Inyección de composite fluido técnica analógica vs técnica digital en el tratamiento de desgaste dental: reporte de caso / Fluid composite injection analog vs digital technique in the treatment of dental wear: case report

El avance de la tecnología permite realizar cambios en la rehabilitación y estética, reduce los tiempos de trabajo y disminuye los riesgos que se presentan al momento de utilizar materiales convencionales para la toma de impresiones. Existen dos técnicas que se pueden emplear, la analógica y la digital; la primera presenta mayores riesgos que el operador no puede controlar, así como tiempos más prolongados. Este reporte describe la rehabilitación bucal en dos pacientes con desgaste dental, se optó por usar ambas técnicas, la analógica y la digital, como tratamiento; en la primera se empleó el encerado convencional y en la segunda el software Exocad para el encerado digital. Finalmente en ambos casos se aplicó (AU)

The advance of technology has allowed changes in rehabilitation and esthetics, providing shorter working times and reducing the risks that occur when using conventional materials for taking impressions. There are two techniques that can be used, analog and digital, the first one presents greater risks that the operator cannot control, as well as more time. This report describes the oral rehabilitation in patients with dental wear. The treatment was carried out using the analogical and digital techniques, the former using conventional waxing and the latter using Exocad software for the digital waxing; finally, in both cases the injection technique with high-load Flow resin was used (AU)

El reposicionamiento malar. Presentación de una técnica original: punto MM / Malar repositioning. Presentation of an original technique: point MM

El envejecimiento facial es una sinergia compleja de cambios texturales de la piel, hiper- o hipoactividad muscular, reabsorción del tejido graso y resorción ósea. El déficit de volumen resultante, la deflación y la posterior caída del tercio medio facial produce una cara menos atractiva y juvenil. Los procedimientos inyectables en región malar son cada vez más populares y solicitados por los pacientes. El conocimiento de la anatomía de la cara media es fundamental para el inyector. La comprensión de la irrigación facial puede ayudar a disminuir la exposición a la aparición de hematomas y complicaciones vasculares severas. Existen múltiples técnicas de inyección propuestas para el tercio medio, en este artículo presentamos una técnica original, simple, segura y eficaz con resultados satisfactorios y riesgo reducido

Facial aging is a complex synergy of textural skin changes, muscle hyperactivity, fat dysmorphism, bone resorption. The resulting volume deficit and deflation of the mid face produces a less attractive and youthful face. Injectable midface procedures are becoming increasingly popular and requested by patients. Knowledge of the anatomy of the midface is critical for the injector. Understanding the irrigation of the face can help decrease the risk of hematoma and severe vascular complications. There are multiple injection techniques proposed for the middle third, in this article we present a simple, safe and effective technique with satisfactory results and lower risk

Qualitative Histologic Assessment vs. Geomorphometric Analysis of Nerve Fiber Shape after the Intraneural Application of Liposomal Bupivacaine / Evaluación Histológica Cualitativa Versus Análisis Geomorfométrico de la Forma de la Fibra Nerviosa Después de la Aplicación Intraneural de Bupivacaína Liposomal

SUMMARY: The preserved form of all components of the nerve fiber is a prerequisite for the proper conduction of the nerve impulse. various factors can change the shape of nerve fibers. In everyday practice, qualitative histological analysis is the gold standard for detecting changes in shape. Geometric morphometry is an innovative method that objectively enables the assessment of changes in nerve fibers' shape after local anesthetics action. A total of sixty sciatic nerves were used as material, which was intraneural injected with saline solution in the control group (n=30), and a solution of 1.33 % liposomal bupivacaine (n=30) in the test group. After the animals were sacrificed, nerve samples were taken and histological preparations were made. The preparations were first described and examined using a qualitative histological method, after which digital images were made. The images were entered into the MorphoJ program and processed using the method of geometric morphometry. Qualitative histological examination revealed no differences in nerve fibers after intraneurally applied physiological solution and liposomal bupivacaine. Using the method of geometric morphometry, a statistically significant change in the shape of axons was found after intraneurally applied saline solution and liposomal bupivacaine (p=0.0059). No significant differences in histological changes were found after the qualitative histological analysis of nerve fiber cross-section preparations. A statistically significant change in the shape of nerve fiber axons was observed after geometric morphometric analysis of digital images after intraneural application of saline and liposomal bupivacaine.

La forma conservada de todos los componentes de la fibra nerviosa es un requisito previo para la conducción correcta del impulso nervioso. Varios factores pueden cambiar la forma de las fibras nerviosas. En la práctica diaria, el análisis histológico cualitativo es el estándar de oro para detectar cambios de forma. La morfometría geométrica es un método innovador que permite evaluar objetivamente los cambios en la forma de las fibras nerviosas después de la acción de los anestésicos locales. Se utilizó como material un total de sesenta nervios ciáticos, que se inyectaron intraneuralmente con solución salina en el grupo control (n=30), y una solución de bupivacaína liposomal al 1,33 % (n=30) en el grupo de prueba. Después de sacrificados los animales, se tomaron muestras de nervios y se realizaron preparaciones histológicas. Primero se describieron y examinaron las preparaciones utilizando un método histológico cualitativo, después de lo cual se tomaron imágenes digitales. Las imágenes fueron ingresadas al programa MorphoJ y procesadas mediante el método de morfometría geométrica. El examen histológico cualitativo no reveló diferencias en las fibras nerviosas después de la aplicación intraneural de solución fisiológica y bupivacaína liposomal. Usando el método de morfometría geométrica, se encontró un cambio estadísticamente significativo en la forma de los axones después de la aplicación intraneural de solución salina y bupivacaína liposomal (p = 0,0059). No se encontraron diferencias significativas en los cambios histológicos después del análisis histológico cualitativo de las preparaciones de secciones transversales de fibras nerviosas. Se observó un cambio estadísticamente significativo en la forma de los axones de las fibras nerviosas después del análisis de morfometría geométrica de imágenes digitales después de la aplicación intraneural de solución salina y bupivacaína liposomal.

