Nonsteroidal Anti-inflammatory Medications Research Articles

Emerging factors affecting peri-implant bone metabolism.

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.

The Therapeutic Challenge of Treating Refractory Psoriasis: An Educational Article and Expert Opinion

Background: Therapies that are commonly used in the treatment of refractory psoriasis include mycophenolate mofetil, methotrexate, acitretin, apremilast, and tofacitinib. The medications can be used in refractory psoriasis either as monotherapy or in combination with other medications. The use of biological medications such as infliximab and etanercept in the treatment of refractory psoriasis has been increasingly reported. Patients and methods: After one month, treatment with mycophenolate and topical calcipotriol was associated with improvement in the activity of skin disease and the arthritic symptoms, but there was no significant reduction the affected area of skin. Therefore, tazarotene 0.1% cream was added. At two months of treatment, both skin and joint symptoms were slightly worsening and the patient needed a non-steroidal anti-inflammatory medication to control joint symptoms. Acitretin was added in an initial dose of 10 mg daily with intention of increasing it to 25 mg daily gradually. However, on the fourth day after adding of oral acitretin the patient reported a significant reduction in the severity of the disease and the affected area that have not achieved long time ago. The patient also reported experiencing unpleasant taste that was attributed to acitretin. Conclusion: The current expert opinion suggests that the choice of the treatment of methotrexate and mycophenolate refractory psoriasis should be based on the available evidence, and it generally depends mostly on the availability and cost of the medications, and the experience of the treating physician with the available medications. In cases of resistance to methotrexate, and mycophenolate, acitretin can be added mycophenolate, and the use of newer safe biological agents such as etanercept and Infliximab can be considered.

Mammary Tumors in Dogs, Recent Perspectives and Antiangiogenesis as a Therapeutic Strategy: Literature Study

A particular type of tumor that is frequently detected in female dogs who are sexually active is a mammary tumor. Neoplasia results from DNA-based alterations in cell cycle regulating genes. The mammary gland is prone to the formation of tumors due to its dynamic structure. The development of this tumor is supported by numerous variables. It has been recently discovered that there is substantial evidence linking the BRCA2 gene to the process of cancer. Standard examination techniques, such as fine needle aspiration, histopathology, and immunohistochemistry, are used along with ancillary tests to determine the tumor type and degree of malignancy. The primary treatment option for malignant tumors is surgical resection followed by adjuvant chemotherapy; benign tumors necessitate surgical resection as well. Adjuvant therapy options include hormone therapy and non-steroidal anti-inflammatory medications. Tumor tissue undergoes angiogenesis as it grows and develops to accommodate the abundant supply of nutrients. Therefore, angiogenesis-inhibiting therapies can be utilized to halt the growth of tumor cells. A number of antiangiogenic medications are now being studied in clinical settings on humans, and several more are undergoing trials on animals. In addition to pharmaceuticals, viruses may be used as a therapeutic to block tumor angiogenesis.

Mostafa Maged sling technique to treat prolapsed uterus in an easy way (New Technique).

In the female population, pelvic organ prolapse is a common problem that lowers people's quality of life in terms of their health. Depending on the severity of the prolapse and the symptoms, there are many treatment options. Simple observation, vaginal pessaries, or surgical management are all possible treatments. Reconstructive pelvic surgery with or without mesh augmentation and obliterative surgery are two surgical treatments that are available. Due to the contentious concerns surrounding the use of mesh and the rising demand for uterine preservation, surgical practices are currently shifting. Just two cases are included in this study due to the rarity of this condition. In this study, I introduce a new technique to the literature (Mostafa Maged sling technique) which will be challenging. This technique depends on round ligaments and ovarian ligament to hitch up the whole uterus. There were no difficulties following the procedure. None of the patients required blood transfusions, and there were no signs of dehiscence or incision infection. Non-steroidal antiinflammatory medications were administered to both patients as analgesia. On the first postoperative day, the foley catheters were removed from both patients. A simple and new manueuver is applied in the literature to treat the uterine prolapse. It is easy to learn and easy to perform. We need further studies to compare different techniques including Mostafa Maged sling operation to manage uterine prolapse.

