A ingestão do anti-inflamatório não esteroide naproxeno afeta parâmetros neuromusculares e metabólicos? / Does the ingestion of naproxen affect neuromuscular and metabolic parameters?

O naproxeno, assim como outros anti-inflamatórios não esteroides (AINEs), está entre os medicamentos mais prescritos no mundo. O objetivo do presente estudo é analisar o efeito da ingestão de naproxeno em parâmetros neuromusculares e determinar seu efeito no dano muscular por meio do uso do marcador lactato. Metodologicamente, foi conduzido um estudo cruzado randomizado, duplo-cego e controlado por placebo em 11 homens treinados em resistência, que realizaram uma sessão de treinamento de força após ingerir 500 mg de naproxeno e outra sessão de treinamento após ingerir um placebo. Os participantes realizaram três séries de supino horizontal com uma carga de 90% da repetição máxima (1RM) até a falha concêntrica. As variáveis de resultado incluíram número de repetições, carga de trabalho e lactato. Os resultados mostraram que há uma correlação positiva e moderada entre as variáveis somatório de repetições e carga total e entre as variáveis lactato e carga total, no grupo naproxeno. No grupo placebo, a correlação positiva e moderada deu-se entre somatório de repetições e carga total. Na análise magnitude baseada nas interferências, as variáveis se mostraram possíveis para uma probabilidade positiva ou trivial e improvável para uma probabilidade negativa. Concluiu-se no presente estudo que o uso do naproxeno como recurso ergogênico no treinamento de força reduz a percepção de fadiga, mas não tem efeito direto no dano muscular, analisado a partir do marcador lactato, logo não interfere de maneira significativa nos parâmetros neuromusculares analisados.

Naproxen, as other non-steroidal anti-inflammatory drugs (NSAIDs), features among the most widely prescribed drugs in the world. The aim of this study is to analyze the effect of naproxen intake on neuromuscular parameters and determine its effect on muscle damage through the use of the lactate marker. In terms of methodology, a randomized, double-blind, placebo-controlled crossover study was conducted on 11 resistance-trained men who underwent a strength training session after taking 500 mg of naproxen and another training session after taking a placebo. The participants performed three sets of horizontal bench presses with a load of 90% maximum repetition (1RM) until concentric failure. Result variables included number of repetitions, workload and lactate. The results showed that there is a positive and moderate correlation between the sum of repetition and total load variables and between lactate and total load variables in the naproxen group. In the placebo group, a positive and moderate correlation was observed between sum of repetitions and total load. In the magnitude analysis, based on the interferences, the variables were shown to be possible for a positive or trivial probability and unlikely for a negative probability. It was concluded that the use of naproxen as an ergogenic resource in strength training reduces the perception of fatigue but has no direct effect on muscle damage when analyzed from the lactate marker, therefore it does not significantly interfere in the analyzed neuromuscular parameters.

Informe diário de evidências COVID-19: busca referente aos dias 25 e 26 de junho de 2020 / COVID-19 daily evidence report: search for June 25 and 26, 2020

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 14 artigos e 9 protocolos.

Factors Affecting Quality of Life and Satisfaction in Patients with Arthritis after Change to a Fixed-Dose Naproxen/Esomeprazole Combination Drug

BACKGROUND: In drug therapy for patients with arthritis, a naproxen/esomeprazole combination drug may be a tolerable choice because it can minimize gastrointestinal and cardiovascular adverse effects. The aim of this study was to investigate the changes in quality of life (QOL), medication adherence, and satisfaction after switch from the existing drug to the combination drug. In addition, we analyzed the correlation between the above-mentioned variables and the stratified demographic and medical data of the patients.METHODS: A prospective, noninterventional, observational study was conducted in 30 hospitals between May 2014 and July 2016. In total, 2,308 patients with osteoarthritis, 99 patients with rheumatoid arthritis, and 76 patients with ankylosing spondylitis were enrolled. Demographic information (age, sex, body mass index [BMI], alcohol consumption, and smoking) and medical information (type of arthritis, duration of disease, and comorbidities) were collected via a self-administered questionnaire. Patients were observed for more than three months after switching to the combination drug. Data on the QOL (EuroQoL 5-Dimension questionnaire [EQ-5D questionnaire]), medication adherence (Morisky Medication Adherence Scale [MMAS]), and satisfaction were collected at the first and last visits.RESULTS: A total of 2,483 patients enrolled at 30 hospitals completed the questionnaire. After the switch to the combination drug, the mean EQ-5D score improved from 0.72 ± 0.17 to 0.79 ± 0.14 (p < 0.001), and significant improvement was associated with female sex (p = 0.016), shorter disease duration (p < 0.001), and absence of comorbidities (p < 0.001). The mean MMAS score was 6.38 ± 1.77, indicating medium adherence. Satisfaction was significantly higher in female patients (p < 0.001), in patients with a shorter disease duration (p < 0.001), osteoarthritis (p = 0.003), and no comorbidities (p < 0.001). Serious drug-related adverse effects did not occur.CONCLUSIONS: The overall QOL was improved with medium adherence after the switch to the combination drug. On the basis of the analysis of stratified data, sex, age, drinking, smoking, disease duration, comorbidities, and BMI might be associated with QOL, satisfaction, and adherence.

