Concentrations Of Triamcinolone Research Articles

Triple-layered scaffold containing cisplatin and curcumin applied for cancerous bone regeneration.

Novel drug delivery system was prepared and evaluated as for application in cancerous bone treatment. It had three stacked layers, including a drug-free layer, a cisplatin-loaded layer, and a curcumin-containing layer. Our previously characterized biomaterials, namely Zr-hydroxyapatite (Zr-HA) and alkaline-treated polycaprolactone (modified-PCL), were used as major components of the drug carrier. Polar-polar interactions between cisplatin and Zr-HA were modulated by the modified-PCL included, leading to increase of cisplatin release. Using β-cyclodextrin (β-CD) to entrap curcumin caused improvement of curcumin solubility and release. The 3D-construct was porous with internal interconnected pores according to SEM micrographs. Large amount of apatite was formed and proteins adsorbed on the scaffolds after immersed in physiologic buffer solution and in medium containing fetal bovine serum, respectively. Optimal concentrations of ascorbic acid and triamcinolone were used for induction of bone marrow stromal cells to become osteoblasts by expressing an enzyme marker, e.g., alkaline phosphatase. The prepared scaffolds were considered osteo-conductive and osteo-inductive. The concentrations of cisplatin and curcumin reached the IC50 of SK-ES-1 cells of osteosarcoma and MCF-7 cells of breast adenocarcinoma after 24h and 3days of release, respectively. These cancer cells were more sensitive to the combined cisplatin and curcumin than each of the drugs. Regeneration of new bone and execution of residential cancer cells in defected bone were proposed after replacing the lost bone by this established drug carrier. The assumption needs to be verified in the future using animal models.

Dose-Dependent Glucocorticoid Regulation of Transcription Factors in Vocal Fold Fibroblasts and Macrophages.

Variable outcomes of glucocorticoid (GC) therapy for laryngeal disease are putatively due to diverse interactions of the GC receptor (GR) with cell signaling pathways, limited consideration regarding concentration-dependent effects, and inconsistent selection of GCs. In the current study, we evaluated the concentration-dependent effects of three frequently administered GCs on transcription factors with an emphasis on the phosphorylation of GR at Ser203 and Ser211 regulating the nuclear translocation of GR. This study provides foundational data regarding the diverse functions of GCs to optimize therapeutic approaches. In vitro. Human vocal fold fibroblasts and THP1-derived macrophages were treated with different concentrations of dexamethasone, methylprednisolone, and triamcinolone in combination with IFN-γ, TNF-α, or IL4. Phosphorylated STAT1, NF-κB family molecules, and phosphorylated STAT6 were analyzed by Western blotting. Ser211-phosphorylated GR (S211-pGR) levels relative to GAPDH and Ser203-phosphorylated GR (S203-pGR) were also analyzed. GCs differentially altered phosphorylated STAT1 and NF-κB family molecules in different cell types under IFN-γ and TNF-α stimuli. GCs did not alter phosphorylated STAT6 in IL4-treated macrophages. The three GCs were nearly equivalent. A lower concentration of dexamethasone increased S211-pGR/GAPDH ratios relative to increased S211-pGR/S203-pGR ratios regardless of cell type and treatment. The three GCs employed in two cell lines had nearly equivalent effects on transcription factor regulation. Relatively high levels of Ser203-phosphorylation at low GC concentrations may be related to concentration-dependent differential effects of GCs in the two cell lines. NA Laryngoscope, 133:2704-2711, 2023.

SENSOR ELETROQUÍMICO PARA CORTICOSTERÓIDES DOPANTES NOS ESPORTES

ABSTRACT Introduction: Identifying and measuring the concentration of Triamcinolone (TA) in biological fluids is essential, especially for patients receiving intensive antibiotic medication. Objective: Make a sensor for electrochemical detection of Triamcinolone (TA) as an anabolic steroid in sports using copper oxide nanomaterials-reduced graphene oxide nanoparticles (CuNPs/rGO). Method: After preparing rGO nanoparticles on a glassy carbon electrode (GCE) using the modified Hummers technique, Cu NPs were deposited on rGO/GCE. The applicability of Cu NPs/rGO/GCE was investigated to determine the TA concentration in a real sample that had been prepared. Results: The deposited irregular Cu NPs evidenced a diameter of about 80 nm, in agreement with SEM morphological investigations. Amperometric studies revealed that the linear range, detection limits, and sensitivity of CuNPs/rGO/GCE as a TA sensor were 10 to 80 µM, 10nM, and 0.06584 µA/µM, respectively. Conclusion: The results revealed that the RSD and recovery values were valid, providing adequate quality and reliability for practical analysis of real samples using Cu NPS/rGO/GCE. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Effect of Different Intracanal Medicaments on the Viability and Survival of Dental Pulp Stem Cells

