Nitroglycerin Ointment Research Articles

Increased PDT Efficacy When Associated with Nitroglycerin: A Study on Retinoblastoma Xenografted on Mice

Purposes: The aim of the study was to assess the efficacy of a treatment protocol that combines photodynamic therapy (PDT) and nitroglycerin (NG) on human retinoblastoma tumors xenografted on mice. We aimed to increase the PDT efficiency (in our least treatment-responsive retinoblastoma line) with better PS delivery to the tumor generated by NG, which is known to dilate vessels and enhance the permeability and retention of macromolecules in solid tumors. Methods: In vivo follow-up of the therapeutic effects was performed by sodium MRI, which directly monitors variations in sodium concentrations non-invasively and can be used to track the tumor response to therapy. NG ointment was applied one hour before PDT. The PDT protocol involves double-tumor targeting, i.e., cellular and vascular. The first PS dose was injected followed by a second one, separated by a 3 h interval. The timelapse allowed the PS molecules to penetrate tumor cells. Ten minutes after the second dose, the PS was red-light-activated. Results: In this study, we observed that the PDT effect was enhanced by applying nitroglycerin ointment to the tumor-bearing animal’s skin. PDT initiates the bystander effect on retinoblastomas, and NG increases this effect by increasing the intratumoral concentration of PS, which induces a higher production of ROS in the illuminated region and thus increases the propagation of the cell death signal deeper into the tumor (bystander effect).

Comparison of Various Analgesic Protocols for Control of Postoperative Pain Following Anorectal Surgery

Background: Anorectal pathology is commonly perceived it and handled in common surgical practitioners’ fistula and abscess, hemorrhoids, fissures, condyloma, and other pathological conditions. Because of the strong sensory innervations of the canal of anal, patients endure severe discomfort during anorectal surgery. It is generally most severe in the first twenty-four hours especially after excisional hemorrhoidectomy. the aim of this study is a comparison between different analgesic protocols used to relieve pain postoperative anorectal surgery.
 Methods: PubMed, Embase, Medline, Science Gate, Scientific Report, Elsevier, Google Scholar, and Cochrane Evidence Based Medicine Reviews were used to conduct a review search. Review of newly released books and papers with regard to the topic, as well as manual searches (Comparison of various analgesic protocols for control of postoperative pain following anorectal surgery), was started at (May,2021). we searched the published studies from 2011 to the present date by the full text:(various analgesic protocols post anorectal surgery).
 Results: Anorectal surgery is marked by excruciating discomfort after the procedure. Using the new technique during anorectal surgery as hemorrhoidectomy to avoid more excision of anal mucosa and the skin, putting the suture nearest to the dentate line and away from the internal anal sphincter, and good hemostasis to avoid the inserting of the anal pack are the most essential methods to lessen pain postoperatively regardless of the type of anorectal surgery performed or the instrument to use during it. We found more protocols using multimodality pain management for the relief of pain, topical drugs that produce direct relaxation of the internal anal sphincter, topical intervention as a pudendal nerve block, a method of surgery as surgical sphincterotomy, and technical tips to reduce pain as ligasure.
 Conclusion: Multimodal pain treatment has been demonstrated to minimize pain intensity and opioid doses in various kinds of surgery. According to the highest degree of proof, using current technological procedures and tools as a ligasure with some topical agent as GTN glyceryl trinitrate ointment provided amazing excellent alleviation of postoperative pain following anorectal surgery.

