Methylprednisolone 40mg/1ml / Lidocaine 10mg/1ml (1%) suspension for injection vials

PurposeThe purpose of this study was to quantify and compare the clinical relevance of the different intra-articular corticosteroids (CS) effects in vivo for osteoarthritis (OA) treatment.MethodsThe search was conducted on PubMed, Cochrane, and Web of Science in October 2023. The PRISMA guidelines were used. Inclusion criteria: animal or human randomized controlled trials (RCTs), English language and no time limitation, on the comparison of different intra-articular CS for OA treatment. The articles' quality was assessed using the Cochrane RoB2 and GRADE guidelines for human RCTs, and SYRCLE's tool for animal RCTs.ResultsEighteen RCTs were selected (16 human and 2 animal studies), including 1577 patients (1837 joints) and 31 animals (51 joints). The CS used were triamcinolone (14 human and 2 animal studies), methylprednisolone (7 human and 1 animal study), betamethasone (3 human studies) and dexamethasone (1 human study). All studies addressed knee OA except for three human and one animal study. A meta-analysis was performed on the comparison of methylprednisolone and triamcinolone in humans with knee OA analysing VAS pain at very short- (≤2 weeks), short- (>2 and ≤4 weeks), mid- (>4 and ≤8 weeks), long- (>8 and ≤ 12 weeks), and very long-term (>12 and ≤24 weeks). Triamcinolone showed better post-injection values compared to methylprednisolone at very short-term (p = 0.028). No difference in terms of VAS improvement was observed at any follow-up.ConclusionsThe available preclinical and clinical literature provides limited evidence on the comparison of different CS, hindering the possibility of determining the best CS approach in terms of molecule and dose for the intra-articular injection of OA joints.Level of evidenceLevel I.

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Hiccups are caused by involuntary spasms of the diaphragm and external intercostal muscles. When persistent, they can significantly reduce the quality of life. However, comprehensive reviews of available treatments and their corresponding evaluation metrics remain scarce. This scoping review aimed to comprehensively map the interventions used to treat hiccups in adults and clarify the current state of outcome measures employed in existing research. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) -ScR guidelines and the framework of Arksey and O'Malley. Using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ichushi-web databases, we identified studies published up to June 3, 2024. The search terms included "HICCUP," "HICCOUGH," and "SINGULTUS." A total of 3248 articles were identified, with 499 duplicates removed. After screening 2749 titles and abstracts, 2708 articles were excluded. Full-text reviews of 41 articles led to the exclusion of 18, resulting in 23 that met the inclusion criteria. Of these, 17 studies focused on pharmacological interventions, including baclofen, metoclopramide, methylprednisolone, and Shitei-to, while 6 studies examined nonpharmacological interventions, such as acupuncture, infrared therapy, rebreathing techniques, and cervical epidural block. Outcome measures were categorized into objective and subjective evaluations. Objective measures included complete cessation, partial cessation, frequency reduction, and time to complete cessation. Subjective measures assessed the distress caused by hiccups using patient-reported scales, such as the numerical rating scale. This scoping review identified 23 studies on hiccup interventions, including five randomized controlled trials on pharmacological agents and one study on a nonpharmacological approach. Studies included both Western and Eastern medicine, offering new perspectives on hiccup management. The outcome measures were primarily objective, with some patient-reported assessments. These findings provide a foundation for future research on hiccup treatment and evaluation methods.

