Comparación del bloqueo periprostático con lidocaina y supositorio de diclofenac y placebo en la biopsia prostática / Comparison of periprostatic block with lidocaine and diclofenac suppository and placebo in prostate biopsy

El bloqueo del nervio peri prostático con lidocaína, proporciona un buen alivio del dolor en la realización de la biopsia prostática guiada por ultrasonido, pero el dolor post-procedimiento, puede llegar a ser significativo, la adición del supositorio de diclofenac, podría proporcionar alivio adicional. Se asignaron al azar pacientes en 2 grupos el grupo 1 bloqueo con lidocaína del plexo peri prostático + supositorio de diclofenac sódico y el grupo 2 bloqueo con lidocaína del plexo peri prostático + supositorio de placebo, realizando biopsia doble sextante, el dolor a varios intervalos después del procedimiento se registró en una escala visual análoga (EVA) de 0 a 10. Los 2 grupos fueron similares en cuanto a edad, volumen de próstata, antígeno prostático específico, diagnóstico histopatológico. Los pacientes que recibieron diclofenac tuvieron puntajes de dolor significativamente más bajos que los que recibieron placebo (2 frente a 3,35) p 0,02. La administración rectal de diclofenac antes de la realización de la biopsia de próstata es un procedimiento simple que alivia significativamente el dolor experimentado sin aumento en la morbilidad(AU)

The peri-prostatic nerve block with lidocaine, provides good pain relief in performing ultrasoundguided prostate biopsy, but the postprocedure pain can be significant, the addition of diclofenac suppository, could provide additional relief. Patients were randomly assigned in 2 groups to group 1 blockade with lidocaine of the prostatic peri plexus + suppository of diclofenac sodium and group 2 blockade with lidocaine of the prostatic peri plexus + placebo suppository, performing double sextant biopsy, pain at several intervals after the procedure was recorded on a visual analog scale (EVA) from 0 to 10. Thee 2 groups were similar in terms of age, prostate volume, prostate-specific antigen, histopathological diagnosis. Patients who received diclofenac had pain scores significantly lower than those who received placebo (2 vs. 3.35) p 0.02. Rectal administration of diclofenac before performing a prostate biopsy is a simple procedure that relieves significantly pain experienced without increased morbidity(AU)

Analgesia preventiva con diclofenaco endovenoso en niños operados por cirugía general de forma electiva / Preventive analgesia with intravenous diclofenac for elective paediatric general surgery

Introducción: El dolor es un síntoma tan antiguo como la propia humanidad y ha formado parte inseparable de esta. Objetivo: Evaluar la efectividad de la analgesia preventiva con diclofenaco en el dolor posoperatorio en niños operados por cirugía general electiva. Método: Se realizó un estudio prospectivo, cuasiexperimental, en 230 niños operados por cirugía general electiva. La muestra se distribuyó en dos grupos; analgesia preventiva con diclofenaco (grupo estudio), versus dipirona por vía rectal (grupo control). Las variables analizadas fueron intensidad del dolor, modificaciones hemodinámicas, evolución clínica y eventos adversos. Resultados: En ambos grupos prevalecieron los pacientes entre los 6 y 10 años de edad. En el grupo estudio, el dolor apareció a partir de las 6 h después de la operación, en solo 23 pacientes. No así en el grupo control que desde las 4 h, 19 pacientes refirieron dolor. En el grupo estudio los 23 pacientes tuvieron aproximadamente 2 h de duración del dolor y de ellos, solo 4 con intensidad severa; mientras que en el control 65 refirieron 2 h de dolor y el resto lo refirieron durante 4 h a pesar del rescate analgésico. Nueve de ellos, presentaron intensidad severa. Algunos pacientes presentaron modificaciones de la tensión arterial, frecuencia cardiaca y respiratoria asociadas al dolor. Los efectos adversos frecuentes fueron náuseas y vómitos. Conclusiones: La administración preventiva de diclofenaco disminuye la intensidad del dolor posoperatorio en los procedimientos quirúrgicos de cirugía general electiva en niños(AU)

Introduction: Pain is a symptom as old as humanity itself and has been an inseparable part of it. Objective: To evaluate the effectiveness of preventive analgesia with diclofenac for postoperative pain in elective paediatric general surgery. Methods: A prospective, quasi-experimental study was carried out with 230 children who underwent elective general surgery. The sample was divided into two groups: preventive analgesia with diclofenac (study group) versus dipyrone by the rectal way (control group). The variables analyzed were pain intensity, hemodynamic modifications, clinical evolution and adverse events. Results: In both groups, patients aged 6-10 years of age prevailed. In the study group, pain onset occurred at 6 hours after surgery, in only 23 patients; not being that way in the control group, in which, at 4 hours, 19 patients reported pain. In the study group, the 23 patients had approximately 2 hours of pain duration and, among them, only 4 hours with severe intensity; while in the control group, 65 patients reported 2 hours of pain and the rest referred it for 4 hours despite the analgesic rescue. Nine of them presented severe intensity. Some patients presented changes in blood pressure, heart rate and breathing associated with pain. The frequent adverse effects include nausea and vomiting. Conclusions: The preventive administration of diclofenac decreases the intensity of posoperative pain in surgical procedures of elective paediatric general surgery(AU)

Effects of NSAIDs and environmental oxygen pressure on bone regeneration / Efecto de los AINEs y la presión de oxígeno ambiental sobre la regeneración ósea

Objective: To evaluate the effects of administering diclofenac and ketoprofen, as well as the effects of environmental oxygen pressure variation on mandibular bone regeneration. Methods: Thirty-six guinea pigs were distributed into two equal groups. Mandibular bone defects were performed on both groups. Group A was monitored under oxygen pressure at altitude (3320msl, 107mm Hg). Group B was monitored at sea level oxygen pressure (150msl, 157mm Hg). Each group was subdivided into 3 equal groups (A1, A2, A3 and B1, B2, B3). Subgroups A1 and B1 were given diclofenac; subgroups A2 and B2 ketoprofen; subgroups A3 and B3 NaCl. Bone regeneration was evaluated histologically on days 15 and 30. Results: After 15 days in the group controlled at sea level, the level of osteoblasts presented by the control subgroup was significantly higher (28.00±2.65) compared to the diclofenac subgroup (16.00±6.25) and to the ketoprofen subgroup (18.00±4.36); (p=0.041). After 15 days in the group controlled at altitude, the level of osteoblasts was significantly higher in the control subgroup (38.00±5.29) compared to the diclofenac subgroup (21.67±6.35) and to the ketoprofen subgroup (19.33±2.52); p=0.007. After 30 days in the group at sea level there was no difference found in the cell counting; p>0.05. After 30 days in the group controlled at altitude, the level of osteoblast was significantly higher in the control subgroup (58.00±4.58) compared to the diclofenac subgroup (34.33±4.73) and the ketoprofen subgroup (34.00±11.14); (p=0.003). Conclusion: The administration of diclofenac and ketoprofen produced lower mandibular bone regeneration, the effect being significantly more negative at sea level.

