Injection-related Complications Research Articles

Cloning and characterization of a hyaluronate lyase EsHyl8 from Escherichia sp. A99

Hyaluronidase, an enzyme that degrades hyaluronic acid (HA), is utilized in clinical settings to facilitate drug diffusion, manage extravasation, and address injection-related complications linked to HA-based fillers. In this study, a novel hyaluronate lyase EsHyl8 was cloned, expressed, and characterized from Escherichia sp. A99 of human intestinal origin. This lyase belongs to polysaccharide lyase (PL) family 8, and showed specific activity towards HA. EsHyl8 exhibited optimal degradation at 40 °C and pH 6.0. EsHyl8 exhibited a high activity of 376.32 U/mg among hyaluronidases of human gut microorganisms. EsHyl8 was stable at 37 °C and remained about 70 % of activity after incubation at 37 °C for 24 h, demonstrating excellent thermostability. The activity of EsHyl8 was inhibited by Zn2+, Cu2+, Fe3+, and SDS. EsHyl8 was an endo-type enzyme whose end-product was unsaturated disaccharide. This study enhances our understanding of hyaluronidases from human gut microorganisms.

Improved Recovery after Vestibular Schwannoma Excision with Intratympanic Gentamicin Prehabilitation.

Translabyrinthine excision of a vestibular schwannoma is associated with acute vestibular failure. Preoperative intratympanic gentamicin (ITG) injections can improve objective balance function after surgery but its clinical benefits remain to be established. Adult patients undergoing translabyrinthine removal of a vestibular schwannoma between January 2014 and February 2018 underwent preoperative vestibular function testing. Patients were divided in to 3 groups, those with vestibular function (VF) who received ITG injections, those with VF but did not receive ITG and those with no VF. Groups were compared according to degree of vertigo, length of stay, time to unassisted mobilization, and postoperative anti-emetic consumption. Forty six patients had ITG injections (Group 1), 7 had residual VF but refused treatment (Group 2), 21 had no VF (Group 3). Group 1 had a significant improvement in vertigo over time whereas groups 2 and 3 did not. There was a statistically significant 70% decrease in time to independent mobilization between Group 1 and other groups and a 19% decrease in length of stay in Group 1 compared to other groups although this did not reach statistical significance. Two patients had injection-related complications. Group 1 used less anti-emetics than other groups but this was not statistically significant. Preoperative intratympanic gentamicin injection with vestibular rehabilitation exercises is associated with less postoperative vertigo and earlier postoperative mobilization. There was reduced duration of hospitalization and decreased consumption of anti-emetic but not significantly so possibly because of low numbers of patients in the no treatment group. 2 Laryngoscope, 134:3316-3322, 2024.

Orbital corticosteroid injections for the treatment of active thyroid eye disease.

To study the efficacy of orbital injections of triamcinolone acetonide mixed 1:1 with dexamethasone in the treatment of active thyroid eye disease. Patients that received orbital injection(s) of triamcinolone acetonide mixed 1:1 with dexamethasone for thyroid eye disease were included in this retrospective study. Demographic and clinical data were collected from the pre-treatment and 1 month follow up evaluations. Clinical data included subjective pain and diplopia scores, best-corrected visual acuity, Intraocular pressure, extraocular motility, clinical activity score, Hertel exophthalmometry, and upper eyelid margin to reflex distance. Fifteen patients, 33 orbital injections, were included in the study. The average patient age was 59.2 years (SD ± 13.0) and 89% female. Subjectively, 67% of patients reported improvement of orbital pain and pressure versus 28% stable and 5% worse (p <0.001). Post-procedure clinical activity score decreased from 3.84 to 3.00 (p = 0.0004). There were no significant differences in upper eyelid margin to reflex distance (4.1 ± 1.4mm vs. 4.3 ± 2.6mm, p = 0.45), Hertel exophthalmometry (21.7 ± 9.4mm vs. 21.8 ± 7.6mm, p = 0.56), or extraocular motility (21% improved vs. 72% stable and 7% worsening, p = 0.50). No steroid-responsive increases in intraocular pressure or injection-related complications were reported. Orbital steroid injections can successfully reduce symptoms of TED and may be a reliable tool in the treatment of TED as a relatively safe, fast-acting, efficacious treatment option, particularly as a bridge to other therapies.

