We describe the first reported case of granulomatosis polyangiitis (GPA)-associated sclerokeratitis in a patient with treated ocular adnexal lymphoma (OAL). The patient presented with pain and decreased vision in the left eye over several weeks. Past medical history was significant for recent bilateral relapsing OAL that was treated successfully with radiotherapy. Examination of the eyes revealed sectoral scleritis and peripheral ulcerative keratitis. Magnetic resonance imaging (MRI) of the orbits excluded recurrence of OAL and serum antineutrophil cytoplasmic autoantibody (ANCA) titres confirmed the diagnosis of GPA. Disease was poorly responsive to systemic steroids, azathioprine and rituximab. Ultimately, resolution was achieved with successive subconjunctival dexamethasone and subconjunctival triamcinolone injections. This case highlights the need to consider ocular inflammation in patients with a history of malignant hemopathies.

We report a case of cystoid macular edema (CME) secondary to syphilitic uveitis that was successfully treated with pars plana vitrectomy with internal limiting membrane peeling. A 37-year-old male with a history of HIV developed a CME secondary to syphilitic panuveitis. His uveitis resolved following treatment with intravenous penicillin, yet his CME persisted and was refractory to four posterior sub-tenon triamcinolone acetonide injections. A pars plana vitrectomy with internal limiting membrane peeling was performed, resulting in lasting resolution of the CME and the improvement of his visual acuity at the two-month follow-up visit. Pars plana vitrectomy with internal limiting membrane peeling may be a viable alternative for the treatment of CME in patients with syphilitic uveitis. In particular, it may serve as a viable alternative for the treatment of CME in patients with a history of infectious uveitis or other comorbidities, such as HIV infection.

Individuals with skin of color represent a diverse population of racial and ethnic backgrounds, including but not limited to Black or African American, American Indian or Alaska Native, Asian American or Pacific Islander, Hispanic or Latino, and Middle Eastern or North African. Dermatologic health disparities exist in part because of systemic racism and are exacerbated by inadequate physician training and a lack of high-quality research on skin diagnoses that disproportionately affect people with skin of color. These conditions, which include postinflammatory hyperpigmentation, keloids, dermatosis papulosa nigra, pseudofolliculitis barbae, and acne keloidalis nuchae, are usually diagnosed clinically and not associated with an underlying systemic disease. They can have significant impacts on mental health and quality of life and are often underdiagnosed or undertreated in skin of color. Hydroquinone 4% is considered the standard treatment for postinflammatory hyperpigmentation. Standard treatment for keloids includes combination intralesional therapy with triamcinolone and fluorouracil. If treatment is preferred for dermatosis papulosa nigra, options include scissor excision, cryotherapy, curettage, electrodesiccation, and laser therapies. Shaving cessation is the best initial treatment for pseudofolliculitis barbae. Individuals with acne keloidalis nuchae should avoid frequent close shaves or short haircuts on the nuchal area of the scalp.

Triamcinolone acetonide (TA) is a corticosteroid that has been used to treat posterior segment eye diseases. TA is injected intravitreally in the management of neovascular disorders; however, frequent intravitreal injections result in many potential side effects and poor patient compliance. In this work, a 3D bioprinter was used to prepare polycaprolactone (PCL) implants loaded with TA. Implants were manufactured with different shapes (filament-, rectangular-, and circle-shaped) and drug loadings (5, 10, and 20%). The characterisation results showed that TA was successfully mixed and incorporated within the PCL matrix without using solvents, and drug content reached almost 100% for all formulations. The drug release data demonstrate that the filament-shaped implants (SA/V ratio~7.3) showed the highest cumulative drug release amongst all implant shapes over 180 days, followed by rectangular- (SA/V ratio~3.7) and circle-shaped implants (SA/V ratio~2.80). Most implant drug release data best fit the Korsmeyer-Peppas model, indicating that diffusion was the prominent release mechanism. Additionally, a biocompatibility study was performed; the results showed >90% cell viability, thus proving that the TA-loaded PCL implants were safe for ocular application.

