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Fulltext Case Series of Pancytopenia Secondary to Pernicious Anaemia

Low, Qin Jian, Hong, Eric Qiu Weng, Cheo Seng Wee

Borneo Journal of Medical Sciences, 2019;13(2):55-59.
MyJurnal

Pernicious anaemia is an autoimmune disorder where vitamin B12 deficiency is caused by autoantibodies that interfere with vitamin B12 absorption by targeting intrinsic factor or parietal cells or both. It is commonly associated with anaemia, rarely pancytopenia. Here we reported two cases of pancytopenia due to undiagnosed pernicious anaemia. First case was a 26-year-old man presented with lethargy and reduced effort tolerance, associated with postural giddiness and palpitation. Clinically, he was pale with no other findings. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was treated with daily subcutaneous injection of vitamin B12 cyanocobalamin 1 mg for one week followed by weekly injection for a month and subsequently with lifelong monthly subcutaneous injection. After receiving 2 weeks of B12 replacement, his full blood count had normalized and his symptoms resolved. Second case was a 65-year-old man presented with yellowish discolouration of the eyes with lethargy. On examination, he was pale with jaundice. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was started with intramuscular injection of 1000 mcg vitamin B12 replacement daily for one week followed by monthly for 6 months. After one week of B12 replacement, his full blood count had normalized. He was started on lifelong 3 monthly injections of vitamin B12 replacement and he remained symptom free. Patients with pernicious anaemia often present with general signs and symptoms which occur insidiously. It is important that early diagnosis is made to avoid harmful complications such as neuropsychiatric disorders.

Matched MeSH terms: Injections, Intramuscular
Outpatient treatment of psychotic patients with a long-acting phenothiazine: fluphenazine decanoate

Kinzie JD, Simons RC

Med J Malaya, 1971 Dec;26(2):129-32.
PMID: 4260859
Matched MeSH terms: Injections, Intramuscular
Fulltext Protein identification of vitellogenin in river catfish (Hemibagrus nemurus)

Roshani Othman, Sharr Azni Harmin, Ina-Salwany Md Yasin

Bioremediation Science and Technology Research, 2015;3(1):1-5.
MyJurnal

Mass production of fish broodstock with high quality eggs requires the knowledge on the chemical composition and physiochemical properties of vitellogenin (Vtg) during ovulation. Vtg is an egg yolk precursor phospholipoglycoprotein, and has been analysed to evaluate the reproductive conditions and determine the spawning period in captive and wild fish. In this study, Vtg was induced in male H. nemurus through three intramuscular injections of 17-estradiol (E2). The Vtg was purified from the serum using gel filtration chromatography and the purified protein was reduced via SDS-PAGE. One major polypeptide corresponding to 130 kDa was observed. Vtg identification was done using peptide mass fingerprint (PMF) from the trypsin digestion of male H. nemurus Vtg induced with E2. The sequence homology of H. nemurus AYLAGAAADVLEVGVR matched the Vtg of other fish species when analysed using MALDI-TOF. Vtg was confirmed by MASCOT at 95% significant level. The potential protein that controls the reproductive process and oocyte development isolated from this study was discussed to understand the structure and function of Vtg.

Matched MeSH terms: Injections, Intramuscular
Piper sarmentosum water extract attenuates diabetic complications in streptozotocin induced sprague-dawley rats

FARIDA HUSSAN, NUR NAZILAH BT MAT ZIN, MOHD RAMDZI BIN ZULLKEFLI, YOW SC, NOOR ADIBAH BT ABDULLAH, TEOH SL

Sains Malaysiana, 2013;42:1605-1612.

