Preinjection Values Research Articles

Evaluation of intraocular pressure change and anterior segment parameters after intravitreal bevacizumab injection - Cannula size matters.

PURPOSE:To determine the changes in intraocular pressure (IOP) and anterior chamber parameters following intravitreal bevacizumab injection with different sizes of cannulas.METHODS:This clinical trial was conducted with 70 eyes of 70 patients who received an intravitreal injection of bevacizumab with 26 G (Group 1) or 30 G (Group 2) needle. Preinjection and postinjection 30th-min IOP and pentacam measurements were obtained. Anterior chamber depth (ACD), anterior chamber volume (ACV), central corneal thickness (CCT), corneal volume (CV), and iridocorneal angle (ICA) measurements were evaluated in pentacam.RESULTS:Preinjection mean IOP values in Group 1 and 2 were 14.7 ± 3.29 mm Hg and 15.1 ± 2.87 mm Hg, respectively. Postinjection mean IOP in Group 1 was 16.8 ± 6.24 mm Hg and in Group 2 was 20.3 ± 3.66 mm Hg. Postinjection mean IOP values were significantly higher than preinjection values in both groups (Group 1 P < 0.005 and Group 2 P < 0.001). IOP change was significantly higher in Group 2 after injection (P < 0.05). In both groups, the change in IOP found to be more significant in phakic eyes than pseudophakic eyes (Group 1 P < 0.001, Group 2 P < 0.001). CCT and CV were significantly higher in both groups 30 min after the injection than preinjection (Group 1 and Group 2; P < 0.01). In Group 2 ACD, ACV and ICA values were significantly lower than preinjection values (P < 0.05).CONCLUSION:Needle bore size is an important parameter that influences anterior segment parameters and IOP change in the intravitreal injection. IOP rise and anterior segment changes are more prominent with a thinner cannula.

Role of Platelet-Rich Plasma in Painful Early Osteoarthritis Knee and Plantar Fasciitis

Introduction: Plantar fasciitis and early osteoarthritis knee are the most common painful orthopedic conditions treated by orthopedic practitioners. This study is to assess the role of platelet-rich plasma (PRP) injection in the treatment of plantar fasciitis and early osteoarthritis knee. Aims and Objectives: To access the role of platelet-rich plasma in plantar fasciitis and early osteoarthritis knee. Materials and Methods: A prospective interventional study was conducted at our center between January 2016 to March 2017. Patients included were complaining of pain in knee for 3 months, Grade 1 to Grade 2 osteoarthritis, presenting with complaints of plantar heel pain, tenderness at the attachment of the plantar fascia. The details of the clinical assessment filled and baseline WOMAC score for osteoarthritis knee and analog pain scale for plantar fasciitis was recorded. We explained the procedure to the patients and informed consent were taken. 4 ml of PRP was injected in either condition. Patients were followed up for 6 months at 1, 2, 3, 4, 5, and 6 months. Visual analog scale (VAS) for the assessment of pain in plantar fasciitis and WOMAC score for early osteoarthritis knee was recorded for all patients at the last visit and compared. Results: In 15 patients with osteoarthritis of knee, the mean score for preinjection baseline was 29.4 ± 5.80, which showed improvement by 27% from baseline during the 1st month with a mean of 21.4S7 ± 5.475 and during 6th month with a mean of 22.47 ± 9.516 but it never reverted to baseline pre injection value. In 30 patients with plantar fasciitis, the results are statistically significant (P ≤ 0.05), and all the patients responded to the treatment. VAS score is statistically significant in comparison with baseline at all duration. Conclusion: In our study, PRP is significantly effective in reducing pain in early osteoarthritis knee and plantar fasciitis.

Effect of Intravenous Morphine Injection on Neurological Examination of Dogs With Thoracolumbar Intervertebral Disk Extrusion.

Objectives: We aimed to determine the effect of intravenous morphine injection on the modified Frankel scores of dogs with thoracolumbar intervertebral disk extrusion (IVDE).Methods: This was a prospective, blinded, randomized, and placebo-controlled study. We included dogs with a presumptive diagnosis of thoracolumbar IVDE that did not undergo analgesic, anti-inflammatory, or sedative treatment within the last 12 h. A neurological examination was performed and the deficits were graded using the modified Frankel score (MFS). Subsequently, each dog was randomly allocated to receive an intravenous injection of either morphine or placebo. After 30 min, the dogs were re-evaluated by the same veterinary officer who was blinded to the contents of the injections. Dogs were included in the study if IVDE was ultimately confirmed by surgery within one week of initial presentation.Results: Among the 79 dogs initially enrolled, 62 dogs met the inclusion criteria. Among them, thirty-two dogs received intravenous morphine injections and there was no difference between the pre- and post-injection modified Frankel scores. Thirty dogs received an intravenous placebo injection. One dog had a worsening of the MFS by one grade in the post-injection examination.Clinical Significance: In dogs with thoracolumbar intervertebral disk extrusion, an intravenous injection of morphine does not affect the modified Frankel score after 30 min compared with the pre-injection value. These findings support the use of an analgesic morphine dose if the neurological examination can be performed 30 min or later after the injection.

