Triamcinolone Injection Research Articles

Efficacy and safety of intravitreal injection of triamcinolone-moxifloxacin after cataract surgery in a low to middle income country - a one-year audit.

To evaluate the safety and efficacy of intravitreal injection of triamcinolone and moxifloxacin regime administered immediately following cataract surgery. The retrospective study was conducted from January to June 2021 at a tertiary care referral centre in Karachi and comprised record of all patients who underwent dropless cataract surgery from April 2018 to June 2019. Data included slit lamp examination, dilated fundal exam, uncorrected visual acuity, best corrected visual acuity, and intraocular pressure. Cataract assessment and anterior chamber reaction were graded according to the World Health Organisation cataract grouping system. Efficacy of the regime was defined as the ability to prevent postoperative endophthalmitis. Stratification analysis was done to note if gender has any role in terms of effectiveness. Data was analysed using Microsoft Excel version 16.0 and IBM SPSS version 27. Of 240 eyes of 161 patients analysed, 114(47.5%) were of men who had a mean age of 57.89±14.32 years, and 126(52.5%) were of females with a mean age of 58.02±10.85 years. Overall, 2(1.75%) male subjects and 1(0.8%) female subject developed breakthrough inflammation within one week of the procedure. They were treated with anti-inflammatory drops and in 1(33%) of the cases antibiotic drop for 1 week. At day 90, no patient had residual inflammation or new onset inflammation. Also, 15(6.25%) patients developed raised intraocular pressure from day 7 to day 30. Most cases 10(66.7%) resolved within 1 week of using intraocular pressure-lowering drops. No patient developed endophthalmitis postoperatively. Dropless cataract regime was found to be an effective and safe alternative that was easy to administer.

Bilateral Extensive Syphilitic Punctate Inner Retinitis Triggering Macular Ischemia after Intravitreal Triamcinolone Injections

Purpose: To report a case of extensive syphilitic punctate inner retinitis (SPIR) triggering bilateral macular ischemia after intravitreal triamcinolone injections, and the multimodal retinal imaging findings.Case summary: A 69-year-old male patient with nonproliferative diabetic retinopathy was transferred to our hospital because of bilateral visual deterioration (to counting fingers) after the first intravitreal triamcinolone injection. Fundus examination revealed numerous yellow punctate precipitates in the superficial retinae, retinal arteriolitis, and vitritis. The punctate lesions and surrounding retinal regions showed decreased vascular density on optical coherence tomography angiography, and focal hypofluorescence on fluorescein angiography. The patient was positive for all of the Venereal Disease Research Laboratory test, the fluorescent treponemal antibody-absorption test, and <i>Treponema pallidum</i> hemagglutination; we diagnosed bilateral SPIR. After treatment with aqueous crystalline penicillin solutions (24 million units per day for 14 days), the punctate lesions reduced but arteriolitis progressed to obliterative vasculitis. After 6 months, the bilateral SPIR and vitritis resolved, and the bilateral visual acuity improved to 20/100. However, inner retinal and macular ischemia persisted because of capillary nonperfusion attributable to obliterative vasculitis.Conclusions: Extensive SPIR can develop after an initial intravitreal steroid injection; the inner retinal ischemia and visual loss may persist after treatment because obliterative vasculitis develops. Therefore, patients scheduled for intravitreal steroid injections should be screened for syphilis infection.

Corticosteroid Versus Dextrose Ultrasound-Guided Injection in the Treatment of Sacroiliac Joint Dysfunction: A Randomized Double-Blinded Clinical Trial

Background: Sacroiliac Joint (SIJ) dysfunction, a common etiology of Low Back Pain (LBP), is a challenging diagnosis. There is controversy over the efficacy of prolotherapy and corticosteroid injections in relieving SIJ dysfunction. Inconsistent success rates reported in previous studies can be due to heterogeneity in selecting the patients and procedures between studies. This study was conducted to compare the efficacy of local injection of dextrose prolotherapy and corticosteroid in treating the SIJ dysfunction.
 Methods: This 36-week, double-blind, Randomized Controlled Trial (RCT) included 40 patients with SIJ dysfunction. The clinical impression was confirmed by the use of a diagnostic injection of local anesthetic inside SIJ. Participants received a single injection of either hypertonic dextrose solution or triamcinolone under Ultrasound (US) guidance. The primary outcome measurement tools, including the Visual Analog Scale (VAS) for pain and the Dallas Pain Questionnaire (DPQ), were evaluated initially and after 2, 8, and 36 weeks.
 Results: In both prolotherapy and corticosteroid groups, VAS significantly declined within 36-weeks of follow-up. However, there was no remarkable difference between the two groups at any follow-up timepoints. Similarly, DPQ revealed a remarkable improvement in the corticosteroid group while it did not show any meaningful change in the prolotherapy group.
 Conclusion: Both local injections of dextrose and corticosteroids can successfully reduce pain in patients with SIJ dysfunction without significant superiority between the two treatments. However, corticosteroid injection was slightly more effective in terms of improvement of functional status. Further investigations are required to extend these results to SIJ dysfunction treatment more reliably.