The purpose of the present paper was to review the available evidence on intra-articular botulinum toxin (BTX) injection in the treatment of knee osteoarthritis and to compare it to other conservative treatment options. A systematic review of the literature was performed on the PubMed, Scopus, Cochrane Library, Web of Science, Pedro and Research Gate databases with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) written in the English language, and (3) published on indexed journals in the last 20 years (2001-2021) dealing with the use of BTX intra-articular injection for the treatment of knee OA. The risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. Nine studies involving 811 patients in total were included. Patients in the control groups received different treatments: conventional physiotherapy, hyaluronic acid injection or prolotherapy or a combination thereof in 5 studies, steroid infiltrative therapy (triamcinolone) in 1 study, placebo in 2, and local anesthetic treatment in 1 study. Looking at the quality of the available literature, two of the included studies reached "Good quality" standard, three were ranked as "Fair", and the rest were considered "Poor". No major complications or serious adverse events were reported following intra-articular BTX, which provided encouraging pain relief, improved motor function, and quality of life. Based on the available data, no clear indication emerged from the comparison of BTX with other established treatments for knee OA. The analysis of the available RCTs on BTX intra-articular injection for the treatment of knee OA revealed modest methodological quality. However, based on the data retrieved, botulinum toxin has been proven to provide good short-term outcomes, especially in patients with pain sensitization, by modulating neurotransmitter release, peripheral nociceptive transduction, and acting on the control of chronic pain from central sensitization.

Lumbar central spinal stenosis (LCSS) is a common disorder that causes disability and pain in the elderly. It causes pain in the radicular leg. Recently, transforaminal epidural steroid injection (TFESI) has been widely used to control radicular leg pain caused by LCSS. However, in cases of severe LCSS, drugs injected using TFESI cannot spread into the spinal canal and would have less therapeutic effects than in mild LCSS. To compensate for this limitation of TFESI, we injected steroids and botulinum toxin type A into the bilateral facet joints, evaluated their effects, and compared them with those of TFESI. One hundred patients with severe LCSS were included in the study and randomly allocated to either the facet injection (FI) or TFESI group. For 50 patients in the FI group, 30 mg (40 mg/mL) of triamcinolone with 50 IU of botulinum toxin type A mixed with a 1 mL solution of 100 mL of 50% dextrose water and 30 mL of 4% lidocaine were administered into the bilateral facet joints under fluoroscopy. For 50 patients in the TFESI group, 30 mg (40 mg/mL) of triamcinolone with 0.8 mL of 2% lidocaine and 2.5 mL of 50% dextrose water was injected bilaterally under fluoroscopy. Radicular leg pain (measured with a numeric rating scale) and pain-related disability (measured with the modified Oswestry Disability Index) due to severe LCSS were significantly reduced after facet joint injection. The therapeutic effects were greater after facet joint injection than after bilateral TFESI. The injection of a mixed solution of steroids and botulinum toxin type A into the bilateral facet joints would be a beneficial therapeutic option in patients with severe LCSS.

Background Intralesional corticosteroid administration (ICA) is a first-line treatment for keloids. However, its clinical results are still highly variable and often suboptimal. Treatment results may strongly be influenced by various operator dependent factors. The aim of this study is to map the details of ICA in keloids described in randomized controlled trials (RCTs), hence presenting the scientific practice of a first-line treatment for keloids in the best available evidence. Summary A systematic search was performed on PubMed, Ovid MEDLINE, Ovid EMBASE and CENTRAL. Eligible studies were RCTs including patients with keloids treated with intralesional corticosteroids. Treatment and study design related data were charted on a predefined form. Thirty-eight RCTs were included for data extraction. Triamcinolone acetonide was used in 37 (97.4%) studies. Dosing per cm2 could only be compared among ten (26%) studies, and varied from 1 to 20 mg. The maximum dose per session varied from 20 to 80 mg. Anesthetics were administered locally and orally in seven and one RCT(s). Treatment intervals varied from weekly to monthly, with four weeks most frequently (50%) used. Needle size was reported in eleven (29%) studies and varied from 26 to 30-gauge. Syringe size was specified in four (11%) studies, being 1 mL. The injection level was described in eleven (29%) studies. Blanching as endpoint was reported in ten (26%) studies. Outcome measures varied widely, from height, surface area or volume, to Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, pain and itch scores, patient satisfaction and different efficacy rates. Only six studies had a follow-up of ≥6 months. Recurrence was identified in two studies with 18 weeks and 1 year of follow-up. Adverse events were reported in 25 (66%) studies. Key messages There is incomplete reporting and substantial heterogeneity in many aspects of ICA and study design among RCTs. This scoping review underscores the urgent need for standardization of treatment protocol and study design to enhance and uniform research conduct among keloid studies.

