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This article examines the adverse drug reactions caused by hyaluronidase and lignocaine in regional ophthalmic anesthesia. The study found that hyaluronidase had a higher incidence rate of positive test results compared to lignocaine. Patients with a history of bronchial asthma or allergic rhinitis were more likely to have a positive reaction to hyaluronidase. The study suggests that the longer residence time of hyaluronidase in the eye may contribute to the higher incidence of allergic reactions. The authors recommend conducting preoperative allergic skin tests for hyaluronidase, especially in patients with allergies, and suggest using ropivacaine as an alternative local anesthetic for patients who have a positive reaction to the combined lignocaine and hyaluronidase test dose. The article emphasizes the importance of considering potential risks and conducting appropriate tests to ensure patient safety during eye surgeries. [Extracted from the article]

Background Inguinal hernia repair is associated with severe postoperative pain. Transversus abdominus plain block has been proved to provide effective analgesia for somatic lower abdominal pain. Several adjuvants have been added to local anesthetic to improve the quality of analgesia. This study compares the additive effect of hyaluronidase versus dexamethasone to improve the quality of analgesia of transversus abdominus plain block for inguinal hernia repair. Patients and methods This prospective, randomized, controlled, and double-blind study was carried out in Sohag University Hospital between November 2020 and February 2021. Seventy-five participants scheduled for inguinal hernia repair were included and randomly assigned into control, hyaluronidase, and dexamethasone groups. Exclusion criteria were neurological, psychiatric, neuromuscular, cardiovascular, pulmonary, renal, hepatic disease, alcoholism or drug abuse, pregnancy or lactating women, and patients receiving adrenoceptor agonist or antagonist therapy or chronic analgesic therapy, patients with morbid obesity, coagulopathy, and known allergy to study medications, and sepsis surgical scar at the site to be operated upon and those who refuse. We targeted from this study to assess time to first analgesia, consumption of morphine, and visual analog scale at rest and during physical activity. Also, we targeted to assess heart rate, noninvasive blood pressure, SpO2%, and adverse effects (nausea and vomiting, respiratory depression). Results Our study showed comparable analgesic efficacy for hyaluronidase versus dexamethasone with longer time to the first request of analgesia, less morphine consumption, and less side effects compared with these two groups to the control group. Conclusion Adding hyaluronidase or dexamethasone to bupivacaine not only prolonged the duration of analgesia and decreased the consumption of opioids but also decreased the incidence of adverse effects. [ABSTRACT FROM AUTHOR]

Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon's blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon's blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries. [ABSTRACT FROM AUTHOR]

Aim: To determine the therapeutic effect and efficacy of oral colchicine tablet and intralesional injection of hyaluronidase with and without ultrasound therapy in the clinical course of oral submucous fibrosis. Materials and Methods: This comparative study involving 45 human participants was divided into three equal groups. The participants in group 1 received oral colchicine and intralesional hyaluronidase. The participants in group 2 received oral colchicine, intralesional hyaluronidase, and ultrasound therapy. The group 3 participants were treated with intralesional dexamethasone and hyaluronidase. Intergroup assessments were done using repeated measures of ANOVA test, where P value of <0.05 was considered as statistically significant difference. Results: Group 2 patients had maximum improvement with respect to all the parameters. Conclusion: Therapeutic ultrasound can be given effectively as an adjunct therapy along with conventional therapy in OSMF patients. [ABSTRACT FROM AUTHOR]

The discovery of new drugs has benefited significantly from the development of research in venomics, increasing our understanding of the envenomation processes. It has been previously reported that honeybee venom (HBV) exhibits several pharmacological activities such as anti-inflammatory, antibacterial, antimutagenic, radioprotective, and anticancer activity and may inclusively act as a complementary treatment for SARS-CoV-2. It composition consists mainly on melittin, phospholipase A2, and apamin but other constituents such as hyaluronidase, mast cell degranulating peptide and secapin are also relevant for its bioactivity. However, and because HBV is not officially recognized as a drug, until now, the international community did not establish quality standards for it. To uncover its exact composition, and boost the discovery of HBV-derived drugs, a significant number of techniques were developed. In this review, a relevant overview of the so far published analytical methods for HBV characterization is organized with the aim to accelerate its future standardization. The literature search was performed within PubMed, Google Scholar, and Science Direct by selecting specific documents and exploring HBV evaluation. [ABSTRACT FROM AUTHOR]

