Injection Of Methylprednisolone Research Articles

Endolymphatic duct blockage surgery vs. intratympanic steroids for treatment of refractory Ménière's disease.

To compare the effectiveness of the Endolymphatic duct blockage (EDB) and intratympanic methylprednisolone(ITMP) injection to control refractory Ménière's disease(MD) symptoms and evaluate their impact on hearing level. Retrospective study in a tertiary care center. 36 received ITMP injection and 52 EDB. Mean outcome measures at 24months included vertigo control, tinnitus, aural fullness and hearing level: pure-tone average (PTA), bone conduction average(BCA) and speech discrimination score(SDS). At 24months postoperatively, 90.4% of the EDB group had complete control of vertigo and 43.4% of the ITMP group (p = 0.001). There was no significant difference in tinnitus or aural fullness control (p = 0.34 and p 0.21 respectively). In each group, the drop in tinnitus and aural fullness frequency at 24months were significant for EDB (p = 0.03; p < 0.001 respectively) and for ITMP group in tinnitus (p = 0.03) but not aural fullness (p = 0.063). At 24months, PTA, BCA and SDS were significantly worst in the ITMP group when compared to preoperative levels (p = 0.038, p = 0.027, p = 0.016). PTA in the EDB group was stable with no difference compared to ITMP group (p = 0.48). BCA and SDS in the EDB group were stable and better than the ITMP group (p = 0.032; p = 0.036). In each group, vestibular paresis was not significantly different before (p = 0.06) and after treatment (p = 0.68). EDB is more effective than the ITMP for controlling the vertigo symptoms of Ménière's disease and in preserving hearing function. It is a novel surgical technique with promising results for a complete treatment of Ménière's disease. ITMP decreases the frequency and the severity of the symptoms but only control vertigo in 27.8% of cases.

Modulation of cytokine response in post-cardiac arrest syndrome through prehospital high-dose glucocorticoid treatment

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation Research Foundation of Rigshospitalet. Background Post-cardiac arrest syndrome (PCAS) following out-of-hospital cardiac arrest (OHCA) is a life-threatening condition, characterized by a cascade of pathological events, including the development of a severe cytokine response. This inflammatory response may be associated with secondary brain injury and multi-organ dysfunction. In the randomized STEROHCA trial, high-dose glucocorticoid was administered immediately following resuscitation in the prehospital setting. The intervention exhibited a significant decrease in interleukin (IL) 6 levels, but its effect on other cytokines has yet to be assessed. Purpose We aimed to investigate the effects of high-dose glucocorticoid treatment in mitigating the cytokine response observed in PCAS after OHCA. Methods The modified intention-to-treat population of the double-blind, randomized STEROHCA trial consisted of 137 OHCA patients, who were randomized to a single prehospital injection of methylprednisolone 250 mg or placebo. Of these, this sub-study included 112 patients who were comatose and admitted to an ICU. Cytokine profiling was performed with a 17-plex assay, including pro- and anti-inflammatory cytokines, which were measured at 0, 24, 48, and 72h after admission. We applied mixed-model analyses to assess the effect of the intervention over time with log-transformed data. To maintain an exploratory approach, we chose not to correct for multiple testing. Results The intervention induced a reduction in the levels of several cytokines, with a significant treatment over time effect for IL-4, IL-8, IL-10, Monocyte Chemoattractant Protein-1 (MCP-1), Macrophage Inflammatory Protein-1 Beta (MIP-1β), and Tumor Necrosis Factor Alpha (TNF-α), all p&amp;lt;0.01. These cytokines, except for IL-10, exhibited lower values in the glucocorticoid group after 24h, Figure 1. Higher levels of IL-10 were observed in the glucocorticoid group at 0h. We found no differences in cytokine levels after 48-, and 72h between the two groups. Conclusion High-dose glucocorticoid treatment administered promptly after resuscitation from OHCA reduced several pro-inflammatory cytokines after 24h. TNF-α has previously been associated with poor outcomes following OHCA, whereas the exact role of the other cytokines following OHCA is unclear.Cytokines at 0-, 24-, 48-, and 72 hours

