Pharmacological Therapy approaches for the treatment of Knee Osteoarthritis

To date, no effective treatment has been able to modify the pathological progression of osteoarthritis (OA).Current therapy can be broadly categorized into pharmacological and non-pharmacological approaches before considering surgical interventions. Non-pharmacological methods address lifestyle modifications, weight reduction and physical therapy, all aiming at alleviating mechanical stress on the affected joint.In this article, we focused on pharmacological treatment options, that primarily target pain reduction by reducing joint inflammation or restoring the altered synovial environment to a normal state.In this literature review , the main focus is on approved conservative therapies and examined emerging conservative strategies. Evaluating their advantages and limitations.

Research progress on oral lichenoid drug reactions / 口腔疾病防治

@#Oral lichenoid drug reactions (OLDRs) are inflammatory reactions of the oral mucosa caused by the use of specific drugs in sensitive individuals and are classified as oral lichenoid lesions (OLLs). Its clinical and pathological manifestations do not have significant specificity compared to other types of OLL. Various types of drugs have been reported to induce OLDR, including antihypertensive drugs, nonsteroidal anti-inflammatory drugs, hypoglycemic drugs, antipsychotics, and immunosuppressants, among other drugs. Apart from local or systemic administrate glucocorticoids, the most effective treatment measure is to stop using suspicious drugs. Most patients can achieve significant relief from mucosal ulcers and erosion, but white lines may still remain. OLDR has been widely reported in the literature. However, due to a lack of systematic understanding, we do not have a recognized standard for the diagnosis and treatment of this disease. There are still doubts about the causal relationship between related drugs and oral lichen-like lesions. In response to the abovementioned problems, we searched the literature on drug-related oral lichen planus and lichen-like lesions at home and abroad over the past 20 years, most of which were case reports and only a few of which were case-control studies. This article describes the current research status of lichenoid lesions from four perspectives: concepts, suspicious drugs, clinical and pathological manifestations, and treatment prognosis. We hope to provide a theoretical reference for the prevention, diagnosis, and clinical treatment of related lichenoid lesions. A literature review demonstrated that there are still many unclear issues related to the etiology, pathogenesis, clinical diagnosis and treatment, treatment prognosis, and other aspects of this disease, and further clinical and basic research is needed for in-depth exploration.

Prescription pattern of non-steroidal anti-inflammatory drugs among patients admitted with fever in a tertiary hospita

Background: WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately. Nonsteroidal anti-inflammatory drugs are a group of drugs that are commonly prescribed for the treatment of fever associated with pain and inflammation. The objective was to assess the prescribing pattern of NSAIDs in fever patients. Along with this, we looked at the clinical indications for prescribing and the pattern of prescribing with respect to use of generic or trade names. Methods: This observational study was conducted in a tertiary care teaching hospital in Malappuram district of Kerala, India by extracting data of inpatients retrospectively from medical records for a six-month period. The reported prevalence of NSAID use in previous study was 20%, with a relative precision of 18% the sample size required was 500. The data was analyzed and expressed as absolute numbers and/or percentages. Results: Out of these 500 patients, Dengue fever was the most common diagnosis (86.6%) followed by Typhoid (2.8%) and Leptospirosis (2.4%). Among these, 392 (78.4%) received any of the NSAIDs. The most commonly prescribed drug was Paracetamol (77.04%). Among to the prescriptions, 91.7% were prescribed with generic names. As concomitant medications, antibiotics were prescribed at 21.2% cases, gastro protective agents were prescribed to 24.23% and vitamins were prescribed in 72.6% cases. Conclusions: This study has shown that the prescribing, usage and preferences of NSAIDs practiced rationally. No over use, under use or misuse of drugs was noticed.

Estudio comparativo para evaluar la efectividad del tratamiento con plasma rico en plaquetas y con AINEs en la gonartrosis grado I-II / Comparative study to evaluate the effectiveness of treatment with platelet-rich plasma and NSAIDs in grade I-II gonarthrosis

