Pharmacokinetic Analysis of Gatifloxacin and Dexamethasone in Rabbit Ocular Biofluid Using a Sensitive and Selective LC-MS/MS Method.

Bacterial keratitis (BK) is an infection that causes inflammation of the cornea and, if severe, can result in blindness. Topical fluoroquinolones combined with corticosteroids have been shown to be useful in the treatment of BK. A rapid, selective, and sensitive bioanalytical method for simultaneous quantification of Gatifloxacin (GAT) and Dexamethasone (DEX) has been developed and validated using tandem mass spectrometry (LC-MS/MS). Optimal separation was accomplished in under 5 min using an Agilent Zorbax C18 column (100 mm × 4.6 mm, 3.5 µm). The mobile phase was composed of a blend of 0.2% formic acid in triple distilled water and methanol with a flow rate of 0.65 mL/min in isocratic mode. GAT and DEX were detected in positive electrospray ionization multiple reaction monitoring mode (MRM), and the retention time was found to be at 1.64 and 2.93 min, respectively. The linearity of GAT and DEX was found to be in the range of 1.56-400 ng mL-1 with good precision and accuracy. The method was validated according to USFDA regulatory guidelines. The validated method was effectively utilized for preclinical pharmacokinetic analysis of GAT and DEX in rabbit tear fluid following the topical application of a commercial formulation.

Does Intralesional Steroid Injection Effectively Mitigate Vocal Fold Scarring in A Rabbit Model?

OBJECTIVES: To assess the efficacy of intralesional steroid treatment in preventing vocal fold scarring following vocal fold surgery using a rabbit model. METHODS: The research involved 42 male New Zealand white rabbits. Fourteen rabbits underwent vocal fold scar surgery using a 532nm laser and served as controls (control group). The remaining rabbits were divided into two groups of 14: one group received vocal fold scar surgery followed by dexamethasone injection (Dexa group) and the other received the same surgery followed by triamcinolone injection (Triam group). Four weeks after surgery, histological examinations and high-speed video analyses of vocal fold vibration were conducted. The maximum amplitude of vibration was the primary measure for assessing vocal fold function. In addition, real-time polymerase chain reaction (PCR) studies were undertaken to analyze scar regeneration and remodeling. RESULTS: The maximum amplitude differences were notably higher in the Dexa and Triam groups than in controls. Histologically, the collagen density (CD) ratios in both the Dexa and Triam groups were significantly reduced compared with controls. Real-time PCR analysis indicated marked elevations of Has-2 and Mmp-9 in the Dexa and Triam groups relative to controls. CONCLUSIONS: Intralesional steroid injections after vocal fold surgery are effective for reducing vocal fold scarring in a rabbit model. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Comparison of Effectiveness of Intraarticular Hyaluronate and Corticosteroid injections in Adhesive Capsulitis: A Systematic Review and Meta-analysis.

BACKGROUND: Adhesive capsulitis of the shoulder causes inflammation and adhesions in the shoulder joint capsule, leading to pain and limited range of motion (ROM). Intraarticular corticosteroid (CS) and hyaluronic acid (HA) injections are common therapeutic options for adhesive capsulitis, but their comparative effectiveness remains unclear. OBJECTIVES: To provide a robust comparison of the outcomes of HA and CS, we conducted a meta-analysis of relevant previous studies that examined the therapeutic effects of intraarticular HA and CS injections in patients with adhesive capsulitis. STUDY DESIGN: Systematic review and meta-analysis. METHODS: This meta-analysis of randomized controlled trials compared the effectiveness of intraarticular HA and CS injections. Of the 10,205 articles, 7 met our predetermined criteria and were included in the analysis. RESULTS: Patients who received CS injections demonstrated superior pain reduction and functional improvement at 2-4 weeks after injection to those who received HA injections. Nevertheless, comparable outcomes were observed between the 2 groups at 6 and 12 weeks. The active or passive range of motion of the shoulder joint was not significantly different between patients who received HA injections and those who received CS injections. LIMITATIONS: The meta-analysis included only a small number of studies, and the number of HA injections examined in those studies varied from one to 3 at a time, whereas an CS injection was performed only once in most of the included studies. CONCLUSIONS: The administration of intraarticular HA injection emerges as a commendable therapeutic option for patients with adhesive capsulitis, particularly for those requiring repetitive injections or at risk of developing side effects from injections of CS. Although intraarticular CS injections offer accelerated short-term (2-4 weeks) pain relief and functional improvement, comparable effects were observed within 6 and 12 weeks after intraarticular HA and CS injections.