Acupuncture for lumbar myofascial pain syndrome: systematic review and Meta-analysis.

This study systematically reviewed the clinical efficacy of acupuncture for lumbar myofascial pain syndrome. The randomized controlled trials (RCTs) regarding acupuncture for lumbar myofascial pain syndrome were searched in PubMed, Cochrane Library, Web of Science, EMbase, Scopus, China national knowledge infrastructure (CNKI), Wanfang database, VIP database, and China biomedical literature service system (SinoMed) from database inception until August 1st, 2022. The Cochrane's risk of bias assessment tool was used to assess the risk of bias in all included studies, and Review Manager 5.3 software was used for statistical analysis of the extracted data. As a result, 12 RCTs, involving 1 087 patients with lumbar myofascial pain syndrome, were ultimately included. The Meta-analysis results showed that the visual analog scale (VAS) score of pain in the observation group was lower than those in the oral non-steroidal anti-inflammatory medication control [SMD=-1.67, 95%CI (-2.44, -0.90), Z=4.26, P<0.000 1] and other treatment control [low-frequency electrical stimulation, tuina, electromagnetic wave irradiation combined with piroxicam gel, SMD=-1.98, 95%CI (-2.48, -1.48), Z=7.74, P<0.000 01]. The pain rating index (PRI) score in the observation group was lower than those in the lidocaine injection control [MD=-2.17, 95%CI (-3.41, -0.93), Z=3.44, P=0.000 6] and other treatment control [low-frequency electrical stimulation, tuina, MD=-5.75, 95%CI (-9.97, -1.53), Z=2.67, P=0.008]. The present pain intensity (PPI) score in the observation group was lower than that in other treatment control [low-frequency electrical stimulation, tuina, MD=-1.04, 95%CI (-1.55, -0.53), Z=4.01, P<0.000 1]. In conclusion, compared with oral non-steroidal anti-inflammatory medication, low-frequency electrical stimulation, tuina, and electromagnetic wave irradiation combined with piroxicam gel, acupuncture is more effective in reducing pain in patients with lumbar myofascial pain syndrome; acupuncture also exhibites advantage over lidocaine injection in improving PRI score and showed better outcomes over tuina and low-frequency electrical stimulation in improving PRI and PPI scores.

The impact of perioperative non-steroidal anti-inflammatory drugs use on pleurodesis following thoracic surgery.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: in patients who have had {visceral and parietal pleural symphysis}, {do NSAIDs reduce} {the efficacy of pleurodesis}? Sixteen papers were discovered in the search. Of these, 3 human studies were included in the analysis. None showed a significantly higher rate of pleurodesis failure in patients given perioperative NSAIDs. The results from the largest study met criteria for noninferiority. Within the constraints of the study, the results suggest that systemic administration of nonsteroidal anti-inflammatory medication in the perioperative period does not necessarily attenuate effective pleurodesis. However, further study is needed as there is a clear paucity of human-based studies.

The role of NSAID in mediating the effect of genetically predicted major depressive disorder on osteomyelitis: A Mendelian randomization study