Early Outcome of a Single Peri-Tendinous Hyaluronic Acid Injection for Mid-Portion Non-Insertional Achilles Tendinopathy - A Pilot Study

AimThe aim of this study was to evaluate the efficacy and safety of a single, peri-tendinous injection of hyaluronic acid for mid-portion, non-insertional Achilles tendinopathy. Materials And MethodsA prospective, open labelled, single center, pilot study was conducted. All patients enrolled received a single peri-tendinous injection of Ostenil Tendon™ (40 mg/2 ml 2% HA with 0.5% mannitol). Outcome measures were Visual Analogue Scale (VAS) pain score and Manchester-Oxford Foot Questionnaire (MOxFQ) scores at 2 weeks and at final follow at 12 weeks. Any major and minor adverse effects were recorded. To assess change in VAS and MOxFQ scores, t test and Wilcoxon signed rank test were employed. ResultsSeventeen patients were enrolled in this study with a mean follow-up of 12 weeks. Mean pre-injection VAS score was 9.38 cm (9-9.8), which significantly reduced post-injection to a mean score of 4.09 cm (2-8) at week-2 stage, and further improved to 3.01 cm (2-3.9) at the final follow-up (p < 0.0001). MOxFQ score showed a significant improvement from pre-injection value of 67.77 (63.03-72.55) to 31.18 (13-60) at week-2 stage, and further improved to 24.20 (15.73-32.67) at the final follow-up (p < 0.0001). The mean improvement from pre-injection to the final follow up was 43.57 (34.25-52.90). No adverse effects for injections were recorded. ConclusionThis small series suggests an encouraging response of a single injection of HA as an effective and safe option for non-insertional Achilles tendinopathy.

Investigating the Impact of Gadolinium-Based Contrast Agents on the Corrected QT Interval.

IntroductionThe manufacturing labels for all currently marketed gadolinium-based MRI contrast agents describe adverse cardiac events reported during post-market use. The goal of this study was to determine prolongation of the rate-corrected QT interval occurs in the immediate setting after gadolinium-based MRI contrast agent injection.MethodsThis study enrolled adults scheduled to have a gadolinium-based MRI contrast agent injection as part of a diagnostic MRI. A single-lead electrocardiogram was recorded using the AliveCor Kardia® ECG (Mountain View, CA) device before and after injection. The rate-corrected QT interval was subsequently measured by two independent investigators. The QT interval was corrected for rate using the two most common formulas, originally cited by Bazett and Fridericia. These rate-corrected QT intervals from before and after gadolinium-based MRI contrast agent injection were compared using the Wilcoxon signed-rank test paired analysis.ResultsA total of 24 consenting adults had electrocardiogram that were free of motion artifact. The mean age of the final patient cohort was 59.4 years. There was an equal split of 12 men and 12 women. The mean pre-injection, rate-corrected QT interval, corrected using Bazett’s formula, was 395 msec. The mean post-injection, rate-corrected QT interval, corrected using Bazett’s formula, was 396 msec. The corrections using Fridericia's formula were 384 and 381 msec, respectively. There was no statistically significant change in Bazett-corrected QT interval (QTc-B) when pre-injection and post-injection values were directly compared.DiscussionThe results of the present investigation support the conclusion that gadolinium-based MRI contrast agents do not commonly affect rate-corrected QT interval in routine clinical use. While the frequency of rate-corrected QT interval prolongation might be overstated, the severity of adverse events is definitively not. A role for concomitant rate-corrected QT interval-prolonging drugs or unidentified rare factors such as genetic predisposition cannot be ruled out. The limitations of this study include its relatively small size and the implementation of a single-lead electrocardiogram to measure rate-corrected QT interval.ConclusionThe present investigation revealed that significant rate-corrected QT interval prolongation, while previously reported in as many as 55% of patients after gadolinium-based MRI contrast agent injection, is not a common occurrence in the routine clinical setting.