The effect of naproxen patches on relieving orthodontic pain by evaluation of VAS and IL-1β inflammatory factor: a split-mouth study

ABSTRACT Introduction: Pain related to orthodontic tooth movement is common and cause dissatisfaction and discomfort. Objective: The present study aimed to compare the efficacy of naproxen patches in pain control during orthodontic tooth separation, by means of visual analogue scale (VAS) and interleukin 1β (IL-1β) levels in gingival crevicular fluid (GCF). Methods: In this split-mouth triple-blind clinical trial, with 40 patients following separation, 5% naproxen or placebo patches were randomly placed on the upper right or left first molars every 8 hours. Pain intensity scores were determined after 2 and 6 hours, sleep time, 24 hours, days 2, 3 and 7 by the patients using a 100-mm VAS ruler. IL-1β levels in GCF were evaluated by ELISA at baseline, 1 and 24 hours and 7 days. Paired samples t-tests and two-way repeated measures ANOVA analysis of variance with a significance level of 0.05 were applied. Results: A total number of 30 patients (13 males and 17 females) finished the trial. Significant differences were found in pain scores (p< 0.0001) and IL-1β levels (p= 0.047) between naproxen and placebo groups. Lower pain scores were reported for the patients using naproxen patches at all time points, except 1 hour after separation. IL-1β levels were lower for the patients using naproxen patches only 1 hour after separation (p= 0.047). The peak of pain scores and IL-1β levels were calculated at 24 hours. Conclusion: In the light of VAS scores and IL-1β levels, naproxen patches reduced the pain caused by separator placement.

RESUMO Introdução: a dor relacionada à movimentação dentária ortodôntica é comum e causa insatisfação e desconforto. Objetivo: o presente estudo teve como objetivo avaliar a eficácia de curativos de naproxeno no controle da dor durante a separação ortodôntica dos dentes, por meio de escalas visuais analógicas (EVA) e dos níveis de interleucina 1β (IL-1β) no fluido crevicular gengival (FCG). Métodos: neste ensaio clínico, triplo-cego, boca dividida, com 40 pacientes após a separação dos dentes, foram aplicados, de forma aleatória, curativos com naproxeno a 5% ou placebo, nos primeiros molares superiores, direito ou esquerdo, a cada 8 horas. Os escores de intensidade da dor foram registrados pelos pacientes após 2 e 6 horas, durante o sono, após 24 horas, 2, 3 e 7 dias, usando uma EVA de 100 mm. Os níveis de IL-1β no FCG foram avaliados pelo ELISA no momento inicial, e após 1 e 24 horas e 7 dias. Foram aplicados testes t para amostras pareadas e ANOVA de duas vias para medidas repetidas, com nível de significância de 0,05. Resultados: no total, 30 pacientes (13 homens e 17 mulheres) terminaram o ensaio clínico. Diferenças significativas foram encontradas nos escores de dor (p< 0,0001) e níveis de IL-1β (p= 0,047) entre os grupos naproxeno e placebo. Índices mais baixos de dor foram relatados pelos pacientes que usaram curativos de naproxeno em todos os tempos avaliados, com exceção de 1 hora após a separação. Os níveis de IL-1β foram menores nos pacientes que usaram os curativos de naproxeno apenas 1 'hora após a separação (p= 0,047). Os picos dos escores de dor e dos níveis de IL-1β foram registrados 24 horas após a separação. Conclusão: considerando-se os escores das EVAs e os níveis de IL-1β, pode-se concluir que os curativos de naproxeno reduziram a dor causada pela instalação dos separadores ortodônticos.

Sinus floor elevation using a new bovine bone grafting material: case report and bone grafting materials update / Actualización en materiales de relleno óseo: reporte de un caso clínico de elevamiento del piso del seno maxilar usando un nuevo material de relleno óseo bovino

Bone grafting is important to preserve the alveolar bone ridge height and volume for dental implant placement. Even though implant-supported overdentures present highly successful outcomes, it seems that a great number of edentulous individuals have not pursued implant-based rehabilitation. The cost of the treatment is one of the reasons of discrepancy between highly successful therapy and its acceptance. Therefore, the development of biomaterials for bone grafting with comparable characteristics and biological effects than those renowned internationally, is necessary. In addition, domestic manufacture would reduce the high costs in public health arising from the application of these biomaterials in the dental feld. The purpose of this clinical case report is to provide preliminary clinical evidence of the efficacy of a new bovine bone graft in the bone healing process when used for sinus floor elevation. (AU)

