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Recent developments in intramuscular iron therapy

BOERMAN AJ

Med J Malaysia, 1963 Sep;18:5-7.
PMID: 14064301
Matched MeSH terms: Injections, Intramuscular*
Problems with rabies postexposure management: a survey of 499 public hospitals in Thailand

Kositprapa C, Wimalratna O, Chomchey P, Chareonwai S, Benjavongkulchai M, Khawplod P, et al.

J Travel Med, 1998 Mar;5(1):30-2.
PMID: 9772313

Rabies is still a major public health problem in Asia. The incidence of known annual human cases in India alone has recently been revised from 20,000 to 30,000, and over 500,000 patients are given some form of postexposure rabies treatment. Only China, Peninsular Malaysia, Singapore, and Thailand are reporting a significant decrease in the prevalence of this disease in humans. Over 150,000 courses of postexposure treatment (PET) are given in Thailand every year. To determine remaining barriers to further reduction of the number of human rabies deaths, we carried out a questionnaire study of government hospitals throughout the Kingdom.

Matched MeSH terms: Injections, Intramuscular
Fulltext Proteus Mirabilis in sternomastoid abscess: a double rarity

Khairi, M.D.M., Irfan, M.

International Medical Journal Malaysia, 2007;6(2):1-5.
MyJurnal

Neck abscess is still common in developing countries. Often the presentation is late especially when the pain becomes intolerable or the airway is compromised. Intramuscular abscess in the neck is very rarely encountered. We report a case of an abscess of the right sternocleidomastoid. The culture grew Proteus mirabilis. The outline of management is discussed.

Matched MeSH terms: Injections, Intramuscular
Fulltext Unusual reaction to intramuscular sulfone in two leprosy patients in Malaysia

Laing ABG

Int. J. Lepr. Other Mycobact. Dis., 1980 Mar;48(1):70.
PMID: 7189187
Matched MeSH terms: Injections, Intramuscular/adverse effects
Toxicokinetics of Naja sputatrix (Javan spitting cobra) venom following intramuscular and intravenous administrations of the venom into rabbits

Yap MK, Tan NH, Sim SM, Fung SY

Toxicon, 2013 Jun;68:18-23.
PMID: 23537711 DOI: 10.1016/j.toxicon.2013.02.017

Existing protocols for antivenom treatment of snake envenomations are generally not well optimized due partly to inadequate knowledge of the toxicokinetics of venoms. The toxicokinetics of Naja sputatrix (Javan spitting cobra) venom was investigated following intravenous and intramuscular injections of the venom into rabbits using double-sandwich ELISA. The toxicokinetics of the venom injected intravenously fitted a two-compartment model. When the venom was injected intramuscularly, the serum concentration-time profile exhibited a more complex absorption and/or distribution pattern. Nevertheless, the terminal half-life, volume of distribution by area and systemic clearance of the venom injected intramuscularly were not significantly different (p > 0.05) from that of the venom injected intravenously. The systemic bioavailability of the venom antigens injected by intramuscular route was 41.7%. Our toxicokinetic finding is consistent with other reports, and may indicate that some cobra venom toxins have high affinity for the tissues at the site of injection. Our results suggest that the intramuscular route of administration doesn't significantly alter the toxicokinetics of N. sputatrix venom although it significantly reduces the systemic bioavailability of the venom.

Matched MeSH terms: Injections, Intramuscular*
Fulltext Yaws in the Western pacific region: a review of the literature

Capuano C, Ozaki M

J Trop Med, 2011;2011:642832.
PMID: 22235208 DOI: 10.1155/2011/642832

Until the middle of the 20th century, yaws was highly endemic and considered a serious public health problem in the Western Pacific Region (WPR), leading to intensive control efforts in the 1950s-1960s. Since then, little attention has been paid to its reemergence. Its current burden is unknown. This paper presents the results of an extensive literature review, focusing on yaws in the South Pacific. Available records suggest that the region remains largely free of yaws except for Papua New Guinea, Solomon Islands, and Vanuatu. Many clinical cases reported recently were described as "attenuated"; advanced stages are rare. A single intramuscular injection of benzathine penicillin is still effective in curing yaws. In the Pacific, yaws may be amenable to elimination if adequate resources are provided and political commitment revived. A mapping of yaws prevalence in PNG, Solomon, and Vanuatu is needed before comprehensive country-tailored strategies towards yaws elimination can be developed.

