Injection Of Methylprednisolone Research Articles

TO COMPARE THE EFFECT OF PRE-EMPTIVE DEXAMETHASONE AND METHYLPREDNISOLONE EITHER BY INTRAMUSCULAR OR BY SUBMUCOSAL ROUTE FOR THE POSTOPERATIVE CONTROL OF PAIN, SWELLING, AND LIMITED MOUTH OPENING FOLLOWING THE EXTRACTION OF IMPACTED THIRD MOLARS

Introduction: The surgical removal of impacted mandibular third molars is an invasive procedure that involves extensive tissue trauma and a considerable postoperative inflammatory response. Although the inflammatory process is necessary for healing when exacerbated it may cause pain, swelling and limited mouth opening. Corticosteroids are among the most widely employed pre-operative medication administered for the control of such complications. Objective: To compare the effects of single dose of pre-operative Injection Dexamethasone versus Injection Methylprednisolone via Intramuscular or Submucosal route for controlling the post-operative pain, swelling and limited mouth opening in the removal of impacted mandibular third molars. Material and Method:. The present study was conducted on 40 healthy adult patients with bilaterally symmetrical impacted mandibular third molar, reporting to the Department of oral and Maxillofacial Surgery of Guru Nanak Dev Dental College and Research Institute, Sunam. Clinically, pain, swelling, mouth-opening were evaluated pre-operatively as baseline and post-operatively on 1st, 3rd and 7th post-operative days. Results: The results of our study are summarized below: In Group A: Submucosal injection of dexamethasone gave better results in controlling pain, swelling and trismus in comparison to Intramuscular injection of dexamethasone. In Group B: Submucosal injection of methylprednisolone showed better results in terms of pain, swelling and trismus when compared with Intramuscular injection of methylprednisolone. In Group C: Intramuscular injection of dexamethasone gave better results in terms of pain and mouth opening but, swelling was reduced with Intramuscular methylprednisolone. In Group D: Submucosal injection of dexamethasone showed better results in terms of pain, but swelling and mouth opening was reduced when methylprednisolone was used submucosal. Conclusion: The results of our study concluded that Dexamethasone is better than Methylprednisolone in controlling post-operative sequelae after third molar surgery. This can attributed to the higher potency and longer half-life and less sodium retaining capacity of dexamethasone than methylprednisolone. The results of our study also concluded that submucosal route of administration of drug is better than Intramuscular route because of the repository effect of the submucosal route, also this route is beneficial to the patient as well to the surgeon because needle penetration is done in the pre-anesthetized area, also it is an easy technique to be mastered by the surgeon.

Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial.

Background The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3). Material and Methods Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval. Results Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00). Conclusions The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo. Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.

Comparison of the effectiveness between epidural methylprednisolone injection and intranasal calcitonin in reduction of back pain due to osteoporosis in postmenopausal patients: a randomized controlled trial

<p class="abstract"><strong>Background:</strong> Back pain is a common symptom in osteoporotic patients due to spinal compression fracture. Conservative management like nonsteroidal anti-inflammatory drugs and spinal orthoses has not been able to produce early pain relief. Intranasal calcitonin spray is considered effective because of its analgesic effect and increase in bone density. Role of epidural steroid injection for the treatment of osteoporotic back pain has not been studied. This study was conducted to find out the efficacy of epidural methylprednisolone injection in management of osteoporotic back pain in postmenopausal patients.</p><p class="abstract"><strong>Methods:</strong> Hundred patients with osteoporotic back pain in postmenopausal subjects were allocated into two groups: epidural and calcitonin. Epidural group received a single dose of interlaminar epidural steroid injection with methylprednisolone 80 mg. Calcitonin group received one puff of 200 IU given through one nostril followed to the other nostril the next day. Visual analogue scale for pain was the outcome measurement used. Pain relief at rest within 7 days was taken as early pain relief and within 21days as late pain relief. Pain relief after 21<sup>st</sup> day was considered no response. Test of significance was done by Kaplan Meier, Chi square and Fisher exact tests.</p><p class="abstract"><strong>Results:</strong> Out of 50 patients, 38 patients in the epidural group got pain relief within 7 days and the finding was statistically significant.</p><p class="abstract"><strong>Conclusions: </strong>Epidural methylprednisolone gives faster pain relief as early as the first post-injection day with a median value of 2 days against 15 days in case of intranasal calcitonin spray.</p>

Cartilage Homeostasis Affects Femoral Head Necrosis Induced by Methylprednisolone in Broilers.