Dexamethasone Versus Magnesium Sulfate as an Adjuvant to Local Anesthetics in the Ultra-Sound Guided Injection of Piriformis Muscle for the Treatment of Piriformis Syndrome

Background:Piriformis Syndrome (PS) is an underdiagnosed cause of buttock, thigh and leg pain, most probably because it is thought to be a rare cause of sciatica. PS is widely believed to be myofascial in origin.Materials and Methods:This prospective, randomized, controlled, double-blind study was conducted at the pain management department. 50 patients aged from 20 to 60 years old were included in this study. The selected patients were randomly allocated into 2 groups containing 25 patients each; Group D received a total of 5 mL which included 2mL lidocaine 2%, 2mL (8 mg) dexamethasone and 1mL normal saline 0.9%, and Group M received a total of 5mL which included 2mL lidocaine 2%, 3mL magnesium sulphate (MgSO4) (2.5%) . Patients demographic characteristics, baseline physical examination findings of the patients as well as the duration of pain were all recorded. Patients were re-assessed immediately after injection, 1 week, 1 month, and 3 months after the injection. Numeric Rating Scale (NRS) values were used at each evaluation time to assess the pain, while patients were in sitting, standing, and lying positions. All patients were assessed immediately and for 4 hours post-injection for any side effects related to the drugs used.Results:In the pre-injection time, immediately after and 1 week after injection, there were no statistically significant differences between groups D and M in pain values. While, on comparison between both groups, group M, was significantly better than group D, in NRS values 1 month and 3 months after injection. In group D, pain score values were significantly better immediately, 1 week, and 1 month after injection compared to the pre-injection values, while these values were not significantly different 3 months after injection compared with the pre-injection values. In group M, pain score values were significantly better immediately, 1 week, 1 month, and 3 months after injection compared to the pre-injection values.Conclusion:Magnesium sulfate was more effective, especially for long term pain relief (3 months) when compared to dexamethasone as they were used as adjuvants to lidocaine, if injected into the piriformis muscle (PM) guided by ultrasound in the management of PS refractory as initial conservative treatment.

Intrastromal Injection of Hyaluronidase Alters the Structural and Biomechanical Properties of the Corneal Stroma

PurposeGlycosaminoglycans (GAGs) are important components of the corneal stroma, and their spatiotemporal arrangement regulates the organization of collagen fibrils and maintains corneal transparency. This study was undertaken to determine the consequences of hyaluronidase (HAse) injected into the corneal stroma on stromal stiffness and ultrastructure.MethodsEqual volumes of HAse or balanced salt solution (vehicle) were injected intrastromally into the corneas of New Zealand white rabbits. Ophthalmic examination and multimodal imaging techniques, including Fourier-domain optical coherence tomography and in vivo confocal microscopy (IVCM), were performed at multiple time points to evaluate the impact of HAse treatment in vivo. Atomic force microscopy and transmission electron microscopy (TEM) were used to measure corneal stiffness and collagen's interfibrillar spacing, respectively.ResultsCentral corneal thickness progressively decreased after HAse injection, reaching its lowest value at day 7, and then returned to normal by day 42. The HAse did not impact the corneal endothelium but transiently altered keratocyte morphology at days 1 and 7, as measured by IVCM. HAse-injected corneas became stiffer by day 1 postinjection, were stiffest at day 7, and returned to preinjection values by day 90. Changes in stromal stiffness correlated with decreased interfibrillar spacing as measured by TEM.ConclusionsDegradation of GAGs by HAse decreases the corneal thickness and increases stromal stiffness through increased packing of the collagen fibrils in a time-dependent manner.Translational RelevanceIntrastromal HAse injection appears relatively safe in the normal cornea, but its impact on corneal biomechanics and structure under pathologic conditions requires further study.

Short-Term Effects of Deliberate Subparaneural or Subepineural Injections With Saline Solution or Bupivacaine 0.75% in the Sciatic Nerve of Rabbits.