E015 Importance of smoking cessation in rheumatological outcomes

Abstract Background/Aims Smoking is a major preventable risk factor for many rheumatological diseases and can influence the severity of symptoms in conditions such as psoriatic arthritis (PsA), ankylosing spondylitis, giant cell arteritis (GCA) and systemic lupus erythematosus (SLE). The increased risk due to smoking is dose dependent. The objective was to identify the proportion of patients with rheumatological conditions who smoke and to ensure that smoking cessation advice is given in line with NICE guidelines. Methods A retrospective qualitative study with data collected from electronic patient records (EPR) between September and November 2022 across multiple rheumatology clinics. Data included age, gender, smoking status, diagnosis, disease duration, comorbidities, treatment, and smoking advice status. Results 459 patients were analysed (68% female), of which 11% were smokers, 6% were ex-smokers, 83% were non-smokers, and 1 vapes regularly. Among the smokers, 72% were female. The median age was 61 years, with a range of 18-91 years. The commonest age range for all patients is 71-80 years, while the commonest age range among smokers was 41-50 years at 28%. The commonest disease duration among smokers is 1-5 years. The most common disease diagnosis among smokers were RA (30%), PsA (19%) and SLE (6%). Regarding disease activity among smokers, 36% had mild, 56% had moderate, and 8% had severe disease activity. Among the 12 patients with respiratory comorbidities; 6 had asthma, and 4 had COPD. Among the 21 patients with cardiovascular comorbidities; 13 had hypertension, and 6 had hypercholesterolaemia. For patients on cDMARDS, 26% were on methotrexate, 11% were on sulfasalazine, 9.4% were on hydroxychloroquine and 2% were on leflunomide. 13% were on prednisolone, while 7.5% had required methylprednisolone injections. 11% were on bDMARDs, most commonly adalimumab. Smoking cessation advice was documented in 4%, whereas 96% had no evidence of any smoking cessation advice. Conclusion This study illustrates the most common age range of smokers in this cohort was 41-50 years (28%), which was almost twice the equivalent national level (14.3% in 45-54 years). Nationally, the most common age range is 25-34 years (15.8%). Patients with rheumatological disease who smoked were of younger age compared to non-smokers, and smoking rates were higher in females compared to males. Smoking cessation advice was only documented in 4% of this cohort. This indicates much scope for improvement, and enhanced disease control in a population with multiple challenges, primarily socioeconomically. VBA (Very Brief Advice) has been shown to be the single most effective and clinically proven preventive action a clinical can give to patients in relation to smoking cessation. The NCSCT (National Centre for Smoking Cessation Training) encourages the 3A’s (ASK, ADVICE, ACT). Disclosure M. Osikoya-Yekini: None. W. Walshe: None. A. Bharadwaj: None. A. Nandagudi: None.

α2-macroglobulin alleviates glucocorticoid-induced avascular necrosis of the femoral head in mice by promoting proliferation, migration and angiogenesis of vascular endothelial cells

To explore the mechanism underlying the protective effect of α2-macroglobulin (A2M) against glucocorticoid-induced femoral head necrosis. In a human umbilical vein endothelial cell (HUVEC) model with injuries induced by gradient concentrations of dexamethasone (DEX; 10-8-10-5 mol/L), the protective effects of A2M at 0.05 and 0.1 mg/mL were assessed by examining the changes in cell viability, migration, and capacity of angiogenesis using CCK-8 assay, Transwell and scratch healing assays and angiogenesis assay. The expressions of CD31 and VEGF-A proteins in the treated cells were detected using Western blotting. In BALB/c mouse models of avascular necrosis of the femoral head induced by intramuscular injections of methylprednisolone, the effects of intervention with A2M on femoral trabecular structure, histopathological characteristics, and CD31 expression were examined with Micro-CT, HE staining and immunohistochemical staining. In cultured HUVECs, DEX treatment significantly reduced cell viability, migration and angiogenic ability in a concentration- and time-dependent manner (P<0.05), and these changes were obviously reversed by treatment with A2M in positive correlation with A2M concentration (P<0.05). DEX significantly reduced the expression of CD31 and VEGF-A proteins in HUVECs, while treatment with A2M restored CD31 and VEGF-A expressions in the cells (P<0.05). The mouse models of femoral head necrosis showed obvious trabecular damages in the femoral head, where a large number of empty lacunae and hypertrophic fat cells could be seen and CD31 expression was significantly decreased (P<0.05). A2M treatment of the mouse models significantly improved trabecular damages, maintained normal bone tissue structures, and increased CD31 expression in the femoral head (P<0.05). A2M promotes proliferation, migration, and angiogenesis of DEX-treated HUVECs and alleviates methylprednisolone-induced femoral head necrosis by improving microcirculation damages and maintaining microcirculation stability in the femoral head.

