Consumption Of Non-steroidal Anti-inflammatory Drugs Research Articles

Ilaser Submucous Destruction in the Treatment of Hemorrhoids

Aim: to improve the results of treatment in patients with hemorrhoids of the 2nd and 3rd stages.Materials and methods. The prospective study included 60 patients with hemorrhoids of the 2nd and 3rd stages. All patients underwent destruction of internal hemorrhoids with a fiber laser with a diode pump with a wavelength of 1940 nm. The technique is based on the effect of laser energy on the cavernous tissue of the internal hemorrhoidal node and on the terminal branches of the upper rectal artery. The efficiency of the destruction of internal hemorrhoids and the frequency of relapses of the disease were evaluated. The effectiveness of the proposed method was evaluated using anoscopy, measurement of the size of internal hemorrhoidal nodes, transrectal ultrasound with dopplerography. The analysis of the intensity of the pain syndrome, the consumption of nonsteroidal anti-inflammatory drugs and the assessment of the quality of life on the SF-36 scale was carried out. Sphincterometry was performed in all patients to determine the possible effect of laser radiation on the rectal locking apparatus. To assess the possible causes of complications, a single-factor analysis of the amount of energy transferred to each hemorrhoidal node and the total amount of energy spent on the operation was conducted.Results. In all patients, by day 7 after surgery, the pain syndrome in 43 patients (75.4 %) corresponded to 0 points according to VAS. In 3 patients (5 %) intraoperative hemorrhage developed. In the early postoperative period, 5 patients (8.3 %) had 7 complications: 5 cases of thrombosis of the external hemorrhoidal node and 2 — of acute urinary retention. The conducted single-factor analysis showed the dependence of the development of complications on the energy transferred to each hemorrhoidal node and its total amount for the entire operation. In terms of up to 6 months, there were no signs of a return of the disease in any case (hemorrhoidal prolapse and blood discharge). The detected hemorrhoids before the operation, a month after the operation, were not visualized, which persisted after 6 months. The performed transrectal ultrasound examination with spectral-wave dopplerography for up to 6 months allowed to diagnose a persistent decrease in blood flow along the terminal branches of the upper rectal artery compared with preoperative values. When performed sphincterometry, there was no change in the parameters of the anal sphincter function compared to preoperative parameters.Conclusion. The proposed method applying a fiber laser with a diode pump with a wavelength of 1940 nm makes it possible to affect transdermally the internal hemorrhoidal node without damaging the mucosa of the anal canal. The absence of postoperative wounds in the anal canal leads to a decrease in pain syndrome, and by day 7 there are no clinical manifestations of hemorrhoids. The method of laser destruction of internal hemorrhoids can be used in outpatient conditions and can improve the quality of life of patients in the early postoperative period.

Modulation of the Immune Response to Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination by Nonsteroidal Anti-Inflammatory Drugs.

Evidence is scarce to guide the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-related adverse effects, given the possibility of blunting the desired immune response. In this pilot study, we deeply phenotyped a small number of volunteers who did or did not take NSAIDs concomitant with SARS-CoV-2 immunizations to seek initial information on the immune response. A SARS-CoV-2 vaccine-specific receptor binding domain (RBD) IgG antibody response and efficacy in the evoked neutralization titers were evident irrespective of concomitant NSAID consumption. Given the sample size, only a large and consistent signal of immunomodulation would have been detectable, and this was not apparent. However, the information gathered may inform the design of a definitive clinical trial. Here we report a series of divergent omics signals that invites additional hypotheses testing. SIGNIFICANCE STATEMENT: The impact of nonsteroidal anti-inflammatory drugs (NSAIDs) on the immune response elicited by repeat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunizations was profiled by immunophenotypic, proteomic, and metabolomic approaches in a clinical pilot study of small sample size. A SARS-CoV-2 vaccine-specific immune response was evident irrespective of concomitant NSAID consumption. The information gathered may inform the design of a definitive clinical trial.

Evaluation of factors that may influence the development of chronic kidney disease in patients with bipolar disorder treated with lithium.