Transforaminal Epidural Autologous Conditioned Serum Injection in the Treatment of Unilateral Lumbar Radicular Pain: A Randomized, Controlled, Double-Blind Clinical Trial

Background: Low back pain could related to disc herniation and managed by surgery. Also, less invasive options, including epidural corticosteroid injection, are available; however, it is associated with side effects. This study aimed to evaluate the effectiveness of autologous conditioned serum (ACS) in treating unilateral lumbar radicular pain. Materials and Methods: In this randomized, controlled, double-blind clinical trial study, a total of 68 patients received the transforaminal epidural injection, 28 patients received ACS, and 30 patients received 40 mg triamcinolone. Under fluoroscopic guidance in anterior-posterior and lateral views, a single injection of ACS or triamcinolone was done via the transforaminal epidural technique. Pain intensity was assessed with a visual analogue scale (VAS) and Oswestry disability index (ODI) at three weeks, three months, and six months. Results: A significant reduction in pain intensity was observed in patients of two groups. There was no significant difference between the two groups during the three months of the study. At the final evaluation at six months, the ACS group showed superiority over the triamcinolone based on the VAS score (P<0.05) and ODI (P=0.007). Conclusions: ACS therapy is a new effective option in treating lumbar radicular pain due to herniated disc. Since no specific complication has been reported, it can be used as a substitute for corticosteroids in such cases.

Study of Comparison of Effect and Complications of Intravitreal Triamcinolone Injection of 1 mg, 2 mg and 4 mg in Macular Edema of Vascular Origin

Introduction: The present study aimed to compare the efficacy and safety of different doses (1 mg, 2 mg and 4 mg) of triamcinolone acetonide (IVTA) in treatment of eyes with macular edema of vascular origin. Methods: Using simple random sampling among patients attending our tertiary healthcare referral centre, 60 patients fulfilling selection criteria were divided into 3 groups and were followed up for a period of 16 weeks. Following IVTA injections of different doses, patients were observed for changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT) on optical coherence tomography (OCT), intraocular pressure (IOP) and cataract occurrence/ progression in all three groups at 1 week , 4 weeks, 12 weeks and 16 weeks. Results: Following IVTA injection in all three groups (1 mg, 2 mg and 4 mg), mean BCVA improved from baseline but no statistically significant difference was observed in mean BCVA at different follow ups between the three groups. Mean CFT significantly improved from baseline in all three groups but no statistically significant difference was observed at different follow ups between groups. Mean IOP increased from baseline in all three groups but no statistically significant difference was observed among groups at different follow ups. Anti glaucoma treatment was required at end of 16 weeks postoperatively in 0, 1 and 3 eyes receiving 1 mg, 2 mg and 4 mg IVTA respectively. Lenticular changes at the end of 16 weeks postoperatively were found in 0, 1 and 2 eyes with 1 mg, 2 mg and 4 mg IVTA respectively. Conclusion: 4 mg dose of IVTA improves the functional and anatomical outcome in macular edema of vascular origin in most patients followed by 2 mg dose. 1 mg and 2 mg dose of IVTA has less incidence of steroid induced elevation of IOP and lenticular opacity development or progression. Further large scale studies are recommended to compare the effectiveness and safety of different doses of IVTA. Keywords: Triamcinolone Acetonide, Macular edema, diabetic retinopathy, retinal vein occlusion

Study of comparison of effect and complications of intravitreal triamcinolone injection of 1 mg, 2 mg and 4 mg in macular edema of vascular origin