Resumen: Introducción: el envejecimiento poblacional es un fenómeno demográfico a nivel mundial de los últimos 30 años. Dicho aumento de la expectativa de vida conlleva a un incremento en la incidencia de enfermedades degenerativas, principalmente de gonartrosis. Según cálculos de la Organización Mundial de la Salud (OMS), se estima que 10% de la población mayor de 60 años padece de osteoartrosis, 40% de la población mayor de 70 años presenta gonartrosis, cifras que podrían aumentar en la siguiente década. Aproximadamente 80% de las personas mayores de 65 años presentan cambios radiográficos con evidencia de gonartrosis, siendo 10-25% del motivo de visita médica en el primer nivel de atención. El tratamiento con plasma rico en plaquetas intraarticular ha demostrado ser una alternativa terapéutica eficaz. Material y métodos: se realizó un estudio prospectivo, cuasiexperimental, no aleatorizado donde se comparó el comportamiento de la gonartrosis grado I y II en 140 pacientes diagnosticados clínica y radiológicamente. Separados en dos grupos de pacientes: primer grupo tratado con antiinflamatorios no esteroideos (AINEs) y el segundo grupo tratado con infiltración intraarticular con plasma rico en plaquetas (PRP). El mismo se llevó a cabo en la Clínica de Especialidades No. 3 de la Jurisdicción Sanitaria Cuauhtémoc, en la consulta de ortopedia durante el año 2020. La estadística descriptiva se analizó a partir de la elaboración de una Tabla de frecuencias que permitió calcular la media y la desviación estándar, de igual manera la estadística inferencial se analizó a través de la χ2. Resultados: el grupo de edad más afectado por gonartrosis es el de 60 a 69 años de edad con 43.5% del total de pacientes, siendo el sexo femenino el más afectado con 33.5%. La mayoría de los pacientes presentaron índice de masa corporal que los ubicaba como sobrepeso y obesos con 39 y 53%, respectivamente. El dolor evolucionó hacia una mejoría en 92% de los pacientes tratados con plasma rico en plaquetas y en 25.7% de los pacientes tratados con antiinflamatorios no esteroideos. La capacidad funcional de la articulación de la rodilla se recuperó en 97% de los pacientes tratados con plasma rico en plaquetas y en 35.7% de los tratados con antiinflamatorios no esteroideos. Conclusiones: el tratamiento de la gonartrosis grado I y II con plasma rico en plaquetas intraarticular es más efectivo que el tratamiento con antiinflamatorios no esteroideos.

Abstract: Introduction: population aging is a worldwide demographic phenomenon of the last thirty years. This increase in life expectancy leads to an increase in the incidence of degenerative diseases, mainly gonarthrosis. According to World Health Organization (WHO) estimates, 10% of the population over 60 years of age suffers from osteoarthrosis, and 40% of the population over 70 years of age suffers from gonarthrosis, Figures that could increase in the next decade. Approximately 80% of people over 65 years of age present radiographic changes with evidence of gonarthrosis, being 10-25% of the reason for medical visits at the first level of care. Treatment with intra-articular platelet rich plasma has proven to be an effective therapeutic alternative. Material and methods: a prospective, quasi-experimental, non-randomized study was carried out to compare the behavior of grade I and II gonarthrosis in 140 patients diagnosed clinically and radiologically. Separated into two groups of patients, the first group treated with non-steroidal anti-inflammatory drugs (NSAIDs) and the second group treated with intra-articular infiltration with platelet-rich plasma (PRP). The same was carried out in the Specialties Clinic No. 3 of the Cuauhtémoc Health Jurisdiction, in the orthopedics office during the year 2020. Descriptive statistics were analyzed through the elaboration of a frequency Table that allowed us to calculate the mean and standard deviation, and inferential statistics were analyzed through the χ2 test. Results: the age group most affected by gonarthrosis is 60 to 69 years of age with 43.5% of the total number of patients, being the female sex the most affected with 33.5%. Most of the patients had a body mass index that placed them as overweight and obese with 39 and 53% respectively. Pain evolved towards improvement in 92% of patients treated with platelet-rich plasma (PRP) and in 25.7% of patients treated with nonsteroidal anti-inflammatory drugs. The functional capacity of the knee joint recovered in 97% of the patients treated with PRP and in 35.7% of those treated with nonsteroidal anti-inflammatory drugs. Conclusions: treatment of grade I and II gonarthrosis with intra-articular platelet-rich plasma is more effective than treatment with non-steroidal anti-inflammatory drugs.

Differences of resting-state percent amplitude of fluctuations among migraineurs without aura with different efficacy of non-steroidal anti-inflammatory drugs / 中华行为医学与脑科学杂志

Objective:To explore the differences of resting-state spontaneous neural activity between migraine without aura (MwoA) patients with response or nonresponse to non-steroidal anti-inflammatory drugs (NSAIDs), and its correlation with migraine-related features.Methods:From February 2021 to April 2022, thirty MwoA patients with response to NSAIDs, 30 MwoA patients with nonresponse to NSAIDs, and 30 healthy controls were recruited in the Affiliated Jiangning Hospital of Nanjing Medical University.All subjects were scanned with a 3.0 T resting-state functional magnetic resonance imaging scanner.The percent amplitude of fluctuation (perAF) approach was used to calculate the differences of the resting state brain functional activities among the three groups (Bonferroni multiple comparison correction). SPSS 24.0 software and RESTplus software were used for statistical analysis.Analysis of variance was used for the perAF values of three groups.Correlation analysis was performed between perAF values of brain regions with significant differences and migraine-related features.Results:The brain areas showing significant differences of perAF among the three groups located in the left anterior cingulate cortex (ACC)( x, y, z = -6, 9, -3), left middle frontal gyrus (MFG)( x, y, z =-39, 48, 9) and left middle temporal gyrus (MTG)( x, y, z = -57, -30, -15)(all P<0.05, Bonferroni correction). Compared with nonresponse group, the perAF in response group showed significant decreased in the left ACC, MFG and MTG.There was positive correlation between the perAF of left ACC and disease duration ( r=0.506, P=0.007). Compared with healthy controls, the perAF of nonresponse group showed increased in the left ACC, which was negatively correlated with frequency ( r=-0.414, P=0.032). Conclusion:The neural activity of prefrontal cortex and ACC may be the neuropathological basis underlying response to NSAIDs in MwoA treatment.Moreover, the ACC has certain correlations with migraine-related characteristics, which may serve as a potential neuroimaging biomarker to evaluate the efficacy of NSAIDs.