IntroductionBipolar disorder (BD) is a serious and chronic mental disease of mood. Lithium is used for treatment and studies have demonstrated that it is the most efficient drug, reducing suicide risk in a high percentage of patients. However, this drug has well known side effects, such as kidney damage. Lithium could cause chronic kidney disease, specially with the presence of other risk factors.ObjectivesObservational and retrospective study of creatinine levels and glomerular filtration rates observed in blood analysis (follow-up period of 11 years). Sample size of 263 patients diagnosed of BD I and BD II in treatment with lithium. We used socio-demographic (age, sex) and clinic variables (diabetes mellitus, hypertension, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or diuretics) to generate bivariate and multivariate analysis.MethodsOur main objective is to analyze the deterioration of kidney function and the development of chronic kidney disease that chronic treatment with lithium can induce in patients with BD. Our secondary objective is to determine variables which could promote the development of chronic kidney disease, and to assess if these variables could be considered as risk factors during the treatment with lithium.Results11,3 % of patients in our study developed chronic kidney disease during monitoring. The deterioration of GFR in patients in treatment with lithium was significantly associated with female sex and NSAIDs consumption. A trend towards statistical significance was found regarding the use of diuretics (p=0,060). No statistical significance was found between diabetes mellitus, hypertension or type of BD and the deterioration of kidney function in our sample. An inverse association was found between the GFR decline and the age but no statistical significance was demonstrated.ConclusionsWe conclude that female sex and use of NSAIDs are predicting factors of GFR decline in patients with BD in chronic treatment with lithium. We must take into account these drugs or even avoid concomitant treatment (lithium and NSAIDs) in order to prevent chronic kidney disease. In addition to it, we should recommend careful use of diuretics during treatment with lithium because of risk of dehydration. Diabetes mellitus and hypertension have universally been associated to increase risk of development of chronic kidney disease. However, we have not found statistical significance in our study. Therefore, research should be done in order to determine specific risk factors in this group of patients and, consequently, optimize their treatment.Disclosure of InterestNone Declared

Endoscopic Findings and Histopathological Patterns of Gastric Mucosal Biopsies in Functional Dyspepsia: A Clinicopathological Study

Background: Endoscopic examination of the gastrointestinal tract through macroscopic and histopathological evaluation provides a tool to differentiate the major causes of functional dyspepsia. The distinction is not always clear. This study aimed to assess the frequency and type of the macroscopic and histopathological changes in gastrointestinal tract endoscopy in patients with symptoms of functional dyspepsia. Methods: A cross-sectional study was performed on 97 patients aged 10–85 years who underwent gastroscopy due to functional dyspepsia symptoms. The patients had no history of weight loss, major comorbidities like diabetes or cirrhosis, non-steroidal anti-inflammatory drug (NSAID) consumption, peptic ulcer, or any other confounding causes. Biopsy specimens were taken from the stomach and duodenum for histopathological examination. The presence of Helicobacter pylori infection was established based on histopathological examination and a positive rapid urease test. Results: Gastric biopsies of 97 patients with functional dyspepsia were studied. In histological examination of gastric mucosal biopsies, chronic inflammation was present in 94 (96.9%), activity was seen in 47 (48.5%), glandular atrophy was seen in 3 (3.1%), and intestinal metaplasia was seen in 9 (9.2%) patients. H. pylori was identified on gastric mucosal biopsies in 46 (47.4%) patients based on sections stained with H&E and Giemsa. Conclusion: According to the obtained results, it is concluded that patients with functional dyspepsia have a higher frequency of gastric mucosal inflammation and H. pylori infection.

The role of oxylipins in NSAID-exacerbated respiratory disease (N-ERD).

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is characterized by nasal polyp formation, adult-onset asthma, and hypersensitivity to all cyclooxygenase-1 (COX-1) inhibitors. Oxygenated lipids are collectively known as oxylipins and are polyunsaturated fatty acids (PUFA) oxidation products. The most extensively researched oxylipins being the eicosanoids formed from arachidonic acid (AA). There are four major classes of eicosanoids including leukotrienes, prostaglandins, thromboxanes, and lipoxins. In N-ERD, the underlying inflammatory process of the upper and lower respiratory systems begins and occurs independently of NSAID consumption and is due to the overproduction of cysteinyl leukotrienes. Leukotriene mediators all induce edema, bronchoconstriction, and airway mucous secretion. Thromboxane A2 is a potent bronchoconstrictor and induces endothelial adhesion molecule expression. Elevated Prostaglandin D2 metabolites lead to vasoconstriction, additionally impaired up-regulation of prostaglandin E2 leads to symptoms seen in N-ERD as it is essential for maintaining homeostasis of inflammatory responses in the airway and has bronchoprotective and anti-inflammatory effects. A characteristic feature of N-ERD is diminished lipoxin levels, this decreased capacity to form endogenous mediators with anti-inflammatory properties could facilitate local inflammatory response and expose bronchial smooth muscle to relatively unopposed actions of broncho-constricting substances. Treatment options, such as leukotriene modifying agents, aspirin desensitization, biologic agents and ESS, appear to influence eicosanoid pathways, however more studies need to be done to further understand the role of oxylipins. Besides AA-derived eicosanoids, other oxylipins may also pay a role but have not been sufficiently studied. Identifying pathogenic N-ERD mechanism is likely to define more effective treatment targets.

