Muscle Relaxant Properties Research Articles

Skeletal Muscle Relaxants for the Treatment of Myofascial Pelvic Pain and High Tone Pelvic Floor Disorders in Women: A Scoping Review

Study Objective To review the evidence of muscle relaxants and non-injectable drugs with muscle relaxant properties for the treatment of chronic pelvic pain. This includes investigation of whether the concept of skeletal muscle relaxant use for lower back striated muscle strain is a valid construct to apply to the context and treatment of women with chronic pelvic pain due to myofascial and hypertonic muscular dysfunction. The clinical effectiveness, side effects, and toxicology risk of the investigated drugs were characterized. Design A scoping review was conducted in accordance with PRISMA-ScR guidelines and protocols. Online databases were searched using MeSH and subject terms. Articles reporting evidence on skeletal muscle relaxant use were reviewed by two independent reviewers with a third reviewer for any discrepancies. Setting Scoping review. Patients or Participants N/A. Interventions N/A. Measurements and Main Results Comparison studies have not shown any skeletal muscle relaxant to be superior. Skeletal muscle relaxants are divided into two categories: antispastic and antispasmodic agents. Antispastic agents reduce muscle hypertonicity and involuntary jerks associated with neurological disorders. Antispasmodic agents aim to treat striated muscle spasms from musculoskeletal conditions such as low back pain and myofascial pain. Cyclobenzaprine is heavily studied, with demonstrated effectiveness for isolated conditions. Intravaginal diazepam may be beneficial, while other drugs have limited investigation. Considerable knowledge gaps remain regarding appropriate use of these medications in the context of pelvic pain. Conclusion Scant high-quality data exist to support the use of skeletal muscle relaxants for chronic pelvic pain secondary to myofascial and hypertonic muscular dysfunction. Antispastic agents have limited evidence. Antispasmodic agent usage should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. Future prospective research on antispasmodic agents in women with myofascial dysfunction is necessary to define medication safety, route, dosage, and clinical outcomes. To review the evidence of muscle relaxants and non-injectable drugs with muscle relaxant properties for the treatment of chronic pelvic pain. This includes investigation of whether the concept of skeletal muscle relaxant use for lower back striated muscle strain is a valid construct to apply to the context and treatment of women with chronic pelvic pain due to myofascial and hypertonic muscular dysfunction. The clinical effectiveness, side effects, and toxicology risk of the investigated drugs were characterized. A scoping review was conducted in accordance with PRISMA-ScR guidelines and protocols. Online databases were searched using MeSH and subject terms. Articles reporting evidence on skeletal muscle relaxant use were reviewed by two independent reviewers with a third reviewer for any discrepancies. Scoping review. N/A. N/A. Comparison studies have not shown any skeletal muscle relaxant to be superior. Skeletal muscle relaxants are divided into two categories: antispastic and antispasmodic agents. Antispastic agents reduce muscle hypertonicity and involuntary jerks associated with neurological disorders. Antispasmodic agents aim to treat striated muscle spasms from musculoskeletal conditions such as low back pain and myofascial pain. Cyclobenzaprine is heavily studied, with demonstrated effectiveness for isolated conditions. Intravaginal diazepam may be beneficial, while other drugs have limited investigation. Considerable knowledge gaps remain regarding appropriate use of these medications in the context of pelvic pain. Scant high-quality data exist to support the use of skeletal muscle relaxants for chronic pelvic pain secondary to myofascial and hypertonic muscular dysfunction. Antispastic agents have limited evidence. Antispasmodic agent usage should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions. Future prospective research on antispasmodic agents in women with myofascial dysfunction is necessary to define medication safety, route, dosage, and clinical outcomes.

Potential benefits of gallic acid as skeletal muscle relaxant in animal experimental models.