Differences According to the Type of Exogenous Hyaluronic Acid and its Frequency of Infiltration in the Treatment of Temporomandibular Osteoarthritis / Diferencias Según el Tipo de Ácido Hiaurónico Exógeno y su Frecuencia de Infiltración en el Tratamiento de la Osteoartritis Temporomandibular

SUMMARY: One of the most important minimally invasive treatments today in temporomandibular joint osteoarthritis (TMJ- OA) is the intra-articular exogenous hyaluronic acid (HA) injection, which has yielded good results in pain relief and improves mandibular function with few side effects. However, the effectiveness of HA continues to be controversial, partly due to the heterogeneity in the injection protocols in their molecular weight, viscosity and frequency of infiltration, among other properties. The aim of this review is to identify the differences in the histological and clinical effects of the different types of HA and the frequency of infiltration on TMJ-OA treatment. Materials and methods: A bibliographic search was performed in the PubMed, Web of Science and Scopus databases. The search was limited up to September 2022. Search terms included "osteoarthritis", "hyaluronic acid, "molecular weight", "concentration", "viscosity", "dose" and "temporomandibular", using AND/OR as Boolean terms. Results: Exogenous HA in its different molecular weights offers an improvement in histological and clinical characteristics. Apparently, low and medium molecular weight HA presents better results. No clinical studies related to the degree of HA viscosity were found. Respect to the frequency of infiltration, single injection, weekly injections for 3 weeks, weekly injections for 5 weeks and other protocols are used. However, their comparison is complex. There seems to be differences in the effects of the different HA preparations for the treatment of TMJ-OA, mainly in their molecular weight. However, the evidence remains scant.

Uno de los tratamientos mínimamente invasivos más importantes en la actualidad en la artrosis de la articulación temporomandibular (OATM) es la inyección intraarticular de ácido hialurónico (AH) exógeno, que ha dado buenos resultados en el alivio del dolor y mejora la función mandibular con pocos efectos secundarios. Sin embargo, la efectividad del AH continúa siendo controversial, en parte debido a la heterogeneidad en los protocolos de inyección en cuanto a su peso molecular, viscosidad y frecuencia de infiltración, entre otras propiedades. El objetivo de esta revisión fue identificar las diferencias en los efectos histológicos y clínicos de los diferentes tipos de HA y la frecuencia de infiltración en el tratamiento de TMJ-OA. Se realizó una búsqueda bibliográfica en las bases de datos PubMed, Web of Science y Scopus. La búsqueda se limitó hasta septiembre de 2022. Los términos de búsqueda incluyeron "osteoartritis", "ácido hialurónico", "peso molecular", "concentración", "viscosidad", "dosis" y "temporomandibular", utilizando AND/OR como términos booleanos. El HA exógeno en sus diferentes pesos moleculares ofrece una mejora en las características histológicas y clínicas. Aparentemente, el AH de bajo y medio peso molecular presenta mejores resultados. No se encontraron estudios clínicos relacionados con el grado de viscosidad del HA. Respecto a la frecuencia de infiltración, se utilizan inyecciones únicas, inyecciones semanales durante 3 semanas, inyecciones semanales durante 5 semanas y otros protocolos. Sin embargo, su comparación es compleja. Parece haber diferencias en los efectos de las diferentes preparaciones de HA para el tratamiento de la OA-TMJ, principalmente en su peso molecular. Sin embargo, la evidencia sigue siendo escasa.

Agentes de abultamiento en incontinencia de orina de esfuerzo femenina: una alternativa a las mallas suburetrales / Bulking agents in female stress urinary incontinence: an alternative to suburethral mesh

OBJETIVO: Presentar una serie de casos de agentes de abultamiento (AA) de nuestro centro. MATERIAL Y MÉTODOS: Estudio retrospectivo. Se evaluaron todos los casos operados con AA entre 2017 y 2022. La inyección de AA se realizó en quirófano, bajo sedación con anestesia local periuretral o raquídea. La inyección se realizó con uretroscopia, 0,5 cc en 4 puntos periuretrales (horas 2, 5, 7 y 10). Se analizaron datos demográficos, quirúrgicos y de seguimiento. RESULTADOS: 15 casos. 13/15 presentaron incontinencia urinaria mixta. Solo dos casos tenían incontinencia de orina de esfuerzo pura. El procedimiento fue ambulatorio. La mediana del tiempo operatorio fue 15 minutos (15-20). La mediana de seguimiento fue 5 meses (1-9). El índice de severidad preoperatorio promedio fue 10,6 y en el seguimiento fue 2,79. La Escala de Mejoría Global mostró mejoría en 12/15, y 12/15 estaban satisfechas con la cirugía con mejoría en la calidad de vida. CONCLUSIÓN: Los AA son una opción quirúrgica efectiva, con una tasa de éxito del 80% en otros reportes, siendo similar con nuestra casuística. Ofrecer esta opción es posible a la hora de hablar de terapias alternativas.