Piper sarmentosum has been shown to possess antihyperglycemic effect. The effect of water extract of PS leaves was determined on the diabetic complications in streptozotocin induced rats. Eighteen male Sprague Dawley rats (n=18) were randomly divided into three groups with six rats each, namely, control, diabetic untreated and PS treated diabetic groups. Diabetes was induced with intramuscular injection of STZ (50 mg/kg). Ten days following the induction, the diabetes was confirmed with fasting blood sugar level more than 8 mmol/L and PS extract was administered orally (0.125 g/kg) for 28 days. The left kidneys were collected to analyze. The body weight and kidney weight index showed significant differences between control and diabetic groups (p<0.05). However, the lesser extent of body weight gain was observed in diabetic group compared with the control groups. The fasting blood sugar level was reduced in PS treated group. The percent area occupied by the glomerulus over a renal corpuscle was found to be 74.5% in DPS, 72% in DNT and 75% in C group; however it was statistically insignificant. Histological study revealed marked inflammatory cells infiltration and glomeruli contraction with widened urinary spaces revealed in DNT group following 28 days of hyperglycemic state whereas the DPS group showed features of improvement. The water extract of PS leaves has the potential preventive effect on the diabetic nephropathy by reducing hyperglycemia.

Matched MeSH terms: Injections, Intramuscular
Influence of route of administration on the absorption and disposition of alpha-, gamma- and delta-tocotrienols in rats

Yap SP, Yuen KH, Lim AB

J Pharm Pharmacol, 2003 Jan;55(1):53-8.
PMID: 12625867

A study was conducted to evaluate the bioavailability of alpha-, gamma- and delta-tocotrienols administered via oral, intravenous, intramuscular and intraperitoneal routes in rats. Three separate experiments, each conducted according to a two-way crossover design, were carried out to compare intravenous and oral, intramuscular and oral, and intraperitoneal and oral administration. Oral absorption of all three tocotrienols was found to be incomplete. Of the three tocotrienols, alpha-tocotrienol had the highest oral bioavailability, at about 27.7+/-9.2%, compared with gamma- and delta-tocotrienols, which had values of 9.1+/-2.4% and 8.5+/-3.5%, respectively. Such biodiscrimination was also observed in their total clearance rates (estimated from the intravenous data). alpha-Tocotrienol showed the lowest clearance rate at about 0.16 L kg(-1) h(-1), whereas that of delta- and gamma-tocotrienols was quite similar, with values of 0.24 and 0.23 L kg(-1) h(-1), respectively. Interestingly, all three tocotrienols were found to be negligibly absorbed when administered intraperitoneally and intramuscularly. Thus, these two routes of administration should be avoided when evaluating the biological activities of the tocotrienols in whole animal experiments.

Matched MeSH terms: Injections, Intramuscular
Fulltext True hermaphrodite--a case report

Yip CH, Pathmanathan R

Singapore Med J, 1996 Feb;37(1):117-8.
PMID: 8783930

A case report of a male true hermaphrodite with 46XX/46XY karyotype is presented. He was first diagnosed at the age of 9 years when he presented with hypospadias and a left undescended testis. He was lost to follow-up until he presented at the age of 23 years with bilateral gynaecomastia. A hormonal profile showed a low testosterone level, while a seminal assay showed very few sperms. However he claimed to be sexually active. A year later, after he got married, he began to complain of impotence. A review of the condition is presented.

Matched MeSH terms: Injections, Intramuscular
Fulltext Effect of Piper sarmentosum Extract on the Cardiovascular System of Diabetic Sprague-Dawley Rats: Electron Microscopic Study

Thent ZC, Seong Lin T, Das S, Zakaria Z

Evid Based Complement Alternat Med, 2012;2012:628750.
PMID: 23304208 DOI: 10.1155/2012/628750

Although Piper sarmentosum (PS) is known to possess the antidiabetic properties, its efficacy towards diabetic cardiovascular tissues is still obscured. The present study aimed to observe the electron microscopic changes on the cardiac tissue and proximal aorta of experimental rats treated with PS extract. Thirty-two male Sprague-Dawley rats were divided into four groups: untreated control group (C), PS-treated control group (CTx), untreated diabetic group (D), and PS-treated diabetic group (DTx). Intramuscular injection of streptozotocin (STZ, 50 mg/kg body weight) was given to induce diabetes. Following 28 days of diabetes induction, PS extract (0.125 g/kg body weight) was administered orally for 28 days. Body weight, fasting blood glucose, and urine glucose levels were measured at 4-week interval. At the end of the study, cardiac tissues and the aorta were viewed under transmission electron microscope (TEM). DTx group showed increase in body weight and decrease in fasting blood glucose and urine glucose level compared to the D group. Under TEM study, DTx group showed lesser ultrastructural degenerative changes in the cardiac tissues and the proximal aorta compared to the D group. The results indicate that PS restores ultrastructural integrity in the diabetic cardiovascular tissues.