Background and ObjectiveMany natural bioactive chemicals have been shown to have functional activity, suggesting that they could be useful in the treatment and management of a wide range of chronic conditions. Flavonoids, which include gallic acid (GA), are the most abundant polyphenols found in nature. Skeletal muscle relaxants are drugs that reduce undesired spasms while maintaining awareness and reflexes unaffected. The purpose of this investigation was to determine if GA has any skeletal muscle relaxant properties in experimental animal models.Materials and MethodsThe muscle relaxant activity of three dosages of GA (5, 10, and 20 mg/kg) was compared to that of normal diazepam (5 mg/kg) utilizing climbing, chimney, and modified Kondziela's inverted tests. An analysis of variance (ANOVA) and a post-ANOVA Tukey multiple comparisons test were used to assess the data.ResultsAnimals given 10 and 20 mg/kg of GA had a great deal of trouble climbing up the chain, presumably because their muscles were relaxed. Similarly, rats given a high dose of GA (20 mg/kg) had a significantly (P < 0.05) longer response time in the chimney test, indicating a lack of attention and slowed muscle tone, resulting in problems with motor coordination. In inverted testing, animals given a high dose of GA had a significantly (P < 0.01) reduced holding capacity on the mesh for a longer period of time. A decrease in holding time is caused by a decrease in muscular contraction. The low dose of GA, on the other hand, failed to show muscle relaxant effect in any of the three models.ConclusionsAs a conclusion, our data show that GA has a dose-dependent skeletal muscle relaxant effect when administered orally to mice.

Study of Multifaceted Effect of Vitexnegundo Leaves Aqueous Extract and Decoction for Pain Relief in Experimental Models

Background: Pain is the warning signal of underlying pathology. Analgesic drugs are used as per the severity of pain. These drugs have their own adverse drug reactions, sometimes requiring the discontinuation of treatment. Perception and reaction to the pain are two important facets of pain. Reaction in the form of fear,restlessness, spasm of the muscles etc. are seen. Effectiveness of Vitexnegundoin pain have been studied, we planned to evaluate the associated components of it. Objectives: To evaluate, the Analgesic action, Anxiolytic action and Muscle relaxant action of Vitexnegundo leaves aqueous extract (VNLE) and Vitexnegundo dried leaves decoction (VNDLD). Material and methods: Fresh prepared VNLE and VNDLD are the two preparations of Vitexnegundo used to evaluate the analgesic, anxiolytic and skeletal muscle relaxant activity. Wistar rats and mice of either sex were divided into four groups, control, positive control, VNLE&amp;VNDLD. Standard drug pentazocine&amp; diazepam were used for analgesic &amp; skeletal muscle relaxant property respectively. Rats were exposed to hot plate for Analgesic activity, elevated plus maze (EPM) for anxiolytic effect and mice to rotarod apparatus for checking skeletal muscle relaxation after the drug treatment.Analysis was done with graph pad prism 6. Results: Pain threshold was significantly increased at (p&lt;0.001) Pentazocine and (p&lt;0.01) in Vitexnigundo juice as observed from increase in reaction time. VNLE and VNDLD significantly showed positive effect on the parameters of the EPM. This observation was comparable with the standard drug diazepam. Time spent on the rota rod was significantly reduced in all drug treated mice. Conclusion:Analgesic and antianxiety activity of Vitexnegundo is confirmed.Fresh juice VNLE was more effective than the VNDLD. It also possesses skeletal muscle relaxant action, enhancing the pain relief.

A Systematic Review on Pharmacological Therapy for Cognitive Deficits of Patients with Primary Central Nervous System Infections: Preliminary Results

<h3>Objective(s)</h3> Infections of the central nervous system (CNS) can create a range of cognitive deficits in the domains of memory, attention, and executive functioning. The objective of this study was to summarize scientific evidence on the effectiveness of pharmacological therapy aiming to improve cognition in patients with primary CNS infections. <h3>Data Sources</h3> We searched for longitudinal studies published from inception to November 2019 within Medline, Embase, and CENTRAL databases. <h3>Study Selection</h3> Peer-reviewed intervention studies published in English, conducted in adult patients with primary CNS infections were considered eligible. Three researchers independently assessed study titles and screened abstracts for inclusion criteria. <h3>Data Extraction</h3> Study quality was assessed independently by two researchers using the National Institutes of Health quality assessment tools for randomized controlled trials (RCTs) and pre-post intervention studies. Data extraction included characteristics of participants, infectious agents, interventions, and measures used to study cognitive outcomes. <h3>Data Synthesis</h3> Nine studies of varying quality (two of high quality, the rest of fair quality), eight of which were RCTs and one pre-post intervention study, reported on the effectiveness of drug(s) on cognitive outcomes in adult patients with Lyme disease (LD; five studies), Herpes Simplex Virus Type 1 (HSV-1; three studies), and Creutzfeldt-Jakob disease (CJD; one study). In patients with LD, the studies reported inconsistent results on the effectiveness of antibiotics' therapy on enhancing cognitive outcomes; the type of drug, route, and duration of administration varied. In patients with HSV-1, antiviral drugs alone, or in combination with antipsychotics, showed that the drug alone or in combination enhanced certain cognitive domains, but not all, compared to placebo. The single study on patients with CJD demonstrated that a non-opioid drug flupirtine maleate, possessing analgesic and muscle relaxant properties, enhanced baseline cognitive performance. <h3>Conclusions</h3> Evidence on the ability of pharmaceutical therapy enhancing cognitive deficits in patients with LD, HSV-1, and CJD is limited and inconclusive. The repeated searches for the period from November 2019 until current, once identified and assessed, may alter the conclusions of the review. Future research should evaluate the meaningfulness of cognitive change in patients with primary CNS infections. <h3>Author(s) Disclosures</h3> None to Disclose.

