SKINNY - SKIN Thickness and Needles in the Young

Background. Intensive diabetes management requires the use of multiple daily injections. Inappropriate insulin injection technique; inadvertent intramuscular (IM) injections; needle phobia and insulin omission negatively affect glucose control.Objectives. To document skin and skin plus subcutaneous skin thickness using high resolution ultrasound (US) in a group of children and adolescents with type 1 diabetes. In addition; injection technique; needle re-use and injection site analysis was performed.Methods. Commonly recommended injection sites were examined using high-resolution US. Patient characteristics such as age; body mass index; frequency of injections and favoured sites were analysed. Results. A total of 40 paediatric and adolescent children aged 4 years 3 months to 18 years were examined. The maximum skin thickness at any site was 2.93 mm. A high rate of IM injection was predicted with the standard 8 mm needle and was reduced but not eliminated with the use of the shortest available 4 mm needle. As the subcutaneous skin thickness increased across injection sites in the following order: arm; thigh; abdomen and buttocks; the risk of IM injection declined.Conclusion. Choice of needle length; injection site and injection technique are important considerations in diabetes management in the paediatric population and are likely to affect quality of glycaemic control. Shorter needles are more acceptable and reduce the risk of IM injections

Injection Technique Guidelines for Diabetes: Sharp and to the Point

Diabetes is the world's fastest growing chronic disease and affects people of all ages. Reliable statistics are not readily available for South Africa; but data held by companies that supply insulin suggest that approximately 200 000 people in South Africa use injectable therapies to treat their diabetes. Health outcomes are affected if the incorrect injection technique is used; and this is a frequent occurrence which can be remedie

Progestogen-only injectable contraceptive: experience of women in Osogbo, southwestern Nigeria

Background: Progestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months; depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. Objectives: To determine the characteristics of women accepting the method; complications and indications for discontinuation. Materials and Methods: This was a retrospective review of clients using progestogen-only injectable contraceptive between 1 st January; 2001 and 31 st December; 2009. Relevant information extracted from the case notes was analyzed. Survival analysis was carried out using Log-Rank Chi-square test to measure association over 12-month period of usage. Level of significance was set at P value less than 0.05.Results: A total of 1;967 women used contraception during the study period and 433 (22.1) made progestogen-only injectable their method of choice. 199(45.96) used NET-EN; while DMPA was used by234 (54.04) women. Many of the women (197; 45.5) used the method for terminal fertility control. Menstrual abnormality was the commonest (264; 71.4) complaint about progestogen-only injectable contraceptive; of which amenorrhea was experienced by constituted 176(66.7). Eighty-three (22.4) women had discontinued the contraceptive; and menstrual abnormality was the commonest reason for the discontinuation (68; 81.9). No pregnancy was reported among the women that came for follow up while on the method. Conclusion: Short duration of POIC use that is within 12 months is still high. However the main reason for discontinuation was found to be due to menstrual irregularities; hence the need for effective education of the women about this side effect; thus increasing the acceptance and continuation rate of the contraceptive method

Superficial Skin Infections and the Use of Topica and Systemic Antibiotics in General Practice

Superficial bacterial infections of the skin are very common. With the increasing burden of human immunodeficiency virus (HIV); this is likely to worsen. Examples of such infections include impetigo; erysipelas; cellulitis; ecthyma; furuncles; carbuncles and subcutaneous abscesses. Common causative organisms are staphylococci and streptococci. Generally; Staphylococcus aureus infections tend to spread locally; causing abscesses and carbuncles; while streptococci are apt to spread along tissue planes; and give rise to either cellulitis or erysipelas. However; this is not always the case. These infections cause a significant morbidity; and have to be diagnosed and treated promptly. Some result in serious complications

The Choice of Contraceptives among Women in Orlu; Nigeria

Background: Remarkable progress has been recorded in the turn of the century towards the development of more efficient and safer contraceptives. Previous studies from some parts of the country showed an increase in the percentage of clients changing from one contraceptive method to another. With the advent of the HIV/AIDS pandemic at the turn of the new millennium there may still be further changes in the choice of contraceptives in different parts of the world; Nigeria inclusive. Aim: To study the choice of contraceptive usage and the factors predictive of such choices in Orlu; southern Nigeria. Design: A cross sectional study Setting: Imo state University Teaching Hospital; Orlu; Nigeria. Subjects: Clients attending the family planning clinic. Main outcome variables: contraceptive choice; reason for choice; awareness and source of awareness about contraceptives. Results: Five hundred and three clients were reviewed. Ninety one percent knew at least one method of contraception. Their ages ranged between 18 and 52 years with majority in the 33-37 years age bracket. Most of the women were housewives (46.5). Clients who had attained post secondary school education or more constituted 29.4; majority were married (84.7); in monogamous marriages (81.7) and grandmultiparous (45.9). The commonest contraceptive choice was the injectables (44.3) while nurses and midwives formed the commonest source of knowledge about contraception and referral. Conclusion: The most commonly used contraceptive method in Orlu; Nigeria is the injectables. The HIV/AIDS pandemic may likely change or affect this trend