Background: Stem cells play an important role in the success of regenerative endodontic procedures. They are affected by the presence of medicaments that are used before the induction of bleeding or the creation of a scaffold for endodontic regeneration. This study examines the effects of different intracanal medicaments on the viability and survival of dental pulp stem cells at different doses and over different exposure times. Methods: Dental pulp stem cells were cultured from healthy third molar teeth using the long-term explant culture method and characterized using flow cytometry and exposed to different concentrations of calcium hydroxide, doxycycline, potassium iodide, triamcinolone, and glutaraldehyde, each ranging from 0 (control) to 1000 µg/mL. Exposure times were 6, 24, and 48 h. Cell viability was measured using the MTT assay, and apoptosis was measured using the Annexin V-binding assay. Results: All medicaments significantly reduced cell viability at different concentrations over different exposure times. Calcium hydroxide and triamcinolone favored cell viability at higher concentrations during all exposure times compared to other medicaments. The apoptosis assay showed a significant increase in cell death on exposure to doxycycline, potassium iodide, and glutaraldehyde. Conclusion: The intracanal medicaments examined in our study affected the viability of dental pulp stem cells in a time and dose-dependent manner. They also adversely affected the survival of dental pulp stem cells. Further studies are needed to better understand the effect of prolonged exposure to medicaments according to clinical protocols and their effect on the stemness of dental pulp stem cells.

Hypopigmentation following intradermal allergy skin testing performed as part of mRNA COVID-19 vaccine allergy evaluation.

Background: Skin prick test (SPT) and intradermal test (IDT) are standard procedures in the allergy practice that are safe when performed. Individuals with a history of allergic reaction to the COVID-19 vaccine can undergo allergy skin testing for polyethylene glycol and polysorbate 80 to determine their eligibility for the same vaccine or a safe alternative.Hypopigmentation is an infrequent adverse effect of corticosteroids, including triamcinolone acetonide, following local and intralesional treatment. Exposure to high potency corticosteroids for a long duration and the intradermal injection route are risk factors for hypopigmentation.In this case report, we describe the development of hypopigmentation following triamcinolone ID testing.Case report: A 29-year-old lady with a history of immediate severe allergic reaction following the first dose of mRNA COVID-19 vaccine (Pfizer) underwent SPT and IDT for polysorbate 80 and polyethylene glycol. Triamcinolone acetonide and Prevnar 13 were used as an indicator of polysorbate 80. Following a negative SPT, IDT for triamcinolone acetonide was negative at 1:10 of 40 mg/mL and positive at 1:1 of 40 mg/mL. A few days later, she noticed hypopigmented lesions at the site of the intradermal skin test for both concentrations of triamcinolone. The lesions have increased in size since then (see image). The patient was diagnosed with steroid-induced hypopigmentation secondary to triamcinolone IDT injection.Conclusion: Skin hypopigmentation following intraarticular and intralesional triamcinolone injection has been reported previously. However, to the best of our knowledge, this is the first reported case of steroid-induced hypopigmentation following intradermal skin testing. Furthermore, this report highlights that even a low dose of local triamcinolone can cause hypopigmentation. We believe that this case report regarding the rare adverse event will alert clinicians to the potential complication of corticosteroid IDT and help them counsel the patients and provide a thorough explanation before any procedure.

Response of intra canal medicaments on viability and survival of SHEDs.