Prevalence and Risk Factors of Gastroesophageal Reflux Disease Among Medical and Dental Students of Rawalpindi/Islamabad

Objectives: To determine the prevalence of gastroesophageal reflux disease among medical and dental students of Rawalpindi Islamabad Pakistan and to find the associated risk factors.
 Study Design: Analytical cross-sectional study.
 Place and Duration of Study: Students of Medical colleges in Rawalpindi Islamabad Pakistan, from March to May 2021. 
 Methodology: Non-probability convenience sampling technique was used. Sample size was found to be 352 using Rao soft.Only undergraduate students from Rawalpindi Islamabad Pakistan were included whereas postgraduate students were excluded. The data was collected via online distributed google forms and analyzed by SPSS version 25.0. 
 Results: There were 157(44.6%) males and 195(55.41%) females among whom 296(84.1%) were enrolled in medical program and 56(15.9%) in dental program. 94 students (26.7%) reported having symptoms of gastroesophageal reflux disease .Based on a GERD score of >=4, 35(9.94%) students were diagnosed with gastroesophageal reflux disease .Use of analgesics (OR=3.11[95% CI 1.32-7.36]; P≤0.010), family history of gastroesophageal reflux disease (OR=6.48[95% CI 3.09-13.57]; P≤0.000),family history of peptic ulcer (OR=2.85[95%CI 1.18-6.83] P≤0.038), frequent use of non-steroidal anti-inflammatory drugs(P≤0.013) had a significant association with the presence of gastroesophageal reflux disease .
 Conclusion: Gastroesophageal reflux disease was diagnosed in approximately 10% of students. There was a significant association of Gastroesophageal reflux disease with use and frequent consumption of non-steroidal anti-inflammatory drugs and family history of peptic ulcer/Gastroesophageal reflux disease

Effect of Islamic Ramadan fasting on peptic ulcer perforation: A retrospective comparative study

Background: Fasting for extended periods of time increases gastric acid and pepsin levels and consequently the risk of peptic ulcer perforation (PUP). The effects of Ramadan fasting on PUP have not been thoroughly studied, and a few existing studies report contradictory findings. The present study compares patients with PUP operated during the Islamic Ramadan fasting to those operated outside this period and determines whether an association between Ramadan fasting and PUP exists. Patients and methods: A retrospective cross-sectional study between June 2019 and December 2020 was conducted at the Al-Nasr Hospital in the city of Ibb in Yemen. All adult patients operated for a PUP were included. Patient demographic characteristics, risk factors for peptic ulcer, ultrasound and radiological findings on admission, operative findings, postoperative complications, and outcomes were collected from the Hospital Medical Records. Patients were divided into two groups for comparison. Group A included the patients operated on during Ramadan, while Group B included patients operated on outside Ramadan. Results: A total of 40 adult patients with PUP were included. The overall mean age of the participants was 41.6 ± 8.21 years (range: 23–58 years). Most patients were men (30, 75%), and most (19, 47.5%) were admitted to the Al-Nasr Hospital between 24 and 48 hours from the start of the symptoms. History of chewing khat, consumption of nonsteroidal anti-inflammatory drugs, dyspepsia, alcohol use, and smoking were presented in 39 (97.5%), 30 (75%), 36 (90%), 6 (15%), and 35 (87.5%) patients, respectively. The most presented blood group (57.5% of patients) was O type. Most of the patients (72.5%) presented with multiple gastrointestinal symptoms such as abdominal pain, anorexia, vomiting, and constipation. An x-ray found air under the diaphragm in 85% of the patients. Ultrasonography found free fluid in 20 (50%) patients. The size of the perforated ulcer (diameter) was less than 10 mm in 65% of the patients. Postoperative complications were surgical site infection, fluid collection, need for reoperation, and intra-abdominal sepsis in 6 (15%), 4 (10%), 3 (7.5%), and 3 (7.5%) patients, respectively. Most patients (37, 92.5%) recovered well and were discharged from the hospital, and three (7.5%) patients died. The comparative analysis demonstrated a significantly younger age in those operated during Ramadan fasting (Group A) compared to those operated at other times of the year (Group B; 38.8 ± 7.42 years vs. 44.4 ± 8.17; p = 0.029). We observed a statistically significant increase in the number of patients with PUP operated on during Ramadan (p = 0.006), compared to those operated at other times of the year. There was no statistically significant difference between groups in demographic factors, radiologic findings, operative findings, or outcomes (p ≥ 0.05). During the ultrasound, ascites were more frequently diagnosed in group A patients, while acute appendicitis was generally misdiagnosed in Group B patients, a statistically significant difference (p = 0.013). Conclusions: The findings of the present study report an increase in the number of PUP operations during Ramadan fasting in Yemen, but not in postoperative complications, suggesting an association between Ramadan fasting and PUP.