Canonical pathways for validating steroid-associated osteonecrosis in mice

The present study aimed to establish and evaluate a preclinical model of steroid-associated osteonecrosis (SAON) in mice. Sixteen 24-week-old male C57BL/6 mice were used to establish SAON by two intraperitoneal injections of lipopolysaccharide (LPS), followed by three subcutaneous injections of methylprednisolone (MPS). Each injection was conducted on working day, with an interval of 24 h. Six cycles of injections were conducted. Additional twelve mice (age- and gender-matched) were used as normal controls. At 2 and 6 weeks after completing induction, bilateral femora and bilateral tibiae were collected for histological examination, micro-CT scanning, and bulk RNA sequencing. All mice were alive until sacrificed at the indicated time points. The typical SAON lesion was identified by histological evaluation at week 2 and week 6 with increased lacunae and TUNEL+ osteocytes. Micro-CT showed significant bone degeneration at week 6 in SAON model. Histology and histomorphometry showed significantly lower Runx2+ area, mineralizing surface (MS/BS), mineral apposition rate (MAR), bone formation rate (BFR/BS), type H vessels, Ki67+ (proliferating) cells, and higher marrow fat fraction, osteoclast number and TNFα+ areas in SAON group. Bulk RNA-seq revealed changed canonical signaling pathways regulating cell cycle, angiogenesis, osteogenesis, and osteoclastogenesis in the SAON group. The present study successfully established SAON in mice with a combination treatment of LPS and MPS, which could be considered a reliable and reproducible animal model to study the pathophysiology and molecular mechanism of early-stage SAON and to develop potential therapeutic approaches for the prevention and treatment of SAON.

449 The Efficiency of Non-surgical Therapies for the Treatment of Mortons Neuroma: A Systematic Review

INTRODUCTION: Morton’s neuroma or Intermetatarsal neuroma is a benign inflammation of the peripheral nerves in the feet causing sharp, burning metatarsalgia and significant morbidity while walking, running, etc. It occurs more in females because tight shoe styles put pressure on the nerve. METHODS: Keyword search of “Morton’s Neuroma”, “treatment”, “conservative” and “non-surgical” was conducted across MEDLINE, EMBASE, and Cochrane databases. Two cohort studies and seven Randomised Controlled Trials were included for review following PRISMA guidelines. These studies were reviewed for pain relief, functionality, and limitations of each procedure. RESULTS: Methylprednisolone injections were proved to reduce the Visual Analog Scale score with &gt;50% cases showing no difficulty in functional daily activity at 9 months post-procedure. Short-term relief was achieved by alcohol and capsaicin injections independently. Modifications in the shoe insole indicated better functionality and analgesia compared to a flat insole but combined with steroids it showed better outcomes. Extracorporeal shockwave therapy provided relief for up to 3 months compared to radiofrequency ablation which provided relief for a longer period. CONCLUSIONS: Although these procedures show statistically significant changes, they are not without limitations. Well-designed randomized controlled trials looking into the avenues for radiofrequency ablation and shockwave therapies as opposed to surgical excision of neuromas are vital.

Comparison of local versus intramuscular steroid injection in patients with carpal tunnel syndrome: A prospective open label randomized clinical trial

AimThis study compared the efficacy and safety of local corticosteroid injection (LCI) vs intramuscular (IM) corticosteroid injection in mild to moderate carpal tunnel syndrome (CTS). MethodsThis is an open labeled, randomized controlled trial conducted during December 2021 to August 2023. Eighty-six patients with CTS were randomized in 1:1 ratio to receive either single 40 mg methylprednisolone (MP) injection at the wrist (LCI arm), or single 40 mg MP intramuscular injection (IM arm) in the deltoid. Primary outcome was absolute Symptom Severity Scale (SSS) at 3 months. Secondary outcomes were SSS score at 1-month, Functional Status Scale (FSS) score at 1 and 3 months, and recurrence at 3 months and injection site pain assessed on visual analog (VAS) scale. ResultsMedian age was 45 (range 22 – 80) years, and 86 % were females. Baseline characteristics were comparable between groups. Mean SSS score at 3 months was similar in two arms (1.72 ± 0.71 vs 2.0 ± 0.93) with mean difference (MD) −0.03 (-0.31 to 0.25, p = 0.83) after adjusting for baseline SSS scores. LCI, however, resulted in significantly better SSS (1.48 ± 0.51 vs 1.88 ± 0.69, adjusted p = 0.04), and FSS scores (1.57 ± 0.44 vs 1.80 ± 0.66, adjusted p = 0.03) at 1 month compared to IM arm. Response rate (67.4 % vs 55.8 %; p = 0.30) and recurrence rate (17.1 % vs 22.6 %, p = 0.74) at 3 months were similar. Injection site pain was severe in LCI arm[median 5 (range 3 – 8) vs median 3 (range 2 – 6)]. ConclusionsIn patients with mild to moderate CTS, LCI resulted in better improvement in the BCTQ scores at 1 month compared to IM steroid. However, 3-month’s outcome was similar. Intramuscular steroid injection was better tolerated.