The Effect of Topical Nitroglycerin on Wound Healing in Rabbits using Histopathological Investigation

Introduction: Nitroglycerin can increase the Cycle Guanosine Mono Phosphate level, enhance nitric oxide rate in tissues dilate vessels, and intensify perfusion within tissues. The aim of the present study was to conduct a microscopic investigation addressing the effect of topical 2% Nitroglycerin ointment on wound healing in rabbits.
 Materials and methods: Six adult male New Zealand white rabbits, weighing approximately 2.25 kg were used. Two wounds were created on each side of the spinal column. The wounds reached the deep fascia and their dimensions were 15 15 mm. The left wound was used as the control and the right wound was used as the experimental one. Immediately after the creation of wounds, a layer of nitroglycerin 2% with 1 mm thickness was put on the experimental wound daily for seven days. On days 3, 5, 7, and 14 after cutting, both the experimental and control wounds with a margin of healthy tissues were taken for the histopathological examination.
 Results: The distance of the two edges on the wound in treated wounds reached a significant difference, compared with control wounds on day 14. The number of inflammatory cells (with neutrophils format) in the treatment group was significantly less than those of the control group starting from day 5. In addition, the fibrin clot diameter in the treatment group was significantly less than the control group on days 5, 7, and 14. At the beginning of the experiment angiogenesis in the control group was more than in the treatment group, but it was the same in both groups on day 7, and angiogenesis in the treatment group was more than in the control group after day 7. The volume of granulation in the treatment group was more than control group and there was a significant difference on days 5, 7, and 14. Epithelial tissues diameter was higher in the treatment group and the difference became significant on day 14.
 Conclusion: In conclusion, the findings indicated a promising function of topical NTG in wound healing of anal fissures, tendinopathies, CNH, diabetic foot, or skin flap necrosis.

Neonatal ischemic limb lesions: From etiology to topical nitroglycerine. A case series analysis.

Although rare, ischemic lesions in neonates may occur in Neonatal Intensive Care Units (NICUs) secondary to routine procedures and/or medicaments. We present double‐center case series, reporting three preterm neonates with ischemic lesions following cardiac arrest and radial blood sampling. The overall outcome after treatment with 2% nitroglycerine (NTG) ointment showed optimal results with no adverse events. The most frequent causes responsible for the onset of such lesions are peripheral arterial catheterization procedures and dopamine extravasation. Our series describe the cardiac arrest as an underestimated cause of onset. Despite the optimal results emerging from the treatment of such lesions with NTG ointment, both in our experience and in the scientific literature, a defined protocol for its use in NICUs is not currently available, hence the need for further studies.

Comparison of efficacy of lateral sphincterotomy versus topical 0.2% Glyceryl Trinitrate Ointment in anal fissure treatment

Aim: To compare the outcomes of both 0.2% glyceryl trinitrate and lateral sphincterotomy to treat the anal fissure. Study design: Comparative study. Methods: This study was performed at the surgery department sir Ganga Ram Hospital hospital Lahore, Pakistan from 1st June 2020 to 30 Dec 2021. Total 80 patients were the participant of this study. After the diagnosis of anal fissure and before the starting treatment, a detailed scenario of its treatment, process, side effects, and chances of recurrence were explained to patients then consent was signed by the individual patients. Patients were divided into two groups to compare the outcomes of both sphincterotomy and glyceryl trinitrate. Group A had 40 patients and Group B had 40 patients as well. The age of all the patients was above the 18 years. Results: Group A had 14 (35%) patients of age range 18-30 years and 26 (65%) of 31-60 years old. 13 (32.5%) females, 27 (67.5%) males, mild pain in 10 (25%), severe pain in 30(75%), Constipation was reported in 16(40%) patients and 29(72%) patients had bleeding issues. Group B found with 17 (42.5%) patients of age range 18-30 years and 23 (57.5%) of 31-60 years old. 10 (25%) females, 30 (75%) males, mild pain in 12 (30%), severe pain in28(70%), Constipation was reported in 20(50%) patients and 31(77%) patients had a bleeding issue. The final comparison after six weeks of treatment shows the 65% of patients healed with the lateral sphincterotomy and 47% of patients healed with ointment of 0.2% glyceryl trinitrate. The healed proportion was measured high for the lateral sphincterotomy treatment as compared to the ointment of 0.2% glyceryl trinitrate. Conclusion: We concluded that lateral sphincterotomy has an effective response to treat the anal fissure as compare to 0.2% ointment of glyceryl trinitrate. Keywords: Lateral sphincterotomy, ointment of 0.2% glyceryl trinitrate, anal fissure.