EUROVISCO Good Practice Recommendations for a First Viscosupplementation in Patients with Knee Osteoarthritis.

Viscosupplementation (VS) with hyaluronic acid is widely used in the management of knee osteoarthritis. There is no clear recommendation on the decision-making to achieve VS. Based on extensive research of the literature and expert opinion, the members of the EUROVISCO (European Viscosupplementation Consensus Group) task force were asked to give their degree of agreement with 60 issues, using a Delphi method. The expert panel achieved unanimous agreement in favor of the following statements: It is recommended to assess pain on a visual or 10-point numeric scale before considering VS. VS can be considered for patients with pain scores between 3 and 8. A standard x-ray must be obtained before the decision of VS. If the x-ray is normal, osteoarthritis must be confirmed by MRI or computed tomography (CT) arthrogram before considering VS. The aims of VS are relieving pain, improving function, and reducing non-steroidal anti-inflammatory drug (NSAID) consumption. The use of VS must not be considered for treating an osteoarthritis flare. VS can be envisaged as a first-line pharmacological treatment in patients having a contra-indication to NSAIDs or analgesics. VS can be considered in patients with contra-indications to arthroplasty. In the case of severe comorbidities (diabetes, hypertension, gastrointestinal disorders, renal failure), VS can avoid the use of potentially dangerous treatments. VS can be considered in patients receiving antiplatelet agents, vitamin K antagonists, and direct factor Xa or thrombin inhibitors. Five other statements obtained a high level of consensus. These recommendations, illustrated in a decision algorithm, have been established to help practitioners in the decision-making of knee VS.

Renal arcuate vein thrombosis-induced acute kidney injury: a rare multiple-Hit-mediated disease.

Renal arcuate vein thrombosis (RAVT) is a rare and recently recognized cause of acute kidney injury (AKI) in young adults. However, the precise incidence and underlying pathophysiologic mechanisms leading to AKI in these patients remain elusive. This study included all patients who underwent a kidney biopsy over a 40-month period sent to the pathology department of Necker-Enfants Malades Hospital, with evidence of RAVT. We performed coagulation tests, genetic testing for thrombophilia, complete urine toxicologic screening and kidney metagenomic sequencing to identify an underlying cause of thrombosis. We report five pediatric cases of RAVT discovered on kidney biopsy performed in the setting of unexplained AKI. Investigations did not reveal an underlying cause of thrombosis but only a significant nonsteroidal anti-inflammatory drugs (NSAIDs) use was reported in 4/5 patients, supporting a potential link between NSAIDs use and RAVT. By performing metagenomic sequencing on kidney biopsy samples, we detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the kidney of one patient. These results suggest that systemic SARS-CoV-2 infection may also be a key contributing factor of renal thrombosis, particularly by inducing potential endothelial disruption. In conclusion, RAVT-induced AKI appears to be a multiple hit-mediated disease in which NSAIDs consumption and viral infection such as SARS-CoV-2 may be crucial contributing factors. These findings may have significant public health implications given the prevalence of NSAIDs use in the general population. Increased awareness and additional study of future cases may lead to a better understanding of this rare cause of AKI in children and young adults.