(1) Background: Since the large-scale poultry industry has been established, femoral head necrosis (FHN) has always been a major leg disease in fast-growing broilers worldwide. Previous research suggested that cartilage homeostasis could be taken into consideration in the cause of FHN, but the evidence is insufficient. (2) Methods: One-day-old broiler chickens were randomly divided into three groups, 16 broilers per group. The birds in group L were injected intramuscularly with methylprednisolone (MP) twice a week for four weeks (12.5 mg·kg−1). The birds in group H were injected intramuscularly with MP (20 mg·kg−1·d−1) for 7 d (impulse treatment). The birds in group C were treated with sterile saline as a control group. Broilers were sacrificed at 42 and 56 d. Blood samples were collected from the jugular vein for ELISA and biochemical analysis. Bone samples, including femur, tibia, and humerus, were collected for histopathological analysis, bone parameters detection, and real-time quantitative PCR detection. (3) Results: The FHN broilers in group L and H both showed lower body weight (BW) and reduced bone parameters. In addition, the MP treatment resulted in reduced extracellular matrix (ECM) anabolism and enhanced ECM catabolism. Meanwhile, the autophagy and apoptosis of chondrocytes were enhanced, which led to the destruction of cartilage homeostasis. Moreover, the impulse MP injection increased the portion of birds with severer FHN, whereas the MP injection over a long period caused a more evident change in serum cytokine concentrations and bone metabolism indicators. (4) Conclusions: The imbalance of cartilage homeostasis may play a critical role in the development of FHN in broilers. FHN broilers induced by MP showed a more pronounced production of catabolic factors and suppressed the anabolic factors, which might activate the genes of the WNT signal pathway and hypoxia-inducible factors (HIFs), and then upregulate the transcription expression of ECM to restore homeostasis.

Short-term Haematological Parameters Following Surgical Removal of Mandibular Third Molars with Different Doses of Methylprednisolone Compared with Placebo. A Randomized Controlled Trial.

ABSTRACTObjectivesTo evaluate the influence of a single intraoperative injection of methylprednisolone on short-term haematological parameters following surgical removal of mandibular third molars.Material and MethodsFifty-two patients with indications for surgical removal of bilateral impacted mandibular third molars were included in a randomized, split-mouth and double-blinded study design. Each molar were randomly allocated into one of following four groups: 20 mg methylprednisolone, 30 mg methylprednisolone, 40 mg methylprednisolone and placebo. Peripheral blood samples were obtained before and three days after surgery. Haematological parameters involving haemoglobin, white blood cell count and C-reactive protein (CRP) were evaluated and expressed as mean changes. Level of significance was 0.05. Furthermore, outcomes were correlated for age, sex, smoking and time of surgery.ResultsThere were no significant differences in postoperative haematological parameters with different doses of methylprednisolone compared with placebo. Peripheral blood samples revealed decreased level of haemoglobin and increased level of leucocytes and CRP in each group. Smokers displayed a significant lower level of haemoglobin and CRP compared with non-smokers (P < 0.05) and level of eosinophils decreased significantly with increasing age (P < 0.05).ConclusionsThis study indicates that a single intraoperative injection of methylprednisolone seems not to cause suppression of short-term haematological parameters compared with placebo following surgical removal of mandibular third molars.

A case of anti-LGI-1 encephalitis presented as acute psychosis

Anti-leucine-rich glioma inactivated protein-1 (LGI-1) encephalitis is a rare autoimmune disease with a varied neuropsychiatric clinical manifestation and have potential for reversal with immunotherapy. Early identification and treatment are therefore of paramount importance. We present the case of a 43-year-old man admitted for acute psychosis with facio-brachial dystonic seizures not responding to anti-epileptic drugs (AEDs). His symptoms started approximately 5 months prior admission to the hospital and associated with progressive cognitive impairment (particularly verbal and visio-spatial domains) followed by altered behavior, irrelevant talk, and disturbance in daily activities of living and facio-brachial dystonic seizures. There was history of allergic reaction to valproate, carbamazepine and levetiracetam, and serum sample tested strongly positive for LGI-1 (leucine rich glioma inactivated-1) antibodies. He was treated with injection methylprednisolone (1 gm intravenous) brief pulse therapy for 7 days and then underwent four sessions of plasma exchange followed by oral steroids and immunosuppressant therapy. Treatment was successful and patient returned to his previous baseline functioning but patient develops steroid induced hypomania and diabetes mellitus in the due course of time. Patient was discharged after successful resolution of symptoms. Patient did not come up for follow-up. He was contacted telephonically and we get to know that he relapsed after 2 weeks and consulted at higher center where he died while on treatment. Prognosis of anti-LGI-1 encephalitis is usually good but our patient died.

