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2.
J Orthop Res ; 39(7): 1441-1451, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33095462

RESUMO

Although core decompression (CD) is often performed in the early stage of osteonecrosis of the femoral head (ONFH), the procedure does not always prevent subsequent deterioration and the effects of CD are not fully clarified. The aim of this study is to evaluate the efficacy of CD for steroid-associated ONFH in rabbits. Twelve male and 12 female New Zealand rabbits were injected intramuscularly 20 mg/kg of methylprednisolone once and were divided into the disease control and CD groups. In the disease control group, rabbits had no treatment and were euthanized at 12 weeks postinjection. In the CD group, rabbits underwent left femoral CD at 4 weeks postinjection and were euthanized 8 weeks postoperatively. The left femurs were collected to perform morphological, biomechanical, and histological analysis. Bone mineral density and bone volume fraction in the femoral head in the CD group were significantly higher than in the disease control group. However, no difference in the mechanical strength was observed between the two groups. Histological analysis showed that alkaline phosphatase and CD31 positive cells significantly increased in the males after CD treatment. The number of empty lacunae in the surrounding trabecular bone was significantly higher in the CD group. The current study indicated that CD improved the morphological properties, but did not improve the mechanical strength in the femoral head at early-stage ONFH. These data suggest the need for additional biological, mechanical strategies, and therapeutic windows to improve the outcome of early-stage steroid-associated ONFH.


Assuntos
Artroplastia Subcondral , Necrose da Cabeça do Fêmur/cirurgia , Animais , Descompressão Cirúrgica , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Necrose da Cabeça do Fêmur/induzido quimicamente , Masculino , Acetato de Metilprednisolona , Coelhos , Fatores Sexuais , Microtomografia por Raio-X
3.
Inflamm Res ; 70(1): 99-107, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33226449

RESUMO

OBJECTIVE AND DESIGN: This study aimed at evaluating the effect of methylprednisolone (MPA) on messenger ribonucleic acid (mRNA) expression levels in immature ovine knee joint tissue explants following interleukin (IL)1ß induction and to assess responsiveness of the explants. MATERIAL OR SUBJECTS: Explants were harvested from the articular cartilage, synovium, and infrapatellar fat pad (IPFP) from immature female sheep. TREATMENT: Methylprednisolone. METHODS: The samples were allocated into six groups: (1) control, (2) MPA (10-3 M), (3) MPA (10-4 M), (4) IL1ß, (5) IL1ß + 10-3 M MPA, or (6) IL1ß + 10-4 M MPA. mRNA expression levels for molecules relevant to inflammation, cartilage degradation/anabolism, activation of innate immunity, and adipose tissue/hormones were quantified. Fold changes with MPA treatment were compared via the comparative CT method. RESULTS: Methylprednisolone treatment significantly suppressed MMPs consistently across the cartilage (MMP1, MMP3, and MMP13), synovium (MMP1 and MMP3), and IPFP (MMP13) (all p < 0.05). Other genes that were less consistently suppressed include endogenous IL1ß (cartilage) and IL6 (IPFP) (all p < 0.05), and others not affected either by IL-1 exposure or subsequent MPA include TGFß1, TLR4, and adipose-related molecules. CONCLUSIONS: Methylprednisolone significantly mitigated IL1ß induced mRNA expression for MMPs in the immature cartilage, synovium, and IPFP, but the extent of the responsiveness was tissue-, location-, and gene-specific.


Assuntos
Anti-Inflamatórios/farmacologia , Cartilagem Articular/efeitos dos fármacos , Interleucina-1beta , Articulação do Joelho/efeitos dos fármacos , Metaloproteinases da Matriz/genética , Acetato de Metilprednisolona/farmacologia , Membrana Sinovial/efeitos dos fármacos , Animais , Cartilagem Articular/citologia , Cartilagem Articular/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Citocinas/genética , Feminino , Expressão Gênica/efeitos dos fármacos , Articulação do Joelho/citologia , Articulação do Joelho/metabolismo , RNA Mensageiro/metabolismo , Ovinos , Membrana Sinovial/citologia , Membrana Sinovial/metabolismo
4.
Equine Vet J ; 53(1): 78-84, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32348605