Drug-induced Stevens-Johnson syndrome: A case series

Stevens-Johnson syndrome (SJS) can be defined as a rare, serious disorder of the skin and mucous membrane characterized by widespread vesiculobullous rash with epidermal sloughing and necrosis involving mainly eyes, oral cavity, and skin. SJS can be diagnosed if there is <10% of the skin involvement. SJS occurs as an idiosyncratic reaction to various medications. Among them, the most common are antimicrobial agents (AMAs), antiepileptics, and non-steroidal anti-inflammatory drugs (NSAIDs). SJS is one of the dermatological emergencies for which initial treatment can only be supportive like fluids and nasogastric or parenteral feeding and symptomatic measures like analgesic mouth rinse for mouth ulcer. Beyond this, no treatment for SJS is approved. Cases of drug-induced SJS as diagnosed by Skin and VD department were included in the study. Interpretations were drawn out from that data and causality assessment was done according to the WHO-UMC causality assessment. Total four cases of drug-induced SJS were available. two cases of male patients and two of female patients. Out of them, three cases were by NSAIDs induced and one case was anti-epileptic (phenytoin) induced. In the present study, it was found that three of the cases of drug-induced SJS were caused NSAIDs and one case by anti-epileptic. According to the WHO-UMC Causality assessment, three cases were probable and one was unclassified.

A comparative analysis of topical corticosteroids and non-steroidal anti-inflammatory drugs to control inflammation and macular edema following uneventful phacoemulsification

Purpose: To compare the efficacy of topical nonsteroidal anti?inflammatory drugs (NSAIDs) and prednisolone acetate in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification. Methods: All patients who underwent uneventful phacoemulsification from December 2020 to Feb 2021 were included in the study. These were randomly assigned to receive any one anti?inflammatory agent among topical nepafenac (0.1%) [96 eyes], bromfenac (0.07%) [93 eyes], preservative?free ketorolac (0.4%) [94 eyes], nepafenac (0.3%) [96 eyes], or prednisolone acetate (1%) [91 eyes]. The efficacy of the drugs was evaluated by comparing the grade of anterior chamber (AC) cells, conjunctival hyperemia, pain score, visual acuity, intraocular pressure (IOP), and central macular thickness (CMT) at 1 and 6 weeks after surgery. Results: At 1 and 6 weeks, there was no significant difference in pain score, conjunctival hyperemia, AC cells, change in IOP, and visual acuity between the prednisolone and the NSAIDs groups, though nepafenac 0.3% was most effective. At 6 weeks, there was no significant difference in the number of patients developing subclinical CME in the prednisolone versus NSAID group. The mean increase in CMT was significantly lower in nepafenac 0.3% than prednisolone at 1 and 6 weeks (P = 0.003 and 0.004, respectively). Conclusion: NSAIDs used in isolation are comparable to prednisolone in preventing inflammation and pain after uneventful phacoemulsification. However, nepafenac 0.3% is most comparable to prednisolone and more efficacious in reducing the incidence of CME. We recommend that nepafenac 0.3% can be used as a sole anti?inflammatory agent in patients with uneventful phacoemulsification.

Pay attention to the role of anti-inflammatory in the treatment of diabetic retinopathy / 中国医师杂志

Diabetic retinopathy (DR) is a retinal microvascular disease associated with diabetes which is the primary cause of impaired vision in working age population. Inflammatory reaction and inflammatory factors such as tumor necrosis factor-α (TNF-α) and interleukin (IL)-1β play an important role in the occurrence and development of DR, and to target at which anti-inflammatory treatments such as glucocorticoids and non-steroidal anti-inflammatory drugs were used, but with disputes on therapeutic effect and drug selection. This review aims to clarify the research on mechanism of inflammatory reaction in DR, summarize the application status of existing anti-inflammatory therapy, and provide some new ideas for the research and clinical application of the treatment of DR.