El uso de injertos óseos es importante para preservar la altura y el volumen de la cresta alveolar para la colocación de implantes dentales. Si bien las sobredentaduras implanto-soportadas presentan resultados altamente exitosos, la mayoría de las personas desdentadas no han sido rehabilitadas mediante implantes dentales. Uno de los principales motivos por los cuales los pacientes no aceptan este tipo de tratamiento, altamente exitoso, es el elevado costo del mismo. Por ello, es necesario el desarrollo de biomateriales de injerto óseo con características y efectos biológicos comparables a los reconocidos internacionalmente. Asimismo, la fabricación nacional reduciría los altos costos en Salud Pública derivados de la aplicación de estos biomateriales en el campo dental. El objetivo de esta comunicación es presentar un caso clínico a fin de proporcionar evidencia preliminar acerca de la eficacia de un nuevo injerto de hueso bovino en el proceso de cicatrización ósea en el levantamiento del piso del seno maxilar. (AU)

Efectividad Analgésica de Naproxeno Sódico y Etoricoxib Post Extracción Dental Simple: Ensayo Clínico Aleatorizado Paralelo / Analgesic Effectiveness of Sodium Naproxen and Etoricoxib Post Simple Dental Extraction: Parallel Randomized Clinical Trial

RESUMEN: El objetivo de este estudio fue comparar la efectividad analgésica de naproxeno sódico y etoricoxib post extracción dental simple. El presente ensayo clínico, aleatorizado paralelo y ciego simple, se desarrolló en la Clínica Odontológica de la Universidad Privada Antenor Orrego. Los pacientes, quienes requerían exodoncia simple por caries dental en molar mandibular, fueron distribuidos aleatoriamente en tres grupos de 17 participantes cada uno, donde recibieron naproxeno sódico, etoricoxib o ibuprofeno (grupo testigo), según los criterios establecidos. El procedimiento fue estandarizado, evaluándose la eficacia analgésica mediante la escala visual analógica (EVA) a las 1, 8, 24 y 48 horas, después del inicio de la medicación. El análisis estadístico se realizó mediante la prueba de Kruskal-Wallis, considerándose un nivel de significancia del 5 %. No se evidenció diferencia en la efectividad analgésica entre naproxeno sódico y etoricoxib, post extracción dental simple. Este hallazgo se observó a las 1 (p=0,602), 8 (p=0,884), 24 (p=0,338) y 48 horas (p=0,189). No existe diferencia en la efectividad analgésica entre naproxeno sódico y etoricoxib, post extracción dental simple.

ABSTRACT: The aim of the study was to compare the analgesic effectiveness of naproxen sodium and etoricoxib after simple dental extraction. This randomized parallel and single blind clinical trial, was developed in the Clínica Odontológica of the Universidad Privada Antenor Orrego. The patients, who required simple exodontia for dental caries in the mandibular molar, were randomized into three groups of 17 participants each, where they received naproxen sodium, etoricoxib or ibuprofen (control group), according to established criteria. The procedure was standardized, evaluating the analgesic efficacy by means of the analog visual scale at 1, 8, 24 and 48 hours, after the start of the medication. The statistical analysis was carried out using the Kruskal-Wallis test, considering a level of significance of 5 %. There was no difference in the analgesic effectiveness between naproxen sodium and etoricoxib, after simple dental extraction. This finding was observed at 1 (p = 0.602), 8 (p = 0.884), 24 (p = 0.338) and 48 hours (p = 0.189). There is no difference in the analgesic effectiveness between naproxen sodium and etoricoxib, after simple dental extraction.

Efecto protector del Desmodium molliculum EAM (manayupa) en ratas con toxicidad hepática inducida por naproxeno / Protective effect of Desmodium molliculum EAM (manayupa) in rats with naproxen-induced liver toxicity

Objetivo. Verificar el efecto protector del extracto acuoso de hojas y tallos de Desmodium molliculum EAM (manayupa), en la toxicidad hepática inducida por el naproxeno en ratas Ratus novergicus variedad Wistar albino, hembras. Materiales y métodos. Estudio experimental. Se utilizaron 36 ratas hembras de 250 ± 10 g, divididas en seis grupos de seis: A (control -); B (control + naproxeno); patrón C (silimarina 100 mg / kg) y 3 experimental (EAM): D 80 mg/kg; E 160 mg/kg y F 240 mg/kg). Los grupos B, C, D, E, F recibieron por vía oral naproxeno 27,38 mg, los primeros cinco días y durante 14 días. El efecto protector hepático se determinó mediante el análisis bioquímico: GOT, GPT, GGT, proteínas totales, albúmina sérica, fosfatasa alcalina y creatinina. Resultados. Se encontró que el grupo B perdió peso (180,65 ± 6,5 g), bilirrubina total (0,76 ± 0,4) bilirrubina directa (1.7 ± 0,8), TGO (160 ± 10,4) y TGP (412 ± 20,4) alto, comparado con el grupo A, C, D, E y F. Conclusiones. El EAM tiene efecto protector sobre la toxicidad hepática inducida por naproxeno en ratas, evidenciado por los parámetros bioquímicos.