Beneficial Effects of Intrathecal Injection of Methylprednisolone Against Spinal Cord Injury in Rats

Background: High dose intravenous (i.t.) injection of methylprednisolone (MPSS) for spinal cord injury (SCI) is clinically controversial. Objectives: This study aimed to investigate whether i.t. MPSS would have a beneficial effect on SCI and whether or not it is a safe operation for SCI patients. Methods: An animal experiment was conducted to explore the safety and feasibility of i.t. Administration of MPSS. Male Sprague-Dawley rats were randomly divided into four groups: (1) sham group, i.t. injection of normal saline (NS) (n = 25); (2) control group, SCI surgery (created using the Infinite Horizon IH-400 impactor) with i.t. injection of NS (n = 25); (3) i.t. MPSS1 group, SCI with i.t. injection of MPSS by a pulse therapy (n = 25); (4) i.t. MPSS2 group, SCI with i.t. injection of MPSS intermittently (n = 25). Malondialdehyde (MDA), superoxide dismutase (SOD), and inflammatory cytokines in serum were measured at 6h, 24h, 48h, 7d, and 14d after surgery with commercial assay kits. Glial fibrillary acidic protein (GFAP) level was observed at 14 days after surgery by immunohistochemistry. Motor evoked potentials (MEP) and somatosensory evoked potential (SEP) were monitored and recorded separately before surgery and 1, 7, and 14 days after surgery. Also, locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale. Results: The results showed that the levels of MDA and SOD, and three inflammatory cytokines, including IL-1b, IL-6, and TNF-α were reduced in i.t. MPSS groups than that of the control group (all P &lt; 0.05). The expression of GFAP was inhibited after i.t. MPSS treatment. The amplitude was reduced, and the latency period of SEP and MEP recovery was prolonged (all P &lt; 0.05) after MPSS administration. In addition, the recovery of limb function (BBB score) was significantly ameliorated (P &lt; 0.05) in SCI rats treated with MPSS compared with the control group. Conclusions: Our results demonstrated that i.t. MPSS was a potential strategy for reducing the secondary damage after SCI, especially the MPSS pulse therapy.

Role of methylprednisolone on mRNA expression of BAX, BCL-2 gene in testicular torsion-detorsion of male albino Wistar rats

Study Background : Testicular torsion is a genitourinary emergency most common in children and emergencies requiring second surgery in adolescents after acute appendicitis1. Testicular torsion is more common on the left with a 1.2: 1 ratio, which is probably caused by a slightly longer spermatic cord on the left2. Testicular torsion can occur at any age, but the peak incidence is at age 14, with a peak of second occurrence at 1 year of age3. At 1 year of age, testicular torsion is a major cause of acute scrotum (83%). At the age of 3 - 13 years, the most frequent diagnosis is the torsion of the testicular appendix. After the age of 17 years, epididymitis is the most frequent diagnosis (75%)4. Method: This study is an experimental study, post-test only control group design, the sample was randomly divided into 4 groups, 2 intervention groups and 2 control groups. In this study the independent variables are the duration of the right torsion-detection treatment of the testes and the injection of Methylprednisolone in Wistar male rats. The dependent variables are mRNA expression in apoptosis and anti-apoptosis genes in rats’ ipsilateral and contralateral testes. . Results and Discussion: In this study, two-way ANOVA is used to analyze data between groups. Significant decrease in BAX gene mRNA expression (p <0.05) with Methylprednisolone was present when group 2 (TD) was compared with group 4 (TD-MP). Significant increase in the expression of BCL-2 anti-apoptotic gene (p <0.05) with Methylprednisolone was present when group 1 (T) was compared with group 3 (T-MP). When group 2 (TD) compared with group 4 (TD-MP) also showed a significant increase in the expression of BCL-2 anti-apoptotic gene (p <0.05). Conclusion: The administration of Methylprednisolone in the case of testicular torsion proved to be significant in increasing the expression of the BCL-2 gene that could be a protective mechanism against germ cell apoptosis in testicular tissue.