Objetivo: Evaluar el efecto de la administración de diclofenaco y ketoprofeno y de la variación de la presión de oxígeno ambiental sobre la regeneración ósea mandibular. Métodos: Participaron 36 cobayos distribuidos en dos grupos iguales. A ambos grupos se les realizaron defectos óseos mandibulares. El Grupo A fue controlado bajo presión de oxígeno en altura (3320msnm, 107mm Hg). El Grupo B fue controlado bajo presión de oxígeno a nivel del mar (150msnm, 157mm Hg). Cada grupo fue dividido en 3 subgrupos iguales (A1, A2, A3 y B1, B2, B3). Los subgrupos A1 y B1 recibieron diclofenaco; A2 y B2, ketoprofeno; A3 y B3, NaCl. La regeneración ósea fue evaluada histológicamente a los 15 y 30 días. Resultados: A nivel del mar, a los 15 días, hubo una significativa mayor cantidad de osteoblastos en el subgrupo control (28,00±2,65) comparado con el subgrupo diclofenaco (16,00±6.25) y ketoprofeno (18,00±4.36); (p=0,041). En altura, a los 15 días, hubo una significativa mayor cantidad de osteblastos en el subgrupo control (38,00±5,29) comparado con el subgrupo diclofenaco (21,67±6,35) y ketoprofeno (19,33±2,52); p=0,007. A nivel del mar, a los 30 días, no se encontró diferencia en el conteo celular; p>0,05. En altura, a los 30 días, se encontró una significativa mayor cantidad de osteoblastos en el subgrupo control (58,00±4,58) comparado con el subgrupo diclofenaco (34,33±4,73) y ketoprofeno (34,00±11,14); (p=0,003). Conclusión: La administración de diclofenaco y ketoprofeno produjeron una menor regeneración ósea mandibular, siendo este efecto significativamente más negativo a nivel del mar.

Intrasound therapy: an effective alternative to sodium diclofenac phonophoresis in the management of mechanical chronic cervical spine pain

The efficacy of Sodium Diclofenac Phonophoresis (SDP) as an effective adjunct in the management of inflammation and pain has been established though its application entails complicated choices of treatment parameters. Intrasound Therapy (IST), acclaimed for its simplicity of operation has been reported to promote healing though no studies have been done on its effect in Chronic cervical spine pain (CCSP). The aim of this study was to determine if IST could be an effective therapeutic option to SDP as an adjunct in the management of CCSP. Forty seven (47) participants with CCSP that had definite diagnoses were randomly assigned into 3 groups. All participants had exercises and massage while in addition, group 1 had SDP and group 2 IST for 10 minutes each. Participants were treated for 40 minutes twice a week for 4 weeks and were evaluated for pain, Quality of life (QoL), disability and range of motion (ROM) of the cervical spine. Paired sample t-test was used to compare the outcome parameters in each group and data presented as Mean ± SEM with significance at p<0.05. IST and SDP significantly (p˂0.05) improved the clinical parametres compared with the control group and there were no significant (p ˃0.05) differences in clinical outcome between the IST and SDP groups. IST was as effective as SDP and considering its relative simplicity of operation could be an alternative therapeutic adjunct in the management of chronic cervical pain

Efficacy of lumiracoxib versus diclofenac sodium in pain control following extraction of impacted lower third molar / Eficacia de lumiracoxib frente a diclofenaco de sodio en el control del dolor después de la extracción de un tercer molar inferior impactado

The aim of this paper was to compare the efficacy of two different anti-inflammatory agents, Diclofenac (Deltaflogin®) and Lumiracoxib (Prexige®) in the control of postoperative pain that results from surgical removal of impacted lower third molars. Twenty adult patients from the Oral and Maxillofacial Surgery Division of the Araraquara Dentistry School, UNESP who presented bilateral impacted lower third molars were included in the study. Removal of the impacted teeth was performed in each side in different operative moments in a split mouth design for the study. The anti-inflammatory drugs evaluated were randomly administered on the first and second surgical procedures. The pain level was recorded using an analogical visual scale at 6, 24, 48 and 72 hours after surgical intervention. Both lumiracoxib 400 mg and diclofenac 100 mg are efficient for acute pain control after surgical removal of impacted lower third molars. However, lumiracoxib offered better pain control.

El objetivo de este trabajo fue comparar la eficacia de dos agentes antiinflamatorios distintos, Diclofenaco (Deltaflogin®) y Lumiracoxib (Prexige®) en el control del dolor postoperatorio resultante de la extracción quirúrgica de terceros molares inferiores impactados. Fueron incluídos, veinte pacientes adultos de la División de Cirugía Oral y Maxilofacial de la Escuela de Odontología de Araraquara, UNESP que presentaron terceros molares inferiores impactados. La extracción de los dientes impactados se realizó en distintos tiempos operatorios a cada lado en un diseño de estudio de boca dividida. Los antinflamatorios evaluados fueron administrados de forma aleatoria en el primer y segundo procedimento quirúrgico. El nivel de dolor se registró utilizando una escala visual análoga a las 6, 24, 48 y 72 horas después de la intervención. Ambos; lumiracoxib 400 mg y diclofenaco 100 mg son eficientes para el control del dolor agudo, después de la extracción quirúrgica de terceros molares inferiores impactados. Sin embargo, lumiracoxib ofreció mejor control del dolor.

Evaluación del desempeño de los métodos analíticos aplicados en el diclofenaco sódico 100 mg retard de producción nacional / Evaluation of the performance of the analytical methods applied to Cuban-made 100mg retard sodium diclofenac

Introducción: el diclofenaco sódico es un derivado del ácido fenilácetico y pertenece al grupo de los antinflamatorios no esteroideos con propiedades antinflamatorios, analgésicas y antipiréticas pronunciadas. En la Farmacopea de los Estados Unidos (USP 36, 2013) aparece reportado los métodos analíticos para el control de calidad del diclofenaco sódico en el ingrediente farmacéutico activo y en las tabletas. Objetivos: evaluar el desempeño de los métodos analíticos que se emplean en el control de la calidad de cuantificación y los estudios de estabilidad del ingrediente farmacéutico activo; así como los ensayos de disolución de las tabletas de diclofenaco sódico 100 mg retard de producción nacional. Métodos: en la evaluación del desempeño del método analítico potenciométrico para la cuantificación del ingrediente farmacéutico activo se analizaron los parámetros de linealidad y de precisión (repetibilidad y precisión intermedia). Para el método cromatográfico aplicable a la cuantificación del ingrediente farmacéutico activo en el producto terminado se analizaron los parámetros de especificidad, precisión y exactitud. En el método espectrofotométrico empleado en el ensayo de disolución se tuvo en cuenta la especificidad, la precisión, la linealidad, la influencia del filtrado y la estabilidad de las soluciones analíticas. Resultados: la evaluación del desempeño realizada a los diferentes métodos analíticos, fueron satisfactorias, demostrando que son lineales, precisos y específicos en el rango de concentraciones estudiadas. Conclusiones: se demostró la confiabilidad de los métodos empleados en el control de la calidad y los estudios de estabilidad del ingrediente farmacéutico activo y de las tabletas de diclofenaco sódico 100 mg retard de producción nacional(AU)