Objective. To verify the protective effect of the aqueous extract of leaves and stems of Desmodium molliculum EAM (manayupa), on the hepatic toxicity induced by Naproxen in rats Ratus novergicus albino Wistar variety, females. Materials and methods. 36 female rats of 250 ± 10 g were used, divided into six groups of six: A (Control -), B (Control + Naproxen), Pattern C (Silymarin 100 mg / kg) and 3 Experimental (EAM): D 80 mg / kg, E 160 mg / kg and F 240 mg / kg). Groups B, C, D, E, F orally received Naproxen 27.38 mg, the first five days and for 14 days. The hepatic protective effect was determined by the biochemical analysis: GOT, GPT, GGT, total proteins, serum albumin, alkaline phosphatase, creatinine. Results. group B was found to lose weight (180.65 ± 6.5 g), total bilirubin (0.76 ± 0.4) direct bilirubin (1.7 ± 0.8), TGO (160 ± 10.4) and TGP (412 ± 20.4) high, compared to group A, C, D, E and F. Conclusion. EAM has a protective effect on hepatic toxicity induced by naproxen in rats, evidenced by biochemical parameters.

Avaliação de cinco excipientes no perfil de dissolução de cápsulas magistrais de naproxeno / Evaluation of five excipients in the profile of dissolution of naproxen magisterial capsules

Introdução: o naproxeno é um anti-inflamatório não esteroidal (AINE) encontrado nas formas farmacêuticas cápsulas e comprimidos. A análise do efeito de diferentes tipos de excipientes na formulação representa uma importante ferramenta no que diz respeito à influência na dissolução. Objetivo: analisar o efeito de diferentes tipos e quantidades de excipientes no perfil de dissolução de cápsulas de naproxeno. Material e Método: foram manipuladas 4 fórmulas de cápsulas de naproxeno na concentração de 250 mg, com variações de excipientes quanto às concentrações de diluentes, molhantes e desintegrantes. No teste de dissolução, foram avaliadas 6 unidades de cada formulação, em tampão fosfato pH 7,4 (900mL), aparato pá + sinker, 50 rpm, em 6 diferentes tempos de coleta, com leitura das amostras obtidas em 332 nm. Para a determinação da porcentagem de princípio ativo liberado em função do tempo no teste de perfil de dissolução, foi previamente construída uma curva de calibração com 5 concentrações diferentes. Segundo USP (2013), a porcentagem mínima de dissolução de comprimidos de naproxeno aos 45 minutos é de no mínimo 80%. Resultados: todas as formulações se encontram dentro das especificações farmacopéicas, sendo que a formulação 1 apresentou melhor perfil de dissolução do naproxeno, além de ser a formulação com menor custo de preparo, constatando a influência da quantidade e do tipo de excipiente. Conclusão: a melhor combinação dos tipos e quantidades de excipientes em uma formulação magistral é essencial para garantir a qualidade e a eficácia dos fármacos manipulados, especialmente os Classe II no Sistema de Classificação Biofarmacêutica.

Introduction: Naproxen is a Nonsteroidal Anti-Inflammatory drugs (NSAIDs) found in pharmaceutical forms capsules and tablets. The analysis of the effect with different kinds of excipients in magistral formulation represents an important tool to the influence on the dissolution. Purpose: to analyze the effect of different kinds and amounts of excipients on the dissolution profile of naproxen capsules. Material and Method: 4 naproxen capsule formulations in the 250 mg concentration were manipulated, with excipient variations regarding concentrations of diluents, wetting agents and disintegrants. In the dissolution test, 6 units of each formulation were evaluated in phosphate buffer pH 7.4 (900mL), paddle + sinker apparatus, 50 rpm, in 6 different collection times, with a reading of the samples obtained at 332 nm. For percentage determination of active principle released in function of time in dissolution profile test, a calibration curve with 5 different concentrations was previously constructed. According to USP (2013), the minimum dissolution rate of naproxen tablets at 45 minutes is at least 80%. Results: all formulations are within pharmacopoeial specifications, and formulation 1 presented a better dissolution profile of naproxen, besides being the formulation with the lowest preparation cost, noting the influence of the amount and type of excipient. Conclusion: The best combination of the kinds and amounts of excipients in a magistral formulation is essential to ensure the quality and efficacy of the drugs handled, especially Class II in the Biopharmaceutical Classification System.