Solid Phase Extraction and Simultaneous Chromatographic Quantification of some Non-steroidal Anti-inflammatory Drug Residues; an Application in Pharmaceutical Industrial Wastewater Effluent

Abstract Two sensitive and selective methods were developed for the simultaneous determination of four commonly used non-steroidal anti-inflammatory drugs (NSAIDs), namely; paracetamol (PCM), diclofenac sodium (DCF), ibuprofen (IBP), and indomethacin (IND) in wastewater effluents. The first method used HPLC for the determination of the studied drugs using a mobile phase consisting of phosphate buffer (pH 3.0) and acetonitrile at a flow rate of 1 mL/min. in gradient elution mode and detection at 220 nm. The separation process was performed on BDS Hypersil Cyano column (250 x 4.6 mm, 5 µm). The second method was a TLC-densitometric one which was performed using n-Hexane: ethyl acetate: acetic acid in the ratio (6:3.5:0.5) as a developing system. The proposed chromatographic methods were successfully applied for the selective determination of the four studied drugs in simulated and real pharmaceutical wastewater samples after their solid-phase extraction

Erupção pigmentar fixa à nimesulida comprovada por teste de contato / Fixed pigmented erythema from nimesulide proven by patch testing

A erupção pigmentar fixa (EPF) é uma reação cutânea adversa a drogas relativamente comum, envolvendo cerca de 10% de todas as reações de hipersensibilidade a medicamentos (RHM). Envolve uma reação imunológica não imediata, mediada por células T CD8+ sensibilizadas, relacionada ao mecanismo do tipo IVc na classificação de Gell e Coombs. Um dos grupos mais frequentemente implicados nesse tipo de reação é o dos antiinflamatórios. Relatamos o caso de um homem que, 24 horas após iniciar tratamento com nimesulida para lombalgia, apresentou um quadro de lesões cutâneas tipo máculas eritemato-violáceas bem delimitadas e disseminadas pelo corpo. A nimesulida é um fármaco anti-inflamatório não esteroidal (AINE) pertencente à classe das sulfonanilidas, que atua como inibidor seletivo da enzima da síntese de prostaglandina, a ciclo-oxigenase, inibindo preferencialmente a COX-2. O diagnóstico foi comprovado pela realização do teste de contato, também conhecido como patch test, que traduziu positividade na segunda leitura realizada após 72 horas da sua colocação.

Fixed pigmented erythema (FPE) is a relatively common adverse drug reaction, consisting of approximately 10% of all drug hypersensitivity reactions. It involves a non-immediate immune reaction mediated by sensitized CD8+ T cells and related to the type IVc mechanism in the Gell-Coombs classification. One of the groups most frequently involved in this type of reaction is that of anti-inflammatory drugs. We report the case of a man who, 24 hours after starting treatment with nimesulide for low back pain, presented with well-defined cutaneous lesions consisting of erythematous-violaceous macules and spread throughout the body. Nimesulide is a non-steroidal anti-inflammatory drug (NSAID) belonging to the sulfonanilide class that acts as a selective inhibitor of the prostaglandin synthesis enzyme, cyclooxygenase (COX), preferentially inhibiting COX-2. The diagnosis was confirmed by a patch test, which translated positively in the second reading performed 72 hours after its placement.

Prescripción de analgésicos no opioides en un Servicio de Ortopedia / Prescription of non-opioid analgesics in an Orthopedics Service

Introducción: El dolor asociado a las alteraciones del sistema musculoesquelético debe ser tratado frecuentemente por los especialistas en Ortopedia. Los analgésicos no opioides se ubican dentro de los fármacos que más se prescriben en este Servicio, aunque no siempre de modo adecuado, según los principios de la prescripción racional. Objetivo: Caracterizar el uso de analgésicos no opioides en el servicio de Ortopedia del Hospital Dr. Salvador Allende. Material y Métodos: Estudio descriptivo de utilización de medicamentos del tipo prescripción-indicación y esquema terapéutico. Se revisaron las historias clínicas de 70 pacientes ingresados en el Servicio de Ortopedia del Hospital Dr. Salvador Allende, durante el período comprendido desde septiembre de 2018 hasta enero de 2019. Resultados: Predominó el sexo femenino y la media de edad de 71,3 años en los pacientes estudiados con una desviación estándar de 22.2 años. Los analgésicos más prescritos fueron dipirona, diclofenaco y paracetamol, en indicaciones aprobadas donde destacaron las fracturas, la celulitis y la seudoartrosis. En la totalidad de los casos, las dosis empleadas fueron adecuadas, no así los intervalos de administración ni la duración del tratamiento. Conclusiones: Es alentador el predominio de la prescripción de analgésicos no opioides con buena relación beneficio-riesgo. No obstante, la presencia de prescripciones irracionales en cuanto a intervalos de administración y duración del tratamiento, indica un déficit en la práctica de la terapéutica analgésica que no debe ser ignorado(AU)