Revolutionizing Back Pain Management: Is Epidural Platelet-Rich Plasma the Superior Choice Over Steroids?

Background and objective Low back discomfort is one of the main factors that restrict physical activity, and it is becoming more and more common. Surgery is the best option when all other conservative treatment methods have failed, but it is not a panacea. While local anesthetic-free and combined epidural steroid injections have been used for many years, their usefulness is limited to shorter periods. In the field of orthopedics, platelet-rich plasma (PRP) has gained widespread recognition as an adjuvant component. PRPhas been applied to improve tissue repair, both soft and hard.This comparative study aimed to evaluate the potential of PRP as atherapy for low back pain (LBP). Methods We included 64 adult individuals with complaints ofLBP. They were classified into two groups: group A underwent a single injection in the afflicted lumbar intervertebral disc (IVD) level with 1.5 ml of methylprednisolone, 1.5 ml 2% lidocaine, and 0.5 ml of saline under rigorous aseptic precautions; in contrast, group B was administered a single injection of 3 milliliters of autologous PRP. Patients' scores on the visual analog scale (VAS), the Modified Oswestry Disability Questionnaire (MODQ), and the Straight Leg Raising Test (SLRT) were assessed before and during therapy. Results The datagathered were subjected to statistical analysis. Statistically significant differences were found in the VAS scores between group A (methylprednisolone group) and group B (PRP group) post-one hour (6.0 ±0.74 vs. 6.92 ±0.57) and after three months (5.2 ±0.65 vs. 3.26 ±0.79). Conclusions Our study revealed gradual progressive improvement in the symptoms of patients in the PRP group as indicated by scores onSLRT, VAS, and MODQ. The results were comparable to those who received methylprednisolone injections. There was a statistically significant difference in VAS scores between the two groups, with the PRP group reporting a higher degree of pain reduction, showing that PRP is an effective alternative to epidural steroid infiltration in managing chronic LBP.

Non-Surgery Management of Globe Rupture in Rural Area

Introduction : Globe rupture is a vision-threatening emergency. The management of globe rupture must arrange immediate.&#x0D; Case Illustration : A 59-year-old woman presented with painful and sudden vision loss on her left eye after hit by wood an hour prior. From the examination, the palpebra was oedema, and spasm, the conjunctiva was chemosis and bleeding, the sclera was laceration. Visual acuity of the left eye was 1/~. We diagnosed as globe rupture of the left eye. We gave levofloxacin injection, methylprednisolone injection, tranexamic acid injection, prednisolone eyedrop every 3 hours, levofloxacin topical every hour, and oxytetracycline eye ointment once a day in night. After 10 days, clinical manifestation was improved, but the visual acuity. From the examination, we found retinal detachment on her left eye. Patient was referred to the primary health care.&#x0D; Discussion : In globe rupture, infection risk is high and requires immediate systemic empiric antibiotics and surgical management. The conservative treatment was administered since the patient rejected for the globe exploration and scleral suture surgery. The aim treatment for this case is to prevent the infection. We used combination systemic and topical levofloxacin antibiotics and corticosteroid. Systemic tranexamic acid was to control the bleeding. No improvement of visual acuity after 10 days, we suspected because of retinal detachment and need surgery management.&#x0D; Conclusion : Surgical exploration and infection prevention are needed for globe injury. The sooner management, the better prognosis it could be.