Antinociceptive local activity of 4-allyl-1-hydroxy-2-methoxybenzene (eugenol) by the formalin test: an anti-inflammatory effect

Eugenol has been employed for decades as a condiment, an antimycotic, an antibacterial, an antiviral, and an antioxidant, and it is one of the natural analgesics most frequently utilized for pain and inflammation. Our objective was to determine the analgesic/anti-inflammatory effect of eugenol compared with diclofenac, naproxen, and tramadol using the formalin test. The formalin method was used in 6- to 10-week-old Wistar rats (weighing 250 g each) divided into six groups: saline (0.9%); formalin (5%); diclofenac (250 µg/kg); naproxen (400 µg/kg); tramadol (500 µg/kg), and eugenol (1,400 µg/kg), in the intraplantar part of the hind-end trunk of the rats, with n = 5 per group. Eugenol diminished 44.4% of nociceptive behavior in phase 1 and 48% in phase 2 (p ≤0.05 vs formalin). Eugenol was shown to be 1.14 times more effective than diclofenac, but 1.62 and 1.75 times less effective than naproxen and tramadol, respectively, in phase 1 and 1.45 times less effective than diclofenac and naproxen and 1.66 less effective than tramadol in phase 2 (p ≤0.05). These data suggest that eugenol possesses moderate activity in the acute pain phase and greater activity in inflammatory-type pain, and both effects are comparable to those produced by diclofenac and are less than the effects produced by naproxen and tramadol in the formalin test

Riesgo cardiovascular de los antiinflamatorios no esteroideos / Cardiovascular risk of non-steroidal anti-inflammatory drug

Los antiinflamatorios no esteroideos (AINEs) se encuentran entre los fármacos más utilizados en la práctica clínica. Actúan mediante el bloqueo de las enzimas ciclooxigenasas (COX), pero el grado de inhibición de COX-1 y COX-2 varía entre ellos. Se ha generalizado la clasificación entre COX-2 selectivos o coxibs, y los no selectivos o AINEs tradicionales. Tanto los efectos analgésico y antiinflamatorio como los efectos adversos cardiovasculares dependen de la inhibición de COX-2. Este trabajo revisa las evidencias disponibles del aumento del riesgo de eventos trombóticos tanto para los coxibs como para los AINEs tradicionales. El efecto protrombótico podría deberse a la inhibición de la COX-2 endotelial, con disminución de la prostaciclina y un incremento relativo de los niveles del tromboxano plaquetario. Los coxibs y el diclofenac, 150 mg/día, aumentarían el riesgo de eventos vasculares mayores en más de un tercio. El ibuprofeno 2400 mg/día aumentaría levemente el riesgo de eventos coronarios. El naproxeno 1000 mg/día no incrementaría el riesgo de eventos vasculares. Además, el ibuprofeno y el naproxeno tienen el potencial del disminuir el efecto cardioprotector de bajas dosis de aspirina. El naproxeno (≤ 1000 mg/día) y el ibuprofeno a bajas dosis (≤ 1200 mg/día) deberían considerarse los AINEs con el mejor perfil de seguridad cardiovascular. Las decisiones terapéuticas deben basarse en una adecuada evaluación del riesgo del paciente, utilizando los AINEs más seguros, a las menores dosis efectivas, por el menor tiempo posible que permita el control de los síntomas, restringiendo su utilización en enfermos con aumento del riesgo cardiovascular.

Non-steroidal anti-inflammatories (NSAIDs) are among the most commonly used drugs in clinical practice. They block cyclooxygenases (COX) enzymes, but the degree of inhibition of COX-1 and COX-2 varies between them. In general, NSAIDs are classified in selective COX-2 or coxibs and non-selective or traditional NSAIDs. Both the analgesic and anti-inflammatory effects, as well as the cardiovascular adverse effects, depend on the COX-2 inhibition. This paper reviews the available evidence of the increased risk of thrombotic events for both coxibs and traditional NSAID. The prothrombotic effect could be due to the inhibition of endothelial COX-2, with a decrease in production of prostacyclin and a relative increase in platelet thromboxane levels. Coxibs and diclofenac 150 mg/day seem to increase the risk of major vascular events by more than a third. Ibuprofen 2400 mg/day could slightly increase the risk of coronary events. Naproxen 1000 mg/day apparently does not increase the risk of vascular events. Besides ibuprofen and naproxen have the potential to decrease the cardioprotective effect of low doses of aspirin. Naproxen (≤ 1000 mg/day) and low doses of ibuprofen (≤ 1200 mg/day) are considered to have the most favorable thrombotic cardiovascular safety profiles of all NSAIDs. Therapeutic decisions should be based on an assessment of a person´s individual risk factors, using the safest NSAIDs, at the lowest effective doses, for the shortest duration necessary to control symptoms, restricting their use in patients with increased cardiovascular risk.