Introduction: The present study aimed to compare the efficacy and safety of different doses (1 mg, 2 mg and 4 mg) of triamcinolone acetonide (IVTA) in treatment of eyes with macular edema of vascular origin.Methods: Using simple random sampling among patients attending our tertiary healthcare referral centre, 60 patients fulfilling selection criteria were divided into 3 groups and were followed up for a period of 16 weeks. Following IVTA injections of different doses, patients were observed for changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT) on optical coherence tomography (OCT), intraocular pressure (IOP) and cataract occurrence/ progression in all three groups at 1 week , 4 weeks, 12 weeks and 16 weeks. Results: Following IVTA injection in all three groups (1 mg, 2 mg and 4 mg), mean BCVA improvedfrom baseline but no statistically significant difference was observed in mean BCVA at different follow ups betweenthe three groups. Mean CFT significantly improved from baseline in all threegroups but no statistically significant difference was observed at different follow ups between groups. MeanIOP increasedfrom baseline in all three groupsbut no statistically significant difference was observed among groups at different follow ups. Anti glaucoma treatment was required at end of 16 weeks postoperatively in 0, 1 and 3 eyes receiving 1 mg, 2 mg and 4 mg IVTA respectively. Lenticular changes at the end of 16 weeks postoperatively were found in 0, 1 and 2 eyes with 1 mg, 2 mg and 4 mg IVTA respectively.Conclusion: 4 mg dose of IVTA improves the functional and anatomical outcome in macular edema of vascular origin in most patients followed by 2 mg dose. 1 mg and 2 mg dose of IVTA has less incidence of steroid induced elevation of IOP and lenticular opacity development or progression. Further large scale studies are recommended to compare the effectiveness and safety of different doses of IVTA. Keywords: Triamcinolone Acetonide, Macular edema, diabetic retinopathy, retinal vein occlusion

Real-world effect of the treatment for painful subacute thyroiditis: The combined injection of lidocaine and triamcinolone using an insulin pen.

: Intrathyroidal injection using an insulin pen filled with a mixture of lidocaine and triamcinolone acetonide is a therapy for subacute thyroiditis (SAT) reported by us previously. We aimed to evaluate the clinical efficacy of ultrasound-guided intrathyroidal injection in the treatment of SAT. A total of 93 patients with SAT completed the study. All patients were evaluated via a history and clinical examination followed by thyroid function tests and ultrasonography of the thyroid. After ultrasound-guided intrathyroidal injection, the patients were followed up with respect to the injection frequency, treatment duration, and patient satisfaction. The visual numerical rating scale was used as a pain questionnaire for a given interval. Thyroid pain instantly decreased to scores below 3.0 following the first injection. Sixty-three patients (67.74%) avoided relapse of thyroid pain within 3 injections, which occurred within only 3 days after the first injection. The pain in 27 patients (29.03%) disappeared completely after 4-6 injections. Only 3 patients (3.23%) were found to need more than 6 injections, with 10 cited as the maximum number of injections, the injection took only 17 days altogether. The mean treatment cycle of the intrathyroidal injection was 3.98 days. There were no other associated complications with the novel therapy except infrequent small subcutaneous hematomas, which could be prevented with skilled practice. The average patient satisfaction score was as high as 9.0. Intrathyroidal injection of lidocaine and triamcinolone acetonide using an insulin pen was found to be an advantageous and satisfactory treatment for SAT.

A Pilot Study of Intralesional Injection of Triamcinolone Acetonide for Desmoid Tumors: Two-Year Outcomes.

The purpose of this pilot study was to examine the clinical efficacy and safety of serial triamcinolone injections for the treatment of desmoid tumors. Nine patients were enrolled into this prospective study and underwent three serial ultrasound-guided triamcinolone injections (120 mg) at 6-week intervals. MRI was compared at baseline and every 6 months, out to 24 months. Safety and tolerability were assessed by clinical evaluation and questionnaires, including the 12-item short form survey (SF-12), visual analog scale (VAS), and desmoid patient-reported outcome (PRO) tool. At 24 months, 8 (88.9%) patients demonstrated a reduction in the volume of their tumor while 1 (11.1%) enlarged. Median tumor volume change was -26.9% (-81.1% to 34.6%; P = 0.055) All 9 tumors remained stable based on World Health Organization criteria, whereas 2 (22.2%) demonstrated partial response based on RECIST. There was a significant decrease in the tumor:muscle postcontrast mean signal intensity ratio at 6 months (P = 0.008) and 24 months (P = 0.004). There was a similar decrease in the tumor:muscle T2 mean signal intensity ratio at 24 months (P = 0.02). We found no difference in the SF-12 and VAS scores, but there were significant improvements in the desmoid PRO. Treatment of desmoid tumors with serial triamcinolone injections appears safe and well tolerated by patients, with a 22% partial response based on RECIST. Further research is needed to confirm our results and determine factors predictive of response.