Dissociative anaesthesia in dogs and cats with use of tiletamine and zolazepam combination. What we already know about it.

This article is an attempt to gather available literature regarding the use of tiletamine and zolazepam combination in anaesthesia in dogs and cats. Although tiletamine and zolazepam mixture has been known in veterinary practice for a long time, the increased interest in these drugs has been observed only recently. Tiletamine, similarly to ketamine, is a drug which belongs to the phencyclidine group. Ketamine has considerable popularity in veterinary practice what suggests that other dissociative anaesthetic drugs, such as tiletamine, could also prove effective in cats' and dogs' anaesthetic care. Zolazepam is a widely used benzodiazepine known for its muscle relaxant and anticonvulsant properties. While conducting an electronic search for articles regarding the use of tiletamine-zolazepam combination in dogs and cats, it has been discovered that the literature on the subject (tiletamine-zolazepam combination in dogs and cats) is quite scarce. Very few articles were published after 2010. Databases used were: Google Scholar, Scopus, PubMed. Most of the adverse effects, including those affecting the cardiovascular, nervous, and respiratory systems, were strictly dose-dependent. Tiletamine-zolazepam combination can be safely used as a premedication agent, induction for inhalation anaesthesia, or an independent anaesthetic for short procedures. Contraindications using tiletamine-zolazepam mixture include central nervous system (CNS) diseases such as epilepsy and seizures, head trauma, penetrative eye trauma, cardiovascular abnormalities (hypertrophy cardiomyopathy in cats, arrythmias or conditions where increase of heart rate is inadvisable), hyperthyroidism, pancreatic deficiencies or kidney failure.

New street drug detected in fatal overdose cases

New street drug detected in fatal overdose cases

In Vivo Antinociceptive, Muscle Relaxant, Sedative, and Molecular Docking Studies of Peshawaraquinone Isolated from Fernandoa adenophylla (Wall. ex G. Don) Steenis.

Fernandoa adenophylla (Wall. ex G. Don) Steenis is traditionally used to cure various diseases and can be included as an ingredient in massage oils, which are supposed to comfort muscular tension and pain. This study was designed to assess the antinociceptive, muscle relaxant, and molecular docking properties of a novel compound, namely, (5aR,5a1R,6R,7aS,14bR,15R)15-hydroxy-7a-methyl-6-(2-methylprop-1-en-1-yl)-7,7a,14b,15-tetrahydro-5H-t-5a,15methanobenzo[g]benzo[5,6]azuleno[1,8-bc]chromene-5,9,14,16(5a1H,6H)- tetraone (peshawaraquinone), isolated from the methanolic extract of F. adenophylla in an animal model. The chemical structure of the isolated compound was elucidated using advanced spectroscopic techniques and further confirmed by XRD analysis. Compound 1 was tested against hot plate-induced noxious stimuli at various doses (2.5, 5, 10, and 15 mg/kg i.p.). The muscle relaxation potency of compound 1 was evaluated in the inclined and traction test, while the open-field test was used for the determination of sedative potential. The isolated compound was also subjected to acute toxicity analysis. The compound was then subjected to molecular docking analysis to determine the exact mechanism of action. Compound 1 demonstrated significant (p < 0.05) analgesic effect in a dose-dependent manner. A noticeable muscle relaxant effect was observed with the passage of time in both experimental models. The compound 1 showed a significant (p < 0.05) sedative effect, and in an acute toxicity study, the compound 1 was devoid of any noxious effects. The docking studies showed preferential affinity for μ-opioid and GABAA receptors. Hence, the prospective antinociceptive and muscle relaxant and sedative properties are probably mediated through these two target interactions.