Regenerative endodontic procedures (REP) rely on the principles of tissue engineering and take advantage of the regenerative abilities of Stem Cells derived from human exfoliated deciduous teeth (SHEDs). Since REPs advise the minimal instrumentation of root canals, they are more dependent on intracanal medicaments with antimicrobial activity to provide a sterile environment for pulpal regeneration. Hence present trial was conducted to examine the influence of different intracanal medicaments on SHEDs proliferation and survival. SHEDs were cultured by using the long-term explant culture method and characterized using flow cytometry and exposed to different concentrations of calcium hydroxide, doxycycline, potassium iodide, triamcinolone, and glutaraldehyde. SHEDs were subjected to the 3-(4,5- dimethylthiazol -2 -yl)-2,5-diphenyl-2H- tetrazolium bromide (MTT) assay, apoptosis using the Annexin V-binding assay and Alkaline Phosphatase (ALP) activity. All medicaments significantly reduced cell viability at different concentrations over different exposure times. Highest number of live cells and ALP activity was observed in SHEDs cultured in calcium hydroxide. Potassium iodide and glutaraldehyde were the significantly less likely of all the medications examined to adversely affect the viability and survival of SHEDs.

Possible tumour cell reimplantation during curative endoscopic therapy of superficial Barrett’s carcinoma

Background and aimsEndoscopic resection has been established as curative therapy for superficial cancer arising from Barrett’s oesophagus (BE); recurrences are very rare. Based on a case series with unusual and...

Intralesional Triamcinolone May Not Be Beneficial for Treating Acute Hidradenitis Suppurativa Lesions: A Double-Blind, Randomized, Placebo-Controlled Trial.

Hidradenitis suppurativa (HS) is a chronic, inflammatory condition characterized by recurrent nodules, sinus tracts, comedones, and scarring. Hidradenitis suppurativa is often associated with pain and decreased quality of life. Limited clinical trial data exist regarding the management of acute HS lesions, but clinical experience and a prospective case series suggest that intralesional triamcinolone may be useful. To compare the efficacy of intralesional triamcinolone to placebo for the treatment of HS inflammatory lesions. This is a double-blind, randomized, placebo-controlled trial comparing intralesional triamcinolone 10 mg/mL, triamcinolone 40 mg/mL, and normal saline (NS). Thirty-two subjects at University of North Carolina Dermatology and Skin Cancer Centers were enrolled for a total of 67 lesions. Subjects reported pain scores, days to resolution, and satisfaction on a standardized survey over a 14-day period. When intralesional injections of triamcinolone 10 mg/mL, triamcinolone 40 mg/mL, and NS were compared, no significant difference was found for days to HS inflammatory lesion clearance, pain reduction at Day 5, or patient satisfaction. No statistically significant difference was found between varying concentrations of triamcinolone and NS for the treatment of HS lesions. Steroid injections may be less effective for the management of acute HS than typically presumed.

536 Systematic review and meta-analysis evaluating the effectiveness of different concentrations of intralesional triamcinolone for alopecia areata

While intralesional steroids are considered first-line treatment for focal alopecia areata, the optimal concentration of intralesional triamcinolone is not known due to the paucity of randomized controlled trials. The current literature is mostly limited to case series with small sample sizes and heterogeneous populations. Therefore, we performed a systematic review and meta-analysis evaluating the efficacy and tolerability of different concentrations of intralesional triamcinolone for alopecia areata. We conducted a comprehensive literature search of MEDLINE and EMBASE, identifying observational cohort studies and randomized controlled trials reporting rates of hair regrowth with intralesional triamcinolone for alopecia areata. Random-effects modeling was used to obtain pooled effect sizes with 95% confidence intervals. Of 3,438 studies screened, a total of six studies (443 participants) with alopecia areata were included in the analysis. Pooled rates of hair regrowth were 62.3% (CI: 50.6-72.8%, p=0.04) at <5 mg/ml, 80.9% (CI: 71-88%, p<0.005) at 5 mg/ml, and 79.9% (CI: 61.9-90.7%, p=0.003) at 10 mg/ml concentrations of intralesional triamcinolone. Skin atrophy occurred in 4/120 (3.33%) treated with 5 mg/ml and 12/59 (20%) treated with 10 mg/ml concentration. Based on our meta-analysis, rates of hair regrowth were comparable with 5 mg/ml and 10 mg/ml concentrations (80.9%, p<0.005 versus 79.9%, p=0.003, respectively) while rate of hair regrowth (62.3%, p=0.04) was lower with <5 mg/ml concentrations of intralesional triamcinolone for treatment of focal alopecia areata. Interestingly, in contrast to our findings, a pilot intra-subject study of 4 participants demonstrated comparable rates of hair regrowth in 2.5 mg/ml, 5 mg/ml, and 10 mg/ml concentrations. Given risk for adverse side effects like skin atrophy with higher concentrations of intralesional steroids, additional studies are needed to determine the lowest effective concentration for the treatment of alopecia areata.