METHYLPREDNISOLONE INDUCED HYPOKALEMIA IN AN IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP) PATIENT

We reported an Idiopathic Thrombocytopenic Purpura (ITP) patient, 66-years-old (woman), with hypokalemia. She received 125 mg three times daily of methylprednisolone injection for her ITP. Corticosteroids are the initial treatment of ITP. Her potassium level decrease after she took methylprednisolone. Hypokalemia is also a common problem affecting the elderly or geriatric population. Many literatures reported side effects of corticosteroid is associated with hypokalemia. Monitoring potassium levels must be check during corticosteroid therapy. In this report, we describe the association between corticosteroid with hypokalemia effect.

Conservative or surgical treatment of carpal tunnel syndrome based on the severity and patient risk factors.

The carpal tunnel syndrome (CTS) is the most common median nerve compression disease which may result in impaired nerve function. This study was carried out to determine which treatment is more appropriate for moderate or severe CTS patients with or without risk factors. In a cohort prospective study, the patients with moderate CTS received a conservative treatment including night splint for 3months, one methyl prednisolone injection whereas patients with severe CTS underwent surgical release. They were followed for 1year using the bland scale based on the electromyography and nerve conduction velocity studies and five-point global assessment outcome scale. Totally, 68 moderate CTS cases (32 patients with risk factors and 36 without any risk factors) and 32 cases with severe CTS (16 patients with risk factors and 16 without any risk factors) were assess at 6months and 1year following the treatment. Although about 22% of moderate CTS patients with risk factors changed to mild CTS after 6months of conservative treatment, about 75% showed mild CTS or complete remedy following 1year (Pvalue < 0.001). This result was about 30% at 6 months and about 95% at 1year following conservative treatment in patients with moderate CTS without risk factors. None of moderate CTS patients with or without risk factors underwent surgery after 1year of follow-up. Although almost all patients with severe CTS, with and without risk factors, showed complete recovery or changed to mild CTS at 1year postoperatively, the result was statistically significant for cases without risk factors (Pvalue = 0.002). Conservative treatment for moderate CTS would be a good option, and the final result may be seen 1year later; however, its positive effect is quicker and better for moderate CTS cases without risk factors. Surgical release of the carpal tunnel may be the best choice not only for severe CTS cases with risk factors but also for cases without risk factors. For obtaining consistent rapid result, it is recommended to do surgical release for all cases of moderate or severe CTS without considering risk factors, but more clinical researches are needed. II.

Long-term Outcomes of Patients With Fungal Infections Associated With Contaminated Methylprednisolone Injections.

BackgroundThe largest health care–associated infection outbreak in the United States occurred during 2012–2013. Following injection of contaminated methylprednisolone, 753 patients developed infection with a dematiaceous mold, Exserohilum rostratum. The long-term outcomes of these infections have not been described.MethodsThis retrospective cohort study of 440 of a total of 753 patients with proven or probable Exserohilum infection evaluated clinical and radiographic findings, antifungal therapy and associated adverse effects, and outcomes at 6 weeks, 3, 6, 9, and 12 months after diagnosis. Patients were grouped into 4 disease categories: meningitis with/without stroke, spinal or paraspinal infections, meningitis/stroke plus spinal/paraspinal infections, and osteoarticular infections.ResultsAmong the 440 patients, 223 (51%) had spinal/paraspinal infection, 82 (19%) meningitis/stroke, 123 (28%) both, and 12 (3%) osteoarticular infection. Of 82 patients with meningitis/stroke, 18 (22%) died; among those surviving, 87% were cured at 12 months. Only 7 (3%) of 223 patients with spinal/paraspinal infection died, but at 12 months, 68% had persistent or worsening pain and only 47% were cured. For the 123 patients with both meningitis/stroke and spinal/paraspinal infection, 10 (8%) died, pain persisted in 72%, and 52% were cured at 12 months. Only 37% of those with osteoarticular infection were cured at 12 months. Adverse events from antifungal therapy were noted at 6 weeks in 71% of patients on voriconazole and 81% on amphotericin B.ConclusionsFungal infections related to contaminated methylprednisolone injections culminated in death in 8% of patients. Persistent pain and disability were seen at 12 months in most patients with spinal/paraspinal infections.