Levosimendan Improves Hemodynamics And Submaximal Exercise Capacity In Ph-hfpef: Primary Results From The Help-ph-hfpef Multicenter Randomized Controlled Trial

Introduction There is currently no effective treatment for patients with HFpEF and pulmonary hypertension (PH-HFpEF). We hypothesized that levosimendan (LEVO), a calcium sensitizer with inotropic and vascular smooth muscle relaxant properties, would improve hemodynamics and exercise capacity in PH-HFpEF. Methods We conducted a multicenter, double-blind, placebo-controlled trial testing the effects of once-weekly IV LEVO on hemodynamics and 6 minute walk distance (6MWD) in patients with PH-HFpEF. Participants with mean pulmonary artery (mPAP) ≥35 mmHg, PCWP ≥20 mmHg, LVEF ≥40% and NYHA II-III symptoms underwent 6MW and invasive hemodynamic assessments at rest, passive leg raise (PLR) and supine cycle exercise (EX) at baseline and following a 24-hour infusion of LEVO (0.1 μg/kg/min). Hemodynamic responders, defined as those with ≥4 mmHg reduction of EX PCWP, were then randomized, double blind, to a once weekly infusion of LEVO (up to 0.1 μg/kg/min) or placebo for 6 weeks, at which point hemodynamic assessments and 6MW test were repeated. The primary endpoint was between-group difference in the change of EX PCWP. Results Of 44 subjects enrolled, 37 (84%) qualified as responders and were randomized to LEVO (n=18) or placebo (n=19). Patients (69±9 years old, 61% women) displayed severe combined pre- and post-capillary PH at baseline (resting mPAP 41±10, PCWP 25±6 mmHg pulmonary vascular resistance 3.4±2.7). At 6-weeks, LEVO had no significant effect on EX PCWP compared to placebo (-1.4 mmHg, 95% CI, -7.7 to 4.8, p=0.65). However, in a mixed-effect repeated measure regression analysis incorporating rest, PLR, and EX stages, LEVO reduced PCWP by 3.9±2.0 mmHg as compared to placebo (p=0.047, Figure). As compared to placebo, LEVO improved 6MWD by 29 m (95% CI, 3 to 56, p=0.033). LEVO was well-tolerated with no difference in the incidence of adverse events compared to placebo. Conclusions In patients with PH-HFpEF, once-weekly treatment with LEVO for 6 weeks reduced PCWP and increased 6MWD without adverse effects. A phase 3 study to definitively test the safety and efficacy of LEVO as a treatment for PH-HFpEF is warranted.

The adulterated XANAX pill: a fatal intoxication with etizolam and caffeine

A 49-year old man was found dead at home next to a glass containing a dried, white, crystalline substance and near a bag containing pills with the imprint XANAX, the trade name of alprazolam. A comprehensive screening of material collected during the autopsy revealed the presence of etizolam and caffeine in lethal concentrations (0.77 μg/mL and 190 μg/mL) but no trace of alprazolam. Benzodiazepine analogue etizolam is rarely prescribed in Germany, and as a result there are not many reports about fatal cases. It has anxiolytic, hypnotic, sedative and muscle-relaxant properties and is used for the short-term treatment of anxiety and panic attacks. The purine alkaloid caffeine, conversely, is the most widely used central nervous system stimulant. The following report outlines potentially the first reported case of a lethal combination of the downer etizolam and the upper caffeine in medical literature.