Use of botox for sialorrhea and dysphagia in the neonatal population

IntroductionBotox is frequently used for sialorrhea in patients with compromised airways and those with etiologies causing difficulty with secretion management (i.e. strokes, neurologic disorders, etc.). There are no published studies regarding the use of botulinum toxin (BoNT) in the neonate population. We aim to discuss our experience and safety of BoNT use in the neonate population in regards to alleviating secretion management and airway protection. MethodsRetrospective review of neonates admitted to the neonatal intensive care unit (NICU) ≤12 months of age who received BoNT injection to submandibular (SMG) and parotid (PG) glands for sialorrhea/dysphagia. BoNT was administered under ultrasound (u/s) guidance by interventional radiology. Results6 children were examined. 2 (33 %) were male. Avg NICU stay was 87.5 ± 33.1 days. 2 underwent surgical airway intervention prior to injection. Mean age at initial BoNT was 1.5 ± 0.7 months. Avg weight at injection was 4 ± 1.1 kg. Each PG and SMG were injected in 5/6 cases. Bilateral SMG were unidentified on u/s in 1 case and thus not injected. Dose range injected per gland was 5-15u. 100 % required tube feeds, 50 % with tubes distal to stomach (NJT/NDT). 83 % were completely NPO prior to injection and there was no noted clinical improvement in oral skills post injection. All had noted desats/apneas prior to injection and 83 % had reported decreased events post injection. 50 % had reported decrease O2 requirements and frequent suctioning 2wks after injection, however 2 (33 %) required surgical airway intervention after injection (trach, SGP/MDO). 4/6 (67 %) trialed medical therapy, anticholinergics being the most common. 50 % underwent 2nd injection (age = 6.5 ± 0.3 months) avg. 4.7 ± 0.7mo after 1st injection, and the same 3pts underwent 3rd injection (age = 12.5 ± 2.4 months) avg. 6.1 ± 2.5mo after 2nd injection. 1 pt. had a total 6 injections. There were no injection related complications. ConclusionBoNT injection is a safe, non-invasive alterative for management of sialorrhea in neonates. Further extensive study needs to be performed to identify the optimal dose per gland in this population.

Transcaruncular double injection technique for peribulbar anesthesia in vitreoretinal surgery.

Local anesthesia is commonly adopted in vitreoretinal surgery to reach painless and akinesia surgical condition. Currently, peribulbar anesthesia (PBA) and subtenonian injection (STN) are the most widely used methods. We propose a transcaruncular double injection peribulbar technique (TRS) and aim to compare it with both standard PBA and STN injections. A total of 105 patients underwent either TRS or PBA or STN. Numerical Rating Scale (NRS) was used to assess pre, post and intraoperative pain. Best akinesia score, onset and duration of akinesia were evaluated by two independent graders. The need for supplementary injection was also registered. TRS group was characterized by a lower intraoperative NRS variation and absolute NRS score both at the beginning of surgery (p 0.046), after 30 minutes (p 0.032) and at the end of surgery (p 0.002) compared to the other groups. TRS group also showed better akinesia score (p 0.004), fastest onset (p 0.002) and longer duration (p 0.042) compared to both PBA ad STN. No injection related complications were reported in the 3 groups. the newly proposed transcaruncular PBA provided superior pain control and akinesia level with no additional adverse events.

Endoscopic Glue Injection Versus Endoscopic Human Thrombin Injection for Bleeding Gastric Varices-A Randomized Controlled Trial.

Acute gastric variceal bleeding (AGVB) is a potentially fatal consequence of portal hypertension, accounting for 10% to 30% of all variceal bleeding. Although endoscopic cyanoacrylate glue injection is a common treatment for acute hemostasis, it has been linked to significant side effects. In the treatment of AGVB, there is limited evidence of the efficacy and relative safety of endoscopic human thrombin injection over glue injection. A total of 52 AGVB patients were randomized to receive either thrombin injection (25 patients) or glue injection (27 patients). The primary outcome was the incidence of any glue or thrombin injection-related post-therapy complications. Initial hemostasis, rebleeding, and mortality were all secondary end goals. Both groups had comparable baseline data. Hemostasis of active bleeding at endoscopy was 100.0% (10/10) in the thrombin group and 87.5% (7/8) in the glue group (P=0.44). Treatment failure after 5 days occurred in 2 patients (6.1%) in the glue group compared with none in the thrombin group (P=0.165). Between 6 and 42 days after index bleeding, rebleeding occurred in 4 patients in the thrombin group compared with 6 patients in the glue group (P=0.728). In the thrombin group, none of the patients had post-treatment ulcers on gastric varices compared with 14.81% (4/27) that occurred in the glue group (P=0.045), a statistically significant observation. Overall, complications occurred in 4 (20%) and 11 (40.7%) patients in the thrombin and glue groups, respectively (P=0.105). Two patients in the glue group died. To achieve successful AGVB hemostasis, endoscopic thrombin injection has been proven efficacious. However, glue injection may be linked to a higher rate of rebleeding and post-therapy gastric variceal ulceration compared with thrombin.