Nitric oxide in multikinase inhibitor-induced hand-foot skin reaction

Hand-foot skin reaction (HFSR) is the most debilitating and prevalent side effect caused by multikinase inhibitors (MKIs) that share vascular endothelial growth factor receptor (VEGFR) as the common inhibition target, such as sorafenib, regorafenib, axitinib, etc. Though not life-threatening, HFSR can significantly deteriorate patients' quality of life and jeopardize the continuity of cancer therapy. Despite years of efforts, there are no FDA-approved treatments for HFSR and the understanding of the precise pathogenic mechanism is still limited. In this study, we hypothesized that nitric oxide has the potential therapeutic effect to reverse the toxicity caused by MKI through upregulation of several VEGF/VEGFR downstream signaling pathways. We found that glyceryl trinitrate (GTN), a nitric oxide donor, could stimulate cell proliferation, migration, and protect cells from apoptosis induced by MKIs in vitro. Local application of GTN mitigated tissue damage in a rat model, while not impacting the anti-tumor effect of the MKI in HepG2 tumor-bearing mice. Finally, GTN ointment alleviated cutaneous damages and improved quality of life in 6 HFSR patients. Our study proposed and validated the mechanism to counteract VEGFR inhibition, providing GTN as the potential treatment to MKI-induced HFSR, which may further improve the therapeutic window of various MKI based cancer therapies.

Perianal Application of Glyceryl Trinitrate Ointment Versus Tocopherol Acetate Ointment in the Treatment of Chronic Anal Fissure: A Randomized Clinical Trial.

