Curcumina, una alternativa térapéutica para la clínica dental. Parte: antiinflamatorio y analgésico / Curcumin, a therapeutic alternative for the dental clinic (Part I):An anti-inflammatory and analgesic

La curcumina es una sustancia derivada de una planta llamada Curcuma longa. A esta sustancia se le han atribuido diversos efectos terapéuticos. En relación con la clínica dental, se ha observado que, además de ayudaren el control del dolor, ha sido efectiva contra la periodontitis, estomatitis y mucositis pediátrica. El control del dolor e inflamación son aspectos muy importantes para la mayoría de los tratamientos en odontología; la búsqueda de nuevas alternativas analgésicas y antiinflamatorias que, en comparación con las actuales, sean más eficientes, efectivas y tengan menos efectos colaterales es uno de los grandes retos de las ciencias biomédicas. La presente revisión muestra algunas evidencias científicas de los efectos de la curcumina como un antiinflamatorio y analgésico, con el propósito de sentar las bases para futuros estudios clínicos y de ciencia básica que aporten un mayor entendimiento de los procesos celulares, bioquímicos, moleculares, fisiológicos y farmacológicos de la curcumina como una sustancia potencialmente útilen el consultorio dental.

Curcumin is a substance derived from the plant Curcuma longa andone that has been attributed a range of therapeutic eff ects. In dentalpractice, curcumin has not only been found to help with pain control, buthas also been eff ective against periodontitis, stomatitis, and pediatricmucositis. Controlling pain and infl ammation are both very importantaspects of most dental treatments. The search for more effi cient andeff ective analgesic and anti-infl ammatory alternatives with fewerside eff ects compared to those currently used is one of the greatestchallenges for biomedical science. This review presents some of thescientifi c evidence of the eff ects of curcumin, both as an analgesic andan anti-infl ammatory agent, in order to establish the foundations forfurther clinical and basic science studies that will provide a greaterunderstanding of the cellular, biochemical, molecular, physiological,and pharmacological processes of curcumin as a potentially usefulsubstance in dental practice.

Evaluation of anti-infl ammatory activity of ethanolic extract of Cananga odorata Lam in experimental animals.

Background: The current study evaluates the anti-infl ammatory activity of ethanolic extract of Cananga odorata Lam (EECO) in experimental animals. Methods: Acute toxicity test was done following OECD guidelines. Carrageenan induced paw edema method in Wistar Albino rats were used in this study. Aspirin in the dose of 300 mg/kg was used as the standard drug and three doses of EECO (100 mg/kg, 200 mg/kg and 400 mg/kg b.w. p.o) were used as the test drug. The results were measured at 1st hr, 3rd hr and 5th hr after carrageenan injection. Results: EECO in the doses of 100 mg/kg, 200 mg/kg and 400 mg/kg showed highly signifi cant anti-infl ammatory activity (p<0.001) (p<0.001) (p<0.001) at 3rd hr and (p<0.001) (p<0.001) (p<0.001) 5th hr, respectively. In doses of 100 mg/kg, 200 mg/kg, and 400 mg/kg of EECO showed the percentage of inhibition of 62.9% which is more than the standard drug aspirin, which showed 60.14% inhibition. Conclusion: EECO has signifi cant anti-infl ammatory activity.

Investigation of centrally and peripherally acting analgesic and anti-infl ammatory activity of biological immune response modulator (an Amazonian plant extract) in animal models of pain and infl ammation.