Non-technical factors for recurrence of sacroiliac joint pain after intra-articular steroid injection: a cohort study

Background & Objective: The effectiveness of intra-articular corticosteroid injection therapy is still debatable, despite numerous studies which demonstrated the benefits of steroid injections. Injection failure can be caused by a variety of technical factors, some of which have been identified in studies, including the accuracy with the injection location is performed and the pattern of corticosteroid distribution. We investigated the non-technical factors that influence the effectiveness of intra-articular corticosteroid injection at the sacroiliac joint (SIJ) in the past.
 Methodology: It was a prospective cohort study to determine non-technical factors associated with recurrence in patients with SIJ pain who had received multidisciplinary treatment for their ailment. A total of 55 patients met the inclusion and exclusion criteria for the study who were followed up. Patients who had SIJ injections before 9 months and, who had no improvement on the pain scale, or there was a worsening of the pain, or the patient returned with SIJ pain complaints on the same side, were included in the trial. The results were analyzed using logistic regression to determine the likelihood of recurrence.
 Results: A total of 55 participants was enrolled in the study, with a higher proportion of females (n = 33; 60 %) than males (n = 22; 40 %). Thirty-one patients were returning patients (56.36 %) out of 55 patients. According to the results of the bivariate analysis, age was associated with recurrent SIJ pain. According to the results of the T-test, the mean age of the recurrent patients was 49.32 ± 16.68 y, whereas the mean age of the non-recurrent patients was 56.7 ± 12.76 y. The results of the multivariate analysis revealed that age, NSAID consumption, and unilateral SIJ pain, all had protective values in the context of recurrence of the sacroiliac joint pain.
 Conclusions: The use of non-steroidal anti-inflammatory drugs (NSAIDs) and the involvement of a single SI joint are protective factors against the recurrence of SI joint pain.
 Abbreviations: COST: European Cooperation in Science and Technology; NSAIDs: Non-steroidal anti-inflammatory drugs; SIJ: Sacroiliac joint;
 Key words: Anti-inflammatory agent; Non-technical risk factors; Intra-articular; Age; Recurrent sacroiliac joint pain
 Citation: Siahaan YMT, Pangestu AR. Sungono V. Non-technical factors for recurrence of sacroiliac joint pain after intra-articular steroid injection: a cohort study. Anaesth. pain intensive care 2022;26(5):773-777. 
 DOI: 10.35975/apic.v26i6.2049

Photobiomodulation vs NSAIDs in the management of postoperative dentoalveolar pain

BackgroundPostoperative pain, the most common complication of dentoalveolar surgery, is routinely controlled by non-steroidal anti-inflammatory drugs (NSAIDs). However, despite its proven efficacy, the long-term consumption of NSAIDs is associated with several serious and adverse effects. As a result, photobiomodulation (PBM) or low-level laser therapy (LLLT) is used in many treatment modalities to reduce pain, inflammation, and promote healing. Aim of the studyTo compare the analgesic effects of LLLT and Ibuprofen after surgical dental extraction. Materials and methodsA clinical trial study was conducted at Umm Al-Qura University Dental Clinics, involving 46 healthy patients between 20 and 60 years of age. The recruited patients were divided into two groups of 23 patients each. Group 1 (positive control group) was prescribed Ibuprofen and Group 2 (experimental group) was treated with LLLT. The pain was measured on days 1, 2, and 7 using the Numeric Pain Rating Scale (NPRS). ResultsThe mean level of pain decreased with both treatments. On the first postoperative day, the pain level in the laser therapy group was significantly lower than in the control group (U = 62.5, p = 0.024). The results indicated a significant decrease in pain level on the second postoperative day for both the control and experimental groups (Z = −3.61, p < 0.005, and Z = −3.1, p = 0.002, respectively). However, the pain level was lower in the control group, although the difference was not statistically significant (U = 79, p = 0.102). ConclusionConsidering the constraints of this study, NSAIDs were found to be significantly better at reducing pain than LLLT.