Introduction: sodium dicloflenac is a phenylacetic acid derivate included in the non-steroidal anti-inflammatory group, with marked analgesic and antipyretic properties. The US Pharmacopeia (USP 36, 2013) reports the analytical methods for the quality control of sodium diclofenac in the active ingredient and in tablets. Objectives: to evaluate the performance of the analytical methods used in the quality control of quantitation and the stability studies of the active ingredient as well as the dissolution tests of the Cuban-made 100 mg retard sodium diclofenac. Methods: the evaluation of the performance of the potentiometric analytical method for quantitation of the active ingredient analyzed the parameters called linearity and precision (repeatability and intermediate precision). For the chromatographic method applicable to quantitation of the active ingredient in the finished product, parameters such as specificity, precision and accuracy were analyzed. The spectrophotometric method used in the dissolution test took into account specificity, precision, linearity, filtering effect and stability of the analytical solutions. Results: the evaluation of the performance of the different analytical methods was satisfactory and they proved to be linear, precise and specific in the range of studied concentrations. Conclusions: the reliability of the methods for the quality control and of the stability studies of the active ingredient and of Cuban-made 100 mg retard sodium diclofenac was demonstrated(AU)

Experimental evidence of pharmacological management of anchorage in Orthodontics: A systematic review

Introduction: Orthodontic anchorage is one of the most challenging aspects of Orthodontics. Preventing undesired movement of teeth could result in safer and less complicated orthodontic treatment. Recently, several reviews have been published about the effects of different molecules on bone physiology and the clinical side effects in Orthodontics. However, the effects of local application of these substances on the rate of orthodontic tooth movement have not been assessed.Objectives: The aim of this research was to analyze the scientific evidence published in the literature about the effects of different molecules on orthodontic anchorage.Methods: The literature was systematically reviewed using PubMed/Medline, Scopus and Cochrane databases from 2000 up to July 31st, 2014. Articles were independently selected by two different researchers based on previously established inclusion and exclusion criteria, with a concordance Kappa index of 0.86. The methodological quality of the reviewed papers was performed.Results: Search strategy identified 270 articles. Twenty-five of them were selected after application of inclusion/exclusion criteria, and only 11 qualified for final analysis. Molecules involved in orthodontic anchorage were divided into three main groups: osteoprotegerin (OPG), bisphosphonates (BPs) and other molecules (OMs).Conclusions: Different drugs are able to alter the bone remodeling cycle, influencing osteoclast function and, therefore, tooth movement. Thus, they could be used in order to provide maximal anchorage while preventing undesired movements. OPG was found the most effective molecule in blocking the action of osteoclasts, thereby reducing undesired movements.

Introdução: a ancoragem ortodôntica é um dos aspectos mais desafiadores da Ortodontia. A prevenção de movimentos dentários indesejados poderia resultar em um tratamento ortodôntico mais seguro e menos complexo. Recentemente, foram publicadas várias revisões de literatura sobre os efeitos de diferentes substâncias na fisiologia do tecido ósseo e os efeitos colaterais clínicos na Ortodontia. Porém, os efeitos da aplicação local dessas substâncias no grau de movimentação dentária ortodôntica não foram avaliados.Objetivos: o objetivo da presente pesquisa foi analisar a evidência científica publicada na literatura sobre os efeitos de diferentes substâncias na ancoragem ortodôntica.Métodos: a literatura foi sistematicamente revisada utilizando-se as bases de dados PubMed/Medline, Scopus e Cochrane, de 2000 a 31 de julho de 2014. Os artigos foram selecionados, de maneira independente, por dois pesquisadores diferentes, tendo como base critérios de inclusão e exclusão previamente estabelecidos, com um índice Kappa de concordância de 0,86. A qualidade metodológica dos artigos revisados foi analisada.Resultados: a estratégia de pesquisa identificou 270 artigos; 25 artigos foram selecionados após a aplicação dos critérios de inclusão e exclusão, mas apenas 11 foram qualificados para a análise final. As substâncias envolvidas na ancoragem ortodôntica foram divididas em três grupos principais: osteoprotegerina (OPG), bisfosfonatos (BFs) e outras substâncias (OSs).Conclusões: diferentes substâncias são capazes de alterar o ciclo de remodelação óssea, influenciando na função dos osteoclastos e, portanto, na movimentação dentária. Sendo assim, essas substâncias podem ser utilizadas para promover o máximo de ancoragem e prevenir movimentos indesejados. A OPG foi a substância mais eficaz no bloqueio da ação dos osteoclastos, reduzindo os movimentos indesejados.

Estudio controlado, doble ciego, randomizado, multicéntrico, para evaluar la eficacia de la combinación fija tiocolchicósido más diclofenaco potásico en contracturas / Multicentered, randomized, double-blind and controlled study for the evaluation of efficacy of a set combination of thiocolchicoside plus potasium diclofenac in spams

Objetivo: determinar la eficacia y la tolerabilidad de la combinación a dosis fija, en una sola tableta, de tiocolchicósido 4 mg más diclofenaco potásico 50 mg en la reducción de la contractura muscular aguda estriada dolorosa comparado contra placebo y el uso de paracetamol tabletas de 500 mg como medicación de rescate. Métodos: fueron reclutados 97 pacientes de 2 ciudades ecuatorianas, Quito y Guayaquil, en tres centros de investigación, públicos y privados, con cervicalgia, dorsalgia y lumbalgia, principalmente de causa funcional. Los pacientes fueron asignados al azar en dos grupos: 1) grupo medicación activa, tiocolchicósido más diclofenaco potásico, 50 pacientes, 2) grupo placebo 47 pacientes. La eficacia en ambos grupos se evaluó por la reducción de la contractura muscular apreciada por inspección, palpación y reducción del dolor medido por una escala visual análoga, después de 5 días de tratamiento. Resultados: la evolución del grado de contractura muscular en el grupo medicación activa por evaluación visual pasó de un 100 por ciento con contractura visible con o sin actividad antiálgica fija a 96 por ciento sin signos visibles de contractura; de un 82 por ciento de contractura moderada a severa con o sin dolor evocado por palpación a un 74 por ciento de contractura leve sin dolor y 26 por ciento de ausencia de contractura. El promedio de dolor según la escala visual análoga disminuyó de 6,66 cm antes del tratamiento a 0,86 cm al finalizar el quinto día de tratamiento. Los efectos adversos fueron leves en el grupo tratado. Conclusiones: la combinación fija de tiocolchicósido 4 mg más diclofenaco potásico 50 mg en una sola tableta, administrado dos veces al día, es eficaz en el manejo de la contractura muscular aguda dolorosa de diversa etiología de manera estadísticamente significativa, bien tolerada y no altera el rendimiento psicomotor(AU)