Matched MeSH terms: Injections, Intramuscular
A field study of Depo-Provera: its use as a contraceptive method by women in a rural town in West Malaysia from February 1968 to December 1969

Hew Wai Sin, Peng JY, Dato Ariffin Marzuki

Med J Malaysia, 1973 Jun;27(4):299-305.
PMID: 4270790

PIP: To determine the acceptability, practicability, and popularity of Depo-Provera as an additional contraceptive method to be offered by the National Family Planning Board NFPB of Malaysia, 550 patients of Sungai Besar, Malaysia, who accepted the Depo-Provera injection method from the start of the injection program, February 23, 1968, until the cutoff date of December 31, 1969, were studied. At the cutoff date, 318 (58%) were still receiving regular injections at 3-month intervals. The remaining 232 women discontinued use of the injection. Of those who discontinued use, 176 (32%) were interviewed, while the other 56 women were lost to follow-up, due mainly to migration. Assuming that 1 injection would protect a woman from getting pregnant for a 3-month period, the retention rates at the end of 12 and 24 months were 63% and 41%. These continuation rates were fairly high and were as good as those for the oral pill, which is the main contraceptive method provided since the beginning of the operational service program of the NFPB in May 1967. Except for a small number of Indian women with a high rate of discontinuation there was not much difference in continuing the method between the Malays (60%) and the Chinese (56%). The younger age group of women seemed to have a higher proportion of discontinuation. The findings showed that amenorrhea (35%)most bothered the women who discontinued the injection method. Irregular bleeding (20%) and other medical side effects (11%) were the other main complaints that caused women to discontinue using the injection as a contraceptive method. It was concluded that Depo-Provera (150 mg) injected once every 3 months appears to be simple, acceptable, popular, and effective as a contraceptive method among women in a rural town in Malaysia.

Matched MeSH terms: Injections, Intramuscular
Fulltext Pharmacokinetics and Acceptability of Subcutaneous Injection of Testosterone Undecanoate

Turner L, Ly LP, Desai R, Singh GKS, Handelsman TD, Savkovic S, et al.

J Endocr Soc, 2019 Aug 01;3(8):1531-1540.
PMID: 31384715 DOI: 10.1210/js.2019-00134

Context: Can injectable testosterone undecanoate (TU) be administered effectively and acceptably by the subcutaneous (SC) route?
Objective: To investigate the acceptability and pharmacokinetics (PK) of SC injection of TU.
Design: Randomized sequence, crossover clinical study of SC vs IM TU injections.
Setting: Ambulatory clinic of an academic andrology center.
Participants: Twenty men (11 hypogonadal, 9 transgender men) who were long-term users of TU. injections. Intervention: Injection of 1000 mg TU (in 4 mL castor oil vehicle) by SC or IM route. Main Outcome Measures: Patient-reported pain, acceptability, and preference scales. PK by measurement of serum testosterone, dihydrotestosterone (DHT), and estradiol (E2) concentrations with application of population PK methods and dried blood spot (DBS) sampling.
Results: Pain was greater after SC compared with IM injection 24 hours (but not immediately) after injection but both routes were equally acceptable. Ultimately 11 preferred IM, 6 preferred SC, and 3 had no preference. The DBS-based PK analysis of serum testosterone revealed a later time of peak testosterone concentration after SC vs IM injection (8.0 vs 3.3 days) but no significant route differences in model-predicted peak testosterone concentration (8.4 vs 9.6 ng/mL) or mean resident time (183 vs 110 days). The PK of venous serum testosterone, DHT, and E2 did not differ according to route of injection.
Conclusions: We conclude that SC TU injection is acceptable but produces greater pain 24 hours after injection that may contribute to the overall majority preference for the IM injection. The PK of testosterone, DHT, or E2 did not differ substantially between SC and IM routes. Hence whereas further studies are required, the SC route represents an alternative to IM injections without a need to change dose for men for whom IM injection is not desired or recommended.