Comparing pain relief and functional improvement between methylprednisolone and dexamethasone lumbosacral transforaminal epidural steroid injections: a self-controlled study.

BackgroundPrevious studies have shown varying results between lumbosacral transforaminal epidural steroid injections (TFESIs) performed with particulate versus non-particulate corticosteroids. The purpose of this study was to investigate the difference in pain relief and functional improvement between particulate and non-particulate lumbosacral TFESIs in patients who had undergone both injections, sequentially.MethodsThis was a self-controlled, retrospective study of 20 patients who underwent both a methylprednisolone and a dexamethasone TFESI to the same vertebral level and side. Primary outcomes included pain relief according to the visual analogue scale (VAS) and functional improvement determined by a yes/no answer to questions regarding mobility and the activities of daily living. Post-injection data was recorded at 2, 3, and 6 months.ResultsA decrease in VAS scores of –3.4 ± 3.0 (mean ± standard deviation), –3.1 ± 3.1, and –2.8 ± 3.4 was seen for the methylprednisolone group at 2, 3, and 6 months, respectively. Similar decreases of –3.9 ± 3.5, –3.4 ± 2.8, and –2.3 ± 3.4 were seen in the dexamethasone group. There was no significant difference in pain relief at any point between the two medications. The percentage of subjects who reported improved function at 2, 3, and 6 months was 65%, 51%, and 41%, respectively, for the methylprednisolone group and 75%, 53%, and 42% for the dexamethasone group.ConclusionsThese findings support the use of non-particulate corticosteroids for lumbosacral TFESIs in the context of documented safety concerns with particulate corticosteroids.

Gastrin for prevention of steroid-associated osteonecrosis in rats

Summary Background/Objective Steroid-associated osteonecrosis (SAON) mostly occurs in large joints such as hip that finally results in joint collapse and replacement. An effective strategy for preventing SAON is inhibition of bone resorption and lipid formation, whereas promoting bone formation at osteonecrotic-sensitive skeletal sites. The objective of this study was to investigate whether gastrin administration could effectively prevent SAON in vivo and had a significant effect on osteogenesis, osteoclast differentiation and/or adipogenesis in vitro. Methods SAON was induced in rats by injection of both lipopolysaccharide and methylprednisolone. SAON rats were divided into three groups (untreated, low- ​and high-dose gastrin) and treated for two weeks. Lesions in SAON were identified, and efficacy of gastrin was evaluated in osteoclast activity, osteogenesis ​and adipogenesis. In vitro experiments evaluated the osteogenic and adipogenic potential of induced bone marrow stem cells, as well as osteoclast differentiation of stimulated bone marrow cells. Results Gastrin administration effectively prevented the development of SAON in vivo and significantly downregulated osteoclastogenesis, and upregulated osteogenesis in vitro. The underlying mechanism was potentially involved in the inhibited nuclear factor kappa-B (NF-κB) pathway leading to not only suppressed osteoclastogenesis but also facilitated osteoblastogenesis. Conclusion The present study demonstrated for the first time that gastrin could effectively prevent SAON in vivo and had a significant effect on osteogenesis, osteoclast differentiation and/or adipogenesis in vitro that should be an important link between gastrointestinal hormone and metabolic bone diseases. Translational potential of this article Gastrin prevents steroid-associated osteonecrosis with decreasing bone resorption and apoptosis, also enhancing bone formation. These findings provide in vivo evidence to support the use of gastrin to treat osteonecrosis.