OBJECTIVE: To present a case series of bulking agents (BA) from our center. MATERIAL AND METHODS: Retrospective study. All cases operated with BA between 2017 and 2022 were evaluated. A BA injection was performed in the operating room, under periurethral local anesthesia sedation or spinal anesthesia. The injection was performed with urethroscopy, 0.5 cc in 4 periurethral points (hours 2, 5, 7 and 10). Demographic, surgical, and follow-up data were analyzed. RESULTS: 15 cases were reported. 13/15 patients presented with mixed urinary incontinence. Only 2 cases had pure stress urinary incontinence. The procedure was ambulatory. Median operative time was 15 minutes (15-20). Median follow-up was 5 months (1-9). The average preoperative Sandvik Severity Index was 10.6 and in follow-up was 2.79. The PGI showed improvement in 12/15, and 12/15 were satisfied with the surgery with quality-of-life improvement. CONCLUSION: BA are an effective surgical option, with a success rate of 80%, according to other reports, being similar with our casuistry. Offer this option is possible at the moment of discussing alternative therapies.

Covid-19: Vacina boa é a aplicada de forma adequada / Covid-19: Vacina boa é a aplicada de forma adequada

Na atualidade, fotografar ou gravar o instante da imunização contra a Covid-19 se tornou rotina compartilhada nas redes sociais. Essa exposição instigou a observação de uma questão relevante: a técnica de aplicação está correta? Com a veiculação de imagens, é possível visualizar as vacinas sendo administradas em diferentes áreas do músculo deltoide, o que pode acarretar efeitos adversos. A otimização da qualificação técnica e pedagógica dos profissionais que elaboram e ministram as capacitações, bem como o envolvimento efetivo dos vacinadores nos treinamentos para injeção intramuscular é uma necessidade constante para evitar mais danos à saúde da população

Currently, photographing or recording the instant of immunization against Covid-19 has become a shared routine on social networks. This exposition prompted the observation of a relevant question: is the application technique correct? With the transmission of images, it is possible to visualize the vaccines being administered in different areas of the deltoid muscle, which can cause adverse effects. The optimization of the technical and pedagogical qualification of the professionals who design and deliver the training, as well as the effective involvement of vaccinators in training for intramuscular injection, is a constant need to avoid further damage to the health of the population

Distribution of various volumes of methylene blue injection in suprainguinal fascia iliaca block under ultrasound guidance: a cadaveric study / Distribución de varios volúmenes de inyección de azul de metileno en el bloque suprainguinal de la fascia ilíaca bajo guía por ultrasonido: un estudio cadavérico

SUMMARY: The local anesthetic volume for a single-shot suprainguinal fascia iliaca block (SFIB) is a key factor of a block success because the courses of the three target nerves from the lumbar plexus (LP), the lateral femoral cutaneous nerve (LFCN), femoral nerve (FN), and obturator nerve (ON), at the inguinal area are isolated and within striking distance. Thus, this cadaveric study aims to demonstrate the distribution of dye staining on the LFCN, FN, ON, and LP following the ultrasound-guided SFIB using 15-50 ml of methylene blue. A total of 40 USG-SFIBs were performed on 20 fresh adult cadavers using 15, 20, 25, 30, 35, 40, 45, and 50 ml of methylene blue. After the injections, the pelvic and inguinal regions were dissected to directly visualize the dye stained on the LFCN, FN, ON, and LP. All FN and LFCN were stained heavily when the 15-50 ml of dye was injected. Higher volumes of dye (40-50 ml) spread more medially and stained on the ON and LP in 60 % of cases. To increase the possibility of dye spreading to all three target nerves and LP of the SFIB, a high volume (≥40 ml) of anesthetic is recommended. If only a blockade of the FN and LFCN is required, a low volume (15-25 ml) of anesthetic is sufficient.

RESUMEN: El volumen de anestésico local para un bloqueo de la fascia ilíaca suprainguinal (FISI) de una sola inyección es un factor clave para el éxito del bloqueo, debido a que los cursos de los tres nervios objetivo del plexo lumbar (PL), el nervio cutáneo femoral lateral (NCFL), femoral (NF) y el nervio obturador (NO), en el área inguinal están aislados y dentro de la distancia de abordaje. Por lo tanto, este estudio cadavérico tiene como objetivo demostrar la distribución de la tinción de tinte en NCFL, NF, NO y PL siguiendo el FISI guiado por ultrasonido usando 15-50 ml de azul de metileno. Se realizaron un total de 40 USG-FISI en 20 cadáveres adultos frescos utilizando 15, 20, 25, 30, 35, 40, 45 y 50 ml de azul de metileno. Después de las inyecciones, se disecaron las regiones pélvica e inguinal para visualizar directamente el tinte teñido en NCFL, NF, NO y PL. Todos los NF y NCFL se tiñeron intensamente cuando se inyectaron los 15- 50 ml de colorante. Volúmenes mayores de colorante (40-50 ml) se esparcen más medialmente y tiñen el NO y la PL en el 60 % de los casos. Para aumentar la posibilidad de que el colorante se propague a los tres nervios objetivo y al PL del FISI, se recomienda un volumen elevado (≥40 ml) de anestésico. Si solo se requiere un bloqueo de NF y NCFL, un volumen bajo (15-25 ml) de anestésico es suficiente.

