INJECTIONS: First Do No Harm (History of Injections)

Injections are one of the most common, effective, reliable and low cost medical/ health care procedures accepted all around the world. Indeed, there are few medical tools so common and yet so indispensable, as the plastic disposable syringe and needle. However, it took thousands of years for injections to get to where it is today. This review article would trace the evolution of syringe from ancient times to the present and would also highlight about the possible risk of infections related to unsafe disposal of used syringes and needles and injection safety.The word “syringe” is derived from the Greek word syrinx, meaning “tube”. The structure and design of syringe is quite simple and yet effective as a medical tool. A syringe is like a simple pump with a tight plunger that fits into a cylindrical tube. The plunger can be pulled and pushed allowing the syringe to pull in or push out a liquid or gas through the open end of the tube that may be attached with a hypodermic needle.The first syringes were used in Roman times (1st Century AD) and are mentioned in a journal called De Medicina as being used to treat medical complications. Simple piston syringes were used to deliver ointments and creams were described by Galen (129-200 CE). An Egyptian, Ammar bin Ali al-Mawsilli was reported using glass tubes for suction for cataract extraction from about 900 CE. In 1650 Blaise Pascal’s experimental work in hydraulics led him to invent the first modern syringe which allowed the infusion of medicines. By 1660 Esholttz and Drs Major used injections on humans with fatal results due to ignorance of suitable dosage and the need for sterilization and infusion. Hence the disastrous consequences of these experiments delayed the use of injections for around 200 years. An Irish physician named Francis Rynd invented the hollow needle and used it to make the first recorded subcutaneous injections in 1844. In 1853 Charles Pravaz and Alexander Wood developed a medical hypodermic syringe with a needle fine enough to pierce a skin. Alexander Wood injected morphine into humans to treat nerve conditions and his wife subsequently became addicted to morphine and is recorded as the first woman to die of an injected drug overdose.In 1899 Letitia Mumford Geer of New York was granted a patent for a syringe design that permitted the user to operate it one-handed.In 1946 Chance Brothers in England made the first all-glass syringe with an interchangeable barrel and plunge and this was revolutionary as mass-sterilization of different components became possible without needing to match up the individual parts. Then shortly thereafter Australian inventor Charles Rotha user created the world’s first plastic, disposable hypodermic syringe made from polyethylene in 1949. Two years later he produced the first injection-molded syringes made of polypropylene, a plastic that can be heat-sterilized. Then in 1956 a New Zealand pharmacist and inventor Colin Murdoch got patents for disposable plastic syringe followed by Becton Dickinson in 1961 and an African American inventor Phil received a US patent for a “Disposable Syringe”.The basic design has remained unchanged though interchangeable parts and the use of plastic resulted in universal use of disposable syringes and needles since the mid-1950s. The syringe has become an indispensable instrument for many aspects of interventional medicine and everyday practice.

PROSPECTIVE RANDOMIZED COMPARITIVE STUDY ON USAGE OF EPISURE AUTODETECT SYRINGE VERSUS GLASS SYRINGE IN LOWER THORACIC EPIDURALANALGESIA

Episure & AutoDetect syringe (EAS), a spring-loaded syringe, is a new loss-of-resistance syringe used to identify epidural space. It has an advantage of subjective and objective confirmation in identifying epidural space over glass syringe (GS) for beginners. We compared the performance of EAS with that of GS for identifying epidural space in lower thoracic epidurals. Methods: A total of 40 American Society of Anesthesiolgists I-II patients aged 18-60 years requiring lower thoracic epidural analgesia for surgery were randomised into Group I (EAS): Epidural identified using EAS and Group II (GS) epidural identified with GS. Patient demographic data, depth to epidural space (cm) was noted Results: There were no differences in patient demographics or depth to the epidural space between the two groups. When epidural was identified in fewer attempts, the time needed to identify epidural space was quicker with EAS . Conclusion: Using EAS allowed reliable and quick identification of the epidural space in lower thoracic epidural technique as compared to use of glass syringe.

Size-Controllable Melt-Electrospun Polycaprolactone (PCL) Fibers with a Sodium Chloride Additive

Melt-electrospun polycaprolactone (PCL) fibers were fabricated by using NaCl as an additive. The size and morphology of the PCL fibers could be controlled by varying the concentration of the additive. The smallest size of the fibers (2.67 0.57) µm was found in the sample with 8 wt% NaCl, which was an order of magnitude smaller than the PCL fibers without the additive. The melt-electrospun fibers were characterized using the differential scanning calorimeter (DSC), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR) techniques. Interestingly, a trace of NaCl was not found in any melt-electrospun fiber. The remaining PCL after melt-electrospinning was evaporated by annealing, and the NaCl residual was found in the glass syringe. The result confirmed that the NaCl additive was not ejected from the glass syringe in the melt-electrospinning process. Instead, the NaCl additive changed the viscosity and the polarization of the molten polymer. Two parameters are crucial in determining the size and morphology of the electrospun fibers. The higher NaCl concentration could lead to higher polarization of the polymer melt and thus a stronger electrostatic force, but it could also result in an exceedingly high viscosity for melt-electrospinning. In addition, the absence of NaCl in the melt-electrospun PCL fibers is advantageous. The fibers need not be cleaned to remove additives and can be directly exploited in applications, such as tissue engineering or wound dressing.

