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Berger MB, Bosh K, Deng J, Jacobs TW, Cohen DJ, Boyan BD, Schwartz Z. Wnt16 Increases Bone-to-Implant Contact in an Osteopenic Rat Model by Increasing Proliferation and Regulating the Differentiation of Bone Marrow Stromal Cells. Ann Biomed Eng 2024; 52:1744-1762. [PMID: 38517621 PMCID: PMC11082046 DOI: 10.1007/s10439-024-03488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
Osseointegration is a complex biological cascade that regulates bone regeneration after implant placement. Implants possessing complex multiscale surface topographies augment this regenerative process through the regulation of bone marrow stromal cells (MSCs) that are in contact with the implant surface. One pathway regulating osteoblastic differentiation is Wnt signaling, and upregulation of non-canonical Wnts increases differentiation of MSCs on these titanium substrates. Wnt16 is a non-canonical Wnt shown to regulate bone morphology in mouse models. This study evaluated the role of Wnt16 during surface-mediated osteoblastic differentiation of MSCs in vitro and osseointegration in vivo. MSCs were cultured on Ti substrates with different surface properties and non-canonical Wnt expression was determined. Subsequently, MSCs were cultured on Ti substrates +/-Wnt16 (100 ng/mL) and anti-Wnt16 antibodies (2 μg/mL). Wnt16 expression was increased in cells grown on microrough surfaces that were processed to be hydrophilic and have nanoscale roughness. However, treatment MSCs on these surfaces with exogenous rhWnt16b increased total DNA content and osteoprotegerin production, but reduced osteoblastic differentiation and production of local factors necessary for osteogenesis. Addition of anti-Wnt16 antibodies blocked the inhibitor effects of Wnt16. The response to Wnt16 was likely independent of other osteogenic pathways like Wnt11-Wnt5a signaling and semaphorin 3a signaling. We used an established rat model of cortical and trabecular femoral bone impairment following botox injections (2 injections of 8 units/leg each, starting and maintenance doses) to assess Wnt16 effects on whole bone morphology and implant osseointegration. Wnt16 injections did not alter whole bone morphology significantly (BV/TV, cortical thickness, restoration of trabecular bone) but were effective at increasing cortical bone-to-implant contact during impaired osseointegration in the botox model. The mechanical quality of the increased bone was not sufficient to rescue the deleterious effects of botox. Clinically, these results are important to understand the interaction of cortical and trabecular bone during implant integration. They suggest a role for Wnt16 in modulating bone remodeling by reducing osteoclastic activity. Targeted strategies to temporally regulate Wnt16 after implant placement could be used to improve osseointegration by increasing the net pool of osteoprogenitor cells.
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Affiliation(s)
- Michael B Berger
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - Kyla Bosh
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - Jingyao Deng
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - Thomas W Jacobs
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - D Joshua Cohen
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA.
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, 313 Ferst Drive, Atlanta, GA, 30332, USA.
| | - Zvi Schwartz
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284, USA
- Department of Periodontology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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Schönburg S. [Botulinum toxin in male lower urinary tract symptoms (LUTS): What can we expect?]. Urologie 2024:10.1007/s00120-024-02352-0. [PMID: 38698262 DOI: 10.1007/s00120-024-02352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
During the last two decades botulinum toxin has also conquered urology. Botulinum toxin reduces the contractility and sensitivity of the detrusor muscle and relieves pain. It is therefore a promising drug whose use in men also appears promising. The following article highlights the practical relevance of botulinum toxin for male lower urinary tract symptoms (LUTS). But first of all, a distinction must be made between use in male LUTS due to benign prostate syndrome (BPS) and use in cases of overactive bladder (OAB) alone. A differentiated diagnosis and treatment of male LUTS is therefore essential.
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Affiliation(s)
- Sandra Schönburg
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland.
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Lu N, Haykal N, McCoy JL, Tobey ABJ. Use of botox for sialorrhea and dysphagia in the neonatal population. Am J Otolaryngol 2024; 45:104210. [PMID: 38241761 DOI: 10.1016/j.amjoto.2023.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Botox is frequently used for sialorrhea in patients with compromised airways and those with etiologies causing difficulty with secretion management (i.e. strokes, neurologic disorders, etc.). There are no published studies regarding the use of botulinum toxin (BoNT) in the neonate population. We aim to discuss our experience and safety of BoNT use in the neonate population in regards to alleviating secretion management and airway protection. METHODS Retrospective review of neonates admitted to the neonatal intensive care unit (NICU) ≤12 months of age who received BoNT injection to submandibular (SMG) and parotid (PG) glands for sialorrhea/dysphagia. BoNT was administered under ultrasound (u/s) guidance by interventional radiology. RESULTS 6 children were examined. 2 (33 %) were male. Avg NICU stay was 87.5 ± 33.1 days. 2 underwent surgical airway intervention prior to injection. Mean age at initial BoNT was 1.5 ± 0.7 months. Avg weight at injection was 4 ± 1.1 kg. Each PG and SMG were injected in 5/6 cases. Bilateral SMG were unidentified on u/s in 1 case and thus not injected. Dose range injected per gland was 5-15u. 100 % required tube feeds, 50 % with tubes distal to stomach (NJT/NDT). 83 % were completely NPO prior to injection and there was no noted clinical improvement in oral skills post injection. All had noted desats/apneas prior to injection and 83 % had reported decreased events post injection. 50 % had reported decrease O2 requirements and frequent suctioning 2wks after injection, however 2 (33 %) required surgical airway intervention after injection (trach, SGP/MDO). 4/6 (67 %) trialed medical therapy, anticholinergics being the most common. 50 % underwent 2nd injection (age = 6.5 ± 0.3 months) avg. 4.7 ± 0.7mo after 1st injection, and the same 3pts underwent 3rd injection (age = 12.5 ± 2.4 months) avg. 6.1 ± 2.5mo after 2nd injection. 1 pt. had a total 6 injections. There were no injection related complications. CONCLUSION BoNT injection is a safe, non-invasive alterative for management of sialorrhea in neonates. Further extensive study needs to be performed to identify the optimal dose per gland in this population.
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Affiliation(s)
- Nathan Lu
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Otolaryngology, Pittsburgh, PA, United States of America.
| | - Nadine Haykal
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Otolaryngology, Pittsburgh, PA, United States of America
| | - Jennifer L McCoy
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Otolaryngology, Pittsburgh, PA, United States of America
| | - Allison B J Tobey
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Otolaryngology, Pittsburgh, PA, United States of America
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Demchenko I, Swiderski A, Liu H, Jung H, Lou W, Bhat V. Botulinum Toxin Injections for Psychiatric Disorders: A Systematic Review of the Clinical Trial Landscape. Toxins (Basel) 2024; 16:191. [PMID: 38668616 PMCID: PMC11054929 DOI: 10.3390/toxins16040191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
Botulinum toxin type A (BONT-A) has shown promise in improving the mood-related symptoms of psychiatric disorders by targeting muscles linked to the expression of negative emotions. We conducted a systematic review of past and ongoing efficacy trials of BONT-A therapy for psychiatric disorders to identify relevant trends in the field and discuss the refinement of therapeutic techniques. A comprehensive search for published clinical trials using BONT-A injections for psychiatric disorders was performed on 4 May 2023 through OVID databases (MEDLINE, Embase, APA PsycINFO). Unpublished clinical trials were searched through the ClinicalTrials.gov and International Clinical Trial Registry Platform public registries. The risk of bias was assessed using the JBI Critical Appraisal tools for use in systematic reviews. We identified 21 studies (17 published, 4 unpublished clinical trials) involving 471 patients. The studies focused on evaluating the efficacy of BONT-A for major depressive, borderline personality, social anxiety, and bipolar disorders. BONT-A was most commonly injected into the glabellar area, with an average dose ranging between 37.75 U and 44.5 U in published studies and between 32.7 U and 41.3 U in unpublished trials. The results indicated significant symptom reductions across all the studied psychiatric conditions, with mild adverse effects. Thus, BONT-A appears to be safe and well-tolerated for psychiatric disorders of negative affectivity. However, despite the clinical focus, there was a noted shortage of biomarker-related assessments. Future studies should focus on pursuing mechanistic explorations of BONT-A effects at the neurobiological level.
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Affiliation(s)
- Ilya Demchenko
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Institute for Biomedical Engineering, Science, and Technology (iBEST), Keenan Research Centre for Biomedical Science, St. Michael’s Hospital—Unity Health Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
| | - Alyssa Swiderski
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
| | - Helen Liu
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Institute for Biomedical Engineering, Science, and Technology (iBEST), Keenan Research Centre for Biomedical Science, St. Michael’s Hospital—Unity Health Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
- Neuroscience Research Program, St. Michael’s Hospital—Unity Health Toronto, 209 Victoria Street, Toronto, ON M5T 3M7, Canada
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Campbell BA, Flormann VB, Davis RB, Mallur PS. Efficacy of Botulinum A Injection to the Laryngeal Adductor Compartment for Treatment of Cough. Laryngoscope 2024; 134:1749-1756. [PMID: 37772912 DOI: 10.1002/lary.31072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/02/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Studies examining electromyography (EMG)-guided laryngeal onobotulinumtoxinA (BTxA) injection for chronic cough reveal promising efficacy, however, are limited by small cohorts and absent quantifiable outcomes. It further remains unclear if pulmonary disease limits efficacy, or if vagal motor neuropathy prognosticates response. We hypothesize BTxA injection results in qualitative improvement in cough, decrease in Cough Severity Index (CSI), no change in Voice Handicap Index-10 (VHI-10), and complication rates comparable to historical data. We also examine the correlation of pulmonary comorbidities and vocal fold hypomobility with treatment efficacy. STUDY DESIGN Retrospective review. METHODS Charts for patients receiving percutaneous adductor compartment BTxA injection for cough were reviewed for the binary outcome of patient-reported presence or absence of improvement. Generalized estimating equations regression models were used to analyze the change in CSI (ΔCSI) and the correlation of ΔCSI with qualitative outcomes. Multivariable analyses were used to examine correlation of vocal fold hypomobility and pulmonary disease with qualitative outcomes and ΔCSI. RESULTS Forty-seven patients underwent 197 BTxA injections from June 2012 to June 2022. A statistical proportion of 0.698 (0.599-0.813, p < 0.0001) or 69.8% of injections resulted in subjective improvement. Mean ΔCSI was -2.12 (0.22-4.02, p < 0.05), indicating overall improvement. With and without subjective improvement, estimated ΔCSI was -4.43 and +2.68, respectively (p < 0.0001). VHI-10 did not change (0.69, p = 0.483). Neither pulmonary disease nor vocal fold hypomobility correlated with subjective improvement or ΔCSI. Dysphagia occurred following 15 (7.6%) injections with no aspiration pneumonia or hospitalization. CONCLUSIONS BTxA injection to the laryngeal adductors may effectively treat cough with limited risk for serious complications. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1749-1756, 2024.