Botulinum Toxin Treatment for Anal Fissure

Objectives: To evaluate the effectiveness of Botulinum toxin injection in the treatment of anal fissure. Methods: 38 patients (22 males; 16 females; mean age (SD) of 33.3 (8.3) years) who have presented to Surgical Outpatient Clinic at Al Ain Hospital; United Arab Emirates; with anal fissure in the period between June 2000 and September 2001 and treated with Botulinum toxin injection were retrospectively studied. They were followed up for at least 8 weeks to evaluate the effects of treatment. Results: Treatment with Botulinum toxin was effective in 89of patients with chronic uncomplicated anal fissure. Two patients experienced minor incontinence in the form of a fecal soiling which disappeared later. Conclusion: Botulinum toxin injection is an effective alternative for surgery for treatment of uncomplicated idiopathic anal fissure. Surgery should be offered to patients who do not improve with Botulinum toxin injection and to those with complicated anal fissure

Spinal (Intrathecal) Ketamine Anaesthesia for Upper Abdominal Surgery : Case Report

Intravenous ketamine is usually administered for the induction of general anaesthesia. Spinal ketamine for lower abdominal and lower limb surgery is sporadically reported in the literature. However; the use of spinal ketamine for upper body surgery is rare. We describe the case of a 35-year old man; with a retroperitoneal tumour and severe intercurrent cardiovascular morbidity; that had exploratory laparotomy and tumour biopsy with Intrathecal ketamine administered through the L4/L5 interspace. The patient had good surgical analgesia; with stable vital signs throughout the surgery. After surgery; the spinal catheter was left in place; and withdrawn 48 hours later. The patient did well in the immediate postoperative period; although he gradually succumbed to the primary illness (malignant retroperitoneal cancer) on the 15th postoperative day

Joint and Soft Tissue Injection

Injection techniques are helpful for diagnosis and therapy in a wide variety of musculoskeletal conditions. Diagnostic indications include the aspiration of fluid for analysis and the assessment of pain relief and increased range of motion as a diagnostic tool. Therapeutic indications include the delivery of local anaesthetics for pain relief and the delivery of corticosteroids for suppression of inflammation. Side effects are few; but may include tendon rupture; infection; steroid flare; hypopigmentation; and soft tissue atrophy. Injection technique requires knowledge of anatomy of the targeted area and a thorough understanding of the agents used. In this overview; the indications; contraindications; potential side effects; timing; proper technique; necessary materials; pharmaceuticals used and their actions; and post-procedure care of patients are presented

Diagnostic and Therapeutic Injection of the Shoulder Region

The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic and therapeutic injection. Joint injection should be considered after other therapeutic interventions such as non-steroidal anti-inflammatory drugs; physical therapy; and activity-modification have been tried. Indications for glenohumeral joint injection include osteoarthritis; adhesive capsulitis; and rheumatoid arthritis. For the acromioclavicular joint; injection may be used for diagnosis and treatment of osteoarthritis and distal clavicular osteolysis. Subacromial injections are useful for a range of conditions including adhesive capsulitis; subdeltoid bursitis; impingement syndrome; and rotator cuff tendinosis. Scapulothoracic injections are reserved for inflammation of the involved bursa. Persistent pain related to inflammatory conditions of the long head of the biceps responds well to injection in the region. The proper technique; choice and quantity of pharmaceuticals; and appropriate follow-up are essential for effective outcomes