BackgroundOsteomyelitis and major depressive disorder (MDD) are significant health concerns with potential interconnections. However, the underlying mechanisms linking these conditions remain unknown. This study aimed to investigate the potential mediating role of non-steroidal anti-inflammatory drug (NSAID) medication in the association between MDD and the risk of osteomyelitis. MethodsWe utilized summary data from large-scale genome-wide association studies (GWAS) to perform Mendelian randomization (MR) mediation analysis. Instrumental variables were selected based on genome-wide significance, and instrumental strength was assessed using F-statistics. Univariable and multivariable MR analyses were conducted to estimate causal effects and proportions mediated by NSAID medication. ResultsThe univariable MR analysis revealed significant associations between MDD and osteomyelitis (odds ratio [OR] = 1.44, 95 % confidence interval [CI]: 1.18–1.874) and between MDD and NSAID medication (OR = 1.36, 95 % CI 1.24–1.49). In the multivariable MR analysis, the direct effect of MDD on osteomyelitis was OR 1.35 (95 % CI: 1.09, 1.67) after adjusting for NSAID medication. The proportion of mediation by NSAID medication was 23 % (95 % CI: 0.05 %, 38.6 %). ConclusionThis MR study provides evidence for a genetically predicted causal association between MDD, NSAID medication, and osteomyelitis. The findings emphasize the need for a comprehensive approach in managing individuals with comorbid depression and osteomyelitis, considering the potential risks and benefits of NSAID medication. Future research should address limitations and explore additional mediators and confounding factors to enhance understanding of this complex relationship.

Optimization of Plasma-Assisted Desorption/Ionization-Mass Spectrometry for Analysis of Ibuprofen

In medical practice, nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to treat osteoarthritis and rheumatoid arthritis. Ibuprofen is a well-known NSAID, analgesic, and antipyretic medication. This chemical is an active ingredient of several oral medications that are offered in tablet, gel pellet, and syrup forms and has higher efficacy, tolerance, and side effect rates than other compounds, including pyrazolone derivatives. We present a unique plasma-assisted desorption/ionization mass spectrometry (PADI-MS) approach for improving pharmaceutically important solids using an ibuprofen tablet as a model solid sample. The goal of the study is to create an innovative mass spectrometric method that could be used for quick and accurate analysis in the development of pharmaceutically relevant compounds. Sniffer tubes were used to route sample ions into a single quadrupole MS, with each acquisition lasting for 1 minute. Without any prior preparation, samples of ibuprofen tablets were directly exposed to PADI plasma for one minute at an atmosphere pressure. The approach is rapid, easy to use, and needs little to no sample preparation. In this study, the settings were improved by optimization of several parameters, such as plasma power, plasma-to-sample distance, and inner/outer flows of helium carrier gas, which were found to be 8 W, 2 mm, and 284 mL/min, respectively. The PADI-MS method provides a real-time information about structural features on the compounds. Ibuprofen tablets were used as a paradigm for pharmaceutically significant materials and direct PADI-MS analysis without a preliminary sample -treatment appeared to be successful: according to PADI-MS data a medication can be examined after one minute of plasma exposure.

Fill levels, cost comparisons, and expulsion force requirements of commonly used topical ophthalmic nonsteroidal anti-inflammatory drugs.

To determine volume fill levels, estimated costs, and force expulsion requirements per bottle of topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) commonly perioperatively in the United States. Tertiary care academic medical center. Prospective laboratory investigation. 8 commercially available NSAIDs (3 branded, 5 generic) were tested: branded bromfenac 0.07%, generic bromfenac 0.09%, diclofenac 0.1%, flurbiprofen 0.03%, generic ketorolac 0.5%, branded ketorolac 0.5%, ketorolac 0.47%, and branded nepafenac 0.3%. 10 bottles of each medication were tested, with an additional bottle tested for expulsion force requirements. A double-blinded method was used to measure the actual bottle fill volume and number of drops per bottle. The total cost per drop was calculated using published cash prices. Force requirements were measured using a customized force gauge apparatus. Formulations were compared using the Kruskal-Wallis test, followed by pairwise comparisons with the Dwass, Steel, Critchlow-Fligner Method. 2 branded NSAIDs (bromfenac and nepafenac) had slightly lower-than-sticker volumes while generics other than ketorolac had higher-than-sticker volumes. Diclofenac and branded bromfenac had the highest and lowest adjusted number of drops respectively. Generic bromfenac and generic ketorolac had the highest and lowest adjusted volume compared with sticker volume respectively. Branded bromfenac was the most expensive medication, while generic diclofenac was the least expensive. Force expulsion requirements varied significantly among generic and branded NSAIDs. Volume fill levels, patient-incurred costs, and expulsion force requirements per bottle of topical NSAID medications vary significantly. Surgeons may wish to consider these factors when deciding how best to use these medications perioperatively.

