Administration Of Anti-inflammatory Drugs Research Articles

A comparison of postoperative pain between transumbilical and suprapubic incision in laparoscopic liver resection.

In laparoscopic liver resection, few reports have investigated the influence of type of incision on postoperative pain in laparoscopic liver resection. We therefore conducted the present study to clarify the difference in postoperative pain between two types of incision. Nineteen patients who underwent laparoscopic lateral sectionectomy were enrolled. In 11 patients with a transumbilical incision and eight with a suprapubic incision, the operation duration, blood loss, length of incision, duration of intravenous fentanyl infusion immediately after surgery and rescue dosage, and period of regular oral nonsteroidal anti-inflammatory drugs were evaluated. There was no significant difference between the two groups in patients' background characteristics, operation time, or amount of blood loss. The length of suprapubic incision was significantly longer than the umbilical incision. Concerning the postoperative pain management, the duration of intravenous fentanyl administration was 1day (1-2 days) for umbilical incisions and 1.5 days (1-2 days) for suprapubic incisions, showing no significant difference. Regarding the rescue dosage of fentanyl, the results were comparable between the groups. Regarding the postoperative duration of regular nonsteroidal anti-inflammatory drug administration, there was also no significant difference between the groups (transumbilical: 14 [5-35] days vs suprapubic: 8 [7-32]). Postoperative pain is comparable between umbilical and suprapubic incision in patients who underwent laparoscopic left lateral segmentectomy. In terms of postoperative pain, either a transumbilical incision or a suprapubic incision can be selected for specimen extraction.

Deep Eutectic Solvent Formulations and Alginate-Based Hydrogels as a New Partnership for the Transdermal Administration of Anti-Inflammatory Drugs.

The transdermal administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is a valuable and safer alternative to their oral intake. However, most of these drugs display low water solubility, which makes their incorporation into hydrophilic biopolymeric drug-delivery systems difficult. To overcome this drawback, aqueous solutions of bio-based deep eutectic solvents (DES) were investigated to enhance the solubility of ibuprofen, a widely used NSAID, leading to an increase in its solubility of up to 7917-fold when compared to its water solubility. These DES solutions were shown to be non-toxic to macrophages with cell viabilities of 97.4% (at ibuprofen concentrations of 0.25 mM), while preserving the anti-inflammatory action of the drug. Their incorporation into alginate-based hydrogels resulted in materials with a regular structure and higher flexibility. These hydrogels present a sustained release of the drug, which is able, when containing the DES aqueous solution comprising ibuprofen, to deliver 93.5% of the drug after 8 h in PBS. Furthermore, these hydrogels were able to improve the drug permeation across human skin by 8.5-fold in comparison with the hydrogel counterpart containing only ibuprofen. This work highlights the possibility to remarkably improve the transdermal administration of NSAIDs by combining new drug formulations based on DES and biopolymeric drug delivery systems.

Clinical characteristics, treatment and outcomes of acute postpartum inflammatory sacroiliitis: a retrospective study.

We performed this research to report the clinical characteristics and clinical therapeutic strategies of acute postpartum inflammatory sacroiliitis. We retrospectively analyzed the data of patients diagnosed with acute postpartum inflammatory sacroiliitis from 2014 to 2020. All their clinical details including clinical symptoms and signs, laboratory tests, radiologic examination, diagnosis and treatment process and clinical outcomes were obtained and analyzed in this retrospective analysis. Eleven patients diagnosed with acute postpartum inflammatory sacroiliitis complain of low back pain. Magnetic resonance imaging (MRI) is useful in diagnosing acute postpartum inflammatory sacroiliitis. The systemic non-steroidal anti-inflammatory drugs (NSAIDs) administration, sacroiliac joint injection, and physical therapy effectively alleviated the pain with symptoms disappearing, and the abnormal signal reduced in MRI. Acute postpartum inflammatory sacroiliitis is an uncommon disease with atypical symptoms. MRI examination may be the best diagnostic method. General NSAIDs and sacroiliac joint injections of local anesthetic plus corticosteroid under the guidance of fluoroscopy or ultrasound can achieve safe and effective treatment. This retrospective study was approved by the Committee on the Ethics of our hospital (No. 202101023). Trial registration was performed in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , No. ChiCTR2100045656).