Matched MeSH terms: Injections, Intramuscular
Efficacy and safety of long-acting intramuscular testosterone undecanoate in aging men: a randomised controlled study

Tan WS, Low WY, Ng CJ, Tan WK, Tong SF, Ho C, et al.

BJU Int, 2013 Jun;111(7):1130-40.
PMID: 23651425 DOI: 10.1111/bju.12037

OBJECTIVE: To evaluate the efficacy and safety of long-acting i.m. testosterone undecanoate (TU) in Malaysian men with testosterone deficiency (TD).
PATIENTS AND METHODS: A total of 120 men, aged 40-70 years, with TD (serum total testosterone [TT] ≤ 12 nmol/L) were randomised to receive either i.m. TU (1000 mg) or placebo. In all, 58 and 56 men in the placebo and treatment arm, respectively, completed the study. Participants were seen six times in the 48-week period and the following data were collected: physical examination results, haemoglobin, haematocrit, TT, lipid profile, fasting blood glucose, sex hormone-binding globulin, liver function test, prostate- specific antigen (PSA) and adverse events.
RESULTS: The mean (sd) age of the participants was 53.4 (7.6) years. A significant increase in serum TT (P < 0.001), PSA (P = 0.010), haematocrit (P < 0.001), haemoglobin (P < 0.001) and total bilirubin (P = 0.001) were seen in the treatment arm over the 48-week period. Two men in the placebo arm and one man in the treatment arm developed myocardial infarction. Common adverse events observed in the treatment arm included itching/swelling/pain at the site of injection, flushing and acne. Overall, TU injections were well tolerated.
CONCLUSIONS: TU significantly increases serum testosterone in men with TD. PSA, haemoglobin and haematocrit were significantly elevated but were within clinically safe limits. There was no significant adverse reaction that led to the cessation of treatment.

Matched MeSH terms: Injections, Intramuscular/adverse effects
The effects of orchidectomy and supraphysiological testosterone administration on trabecular bone structure and gene expression in rats

Chin KY, Ima-Nirwana S

Aging Male, 2015 Mar;18(1):60-6.
PMID: 25166624 DOI: 10.3109/13685538.2014.954995

This study aimed to determine the effects of orchidectomy and supraphysiological testosterone replacement on trabecular structure and gene expression in the bone.

Matched MeSH terms: Injections, Intramuscular
Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial

A Hamid MS, Mohamed Ali MR, Yusof A, George J, Lee LP

Am J Sports Med, 2014 Oct;42(10):2410-8.
PMID: 25073598 DOI: 10.1177/0363546514541540

BACKGROUND: A hamstring injury is one of the most common types of injury affecting athletes. Despite this, the optimal management of hamstring muscle injuries is not yet defined. The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear.
PURPOSE: To investigate the effect of a single PRP injection in the treatment of grade 2 hamstring muscle injuries.
STUDY DESIGN: Randomized controlled trial; Level of evidence, 2.
METHODS: Twenty-eight patients diagnosed with an acute hamstring injury were randomly allocated to autologous PRP therapy combined with a rehabilitation program or a rehabilitation program only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and pain interference scores over time were examined.
RESULTS: Patients in the PRP group achieved full recovery significantly earlier than controls (P = .02). The mean time to return to play was 26.7 ± 7.0 days and 42.5 ± 20.6 days for the PRP and control groups, respectively (t(22) = 2.50, P = .02). [corrected]. Significantly lower pain severity scores were observed in the PRP group throughout the study. However, no significant difference in the pain interference score was found between the 2 groups.
CONCLUSION: A single autologous PRP injection combined with a rehabilitation program was significantly more effective in treating hamstring injuries than a rehabilitation program alone.
KEYWORDS: management; muscle injury; platelet-rich plasma (PRP); return to play

Matched MeSH terms: Injections, Intramuscular
The effects of intramuscular and intraperitoneal injections of benzo[a]pyrene on selected biomarkers in Clarias gariepinus