Uso de vasopresina y suturas transfixivas para el tratamiento quirúrgico de la gestación ectópica intersticial / Use of vasopressin and transfixive sutures for the surgical treatment of interstitial ectopic gestation

Resumen La gestación cornual, también conocida como intersticial, es una gestación ectópica infrecuente que ocurre en 1/2500 a 1/5000 de los embarazos cuando el embrión implanta en el trayecto intramiometrial de la porción proximal de la trompa. Puede debutar como shock hipovolémico en un 25% de los casos, conllevando una mortalidad de hasta un 2,5%. Mediante ecografía se encuentra un saco gestacional excéntrico y rodeado por una fina capa de miometrio. El tratamiento, en la mayoría de los casos, es quirúrgico, y el control de la hemostasia supone todo un reto. Se presentan dos casos clínicos de mujeres con diagnóstico de gestación intersticial en quienes se realizó exéresis por laparoscopia tras inyección de vasopresina, permitiendo así controlar el sangrado. En una de las pacientes se practicaron también puntos transfixivos transitorios en la arteria uterina y el ligamento útero-ovárico.

Abstract Cornual gestation, also known as interstitial, is a rare ectopic gestation that occurs in 1/2500 to 1/5000 of pregnancies when the embryo implants in the intramyometrial tract of the proximal tube. It can debut as hypovolemic shock in 25% of cases, leading to a mortality rate of up to 2.5%. Using ultrasound, we will find an eccentric gestational sac surrounded by a thin layer of myometrium. Treatment, in most cases, is surgical and control of hemostasis is a challenge. Two clinical cases are presented of women with a diagnosis of interstitial pregnancy in whom transient transfixive sutures were performed at the level of the uterine artery and uterine-ovarian ligament and injection of vasopressin prior to laparoscopic exeresis, thus allowing the bleeding to be controlled.

Exérese de pterígio em paciente pós-LASIK com técnica de air bubble / Pterygium surgery with air bubble technique in a post-LASIK patient

RESUMO O pterígio é uma das doenças que mais acomete a superfície ocular, principalmente em regiões próximas ao Equador. Ocorre principalmente em adultos jovens, podendo ocasionar sintomas, danos estéticos e ópticos. Relata-se um caso de exérese de pterígio classificado pela extensão corneana em grau II e, pela vascularização, em grau 2 de Tan, com cirurgia prévia de LASIK, a partir de uma nova técnica, a técnica de Moscovici, a qual fundamenta-se na dissecção com bolha de ar, com a finalidade de separar o epitélio conjuntival do estroma profundo e da Tenon, com maior facilidade e rapidez e para obter enxertos finos.

ABSTRACT Pterygium is one of the diseases that most affect the ocular surface, especially in regions close to the equator. It mainly affects young adults and can cause symptoms, as well as aesthetic and optical impairment. We report a case of pterygium excision classified by grade II corneal extension and Tan grade 2 vascularization with previous laser in situ keratomileusis (LASIK) surgery, using a new technique, the Moscovici technique, which is based on dissection with an air bubble to separate easier and faster the conjunctival epithelium from the deep stroma and the Tenon, obtaining thinner grafts.

Comparative application of biological and ninhydrin- derivatized spectrophotometric assays in the evaluation and validation of amikacin sulfate injection

Abstract Instrumental techniques are preferred over bioassay methods for antibiotic quantification mainly due to speed and ability to quantify metabolites in biological samples; however, the potency and biological activity of these drugs cannot be assessed. Two methods - agar well diffusion (bio-assay) and spectrophotometric methods were used to evaluate amikacin sulfate injection. Agar plates were inoculated with S. aureus inoculum; zones of inhibition from its susceptibility to amikacin were obtained, while spectrophotometric absorption at 650 nm of ninhydrin- derivatized amikacin in phosphate buffer (pH 8) was measured. Methods performance showed linearity from 1 - 16 µgmL-1 (bioassay, r = 0.9994) and 10-50 µgmL-1 (spectrophotometric, r = 0.9998). Molar absorptivity was 2.595 x 104 Lmol-1cm-1. Limits of detection and quantification were 1.07 and 3.24 µgmL-1 respectively for bioassay method, while corresponding values for spectrophotometric method were 0.98 and 2.97 µg mL-1. Relative standard deviations were ≤ 2.0% for both methods, with recoveries from 95.93 - 100.25%. Amikacin in brands ranged from 97.53 ± 2.68 to 100.84 ± 1.82%, student's t-test was ≤ 2.78 (n = 4) with respect to label claim for both methods. Experimental paired t-test (t = 2.07; n = 4) and F-test (F = 3.94; n = 4) values indicated no significant difference between both methods, hence comparable and can jointly be used in quality control assessment of antibiotics

Protective effects of Baicalin injection on severe acute pancreatitis through regulating follistatin-like-1 signaling pathway by down-regulating miR-429 expression in mice