A randomized single-dose, two-period crossover bioequivalence study of two fixed-dose Paracetamol/Orphenadrine combination preparations in healthy volunteers under fasted condition

BackgroundParacetamol/Orphenadrine is a fixed dose combination containing 35 mg orphenadrine and 450 mg paracetamol. It has analgesic and muscle relaxant properties and is widely available as generics. This study is conducted to investigate the relative bioavailability and bioequivalence between one fixed dose paracetamol/orphenadrine combination test preparation and one fixed dose paracetamol/orphenadrine combination reference preparation in healthy volunteers under fasted condition for marketing authorization in Malaysia.MethodThis is a single-center, single-dose, open-label, randomized, 2-treatment, 2-sequence and 2-period crossover study with a washout period of 7 days. Paracetamol/Orphenadrine tablets were administered after a 10-h fast. Blood samples for pharmacokinetic analysis were collected at scheduled time intervals prior to and up to 72 h after dosing. Blood samples were centrifuged, and separated plasma were kept frozen (− 15 °C to − 25 °C) until analysis. Plasma concentrations of orphenadrine and paracetamol were quantified using liquid-chromatography-tandem mass spectrometer using diphenhydramine as internal standard. The pharmacokinetic parameters AUC0-∞, AUC0-t and Cmax were determined using plasma concentration time profile for both preparations. Bioequivalence was assessed according to the ASEAN guideline acceptance criteria for bioequivalence which is the 90% confidence intervals of AUC0-∞, AUC0-t and Cmax ratio must be within the range of 80.00–125.00%.ResultsThere were 28 healthy subjects enrolled, and 27 subjects completed this trial. There were no significant differences observed between the AUC0-∞, AUC0-t and Cmax of both test and reference preparations in fasted condition. The 90% confidence intervals for the ratio of AUC0-t (100.92–111.27%), AUC0-∞ (96.94–108.08%) and Cmax (100.11–112.50%) for orphenadrine (n = 25); and AUC0-t (94.29–101.83%), AUC0-∞ (94.77–101.68%) and Cmax (87.12–101.20%) for paracetamol (n = 27) for test preparation over reference preparation were all within acceptable bioequivalence range of 80.00–125.00%.ConclusionThe test preparation is bioequivalent to the reference preparation and can be used interchangeably.Trial registrationNMRR- 17-1266-36,001; registered and approved on 12 September 2017.

Classics in Chemical Neuroscience: Baclofen.

Baclofen, β-(4-chlorophenyl)-γ-aminobutyric acid, holds a unique position in neuroscience, remaining the only U.S. Food and Drug Administration (FDA) approved GABAB agonist. While intended to be a more brain penetrant, i.e, ability to cross the blood-brain barrier (BBB), version of GABA (γ-aminobutyric acid) for the potential treatment of epilepsy, baclofen's highly efficacious muscle relaxant properties led to its approval, as a racemate, for the treatment of spasticity. Interestingly, baclofen received FDA approval before its receptor, GABAB, was discovered and its exact mechanism of action was known. In recent times, baclofen has a myriad of off-label uses, with the treatment for alcohol abuse and drug addiction garnering a great deal of attention. This Review aims to capture the >60 year legacy of baclofen by walking through the history, pharmacology, synthesis, drug metabolism, routes of administration, and societal impact of this Classic in chemical neuroscience.

A Δ9-Tetrahydrocannabinol Physiologically-Based Pharmacokinetic Model Development in Humans.

∆9-Tetrahydrocannabinol (THC) exhibits several therapeutic effects, such as analgesics, anti-emetic, antispastic, and muscle relaxation properties. Knowledge concerning THC disposition in target organs is crucial for THC therapy. The objective of this study was to develop a physiologically-based pharmacokinetic (PBPK) model of THC in humans to characterize tissue-specific pharmacokinetics of THC in organs of interest. The model was extrapolated from the previously developed PBPK model conducted in mice, rats, and pigs. The model consisted of seven compartments: brain, lungs, liver, kidneys, fat, and rapidly perfused and slowly perfused tissues. P-glycoprotein was included in the brain compartment to characterize an efflux of THC from the brain. Physiologic, biochemical, and physicochemical parameters were determined and acquired from the literature. Model validation was performed by comparisons of the predicted and observed THC concentrations acquired from published studies. The developed PBPK model resulted in good agreement between the predicted and observed THC concentrations across several studies conducted following IV bolus, IV infusion, oral, and smoking and inhalation, with the coefficient of determination (R2) ranging from 0.54 to 0.95. A PBPK model of THC in humans was developed. The model could describe THC concentration-time profiles in several dosing scenarios (i.e., IV bolus, IV infusion, oral administration and inhalation).