Matched MeSH terms: Injections, Intramuscular
Improved spinal cord gray matter morphology induced by Spirulina platensis following spinal cord injury in rat models

Abdullahi D, Ahmad Annuar A, Sanusi J

Ultrastruct Pathol, 2020 Nov 20;44(4-6):359-371.
PMID: 32686973 DOI: 10.1080/01913123.2020.1792597

Despite intense preclinical research focusing on developing potential strategies of mitigating spinal cord injury (SCI), SCI still results in permanent, debilitating symptoms for which there are currently no effective pharmacological interventions to improve the recovery of the fine ultrastructure of the spinal cord. Spirulina platensis is thought to have potential neuroprotective effects. We have previously demonstrated its protective potential on the lesioned corticospinal tracts and behavioral recovery. In this study, spirulina, known for its neuroprotective properties was used to further explore its protective effects on spinal cord gray matter ultrastructural. Twenty-four Sprague-Dawley rats were used and divided into sham group (laminectomy without SCI), control group (SCI without S. platensis), and S. platensis group (SCI + 180 mg/kg S. platensis). All animals were anesthetized via intramuscular injection. A partial crush injury was induced at the level of T12. The rats were humanely sacrificed for 28 days postinjury for ultrastructural study. There were significant mean differences with respect to pairwise comparisons between the ultrastructural grading score of neuronal perikarya of control and the S. platensis following injury at day 28, which correlates with the functional locomotor recovery at this timepoint in our previous study. The group supplemented with spirulina, thus, revealed a better improvement in the fine ultrastructure of the spinal cord gray matter when compared to the control group thereby suggesting neuroprotective potentials of spirulina in mitigating the effects of spinal cord injury and inducing functional recovery.

Matched MeSH terms: Injections, Intramuscular
Fulltext A new insight to biomarkers related to resistance in survived-white spot syndrome virus challenged giant tiger shrimp, Penaeus monodon

Mohd Ghani F, Bhassu S

PeerJ, 2019;7:e8107.
PMID: 31875142 DOI: 10.7717/peerj.8107

The emergence of diseases such as white spot disease has become a threat to Penaeus monodon cultivation. Although there have been a few studies utilizing RNA-Seq, the cellular processes of host-virus interaction in this species remain mostly anonymous. In the present study, P. monodon was challenged with WSSV by intramuscular injection and survived for 12 days. The effect of the host gene expression by WSSV infection in the haemocytes, hepatopancreas and muscle of P. monodon was studied using Illumina HiSeq 2000. The RNA-Seq of cDNA libraries was developed from surviving WSSV-challenged shrimp as well as from normal healthy shrimp as control. A comparison of the transcriptome data of the two groups showed 2,644 host genes to be significantly up-regulated and 2,194 genes significantly down-regulated as a result of the infection with WSSV. Among the differentially expressed genes, our study discovered HMGB, TNFSF and c-Jun in P. monodon as new potential candidate genes for further investigation for the development of potential disease resistance markers. Our study also provided significant data on the differential expression of genes in the survived WSSV infected P. monodon that will help to improve understanding of host-virus interactions in this species.

Matched MeSH terms: Injections, Intramuscular
Evaluation of anaesthetic and cardiorespiratory effects after intramuscular administration of alfaxalone alone, alfaxalone-ketamine and alfaxalone-butorphanol-medetomidine in common marmosets (Callithrix jacchus)

Miyabe-Nishiwaki T, Miwa M, Konoike N, Kaneko A, Ishigami A, Natsume T, et al.

J Med Primatol, 2020 12;49(6):291-299.
PMID: 32654222 DOI: 10.1111/jmp.12482

BACKGROUND: Anaesthesia is often required in common marmosets undergoing various procedures. The aim of this study was to evaluate anaesthetic and cardiopulmonary effects of alfaxalone, alfaxalone-ketamine and alfaxalone-butorphanol-medetomidine in common marmosets.
METHODS: The following treatments were repeatedly administered to seven female common marmosets: Treatment A, alfaxalone (12 mg kg-1 ) alone; treatment AK, alfaxalone (1 mg animal-1 ) plus ketamine (2.5 mg animal-1 ); treatment AMB, alfaxalone (4 mg kg-1 ), medetomidine (50 µg kg-1 ) plus butorphanol (0.3 mg kg-1 ); and treatment AMB-Ati, AMB with atipamezole at 45 minutes.
RESULTS AND CONCLUSIONS: Marmosets became laterally recumbent and unresponsive for approximately 30 minutes in A and AK and for approximately 60 minutes in AMB. The animals showed rapid recovery following atipamezole injection in AMB-Ati. The decrease in heart rate and SpO2 was significantly greater in AMB compared to A and AK. Oxygen supplementation, anaesthetic monitors and atipamezole should be available especially when AMB is administered.

