for the treatment of OA and joint pain.
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Liu, Shao-Hsien, Catherine E. Dubé, Charles B. Eaton, Jeffrey B. Driban, Timothy E. McAlindon i Kate L. Lapane. "Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis". Journal of Rheumatology 45, nr 9 (15.06.2018): 1316–24. http://dx.doi.org/10.3899/jrheum.171385.
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Objective.We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA).Methods.Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup.Results.Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82–1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10–0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94–4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI −0.11 to 1.11; stiffness: −0.07, 95% CI −0.38 to 0.24; and functioning: 0.49, 95% CI −1.34 to 2.32).Conclusion.Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.
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Yoshida, Yuko, Masuko Sumikawa, Hiroyuki Sugimori i Rika Yano. "Factors That Affect Symptoms of Injection Site Infection among Japanese Patients Who Self-Inject Insulin for Diabetes". Healthcare 9, nr 4 (1.04.2021): 402. http://dx.doi.org/10.3390/healthcare9040402.
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In Japan, skin disinfection is typically considered necessary before an insulin injection to prevent infection at the injection site. This cross-sectional study evaluated factors that influenced symptoms of injection site infection among 238 Japanese patients who self-injected insulin for diabetes between October 2015 and January 2016. A structured questionnaire was used to collect data regarding skin disinfection practices, infection symptoms at the injection site, frequency of injections, environment at the time of injection, and hygiene habits. The majority of patients (83.2%) performed skin disinfection before the self-injection. Logistic regression analysis revealed that infection at the injection site was positively associated with skin disinfection before injection, age, and performing injections outside home. It was speculated that omitting skin disinfection before administering subcutaneous insulin injection was not the factor that affected the symptoms of injection site infection. The greatest contributor to infection symptoms was injections performed outside the home. Future studies focusing on the environment, in which patients administer insulin injections, to assess its influence on symptoms of injection site infections are warranted.
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Ponce, Brent, Andrew McGee, Alex Dombrowsky, Raymond Waldrop, Joshua Wild, Naqeeb Faroqui, Samuel Roswell Huntley, Kennieth Charles McCollough, Eugene W. Brabston i Amit Mukesh Momaya. "The Cost Variability of Orthobiologics". Orthopaedic Journal of Sports Medicine 7, nr 7_suppl5 (lipiec 2019): 2325967119S0028. http://dx.doi.org/10.1177/2325967119s00285.
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Objectives: Despite limited clinical data, many orthopedic practices offer orthobiologic injections. Such injections are not covered by insurance, and thus patients pay out of pocket for these treatments. The purpose of this study was to assess the variability in costs for platelet rich plasma (PRP) and stem cell (SC) injections across practices and evaluate for variables that influence pricing. Methods: A list of 1,345 orthopedic sports medicine practices across the United States was compiled. Calls were made inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, practice type (academic or private), number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables. Results: Of the contacted offices, 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only stem cell injections, and 487 (36.2%) did not offer either treatment. The mean (± SD) cost of a PRP injection was $707 ± $388 (range, $175 to $4,973), and the mean cost of a SC injection was $2,728 ± $1,584 (range, $300 to $12,000). Practices offering PRP and SC injections tended to be larger (for PRP - 11.6 physicians per practice vs. 8.1, P<0.001; for SC - 12.3 vs. 9.7, P=0.006). In addition, practices that offered PRP injections were located in areas with higher mean income ($67,500 vs. $64,300, P=0.047). Variables associated with higher cost of PRP injection included city population (P<0.001) and mean income of residents (P<0.001). Conclusion: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections. The cost for PRP injections is higher in practices located in highly populated areas and in areas with greater mean incomes.
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Barrett, Stephen L., Jim Maxka, Jamie N. Mieras i Kimbal E. Cooper. "Reducing the Pain of Local 1% Lidocaine Infiltration with a Preceding Bacteriostatic Saline Injection". Journal of the American Podiatric Medical Association 101, nr 3 (1.05.2011): 223–30. http://dx.doi.org/10.7547/1010223.