Comparison Between Intra Vitreal Bevacizumab and Triamcinolone in Reducing Macular Thickness in Central Retinal Vein Occlusion

Objectives: To compare the effect of intra vitreal bevacizumab (IVB) and intra vitreal triamcinolone (IVT) in reducing macular thickness in central retinal vein occlusion. Methods and Materials: This quasi experimental study was conducted at Department of Ophthalmology, Hayat Abad Medical Complex Peshawar in the period from 01 January 2020 to 30 June 2020. Total 40 patients presented with central retinal vein occlusion (CRVO). Patients were divided into two groups, group A received IVB treatment and group B received IVT treatment. The patients were followed up on 6th month post treatment. The primary outcomes of the study were visual acuity and reduction in macular thickness on OCT post treatment. Results: 40 patients were enrolled in the study. The mean age of patients was 60.70±15.49 in group A and in group B 60.40±12.83. There were 13 males and 7 females in group A and 12 males and 8 females in group B. Mean VA at baseline was 1.0825±0.25 logMAR in group A and 0.9745±0.29 logMAR in group B. Mean macular thickness at baseline was 625.40±47.15 µm in group A and 642.05±44.23 µm in group B. Mean VA at 6th month post treatment follow up was 0.4195±0.23 logMAR in group A and in group B was 0.4960±0.27 logMAR. At 6th month follow up macular thickness was 261.80±26.269 µm in group A and 263.80±22.209 µm in group B. Conclusion: Intravitreal injections of bevacizumab and triamcinolone have shown a reduction in macular edema in CRVO patients along with improvement in visual acuity. Keywords: Bevacizumab, Triamcinolone, Macular Edema, Central Retinal Vein Occlusion, Visual Acuity

To Determine the Efficacy of Suprachoroidal Triamcinolone Injection for the Treatment of Refractory Diabetic Macular Edema

Goal: To determine the safety and effectiveness of suprachoroidal triamcinolone injections (SCT) in refractory diabetic macular edema cases. Study Design: An Interventional case series. Place and Duration: In the Ophthalmology department of Allama Iqbal Memorial Teaching Hospital, Sialkot for six-months duration from January 2021 to June 2021 Methods: A total of 40 eyes from patients with type-I or II diabetes who were over the age of 18 years and were included. Inclusion criteria for the study included patients with treatment resistant central Diabetic Macular Edema of at least 320 um or above (as determined by Zeiss Cirrus HD-OCT) and a BCVA of equal to or less than 20/40. The central subfield thickness (CST), BCVA, and intraocular pressure (IOP) were all documented. Patients who had received suprachoroidal triamcinolone (SCTA) were monitored for 3-months and the similar clinical parameters were noted, and the findings were noted. Results: The results showed that 22 (55%) of the 40 patients were female and 18 (45%) were male. The 0.9± 0.22 was the mean log MAR BCVA and 612.89± 195.58 um was the mean pre-injection CST. In the first and third months, the mean post-injection CST was 308.59± 56.75um and 304.89± 54.29um, respectively. After injection at 1 and 3-months, the mean log MAR BCVA was 00.51± 0.3 and 0.36 ±0.20, correspondingly. At the first and third months, the results for pre- and post-injection CST were statistically significant (p value <0.00001). Conclusion: The reduction of refractory diabetic macular edema and improvement of macular thickness on OCT can both be accomplished safely and effectively using CST. Keywords: Central subfield thickness, suprachoroidal triamcinolone, diabetic macular edema.

Combined phacoemulsification surgery and intravitreal triamcinolone injection versus stand-alone surgery in patients with type 2 diabetes: a prospective randomized trial