Background: Biological immune response modulator (BIRM) - An aqueous extract of dried roots of the species dulcamara (family Solanaceae) grown in Ecuador, considered as a natural remedy for various disease is promoted as a natural herbal medicine. Our aim of the study was to assess the central and peripheral analgesic and anti-infl ammatory property of BIRM and to study its mechanism of action. Methods: Peripheral analgesic and anti-infl ammatory activity was evaluated using acetic acid induced writhing test and carrageenan paw edema test in male Swiss Albino mice (n=8 per group). Formalin test was taken up to evaluate BIRM’s centrally, as well as peripheral antinociceptive action. Results: We observed through our studies that BIRM when administered repeatedly for 7 days (4 ml/kg, p.o.) was able to exert its anti-nociceptive and anti-infl ammatory activity through central and peripheral mechanism. BIRM was able to signifi cantly inhibit both acetic acid induced writhes and carrageenan-induced paw edema indicating it’s possible peripheral analgesic and anti-infl ammatory action. BIRM was also able to inhibit both neurogenic and infl ammatory pain in the formalin test indicating its action through central and peripheral nervous system. Conclusion: Our study results show that BIRM has the potential anti-infl ammatory property and is able to exert its anti-nociceptive effect through both central and peripheral mechanisms.

Adverse drug reactions and cost effectiveness of non-steroidal antiinfl ammatory drugs, muscle relaxants, and neurotropic drugs in patients with low back pain.

Background: The objective was to evaluate the adverse drug reactions (ADRs) and cost effectiveness of different classes of drugs in therapy of low back pain. Methods: A prospective observational study was carried out over a period of 12 months (November 2012 to November 2013) in which a total of 300 patients with low back pain were enrolled and divided equally into three groups – Group 1 (nonsteroidal anti-infl ammatory drugs [NSAIDs]), Group 2 (NSAIDs ± muscle relaxant), and Group 3 (NSAIDs ± muscle relaxant ± neurotropic drugs). Any ADR developed after the initiation of treatment at 3 weeks and 6 weeks was noted. Prescription cost per day was also calculated. Results: There was a male predominance in the study population with a mean age of 39.76±9.40 years. A total of 262 ADRs were noted among which most were seen in Group 3 (119 ADRs). Gastritis was the most common ADR in Group 1. Drowsiness was the most common ADR in Group 2 (30%) and 3 (46%). Prescription cost per day was highest in Group 3 (30.28±11.24 Indian Rupee [INR]) followed by Group 2 (25.92±8.66 INR) and Group 1 (12.22±3.38 INR). Conclusion: Patient on combination of three drugs (NSAIDs, muscle relaxants, and neurotropic agents) had maximum ADRs and their prescription cost per day was highest among the three groups.

Comparative evaluation of effi cacy and safety of carboxymethylcellulose either alone or in combination with non-steroidal anti-infl ammatory drug in the treatment of dry eye in a tertiary care teaching hospital.

Background: Dry eye produces discomfort and reduced vision. The treatment of dry eyes has traditionally involved hydrating and lubricating artifi cial tears. The newer medications include non-steroidal anti-infl ammatory drugs (NSAIDs) for the treatment of dry eye disorders. This study was designed to compare the effect of topical carboxymethylcellulose (CMC) alone or in combination with topical NSAID for the treatment of dry eye in a tertiary care teaching hospital. Methods: A total of 60 patients diagnosed with dry eye were enrolled for a study period of 1 year. Patient of either sex (male/female), age between 18 and 70 years, and all diagnosed cases of dry eye in ophthalmology outpatient department were selected. Patients (n=60) were stabilized on CMC for 2 weeks and thereafter divided into two groups. Group I (n=30) received only topical CMC; Group II (n=30) received CMC+NSAID. The patients were followed up to 12 weeks. Diagnostic tests included Schirmer’s test and tear break up time (TBUT). Ocular Surface Disease Index (OSDI) was used for assessing the Quality of Life. Analysis was done using GraphPad InStat software. p<0.05 was considered signifi cant. Results: This was an open-label study revealing a mean age of 46.0±1.79 years. Females (56.67%) showed a signifi cantly higher prevalence of dry eye symptoms compared to males (43.33%). The mean duration of illness was 1.95±0.16 years. Schirmer’s test, TBUT test values and OSDI score in Group I and Group II at 0 and 12 weeks revealed signifi cant intragroup difference (p<0.0001). At 12 weeks intergroup comparison in Schirmer’s test value (p>0.05) and TBUT test value (p>0.05) showed no signifi cant difference while OSDI score revealed signifi cant difference (p<0.05). Burning, stinging, blurring of vision, photophobia, and hyperemia were among the common adverse effects seen. Conclusion: Both groups showed signifi cant improvement in Schirmer’s test and TBUT test value and OSDI score at the end of the study. Intergroup comparison showed a signifi cant difference with reference to OSDI score. Patients receiving NSAID reported more adverse effects.