Клинический случай пациентки с увеитом, ассоциированным с ювенильным идиопатическим артритом

The prevalence of juvenile idiopathic arthritis is 0.05–0.6% in different countries, and in the territory of the Russian Federation it reaches 62.3 100 thousand children. The incidence of uveitis associated with juvenile idiopathic arthritis is 10–30%. Uveitis in juvenile idiopathic arthritis occurs in 80–93% of the type of chronic iridocyclitis. In 3–19.6% of cases, recurrent macular edema develops. In order to treat uveitis associated with juvenile idiopathic arthritis, systemic immunosuppressive therapy, local and systemic administration of antiinflammatory drugs are used. Uveitis in juvenile idiopathic arthritis is asymptomatic in the early stages of the disease, so screening ophthalmological examination of children 2–4 times a year is recommended. Purpose. Description of a clinical case of a patient with uveitis associated with juvenile idiopathic arthritis. Material and methods. A clinical observation of a patient with uveitis associated with juvenile idiopathic arthritis was described. Patient Z., 10 years old, underwent a standard ophthalmological examination, ultrasound examination, optical coherence tomography. Results. The patient had a low-symptomatic course of chronic persistent anterior uveitis, the development of cystic macular edema of the left eye. Anti-inflammatory treatment was carried out in the conditions of the academician S.N. Fyodorov Federal State Institution National Medical Research Center “Intersectoral Research and Technology Complex “Eye microsurgery” Ministry of Health of the Russian Federation”, Novosibirsk Branch. The rheumatologist recommended intensification of systemic immunosuppressive therapy. The prescribed treatment made it possible to preserve visual functions, reduce the frequency and severity of the development of relapses of the disease. Conclusions.Uveitis associated with juvenile idiopathic arthritis is a serious pathology, often accompanied by the development of complications, requires a multidisciplinary approach, regular monitoring and timely adequate treatment. Key words: uveitis, macular edema, juvenile idiopathic arthritis.

Effects of dietary butyrate supplementation and oral nonsteroidal anti-inflammatory drug administration on serum inflammatory markers and productivity of dairy cows during the calving transition

Dairy cattle experience inflammation during the calving transition period, and butyrate and nonsteroidal anti-inflammatory drugs (NSAID) are expected to reduce the inflammation. Our objective was to evaluate the effects of dietary butyrate supplementation and oral NSAID administration on feed intake, serum inflammatory markers, plasma metabolites, and milk production of dairy cows during the calving transition period. Eighty-three Holstein cows were used in the experiment with a 2 × 2 factorial arrangement of treatments. The cows were blocked by parity and calving date, and randomly assigned to a dietary butyrate or control supplement, and NSAID or a placebo oral administration. Experimental diets were iso-energetic containing calcium butyrate at 1.42% of diet dry matter (DM) or the control supplement (1.04% commercial fat supplement and 0.38% calcium carbonate of diet DM). The close-up diets contained 13.3% starch and 42.4% neutral detergent fiber on a DM basis, and were fed from 28 d before expected calving date until calving. The postpartum diets contained 22.1% starch and 34.1% neutral detergent fiber on a DM basis and were fed from calving to 24 d after calving. Oral NSAID (1 mg of meloxicam/kg of body weight) or placebo (food dye) was administered 12 to 24 h after calving. Dietary butyrate supplementation and oral NSAID administration did not affect milk yield or postpartum serum concentrations of amyloid A and haptoglobin. However, butyrate-fed cows increased plasma fatty acid concentration on d -4 relative to calving (501 vs. 340 μEq/L) and tended to increase serum haptoglobin concentration (0.23 vs. 0.10 mg/mL). There was a supplement by drug interaction effect on plasma glucose concentration on d 4; in cows administered the placebo drug, butyrate supplementation decreased plasma glucose concentration compared with control-fed cows (62.8 vs. 70.1 mg/dL). Butyrate-fed cows tended to have lower milk crude protein yield compared with cows fed the control diet (1.21 vs. 1.27 kg/d). Dietary butyrate supplementation and oral NSAID administration did not have overall positive effects on production performance of dairy cows during the calving transition period.