Matched MeSH terms: Injections, Intramuscular/veterinary
Superovulation and egg recovery in goats in the tropics

Rosnina Y, Jainudeen MR, Nihayah M

Vet Rec, 1992 Feb 01;130(5):97-9.
PMID: 1557879

The superovulatory response to gonadotrophin treatment during different months of the year was investigated in Kambing kacang goats, a tropical breed, in Malaysia. Sixty-three cycling does, fitted with progesterone impregnated intravaginal sponges for 17 days, received two days before sponge withdrawal, an intramuscular injection of either 10, 15 or 20 mg of follicle stimulating hormone (FSH) or 500, 1000 or 1500 iu of equine chorionic gonadotrophin (eCG). The dose of FSH was divided into four decreasing daily doses and each daily dose was subdivided into two and administered at 07.00 and 19.00. Fifty-four does detected in oestrus were mated with fertile bucks. The ovarian response was determined by laparoscopy and eggs were recovered surgically five or six days after oestrus. The ovulatory response (mean +/- standard deviation) based on corpora lutea was higher in the FSH (13.4 +/- 8.4 corpora lutea per doe, n = 20) than the eCG-treated groups (6.4 +/- 5.1 corpora lutea per doe, n = 25) but the difference was not significant (P greater than 0.05). Does responded to gonadotrophins throughout the year with more than 50 per cent of does responding during the rainy months compared with less than 35 per cent responding during the dry months. This difference was statistically significant (P less than 0.05). Egg recovery was better in the FSH (6.8 +/- 5.3 per doe, n = 20) than the eCG groups (3.0 +/- 3.8 per doe, n = 21) but the difference was not significant (P greater than 0.05).

Matched MeSH terms: Injections, Intramuscular/veterinary
Periodic vicissitudes of different concentrations of a developed prototype killed S. aureus mastitis vaccine on immune modulators, mediators and immunoglobulins in cows

Hambali IU, Abdullah FFJB, Bhutto KR, Mohd Azmi ML, Wahid AH, Zakaria Z, et al.

Trop Anim Health Prod, 2019 May;51(4):781-789.
PMID: 30449009 DOI: 10.1007/s11250-018-1755-8

Mastitis is the inflammation of the mammary gland due to microbial infiltration causing a reduced mammary function. This study aims at developing a vaccine using Malaysian local isolate of Staphylococcus aureus and evaluating serum amyloid A, Interleukin-10, IgM and IgG responses periodically. Four bacterin concentrations (106, 107, 108 and 109 cfu/ml of the local isolate of S. aureus) were adjuvanted with aluminium potassium sulphate. Thirty cows grouped into 4 treatment groups (G-) were vaccinated (2 ml) intramuscularly, with a fifth G-A as control. The mean concentration (MC) of serum amyloid A (SAA) was significantly different (sig-d) (p ˂ 0.05) in G-D at 0 h post vaccination (PV), 3 h PV, 24 h PV, weeks 1, 2, 3 and 4 PV (6-, 15-, 5-, 12-, 11-, 4- and 11-fold increased (FI) respectively). The MC of serum amyloid A was also sig-d in G-E at 0 h PV, weeks 1, 2 and 4 PV (3, 8, 5 and 8 FI respectively). The MC of IL-10 was sig-d in G-D and C at 3 h PV and week 2 PV (5 and 2 FI respectively). The IgM MC was sig-d in G-B and C at 3 h PV (5 and 6 FI respectively), at 24 h PV (5 and 9 FI respectively), at week 3 PV(2 and 2 FI respectively) and week 4 PV (3 and 4 FI respectively). The MC of IgG was sig-d in G-E at 0 h, 3 h and week 3 PV(5, 6 and 2 FI respectively) and in G-D at weeks 1-4 (3, 3, 3 and 5 FI respectively). In conclusion, elevated levels of SAA, IgG and IL-10 in G-D(108) informed our choice of best dosage which can be used to evoke immunity in cows.