Analgesic and anti-infl ammatory properties of the aqueous extract leaves of Murraya koenigii linn in small animal models.

Background: The present study was carried out to evaluate the analgesic activity of aqueous extract leaves of Murraya koenigii linn in Albino rats using tail fl ick method, Eddy’s hot plate methods and anti-infl ammatory activity in Carrageenan induced paw edema in rats. Methods: The analgesic activity was evaluated using Eddy’s hot plate induced hyperalgesia and tail fl ick method, which served as thermal induced pain, where the animal were placed on the hot plate and the reaction time to (lick the paw/ jump out) from the hot plate was observed, 0, 30, 60, 90 mins. Murraya 300 mg, 600 mg/kg/body weight (BW) and ibuprofen (5 mg/kg BW) was administered per oral. The anti-infl ammatory activity was measured by Carrageenan induced paw edema volumes at 0, 1, 2, 3 and 4 hrs using mercury plethysmometer, which served as chemical induced pain models. Results: The mean reaction time in Murraya at a dose of 600 mg/kg at 0 min 5.45±0.72, at 30 mins 6.52±1.03, at 60 mins 7.6±0.81, at 90 mins 8.8±0.63 respectively. The mean reaction time increased signifi cantly with Murraya at dose of 600 mg/kg when compared with control. In the ibuprofen group, the mean reaction time at 0 hr was 0.28±0.04, at 1 hr 0.34±0.05, at 2 hrs 0.46±0.03, at 3 hrs 0.61±0.05, at 4 hrs 0.76±0.05. The mean reaction time Murraya in group 600 mg/kg at 0 hr 0.27±0.04, at 1 hrs 0.39±0.03, at 2 hrs 0.48±0.06, at 3 hrs 0.68±0.05, at 6 hrs 0.80±0.03, respectively. Conclusions: The results indicate that the aqueous extract of Murraya (leaf) extract revealed signifi cant analgesic and anti-infl ammatory in thermal and chemical induced pain models.

Evaluation of the analgesic and anti-inflammatory activity of fixed dose combination: Non-steroidal anti-inflammatory drugs in experimental animals.

Background: In India, a number of fixed dose drug combinations of non-steroidal anti-inflammatory drugs (NSAID's) are available, often as over-the-counter products. These combinations are being prescribed too. Evidence for efficacy of NSIAD fixed dose combination is lacking. Objectives: The current study was undertaken to assess the analgesic and anti-inflammatory efficacy of these combinations over their individual components. Materials and Methods: The study used three NSAIDs viz; paracetamol, ibuprofen and diclofenac sodium, alone or in combination with paracetamol. Animals were divided into six groups with six animals in each group. Analgesic activity was tested by writhing test and paw edema model was used to assess the anti-inflammatory activity. The test drugs were administered orally 30 min prior to injecting 0.6% solution of glacial acetic acid intraperitoneally for writhing test. For paw edema test, after 30 min of drugs administration, animals were injected with 0.1 ml of 1% carrageenan in subplanter region for inducing inflammation. Paw volume was again measured at baseline and after 3 h of subplanter injection of 1% carrageenan. Results: The analgesic and the anti-inflammatory activity of paracetamol and ibuprofen combination were significantly greater than the individual agents when used alone. However, no significant difference in the analgesic or anti-inflammatory activity was found between diclofenac sodium and its combination with paracetamol. It was observed that diclofenac sodium was the most efficacious of the analgesics tested. Combining paracetamol with diclofenac did not show superior analgesic activity compared to diclofenac alone (P = 0.18). Conclusion: Combining paracetamol with ibuprofen enhances analgesic/anti-inflammatory activity over their individual component but potentiation of analgesic activity of diclofenac was not seen when paracetamol was added to it.