Introduction: The pain associated with alterations of the musculoskeletal system should be frequently treated by the specialist in Orthopedics. Non-opioid analgesics are the most prescribed drugs in this medical service although they are not always used appropriately according to the principles of national prescription. Objective: To characterize the use of non-opioid analgesics in the orthopedics service of the Dr. Salvador Allende Hospital. Material and Methods: A descriptive study of the use of prescription-indication medications and therapeutic scheme was conducted. Medical records of 70 patients admitted to the orthopedics service of the Dr. Salvador Allende Hospital during the period between September 2018 and January 2019 were reviewed. Results: The female sex and a mean age of 71.3 years with standard deviation of 22,2 years predominated in the study. The most frequently used analgesics, which were indicated in the treatment of fractures, cellulitis and pseudarthrosis, were dipyrone, diclofenac and paracetamol. In all cases, the doses used were adequate, but not the administration intervals or the duration of treatment. Conclusions: The predominance of the prescription of non-opioid analgesics with a good benefit-risk ratio is encouraging. However, the presence of irrational prescriptions regarding administration intervals and duration of treatment indicates a deficit in analgesic therapy that should not be ignored(AU)

The predicting effect of disrupted functional connectivity of anterior cingulate cortex on the efficacy of nonsteroidal anti-inflammatory drugs in migraineurs without aura / 中华行为医学与脑科学杂志

Objective:To investigate the predicting effect of the disrupted functional connectivity of the anterior cingulate cortex (ACC) on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with migraineurs without aura (MwoA).Methods:From January 2019 to January 2021, seventy patients with migraine and thirty-three healthy people in the same period were selected.The functional connectivity analysis based on the ACC was used in MwoA patients with NSAIDS-effective ( n=35), MwoA patients with NSAIDS-ineffective ( n=35), and healthy controls (HCs) ( n=33). The abnormal resting-state functional connectivity patterns among the three groups were analyzed to reveal potential correlations with clinical characteristics in migraine. Then the receiver operating characteristic (ROC) curve was used to analyze the predictive ability of the abnormal ACC functional connectivity on the efficacy of NSAIDs in patients with MwoA. Results:(1)Compared with the MwoA patients with NSAIDs-ineffective, the MwoA patients with NSAIDs-effective showed higher functional connectivity between bilateral ACC and left middle cingulate cortex (MCC) (MNI: x, y, z=0, -24, 48, cluster=14, t=3.380) and postcentral gyrus (PoCG)( MNI: x, y, z=-21, -45, 69, cluster=12, t=3.016) (all P<0.005, Bonferroni correction). Compared with the HCs, patients with MwoA showed increased functional connectivity between left ACC and ipsilateral inferior parietal lobule, middle frontal gyrus (MFG) and angular gyrus (AG), and between right ACC and right precuneus, bilateral MFG and left AG (all P<0.005, Bonferroni correction). (2)There was a positive correlation between the functional connectivity of right ACC to right precuneus and MIDAS scores ( r=0.375, P=0.035) in MwoA patients with NSAIDs-effective. In MwoA patients with NSAIDs-ineffective, there were also significant correlations between the functional connectivity of left ACC to ipsilateral AG and MFG and headache onset duration ( r=0.357, P=0.045) and disease duration ( r=-0.367, P=0.039). (3)ROC curve analysis showed that the area under the curve (AUC) for the functional connectivity between the right ACC and left MCC and between the left ACC and left PoCG to predict the efficacy of NSAIDs were 0.728 and 0.736, respectively. Conclusions:Resting-state functional connectivity of the ACC is involved in the evaluation and prediction for analgesic efficacy of NSAIDs in migraine patients, which provides neuroimaging evidence for further investigations on the neurophysiological mechanism of migraine and assistance in clinical individualized precise treatment.

Network Meta-analysis on efficacy and safety of non-steroidal anti-inflammatory drugs for osteoarthritis in middle aged and old people / 药学实践杂志

Objective To systematically evaluate the efficacy and safety of different non-steroidal anti-inflammatory drugs (NSAIDs) in middle-aged and old Chinese patients with osteoarthritis(OA). Methods A systematic literature search was conducted through PubMed, Cochrane Library, CNKI, Wan Fang Data and VIP databases to collect randomized controlled trials with non-steroidal anti-inflammatory drugs in middle-aged to old Chinese OA patients. The search time was from the establishment of the database to November 17, 2020. Two researchers independently carried out literature screening, data extraction and literature quality evaluation. Bayesian network meta-analysis was conducted with R3.6.0 software. Results 28 RCTs were included with 2531 patients. Based on the last follow-up pain visual analogue scale (VAS) score, the ranking chart showed that Etoricoxib had the highest probability of having the lowest pain VAS score (88.55%). In terms of total effective rate, the ranking chart showed that the probability of Etoricoxib as first choice was the highest (92.49%). As far as safety, diclofenac sodium patch had the lowest adverse effects rate (59.10%). Conclusion The results of this study indicated that Etoricoxib was the most effective treatment for middle-aged and old Chinese OA patients. It can significantly reduce the OA pain. Diclofenac sodium patch had the least adverse effects.