RESUMO

BACKGROUND: Intra-articular (IA) administration of corticosteroids is performed routinely in equine practice. The lung function of severe asthmatic horses has recently been shown to be improved by IA triamcinolone acetonide (TA). We therefore hypothesised that IA methylprednisolone acetate (MPA), another commonly used corticosteroids, would also decrease the airway obstruction in severe asthmatic horses. OBJECTIVES: To compare the effects of intra-articular (IA) and intramuscular (IM) methylprednisolone acetate (MPA) administration on lung function and serum cortisol levels in horses with severe asthma. STUDY DESIGN: Randomised and controlled experiments on severe asthmatic research animals. METHODS: Severe asthmatic horses in exacerbation were administered 200 mg of MPA either intramuscularly (n = 6) or via intra-articular injections in the tarsocrural joints (n = 6; 100 mg/joint). Serum cortisol concentration and pulmonary function was measured for 8 days. RESULTS: A significant decrease in pulmonary resistance in the IA group (P = .003, mean diff 1.14) on day 1 in comparison with baseline was observed. A significant decrease from baseline was also observed on serum cortisol values in the IA group 6 hours after injection (P = .001, mean diff 44.5), and at day 1 (P = .003, mean diff 45.1). MAIN LIMITATIONS: Joint health was not evaluated in the current study and the physiological response of the severe asthmatic horses might deviate from that of the milder forms of asthma. CONCLUSIONS: MPA IA administration improves the lung function of severe asthmatic horses. However, this effect was mild and of a short duration.


Assuntos
Asma , Doenças dos Cavalos , Animais , Asma/tratamento farmacológico , Asma/veterinária , Doenças dos Cavalos/tratamento farmacológico , Cavalos , Injeções Intra-Articulares/veterinária , Pulmão , Metilprednisolona/uso terapêutico , Acetato de Metilprednisolona , Triancinolona Acetonida/uso terapêutico
5.
Work ; 67(4): 763-765, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33325426

RESUMO

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. OBJECTIVE AND METHODS: This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. RESULTS: The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. CONCLUSION: In short, we highlight the importance of ultrasound examination in the management of work (overuse)-related disorders in occupational medicine practice.


Assuntos
COVID-19 , Doenças do Pé/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Doenças Profissionais/diagnóstico por imagem , Indústria Têxtil , Voluntários , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Transtornos Traumáticos Cumulativos/complicações , Drenagem/métodos , Feminino , Doenças do Pé/etiologia , Traumatismos do Pé/complicações , Cistos Glanglionares/etiologia , Humanos , Máscaras , Acetato de Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Pandemias , SARS-CoV-2 , Trimecaína/administração & dosagem , Ultrassonografia de Intervenção
6.
Pediatr Rheumatol Online J ; 18(1): 75, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32998740

RESUMO

BACKGROUND: Intraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting. METHODS: In this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligoarthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for 2 years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation. RESULTS: Among the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p = 0.045 and decreased MRI mean additive inflammatory score from 4.4 ± 1.8 standard deviations (SD) to 3.4 ± 2.0, p = 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent. CONCLUSIONS: In this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No severe side effects were seen.


Assuntos
Anti-Inflamatórios/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Glucocorticoides/uso terapêutico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Adolescente , Artrite Juvenil/diagnóstico por imagem , Criança , Feminino , Humanos , Injeções Intra-Articulares , Imageamento por Ressonância Magnética , Masculino , Acetato de Metilprednisolona/uso terapêutico , Noruega , Projetos Piloto , Estudos Prospectivos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Resultado do Tratamento , Triancinolona Acetonida/análogos & derivados , Triancinolona Acetonida/uso terapêutico
7.
J Pak Med Assoc ; 70(8): 1314-1318, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32794478