Matched MeSH terms: Injections, Intramuscular/veterinary
Fulltext The efficacy and safety of intramuscular injections of methylcobalamin in patients with chronic nonspecific low back pain: a randomised controlled trial

Chiu CK, Low TH, Tey YS, Singh VA, Shong HK

Singapore Med J, 2011 Dec;52(12):868-73.
PMID: 22159928

INTRODUCTION: Chronic, nonspecific low back pain is a difficult ailment to treat and poses an economic burden in terms of medical expenses and productivity loss. The aim of this study was to determine the efficacy and safety of intramuscular metylcobalamin in the treatment of chronic nonspecific low back pain.
METHODS: This was a double-blinded, randomised, controlled experimental study. 60 patients were assigned to either the methylcobalamin group or the placebo group. The former received intramuscular injections of 500 mcg parenteral methylcobalamin in 1 ml solution three times a week for two weeks, and the placebo group received 1 ml normal saline. Patients were assessed with Oswestry Disability Index questionnaire Version 2.0 and Visual Analogue Scale pain score. They were scored before commencement of the injections and at two months interval.
RESULTS: Of the 60 patients, 27 received the placebo injections and 33 were given methylcobalamin injections. A total of 58 patients were available for review at two months (placebo: n is 26; methylcobalamin: n is 32). There was a significant improvement in the Oswestry Disability Index and Visual Analogue Scale pain scores in the methylcobalamin group as compared with the placebo group (p-value less than 0.05). Only minor adverse reactions such as pain and haematoma at the injection sites were reported by some patients.
CONCLUSION: Intramuscular methylcobalamin is both an effective and safe method of treatment for patients with nonspecific low back pain, both singly or in combination with other forms of treatment.
Study site: Orthopaedic Clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Injections, Intramuscular/methods*
Fulltext Pharmacokinetics of Naja sumatrana (equatorial spitting cobra) venom and its major toxins in experimentally envenomed rabbits

Yap MK, Tan NH, Sim SM, Fung SY, Tan CH

PLoS Negl Trop Dis, 2014 Jun;8(6):e2890.
PMID: 24901441 DOI: 10.1371/journal.pntd.0002890

BACKGROUND: The optimization of snakebite management and the use of antivenom depend greatly on the knowledge of the venom's composition as well as its pharmacokinetics. To date, however, pharmacokinetic reports on cobra venoms and their toxins are still relatively limited. In the present study, we investigated the pharmacokinetics of Naja sumatrana (Equatorial spitting cobra) venom and its major toxins (phospholipase A2, neurotoxin and cardiotoxin), following intravenous and intramuscular administration into rabbits.
PRINCIPAL FINDINGS: The serum antigen concentration-time profile of the N. sumatrana venom and its major toxins injected intravenously fitted a two-compartment model of pharmacokinetics. The systemic clearance (91.3 ml/h), terminal phase half-life (13.6 h) and systemic bioavailability (41.9%) of N. sumatrana venom injected intramuscularly were similar to those of N. sputatrix venom determined in an earlier study. The venom neurotoxin and cardiotoxin reached their peak concentrations within 30 min following intramuscular injection, relatively faster than the phospholipase A2 and whole venom (Tmax=2 h and 1 h, respectively). Rapid absorption of the neurotoxin and cardiotoxin from the injection site into systemic circulation indicates fast onsets of action of these principal toxins that are responsible for the early systemic manifestation of envenoming. The more prominent role of the neurotoxin in N. sumatrana systemic envenoming is further supported by its significantly higher intramuscular bioavailability (Fi.m.=81.5%) compared to that of the phospholipase A2 (Fi.m.=68.6%) or cardiotoxin (Fi.m.=45.6%). The incomplete absorption of the phospholipase A2 and cardiotoxin may infer the toxins' affinities for tissues at the injection site and their pathological roles in local tissue damages through synergistic interactions.
CONCLUSION/SIGNIFICANCE: Our results suggest that the venom neurotoxin is absorbed very rapidly and has the highest bioavailability following intramuscular injection, supporting its role as the principal toxin in systemic envenoming.

Matched MeSH terms: Injections, Intramuscular
Fulltext A randomized, double-blind, placebo-controlled trial on the effect of long-acting testosterone treatment as assessed by the Aging Male Symptoms scale

Ho CC, Tong SF, Low WY, Ng CJ, Khoo EM, Lee VK, et al.