Comparison of Ultrasound-guided Transverse Carpal Ligament Release via Different Approaches in Carpal Tunnel Syndrome: A Prospective, Randomized, Controlled Trial.

BACKGROUND: Ultrasound-guided transverse carpal ligament (TCL) needle release has been demonstrated to be an effective treatment for carpal tunnel syndrome (CTS). However, no existing evidence has investigated the comparative efficacy of different release approaches. OBJECTIVE: To compare the efficacy of ultrasound-guided TCL needle release via different approaches for patients with mild to moderate CTS over a 12-month follow-up. STUDY DESIGN: A prospective, randomized, controlled trial. SETTING: Outpatient clinic at a university hospital. METHODS: Sixty-four patients with mild to moderate CTS (> 3 months' duration) were randomly assigned to either the long-axis group (one session of ultrasound-guided corticosteroid injection plus long-axis TCL needle release) or the short-axis group (one session of ultrasound-guided corticosteroid injection plus short-axis TCL needle release) in a one-to-one ratio. The primary outcomes were the symptom severity scale (SSS) and functional severity scale (FSS) scores of the Boston Carpal Tunnel Questionnaire (BCTQ). The secondary outcomes were electrophysiological studies, including distal motor latency (DML) and sensory nerve conduction velocity (SNCV), cross-sectional area (CSA) of the median nerve (MN), and patient-reported successful clinical response. Assessments were performed before treatment and at one, 3, 6, and 12 months after treatment. RESULTS: A total of 60 patients (30 per group) completed the trial. Compared to the baseline, both groups exhibited improvement in SSS, FSS, SNCV, DML, and CSA at all follow-up time points, with statistical differences for SSS, FSS, and SNCV at 3, 6, and 12 months (P < 0.05), DML at 6 and 12 months (P < 0.05), and CSA at each follow-up time point (P < 0.05). Compared to the short-axis group, the long-axis group exhibited more improvement in SSS and FSS at all follow-up time points, with statistical differences at 3, 6, and 12 months (P < 0.05), and in SNCV and DML at 6 and 12 months (P < 0.05). Although the long-axis patients exhibited more improvement in their wrists' CSAs, the intergroup differences were nonsignificant at all follow-up time points (P > 0.05). Four patients in the short-axis group experienced recurrent symptoms and underwent surgery at 12 months, whereas no recurrence was observed in the long-axis group. LIMITATIONS: A relevant future trial with a longer follow-up period than this one used is still necessary. CONCLUSIONS: Ultrasound-guided TCL needle release via the long-axis approach appears to be more effective than the short-axis approach for treating mild to moderate CTS.

Comparison of the Efficacy of Ultrasound-Guided Suprascapular Nerve Blocks and Intraarticular Corticosteroid Injections for Frozen Shoulder: A Randomized Controlled Trial.

BACKGROUND: The current mainstream treatment for frozen shoulder is a combination of physiotherapy and intraarticular corticosteroid injections (IACIs). Recently, the ultrasound-guided suprascapular nerve block (SSNB) has developed as a notable alternative option to the mainstream treatment. OBJECTIVE: We aimed to compare ultrasound-guided SSNBs' effectiveness to IACIs' as treatments for frozen shoulder. STUDY DESIGN: This study was conducted as a prospective single-blind, randomized controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, a medical center in Taipei, Taiwan. METHODS: Patients with frozen shoulder (n = 76) were enrolled as participants and allocated to either an SSNB group (n = 38) or an IACI group (n = 38). Both groups received 2 injections of 20 mg of triamcinolone and 3 mL of 1% lidocaine at 2-week intervals and underwent the same physiotherapy protocol for 3 months. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). The secondary outcome measures were the Shoulder Disability Questionnaire (SDQ), the active and passive range of motion (ROM) of each patient's affected shoulder, and the 36-item Short Form Health Survey (SF-36). Evaluations were performed at baseline and at 4 and 12 weeks after starting treatment. RESULTS: Both groups achieved significant improvements in all outcome measures, except the general health subscale of the SF-36 at 4 and 12 weeks after starting treatment. For time and group interaction, the results for the SDQ (P = .047) and SF-36 (bodily pain, P = .025) indicated significant differences that favored IACIs. Additionally, the IACI group achieved more favorable outcomes than did the SSNB group on the SPADI (P = .094) and in ROM (i.e., abduction [P = .190] and external rotation [P = .081]) as well as on 2 subscales of the SF-36: bodily pain (P = .059) and role-emotional (P = .072). LIMITATIONS: Our study is limited by the lack of participant stratification based on the stages of frozen shoulder and the 12-week follow-up period. CONCLUSIONS: A combination of ultrasound-guided IACIs and physiotherapy should be attempted first as a frozen shoulder treatment.