RESUMO

OBJECTIVE: To compare the success of treatment between thumb spica cast with "methylprednisolone acetate injection" versus thumb spica cast alone for the treatment of de Quervain's disease as functional outcomes, complications and patient compliance. METHODS: A single blinded randomized controlled trial using a probability sampling technique was conducted from January 2014 to h February 2017at the Orthopaedic Unit II, King Edward Medical University / Mayo Hospital, Lahore. A total of 134 patients of both genders, between 30-60 years of age presented with wrist pain and diagnosed de Quervain's disease, were included in the study. Patients were randomly divided into two group by the computer allocation method. Patients in Group-A received thumb spica cast with methylprednisolone acetate and xylocaine injection while patients in Group-B were treated with thumb spica cast alone. The outcome variable was frequency of successful treatment which was noted and compared among the groups. RESULTS: Amongst the total 134 patients, the age of the patients ranged from 30 to 60 years with a mean of 37.16±5.15 years. Most of the patients were aged between 30 40 years (78.8%) followed by 41-50 years (21.2%). There were 38 (28.4%) male and 96 (71.6%) female patients in the study group with a male to female ratio of 1:2.5. In group-A mean VAS and Quick DASH score before treatment and after the treatment was statistically significant (p-value <0.001). In group-B mean VAS and Quick DASH score before and after the treatment was also significant (p-value <0.001) ( Table-2). CONCLUSIONS: The effectiveness of treatment was significantly higher in patients treated with thumb spica cast with methylprednisolone acetate injection as compared to thumb spica cast alone.


Assuntos
Doença de De Quervain , Tenossinovite , Adulto , Doença de De Quervain/tratamento farmacológico , Feminino , Humanos , Masculino , Acetato de Metilprednisolona , Pessoa de Meia-Idade
8.
Cutan Ocul Toxicol ; 39(3): 274-280, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32619116

RESUMO

OBJECTIVE: To investigate the effect of high-dose systemic steroids on retinal tissues and the effectiveness of ozone (O3) therapy. METHODS: Twenty-four New Zealand white rabbits were divided into three groups of eight. Group 1 was accepted as the control group, Group 2 received intramuscular 20 mg/kg methylprednisolone acetate and Group 3 received 14 sessions of ozone treatment in addition to methylprednisolone acetate. The subjects were sacrificed on the 30th day. Retinal tissues were removed. Superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), total antioxidant status (TAS) and total oxidant status (TOS) levels were evaluated for tissue biochemistry and serum ischaemic modified albumin (IMA), interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) levels were evaluated with the ELISA method. Haematoxylin-eosin staining and TUNEL evaluation for apoptosis were evaluated as histopathological methods. RESULTS: In the treatment group, antioxidant parameters of TAS, SOD and CAT were higher, oxidative and ischaemic parameters of MDA, TOS and IMA were lower, inflammatory parameters of IL-6 and TNF-α were lower, retinal thickness was better and apoptosis amount was lower. CONCLUSION: Apoptosis increases in retinal tissues due to high dose systemic steroid administration and the retina becomes thinner. With biochemical examination, oxidation parameters increased while antioxidant parameters decreased. Both histopathological and biochemical parameters improved significantly with ozone treatment.


Assuntos
Anti-Inflamatórios/efeitos adversos , Acetato de Metilprednisolona/efeitos adversos , Ozônio/uso terapêutico , Doenças Retinianas/induzido quimicamente , Doenças Retinianas/tratamento farmacológico , Animais , Apoptose/efeitos dos fármacos , Biomarcadores , Catalase/metabolismo , Interleucina-6/metabolismo , Masculino , Malondialdeído/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Coelhos , Retina/efeitos dos fármacos , Retina/lesões , Retina/metabolismo , Retina/patologia , Doenças Retinianas/metabolismo , Doenças Retinianas/patologia , Albumina Sérica Humana , Superóxido Dismutase/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
10.
Int J Pharm ; 582: 119302, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32276091