3D-Printed Polypyrrole Microneedle Arrays for Electronically Controlled Transdural Drug Release

After the spinal cord injury, inflammation and cytotoxicity cause further damage to neural cells. The progression of this secondary injury might be reduced by the administration of anti-inflammatory drugs. To allow the local delivery of such drugs while minimizing dural opening, we have created a polypyrrole (PPy)-coated microneedle array using a microscale three-dimensional (3D) printing technology that facilitates electronically controlled encapsulation and the transdural release of drugs. PPy microneedles demonstrated an electronically controlled release of steroid dexamethasone (Dexa) in a novel in vitro transdural model and in vivo. The biological activity of the device was then tested by the electronic release of Dexa into an in vitro model of neuroinflammation, using activated microglia. Following electrically activated Dexa release, inflammation was reduced, as demonstrated by a decrease in nitric oxide and proinflammatory cytokines Il-6 and MCP-1. These results demonstrate the feasibility of PPy-coated microneedles for the transdural delivery of anti-inflammatory drugs to the central nervous system.

Risk Factors for Length of Hospital Stay in Acute Exacerbation Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study.

Background/PurposeA patient’s length of hospital stay (LHS) is associated with the severity and outcome of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Therefore, identification of patients with prolonged LHS at an early stage can potentially reduce the risk of adverse events and treatment costs in patients with AECOPD. Therefore, this study aimed to explore the independent predictors of prolonged LHS in AECOPD patients.Patients and MethodsThis multicenter cross-sectional study was conducted at two tertiary hospitals between January 2019 and August 2020. Demographic data, underlying diseases, symptoms, and laboratory findings were collected. Univariate analysis was used to identify variables with significant differences. A collinearity diagnostic was applied to the selected variables before the establishment of the regression model. Ordinal logistic regression was performed to explore the independent risk factors for prolonged LHS in patients with AECOPD.ResultsIn total, 598 patients with AECOPD were screened. Finally, the LHS of 111, 218, and 100 patients was <7, 7–10, and ≥11 days, respectively. Significant differences in the 12 variables were found in the univariate analysis. Because collinearities among white blood cells (WBC), neutrophils (NS), and NS% were observed, WBC and NS% were excluded. Subsequently, an ordinal logistic regression model identified that rates of hypertension and chronic cor pulmonale (CCP), neutrophil–lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) were independent predictors of prolonged LHS in AECOPD patients.ConclusionCollectively, our results showed that inflammatory status, hypertension, and CCP were independently associated with LHS in patients with AECOPD. These data indicate that early and appropriate administration of antibiotics and anti-inflammatory drugs is essential for reducing LHS. Hypertension and CCP were independent predictors of worse outcomes in patients with AECOPD. Therefore, advanced management and care should be provided to AECOPD patients with hypertension and/or CCP on admission.

Chitosan/Pluronic F127 Thermosensitive Hydrogel as an Injectable Dexamethasone Delivery Carrier.

Intra-articular administration of anti-inflammatory drugs is a strategy that allows localized action on damaged articular cartilage and reduces the side effects associated with systemic drug administration. The objective of this work is to prepare injectable thermosensitive hydrogels for the long-term application of dexamethasone. The hydrogels were prepared by mixing chitosan (CS) and Pluronic-F127 (PF) physically. In addition, tripolyphosphate (TPP) was used as a crosslinking agent. Chitosan added to the mix increased the gel time compared to the pluronic gel alone. The incorporation of TPP into the material modified the morphology of the hydrogels formed. Subsequently, MTS and Live/Dead® experiments were performed to investigate the toxicity of hydrogels against human chondrocytes. The in vitro releases of dexamethasone (DMT) from CS-PF and CS-PF-TPP gels had an initial burst and took more time than that from the PF hydrogel. In vivo studies showed that hydrogels retained the fluorescent compound longer in the joint than when administered in PBS alone. These results suggest that the CS-PF and CS-PF-TPP hydrogels loaded with DMT could be a promising drug delivery platform for the treatment of osteoarthritis.