Objective: to determine the efficacy and tolerability of a combination at a set dose in a single tablet of thiocolchicoside 4 mg plus potassium diclofenac 50 mg in the reduction of painful acute muscle spasm compared with the placebo and the use of 500 mg paracetamol as rescue medication. Methods: ninety seven patients from two Ecuador cities, named Quito and Guayaquil, were recruited in three research centers, both public and private. They suffered cervical pain, low back pain and dorsal pain, mainly of functional cause. The patients were randomly assigned in two groups 1) active medication group with 50 patients treated with thiocolchicoside plus potassium diclofenac and 2) placebo group with 47 patients. The efficacy of both groups was evaluated by the reduction of muscle spams observed in checking, palpation and pain reduction measured in an analogue visual scale after 5 days of treatment. Results: the progress of the muscle spasm degree in the active medication group according to visual evaluation went from 100 percent with visible spasm with or without fixed antialgic activity to 96 percent with no visible signs of spasm; from 82 percent of moderate spasm to severe with or without evoked pain by palpation to 74 percent of mild spasm without pain and 26 percent of spasm-free muscle. The pain average according to the visual scale decreased from 6.66 cm before treatment to 0,86 cm after the 5th day. The adverse effects were mild in t he treated group. Conclusions: the fixed combination of thiocolchicoside 4mg plus potassium diclofenac 50 mg in a single tablet, administered two times a day is efficacious in the painful acute muscle spasm of diverse etiology in a statistically significant way, well-tolerated and with no alteration of the psychomotor performance(AU)

O efeito da laserterapia de baixa potência em aspectos histológicos em um modelo experimental de lesão muscular por estiramento controlado em ratos / The effect of low-level laser therapy in histological aspects in a model of experimental muscle injury in rat controlled muscle strain

Estiramento muscular e outras desordens musculoesqueléticas são as principais causas que desabilitam atletas e praticantes de atividades físicas. Seu tratamento inclui AINES que desencadeiam vários efeitos adversos. Objetivo: o objetivo do estudo foi avaliar o efeito dos tratamentos com Laserterapia de Baixa Potência e do anti-inflamatório diclofenaco, tanto individualmente quanto combinados (laser + aplicação por vias tópica ou intramuscular de diclofenaco) em aspectos histológicos no modelo experimental de lesão muscular por estiramento controlado em ratos. Materiais e Métodos: a lesão por estiramento foi induzida, por sobre carga, no músculo tibial anterior de ratos (n=6). O grupo controle não recebeu tratamento, grupos lesados receberam um único tratamento com diclofenaco através das vias tópica ou intramuscular, irradiação com laser (3 J, 830 nm, 100 mW) ou os dois tratamentos conjuntamente, laser e diclofenaco, totalizando seis grupos experimentais. Os tratamentos foram realizados 1 hora após a lesão. O músculo tibial foi removido para análise histológica, três horas após a indução da lesão e também seis horas após indução. Resultados e discussão: a avaliação histológica demonstrou uma melhor organização estrutural do tecido muscular, células bem delineadas e menor quantidade de fibras fragmentadas e menor descontinuidade de acidofilia nos grupos tratados com laser e diclofenaco, nas duas vias de aplicação, tanto no período de 3 horas quanto no de 6 horas após a lesão. Conclusão: a irradiação do laser de baixa potência conjuntamente ao diclofenaco tópico e intramuscular melhorou aspectos histológicos do tecido muscular, após lesão por estiramento, na fase aguda quando comparado com os demais tratamentos...

Muscle stretch and other musculoskeletal disorders are the main causes that disable athletes and fitness enthusiasts. His treatment includes NAIDs that trigger various adverse effects. Objective: the objective of the study the effect of treatments with Low Power Laser (LPL) Therapy and the anti-inflammatory diclofenac, both individually and combined (LPL + intramuscular or topical application of diclofenac pathways) in histological aspects in an experimental model was to evaluate muscle injury in rats controlled stretch. Materials and Methods: the injury was induced by muscle stretch, overload, the tibialis anterior muscle of rats (n = 6). The control group received no treatment, injured groups received a single treatment with diclofenac through the anti-inflammatory topical or intramuscular (AT and AIM), irradiation with LPL (3 J 830 nm, 100 mW), or the two treatments together, LPL and diclofenac (LPL/LPL or AT/AIM), totaling six experimental groups. All treatments were performed 1 hour after the injury. The right anterior tibial muscle was removed for histological analysis, within 3 hours after induction of the lesion and also 12 hours after induction. Results and discussion: histological evaluation in this study showed a better estructural organization of muscle tissue, cells and less well defined amount of fragmented fibers in the group treated with LPL and LPL AT + 3J 3J + AIM in both the 3-hour period and in 6 hours following injury. Conclusion: treatment with LPL jointly to the topic and intramuscular diclofenac improved the histological aspects of muscle tissue after stretch injury in the acute phase compared with the other treatments...

O papel dos anti-inflamatórios não hormonais no tratamento da dor musculoesquelética / The role of non-steroid anti-inflammatory in the treatment of musculoskeletal pain

Os anti-inflamatórios não esteroides (AINEs) estão entre os medicamentos mais comumente prescritos em todo o mundo e são responsáveis por cerca de um quarto de todas as notificações de reações adversas. Têm sido amplamente indicados em pacientes com doença reumática e outras doenças musculoesqueléticas - população de maior risco de graves complicações gastrintestinais (GI). Os AINEs tópicos são administrados para o tratamento de diversas condições: lesões musculoesqueléticas, dor pós-operatória, neuralgia pós-herpética, periodontite, úlceras aftosas e ceratoses actínicas. Dados mostram que metade dos AINEs é indicada para osteoartrite (OA). Sua administração tópica oferece como benefício menor incidência de efeitos adversos sistêmicos, como úlcera péptica e hemorragia GI, na metabolização do medicamento nos tecidos afetados...

Nonsteroidal anti-inflammatory are among the drugs more usually prescribed in all over the world which is responsible for about a fourth of all notifications of adverse reactions. It has been widely indicated in patients with rheumatic disease and others musculoskeletal disease - high risk population of severe gastrointestinal complications (GI). The topic AINEs are managed for the treatment of many conditions: musculoskeletal injury, postoperative pain, postherpetic neuralgy, periodontic, mouth ulcer and actinic keratosis. Data show that half of AINEs are indicated for osteoarthritis (OA). Its topic administration provides benefits like less incidence of systemic adverse effects like peptic ulcer and GI bleeding in drug-metabolizing in affected tissues...

