Nonsteroidal Research Articles

1,5- diaryl pyrazole-loaded chitosan nanoparticles as COX-2 inhibitors, mitigate neoplastic growth by regulating NF-κB pathway in-vivo zebrafish model

Non-steroidal anti-inflammatory drugs (NSAIDs) have been researched for their capacity to reduce cancer incidence, primarily due to their COX-2 inhibition properties. However, concerns have arisen regarding the precision of their targeting abilities. Nanoparticle approaches are revolutionizing cancer treatment by enabling targeted drug delivery, which enhances the efficacy and reduces the toxicity of chemotherapy. Particularly, chitosan-based nanoparticles are noteworthy for their biocompatibility, biodegradability, and ability to improve drug delivery. In this study, we synthesized folic acid-conjugated, 1,5-diaryl pyrazole-loaded chitosan (FA-CS-DP) nanoparticles using the ionic gelation method. The bioavailability and anti-neoplastic effects in a 7,12-dimethylbenzanthracene (DMBA)-exposed zebrafish model was investigated. MTT assay showed dose-dependent cytotoxicity of FA-CS-DP nanoparticles against MCF-7 breast cancer. The nanoparticles showed no toxicity to zebrafish embryos up to 100 μg/mL. The nanoparticle reduced oxidative stress and enhanced apoptosis in zebrafish exposed to DMBA. The morphological examination suggests that tumor growth was prevented in the zebrafish's surface and internal regions. The gene expression analysis confirmed the decrease in the expression of anti-inflammatory genes, such as cox-2 and nf-κb, and apoptosis inhibitor genes, such as bcl-2 and mdm2. By regulating the anti-inflammatory and apoptosis inhibitor genes, FA-CS-DP nanoparticle prevents neoplastic growth in the zebrafish model.

A Prevalence-Based Study to Estimate Cost of Illness of Rheumatoid Arthritis in a Tertiary Care Hospital in India

Background: Rheumatoid arthritis (RA) is a chronic progressive inflammatory condition with high cost of management and significant impact on the patient and healthcare system. Hence, there is a need to estimate and analyze the economic impact of RA. Materials and Methods: It was a cross-sectional prospective follow-up single-center study at a tertiary care hospital conducted over a period of 02 years and 06 months from September 2019 to February 2022 after ethical committee clearance. Results: A total of 189 RA patients were included after excluding 15 patients. The male-to-female ratio was 0.687. The mean age of the study population was 44.74 ± 5.2 years. The mean yearly average cost of management of RA was Rs 29155.1 ± 18234.1, of which 49.6% was direct medical, 19.4% was direct non-medical, and 31% was indirect costs. Of average direct medical costs, cost toward non-steroidal anti-inflammatory drugs (NSAIDs) was 3.1%; conventional disease-modifying antirheumatic drugs (DMARDs) was 36.3%; and laboratory, radiology investigations, and consultations was 6.4%, 1.48%, and 12.3%, respectively. Factors, such as longer duration of treatment, use of biologic DMARDs, loss of productive workdays, extraarticular manifestations, and management of complications, were associated with higher cost of treatment of RA. Conclusions: This study quantifies the economic burden of the RA by measuring costs incurred toward all aspects of the patient’s life including the indirect costs due to loss of workdays. The knowledge of cost will help in financial management by patients and healthcare providers.

Hemorrhagic cholecystitis afflicted with glanzmann thrombasthenia patient

ABSTRACT Hemorrhagic cholecystitis is a rare and potentially life-threatening condition that requires immediate medical attention. If the gallbladder perforates, it can lead to even more severe complications. We present the case of a 27-year-old man with Glanzmann’s thrombasthenia, a rare platelets disorder, who visited the emergency department twice before being diagnosed with this condition. Initially, he complained of ear pain, and later, chest pain. Despite a normal ECG and cardiac markers, he was discharged with non-steroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain. However, when he returned with abdominal pain, nausea, and vomiting, an ultrasound revealed signs of cholecystitis. An emergency laparoscopic cholecystectomy was performed, which revealed hemorrhagic cholecystitis.

Acupuncture combined with Chinese herbal medicine for discogenic low back pain: protocol for a multicentre, randomised controlled trial

IntroductionDiscogenic low back pain is a common form of chronic low back pain. In traditional Chinese medicine, combinations of acupuncture and herbal medicine are frequently used to manage this condition....

Response of crop seed germination and primary root elongation to a binary mixture of diclofenac and naproxen.