Automedicación con AINE en futbolistas profesionales de los equipos de primera división del DMQ / Self-medication with nsaids in professional soccer players of the first division teams of the DMQ / Automedicação com nsaids em jogadores profissionais de futebol das equipes da primeira divisão do DMQ

INTRODUCCIÓN: varios estudios a cargo de la Federación Internacional de Fútbol han identificado el abuso de AINE (Analgésicos Antinflamatorios No Esteroideo) en los futbolistas indicando que casi el 40% de los jugadores del mundial de 2010 tomaron medicamentos para el dolor antes de cada partido. OBJETIVO: identificar el nivel de conocimiento sobre AINE que presentan los futbolistas profesionales de las plantillas de primera división, a través del análisis y realidad de cada equipo. MÉTODO: se aplicaron encuestas validadas por los departamentos médicos de cada club y a través de preguntas abiertas, cerradas y formato de opción múltiple, se determinó que: la edad de los futbolistas profesionales en estudio oscila entre los 15 y 34 años. RESULTADOS: respecto al conocimiento del grupo farmacológico que contrarresta síntomas de dolor, fiebre e inflamación; se determinó que existe gran confusión e ignorancia en relación a la identificación de medicamentos y su conceptualización. Así mismo, respecto a principios activos que tratan dolor, fiebre e inflamación, se notó preferencia por Ibuprofeno, Paracetamol y Diclofenaco. Y que menos del 50% del total de futbolistas reconocen los efectos adversos de los fármacos en estudio. CONCLUSIÓN: existen falencias respecto al conocimiento de medicamentos (AINE), y que debido a la premura con la que requieren volver a las canchas, éstos profesionales del deporte, suelen confiar en personas que no se encuentran capacitados en medicina o en temas farmacológicos.

INTRODUCTION: several studies conducted by the International Football Federation have identified the abuse of NSAIDs (Non-Steroidal Anti-Inflammatory Analgesics) in soccer players, indicating that almost 40% of the 2010 World Cup players took pain medication before each match. OBJECTIVE: to identify the level of knowledge about NSAIDs presented by professional footballers of the first division squads, through the analysis and reality of each team. METHOD: surveys validated by the medical departments of each club were applied and through open and closed questions and multiple choice format, it was determined that: the age of the professional soccer players in the study ranges between 15 and 34 years. RESULTS: regarding the knowledge of the pharmacological group that counteracts symptoms of pain, fever and inflammation; It was determined that there is great confusion and ignorance in relation to the identification of drugs and their conceptualization. Likewise, with respect to active principles that treat pain, fever and inflammation, a preference was noted for Ibuprofen, Paracetamol and Diclofenac. And that less than 50% of all footballers recognize the adverse effects of the drugs under study. CONCLUSION: there are shortcomings regarding the knowledge of medications (NSAIDs), and that due to the haste with which they need to return to the courts, these sports professionals often trust people who are not trained in medicine or pharmacological issues.

INTRODUÇÃO: vários estudos realizados pela Federação Internacional de Futebol identificaram o uso abusivo de NSAIDs (Analgésicos Antiinflamatórios Não Esteróides) em jogadores de futebol, indicando que quase 40% dos jogadores da Copa do Mundo de 2010 tomavam analgésicos antes de cada partida. OBJETIVO: identificar o nível de conhecimento sobre os AINE apresentado por futebolistas profissionais das equipes da primeira divisão, por meio da análise e da realidade de cada equipe. MÉTODO: foram aplicadas pesquisas validadas pelos departamentos médicos de cada clube e por meio de questões abertas e fechadas e no formato de múltipla escolha, determinou-se que: a idade dos jogadores profissionais de futebol em estudo varia entre 15 e 34 anos. RESULTADOS: quanto ao conhecimento do grupo farmacológico que neutraliza os sintomas de dor, febre e inflamação; Constatou-se que existe grande confusão e desconhecimento em relação à identificação dos medicamentos e sua conceituação. Da mesma forma, no que diz respeito aos princípios ativos que tratam a dor, febre e inflamação, foi observada uma preferência para ibuprofeno, paracetamol e diclofenaco. E que menos de 50% de todos os jogadores de futebol reconhecem os efeitos adversos das drogas em estudo. CONCLUSÃO: há lacunas no conhecimento sobre medicamentos (NSAIDs) e que, devido à pressa com que precisam retornar às quadras, esses profissionais do esporte costumam confiar em pessoas sem formação em medicina ou farmacologia.