Background: Ultrasound (US)-guided techniques for peripheral nerve blockade have revealed that intraneural injections are relatively frequent and not necessarily associated with neurological deficits.Objectives: To evaluate the short-term effects of deliberate injections performed under direct vision in two different sites of the sciatic nerve (ScN).Material and Methods: Seventy-two New Zealand white rabbits randomly assigned to one of four experimental groups (n = 18) were employed. All procedures were conducted at a proximal femoral level where the ScN incorporates the common peroneal nerve and the tibial nerve (TN). Fixed volumes of 0.5 ml of saline solution (ES group) or bupivacaine 0.75% (EB group) were administered extrafascicularly inside the paraneurium of the ScN or intrafascicularly (IS and IB groups) under the epineurium of the TN. Cross-sectional area (CSA) and relative echogenicity (RE) of the entire ScN were determined by US before injections, after injections, and at 3 and 7 days. ScN samples were obtained for structural and ultrastructural histopathological studies. Proprioceptive, sensorial, and motor function were clinically evaluated on a daily basis.Results: The CSA of the ScN increased significantly immediately after injections when compared with pre-injection values in all groups (p < 0.05). The RE of the ScN decreased in relation to pre-injection values in all groups (p < 0.05). The CSA and RE of the ScN returned to normal values 7 days after injections in almost all groups. Injected nerves showed histological signs of mild perineural inflammation. Histopathological scores were not significantly different between groups (p > 0.05). The architecture of the ScN was preserved in all rabbits at 3 days and in 31/32 rabbits at 7 days. A focal area of damaged nerve fibers with degeneration of the axons and myelin sheath affecting the TN was observed in one rabbit of the IB group. Nerve function was not clinically impaired in any case.Conclusion: Despite the lack of severe nerve disruption observed in most rabbits, the evidence of a focal area of damaged nerve fibers in one rabbit injected intrafascicularly with bupivacaine confirms that intrafascicular injections should be avoided as they may increase the risk of nerve damage.

ACUTE MACULAR AND PERIPAPILLARY ANGIOGRAPHIC CHANGES WITH INTRAVITREAL INJECTIONS.

Intravitreal injections acutely and temporarily increase intraocular pressure (IOP), and this may have cumulative long-term effects including an increased risk for glaucoma surgery. This study was designed to measure retinal perfusion density changes on optical coherence tomography (OCT) angiography and OCT thickness alterations associated with acutely increased IOP after intravitreal injections. Retrospective observational clinical study of 40 eyes (39 patients) with various retinopathies from October 2016 to June 2017 at a tertiary care retina clinic in NYC. Patients were older than 18 years, with vision >20/100, able to fixate and without media opacities precluding OCT angiography, receiving intravitreal bevacizumab or aflibercept for diabetic retinopathy, retinal vein occlusion, macular degeneration, retinal neovascularization, or radiation retinopathy. The 3-mm × 3-mm macular and 4.5-mm × 4.5-mm peripapillary OCT angiography perfusion density, macular OCT thickness, and IOP were measured before and immediately after intravitreal injections. Paired t-test was used to compare preinjection and postinjection values for perfusion density and OCT thickness. Regression analysis was performed for potential effects of baseline IOP, IOP change, and age. Statistically significant decreases in angiographic perfusion density (P < 0.05) were found in most areas of the superficial and deep layer macular OCT angiography, and the overall optic nerve head and the radial peripapillary capillary layer, preferentially temporal. Macular OCT thickness was significantly decreased in the temporal region and increased in the nasal region. Regression analysis showed relationships between age and decreased superficial macular perfusion. Preinjection IOP was only related to OCT thickness in the fovea. Intraocular pressure change was related only to decreased superficial macular perfusion density. Intravitreal injections produce acute IOP changes that are associated with reduced macular and peripapillary perfusion density. Therefore, it is possible that patients receiving regular intravitreal injections may be sustaining perfusion-related injury to ocular structures that may produce glaucomatous damage to the macula and optic nerve.

Evaluation of dietary trace mineral supplementation in young horses challenged with intra-articular lipopolysaccharide1