Abstract In China, Scutellaria is used for treating inflammatory-related diseases. Baicalin is the main active component of Scutellaria and has protective effects on acute pancreatitis. However, the mechanism of Baicalin is still unclear. In this study, the protective effects of baicalin on acute pancreatitis induced by taurocholate and its mechanism are investigated. In this study, mice were randomly divided into three groups: sham operation, model, and treatment groups. Acute pancreatitis in mice was induced by intraperitoneal injection of taurocholate (35 mg/kg). The treatment group was given baicalin (100 mg/kg) 2 h before acute pancreatitis induction. The mRNA expression levels of miR-429, nuclear factor kappa B65(NF-kB65), toll-like receptor 4(TLR4), TNF receptor associated factor6 (TRAF6), NF-kappa-B inhibitor(IkB), Follistatin-like 1 (FSTL1), and interleukin-1 receptor-associated kinase (IRAK) in the liver tissues 24 h after intraperitoneal injection were detected by RT-PCR. Then, the expression levels of NF-kB65, p-NF-κB65, TLR4, TRAF6, IkB, FSTL1, IRAK, p- IRAK, and p- IkB-а proteins were detected by Western blot. IL-6, TNF-α and IL-1 ß in plasma were measured by ELISA, and histopathological changes in the pancreases of the mice were observed. The results showed that after baicalin treatment, miR-429 expression in the pancreatic tissues and the expression levels of NF-kB65, TLR4, TRAF6, p-IkB-а, FSTL1, and p-IRAK decreased. Similarly, pancreatic myeloperoxidase (MPO) activity and the plasma levels of IL-6, TNF-а, IL-12, IL-1ß1, endotoxin, serum amylase, and lipase were reduced. Thus, the pancreatic injury induced by taurocholate was alleviated. The present study indicates that pretreatment with Baicalin can alleviate acute pancreatic injury induced by taurocholate in mice. The mechanism may be associated with the decreased miR-429 expression, reduced FSTL1 signaling pathway activity, TLR4 and TLR4/MyD88 signaling pathway inhibition, and reduced pancreatic inflammation. FSTL1 is the regulatory target for miR-429

Enfermagem e controle de infecções em medicações injetáveis: elaboração e validação de instrumento / Enfermería y control de infecciones en medicamentos inyectables: preparación y validación del instrumento / Nursing and infection control in injectable medications: preparation and validation of instrument

Objetivo: elaborar e validar instrumento para mensuração de conhecimento de profissionais de enfermagem sobre práticas seguras para prevenção de infecção em medicações injetáveis. Método: estudo metodológico, realizado em município paulista, entre março de 2018 e dezembro de 2019, conforme etapas: estabelecimento da estrutura conceitual e construção do instrumento; validação por especialistas com experiência assistencial ou controle de infecção ou pesquisadores na área, com taxa de concordância >80% e índice de validade de conteúdo ≥0,78; e análise semântica junto ao público-alvo, recrutado por meio da técnica bola de neve. Resultados: construiu-se instrumento com 27 itens, contemplando: preparo do ambiente, preparo e administração de medicações injetáveis e descarte de materiais perfurocortantes. Houve alta taxa de concordância entre os 10 especialistas e refinamento semântico após resposta de 34 participantes do público-alvo. Conclusão: consolidada ferramenta para mensurar, de forma padronizada, o conhecimento de profissionais de enfermagem sobre o tema, permitindo intervenções educativas específicas, conforme diagnóstico situacional.

Objetivo: desarrollar y validar un instrumento para medir el conocimiento de los profesionales de enfermería sobre prácticas seguras para la prevención de la infección en medicamentos inyectables. Método: estudio metodológico, realizado en un municipio de São Paulo, entre marzo de 2018 y diciembre de 2019, según etapas: establecimiento de la estructura conceptual y construcción del instrumento; validación por especialistas con experiencia en atención o control de infecciones o investigadores en el área, con >80% de tasa de concordancia e índice de validez de contenido ≥0,78; y análisis semántico con el público objetivo, reclutado a través de la técnica de bola de nieve. Resultados: se construyó un instrumento con 27 ítems, entre ellos: preparación del ambiente, preparación y administración de medicamentos inyectables y disposición de materiales de corte afilado. Hubo una alta tasa de acuerdo entre los 10 especialistas y refinamiento semántico después de la respuesta de 34 participantes del público objetivo. Conclusión: herramienta consolidada para medir, de manera estandarizada, el conocimiento de los profesionales de enfermería sobre el tema, permitiendo intervenciones educativas específicas, de acuerdo al diagnóstico situacional.

Objective: to develop and validate an instrument for measuring nursing professionals' knowledge about safe practices for infection prevention in injectable medications Method: methodological study, conducted in a municipality of São Paulo, between March 2018 and December 2019, according to stages: establishment of the conceptual structure and construction of the instrument; validation by specialists with experience of care or infection control or researchers in the area, with >80% agreement rate and content validity index ≥0.78; and semantic analysis with the target audience, recruited through the snowball technique. Results: an instrument was constructed with 27 items, including: preparation of the environment, preparation and administration of injectable medications and disposal of sharp-cutting materials. There was a high rate of agreement among the 10 specialists and semantic refinement after response from 34 participants from the target audience. Conclusion: consolidated tool to measure, in a standardized way, the knowledge of nursing professionals on the subject, allowing specific educational interventions, according to situational diagnosis.