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Affiliation(s)
- Brett A Campbell
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Division of Otolaryngology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Victoria B Flormann
- Division of Otolaryngology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Roger B Davis
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Pavan S Mallur
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Division of Otolaryngology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
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6
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Fiedler LS, Burk F. Treatment of Frey Syndrome with Botulinum Toxin-A: A Practical Approach from Minor's Test to Injection. J Maxillofac Oral Surg 2024; 23:337-339. [PMID: 38601257 PMCID: PMC11001827 DOI: 10.1007/s12663-023-02029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/29/2023] [Indexed: 04/12/2024] Open
Abstract
Introduction Frey's syndrome, described by Lucy Frey in 1923, is a unique condition characterized by sweating, flushing, and reddening as a direct response to mastication. This phenomenon results from the aberrant regeneration of postganglionic parasympathetic neurons originating from the auriculotemporal nerve and the subsequent acetylcholine secretion induced by masticatory stimuli. Although rare, this syndrome can have multiple underlying causes and is frequently observed, occurring in up to 65% of cases following lateral parotid resections. Additionally, it can less commonly manifest after neck dissection, facelift procedures, or be associated with diabetes mellitus. Method This article outlines a comprehensive diagnostic algorithm for Frey's syndrome, which includes the utilization of the Minor-Starch-Iodine Test. This test is a key component in diagnosing the syndrome and is discussed in detail, providing insights into its procedure and interpretation. Additionally, the gold standard of treatment for established Frey's syndrome, botulinum toxin A, is thoroughly described, including its mechanism of action, administration, and potential side effects. Discussion Finally, the article underscores the need for further research to enhance our understanding of Frey's syndrome, leading to better diagnostic methods and more tailored treatment options for patients.
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Affiliation(s)
- Lukas S. Fiedler
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Burk
- Department of Phoniatrics and Pedaudiology, University Medical Centre Münster, Münster, Germany
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Huerta S, Raj R, Chang J. Botulinum Toxin A as an Adjunct for the Repair Giant Inguinal Hernias: Case Reports and a Review of the Literature. J Clin Med 2024; 13:1879. [PMID: 38610644 PMCID: PMC11012701 DOI: 10.3390/jcm13071879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
The management of giant inguinoscrotal hernias remains a challenge as a result of the loss of the intra-abdominal domain from long-standing hernia contents within the scrotum. Multiple techniques have been described for abdominal wall relaxation and augmentation to allow the safe return of viscera from the scrotum to the intraperitoneal cavity without adversely affecting cardiorespiratory physiology. Preoperative progressive pneumoperitoneum, phrenectomy, and component separation are but a few common techniques previously described as adjuncts to the management of these massively large hernias. However, these strategies require an additional invasive stage, and reproducibility remains challenging. Botulinum toxin A (BTA) has been successfully used for the management of complex ventral hernias. Its use for these hernias has shown reproducibility and a low side effect profile. In the present report, we describe our institutional experience with BTA for giant inguinal hernias in two patients and present a review of the literature. In one case, a 77-year-old man with a substantial cardiac history presented with a giant left inguinal hernia that was interfering with his activities of daily living. He had BTA six weeks prior to inguinal hernia repair. Repair was performed via an inguinal incision with a favorable return of the viscera into the peritoneum. He was discharged on the same day of the operation. A second patient, 78 years of age, had a giant right inguinoscrotal hernia. He had a significant cardiac history and was treated with BTA six weeks prior to inguinal hernia repair via a groin incision. Neither patient had complaints nor recurrence at 7- and 3-month follow-ups. While the literature on this topic is scarce, we found 13 cases of inguinal hernias treated with BTA as an adjunct. BTA might be a promising adjunct for the management of giant inguinoscrotal hernias in addition to or in place of current strategies.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Roma Raj
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Jonathan Chang
- Department of Anesthesia and Pain Management, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
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Fair L, Leeds SG, Bokhari SH, Esteva S, Mathews T, Ogola GO, Ward MA, Aladegbami B. Achieving fascial closure with preoperative botulinum toxin injections in abdominal wall reconstruction: outcomes from a high-volume center. Updates Surg 2024:10.1007/s13304-024-01802-w. [PMID: 38507174 DOI: 10.1007/s13304-024-01802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
Preoperative injection of Botulinum Toxin A (Botox) has been described as an adjunctive therapy to facilitate fascial closure of large hernia defects in abdominal wall reconstruction (AWR). The purpose of this study was to evaluate the impact of Botox injections on fascial closure and overall outcomes to further validate its role in AWR. A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2014 and March 2022. Patients who did and did not receive preoperative Botox injections were analyzed and compared. A total of 426 patients were included (Botox 76, NBotox 350). The Botox group had significantly larger hernia defects (90 cm2 vs 9 cm2, p < 0.01) and a higher rate of component separations performed (60.5% vs 14.4%, p < 0.01). Despite this large difference in hernia defect size, primary fascial closure rates were similar between the groups (p = 0.49). Notably, the Botox group had higher rates of surgical-site infections (SSIs)/surgical-site occurrences (SSOs) (p < 0.01). Following propensity score matching to control for multiple patient factors including age, sex, diabetes, chronic obstructive pulmonary disease (COPD), and hernia size, the Botox group still had a higher rate of component separations (50% vs 26.3%, p = 0.03) and higher incidence of SSIs/SSOs (39.5% vs 13.5%, p = 0.01). Multimodal therapy with Botox injections and component separations can help achieve fascial closure of large defects during AWR. However, adding these combined therapies may increase the occurrence of postoperative SSIs/SSOs.
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Affiliation(s)
- Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA.
| | - Steven G Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Syed Harris Bokhari
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | | | - Tanner Mathews
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald O Ogola
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Bola Aladegbami
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
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Brin MF, De Boulle K, Liew S, Carruthers A, Carruthers J, Rivkin A, Wu Y, Kawashima M, Yushmanova I, Boodhoo TI, Lee E. Safety and tolerability of onabotulinumtoxinA in the treatment of upper facial lines from global registration studies in 5298 participants: A meta-analysis. JAAD Int 2024; 14:4-18. [PMID: 38035126 PMCID: PMC10682279 DOI: 10.1016/j.jdin.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background Since its discovery as a facial aesthetic treatment >30 years ago, onabotulinumtoxinA has received worldwide approval for dynamic upper facial line treatment. Objective Meta-analysis examining the safety of onabotulinumtoxinA for treatment of glabellar lines (GL), crow's feet lines (CFL), and forehead lines (FHL). Methods Participants (N = 5298) with moderate to severe GL, CFL, or FHL at maximum contraction received onabotulinumtoxinA or placebo in 1 of 18 registration studies (14 double-blind, placebo-controlled [DBPC]; 1 double-blind; 3 open-label). Adverse events (AEs) were analyzed by descriptive statistics and fixed-effects meta-analysis. Results In the overall double-blind placebo-controlled (DBPC) population, AEs were reported in 1443 (42.1%) and 486 (35.8%) participants in the onabotulinumtoxinA (n = 3431) and placebo (n = 1359) groups, respectively. Serious AEs were reported in 54 (1.6%) and 17 (1.3%) participants; 1 (spontaneous abortion) was considered possibly treatment related by the investigator. Using fixed-effects statistical meta-analysis, AEs of interest that were found to be statistically higher for onabotulinumtoxinA than placebo in the DBPC population were eyelid ptosis, eyelid sensory disorder, skin tightness, brow ptosis, eyelid edema, and facial pain (P ≤ .05). Limitations Retrospective, ad hoc analysis. Conclusion This meta-analysis confirms the onabotulinumtoxinA safety profile for GL, CFL, and FHL treatment, with no new onabotulinumtoxinA-associated AEs.
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Affiliation(s)
- Mitchell F. Brin
- Allergan Aesthetics, an AbbVie Company, Irvine, California
- University of California, Irvine, California
| | | | | | | | - Jean Carruthers
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Yan Wu
- Peking University First Hospital, Beijing, China
| | - Makoto Kawashima
- Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | | | | | - Elisabeth Lee
- Allergan Aesthetics, an AbbVie Company, Irvine, California
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10
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Sinha MD, Sinha PK. Liquid Facelift. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:35-41. [PMID: 38307633 DOI: 10.1016/j.cxom.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Affiliation(s)
- Maya D Sinha
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
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11
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Fisher E. Applications for Neurotoxins in the Face and Neck. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:7-14. [PMID: 38307637 DOI: 10.1016/j.cxom.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Affiliation(s)
- Elda Fisher
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University; ASOD - Division of Craniofacial and Surgical Care, University of North Carolina at Chapel Hill, 149 Brauer Hall, CB 7450, Chapel Hill, NC 27599, USA.
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12
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Hubálovská M, Hubálovský Š, Trojovský P. Botox Optimization Algorithm: A New Human-Based Metaheuristic Algorithm for Solving Optimization Problems. Biomimetics (Basel) 2024; 9:137. [PMID: 38534822 DOI: 10.3390/biomimetics9030137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024] Open
Abstract
This paper introduces the Botox Optimization Algorithm (BOA), a novel metaheuristic inspired by the Botox operation mechanism. The algorithm is designed to address optimization problems, utilizing a human-based approach. Taking cues from Botox procedures, where defects are targeted and treated to enhance beauty, the BOA is formulated and mathematically modeled. Evaluation on the CEC 2017 test suite showcases the BOA's ability to balance exploration and exploitation, delivering competitive solutions. Comparative analysis against twelve well-known metaheuristic algorithms demonstrates the BOA's superior performance across various benchmark functions, with statistically significant advantages. Moreover, application to constrained optimization problems from the CEC 2011 test suite highlights the BOA's effectiveness in real-world optimization tasks.
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Affiliation(s)
- Marie Hubálovská
- Department of Technics, Faculty of Education, University of Hradec Kralove, 50003 Hradec Králové, Czech Republic
| | - Štěpán Hubálovský
- Department of Technics, Faculty of Education, University of Hradec Kralove, 50003 Hradec Králové, Czech Republic
| | - Pavel Trojovský
- Department of Technics, Faculty of Education, University of Hradec Kralove, 50003 Hradec Králové, Czech Republic
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Karcioglu O, Akman C, Atnis I. Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril? Curr Pharm Des 2024; 30:CPD-EPUB-138682. [PMID: 38409723 DOI: 10.2174/0113816128284720240212111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/24/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024]
Abstract
Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.