Diclofenac topical gel in excisional wounds maintain heal quality and reduce phlogistic signals1

PURPOSE: To investigate diclofenac topical gel as an alternative to reduce phlogistic signals and maintain quality of wound repair. METHODS: Fifteen Wistar rats were used in this study; four excisional wounds were performed on the dorsum of each animal. Once in a day, cranial wounds received topical diclofenac gel administration and caudal wounds were washed with isotonic saline. After seven, 14 and 21 postoperative days, five animals were randomly chosen for macroscopic and microscopic wound analysis. RESULTS: On the 7th day: diclofenac wounds showed significant higher scab formation, however showed less phlogistic signal; diclofenac wounds had larger area and had less neutrophil invasion. On the 14th day: No area difference was noted and diclofenac wounds showed less hyperemia and phlogistic signals; diclofenac wounds showed greater keratinocytes invasion. On the 21st day: Almost all wounds were closed and there were no difference regarding the type of scar formation; diclofenac wounds showed greater monocytes invasion and lower angiogenesis level. No difference was noted in any postoperative day regarding fibroblast invasion, collagen deposit quantity and quality. CONCLUSION: Diclofenac topical gel is capable of reducing phlogistic signals and do not cause fibroblast or keratinocyte downregulation thus do not lead to excisional wound healing impairment. .

Concentration of Non-Steroidal Anti-Inflammatory Drugs in the Pelvic Floor Muscles: An Experimental Comparative Rat Model

PURPOSE: The aim of this study is to explore non-steroid anti-inflammation drugs (NSAIDs) potency for pelvic floor muscle pain by measuring local concentration in a rat model. MATERIALS AND METHODS: We used nine NSAIDs, including nabumetone, naproxen, ibuprofen, meloxicam, piroxicam, diclofenac potassium, etodolac, indomethacin, and sulindac, and 9 groups of female Wister rats. Each group of rats was fed with one kind of NSAID (2 mg/mL) for three consecutive days. Thereafter, one mL of blood and one gram of pelvic floor muscle were taken to measure drug pharmacokinetics, including partition coefficient, lipophilicity, elimination of half-life (T1/2) and muscle/plasma converting ratio (Css, muscle/Css, plasma). RESULTS: Diclofenac potassium had the lowest T1/2 and the highest mean Css, muscle/Css, plasma (1.9 hours and 0.85+/-0.53, respectively). The mean Css, muscle/Css, plasma of sulindac, naproxen and ibuprofen were lower than other experimental NSAIDs. CONCLUSION: Diclofenac potassium had the highest disposition in pelvic floor muscle in a rat model. The finding implies that diclofenac potassium might be the choice for pain relief in pelvic muscle.

Evaluation of the efficacy of pulsed electromagnetic therapy in the treatment of back pain: a randomized controlled trial in a tertiary hospital in Nigeria / Evaluación de la eficacia de la terapia electromagnética en pulsos en el tratamiento de lumbago: prueba controlada aleatoria en un hospital terciario de Nigeria

Musculoskeletal system disorders (MSDs) are amongst the most commonly encountered problems in orthopaedics and physiotherapy practice all over the world and back pain is amongst the most prevalent of musculoskeletal presentations encountered in clinical practice. The attendant deformities, huge economic loss among many other sequelae on the affected individuals have always informed the search for costeffective treatment modalities that are noninvasive and are devoid of, or at least have minimal side effects. This randomized controlled trial was conducted to assess the therapeutic efficacy of the use of a nonpharmacological device [pulsed electromagnetic field (PEMF)] modality in the treatment of back pain. A total of 16 patients (mean age: 42.82 ± 8.63 years) with back pain without radiculopathy who met the inclusion criteria were purposively enrolled in the study. Patients were randomly assigned into two groups. Group A had eight patients treated with PEMF plus medications (analgesics, nonsteroidal antiinflammatory - diclofenac sodium) while the eight patients in group B were treated with only standard medications. The PEMF device was applied in group A four times a day for the period the patients were admitted (maximum of nine days). Measured outcome parameters were reduction in pain as assessed with numeric pain rating scale (NPRS) and improvement in functional ability status as assessed with functional activity scale (FAS). Obtained data were analysed with paired and independent ttest to test the significant efficacy of the treatment outcomes in the two groups. There was a statistically significant faster pain relief and resumption of active functions in patients treated with PEMF plus analgesic compared with the rates exhibited by patients treated with standard analgesics alone. These results suggest that PEMF therapy is beneficial in reducing pain and disability in patients with back pain and should be made part of holistic care for back pain. Further studies using PEMF on larger patient populations are advocated to further confirm the efficacy of PEMF therapy in back pain management.

Los trastornos del sistema músculoesquelético (SME) se encuentran entre los problemas más comunes en la práctica de la ortopedia y la fisioterapia en todo el mundo, en tanto que el lumbago se halla entre las manifestaciones más prevalecientes en la práctica clínica. Las deformidades concomitantes y las enormes pérdidas económicas - entre otras muchas secuelas que afectan a los individuos en estos casos - han sido siempre razón para buscar modalidades de tratamientos costoefectivos, que no sean invasivos y estén totalmente libres de efectos secundarios, o tengan al menos efectos colaterales mínimos. Esta prueba controlada aleatoria se realizó para evaluar la eficacia terapéutica de una modalidad no farmacológica [terapia con campos electromagnéticos (PEMF)] en el tratamiento del lumbago. Un total de 16 pacientes (edad promedio: 42.82 ± 8.63 años) con lumbago sin radiculopatía, quienes satisfacían los criterios de inclusión criterios, fueron deliberadamente enrolados en este estudio. Los pacientes fueron aleatoriamente divididos en dos grupos. El grupo A estuvo formado por ocho pacientes tratados con PEMF además de medicamentos (analgésicos, antiinflamatorios no esteroideos, diclofenaco de sodio), mientras que los otros ocho pacientes en el grupo B fueron tratados sólo con medicamentos normales. El dispositivo PEMF se aplicó al grupo A dos veces al día durante el período de que los pacientes estuvieron ingresados (como máximo nueve días). Los parámetros medidos en relación con el resultado fueron la reducción de dolor evaluada de acuerdo con la escala de calificación del dolor (ECD) y la mejoría de la capacidad funcional, según la evaluación de la escala de la actividad funcional (EAF). Los datos obtenidos se analizaron con prueba t pareada y prueba de t independiente a fin de comprobar la eficacia de los resultados del tratamiento en los dos grupos. En los pacientes tratados con PEMF y analgésicos, hubo tanto un alivio del dolor como una reanudación de las funciones activas significativamente más rápidos según las estadísticas, en comparación con los índices provenientes de los pacientes tratados con analgésicos normales solamente. Estos resultados sugieren que la terapia PEMF es beneficiosa para reducir el dolor y la discapacidad en los pacientes con lumbago, y debe hacerse parte de la atención holística al lumbago. Se recomienda realizar más estudios usando PEMF en poblaciones mayores de pacientes para confirmar aún más la eficacia de la terapia PEMF en el tratamiento de lumbago.