Economic impact of gastrointestinal nematodes in Morada Nova sheep in Brazil / Impacto econômico de nematódeos gastrintestinais em ovinos Morada Nova no Brasil

Abstract This study evaluated the economic impact of gastrointestinal nematode (GIN) infection in Morada Nova lambs under different parasite chemical control conditions. For this, 246 lambs, in the rainy and dry season, were randomized into groups according to their anthelmintic treatment with levamisole: control (CT: no treatment); routine treatment (RT: treated every 42 days); and targeted selective treatment (TST: treated according to the average daily weight gain, DWG). From 63 days of age (D63) to D210, the lambs were weighed and monitored for GIN infection parameters. Spending on anthelmintics in the production system was 1.3% of the total economic result. The economic result per animal (R$ 5.00 = US$ 1.00) was higher in the RT group, amounting to US$ 6.60 in the rainy and US$ 5.69 in the dry season, due to higher DWG. Thus, RT presented economic results 14.4% and 10.9% higher than CT, and 7.2% and 1.9% higher than TST, in the rainy and dry season, respectively. However, fast development of resistance made RT unfeasible. Here, the economic impact of GIN infection on a national scale is discussed, demonstrating its importance and the impossibility of profitable and sustainable sheep production without adequate control.

Resumo Este estudo avaliou o impacto econômico da infecção por nematoides gastrintestinais (NGI), em cordeiros Morada Nova, sob diferentes condições de controle químico dos parasitas. Para isso, 246 cordeiros, na estação chuvosa e seca, foram randomizados em grupos de acordo com o tratamento com levamisol: controle (TC: sem tratamento); tratamento rotineiro (TR: tratado a cada 42 dias); e tratamento seletivo direcionado (TST: tratado de acordo com o ganho de peso médio diário, GMD). Dos 63 dias de idade (D63) ao D210, os cordeiros foram pesados ​​e monitorados quanto aos parâmetros de infecção por NGI. O gasto com anti-helmínticos no sistema produtivo foi de 1,3% do resultado econômico total. O resultado econômico por animal (R$ 5,00 = US$ 1,00) foi maior no grupo RT, totalizando US$ 6,60 na estação chuvosa e US$ 5,69 na seca, devido ao maior GMD. Assim, o RT apresentou resultados econômicos 14,4% e 10,9% superiores ao TC, e 7,2% e 1,9% superiores ao TST, no período chuvoso e seco, respectivamente. Entretanto o rápido desenvolvimento de resistência inviabiliza o TR. O impacto econômico da infecção por NGI em escala nacional são aqui discutidos, demonstrando sua importância e a impossibilidade de uma ovinocultura lucrativa e sustentável sem o controle adequado.

Relación de las distracciones, las características sociodemográficas y contextuales con las prácticas seguras de inyecciones durante la práctica clínica del enfermero / Relationship of distractions, sociodemographic and contextual characteristics with safe injection practices during nurses' clinical practice

Objetivo: Analizar la relación entre las distracciones, las características sociodemográficas y contextuales con la realización de las prácticas seguras de inyecciones realizadas por el enfermero durante la preparación y administración de los medicamentos en los servicios de hospitalización y terapia intensiva de adultos. Método: Estudio cuantitativo, transversal y correlacional que utilizó la observación estructurada guiada por listas de chequeo, con un muestreo no probabilístico a propósito de 446 prácticas de inyecciones. Se realizó un análisis univariado y bivariado según el nivel de medición de las variables (correlación de Spearman, punto biserial y coeficiente Eta) en el paquete estadístico IBM SPSS Statistics 24.0 y un análisis de covarianza en el paquete estadístico Statgraphic XVII. Resultados: Se observaron 448 prácticas de inyecciones ejecutadas por 26 enfermeros con 5 años de experiencia, una mediana de 4 pacientes por turno y 3 medicamentos por ronda de medicación. Las distracciones fueron más frecuentes en la fase de preparación (67,9%), siendo las comunicaciones profesionales y sociales las más comunes con relevancias opuestas según la fase del proceso de medicación. La estrategia de manejo más usada fue "multitareas". Las prácticas de inyecciones conservaron la regla "un medicamento, una aguja, una jeringa, un solo diluyente por única vez" por paciente. El porcentaje total de ítems realizados de la lista de chequeo osciló entre el 47,3% y el 84,2%. Las variables de género (femenino p=0,028, IC 95%=0,051; 0,895), familia del medicamento (antiinfectivos: p=0,000, IC 95%=3,711; 5,568; preparaciones hormonales: p=0,000, IC 95%=1,197; 5,050 y sistema musculoesquelético: p=0,000, IC 95%=-2,046; 2,822), tipo de inyección (intravenosa: p=0,000, IC 95%=-0,749; 2,060), día de la semana (fin de semana: p=0,000, IC 95%=0,358; 1,404), servicio (hospitalización: p=0,001, IC 95%=6,613; 7,925) y turno (mañana: p=0,003, IC 95%=-0,227; 0,885) explicaron en un 81,67% la práctica segura de inyecciones. Conclusiones: Las distracciones (p=0,567, IC 95%=-0,742; 0,567) no fueron una variable que explicara la práctica segura de inyecciones a diferencia de las ocho características sociodemográficas y contextuales (turno, procedimiento e insumos) del enfermero.