Redundancy of Pharmacologic Ingredients in Over-the-Counter Nasal Sprays.

Objective: To evaluate and determine the prevalence of ingredients in over-the-counter (OTC) nasal sprays. Study Design: Cross-sectional. Setting: Retail pharmacies. Methods: An inventory of brand-name and generic OTC nasal sprays was recorded at five national pharmacy outlets in August 2023. Data regarding the active ingredients were collected on commercial websites, MedlinePlus and drugs.com, and frequency statistics were calculated. Results: Five pharmacies were visited, at which 12 different brand names of nasal sprays were identified at multiple pharmacies. Nine brand names were associated with multiple formulations, accounting for 49 different products. The active ingredients included in our analysis were oxymetazoline, phenylephrine, fluticasone, triamcinolone, budesonide, azelastine, cromolyn sodium, and mometasone. Nasal decongestants had the greatest number of brand name formulations compared to intranasal steroids and antihistamine sprays which had limited choices. Products that included oxymetazoline were the most widely marketed drug (51 unique products) followed sodium chloride (40 unique products). Conclusion: These findings suggest that there are widespread redundancies in the OTC nasal spray market. Clinician should be aware of the redundancy in OTC formulations and encourage patients to read the labels in order to make informed decisions regarding their use of OTC medications.

[Current recommendations for the diagnosis and treatment of autoimmune hemolytic anemia based on etiology and pathology].

Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies that can be divided into two types-warm and cold-depending on their thermal amplitudes. The pathology differs depending on the type of autoantibody involved; however, the underlying etiology can differ even when the pathology is the same. Therefore, understanding the underlying mechanisms and making an accurate diagnosis is critical, as inappropriate treatment not only results in treatment failure, but can also cause life-threatening complications and reduce patient quality of life. Corticosteroids are the first-line treatment for warm AIHA, but have limited efficacy against cold agglutinin disease (CAD). Moreover, long-term and high-dose administration of corticosteroids increases risk of infection, fracture, and thromboembolism. A novel therapeutic agent for CAD targeting the complement system is effective only against hemolysis, but does not improve symptoms induced by red blood cell aggregation. In addition, elderly patients who present with either warm AIHA or CAD should also be assessed for possible malignancy. This review discusses the etiologies and pathological conditions associated with AIHA and describes the recommendations for diagnosis and treatment according to the Japanese guideline for AIHA revised in 2022.

Corticosteroid-induced bradycardia following high-dose methylprednisolone administration: a case report.

Introduction: Besides their wide use in the clinical field due to their anti-inflammatory and immune-modulating effect, corticosteroids still have a lot of adverse effects. The most common adverse effects are hyperglycemia, hypertension, osteoporosis, psychosis, immunosuppression, weight gain, and hyperlipidemia. Another important side effect is cardiac arrhythmias. Case presentation: We report a case of a 43-year-old woman with multiple sclerosis who developed symptomatic bradycardia after 3 days of treatment with a high dose of methylprednisolone. The patient received a dose of atropine and her bradycardia resolved after 36 h of stopping methylprednisolone. Discussion: While tachyarrhythmias are more common, bradyarrhythmias such as bradycardia and premature atrial or ventricular contraction are rare but crucial to be considered. Conclusion: Corticosteroid-induced bradycardia is usually in sinus rhythm and has an unknown etiology, possibly occurring at high and low doses. The majority of cases in the literature were asymptomatic and resolved spontaneously.

Corticosteroid Therapy Duration and Dosage According to the Timing of Treatment Initiation for Post-COVID-19 Organizing Pneumonia.