Immediate postpartum intrauterine contraceptive device insertions in caesarean and vaginal deliveries: a comparative study

Background: Post-partum family planning is prevention of unintended and closely spaced pregnancies during first 12 months following childbirth. Postpartum IUCD is the best method of all as it is the safest, most effective, has no effect on breast feeding, reliable and with minimum complications.Methods: The cross-sectional study was conducted in AIMSR Bathinda on 400 postpartum patients. It was a prospective, observational study of women who received PPIUCD in our region.Results: Out of total 400, 58% had normal vaginal delivery and 42% had cesarean section. PPIUCD was done in all cases after applying exclusion criteria and the females were called for follow up.  53% cases who had cesarean and 47% of normal vaginal delivery turned up for follow up. Acceptance is more in multipara (20.7%) than in primi patients (13.7%). Almost 90% patients had good continuation rate. There were few problems faced by patients like irregular bleeding for first few months, pain lower abdomen, leucorrhea etc. which were removed by good counseling and some treatment like NSAIDs for bleeding.Conclusions: The acceptance of PPIUCD was high in present study in both types of females delivered by normal vaginal delivery or post LSCS but with good counseling efforts. It was safe and effective and had high retention rate when done at good timing by trained service provider that is within 10 minutes of placental delivery. So the need of time is creating awareness of public towards it and removing fear from minds, breaking taboos and myths.

Dentists knowledge about over the counter-NSAIDs: An emerging need for NSAID-avoidance education

Objectives of the study: Non-steroidal anti-inflammatory drugs (NSAIDs) belong to a group of drugs used in themanagement of pain. The aim of this study is to assess dentists’ knowledge of NSAIDs risks and to determine the mostprescribed NSAIDs by dentists.Materials and Methods: We collected information concerning the dentists’ knowledge of NSAIDs use and adverseeffects. A questionnaire consisting of 22 questions was distributed to 123 Albanian dentists reached in different dentalclinics, out of which only 87 agreed to participate. Only 70.73% of the distributed questionnaires were completed.Results: Respondents demonstrated poor knowledge of NSAIDs. Most of the respondents did not respond correctlyto the questions with 39.08% of incorrect answers regarding the implications of NSAIDs in elderly patients and only3.44% responded correctly to the contraindication of NSAIDs. The most common prescriptions were ketoprofen,ibuprofen, followed by ketorolac, aspirin, and diclofenac.Conclusions: Dentists who participated in the survey have limited knowledge of NSAIDs use, contraindication, andsafety limitation which can affect patients’ safety and well-being. Dentists should pay particular attention to informingpatients on NSAIDs use and should also keep updated on NSAIDs, through continuing education programs.

Effects of Different NSAIDs Combined with PICA on Postoperative Analgesia in Patients Undergoing Gynecolo- gical Laparoscopic Surgery and Its Effect on Serum Related Factors / 中国药房

OBJECTIVE：To investigate the effects of parecoxib sodium ，flurbiprofen axetil and lornoxicam combined with patient controlled intravenous analgesia （PICA） on postoperative analgesia in patients undergoing gynecological laparoscopic surgery and its effect on serum related factors. METHODS ：A total of 280 patients who underwent gynecologic laparoscopic surgery in the Second Affiliated Hospital of Hainan Medical University from Mar. 2017 to Mar. 2019 were randomly divided into control group （group C ），parecoxib sodium group （group P ），and flurbiprofen axetil group （group F ）and lornoxicam group （group L ）acording to random number table ，with 70 patients in each group. Four groups of patients received Sodium chloride injection 5 mL，Parecoxib sodium for injection 40 mg，Flurbiprofen axetil injection 50 mg and Lornoxicam for injection 8 mg （added 8 mg when the effect was not good ）intravenously at 30 min before the end of surgery. At the end of surgery ，they were given PICA of Sufentanil citrate injection and Dizosin injection for analgesia. The situation of pain and nausea symptom were evaluated at 6，12，24 and 48 h after surgery by using numerical rating scale （NRS）. The levels of serum CRP ，IL-6，SP and PGE 2 were detected by chemiluminescence method and ELISA. The times of pressing PICA pump and the dosage of analgesic were recorded in 4 groups within 24 h after surgery. The ADRs of patients within 48 h after surgery were recorded ，such as bloating ， dizziness，itchy skin ，respiratory depression and urinary retention. RESULTS ：At different time points ，the NRS scores of pain of group P ，F and L were significantly lower than those of group C ；and 48 h after surgery ，NRS score of pain of group L was significantly lower than those of group P and F （P＜0.05）. There was no statistical significance in the level of CRP ，IL-6，SP and PGE2 of 4 groups before surger （P＞0.05）. The CRP ，IL-6，SP and PGE 2 levels at each time point after surgery of group P ，F and L were significantly lower than those of group C ；compared with group P ，serum level of SP at 48 h after surgery as well as serum levels of PGE 2 at 12，24 and 48 h after surgery were significantly decreased in group F ，and serum level of IL- 6 at 48 h after surgery，serum levels of SP at 24 and 48 h after surgery ，serum levels of PGE 2 at 12，24，48 h after surgery were decreased significantly in group L ；compared with group F ，serum level of SP at 48 h after surgery as well as serum levels of PGE 2 at 12， 24，48 h after surgery were all decreased significantly in group L （P＜0.05）. There was no statistical significance in the incidence of anausea and vomiting among 4 groups（P＞0.05）. CONCLUSIONS ：Parecoxib sodium ，flurbiprofen axetil and lornoxicam combined with PICA can effectively relieve the pain of patients after gynecological laparoscopic surgery and reduce the levels of serum related factor ，and lornoxicam has the most obvious effect.