Vasculitis of small and large vessels, a casual association?

SUMMARY The authors report a case of a 69-year-old man with idiopathic leukocytoclastic cutaneous vasculitis. For three years, the lesions recurred with progressive worsening and were associated with systemic manifestations of low-grade fever, weight loss and raised inflammatory markers. The patient latter presented a 6th cranial nerve involvement, raising the concern of a possible systemic vasculitis, which was latter evidenced by the development of deep vein thrombosis and angina pectoris. The treatment of the patient witch based on the decreasing of inflammatory activity, by using effective immunosuppressive therapy, with lower toxicity is more important than identifying the type of the vasculitis. This case illustrates the importance of awareness for the systemic involvement that can occur in up to 50% of patients with leukocytoclastic cutaneous vasculitis.

RESUMO Os autores reportam um caso de vasculite leucocitoclástica recidivante num homem de 69 anos. Durante cerca de três anos as lesões cutáneas de vasculite leucocitoclástica reapareceram periodicamente, acompanhando-se sempre de um quadro sistêmico caracterizado por febrícula, perda de peso e astenia, assim como aumento de novo dos parâmetros inflamatórios. O aparecimento de parésia do sexto par craniano no decurso de uma dessas recorrências cutâneas levantou a hipótese de estarmos perante uma vasculite mais agressiva, com envolvimento extracutâneo. Esse envolvimento sistêmico foi novamente evidente com aparecimento de angina pectoris e trombose venosa profunda. Atualmente, mais do que a identificação do tipo de vasculite, a abordagem dos doentes com essa patologia assenta na cessação da atividade inflamatória recorrendo a terapêutica imunossupressora eficaz, com a menor toxicidade possível. Destacamos a importância da vigilância do componente sistêmico, que pode ocorrer até 50% na vasculite leucocitoclástica cutânea.

Clinical manifestations of headache in children younger than 7 years / 소아과

PURPOSE: Headache is a common symptom during childhood. It is usually persistent and requires special care. This study aimed to identify the characteristics of headache in children < 7 years of age. METHODS: We reviewed 3 years of clinical files on children < 7 years of age with a chief complaint of headache. RESULTS: This study included 146 children (66 males, 80 females; mean age, 5.5±1.0 years). Mean symptom duration was 5.8±7.9 months. Attack durations were longer than 2 hours in 31 patients, shorter than 2 hours in 70 patients, and unchecked in 45 patients. Attack frequency was 15.1±10.6 times per month. Pain locations and characteristics were also variable. Mean pain severity score was 5.1±2.2 on the visual analog scale. Of 38 patients who underwent electroencephalography, 9 showed positive findings. Of 41 who underwent brain magnetic resonance imaging, 20 showed positive findings. The diagnoses were migraine (including probable migraine) in 34, tension-type headache in 5, and congenital malformations in 3. Medications were used in 29 patients: acetaminophen in 17, ibuprofen in 8, naproxen sodium in 1, and topiramate or amitriptyline in 3. CONCLUSION: In children aged < 7 years, headache has a relatively benign course, but detailed history taking is needed for more accurate diagnosis.

Absceso de psoas / Psoas abscess

El absceso de psoas es una enfermedad relativamente rara. Muchos casos presentan características clínicas atípicas. El absceso de psoas puede ser primario en pacientes inmunodeprimidos o secundario a infecciones gastrointestinales y genitourinarias. En los países no desarrollados, la mayoría de estos pueden ser de etiología tuberculosa. Una alta sospecha clínica, una buena historia clínica y estudios de imagen, pueden ser útiles en el diagnóstico y tratamiento de la enfermedad. El tratamiento temprano con antibióticos, drenaje guiado o cirugía abierta es necesario debido a su alta morbimortalidad. Se reporta el caso de un paciente varón de 57 años con historia de Diabetes mellitus (DM) de 20 años de evolución, quien refiere dolor en región lumbar izquierda asociada a aumento de volumen y fiebre intermitente, por lo que se hospitaliza, detectándose un absceso de psoas izquierdo, el cual es drenado por cirugía abierta con abordaje extra-peritoneal, presentando evolución favorable.

Psoas abscess is a relatively rare disease. Many cases present atypical clinical features. Psoas abscess may be primary in immunosuppressed patients or secondary to gastrointestinal and genitourinary infections. In non-developed countries most of these can be of tuberculous etiology. A high clinical suspicion, a good clinical history and imaging studies can be useful in diagnosing the disease. Early treatment with antibiotics, guided drainage or open surgery is necessary due to its high morbidity and mortality. It's reported the case of a male patient of 57 years with a history of diabetes mellitus (DM) of 20 years of evolution, who referred pain in the left lumbar region associated with increased volume and intermittent fever, so he is hospitalized, detecting an extensive left psoas abscess which is drained by open surgery with extraperitoneal approach, showing favorable evolution.