Non-steroidal anti-inflammatory drugs, diclofenac (DCF) and naproxen (NPX), represent a group of environmental contaminants often detected in various water and soil samples. This work aimed to assess possible phytotoxic effects of DCF and NPX in concentrations 0.1, 1 and 10 mg/L, both individually and in binary mixtures, on the seed germination and primary root elongation of crops, monocots Allium porrum and Zea mays, and dicots Lactuca sativa and Pisum sativum. Results proved that the seed germination was affected by neither individual drugs nor their mixture. The response of primary root length in monocot and dicot species to the same treatment was different. The Inhibition index (%) comparing the root length of drug-treated plants to controls proved to be approximately 10% inhibition in the case of dicots lettuce and pea, and nearly 20% inhibition in monocot leek, but almost 20% stimulation in monocot maize. Assessment of the binary mixture effect confirmed neither synergistic nor antagonistic interaction of DCF and NPX on early plant development in the applied concentration range.

Radiation Therapy for the Treatment of Osteoarthritis

Osteoarthritis is a common cause of pain and disability in the United States. Many patients experience pain that is refractory or unable to be treated by traditional treatments such as exercise, physical therapy, nonsteroidal anti-inflammatory drugs, and/or cyclooxygenase-2 inhibitors. For patients with medically refractory disease, intra-articular corticosteroid therapy, hyaluronic acid, or surgery can be considered. However, for many older patients with significant impairment in quality of life related to osteoarthritis, radiation therapy is a noninvasive treatment option that has a long history of global use. In this topic discussion, we review the clinical evidence supporting treatment of osteoarthritis, as well as considerations for how to select which patient and joint to treat. We discuss technical considerations for treatment including dose and immobilization, assessment of treatment response, and the role of retreatment.

Therapeutic strategies to modulate gut microbial health: Approaches for sarcopenia management.

Sarcopenia is a progressive and generalized loss of skeletal muscle and functions associated with ageing with currently no definitive treatment. Alterations in gut microbial composition have emerged as a significant contributor to the pathophysiology of multiple diseases. Recently, its association with muscle health has pointed to its potential role in mediating sarcopenia. The current review focuses on the association of gut microbiota and mediators of muscle health, connecting the dots between the influence of gut microbiota and their metabolites on biomarkers of sarcopenia. It further delineates the mechanism by which the gut microbiota affects muscle health with progressing age, aiding the formulation of a multi-modal treatment plan involving nutritional supplements and pharmacological interventions along with lifestyle changes compiled in the review. Nutritional supplements containing proteins, vitamin D, omega-3 fatty acids, creatine, curcumin, kefir, and ursolic acid positively impact the gut microbiome. Dietary fibres foster a conducive environment for the growth of beneficial microbes such as Bifidobacterium, Faecalibacterium, Ruminococcus, and Lactobacillus. Probiotics and prebiotics act by protecting against reactive oxygen species (ROS) and inflammatory cytokines. They also increase the production of gut microbiota metabolites like short-chain fatty acids (SCFAs), which aid in improving muscle health. Foods rich in polyphenols are anti-inflammatory and have an antioxidant effect, contributing to a healthier gut. Pharmacological interventions like faecal microbiota transplantation (FMT), non-steroidal anti-inflammatory drugs (NSAIDs), ghrelin mimetics, angiotensin-converting enzyme inhibitors (ACEIs), and butyrate precursors lead to the production of anti-inflammatory fatty acids and regulate appetite, gut motility, and microbial impact on gut health. Further research is warranted to deepen our understanding of the interaction between gut microbiota and muscle health for developing therapeutic strategies for ameliorating sarcopenic muscle loss.

Extraction of diclofenac and tetracycline from simulated aqueous wastewater using ionic liquids as carriers by pseudo-emulsion hollow fiber strip dispersion