Medical treatment, including glyceryl trinitrate ointment, represents the first step for the management of chronic anal fissure. However, glyceryl trinitrate ointment is associated with headache and, consequently, a high withdrawal rate of the treatment. The aim of the present study was to evaluate the effect of the topical application of tocopherol acetate ointment on pain relief and chronic anal fissure epithelialization, comparing it with the effect of a standard treatment with glyceryl trinitrate ointment. This is a 2-parallel-group, single-center, randomized controlled, intent-to-treat clinical trial. This study was conducted at the Garcilaso Clinic affiliated with Universidad Alfonso X (Madrid, Spain). Patients with chronic anal fissure were selected. Patients were randomly assigned into 2 groups: patients receiving tocopherol acetate ointment and patients receiving glyceryl trinitrate ointment. The primary end point was quantification of anal pain 8 weeks after beginning the treatment as measured by a Visual Analogue Scale ranging from 0 to 100 mm. The secondary end points were the healing rate (during the treatment period of 8 weeks) and the recurrence rate. One hundred sixty consecutive patients were treated, 80 in each group. By 8 weeks after treatment, mean anal pain score declined by 56.2 mm in the glyceryl trinitrate ointment group compared with a mean anal pain score decline of 67.1 mm in the tocopherol acetate ointment group (mean difference, 10.9 mm (95% CI, 4.3-18.6); p = 0.018). Sixteen weeks after finishing the therapy, the recurrence rate was 13.2% in the glyceryl trinitrate ointment group vs 2.9 in the tocopherol acetate ointment group (p = 0.031). Limitations of the study include the absence of manometric measurements of the internal anal sphincter before and after the treatments and the use of glyceryl trinitrate ointment as an active comparator, whereas calcium channel blockers are actually the standard treatment. Anal pain was significantly lower in the tocopherol acetate ointment group than in the glyceryl trinitrate ointment group at 8 weeks after treatment. Tocopherol acetate ointment achieved a greater healing rate and a lower recurrence rate 16 weeks after finishing the treatment. See Video Abstract at http://links.lww.com/DCR/B751. URL: https://www.clinicaltrials.gov; Identifier: NCT03787030.APLICACIÓN PERIANAL DE POMADA DE TRINITRATO DE GLICERILO FRENTE A LA POMADA DE ACETATO DE TOCOFEROL EN EL TRATAMIENTO DE LA FISURA ANAL CRÓNICA: UN ENSAYO CLÍNICO ALEATORIZADOANTECEDENTES:El tratamiento médico, incluida la pomada de trinitrato de glicerilo, representa el primer paso para el tratamiento de la fisura anal crónica. Sin embargo, la pomada de trinitrato de glicerilo se asocia con cefalea y, en consecuencia, una alta tasa de cancelación del tratamiento.OBJETIVO:El objetivo del presente estudio fue evaluar el efecto de la aplicación tópica de pomada de acetato de tocoferol en el alivio del dolor y la epitelización de la fisura anal crónica, comparándolo con el efecto de un tratamiento estándar con pomada de trinitrato de glicerilo.DISEÑO:Ensayo clínico con intención de tratar controlado, aleatorizado, de un solo centro, con dos grupos paralelos.ESCENARIO:Clínica Garcilaso adscrita a la Universidad Alfonso X (Madrid, España).PACIENTES:Pacientes con fisura anal crónica.INTERVENCIONES:Los pacientes fueron aleatorizados en 2 grupos: pacientes que recibieron pomada de acetato de tocoferol y pacientes que recibieron pomada de trinitrato de glicerilo.PRINCIPALES MEDIDAS DE RESULTADO:El criterio de valoración principal fue la cuantificación del dolor anal 8 semanas después de comenzar el tratamiento, medido por la escala analógica visual que varía de 0 a 100 mm. Los criterios de valoración secundarios fueron la tasa de curación (durante el período de tratamiento de 8 semanas) y la tasa de recurrencia.RESULTADOS:Se trataron ciento sesenta pacientes consecutivos, 80 en cada grupo. A las ocho semanas después del tratamiento, la puntuación media de dolor anal se redujo en 56.2 mm en el grupo de pomada de trinitrato de glicerilo en comparación con una disminución de la puntuación de dolor anal medio de 67.1 mm en el grupo de pomada de acetato de tocoferol (diferencia media: 10.9 mm (intervalo de confianza del 95%; 4.3 a 18.6; p = 0.018) Dieciséis semanas después de finalizar la terapia, la tasa de recurrencia fue del 13.2% en el grupo de pomada de trinitrato de glicerilo frente a 2.9 en el grupo de pomada de acetato de tocoferol (p = 0.031).LIMITACIONES:Ausencia de medidas manométricas del esfínter anal interno antes y después de los tratamientos. Ungüento de trinitrato de glicerilo como comparador activo, mientras que los bloqueadores de los canales de calcio son en realidad el tratamiento estándar de oro.CONCLUSIONES:El dolor anal fue significativamente menor en el grupo de ungüento de acetato de tocoferol que en el grupo de ungüento de trinitrato de glicerilo a las 8 semanas después del tratamiento. La pomada de acetato de tocoferol logró una mayor tasa de curación y una menor tasa de recurrencia 16 semanas después de finalizar el tratamiento. Consulte Video Resumen en http://links.lww.com/DCR/B751. (Traducción-Dr. Jorge Silva Velazco).