Effect of a 5% naproxen patch on reducing pain caused by separators prior to fixed orthodontic treatment

BACKGROUND: The pain involved in orthodontic treatments may involve inflammatory processes. This study evaluated the effect of using a naproxen patch for pain reduction in the separating stage of fixed orthodontic treatment. METHODS: In this double-blind, randomized, controlled clinical trial of 35 orthodontic patients (age: 14–19 years) who had pain during separator placement, each patient randomly placed naproxen and placebo patches in the first permanent molar region, in opposite quadrants of the same jaw. Patches were replaced every 8 hours until 3 days after separator placement. Patients recorded their pain perception at 2, 6, and 24 hours, and on days 2 (6 PM), 3 (10 AM and 6 PM), and 7 (10 AM and 6 PM), using a visual analog scale. Mean pain scores were compared for the two patches, and effects of sex and age thereon determined. RESULTS: Data from 29 patients (21 girls, eight boys) were analyzed. Mean pain values decreased over time for both patches (P < 0.001). Recorded pain did not differ significantly between the sexes (P = 0.059) or between those aged <16 and those ≥16 years (P = 0.106). Mean pain recorded with naproxen patches was statistically significantly less than that with placebo patches at all time points (P = 0.004). CONCLUSION: The naproxen patch was more efficient than the placebo patch for reducing pain at all time points. The highest pain score was recorded at 6 hours, and the least pain was recorded at the 7th day after separator placement.

Ampliação do uso do naproxeno para osteoartrite de joelho e quadril / Increased use of naproxen for knee and hip osteoarthritis

CONTEXTO: A SCTIE propôs a ampliação de uso do naproxeno para o controle da dor associada à osteoartrite do joelho e do quadril. TECNOLOGIA: Naproxeno 250 a 500mg. INDICAÇÃO: Controle da dor associada à osteoartrite de joelho e quadril. PERGUNTA: O uso do naproxeno no controle da dor associada à osteoartrite do joelho e do quadril é eficaz e seguro quando comparado aos outros anti-inflamatórios não esteroides (AINE) não seletivos? EVIDÊNCIAS CIENTÍFICAS: Foram selecionadas 3 revisões sistemáticas com metanálise. O naproxeno apresentou eficácia superior ao paracetamol e apresentou menores riscos de infarto do miocárdio e de eventos cardiovasculares totais, juntamente com o ibuprofeno para o último desfecho, que os outros AINES avaliados. DECISÃO: Os membros da CONITEC deliberaram por recomendar a ampliação de uso de naproxeno para osteoartrite de quadril e joelho. Foi assinado o Registro de Deliberação nº 298/2017.(AU)

Cardiovascular and Gastrointestinal Effects of Etoricoxib in the Treatment of Osteoarthritis: A Systematic Review and Network Meta-analysis

OBJECTIVE: To estimate the cardiovascular (CV) and gastrointestinal (GI) risks of etoricoxib in the treatment of osteoarthritis (OA) compared to a placebo and other non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: A systematic review of randomized, controlled trials (RCTs) of etoricoxib were performed. Bayesian network meta-analysis was used over a duration of 12 weeks. The incidence of CV and GI events for a duration ≥26 weeks were also tabulated and presented using descriptive statistics. RESULTS: From this search, 10 studies were identified. Of these, 6 and 5 RCTs that measured the CV and GI events at 12 weeks were included in meta-analysis. They showed that etoricoxib did not increase the CV events compared to the placebo or NSAIDs during the 12 week period (odds ratio [OR]=0.59 compared to celecoxib, OR=0.89 with ibuprofen, OR=0.70 with placebo, and OR=2.16 with naproxen). The risk of GI events was comparable to that of most comparators, with the exception of naproxen, which had a significantly lower risk of GI events (OR=0.18) during the 12 week period. For a duration ≥26 weeks, the incidence of CV and GI events with etoricoxib increased with increasing duration. CONCLUSION: Etoricoxib is an alternative short-term treatment option for OA, showing comparable CV and GI complications to other NSAIDs. Nevertheless, further studies will be needed to elucidate the long-term safety of etoricoxib in the treatment of OA.