Corticosteroid and Cortisol Serum Levels Following Intra‐articular Triamcinolone Acetonide Lumbar Facet Joint Injections

Facet joint steroid injections are used to treat chronic low back pain. However, little is known about the systemic absorption and serum levels of steroids following intra-articular facet joint injections. The primary objective of this preliminary study was to investigate the pharmacokinetics of triamcinolone acetonide following fluoroscopically guided intra-articular lumbar facet joint injections in a cohort of patients with chronic low back pain. A secondary aim was to investigate the effects of triamcinolone on serum cortisol levels following lumbar facet joint injections. The study cohort included 5 patients undergoing fluoroscopically guided intra-articular lumbar facet joint injections at a pain medicine specialty clinic. Blood was collected prior to the injections and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injections. The terminal elimination half-life of triamcinolone in a noncompartmental analysis was 213 hours. The peak median triamcinolone concentration of 3.6 ng/mL was detected within 24 hours after the injections. Serum cortisol levels were < 30 ng/mL for an average of 4.4 days. The maximum effect of triamcinolone on cortisol suppression was observed with triamcinolone serum levels of > 1.9 ng/mL. The peak serum concentration of triamcinolone following intra-articular facet joint injections occurred within 24 hours. The median terminal elimination half-life was 213 hours, but baseline cortisol levels were suppressed for an average of 4.4 days. Clinically, the prolonged half-life and endocrine effects of triamcinolone could increase the risk for serious drug-drug interactions in patients taking medications that inhibit corticosteroid metabolism.

Serum Triamcinolone Levels following Cervical Interlaminar Epidural Injection.

Background Cervical interlaminar epidural steroid injections (ESIs) are commonly performed procedures to treat painful cervical radiculopathy, but little is known about the systemic absorption and serum levels of steroids following injection. The primary objective of this study was to investigate the pharmacokinetics of fluoroscopy-guided cervical epidural-administered triamcinolone acetonide in a cohort of patients with cervical radicular pain seeking treatment in a pain medicine clinic. Methods The study cohort included eight patients undergoing a fluoroscopically guided C7-T1 interlaminar ESI at a pain medicine specialty clinic. Blood was collected prior to the ESI and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injection. The sample extract was analyzed by tandem mass spectrometry. Results The terminal elimination half-life of cervical epidural-administered triamcinolone in a noncompartmental analysis was 219 hours. In the noncompartmental analysis, peak triamcinolone concentrations of 5.4 ng/mL were detected within 22.1 hours after administration. Conclusions The pharmacokinetics of cervical epidural-administered triamcinolone is consistent with our previous study of lumbar ESI, demonstrating that the elimination half-life is longer than that which has been reported following intravenous triamcinolone. The elimination half-life was shorter following cervical ESI than that which has been reported following lumbar ESI.

Clinical implication of triamcinolone in aqueous humor after depository sub-Tenon application

To determine the triamcinolone concentration in the aqueous humor after anterior sub-Tenon injection versus posterior sub-Tenon injection and the possible association between the levels of triamcinolone in the aqueous and the elevation in intraocular pressure (IOP). University teaching hospitals at Wenzhou and Shanghai, China. Prospective case series. The aqueous humor was sampled and triamcinolone quantitated after anterior sub-Tenon injection or posterior sub-Tenon injection in a cohort of patients and in experimental rabbits. Patients' IOPs were measured before and up to 3months after triamcinolone acetonide injection. The study comprised 46 patients and 18 rabbits. The mean aqueous humor triamcinolone concentration in rabbit eyes and human eyes was significantly higher after an anterior sub-Tenon injection than that after a posterior sub-Tenon injection (rabbit eye: anterior sub-Tenon injection, 2.67ng/mL±0.78 [SD] and posterior sub-Tenon injection 1.38±0.48ng/mL; human eye: 133.8±149.2ng/mL and 10.2±10.9ng/mL, respectively) (both P<.0001). After anterior sub-Tenon injection, the mean triamcinolone concentration in the aqueous humor was significantly higher in human eyes than in rabbit eyes (133.8±149.2ng/mL versus 11.0±8.1ng/mL) (P=.0003). The levels of triamcinolone in the human aqueous humor had a significant positive association with the elevation in IOP (β=0.12, P=.026). The triamcinolone level in aqueous humor was associated with IOP elevation after sub-Tenon application. Posterior sub-Tenon injection with a small injection volume ofconcentrated suspension offered a better targeted delivery and might significantly reduce steroid-associated IOP elevation.