Karami A, Christianus A, Ishak Z, Syed MA, Courtenay SC

Ecotoxicol Environ Saf, 2011 Sep;74(6):1558-66.
PMID: 21636131 DOI: 10.1016/j.ecoenv.2011.05.012

This study investigated the dose-dependent and time-course effects of intramuscular (i.m.) and intraperitoneal (i.p.) injection of benzo[a]pyrene (BaP) on the biomarkers EROD activity, GST activity, concentrations of BaP metabolites in bile, and visceral fat deposits (Lipid Somatic Index, LSI) in African catfish (Clarias gariepinus). Intraperitoneal injection resulted in 4.5 times higher accumulation of total selected biliary FACs than i.m. injection. Hepatic GST activities were inhibited by BaP via both injection methods. Dose-response relationships between BaP injection and both biliary FAC concentrations and hepatic GST activities were linear in the i.p. injected group but nonlinear in the i.m. injected fish. Hepatic EROD activity and LSI were not significantly affected by BaP exposure by either injection route. We conclude that i.p. is a more effective route of exposure than i.m. for future ecotoxicological studies of PAH exposure in C. gariepinus.

Matched MeSH terms: Injections, Intramuscular
Fulltext All elevated creatine kinase is not neuroleptic malignant syndrome

Maniam T, Rahman MA

Med J Malaysia, 1994 Sep;49(3):252-4.
PMID: 7845275

Creatine kinase (CK) is an enzyme that is found widely in muscle tissues. Raised levels would occur when there is muscle damage. Raised levels are used as one of the diagnostic criteria for Neuroleptic Malignant Syndrome (NMS). This study looks at CK levels in 30 psychotic inpatients without NMS and compares them with 10 patients with NMS. It was found that 67% of the patients without NMS had raised CK levels, 20% of whom had levels in excess of 1000 IU/L. The rest had a two to five-fold increase over normal limits. Raised levels were associated with the use of intramuscular injections and physical restraints, situations which are well known to result in muscle injury. All the NMS patients had raised CK levels but 40% had levels below 1000 IU/L. Our findings support the idea that CK levels, though helpful, should be interpreted with care as raised levels are nonspecific.

Matched MeSH terms: Injections, Intramuscular
Effects of nicardipine on lipid peroxidation in rabbits given 2% cholesterol diet

Ismail NM, Jaarin K, Vasudevan SK, Hashim S

Pharmacol. Toxicol., 1995 Jul;77(1):10-5.
PMID: 8532606

Nicardipine has been shown to have an anti-atherogenic effect in rabbits given a 2% cholesterol diet. Current evidence suggests that lipid peroxidation plays an important role in atherogenesis. This study examines the effect of nicardipine on lipid peroxidation in rabbits given a 2% cholesterol diet, 8 of these rabbits given nicardipine 0.5 mg/kg twice daily intramuscularly for ten weeks while the remaining untreated 6 were controls. After ten weeks, serum malondialdehyde in the control group was significantly higher compared to their baseline levels (P < 0.05). However, there was no increase in serum malondialdehyde in the nicardipine group after 10 weeks. The area of Sudan IV positive intimal lesions (atherosclerotic plaques) were significantly decreased (P < 0.01) in the treated group compared to the control group. The aortic tissue content of cholesterol and diene conjugates were also decreased in the nicardipine group (P < 0.01). These findings suggest a possible link between nicardipine and lipid peroxidation in mediating its antiatherogenic effects.

Matched MeSH terms: Injections, Intramuscular
Coagulation studies in Asian women using injectable progestogen for contraception

Tsakok FH, Koh S, Yuen R, Ratnam SS

Int J Gynaecol Obstet, 1980 9 1;18(2):105-8.
PMID: 6108245 DOI: 10.1002/j.1879-3479.1980.tb00256.x

Coagulation, fibrinolytic activity and platelet function were studied in 104 Asian women volunteers who received 150 mg of depot medroxyprogesterone acetate intramuscularly every three months for two years or more. The results were compared with those in matched controls. There was a paucity of change in coagulation factors. The fibrinogen levels were increased and prothrombin time was shortened. The fibrinolytic activity, as shown by the euglobulin clot lysis time, was significantly increased. This latter change contrasts with the many reports concerning Caucasian women and may reflect an increase in fibrinolytic potential in Asian women.