Cell-free fat extract-loaded microneedles attenuate inflammation-induced apoptosis and mitochondrial damage in tendinopathy.

Existing clinical treatments for tendinopathy mainly focus on reducing pain, whereas inhibiting or reversing disease progression remains challenging. Local therapeutic drugs, such as glucocorticoids, cause adverse effects on the metabolism of tendon tissues and injection-related complications. Therefore, new administration modalities for tendinopathy need to be developed. In this study, we designed a hydrogel-based microneedle (MN) system for the long-term transdermal delivery of our novel biological cell-free fat extract (CEFFE) to treat tendinopathies. We found that CEFFE-loaded MNs (CEFFE-MNs) had good biosafety and inhibited lipopolysaccharide (LPS)-induced apoptosis and matrix degradation in Achilles tendon cells of rats. The Achilles tendons of rats returned to their maximum mechanical strength after applying CEFFE-MNs. The administration of CEFFE-MNs had better anti-apoptosis and tendon repair-promoting effects than CEFEF injections in vivo. Transcriptome sequencing indicated that the anti-apoptosis effect of CEFFE-MNs was highly related to tumor necrosis factor (TNF) signaling. CEFFE-MNs inhibited the expression of TNF, TNF receptor 1, and downstream nuclear factor-kappa B signaling. Additionally, CEFFE-MNs rescued LPS-induced mitochondrial dynamics in tendon cells via the TNF-Drp1 axis. Our study reports a novel CEFFE-MN system that exhibits long-term anti-inflammatory and anti-apoptotic effects, suggesting it as a new treatment route for tendinopathy with broad clinical translation prospects.

People who inject oral morphine favor experimentation with injectable opioid substitution

BackgroundThe French Addictovigilance network has observed the existence of the intravenous use of oral morphine capsules among people suffering from opioid use disorders. According to persons who inject morphine, these capsules are easy to dissolve and then inject, giving them the image of an "injectable" opioid substitution treatment (OST). In France, validated OSTs are only available orally, so dissolving morphine capsules represents the only alternative for patients who are not sufficiently relieved by oral forms.This practice presents risks related to the potential persistence of particles of the oral galenic in the injectable solution, despite its filtration, but also risks—notably of overdose—related to the pharmacological effects of opioids and to variations of the quantities of morphine extracted during the dissolution of the capsules. We conducted an online survey among the people concerned to collect data on their needs and expectations regarding a possible injectable substitution.MethodAn anonymous online survey including all voluntary respondents residing in France and using oral morphine intravenously was conducted in partnership with the Psychoactif harm reduction organization, from 23/03/2020 to 01/04/2021.ResultsThe analysis of the 157 exploitable questionnaires showed that 41% of the respondents obtained their drugs only from illegal markets. The others received, regularly or occasionally, medical prescriptions, reimbursed in 84% of cases. For 78% of the respondents, injection was the most frequent route of morphine administration, with 3.8 ± 2 injections per day. 56% of the respondents were receiving an OST, on prescription (79%), monthly (86%), in addition to morphine.Skenan® capsules were the most frequently used (81%) and 47.2% of the respondents had already experienced injection-related complications. 95% of the respondents were in favor of experimenting with an injectable morphine substitution. Those who never received medical prescriptions were the youngest (< 25 years) respondents, they reported only occasional use of morphine, and always intravenously.ConclusionOral morphine capsules dissolved and injected intravenously are not a safe and sustainable injectable substitution. Respondents wish to be able to benefit from an injectable substitution with a formulation adapted to the intravenous route. The availability of an injectable substitution would facilitate harm reduction and entry into care for the people concerned, particularly the youngest who have never received morphine prescriptions.