Background: An ideal anesthetic solution should provide good anesthesia and akinesia with minimal pain on injection. Aims: The aim of this study is to determine the effect on pain perception and efficacy of sodium bicarbonate over hyaluronidase in the local anesthetic mixture during peribulbar anesthesia. Settings and Design: A prospective, randomized, double-blind study. Materials and Methods: An independent observer labeled two injections as A (hyaluronidase 1500 IU in 30 mL of lignocaine) and B (7.5% sodium bicarbonate 1 mL in 30 mL of lignocaine). Group 1 was injected with injection A while Group 2 was injected with injection B. The visual analog scale (VAS) was used to determine the intensity of pain. Onset and degree of anesthesia and akinesia were recorded. Statistical Analysis: Computer software Microsoft Excel SPSS version 26 (Chicago Inc) for windows was used. The qualitative data and quantitative data were reported as proportions and mean ± (standard deviation), respectively. Chi-square test for proportions was used for the comparison of qualitative variables and unpaired Student's t-test was used to test the significance between quantitative variables. P < 0.05 was considered statistically significant. All P were two-tailed. Results: Out of 123 patients, 23 were excluded from the study. Hundred patients were divided into Group 1 and Group 2. The mean age in Group 1 was 64.92 ± 10.77 years while in Group 2 was 62.86 ± 11.17 years. The mean heart rate and mean systolic blood pressure in both groups were statistically insignificant. Group 2 experienced very less pain (mean pain score VAS = 5.12 ± 1.17) as compared to Group 1 (mean pain score was 7.16 ± 1.09) and the difference between both the groups was found to be statistically significant. There was a significant difference in the onset of anesthesia in both groups (P = 0.001). In the sodium bicarbonate group, the onset was faster. The onset of akinesia was better in Group 1 (4.76 ± 2.06 min). Grading of akinesia was better in Group 1. Conclusion: Sodium bicarbonate reduces pain on injection in peribulbar anesthesia and also results in a quicker onset of anesthesia. [ABSTRACT FROM AUTHOR]

Background: Transversus abdominis plane (TAP) block is a regional anesthesia technique for postoperative analgesia. Since multiple nerves are to be blocked in a single prick, mucolytic enzyme hyaluronidase is being used to improve the spread of the local anesthetic. The present study was conducted to evaluate the effect of adding hyaluronidase as an adjuvant to local anesthetic in ultrasound (US)-guided TAP block. Materials and Methods: Eighty patients were randomly divided into two groups, Group B and Group BH. Group B patients received US-guided bilateral TAP block with 38 ml of 0.25% bupivacaine (heavy) and 2 ml of NS. Group BH patients received 38 ml of 0.25% bupivacaine (heavy) with 3000 IU hyaluronidase (2 ml) after completion of surgery under spinal anesthesia. Visual analog score (VAS) and heart rate were noted periodically. Time of demand of the first rescue analgesia and total analgesic consumption in 24 h were noted. Patient satisfaction survey was done at the end of 24 h. Results: Group BH patients had lower mean VAS scores at 6 and 8 h postoperatively as compared to Group B. The mean time of demand for the first rescue analgesia was longer in Group BH (351 ± 16 min) as compared to Group B (307 ± 13 min). The cumulative dose of rescue analgesic needed was more in Group B (370 ± 9 min) as compared to Group BH (343 ± 8 min). Patient satisfaction score was 3.3 ± 0.5 in Group BH and 2.3 ± 0.5 in Group B. All the differences were statistically significant. Conclusion: Addition of hyaluronidase improved quality of postoperative analgesia which can be due to the enzymatic action of hyaluronidase which hydrolyses the hyaluronic acid in the connective tissue and facilitates the spread of local anesthetic solution. [ABSTRACT FROM AUTHOR]