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Background: Lidocaine injection for local anesthesia is a common podiatric medical procedure. We tested the hypothesis that injection of bacteriostatic saline solution containing 0.9% benzyl alcohol before the lidocaine infiltration can reduce the burning caused by lidocaine injection. Methods: This double-blind prospective trial involved 45 participants who each received four injections in two areas of the dorsum of the foot and rated the perceived pain on a visual analog scale. The order of the injections was designed to disguise the control and intervention arms of the study. Results: The sensation of the lidocaine injection after the injection of saline was reduced significantly (P = .028). The percentage of lidocaine injections with visual analog scale scores of 0 increased by 36% after preinjection with bacteriostatic saline solution containing 0.9% benzyl alcohol. Conclusions: The fact that 40% of the intervention visual analog scale pain scores for lidocaine injections were 0 suggests that a near painless lidocaine injection technique is an achievable goal and that the present technique is a simple and inexpensive method of reducing the pain of lidocaine injections. (J Am Podiatr Med Assoc 101(3): 223–230, 2011)
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Ganesan, Dinesh Kumar, Hema Kairavi Rathinavelu i Rajan Rushender Chitharaj. "A study on injection practice and its awareness among adults residing in the rural field practice area of a teaching hospital in South India". International Journal Of Community Medicine And Public Health 6, nr 5 (27.04.2019): 1954. http://dx.doi.org/10.18203/2394-6040.ijcmph20191561.
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Background: Injections are some of the most commonly done medical practice worldwide and it is estimated that approximately 16.7 billion injections are administered worldwide. A national study from India published in 2012 found that frequency of injection was 2.9 per person per year.Methods: Community based cross-sectional study was done to asses the practice and awareness of injection use among 119 adults in a rural field practice area of a teaching hospital in South India. A pre-validated, unstructured questionnaire was used to collect the data. It consisted questions about demographic data such as age, sex, education, marital status etc. and questions about injection usage such as type, frequency, route of administration was recorded.Results: Mean age of the study participant was 36.6. More than half 67 (56.3%) used injections in the past 3 months. On assessing the reasons for injection use, most of the participants complained of muscle pain 37 (31.1%). Among those who had injections in the past 3 months 52 (43.7%) received Intramuscular (I.M). 30 percent (35) of the injections were administered by interns followed by medical officer/physician 22 (34.5%) when asked about their general feeling after an injection, majority 78 (65.5%) of them said they felt better after receiving the injection. When asked about diseases transmitted through contaminated needles, 24 (20.2%) said don’t know.Conclusions: Nearly 60 percent of the individuals preferred injections to oral medicine awareness on the risk of injection and diseases transmitted through needles was low.
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Yoshizue, Takahiro, Subbaian Brindha, Rawiwan Wongnak, Hitoshi Takemae, Mami Oba, Tetsuya Mizutani i Yutaka Kuroda. "Antisera Produced Using an E. coli-Expressed SARS-CoV-2 RBD and Complemented with a Minimal Dose of Mammalian-Cell-Expressed S1 Subunit of the Spike Protein Exhibits Improved Neutralization". International Journal of Molecular Sciences 24, nr 13 (24.06.2023): 10583. http://dx.doi.org/10.3390/ijms241310583.