Diclofenac (DCF) and Tetracycline (TC) are used as non-steroidal anti-inflammatory drugs (NSAID) and antibiotics, respectively. Both these drugs, when released into the environment through various routes, cause adverse effects on aquatic life and humans. The traditional approaches employed for the removal of these drugs have various drawbacks and adverse effects on the environment. The present work gives a deeper insight into the potential application of ionic liquids as carriers in the pseudo-emulsion hollow fiber strip dispersion (PEHFSD) technique for removing these compounds from the simulated aqueous solution. The extraction of DCF and TC was performed using different organic carriers, Di-(2-ethylhexyl)phosphoric acid (D2EHPA), Tributyl phosphate (TBP), Trioctyl amine (TOA), and also using ionic liquids, 1-Ethyl-3-methylimidazolium Bis(trifluoromethanesulfonyl)imide ([EMIM][[TFSI]), 1-Butyl-1-methylpyrrolidinium Bis(trifluoromethanesulfonyl)imide ([BMPy][[TFSI]) and 1-Octyl-3-methylimidazolium Hexafluorophosphate ([OMIM][PF6]). Comparing the performance of all carriers, it was found that [OMIM][PF6] showed 100 % extraction of DCF, while for TC, the maximum extraction obtained was 91.85 %. Effective extraction of DCF and TC up to the 4th cycle indicated the stability of the membrane phase inside the micropore. Membrane phase and pseudo-emulsion are also characterized by FTIR, micrograph images and Turbiscan. A recyclability study of pseudo-emulsion showed that with the increase in the number of cycles for extraction, the stripping phase was gradually saturated by extracting feed (DCF/TC), which led to a drop in extraction efficiency.

Inflammatory Risk Factors for Chronic Subdural Hematoma in a Nationwide Cohort.

The discovery of biomarkers in chronic subdural haematomas (CSDH) suggests that inflammation is part of CSDH pathophysiology. It is unknown whether inflammation reflects an independent CSDH driver or haematoma degeneration. This knowledge holds a potential target for anti-inflammatory treatment in patients at risk of CSDH. This study investigated the association of pro- and anti-inflammatory factors with CSDH development. This cohort study included all individuals in Denmark over 50 years between 2007-2018. The outcome was first-time CSDH surgery. Hazard ratios (HR) according to potential risk factors were estimated using Cox regression, with age as underlying time scale. Among the 2,391,853 individuals, head trauma was registered in 427,612 individuals (17%), and among these, only 812 were operated for CSDH (0.18%). Among individuals without registered head trauma, the pro-inflammatory conditions of alcohol addiction, diabetes, anti-hypertensive treatment, and chronic hepatic disease were significantly associated with CSDH among individuals (50-74 years). The use of glucocorticoids displayed a decreased risk in cohort members aged 75 and older. Non-steroid anti-inflammatory drugs and statins appeared to be risk factors for CSDH in individuals between the ages of 50-64 and 65-74. Although head trauma was a risk factor for CSDH, the absolute risk was low (0.18%), which does not support preventive measures after emergency room contacts for head trauma. Interestingly, pro-and anti-inflammatory factors were significantly associated with CSDH in patients without registered head trauma, and the pronounced age-dependency of the associations suggests that the pathophysiological mechanisms vary with age.

New Binary Adducts of Panobinostat with Different Carboxylic Acid Based NSAIDs: Structural Analysis and Physicochemical Properties Investigation

AbstractAdoption of multitarget, cost‐effective fixed‐dose medication combinations can help lower the pill load without increasing the risk of adverse events. In this study, three new 1:1 drug‐drug binary solid forms of panobinostat (PNB) and nonsteroidal anti‐inflammatory drugs (NSAIDs) were effectively synthesized by liquid‐assisted grinding and slow evaporation crystallization techniques. The obtained solid forms were extensively characterized by various analytical techniques. The structural investigation revealed that all molecular adducts formed salt with a comparable (10) graph set pattern created by heteromeric interactions formed between PNB and corresponding salt formers. To determine the dissolving behavior of the newly developed adducts, solubility tests were performed at various pH levels (pH 1.2 and pH 7), and the results indicated that the solubility of all forms is increased at pH 7.0, particularly PNB.NIF has a solubility of 0.195 mg/mL, which is seven times higher than the parent drug. Furthermore, PXRD was used to assess the stability of the synthesized adduct at varied temperature and humidity levels and it was found that all the adducts are stable. Based on the findings, we hope that the newly found PNB drug‐drug binary adducts have possible potential to broaden the use of drug combinations without changing the chemical structures.

Total knee arthroplasty combined with simultaneous open reduction and internal fixation in the treatment of knee osteoarthritis with patellar fracture: a case report and review of the literature