Trends in Prescribing of Non-steroidal Anti-inflammatory Medications in the US Ambulatory Care Setting From 2006 to 2016

While opioid prescribing has significantly decreased from a peak in 2012, less is known about the national utilization of non-opioid analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (APAP) in the context of the opioid crisis. The objective of this study is to characterize the prescribing trends of NSAIDs and APAP in the US ambulatory care setting. We conducted repeated cross-sectional analyses using the 2006–2016 National Ambulatory Medical Care Survey. NSAID-involved visits were defined as patient visits among adults in which NSAIDs were ordered, supplied, administered, or continued. We used similarly-defined APAP visits as a referent group for context. After excluding aspirin and other NSAID/APAP combination products containing opioids, we calculated the annual proportion of NSAID-involved visits among all ambulatory visits. We conducted trend analyses using multivariable logistic regression adjusted for years, patient, and prescriber characteristics. From 2006 to 2016, there were 775.7 million NSAID-involved visits and 204.3 million APAP-involved visits. Most NSAIDs-involved visits were from patients aged 46–64 years (39.6%), female (60.4%), White (83.2%), and having commercial insurance (49.0%). There were significant increasing trends for the proportion of NSAID-involved visits (8.1–9.6%) and APAP-involved visits (1.7–2.9%) (both P < .0001). We observed an overall increase in NSAID and APAP-involved visits in US ambulatory care settings from 2006 to 2016. This trend may be attributed to decreasing opioid prescribing and raises safety concerns related to acute or chronic NSAID and APAP use. PerspectiveThis study shows an overall increasing trend in NSAID use reported in nationally representative ambulatory care visits in the United States. This increase coincides with previously reported significant decreases in opioid analgesic use, particularly after 2012. Given the safety concerns related to chronic or acute NSAID use, there is a need to continue monitoring the use trends of this class of medication.

#2907 ASYMPTOMATIC NEPHROTIC SYNDROME: AN INTERESTING PRESENTATION OF ADULT ONSET MINIMAL CHANGE DISEASE

Abstract Background and Aims Minimal change disease (MCD), a predominantly pediatric disease, is less common in adults. Patients often present with florid hypervolemia, manifested by significant lower extremity edema, anasarca, pericardial effusion or pleural effusion. Herein, we present a case of newly diagnosed MCD in an elderly gentleman with an atypical presentation. Method A 69 year old male with hypertension and benign prostate hypertrophy presented to the emergency department (ED). He was noted to have abnormal labs at an outside clinic on routine testing and was directed to the ED. In the ED, he was found to have a serum creatinine (SCr) of 10.89 mg/dL. Initial urine studies also revealed proteinuria of 11g/g with 6.5 g/g of albuminuria. Other initial labs were significant for a potassium of 4.5 mEq/L, BUN 126 mg/dL and albumin 2.2 g/dL with normal liver enzymes. Renal ultrasound was unremarkable. Upon further discussion with the patient, he endorsed long term daily use of diclofenac for many months. He stated that he stopped diclofenac three weeks prior to presentation. He denied any proton pump inhibitor or recent antibiotic use. He denied any fevers, nights sweats or weight loss to suggest Type B symptoms. There was no personal kidney disease history nor family history of kidney disease. He was a non-alcoholic and non-smoker. We continued to hold further non-steroidal anti-inflammatory medications as well as other nephrotoxic medications. Although patient had elevated SCr and azotemia, he did not meet any acute indications for dialysis and we continued to manage the patient conservatively. Serologies were negative for ANA, ANCA, Anti-GBM, HIV, hepatitis B and C, as well as antiPLA2R. Serum protein electrophoresis, kappa to lambda ratio, complements 3 and 4 were all within normal values. A kidney biopsy was revealing for patchy interstitial inflammatory infiltrate containing mononuclear cells admixed with few eosinophils on light microscopy as well as diffuse foot process effacement on electron microscopy (Figure 2). The patient had a one-week hospital stay with improvement of SCr to 2.29 mg/dL without any prednisone or treatment for MCD. Spot urine protein improved to 7.4 g/g by time of discharge. At clinic follow up 2 weeks later his creatinine had improved to 1.1 mg/dL with UPCR of 0.4 g/g. Results MCD is a podocytopathy that can occur in up to 10% of adults with nephrotic syndrome [1]. Secondary MCD has been reported with NSAIDs. Steroids are the first line therapy for MCD and can lead to remission in the majority of the cases. In patients who do not respond to steroids, calcineurin inhibitors or mycophenolate can be used. Conclusion Our patient presented with biopsy proven-MCD that was presumed to be secondary to diclofenac. His clinical presentation was not characteristic of nephrotic syndrome with no edema. Few reports exist of spontaneous remission in these patients with most of the patient requiring steroids. While it is uncommon for patients with MCD to spontaneously resolve, not all patients with NSAID-induced MCD require treatment and these patients could be monitored conservatively.

