Peppering versus Single Injection Technique in Tennis Elbow - A Prospective Comparative Study

@#Introduction: Lateral epicondylitis is a common condition causing severe incapacitating pain. Several methods of treatment have been approached for its management. In our study we aim to compare the results of injecting steroid and lignocaine mixture via single injection and peppered injection technique and analyse the outcome in each category. Materials and methods: A prospective randomised study comprising of 25 patients in each group (single vs peppered group) were included in the study after satisfying inclusion and exclusion criteria. Outcome of the treatment was measured in the form of Patient Related Tennis Elbow Evaluation (PRTEE) Questionnaire, Visual analogue score (VAS) and tenderness grading at two weeks, six weeks and six months after injection. Results: Results of our study showed that the mean PRTEE score was 22.36, 18.40 and 14.16 at 2 weeks, 6 weeks and 6 months following peppered injection as compared to 28.96, 21.84 and 25.32 in the single injection group (p value <0.05). VAS score at 2 weeks, 6 weeks and 6 months after the peppered injection was found to be 2.72, 1.72 and 1.36 and in the single injection group was 2.96, 1.92 and 2.72 at 2weeks, 6 weeks and 6 months, respectively (p value <0.05). On comparison of the 2 groups, there was a significant reduction of VAS scores at 6 months post-injection (p value <0.05) and PRTEE score at 6 weeks, 6 months in peppered injection group. Conclusion: The effects of peppered injection technique is seen to be advantageous over the single injection technique in the management of chronic lateral epicondylitis.

Formulation And Optimization Of Terbinafine Hcl Solid Lipid Nanoparticles For Topical Antifungal Activity

Objective: Solid lipid nanoparticles (SLNs) are at the forefront of the rapidly developing field of nanotechnology with several potential applications in drug delivery and research. The aim of this study was to develop and characterize SLNs formulae of Terbinafine HCl (TFH) for topical drug delivery applications. Methods: SLNs were prepared using the solvent injection technique. Glyceryl Monostearate (GMS) served as the lipid base. Three stabilizers; Tween 80, Cremophor RH40, and Poloxamer 188, were used. The effect of stabilizer type and concentration, as well as the lipid concentration, were studied, factorial design of 32*21was applied. The prepared SLNs were characterized regarding their particle size, zeta potential, polydispersity index (PDI), entrapment efficiency percent (EE %), and physicochemical stability. The selected formulae were subjected to further investigations such as morphological studies, in vitro release studies, and Infrared (IR) spectroscopy. They were compared with the marketed cream Lamifen® in term of their antifungal activity against Candida albicans. Results: Lipid concentration, together with the type and concentration of stabilizer, appeared to be the main cornerstones which affect the formation of SLNs. Smaller particle size was observed when increasing the stabilizer concentration and decreasing the lipid concentration. Higher EE% was observed when increasing both the stabilizer and the lipid concentrations. Formulae (F6, F12 andF19) were selected as the most suitable SLNs with optimum particle size of 480.2±18.89, 458.6±12.45 and 246.7±10.5 nm, respectively as well as the highest EE% of 87.13±0.19, 93.69±0.7 and 95.06±0.25, respectively. In vitro microbiological screening of their antifungal activity showed significantly larger zones of inhibition of diameters 25.9±0.25, 25±0.35 and 24.67±0.36 mm, respectively in comparison with the marketed Lamifen® cream which showed a zone of 11.2±0.44 mm diameter. Conclusion: Applying SLNs containing TFH as topical antifungal preparations may be considered as a very promising option as they show good physicochemical characterization with high antifungal activity, which delineates them as a promising dosage form for topical antifungal treatment.