Tratamiento del cólico nefrítico con diclofenaco sódico / Treatment of nephritic colic with diclofenac sodium

Introducción: habitualmente se utilizan como tratamiento para el cólico nefrítico los antiespasmódicos y relajantes de la fibra lisa muscular, pero desde los años 90 muchos estudios avalan el uso de los antiinflamatorios no esteroideos como mejor opción de tratamiento para el alivio sintomático del mismo.Objetivo: evaluar la efectividad del diclofenaco sódico en el tratamiento del cólico nefrítico.Métodos: se realizó un estudio observacional, descriptivo, de corte longitudinal, retrospectivo en 54 pacientes que asistieron al Servicio de Urgencia del Hospital General Docente Leopoldito Martínez, del municipio San José de las Lajas, Mayabeque por presentar cólico nefrítico y recibieron tratamiento con diclofenaco sódico, en el período comprendido de enero 2010 a febrero 2011. Resultados: el 57,4 por ciento de los pacientes se encontraban entre los 31 y 40 años de edad, el 83,3 por ciento pertenecieron al sexo masculino, en el 75,6 por ciento se comprobó hematuria microscópica en el parcial de orina y en el ultrasonido abdominal se constató litiasis renoureteral en el 62,5 por ciento y pielocaliectasia ligera en el 12,5 por ciento. la evolución del dolor en los pacientes se evaluó previo y posterior a la administración intramuscular de Diclofenaco sódico, a través de la Escala Visual Análoga (EVA). Donde se observó que en el mayor por ciento de los pacientes hubo una disminución significativa del dolor, cuyo promedio de tiempo de estancia en el hospital fue de 37,5 minutos después de administrado el medicamento.Conclusiones: el uso del diclofenaco sódico tiene una buena efectividad en el tratamiento del cólico nefrítico

Introduction: antispasmodics and relaxants of smooth muscle fiber are usually used as a treatment for nephritic colic, but since the 90's many studies support the use of nonsteroidal antiinflammatory drugs (NSAIDs) as best treatment option for the symptomatic relief of it.Objective: to assess the effectiveness of diclofenac sodium in the treatment of nephritic colic.Methods: an observational, descriptive, longitudinal, retrospective study was performed in 54 patients who attended the Emergency Service of Leopoldito Martinez General Teaching Hospital, in San José de las Lajas municipality, Mayabeque for exhibiting nephritic colic and who were treated with diclofenac sodium, in the period from January 2010 to February 2011. Results: 57,4 per cent of the patients were between 31 and 40 years old, 83,3 per cent were males, in 75,6 per cent it was found microscopic hematuria in partial urinalysis and in the abdominal ultrasound it was confirmed reno-ureteral lithiasis in 62,5 per cent and mild pyelocaliectasis in 12,5 per cent. The evolution of pain in patients was assessed prior and subsequent to intramuscular administration of diclofenac sodium through the Visual Analogue Scale (VAS). Where it was noted that in the highest percentage of patients there was a significant decrease in pain, whose average length of stay in hospital was 37,5 minutes after medication administration.Conclusions: the use of diclofenac sodium has good effectiveness in the treatment of nephritic colic

Gingivitis ulceronecrotizante. Recuperación de las papilas después del tratamiento: informe de casos / Necrotizing ulcerative gingivitis. Papillae recovering after treatment: case reports

Objetivo: describir la cicatrización gingival en tres pacientes con gingivitis ulceronecrotizante y revisar el tratmiento propuesto en la literatura, para evaluar los factores que influyen en la respuesta gingival. Caso clínico: en los casos presentados, se priorizaron el diagnóstico y el tratamiento precoz de la lesión, a fin de ayudar a mantener y recuperar los tejidos interdentales. Conclusión: es importante preservar los tejidos gingivales interdentales, no solamente desde el punto de vista estético, sino también desde lo funcional. El diagnóstico y tratamiento temprano de las lesiones, seguidos de una intervención efectiva, ayudarán a reducir la destrucción del tejido interdentario. El mantenimiento a largo plazo es fundamental para garantizar la salud y evitar la recidiva

Desarrollo tecnológico de una formulación de diclofenaco de sodio 0, 1 por ciento para administración oftálmica / Technological development of a 0.1 percent sodium diclophenac formulation for opththalmological use

Introducción: el diclofenaco de sodio es un derivado del ácido fenilacético que pertenece al grupo de los antiinflamatorios no esteroideos con propiedades antirreumáticas, antiinflamatorias, analgésicas y antipiréticas pronunciadas. Al nivel ocular se indica para el tratamiento de conjuntivitis, queratoconjun­tivitis, úlceras corneales, y en el de inflamación de la córnea y la conjuntiva por traumatismos. Además, es empleado en la inflamación subsecuente a la cirugía de cataratas y para inhibir la miosis intraoperativa y el edema macular cistoide posoperativo. Objetivo: diseñar una formulación de diclofenaco de sodio 0,1 por ciento colirio, que cumpla con los índices de control de calidad para esta forma farmacéutica y que proporcione el efecto terapéutico deseado. Métodos: se realizaron cinco ensayos tecnológicos en los que se ajustó el pH y la isotonicidad de la formulación según las exigencias de un preparado oftálmico. La isotonicidad se ajustó con ácido bórico y el pH de máxima estabilidad se logró empleando la trometamina. Resultados: el desarrollo tecnológico de la formulación resultó satisfactorio, y se obtuvo un producto que cumplió con todas las especificaciones descritas en la técnica desarrollada por el fabricante para el control de la calidad del producto. La preparación mantuvo sus propiedades físicas, químicas y microbiológicas inalterables por un período de 12 meses, almacenada a una temperatura controlada por debajo de 25 °C. Conclusiones: la formulación de un medicamento obtenida en forma de colirio, que contiene diclofenaco de sodio como principio activo, empleado en diferentes afecciones al nivel ocular, cumple con todas las especificaciones de calidad para este tipo de forma farmacéutica, lo cual puede aumentar el arsenal terapéutico de Cuba

Introduction: Sodium diclophenac derives from the phenylacetic acid belonging to the non-steroid anti-inflammatories that have notable anti-rheumatic, anti-inflammatory, analgesic and antipyretic properties. It is prescribed to treat conjunctivitis, keratoconjunctivitis, corneal ulcers, corneal and conjunctival inflammation due to traumas. Additionally, it is used in reducing inflammation after the cataract surgery and in inhibiting the intraoperative myosis and the postoperative cystoid macular edema. Objective: to design a formulation of 0.1 percent sodium diclophenac eye drops that meets the quality control parameters for this pharmaceutical form and that provides the desired therapeutic effect. Methods: five technological assays were conducted to adjust for the pH and the isotonicity of the formulation as required for an ophthalmologic preparation. Isotonicity was adjusted with boric acid, and Trometamin served to obtain highly stable pH. Results: the technological development of the formulation was satisfactory. There was obtained a product that met all the specifications described in the manufacturer's technique for the quality control. The physical, chemical and microbiological properties of the preparation remained unchanged for 12 months under storage conditions below 25 °C. Conclusions: the eye drop formulation, with sodium diclophenac as active principle, meets all the quality specifications for this pharmaceutical form to treat various eye diseases. This might broadens the therapeutic options in Cuba

Chronic temporomandibular pain treatment using sodium diclofenac / Tratamiento crónico del dolor temporomandibular con diclofenaco sódico

This study evaluate spontaneous pain after and before administration of sodium diclofenac, isolated or associated to carisoprodol, acetaminophen and caffeine, in chronic temporomandibular disorders (TMD) patients. Were selected eighteen volunteers, both men and women, between 35-70 years of age (mean age 50 years). The inclusion criteria was masticatory muscle pain, and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used on the diagnose. The selection of treatment for each individual was done by a triple-blind full-randomized crossover methodology. Thus, all patients were submitted to all treatment at different moments, in a non standardized sequence, avoiding tendentious results. The treatments were: A (sodium diclofenac + carisoprodol + acetaminophen + caffeine), B (sodium diclofenac) and C (placebo), all associated with an occlusal splint. Each treatment period was followed by an eleven-day washout. There weren't observed differences between initial and final values of treatments. However, there were statistically significant differences in evaluative and miscellaneous sensorial groups after B treatment; and in sensorial, affective, and total score groups after B and C treatments. Within the limitations of this investigation, we conclude that treatment of muscular TMD patients with sodium diclofenac isolated promoted higher analgesia than treatment with sodium diclofenac more associations or placebo, when associated to an occlusal splint.