COVID-19 can lead to pulmonary complications, including organizing pneumonia. Steroids are essential in treating post-COVID-19 organizing pneumonia. However, research on the clinical benefits of initiating steroid treatment early for this condition is limited. To investigate the steroid initiation time in its association with treatment duration and corticosteroid dose for treating post-COVID-19 organizing pneumonia, we analyzed the data of 91 patients with post-COVID-19 organizing pneumonia at Chonnam National University Hospital between October 2020 and December 2022. Patients were categorized into early and late groups based on time from COVID-19 diagnosis to steroid initiation time for organizing pneumonia. The mean time interval between COVID-19 infection and steroid initiation time for treating organizing pneumonia, was 18.4±8.6 days. Within the early treatment group (treatment initiated <18.4 days after COVID-19), which included 55 patients, the mean duration of steroid treatment was 43.1±18.3days. In contrast, the late treatment group (initiated ≥18.4 days after COVID-19), which consisted of 36 patients, had a longer mean duration of steroid treatment 59.1±22.6 days) (p<0.01). Regarding corticosteroid dosing, the early treatment group had an average dosage of 0.5±0.3 mg/kg/day, in contrast to the late group, which averaged 0.8±0.3 mg/kg/day (p<0.01). Regression analysis showed steroid initiation time significantly influenced treatment duration (ß=0.80 , p<0.01) and dosage (ß=0.03, p<0.01). The clinical benefits of early steroid treatment for post-COVID-19 organizing pneumonia may lie in its association with reduced steroid treatment duration and dosage.

Ultrasound-Guided Glucocorticoid Injection as a Treatment for Rotator Cuff Calcific Tendinopathy: A Case Report.

Rotator cuff calcific tendinopathy (RCCT) is a common disorder of the rotator cuff causing shoulder pain and dysfunction. RCCT is characterized by calcium deposition on and around the tendons of the rotator cuff muscles. Treatment is typically conservative, consisting of anti-inflammatory drugs (NSAIDs) and physical therapy, although certain patients require more invasive treatment. If first-line treatments do not resolve the pain, second-line treatments such as glucocorticoid injections, extracorporeal shock wave therapy (ESWT), barbotage, and surgery may be considered; however, there is no gold standard treatment for these refractory cases. In this case study, a 36-year-old female patient with confirmed RCCT achieved symptom remission with ultrasound-guided methylprednisolone injection followed by adjunctive physical therapy. Ultrasonography enabled precise, targeted delivery of steroids to the calcified lesions, with near 100% resolution of deposits on repeat radiography. With additional physical therapy, the patient was completely pain-free with a full range of motion and the ability to perform daily activities. This case report demonstrates that ultrasound-guided glucocorticoid injection can be an efficacious treatment option for refractory cases of RCCT.

Systematic review of intervention descriptions in randomised controlled trials with injectable agents for temporomandibular disorder using TIDieR and PEDro scales.

The effectiveness of healthcare depends on clinical trials in which the benefits and harms of interventions are assessed and accurately reported. The aim of this study was to evaluate the quality of the description of randomised controlled trial (RCT) interventions with injectable substances in painful temporomandibular joint disorder after arthrocentesis. RCTs with patients aged ≥ 18 years old, with temporomandibular disorder that analysed the use of intra-articular substances after arthrocentesis, comparisons with arthrocentesis/other injectable techniques, with joint pain and mandibular movement limitation were included. Non-randomised controlled trials, and RCTs in patients with systemic disorders were excluded. The search was performed in the PubMed, Embase, Scopus, Web of Science, Cochrane, and Google Scholar databases. The study description quality was evaluated by Template for intervention Description and Replication (TIDieR). The methodological quality was performed using the Physiotherapy Evidence Database's PEDro scale. The data were submitted to the Spearman correlation test to evaluate the direction and magnitude of the association between the quality of the intervention description and the methodological quality of the RCTs. A total of 9,793 articles were identified, of which 113 were eligible studies and 19 were included. The mean (SD) ratings by TIDieR = 8 (1.07). Absent items in all RCTs that negatively impacted the TIDieR score were: 'Were there adaptations?', 'Were there modifications?' and 'Assessment of adherence'. Other topics were not satisfactorily described: 'Who performed the intervention?' (52.63%), and 'Where it was performed' (36.84%). There was no correlation between TIDieR and PEDro (r=0.009). RCTs with good methodological quality do not contemplate all the TIDieR items and the scale's proper use would contribute to more detailed reports and more faithful reproduction of therapies in clinical research and practice. Complete reports facilitate the understanding of the evidence obtained and serve as a guide in the reproduction of the research in future studies and in clinical application.