Formulation And Evaluation Of Controlled Release Maintenance Dose Loaded Niosomes Of Anti-Hypertensive Drug

The present study was aimed to formulate, comparatively evaluate and optimize multiple lipid drug carriers of valsartan for oral controlled release to overcome the problems associated with the drug such as bioavailability, to reduce the dosage regimen, half life and to determine the appropriateness of niosomal formulation as a drug carrier. Ether injection method was chosen for the formulation of physically and chemically stable niosomes of valsartan. The formulation and process parameters were optimized by manufacturing placebo niosomes. Than drug loaded niosome was prepared by varying the concentration of span 60. The prepared nine formulations were evaluated for various parameters. Placebo niosomes were evaluated for appearance, odour, texture, creaming volume, pH and changes after 15 days. The medicated nine formulations were evaluated for organoleptic properties (appearance/color, odour), pH, total drug content, entrapment efficiency, mean particle size and polydispersibility index, zeta potential and In-vitro drug release. All formulations were off-white in color, odourless, and fluid in nature. It was stable and did not show sedimentation. The pH was found to be in the range of 4.6-5.4. Drug content was found in the range of 89.13 to 99.52. The Entrapment efficiency was found in range of 79.05 to 98.24. The mean vesicle size of drug loaded niosomes of the different batches ranged between 2.52-3.42μm. The polydispersvity index was in the range of 0.325 to 0.420 which indicates a narrow vesicle size distribution. The values of zeta potential were in the range of -20.29 mV to -30.55 mV which indicates that niosome had sufficient charge and mobility to inhibit aggregation of vesicles. All the nine formulations shows constant drug release in controlled manner up to 24 h. Formulation V7 was considered to be the best formulation as the % drug content (99.52 ± 0.97), % entrapment efficiency (98.24 ± 1.50) and % drug release at the end of 24th h (98.55) were high for V7. The optimized formulation V7 showed higher degree of correlation coefficient (r2) 0.9805 which indicates process of constant drug release from dosage form. The present study concludes that the prepared niosome is a convenient and efficiency carrier for the delivery of antihypertensive drug. Besides this, it provided controlled delivery of drug.

Evaluation on analgesic effect of the single-injection technique of pectoral nerves Ⅰ and Ⅱ in patients undergoing modified radical mastectomy / 临床麻醉学杂志

Objective To investigate the efficacy of the single-injection technique of PECS Ⅰ and Ⅱ blocks for postoperative analgesia in patients undergoing modified radical mastectomy. Methods Sixty female patients who would undergo elective unilateral modified radical mastectomy, aged 30-65 years, falling into ASA physical status Ⅰ or Ⅱ, were selected and randomly divided into PECS group (group P) or control group (group C), 30 cases in each. After induction, patients in group P underwent ultrasound-guided combined PECS Ⅰ and Ⅱ blocks in a single-injection technique before surgery, 30 ml of 0.5％ ropivacaine was given to these patients. Patients in group C received general anesthesia alone. Anesthesia maintenance was performed by total intravenous anesthesia. The dosage of intraoperative propofol and remifentanil, postoperative recovery time, the requirement of sufentanil at 48 h after operation and the first time pressing the analgesic pump button, rescue analgesic requirements at 48 h after operation and the pressing frequency of analgesic pump were recorded in the two groups. Results The usage of propofol and remifentanil in group P were significantly less than those in group C (P ＜ 0.05). The recovery time after operation was significantly shorter than that in group C (P ＜ 0.05). The total consumption of sufentanil after 48 h was significantly less than that in group C (P ＜ 0.05). The first pressing time of the analgesic pump in group P was significantly later than that in group C (P ＜ 0.05).The rescue analgesic requirements in group P at 48 h were lower than those in group C (P ＜ 0.05).The pressing frequencies of analgesic pump in group P at 24 h were less than those in group C (P ＜ 0.05). Conclusion For patients undergoing modified radical mastectomy, ultrasound-guided combined PECS Ⅰ and Ⅱ blocks in a single-injection technique can reduce the dosage of opioid drugs in the perioperative period, and can provide better analgesic effect after operation.

The efficacy of injecting insulin in family diabetes mellitus in Xiaofeng town community in Huzhou area and the analysis of the problems of injection technique / 中国生化药物杂志