BackgroundWe would assess the efficacy of intravitreal injection of triamcinolone acetonide IVTA combined with standard phacoemulsification on the central subfield macular thickness (CSMT), the progression of diabetic retinopathy (DR), and the corrected distant visual acuity (CDVA) in type 2 diabetic patients.MethodsIn this prospective single-blinded randomized clinical trial we recruited patients with type 2 diabetes who were eligible for cataract surgery. The patients were randomly assigned to two groups. The case group received an intravitreal IVTA at the end of phacoemulsification, and the control group had routine surgery. CSMT, progression of DR, CDVA, IOP, and adverse events including endophthalmitis were compared between the groups preoperatively and at 1, 3, and 6 months postoperatively.ResultsAmong a total of 66 patients that were treated within the study period, 50 patients were included in the final analysis. The case group comprised 21 eyes, and the control group included 29 eyes. Regression models and corrected ANOVA test for repeated measures showed a significant reduction in CSMT at 3 and 6 months postoperatively, which was most significant when the preoperative CSMT was ≥300 μm, with a cut-off value of 347.3 μm in the case group (p < 0.000). DR progression was halted in the case group at 6 months with 52.38% of patients having their DR classified as moderate (P = 0.012). CDVA was significantly improved from baseline 6/60 (logMAR 1.0) pre-op to 6/6 (logMAR 0.00) at 6 months post-op in the case group, and from baseline 6/120 (logMAR 1.3) pre-op to 6/12 (logMAR 0.3) at 6 months post-op in the control group. The gain in visual acuity was significantly higher in the case group at all study points (p < 0.001). No significant rise in IOP was observed at any study point in both groups (p = 0.23 > 0.05). No endophthalmitis was recorded.ConclusionsDiabetic patients benefit significantly from cataract surgery. This study supports IVTA injection at the end of phacoemulsification in diabetic patients. Triamcinolone is an affordable (which is of particular importance in low-income countries as per our setting), and relatively safe “phaco-enhancer”.Trial registrationNCT05413330. Initial release 10/06/2022. Unique Protocol ID: UDMS-Opthal-01-2022.

Efficacy and safety of platelet-rich plasma in the treatment of carpal tunnel syndrome: A network meta-analysis of different injection treatments.

Purpose: Carpal tunnel syndrome (CTS) is a common form of median nerve compression in the wrist caused by focal peripheral neuropathy. Platelet-rich plasma (PRP) therapy could improve the healing ability by exposing the injured tissues to high concentrations of autologous growth factors. Our study aims to compare all injective treatments for CTS and assess the efficacy and priority of PRP therapy. Methods: We searched Medline, Embase, Web of Science, Cochrane databases, and Clinicaltrial.gov until 17 October 2022. We only included data from randomized controlled trials (RCTs) that evaluated PRP injection therapy or drug injection therapy. The included RCTs measured at least one of the following three outcomes with validated instruments: in the visual analog scale (VAS), symptom severity scale (SSS), and functional status scale (FSS). Results: Overall, 19 studies with 1,066 patients were included in this study. We used the SUCRA rankings to determine the merits of various therapies. In all, 5% dextrose injections were the best treatment strategy for the VAS (MD -1.22, 95% CI -2.66 to 0.23; SUCRA = 79.2%), followed by triamcinolone (high-dose) injections (MD -0.69, 95% CI -2.11 to 0.73; SUCRA = 62.7%) and PRP injections (MD -0.39, 95% CI -1.67 to 0.89; SUCRA = 60.0%). In the SSS, the most effective intervention was hydroxyprogesterone injections (MD -0.62, 95% CI -1.09 to -0.16; SUCRA = 91.0%). The SUCRA ranking of PRP was second only to steroids and estrogen (MD -0.39, 95% CI -0.60 to -0.18; SUCRA = 60.8%). In the FSS, the best regimen strategy was hydroxyprogesterone injections (MD 0.12, 95% CI -0.30 to 0.54; SUCRA = 99.5%), followed by triamcinolone (low-dose) injections (MD -0.02, 95% CI -0.54 to 0.49; SUCRA = 87.4%) and PRP injections (MD -0.26, 95% CI -0.43 to -0.09; SUCRA = 77.1%). Conclusion: PRP is an alternative choice for CTS treatment. PRP injection is second only to steroids and estrogen in the treatment efficacy of CTS, with a wide indication and safe outcome.