Exploring the role of pharmacology in surgical anatomy and patient outcomes

Introduction: This study looked at how pharmacology affected surgical anatomy and patient outcomes. Methods: The research included a total of 162 participants who were having elective surgery. Propofol or sevoflurane was randomly allocated to patients for the initiation and maintenance of anesthesia. Acetaminophen, nonsteroidal anti-inflammatory medications (NSAIDs), and opioids were used in combination to alleviate pain. Results: When compared to patients receiving sevoflurane, those receiving propofol had substantially reduced rates of postoperative nausea and vomiting (PONV) (p 0.05). Additionally, the propofol group saw quicker healing and shorter hospital stays (p 0.05). Multimodal analgesia was linked to better pain management and reduced opioid use. Conclusion: The use of propofol for anesthesia induction and maintenance, as well as multimodal analgesia, may provide superior outcomes for patients undergoing surgery. These findings highlight the importance of pharmacology in surgical anatomy and patient outcomes and emphasize the need for further research to optimize the use of these interventions in the perioperative period.

EVALUATION OF ANTIDEPRESSANT AND ANXIOLYTIC ACTIVITY OF OXAPROZIN IN SWISS ALBINO MICE

Depression is a prevalent mental illness. According to estimates, 5 percent of adults worldwide experience depression. Depression affects more women than males. Oxaprozin is a non-narcotic, non-steroidal anti-inflammatory medication (NSAID) used to treat osteoarthritis and rheumatoid arthritis-related inflammation, edoema, stiffness, and joint discomfort. The present study is based on the evaluation of antidepressant and anxiolytic activity of oxaprozin in Swiss albino (either sex) weight 20-25 gm were procured from ICAR-Indian Veterinary Research Institute (ICAR-IVRI), Izzat nagar, Bareilly, Uttar Pradesh. All the mice were divided into 4 groups (n=6) i.e., normal control which was given normal saline, positive control given Imipramine (10mg/kg, i.p.) and diazepam (10mg/kg, subcutaneously), test 1given oxaprozin(10mg/kg, p.o.) and test 2 given Oxaprozin (20mg/kg, p.o.) up to 7 days. The anxiolytic and antidepressant activity were evaluated by parameters i.e., elevated plus maze, FST, rota-rod test and biochemical parameters. It resulted that oxaprozin demonstrates anxiolytic and antidepressant activity. It exhibits antidepressant action probably by facilitating the release of neurotransmitters i. e., serotonin, dopamine. It also increases the release of GABA (Gamma Amino Butyric Acid) and chloride ions influx that leads to hyperpolarization .In conclusion, Oxaprozin is a predominant anxiolytic &amp; anti-depressant drug. It can be effectively used in the treatment of depression, mental agitation and other neurological disorders after successfully evaluating mechanism of action against the same.This study refers, that it might be used in the treatment of depression among human beings after clinical trials.