Background: Oral submucous fibrosis (OSMF) is a chronic progressively scarring disease of the oral cavity. Lycopene is a powerful antioxidant obtained from tomatoes and has the highest singlet oxygen quenching capacity and a high capacity of quenching other free radicals in vitro among dietary carotenoids. Hyaluronidase is a substance prepared from the testes and semen of mammals that modifies the permeability of connective tissue through the hydrolysis of hyaluronic acid. Objective: To evaluate the efficacy of lycopene and lycopene- hyaluronidase combination, and to compare the efficacy of lycopene and lycopene-hyaluronidase combination in the treatment of OSMF. Study Design: The study consisted of 45 patients with OSMF divided into three equal groups. Patients in Group A were given Lycored 16 mg daily in two equally divided doses for 3 months. Patients in Group B were given LycoRed along with hyaluronidase intralesional injection of 1500 IU twice weekly for 3 months. Patients in Group C were given placebo capsules. Patients were evaluated after 3 months. The following parameters were recorded: mouth opening, visual inspection, palpatory findings, and burning sensation. Results: There was statistically significant change in mouth opening and burning sensation for lycopene and lycopene-hyaluronidase combination than in the placebo group in the treatment of OSMF, but the lycopene-hyaluronidase combination did not show any statistically significant change when compared with lycopene alone. Conclusion: Lycopene appears to be a very promising antioxidant in the management of oral submucous fibrosis, both in clinical and symptomatic improvement. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare orbital muscle akinesia caused by rocuronium versus hyaluronidase when mixed with the local anesthetic in single-injection peribulbar anesthesia (PBA). Patients and Methods: Sixty patients were included in the study and subjected to cataract extraction using phacoemulsiication technique with intraocular lens implantation. Group I received peribulbar block with 5 ml mixture of 30 IU/ml hyaluronidase and 2% lidocaine. Group II received peribulbar block with 5 ml mixture of rocuronium 5 mg and 2% lidocaine. The onset and duration of akinesia were assessed; the akinesia score at 2, 5, and 10 min was measured after injection. The need for supplementary injection was also recorded. Results and Conclusion: PBA using a mixture of rocuronium and lidocaine provides optimal globe akinesia and faster establishment of suitable conditions to start eye surgery and shortens the block onset time as compared with the addition of hyaluronidase to lidocaine. [ABSTRACT FROM AUTHOR]

We describe the treatment of lower eyelid cicatricial ectropion in a 24-yearold male using volumizing hyaluronic acid (HA) filler. One milliliter of Juvéderm Voluma® (Allergan) was injected directly under the skin in each lower eyelid to create a large bubble. The filler was dissolved with hyaluronidase (750 I.U. / side) 5 months later, achieving an excellent and stable functional and cosmetic result. There was a 2.4 mm improvement in MRD-2 with the filler in place, which decreased to 1.72 mm at 6 months after filler dissolution with hyaluronidase. This resulted in complete resolution of the signs and symptoms of corneal exposure. To date, there have been reports of low density HA injection for the treatment of cicatricial ectropion in elderly patients as well as infants with lamellar ichthyosis. In these cases, the HA was injected and left in place to dissolve spontaneously by itself. Our case is the first report of a HA with high G properties injected directly under the skin, followed by complete dissolution with hyaluronidase once the tissue expansion took place. [ABSTRACT FROM AUTHOR]

Objective To access the anti-hyaluronidase activity of Sri Lankan low grown orthodox orange pekoe (OP) grade black tea with a view to develop an anti-aging skin formulation. Methods Five concentrations (0.125, 0.250, 0.500, 1.000 and 2.000 mg/mL) of black tea brew (BTB) were made using a freeze dried sample of Sri Lankan low grown orthodox OP grade black tea which was prepared according to international organization for standardization specification. Epigallocatechin gallate (EGCG) was used as the reference agent (concentrations tested: 0.012, 0.025, 0.050, 0.100 and 0.200 mg/mL). Anti-hyaluronidase activity of BTB and EGCG in vitro were ascertained spectrometrically using hyaluronic acid (from rooster comb) and bovine testicular hyaluronidase. Results The results revealed that BTB had moderate [IC 50 =(1.09±0.12) mg/mL] and dose dependent ( r 2 =0.94) anti-hyaluronidase activity. EGCG also exhibited dose dependent ( r 2 =0.93, P <0.05) anti-hyaluronidase activity which was superior [IC 50 =(0.09±0.00) mg/mL] to BTB. Conclusions Sri Lankan low grown orthodox OP grade black tea has promising anti-hyaluronidase activity in vitro and has the potential to be used as an anti-aging cosmaceutical. In addition, it may prove useful as a beverage in the management of allergy, some joint diseases and envenomation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate effect on intraocular pressure (IOP) during sub-Tenon's local anesthesia (LA) during cataract surgery with 4 ml of anesthetic injected without and with addition of hyluronidase to anesthetic solution. Materials and Methods: This randomized controlled study included 65 eyes of 65 patients undergoing phacoemulsification and lens implant for cataract. The patients were randomized to a standardized procedure of administration of 4 ml of sub-Tenon's LA without and with addition of 15 IU/ml hylaluronidase to 2% lidocaine (control group and intervention group respectively). IOP measurements were carried out immediately prior to and at 2, 5, and 10 and 15 min after sub-Tenon's injection using a hand held tonometer (Tonopen). Results: All patients achieved satisfactory akinesia and complete analgesia during surgery. The mean age of patients in control group was 59.56 ± 14.3 years, and 61.77 ± 11.91 years in intervention group (P = 0.507). The mean preinjection and 15 min IOP was 19.16 ± 4.39 and 20.21 ± 5.49 mm Hg, respectively in control group (P = 0.220); and 19.81 ± 3.8 and 19.68 ± 5.19 mmHg respectively in intervention group (P = 0.911). No statistical difference from baseline was detected between preinjection and at 2, 5, 10, and 15 min after injection in control (P = 0.124, 0.310, 0.804, 0.220, respectively) and intervention group (P = 0.367, 0.879, 0.765, 0.911 respectively). Conclusion: No significant rise in IOP occurs following injection of sub-Tenon's LA, when up to 4 ml of anesthetic is injected. The addition of hyaluronidase to 2% lignocaine has no beneficial lowering effect on IOP in sub-Tenon's LA. Hence, the practice of addition of this agent may not be necessary during cataract surgery. [ABSTRACT FROM AUTHOR]