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Affiliation(s)
- Ozgur Karcioglu
- Department of Emergency Medicine, Taksim Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ilknur Atnis
- Department of Emergency Medicine, Niğde Omer Halisdemir Education and Research Hospital, University of Health Sciences, Nigde, Turkey
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Vasdev R, Softness K, Cahill D, Panagides J, Logvinenko T, Saunders R, Bauer S, Estrada C, Wang HHS. Intradetrusor botox injection and augmentation cystoplasty trends among spina bifida patients at US freestanding children's hospitals. J Pediatr Urol 2024:S1477-5131(24)00092-5. [PMID: 38402080 DOI: 10.1016/j.jpurol.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Intra-detrusor botulinum toxin (Botox) injection is a minimally invasive alternative to augmentation cystoplasty in patients with refractory neurogenic bladder. Botox was first used for neurogenic bladder children two decades ago. However, there are no existing guidelines on indications or use among patients with spina bifida. Furthermore, there are little data regarding its use relative to bladder augmentation and patient volume on a national scale. OBJECTIVE We sought to investigate the contemporary trends of intra-detrusor Botox injection and augment cystoplasty in free-standing children's hospitals. STUDY DESIGN We queried the Pediatric Health Information System database to identify spina bifida patients from 2016 to 2019 who underwent intra-detrusor Botox injection and augment cystoplasty based on CPT and ICD-10 codes. Total spina bifida population under care in the free-standing children's hospitals was estimated by all inpatient and ambulatory surgery encounters as denominators to calculate frequency by time for both intra-detrusor Botox injections and augmentation cystoplasty. RESULTS In total, we included 1924 intra-detrusor Botox injections and 842 augmentation cystoplasties. 1413 (51.1%) patients were female. Median age at surgery was 10.0 (interquartile range 6.98-13.5) years. There was a significant increase in intra-detrusor Botox injection frequency (p < 0.001). While there was an overall decreasing, but not significant, trend for augmentation cystoplasty, there was a significant increase in this procedure during the summer months compared to the rest of the year (p < 0.001, Figure 1). Sensitivity analysis using only first intra-detrusor Botox injection per patient demonstrated similarly significant increasing trend. DISCUSSION Use of intra-detrusor Botox injection for the management of neurogenic bladder has significantly increased among patients with spina bifida while augmentation cystoplasty has slightly decreased, but not significantly. CONCLUSIONS Over time, practice patterns for the treatments of neurogenic bladder among spina bifida children have favored minimally invasive Botox injections while augmentation cystoplasty use has not significantly changed.
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Affiliation(s)
- Ranveer Vasdev
- Medical School, University of Minnesota Twin Cities, 420 Delaware St SE, Minneapolis, MN, USA.
| | - Kenneth Softness
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston, Boston, MA, USA.
| | - Dylan Cahill
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA.
| | - John Panagides
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA.
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
| | - Rachel Saunders
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
| | - Stuart Bauer
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA
| | - Carlos Estrada
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
| | - Hsin-Hsiao Scott Wang
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
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Alfatih A, Ibrahim B, Abu A, Hamza M, Hassan I. Botox in below knee amputation for the management of post-operative contracture: a systematic review. Pan Afr Med J 2024; 47:26. [PMID: 38558551 PMCID: PMC10979811 DOI: 10.11604/pamj.2024.47.26.42249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/17/2024] [Indexed: 04/04/2024] Open
Abstract
During the 1970s, scientists first used botulinum toxin to treat strabismus. While testing on monkeys, they noticed that the toxin could also reduce wrinkles in the glabella area. This led to its widespread use in both medical and cosmetic fields. The objective of the study was to evaluate the potential use of Botox in managing post-operative contracture after below-knee amputation. We conducted a systematic review In Pubmed, Cochrane Library, Embase, and Google Scholar using the MESH terms Botox, botulinum toxin, post-operative contracture, amputation, and below knee amputation. Our goal was to evaluate the potential use of Botox to manage post-operative contracture in patients who have undergone below-knee amputation. Our findings show evidence in the literature that Botox can effectively manage stump hyperhidrosis, phantom pain, and jumping stump, but no clinical trial has been found that discusses the use of Botox for post-operative contracture. Botox has been used in different ways to manage spasticity. Further studies and clinical trials are needed to support the use of Botox to manage this complication.
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Affiliation(s)
| | - Basil Ibrahim
- Manchester Foundation Trust, Manchester, United Kingdom
| | | | | | - Iman Hassan
- Royal Liverpool Trust, Liverpool, United Kingdom
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Burtic SR, Castiglione L, Murariu M, Rosca O, Dumitru C, Neagoe O. Assessment of Quality of Life in Patients with Chronic Anal Fissures: A 1-Year Follow-Up Study before and after Botulinum Toxin ( Botox) Injection. J Clin Med 2024; 13:316. [PMID: 38256449 PMCID: PMC10816032 DOI: 10.3390/jcm13020316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
This longitudinal study aimed to assess the quality of life in patients with anal fissures treated with botulinum toxin (Botox) injections over a one-year period. The study hypothesized that Botox injections would significantly improve quality of life and that these improvements would be sustained over a year. Conducted as a cross-sectional study, it assessed adults diagnosed with chronic anal fissures unresponsive to conventional treatments. Participants received 25 U of Botox in two sessions and their quality of life was assessed using the WHOQOL-BREF, COPE-60, Hospital Anxiety and Depression Scale (HADS), and SF-36 surveys. Data were collected at baseline six months and one year post-treatment. The study involved 113 patients, with a mean age of 38.1 years. Significant improvements were observed in the WHOQOL-BREF scores across all domains from baseline to 12 months (physical domain: 49.4 ± 10.5 to 70.2 ± 10.6, p < 0.001; mental domain: 34.8 ± 11.2 to 61.9 ± 11.5, p < 0.001). SF-36 scores also showed significant enhancements in physical and mental health components (physical: 44.3 ± 7.5 to 56.9 ± 5.9, p < 0.001; mental: 41.1 ± 7.2 to 54.4 ± 6.3, p < 0.001). Additionally, significant improvements were noted in patient perception on quality of life from the perspective of various aspects including physical discomfort, pain management, and mood and emotional well-being. The study demonstrated that Botox injections significantly improved the quality of life in patients with chronic anal fissures, with sustained benefits observed over a year. These findings suggest Botox as an effective treatment modality for enhancing life quality in patients with this condition, highlighting the potential for broader applications in managing chronic anal fissures.
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Affiliation(s)
- Sonia-Roxana Burtic
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department II, Discipline of Medical Communication, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Luca Castiglione
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Marius Murariu
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Ovidiu Rosca
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Catalin Dumitru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Octavian Neagoe
- Second Discipline of Surgical Semiology, First Department of Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Palm KM, Abrams MK, Sears SB, Wherley SD, Alfahmy AM, Kamumbu SA, Chakraborty NN, Mahajan ST, El-Nashar SA, Henderson JW, Hijaz AK, Mangel JM, Pollard RR, Al-Shakhshir H, Retuerto MA, Steller KM, Elshaer M, Ghannoum MA, Sheyn D. The Response of the Urinary Microbiome to Botox. Int Urogynecol J 2024; 35:237-251. [PMID: 38165444 DOI: 10.1007/s00192-023-05703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Our objective was to evaluate if botox alters the urinary microbiome of patients with overactive bladder and whether this alteration is predictive of treatment response. METHODS This multicenter prospective cohort study included 18-89-year-old patients undergoing treatment for overactive bladder with 100 units of botox. Urine samples were collected by straight catheterization on the day of the procedure (S1) and again 4 weeks later (S2). Participants completed the Patient Global Impression of Improvement form at their second visit for dichotomization into responders and nonresponders. The microbiome was sequenced using 16s rRNA sequencing. Wilcoxon signed rank and Wilcoxon rank sum were used to compare the microbiome, whereas chi-square, Wilcoxon rank sum, and the independent t-test were utilized for clinical data. RESULTS Sixty-eight participants were included in the analysis. The mean relative abundance and prevalence of Beauveria bassiana, Xerocomus chrysenteron, Crinipellis zonata, and Micrococcus luteus were all found to increase between S1 and S2 in responders; whereas in nonresponders the mean relative abundance and prevalence of Pseudomonas fragi were found to decrease. The MRA and prevalence of Weissella cibaria, Acinetobacter johnsonii, and Acinetobacter schindleri were found to be greater in responders than nonresponders at the time of S1. Significant UM differences in the S1 of patients who did (n = 5) and did not go on to develop a post-treatment UTI were noted. CONCLUSIONS Longitudinal urobiome differences may exist between patients who do and do not respond to botox.
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Affiliation(s)
- Kasey M Palm
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Megan K Abrams
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah B Sears
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Susan D Wherley
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anood M Alfahmy
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stacy A Kamumbu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Natalie N Chakraborty
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sangeeta T Mahajan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sherif A El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Joseph W Henderson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adonis K Hijaz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Mangel
- Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert R Pollard
- Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hilmi Al-Shakhshir
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Martin A Retuerto
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Kelly M Steller
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Mohammed Elshaer
- Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mahmoud A Ghannoum
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Getaneh FW, Simhal R, Sholklapper T, Melvin E, Dorris CS, Chou J, Richter LA, Dieter A. Antibiotic prophylaxis for onabotulinum toxin A injections: systematic review and meta-analysis. Int Urogynecol J 2024; 35:19-29. [PMID: 37938397 DOI: 10.1007/s00192-023-05665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To our knowledge, there are no evidence-based recommendations regarding the optimal prophylactic antibiotic regimen for intradetrusor onabotulinum toxin type A (BTX) injections. This systematic review and meta-analysis was aimed at investigating the optimal prophylactic antibiotic regimen to decrease urinary tract infection (UTI) in patients undergoing BTX for overactive bladder syndrome (OAB). METHODS A systematic search of MEDLINE, Embase, CINAHL, and Web of Science was conducted from inception through 30 June 2022. All randomized controlled trials and prospective trials with > 20 subjects undergoing BTX injections for OAB in adults that described prophylactic antibiotic regimens were included. Meta-analysis performed to assess UTI rates in patients with idiopathic OAB using the inverse variance method for pooling. RESULTS A total of 27 studies (9 randomized controlled trials, 18 prospective) were included, representing 2,100 patients (69% women) with 19 studies of idiopathic OAB patients only, 6 of neurogenic only, and 2 including both. No studies directly compared antibiotic regimens for the prevention of UTI. Included studies favor the use of antibiotics in patients with idiopathic OAB and favor continuing antibiotics for 2-3 days after the procedure for prevention of UTI. Given the heterogeneity of the data, direct comparisons of antibiotic type or duration could not be performed. Meta-analysis found a 10% UTI rate at 4 weeks and 15% at 12 weeks post-injection. CONCLUSIONS Although there are insufficient data to support the use of a specific antibiotic regimen, available studies favor the use of prophylactic antibiotics for 2-3 days in idiopathic OAB patients undergoing BTX injection. Future trials are needed to determine the optimal regimens to prevent UTI in patients undergoing BTX for OAB.