Sixteen weanling Quarter Horses (255 ± 22 kg) were utilized in a 56-d trial to evaluate the effects of trace mineral (TM) source on intra-articular inflammation following a single acute inflammatory insult. Horses were stratified by age, sex, and BW and then randomly assigned to dietary treatment: concentrate formulated with Zn, Mn, Cu, and Co as inorganic sources (CON; n = 8) or complexed TMs (CTM; n = 8). Added TM were formulated at iso-levels across treatments and intakes met or exceeded NRC requirements. Horses were offered 1.75% BW (as-fed) of treatment concentrate and 0.75% BW (as-fed) coastal Bermudagrass hay. Growth measurements were collected on days 0, 28, and 56, and plasma was collected biweekly for determination of Mn, Cu, Zn, and Co concentrations. On day 42, carpal joints were randomly assigned to receive injections of 0.5 ng lipopolysaccharide (LPS) or sterile lactated Ringer’s solution (LRS; contralateral control). Synovial fluid was collected at preinjection hours (PIH) 0, and 6, 12, 24, 168, and 336 h post-injection and analyzed for TM concentration, prostaglandin E2 (PGE2), carboxypeptide of type II collagen (CPII), collagenase cleavage neopeptide (C2C), and aggrecan chondroitin sulfate 846 epitope (CS846). Data were analyzed using the MIXED procedure of SAS. Results showed a TM source × LPS × h effect for synovial fluid Co, Cu, and Se (P < 0.05); concentrations of TM peaked at hour 6 and decreased to preinjection values by hour 168 in both CON and CTM–LPS knees. A delayed peak was observed at hour 12 for CTM–LRS. Peak synovial fluid Cu and Se concentrations were higher in LPS knees, and Co was highest in CTM–LPS. A TM source × h interaction was observed for Zn (P < 0.05); concentrations peaked at hour 6 in CON vs. hour 12 for CTM. An LPS × h interaction was observed for Mn (P < 0.01); synovial concentration peaked at hour 6 in LPS knees compared with hour 24 in LRS. Synovial PGE2, C2C, CPII, and CS846 concentrations were greater with LPS (P ≤ 0.01), and C2C was greater (P < 0.01) in CTM compared with CON. Concentrations of CPII and PGE2 were unaffected by diet. A TM source × h × LPS interaction was observed for CS846 (P = 0.02). Concentrations of CS846 in CTM peaked at 12 h, whereas CON peaked at a lower concentration at 24 h (P < 0.05). Data indicate sufficient intake of a complexed TM source may support cartilage metabolism through increased aggrecan synthesis and type II collagen breakdown following an intra-articular LPS challenge in growing horses.

Evaluation of efficacy and safety of Botulinum toxin injection in treatment of epiphora

Purpose The aim of this study was to evaluate the efficacy and safety of Botulinum toxin injection in the palpebral lobe of the lacrimal gland for treatment of epiphora.Patients and methods A total of 20 patients with epiphora (crocodile tears syndrome, lower lid laxity, malposition of the lower lid, and obstruction of lacrimal drainage system in which lacrimal surgery was impossible) received intralacrimal gland injection of Botulinum toxin (2.5 IU/0.1 ml). Follow-up was performed on the first day, first week, first month, third month, and sixth month after injection to evaluate the efficacy, safety, and occurrence of any complications and to record the rate of recurrence.Results Cure was successfully achieved in 60% of the patients after the first injection and in 90% of patients after the second injection. There were 15% of recurrent cases after the first injection, and there were no recurrent cases after the second injection. Temporary ptosis occurred in 10% of this study group after the first injection and in 5% after the second injection. There was a highly significant decrease in Schirmer’s test and tear meniscus height among the study group regarding the pre-injection and follow-up values (P<0.01). In addition, there was a highly significant decrease in Munk scale and time of dye disappearance test among the study group regarding the pre-injection and follow-up values (P<0.01).Conclusion The injection of Botulinum toxin in the palpebral lobe of the lacrimal gland was effective and safe as a temporary measure to reduce excessive tearing until a more permanent measure can be taken.

The Efficacy of Single-Dose Intravitreal Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-VEGF Therapy: Real-Life Results.

Objectives:To investigate the efficacy, safety, and side effect profiles of a single-dose intravitreal dexamethasone implant (IDI, Ozurdex) in patients with diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy.Methods:This study included 101 eyes of 78 diabetic patients with DME that remained persistent despite administering at least six doses of anti-VEGF therapy. The patients were evaluated at baseline and were followed up monthly until the sixth month after the IDI injection. The primary outcomes were central foveal thickness (CFT) and best-corrected visual acuity (BCVA).Results:The mean number of anti-VEGF injection administered to patients was 6.50±0.33. One month after the last injection, the response to treatment was evaluated. IDI injection was performed approximately 1.14±0.08 months after the last anti-VEGF injection. After the IDI injection, BCVA value increased (p<0.001) and CFT value decreased (p<0.001). The peak effect of the IDI was observed in the second month after the injection. CFT values increased and BCVA values decreased from the beginning of the fourth month after the IDI injection. The recurrence rate of CFT elevation in the sixth-month follow-up was 57.4%. Moreover, we observed that high pre-injection CFT values were correlated with a high post-injection recurrence rate of CFT elevation (p<0.001).Conclusion:These findings suggest that the IDI injection significantly improves BCVA and CFT values in patients with DME refractory to anti-VEGF therapy. However, recurrence of CFT elevation may occur in >50% patients in the sixth month after the first injection.