RESUMO

Lacidipine is a potent dihydropyridine calcium channel blocker used for management of hypertension and atherosclerosis. The drug has low and fluctuating oral bioavailability owing to its extensive hepatic first-pass metabolism and reduced water solubility. Accordingly, this work aimed at overcoming the aforementioned challenges through the formulation of intranasal nano-sized lacidipine glycerosomes. Box-Behnken was successfully employed for the formulation and in vitro optimization of the glycerosomes. Statistical analysis revealed that cholesterol concentration exhibited a significant effect on the vesicle size, while Phospholipon® 90G and glycerol concentrations exhibited significant effects on both entrapment efficiency and deformability index. The optimized formulation showed spherical shape, good deformability, vesicular size of 220.25 nm, entrapment efficiency of 61.97%, and enhanced ex vivo permeation by 3.65 fold compared to lacidipine suspension. Confocal laser scattering microscope revealed higher penetration depth via nasal mucosa for rhodamine labelled glycerosomes (up to 60 µm) in comparison to rhoadamine dye solution (26 µm). In addition, the optimized lacidipine glycerosomes caused significant reduction in methylprednisolone acetate-induced hypertension in rats for up to 24 h in comparison to oral drug suspension. Histopathological assessment showed intact nasal mucosal epithelial lining with no signs of inflammation or necrosis confirming the safety and tolerability of the proposed glycerosomes. The declared results highlights the potential of utilizing the proposed glycerosomes as safe and effective platform for intranasal delivery of lacidipine.


Assuntos
Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/administração & dosagem , Colesterol/química , Di-Hidropiridinas/administração & dosagem , Glicerol/química , Hipertensão/tratamento farmacológico , Fosfatidilcolinas/química , Administração Intranasal , Administração Oral , Animais , Anti-Hipertensivos/química , Anti-Hipertensivos/metabolismo , Anti-Hipertensivos/toxicidade , Bloqueadores dos Canais de Cálcio/química , Bloqueadores dos Canais de Cálcio/metabolismo , Bloqueadores dos Canais de Cálcio/toxicidade , Di-Hidropiridinas/química , Di-Hidropiridinas/metabolismo , Di-Hidropiridinas/toxicidade , Modelos Animais de Doenças , Composição de Medicamentos , Liberação Controlada de Fármacos , Hipertensão/induzido quimicamente , Hipertensão/fisiopatologia , Lipossomos , Masculino , Acetato de Metilprednisolona , Absorção Nasal , Mucosa Nasal/efeitos dos fármacos , Mucosa Nasal/metabolismo , Permeabilidade , Ratos Wistar , Solubilidade
11.
Acta Orthop Traumatol Turc ; 54(1): 49-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32175897

RESUMO

OBJECTIVE: The aim of this study was to compare the outcome of intra-lesional autologous bone marrow concentrate (BMC) and equine derived demineralized bone matrix (EDDBM) injections with methylprednisolone acetate injections in patients with simple bone cyst. METHODS: Clinical records and radiographs of 53 consecutive patients (37 females,and 16 males; mean age: 10.6±1.53 years) treated between 2006 and 2016 were retrospectively reviewed. Healing was assessed by an independent radiologist according to Neer scoring system. Functional outcome was assessed with the Activity Scale for Kids (ASK). Thirty-four cysts were in the humerus, 13 in the femur and 6 in other locations. Twenty-nine patients were included in Steroid Group and treated with 3 cycles of injections of methylprednisolone acetate, while 24 patients were treated with injection of autologous bone marrow concentrate and equine derived demineralized bone matrix (BMC+ EDDBM Group). The two groups were homogenous for the mean age, sex distribution, cysts location and their clinical presentation. RESULTS: At a minimum follow-up of 24 months, success rate (Neer/Cole score 3 and 4) was higher in EDDBM+BMC group (83.3% vs 58.6%; p=0.047). Female patients had higher healing rates in both groups (p=0.002). No association was found between healing and age (p=0.839), cyst activity (p=0.599), cyst localization (p=0.099) and clinical presentation (p=0.207). BMC+EDDBM group showed higher ASK score (p=0.0007). CONCLUSION: Treatment with BMC+EDDBM injections may provide better results with a single procedure than 3 methylprednisolone acetate injections and represent an interesting alternative for the treatment of unicameral bone cysts. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Cistos Ósseos , Transplante de Medula Óssea/métodos , Acetato de Metilprednisolona/administração & dosagem , Materiais Biocompatíveis/administração & dosagem , Cistos Ósseos/diagnóstico por imagem , Cistos Ósseos/terapia , Matriz Óssea , Criança , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais/métodos , Masculino , Radiografia/métodos , Estudos Retrospectivos , Resultado do Tratamento
13.
Eye Contact Lens ; 46(3): 174-181, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31206369