PROSPECTS FOR THE DEVELOPMENT OF A NEW DOSAGE FORM FOR THE TREATMENT OF ANAL FISSURES

Abstract: Anal fissure is one of the most common diseases of the rectum. In recent years, the number of patients suffering from this pathology for social reasons has sharply increased. The aim of the work is to study the methods of treatment of this disease, in particular the principles of drug therapy. Annotation. The article describes the main modern conservative and radical treatment methods. The analysis of the pharmaceutical market of drugs with indications for the use of anal fissure has been carried out. There are 38 registered drugs on the Russian pharmaceutical market, 73% of them are suppositories, 25% are rectal ointments and 2% are rectal gel. About 50% of the drugs in this group are produced by domestic manufacturers, such as JSC "Nizhpharm”, JSC "Dalkhimpharm", LLC "Altpharm", JSC "FP "Obolenskoye", LLC "Tula Pharmaceutical Factory", etc., and the same amount is produced by foreign companies represented by major global holdings: Bayer AG, Switzerland, Stada AG, Germany, Hemofarm A.D., Serbia, Dr. Kade, Germany, JSC "Gedeon Richter", Hungary, Recordati S.p.A. Ireland, etc. They include anticoagulants, venotonic and venoprotective agents, hemostatics, local anesthetics, anti-inflammatory drugs of the group of non-steroidal anti-inflammatory drugs, glucocorticosteroids, antispasmodics, nonspecific drugs that have an antiseptic and antiseptic effect. On the Russian pharmaceutical market, there are no domestic drugs of industrial production, designed to reduce the hypertonicity of the internal sphincter. One drug based on nifedipine, manufactured in Germany, has been registered, which is not able to fully cover the need to provide drugs for this group. One drug has been registered to solve this problem - relifipin gel containing nifedipine and lidocaine, produced in Germany. Ointments of extemporal production are also used, the most widely used is 0.2% nitroglycerin ointment. Obtaining dosage forms of industrial manufacture based on nitric oxide donors is fraught with difficulties due to their explosiveness. These drugs are not able to fully meet the need for the provision of medicines of this group. Conclusion: It has been shown that a well-chosen medical treatment is necessary for the treatment of diseases of mild and moderate severity, as well as after surgery. The urgency of the development of new combined drugs for the treatment of anal fissures, aimed at eliminating all links of the pathological process in the form of ointments and suppositories, has been substantiated.

A comparison between the preventive effect of Nitroglycerin and Clobetasol on cannulation-induced phlebitis; A clinical trials study

Aim: The primary aim of this study is to determine the effect of clobetasol ointment with nitroglycerin ointment on the prevention of superficial phlebitis caused by Angio catheter. Secondary aim is to compare the effect of mentioned ointments on prevention of phlebitis. Design: prospective randomized trial Method: the study did not receive any funding. The target sample is 144patients admitted to surgical ward, randomized to 3 groups. The intervention involves application of clobetasol and nitroglycerin ointment in the distal part of the cannula; while the usual care group did not receive any tropical ointment in cannulation site. the data collection tools included demographic information, information about intravenous treatment and phlebitis measurement scale. In the intervention groups, after venipuncture, 1.5 cm (about 2 g) of ointment was applied, and the site was dressed with sterile gauze. In three time periods of 24, 48 and 72 hours from the time of venipuncture. Results: the age group of 18 to 30 years was the most common age group. The most common site of cannulation was the back of hand.in the first 24hours after the placement of cannula, there was no significant difference between the three groups. But at 48 and 72 hours after placement, the difference between intervention and control groups was significant (P <0.0001). Conclusion: it is recommended to use clobetasol ointment and nitroglycerin ointment to prevent the occurrence of phlebitis in patients who need long-term use of Angio catheter (more than 48 hours). Trial registration: NCT04685031 registered on https://www.clinicaltrials.gov/

Comparison of Glyceryl Trinitrate Ointment versus Internal Lateral Sphincterotomy for Anal Fissure Pain Relief

Background: Anal fissure is a linear painful mucosal tearing in the distal part of anal canal. It extends from dentate to anal edge. Aim: To compare the glyceryltrinitrate ointment and internal lateral sphincterotomy for anal fissure pain relief in acute/chronic pts. Study Design: Prospective study Place and duration of study: Department of Surgery Unit-II, Fatima Memorial Hospital, Shadman Lahore from 1st October 2018 to 31stDecember 2020. Methodology: 40 pts with acute and chronic anal fissure were enrolled. Half of the patients undergo internal lateral sphincterotomy while other opted 0.2% use of glyceryl trinitrate ointment. Each patient was followed for pain, recovery, complications and recurrence until 12 months for internal lateral sphincterotomy and 18 months in glyceryl trinitrate ointment. Results: There were 24 males and 16 females with a mean age of patients as 30±3.2 years. Initial follow-up of patients showed 100% pain and fissure improvement in internal lateral sphincterotomy group as compared to 60% in glyceryl trinitrate ointment group respectively. Conclusion: Internal lateral sphincterotomy is most efficient and reliable procedure in relieving anal fissure pains. Keywords: Anal fissure, Internal lateral sphincterotomy, Glyceryl trinitrate