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BackgroundThere is inadequate evidence of the efficacy of greater occipital nerve block (GONB) for the preventive treatment of cluster headaches. We assessed the efficacy and tolerability of GONB injections as a transitional preventive treatment for episodic cluster headaches (ECH).MethodsThis randomized, double-blind, placebo-controlled, parallel-group trial conducted at GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India, included ECH patients diagnosed by ICHD-3 criteria, aged 18-65, with one or more attacks per 24 h for seven days before randomization (baseline). ECH patients were either not on preventive medications or on stable doses for at least three months. ECH patients were randomized to receive active GONB (2 ml methylprednisolone (80 mg) and 2 ml lignocaine (2%)) and placebo (4 ml saline injections). Before giving GONB, lignocaine jelly was applied topically to mask the effect of numbness following the GONB. The primary efficacy endpoint was the mean change in weekly attack frequency from baseline to Week 4. Efficacy analyses were performed in a modified intention-to-treat population that included all patients who received at least one injection of GONB and had a follow-up for one week following GONB. The safety analysis included treatment-emergent adverse effects (TEAE) in all patients who received at least one dose of investigational product. The trial was registered with the Clinical Trials Registry of India (CTRI/2021/21/038397).ResultsForty ECH patients were randomized between December 2021 and January 2023. Thirty-nine patients (19 in the active and 20 in the placebo groups) were available for efficacy analysis. The change in weekly attack frequency from baseline to Week 4 was -11.1 (95% CI: -8.5 to -4.4) for the active group compared to -7.7 (95% CI: -11.8 to -9.8) for placebo (mean difference -3.4 (95% CI: -5.2 to -1.7, p p = 0.38). The common TEAE were local site bleeding and pain, which were mild and transient. No serious adverse events were reported.ConclusionThis study found that GONB with methylprednisolone and lignocaine significantly reduced the weekly attack frequency from baseline to Week 1 through Week 4 in ECH patients compared to a placebo. GONB was well tolerated.

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PurposeKeloids are unaesthetic benign dermatosis characterized by a disorganized proliferation of collagen. Treatment of keloids constitutes a therapeutic challenge. The aim of this study was to evaluate the efficacy and effectiveness of topical imiquimod associated with surgical excision in the treatment of keloid.MethodsA randomized, double blind, matching-lesion (self-paired manner) clinical trial. Ten patients with two keloid lesions each in similar anatomical and contralateral areas (paired lesions) had their keloids excised, and the operative site treated with the application of 5% imiquimod cream or 0.1% methylprednisolone aceponate cream (gold standard) for eight weeks.ResultsEight patients (total = 16 lesions) completed the study. Four of the total eight keloids (50%) in the methylprednisolone group vs. 3/8 keloids (37.5%) in the imiquimod group recurred in the first post-treatment year (p 0.05).ConclusionSurgical removal plus application of topical imiquimod was shown as safe, and its efficacy was not statistically inferior for the treatment of keloids as compared to methylprednisolone. Due to the lack of efficacy in most therapeutic modalities, surgical removal plus topical imiquimod could be recommended as an additional first line therapy and especially for recurrent keloids. Studies with larger samples are necessary to evaluatre therapies for keloids.

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BackgroundParesthesias occurring during combined spinal-epidural labor analgesia due to needle puncture or epidural catheter placement may lead to nerve injury. We compared the effects of epidural dexamethasone versus methylprednisolone on neurological outcomes.MethodsIn this prospective, randomized, double-blind clinical trial conducted at a Chinese obstetrics hospital, parturients who developed paresthesias during combined spinal-epidural labor analgesia due to needle puncture or epidural catheter placement were randomized to receive an epidural injection of dexamethasone (5 mg) or methylprednisolone (40 mg). The primary outcome was neurological function at 14 days postpartum, including impaired skin sensation, decreased muscle strength, or other neurological symptoms. Secondary outcomes included adverse events and changes in inflammatory biomarkers.ResultsA total of 315 parturients were randomized and completed the study. At 14 days postpartum, the neurological function outcomes did not differ significantly between the two groups (p > 0.05). Among the secondary outcomes, the dexamethasone group had a higher incidence of epidural-related maternal fever (ERMF) (7.6% vs. 2.5%, p p p > 0.05).ConclusionIn parturients who developed paresthesia during combined spinal-epidural labor analgesia, epidural administration of dexamethasone or methylprednisolone resulted in comparable neurological outcomes at 14 days postpartum.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2300078866.

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