Non-Surgery Management of Globe Rupture in Rural Area

Introduction : Globe rupture is a vision-threatening emergency. The management of globe rupture must arrange immediate.&#x0D; Case Illustration : A 59-year-old woman presented with painful and sudden vision loss on her left eye after hit by wood an hour prior. From the examination, the palpebra was oedema, and spasm, the conjunctiva was chemosis and bleeding, the sclera was laceration. Visual acuity of the left eye was 1/~. We diagnosed as globe rupture of the left eye. We gave levofloxacin injection, methylprednisolone injection, tranexamic acid injection, prednisolone eyedrop every 3 hours, levofloxacin topical every hour, and oxytetracycline eye ointment once a day in night. After 10 days, clinical manifestation was improved, but the visual acuity. From the examination, we found retinal detachment on her left eye. Patient was referred to the primary health care.&#x0D; Discussion : In globe rupture, infection risk is high and requires immediate systemic empiric antibiotics and surgical management. The conservative treatment was administered since the patient rejected for the globe exploration and scleral suture surgery. The aim treatment for this case is to prevent the infection. We used combination systemic and topical levofloxacin antibiotics and corticosteroid. Systemic tranexamic acid was to control the bleeding. No improvement of visual acuity after 10 days, we suspected because of retinal detachment and need surgery management.&#x0D; Conclusion : Surgical exploration and infection prevention are needed for globe injury. The sooner management, the better prognosis it could be.

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial

BackgroundFollowing resuscitated out-of-hospital cardiac arrest (OHCA), inflammatory markers are significantly elevated and associated with hemodynamic instability and organ dysfunction. Vasopressor support is recommended to maintain a mean arterial pressure (MAP) above 65 mmHg. Glucocorticoids have anti-inflammatory effects and may lower the need for vasopressors. This study aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients.MethodsThe STEROHCA trial was a randomized, placebo-controlled, phase 2 trial comparing one prehospital injection of methylprednisolone 250 mg with placebo immediately after resuscitated OHCA. In this sub-study, we included patients who remained comatose at admission and survived until intensive care unit (ICU) admission. The primary outcome was cumulated norepinephrine use from ICU admission until 48 h reported as mcg/kg/min. Secondary outcomes included hemodynamic status characterized by MAP, heart rate, vasoactive-inotropic score (VIS), and the VIS/MAP-ratio as well as cardiac function assessed by pulmonary artery catheter measurements. Linear mixed-model analyses were performed to evaluate mean differences between treatment groups at all follow-up times.ResultsA total of 114 comatose OHCA patients were included (glucocorticoid: n = 56, placebo: n = 58) in the sub-study. There were no differences in outcomes at ICU admission. From the time of ICU admission up to 48 h post-admission, patients in the glucocorticoid group cumulated a lower norepinephrine use (mean difference − 0.04 mcg/kg/min, 95% CI − 0.07 to − 0.01, p = 0.02). Moreover, after 12–24 h post-admission, the glucocorticoid group demonstrated a higher MAP with mean differences ranging from 6 to 7 mmHg (95% CIs from 1 to 12), a lower VIS (mean differences from − 4.2 to − 3.8, 95% CIs from − 8.1 to 0.3), and a lower VIS/MAP ratio (mean differences from − 0.10 to − 0.07, 95% CIs from − 0.16 to − 0.01), while there were no major differences in heart rate (mean differences from − 4 to − 3, 95% CIs from − 11 to 3). These treatment differences between groups were also present 30–48 h post-admission but to a smaller extent and with increased statistical uncertainty. No differences were found in pulmonary artery catheter measurements between groups.ConclusionsPrehospital treatment with high-dose glucocorticoid was associated with reduced norepinephrine use in resuscitated OHCA patients.Trial registration: EudraCT number: 2020-000855-11; submitted March 30, 2020. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04624776.Graphic

Intramuscular methylprednisolone administration in hand osteoarthritis patients: a feasibility study to inform a randomized controlled trial.