Efficacy of 0.2% GTN in Reducing Duration of Wound Healing after Fistulectomy

OBJECTIVE: To analysis the efficacy of 0.2% GTN in patients undergoing fistulectomy for fistula in ano low variety in terms of early wound healing. METHODOLOGY: A randomized controlled trail was conducted at general surgery department of Liaquat University Hospital Hyderabad from February 2013 to August 2013 among patients with low anal fistula. All participants underwent fistulectomy by a consultant general surgeon. Patients were divided into two groups using lottery methods. Group A treat fistula in ano with 0.2% glyceryl trinitrate ointment and group B treat fistula in ano without 0.2% glyceryl trinitrate ointment and wounds covered with pyodine soaked dressings. All patients were discharged on second postoperative day. Wound healing was assessed weekly for six weeks. Parameters of incomplete wound healing such as discharge, perineal irritation and pain were noted. Presence of granulation tissue at the end of 6 weeks was considered as sign of healing. Data was collected via study proforma. RESULTS: This study was conducted on 94 patients in Liaquat University Hospital Hyderabad. In GTN group 35(74.46%) were male while in Control group 38(80.85%) were male. In GTN group mostly observed single opening 37(78.72%) cases while in control group 35(74.46%) cases. The healing time in GTN Group was found to be between 21-36 days (mean 26.38 days), while the healing time control group was 32-46 days with a mean of 38.64 days (P. value &lt;0.001). The complications were also found significantly higher in the control group CONCLUSION: In conclusion our study revealed that postoperative 0.2% GTN after fistulectomy can be used as a primary treatment of low fistula in ano as a shorter period of time for wound to early heal and the less incidence of complications is comparable to that of control group. Key words: fistula in ano, 0.2% GTN, Effectiveness

Ointment therapy and prevention of cannulation-induced superficial phlebitis

The primary aim of this prospective randomized trial is to determine the effect of clobetasol ointment with nitroglycerin ointment on the prevention of phlebitis caused by cannulation. The target sample is 144 patients admitted to surgical ward, randomized to 3 groups. the data collection tools included demographic information, information about intravenous treatment and phlebitis measurement scale. In the intervention groups, after venipuncture, 1.5 cm of ointments (clobetasol and nitroglycerin) was applied n three time periods of 24, 48 and 72 hours from the time of venipuncture. In the first 24 hours after cannulation, there was no significant difference between the three groups. But at 48 and 72 hours after placement, the difference between intervention and control groups was significant (P&lt;0.0001). It is recommended to use clobetasol ointment and nitroglycerin ointment to prevent the occurrence of phlebitis in patients who need long-term use of cannula (more than 48 hours).

Comparative Study between the Use of Topical GlycerylTrinitrate Vs. Topical Diltiazem in Treatment of Acute Anal Fissure