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Affiliation(s)
- Feven W Getaneh
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 106 Irving Street NW, Suite 405 South, Washington, DC, 20010, USA.
| | - Rishabh Simhal
- Department of Urology, Ochsner Health, New Orleans, LA, USA
| | | | - Emilie Melvin
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | | | - Jiling Chou
- Medstar Health Research Institute, Washington, DC, USA
| | - Lee A Richter
- Department of Obstetrics and Gynecology and Department of Urology, MedStar Georgetown Washington Hospital Center, Washington, DC, USA
| | - Alexis Dieter
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 106 Irving Street NW, Suite 405 South, Washington, DC, 20010, USA
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Zdroik A, El Haraki A, Smith W, Badlani G, Parker-Autry C, Matthews C. Injection site number and outcomes of intradetrusor onabotulinumtoxinA for refractory overactive bladder syndrome: a randomized clinical trial. Int Urogynecol J 2024; 35:119-126. [PMID: 37991564 DOI: 10.1007/s00192-023-05685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The optimal number of onabotulinumtoxinA injections for the treatment of refractory overactive bladder syndrome is unknown. Our primary objective was to determine whether 10-injections sites with 100 units of onabotulinumtoxinA each were associated with less pain than 20-injections sites. METHODS In a single-blinded randomized trial, 100 units of onabotulinumtoxinA was administered, either as 10 × 1 ml or as 20 × 0.5 ml injections following the instillation of 30 ml of bupivacaine and 5 ml of NaHCO3 solution for 15 min. The primary outcome was procedural pain, as measured on an 11-point Numerical Pain Rating Scale (NPRS) immediately following the procedure. A power calculation estimated that 16 subjects in each arm were needed to detect a mean difference of 1 with a standard deviation of 1, on the NPRS score between the two treatment groups, with α 0.05 and power 80%. To adjust for an estimated 20% dropout rate, the final sample size was planned for 20 patients per group. RESULTS From October 2020 to November 2022, a total of 56 patients were approached and 40 were enrolled and randomized to two groups (21 in the 10-injections group and 19 in 20-injections group). The difference in the median pain score between the group was not statistically significant (4 [1.5-5] for 10 injections vs 3 [1-4] for 20 injections, p=0.823). CONCLUSION Patients' perception of pain, efficacy, and adverse events did not significantly differ between patients receiving 10 and those receiving 20 injections of 100 units of onabotulinumtoxinA.
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Affiliation(s)
- Anna Zdroik
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Amr El Haraki
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Whitney Smith
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gopal Badlani
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Candace Parker-Autry
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA
| | - Catherine Matthews
- Department of Urology, Atrium Health Wake Forest Baptist Hospital, 1 Medical Center Boulevard, Winston-Salem, NC, 27101, USA.
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Karagozoglu I, Ozcan M. Evaluation of biochemical changes and treatment efficacy in patients with bruxism following botulinum toxin or splint therapy: a randomized clinical trial. Clin Oral Investig 2023; 28:43. [PMID: 38153567 DOI: 10.1007/s00784-023-05453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES This clinical study aims to analyze the levels of cortisol, dehydroepiandrosterone (DHEA), and tumor necrosis factor alpha (TNF-α) in the gingival crevicular fluid (GCF) of persons with bruxism and to compare the efficacy of botulinum toxin (botox) and occlusal splint treatments through biomarkers. MATERIALS AND METHODS A total of 40 patients with bruxism were selected according to the clinical examination and anamnesis of which 20 received occlusal splint treatment and 20 botox treatment. GCF samples were taken from the patients before and after treatment. Cortisol, DHEA, and TNF-α levels were measured by enzyme-linked immunosorbent assay test. The change in measurements between time and groups and the time-group interaction were tested by repeated measures ANOVA. RESULTS There was a statistically significant difference between the cortisol levels before and after treatment in both groups (p = 0.001). In individuals with bruxism, a statistically significant decrease in cortisol levels was observed after both treatments (p < 0.05), while DHEA levels increased after treatment but were not statistically significant (p > 0.05). There was no statistically significant difference between TNF-α intra-group measurements (p > 0.05). CONCLUSIONS Stress and inflammatory biomarkers were found to be associated with bruxism. Cortisol levels decreased in people with bruxism after treatment with both occlusal splint and botox. CLINICAL RELEVANCE Both splint and botox treatments were effective for bruxism by reducing the stress levels.
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Affiliation(s)
- Irem Karagozoglu
- School of Dentistry, Department of Prosthodontics, Gaziantep University, Şahinbey, 27310, Gaziantep, Turkey.
| | - Mutlu Ozcan
- Clinic of Masticatory Disorders and Dental Biomaterials, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Licow-Kamińska AA, Ciećwież SM, Ptak M, Kotlęga D, Brodowska A. Quality of Life in Female Patients with Overactive Bladder after Botulinum Toxin Treatment. Toxins (Basel) 2023; 16:7. [PMID: 38276531 PMCID: PMC10819285 DOI: 10.3390/toxins16010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Manifestations of OAB can considerably diminish the quality of life. Botulinum toxin has emerged as a valuable treatment option in diseases whose symptoms cannot be controlled adequately with other available therapies. The aim of the present study was to compare the subjective quality of life of patients with OAB before the injection of botulinum toxin and three and six months after the intervention. METHODS This study was based on a diagnostic survey with three validated questionnaires, ICIQ-OAB, ICIQ-OABqol, and ICIQ-LUTSqol, and an additional questionnaire developed by the authors to collect sociodemographic characteristics and selected medical data. RESULTS This study demonstrated significant differences between pre-treatment scores and those at three and six months post injection. At three and six months after the intervention, mean scores for all three instruments (ICIQ-OAB, ICIQ-OABqol, ICIQ-LUTSqol) were significantly lower than the respective pre-treatment values, implying a significant attenuation of OAB symptoms and their lower impact on the quality of life. However, the severity of OAB symptoms and their impact on the quality of life at six months post intervention were significantly higher than at three months, except for the social interaction domain. CONCLUSIONS Botulinum toxin is an effective treatment for OAB.
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Affiliation(s)
- Agnieszka A. Licow-Kamińska
- Department of Neonates, Pathology and Intensive Therapy, Independent Public Specialist Institute of Health “Zdroje”, ul. Mączna 4, 70-780 Szczecin, Poland;
- Department of Children Disease and Children Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland
| | - Sylwester M. Ciećwież
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Magdalena Ptak
- Independent Subdepartment of Perineological Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 51-210 Szczecin, Poland;
| | - Dariusz Kotlęga
- Department of Pharmacology and Toxicology, University of Zielona Góra, ul. Licealna 9, 65-417 Zielona Góra, Poland
| | - Agnieszka Brodowska
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland;
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22
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de Jongh FW, Wolf O, Wong ZY, Ingels KJAO, Pouwels S. Botulinum toxin treatment of the buccinator muscle facial synkinesis: A systematic review. J Plast Reconstr Aesthet Surg 2023; 86:88-93. [PMID: 37716254 DOI: 10.1016/j.bjps.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND The purpose of this review is to provide an overview of the available literature assessing the treatment of botulinum toxin injections for the treatment of synkinesis of the buccinator muscle in patients with peripheral facial palsy (PFP). MATERIALS AND METHODS A multi database search was performed, including the following databases: Pubmed, Medline, Embase, and the Cochrane Library. Each database was searched from its earliest date until 8 June 2023. The following outcome measures were extracted from the articles when available: subjective, somatic, and psychological effects on the patients and objective outcomes such as the House-Brackmann, Sunnybrook and Sydney scores. The methodological quality of the included studies was rated using the Newcastle-Ottawa scale for nonrandomised trials. RESULTS The primary literature search generated 37 articles. After removing duplicates, 25 articles remained for abstract appraisal, of which 20 underwent full-text appraisal, resulting in 3 studies for analysis. All of these studies showed (significant) improvement in synkinesis either measured using the Synkinesis Assessment Questionnaire or subjectively measured by asking treated patients. CONCLUSION The available literature supports the finding that botulinum toxin treatment of the buccinator muscle could be a welcome addition to facial synkinesis treatment and could significantly improve patient outcomes. In future studies, the efficacy of EMG-guided buccinator injections, optimal dose, and a validated measuring method could be beneficial in optimising treatment for patients with a PFP and synkinesis.
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Affiliation(s)
- Frank W de Jongh
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Olga Wolf
- Department of Plastic, Reconstructive and Aesthetic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany
| | - Zhen Yu Wong
- Department of General Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Klinik, Oberhausen, NRW, Germany; Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; Faculty of Health, Witten/Herdecke University, Witten, Germany.
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Amini-Salehi E, Eslami N, Tamimi A, Sedighi N, Moghdam SS, Yaghubi-Kalurazi T, Hassanipour S, Joukar F, Mansour-Ghanaei F, Eftekhari H. Unusual herpetic reactivation in a young female following botox injection: a case report study. BMC Infect Dis 2023; 23:647. [PMID: 37784014 PMCID: PMC10546652 DOI: 10.1186/s12879-023-08514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/04/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Botox injections are commonly used for cosmetic and therapeutic purposes because they temporarily paralyze muscles, reduce wrinkles, and alleviate certain medical conditions. Although generally considered safe and effective, Botox injections may cause potential complications. While herpes reactivation is more commonly associated with immunosuppressive therapies, such as chemotherapy or corticosteroid use, its association with Botox injection is poorly documented. CASE PRESENTATION A 33-year-old woman presented with progressive painful rashes and vesicles on her forehead, scalp, and right upper eyelid, accompanied by fever and malaise following a Botox injection to treat wrinkles. A positive Tzanck smear test result confirmed the diagnosis of herpes infection. The patient was treated with antiviral medication, and her symptoms gradually regressed over several days. CONCLUSIONS Although herpes reactivation is more commonly associated with immunosuppressive therapies, few cases of herpes zoster and herpes simplex following Botox injection have been reported. The pathogenesis of herpes reactivation following Botox injection is unclear; however, it has been hypothesized that the Botox protein is a potent antigen that may activate the cellular immune system, making it easier for the virus to reactivate. Healthcare providers should be aware of this potential complication and consider it when evaluating patients who present with painful rashes following Botox injections. In addition, individuals who want to receive Botox injections should be informed of this complication. The diagnosis of herpetic infection should be made promptly, and antiviral therapy should be initiated to minimize the risk of complications. Further research is needed to better understand the pathogenesis and risk factors for herpes following Botox injection and to develop strategies for preventing and managing this complication.