Stability of Insulin Detemir Injection in Different Primary Packaging Systems at Room Temperature

Purpose: To assess the stability of insulin detemir at controlled room temperature (RT) at 25°C in different packaging systems over 7 days. Methods: The degradation characteristics of insulin detemir were determined based on the assay results in different packaging systems (pinhole glass vial, closed glass vial, glass syringe, and plastic syringe) at RT using a reverse-phase high-performance liquid chromatography (HPLC) assay method for insulin injection. Each packaging system was compared to insulin detemir stored in the original packaged closed glass vial at 2°C to 8°C. Results: Insulin detemir stored in a closed glass vial and a glass syringe showed minor degradation at the end of day 7 (98.96% ± 1.49% and 99.78% ± 0.10%, respectively). Insulin detemir stored in plastic syringe decreased to 94.90% ± 2.50% by day 3 and to 93.52% ± 0.29% by day 7. Storage in pin-hole glass vial showed an increase in the assay (152.13% ± 0.12%) by day 7. Conclusion: Stability studies in different packaging systems demonstrated that insulin detemir remained stable for at least 7 days in a closed glass vial or glass syringe, but for only 3 days in a plastic syringe at RT. This study will allow pharmacists in the hospital setting to deliver patient-specific insulin doses into an insulin syringe with confidence in the stability.

Determination of valproic acid and 3-heptanone in plasma using air-assisted liquid-liquid microextraction with the assistance of vortex: Application in the real samples

Introduction: Valproic acid (VPA) is an antiepileptic drug used to treat epilepsy and bipolar disorder. Adverse effects of VPA were studied in many reports, however, a dose-response relationship between VPA and its metabolites in epilepsy patients are extremely limited. In this paper, a high efficient method was developed for the preconcentration and determination of VPA and its main metabolite in plasma. Methods: For the extraction and preconcentration of the selected analytes, a volume of an extractant was placed at the bottom of the microtube containing pretreated plasma. The mixture was repeatedly withdrawn from the microtube and pushed-out into it using a 1.0-mL glass syringe and resulted in a cloudy mixture. For further turbidity, the mixture was shaken on a vortex agitator. This procedure was used to analyze the plasma samples of patients with epilepsy (n = 70). Results: The results revealed that in most patients with a low level of VPA relative to its expected level, 3-heptanone concentrations were high. The limits of quantification of 3-heptanone and VPA were 0.04 mg L–1 and 0.2 mg L–1, respectively. A suitable precision at a concentration of 2 mg L-1 for each analyte was obtained (relative standard deviation ≤ 9%). Conclusion: The obtained results indicated that this procedure is easy, sensitive, and reliable, and can be used for the analysis of the selected analytes in the plasma samples of patients with epilepsy.

Evaluation of transport conditions for autologous bone marrow-derived mesenchymal stromal cells for therapeutic application in horses

Background.Mesenchymal stromal cells (MSCs) are increasingly used for clinical applications in equine patients. For MSC isolation and expansion, a laboratory step is mandatory, after which the cells are sent back to the attending veterinarian. Preserving the biological properties of MSCs during this transport is paramount. The goal of the study was to compare transport-related parameters (transport container, media, temperature, time, cell concentration) that potentially influence characteristics of culture expanded equine MSCs.Methods.The study was arranged in three parts comparing (I) five different transport containers (cryotube, two types of plastic syringes, glass syringe, CellSeal), (II) seven different transport media, four temperatures (4 °C vs. room temperature; −20 °C vs. −80 °C), four time frames (24 h vs. 48 h; 48 h vs. 72 h), and (III) three MSC concentrations (5 × 106, 10 × 106, 20 × 106MSC/ml). Cell viability (Trypan Blue exclusion; percent and total number viable cell), proliferation and trilineage differentiation capacity were assessed for each test condition. Further, the recovered volume of the suspension was determined in part I. Each condition was evaluated using samples of six horses (n= 6) and differentiation protocols were performed in duplicates.Results.In part I of the study, no significant differences in any of the parameters were found when comparing transport containers at room temperature. The glass syringe was selected for all subsequent evaluations (highest recoverable volume of cell suspension and cell viability). In part II, media, temperatures, or time frames had also no significant influence on cell viability, likely due to the large number of comparisons and small sample size. Highest cell viability was observed using autologous bone marrow supernatant as transport medium, and “transport” at 4 °C for 24 h (70.6% vs. control group 75.3%); this was not significant. Contrary, viability was unacceptably low (<40%) for all freezing protocols at −20 °C or −80 °C, particularly with bone marrow supernatant or plasma and DMSO. In part III, various cell concentrations also had no significant influence on any of the evaluated parameters. Chondrogenic differentiation showed a trend towards being decreased for all transport conditions, compared to control cells.Discussion.In this study, transport conditions were not found to impact viability, proliferation or ability for trilineage differentiation of MSCs, most likely due to the small sample size and large number of comparisons. The unusual low viability after all freezing protocols is in contrast to previous equine studies. Potential causes are differences in the freezing, but also in thawing method. Also, the selected container (glass syringe) may have impacted viability. Future research may be warranted into the possibly negative effect of transport on chondrogenic differentiation.