Trimethylamine-N-oxide acutely increases cardiac muscle contractility.

Cardiovascular disease is a major cause of morbidity and mortality among patients with chronic kidney disease (CKD). Trimethylamine-N-oxide (TMAO), a uremic metabolite that is elevated in the setting of CKD, has been implicated as a nontraditional risk factor for cardiovascular disease. While association studies have linked elevated plasma levels of TMAO to adverse cardiovascular outcomes, its direct effect on cardiac and smooth muscle function remains to be fully elucidated. We hypothesized that pathological concentrations of TMAO would acutely increase cardiac and smooth muscle contractility. These effects may ultimately contribute to cardiac dysfunction during CKD. High levels of TMAO significantly increased paced, ex vivo human cardiac muscle biopsy contractility (P < 0.05). Similarly, TMAO augmented contractility in isolated mouse hearts (P < 0.05). Reverse perfusion of TMAO through the coronary arteries via a Langendorff apparatus also enhanced cardiac contractility (P < 0.05). In contrast, the precursor molecule, trimethylamine (TMA), did not alter contractility (P > 0.05). Multiphoton microscopy, used to capture changes in intracellular calcium in paced, adult mouse hearts ex vivo, showed that TMAO significantly increased intracellular calcium fluorescence (P < 0.05). Interestingly, acute administration of TMAO did not have a statistically significant influence on isolated aortic ring contractility (P > 0.05). We conclude that TMAO directly increases the force of cardiac contractility, which corresponds with TMAO-induced increases in intracellular calcium but does not acutely affect vascular smooth muscle or endothelial function of the aorta. It remains to be determined if this acute inotropic action on cardiac muscle is ultimately beneficial or harmful in the setting of CKD.NEW & NOTEWORTHY We demonstrate for the first time that elevated concentrations of TMAO acutely augment myocardial contractile force ex vivo in both murine and human cardiac tissue. To gain mechanistic insight into the processes that led to this potentiation in cardiac contraction, we used two-photon microscopy to evaluate intracellular calcium in ex vivo whole hearts loaded with the calcium indicator dye Fluo-4. Acute treatment with TMAO resulted in increased Fluo-4 fluorescence, indicating that augmented cytosolic calcium plays a role in the effects of TMAO on force production. Lastly, TMAO did not show an effect on aortic smooth muscle contraction or relaxation properties. Our results demonstrate novel, acute, and direct actions of TMAO on cardiac function and help lay the groundwork for future translational studies investigating the complex multiorgan interplay involved in cardiovascular pathogenesis during CKD.

Plants in the management of male infertility.

This review attempts to collate existing data and provide the perspectives for future studies on the effects of plants on the male gonads. For many of these medicinal plants such as Lepidium meyenii, Rupus coreanus, Tribulus terrestres, Panax ginseng, Petasites japonicas, Apium graveolens, Eurycoma longifólia, Pedalium murex, Corchorus depressus, Mucuna pruriens, Astragalus membranaceus, Nigella sativa, Crataegus monogyna, Fagara tessmannii, Phaleria macrocarpa, Anacyclus pyrethrum, Cynomorium songaricum and Morinda officinalis, the mechanism of actions of their active principles and crude extracts has been shown in both laboratory animals, in vitro, and human studies, and includes their antioxidant, anti-inflammatory, spermatogenesis-inducing, aphrodisiac, smooth muscle relaxing and androgenic properties. Several active chemical leads including glucosinolates, anthocyanins, protodioscin, ginsenosides, sesquiterpenes, phyto-oestrogens, quassinoids, diosgenin, thymoquinone, proanthocyanidins and bajijiasu isolated from these plants are known to have target effects on the testis, but efforts have been limited in their application at the clinical level. There still appear to be many more extracts of medicinal plants that have not been characterised to determine the phytochemicals unique to them that have target effects on the gonads. Further, collaborative efforts at isolating pro-drug candidates from medicinal plants for studies at the molecular, cellular and clinical level towards elucidating their mechanisms of action on the testes are therefore warranted in the light of the current male fertility crisis.

Does aquatic thermal therapy improve quality of life after total hip replacement? A retrospective preliminary pilot study.