Objective To investigate the efficacy of injecting insulin in family diabetes mellitus in Xiaofeng town community in Huzhou area and the problems of injection technique.Methods From February 2015 to December 2016, 94 patients with diabetes were injected with insulin in Xiaofeng town community in Huzhou area.From February 2015 to 3016, the fasting blood glucose(FPG), 2 h postprandial blood glucose 2hPG) and glycosylated hemoglobin(HbA1c), and to investigate the problems in the process of injecting insulin by questionnaire.Results After 3 months of injection, FPG, 2hPG and HbA1c were decreased in all patients(P<0.05).71 cases(75.53) were regularly rotated in the injection of insulin and 82 cases were alcoholic(81.9%), the use of 5 mm needle 86 cases(91.49%)[our hospital only 5 mm and 8 mm Needle, jurisdiction of the surrounding hospital needle is 6 mm.(76.20%), 12 cases(12.77%) of insulin needle, and 2 to 3 days of insulin needle(72.60%) were injected in the subcutaneous 10s(71.28%) after injection, 16 cases(17.2%) were replaced, 10 cases(48.94%) were replaced on the 10th day, and 11 cases(11.70%) were replaced when the insulin was replaced.9 cases(9.57%) were replaced after the pain.Conclusion Diabetic patients have definite therapeutic effect on insulin injection in family, but there are some defects in injection technique and injection hygiene.Therefore, health care workers need to strengthen their knowledge of injection of insulin injections in families.

New Insulin Injection Recommendations / 임상당뇨병

Based on the 4th Injection Technique Questionnaire results, new insulin injection technique recommendations were announced at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, on October 23 and 24, 2015, in which 183 physicians, nurses, educators, and allied healthcare professionals from 54 countries attended. Through these new recommendations, we hope to identify and localize the new insulin injection technique recommendations that could be applicable in local clinical settings. It is recommended to use a pen needle with a wider inner diameter when its gauge remains the same. Also, recommended injection sites such as the abdomen, upper arms, thighs, and buttocks are well described based on anatomical landmarks. The insulin absorption rate is the fastest at the abdomen, upper arms, thighs and buttocks in the case of human insulin; however, there is no difference in absorption rate in the case of insulin analog, regardless of site selection. Also, air-shooting is not necessary if drops are observed as soon as the needle is attached to the pen. Diabetes educators should be familiar with new insulin injection technique recommendations, not only to keep themselves updated with new knowledge, but also so they can educate patients to assure patient safety and achieve better outcomes.

Clinical Outcomes of Individualized Botulinum Neurotoxin Type A Injection Techniques in Patients with Essential Blepharospasm

PURPOSE: To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualized injection technique based on the types of spasms and to compare the results of the individualized injection technique with those of the conventional injection technique in the same patients. METHODS: From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteen patients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred to our hospital for unsatisfactory results after a conventional injection technique. We classified the patients by spasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); the glabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral part of the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites of the blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) after treatment. RESULTS: This study included 38 patients (26 women, 12 men; mean age, 60.6 +/- 10.9 years). There were 21 patients in the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 +/- 12.6, 59.8 +/- 8.5, and 66.8 +/- 9.0 years, and mean BoNT-A injection dose was 38.8 +/- 11.2, 38.8 +/- 11.2, and 38.8 +/- 10.8 U in each group, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 +/- 0.7 in the ODG, 1.4 +/- 0.8 in the CDG, and 1.2 +/- 0.3 in the PDG. There were significant differences in reading and job scale among the three groups. In a comparison between the conventional and individualized injection techniques, there was a significant improvement in mean FDS and in the reading scale in the PDG with the individualized injection technique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualized injection group. CONCLUSIONS: The individualized injection technique of BoNT-A according to the spasm-dominant site is an effective and safe treatment method for essential blepharospasm patients.

Percutaneous Vertebroplasty: A New Serial Injection Technique to Minimize Cement Leak

STUDY DESIGN: This is a prospective cohort study. PURPOSE: This study discusses a new technique for injecting cement in the affected vertebrae. OVERVIEW OF LITERATURE: Since introduction of vertebroplasty to clinical practice, the cement leak is considered the most frequent and hazardous complication. In literature, the cement extravasation occurred in 26%-97% of the cases. METHODS: A hundred and twenty-three patients underwent vertebroplasty using the serial injection technique. The package of the cement powder and the solvent was divided into five equal parts. Each part of the powder and the solvent was mixed as a single dose and injected to the affected vertebra. The duration between subsequent injections was 10 minutes. Each injection consisted of 1-1.5 mL of cement. RESULTS: This new technique gives the surgeon enough time to make multiple separate injections using the same package. The time interval between injections hardens the cement just enough so that it does not get displaced by the next cement injection. This technique gives time to the preceding injected cement to seal off the cracks and cavities in the vertebra, and subsequently leads to a significant decrease in cement leak (p<0.001), as compared to literature. CONCLUSIONS: This study demonstrates a previously unreported technique for vertebroplasty that adds more safety to the procedure by significantly decreasing cement leak. It also makes the surgeon more relaxed due to time intervals, giving him more self-confidence whilst performing the procedure.