Treatment of rats with spinal cord injury using human bone marrow-derived stromal cells prepared by negative selection

BackgroundSpinal cord injury (SCI) is a highly debilitating pathology without curative treatment. One of the most promising disease modifying strategies consists in the implantation of stem cells to reduce inflammation and promote neural regeneration. In the present study we tested a new human bone marrow-derived stromal cell preparation (bmSC) as a therapy of SCI.MethodsSpinal cord contusion injury was induced in adult male rats at thoracic level T9/T10 using the Infinite Horizon impactor. One hour after lesion the animals were treated with a sub-occipital injection of human bmSC into the cisterna magna. No immune suppression was used. One dose of bmSC consisted, on average, of 2.3 million non-manipulated cells in 100 μL suspension, which was processed out of fresh human bone marrow from the iliac crest of healthy volunteers. Treatment efficacy was compared with intraperitoneal injections of methylprednisolone (MP) and saline. The recovery of motor functions was assessed during a surveillance period of nine weeks. Adverse events as well as general health, weight and urodynamic functions were monitored daily. After this time, the animals were perfused, and the spinal cord tissue was investigated histologically.ResultsRats treated with bmSC did not reject the human implants and showed no sign of sickness behavior or neuropathic pain. Compared to MP treatment, animals displayed better recovery of their SCI-induced motor deficits. There were no significant differences in the recovery of bladder control between groups. Histological analysis at ten weeks after SCI revealed no differences in tissue sparing and astrogliosis, however, bmSC treatment was accompanied with reduced axonal degeneration in the dorsal ascending fiber tracts, lower Iba1-immunoreactivity (IR) close to the lesion site and reduced apoptosis in the ventral grey matter. Neuroinflammation, as evidenced by CD68-IR, was significantly reduced in the MP-treated group.ConclusionsHuman bmSC that were prepared by negative selection without expansion in culture have neuroprotective properties after SCI. Given the effect size on motor function, implantation in the acute phase was not sufficient to induce spinal cord repair. Due to their immune modulatory properties, allogeneic implants of bmSC can be used in combinatorial therapies of SCI.

Effect of icariin on early steroid-induced osteonecrosis of the femoral head in rabbits

To explore the effect of icariin on early steroid-induced osteonecrosis of the femoral head in rabbits. Fifty mature New Zealand rabbits (weighing, 2.5-3.0 kg) were randomly divided into control group ( n=10), model group ( n=20), and experimental group ( n=20). The rabbits of model and experimental groups were injected with lipopolysaccharide and methylprednisolone to establish the animal model of early steroid-induced osteonecrosis of the femoral head. The rabbits of experimental group were feeded with icariin solution once a day for 6 weeks since the first injection of methylprednisolone, whereas the rabbits of control and model groups were given normal saline at the same time points. The left femoral heads were removed after 6 weeks and gross morphological features were evaluated. Micro-CT scan was performed to analyze the trabecular microstructure with the following parameters: trabecular bone volume to total volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Tn), and trabecular separation (Tb.Sp). The Micro-CT scan was also converted to three-dimensional reconstruction images for observation. HE staining was applied to observe the trabecular structure and morphological changes of osteocytes and marrow adipocytes. It was also used to determine whether the samples of femoral heads occurred osteonecrosis based on the criteria for pathological diagnosis, and calculate the rate of empty lacunae. Seven rabbits died during the study, and 9, 16, and 18 rabbits in the control, model, and experimental groups, respectively, enrolled the final analysis. Compared with control group, the femoral head collapse and trabecular breaks were more obvious, and the trabeculae were sparse with irregular arrangement in the model group according to the results of gross observation, Micro-CT scan, and three-dimensional reconstruction images. But in the experimental group, the surface of femoral head was slight shrinking without obvious collapse, and the degeneration of trabecular structure was mild. According to bone microstructures analysis, the Tb.N, Tb.Tn, and BV/TV of femoral head in model and experimental groups were lower than those in control group, while the Tb.Sp in the model and experimental groups were significantly higher. The Tb.N, Tb.Tn, and BV/TV of femoral head in experimental group were higher than those in model group, while the Tb.Sp in the experimental group was significantly lower. The differences between groups were all significant ( P<0.05). In the model group, HE staining showed that the number of osteocytes reduced, the number of empty lacunae increased, and the marrow adipocytes piled up in the space between femoral trabeculae, some even mashed together like a cyst. In the experimental group, the trabecular structure was still relatively complete compared with model group, no obvious apoptosis of osteocytes was observed, the size and number of adipocytes were basically normal. None of the animals in control group occurred osteonecrosis of the femoral head based on the criteria for pathological diagnosis, and the incidence of osteonecrosis were 81.3% (13/16) in the model group and 66.7% (12/18) in the experimental group, and the difference was not significant ( P=0.448). The rate of empty lacunae of osteonecrotic femoral heads in the model group was 33.1%±1.4%, which was higher than that in experimental group (18.9%±0.8%) and in control group (12.7%±1.5%), and the differences between groups were significant ( P<0.05). The icariin has a protective effect on the early steroid-induced osteonecrosis of the femoral head in rabbits, which can decrease osteocytes apoptosis, improve the bone microstructure, and delay such disease processes.