Hydrokinesiotherapy has antalgic and muscle relaxant properties, as well as anti-edema and anti-inflammatory effects. Currently, the management of persons with total hip replacement (THR) consists of multiple pharmacologic and non-pharmacologic therapies, which include therapeutic exercise, physical therapies, and education. Our hypothesis is that kinesiotherapy in thermal water would improve functional outcome. The aim of the study was to assess thermal hydrokinesiotherapy efficacy on pain, mood, and quality of life. We enrolled 11 participants (mean age of 70.55 ± 14years) with total hip replacement (THR) after early hospital discharge at a residential rehabilitation facility. All participants underwent a standardized combined land-based and hydrokinesiotherapy rehabilitation program for 2 consecutive weeks. Clinical data were collected at beginning and end of rehabilitation; pain, anxiety, and quality of life scores were collected at admission, discharge, 3 and 6months from surgery. Functional outcome scores improved and were maintained at 6-month follow-up. These preliminary data demonstrate that thermal hydrokinesiotherapy may positively influence functional recovery in orthopedic post-surgical patients. Further randomized controlled trials are mandatory to consolidate this finding.

The Possible Therapeutic Effects of Some Medicinal Plants for Chronic Cough in Children.

The use of plants or their isolated bioactive components for the prevention and treatment of various disorders has been developed. Here, we aim to identify effective medicinal plants for relief of cough and respiratory symptoms in children. The data of this review article were obtained from published articles in scientific databases, including PubMed, Google Scholar, and Scopus, until December 2019. The keywords, including “Zataria multiflora Boiss.” OR “Portulaca oleracea L.” OR “Ferula assa-foetida L.” OR “Nigella sativa L.” AND “respiratory symptoms” OR “airway inflammation” OR “smooth muscle relaxant effects,” were searched individually or combined. The mentioned medicinal plants decreased total white blood cell (WBC), neutrophils, and eosinophils counts of blood and lung lavage in animal model-induced respiratory disorders. These plants also have protective effects on serum immunoglobulin, antibody titer, eosinophil count, and proinflammatory cytokines. Evidence from the studies indicated that the abovementioned medicinal plants have smooth muscle relaxant properties (bronchodilator effects) via stimulation of β-adrenoceptor or inhibition of muscarinic receptors (in vitro) and also improved the pulmonary function test in clinical settings. These medicinal plants are safe and easy to use. Based on the anti-inflammatory, anti-antispasmodic, and immunomodulatory effects, the clinical benefit may be assumed, therefore considering a place for these medicinal plants in relieve of chronic cough and symptoms of children's allergy, asthma, and common cold.

A study to evaluate the skeletal muscle relaxant property of Pregabalin and Gabapentin in albino rats

Background: Skeletal muscle relaxants are the drugs which reduce unwanted spasm without interfering with consciousness and voluntary movements. The centrally acting muscle relaxants like Diazepam, is known to be GABA mimetics and other antiepileptics like Gabapentin and Pregabalin also act through the release of GABA. This study is done to investigate skeletal muscle relaxant property of these drugs in comparison to Diazepam.Methods: T Models used in the experiment are Grip Strength Test, Rota Rod Method, Beam Walk Test, Photoactometer Test. Animals were divided into 6 groups of 6 rats each: Group 1: Control group treated with normal saline (0.1 ml/10gm), Group 2: Standard-15mg/kg of Diazepam, Group 3:T1-60 mg/kg of Gabapentin, Group 4:T2-10 mg/kg of Pregabalin, Group 5:T3-60 mg/kg of Gabapentin+Diazepam, Group 6:T4- 10 mg/kg of Pregabalin+Diazepam. Mean and standard deviation was calculated for each group. One way ANOVA was used for multiple group comparisons followed by post hoc Tukey’s test for statistical significance between the groups.Results: Treatment with the above test drugs produced significant muscle relaxation and caused decreased fall off, sliding time, increase climbing time and decreased locomotor activity in all models indicating motor incoordination. The results obtained from both standard and test groups showed a highly significant difference in muscle relaxation when compared with the control group.Conclusions: The test drugs showed skeletal muscle relaxant property in rats comparable to Diazepam. In view of these results, it can open a new avenue for these drugs to be used as skeletal muscle relaxants after conducting clinical trials.