RESUMO

PURPOSE: There is a recognition that nerve dysfunction can contribute to chronic ocular pain in some individuals. However, limited data are available on how to treat individuals with a presumed neuropathic component to their ocular pain. As such, the purpose of this study was to examine the efficacy of our treatment approaches to this entity. METHODS: A retrospective review of treatments and outcomes in individuals with chronic ocular pain that failed traditional therapies. RESULTS: We started eight patients on an oral gabapentinoid (gabapentin and/or pregabalin) as part of their pain regimen (mean age 46 years, 50% women). Two individuals reported complete ocular pain relief with a gabapentinoid, in conjunction with their topical and oral medication regimen. Three individuals noted significant improvements, one slight improvement, and two others no improvement in ocular pain with gabapentin or pregabalin. We performed periocular nerve blocks (4 mL of 0.5% bupivacaine mixed with 1 mL of 80 mg/mL methylprednisolone acetate) targeting the periocular nerves (supraorbital, supratrochlear, infratrochlear, and infraorbital) in 11 individuals (mean age 54 years, 36% women), 10 of whom had previously used a gabapentinoid without ocular pain improvement. Seven individuals experienced pain relief after nerve blocks that lasted from hours to months and four failed to benefit. Five of the individuals who experienced pain relief underwent repeat nerve blocks, weeks to months later. CONCLUSIONS: Approaches used to treat chronic pain outside the eye can be applied to ocular pain that is not responsive to traditional therapies.


Assuntos
Analgésicos/administração & dosagem , Anestésicos Locais/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Ocular/tratamento farmacológico , Gabapentina/administração & dosagem , Bloqueio Nervoso/métodos , Pregabalina/administração & dosagem , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Bupivacaína/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Acetato de Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Nervo Oftálmico/efeitos dos fármacos , Manejo da Dor , Estudos Retrospectivos , Adulto Jovem
15.
Clin Rheumatol ; 38(10): 2933-2940, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31209710

RESUMO

OBJECTIVE: To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome (CTS) in type 2 diabetes mellitus (DM). METHOD: Study included 60 patients with electrophysiologic evidence of mild to moderate CTS. They were randomly divided into three groups: group I received insulin injection locally into the affected carpal tunnel at first visit and a similar dose after 2 weeks; group II received single injection of 40 mg methylprednisolone acetate injection; and group III received steroid injection then followed by insulin injection twice after 2 and 4 weeks. All injections were performed with ultrasonographic guidance. All patients were assessed by modified Boston Carpal Tunnel Questionnaire (FD score), CTS severity score (SS score), and neurophysiological and ultrasonographic assessments at baseline and 10 weeks after treatment. RESULTS: A significant improvement in mean FD score, SS score, DML (distal motor latency), SNCV (sensory nerve conduction velocity), PSL (peak sensory latency), Samp (sensory amplitude), and CSA (cross-sectional area of median nerve) observed in all groups (with exception of mean DML and Samp in the second group and mean Samp in the third group). Group III showed significant improvement in CSA especially when compared to group II by post hoc analysis (P = 0.005). CONCLUSIONS: Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 DM and is a safer alternative. Adding insulin injections after steroid shows more sonographic improvement than steroid alone. Key Points • Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 diabetic patients. • Measuring CSA of median nerve at CT inlet by US is a better tool for monitoring median nerve changes after treatment. • Adding insulin injections after steroid has more sonographic improvement than steroid alone.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Insulina/administração & dosagem , Ultrassonografia , Adolescente , Adulto , Idoso , Síndrome do Túnel Carpal/complicações , Eletrofisiologia , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Acetato de Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Condução Nervosa , Índice de Gravidade de Doença , Método Simples-Cego , Esteroides/administração & dosagem , Resultado do Tratamento , Punho/diagnóstico por imagem , Adulto Jovem
16.
Pain Med ; 20(12): 2360-2370, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31099846