Serum Triamcinolone Levels Following Interlaminar Epidural Injection.

Lumbar interlaminar epidural steroid injections (ESIs) are one of the most commonly performed procedures in pain medicine, but little is known about the serum levels of steroids following injection into the epidural space. The primary objective of this study was to investigate the pharmacokinetics of fluoroscopy-guided epidural-administered triamcinolone acetonide in a cohort of patients with chronic low-back pain seeking treatment in a pain medicine clinic. The study cohort included 10 patients undergoing a fluoroscopically guided L4-L5 or L5-S1 lumbar interlaminar ESI at a pain medicine specialty clinic. Blood was collected prior to the ESI and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injection. The sample extract was analyzed by tandem mass spectrometry. The terminal elimination half-life of epidural-administered triamcinolone in a noncompartmental analysis was 523 hours. In the noncompartmental analysis, peak triamcinolone concentrations of 4.1 ng/mL were detected within 24 hours after administration. The pharmacokinetics of epidural-administered triamcinolone is consistent with previously observed adverse effects of the drug on endocrine function. The pharmacokinetics of other epidural-administered steroids should be determined and incorporated in clinical trials to investigate the potential associations between serum levels, clinical outcomes, and potential adverse endocrine effects.

Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation

ObjectivePostoperative atrial fibrillation is the most frequent complication arising after cardiac surgery, occurring in 40% of cases. The treatment of postoperative atrial fibrillation with epicardial amiodarone/corticosteroid hydrogel delivery can increase efficacy and reduce side effects. To further evaluate whether amiodarone hydrogel is superior to corticosteroid hydrogel or placebo, we performed a randomized prospective study in 150 patients with coronary artery bypass grafting to compare the effectiveness with different epicardial drug approaches in the postoperative period. MethodsAfter institutional review board approval, 150 patients, from January 2012 to July 2014, who had undergone cardiac surgery were randomized to 3 equal groups. Group I received poly-based hydrogel with amiodarone, and group II received poly-based hydrogel with triamcinolone. Both hydrogels were sprayed diffusely over the biatrial epicardium. The control group underwent the procedure with only hydrogel spray. Continuous telemetry monitored for postoperative atrial fibrillation, and amiodarone or triamcinolone levels in the atria, plasma, and tissue were measured postoperatively. Daily electrocardiographic parameters were measured until postoperative day 14. ResultsThe incidence of postoperative atrial fibrillation was significantly less in group I, with 4 of 50 patients (8%) incurring atrial fibrillation compared with 11 of 50 patients (22%) in group II and 13 of 50 patients (26%) in the control group (P < .01). The mean amiodarone and triamcinolone concentrations in the atria (12.06 ± 3.1/1.5 ± 0.7) were significantly greater than those in the extracardiac tissues (1.32 ± 0.9/0.2 ± 0.4; P < .01). The plasma amiodarone and triamcinolone levels remained below the detection limit (<8 μg/mL and <0.2 μg/mL) during the 14 days of follow-up. Bradycardia was observed less in the control group (93 ± 18) than in study group I (76 ± 29; P < .01). ConclusionsEpicardial application of amiodarone-releasing adhesive hydrogel is a less-invasive, well-tolerated, quick, and effective therapeutic option for preventing postoperative atrial fibrillation with minimal risk of extracardiac adverse side effects. However, there was no clinical evidence that epicardial corticosteroid prevented postoperative atrial fibrillation.

The viability of chondrocytes after an in vivo injection of local anaesthetic and/or corticosteroid: a laboratory study using a rat model.