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E. coli-expressed proteins could provide a rapid, cost-effective, and safe antigen for subunit vaccines, provided we can produce them in a properly folded form inducing neutralizing antibodies. Here, we use an E. coli-expressed SARS-CoV-2 receptor-binding domain (RBD) of the spike protein as a model to examine whether it yields neutralizing antisera with effects comparable to those generated by the S1 subunit of the spike protein (S1 or S1 subunit, thereafter) expressed in mammalian cells. We immunized 5-week-old Jcl-ICR female mice by injecting RBD (30 µg) and S1 subunit (5 µg) according to four schemes: two injections 8 weeks apart with RBD (RBD/RBD), two injections with S1 (S1/S1), one injection with RBD, and the second one with S1 (RBD/S1), and vice versa (S1/RBD). Ten weeks after the first injection (two weeks after the second injection), all combinations induced a strong immune response with IgG titer > 105 (S1/RBD < S1/S1 < RBD/S1 < RBD/RBD). In addition, the neutralization effect of the antisera ranked as S1/RBD~RBD/S1 (80%) > S1/S1 (56%) > RBD/RBD (42%). These results indicate that two injections with E. coli-expressed RBD, or mammalian-cell-produced spike S1 subunit alone, can provide some protection against SARS-CoV-2, but a mixed injection scheme yields significantly higher protection.
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Gutierrez, Juanmarco, Jason J. Lamanna, Natalia Grin, Carl V. Hurtig, Joseph H. Miller, Jonathan Riley, Lindsey Urquia i in. "Preclinical Validation of Multilevel Intraparenchymal Stem Cell Therapy in the Porcine Spinal Cord". Neurosurgery 77, nr 4 (1.07.2015): 604–12. http://dx.doi.org/10.1227/neu.0000000000000882.
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Abstract BACKGROUND: Although multiple clinical trials are currently testing different stem cell therapies as treatment alternatives for many neurodegenerative diseases and spinal cord injury, the optimal injection parameters have not yet been defined. OBJECTIVE: To test the spinal cord's tolerance to increasing volumes and numbers of stem cell injections in the pig. METHODS: Twenty-seven female Göttingen minipigs received human neural progenitor cell injections using a stereotactic platform device. Cell transplantation in groups 1 to 5 (5–7 pigs in each) was undertaken with the intent of assessing the safety of an injection volume escalation (10, 25, and 50 µL) and an injection number escalation (20, 30, and 40 injections). Motor function and general morbidity were assessed for 21 days. Full necropsy was performed; spinal cords were analyzed for graft survival and microscopic tissue damage. RESULTS: No mortality or permanent surgical complications were observed during the 21-day study period. All animals returned to preoperative baseline within 14 days, showing complete motor function recovery. The histological analysis showed that there was no significant decrease in neuronal density between groups, and cell engraftment ranged from 12% to 31% depending on the injection paradigm. However, tissue damage was identified when injecting large volumes into the spinal cord (50 μL). CONCLUSION: This series supports the functional safety of various injection volumes and numbers in the spinal cord and gives critical insight into important safety thresholds. These results are relevant to all translational programs delivering cell therapeutics to the spinal cord.
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Lin, Chih-Peng, Ke-Vin Chang, Yi-Kai Huang, Wei-Ting Wu i Levent Özçakar. "Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis". Pharmaceuticals 13, nr 3 (18.03.2020): 49. http://dx.doi.org/10.3390/ph13030049.
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This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections—including 5% dextrose (D5W) and platelet-rich plasma (PRP)—for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Ranking probabilities of the SMD of each treatment were acquired by using simulation. Ten studies with 497 patients and comparing five treatments (D5W, PRP, splinting, corticosteroid, and normal saline) were included. The results of the simulation of rank probabilities showed that D5W injection was likely to be the best treatment, followed by PRP injection, in terms of clinical effectiveness in providing symptom relief. With respect to functional improvement, splinting ranked higher than PRP and D5W injections. Lastly, corticosteroid and saline injections were consistently ranked fourth and fifth in terms of therapeutic effects on symptom severity and functional status. D5W and PRP injections are more effective than splinting and corticosteroid or saline injection for relieving the symptoms of CTS. Compared with splinting, D5W and PRP injections do not provide better functional recovery. More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.
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Springer, Matthew L., Richard E. Sievers, Mohan N. Viswanathan, Michael S. Yee, Elyse Foster, William Grossman i Yerem Yeghiazarians. "Closed-chest cell injections into mouse myocardium guided by high-resolution echocardiography". American Journal of Physiology-Heart and Circulatory Physiology 289, nr 3 (wrzesień 2005): H1307—H1314. http://dx.doi.org/10.1152/ajpheart.00164.2005.