Efficacy of combination therapy of Hyaluronic acid and Methylprednisolon verses Hyaluronic acid single therapy in knee Osteoarthritis : A comparative study

Background: Osteoarthritis of knee joint is one of the most common problem which cause pain, loss of function even joint disability and increases misery and morbidity in old age. Now a day’s intra-articular injection of single Hyaluronic acid or corticosteroids (Methylprednisolone) are using for knee osteoarthritis cases. But the combined therapy by injection of both Hyaluronic acid and Methyl prednisolone are not so much practiced and still under debate.&#x0D; Objectives: To compare the efficacy of intra-articular injection of combined Hyaluronic acid and Methyl prednisolone with single Hyaluronic acid alone.&#x0D; Methods: A prospective, comparative study was done in Northern International Medical College Hospital, Dhaka, during May 2017 to April 2018 at Out Patient Department with 80 patients (132 knees). Patients were randomized into two groups: Group-A with 40 patients with 15 unilateral and 25 bilateral knee cases (65 knees) were treated with combined Hyaluronic acid and Methyl prednisolone and Group-B with 40 patients with13 unilateral and 27 bilateral knee cases (67 knees) were infiltrated with single Hyaluronic acid. Results were evaluated with Knee Society Score (KSS) and Visual analogue score (VAS) at the 1st week, 1st month and 3rd month after injection.&#x0D; Result: In both Group (A and B) patients of age 61–70 years were highest, 50% and 45% respectively. Male and female ratio was 1:2.2. At the 1st week KSS for pain in Group-A (mean 65.6) was better than Group-B (mean 57.4). At the 1st month mean pain scores (Group-A 72.4, Group-B 64.4) and the 3rd month (Group-A 81.4, Group-B 75.6) and mean function scores at 1st week (Group-A 61.3, Group-B 49.6)), 1st month (Group-A65.1, Group-B 53.6) and 3rd month (Group-A68.4, Group-B 59.4). The KSS for pain and function improved in combination therapy group.VAS decreased in both groups.&#x0D; Conclusion: As combination therapy by Hyaluronic acid and Methyl prednisolone showed better efficacy than single Hyaluronic acid. Therefore, combination of these two drugs in a single vial can be used as an effective and easy nonoperative treatment of knee osteoarthritis.&#x0D; Northern International Medical College Journal Vol.10 (2) Jan 2019: 366-369

Successful and Complete Recovery of the Ulnar Nerve After Eight Years of Chronic Injury Through Local Steroid Injections: A Case Report.

Peripheral neuropathy is a common neurodegenerative disease, with vastness of inducers and causalities. The acquired form peripheral neuropathy can be caused by traumatic injuries caused by nerve lacerations or compressions. Such injuries are usually followed by Wallerian degeneration, and inflammatory reaction. We present a case of a 33-year-old female with a chronic loss of the ulnar nerve function for 8 years after traumatic laceration. After that, she regained the functions of ulnar nerve after nerve stimulation by peri-ulnar nerve injection of methylprednisolone and lidocaine. The theory behind using steroids is related to the fact that the immune system could induce a secondary injury that interferes with the recovery. Many studies have shown effectiveness in using steroids alone or when combined with other substances on nerve regeneration in animal models. We believe that this is the first report of nerve recovery using local steroidal injections after a traumatic injury.