The Efficacy of Oral/Intravenous Corticosteroid Use in COVID-19 Patients: A Systematic Review.

The COVID-19 pandemic is prompting extensive investigation into potential treatments, including the use of corticosteroids to manage inflammation and mitigate severe disease outcomes. Therefore, this systematic review aimed to evaluate the efficacy of oral/intravenous corticosteroids in the management of COVID-19. A comprehensive search was conducted across major scientific databases such as MEDLINE, Scopus, and Cochrane for relevant studies published from 2019-2024. The inclusion criteria included studies investigating the use of oral/intravenous corticosteroids in COVID-19 patients >18 years with a randomized placebo-controlled trial method. Non-placebo-controlled studies, studies using combined treatments with other drugs, as well as protocol articles, conference proceedings, review articles, and non-English studies were excluded. A narrative synthesis approach was adopted given the significant methodological diversity. The results showed that a total of 12 studies met the inclusion criteria covering the use of three drugs, including dexamethasone (three), hydrocortisone (two), and methylprednisolone (seven). The outcome parameters used for each study were different. Among the total 12 studies, five showed insignificant results for hydrocortisone (two) and methylprednisolone (three), while others reported significant results. This systematic review suggested that oral/intravenous corticosteroids might confer clinical benefits in the management of COVID-19, particularly in reducing mortality and severe disease outcomes. However, further investigation was needed to establish standardized protocols regarding dosage, duration, and safety considerations to optimize efficacy and minimize potential adverse effects.

Juvenile idiopathic arthritis management: insights into the utilization of intra-articular corticosteroid injections.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children, requiring careful management to reduce both short- and long-term morbidity. In this study, our objective was to assess the clinical features of patients diagnosed with JIA who received intra-articular corticosteroid injections (IACI). METHODS: In this retrospective study, we evaluated the clinical and laboratory characteristics of 225 JIA patients monitored from January 2012 to October 2023 at a tertiary care center. We focused on patients who underwent intra-articular corticosteroid injections (IACI) as part of their treatment. Triamcinolone hexacetonide (TH) was used due to its demonstrated safety and efficacy. RESULTS: Our analysis revealed that IACI, particularly utilizing TH, was a widely employed and effective adjunct therapy, contributing to rapid symptom relief and local disease control. Patients receiving IACI exhibited earlier symptom onset, younger age at diagnosis, longer follow-up durations, and higher cumulative treatment burden (p < 0.001, p < 0.001, p < 0.01, p < 0.001 respectively). Despite inconclusive acute-phase reactants, a higher frequency of ANA positivity and elevated initial lymphocyte counts were associated with increased IACI use (p < 0.001, p < 0.001 respectively). Importantly, on a joint basis, a high percentage of arthritis remission following IACI underscores its efficacy and favorable safety profile. CONCLUSIONS: Notably, the high percentage of arthritis remission achieved with intra-articular corticosteroid injections (IACI) on a joint-specific basis highlights its efficacy and favorable safety profile. A lymphocyte count exceeding 5000/mm3 at the time of diagnosis may serve as an early indicator for considering intra-articular steroid administration. These findings emphasize the need for nuanced and individualized treatment strategies in JIA management to optimize outcomes for affected children.

Efficacy and safety of telitacicept, a BLyS/APRIL dual inhibitor, in the treatment of IgA nephropathy: a retrospective case-control study.