Formulation and in vitro evaluation of meloxicam as a self-microemulsifying drug delivery system.

Background: The nonsteroidal anti-inflammatory medication meloxicam (MLX) belongs to the oxicam family and is used to reduce inflammation and pain. The aim of this study was to improve MLX's dispersibility and stability by producing it as a liquid self-microemulsifying drug delivery system since it is practically insoluble in water. Methods: Five different formulations were made by adjusting the amounts of propylene glycol, Transcutol P, Tween 80, and oleic acid oil and establishing a pseudo-ternary diagram in ratios of 1:1, 1:2, 1:3, 1:4, and 3:4, respectively. All of the prepared formulations were tested for a variety of properties, including thermodynamicstability, polydispersity index, particle size distributions, dilution resistance, drug contents, dispersibility, in vitro solubility of the drug, and emulsification time. Results: F5 was chosen as the optimal MLX liquid self-microemulsion due to its higher drug content (99.8%), greater in vitro release (100% at 40 min), smaller droplet size (63 nm), lower polydispersity index (PDI) value (0.3), and higher stability (a zeta potential of -81 mV). Conclusions: According to the data provided here, the self-microemulsifying drug delivery system is the most practical method for improving the dispersibility and stability of MLX.

Anaesthetic Techniques and Strategies: Do They Influence Oncological Outcomes?

Background: With the global disease burden of cancer increasing, and with at least 60% of cancer patients requiring surgery and, hence, anaesthesia over their disease course, the question of whether anaesthetic and analgesia techniques during primary cancer resection surgery might influence long term oncological outcomes assumes high priority. Methods: We searched the available literature linking anaesthetic-analgesic techniques and strategies during tumour resection surgery to oncological outcomes and synthesised this narrative review, predominantly using studies published since 2019. Current evidence is presented around opioids, regional anaesthesia, propofol total intravenous anaesthesia (TIVA) and volatile anaesthesia, dexamethasone, dexmedetomidine, non-steroidal anti-inflammatory medications and beta-blockers. Conclusions: The research base in onco-anaesthesia is expanding. There continue to be few sufficiently powered RCTs, which are necessary to confirm a causal link between any perioperative intervention and long-term oncologic outcome. In the absence of any convincing Level 1 recommending a change in practice, long-term oncologic benefit should not be part of the decision on choice of anaesthetic technique for tumour resection surgery.

Isolated Fourth Carpometacarpal Joint Injury in High-Level Baseball Players: A Case Series.

We present a case series of high-level baseball players having sustained a rare, isolated injury to the fourth carpometacarpal joint of the nondominant or bottom hand during a jammed swing. Ten patients were evaluated for ulnar-sided wrist pain and were subsequently diagnosed with fourth carpometacarpal joint synovitis based on physical examination and magnetic resonance imaging revealing increased signal intensity within the joint. Conservative treatment modalities including rest, nonsteroidal anti-inflammatory medications, splinting, and corticosteroid injections resulted in return to play within 4 weeks for all patients. We propose a mechanism of injury involving the bottom hand in relative pronation receiving a dorsally directed force from bat during a jammed swing resulting in isolated injury to the fourth carpometacarpal joint. This report serves to highlight this rare injury in high-level baseball players and recommend a treatment algorithm for early return to play.