Effect of Platelet Rich Plasma Therapy for Shoulder Osteoarthritis: Double Blinded Randomized Controlled Study

Abstract Background Platelet-rich plasma (PRP) is widely used in musculoskeletal conditions and orthopaedic surgery ranging from clinic-based injections for tendinopathies to intra-operative application to augment soft-tissue healing. It has been used in knee osteoarthritis, rotator cuff tears, elbow epicondylitis, anterior cruciate ligament reconstruction, shoulder impingement syndrome and various tendinopathies to date, with an expanding list of indications. While available evidence supports the use of PRP in the management of lateral epicondylitis and knee osteoarthritis, there is limited clinically significant evidence for other indications Aim of the Work This study aims to evaluate the efficacy of platelet-rich plasma as a treatment for primary and secondary shoulder osteoarthritis pain. Patients and Methods A prospective, double-blinded randomized control study in Ain Shams University Hospitals from 3 to 6 months. The patients were divided into 2 groups using computerized generated randomization. The control group received 5 ml 0.9% saline injection in the intra-articular shoulder (between glenohumeral joint). The study group received 5 ml of PRP treatment. Results The study results showed: All demographic data (age, sex, weight and BMI) and chronic diseases were insignificantly different between both groups, all medical data (chronic diseases, type of osteoarthritis, severity of symptoms, time of symptoms, radiological finding and type of treatment) were insignificantly different between both groups, NRS was significantly lower in study group compared to control group at ―2nd evaluation post injection|| and was insignificantly different between both groups at ―1st evaluation post injection||. (P &amp;lt; 0.05), range of movement was insignificantly different between both groups at 2nd evaluation post injection and injection related complications (inflammation and infection) were insignificantly different between both groups. Conclusion In general, efficacy was observed in treatment with PRP alone in shoulder osteoarthritis. However, patients receiving PRP treatment are less likely to experience post-injection pain and are more likely to recover faster when compared to patients receiving saline alone.

Treatment of Retinopathy of Prematurity by Intravitreal Injection of Bevacizumab

Introduction: Retinopathy of prematurity is a vasoproliferative disease of the developing retina that is a significant cause of paediatric morbidity and blindness worldwide. Although management by early treatment ROP (ETROP) criteria has led the way to improving the outcomes of treatment-requiring posterior (zone 1) ROP, the failure rate continues to be significant for aggressive disease. Managing a premature infant with ROP is a significant challenge to ophthalmologists and associated physicians. However, increasingly younger and lower birth-weight infants can survive with advances in neonatal care. Objectives: To assess the effectiveness of intravitreal injection of Bevacizumab on regression of retinal neovascularization in stage III, Zone 1, 2 retinopathy of prematurity and aggressive posterior retinopathy of prematurity. Methods: Intravitreal Injection of Bevacizumab (0.625mg/0.025mL) was performed on 34 eyes of 17 newborns with stage III, Zone 1, 2 retinopathy of prematurity and aggressive posterior retinopathy of prematurity. The changes in retinal neovascularization were assessed by frequent fundoscopy. Results: Retinopathy of prematurity regressed in all the eyes treated. The retinal vascularization proceeded beyond the demarcation line. Four eyes of 2 patients needed repeat injections. One eye needed an additional laser. There was no injection-related complication observed. Conclusion: Intravitreal injection of Bevacizumab can be considered an effective modality in treating Retinopathy of Prematurity. It is recommended to perform more studies to assess its long-term effect on the body's vascular system. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 24-27

Efficacy and safety of different doses of subcutaneous galcanezumab in chronic and episodic migraine: A pooled analysis of 3651 patients (P10-12.003)