Efficacy of painless injection technique - Vibraject – Clinical trial in Chennai, India.

Background: Pain is the most common cause of needle Phobia. In order to overcome this many advanced injection techniques has been implemented. The most recent and advanced technique was using a small vibrating device to the conventional injection technique. Objectives: To evaluate the efficacy of vibraject versus conventional injection technique. Material and methods: Prospective, randomized, cross- over, single blinded design was carried out among adults above 18 years of age in private hospital in Chennai city, Tamil Nadu, India. Out of 52 subjects, 37 were willing to participate in the study. Split mouth technique was carried out. A calibrated single examiner used an appropriate amount of anaesthetic solution, 2% lidocaine with 1:100,00 dilution of epinephrine was injected slowly and then patient was asked to report their discomfort and pain was noted using verbal descriptor scale. Sign test was calculated to check the efficacy of vibraject to that of conventional injection technique. Results: The total sample size consists of 37 study subjects. Out of total study subject, 35 subjects reported increased pain score while using conventional injection technique than using vibraject with a significant difference (Z=-5.5, p=0.00). Out of total study subject, 14 subjects reported increased pain score while using conventional injection technique than using vibraject. The p value for 2-tailed sign test shows (p=0.04) there was significant difference between two techniques. Conclusion: Vibraject has significantly reduced pain both during insertion of needle and during deposition of solution when compared to the conventional injection technique.

Evaluation of the Spreading Effect of Injection Volume due to Use of the Modified Injection Technique in Stellate Ganglion Block / 대한마취과학회지

BACKGROUND: Stellate ganglion block (SGB) results in a sympathetic block of the head, neck, and upper extremities. In a previous study, the modified injection technique (MIT) was found to exert a better sympathetic block effect on the upper extremities than the classic injection technique (CIT). Therefore, this study was conducted to evaluate the spreading effect of injection volume when the MIT was used in the paratracheal SGB at the 6th cervical level. METHODS: One hundred patients were equally divided into 4 groups. Patients in Groups I, II, and III were subjected to paratracheal SGB at the 6th cervical level with 6 ml, 8 ml, 10 ml of 0.5% mepivacaine administered using the CIT, respectively, whereas patients in Group IV were subjected to block with 6 ml of 0.5% mepivacaine by the MIT using a method such as strong pressure at the cephalad portion of the needle entry point. The skin temperature of the second finger was measured before and after SGB, and the occurrence of warm sensation on the face and upper extremities, and the occurrence of hoarseness were evaluated. RESULTS: The increase in the skin temperature of patients in Groups I, II, III, and IV were 0.28 +/- 0.29, 0.52 +/- 0.58, 0.82 +/- 0.77, and 0.80 +/- 0.72, respectively, with the increases in skin temperature observed in the Groups III and IV being statistically significant when compared to Group I (P < 0.05). There were no significant differences observed in the occurrence of warm sensations on the face and upper extremities, or in the occurrence of hoarseness among the groups. CONCLUSIONS: The results of this study could not differentiate the spreading effect of injection volume that occurred when the MIT was used from the effect that occurred as a result of injection of 8 or 10 ml using the CIT. However, the MIT showed better sympathetic block on the upper extremities than the CIT when the same volume was used. Taken together, these results suggest that the spread effect of 6 ml administered by MIT is similar to that of 10 ml administered by CIT.