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The mouse is an important model for the development of therapeutic stem cell/bone marrow cell implantation to treat ischemic myocardium. However, its small heart size hampers accurate implantation into the left ventricular (LV) wall. Precise injections have required surgical visualization of the heart, which is subject to complications and is impractical for delayed or repeated injections. Furthermore, the thickness of the myocardium is comparable to the length of a needle bevel, so surgical exposure does not prevent inadvertent injection into the LV cavity. We describe the use of high-resolution echocardiography to guide nonsurgical injections accurately into the mouse myocardial wall. We optimized this system by using a mixture of ultrasound contrast and fluorescent microspheres injected into the myocardium, which enabled us to interpret the ultrasound image of the needle during injection. Quantitative dye injection studies demonstrated that guided closed-chest injections and open-chest injections deliver comparable amounts of injectate to the myocardium. We successfully used this system in a mouse myocardial infarction model to target the injection of labeled cells to a region adjacent to the infarct. Intentional injection of tracer into the LV cavity resulted in a small accumulation in the myocardium, suggesting that nonguided cell injections into mouse hearts may appear to be successful even if the majority of the injectate is lost in the chamber. The use of this system will allow more precise cellular implantation into the mouse myocardium by accurately guiding injections to desired locations, confirming successful implantation of cells, in a clinically relevant time frame.
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Srivastav, SL. "Unnecessary & Unsafe Injections Replace Disposable by Auto-Disable Syringes". Journal of Universal College of Medical Sciences 1, nr 3 (28.09.2013): 67–70. http://dx.doi.org/10.3126/jucms.v1i3.8770.
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Injections are a skin procedure performed with a syringe and needle to introduce a substance for prophylactic, curative, or recreational purpose. Injections can be given intevenously, intramuscularly, intradermally, or subcutaneously. Injections are among the most frequently used medical procedures, with an estimated 12 billion injections administered worldwide. A large majority (more than 90%) of these injections are administered for curative purpose (for every vaccination, 20 curative injections are administered). Injections have been used effectively for many years in preventive and curative healthcare. In preventive healthcare, injections have been used to administer vaccinations that have had major impact in reducing childhood mortality due to measles and other vaccine preventable diseases. While injections are still necessary today to administer most vaccination, the number of vaccination injections could be reduced through the use of combination vaccines. In curative healthcare, injections have been used to administer such antibiotics as Penicillin, Streptomycin, as well as many other life saving medications. Today, safe and effective alternatives to injected medications are available and most medications used in primary care can be administered orally. Injections are predominantly needed for treatment of severe diseases, mostly in hospital settings. Nevertheless, injections are overused to administer medications in many countries because of an ingrained preference for injections among health workers and patients. A safe injection does no harm to the recipient, does not expose the healthcare worker to any risk, and does not result in waste that is dangerous for the community. To achieve this, an injection needs to be prepared with clean hands in a clean area, using a syringe and a sterile needle. After administration, sharp equipments such as needle need to be discarded in a puncture proof container for appropriate disposal. When these rules are not followed, injections are unsafe and may expose recipients, healthcare workers, or the community to infections. Among unsafe practices, syringe or needle reuse between patients without sterilization is associated with a high risk of blood-borne pathogen transmission. Unsafe injections occur in many parts of the world and more particularly in developing countries where up to 50% of injections are administered with reused syringes and needles. To reduce the overuse of injections, and to assure safe injection practice, multidisciplinary strategies comprising of various elements have been discussed in this article. DOI: http://dx.doi.org/10.3126/jucms.v1i3.8770 Journal of Universal College of Medical Sciences Vol.1(3) 2013: 67-70
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Ko, Yun Dam, Soo In Yun, Dahye Ryoo, Myung Eun Chung i Jihye Park. "Accuracy of Ultrasound-Guided and Non-guided Botulinum Toxin Injection Into Neck Muscles Involved in Cervical Dystonia: A Cadaveric Study". Annals of Rehabilitation Medicine 44, nr 5 (31.10.2020): 370–77. http://dx.doi.org/10.5535/arm.19211.