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Affiliation(s)
- Ehsan Amini-Salehi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Narges Eslami
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | | | | | - Tofigh Yaghubi-Kalurazi
- Department of Health, Nutrition & Infectious Diseases, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hojat Eftekhari
- Department of Dermatology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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24
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Nieri CA, Benaim EH, Zhang YH, Garcia-Godoy F, Herr MJ, Zhang W, Schwartz D, Coca KK, Gleysteen JP, Gillespie MB. Botox for the prevention of radiation-induced Sialadenitis and xerostomia in head and neck cancer patients: A pilot study. Head Neck 2023; 45:2198-2206. [PMID: 37403447 DOI: 10.1002/hed.27449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND To determine the safety of Botox and its potential effect on alleviating radiation therapy (RT)-induced sialadenitis in head and neck cancer patients. METHODS Twenty patients with stage III/IV head and neck cancer were randomized to receive Botox or saline injections into both submandibular glands (SMG). There were three visits: one before RT (V1); 1 week after RT (V2); and 6 weeks after RT (V3), each of which included saliva collection, a 24-h dietary recall, and a quality-of-life survey. RESULTS No adverse events were observed. While the control group was much older, the Botox group more commonly underwent induction chemotherapy compared with controls. From V1 to V2, salivary flow decreased in both groups, but only in the control group from V1 to V3. CXCL-1 (GRO), a neutrophil chemoattractant, was lower in the Botox group compared with the control group at V3. CONCLUSION Botox can be safely administered to the salivary glands prior to external beam radiation without observed complications or side-effects. After an initial reduction in salivary flow following RT, the Botox group showed lack of further flow reduction compared with controls. The inflammatory marker CXCL 1, which was reduced in the in Botox group at V3, may be a candidate for further studies of radiation-induced sialadenitis.
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Affiliation(s)
- Chad Alexander Nieri
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ezer Haim Benaim
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yanhui H Zhang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- The Forsyth Institute, Cambridge, Massachusetts, USA
- Department of Surgery, Herbert Wertheim, College of Medicine, Florida International University, Miami, Florida, USA
| | - Michael J Herr
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Weiqiang Zhang
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Physiology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kimberly K Coca
- Department of Otolaryngology, Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - John P Gleysteen
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marion Boyd Gillespie
- Department of Otolaryngology- Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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25
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McCarthy MB, Duesterdieck-Zellmer KF, Larson MK. Botulinum neurotoxin type A does not exert concentration-dependent effects on equine articular cartilage in vitro. Am J Vet Res 2023; 84:ajvr.23.04.0076. [PMID: 37442543 DOI: 10.2460/ajvr.23.04.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To determine whether Botulinum neurotoxin type A (BoNT-A) ameliorates the effects of interleukin 1 (IL-1) on equine articular cartilage, or exerts negative effects on normal equine articular cartilage homeostasis in vitro. SAMPLE Articular cartilage explants from 6 healthy femoropatellar joints of 3 adult horses. METHODS Explants were allocated to the IL-1 challenged or unchallenged group, then exposed to 1 of 6 concentrations of BoNT-A (0, 1, 10, 50, 100, or 500 pg/mL) for 96 hours. To assess BoNT-A's effects on inflammation, prostaglandin E2 (PGE2) was measured in media via ELISA. Matrix degradation was determined as the percentage of sulfated glycosaminoglycans (sGAG) released from explants via dimethylmethylene blue assay. Aggrecan synthesis was estimated using CS846 ELISA and collagen type II degradation was estimated using C2C ELISA on media. Chondrocyte apoptosis was assessed via in-situ TUNEL assay. Generalized linear mixed models were fitted to determine treatment effects using α = 0.05. RESULTS The challenge with IL-1 resulted in increased concentrations of PGE2 and CS846 in media and increased release of sGAG from explants. BoNT-A did not significantly impact PGE2 or CS846 concentration in media, percentage of sGAG released, or chondrocyte apoptosis in IL-1 challenged or unchallenged cartilage explants. The concentration of C2C in media was below the quantifiable limit of the ELISA in all samples. CLINICAL RELEVANCE BoNT-A did not show chondroprotective effects or have negative effects on cartilage homeostasis in vitro at the concentrations tested. While chondroprotective effects were not observed, BoNT-A may be safe for intraarticular use. In vivo testing is warranted before clinical use.
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Tran D, Leeds SG, Fair L, Fang J, Rubarth C, McGowan T, Ramakrishnan S, Ogola G, Aladegbami B, Ward MA. Gastric per-oral endoscopic myotomy versus pyloric injection of botulinum toxin for the treatment of gastroparesis: our institutional experience and a systematic review of the literature. Surg Endosc 2023; 37:7280-7287. [PMID: 37430121 DOI: 10.1007/s00464-023-10262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Gastric Per-Oral Endoscopic Myotomy (GPOEM) has been developed as an effective treatment option for patients with medically refractory gastroparesis. Other endoscopic options, such as pyloric injection of botulinum toxin (Botox), is often performed with limited efficacy. The purpose of this study was to evaluate GPOEM for the treatment of gastroparesis and compare its efficacy to Botox injection results reported in the literature. METHODS A retrospective review was conducted to identify all patients who underwent a GPOEM for the treatment of gastroparesis between September 2018 and June 2022. Changes in Gastric Emptying Scintigraphy (GES) studies and Gastroparesis Cardinal Symptom (GCSI) scores from the preoperative to postoperative period were analyzed. In addition, a systematic review was conducted to identify all publications reporting the outcomes of Botox injections for the treatment of gastroparesis. RESULTS A total of 65 patients (51 female, 14 male) underwent a GPOEM during the study period. Twenty-eight patients (22 female, 6 male) had both preoperative and postoperative GES studies in addition to GCSI scores. The etiologies of gastroparesis were diabetic (n = 4), idiopathic (n = 18), and postsurgical (n = 6). Fifty percent of these patients had undergone previous failed interventions including Botox injections (n = 6), gastric stimulator placement (n = 2), and endoscopic pyloric dilation (n = 6). Outcomes showed a significant decrease in GES percentages (mean difference = - 23.5%, p < 0.001) and GCSI scores (mean difference = - 9.6, p = 0.02) postoperatively. In the systematic review for Botox, transient mean improvements in postoperative GES percentages and GCSI scores were reported at 10.1% and 4.0, respectively. CONCLUSION GPOEM leads to significant improvement in GES percentages and GCSI scores postoperatively and is superior to Botox injection results reported in the literature.
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Affiliation(s)
- Daniel Tran
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Steven G Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Jenifer Fang
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Charles Rubarth
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Titus McGowan
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Sudha Ramakrishnan
- Baylor Health Sciences Library, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald Ogola
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Bola Aladegbami
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
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27
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Etrusco A, Geru M, Laganà AS, Chiantera V, Giannini A, Buzzaccarini G. Use of botulinum toxin in aesthetic medicine and gynaecology: current approaches, controversies, and future directions. Prz Menopauzalny 2023; 22:155-160. [PMID: 37829261 PMCID: PMC10566329 DOI: 10.5114/pm.2023.131457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/06/2023] [Indexed: 10/14/2023]
Abstract
This review looks at the use of botulinum toxin in the gynaecological field with the aim of determining what needs to be further investigated to achieve a standardized application. Numerous studies have been conducted to explore how botulinum toxins (BoNT) can be applied, and it is becoming popular for treating various disorders such as chronic pelvic pain, vestibulodynia, and vaginism. However, the exact dosage and ideal location for injections still need to be clarified. The objective of this study is to point out which aspects need to be more carefully studied to ensure a consistent use of BoNT in gynaecology.
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Affiliation(s)
- Andrea Etrusco
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Maurina Geru
- Department of Women’s and Children’s Health, Gynaecology and Obstetrics Clinic, University of Padua, Padua, Italy
| | - Antonio Simone Laganà
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, Rome, Italy
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Kozan AA, Morley R, Rahman AA, Biyani CS, Urwin G, Elmamoun M, Hanchanale V, Slemeck L, Ramage C, Marsh F, Downey A, Garthwaite M, Ali A. Design, implementation and assessment of a novel, introductory curriculum into female, neurological and urodynamic urology: a 7-year experience of urology simulation bootcamp course. World J Urol 2023; 41:2437-2442. [PMID: 37493708 DOI: 10.1007/s00345-023-04522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/02/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE To present the seven-year experience of a multi-component and interactive module on female, neurological and urodynamic urology (FNUU) training at the UK National Urology Simulation Bootcamp Course (USBC) and demonstrate trainee satisfaction and competency progression. METHODS During the week-long USBC, a four-hour module on FNUU was designed which consisted of short interactive presentations with an emphasis on practical stations in urodynamics, intravesical botulinum toxin injection, urethral bulking injection, female pelvic examination and, initially, mid-urethral tapes (subsequently replaced with percutaneous sacral nerve evaluation). The trainee's level of knowledge, operative experience and confidence were assessed pre- and post-course. The practical assessment consisted of preparation and intravesical administration of botulinum toxin, female pelvic examination, urodynamic trace interpretation or mid-urethral tape simulation. Trainee feedback was also collected. RESULTS Two-hundred sixty-one newly appointed urology trainees participated in the USBC during this period. A high level of satisfaction was constantly reported. The highest rated session was urethral bulking with 72% being very satisfied, followed by Botox and urodynamics. The final assessment showed 70% had achieved level 4 competency in cystoscopy and Botox. Qualitative feedback was also obtained. CONCLUSION To our knowledge, this is the first module of its kind, and it shows that it is feasible to develop, implement and evaluate an introductory curriculum into FNUU that is reproducible over a 7-year period with very positive feedback.