Effect of Carrots (Daucus carota L.) on Gastric Histopathology of Piroxicam-Induced Mice as a Peptic Ulcer Prevention

Highlights:1. Carrots (Daucus carota L.) can reduce the side effects of non-steroidal anti-inflammatory drugs (NSAIDs) due to its gastroprotective components.2. Histopathological studies of the gastric inflammation signs showed that carrots can prevent NSAID-induced peptic ulcers. AbstractIntroduction: Non-steroidal anti-inflammatory drugs (NSAIDs) consumption contributes significantly to gastrointestinal morbidity, including peptic ulcers. NSAIDs cause gastric mucosal damage by inhibiting PGE2 and PGI2 secretion, increasing HCl secretion, and also causing local irritation and neutrophil adhesion. Flavonoids and chlorogenic acid are gastroprotective agents found in carrots (Daucus carota L.). Therefore, this study aimed to validate the effect of carrots on gastric histopathology of piroxicam-induced mice.Methods: This was an experimental study using a post-test-only control group design. 35 mice were divided into 5 groups and were allowed to adapt for 1 week. The negative control group received 0.25 mL aqua dest, while the positive control group received 0.104 mg famotidine. Group A, B, and C received carrot extract with each dosage was 200 mg/kgBW, 300 mg/kgBW, and 400 mg/kgBW. The mice were induced 2 hours later with 0.052 mg piroxicam. The treatments lasted 14 days. Each stomach was taken and examined on the 15th day. Afterward, histopathological preparations were made.Results: The results of the histopathological signs of inflammation using the Kruskal-Wallis method showed p = 0.000, indicating that there was an effect of the carrot extract in preventing the inflammation on the gastric histopathology (p &lt; 0.05).Conclusion: In conclusion, this study confirmed that carrot extract is more effective in avoiding peptic ulcers due to NSAID consumption.

Persistent Aseptic Pyelonephritis After Acute Bacterial Pyelonephritis: Possible Role of Corticosteroids

Persistent Aseptic Pyelonephritis After Acute Bacterial Pyelonephritis: Possible Role of Corticosteroids

Pulsed electromagnetic fields improve pain management and clinical outcomes after medial unicompartmental knee arthroplasty: A prospective randomised controlled trial

BackgroundTo assess pain relief and clinical outcomes in patients undergoing unicompartmental knee arthroplasty (UKA) stimulated with pulsed electromagnetic fields (PEMFs) compared to a control group. MethodsA prospective randomised controlled trial (RCT) was performed in which 72 patients undergoing medial UKA were randomised into a control group or an experimental PEMFs group. The patients allocated to the experimental group were instructed to use PEMFs for 4 h per day for 60 days. They were evaluated before a surgery and then during the time points corresponding to 1 month, 2 months, 6 months, 12 months, and 36 months after the surgery. No placebo group was included in the RCT. Clinical assessment included the Visual Analogue Scale (VAS) for pain, Oxford Knee Score (OKS), the Short Form 36 (SF-36) health survey questionnaire, and joint swelling. During each follow-up visit, the consumption of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) was recorded. ResultsThe VAS decreased on follow-up visits in both the groups; a statistically significant difference between the groups was observed during the 6 (p = 0.0297), 12 (p = 0.0003), and 36 months (p = 0.0333) follow-ups in favour of the PEMFs group. One month after UKA, the percentages of patients using NSAIDs in the PEMFs and control group were 71% and 92%, respectively (p = 0.0320). At the 2 months point, 15% of the patients in the PEMFs group used NSAIDs compared to 39% in the control group (p = 0.0317). The objective knee girth evaluation showed a statistically significant difference at 6 (p = 0.0204), 12 (p = 0.0005), and 36 (p = 0.0005) months with improved values observed in the PEMFs group. The subjective assessment of the swelling demonstrated a statistically significant difference at 2 (p = 0.0073), 6 (p = 0.0006), 12 (p = 0.0001), and 36 (p = 0.0011) months with better values noted in the PEMFs group. Last, the OKS result was significant higher in the experimental group during all the follow-ups (1mth: p = 0.0295; 2mths: p = 0.0012; 6mths: p = 0.0001; 12mths: p < 0.0001; 36mths: p = 0.0061). ConclusionsThe use of PEMFs leads to significant pain relief, better clinical improvement, and lower NSAIDs consumption after medial UKA when compared to the control group. Level of evidenceII.