Evaluation of epidural injection of steroid methyl prednisolone, linocaine and normal saline through the lumber epidural route in the management of low back pain

Background: Epidural injections have been used for decades for treatment of low back pain. The use of extradural medication to relieve back-ache has been studied in recent years and encouraging results have been published. The present study deals with the epidural injection of steroid methyl prednisolone, lignocaine and normal saline combination in the management of low back pain. Method: The present prospective study was conducted on 50 patients with low back pain form Karnataka Institute of Medical Sciences Hospital, Hubli were selected. All the patients were admitted and referred from the orthopedic department of the Karnataka Institute of Medical Sciences, Hubli to the Pain Clinic of our Anesthesiology Department, after they failed to improve with two weeks of conservative therapy such as bed rest, skin traction and non-steroidal anti-inflammatory drugs. Out of 50 patients 36 were males and 14 were females (n=50). Study was explained to the patients and the informed consent was obtained from all the patients. Result: The pain relief was assessed by VAS and the score was excellent in 23.91%, good in 47.82%, satisfactory in 15.22 and poor in 13.42%. There was a very mild fall of 10 mmHg of BP below pre-operative value in 5 patients and two patients complained of headache. Other than these no complications have been encountered. Conclusion: Epidural injection of corticosteroids methyl prednisolone and local anaesthetic lignocaine is an excellent technique for the relief of chronic low back-ache. The side effects are few compared to surgical management. The success rate is high in comparison with other conservative methods. So it can be safely recommended for the relief of low back pain where conservative methods have failed to relieve the pain before embarking on surgical procedure (laminectomy).

A case of glutathione-induced life-threatening asthma attack

Baek-ok injection (glutathione) has been widely used antioxidant therapy to whiten and has antiaging effects in Korea. Glutathione is an enzyme which synthesizes leukotriene, then it can induce asthma attack theoretically; however, there have been few case re ports concerning this therapy. In this report, we described a 41-year-old woman who developed glutathione-induced life-threaten ing asthma attack. She has asthma history controlled by an intermittent salbutamol inhaler. She developed general weakness and dyspnea right after glutathione injection, and injection was discontinued. Dyspnea was progressively aggravated, and she lost con sciousness with shock. Cardiopulmonary resuscitation was started, and she arrived at the Emergency Department with wheezing, hypoxia, severe respiratory acidosis, and nonmeasurable blood pressure. Intubation and mechanical ventilation were started with intramuscular epinephrine/intravenous methylprednisolone injection and repeated salbutamol/ipratropium/budesonide inhala tion. After 5 hours, extubation and spontaneous breathing were successful without wheezing. Next day, pulmonary function test showed moderate an obstructive airway disease pattern, and she was discharged with inhaled fluticasone/salmeterol, oral methyl prednisolone, and montelukast. We can exclude anaphylaxis, because serum tryptase obtained at the Emergency Department was 0.0 mg/dL and the absence of skin lesions and angioedema at arrival. Baek-ok injection (glutathione) should be carefully performed in asthma patients. (Allergy Asthma Respir Dis 2020;8:89-91)

Monoarticular synovitis of knee: dealing with the dilemma.

Introduction: Chronic synovitis involving a single large joint remains a diagnostic dilemma. We present 61 cases of chronic synovitis of the knee, followed prospectively for 2 years. The study focuses on the diagnosis, management, and histopathological correlation. Methods: We prospectively studied 61 patients with chronic mono-articular synovitis of the knee joint, between July 2016 and September 2017. All patients underwent plain radiographs, magnetic resonance imaging, and arthroscopic examination with synovial biopsy. Further treatment was based on findings of histopathological examination. Results: The average duration of symptoms was 7.72 ± 4.34 months. The mean age at presentation was 29.93 ± 15.56 years. Results of histopathological examination showed chronic nonspecific inflammation in 28 patients (46%), features suggesting tubercular infection in 19 patients (31%), pigmented villonodular synovitis in seven patients (11.5%), rheumatoid arthritis in three (5%) patients, acute inflammation in three (5%) patients and findings suggestive of synovial chondromatosis in one (1.5%) patient. Treatment was based on histopathological results. Intra-articular injections of methylprednisolone (80 mg depot preparation) were given to all patients with nonspecific synovitis and rheumatoid arthritis. Anti-tubercular treatment was started for patients with tubercular synovitis. Complete arthroscopic/open synovectomy followed by radiotherapy was carried out for patients with pigmented villonodular synovitis. Non-steroidal anti-inflammatory drugs are used for patients with acute on chronic inflammation. All patients had symptomatic relief and functional improvement in further follow-up. Discussion: Histopathological reporting remains the mainstay for diagnosis. The various differentials should always be kept in mind when approaching patients with chronic mono-articular synovitis. Specific treatment can be started once the diagnosis is confirmed.