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Affiliation(s)
- Andrei Adrian Kozan
- Department of Urology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Roland Morley
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Chandra Shekhar Biyani
- Department of Urology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
| | | | - Mamoun Elmamoun
- Department of Urology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Vishwanath Hanchanale
- Department of Urology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Libby Slemeck
- Department of Obstetrics and Gynaecology, Airedale General Hospital, Keighley, UK
| | - Carmel Ramage
- Department of Obstetrics and Gynaecology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Fiona Marsh
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alison Downey
- Department of Urology, Pinderfields Hospital, Wakefield, UK
| | | | - Ased Ali
- Department of Urology, Pinderfields Hospital, Wakefield, UK
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Hanna MG, Bradley M, Zyczynski H, Wang L, Giugale L. The impact of postinjection urinary tract infection on efficacy of intravesical onabotulinumtoxinA-A secondary analysis. Neurourol Urodyn 2023; 42:1238-1244. [PMID: 37086398 PMCID: PMC11033699 DOI: 10.1002/nau.25191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES To compare treatment response in women who did and did not develop a urinary tract infection (UTI) within 14 days after intravesical onabotulinumtoxinA injections for treatment of refractory urgency urinary incontinence (UUI). METHODS This is a secondary analysis of women who received Onabotulinumtoxin A in the Refractory Overactive Bladder: Sacral Neuromodulation vs Botulinum Toxin Assessment (ROSETTA) Trial. Participants were grouped by presence or absence of UTI within 14 days of injection. UTI was defined as symptomatic with positive urine culture per the primary ROSETTA protocol. Our primary outcome was change from baseline in mean number of UUI episodes based on monthly 3-day bladder diaries averaged over 6 months. We performed t tests and chi-square/Fisher's exact for continuous and categorical variables. A p value of <0.05 was considered statistically significant. RESULTS Of 187 participants in the onabotulinumtoxinA arm, 10 (5.3%) experienced UTI within 14 days of injection, and 177 (94.7%) did not. At baseline, groups did not differ in demographics, mean UUI episodes per day (no UTI [5.37 ± 2.65] vs. UTI [6.40 ± 3.02], p = 0.24), or other diary parameters. For our primary outcome, groups did not differ in the change in mean daily UUI episodes at 1 month (no UTI [-4.29 ± 2.75] vs. UTI [-3.74 ± 2.01]; mean difference [95% confidence interval, CI] -0.55 [-2.39 to 1.28], p: 0.55) or 6 months (no UTI [-3.63 ± 2.89] vs. UTI [-2.15 ± 3.18]; mean difference [95% CI] -1.48 [-3.44 to 0.48], p: 0.14). CONCLUSIONS UTI within 14 days after intravesical injection of onabotulinumtoxinA for refractory UUI was not significantly associated with inferior treatment response at 1 or 6 months.
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Affiliation(s)
- Marina Guirguis Hanna
- Division of Urogynecology, Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Megan Bradley
- Division of Urogynecology, Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Halina Zyczynski
- Division of Urogynecology, Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Li Wang
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Giugale
- Division of Urogynecology, Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Rehman U, Mukhtar A, Syed L, Sarwar MS, Brennan PA. Can we support second degree students by incorporating non-surgical facial aesthetics into undergraduate dentistry during the first degree? Br J Oral Maxillofac Surg 2023; 61:443-445. [PMID: 37393184 DOI: 10.1016/j.bjoms.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 07/03/2023]
Abstract
Non-surgical facial aesthetics (NSFA) are cosmetic procedures intended to reduce signs of ageing and provide facial rejuvenation. There is currently no recommendation for NSFA to be included in the undergraduate dental curriculum globally. This study aims to gain the views of final year dental students about pursuing a career in NSFA. An online survey was completed by 114 final year dental students across two English Universities. A total of 67% (77/114) of students would pursue a career in NSFA. A total of 76% (87/114) and 75% (86/114) of students were not aware of the complications associated with the administration of dermal fillers and Botox injections, respectively. Most students considered NSFA upon graduation. NSFA provides a transferable skillset and useful anatomical knowledge. Incorporation of NSFA in undergraduate education could financially support oral and maxillofacial surgery (OMFS) trainees within their second degree. This may in turn promote retention within the speciality with high financial costs associated with OMFS training.
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Affiliation(s)
- Umar Rehman
- Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Ayman Mukhtar
- Peninsula Dental Foundation School, Tavistock, United Kingdom.
| | - Labib Syed
- Department of Surgery, University Hospitals Sussex, Sussex, United Kingdom.
| | | | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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31
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Jamtøy KA, Thorstensen WM, Stovner LJ, Rosén A, Maarbjerg S, Bratbak D, Simpson MR, Tronvik E. Onabotulinum toxin A block of the sphenopalatine ganglion in patients with persistent idiopathic facial pain: a randomized, triple-blind, placebo-controlled, exploratory, cross-over study. Cephalalgia 2023; 43:3331024231187132. [PMID: 37435807 DOI: 10.1177/03331024231187132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of injecting onabotulinum toxin A (BTA) towards the sphenopalatine ganglion (SPG) using the MultiGuide® in patients with persistent idiopathic facial pain (PIFP). METHODS This cross-over, exploratory study compared the injection of 25 units BTA versus placebo in patients who met modified ICDH-3 criteria for PIFP. Daily pain diaries were registered for a 4-week baseline, a 12-week follow-up after each injection, and an 8-week conceptual washout period in between. The primary efficacy endpoint was the change from baseline to weeks 5-8 in average pain intensity using a numeric rating scale. Adverse events were recorded. RESULTS Of 30 patients who were randomized to treatment, 29 were evaluable. In weeks 5-8, there was no statistically significant difference in average pain intensity between BTA versus placebo (0.00; 95% CI = -0.57 to 0.57) (P = 0.996). Following both BTA and placebo injections, five participants reported at least a 30% reduction in average pain during weeks 5-8 (P = 1.000). No serious adverse events were reported. Post-hoc analyses indicated a possible carry-over effect. CONCLUSIONS Injection of BTA toward the SPG with the MultiGuide® did not appear to provide a reduction in pain reduction at 5-8 weeks, although this finding may be influenced by a carry-over effect. The injection appears to otherwise be safe and well-tolerated in patients with PIFP.Trial Registration: The study protocol is registered in ClinicalTrial.gov (NCT03462290) and EUDRACT (number: 2017-002518-30).
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Affiliation(s)
- Kent A Jamtøy
- Department of Maxillofacial Surgery, St Olavs University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wenche M Thorstensen
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Otolaryngology, Head and Neck Surgery, St Olavs University Hospital, Trondheim, Norway
| | - Lars J Stovner
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukelands University Hospital, Bergen, Norway
| | - Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, Denmark
| | - Daniel Bratbak
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Melanie R Simpson
- The Clinical Research Unit, St Olavs University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
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Ghazavi M, Rezaii S, Ghasemi M, Azin N, Reisi M. Botox injection in treatment of sialorrhea in children with cerebral palsy. Am J Neurodegener Dis 2023; 12:97-102. [PMID: 37457841 PMCID: PMC10349299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/15/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The occurrence of sialorrhea (drooling) in children with cerebral palsy is one of the important complications of this disease, which is associated with the impaired quality of life of patients and also the dissatisfaction of their parents. Botox injection in the salivary glands is one of the treatment methods that has recently received special attention in these patients, but there are still many challenges regarding its effectiveness and safety. We aimed to test the effectiveness and safety of botulinum toxin type A in reducing sialorrhea in children with cerebral palsy. METHODS This semi-experimental before-after study was performed on 12 children who suffering from sialorrhea. The ethics code of this project is IR.MUI.MED.REC.1400.774 and the clinical trial registry code is IRCT20220516054868N1 (https://www.irct.ir/trial/64393). In each of the parotid and submandibular glands, an amount of 0.5 U/kg of botulinum toxin type A was injected by ultrasound guidance under general anesthesia. Before and 6 months after the intervention, the severity and frequency of drooling were tested by Drooling Frequency and Severity Scale. RESULTS We found a decreasing trend in the severity and frequency scores for drooling within one month; however, after that time, until the end of the 24th week, we saw an increasing trend in the intensity and frequency of this complication. Only two-thirds of parents were satisfied with the therapeutic protocol. Side effects related to botox injection were revealed in 25.0% mostly as dysphagia. CONCLUSION Botox injection in salivary glands is not a definitive and stable treatment in the treatment of sialorrhea in children with cerebral palsy.
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Affiliation(s)
| | - Samira Rezaii
- Emam Hossein Children Hospital, Isfahan University of Medical SciencesIsfahan, Iran
| | - Mohadese Ghasemi
- Pediatrician, Isfahan University of Medical SciencesIsfahan, Iran
| | - Neda Azin
- Isfahan University of Medical SciencesIsfahan, Iran
| | - Mohsen Reisi
- Pediatric Pulmonologist, Imam Hossein Children Hospital, Isfahan University of Medical SciencesIsfahan, Iran
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Drugs for migraine. Med Lett Drugs Ther 2023; 65:89-96. [PMID: 37266987 DOI: 10.58347/tml.2023.1678a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Comparison table: Some drugs for migraine prevention in adults. Med Lett Drugs Ther 2023; 65:e100-2. [PMID: 37266989 DOI: 10.58347/tml.2023.1678c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Thatte MR, Shah HR, Hiremath A. Birth Brachial Plexus Palsy: An Indian Perspective. Semin Plast Surg 2023; 37:117-133. [PMID: 37503527 PMCID: PMC10371416 DOI: 10.1055/s-0043-1767782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Birth brachial plexus palsy (BBPP) is an unfortunate outcome of a difficult labor, which can often lead to long-lasting upper limb impairments. Spontaneous recovery may or may not occur. Timely diagnosis of the condition and initiation of the appropriate treatment can be instrumental in decreasing the functional impact. The management begins right from the day the child presents first and ranges from physiotherapy to surgical intervention such as nerve repair/transfer or grafts. The sequelae of the condition are also quite common and need to be detected preemptively with initiation of appropriate treatment. However, prevention is the key to reducing the incidence of secondary deformities. In this study, the team of authors, based on their considerable experience, discuss their approach to the management of BBPP. This is done in the background of Indian cultural practices and social constraints. A detailed discussion has been done on importance of preoperative passive joint mobilization regime and role of botulinum toxin in the authors' preferred ways of surgical correction of primary as well as secondary deformities. An extensive review of peer-reviewed publications has been done in this study, including clinical papers, review articles, and systematic review of the subject. Good results are possible with early and appropriate intervention even in severe cases.
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Affiliation(s)
- Mukund R. Thatte
- Department of Plastic, Hand and Reconstructive Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
- Department of Plastic Surgery, BJ Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Harsh R. Shah
- Department of Plastic, Hand and Reconstructive Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Amita Hiremath
- Department of Plastic, Hand and Reconstructive Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Albalat W, Ghonemy S, Saleh A, Elradi M. Microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study. Arch Dermatol Res 2023; 315:839-846. [PMID: 36334117 PMCID: PMC10085893 DOI: 10.1007/s00403-022-02446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Atrophic post-acne scarring constitutes a troublesome cosmetic concern for both patients and dermatologists. Old and new therapies as well as combinations are being introduced to achieve a satisfactory response. Microneedling has been used either alone or under different combinations for its treatment. The aim was to compare its combination with topical platelet-rich plasma versus its combination with topical Botulinum Toxin-A. METHODS 30 subjects with different types and grades of atrophic post-acne scars completed the study. Right side of the face was treated with microneedling and platelet-rich plasma while the left side was treated microneedling and Botox. Response was assessed using two different scales. Patient satisfaction and pain were also assessed. RESULTS Regarding response to therapy and according to the quartile grading scale, there was no statistically significant difference between the two sides where (23.4% & 13.3%) of the right and left sides, respectively, had an excellent response. Regarding the difference in the qualitative global scarring grading system before and after treatment, there was a highly statistically significant improvement on both sides with higher improvement on the right side than left side but in a non-statistically significant way. CONCLUSIONS Both combinations present efficacious options for treating acne scars with comparable efficacy. TRIAL REGISTRATION Registered and approved prospectively by the ethical review board of the faculty of medicine, Zagazig University.