Stereotactic electroencephalography is associated with reduced opioid and nonsteroidal anti-inflammatory drug use when compared with subdural grids: a pediatric case series

Patients undergoing surgical intervention for epilepsy mapping are typically administered opioids for pain control. The use of opioids is demonstrably lower after other procedures when a minimally invasive surgery (MIS) technique is used. Our objective was to determine whether using MIS for stereoelectroencephalography (SEEG) resulted in lower opioid requirement by pediatric patients when compared with subdural grid placement after craniotomy (ECoG). A retrospective chart review was conducted to identify patients < 18 years who underwent epilepsy mapping surgery using SEEG or ECoG in 2015–2019. The hospital stay was divided into four time periods, and the total amounts of opioids (converted into morphine milligram equivalents (MMEs)) and nonsteroidal anti-inflammatory drugs (NSAIDs) and pain scores (on numerical rating scale (NRS)) were calculated for each time interval. The two groups were then compared statistically. The study included 31 patients in the SEEG group and 9 in the ECoG group. The SEEG group consumed significantly fewer opioids during the hospital stay than the ECoG group (23.6 vs. 61.7 MMEs; p = 0.041). There were also significant differences in the length of stay (6.9 vs. 12.2 days; p = 0.002), rate of complications (0% vs. 20%; p = 0.006), and total NSAIDs consumed (3,264.8 vs. 12,730.2 mg; p = 0.002). Opioid and NSAID consumption were significantly lower and hospital stays were shorter in pediatric patients who underwent epilepsy mapping via SEEG compared with ECoG. These results suggest that MIS for epilepsy mapping may decrease the overall pain medication use and expedite patient discharge.

Synergism interaction between genetic polymorphisms in drug metabolizing enzymes and NSAIDs on upper gastrointestinal haemorrhage: a multicenter case-control study

Background Interindividual genetic variations contribute to differences in patients’ response to drugs as well as to the development of certain disorders. Patients who use non-steroidal anti-inflammatory drugs (NSAIDs) may develop serious gastrointestinal disorders, mainly upper gastrointestinal haemorrhage (UGIH). Studies about the interaction between NSAIDs and genetic variations on the risk of UGIH are scarce. Therefore, we investigated the effect of 16 single nucleotide polymorphisms (SNPs) involved in drug metabolism on the risk of NSAIDs-induced UGIH. Materials and methods We conducted a multicenter case-control study of 326 cases and 748 controls. Participants were sub-grouped into four categories according to NSAID exposure and genetic profile. We estimated odds ratios (ORs) and their 95% confidence intervals (CI) using generalized linear mixed models for dependent binomial variables and then calculated the measures of interaction, synergism index (S), and relative excess risk due to interaction (RERI). We undertook stratified analyses by the type of NSAID (aspirin, non-aspirin). Results We observed an excess risk of UGIH due to an interaction between any NSAID, non-aspirin NSAIDs or aspirin and carrying certain SNPs. The greatest excess risk was observed for carriers of: rs2180314:C>G [any NSAID: S = 3.30 (95%CI: 1.24–8.80), RERI = 4.39 (95%CI: 0.70–8.07); non-aspirin NSAIDs: S = 3.42 (95%CI: 1.12–10.47), RERI = 3.97 (95%CI: 0.44–7.50)], and rs4809957:A>G [any NSAID: S = 2.11 (95%CI: 0.90–4.97), RERI = 3.46 (95%CI: −0.40–7.31)]. Aspirin use by carriers of rs6664:C>T is also associated with increased risk of UGIH [ORaspirin(+),wild-type: 2.22 (95%CI: 0.69–7.17) vs. ORaspirin(+),genetic-variation: 7.72 (95%CI: 2.75–21.68)], yet larger sample size is needed to confirm this observation. Conclusions The joint effect of the SNPs s2180314:C>G and rs4809957:A>G and NSAIDs are more than three times higher than the sum of their individual effects. Personalized prescriptions based on genotyping would permit a better weighing of risks and benefits from NSAID consumption. KEY MESSAGES Multicenter case-control study of the effect of genetic variations involved in drug metabolism on upper gastrointestinal haemorrhage (UGIH) induced by NSAIDs (aspirin and non-aspirin). There is a statistically significant additive synergism interaction between certain genetic polymorphisms and NSAIDs on UGIH: rs2180314:C>G and rs4809957:A>G. The joint effect of each of these single nucleotide polymorphisms and NSAIDs on UGIH is more than three times higher than the sum of their individual effects. Genetic profiling and personalized prescriptions would be useful in managing the risks and benefits associated with NSAIDs.