Background: Telitacicept, a B lymphocyte stimulator/A proliferation-inducing ligand dual-target fusion protein, has recently been used in autoimmune diseases. We assessed the efficacy and safety of telitacicept in immunoglobulin A nephropathy (IgAN) patients. Methods: This study included 42 IgAN patients who received telitacicept treatment, forming the 'whole telitacicept group'. Among them, 20 patients who had not previously received corticosteroid (CS) therapy or immunosuppressive (IS) agents were categorized as the 'newly treated telitacicept subgroup'. Additionally, 28 patients who were selected to match historical controls received conventional IS therapy (CS therapy with/without IS agents) and were classified as the 'conventional IS group'. Telitacicept was partially used in combination with conventional IS therapy, including initial CS in different doses. Various indicators were compared at 4-week intervals up to 24 weeks among the three groups. Results: After 24 weeks of treatment, the 24-hour proteinuria decreased from 1.70 g [interquartile range (IQR) 1.05-2.58] to 0.21 g (IQR 0.39-0.13) (P = .043) in the newly treated telitacicept subgroup, from 1.78 g (IQR 0.97-2.82) to 0.44 g (IQR 1.48-0.16) (P = .001) in the conventional IS group and from 1.07 g (IQR 0.66-1.99) to 0.26 g (IQR 0.59-0.17) (P = .028) in the whole telitacicept group. The estimated glomerular filtration rate (eGFR) increased from 76.58 ± 30.26 ml/min/1.73 m2 to 80.30 ± 26.76 ml/min/1.73 m2 (P = .016) in the newly treated telitacicept subgroup, from 72.73 ± 33.41 ml/min/1.73 m2 to 84.08 ± 26.81 ml/min/1.73 m2 (P = .011) in the conventional IS group and from 70.10 ± 32.88 ml/min/1.73 m2 to 71.21 ± 31.49 ml/min/1.73 m2 (P = .065) in the whole telitacicept group. During follow-up periods, the efficacy rates of the three groups did not show statistically significant differences and no serious adverse events were observed. Conclusions: Telitacicept may be a safe and effective treatment for IgAN, offering reductions in proteinuria and increases in eGFR similar to conventional IS therapy. After a 24-week follow-up, the incidence of adverse events was lower for telitacicept than for conventional IS therapy.

[Survey of the management of moderate to severe active Graves' orbitopathy at 28 metropolitan centers of excellence in France]. / État des lieux de la prise en charge de l'orbitopathie dysthyroidïenne modérée à sévère active en France à partir de 28 centres experts métropolitains.

INTRODUCTION: This study investigates the management of Graves'orbitopathy (GO) in France, at 26 university medical centers (CHU) as well as the Rothschild Foundation and the Quinze-Vingts national eye hospital in Paris. METHODS: The 28 metropolitan university medical centers were contacted by telephone or e-mail. The authors devised a 5-item questionnaire that explored the scheduling of multidisciplinary meetings, the existence or lack of a dedicated Graves' consultation service, the place of hospitalization, and first- and second-line treatments. RESULTS: Eighty-nine percent of hospital departments had a dedicated service for patients with GO, with 36% organizing multidisciplinary meetings. Intravenous corticosteroid therapy is still used as first-line treatment, while mycophenolate is used much less (14.3%), despite the new EUGOGO (European Group on Graves' orbitopathy) 2021 recommendations. For second-line treatment, tocilizumab is most commonly used (64%). Teprotumumab is available in France only on a compassionate basis, and its use is limited (18%). CONCLUSION: This study highlights the variability in practices and the importance of a multidisciplinary approach, while calling for national standardization of practices. Despite disparities in the application of recommendations, the emergence of second-line treatments such as tocilizumab and teprotumumab indicates a steady evolution in therapeutic options, although obstacles in terms of accessibility and cost remain.

Comparative Effectiveness of Acupuncture Versus Non-surgical Modalities for Treating Plantar Fasciitis: A Network Meta-Analysis.