Comparison of bond strength of a fiber post cemented with various resin cements / 대한치과보존학회지

The purpose of this study was to compare the push-out strength of a fiber post cemented with various resin cements. Newly extracted 36 human mandibular premolars which had single root canal were selected and their crown portions were removed. The root canal was instrumented using PROTAPER(TM) system and obturated using continuous wave technique. In each root, a 9-mm deep post space was prepared. #2 translucent fiber post (DT Light post, Bisco Inc., Schaumburg, IL, U.S.A.) was cemented using injection technique with Uni-dose needle tip (Bisco) and six different resin cements. The tested resin cements were Duo-Link (Bisco Inc., Schaumburg, IL, U.S.A.), Variolink II (Ivoclar-Vivadent AG, Schann, Liechtenstein), Panavia F (Kuraray Medical Inc., Okayama, Japan), Multilink Automix (Ivoclar-Vivadent AG, Schann, Liechtenstein), RelyX Unicem (3M ESPE Dental Products, St. Paul, MN, U.S.A.), and Maxcem (Kerr Co., CA, U.S.A.). After storage in distilled water for 24 hours, each root was transversally sectioned into approximately 1-mm thick sections. This procedure resulted in 6 serial sections per root. Push-out test was performed using a universal testing machine (EZ Test, Shimadzu Co.) with a crosshead speed of 1 mm/min. The data were analyzed with one-way ANOVA and Tukey HSD (p=0.05). The push-out strength of the groups which cemented fiber post with Panavia F and Multilink Automix were lower than those of the other groups. But, there were no statistically significant difference among groups at a probability level of 0.05.

The Utility of Upper Limb Sympathetic Block by Modified Injection Technique in Stellate Ganglion Block / 대한마취과학회지

BACKGROUND: From our clinical experiences, there are some problems with a paratracheal stellate ganglion block at the 6th cervical level e.g. small changes in blood flow to the upper extremities and more difficulty in differentiating sympathetically-maintained pain from neuropathic pain. This study compared the effectiveness of the classic injection technique and the modified injection technique in paratracheal stellate ganglion block at the 6th cervical level. METHODS: Forty patients were randomly divided into 2 groups. In Group I, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the classic injection technique. In Group II, the patients underwent a paratracheal stellate ganglion block at the 6th cervical level with 1% mepivacaine 6 ml using the modified injection technique by applying strong pressure to the cephalad portion of the needle entry point. The skin temperature of the first finger was measured before and after the stellate ganglion block, and the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis were examined. RESULTS: The increase in skin temperature of the first finger after the procedure was 0.26 +/- 0.22 degrees C in Group I and 0.84 +/- 0.63 degrees C in Group II, which was statistically significant (P < 0.05). There were no significant differences in the warm sensation on the face and upper extremities, hoarseness and upper extremity paralysis between the two groups. CONCLUSIONS: The modified injection technique is more effective in the sympathetic block on the upper extremities than the classic injection technique.

Total Parathyroidectomy and Autotransplantation by Subcutaneous Injection Technique in Renal Hyperparathyroidism

PURPOSE: Total parathyroidectomy and forearm intramuscular autotransplantation (Wells' method) is currently widely accepted procedure for renal hyperparathyroidism because it is far easier to deal with in the case of a recurrence, caused by the autotransplanted tissue. The Wells method, however, is somewhat complex and time-consuming. We developed a simple, easy, and non-surgical injection technique for autografting parathyroid tissue into the forearm subcutaneous layer. This study was performed to evaluate the feasibility of this new method and to document the biochemical function of the parathyroid tissue that was autografted using the subcutaneous injection technique. METHODS: The new method was applied to 14 patients with renal hyperparathyroidism, and the short-term operative results, 4 months after surgery, were evaluated in terms of biochemical parameters such as calcium, inorganic phosphorus, intact PTH and alkaline phosphatase. The graft "uptake" was judged by a significant intact PTH ratio (>1.5) between the antecubital vein blood from the grafted and non-grafted arms. RESULTS: Biochemical parameters were normalized in all patients during the postoperative 4 months. All of the grafted parathyroid tissues were functional. In these patients with the graft "uptake", a significant intact PTH ratio (>1.5) between the grafted and non-grafted arms was demonstrated at 2 weeks post operation. A maximal intact PTH gradient was reached at 4 weeks post operation, and the biochemical function persisted in all patients at 4 months post operation. CONCLUSION: This study suggests that total parathyroidectomy and forearm autotransplantation by subcutaneous injection technique can be an alternative to the Wells' method in the surgical treatment of secondary hyperparathyroidism.