Este estudio evaluó el dolor espontáneo antes y después de la administración de diclofenaco sódico, aislado o asociado a carisoprodol, paracetamol y cafeína, en pacientes con trastornos temporomandibulares crónicos (TTM). Se seleccionaron dieciocho voluntarios, hombres y mujeres, entre 35-70 años de edad (edad media 50 años). Los criterios de inclusión fueron dolor muscular masticatorio, y los criterios diagnósticos para trastornos temporomandibulares (RDC / TMD) como diagnóstico. La selección del tratamiento para cada individuo se llevó a cabo mediante una metodología de cruce triple ciego completo al azar. Por lo tanto, todos los pacientes fueron sometidos a todos los tratamientos en diferentes momentos, en una secuencia no estandarizada, evitando los resultados tendenciosos. Los tratamientos fueron: A (diclofenaco sódico + carisoprodol + acetaminofen + cafeína), B (diclofenaco sódico) y C (placebo), todos asociados a una férula oclusal. Cada período de tratamiento fue seguido por once días. No se encontraron diferencias entre los valores inicial y final de los tratamientos. Sin embargo, hubo diferencias estadísticamente significativas en los grupos de evaluación sensorial y después del tratamiento B, y en los grupos de calificación sensorial, afectivo, y el total después de los tratamientos B y C. Dentro de las limitaciones de esta investigación, se concluye que el tratamiento con diclofenaco sódico aislado en pacientes con TTM musculares promueve una mayor analgesia que el tratamiento con diclofenaco sódico más asociaciones o placebo, cuando se asocia a una férula oclusal.

Utilização do diclofenaco na prática clínica: revisão das evidências terapêuticas e ações farmacológicas / Use of diclofenac in clinical practice: review of the therapeutic evidence and pharmacologic actions

JUSTIFICATIVA E OBJETIVOS: Os anti-inflamatórios não esteroides (AINES) apresentam atividade farmacológica de inibição das isoenzimas ciclo-oxigenase-1 (COX-1) e ciclo-oxigenase-2 (COX-2) em graus diversos, cujos perfis de segurança variam individualmente.A eficácia é semelhante, porém os possíveis eventos adversos são relevantes nas decisões do tratamento prescrito. O diclofenaco está disponível internacionalmente há mais de 40 anos, tendo seu perfil farmacológico e de segurança documentados em diversos estudos básicos e clínicos. O objetivo desta revisão da literatura foi de apresentar aspectos da dor e do uso de diclofenaco na prática clínica, incluindo as indicações as questões de segurança e a eficácia do medicamento. CONTEÚDO: Esta revisão da literatura apresentará a farmacologia básica do diclofenaco, bem como evidências terapêuticas com o uso deste fármaco em diversas condições dolorosas e suas implicações na prática clínica. CONCLUSÃO: O diclofenaco tem demonstrado eficácia clínica no tratamento de diversas condições dolorosas, entre estas lombalgias, artrites, dores pós-traumáticas e pós-cirúrgicas, dismenorreias,bem como cólica renal e biliar. Vale ressaltar que, na avaliação de um paciente apresentando dor e ao decidir um plano de tratamento e na prescrição de qualquer medicamento, cabe ao médico avaliar cuidadosamente o paciente para determinar o melhor curso de ação no individuo, levando-se em consideração o histórico médico do paciente, comorbidades e uso de medicamentos concomitantes, a fim de proporcionar a melhor alternativa terapêutica, com redução máxima da dor e inflamação e a restauração da funcionalidade de forma mais segura.

BACKGROUND AND OBJECTIVES: The nonsteroidal antiinflammatory-drugs (NSAIDs) exhibit pharmacological activity inhibiting the isoenzymes cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in varying degrees, and their safety profiles vary individually. Their efficacy is similar, but the possible adverse effects are relevant in deciding treatment prescriptions. Diclofenac has been available internationally for over 40 years, and its pharmacological and safety profile has been documented in numerous preclinical and clinical studies. The objective of this literature review was to present aspects of pain and the use of diclofenac in clinical practice, including indications, safety issues, and efficacy of the drug. CONTENTS: This literature review will present the basic pharmacology of diclofenac, as well as evidence for the therapeutic use of this drug in several painful conditions and the implications for clinical practice. CONCLUSION: Diclofenac has shown clinical efficacy in the treatment of a variety of painful conditions, including lumbagos,arthritis, post-traumatic and post-surgical pain, dysmenorrhea,as well as renal and biliary colic. It is important to note that in the evaluation of a patient presenting pain and when deciding a treatment plan and the prescription of any medication, it is upto the physician to carefully assess the patient to determine the best course of action in that individual, taking into account thepatients' medical history, co-morbidities, and use of concomitant medications, in order to provide the best therapeutic alternative,with a maximum reduction of pain and inflammation and restoration of functionality in the safest possible way.

Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing periodontal surgery

The aim of the present study was to compare the pre-emptive use of a cyclooxygenase-2 (COX-2) inhibitor with a well established steroidal anti-inflammatory drug for pain and edema relief following periodontal surgery for crown lengthening. Thirty patients requiring periodontal surgery were randomly assigned to receive one of the following medications: selective COX-2 inhibitor or steroidal anti-inflammatory drug, 60 min before the surgical procedure. To examine patient anxiety, a Corah's dental anxiety scale was applied before surgery. Using a visual analog scale, the extent of pain/discomfort during the trans-operative period and immediately after the surgery was measured. Additionally, intensity of pain/discomfort and edema were examined 4, 8, 12 and 24 h postoperatively. With regard to anxiety, no statistical differences between the groups were observed (p>0.05). With respect to the extent of pain/discomfort during the trans-operative, immediate and late postoperative period, data demonstrated no significant differences (p>0.05) between the COX-2 inhibitor and steroidal groups. With regard to edema, intragroup analysis did not reveal any statistically significant difference (p>0.05) during the 24 h following surgery in either group. In conclusion, both anti-inflammatory drugs presented a similar potential for pain and edema relief following periodontal surgery.