Inflammation is thought to play an important role in hand osteoarthritis (HOA), which is associated with pain and increased limitation of hand function. To explore the acceptability of therapy with intramuscular methylprednisolone in HOA among health-care providers (HCPs) and HOA patients. Additionally, the response to a single methylprednisolone injection was investigated. We adopted a mixed-methods design. In a qualitative study, we asked HCPs and patients for their acceptability of intramuscular methylprednisolone. A prospective observational study was performed afterward in HOA patients who received a single 120-mg intramuscular methylprednisolone injection as part of off-label administration. Average pain, functional impairment, and occurrence of adverse events were assessed at baseline and at 4, 8, and 12 weeks after the injection. Fourteen HCPs and 15 patients participated in the first part of the study. They considered intramuscular methylprednisolone potentially effective, yet expressed concerns about the risk for long-term adverse events. Among the 22 HOA patients who received intramuscular methylprednisolone, 13 patients reported 44 adverse events, with half of them occurring within the first 4 weeks after injection and being classified as nonserious. Mean hand pain decreased the most 4 weeks after injection and this effect persisted till week 12, though less pronounced. Similar results were seen with HOA-related functional impairment, which improved the most at week 4 and to a lesser extent at week 12. We found a good acceptability of intramuscular methylprednisolone treatment among HCPs and HOA patients, as well as a potential to reduce pain and improve hand function with a good safety profile for as long as 12 weeks after a single administration.

Ultrasound-guided injection of steroids versus platelet-rich plasma for sacroiliac joint chronic pain management

Background The spectrum of pain and disability from sacroiliac joint dysfunction is extremely variable. The treatment of SIJ pain remains a therapeutic challenge. Intra-articular SIJ infiltrations with local anesthetic and corticosteroids have the most reliable evidence supporting their use. New modalities have been introduced, such as platelet-rich plasma (PRP) injection. Aim This study aimed to assess and compare the efficacy of ultrasound (US) guided intra-articular and peri-articular SIJ injection with steroids (methylprednisolone) versus platelet-rich plasma (PRP) in relieving chronic SIJ pain and to assess the patient’s satisfaction, record any complications and deal with them accordingly. Patients and methods Fifty patients undergoing sacroiliac joint injection for the treatment of SIJ pain were included in the study. All patients have been randomly allocated to one of two groups: Group S received US-guided intra-articular and peri-articular injection of bupivacaine and methylprednisolone. Group P received US-guided intra-articular and peri-articular SIJ injection of bupivacaine and PRP. Results Demographic data showed no statistically significant difference between both groups. The provocative tests, the VAS score, and the MODQ score at preinjection showed no statistically significant difference. At 2 and 4 weeks postinjection, there was a statistically significant difference between the two groups showing higher values in group S than in group P. At six weeks postinjection, provocative tests were recorded in both groups with no significant difference between them. On the other hand, at eight weeks and four months postinjection, there was a statistically significant difference between the two groups showing higher values for group P than group S. The SAPS score was compared between the two groups and showed no statistically significant difference between them in any of the follow-up periods. As for the efficacy between the two groups, no statistically significant difference was noted. Regarding the complications between the two groups, there was no statistically significant difference. Conclusion US-guided PRP and steroid (methylprednisolone) injections into the SIJ are safe and effective modalities for reducing functional disability as well as decreasing low back pain.

Clinical and diagnostic profile of Tolosa-Hunt syndrome; a 7-year retrospective observational study

Background Tolosa Hunt Syndrome (THS) was first delineated in 1954 and is caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. In this study the different clinical and diagnostic findings of THS are discussed. Methods Case records of patients diagnosed with THS using the International Classification of Headache Disorders 3rd edition criteria from January 2016–July 2022 were considered for the current study. Demographic, Clinical, Laboratory and Radiological data of all patients fulfilling the inclusion and exclusion criteria was collected from the patient case records through the Medical Records Department of BMCRI Super Specialty Hospital. Results A total of 60 patients were included in the study with mean age with SD, 50.9 years (13.9) and were predominantly male (66.6%). Restriction of eye movements was the most common symptom affecting 31 (51.7%) patients. Oculomotor nerve (IIIrd Cranial Nerve) palsy was the most common nerve palsy, affecting 36 (60%) patients. Contrast enhancing lesions or T2/FLAIR Hyper-intense areas were seen in the Magnetic Resonance Imaging (MRI) of 59 (98.3%) patients. Cavernous sinus involvement, was the most common site of involvement, in 25 (41.6%) of the patients. All patients were treated with intravenous methyl prednisolone injections and responded well. Conclusion Restriction of eye movements was the most common symptom, along with cavernous sinus being the most common site of involvement in THS. MRI scans are important diagnostic tools for THS.