Indomethacin attenuates mechanical allodynia during the organization but not the maintenance of the peripheral neuropathic pain induced by nervus ischiadicus chronic constriction injury

The neurochemical mechanisms underlying neuropathic pain (NP) are related to peripheral and central sensitization caused by the release of inflammatory mediators in the peripheral damaged tissue and ectopic discharges from the injured nerve, leading to a hyperexcitable state of spinal dorsal horn neurons. The aim of this work was to clarify the role played by cyclooxygenase (COX) in the lesioned peripheral nerve in the development and maintenance of NP by evaluating at which moment the non-steroidal anti-inflammatory drug indomethacin, a non-selective COX inhibitor, attenuated mechanical allodynia after placing one loose ligature around the nervus ischiadicus, an adaptation of Bennett and Xie's model in rodents. NP was induced in male Wistar rats by subjecting them to chronic constriction injury (CCI) of the nervus ischiadicus, placing one loose ligature around the peripheral nerve, and a sham surgery (without CCI) was used as control. Indomethacin (2 mg/kg) or vehicle was intraperitoneally and acutely administered in each group of rats and at different time windows (1, 2, 4, 7, 14, 21, and 28 days) after the CCI or sham surgical procedures, followed by von Frey's test for 30 min. The data showed that indomethacin decreased the mechanical allodynia threshold of rats on the first, second, and fourth days after CCI (P<0.05). These findings suggested that inflammatory mechanisms are involved in the induction of NP and that COX-1 and COX-2 are involved in the induction but not in the maintenance of NP.

Self-medication practices of over the counter analgesics among first and third semester undergraduate medical students in a tertiary care medical college, Jharkhand

Background: Self-medication is a widely practiced trend in the general Indian population. Among the medical students, self- medication is popular because of awareness about the disease and their treatment. Analgesics are one of the most common drugs used for self-medication. Very few studies are available in Jharkhand regarding this subject. So, the present study aims to delve into the pattern of self-medication practices of analgesics among the 1st and 3rd semester medical students of RIMS, Ranchi, Jharkhand.Methods: A questionnaire based cross sectional study was done in RIMS, Ranchi, Jharkhand, India in March-April 2019 among the undergraduate medical students. The results were expressed as percentage and frequency.Results: Out of total 150 and 142 students in the 1st and 3rd semester respectively, 140 and 130 students practiced self- medication. Advice from seniors was the biggest source of information in both the groups followed by internet and books. Paracetamol was the most common drug (75%; 60%) and headache was the most common indication (55%; 68%). Quick relief of symptoms was the most common reason for self-medication in both the groups (44%; 48%).Conclusions: In both the groups, the students continued the drug even after experiencing side effects (77%; 60%). Most students were of the view that such practice is not acceptable at all times (75%; 72%).

To Evaluate the Therapeutic Efficacy of Vildagliptin on Microalbuminuria in Type 2 Diabetes Mellitus

Introduction: Diabetic kidney disease (DKD) representsone of the most frequent microvascular complications ofdiabetes with an overall prevalence of approximately 40% intype 2 diabetes population. Microalbuminuria is one of themost serious problems in type 2 DM. Vildagliptin, DPP-4inhibitors, is a novel oral anti-diabetic drug for the treatmentof type 2 diabetes mellitus (T2DM). The objective of the studywas to evaluate the therapeautic efficacy of vildagliptin onmicroalbuminuria in type 2 diabetes mellitus.Material and methods: We included in our study 103 T2DMpatients with microalbuminuria. Exclusion criteria: NSAIDsinduced nephropathy, Lupus nephropathy, Polycystic KidneyDisease, Medullary Sponge Kidney, All causes of nephriticand nephrotic syndrome, ESRD due to diabetes mellitus andmoderate to severe hepatic failure. We measured UrinaryACR value of parameters at 0,3.6,9,12 months respectively.Vildagliptin was given to those patient and was observed thatafter giving vildagliptin was there any change in albumin tocreatinine i.e microalbuminuria.Result: The mean of ACR baseline (mean±s.d.) of patientswas 125.1436 ± 58.810 with range 50.7000 - 298.0000 and themedian was 100.0000. The mean of ACR of 3, 6, 9, 12months(mean±s.d.) of patients were 110.3184 ± 57.5647, 106.7340 ±48.8492, 103.7252 ± 45.6745, 95.4466 ± 62.342 respectively.Association of ACR in five groups was not statisticallysignificant (p=0.6118).Conclusion: We found that after 12 months of therapy withvildagliptin, a DPP-4 inhibitor, there was some reduction ofACR and it is approximately 30%