In this study, we aimed to analyze the effect of 5-fluorouracil, triamcinolone, and bevacizumab on scar modulation in an experimental rat model of surgical lesions. Rats (Rattus norvegicus albinus) were divided into four groups: bevacizumab, 5-fluorouracil + triamcinolone, bevacizumab + 5-fluorouracil + triamcinolone, and control (received no medication) groups. A linear, dorsal incision was created and sutured for the first intention wound healing, mimicking the surgical incision of upper blepharoplasty. Treatments were initiated on day 7, and the rats were euthanized on day 14. Only in the 5-fluorouracil + triamcinolone group was there a difference in the number of infiltrated monocytes. There was 56%, 86%, and 85% decrease in the number of neovessels in the bevacizumab, 5-fluorouracil + triamcinolone, and bevacizumab + 5-fluorouracil + triamcinolone groups, respectively, compared with the control. Picrosirius red staining showed higher collagen density and more organized collagen in the treatment groups than in the control group. Scar modulation was observed in all groups, but the 5-fluorouracil + triamcinolone group presented the best results. To our knowledge, this is the first study to evaluate the influence of three medications in combination on healing. When used together, these medications can prevent the development of unsightly scars, and are therefore promising alternatives to corticosteroids.

Because no information is available on the use of oral or injectable triamcinolone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, use of triamcinolone as a nasal spray or local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. Expert opinion considers inhaled and oral corticosteroids acceptable to use during breastfeeding.[1,2] Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply. See also Triamcinolone, Topical.

Background: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition of the mammary gland that presents as a painful mass, and it must be distinguished from both infectious mastitis and breast cancer. When diagnosed during lactation, it can result in significant distress and early weaning. Injection of triamcinolone has been used as a successful treatment method, but safety in breastfed infants has not been established. Methods: We present a case of a lactating patient who received a direct injection of triamcinolone (dosage 40 mg) in her breast to treat IGM after failure of oral corticosteroids. Breastmilk samples were expressed by the patient 0, 1, 4, and 24 hours after the procedure, and then daily for 1 week. All the samples were analyzed using liquid chromatography mass spectrometry. The patient was supported by a breastfeeding and lactation medicine clinic. Results: After injection of triamcinolone into the granulomatous mass, breast milk samples were collected and analyzed. No samples were found to contain triamcinolone. A temporary but significant decrease in milk production was noted after injection, though only a slight decrease had been noted with 6 weeks of systemic corticosteroids. With support, the patient rebuilt milk production and continued to breastfeed from both breasts. Conclusion: Triamcinolone was not found in any milk samples (≥0.78 ng/mL) following therapeutic injection of the affected breast. The patient was able to continue breastfeeding from the affected breast with intermittent symptoms.

This corrects the article on p. e87 in vol. 33, PMID: 29542298.

Uveitis and scleritis are eye diseases associated with immunoglobulin A (IgA) nephropathy, but reports on retinal pigment epithelial detachment (PED) in relation to IgA nephropathy are scarce. We have experienced a case of PED associated with IgA nephropathy that was improved by pulse steroid treatment. A 68-year-old woman underwent examination for visual loss in the right eye. Her corrected visual acuity was 20/20 on both sides, and serous PED was observed in both eyes. One month later, the PED improved in both eyes but recurred 3 months later. Results of blood examination raised suspicion of IgA nephropathy, and she was referred to a nephrologist. Two weeks later, the PED in both eyes worsened, and a retinal pigment epithelium (RPE) tear appeared in the right eye. A sub-Tenon's injection of triamcinolone acetonide was performed to address the PED, but it was not effective; thus, pulse steroid therapy was performed twice. The PED disappeared from both eyes, and the visual acuity in her left eye was maintained at 20/20, but it decreased to 20/200 in her right eye due to macular atrophy after the RPE tear. The PED had not recurred despite having no improvement in renal function. In conclusion, in IgA nephropathy, deposition of immune complexes on the RPE causes its inflammation, which may lead to PED. In cases of unexplained PED, the possibility of a systemic disease as the cause should be considered.