RESUMO

OBJECTIVE: Low back pain is the leading cause of worldwide disability, with lumbosacral radiculopathy accounting for over one-third of these cases. There are limited data on the relationship between etiologies and lumbosacral radiculopathy, and it is unknown whether specific causes predict treatment outcomes. DESIGN, SETTING, AND SUBJECTS: This study explores patient-reported etiologies for lumbosacral radiculopathy in a chronic pain clinic between January 2007 and December 2015 and examines whether these causes affected epidural steroid injection outcomes. METHODS: We reviewed the medical records of 1,242 patients with lumbosacral radiculopathy who received epidural steroid injections. The recording of an inciting event was done contemporaneously based on note templates. A positive outcome following an epidural steroid injection was defined as ≥30% pain relief sustained for six or more weeks without additional intervention. Factors associated with epidural steroid injection outcome were analyzed by multivariable logistic regression. RESULTS: Fifty point seven percent reported an inciting event, and 59.9% of patients experienced a positive epidural steroid injection outcome. The most commonly reported causes were falls (13.1%), motor vehicle collisions (10.7%), and lifting (7.8%). Individuals with a herniated disc (56.3%) were more likely to report a precipitating cause than those with stenosis (44.7%) or degenerative discs (47.8%, P = 0.012). An inciting event did not predict treatment outcome. Factors associated with negative treatment outcome included opioid consumption (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.39-0.95, P = 0.027), secondary gain (OR = 0.69, 95% CI = 0.50-0.96, P = 0.030), and baseline pain score (OR = 0.90, 95% CI = 0.84-0.97, P = 0.006). The number of levels injected was associated with a positive outcome (OR = 2.72, 95% CI = 1.28-6.47, P = 0.008). CONCLUSIONS: Reported inciting events are common in patients with lumbosacral radiculopathy but are not associated with outcome following epidural steroid injection, and their occurrence is not always consistent with the purported mechanism of injury.


Assuntos
Analgésicos Opioides/uso terapêutico , Glucocorticoides/uso terapêutico , Dor Lombar/tratamento farmacológico , Vértebras Lombares , Radiculopatia/tratamento farmacológico , Sacro , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Idoso , Dexametasona/uso terapêutico , Feminino , Humanos , Injeções Epidurais , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Remoção , Modelos Logísticos , Dor Lombar/etiologia , Região Lombossacral , Masculino , Acetato de Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Medição da Dor , Prognóstico , Radiculopatia/etiologia , Estenose Espinal/complicações , Resultado do Tratamento
18.
Pharmacology ; 103(3-4): 163-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30695776

RESUMO

OBJECTIVES: Present investigation determines the protective effect of cimiracemate A against glucocorticoid-induced osteoporosis rat. METHODS: Osteoporosis was induced by injecting methylprednisolone acetate (21 mg/kg) for the period of 6 weeks, and the rats were treated with cimiracemate A 5 and 10 mg/kg, p.o. 60 min after the administration of methylprednisolone acetate (21 mg/kg) for the duration of 6 weeks. Effect of cimiracemate A was observed by estimating the microarchitecture of bone and histopathological changes by micro-CT scan and light microscope. Moreover, lipid profile, mediators of inflammation, and parameters that affect bone formation were determined in the serum and western blot assay, and reverse transcription polymerase chain reaction was done for the estimation of protein expression in the bone tissues. Moreover, cytotoxic effect of cimiracemate A on bone marrow macrophages and bone marrow stromal cells was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. RESULTS: Result of the investigation suggests that treatment with cimiracemate A ameliorates the microarchitecture of bone and histopathological changes in the glucocorticoid-induced osteoporosis rat. Level of lipid and mediators of inflammation was significantly reduced in the serum of cimiracemate A-treated rats than the negative control group. However, the activity of tartrate-resistant acid phosphatase and the level of collagen type I fragments in the serum were found to be reduced, and osteocalcin level was enhanced in cimiracemate A-treated rats than the negative control group. Moreover, treatment with cimiracemate A attenuates the expression of receptor activator of nuclear factor kappa-Β ligand (RANKL), receptor activator of nuclear factor κ B (RANK), and osteoprotegerin (OPG) protein in glucocorticoid-induced osteoporosis rats. CONCLUSION: In conclusion, our study suggests that cimiracemate A protects the glucocorticoid-induced osteoporosis by regulating the RANKL/RANK/OPG signaling pathway.