Revolutionizing Drug Removal: Green Magnetic Nanoparticles Functionalized with Hydrophobic Deep Eutectic Solvents for Anti-Inflammatory Drug Adsorption

Non-steroidal anti-inflammatory medications are popular pharmaceutical and personal products due to their anti-inflammatory properties and ease of availability. However, the complex structure of these pollutants and their existence at low concentration makes them difficult to trace, posing a major challenge in their removal from aquatic environments. Therefore, the disposal and treatment of these emerging compounds have become a key concern in water treatment. In this study, new hydrophobic deep eutectic solvents (HDES) were successfully prepared using a cheap and simple component consist of decanoic acid and 2-pentanol as the hydrogen bond acceptor and hydrogen bond donor, respectively. The prepared HDES was functionalized onto magnetic nanoparticles, namely Fe3O4@HDES, as an efficient adsorbent for diclofenac and ibuprofen. Based on the findings of the cytocompatibility study, HDES offers new possibilities for safe distribution and application. The optimum adsorption conditions, including solution pH, adsorbent amount, and sample volume, were determined using the Taguchi experimental design. The One-Variable-at-a-Time (OVAT) method was used to determine the other parameters, such as the types of adsorbents, contact time, initial concentration, and initial temperature. Analysis of Variance (ANOVA) revealed that the solution pH played the most significant role in the adsorption of both diclofenac and ibuprofen, followed by the adsorbent amount and sample volume. The characterization involved several tools, including Fourier transform-infrared spectroscopy (FTIR), scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), vibrating-sample magnetometer (VSM), and Brunauer-Emmett-Teller (BET) analysis. Both diclofenac and ibuprofen adsorption followed chemisorption, and the process was feasible, spontaneous, and exothermic. Molecular docking also supported the choice of HDES as a functionalized agent by suggesting a schematic diagram of the energetically advantageous adsorption mechanism, which was in good accord with the experimental findings. The interaction between the adsorbent and adsorbates via hydrophobic interaction and hydrogen bonding was found to be accountable for adsorption. The results indicated that green synthesized Fe3O4@HDES offers a possible sustainable and green benefit through the adsorption of diclofenac and ibuprofen from contaminated water as an adsorbent.

Centers for Disease Control and Prevention Clinical Practice Guideline for Prescribing Opioids: United States, 2022: What dentists need to know

BackgroundThe Centers for Disease Control and Prevention (CDC) published the Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022 (CDCCPG) to replace the 2016 guideline. This guideline was designed to serve as a clinical tool to improve communication between clinicians and patients and empower them to make informed, person-centered decisions regarding pain management and the prescribing of opioids. It is intended for primary care and other clinicians, including dentists, who provide pain management for adults with acute, subacute, and chronic pain. Types of Studies ReviewedThis article summarizes the CDCCPG, with an emphasis on information of relevance to dentistry. ResultsFor dentists, the most important recommendations for pain management are that nonsteroidal anti-inflammatory medications are first-line medications for acute dental pain, interdisciplinary care for chronic orofacial pain is indicated, and opioids should only be prescribed for acute dental pain for a maximum of 3 days after risk assessment. Practical ImplicationsThe CDCCPG contains a great deal of relevant information that can help dentists and dental specialists make safe, effective, and evidence-based decisions in providing pain control for their patients.

Aromatase Inhibitor Musculoskeletal Syndrome and Bone Loss: a Review of the Current Literature.

The study aims to review the literature regarding musculoskeletal complications of aromatase inhibitors and treatment options for these complications. Aromatase inhibitors are common medications to treat hormone receptor-positive breast cancer in postmenopausal women and have been shown to improve survival and prevent disease recurrence. However, 20-60% patients stop treatment prematurely due to side effects. Side effects include joint stiffness and pain, tendonitis, tendon tears, muscle pain, and carpal tunnel syndrome known as aromatase inhibitor musculoskeletal syndrome (AIMSS) as well as bone loss. Proposed mechanisms of AIMSS include decreased estrogen levels, inflammation, and genetic factors. Switching aromatase inhibitors, exercise, non-steroidal anti-inflammatory medications, duloxetine, acupuncture, prednisone, and bisphosphonates are some treatment options for this syndrome and will be discussed in more detail in this review. Aromatase inhibitors are important in the treatment of hormone receptor-positive breast cancer in postmenopausal women. As we study the incidence of side effects of these medications including bone loss and AIMSS and determine the mechanisms of these symptoms and possible treatment options, we will decrease the incidence of patients discontinuing treatment prematurely and improve symptoms, quality of life, and survival in this patient population.