<h3>Objective:</h3> In this systematic review and meta-analysis, we aimed to assess the efficacy and safety of galcanezumab doses in chronic and episodic migraines. <h3>Background:</h3> Migraine is a severe kind of headache and is represented by 14% of the population and up to 18% of women. Galcanezumab is a humanized monoclonal antibody that binds to calcitonin gene-related peptides and is used to prevent migraines. <h3>Design/Methods:</h3> In September 2022, we conducted a comprehensive search in five databases, including EMBASE, PubMed, Cochrane Library, Web of Science, and SCOPUS. We appraised each study using the Cochrane risk of bias tool. Our primary outcome was the change in the monthly migraine headache days (MMDs). Data were extracted and analyzed using RevMan version 5.4. <h3>Results:</h3> We included eight randomized controlled trials with 3651 migraine patients. In episodic migraine, galcanezumab (120–150 and 240–300mg) showed a significant reduction in MMDs compared to placebo after six months. Also, in chronic migraine, galcanezumab (120mg) reduced MMDs compared to placebo after three months. The analysis was conducted according to each month’s records, and the mean difference change ranged from −1.62 to −2.86 (P-value &lt; 0.001). All doses showed a significantly higher rate in ≥50%, ≥75%, and 100% response rates. Regarding safety outcomes, galcanezumab was associated with injection site-related complications such as pruritis, reaction, swelling, or erythema. In contrast, the two groups showed no difference regarding any adverse or serious adverse events, upper respiratory tract infection, oropharyngeal pain, injection site pain, back pain, sinusitis, and diarrhea. <h3>Conclusions:</h3> Subcutaneous galcanezumab reduced MMDs and increased response rates in chronic and episodic migraine patients. It is generally safe except for injection-related complications. <b>Disclosure:</b> Mohamed Sayed Zaazouee has nothing to disclose. Mr. Elsnhory has nothing to disclose. Ms. Ebrahim has nothing to disclose. Dr. Alaraj has nothing to disclose. Dr. Saad has nothing to disclose. Dr. Zaki has nothing to disclose. Mr. Ali has nothing to disclose. Dr. Fahmy Fawy has nothing to disclose. Dr. Ahmed has nothing to disclose. Dr. Elshennawy has nothing to disclose. Dr. Eleyan has nothing to disclose. Dr. Alahmad has nothing to disclose. Dr. Abo Hamra has nothing to disclose. Dr. AbuEl-Enien has nothing to disclose. Dr. Elromely has nothing to disclose. Dr. Elshanbary has nothing to disclose.

Application of urethral injection of calcium hydroxyapatite as a natural bulking agent for improvement of urinary incontinence in children with spinal dysraphism

The aim of this report is to evaluate the efficacy of endoscopic injection of calcium hydroxyapatite (CaHA) into the bladder neck and posterior urethra in children with refractory urinary incontinence due to spinal dysraphism. A retrospective study was performed on patients with neuropathic bladder due to spinal dysraphism who had undergone submucosal urethral injections of CaHA from 2010 until 2019. All patients were totally incontinent without voiding per urethra and did not respond to 1-year standard pharmacotherapy with anticholinergic drugs. All children underwent a precise physical exam and urodynamic studies. Patients underwent urethrocystoscopy and injection of pure soluble CaHA into the bladder neck and posterior urethra except for the verumontanum. The outcomes were determined as no change, improvement (social continent), or cure (total continent). Fifteen children (ten boys, five girls, mean age of 7.6years) with a history of spinal dysraphism and refractory urinary incontinence were included. Endoscopic injections of CaHA were performed one or two times for each patient. At the median follow-up of 2years (interquartile range = 6), seven (46.7%), three (20.0%), and five (33.3%) of the patients were total continent, social continent, and total incontinent, respectively. In four patients, intradetrusor botulinum toxin injection was performed simultaneously with CaHA injection. Also, one patient experienced a febrile urinary tract infection between two CaHA injections. Among 15 patients, 9 had atonic/hypotonic bladders both before and after CaHA injections; at the last follow-up, 4 of these children (44.4%) were totally continent. No injection-related or other complications were observed in the patients. Injection of CaHA into the bladder neck is relatively safe, reproducible, and effective for total dribbling urinary incontinence in children with spinal dysraphism. The bladder neck reconstruction with or without a urethral sling or other surgical procedures could be postponed until puberty in selected cases. However, further multicenter clinical trials are highly recommended.