Laboratory animal euthanasia using intra-medullary injection of air

Background and Objective: Globally, millions of rodents are used for various researches annually. These animals must be euthanised with a minimum of physical and mental suffering. We describe intramedully injection of air as safe, reliable and humane method of euthanasia for rodents. Design: A prospective study of the effectiveness of intramedullary injection of air was conducted on thirty six Wister rats in the histology laboratory of the Department of Anatomy, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria between April to October 2004. Methodology: Thirty six pregnant Wister rats were euthanised by injecting 1ml of air into the medulla through foramen magnum. The time lag between the intramedullary injection of air and achievement of adequate euthanasia was documented for each rat using a stop watch. Results: Out of thirty six rats euthanised through intramedullary injection of air, thirty (83.3%) rats died within 10 seconds after the injection and the remaining 6(16.7%) rats died within 20 seconds after the injection. Conclusion: Intramedullary injection of air is effective, cheap, reliable and humane method of euthanasia in small rodents and requires inexpensive personnel training and is therefore advocated for use in small laboratory animals

The formalin test : effects of different injection sites on the pattern of nociceptive responses

The formalin test is widely believed to provide a more valid model for clinical pain than tests with phasic mechanical or thermal stimuli. However; the different implementations of the test in use pose the possibility of confounding results. This study evaluated the effects of different injection sites on the pattern of nociceptive responses. The responses to forepaw injection was found to be significantly higher than that of hind paw injection in the first phase while the response to plantar injection was found to be significantly higher than that of dorsal injection. We conclude that the choice of injection site has some effects on the pattern of nociceptive responses

Effects of some storage conditions on the stability of hydrocortisone sodium succinate injections

In this study; the effects of some environmental storage conditions -light; temperature and humidity on the stability of the steroidal drug; hydrocortisone sodium succinate injection were investigated. The drug samples were stored at varying conditions of light; temperature (0OC; 28OC and 60OC) and humidity; after which each sample was assayed at weekly intervals for their content of the drug using a UV -Vis spectrophotometer. From the results obtained; storage under light; at enhanced temperature and in the presence of moisture had pronounced degradative effects on the stability of hydrocortisone sodium succinate injection; calling for caution in the storage of this widely used anti-allergic and anti-inflammatory drug

Long-term efficacy of macroplastique injection for the treatment of urinary incontinence in males and females

Objective To evaluate the long-term efficacy of endoscopic injection of Macroplastique (Polydimethylsiloxane; PDMS) in male and female urinary incontinence (UI). Patients and Methods A total of 87 patients with different causes of urinary incontinence have been treated by endoscopic injection of PDMS at our department between 1997 and 2001. The group consisted of 39 male and 48 female patients with a mean age of 58 and 44 years; respectively. All patients underwent a sophisticated history taking including urodynamics and were instructed to complete a pre- and postoperative voiding diary. The results were evaluated by questionnaire at 1; 6; 12 and 24 months after injection. The outcome was classified as dry in all circumstances; improved or failed. Results At one month; 5 male (13) and 10 female (21) patients were dry; while 27 males and 29 females had improved and treatment had failed in 7 males (18) and 9 females (19). At the last follow-up (mean injections = 2.5); 12 males patients (31) and 27 female patients (56) were classified as dry; 18 males (46) and 14 females (29) were improved; while in 9 males (23) and 7 females (15) the procedure had failed. The overall success rate (dry and improved) was 77for the males and 85for the females. Conclusion The use of PDMS (Macroplastique) is a good and effective alternative for the treatment of intrinsic sphincter deficiency in male and female patients. The implants do not lose volume over time and have a good long-term effect

A 13-year survey of paralytic poliomyelitis in the paediatric department: Komfo Anokye Teaching Hospital; Kumasi; Ghana

A 13 year survey of paralytic poliomyelitis was carried out in Komfo Anokye Teaching Hospital which is situated in a tropical rain forest. The diagnosis was made clinically. One thousand; one hundred and sixty-four cases of paralytic polio were recorded during the period of 13 years. The disease was found to be seasonal with June-October as the peak months. Children between 1-2 years formed 57.7 per cent of all the cases of paralytic polio and 95.5 per cent involved children under 5 years. The younger the child the more readily it developed paralysis after injections. Although chloroquine was the commonest drug injected (78 per cent) antibiotics and DPT vaccines also provoked paralysis. The death rate was found to be 3.1 per cent. After physiotherapy 68 per cent of the cases recovered from the paralysis; the remaining 32 per cent involving children who had multiple injections had to use either calipers or clutches. Injections may have played an important role in provoking poliomyelitis in this survey. Unnecessary injections should therefore be avoided. The tremendous decline of paralytic polio after 1980 in the survey is definitely due to the improved vaccination programme; which should further be intensified to completely eradicate this handicapping disease

Re: qualities of frequent injection prescribers and injection seekers

A reminder to health personnel that unsterilized injection needles can spread HIV/Acquired Immunodeficiency Syndrome and a look at how to minimize prescribing injections