BackgroundPatients with severe knee osteoarthritis combined with patellar fracture are rare, and it is unclear whether single-stage surgery affects the enhanced recovery after surgery.Case presentationThis case report describes two patients of Han nationality. A 69-year-old male patient was previously diagnosed with severe knee osteoarthritis of the left knee joint and was treated conservatively with long-term oral nonsteroidal antiinflammatory drugs and intraarticular injection of sodium hyaluronate. He was hospitalized for acute left knee injury owing to a fall from a height. He was diagnosed with knee osteoarthritis of the left knee joint and patellar fracture. Another 74-year-old female patient was previously diagnosed with severe knee osteoarthritis, long-term oral nonsteroidal antiinflammatory drugs and topical Chinese medicine to relieve the pain. A month ago, she fell down the stairs and fractured the patella in her left knee, she was diagnosed with severe left knee osteoarthritis combined with an old left patella fracture. Both patients were successfully treated by single-stage primary total knee arthroplasty and fixation of the patellar fracture. They both carried out early functional exercise normally and successfully achieved enhanced recovery.ConclusionSuccessful single stage total knee replacement with patella management can not only reduce the number of operations, but also enable patients to achieve rapid postoperative recovery. However, single stage may increase the risk of local surgical complications. Therefore, for most patients, especially those with low risk of anesthesia related complications, standard of treatment remains first fixing the patellar fracture and when the fracture is healed proceed with the total knee arthroplasty.

Facile synthesis and fabrication of Mg2SnO4/carbon black as a sustainable electrode for determination of non-steroidal anti-inflammatory drug-flutamide

The accumulation of hazardous pharmaceutical wastes in aquatic organisms, particularly nonsteroidal anti-inflammatory drug molecules, has severe toxicological consequences for both aquatic life and humans. To protect the environment, it is essential to develop a highly efficient device with dual-purpose capabilities for drug detection while minimizing catalyst expenditure. In this work, we explored a simple and effective design for fabricating a magnesium stannate combined with carbon black (Mg2SnO4/CB) nanocomposite as a cost-effective, sustainable electrode material for the electrochemical detection of flutamide (Flu). The Mg2SnO4/CB nanocomposite was synthesized through a simple hydrothermal process followed by sonication. Various analytical methods were used to determine its physico-chemical characteristics. The electrochemical efficiency of Mg2SnO4/CB/GCE was evaluated by detecting Flu, showing a remarkable linear range from 0.6 to 198.4 µM with a sensitivity of 3.91 μA μM−1 cm−2. In addition, the constructed sensor demonstrated excellent selectivity, high repeatability, outstanding reproducibility, and long-lasting stability. The anti-interference experiments yielded a definite current response without any change in peak shifts. Consequently, Mg2SnO4/CB/GCE demonstrated superior performance in determining Flu in human urine and river water samples.

Electrodeposition of Zn-Al-Layered Double Hydroxides With Interlayer Modification by Ibuprofen as Fiber Coating for Solid Phase Microextraction of Nonsteroidal Anti-Inflammatory Drugs.

In this study, in situ electrodeposition of Zn─Al-layered double hydroxides (Zn─Al-LDHs) on the surface of pencil graphite substrate were practiced with interlayer modification by ibuprofen. The prepared composite increases the efficiency of the proposed method by increasing the level of interaction between the sorbent and the selected analytes including acetylsalicylic acid and naproxen (NAP) in real sample. Eventually, the extracted target analytes were injected into high-performance liquid chromatography ultraviolet (HPLC-UV) for their measurement. The experimental design including PBD and BBD was implemented to obtain the maximize efficiency and optimal condition for extraction of the target analytes. Therefore, in optimal conditions, limits of detection of 0.33-0.64µgL-1, linear dynamic range (LDR) of 1-100µgL-1 (with r2>0.9934), and limits of quantification (LOQs) of 1.1-2.1µgL-1 were obtained for target analytes by SPME-HPLC-UV. The intra-day relative standard deviation (RSD%) were found to range in 3.90%-5.30% (4.90%-6.80%) at concentration of 5-50µgL-1 (2-10µgL-1). According to obtained result, the relative recovery was calculated between 90% and 109%. Therefore, the obtained results showed that the selected method has a suitable performance for the preconcentration and extraction of acetylsalicylic acid and NAP in biological samples.

Parecoxib inhibits tumorigenesis and angiogenesis in hepatocellular carcinoma through ERK-VEGF/MMPs signaling pathway.