BJU Int, 2012 Jul;110(2):260-5.
PMID: 22093057 DOI: 10.1111/j.1464-410X.2011.10755.x

Study Type - Therapy (RCT). Level of Evidence 1b. What's known on the subject? and What does the study add? Testosterone deficiency syndrome can be treated with testosterone replacement in the form of injectable, transdermal, buccal and oral preparations. Long-acting i.m. testosterone undecanoate 1000 mg, which is given at 10-14 week intervals, has been shown to be adequate for sustaining normal testosterone levels in hypogonadal men. This study confirms that long-acting i.m. testosterone undecanoate is effective in improving the health-related quality of life in men with testosterone deficiency syndrome as assessed by the improvement in the Aging Male Symptoms scale. Testosterone treatment can be indicated in men who have poor health-related quality of life resulting from testosterone deficiency syndrome.

Matched MeSH terms: Injections, Intramuscular
Fulltext Use of intramuscular botulinum toxin in Malaysian children with cerebral palsy

Khoo TB, Yusniza MY, Chern PM

Med J Malaysia, 2007 Mar;62(1):3-5.
PMID: 17682560 MyJurnal

A study was carried out to determine the clinical effectiveness of intramuscular botulinum toxin type A (BTX) in the treatment of spasticity or dystonia in 58 consecutive children with cerebral palsy (CP). The effectiveness of the treatment was determined by the reduction of spasticity and global parental perception scale. The mean age of treatment was six years and the most frequent aim of treatment (91.1%) was functional improvement. The median reduction of spasticity as measured by modified Ashworth scale was 1. The short term outcome was graded as excellent or good by 44.6% and satisfactory by 38.4% of parents. Patients with dyskinetic Cerebral Palsy had the best response. Adverse effects were minimal. BTX treatment is modestly effective in the majority of our patients with spastic and dyskinetic cerebral palsy.

Matched MeSH terms: Injections, Intramuscular
Treatment of gonorrhea with sulbactam/ampicillin

Ngeow YF, Ramachandran S, Cheong YM

Sex Transm Dis, 1991 7 1;18(3):192-4.
PMID: 1948519

Between January and August, 1989, 36 men and 28 women with uncomplicated lower genital tract infections by Neisseria gonorrhoeae were given single intramuscular injections of sulbactam (500 mg)/ampicillin (1000 mg) together with 1 g oral probenecid. Cure rates that were obtained were 100% for women, 97.2% for men, 100% for patients with penicillinase-producing Neisseria gonorrhoeae (PPNG), and 98.4% for patients with non-PPNG. No serious side effects were encountered, and patient acceptance of the drug was good. A high proportion of patients had concurrent chlamydial infection. Sulbactam/ampicillin was found to be effective against gonococcal urethritis and cervicitis by both PPNG and non-PPNG but have little effect on concomitant chlamydial infections, especially in women.

Matched MeSH terms: Injections, Intramuscular
Ablaton: single intramuscular injection to suppress lactation

Kuah KB

Med J Malaysia, 1975 Mar;30(3):223-6.
PMID: 1160683
Matched MeSH terms: Injections, Intramuscular
Fulltext Anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) in rural Sarawak, Malaysian Borneo

Steve Utap M, Bin Mohd Jamal MS

Rural Remote Health, 2019 08;19(3):5163.
PMID: 31421666 DOI: 10.22605/RRH5163

Nycticebus spp, commonly known as the slow lorus, is a small nocturnal primate found mainly in Asia. The adult slow loris weighs between 265 g and 1150 g depending on the type of species. It has a characteristic round head with large, forward-facing eyes. Slow lorises are known for their poisonous bite and are the only venomous primates. To date, there have been two published cases of slow loris bite in humans. This case report illustrates a case of anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) to a young man at Mulu District, in a remote area of Sarawak, Malaysian Borneo. The patient developed dyspnoea, a feeling of suffocation, swollen lips and cramp-like sensations over both hands. He subsequently developed syncope and hypotension. The patient was clinically stable following intramuscular injection of adrenaline 0.5 mg stat dose.

Matched MeSH terms: Injections, Intramuscular

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