Robotic-Arm-Assisted Lateral Unicompartmental Knee Arthroplasty with a Fixed-Bearing Implant.

Approximately 5% to 10% of patients with knee arthritis have isolated lateral compartment arthritis; however, lateral unicompartmental knee arthroplasty (UKA) comprises just 1% of all knee arthroplasties1. This low proportion is partly because of the perceived complexity of lateral UKA and concerns over implant longevity and survivorship compared with total knee arthroplasty (TKA)2,3. With an improved understanding of knee kinematics alongside advances in implant design and tools to aid in appropriate restoration of limb alignment, lateral UKA can be an appealing surgical alternative to TKA for certain patients with lateral knee arthritis4,5. In appropriately selected patients, lateral UKA has been associated with reduced osseous and soft-tissue resection, more natural knee kinematics, less pain, shorter hospitalization, decreased blood loss and infection rates, and excellent survivorship and patient-reported outcomes6-9. This surgical approach and technique described for lateral UKA utilizes robotic-arm assistance and modern fixed-bearing implants10. The specific steps involve appropriate patient evaluation and selection, extensive radiographic and computed-tomography-based preoperative templating, a lateral parapatellar approach, intraoperative confirmation of component position and alignment, and robotic-arm assistance to perform osseous resections to achieve limb alignment and kinematic targets10. Final implants are cemented in place, and patients typically are discharged home on the day of surgery10. Nonoperative treatment for end-stage knee arthritis includes weight loss, activity modification, assistive devices, bracing, nonsteroidal anti-inflammatory medications, and various injections11. Alternative surgical treatments include TKA4 and, in certain patients, an offloading periarticular osteotomy12. Lateral UKA is an appealing surgical option for nonobese patients who have disabling knee pain isolated to the lateral compartment, good preoperative range of motion, and a passively correctable valgus limb deformity10,13. Patients are typically discharged home on the day of surgery, or occasionally on postoperative day 1 if medical comorbidities dictate hospital monitoring overnight10. Patients return to light activities, including walking, immediately postoperatively. By 3 months postoperatively, patients will generally have returned to all desired activities9. The mid-term outcomes of this procedure, as performed by the corresponding author, have been published recently14,15. The 5-year survivorship of 171 lateral UKAs was 97.7%, with 72.8% of patients reporting that they were very satisfied with their procedure and 19.8%, that they were satisfied14. Only 3.8% of patients reported dissatisfaction with their lateral UKA14. The mean Knee Injury and Osteoarthritis Outcome Score (KOOS) and standard deviation were 85.6 ± 14.314. These outcomes did not differ from those observed in 802 medial UKAs, which showed a survivorship of 97.8% and KOOS of 84.3 ± 15.914. These findings are generally in line with previously published studies, which have demonstrated excellent survivorship and patient-reported outcomes with fixed-bearing lateral UKA16-19. Component position and alignment are critical to achieve target knee kinematics.Target postoperative alignment is 1° to 4° of valgus.A meticulous cementation technique is required for optimal fixation and avoidance of excess residual cement in the posterior knee. ACL = anterior cruciate ligamentAP = anteroposteriorBMI = body mass indexCT = computed tomographyCAT = computed axial tomographyIT = iliotibialKOOS JR = Knee Injury and Osteoarthritis Outcome Score for Joint ReplacementMCL = medial collateral ligamentMRI = magnetic resonance imagingOR = operating roomPFJ = patellofemoral jointpoly = polyethyleneROM = range of motionTKA = total knee arthroplastyUKA = unicompartmental knee arthroplasty.