Exosomes from bone marrow mesenchymal stem cells ameliorate glucocorticoid-induced osteonecrosis of femoral head by transferring microRNA-210 into bone microvascular endothelial cells

ObjectivesBone microvascular endothelial cells (BMECs) played an important role in the pathogenesis of glucocorticoid-induced osteonecrosis of femoral head (GCS-ONFH), and exosomes derived from bone marrow mesenchymal stem cells (BMSC-Exos) may provide an effective treatment. This study aimed to evaluate the effects of BMSC-Exos and internal microRNA-210-3p (miRNA-210) on GCS-ONFH in an in vitro hydrocortisone-induced BMECs injury model and an in vivo rat GCS-ONFH model.MethodsBMECs, BMSCs and BMSC-Exos were isolated and validated. BMECs after the treatment of hydrocortisone were cocultured with different concentrations of BMSC-Exos, then proliferation, migration, apoptosis and angiogenesis of BMECs were evaluated by CCK-8, Annexin V-FITC/PI, cell scratch and tube formation assays. BMSCs were transfected with miRNA-210 mimics and miRNA-210 inhibitors, then BMSC-ExosmiRNA−210 mimic and BMSC-ExosmiRNA−210 inhibitor secreted from such cells were collected. The differences between BMSC-Exos, BMSC-ExosmiRNA−210 mimic and BMSC-ExosmiRNA−210 inhibitor in protecting BMECs against GCS treatment were analyzed by methods mentioned above. Intramuscular injections of methylprednisolone were performed on Sprague–Dawley rats to establish an animal model of GCS-ONFH, then tail intravenous injections of BMSC-Exos, BMSC-ExosmiRNA−210 mimic or BMSC-ExosmiRNA−210 inhibitor were conducted after methylprednisolone injection. Histological and immunofluorescence staining and micro-CT were performed to evaluate the effects of BMSC-Exos and internal miRNA-210 on the in vivo GCS-ONFH model.ResultsDifferent concentrations of BMSC-Exos, especially high concentration of BMSC-Exos, could enhance the proliferation, migration and angiogenesis ability and reduce the apoptosis rates of BMECs treated with GCS. Compared with BMSC-Exos, BMSC-ExosmiRNA−210 mimic could further enhance the proliferation, migration and angiogenesis ability and reduce the apoptosis rates of BMECs, while BMECs in the GCS + BMSC-ExosmiRNA−210 inhibitor group showed reduced proliferation, migration and angiogenesis ability and higher apoptosis rates. In the rat GCS-ONFH model, BMSC-Exos, especially BMSC-ExosmiRNA−210 mimic, could increase microvascular density and enhance bone remodeling of femoral heads.ConclusionsBMSC-Exos containing miRNA-210 could serve as potential therapeutics for protecting BMECs and ameliorating the progression of GCS-ONFH.

Comparing the Intensity of Pain and Incidence of Flare Reaction Following Trigger Finger Injections Using Betamethasone and Methylprednisolone: A Double-Blinded, Randomized Controlled Trial.

Considerable evidence supports corticosteroid injection as an effective treatment for trigger finger. One common side effect, the flare reaction, is a well-documented phenomenon of increased pain following steroid injections. Its incidence and intensity may be related to steroid composition. The purpose of this study was to determine whether betamethasone and methylprednisolone injections for trigger fingers have differing intensity of pain or incidence flare reaction. Patients with symptomatic trigger finger were recruited during their hand surgery visits. Patients were randomized into 2 treatment groups: betamethasone (40 mg) and methylprednisolone (6 mg) mixed with lidocaine 1%. Treatment group assignment was blinded to the patients and investigators. Visual analog scale pain measurements were taken prior to injection, 5 minutes postinjection, and daily thereafter for 7 days. Sixty-four patients were randomized into the 2 treatment groups. Patients in the betamethasone group reported slightly higher baseline pain compared with the methylprednisolone group, but lower pain on day 1. None of the following days showed a statistically significant difference. The incidence of flare and severe flare reactions of betamethasone injections for trigger finger management was roughly double that of methylprednisolone, but this difference was not statistically significant. Further studies are required to evaluate the relative course of nonflare postinjection pain for different corticosteroid injections for trigger finger injections.