Design, optimization, and validation of chemometrics-assisted spectrophotometric methods for simultaneous determination of etodolac and thiocolchicoside in pharmaceuticals

Etodolac (ET) is a nonsteroidal anti-inflammatory drug (NSAID) that shows anti-inflammatory, analgesic, and antipyretic activities. Various NSAIDs have been demonstrated to enhance analgesia such as thiocolchicoside (TC) which is also an anti-inflammatory analgesic with muscle relaxant properties. A new quantitative method by using the data obtained from chemometrics calibration partial least squares (PLS), principal component regression (PCR), and inverse least squares (ILS) was developed for the simultaneous analysis of ET and TC without any separation process in combined pharmaceutical products. The calibration (25 samples) and validation (8 samples) concentration data matrices were prepared by using the mixtures containing ET (15–75 μg/mL) and TC (1–10 μg/mL) via factorial design method. The absorbance values were measured in the 240–440 nm. The recovery % of PLS, PCR, and CLS methods were found as ≤ 98.26%, 98.16%, and 98.17% for ET and 99.14%, 98.26%, and 98.15% for TC, respectively. These three chemometric techniques, which do not require neither separation nor derivatization steps, were confidentially applied for the determination of ET and TC in combined formulations. In conclusion, it is claimed that these new chemometrics-assisted spectrophotometric methods are inexpensive, rapid, and simple and can be trustfully carried out in quality control laboratories as an alternative to existing methods.

Prescribing benzodiazepines in general practice.

Benzodiazepines are very widely prescribed in general practice. They have very effective anti-anxiety, sedative, anticonvulsant, and muscle-relaxant properties. Enormous divergence exists between best-practice guidance,1,2 which generally recommends short-term use at the lowest possible dose for severe anxiety or insomnia, and the reality of general practice, where very large numbers of patients are known to be prescribed these drugs on a long-term basis, at high dosages, and for less than ‘severe’ indications.3,4 The recommendation to limit the use of benzodiazepines to the short term (for example, <2–4 weeks) is largely based on the issues of tolerance and dependence. Tolerance is a physiological response whereby, with continued use, a higher dose than that originally prescribed is required in order to achieve the identical original clinical effect. Thus, use beyond the short term often leads to dose escalation just to maintain the same effect originally brought about at a lower initial dose. The rate of development of tolerance is variable from one person to the next, but certainly can occur after just 3–4 weeks of use. Dependence can be considered in physiological and psychological terms. Physiological dependence refers to the experience of withdrawal symptoms on stopping the drug. Symptoms range from relatively minor (for example, headache, tremor, or sweating) to very serious and potentially life threatening (for example, seizures, psychosis, or delirium tremens). With psychological dependence, patients increasingly require their drug in order to cope with life events. Other negative effects resulting from long-term use include memory impairment in older patients, diminished sleep quality, daytime drowsiness, decreased reaction time, …

Impact of Peppermint Therapy on Dysphagia and Non-cardiac Chest Pain: A Pilot Study.

Due to its smooth muscle relaxing properties, peppermint oil (PO) may relieve dysphagia and chest pain due to esophageal motility disorders. To explore the impact of PO on dysphagia and/or chest pain in patients referred for motility testing. Patients initiated on PO for dysphagia and/or chest pain from 2013 to 2016 were identified. We excluded patients with obstructing esophageal lesions, patients lost to follow-up, and those with preexisting cardiac conditions. Concentrated PO was given as commercially available dissolvable peppermint tablets; two tablets before meals were prescribed to patients with dysphagia and on an as-needed basis for patients with chest pain. Patient-reported symptom response was assessed using a modified five-point Likert scale. Thirty-eight patients were included. Twenty-four patients (63%) reported improvement; 12 were much better and 12 were slightly better. Fourteen experienced no change and none reported feeling worse. Based on pre-treatment HRM, patients with distal esophageal spasm (DES) (n = 10) and esophagogastric junction outflow obstruction (EGJOO) (n = 8) appeared to demonstrate the best subjective improvement (83% and 100%, respectively)(P<0.05). PO appears to provide symptomatic relief in some patients with dysphagia and CP. Presence of a well-defined manometric disorder, particularly DES or EGJOO, appeared to predict response.