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Objective To compare the accuracy of ultrasound-guided and non-guided botulinum toxin injections into the neck muscles involved in cervical dystonia.Methods Two physicians examined six muscles (sternocleidomastoid, upper trapezius, levator scapulae, splenius capitis, scalenus anterior, and scalenus medius) from six fresh cadavers. Each physician injected ultrasound-guided and non-guided injections to each side of the cadaver’s neck muscles, respectively. Each physician then dissected the other physician’s injected muscle to identify the injection results. For each injection technique, different colored dyes were used. Dissection was performed to identify the results of the injections. The muscles were divided into two groups based on the difficulty of access: sternocleidomastoid and upper trapezius muscles (group A) and the levator scapulae, splenius capitis, scalenus anterior, and scalenus medius muscles (group B).Results The ultrasound-guided and non-guided injection accuracies of the group B muscles were 95.8% and 54.2%, respectively (p<0.001), while the ultrasound-guided and non-guided injection accuracies of the group A muscles were 100% and 79.2%, respectively (p<0.05).Conclusion Ultrasound-guided botulinum toxin injections into inaccessible neck muscles provide a higher degree of accuracy than non-guided injections. It may also be desirable to consider performing ultrasound-guided injections into accessible neck muscles.
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Bashir, MA, R. Ray, P. Sarda, S. Li i S. Corbett. "Determination of a safe INR for joint injections in patients taking warfarin". Annals of The Royal College of Surgeons of England 97, nr 8 (1.11.2015): 589–91. http://dx.doi.org/10.1308/rcsann.2015.0044.
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Introduction With an increase in life expectancy in ‘developed’ countries, the number of elderly patients receiving joint injections for arthritis is increasing. There are legitimate concerns about an increased risk of thromboembolism if anticoagulation is stopped or reversed for such an injection. Despite being a common dilemma, the literature on this issue is scarce. Methods We undertook 2,084 joint injections of the knee and shoulder in 1,714 patients between August 2008 and December 2013. Within this cohort, we noted 41 patients who were taking warfarin and followed them immediately after joint injection in the clinic or radiology department, looking carefully for complications. Then, we sought clinical follow-up, correspondence, and imaging evidence for 4 weeks, looking for complications from these joint injections. We recorded International Normalised Ratio (INR) values before injection. Results No complications were associated with the procedure after any joint injection. The radiologists who undertook ultrasound-guided injections to shoulders re-scanned the joints looking for haemarthroses: they found none. A similar outcome was noted clinically after injections in the outpatient setting. Conclusion With a mean INR of 2.77 (range, 1.7–5.5) and a maximum INR within this group of 5.5, joint injections to the shoulder and knee can be undertaken safely in primary or secondary care settings despite the patient taking warfarin.
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Enomoto, Hiroko, Masahiko Sugimoto, Shin Asami i Mineo Kondo. "Progress of Diabetic Macular Edema after Loading Injection of Anti-Vascular Endothelial Growth Factor Agents in Real-World Cases". Medicina 58, nr 10 (21.09.2022): 1318. http://dx.doi.org/10.3390/medicina58101318.