Comparative Pharmacokinetic Studies of Marketed Gel and Transdermal Patches Loaded with Diclofenac Diethylamine in Rabbits

Oral administration of the non-steroidal anti-inflammatory drug, Diclofenac diethylamine (DDEA) is often associated with gastrointestinal ulcers, extensive first-pass hepatic metabolism, and gastric bleeding. As an alternative to oral administration, a transdermal drug delivery system (TDDS) of DDEA was developed for topical administration, to quantify diclofenac diethylamine in plasma of rabbits for this, a sensitive Reverse Phase-high performance liquid chromatography (RP-HPLC) method was developed to compare DDEA in marketed gel and optimized formulation, using Carbamazepine as Internal standard (IS). DDEA provoke on Hypersil RP C18 column (250 mm × 4.6 mm 5 μm) using a mobile phase mixture of potassium dihydrogen buffer pH 2.5 and acetonitrile in the ratio of 30:70v/v at an isocratic flow rate of 1mL/min. The retention time of DDEA was found to be 5.3min. The calibration curve was linear over the concentration range from 50-750ng/mL of DDEA. This method was accurate for quantitative estimation of the drug in marketed gel and optimized formulation. The main aim of study is to compare Pharmacokinetic profile of diclofenac diethylamine in pharmaceutical dosage forms (Marketed gel &amp; formulated transdermal patches) using WinNonlin software version 8.1.

Comparative Pharmacokinetic Studies of Marketed and Microsponges Gel Loaded with Diclofenac Diethylamine in Rabbits

Oral administration of the non-steroidal anti-inflammatory drug, Diclofenac Diethylamine (DDEA) is often associated with gastrointestinal ulcers, bleeding and extensive first-pass hepatic metabolism. As an alternative to oral administration, formulated microsponges-based gel of DDEA was developed for topical administration, to quantify diclofenac diethylamine in plasma of rabbits for this a sensitive Reverse Phase High-Performance Liquid Chromatography (RP-HPLC) method was developed using carbamazepine as Internal standard (IS) and DDEA (pure drug) was provoked on Hypersil RP C18 column (250mm × 4.6mm 5µm) using a mobile phase mixture of potassium dihydrogen buffer pH 2.5 and acetonitrile in the ratio of 30:70 v/v at an isocratic flow rate of 1mL/min. The drug peak area was detection and found at 276nm. The retention time of DDEA was found to be 5.3 min. The calibration curve was linear over the concentration range of 50-750ng/ml of DDEA. This method was accurate for quantitative estimation of the drug from the marketed gel and optimized microsponge gel. The main of investigation is to compare pharmacokinetic profile of diclofenac diethylamine in pharmaceutical dosage forms (marketed gel and microsponges gel) using WinNonlin software version 8.1.

Beneficial postoperative micro-rheological effects of intraoperative administration of diclophenac or ischemic preconditioning in patients with lower extremity operations - Preliminary data.

Ischemia-reperfusion (I/R) may worsen blood rheology that has been demonstrated by clinical and experimental data. It is also known that anti-inflammatory agents and preconditioning methods may reduce I/R injury. We aimed to analyze hemorheological alterations in elective knee operations and the effects of intraoperative nonsteroidal anti-inflammatory drug (NSAID) administration and application of ischemic preconditioning. Hemorheological variables of 17 patients with total knee replacement or anterior crucial ligament replacement were analyzed. The ischemic (tourniquet) time was 92±15 minutes. Seven patients did not receive NSAID (Control group), 5 patients got i.v. sodium-diclophenac 10 minutes before and 6 hours after reperfusion. Five patients had ischemic preconditioning (3×15 minutes). Blood samples were collected before the ischemia, 10 minutes after reperfusion, on the 1st and 2nd p.o. day. Whole blood viscosity didn't show notable inter-group differences, except for a slight decrease in the preconditioning group. RBC deformability decreased, erythrocyte aggregation enhanced by the 1st and 2nd p.o. days in Control group. In NSAID and preconditioning groups the changes were moderate, aggregation values significantly lowered compared to the Control group. Intraoperatively administered diclophenac or ischemic preconditioning could moderate the deterioration in micro-rheological parameters caused by I/R in patients.