Safety and technical success of diphenhydramine as an alternative local anaesthetic agent for radiology procedures

To evaluate retrospectively the safety and technical success of subcutaneous diphenhydramine as an alternative local anaesthetic for radiology procedures. Between January 2000 and April 2021, 84 image-guided procedures were performed in 81 adult patients (mean age 61 years, 86% female) using 1% injectable diphenhydramine as a local anaesthetic. Indications were history of severe allergy to "-caine" local anaesthetics in 76 (90%) patients and recent administration of bupivacaine liposomal injectable suspension in eight (10%) patients. Twelve of the 84 (14%) procedures were performed with concomitant moderate sedation. Patient characteristics, procedural techniques, and clinical outcomes were reviewed. Early and delayed (30-day) complications were classified as either related to local diphenhydramine injection or to the procedure itself. Procedure-related complications were gradated using the Clavien-Dindo system. Percutaneous biopsy was the most frequently performed procedure (57/84, 67%). Fifty-nine (70%) of the 84 procedures were ultrasound guided. The most common procedural site was the breast (34/84, 40%). All procedures were technically successful. There were two minor injection-related complications related to post-procedural pain. A single minor procedure-related complication involved a patient requiring hospital admission for post-renal biopsy related haematuria. Injectable diphenhydramine appears to be a safe and effective local anaesthetic alternative in patients with "-caine" class contraindications undergoing radiology procedures. A future prospective trial would be useful to assess the safety profile in an large cohort of patients.

Choroidal neovascularization caused by angioid streaks: seven-year follow-up

Angioid streaks are irregular lines that radiate away from the optic disc to the retinal periphery, lying deep into the retina. They indicate the breaks in the calcified Bruch’s membrane. The most common complication of angioid streaks is choroidal neovascularization. They appear primarily bilaterally and are asymmetrical in nature.We report a 29-year-old man with choroidal neovascularization caused by angioid streaks. The study emphasizes seven years of follow-up of the disease treated with intravitreal bevacizumab and aflibercept injections. There were no injection related complications. Anti-VEGF treatment can help the clinician to stabilize the disease and achieve gradual progression. Nonetheless, it cannot help to prevent significant vision loss in long-term follow-up in all cases.

Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial.

Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF. PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance. Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index (P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups (PVAS = .589; PFADI = .742). Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups. Level I, prospective randomized double-anonymized clinical comparative study.

Ophthalmic Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-Analysis.

With the recent increase in interest in using autologous fat (AF) filler injections to enhance aesthetic facial appearance, there is a noticeable increase in the complications such as vascular compromise and blindness. This systematic review and meta-analysis aimed to understand the symptomatology of ophthalmic complications related to AF facial injections for cosmetic purposes, their underlying causes, management options, and the final clinical outcomes. This review was conducted according to the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. In November 2021, we performed a systematic review of available literature using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Our search was limited to the published studies between 2000 and 2021. A total of 1052 publications and 34 articles published were included. Twenty case reports, two case series, one prospective cohort study, and eleven retrospective studies were evaluated. The forehead was the most common single injection site (n = 196, 55.36%). The most common initial symptom was periorbital swelling (92.7%). The pooled prevalence of ophthalmic artery occlusion was 50.4% out of all AF injection-related complications. Regarding the management, most patients were managed conservatively (n = 278, 51.38%). Complete improvement was observed among 423 patients (80.57%). Autologous facial fat injection is a minimally invasive procedure with a favorable safety profile in cosmetic applications. However, the common use of these injections in aesthetic surgery has resulted in a concomitant increase in devastating consequences, such as blindness. Therefore, a firm understanding of the potential complications of such interventions is essential. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness of ultrasound-guided local steroid injection to the wrist for the treatment of carpal tunnel syndrome: Is it worth it?

BackgroundCarpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist level and the most frequent entrapment neuropathy in the upper limb. It can be treated with surgical or non-surgical methods. When nonsurgical treatment is indicated, a local corticosteroid injection into the carpal tunnel can be used to reduce pain and tingling sensation. To assess the clinical outcomes and effectiveness of patient satisfaction following ultrasound-guided steroid injection for the treatment of carpal tunnel syndrome.ResultsThe study comprises 44 female (73%) and 16 (27%) male patients, with a mean age of 57 (27–84) years. Thirty-one patients were left-handed and 29 right-handed. Twenty-six (43%) injections were performed on the right side, 8 (13%) on the left, and 26 were bilateral. Fifty-six hands of thirty-seven (70%) patients reported significant improvement symptoms, five (8%) had temporary improvement with recurrence, seventeen patients (28%) failed to improve, and one patient’s symptoms have resolved before intervention. Among temporary responders and nonresponders, two were referred to the neurologist for further evaluation. Out of twenty patients, fourteen patients (23%) had surgical decompression of carpal tunnel with complete resolution of symptoms, four patients had opted for repeat injections, and two patients refused any further intervention.ConclusionsThe use of ultrasound-guided injection for the treatment of mild to moderate carpal tunnel syndrome is a practical procedure before offering surgical treatment. It is also appropriate for the patient with significant medical problems or not willing to undergo surgical intervention. Its ultrasound guide reduces injection-related complications, improves patient satisfaction, is cost-effective, and improves patient compliance.