Aim: Plant Clitoria ternatea L. is claimed to possess a wide range of activities including antiinflammatory, local anesthetic and antidiabetic effect, etc. The aim of the present study was to evaluate the wound healing potential of standardized C. ternatea leaf extract in terms of different enzymatic models, which are mostly associated with skin wound. Materials and Methods: The methanol extract and fractions were screened for its hyaluronidase, elastase, and matrix metalloproteinase-1 (MMP-1) inhibitory activity compared with standard oleanolic acid. The activity was rationalized through reverse phase high performance liquid chromatography (RP-HPLC) standardization of the extract and fractions with respect to its isolated biomarker taraxerol (yield 5.27% w/w). Results: The extract showed significant (P < 0.001) hyaluronidase (IC50 18.08 ± 0.46 µg/ ml) and MMP-1 (P < 0.05) inhibition, but the elastase inhibition was insignificant (IC50 42.68 ± 0.46 µg/ml). Among the fractions, ethyl acetate fraction showed significant (P < 0.001) inhibition of hyaluronidase (IC50 28.01 ± 0.48 µg/ml) and MMP-1 (P < 0.01). The HPLC analysis revealed that the extract and the ethyl acetate fraction are enriched with taraxerol (5.32% w/w and 4.55% w/w, respectively). Conclusions: The experiment validated the traditional uses of C. ternatea and may be recommended for use in the treatment of different types of skin wounds, where taraxerol may be a responsible biomarker. [ABSTRACT FROM AUTHOR]

Background: We evaluated the anesthetic efficacy and the postoperative analgesic effects of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in patients undergoing primary vitreoretinal surgery. Methods: We investigated 120 patients subjected to vitreoretinal surgery under peribulbar anesthesia. They were randomized into two equal groups according to the local anesthetic (LA) used, namely, 0.75% levobupivacaine or 0.75% ropivacaine, both with the addition of hyaluronidase. Nerve block was carried out by injection of 5-7 mL of the LA using single injection percutaneous peribulbar anesthesia with a short needle. Results: When compared with 0.75% ropivacaine, 0.75% levobupivacaine provided more successful akinesia at 10 min after block (P=0.026), fewer supplementary injections (P=0.026), and less volume (mL) was used (P=0.031). Also, levobupivacaine provided significantly longer motor block duration (342±27 min versus 206±40 min, P=0.001) and significantly longer sensory block duration (513±24 min versus 394±11 min, P=0.001) when compared with ropivacaine. In the postoperative period, the patients in the levobupivacaine group achieved lower values of verbal numeric rating scale of pain compared with patients in the ropivacaine group among the period from 4 to 12 h. Also, there were significantly (P=0.001) lower diclofenac consumption (mg) and the percentage of patients who required tramadol rescue medication were significantly less (P=0.034) in the levobupivacaine group compared with the ropivacaine group. Conclusion: We are concluding that, at equipotent doses and concentrations, 0.75% levobupivacaine provides more effective peribulbar anesthesia and more effective postoperative analgesia for vitreoretinal surgery compared with 0.75% ropivacaine. [ABSTRACT FROM AUTHOR]

Peribulbar block, though safe, can cause serious complications such as globe perforation and peribulbar hemorrhage. Hyaluronidase is an enzyme that is used as an adjuvant in peribulbar anesthesia, and it helps in rapid penetration of the anesthetic agent. Hypersensitivity to hyaluronidase is a rare but potentially sight-threatening complication. We report a case of hyaluronidase hypersensitivity following peribulbar injection for cataract surgery mimicking as peribulbar hematoma in the immediate postinjection phase and as orbital cellulitis 48 h later. [ABSTRACT FROM AUTHOR]