COMPARISON OF FOCAL LASER WITH INTRAVITREAL TRIAMCINOLONE INJECTION AS TREATMENT FOR MACULAR OEDEMA FOLLOWING BRANCH RETINAL VEIN OCCLUSION

Background: Branch Retinal Vein Occlusion is a sight threatening disease in which Macular edema is the most important cause of central visual loss. Grid laser photocoagulation was the only treatment for macular oedema. Nowadays, intravitreal injection of vascular endothelial growth factors inhibitors and triamcinolone acetonide can play a role in management of BRVO. To study the visual acuity after focal laser and Objective: intravitreal triamcinolone injection and to compare the visual outcome of focal laser with intravitreal triamcinolone injection. 30 eyes Methods: were taken up for study. Based on the FFA ndings, the area with capillary non perfusion were excluded from the treatment. Only 24 cases were included in the treatment with focal laser and IVTA. The study groups were di Result: vided into Group 1 (underwent focal laser) and Group 2 (underwent Triamcinolone injection). The p-value was &gt;0.5 and there was no signicant difference in the visual outcome among the 2 groups. Conclusion: The therapeutics effects of Triamcinolone showed no signicant difference compared with focal laser with regard to visual outcomes but seemed to cause more adverse events. Therefore, further large randomized trials with longer follow up are needed to compare the long term safety and efcacy of these treatments provide sustainable concrete.

ODP596 Central Adrenal Insufficiency After Intra-Articular Triamcinolone Injection In A Patient On Dolutegravir And Cobicistat Boosted Darunavir

Abstract Background Central adrenal insufficiency from drug-drug interaction between steroids and HIV anti-retroviral medications is a well-documented phenomenon in the literature, but in clinical practice making this diagnosis can prove challenging. Clinical Case 58-year-old woman with well-controlled HIV on dolutegravir and cobicistat/darunavir, type 2 diabetes mellitus, and chronic kidney disease presented to our emergency department with 3 days of polyuria, polydipsia, headaches, nausea, and decreased appetite. She also noticed that her glucose readings have been much higher than usual. 5 days prior to presentation, she received a 40 mg triamcinolone acetonide injection into her right subacromial bursa for chronic shoulder pain. For diabetes, she had been on the same dosage of weekly dulaglutide with good control. Initial laboratory evaluation revealed elevated serum glucose of 763 mg/dl (70 - 140 mg/dL) without an elevated anion gap, sodium of 124 mEq/L (135 - 145 mEq/L) and potassium of 5.9 mmol/L (3.6 - 5.2 mmol/L). Morning cortisol was sent as part of the workup for hyponatremia and returned low at 1.2 ug/dL (4 - 20 ug/dL). A 250 mcg cosyntropin stimulation test was performed, with baseline cortisol at 1.3 ug/dL and one-hour post-stimulation cortisol of 8.8 ug/dL. Pre-stimulation ACTH was &amp;lt; 5. 0 pg/mL (10 - 60 pg/mL). A synthetic glucocorticoid panel were sent on the 11th day after her injection and detected triamcinolone acetonide at 3.3 mcg/dL (cutoff: 0.1 mcg/dL) in urine and 0.85 mcg/dL (cutoff: 0.1 mcg/dL) in serum. She was diagnosed with iatrogenic adrenal insufficiency from intra-articular triamcinolone injection, the effect of which had been potentiated by her HIV medications cobicistat and dolutegravir (both CYP3A4 inhibitors). She was started on hydrocortisone and experienced improvement in appetite and fatigue. A plasma renin activity assay was elevated at 7.66 ng/mL/h (0.25 - 5.82 ng/ml/h) with 15 ng/dL of aldosterone (3 - 16 ng/dL). While awaiting the ACTH result, we discussed the possibility of primary adrenal insufficiency given persistent hyponatremia despite improved glucose control. However, given recent normal cross-sectional abdominal imaging, the history of steroid exposure, and lack of opportunistic infections in the past, central adrenal insufficiency remained the leading diagnosis. Further workup, including urine anion gap, eventually determined the cause of her hyponatremia to be a type 4 RTA likely related to her longstanding history of diabetes. The patient was discharged home on hydrocortisone with plan for repeat stimulation test in 6 weeks. Conclusion 1. Keep primary adrenal insufficiency in mind in a patient with HIV who presents with hyponatremia and low cortisol. 2. Steroid injections carry risks of significant hyperglycemia and iatrogenic adrenal insufficiency in patients receiving cobicistat and integrase inhibitor. Presentation: No date and time listed

ODP436 Adrenal Insufficiency After Combined Treatment of Itraconazole and Triamcinolone