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Affiliation(s)
- Waleed Albalat
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Soheir Ghonemy
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Ayat Saleh
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Mona Elradi
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt.
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Lucci VEM. Recent updates in autonomic research: advances in the understanding of autonomic dysfunction after spinal cord injury. Clin Auton Res 2023; 33:83-85. [PMID: 37071264 DOI: 10.1007/s10286-023-00944-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Vera-Ellen M Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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Luton OW, Mortimer M, Hopkins L, Robinson DBT, Egeler C, Smart NJ, Harries R. Is there a role for botulinum toxin A in the emergency setting for delayed abdominal wall closure in the management of the open abdomen? A systematic review. Ann R Coll Surg Engl 2023; 105:306-313. [PMID: 35174720 PMCID: PMC10066655 DOI: 10.1308/rcsann.2021.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency laparotomy for either trauma or non-trauma indications is common and management is varied. Use of the open abdomen technique allowing for planned re-look is an option; however, performing delayed definitive fascial closure (DFC) following this can be a challenge. The use of botulinum toxin-A (BTX) infiltration into the lateral abdominal wall has been well documented within the elective setting; its use within the emergency setting is undecided. This systematic review assesses the efficacy and safety of BTX injection into the lateral abdominal wall muscles in the emergency setting. The primary outcome is DFC rate. METHODS Systematic review was performed according to the PROSPERO registered protocol (CRD42020205130). Papers were dual screened for eligibility, and included if they met pre-stated criteria where the primary outcome was DFC. Articles reporting fewer than five cases were excluded. Bias was assessed using the Cochrane Risk of Bias and Joanna Brigg's appraisal tools. FINDINGS Fourteen studies were screened for eligibility, twelve full texts were reviewed and two studies were included. Both studies showed evidence of bias due to confounding factors and lack of reporting. Both studies suggested significantly higher rates of DFC than reported in the literature against standard technique (90.7% vs 66%); however, these data are difficult to interpret due to strict study inclusion criteria or lack of a control population. CONCLUSION The use of BTX is deemed safe and its effects in the emergency situation may have great potential. Unfortunately, to date, there is insufficient evidence to facilitate opinion.
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Affiliation(s)
- OW Luton
- Health Education and Improvement Wales, UK
| | | | - L Hopkins
- Health Education and Improvement Wales, UK
| | | | - C Egeler
- Swansea Bay University Health Board, UK
| | - NJ Smart
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - R Harries
- Swansea Bay University Health Board, UK
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Werner Z, Trump T, Zaslau S, Shapiro R. Assessing comprehension of online information in the United States for third-line treatment of overactive bladder. Int Urogynecol J 2023; 34:701-5. [PMID: 35556151 DOI: 10.1007/s00192-022-05218-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Overactive bladder (OAB) affects up to 43% of women. Treatment ranges from lifestyle modification to invasive therapies. Nearly 75% of patients report using the internet to gain health information creating a need for interpretable, online resources. This study is aimed at evaluating the readability of online resources for OAB treatment in the US population. METHODS Google and Bing were queried regarding "sacral neuromodulation," "peripheral tibial nerve stimulation (PTNS)," and "bladder botox." The first 20 results from each search engine were assessed, representing over 90% of accessed search results. Websites were categorized as institutional/reference, commercial, nonprofit, or personal. The Gunning fog (GF), Simple Measure of Gobbledygook (SMOG), and Dale-Chall (DC) validated readability scores were used to assess results. RESULTS Sacral neuromodulation yielded 27 eligible results. The associated mean readability scores correlated with levels of college senior (GF), high school junior (SMOG), and college level (DC). PTNS yielded 31 eligible results. The associated mean readability scores correlated with levels of college senior (GF), high school senior (SMOG), and college level (DC). Bladder botox yielded 17 eligible results. The associated mean readability scores correlated with levels of college sophomore (GF), high school junior (SMOG), and college level (DC). There was no difference between the therapies regarding readability. Sixty-one percent of websites were institutional/reference, 24% were commercial, 13% were nonprofit, and 2% were personal. CONCLUSIONS High levels of reading comprehension are required by the general US population to understand OAB information obtained through the internet. These findings highlight a need for simplification of online resources pertaining to OAB.
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Eriksson SE, Zheng P, Morton S, Maurer N, Hoppo T, Jobe BA, Ayazi S. Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome? Surg Endosc 2023:10.1007/s00464-023-09882-2. [PMID: 36749378 DOI: 10.1007/s00464-023-09882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/08/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pyloroplasty and gastric peroral endoscopic myotomy (G-POEM) are effective surgeries for gastroparesis. The primary aim of this study was to evaluate outcomes of pyloroplasty and G-POEM in patients with gastroparesis and determine factors associated with favorable outcome. The secondary aim was to assess the utility of clinical response to preoperative pyloric dilation or botulinum toxin injection (Botox) on surgical outcome, a factor conventionally used as a favorable marker. METHODS There were 204 patients who underwent pyloroplasty (n = 177) or G-POEM (n = 27) for gastroparesis at our institution from 2014 to 2021. Demographic and clinical parameters were analyzed to assess their impact on surgical outcome. A subgroup of patients who had pyloric dilation or Botox injection were assessed separately. Favorable outcome was defined as patient reported complete resolution of the predominant gastroparesis symptom. RESULTS Favorable outcome was achieved in 78.4% of patients (pyloroplasty: 79.7% and G-POEM: 70.4%, p = 0.274). Among 61 patients where pre- and postoperative gastric emptying studies (GES) were available, mean 4-hour retention significantly improved from 33.5 to 15.0% (p < 0.001) and 77.0% of patients achieved normalization. Favorable outcome was not significantly impacted by etiology of gastroparesis (p = 0.120), GERD (p = 0.518), or primary gastroparesis symptom (p = 0.244). Age ≥ 40 was a significant predictor of favorable surgical outcome on multivariate analysis [OR: 2.476 (1.224-5.008), p = 0.012]. Among the patients who had preoperative dilation (n = 82) or Botox injection (n = 46), response to these interventions was not a predictor of favorable surgical outcome (p = 0.192 and 0.979, respectively). However, preoperative Botox injection, regardless of response to injection, was associated with favorable surgical outcome [OR: 3.205 (CI 1.105-9.299), p = 0.032]. CONCLUSION Symptomatic improvement after pyloroplasty or G-POEM is independent of etiology of gastroparesis, GERD, and primary symptom. Response to dilation or Botox are not markers of response to surgery. However, patients who receive Botox are 3.2 times more likely to improve postoperatively.
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Affiliation(s)
- Sven E Eriksson
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Ping Zheng
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Scott Morton
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Nicole Maurer
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Toshitaka Hoppo
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Blair A Jobe
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA.,Department of Surgery, Drexel University, Philadephia, PA, USA
| | - Shahin Ayazi
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA. .,Department of Surgery, Drexel University, Philadephia, PA, USA.
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Yıldız S, Becet N, Buyuk SK. Quality of information on Instagram about masseter botox injection for bruxism. J Stomatol Oral Maxillofac Surg 2023; 124:101279. [PMID: 36058535 DOI: 10.1016/j.jormas.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/31/2022] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM Nowadays, masseter botulinum toxin injections are frequently used to treat bruxism. People first search for social media resources for their health-related problems. However, the quality of the information on Instagram about masseter botox injection for bruxism is unknown. PURPOSE The aim of this study was to evaluate the quality ant content of the Instagram posts shared publicly about masseter botox. The hashtag #masseterbotox was searched on Instagram. MATERIALS AND METHODS A total of 1000 posts were scanned. Unrelated posts were excluded from the study. The video posts were evaluated by using Global Quality Scale (GQS) and reliability of information toolkits. RESULTS One-hundred seventy-nine photograph and 65 video posts that met the criteria were analyzed. Most of the posts were posted by doctors and healthcare professionals (151 posts), followed by clinics (87 posts) and patients (6 posts). The information reliability scores of Instagram video posts about #masseterbotox were found to be very low (1.34±1.28). Number of views, reliability of information and GQS scores were not statistically significant between groups according to the source of the video posts (p>.05). GQS scores were higher in experience videos than information and advertisement videos (p<.05). CONCLUSIONS Clinicians should warn their patients about the reliability of information on Instagram and should guide them to the right social media resources. CLINICAL IMPLICATIONS Dental professionals should direct their patients about masseter botox injections to the right resources on social media platforms.
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Hong SO. Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques. Toxins (Basel) 2023; 15:toxins15020082. [PMID: 36828397 PMCID: PMC9964918 DOI: 10.3390/toxins15020082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed.
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Affiliation(s)
- Sung Ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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Stevens J, Baillie C, Choi B, Chapman A, Kostalas M, Ratnasingham K. The use of botulinum toxin in the acute management of symptomatic complex incisional hernia: a case series. Hernia 2023. [PMID: 36633705 DOI: 10.1007/s10029-023-02739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Complications of incisional hernia are amongst the commonest presentations to the emergency surgical take. Outcomes from emergency hernia repair are poor, particularly for those with complex defects and for the growing population of comorbid, high-risk patients. Attempts to avoid emergency surgery by improving success rates of non-operative management could prove hugely beneficial. Botulinum toxin A (Botox) is already used in the elective management of incisional hernia and this study evaluates if the relaxation produced could be used to augment the outcomes of conservative management of acutely presenting incisional hernia. METHODS Patients presenting between October 2020 and April 2022 without evidence of visceral ischaemia, who had been selected for a non-operative approach, were given 300 units of Botox under image guidance to the abdominal wall in addition to standard conservative measures. RESULTS Twelve patients were eligible for Botox administration. Median age was 75 years and median BMI was 36.45 kg/m2. All patients were high risk; minimum ASA score was 3, and median frailty score was 5. In ten patients, symptoms resolved following Botox allowing for discharge without further complication. Seven subsequently referred on to the abdominal wall team. Symptoms did not settle in the two remaining patients; one required emergency laparotomy and the second was palliated. CONCLUSION Botox may be a useful adjunct to established non-operative measures in patients with acute presentations of incisional hernia. It may improve the acute symptoms, eliminate the need for high-risk emergency surgery, or provide a bridge to abdominal wall reconstruction.