Plantar fasciitis, or plantar heel pain, causes inflammation of the plantar fascia due to various causes, with no clear consensus on the treatment protocol. Standard first-line treatment includes non-steroidal anti-inflammatory drugs and physiotherapy. Second-line treatment prior to surgery includes extracorporeal shockwave therapy (ESWT), ultrasound-guided (USG) therapy, corticosteroid injection (CSI), and platelet-rich plasma (PRP) injection. Recently, the use of acupuncture treatment has been gaining popularity, with increasing published evidence showing its effectiveness in treating plantar fasciitis. The objective of this study was to determine whether acupuncture intervention was a viable alternative treatment method for managing plantar fasciitis when compared to ESWT, USG therapy, CSI, and PRP injection. Data sources from PubMed, Google Scholar, Scopus, Science Direct, and China National Knowledge Infrastructure were reviewed. Clinical trials were searched from their inception over the period of January 2000 to October 2020. A total of 32 relevant papers were included for analysis, totaling 2390 samples. Visual Analog Scale (VAS) scores measuring pain were analyzed in terms of outcome after one and three months of treatment. Each time point was analyzed separately through a network meta-analysis using the frequentist approach. VAS scores for each intervention at baseline and the two-time points (i.e., one and three months) were included in the comprehensive meta-analysis. Then, differences in VAS scores were calculated in R studio (V4.1.2; RStudio: Integrated Development for R, RStudio, Inc., Boston, USA) using the netmeta package. The netmeta package was also used to perform the network meta-analysis and generate corresponding figures. Direct and indirect effects were assessed and visualized through a direct evidence plot and a node-splitting forest plot. Randomized controlled trials (RCTs) and non-RCTs involving treatments of acupuncture, ESWT, USG therapy, CSI, or PRP injection, either in comparison with each other or with a placebo, were included in our review. Our meta-analysis showed that at one month, VAS scores for acupuncture treatment had the highest mean difference (MD) of -1.33 (95% confidence interval (95% CI) = -2.19 to -0.46) compared to placebo, indicating that acupuncture treatment was more effective than other treatment arms when compared to placebo. Analysis at threemonths showed that the highest-ranked treatment was PRP injection, with an MD of -2.67 (95% CI = -6.23 to 0.89). However, the CI for the net effect of all treatments crossed the null effect on the forest plot, indicating no statistically significant difference between the treatment and placebo. Acupuncture treatment should be considered as a second-line treatment for treatment of plantar fasciitis together with other common treatment options such as ESWT, PRP injection, CSI, and USG therapy. Further long-term studies measuring acupuncture treatment outcomes would be beneficial in the future.

Clinical Effects of Additional Platelet-Rich Plasma Application to Exercise Therapy in Patients with Subacromial Impingement Syndrome: A Double-Blind Randomized Controlled Trial.

Background: Exercise therapy (ET) is the main and initial treatment modality for treating subacromial impingement syndrome (SIS). The isolated or combined use of platelet-rich plasma (PRP) applications in treating SIS is increasing and promising. A comparison was made on the effectiveness of ET alone and in combination with PRP on pain, functionality, and quality of life (QoL) in patients with SIS. Purposes/Hypothesis: The purposes of this study were to (1) investigate the possible positive effects of PRP injections combined with ET in treating SIS on pain, functionality, and QoL and (2) propose an alternative treatment protocol. It was hypothesized that the group receiving PRP applications in addition to ET would have a better QoL due to less pain and higher functionality 6 months after treatment. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Volunteer patients diagnosed with SIS were included based on history and physical examination findings. All participants underwent magnetic resonance imaging to confirm the diagnosis and exclude possible accompanying pathologies. The patients were randomly divided into 2 groups. The first group underwent ET at home for 8 weeks (ET group), and the second group received the same ET program and an additional 2 PRP injections, at the beginning of the study and the end of the fourth week (PRP group). Patients were evaluated initially and 6 months after the treatment using the visual analog scale (VAS) for pain score, Constant-Murley Score (CMS), and the 36-Item Short Form Health Survey (SF-36). The Kolmogorov-Smirnov test determined the conformity of the data to a normal distribution, chi-square analysis was used to compare categorical variables between groups, and the Mann-Whitney U test was used to compare continuous and intergroup variables. Intragroup changes before and after treatment were evaluated with the Wilcoxon signed-rank test. P < .05 was considered statistically significant. Results: A total of 67 patients were initially enrolled; 5 were excluded and 6 were lost to follow-up (1 because of a COVID diagnosis). Thus, 56 patients (56 shoulders) were included for analysis. There were 28 patients in the ET group and 28 patients in the PRP group. There were no statistical differences between groups regarding participant characteristics and clinical evaluations before treatment. A statistically significant improvement was observed in pain (VAS subgroups), functionality (CMS subgroups), and QoL (SF-36 subgroups) evaluations of patients in both the ET and the PRP groups compared with before the treatment and 6 months after treatment (P < .05). At the 6-month posttreatment evaluation, the PRP group was statistically significantly superior to isolated ET in terms of VAS rest (P = .001) and night (P = .004) scores. This superiority was also in favor of the PRP group in flexion strength (P = .001), abduction strength (P = .046), and abduction degree (P = .041) measurements. There was no significant difference between ET and PRP groups regarding VAS activity, CMS, and SF-36 scores (P > .05) at 6 months. Conclusion: Our study showed that both isolated ET and additional PRP application to ET are effective methods in SIS treatment regarding pain, function, and QoL. Combining ET with PRP was superior in reducing pain and improving abduction degree and strength.