This in vivo controlled laboratory study was performed to evaluate various intra-articular clinical injection regimes that might be less toxic than some in vitro studies suggest. We hypothesised that low-concentration, preservative-free, pH-balanced agents would be less toxic than high-concentration non-pH-balanced agents with preservatives, and that injections of individual agents are less toxic than combined injections. The left knees of 12- to 13-week-old Sprague-Dawley rats were injected once with eight different single agents, including low and high concentrations of ropivacaine and triamcinolone, alone and in combination, as well as negative and positive controls. The rats were killed at one week or five months, and live-dead staining was performed to quantify the death of chondrocytes. All injections except pH-balanced 0.2% ropivacaine combined with preservative-free 1 mg/ml triamcinolone acetonide resulted in statistically significant decreases in chondrocyte viability, compared with control knees, after one week and five months (p < 0.001). After one week there was no significant difference in viability between 0.2% and 0.5% ropivacaine; however, 4 mg/ml triamcinolone resulted in a lower viability than 1 mg/ml triamcinolone. Although many agents commonly injected into joints are chondrotoxic, in this in vivo study diluting preservative-free 10 mg/ml triamcinolone 1:9 in 0.2% pH-balanced ropivacaine resulted in low toxicity.

Positive doping results caused by the single-dose local injection of triamcinolone acetonide

Triamcinolone acetonide (TA) is classified as an S9 glucocorticoid in the 2014 Prohibited List published by the World Anti-Doping Agency, which caused it to be prohibited in-competition when administered orally, intravenously, intramuscularly or rectally. The Minimum Required Performance Level (MRPL) for the detection and identification of glucocorticoids is 30ng/mL. Other common local injection routes, such as intraarticular, intratendinous, or intrabursal injection, are not prohibited. The purpose of this study was to analyze the TA and triamcinolone (T) concentrations in urine after a single injection of TA in patients to determine if it would produce a positive result. This study was performed on 40 patients with sports injuries or joint pains. TA was administered locally (doses varied from 12 to 80mg). Samples were extracted using a solid-phase extraction column, followed by hydrolysis and liquid extraction using diethyl ether. The elution solvents were collected and dried. The dried residue was reconstituted and assayed by performing liquid chromatography–tandem mass spectrometry (LC–MS/MS) in positive ionization mode using electrospray ionization and multiple-reaction monitoring as the acquisition mode. The results demonstrated that the concentrations of both TA and T in urine exceeded the MRPL (30ng/mL) after a single local injection. We obtained positive results for TA in 25 patients, and a positive result for T in one patient. Furthermore, the metabolic situation of TA, a long-acting glucocorticoid, was not an exact linear model. The highest concentrations of TA and T appeared 1–4h after injection. This information could be useful for limiting the misuse of TA by athletes. We suggest that athletes be aware when using TA injections during a competition period and obtain approval for therapeutic use exemption prior to using TA.

Vitreous Pharmacokinetics and Retinal Safety of Intravitreal Preserved Versus Non-preserved Triamcinolone Acetonide in Rabbit Eyes

Purpose: To compare the intravitreal pharmacokinetic profile of a triamcinolone acetonide formulation containing the preservative benzyl alcohol (TA-BA) versus a preservative-free triamcinolone acetonide formulation (TA-PF), and evaluate potential signs of toxicity to the retina.Methods: A total of 60 New Zealand male white rabbits, divided into two groups, were studied. In the TA-BA group, 30 rabbits received an intravitreal injection of TA-BA (4 mg/0.1ml) into the right eye. In the TA-PF group, 30 rabbits received an intravitreal injection of TA-PF (4 mg/0.1ml) into the right eye. The intravitreal drug levels were determined in 25 animals from each group by high-performance liquid chromatography (HPLC). The potential for toxicity associated with the intravitreal triamcinolone injections was evaluated in five randomly selected animals from each group by electroretinography (ERG) and by light microscopy.Results: Median intravitreal concentrations of TA-BA (µg/ml) were 1903.1, 1213.0, 857.8, 442.0, 248.6 at 3, 7, 14, 21 and 28 days after injection. Intravitreal concentrations of TA-PF (µg/ml) were 1032.9, 570.1, 516.6, 347.9, 102.8 at 3, 7, 14, 21 and 28 days after injection. The median intravitreal triamcinolone concentration was significantly higher in the TA-BA compared to the TA-PF group at 7 days post-injection (p < 0.05). There was no significant difference between the two groups in median triamcinolone concentration at the other time points evaluated. There was no evidence of toxic effects on the retina in either group based on ERG or histological analyses.Conclusions: Following a single intravitreal injection, the median concentration of triamcinolone acetonide is significantly higher in the TA-BA compared to the TA-PF group at 7 days post-injection. No toxic reactions in the retina were observed in either group.