Objective: Analyze the relationship between distractions, sociodemographic and contextual characteristics with the accomplishment of safe injection practices performed by the nurse during the preparation and administration of medications in hospitalization and adult intensive care services. Method: Quantitative, cross-sectional, correlational study that used structured observation guided by checklists, with a non-probabilistic sampling of 446 injection practices. A univariate and bivariate analysis was performed according to the level of measurement of the variables (spearman correlation, biserial point and eta coefficient) in the IBM SPSS Statistics 24.0 statistical package and an analysis of covariance in the Statgraphic XVII statistical package. Results: 448 injection practices were observed, carried out by 26 nurses with 5 years of experience, a median of 4 patients per shift and 3 medications per round of medication. Distractions were more frequent in the preparation phase (67.9%), the professional and social communications are the most common with opposite relevance according to the phase of the medication process and the most used management strategy was "multitasking". The injection practices kept the rule "one medicine, one needle, one syringe, one diluent at a time" per patient. The total percentage of items made from the checklist ranged between 47.3% and 84.2%. Gender variables (female p=0.028, 95% CI=0.051; 0.895), drug family (anti-infectives: p=0.000, 95% CI=3.711; 5.568, hormonal preparations: p=0.000, 95% CI=1.197; 5.050 and system musculoskeletal: p=0.000, 95% CI =-2.046; 2.822), type of injection (intravenous: p=0.000, 95% CI=-0.749; 2.060), day of the week (weekend: p=0.000, 95% CI=0.358; 1.404), service (hospitalization: p=0.001, 95% CI =6.613; 7.925) and shift (morning: p=0.003, 95% CI =-0.227; 0.885) explained the safe practice of injections by 81.67%. Conclusions: Distractions (p=0.567, 95% CI =-0.742; 0.567) were not a variable that explained the safe practice of injection, unlike the eight sociodemographic and contextual characteristics (shift, procedure, and supplies) of the nurse.

Stability indicating Rp-UPLC method development and validation for the simultaneous estimation of fosnetupitant and palonosetron in bulk and injection dosage form

Abstract A stability indicating UPLC method has been developed and validated for the simultaneous determination of fosnetupitant and palonosetron in bulk and in injection dosage form. This combination is used for the prevention of acute and delayed nausea and vomiting associated with initial and repeated courses of highly emetogenic chemotherapy for cancer. The chromatographic analysis was performed on an HSS, RP C18 column (2.1 x 100 mm, 1.8 µm) with an isocratic mobile phase composed of 0.25 M potassium dihydrogen orthophosphate buffer (pH 6.5), pH adjusted with dilute sodium hydroxide:acetonitrile (55:45 v/v), at a flow rate of 0.5 mL/min, and the eluents were monitored at an isosbestic point of 286 nm. The developed method was validated according to the ICH guidelines pertaining to specificity, precision, accuracy, linearity and robustness, and the stability indicating nature of the method was established by forced degradation studies. The retention times of fosnetupitant and palonosetron were observed at 1.390 and 2.404 min, respectively. The developed method proved to be accurate and precise. Linearity was established between 4.70 and 14.10 µg/mL for fosnetupitant and between 0.05 and 0.15 µg/mL for palonosetron. The LOD and LOQ were 0.115 and 0.385 µg/mL, respectively, for fosnetupitant, and 0.005 and 0.016 µg/mL, respectively, for palonosetron. Therefore, the proposed UPLC method was reliable, reproducible, precise and sensitive for the quantification of fosnetupitant and palonosetron.

Lipoinyección mamaria con fines estéticos: resultados a largo plazo con una sesión / Breast lipoinjection for aesthetic purposes: long-term results with one session

Resumen Antecedentes: La cirugía de aumento mamario con lipoinjerto se ha incrementado debido a que evita usar prótesis. Es utilizado para aumentos moderados con fines estéticos, no retarda el diagnóstico de cáncer ni aumenta el riesgo de sufrirlo. Objetivo: Revisar nuestra experiencia en aumento mamario estético con lipoinjerto, en una sesión y con seguimiento superior a un año. Materiales y Método: Se diseñó una cohorte prospectiva de mujeres. Se excluyeron aquellas con alteraciones congénitas, mesenquimopatías y fumadoras. La lipoinyección se efectuó con principios de Coleman. Para la medición del volumen mamario preoperatorio se utilizó la aplicación Breast-V. Volumen de aumento, tasa de retención y tasa de aumento fueron calculados. Resultados: 73 pacientes fueron lipoinjertadas, 35 superaron seguimiento a un año. Volumen mamario inicial fue 219,5 ± 44,1 cc. Volumen de aumento fue 99,9 ± 29,8 cc, tasa de retención grasa injertada 41,4%, tasa de aumento del volumen mamario 48,1%. 41 pacientes presentaron imágenes posoperatorias: quistes 15 pacientes (36,6%); necrosis grasa 2 pacientes (4,9%); macrocalcificaciones 8 pacientes (19,5%); microcalcificaciones 1 paciente (2,5%), cuya biopsia fue negativa para malignidad. Discusión: El lipoinjerto mamario es un procedimiento seguro, con resultados adecuados cuando se realiza en una sesión y por el mismo cirujano, siguiendo principios de Coleman. El aumento porcentual es el índice más significativo para evaluar su éxito. Conclusiones: Lipoinyección mamaria en una sesión es una técnica segura que logra aumento moderado del volumen mamario. Es útil para aumentos moderados o corrección de asimetrías leves. No hay evidencia de que interfiera con el diagnóstico precoz del cáncer de mama.