In vivo joint synovial fluid disposition of a novel sustained-release formulation of diclofenac and hyaluronic acid in horses.

Intra-articular administration of sustained-release anti-inflammatory drugs is indicated in horses suffering from joint inflammation, but no such drugs are labelled for veterinary use. To obtain initial data on synovial disposition and safety of a new sustained-release formulation of diclofenac (SYN321) in the joints of horses, an experimental interventional study of elimination and side effects of intra-articular administration of SYN321 was conducted. Nine clinically sound horses were included in the study, and SYN321 was administered by the intra-articular route. Dose ranges and sampling intervals were established in a pilot study with two horses, and then applied in a main study involving seven horses treated in the fetlock joint. Diclofenac was detected above lower limit of quantification (LOQ: 0.5ng/ml) in synovial fluid throughout the study period (14days), and below LOQ (0.1ng/ml) in plasma after 4days and in urine after 14days. No obvious clinical side effects were detected. Clinical examination and objective lameness evaluation suggested that SYN321has potential as a local joint NSAID treatment with sustained release in horses, but further studies on synovial fluid exposure, safety and clinical efficacy are warranted.

Natural History of Paclitaxel-associated Acute Pain Syndrome: A Case Report of Rare Side Effect of Paclitaxel

BACKGROUND: One of the harshest side effects following anticancer agent treatments is chemotherapy-induced neuropathic pain. After surgical staging, chemotherapy combination of paclitaxel carboplatin could be a choice of therapy for Stage II or more advanced stage of ovarian cancer. Different side effects may appear after the application of paclitaxel. CASE REPORT: Here, we show an uncommon case of paclitaxel-acute pain syndrome (P-APS), and how we deal with such cases according to our experiences. One uncommon side effect is P-APS, which can be treated effectively with the administration of non-steroidal anti-inflammatory drugs, corticosteroid, and supportive therapy. CONCLUSION: One uncommon side effect of Paclitaxel induced neuropathic can be treated effectively with the administration of non-steroidal anti inflammatory drugs, corticosteroid, and supportive therapy.

Effect of omeprazole and sucralfate on gastrointestinal injury in a fasting/NSAID model.

Equine gastric ulcer syndrome (EGUS) is a common and significant cause of morbidity in horses, with a range of clinical signs, including inappetence, colic and poor performance. Hospitalised horses are exposed to factors that may induce EGUS, including fasting and nonsteroidal anti-inflammatory drug (NSAID) administration, and may be at risk for development of squamous (ESGD) and glandular gastric disease (EGGD). Prophylactic anti-ulcer medication is often prescribed for these patients, but drug selection is complicated by different aetiology and response to treatment of ESGD and EGGD. To establish the efficacy of sucralfate or omeprazole used prophylactically in horses exposed to a combined feed-fast and NSAID administration EGUS induction protocol. We hypothesised that these drugs would be equally effective for prevention of gastric lesions in the experimental cohort. Randomised crossover experimental design. Horses (n=14) received either omeprazole (1mg/kg PO q24h) or sucralfate (20mg/kg PO q8h) while undergoing the feed-fast/NSAID protocol, allowed an 8-week washout period, and then administered the alternate treatment. Serial gastroscopy, ultrasound and haematology documented treatment effects. ESGD and EGGD score increased over time under both treatments. There was a significant effect of treatment on EGGD scores (P<.001), with post-treatment EGGD scores higher for horses receiving sucralfate (median 3; IQR 2.25,3) than omeprazole (1; 1,1). The effect of treatment on ESGD scores just achieved significance (P=.05), with post-treatment ESGD scores higher for sucralfate (4; 3,4) than omeprazole (2; 2,3). This study was performed in healthy horses, and response to treatment may differ in horses with clinical illness. Additional investigation in a larger population may be required to detect significant differences in other clinical parameters. Omeprazole was superior to sucralfate for mitigating gastric lesion severity in healthy horses exposed to a feed-fast/NSAID model.

