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The Lancet. HIV May 2023Intramuscular injection of long-acting cabotegravir and rilpivirine is a novel, long-acting antiretroviral therapy (ART) combination approved for use as a fully... (Review)
Review
Intramuscular injection of long-acting cabotegravir and rilpivirine is a novel, long-acting antiretroviral therapy (ART) combination approved for use as a fully suppressive regimen for people living with HIV. Long-acting cabotegravir with rilpivirine ART has reduced required dosing frequency from once daily to once every month or every 2 months injections. This new era of long-acting ART, which includes other antiretrovirals and formulations in various stages of clinical development, holds tremendous promise to change the standard of HIV treatment. Although long-acting ART has high potential to be revolutionary in the landscape of HIV care, prevention, and treatment cascade, more data are needed to substantiate its efficacy and cost-effectiveness among patients at risk of non-adherence and across age groups, pregnancy, and post partum. Advocacy efforts and policy changes to optimise a sustained, high-quality, equitable reach of long-acting ART, especially in low-income and middle-income countries where most people living with HIV reside, are needed to realise the full benefits of long-acting ART.
Topics: Humans; Anti-HIV Agents; HIV Infections; Anti-Retroviral Agents; Rilpivirine; Injections, Intramuscular
PubMed: 37062293
DOI: 10.1016/S2352-3018(23)00051-6 -
PloS One 2021To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults. (Meta-Analysis)
Meta-Analysis
AIM
To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults.
METHODS
The review protocol was registered on PROSPERO (CRD42019136097). MEDLINE, EMBASE, British Nursing Index and CINAHL were searched up to June 2020. Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Standardised mean difference (SMD) with a 95% confidence interval in reported injection pain (intervention cf. control) was reported.
RESULTS
29 studies were included in the systematic review and 20 studies in the meta-analysis. 13 IMI techniques were identified. 10 studies applied local pressure to the injection site. Of these, applying manual pressure (4 studies, SMD = -0.85[-1.36,-0.33]) and Helfer (rhythmic) tapping (3 studies, SMD = -2.95[-5.51,-0.39]) to the injection site reduced injection pain, whereas the use of a plastic device to apply local pressure to the skin (ShotBlocker) did not significantly reduce pain (2 studies, SMD = -0.51[-1.58,0.56]). Acupressure techniques which mostly involved applying sustained pressure followed by intermittent pressure (tapping) to acupressure points local to the injection site reduced pain (4 studies: SMD = -1.62[-2.80,-0.44]), as did injections to the ventrogluteal site compared to the dorsogluteal site (2 studies, SMD = -0.43[-0.81,-0.06]). There was insufficient evidence on the benefits of the 'Z track technique' (2 studies, SMD = -0.20[-0.41,0.01]) and the cold needle technique (2 studies, SMD = -0.73[-1.83,0.37]) on injection pain. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants.
CONCLUSIONS
Manual pressure or rhythmic tapping over the injection site and applying local pressure around the injection site reduced IMI pain. However, there was very high unexplained heterogeneity between studies and risk of significant bias within small studies.
Topics: Humans; Injections, Intramuscular; Pain; Pain Measurement
PubMed: 33939726
DOI: 10.1371/journal.pone.0250883 -
JAMA Nov 2014The incidence of syphilis in the United States is increasing; it is estimated that more than 55,000 new infections will occur in 2014. Treatment regimens are... (Review)
Review
IMPORTANCE
The incidence of syphilis in the United States is increasing; it is estimated that more than 55,000 new infections will occur in 2014. Treatment regimens are controversial, especially in specific populations, and assessing treatment response based on serology remains a challenge.
OBJECTIVE
To review evidence regarding penicillin and nonpenicillin regimens, implications of the "serofast state," and treatment of specific populations including those with neurosyphilis or human immunodeficiency virus (HIV) infection and pregnant women.
EVIDENCE REVIEW
We searched MEDLINE for English-language human treatment studies dating from January 1965 until July 2014. The American Heart Association classification system was used to rate quality of evidence.
FINDINGS
We included 102 articles in our review, consisting of randomized trials, meta-analyses, and cohort studies. Case reports and small series were excluded unless they were the only studies providing evidence for a specific treatment strategy. We included 11 randomized trials. Evidence regarding penicillin and nonpenicillin regimens was reviewed from studies involving 11,102 patients. Data on the treatment of early syphilis support the use of a single intramuscular injection of 2.4 million U of benzathine penicillin G, with studies reporting 90% to 100% treatment success rates. The value of multiple-dose treatment of early syphilis is uncertain, especially in HIV-infected individuals. Less evidence is available regarding therapy for late and late latent syphilis. Following treatment, nontreponemal serologic titers should decline in a stable pattern, but a significant proportion of patients may remain seropositive (the "serofast state"). Serologic response to treatment should be evident by 6 months in early syphilis but is generally slower (12-24 months) for latent syphilis. Evidence defining treatment for HIV-infected persons and for pregnant women is limited, but available data support penicillin as first-line therapy.