Abstract Introduction Adrenal insufficiency (AI) has been reported due to the use of budesonide and itraconazole. We report an unusual presentation of adrenal insufficiency from the use of triamcinolone and itraconazole. Clinical Case 46-year-old man with a history of NASH and alcoholic cirrhosis requiring liver transplant presented to ER with two weeks of progressive lower extremity weakness. He reported difficulty climbing stairs and getting up from a chair. He denied anorexia, nausea, vomiting, abdominal pain, or lightheadedness. He was treated with itraconazole for diffuse histoplasmosis for over one year and received one dose of intra-articular triamcinolone 40mg for shoulder pain 2 weeks prior to the hospital admission. Physical exam was significant for proximal weakness, ecchymoses on upper and lower bilateral extremities, mild truncal obesity, but no violaceous striae, moon facies, dorsocervical fat pad or supraclavicular fullness. Laboratory evaluation was notable for sodium 129 mEq/L (n: 135-145), potassium 5.9 mEq/dl (n: 3.5-5), albumin 2.9 g/dl (n: 3.5-5) and glucose 345 mg/dl (n: 70-140), ACTH of 6 pg/ml (6-20) AM cortisol of &amp;lt;1 ug/dl (n: 4-20), aldosterone &amp;lt;1 ng/dl (n: 3-16), and plasma renin activity (PRA)20.54 ng/mL/h (n: 0.25-5.82). Serum cortisol increased to 3.4 ug/dl at 60 minutes of cosyntropin stimulation test, consistent with adrenal insufficiency. Synthetic glucocorticoid panel detected triamcinolone. Patient was discharged on hydrocortisone and fludrocortisone with marked clinical improvement. Abdominal MRI 3 months after admission did not show any adrenal involvement by histoplasmosis. Fludrocortisone was slowly titrated off and only hydrocortisone continued. Repeat evaluation 6 months after last triamcinolone injection demonstrated recovery of HPA axis with peak cosyntropin stimulation cortisol level 16.3 ug/dL (assay by Abbott Alinity) and recovery of renin/angiotensin/aldosterone axis (AM aldosterone 7 ng/dl, renin 2 ng/ml/h). Repeat synthetic glucocorticoid testing confirmed clearance of triamcinolone. Conclusion Itraconazole is CYP3A inhibitor that has been shown to decrease the metabolism and clearance of different corticosteroids. While our patient's lab results supported a diagnosis of AI, it was unclear if the etiology was primary (PAI) or central AI (CAI). The Na+, K+, aldosterone and PRA levels support a diagnosis of PAI; whereas the suppressed ACTH level supports CAI. We believe that our patient had an atypical presentation of both PAI due to histoplasmosis and CAI due to itraconazole/triamcinolone. This confounding picture can potentially be explained by an underlying PAI that may have been masked and exacerbated by the HPA axis suppression of the itraconazole/triamcinolone combination. Presentation: No date and time listed

Early Compression Therapy for Deep Skin Defects: A New Treatment Option to Prevent Hypertrophic Scars or Contractures

Background: Conservative treatment of deep dermal or full-thickness skin defects often results in hypertrophic scars or contractures; thus, compressive therapy has been used after wound closure to prevent or treat scar deformities. However, wound contraction begins in the early proliferative phase and peaks after 2 weeks. We therefore attempted early compression therapy as a means of conservative treatment of deep-skin defects and evaluated its clinical outcomes. Methods: In 21 cases of deep skin defects (19 patients), early compressive therapy was started the second week after injury. Saline-moistened gauze or foam dressings were placed on open wounds, and foam dressings or silastic plates were used after epithelialization. The compression materials included elastic bandages, adhesive tapes, or garments. The final scars were assessed using the Vancouver Scar Scale (VSS) and satisfaction degree.Results: Defect size ranged from 1.4×0.7 to 5×5 cm. The duration of compression was 4 to 12 months. The follow-up periods were 4 to 61 months. Mild scar hypertrophy or contracture occurred in 15 cases and subsided after application of topical corticosteroid or triamcinolone injection. The final scar shapes were linear (n=12), geographic (n=5), and oval (n=4). The mean VSS score was 2.3. The degrees of satisfaction were excellent (61.9%) and good (23.8%). In most cases, aesthetically and functionally satisfactory outcomes without pathologic scars were demonstrated with minimal scar size, high scar quality, and high satisfaction.Conclusion: Early compression therapy might be a good option to prevent pathologic scars in the conservative treatment of deep skin defects.