O objetivo do presente estudo foi comparar a utilização pré-emptiva de medicamento inibidor da COX-2 (cicloxigenase-2) com uma droga antinflamatória esteroidal amplamente utilizada, para o controle da dor e edema após cirurgia periodontal para aumento de coroa. Trinta pacientes que necessitavam de cirurgia periodontal foram aleatoriamente designados a receber uma das seguintes medicações: inibidor seletivo da COX-2 ou a droga antinflamatória esteroidal, 60 min antes do procedimento cirúrgico. Para avaliar a ansiedade do paciente, a escala de ansiedade ao tratamento dental de Corah foi aplicada antes da cirurgia. Com a utilização de escala analógica visual a extensão de dor/desconforto durante o período trans-cirúrgico e imediatamente após a cirurgia foi mensurada. Adicionalmente, a intensidade de dor/desconforto e edema foram avaliados no periodo pós-operatório tardio 4, 8, 12 e 24 h após o procedimento cirúrgico. Com relação à ansiedade, não foi observada diferença estatística entre os grupos (p>0,05). Com relação à extensão de dor/desconforto durante os períodos trans-cirúrgico e pós operatório imediato e tardio, os dados não demonstraram diferenças entre o grupo que recebeu o inibidor seletivo da COX-2 e o aintinflamatório esteroidal (p>0,05). A avaliação do edema, intragrupo, não revelou diferença estatística durante as primeiras 24 h em nenhum dos grupos estudados (p>0,05). Em conclusão, ambas as drogas antiinflamatórias utilizadas apresentaram um potencial similar no controle da dor e edema após cirurgia periodontal.

Estudo comparativo dos efeitos da dexametasona e do diclofenaco sódico sobre o processo reparativo de feridas induzidas no ventre lingual de ratos / Comparative study of the effects of dexamethasone and diclofenac sodium on the repair process of induced wounds in the ventral tongue of rats

A inflamação é uma resposta protetora para livrar o organismo da causa inicial da lesão celular e suas consequências, porem se excessiva e não modulada, pode provocar a destruição progressiva do tecido. Este estudo pretende contribuir para o esclarecimento da influência de dois anti-inflamatórios, a dexametasona e o diclofenaco sódico, sobre a fase inflamatória do processo reparativo tecidual, bem como sobre o número de mastócitos nas diferentes fases do reparo. Foram utilizadas 60 ratas Wistar, divididas em 3 grupos (1, 2 e 3), medicadas 30 minutos antes de uma intervenção cirúrgica (lesão de 3mm de diâmetro no ventre lingual), com injeção intramuscular de 0,235mg/kg de dexametasona; 4,45mg/kg de diclofenaco sódico ou solução salina estéril, respectivamente. Os 3 grupos foram subdivididos em a, b, c, d, de acordo com o tempo de sacrifício: 6, 24, 48 e 120 horas após a cirurgia. As lesões foram fotografadas logo no momento cirúrgico e no sacrifício e as fotos utilizadas para análise clínica do processo de reparo e morfometria. As línguas foram extirpadas e enviadas para processamento histológico, os cortes foram direcionados para coloração em hematoxilina-eosina e em Azul de Toluidina para evidenciação e contagem do número de mastócitos. As características do processo reparativo foram descritas por meio de avaliação qualitativa dos seguintes componentes: extensão de áreas necróticas; intensidade de edema intersticial; tipo e intensidade do infiltrado inflamatório; graus de reepitelização, tecido de granulação e neovascularização.

Os cortes corados em HE também tiveram seus campos digitalizados e analisados morfometricamente, para quantificação da reepitelização, mensurações do tecido de granulação, celularidade e edema. Os resultados da análise histológica semiquantitativa evidenciaram que o diclofenaco e a dexametasona acarretaram menor infiltrado inflamatório em relação ao controle na fase inflamatória do reparo, porém na fase produtiva a dexametasona exibiu menor intensidade de reepitelização e de neovascularização em relação aos demais grupos. Os resultados da análise histomorfométrica mostraram significativamente menor edema no grupo do diclofenaco em 6h (p=0,0041) e em 24h (p=0,0429), bem como menor porcentagem da celularidade em 6 horas no grupo da dexametasona (p<0,0001). O grupo diclofenaco ainda exibiu menor área de lesão em 120h do que os demais grupos (p=0,0060), indicando maior eficiência de reparo. Quanto à quantidade de mastócitos em 24, 48 e 120 horas, o grupo controle exibiu significativamente os maiores valores (p<0,0001). Com base nesses resultados, conclui-se que o grupo da dexametasona apresentou pior desempenho em relação à reparação; que o diclofenaco sódico apresentou um melhor efeito sobre o fechamento da ferida cirúrgica e redução mais intensa do infiltrado inflamatório, e que ambos provocam redução de mastócitos na área lesionada.

Inflammation is a protective response to rid the body of the initial cause of cell damage and its consequences, but when excessive and unmodulated, may cause progressive destruction of tissue. The aim of this study is to clarify the influence of two anti-inflammatory, diclofenac sodium and dexamethasone on the inflammatory phase of tissue repair process, as well as on the number of mast cells in different stages of repair. It was used 60 Wistar rats, divided into 3 groups (1, 2 and 3), medicated 30 minutes before surgery (lesion 3 mm in diameter in the ventral tongue), with intramuscular injection of 0.235 mg / kg dexamethasone, 4, 45mg/Kg of diclofenac sodium or sterile saline, respectively. The 3 groups were subdivided into a, b, c, d, according to the time of sacrifice, 6, 24, 48 and 120 hours after surgery. The lesions were photographed immediately at surgical time and at sacrifice, the photos were used for clinical analysis of the repair process and morphometry. The tongues were excised and sent for histological processing, the slices were directed for staining with hematoxylin-eosin and toluidine blue, for disclosure and count of the number of mast cells. The characteristics of the repair process were described through qualitative evaluation of the following components: extension of necrotic areas; intensity of interstitial edema, type and intensity of inflammatory infiltrate; degrees of reepithelialization, granulation tissue and neovascularization. Slices stained with HE also had their fields scanned and analyzed morphometrically to quantify reepithelialization, measurements of the granulation tissue, cellularity and edema.

The results of semiquantitative histological analysis showed that diclofenac and dexamethasone led to lower inflammatory infiltrate compared to control in the inflammatory phase of repair, although in the productive phase dexamethasone showed less intensity of reepithelialization and neovascularization compared to the other groups. The results of the histomorphometric analysis showed significantly less edema in the diclofenac group at 6h (p = 0.0041) and 24 (p = 0.0429), as well as a lower percentage of cellularity in 6 hours in the dexamethasone group (p <0.0001). The diclofenac group also exhibited lower lesion area at 120h than the other groups (p = 0.0060), indicating greater efficiency of repair. Regarding the quantity of mast cells 24, 48 and 120 hours, the control group exhibited significantly higher values (p <0.0001). Based on these results, we conclude that the dexamethasone group showed the worst performance in relation to repair; that diclofenac sodium showed a better effect on surgical wound closure and greater reduction of inflammatory infiltration, and that both cause a reduction of mast cells in the injured area.