The prevalence and habit-associated risk factors of gastroesophageal reflux disease among fishermen in Indonesia

Background. This study was aimed to investigate the prevalence and habit-associated risk factors of gastroesophageal reflux disease (GERD) among fishermen.Methods. A cross-sectional study was conducted among 168 adult fishermen in Cirebon Regency, West Java, Indonesia. A self-administered questionnaire was given. The questionnaire consisted of demographic characteristics and validated GERD questionnaire (GERDQ) in Indonesian language. Data were analyzed using descriptive statistics and chi-square test. The study has been approved by the Medical Research Ethic Comiittee.Results. The medan age of the participants was 39.0 (24-86) years old. They were predominanty (60.7%) female. The prevalence of GERD was 22.6%. According to bivariate analysis, there was association between smoking (PR 1.181; 95%CI 1.013-1.377;p 0.041), high-salt intake (PR 2.419;95%CI 1.079-5.424; p 0.029), herb consumption (PR 3.068; 95%CI 1.307-7.200; p 0.008), poor hand hygiene (PR 3.202; 95%ci 1.445-7.095; p 0.003), and non-steroidal anti-inflammatory drug (NSAID) consumption (PR 3.062; 95%CI 1.446-6.488; p 0.00) with GERD. Tea consumption, coffee consumption, and raw vegetable eating were not associated with GERD.Conclusions This population-based study showed that the prevalence of GERD among fishermen in Indonesia is high. Habits associated with GERD in this study were smoking, high-salt intake, herb consumption poor, hand hygiene,

Predictors of postoperative pain, opioid consumption, and functionality after arthroscopic shoulder surgery: A prospective observational study.

This study aims to identify predictors of postoperative pain and opioid consumption after shoulder surgery to help optimize postoperative pain protocols. Observational cohort study. One thirty-four patients undergoing arthroscopic shoulder repair were included. Variables related to the patient, surgery and anesthesia were collected and correlated with postoperative pain intensity, analgesic consumption, and functionality up to 1-month post-surgery. We used mixed-effect linear models to estimate the association of gender, interscalene block (ISB), preoperative shoulder pain, non-steroidal anti-inflammatory drugs (NSAIDs) consumption before surgery, and type of surgery with each of the following outcomes: postoperative pain scores, opioid consumption, and functionality. We further analyzed the data for pain scores and opioid consumption per body weight using the multiple linear regression analysis to demonstrate the aforementioned associations specifically at 1h, 6h, 12h, 24h, 72h, 1week and 1month after surgery. Omitting the ISB was associated with higher postoperative pain and cumulative opioid consumption over the first 24h after surgery. Rotator cuff repair and stabilization surgeries were found to be predictive of higher postoperative pain at 24h, 72h, and 1week and lower functionality at 1week after surgery. Preoperative shoulder pain and NSAIDs consumption were also predictive of postoperative pain and cumulative opioid consumption. Omitting a single shot ISB is a strong predictor of postoperative pain and opioid consumption in the early postoperative phase, beyond which the type of surgery, particularly rotator cuff repair and stabilization surgery, emerges as the most important predictor of postoperative pain and functionality.

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery.

Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate.

Protective Effects of Chitosan-Bilirubin Nanoparticles Against Ethanol-Induced Gastric Ulcers.

PurposeGastric ulcers (GU) are a disease of the gastrointestinal tract that can be caused by excessive alcohol consumption and heavy use of nonsteroidal anti-inflammatory drugs. GU manifests predominantly as pathological damage, such as extensive inflammatory erosion and superficial bleeding of the gastric mucosa. Oxidative stress damage and the inflammatory response are now considered important predisposing factors for GU, suggesting that antioxidant and anti-inflammatory drugs could be treatments for GU. Nanoparticle drug carriers offer many advantages over conventional drugs, such as improved drug efficiency, increased drug stability, and increased half-life.MethodsWe designed chitosan-bilirubin conjugate (CS-BR) nanoparticles and assessed the anti-inflammatory and antioxidant abilities of CS-BR in gastric epithelial cells. Then, we evaluated the intragastric retention time and the anti-ulcer effects of CS-BR in vivo.ResultsThe in vitro data showed that CS-BR nanoparticles protect gastric epithelial cells against oxidative/inflammatory injury. The in vivo study demonstrated that CS-BR nanoparticles accumulate permanently in the stomach and exert powerful antioxidant and anti-inflammatory effects against GU.ConclusionThis study applied bilirubin to the treatment of GU and confirmed that CS-BR nanoparticles are effective at alleviating acute GU in an experimental model. The findings provide innovative ideas for prophylaxis against or treatment of GU.