Background: Lipograft breast augmentation has increased due to avoidance of prosthetics. It is used for moderate increases for aesthetic purposes, it does not delay the diagnosis of cancer or increase the risk of suffering it. Aim: To review our experience in cosmetic breast augmentation with lipograft, in one session and with a follow-up of more than one year. Materials and Method: A prospective cohort of women was designed. Those with congenital alterations, mesenchymopathies and smokers were excluded. Lipoinjection was carried out with Coleman's principies. The Breast-V application was used to measure preoperative breast volume. Volume of increase, retention rate and rate of increase were calculated. Results: 73 patients were lipografted, 35 had a one-year follow-up. Initial breast volume was 219.5 ± 44.1 cc. Volume increase was 99.9 ± 29.8 cc, grafted fat retention rate 41.4%, breast volume increase rate 48.1%. 41 patients presented postoperative images: cysts 15 patients (36.6%); fat necrosis 2 patients (4.9%); macrocalcifiations 8 patients (19.5%); microcalcifiations 1 patient (2.5%), whose biopsy was negative for malignancy. Discussion: The mammary lipograft is a safe procedure, with adequate results when performed in one session and by the same surgeon, following Coleman principles. The percentage increase is the most significant index to evalúate your success. Conclusions: Breast lipoinjection in one session is a safe technique that achieves a moderate increase in breast volume. It is useful for moderate magnification or correction of slight asymmetries. There is no evidence that it interferes with the early diagnosis of breast cancer.

Hidrodisección guiada por ultrasonido para el tratamiento de pacientes con sindrome del tunel carpiano / Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluían el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas para los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides. Los datos clínicos, las puntuaciones de CSA-MN antes de la inyección en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejora en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa

The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of preinjection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1-, 3-, and 6-months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections The clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury

Hidrodisección guiada por ultrasonido para el tratamiento de pacientes con sindrome del tunel carpiano / Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después 21. Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve 2017 June 16. doi: 10.1002/mus.25723. 22. Smith J, Wisniewski S, J, Finnoff JT, Payne JM. Sonographically Guided Carpal Tunnel Injections. J Ultrasound Med 2008;27:1485-1490. 23. Trescott AME. Peripheral Nerve Entrapments: Clinical Diagnosis and Management. Switzerland: Springer International Publishing; 2016 24. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2002(4). 25. Atroshi I, Flondell M, Hofer M, Ranstam J. Methyprednisolone Injections for the Carpal Tunnel Syndrome: A randomized Placebo-Controlled Trial. Ann Int Med 2013;159:309-317. 26. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC family practice 2010;11:54. 27. Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlledtrial. Mayo Clinic proceedings 2017;92:1179-1189. 28. Kirwan J. Is there a place for intra-articular hyaluronate in osteoarthritis of the knee? The Knee 2001;8:93-101. 29. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Jr., et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: Ameta-analysis of evidence level 1 studies. The American journal of sports medicine 2017;45:2647-2653. 30. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56(11):1459­ 66 31. Ortiz-Corredor F, Enriquez F, Diaz-Ruiz J, Calambas N. Natural evolution of carpal tunnel syndrome in untreated patients. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 2008;119:1373-1378 32. Gordon T, Brushart TM, Chan KM. Augmenting nerve regeneration with electrical stimulation. Neurol Res 2008; 30:1012- 1022. 33. Aulisa L, Tamburrelli F, Padua R, Romanini E, Lo Monaco M, Padua L. Carpal tunnel syndrome: Indication for surgical treatment based on electrophysiologic study. J Hand Surg Am 1998; 23:687-691. 34. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom- de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract. 2010;11:54. 35. Girlanda P, Dattola R, Venuto C, Mangiapane R, Nicolosi C, Messina C. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and longterm efficacy. J Neurol. 1993; 240(3):187- 190. 36. Karadas¸ Ö, Tok F, Ulas¸ UH, Odabas¸i Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double blind randomized clinical trial. Am J Phys Med Rehabil. 2011; 90(4):287-292. 128 LA PRENSA MÉDICA ARGENTINA Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome V.107/Nº 2 de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluyen el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas de los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides; los datos clínicos, la preinyección de CSA-MN en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejoría en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa.

The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of pre-injection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1, 3, and 6 months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections the clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury.

Local tissue reaction and histopathological characteristics of three different bulking agents: a rabbit model

ABSTRACT Purpose: We assessed the efficacy and safety of a single injection of three bulking agents over the short- and long-term follow-ups in rabbits. Dermal and preputial matrices were compared with Deflux (DxHA) injection. Material and methods: Twenty-four rabbits were divided into three groups. Group I (n=8) underwent the injection of a lyophilized dermal matrix (LDM) beneath the seromuscular layer of the bladder wall. Rabbits in group II (n=8) were injected with lyophilized preputial matrix (LPM). Rabbits of group III (n=8) were injected with DxHA as the control group. They were followed up for 1 and 6 months after the injection. Subcutaneous injection of all bulking agents was also performed in nude mice. Biopsies were stained with LCA (leukocyte common antibody), CD68, CD31, and CD34. Scanning electron microscopy (SEM) and MTT assay were also performed. Results: Immunohistochemistry staining with CD68 and LCA revealed higher inflammation grade in LDM as compared with LPM and DxHA. Fibrosis grade was also higher in LDM both in short- and long-term follow-ups. However, no significant difference was detected in CD31 and CD34 staining between control and experimental groups. SEM analysis showed that the particle size of LPM was more similar to DxHA. MTT assay revealed that cell proliferation was similar in DxHA, LDM, and LPM. In-vivo assay in nude mice model showed more promising results in LPM as compared with LDM. Conclusion: The long-term results demonstrated that LPM was more similar to Deflux with the least local tissue reaction, inflammation, and fibrosis grade.