An intra-articular injection provides a safe and effective remedy for lateral epicondylitis

Background: Lateral epicondylitis (LE) is an overuse injury affecting people performing repetitive forearm movements. The intra-tendinous injection of triamcinolone has successfully relieved the symptoms of LE but some side effects have been frequently reported. The aim of the study was to investigate whether an intra-articular triamcinolone injection is effective in pain relief and functional improvement in LE. Methods and results: This retrospective study examined the results of fifty-three patients who presented with LE from July 2020 to December 2021, with an average age of 54 and having a symptom duration of more than 3 months. Mixtures of 1 ml (30 mg) of triamcinolone and 1 ml of 2% lidocaine were prepared and infused into the elbow joint. Two weeks after the treatment, there was a down-gradation in pain and up-gradation in functional ability. Conclusion: Intra-articular triamcinolone injection was proved to be effective in pain reduction and LE-related functional disability. Complications were observed in none.

An outbreak of devastating facial stigmata caused by a single unlicensed aesthetic practitioner

Background The practice of medicine by uncertified personnel is a common concern in public healthcare. Although the introduction of the Korean National Health Insurance Service has significantly reduced the number of these cases, the problem persists in the field of aesthetics. Herein, we report an outbreak of devastating facial stigmata in patients treated with illegal cosmetic procedures.Methods During 1 week in November 2021, five patients presented to Bucheon St. Mary’s Hospital for the management of identical patterns of severe facial scarring. Each patient had been treated for “skin rejuvenation” by a single unlicensed practitioner. Months of needling therapy by the practitioner, aimed at resolving the problem, only aggravated the scarring. The victims visited our hospital after the practitioner ceased to answer their calls. The patients had similar presentations with multiple prominent scars on both cheeks. Ectropion of the right lower eyelid due to scar contracture was observed in one patient.Results Five monthly treatments with intralesional triamcinolone injection and laser therapy were performed. Despite thorough management, the patients were left with improved but distinctive stigmata on their faces.Conclusions Cases of illegal aesthetic procedures are difficult to prosecute because the patients have implicitly agreed to the procedure. Therefore, active legislative measures should be adopted to prevent further victimization. Public education on the dangers of illegal aesthetic practices is also necessary.

The effective analysis of refractory esophageal stricture after endoscopic mucosal dissection of early esophageal cancer treated by endoscopic radiotomy combined with local injection of triamcinolone acetonide

Refractor esophageal stenosis after endoscopic submucosal dissection of early esophageal carcinoma is a difficult clinical problem. To verify the effect of endoscopic radial incision combined local triamcinolone injection to treat refractory esophageal stenosis, we retrospectively analyzed 7 patients diagnosed with refractory esophageal stricture after endoscopic mucosal dissection of early esophageal cancer in this study, of whom 4 male and 3 female patients, aged 50-76 years, with the mean age of 63 years. We performed the endoscopic radial incision in the thickness point of the scar stricture and injected the triamcinolone locally. The results showed it was safe and effective. The follow-up showed no esophageal stenosis occured and no adverse reaction such as hemorrhage, perforation, tumor-recurrence and triamcinolone-allergy occured.

Bleomycin-triamcinolone sclerotherapy in the management of propranolol resistant infantile hemangioma of the maxillofacial region: A single arm prospective evaluation of clinical outcome and Doppler ultrasound parameters

IntroductionPropranolol has emerged as a first line agent in the management of hemangiomas. With increased use of propranolol, studies have also focused on relapses following propranolol therapy. Our current study evaluates the role of bleomycin triamcinolone sclerotherapy for the management of propranolol resistant Infantile Hemangioma (IH). We also evaluated the role color Doppler USG for response assessment of sclerotherapy. MethodsPatients with Propranolol resistant (Non- responders/ Partial responders) IHs were included in the study. Patients received intralesional bleomycin at a dose of 0.5 IU/kg followed by intralesional injection of triamcinolone at a dose of 2mg/kg body weight. Clinically patients were grouped into excellent, partial and non responders. Doppler parameters; Resistivity index (RI), Pulsatility index(PI) and Peak systolic velocity (PSV) were used to evaluate the response to sclerotherapy. These parameters were evaluated prior to sclerotherapy and 3 months following completion of therapy. The clinical responses of the patients were compared with the change in Doppler parameters before and after treatment. ResultsA total of 115 participants were considered for analysis; 60.86% had excellent response, 32.17% had partial response and 6.95% had poor response. There was a significant change in terms of RI, PI and PSV in patients who were either excellent or partial responders. Poor responders did not have a significant change in Doppler parameters. Conclusion: Combined bleomycin- triamcinolone sclerotherapy is an effective therapy for the management of propranolol resistant IHs. Doppler parameters RI, PI and PSV are reliable indicators of response in the management of IH.