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Background: There is a perception that Mefenamic Acid should be the preferred NSAID for menorrhagia. However, there are insufficient evidences to prove this. Further RCTs are required to compare individual NSAIDs.Purposes of the study were to assess and compare the efficacy of mefenamic acid and diclofenac in control of menorrhagia in patients with DUB, to assess and compare their analgesic effects in dysmenorrhea associated with DUB and to study their adverse effects.Methods: Sixty-eight patients were randomized into either Mefenamic Acid (n=34) or Diclofenac (n=34) group. Efficacy variables (Pictorial Blood loss Assessment Chart quantification, Number of pads used, Number of days of menstrual bleeding, Visual Analog Scale score) and adverse effects were recorded over three menstrual cycles.Results: The median reduction of menorrhagia with Mefenamic Acid was 43.39% (Range: 2.86% to 94.4%) and for Diclofenac was 57.5% (Range: 9.9% to 93.58%). The Diclofenac group showed a statistically significant decrease in median bleeding volume, median number of pads used and median number of days of bleeding compared to the Mefenamic Acid group (p<0.05, CI = 95%) but did not show a statistically significant decrease in median VAS score compared to the Mefenamic Acid group. Adverse effects with both groups were mild.Conclusions: Mefenamic Acid and Diclofenac individually managed to significantly reduce excessive bleeding compared to baseline. Diclofenac fared better than Mefenamic Acid in terms of control of excessive menstrual bleeding. Both these agents were able to reduce the menstrual pain and on comparison, were found to be equi-efficacious.
RESUMO
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.
Assuntos
Analgésicos , Animais de Laboratório , Anti-Inflamatórios não Esteroides/análise , Anti-Inflamatórios não Esteroides/uso terapêutico , Combinação de Medicamentos/administração & dosagem , Edema/tratamento farmacológico , Pé , Ratos , EspasmoRESUMO
Background & objectives: Antidepressants are being used as analgesics for various pain related disorders like neuropathic and non neuropathic pain. Although their analgesic activity is well recognized but anti-inflammatory potential of antidepressants is still inconclusive. Since the antidepressants are used for longer duration, it becomes important to elucidate effect of anti-depressants on blood pressure and gastric mucosa. This study was undertaken to evaluate the anti-inflammatory potential of various antidepressant drugs as well as their effect on blood pressure and gastric tolerability on chronic administration in rats. Methods: Rat paw oedema model was used for studying anti-inflammatory activity, single dose of test drug (venlafaxine 20 and 40 mg/kg, amitryptline 25 mg/kg, fluoxetine 20 mg/kg) was administered intraperitoneally 45 min prior to administration of 0.1 ml of 1 per cent carrageenan in sub-planter region. Oedema induced in test group was compared with normal saline treated control group. For studying effect on blood pressure and gastric tolerability, test drugs were administered for 14 days. Blood pressure was recorded on days 0, 7 and 14 using tail cuff method. On day 14, 4 h after drug administration, rats were sacrificed and stomach mucosa was examined for ulcerations. Results: Pretreatment of rats with venlafaxine (40 mg/kg) resulted in a significant decrease in paw oedema as compared to control (2.4 ± 0.15 to 1.1 ± 0.16 ml, P<0.01). Similarly, in the group pretreated with fluoxetine, significant decrease in paw oedema was observed in comparison to control (P<0.05). Significant change in mean blood pressure was seen in rats pretreated with venlafaxine 40 mg/kg (126.7 ± 4.2 to 155.2 ± 9.7, P<0.05) and fluoxetine (143.5 ± 2.6 to 158.3 ± 1.2, P<0.05) on day 7. No significant difference with regard to gastric tolerability was observed among groups. Interpretation & conclusions: Our findings showed significant anti-inflammatory activity of venlafaxine (40 mg/kg) and fluoxetine but these drugs were also associated with an increase in blood pressure. No significant change in mean ulcer index was observed among groups.
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OBJECTIVE: The study was undertaken with the aim to determine correlation between the initial plasma cortisol level and severity of asthma attack and the response to standard treatment for acute exacerbation of bronchial asthma in pediatric age group. METHODS: The study was performed in 33 asthmatic patients between 5-12 years of age, presenting to pediatric emergency with acute exacerbation of bronchial asthma. None of the patients included in the present study was on steroids. Venous blood sample for determination of plasma cortisol level was taken and patients were nebulized with salbutamol every 20 minutes, up to 1 hour. The patients who failed to respond even after three nebulizations were labeled as nonresponders and repeat venous blood sample for plasma cortisol estimation was taken before giving injection hydrocortisone. In responders sample was taken 1 hour after last nebulization. RESULTS: The mean plasma cortisol value at the time of admission in responders (12.42 +/- 1.9 microg/dl) was not found to be significantly different from that in nonresponders (13.1 +/- 2.74 microg/dl). Children with severe attack of asthma had significantly higher plasma cortisol levels both at the time of admission (p=0.03) and at the end of study (p=0.001), as compared to patients with moderate attack. The mean percentage change in plasma cortisol levels in nonresponders was an increase of 80.65 +/- 60.64%, whereas, in responders it decreased by 16.49 +/- 21.7% and this difference was statistically significant (p<0.05). CONCLUSION: The hypothalamo pituitary adrenal axis functions normally in asthmatic patients, producing a rise in cortisol levels corresponding to degree of stress; and from initial cortisol level alone, it cannot be predicted, whether a patient will respond to beta-2 agonist (salbutamol) nebulization alone or will require exogenous corticosteroids.