Unveiling a Rare Phenomenon: Sudden Sensorineural Hearing Loss Following Skin Prick Testing.

Introduction: The skin prick test (SPT) is a standard method for diagnosing allergic diseases, while sudden sensorineural hearing loss (SSNHL) remains a perplexing condition often of unknown etiology. We present a unique case of SSNHL emerging shortly after an SPT, suggesting a potential link between allergic reactions and inner ear disorders. Case Report: A 27-year-old male presented with unilateral hearing loss following an SPT for allergic rhinitis. Audiometric findings revealed SSNHL in the affected ear. Treatment with corticosteroids led to a full recovery of hearing function. Conclusion: This case highlights the rare occurrence of SSNHL possibly triggered by a type 1 allergic reaction to an SPT. Prompt corticosteroid therapy proved effective in restoring hearing. Further research is needed to understand the relationship between allergies and SSNHL and explore alternative treatment options.

Administration of Corticosteroids for Prompt Suppression of Cytokine Storm in Severe Cases of Japanese Spotted Fever.

Japanese spotted fever (JSF) is a tick-borne disease caused by Rickettsia japonicaand primarily affects the warmer coastal areas of Japan. Early treatment with tetracycline antibiotics is crucial to prevent severe complications, such as pneumonia, meningitis, disseminated intravascular coagulation (DIC), and systemic inflammatory response syndrome. An 83-year-old man with hypertension, chronic kidney disease, and hyperuricemia presented with DIC and subsequently developed septic shock. Polymerase chain reaction confirmed JSF caused by R. japonica. Initial treatment with ceftriaxone was ineffective, leading to a switch to intravenous minocycline and levofloxacin. Considering the high levels of C-reactive protein, procalcitonin, ferritin, and soluble interleukin-2 receptor, intravenous hydrocortisone (200 mg/day) was administered to control the cytokine storm. On day 4, the patient's condition improved significantly, with increased blood pressure, reduced DIC markers, and decreased levels of inflammatory cytokines, including interleukin-6 and tumor necrosis factor-α. The patient's recovery continued, and he was transferred to a chronic care hospital. Severe JSF cases are primarily driven by a cytokine storm caused by an excessive immune response. Early administration of corticosteroids along with antibiotics effectively suppressed the cytokine storm in this case. Reports have shown mixed results, indicating the need for further research to determine the optimal type, dosage, and duration of corticosteroid treatment.

Comparative efficacy of intratympanic gentamicin and intratympanic corticosteroid in the treatment of Meniere's disease: a systematic review and meta-analysis.

Purpose: We aimed to evaluate the efficacy of gentamicin compared to corticosteroids for the treatment of Meniere's disease. Methods: An extensive search was conducted in PubMed, Embase, and Web of Science until May 2024. For continuous outcomes, pooled effect estimates were determined by calculating the weighted mean difference (WMD), while for binary outcomes, the risk ratio (RR) was used, each accompanied by their respective 95% confidence intervals (CIs). Heterogeneity among the studies was assessed using Cochran's I 2 and Q statistics. Results: A total of 12 studies were selected, involving 694 patients. Our analysis found that the gentamicin group demonstrates superior vertigo control rates compared to the corticosteroid group (RR: 1.36, 95% CI: 1.13 to 1.65, p < 0.001). In subgroup analysis, the gentamicin group showed a higher vertigo control rates at 6 months compared to the corticosteroid group (RR: 1.69, 95% CI: 1.28 to 2.24, p < 0.001); however, there was no statistically significant difference between the two groups at 12 months (RR: 1.48, 95% CI: 0.88 to 2.49, p = 0.14). Regarding changes in pure tone average, the corticosteroid group was superior to the gentamicin group (WMD: 4.41, 95% CI: 3.31 to 5.52, p < 0.001). Conclusion: Our study suggests that the intratympanic gentamicin group achieves higher vertigo control rates, whereas the corticosteroid group demonstrates better improvement in pure tone averages. However, the high heterogeneity in vertigo control rates warrants caution. Larger sample-sized randomized controlled trials are needed to further validate these findings.