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Background and Objectives: To evaluate the recurrence of diabetic macular edema (DME) after loading an injection of anti-VEGF agents by a pro re nata (PRN) protocol using central retinal thickness (CRT) as a re-injection criterion. Materials and Methods: This is a retrospective, observational single-center study. DME patients with a central retinal thickness (CRT) over 350 μm received a PRN injection of anti-VEGF agents following one to three consecutive monthly loading injections (bevacizumab, ranibizumab, and aflibercept) for 6 months from January 2012 to June 2019. Results: We enrolled a total of 72 eyes for loading injections and the mean CRT improved from 434.04 ± 139.4 μm (before treatment) to 362.9 ± 125.0 μm after the loading injection. One week after injection, 36 eyes (50%) obtained a CRT of ≤350 μm. Fourteen eyes (19.4%) remained with a CRT of ≤350 μm for 6 months without additional injections. A total of 22 eyes (30.6%) had a CRT of >350 μm at 6 months. Fifteen eyes did not receive additional injections because of visual improvement. Conclusions: About 20% of DME patients can be maintained at a CRT of ≤350 μm for 6 months with only a loading injection. However, there is a tendency to delay additional injections for patients with recurrences using PRN protocol.
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Matsubara, Hisashi, Ryohei Miyata, Maki Kobayashi, Hideyuki Tsukitome, Kengo Ikesugi i Mineo Kondo. "A Case of Sustained Intraocular Pressure Elevation after Multiple Intravitreal Injection of Ranibizumab and Aflibercept for Neovascular Age-Related Macular Degeneration". Case Reports in Ophthalmology 7, nr 1 (29.04.2016): 230–36. http://dx.doi.org/10.1159/000446016.
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Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents are widely used to treat neovascular age-related macular degeneration (nAMD). Although these treatments are effective, multiple injections have recently been recommended to ensure that there is a good long-term prognosis. However, sustained intraocular pressure (IOP) elevations have been reported to develop after multiple injections of anti-VEGF agents. We present our findings of a case of uncontrolled and persistent IOP elevation after switching from intravitreal ranibizumab injections to intravitreal aflibercept injections. A 74-year-old Japanese man without a history of glaucoma underwent 22 ranibizumab injections for nAMD and suddenly developed an elevated IOP after the 22nd injection. Although the subsequent medical treatment led to normalization of his IOP, the subretinal fluid under the central fovea remained even after the 25th injection of ranibizumab. Thus, ranibizumab treatment was switched to bimonthly intravitreal aflibercept injections in conjunction with glaucoma medications. His IOP recovered to within the normal range; however, after the 11th aflibercept injection, there was a sudden elevation of his IOP in spite of the continued glaucoma medications. Due to this sustained IOP elevation, his aflibercept injections were suspended for 16 weeks. Because his IOP could not be normalized by a full glaucoma medication regimen, the patient underwent trabeculotomy, which resulted in a lowering of the IOP to normal levels. We conclude that patients who receive serial intravitreal injections of anti-VEGF agents need to be closely monitored because severe and sustained ocular hypertension can develop.
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Samandari, Taraz, Naile Malakmadze, Sharon Balter, Joseph F. Perz, Marina Khristova, Leah Swetnam, Katherine Bornschlegel i in. "A Large Outbreak of Hepatitis B Virus Infections Associated With Frequent Injections at a Physician's Office". Infection Control & Hospital Epidemiology 26, nr 9 (wrzesień 2005): 745–50. http://dx.doi.org/10.1086/502612.
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AbstractObjectives:To determine whether hepatitis B virus (HBV) transmission occurred among patients visiting a physician's office and to evaluate potential transmission mechanisms.Design:Serologic survey, retrospective cohort study, and observation of infection control practices.Setting:Private medical office.Patients:Those visiting the office between March 1 and December 26, 2001.Results:We identified 38 patients with acute HBV infection occurring between February 2000 and February 2002. The cohort study, limited to the 10 months before outbreak detection, included 91 patients with serologic test results and available charts representing 18 case-patients and 73 susceptible patients. Overall, 67 patients (74%) received at least one injection during the observation period. Case-patients received a median of 14 injections (range, 2-25) versus 2 injections (range, 0-17) for susceptible patients (P < .001). Acute infections occurred among 18 (27%) of 67 who received at least one injection versus none of 24 who received no injections (RR, 13.6; CI95, 2.4-undefined). Risk of infection increased 5.2-fold (CI95, 0.6-47.3) for those with 3 to 6 injections and 20.0-fold (CI95, 2.8-143.5) for those with more than 6 injections. Typically, injections consisted of doses of atropine, dexamethasone, vitamin B12, or a combination of these mixed in one syringe. HBV DNA genetic sequences of 24 patients with acute infection and 4 patients with chronic infection were identical in the 1,500-bp region examined. Medical staff were seronegative for HBV infection markers. The same surface was used for storing multidose vials, preparing injections, and dismantling used injection equipment.Conclusion:Administration of unnecessary injections combined with failure to separate clean from contaminated areas and follow safe injection practices likely resulted in patient-to-patient HBV transmission in a private physician's office.