Comparison of the postoperative analgesic effects of naproxen sodium and naproxen sodium-codeine phosphate for arthroscopic meniscus surgery / Comparação dos efeitos analgésicos pós-operatórios de naproxeno sódico e naproxeno sódico-fosfato de codeína em artroscopia de menisco

ABSTRACT BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid "codeine" to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium-codeine phosphate when administered preemptively for arthroscopic meniscectomy. METHODS: Sixty-one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium-codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient-controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded. RESULTS: The groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18th hour on movement (p < 0.05). The median time to the first demand of PCA was shorter in Group N compared with Group NC (p < 0.001). Meperidine consumption was higher in Group N compared with Group NC (p < 0.001). There was no difference between groups with respect to side effects (p > 0.05). CONCLUSIONS: The combination of naproxen sodium-codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os anti-inflamatórios não esteroides (AINEs) são frequentemente usados para controlar a dor após artroscopia. A adição de um opiáceo oral eficaz (codeína) aos AINEs pode ser mais efetiva e diminuir o consumo de opiáceo parenteral no pós-operatório. O objetivo deste estudo foi comparar a eficácia e os efeitos colaterais de naproxeno sódico e uma nova preparação, naproxeno sódico-fosfato de codeína, quando administrados preventivamente para meniscectomia artroscópica. MÉTODOS: Foram randomicamente divididos em dois grupos 61 pacientes para receber naproxeno sódico por via oral (Grupo N) ou naproxeno sódico-fosfato de codeína (Grupo NC) antes da cirurgia. A cirurgia foi feita sob anestesia geral. Meperidina intravenosa foi iniciada por meio de analgesia controlada pelo paciente (ACP) para todos os pacientes. O desfecho primário foi o escore de dor na primeira hora de pós-operatório, avaliada com a escala visual snalógica (EVA). A sedação foi avaliada com a escala de sedação de Ramsey. A primeira demanda de ACP, o consumo de meperidina no pós-operatório, os efeitos colaterais e os dados hemodinâmicos também foram registrados. RESULTADOS: Os grupos foram demograficamente comparáveis. As medianas dos escores EVA tanto em repouso quanto em movimento foram significativamente menores no Grupo NC comparado com o Grupo N; exceto para movimento na avaliação de 18 horas (p < 0,05). A mediana do tempo até a primeira demanda de ACP foi menor no Grupo N em comparação com o Grupo NC (p < 0,001). O consumo de meperidina foi maior no Grupo N em comparação com o Grupo NC (p < 0,001). Não houve diferença entre os grupos em relação aos efeitos colaterais (p > 0,05). CONCLUSÕES: A combinação de naproxeno sódico-fosfato de codeína forneceu analgesia mais efetiva que naproxeno sódico, sem aumentar os efeitos colaterais.

Low level laser therapy versus pharmacotherapy in improving myofascial pain disorder syndrome

Introduction: Temporomandibular disorders [TMD] lead to masticatory muscle pain, jaw movement disability and limitation in mouth opening. Pain is the chief complaint in 90% of the TMD patients which leads to disability and severe socioeconomic costs. The purpose of this study was to evaluate the therapeutic effects of low level laser therapy [LLLT] compared to pharmacotherapy with NSAIDs [naproxen] in myofascial pain disorder syndrome [MPDS]

Methods: In this randomized controlled clinical trial, 40 MPDS patients were divided into two groups. One group received naproxen 500 mg bid for 3 weeks as treatment modality and also had placebo laser sessions. The other group received active laser [diode 810 nm CW] as treatment and placebo drug. Pain intensity was measured by visual analogue scale [VAS] and maximum painless mouth opening was also measured as a functional index every session and at 2 months follow up. Data was collected and analyzed with SPSS software. Independent t test was used to analyze the data. A P<0.05 was considered significant

Results: Low level laser caused significant reduction in pain intensity [P<0.05] and a significant increase in mouth opening. In naproxen group neither pain intensity nor maximum mouth opening had significant improvement. Pain relief, in subjective VAS was observed in third session in LLLT group, but did not occur in naproxen group. Maximum mouth opening increased significantly in laser group compared to the naproxen group from the eighth session

Conclusion: Treatment with LLLT caused a significant improvement in mouth opening and pain intensity in patients with MPDS. Similar improvement was not observed in naproxen group

Preparation of nanohybrid compound from the drugs [naproxen and cephalexin] with zinc oxide and studying biological activities against Aeromonas bacteria

Objectives: This study focus on the preparation of the compound nanoscale layers of Zinc oxide [ZnO] with naproxen and cephalexin

Methods: Ion exchange technique via sol-gel method synthesised under aqueous environment, resulted in the formation of inorganic organic characteristics of nanohybrid by using X-ray diffraction [XRD] method and study antibacterial activity of hybrid and free compound against some bacteria

Results: The powder X-ray diffraction showed new level for nanohybrid compounds differ from free compounds. The antibacterial results show more nanohybrid compounds concentration increased its effectiveness against bacteria, the greater the concentration of the compound greater is the increase in its effectiveness against bacteria inhibitory

Conclusions: The possibility of the bind of drugs [Cephalexin and Naproxen] in the preparation of nanohybrid-ZnO compound and the use of nanocompounds as antibacterial agent in better treatment of pathogenic bacteria. And this nanocompound is more efficient from free compounds