Matched MeSH terms: Injections, Intramuscular
Radioactive uptake of [14C]histamine by certain tissues in guinea-pigs treated and untreated with chlorpromazine

Ridzwan BH, Waton NG

Comp Biochem Physiol C Comp Pharmacol Toxicol, 1990;97(2):251-5.
PMID: 1982867

1. Oral administration of [14C]histamine induced the presence of small amounts of [14C]histamine in stomach and ileal tissues of control guinea-pigs. In contrast, much larger amounts were found after 8 h infusion. 2. Similar amounts of [14C]histamine were found in the tissues when [14C]histamine was given by intravenous infusion from 24-30 h after chlorpromazine injection.

Matched MeSH terms: Injections, Intramuscular
The effect of iodized oil on goitre size, thyroid function and the development of the Jod Basedow phenomenon

Maberly GF, Corcoran JM, Eastman CJ

Clin Endocrinol (Oxf), 1982 Sep;17(3):253-9.
PMID: 6299619
Matched MeSH terms: Injections, Intramuscular
Pharmacokinetics of the Sri Lankan hump-nosed pit viper (Hypnale hypnale) venom following intravenous and intramuscular injections of the venom into rabbits

Tan CH, Sim SM, Gnanathasan CA, Fung SY, Tan NH

Toxicon, 2014 Mar;79:37-44.
PMID: 24412778 DOI: 10.1016/j.toxicon.2013.12.011

The knowledge of venom pharmacokinetics is essential to improve the understanding of envenomation pathophysiology. Using a double-sandwich ELISA, this study investigated the pharmacokinetics of the venom of hump-nosed pit viper (Hypnale hypnale) following intravenous and intramuscular injections into rabbits. The pharmacokinetics of the venom injected intravenously fitted a three-compartment model. There is a rapid (t1/2π = 0.4 h) and a slow (t1/2α = 0.8 h) distribution phase, followed by a long elimination phase (t1/2β = 19.3 h) with a systemic clearance of 6.8 mL h(-1) kg(-1), consistent with the prolonged abnormal hemostasis reported in H. hypnale envenomation. On intramuscular route, multiple peak concentrations observed in the beginning implied a more complex venom absorption and/or distribution pattern. The terminal half-life, volume of distribution by area and systemic clearance of the venom injected intramuscularly were nevertheless not significantly different (p > 0.05) from that of the venom injected intravenously. The intramuscular bioavailability was exceptionally low (Fi.m. = 4%), accountable for the highly varied median lethal doses between intravenous and intramuscular envenomations in animals. The findings indicate that the intramuscular route of administration does not significantly alter the pharmacokinetics of H. hypnale venom although it significantly reduces the systemic bioavailability of the venom.

Matched MeSH terms: Injections, Intramuscular
Non-clinical safety assessment of repeated intramuscular administration of an EV-A71 VLP vaccine in rabbits

Salmons B, Lim PY, Djurup R, Cardosa J

Vaccine, 2018 10 29;36(45):6623-6630.
PMID: 30293762 DOI: 10.1016/j.vaccine.2018.09.062

A candidate hand, foot, and mouth disease vaccine comprising of human enterovirus A71 (EV-A71) virus-like particles (VLPs) was tested in rabbits to evaluate the potential local and systemic effects of this vaccine. The rabbits received more than double the full human dose and one additional dose according to the n + 1 recommended scheme. The three doses were given mixed with Alhydrogel adjuvant as intramuscular (IM) injections. Vaccinations were well-tolerated, with no indication of overt toxicity in any parameter observed. An EV-A71 specific immune response in the form of antibodies that specifically reacted with the virus capsid proteins VP1 and VP0, the complete VLP, and EV-A71 viruses of different subgenotypes to that of the vaccine could be demonstrated. A boosting effect in the form of higher EV-A71 specific antibody titers was observed after the subsequent doses, and these enhanced titers were shown to be statistically significant in one-way ANOVA analyses. Fortnightly intramuscular administration of EV-A71 VLP vaccine did not result in any test article-related changes in immunotoxicity as defined by increased serum IL-6, and in general IL-6 concentrations remained below the lower limit of quantitation for the majority of animals throughout the study. Although increased indicators of inflammation at the injection site were observed in animals sacrificed immediately after the last vaccination, these largely reversed at the end of the recovery phase. No findings suggestive of systemic or delayed toxicity were recorded in this independently conducted study. In conclusion, repeated IM administration of the EV-A71 VLP vaccine were locally and systemically well-tolerated in rabbits and immunogenic, supporting the clinical development of the vaccine.