Pharyngeal Motility Before and After Thyroarytenoid Muscle Botulinum Toxin Injection.

Botulinum toxin type A (BTA) injection in intrinsic laryngeal musculature may result in dysphagia and consequent loss of quality of life (QOL) in a percentage of patients. This study aims to evaluate pharyngeal motility as a putative cause for this change in swallow quality in light of high-resolution manometry (HRM). Twenty patients (95% females, median age 66years) underwent high-resolution manometry before and after BTA injection. Dysphagia was evaluated based on a QOL dedicated questionnaire (SWAL-QOL) before and after BTA injection. Pharyngeal motility at the topography of the vellum, epiglottis, and upper esophageal sphincter (UES) were recorded. Eleven (55%) subjects had worsened QOL after BTA injection. In patients with worsened QOL, UES extension decreased (p = 0.005), UES residual pressure increased (p = 0.02), UES basal pressure decreased (p = 0.04), and velopharynx contraction duration decreased (p = 0.04). UES residual pressure increased (p = 0.01), velopharynx peak pressure (p = 0.04) and upstroke (p = 0.007) decreased in patients with maintained QOL. There was no difference between groups when comparing pre-injection values. UES extension (p = 0.01) and UES maximum relaxation time (p = 0.03) was lower in the group with worsened QOL after BTA as compared to no change in QOL. Pharyngeal motility as measured by HRM was not a predictor for post procedure dysphagia and the changes in motility after BTA injection does not seem to be a strong contributor to dysphagia.

Concentration- and time-dependent effects of myo-inositol on evoked epileptic afterdischarge in the hippocampus in vivo

Epilepsy is one of the most widespread neurological diseases characterized by spontaneous recurrent seizures. There is no cure for epilepsy, and available pharmacological treatments with anti-seizure drugs are only symptomatic. Moreover, about third of epilepsy patients are resistant to the anti-seizure drugs. Thus, it is essential to discover new anti-epilepsy drugs. Recently, myo-inositol has been identified as a promising antiepileptic compound. In the present study, using electrophysiological method, we examined for the first time, the effect of myo-inositol on the generation of epileptic afterdischarges in the hippocampus evoked by a local electrical stimulation. This was achieved by implanting two electrodes with a cannula into the same dorsal hippocampus, which allowed for simultaneous local injection of myo-inositol or saline and afterdischarges induction and recording from the same hippocampus. We found that myo-inositol has time- and concentration-dependent effects on the evoked afterdischarges. Specifically, 5 minutes after 1 M myo-inositol infusion, the afterdischarges duration was significantly decreased as compared to preinjection durations in the same animals and also as compared to preinjection level durations in saline injected or contralateral hippocampus myo-inositol infused animals. Further, 0.055 M myo-inositol significantly decreased afterdischarges duration at 5 minutes as compared to 40 minutes post-injection. At both concentrations, the afterdischarges duration recovered to the pre-injection value at 40 minutes after the myo-inositol injection. The present data, taken together with our previous results, strongly suggest that myo-inositol has significant local seizure-suppressant effect.

Abstract 360: Therapeutic potential of EC-18 as a chemotherapy adjuvant for 5-fluorouracil-induced neutropenia