BACKGROUND Calcific tendinitis of the hip is rare but most commonly occurs in the gluteus medius. It occurs more frequently in women, usually between the ages of 40 and 70 years. Calcific tendinitis of the gluteus medius is associated with pain and tenderness in the greater trochanter region, can be acute or chronic, and should be distinguished from other differential diagnoses, such as trochanteric bursitis. Calcific tendinitis of the gluteus medius is scarcely reported in the literature, and there is no management guideline for this condition. Although it is usually managed conservatively, there are reports of more invasive techniques, such as needle lavage and surgery. CASE REPORT We report the case of a middle-aged woman who presented with right hip pain of a 1-year duration, mainly on climbing stairs. Plain radiograph and magnetic resonance imaging revealed calcific tendinitis of the right gluteus medius. She underwent a trial of conservative management, which included a triamcinolone injection, but remained symptomatic. She subsequently underwent endoscopic debridement of the calcification and recovered uneventfully after surgery, with complete resolution of her symptoms at the 2-month follow-up. CONCLUSIONS This report has shown the importance of imaging in the diagnosis of calcific tendinitis of the gluteus medius and supports endoscopic debridement as an effective modality in the management of this condition.

Joint defects associated with a variety of etiologies often extend deep into the subchondral bone leading to functional impairment and joint immobility, and it is a very challenging task to regenerate the bone-cartilage interface offering significant opportunities for biomaterial-based interventions to improve the quality of life of patients. Herein drug-/bioactive-loaded porous tissue scaffolds incorporating nano-hydroxyapatite (nHAp), chitosan (CS) and either hydroxypropyl methylcellulose (HPMC) or Bombyx mori silk fibroin (SF) are fabricated through freeze drying method as subchondral bone substitute. A combination of spectroscopy and microscopy (Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), energy dispersive X-ray (EDX), and X-ray fluorescence (XRF) were used to analyze the structure of the porous biomaterials. The compressive mechanical properties of these scaffolds are biomimetic of cancellous bone tissues and capable of releasing drugs/bioactives (exemplified with triamcinolone acetonide, TA, or transforming growth factor-β1, TGF-β1, respectively) over a period of days. Mouse preosteoblast MC3T3-E1 cells were observed to adhere and proliferate on the tissue scaffolds as confirmed by the cell attachment, live-dead assay and alamarBlue™ assay. Interestingly, RT-qPCR analysis showed that the TA downregulated inflammatory biomarkers and upregulated the bone-specific biomarkers, suggesting such tissue scaffolds have long-term potential for clinical application.

Herein, a novel homemade electrical device was designed, including two pieces of external neodymium magnets, providing a reciprocating magnetic field to introduce a magnetic-assisted dispersive pipette-tip micro solid-phase extraction. To evaluate the performance efficiency of the proposed method, a novel magnetic calcined GO/SiO2@Co-Fe nanocube sorbent was synthesized, filled into the pipette-tip, exposed to the reciprocating magnetic field, and applied for the preconcentration of some hormone therapy drugs in human biological matrices. The effective adsorption and desorption parameters were optimized using a rotatable central composite design and one-variable-at-a-time approaches. Under the optimized conditions, the target analytes' detection limits were found to be below 0.02 ng mL-1. Moreover, the calibration curves were linear in the range of 0.03-500.00 ng mL-1 (R2 > 0.9966), with RSDs% less than 7.8 %. Eventually, the established method was applied to extract the analytes from breast milk samples, followed by LC-ESI-MS/MS analysis.