AbstractBackground: Acute anal fissure is a painful conditioncommonly results due to an increase in internal anal sphincterpressure. It is a painful condition which leads to significantmorbidity mostly in young adults. It is a split in the mucosaof the distal anal canal that can progress to form a chroniclinear ulcer. The common symptoms are severe pain on orafter defecation and bleeding per anus.Aim of Study: The main aim of this study is to evaluatethe efficacy and adverse effects of topical 2% Diltiazem (Calcium channel blocker) and topical 0.2% Glyceryl trinitrate (GTN), when administered as single agents in the treatmentof acute anal fissure.Patients and Methods: 40 Patients with acute anal fissurewere enrolled in the study. They were randomized using aclosed envelop technique into two group (20 patients each):Group A (2% Diltiazem users), and Group B (0.2% Glyceryltrinitrate users). Pain was evaluated using a pain Visual AnalogScale (VAS), we also evaluated the anal bleeding, constipation,perianal itching (anal pruritus) before, during and after thetopical medications are used, and the results of each topicalmedications as healing, recurrence rates, onset of relief ofsymptoms, onset required to achieve complete healing, numberand severity of side effects as (headache, postural hypotension,flushing, allergy, GIT upset) or ineffectiveness.Results: Both 0.2% glyceryl trinitrate ointment and 2%diltiazem ointment are equally effective concerning pain relief,and recurrence rates, while higher healing rates with topicalDiltiazem (DTZ) than topical Glyceryl Trinitrate (GTN) wererecorded (85% compared to 75% respectively). However,headache is a troublesome side effect with topical glyceryltrinitrate. Accordingly, topical 2% diltiazem is preferable asthe treatment of choice for acute anal fissure.Conclusion: Although surgical management like analdilatation and open or closed sphincterotomy are a one-timesolution with good symptomatic relief, it may be complicated by complications of wound healing, and permanent incontinence of flatus or faeces. The preferable treatment of acute anal fissure is becoming more medical since it is cost-effective. Both 0.2% glyceryl trinitrate ointment and 2% diltiazem ointment are equally effective in concerning pain relief, healing and recurrence rates. However, headache is a troublesome side effect in patients treated with topical glyceryl trinitrate.Therefore, when considering medical management for treatingacute anal fissure, topical 2% diltiazem is the treatment ofchoice.

Topical nitroglycerin ointment as salvage therapy for peripheral tissue ischemia in newborns: a systematic review.

Background:Topical nitroglycerin (TNG) ointment has been used for almost 3 decades to treat neonatal peripheral tissue ischemia, but this product is now no longer being produced by its Canadian manufacturer. Our aim was to investigate the efficacy and safety of TNG products in newborns in neonatal intensive care units.Methods:In this systematic review we searched Embase, CINAHL, MEDLINE, PubMed and Web of Science from inception to April 2020 for studies on the use of TNG products (TNG ointment, TNG spray, glyceryl trinitrate [GTN] patch) for the treatment of neonatal tissue ischemia. We did not apply language or study design limitations. Animal studies and duplicate records were excluded. Two reviewers screened and extracted data. The Tool for Evaluating the Methodological Quality of Case Reports and Case Series was used to assess the risk of bias of individual studies.Results:We included 23 articles (20 case reports, 2 case series and 1 retrospective audit) describing the use of TNG ointment, TNG spray or GTN patch in the treatment of 39 tissue ischemia events in 37 newborns. Twenty-three (62.2%), 12 (32.4%), 1 (2.7%) and 1 (2.7%) infants received TNG ointment, GTN patch, both TNG ointment and GTN patch, and TNG spray, respectively. Nineteen (76.0%) and 7 (53.8%) injuries treated with TNG ointment and GTN patch showed complete recovery, respectively. Two (16.7%) infants treated with GTN patch experienced adverse events (i.e., methemoglobinemia) requiring treatment discontinuation.Interpretation:TNG ointment presents a safe therapeutic modality for salvage therapy of neonatal tissue ischemia. Engagement of stakeholders is essential to address its recent commercial inaccessibility in Canada.

Comparison of efficacy of internal sphincterotomy versus topical 0.2 % glyceryl trinitrate ointment after hemorrhoidectomy.