Abstract Chemotherapy-induced neutropenia (CIN) is a complication that arises during cancer treatment and necessitates dose reduction. Preventing CIN and maintaining absolute neutrophil counts (ANC) is critical for successful chemotherapy because a rapid decline of neutrophils increases susceptibility to infection. Here, we investigated whether administration of EC-18 has therapeutic effects on the treatment of CIN in 5-fluorouracil (5-FU)-induced neutropenia mouse model. A single injection of 5-FU 100mg/kg reduced the ANC in the control, EC-18 125 and EC-18 250mg/kg-treated cohort from pre-injection values to &amp;lt;500 cells/μL by 5.2±0.45, 5.8±0.45 and 5.8±0.45 days, respectively. The administration of EC-18 in 5-FU-injected mice resulted in significant reduction in the duration of neutropenia and the time to recovery of ANC &amp;gt;1000 cells/μL. EC-18 125 or 250mg/kg significantly reduced the duration of neutropenia from 7.4±1.14 days to 2.6±0.55 or 3.0±0.71 days, respectively. Moreover, the ANC of all individuals in the control cohort fell to severely neutropenic range (ANC &amp;lt;100 cells/μL), while only 20% of individuals in both EC-18 125 and 250mg/kg-treated cohorts experienced severe neutropenia. EC-18 also reduced the duration of severe neutropenia from 5.2±1.48 days to 2 days. EC-18 125 or 250mg/kg administration significantly increased the mean nadir after 5-FU injection from 2.0±4.47 cells/μL to 236±4.47 or 158±11.32 cells/μL, respectively. The time of recovery to an ANC ≥500 or 1000 cells/ μL was significantly reduced in EC-18 125 and 250 mg/kg-treated cohorts. Besides neutropenia, a single treatment of 5-FU induced the reduction of blood monocytes and eosinophils, similar to the pattern of the decrease of neutrophil counts. The administration of EC-18 125 or 250mg/kg in 5-FU-injected mice remarkably prevented the reduction of blood monocytes and eosinophils. In this study, thrombocytopenia is defined as a 50% or greater reduction in platelet count from baseline, and 2-fold or greater increase of platelet count from baseline for thrombocytosis. 5-FU treatment induced the moderate thrombocytopenia from 4 to 6 days and followed by a more pronounced and prolonged rebound thrombocytosis. EC-18 significantly reduced the extreme change in platelet counts, thus preventing 5-FU-induced thrombocytopenia and thrombocytosis. Moreover, EC-18 effectively prevented a constant reduction of red blood cell (RBC) count induced by 5-FU treatment. Based on the observations in this study, we concluded that EC-18 has therapeutic potential as a chemotherapy adjuvant for the treatment of 5-FU-induced CIN as well as chemotherapy-associated other hematologic disorders. Citation Format: Yong-Jae Kim, Jinseon Jeong, Ki-Young Sohn, Do Young Lee, Sun Young Yoon, Jae Wha Kim. Therapeutic potential of EC-18 as a chemotherapy adjuvant for 5-fluorouracil-induced neutropenia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 360.

Efficacy of intraarticular steroid injection in knee osteoarthritis using knee society score and visual analog score

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling, stiffness and decreased quality of life. The purpose of this study was to assess the effect of intra-articular steroid injection for osteoarthritis knee by using knee society score (KSS) and visual analog scale (VAS).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study of 38 patients (44 knees) diagnosed with osteoarthritis of knee were given 80mg of intra-articular methylprednisolone injection. The outcome was assessed using KSS and VAS before the injection and 3 months post injection.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean VAS improved 3 months post injection whereas there was no improvement in the mean KSS. The scores of VAS 3 months post injection were statistically significant whereas the KSS scores were statistically insignificant compared with the pre injection values.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intra-articular steroid injection for osteoarthritis of knee produces significant pain relief for most patients even in severe cases but this not translate to better functional outcomes.&lt;/p&gt;

Laser flare photometry: a cost-effective method for early detection of endophthalmitis after intravitreal injection of anti-VEGF agents

BackgroundIntravitreal injection of anti-vascular endothelial growth factor agents is the most common intraocular procedure worldwide, inevitably causing more cases of post-injection endophthalmitis. The purpose of this study was to evaluate the utility of laser flare photometry in monitoring inflammation after intravitreal injection of anti-vascular endothelial growth factor agents, particularly to detect early stage post-injection endophthalmitis.Main body of the abstractA retrospective case review was performed of all patients who underwent flare assessment by laser flare photometry before and after intravitreal injection of bevacizumab or aflibercept at the Centre for Ophthalmic Specialized Care in Lausanne, Switzerland, between January 2015 and May 2018. The following data were retrieved: indication for intravitreal injection, medication administered, pre-injection and 72-h post-injection laser flare photometry values, and occurrence of post-injection endophthalmitis. A total of 736 injections were included in this study; 705 cases (95.8%) had a post-injection flare at 72 h ≤ 30 ph/ms, 29 cases (3.9%) had a post-injection flare at 72 h between > 30 and 50 ph/ms, and 2 cases (0.3%) had a post-injection flare at 72 h above > 50 ph/ms (664 and 742 ph/ms). These latter two cases were diagnosed as early-stage endophthalmitis.ConclusionLaser flare photometry is a cost-effective method of screening for early stage post-injection endophthalmitis. Values > 50 ph/ms 72-h post-injection should prompt immediate evaluation by an ophthalmologist.