CONCLUSIONS AND RELEVANCE
The mainstay of syphilis treatment is parenteral penicillin G despite the relatively modest clinical trial data that support its use.
Topics: Adult; Anti-Bacterial Agents; Female; Humans; Injections, Intramuscular; Male; Penicillin G Benzathine; Pregnancy; Syphilis
PubMed: 25387188
DOI: 10.1001/jama.2014.13259 -
Ugeskrift For Laeger Mar 2024Intramuscular injection of site enhancement oil is a cosmetic procedure used primarily in the bodybuilder environment to enlarge and reshape muscles. It comes with... (Review)
Review
Intramuscular injection of site enhancement oil is a cosmetic procedure used primarily in the bodybuilder environment to enlarge and reshape muscles. It comes with potential lifelong complications in the musculoskeletal system with scars, chronic wounds, pain, deformities of muscles and loss of muscle function. Magnetic resonance imaging is the best tool to diagnose and determine the propagation of the condition in the tissues. Treatment is complex and may consist of antibiotics, anti-inflammatories, compression therapy and surgical revision when possible. However, as stated in this review, prevention is crucial.
Topics: Humans; Injections, Intramuscular; Anti-Bacterial Agents; Cicatrix; Pain; Reoperation
PubMed: 38445344
DOI: 10.61409/V09230563 -
The Journal of International Medical... Aug 2014Nerve injury is a common complication following intramuscular injection and the sciatic nerve is the most frequently affected nerve, especially in children, the elderly... (Review)
Review
Nerve injury is a common complication following intramuscular injection and the sciatic nerve is the most frequently affected nerve, especially in children, the elderly and underweight patients. The neurological presentation may range from minor transient pain to severe sensory disturbance and motor loss with poor recovery. Management of nerve injection injury includes drug treatment of pain, physiotherapy, use of assistive devices and surgical exploration. Early recognition of nerve injection injury and appropriate management are crucial in order to reduce neurological deficit and to maximize recovery. Sciatic nerve injection injury is a preventable event. Total avoidance of intramuscular injection is recommended if other administration routes can be used. If the injection has to be administered into the gluteal muscle, the ventrogluteal region (gluteal triangle) has a more favourable safety profile than the dorsogluteal region (the upper outer quadrant of the buttock).
Topics: Buttocks; Humans; Injections, Intramuscular; Pain; Sciatic Nerve; Sciatic Neuropathy
PubMed: 24920643
DOI: 10.1177/0300060514531924 -
Yonsei Medical Journal Jul 2023The favorable clinical efficacies of intramuscular injection of autologous blood in patients with atopic dermatitis (AD) and intramuscular injection of autologous serum... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The favorable clinical efficacies of intramuscular injection of autologous blood in patients with atopic dermatitis (AD) and intramuscular injection of autologous serum in patients with chronic urticaria have been demonstrated by randomized clinical trials. In this study, we assessed the clinical effectiveness and safety of the intramuscular injection of autologous serum in patients with AD.
MATERIALS AND METHODS
In this randomized, placebo-controlled, and double-blind trial, 23 adolescent and adult patients with moderate-to-severe AD were enrolled. The patients were randomized to receive eight intramuscular injections of 5 mL of autologous serum (n=11) or saline (n=12) over 4 weeks, and were followed up until week 8. Changes in the clinical severity scores of AD assessed by SCORing Atopic Dermatitis (SCORAD), patient-reported Dermatology Life Quality Index (DLQI) score, and incidence of adverse events were assessed from baseline to week 8.
RESULTS
One patient in the treatment group and two patients in the placebo group were lost to follow-up before week 8. The intramuscular administration of autologous serum, compared with saline, decreased the SCORAD clinical severity score (-14.8% vs. 10.7%, =0.006) and improved the DLQI score (-32.6% vs. 19.5%, =0.01) from baseline to week 8. Serious adverse events were not observed.
CONCLUSION
Intramuscular injection of autologous serum may be effective in treating AD. Further studies are needed to evaluate the clinical usefulness of this intervention for AD (KCT0001969).
Topics: Humans; Adult; Adolescent; Dermatitis, Atopic; Injections, Intramuscular; Treatment Outcome; Double-Blind Method; Severity of Illness Index
PubMed: 37365736
DOI: 10.3349/ymj.2022.0559 -
BMJ Case Reports Mar 2016Intramuscular injection has been used to administer medications for more than a hundred years. However, despite our profession's long experience with intramuscular...
Intramuscular injection has been used to administer medications for more than a hundred years. However, despite our profession's long experience with intramuscular administration, preventable complications such as injection nerve palsies are still prevalent in developing countries. Injections account for one-fifth of all traumatic nerve injuries. These injuries largely occur due to indiscriminate use of intramuscular injections for treating common illnesses, frequently by unlicensed or undertrained practitioners administering unnecessary treatment to impoverished patients. The sciatic nerve is the most commonly injured, and frequently the resulting muscle weakness and associated disability are irreversible. This case report includes a video of a patient with foot drop 6 weeks after gluteal intramuscular injection. Such injuries can be prevented by proper awareness and training, the implementation of safer injection techniques, and quality assurance methods.