Management of partial-thickness rotator cuff tears with autologous adipose-derived regenerative cells is safe and more effective than injection of corticosteroid

Symptomatic, partial-thickness rotator cuff tears (sPTRCT) are problematic. This study tested the hypothesis that management of sPTRCT with injection of fresh, uncultured, unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs) is safe and more effective than injection of corticosteroid even in the long run. To this end, subjects who had completed a former randomized controlled trial were enrolled in the present study. At baseline these subjects had not responded to physical therapy treatments for at least 6 weeks, and were randomly assigned to receive respectively a single injection of UA-ADRCs (n = 11) or a single injection of methylprednisolone (n = 5). Efficacy was assessed using the ASES Total score, pain visual analogue scale (VAS), RAND Short Form-36 Health Survey and range of motion at 33.2 ± 1.0 (mean ± SD) and 40.6 ± 1.9 months post-treatment. Proton density, fat-saturated, T2-weighted MRI of the index shoulder was performed at both study visits. There were no greater risks connected with injection of UA-ADRCs than those connected with injection of corticosteroid. The subjects in the UA-ADRCs group showed statistically significantly higher mean ASES Total scores than the subjects in the corticosteroid group. The MRI scans at 6 months post-treatment allowed to “watch the UA-ADRCs at work”.

The polarization of M2 macrophages can be adjusted to alleviate renal injury by methylprednisolone in sepsis-AKI

Acute kidney injury in sepsis patients has an extreme mortality rate in clinical. It obviously seems that immune cells, for example, macrophages are involved with this process. Macrophages, as highly important immune cells, play a significant role in the development of human kidney diseases. But the specific role of macrophages in this process is still unclear. Under different timeline points, we surprisingly found that macrophages had the most dynamic changes in acute kidney injury immune cells. Based on macrophages’ functions, they are primarily classified into M1 macrophages (pro-inflammatory) and M2 macrophages (anti-inflammatory). The polarization of M2 macrophages is closely associated with the seriousness of sepsis-induced kidney injury, but how to modulate their polarization to alleviate sepsis-associated renal damage remains unknown. We discovered that the polarization of M2 macrophages after methylprednisolone injection can significantly alleviate acute kidney injury by reducing secreted cytokine. This study suggests that the proportion of macrophage subtypes can be regulated by methylprednisolone to alleviate acute kidney injury in sepsis to provide a new sight for a clinical to provide a promising strategy for renal injury caused.

Inadvertent intraocular injection of methylprednisolone in a patient with prior superior oblique tuck surgery

Summary Background To report inadvertent intraocular methylprednisolone injection into an eye that had previously undergone superior oblique tuck surgery. Material and methods An observational case report. Results An inadvertent intraocular penetration occurred following periorbital methylprednisolone injection, which was performed via the superonasal quadrant to relieve trochlear pain in an eye that had undergone previous superior oblique tuck procedure. There was immediate loss of vision, afferent pupillary defect, and raised intraocular pressure. Fundoscopy revealed intravitreal and subretinal methylprednisolone with retinal detachment. Immediate removal of intravitreal and subretinal methylprednisolone was performed with a retinal reattachment procedure. Postoperatively, retinal necrosis was noted in the area that was in contact with methylprednisolone. Conclusions This case highlights the risk of inadvertent intraocular penetration while injecting through a limited periorbital space that has been previously operated on.

An Intriguing Case of Erythroderma Possibly Related to Psoriasis Vulgaris

Erythroderma or generalized exfoliating dermatitis is an inflammatory disease characterized by erythema and thickened scales. A woman, 34 years old, was consulted with complaints of red spots accompanied by blisters and peeling skin almost all over her body for 4 days. Complaints are accompanied by itching and burning sensations. The patient had experienced complaints like this 5 months ago and had been treated at three different hospitals. Physical examination found in the facial region, thorax, superior and inferior right and left extremities, erythematous patches with diffuse borders, thick scales, erosions, and a generalized distribution. The patient's fingernails were found to have a change in shape (pitting nails). Examination of the ANA profile was negative, IgE atopy did not show an allergic reaction to a specific allergen, and histopathological examination was within normal limits. The patient was diagnosed with erythroderma based on psoriasis vulgaris. Treatment includes injection of methylprednisolone, cetirizine 10 mg tablets, and wound care with wet gauze and topical cream. After giving therapy, the patient's clinical improvement. Erythroderma occurs because of an underlying condition and cannot be prevented by itself. Erythroderma because of an underlying inflammatory skin condition usually resolves with treatment but can recur at any time. Overall, the prognosis for erythroderma depends on the underlying cause and is generally good if the underlying disease can be treated effectively.