Effect of dexamethasone intravitreal implant (Ozurdex\xae) on corneal endothelium in retinal vein occlusion patients

BackgroundTo assess corneal endothelial cell changes after intravitreal dexamethasone (DEX) implant (Ozurdex®) injection in patients with macular edema secondary to retinal vein occlusion (RVO).MethodsTwenty-two eyes of 22 patients were assessed prospectively after intravitreal 0.7 mg DEX implant injection. Twenty-two eyes of 22 healthy volunteers served as control group. Corneal endothelial cell parameters including endothelial cell density (ECD), coefficient of variation of cell size (CV), percentage of hexagonality (Hex) and central corneal thickness (CCT) were analyzed before and 1 and 3 months after injection by specular microscopy. The results of the study were compared statistically.ResultsThere were 17 (77.3%) patients with branch RVO and 5 (22.7%) patients with central RVO. Mean intraocular pressure (IOP) was 14.73 mmHg before injection, 17.05 mmHg at 1 month and 17.15 mmHg at 3 months after injection. Mean IOP at 1 and 3 months were significantly higher than pre-injection value (p = 0.002 and p = 0.003, respectively). There was a statistically significant reduction in mean ECD at 3 months after injection compared to pre-injection and 1 month (p = 0.013, p = 0.009, respectively) in the injected eyes. Mean ECD showed no significant difference in the uninjected fellow eyes during the follow up (p>0.05). Mean CV and Hex did not reveal a statistically significant difference in injected and uninjected fellow eyes (p > 0.05). No significant change was observed in mean CCT values during the follow up (p = 0.8).ConclusionIntravitreal dexamethasone implant may cause a transient reduction in corneal endothelial cell density in short term without changing cell morphology.

Evaluation of self-injurious behavior, thermal sensitivity, food intake, fecal output, and pica after injection of three buprenorphine formulations in rats (Rattus norvegicus).

OBJECTIVE To assess effects of buprenorphine hydrochloride (BH), sustained-release buprenorphine (SRB), and high-concentration buprenorphine (HCB) formulations in healthy rats. ANIMALS 8 Sprague-Dawley rats. PROCEDURES In a crossover-design study, rats received BH (0.05 mg/kg), SRB (1.2 mg/kg), HCB (0.30 mg/kg), or 5% dextrose solution (0.2 mL/kg), SC, once. Self-injurious behavior and thermal sensitivity (hind limb withdrawal latencies) were assessed prior to injection (time 0) and 1, 4, 8, 12, and 24 hours after injection. Food intake, kaolin intake, and fecal output were measured over 12-hour light and dark periods before and after each treatment. Values were compared among treatments and time points. RESULTS Self-injurious behavior was detected with all buprenorphine treatments; scores were greater at all time points during the 12 hours after HCB and 24 hours after SRB administration than at time 0. Percentage change in hind limb withdrawal latencies from time 0 was higher with BH and HCB 1 hour after injection than at other time points. Postinjection light-period food intake was higher (BH and HCB) and dark-period food intake was lower (BH, HCB, and SRB), compared with preinjection values for the same treatments. For SRB, postinjection light-period kaolin intake was greater than the preinjection value, and postinjection light- and dark-period kaolin intake was greater than that for other treatments. CONCLUSIONS AND CLINICAL RELEVANCE Hypoalgesic effects were briefly observed after administration of BH or HCB in healthy rats; adverse effects were detected in some rats with all buprenorphine formulations. Studies comparing effects of BH, SRB, and HCB in rats undergoing surgery or other noxious stimuli are indicated to determine clinical benefits in this species.

Randomised controlled trial comparing the intra-articular hyaluronic acid versus intra-articular steroid in osteoarthritis of knee

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling and stiffness. Intra-articular hyaluronic acid or steroids are being used for its treatment. The purpose of the present study was to assess the effect of intra articular hyaluronic acid in comparison to steroids for knee osteoarthritis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective randomized study including 70 patients (121 knees) diagnosed with osteoarthritis of knee, were randomly divided into two groups: 35 patients (58 knees) were given intra-articular hyaluronic acid and 35 patients (63 knees) were given intra-articular methylprednisolone. The outcome was evaluated with knee society score (KSS) and visual analog scale (VAS) before the injection and 1, 3 and 6 months after the injection.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean KSS pain and function scores increased while VAS decreased in both the groups. All the scores showed improvement at 6 months follow up. In both the groups, the scores at 6 months were significantly better than the pre injection values, and the scores of hyaluronic acid group were significantly better compared to steroid group.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intraarticular hyaluronic acid seems to be better for long term pain relief and preservation of function in comparison to intraarticular steroids in osteoarthritis of knee.