Topical nepafenac 0.1% alone versus prednisolone acetate 1% as postoperative anti-inflammatory agents in small gauge vitrectomy.

Aim: To compare the effi cacy of postoperative topical nepafenac (0.1%) with prednisolone acetate (1%) as anti-infl ammatory agents in eyes undergoing Transscleral Sutureless Vitrectomy (TSV). Se􀄴 ings and Design: Prospective, double-blind, randomized, single center clinical study. Materials and Methods: Eighty eyes of 76 subjects, who underwent small gauge vitrectomy, were included in the study. The subjects who fulfi lled the inclusion criteria were randomized to either topical nepafenac only (Group 1) or prednisolone acetate only (Group 2), to be used as postoperative anti-infl ammatory agents. The subjects were reviewed on days 1, 30, and 90. Ocular and adnexal infl ammation was appropriately graded using the standardized classifi cation. Grading of ocular pain was done on the Visual Analog Scale (VAS). Statistical Analysis: The Wilcoxon rank-sum test, using two-sided analysis, was used. Results: During the follow-up, both Group 1 and Group 2 did not have a signifi cant diff erence related to the grade of the anterior chamber infl ammation (P > 0.05) or adnexal infl ammation (P > 0.05). Pain perception was less in the subjects in Group 1 as compared to subjects in Group 2, but was not statistically signifi cant (P > 0.05). Conclusion: Postoperative topical nepafenac was non-inferior to prednisolone acetate in reducing postoperative ocular infl ammation in eyes undergoing TSV.

Anti-infl ammatory activity of two classical formulations of Laghupanchamula in rats.

Background: Laghupanchamula denotes combinations of roots of fi ve herbs. However, in Ayurvedic classics besides four common herbs viz. Kantakari, Brihati, Shaliparni, and Prinshniparni, the fi fth one is either Gokshura (Laghupanchamula with Gokshura LPG) or Eranda (Laghupanchamula with Eranda LPE), and both formulations have been documented to have shothahara (anti-infl ammatory) action. Objectives: The present study was undertaken to compare the anti-infl ammatory activity of 50% ethanolic extract of LPG (LPGE) and LPE (LPEE) in rats and safety in mice. Materials and Methods: LPGE and LPEE were given orally, administered either just before or 60 min before experiment on mice and for 7 days to rats. Paw edema was induced by carrageenan (acute) and formalin (sub-acute), whereas granuloma pouch (sub-acute) was induced by turpentine in rats. Results: Both LPGE and LPEE (1.0 g/kg) at 3 h after their administration showed inhibition of formalin-induced paw edema by 46.2% and 44.3% (P 0.001) and carrageenan-induced paw edema by 53.9% and 60.4% (P0.001), respectively. After 7 days of treatment, both LPGE and LPEE showed 26.3% (P0.01) and 32.5% (P0.05) inhibition, respectively, against formalin-induced paw edema, and reduced weight of turpentine-induced granuloma pouch by 42.8% and 36.1% (P0.001), and volume of exudates by 31.2% and 36.2% (P0.001), respectively. No acute toxicity was observed in mice even with a 10.0-g/kg dose of both extracts. Conclusion: LPGE and LPEE signifi cantly reduced acute and sub-acute infl ammation, and showed effective and similar anti-infl ammatory activity. They seemed to be safe, and use of both formulations in the Laghupanchamula for their anti-infl ammatory activity is, thus, authenticated.