Lumbar zygapophyseal joints injections under ultrasound guidance an alternative to fluoroscopy guidance in the management of low back pain

Ultrasound-guided injections are an alternative to evaluate in the management of low back pain associated with osteoarthritis of the lumbar facet joints: it eliminates the risk of ionizing radiation for both the patient and the practitioner. This study aims to compare the short-term clinical efficacy of lumbar facet joints injections between ultrasound-guided injections and fluoroscopy-guided injections. Observational, retrospective, single-center study. Patients received one or two lumbar zygapophyseal joints injections under fluoroscopy or ultrasound and a follow-up consultation at one month. Data from 54 patients was collected. The median of the evolution of VAS at one month was − 30 mm [−50.0; −20.0] in the ultrasound group and – 29.5 mm [−47.0; −15.0] (p < 0.001) in the fluoroscopy group with no statistically significant difference between the two groups (p = 0.835). There were no injection-related complications in either group during the follow-up. The percentage of patients who stopped NSAIDs was not statistically significant between the two groups (p = 1.00). Injections of corticosteroids of lumbar facet joints under ultrasound guidance significantly reduced pain after one month, with no difference found between the two techniques. Ultrasound-guided injections are reliable, accessible and a safe alternative that should be preferred over those under fluoroscopy.

Optimizing surgical outcome of auricular keloid with a novel multimodal approach

Various treatments are available for auricular keloids, but none has an absolute advantage. A practical and safe therapy to optimize the surgical outcome for auricular keloids is needed. We adopted a multimodal treatment of surgical enucleation, core fillet flap reconstruction, intraoperative corticosteroid injection, and immediate postoperative radiotherapy. There were no routine intralesional corticosteroid injections during follow-up. Keloid recurrences, complications, and risk factors for recurrences were analyzed. The outcome was compared with other published literatures. 45 auricular keloids were included in this study. 85.7% were female with an average age of 27.1 ± 7.5 years, and averaged size was 1.8 × 1.2 ± 0.9 × 0.6 cm. 71.1% were located at ear helix with 28.9% at the ear lobe. Nine keloids were classified as Chang-Park classification type I, 30 for type II, two for type III, and four for IV. The average radiation dosage was 1578.6 cGy. The recurrence rate was 6.7% at an average 24.1-month follow-up. There were no complications of surgery, radiotherapy, and intralesional corticosteroid injection. Our recurrence rate was lower than those in mono-adjuvant therapies of intraoperative corticosteroid injection or radiotherapy. This one-session multimodal approach optimizes treating auricular keloids with a low recurrence rate and minimal post-radiation and long-term corticosteroid injection-related complications.

Effect of Reuse of Insulin Needle on Glycaemic Control and Related Complications in Children with Type 1 Diabetes Mellitus: A Prospective Observational Study.

Background:Children with type 1 diabetes (T1D) take multiple subcutaneous injections of insulin daily to survive. It is controversial whether the insulin needles can be reused safely or not. This study assesses the effect of the reuse versus single-use of insulin needle on glycaemic control and injection-related complications.Methods:Nearly 121 children (<15 years) with T1D were prospectively observed for existing practice of needle reuse for first 3 months and then were asked to practice single-use for the next 3 months.Results:It was found that 78% participants were reusing needles more than three times. After 3 months of needle reuse, 91.3% patients had lipodystrophy. Frequency of reuse positively correlated with local redness, bleeding and leakage of insulin. The patients achieving HbA1c ≤7.5% was significantly low among those reusing needles more than four times. After 3 months of single-use, no significant difference was found in mean HbA1c. However, hyperglycaemic episodes, lipodystrophy and local complications reduced significantly. There was a significant reduction in mean HbA1c among those using needles more than six times earlier.Conclusion:Reuse of insulin needles up to six times does not affect the glycaemic control significantly. To achieve target HbA1c (<7.5%) the needle reuse should be restricted to three times only, which can also reduce injection-related local complications.