Investigation of Triamcinolone in Acute Phonotrauma

Objective: Investigate the effects of triamcinolone on transcript levels of the inflammatory markers (COX-2, TGF-β1, IL-1β) and tight junction proteins (zonula occludin-1 (ZO-1), occludin, E-cadherin, β-catenin) in an in vivo model of acute phonotrauma. We hypothesized that triamcinolone downregulates inflammatory mediator gene expression and upregulates tight junction gene expression. Method: Eight New Zealand white rabbits received intralaryngeal triamcinolone acetonide at the following concentrations: saline control, 100 µg/25 µL, 400 µg/25 µL, and 800 µg/25 mL followed by 30 minutes of raised intensity phonation. Quantitative polymerase chain reaction (qPCR) was used to investigate gene expression levels of inflammatory markers and epithelial tight junction proteins. Results: Results of qPCR revealed dose-dependent changes in COX-2, TGF-β1, and IL-1β. Higher concentrations of triamcinolone showed an inverse relationship with transcription of these gene products. For tight junction proteins, qPCR showed upregulated gene expression of ZO-1, occludin, and E-cadherin in rabbits receiving 100 µg/25 µL triamcinolone compared to controls. However, higher concentrations of triamcinolone resulted in decreased levels of tight junction gene expression. Conclusion: Triamcinolone is used for treatment of laryngeal disorders. However, the anti-inflammatory properties of triamcinolone have not been demonstrated in the larynx. Results of this experiment provide support for the hypothesis that triamcinolone downregulates inflammatory mediator gene expression and upregulates tight junction gene expression at lower concentrations in acute phonotrauma.

Efficacy of photodynamic therapy associated with intravitreal triamcinolone to treat subfoveal choroidal neovascularization secondary to age related macular degeneration (VERTA study)

Abstract Purpose To report the efficacy of photodynamic therapy with Visudyne (PDT) associated with two different concentrations of intravitreal triamcinolone (TA) to treat subfoveal choroidal neovascularization (CNV) secondary to age related macular degeneration (AMD). Methods Prospective, controlled, randomized, multicenter, phase IIIb clinical trial. Fifty five eyes from 55 patients presenting CNV secondary to AMD were randomized to be treated by PDT as monotherapy, PDT associated with 4mg TA or PDT associated with 20mg TA. Primary outcome measure was the average change in visual acuity at one year. Secondary outcome measures were the proportion of patients with severe vision loss (≥15 letters) at one year, the proportion of patients with moderate vision loss (&lt;15 letters) and CNV activity as determined by fluorescein angiography at three month intervals, and the appearance of side effects. Results No statistically significant differences were observed for the average change in visual acuity and for the proportion of patients with severe vision loss at one year. The proportion of patients with moderate vision loss was higher among patients treated by PDT combined with 4mg TA at 3 and 6 months. The most frequent adverse events were increased intraocular pressure and retinal pigment epithelium detachment. Conclusion Combined treatment PDT‐4mg TA may increase the proportion of patients with moderate vision loss at month 3 and 6 compared with PDT monotherapy and combined PDT‐20mg TA.

Adrenal suppression due to an interaction between ritonavir and injected triamcinolone: a case report

Two HIV-1 infected patients developed signs and symptoms consistent with adrenal suppression after being exposed to intra-articular triamcinolone acetate while also receiving ritonavir as part of their highly active antiretroviral therapy. Laboratory evaluation confirmed secondary adrenal suppression in both cases. Both patients recovered without the need for chronic replacement steroids. Adrenal suppression has been described as an adverse outcome in patients treated with fluticasone and concomitant ritonavir. In the reported cases, the adrenal suppression likely developed as a result of increased systemic concentrations of triamcinolone due to an inhibition of cytochrome p450 3A4 metabolism. Practitioners of HIV medicine should be aware of the potential negative interaction of injected triamcinolone and ritonavir.