Genes and miRNAs as Hurdles and Promoters of Corticospinal Tract Regeneration in Spinal Cord Injury.

Spinal cord injury (SCI) is a devastating lesion to the spinal cord, which determines the interruption of ascending/descending axonal tracts, the loss of supraspinal control of sensory-motor functions below the injured site, and severe autonomic dysfunctions, dramatically impacting the quality of life of the patients. After the acute inflammatory phase, the progressive formation of the astrocytic glial scar characterizes the acute-chronic phase: such scar represents one of the main obstacles to the axonal regeneration that, as known, is very limited in the central nervous system (CNS). Unfortunately, a cure for SCI is still lacking: the current clinical approaches are mainly based on early vertebral column stabilization, anti-inflammatory drug administration, and rehabilitation programs. However, new experimental therapeutic strategies are under investigation, one of which is to stimulate axonal regrowth and bypass the glial scar. One major issue in axonal regrowth consists of the different genetic programs, which characterize axonal development and maturation. Here, we will review the main hurdles that in adulthood limit axonal regeneration after SCI, describing the key genes, transcription factors, and miRNAs involved in these processes (seen their reciprocal influencing action), with particular attention to corticospinal motor neurons located in the sensory-motor cortex and subjected to axotomy in case of SCI. We will highlight the functional complexity of the neural regeneration programs. We will also discuss if specific axon growth programs, that undergo a physiological downregulation during CNS development, could be reactivated after a spinal cord trauma to sustain regrowth, representing a new potential therapeutic approach.

Medical conditions associated with gastroduodenal ulceration or erosion in 168 dogs: 2008-2018.

BackgroundMany medical conditions are thought to cause gastroduodenal ulceration or erosion (GUE) in dogs. However, evidence for the association between many of these conditions and GUE in dogs is lacking.ObjectiveTo identify medical conditions associated with GUE in dogs.AnimalsOne hundred and sixty‐eight dogs with GUE and 168 randomly selected control dogs without evidence of GUE identified on necropsy between January 2008 and September 2018.MethodsPatient signalment, blood urea nitrogen (BUN) and serum creatinine concentrations, recently administered ulcerogenic drugs, as well as necropsy findings were recorded. The association between these findings and presence of GUE was assessed by univariable and multivariable analysis.ResultsIn the final multivariable model, the following factors were associated with GUE: Nonsteroidal anti‐inflammatory drug (NSAID) administration (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.3‐17.4; P = .0004), glucocorticoid administration (OR, 3.0; 95% CI, 1.5‐5.9; P = .001), gastrointestinal neoplasia (OR, 13.5; 95% CI, 1.7‐108.0; P = .01) and gastrointestinal mechanical disease (foreign bodies, gastric dilatation, and volvulus; OR, 4.8; 95% CI, 1.2‐19.7; P = .03). Additionally, working dog breeds were predisposed to GUE compared to mixed breed dogs (OR, 2.8; 95% CI, 1.1‐7.4; P = .04). Insufficient clinical data was available to either support or refute a role of other putative risk factors evaluated.Conclusion and Clinical ImportanceAdministration of NSAID or glucocorticoid and gastrointestinal neoplasia or mechanical disease were associated with GUE in dogs. The potential predisposition of working breed dogs for GUE requires further investigation.

Lung Delivery Systems to Optimize Pharmacotherapy of COVID-19: A Concise Review

Background: COVID-19 is an ongoing viral pandemic caused by the SARS-COV-2 virus. Several drugs were repurposed for its management; however, most of these drugs were not ideal treatments by traditional methods of administration, whether given by injection or orally. This is due to many reasons including pharmacokinetic limitations or drug-induced adverse effects. There is an urgent need to develop these drugs to target the virus in the lung tissue through inhalation.&#x0D; Objective: To address the gap in knowledge regarding efficacy and safety of pulmonary drug delivery of repurposed antiviral against COVID-19.&#x0D; Findings: Ongoing trials for inhalable formulations of several drugs such as Niclosamide; Remdesivir, Hydroxychloroquine, and Azithromycin among others showed promising results.&#x0D; Conclusion: The development of pharmaceutical forms for inhaled administration of antiviral and anti-inflammatory drugs is an important direction that needs more attention to achieve the optimal management of respiratory infectious diseases.