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Patel AA, Garg SP, Varghese J, Alleyne B, Williams T, Huffman K, Ellis M, Galiano RD. A Comparative Analysis of Online Reporting of Possible Complications for Minimally Invasive Cosmetic Procedures. Eplasty 2023; 23:e17. [PMID: 37187869 PMCID: PMC10176491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Background The rise in Botox, fillers, and chemical peel procedures demands transparent online information that discloses all relevant risks and complications. This study assesses the quality of complication disclosure on the most popular cosmetic sites. Methods The top 50 Google search results for "Botox," "fillers," and "chemical peel" were analyzed for their reporting on relevant complications. Websites were categorized based on their origin. An overall complication, prevention, management, prevalence, and disclaimer score were assigned to each site. Results A total of 136 websites were analyzed. Of these websites, 31 (22.7%) did not mention any complications or risks associated with the treatment. The most commonly reported complications were bruising (67.0%) for Botox, swelling (79.0%) for fillers, and redness (58%) for chemical peels. The least-reported serious complications were toxin spread effects (31.0%) for Botox, vision loss (23.0%) for fillers, and allergic reaction for chemical peel (18.0%). Reports of serious and rare side effects were significantly lower than those of common side effects (Botox, P = .001; fillers, P = .004; chemical peels, P < .001). The overall mean (standard deviation) complication score across all websites was 2.81/5 (1.31). Online health reference and academic/hospital sites disclosed complications better than sources in most other categories (P < .001). Conclusions The reporting of online complications for the top 3 cosmetic procedures performed in the US is highly variable, biased, and at times, completely absent. Patients pursuing cosmetic surgery are heavily influenced by the internet and vulnerable to misinformation. Cosmetic procedure websites are in need of drastic improvement to ensure the health and safety of all patients.
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Affiliation(s)
- Anooj A Patel
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota School of Medicine, Minneapolis, MN
| | - Stuti P Garg
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Chicago, IL
| | - Jeffrey Varghese
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Chicago, IL
| | | | - Tokoya Williams
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Chicago, IL
| | - Kristin Huffman
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Chicago, IL
| | - Marco Ellis
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Chicago, IL
| | - Robert D Galiano
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Chicago, IL
- Correspondce: Robert D Galiano, MD;
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Mussarat A, Mustafa MS, Azam ST, Nafees uddin MM, Nasrullah RMU, Siddiq MA. DAXI (DaxibotulinumtoxinA) - An Innovative Approach for Frown Lines. Int J Gen Med 2023; 16:1267-1269. [PMID: 37065981 PMCID: PMC10103897 DOI: 10.2147/ijgm.s406563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/02/2023] [Indexed: 04/18/2023] Open
Abstract
Glabellar frown lines, also known as worry lines, are a common sign of aging. The current treatment option for glabellar lines is subjective and ranges from economical anti-wrinkle creams and skin resurfacing techniques such as microdermabrasion and fillers to highly expensive facelifts. Botox® has been the mainstream treatment for decades, but the suggested time between treatments for most toxins is 12-16 weeks, and evidence shows that patients being treated for glabellar lines want longer-lasting results. Recently, on September 16th, the US Food and Drug Administration (FDA) approved the development of daxibotulinumtoxinA (DAXI) for injection based on clinical trials (SAKURA 1, 2, and 3). These encouraging findings followed by FDA approval mean that the need for repeated treatments to sustain the desired outcome has decreased. DAXI could be a reliable and secure choice for reducing the appearance of wrinkles on the face caused by muscle activity, and its long duration has the potential to enhance the treatment of both therapeutic and cosmetic disorders.
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Affiliation(s)
- Abdullah Mussarat
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Syed Talal Azam
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Mohammad Arham Siddiq
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
- Correspondence: Mohammad Arham Siddiq, Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Road, Karachi, Pakistan, Tel +923412127759, Email
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Holmes A, Kelsey E, Wombwell A, Molesworth C, McLeod K. Are we underestimating urinary retention following intravesical onabotulinumtoxinA in women with overactive bladder and a history of prior pelvic surgery? Neurourol Urodyn 2023; 42:106-112. [PMID: 36183370 PMCID: PMC10092604 DOI: 10.1002/nau.25054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/03/2023]
Abstract
AIMS This study's purpose is to review the rates of urinary retention requiring intermittent catheterization (IC) post intravesical OnabotulinumtoxinA (BTN/A) injection for idiopathic overactive bladder from a single practicing specialist urological surgeon. METHODS We performed a retrospective review of a single Australian urologist to identify the rate of intermittent catheterization in our clinical setting. Logistic regression was used to assess associations between requirement of IC and risk factors for urinary retention. RESULTS Ninety-four patients were included after inclusion and exclusion criteria were applied and the average age was 69.7 years (SD 17.2) and all participants were female. Thirty-six percent (n = 34) of patients required IC. Of patients requiring IC, 32% had a prior urethral sling, 35% had prior vaginal prolapse surgery, and 29% had a preoperative urinary tract infection (UTI). There was strong evidence of univariate associations between IC and prior sling (odds ratio [OR]: 5.26, 95% confidence interval [CI]: 1.64-16.55, p = 0.005), preoperative UTI (OR: 4.25, 95% CI: 1.31-13.08, p = 0.016) and prior vaginal prolapse surgery (OR: 4.91, 95% CI: 1.64-14.72, p = 0.005). Evidence that prior sling patients were more likely to require IC remained strong in a multivariable model (OR: 7.35, 95% CI: 1.59-34.11, p = 0.011). CONCLUSION Prior urethral sling surgery, prior vaginal prolapse surgery, and positive preoperative UTI, despite treatment, were found to be associated with a higher rate of initiation of intermittent catheterization. The rate of IC initiation of 36% was higher than reported in prior clinical trials.
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Affiliation(s)
- Angela Holmes
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ellen Kelsey
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Amy Wombwell
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | | | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.,Department of Surgery, School of Medicine, Deakin University, Geelong, Victoria, Australia
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Anwar H, Attard A, Green J, Elledge ROC. Botulinum toxin in the management of myalgia in temporomandibular disorders: are all injections equal? Br J Oral Maxillofac Surg 2023; 61:89-93. [PMID: 36522255 DOI: 10.1016/j.bjoms.2022.11.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
Botulinum toxin (BTX) is becoming widely used as an adjunct to conservative management of myalgia-predominant temporomandibular disorders (TMDs) with reports of improved quality of life. There is, however, no consensus on the optimal dosage. Based on previous studies, dose regimens vary between clinicians, and we know of no standard dose protocol for the administration of BTX for the purpose of TMD management. A survey was sent to members of the British Association of Oral and Maxillofacial Surgeons (BAOMS) Temporomandibular Joint Sub-Specialty Interest Group (TMJ SSIG) and an international mailing list of high-volume TMJ surgeons (the TMJ Internetwork) to ascertain variations in dose regimens between different clinicians. The survey found that 41 respondents offered BTX to patients. The masseter muscle group was the most commonly injected site, and the majority of respondents (34/41) used Botox® (Allergan). Brands less commonly used included Dysport® (Ipsen), and Xeomin® (Merz Pharma). Botox® doses varied between 30 and 100 units, whilst Dysport® doses ranged from 50 - 300 units/muscle. The number of injection sites/muscle also varied. This survey demonstrates the wide variation in practice amongst clinicians with respect to BTX administration. To ensure optimal dose and response titration, further studies and evidence-based research are needed to standardise its use for the treatment of TMDs.
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Azzam SH, Mukari A, Hamed M, Kridin K. Influence of COVID-19 mRNA vaccination on the efficacy and safety of Botulinum Toxin type A injections. J Cosmet Dermatol 2022; 21:3663-3666. [PMID: 35866341 PMCID: PMC9349385 DOI: 10.1111/jocd.15251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Concerns have been raised recently regarding the efficacy and safety of Botulinum toxin type A (BTA) injections following COVID-19 vaccination. AIMS To assess the influence of BNT162b2 mRNA vaccine on the safety and efficacy of BTA injections performed for aesthetic indications. METHODS A retrospective cohort study followed patients undergoing periodic BTA treatments who completed two doses of BNT162b2 vaccine. The latency between BTA injections before and after getting vaccinated was assessed for all study participants. Efficacy and longevity of BTA was reflected and evaluated by the latency between BTA injections. Patients were longitudinally monitored for the development of adverse events. RESULTS Forty-five patients were eligible for inclusion in the current study. The mean (standard deviation [SD]) age of patients was 48.3 (8.9) years and 40 (88.9%) patients were females. The mean (SD) number of pre- and post- COVID-19 vaccination BTA injections was 5.1 (2.6) and 3.1 (0.4), respectively. The average (SD) interval between BTA injections after COVID-19 vaccination (96.0 [12.3] days) was significantly shorter than before it (118.6 [22.7]; P<0.001). No severe BTA-associated adverse events were registered after the administration of BNT162b2 vaccine. CONCLUSIONS Our findings indicate that BTA might be less effective after COVID-19 vaccination. Further research is required to delineate the pathomechanism underlying this observation.
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Affiliation(s)
- Shirin Hamed Azzam
- Oculoplastic Clinic, Estemed Medical Center, Kfar Kanna, Israel.,Ophthalmology department, Baruch Padeh Medical Center, Poriya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Abed Mukari
- Oculoplastic Clinic, Estemed Medical Center, Kfar Kanna, Israel
| | - Mira Hamed
- Dermatology department, Emek Medical Center, Afula, Israel
| | - Khalaf Kridin
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Poria Medical Center, Israel
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Fan T, Frederick R, Abualsoud A, Sheyn A, McLevy-Bazzanella J, Thompson J, Akkus C, Wood J. Treatment of sialorrhea with botulinum toxin injections in pediatric patients less than three years of age. Int J Pediatr Otorhinolaryngol 2022; 158:111185. [PMID: 35594794 DOI: 10.1016/j.ijporl.2022.111185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the patient demographics and the efficacy and safety profile of botulinum toxin (BTX) injections for sialorrhea control in patients under the age of three. METHODS This is a retrospective chart review study. Patients under three years of age who received BTX injections for sialorrhea management from 2010 to 2021 were assessed. Patient demographics, comorbidities, medical and surgical histories, indications, BTX injection details, and post injection complications were documented. RESULTS Forty-nine patients met inclusion criteria. The most common patient under three years of age with sialorrhea to receive BTX injections were white (51.0%) male (51.0%) with congenital (73.5%) and/or neurologic (53.1%) comorbidities. Thirty-six (73.5%) patients were from medically underserved areas/populations. Our patients on average received 1.7 injections, with 44.9% requiring multiple BTX injections. Bilateral parotid and bilateral submandibular glands (four-gland) BTX injections were associated with significant decrease in admissions for pneumonia and cessation of anticholinergics usage (both P < 0.05). Post BTX injections, 15 (30.6%) patients required additional surgeries for sialorrhea control. No adverse outcomes due to BTX injections were reported. CONCLUSIONS Pediatric sialorrhea was commonly associated with congenital and/or neurologic comorbidities and disproportionately impacted medically underserved black patients. BTX injections offered multifaceted benefits for controlling sialorrhea in patients under the age of three. Four-gland BTX injections led to reduction of unnecessary hospitalization, usage of anticholinergics, and additional surgeries for sialorrhea management.
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