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PATHAK, Subodh Kumar, Abhijeet Ashok SALUNKE, Prem Haridas MENON, Praveen THIVARI, Kunal NANDY i CHEN Yongsheng. "Corticosteroid Injection for the Treatment of Trigger Finger: A Meta-Analysis of Randomised Control Trials". Journal of Hand Surgery (Asian-Pacific Volume) 27, nr 01 (luty 2022): 89–97. http://dx.doi.org/10.1142/s242483552250014x.
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Background: The purpose of this meta-analysis is to provide an evidence-based overview of the effectiveness of corticosteroid injection for the treatment of stenosing tenosynovitis (trigger digits). We have analysed only randomised control trials (RCTs) which compared the effectiveness of corticosteroid injections with control injections. Methods: The Cochrane Library, PubMed, Medline, Web of Science and Scopus were searched to identify relevant studies. The keywords for search in the database were (‘stenosing tenosynovitis’ OR ‘trigger finger’) AND injections. After screening titles and abstracts of these studies, full-text articles of studies that fulfilled the selection criteria were obtained. For the meta-analysis, we determined the pooled mean failure rate, odds ratio (OR), relative risk (RR) and 95% confidence intervals (CI) for the risk of failure rate between the corticosteroid injection group and the control group through the random-effects model. Results: Six RCTs were found that involved 368 participants. The corticosteroid injection group included 190 patients and 178 patients were included in the control group. The pooled estimate of successful treatment in the corticosteroid injections group was 63.68 ± 5.32% and that in the control group was 27.53 ± 11.52%. The pooled RR of treatment failure between the corticosteroid injection group and the control group was 0.49 (95% CI 0.40–0.60). The pooled OR of treatment failure between the corticosteroid injection group and the control group was 0.18 (95% CI 0.08–0.44). All the included studies reported either mild or no complications with corticosteroids or placebo injections. Conclusions: In the treatment of stenosing tenosynovitis, the corticosteroid injections have better outcomes compared to the control injections and this meta-analysis provides significant evidence of the effectiveness of corticosteroid injection for stenosing tenosynovitis with minimal adverse effects. Level of Evidence: Level II (Therapeutic)
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Karls, Shanna L., Kelli R. Snyder i Peter J. Neibert. "Effectiveness of Corticosteroid Injections in the Treatment of Plantar Fasciitis". Journal of Sport Rehabilitation 25, nr 2 (maj 2016): 202–7. http://dx.doi.org/10.1123/jsr.2014-0234.
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Clinical Scenario:For active individuals, plantar fasciitis (PF) is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although PF has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. However, the literature has not been examined to determine the effect of corticosteroid injection on PF.Focused Clinical Question:Are corticosteroid injections more effective than other interventions (placebo, platelet-rich plasma, and tenoxicam injections) in the short- and long-term treatment of PF?Summary of Key Findings:Corticosteroid injections are not more effective in the long-term treatment of PF pain than other treatments (platelet-rich plasma, tenoxicam).Clinical Bottom Line:The level 2 and 3 evidence shows that corticosteroids are more effective than placebo injections but are no more effective than tenoxicam injections and perhaps less effective than platelet-rich plasma treatment.Strength of Recommendation:Level 2 and 3 evidence suggests that corticosteroid injections are not more effective in the long-term treatment of PF than platelet-rich plasma or tenoxicam.