Matched MeSH terms: Injections, Intramuscular
Fulltext Survey of postoperative pain in University Hospital Kuala Lumpur

Vijayan R, Tay KH, Tan LB, Loganathan

Singapore Med J, 1994 Oct;35(5):502-4.
PMID: 7701371

One hundred and eighty-three patients undergoing surgery were interviewed twenty-four hours following surgery to assess the quality of pain relief they received in the immediate postoperative period. Interviews were conducted using a standard questionnaire for all patients. They were asked to (1) rate the quality of pain relief they obtained on a Visual Pain Analogue Scale (VPAS-0 being no pain and 10 being the worst imaginable pain); (2) state whether they were happy and satisfied with the pain relief they received; (3) if dissatisfied, they were asked to give their reasons. 37.7% (69 patients) had moderate to severe pain--pain score greater than 6 on the VPAS. Most of these patients had undergone abdominal or major orthopaedic surgery. 32.7% (60 patients) were unhappy with their postoperative pain control. The main reasons for complaint from the patients were that analgesic injections were either not given promptly or were not given at all. The survey also highlighted the inadequate under-administration of narcotic injections in the postoperative period despite orders being written up. It showed there is an urgent need for setting up an Acute Pain Service for better postoperative pain control. An anaesthesiology based Acute Pain Service was started in October 1992.

Matched MeSH terms: Injections, Intramuscular
Fulltext Mutagenicity evaluation of Anastatica hierochuntica L. aqueous extract in vitro and in vivo

Md Zin SR, Mohamed Z, Alshawsh MA, Wong WF, Kassim NM

Exp Biol Med (Maywood), 2018 Feb;243(4):375-385.
PMID: 29237294 DOI: 10.1177/1535370217748574

Anastatica hierochuntica L. ( A. hierochuntica), a folk medicinal plant, was evaluated for mutagenic potential via in vitro and in vivo assays. The in vitro assay was conducted according to modified Ames test, while the in vivo study was performed according to Organisation for Economic Co-operation and Development guideline for mammalian erythrocyte micronucleus assay. Four groups ( n= 5 males and 5 females per group) Sprague Dawley rats were randomly chosen as the negative control, positive control (received a single intramuscular injection of cyclophosphamide 50 mg/kg), 1000 and, 2000 mg/kg A. hierochuntica aqueous extracts. All groups except the positive control were treated orally for three days. Findings of the in vitro assay showed mutagenic potential of AHAE at 0.04 and 0.2 mg/ml. However, no mutagenic effect was demonstrated in the in vivo study up to 2000 mg/kg. No significant reduction in the polychromatic and normochromatic erythrocytes ratio was noted in any of the groups. Meanwhile, high micronucleated polychromatic erythrocytes frequency was seen in cyclophosphamide-treated group only. These findings could perhaps be due to insufficient dosage of A. hierochuntica aqueous extracts to cause genetic damage on the bone marrow target cells. Further acute and chronic in vivo toxicity studies may be required to draw pertinent conclusion on the safety aspect of A. hierochuntica aqueous extracts consumption. Impact statement In this paper, we report on the mutagenicity evaluation of Anastatica hierochuntica aqueous extract. This is a significant research in view of the popularity of this herb consumption by the people across the globe despite of limited scientific evidence on its toxicity potential. This study is intended to encourage more extensive related research in order to provide sufficient evidence and guidance for determining its safe dosage.

Matched MeSH terms: Injections, Intramuscular

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