Objectives: To compare the efficacy of 0.2% glyceryl trinitrate ointment versus internal sphincterotomy after hemorrhoidectomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery Unit III, at Lahore General Hospital, Lahore. Period: 6 months (August 2017 to February 2018). Material &amp; Methods: The OPD of the Department of Surgery included 124 patients who satisfied the inclusion criteria. There were two groups of patients, Group A and Group B. Group-A was told to use gloved finger three times daily for 0.2 percent GTN ointment topically. For Group B, lateral internal sphincterotomy was performed as day care procedure. On visit, patients were assessed for pain relief by using VAS. All data was collected using a pre-designed (attached) proforma. In SPSS v23.0 the data were input and analyzed. It was stratified for age, sex, disease duration and hemorrhoid stage. The effectiveness of both groups was compared by using a p-value of 0.05 as significant for a chi-square test. Results: Male predominance; in group-A, 41(66.1%) patients were male and 21(33.9%) were female, while in group-B, 52(83.9%) patients were male and 10(16.1%) were females. Efficacy was found in 11(17.7%) patients in group-A (0.2% GTN) while in 25(40.3%) patients in group-B (Internal sphincterotomy) with p-value of 0.006 which is statistically significant. Conclusion: Open hemorrhoidectomy internal sphincterotomy is an effective method to reduce pain after hemorrhoidectomy in contrast to Glyceryl Trinitrate (GTN) topical cream of 0.2 percent.

Efficacy of Glyceryl Trinitrate Ointment for Perianal- Intrarectal Local Anesthesia in Transrectal Ultrasound- Guided Prostate Biopsy- Compared to Topical Lignocaine

Objective: Anorectal pain and discomfort during transrectal ultrasound (TRUS)-guided prostate biopsy is an important issue of this procedure. Therefore present study was designed to compare whether the use of topical glyceryl trinitrate (GTN) ointment or lignocaine gel is more effective as an adjunct to periprostatic nerve block (PPNB) in reducing pain associated with transrectal ultrasound (TRUS)-guided prostate biopsy. Methods: In all, 120 consecutive patients having their first TRUS-guided prostate biopsy were randomized to receive either 0.4% GTN ointment or 2% lignocaine gel, 10 minutes or 5 minutes respectively before biopsy. All patients had a biopsy preceded by an injection with 5 ml of 2% lignocaine local anaesthesia. Results: A 100-point visual analogue score was used to record overall pain due to the presence of the probe, the biopsy itself and pain after the procedure. There was no significant difference in age, PSA level and prostate volume between the groups. There was a significantly lower mean pain score due to probe insertion, in the GTN than lignocaine group (18.32 vs 37.48, P &lt; 0.001); pain perception was lower for the whole procedure in the GTN group (16.59 vs 35.17, P &lt; 0.001); and was most pronounced in men aged d”65 years (21.45 vs 40.7, P &lt; 0.001). Five patients (8.3%) in the GTN group complained of headache. Conclusion: So it can be concluded that, topical GTN ointment is safe and effective in reducing the discomfort and pain associated with TRUS-guided prostate biopsy, in particular the insertion of the ultrasound probe. It might be of maximum benefit in the younger patient(d”65years). Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.14-19

Response to the Time

Response to the Time

Drug Treatment of Raynaud's Phenomenon of the Nipple.

Drug Treatment of Raynaud's Phenomenon of the Nipple.

A Comparative Study on the Effect of Aloe Vera and Nitroglycerin Ointment on the Incidence and Severity of Phlebitis Caused by the Peripheral Catheter

A Comparative Study on the Effect of Aloe Vera and Nitroglycerin Ointment on the Incidence and Severity of Phlebitis Caused by the Peripheral Catheter

Efficacy and safety of topical nitroglycerin in the prevention of mastectomy flap necrosis: a systematic review and meta-analysis

Flap necrosis is a common complication after mastectomy, and nitroglycerin (NTG) ointment has been used successfully to treat it. However, it is not clear whether topical NTG can completely prevent the occurrence of flap necrosis after breast cancer surgery, and it is also unclear whether this treatment may cause side effects. Three randomized controlled trials (RCTs) and two retrospective cohort studies (RCSs) were included in our investigation. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that NTG significantly reduced the rates of mastectomy flap necrosis, full-thickness flap necrosis, and debridement as well as the rate of early complications other than flap necrosis. However, there was no significant difference in drug-related adverse reactions, explantation, superficial flap necrosis, infection, hematoma or seroma between the NTG and placebo groups.