Assuntos
Conservadores da Densidade Óssea/farmacologia , Remodelação Óssea/efeitos dos fármacos , Cinamatos/farmacologia , Fêmur/efeitos dos fármacos , Acetato de Metilprednisolona , Osteoporose/prevenção & controle , Osteoprotegerina/metabolismo , Ligante RANK/metabolismo , Receptor Ativador de Fator Nuclear kappa-B/metabolismo , Animais , Células Cultivadas , Modelos Animais de Doenças , Fêmur/diagnóstico por imagem , Fêmur/metabolismo , Fêmur/fisiopatologia , Camundongos , Osteoporose/induzido quimicamente , Osteoporose/metabolismo , Osteoporose/fisiopatologia , Osteoprotegerina/genética , Ligante RANK/genética , Ratos Wistar , Receptor Ativador de Fator Nuclear kappa-B/genética , Transdução de Sinais/efeitos dos fármacos , Microtomografia por Raio-X
19.
J Sep Sci ; 42(7): 1468-1476, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30689289

RESUMO

We developed an approach for the use of polyester dendrimer during the imprinting process to raise the number of recognized sites in the polymer matrix and improve its identification ability. Photoresponsive molecularly imprinted polymers were synthesized on modified magnetic nanoparticles involving polyester dendrimer which uses the reactivity between allyl glycidyl ether and acrylic acid for the high-yielding assembly by surface polymerization. The photoresponsive molecularly imprinted polymers were constructed using methylprednisoloneacetate as the template, water-soluble azobenzene involving 5-[(4, 3-(methacryloyloxy) phenyl) diazenyl] dihydroxy aniline as the novel functional monomer, and ethylene glycol dimethacrylate as the cross-linker. Through the evaluation of a series of features of spectroscopic and nano-structural, this sorbent showed excellent selective adsorption, recognition for the template, and provided a highly selective and sensitive strategy for determining the methylprednisoloneacetate in real and pharmaceutical samples. In addition, this sorbent according to good photo-responsive features and specific affinity to methylprednisoloneacetate with high recognition ability, represented higher binding capacity, a more extensive specific area, and faster mass transfer rate than its corresponding surface molecularly imprinted polymer.


Assuntos
Dendrímeros/química , Nanopartículas de Magnetita/química , Acetato de Metilprednisolona/isolamento & purificação , Impressão Molecular , Polímeros/química , Acetato de Metilprednisolona/química , Tamanho da Partícula , Processos Fotoquímicos , Propriedades de Superfície
20.
Acta Clin Croat ; 58(3): 403-409, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31969750

RESUMO

Unicameral bone cysts (UBC) are benign bone tumor-like lesions. Mostly they are located in the metaphyseal-diaphyseal region of long bones in children and adolescents. The etiology of UBC is still unclear. There is no consensus about the protocol of UBC treatment. The aim of this study was to evaluate the effectiveness of three different techniques for the treatment of UBC. This study included 129 pediatric patients with UBC treated at University Children's Hospital in Belgrade during the 8-year period. The mean follow up was 7.14 years. The following parameters were observed: gender, age, site, length of cyst, cyst index, cortical thickness, presentation of pathologic fracture, healing of cyst, treatment complications and length of hospitalization. These parameters were correlated to three treatment modalities, i.e. intracystic methylprednisolone acetate injection (group 1), curettage with bone grafting (group 2) and osteoinductive procedure using demineralized bone matrix (group 3). We found statistically significant differences in healing of the cysts and length of hospital treatment between groups 1 and 2, and between groups 2 and 3. In conclusion, complete healing of UBC can be achieved only using open surgery procedure. Intracystic methylprednisolone acetate instillation can be considered a good option for initial treatment of UBC.


Assuntos
Cistos Ósseos , Transplante Ósseo/métodos , Dentina/transplante , Fraturas Espontâneas , Acetato de Metilprednisolona/administração & dosagem , Adolescente , Cistos Ósseos/complicações , Cistos Ósseos/diagnóstico , Cistos Ósseos/epidemiologia , Cistos Ósseos/terapia , Regeneração Óssea , Criança , Croácia/epidemiologia , Feminino , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/etiologia , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde
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