Topics: Adult; Humans; Injections, Intramuscular; Male; Muscle Weakness; Paralysis; Peroneal Neuropathies; Sciatic Nerve; Sciatic Neuropathy
PubMed: 26931130
DOI: 10.1136/bcr-2015-211127 -
The Journal of Allergy and Clinical... Dec 2023Epinephrine is the first-line treatment for severe allergic reactions, and rapid treatment is associated with lower rates of hospitalization and death. Current treatment... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Epinephrine is the first-line treatment for severe allergic reactions, and rapid treatment is associated with lower rates of hospitalization and death. Current treatment options (epinephrine auto-injectors and manual intramuscular injection) are considered cumbersome, and most patients/caregivers fail to use them, even during severe reactions. An intranasal epinephrine delivery device, neffy, has been designed to provide an additional option for patients/caregivers.
OBJECTIVE
We sought to assess the comparative pharmacokinetics and pharmacodynamics of neffy 2.0 mg, EpiPen 0.3 mg, and manual intramuscular injection 0.3 mg.
METHODS
This was a phase 1, randomized, 6-treatment, 6-period, 2-part crossover study in 59 healthy subjects. Pharmacokinetic and pharmacodynamic parameters following single and repeat doses of epinephrine were assessed before dosing and at various postdose intervals.
RESULTS
The pharmacokinetic profile of neffy was bracketed by approved injection products, with a mean peak plasma level of 481 pg/mL, which fell between EpiPen (753 pg/mL) and epinephrine manual intramuscular injection (339 pg/mL). When dosed both once and twice, neffy resulted in more pronounced increases in pharmacodynamic parameters relative to EpiPen or manual injection.
CONCLUSIONS
neffy's pharmacokinetic profile was bracketed by approved injection products, with pharmacodynamic responses that were comparable to or better than approved injection products. neffy is expected to be a safe and effective option, particularly for patients/caregivers who are reluctant to carry and use injection devices.
Topics: Humans; Injections, Intramuscular; Anaphylaxis; Cross-Over Studies; Epinephrine; Caregivers
PubMed: 37604314
DOI: 10.1016/j.jaci.2023.08.007 -
Scientific Reports Oct 2021Skeletal muscle mass is critical for good quality of life. Mesenchymal stem cells (MSCs) are multipotent stem cells distributed across various tissues. They are...
Skeletal muscle mass is critical for good quality of life. Mesenchymal stem cells (MSCs) are multipotent stem cells distributed across various tissues. They are characterized by the capacity to secrete growth factors and differentiate into skeletal muscle cells. These capabilities suggest that MSCs might be beneficial for muscle growth. Nevertheless, little is known regarding the effects on muscle protein anabolic and catabolic systems of intramuscular injection of MSCs into skeletal muscle. Therefore, in the present study, we measured changes in mechanistic target of rapamycin complex 1 (mTORC1) signaling, the ubiquitin-proteasome system, and autophagy-lysosome system-related factors after a single intramuscular injection of MSCs with green fluorescence protein (GFP) into mouse muscles. The intramuscularly-injected MSCs were retained in the gastrocnemius muscle for 7 days after the injection, indicated by detection of GFP and expression of platelet-derived growth factor receptor-alpha. The injection of MSCs increased the expression of satellite cell-related genes, activated mTORC1 signaling and muscle protein synthesis, and increased protein ubiquitination and autophagosome formation (indicated by the expression of microtubule-associated protein 1 light chain 3-II). These results suggest that the intramuscular injection of MSCs activated muscle anabolic and catabolic systems and accelerated muscle protein turnover.
Topics: Animals; Autophagy; Cells, Cultured; Injections, Intramuscular; Male; Mechanistic Target of Rapamycin Complex 1; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Mice; Muscle, Skeletal; Proteolysis; Receptor, Platelet-Derived Growth Factor alpha; Ubiquitination
PubMed: 34707171
DOI: 10.1038/s41598-021-00627-6 -
Human Vaccines & Immunotherapeutics 2015Analysis of medically attended injection site events data provides a vehicle to appreciate the inadequacies of vaccination practice for deltoid intramuscular injection... (Review)
Review
Analysis of medically attended injection site events data provides a vehicle to appreciate the inadequacies of vaccination practice for deltoid intramuscular injection and to develop best practice procedures. These data can be divided into 3 groups; nerve palsies, musculoskeletal injuries and cutaneous reactions and reflect inappropriate site of injection, needle over or under penetration, local sepsis and vascular complications. The aim of this review is to formulate best vaccination practice procedures for deltoid intramuscular injection of vaccines through the collation and analysis of medically attended injection site events.
Topics: Humans; Injections, Intramuscular; Vaccination
PubMed: 25868476
DOI: 10.1080/21645515.2015.1017694