Mastitis in meat sheep

Mastitis in meat sheep occurs in all flocks, but incidence can vary. It can be a severe disease, resulting in ewe deaths, but chronic and subclinical cases also occur. It is a costly disease, but accurate assesments of the impact, especially of chronic and subclinical disease, are lacking. The most commonly involved pathogens are Mannheimia haemolytica and Staphylococcus aureus. The most important risk factors relate to compromise of teat defences, and increased transmission, but environmental cases do occur. Treatment of acute clinical cases requires systemic antibiosis and non-steroidal anti-inflammatory drug administration, and, where required, supportive care. Prevention involves tackling the risk factors, and using vaccination and breeding to reduce ewe susceptibility.

Adherence of NSAID Administration in Patients with Mild and Moderate Traumatic Brain Injury in Dr. Soetomo General Hospital, Surabaya

Introduction: Traumatic brain injury (TBI) has a concerning incidence rate. One of the therapies for patients with TBI is non-steroidal anti-inflammatory drugs (NSAID) administration as an analgesic with proper adherence to achieve optimal therapy results. This research aimed to evaluate physicians’ NSAID administration adherence in patients with mild and moderate TBI in Dr. Soetomo General Hospital, Surabaya.Methods: This was an observational descriptive study with a retrospective design. NSAID administration adherence was graded by evaluating the dose, route, frequency, and interval of NSAID administration. The variables were evaluated by observing the medical records of inpatients with mild and moderate TBI from 1 January to 31 December 2018.Results: NSAIDs used for TBI management were metamizole, paracetamol, mefenamic acid, and ketorolac. Metamizole was administered in 10 patients (34.5%), paracetamol in 1 patient (3.4%), metamizole and paracetamol in 15 patients (51.7%), metamizole and mefenamic acid in 1 patient (3.4%), metamizole and paracetamol with mefenamic acid in 1 patient (3.4%), and metamizole and ketorolac in 1 patient (3.4%). Adherence of paracetamol, mefenamic acid, and ketorolac administration in patients with mild and moderate TBI were well-administered in every evaluated variable. Metamizole administration’s adherence was already well-administered in drug dosage and drug administration route, but it was not well-administered in drug administration interval and frequency.Conclusion: Physicians’ adherence to NSAID administration in patients with mild and moderate TBI in Dr. Soetomo General Hospital, Surabaya was well-administered, except for metamizole.

Chemotherapy: a double-edged sword in cancer treatment.

Chemotherapy is a well-known and effective treatment for different cancers; unfortunately, it has not been as efficient in the eradication of all cancer cells as been expected. The mechanism of this failure was not fully clarified, yet. Meanwhile, alterations in the physiologic conditions of the tumor microenvironment (TME) were suggested as one of the underlying possibilities. Chemotherapy drugs can activate multiple signaling pathways and augment the secretion of inflammatory mediators. Inflammation may show two opposite roles in the TME. On the one hand, inflammation, as an innate immune response, tries to suppress tumor growth but on the other hand, it might be not powerful enough to eradicate the cancer cells and even it can provide appropriate conditions for cancer promotion and relapse as well. Therefore, the administration of mild anti-inflammatory drugs during chemotherapy might result in more successful clinical results. Here, we will review and discuss this hypothesis. Most chemotherapy agents are triggers of inflammation in the tumor microenvironment through inducing the production of senescence-associated secretory phenotype (SASP) molecules. Some chemotherapy agents can induce systematic inflammation by provoking TLR4 signaling or triggering IL-1B secretion through the inflammasome pathway. NF-kB and MAPK are key signaling pathways of inflammation and could be activated by several chemotherapy drugs. Furthermore, inflammation can play a key role in cancer development, metastasis and exacerbation.