Parecoxib, a well-recognized nonsteroidal anti-inflammatory drug, has been reported to possess anticancer properties in various tumor types. In this work, we aimed to investigate the potential anticancer effects of parecoxib on hepatocellular carcinoma (HCC) cells. To assess the impact of parecoxib on HCC cell proliferation, we employed Cell Counting Kit-8, colony formation, and 5-ethynyl-2'-deoxyuridine assays. Hoechst/propidium iodide (PI) double staining and flow cytometry were performed to evaluate apoptosis and cell cycle analysis. Wound healing and transwell assays were utilized to assess cell migration and invasion. Tube formation assay was employed to analyze angiogenesis. Protein levels were determined using western blotting, and mRNA expression levels were assessed using quantitative real-time polymerase chain reaction (PCR). A xenograft mouse model was used to confirm the antitumor effects of parecoxib on HCC tumors in vivo. Our data demonstrated that parecoxib effectively inhibited the proliferation of HCC cells in a dose- and time-dependent manner. In addition, parecoxib induced cell cycle arrest in the G2 phase and promoted apoptosis. Moreover, parecoxib hindered tumor migration and invasion by impeding the epithelial-mesenchymal transition process. Further investigation showed that parecoxib could significantly suppress angiogenesis through the inhibition of extracellular signal-regulated kinase (ERK)-vascular endothelial growth factor (VEGF) axis. Notably, treatment with the ERK activator phorbol myristate acetate upregulated the expression of matrix metalloproteinase (MMP)-2, MMP-9, and VEGF and reversed the function of parecoxib in HCC cells. Besides, parecoxib displayed its antitumor efficacy in vivo. Collectively, our results suggest that parecoxib ameliorates HCC progression by regulating proliferation, cell cycle, apoptosis, migration, invasion, and angiogenesis through the ERK-VEGF/MMPs signaling pathway.

Non-steroidal anti-inflammatory drug use and inflammatory markers associated with gallbladder dysplasia: A case-control analysis within a series of patients undergoing cholecystectomy.

Inflammation has been associated with the development of gallbladder cancer (GBC). However, little is known about the associations of both, inflammation and the use of non-steroidal anti-inflammatory drugs (NSAIDs), with preneoplastic lesions. We analyzed the association of NSAIDs and gallbladder dysplasia in 82 patients with dysplasia and 1843 patients with gallstones among symptomatic patients from a high-risk population. We also analyzed associations for 33 circulating immune-related proteins in a subsample of all 68 dysplasia cases diagnosed at the time of sample selection and 136 gallstone controls. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Biliary colic was reported among most cases (97.6%) and controls (83.9%). NSAID use was inversely associated with gallbladder dysplasia (OR: 0.48, 95%CI: 0.26-0.83). Comparing the highest versus lowest category of each immune-related protein, eight proteins were inversely associated with dysplasia with sex- and age-adjusted ORs ranging from 0.30 (95%CI: 0.12-0.77) for IL-33 to 0.76 (95%CI: 0.59-0.99) for MIP-1B. Of those, GRO remained associated with dysplasia (OR: 0.64, 95%CI: 0.45-0.91) and BCA-1 was borderline associated (OR: 0.74, 95%CI: 0.54-1.01) after adjusting the logistic regression model for sex, age, and NSAIDs. In conclusion, NSAID users were less likely to have gallbladder dysplasia, suggesting that NSAIDs might be beneficial for symptomatic gallstones patients. The inverse association between immune-related markers and dysplasia requires additional research, ideally in prospective studies with asymptomatic participants, to understand the role of the inflammatory response in the natural history of GBC and to address the biological effect of NSAIDs.

Differences in Anti-inflammatory Effects of Celecoxib Emulgel Preparations with Variations in Surfactant Concentration between Lecithin and Tween 80

Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) which is widely used to treat inflammation such as rheumatoid arthritis and primary dysmenorrhea. The absorption of celecoxib in the body is very low when taken orally, so it can be increased by changing the route of administration via transdermal route such as emulgel. This study aims to determine the increase in the anti-inflammatory activity of celecoxib emulgel with varying concentrations of surfactants in formula with Lecithin and formula with Tween 80. Celecoxib emulgel, was made into 3 formulas with variations in the concentration for each formula with Lecithin (FI=3%; FII=5%; FIII=7%) and Tween 80 (FI=5%; FII=10%; FIII=15%). The anti-inflammatory activity test was carried out by inducing edema in the soles of rats' feet using carrageenan. Rats were divided into 5 groups for each formula: 1) negative control, 2) without surfactant, 3) FI, 4) FII, and 5) FIII. The edema volume was measured every 1 hour for 6 hours using a plethysmometer. Results of the anti-inflammatory test showed that the average value of AUC0-360 in the Lecithin group = 57.97-77.17 μg/hour/mL and in the Tween 80 group = 51.45-77.17 μg/hour/mL. %DAI results of formula without surfactant=9.33%, FI (Lecithin=10.01%; Tween 80=24.49%), FII (Lecithin=18.36%; Tween 80=29.05%), and FIII (Lecithin=24.88%; Tween 80=33.33%). Based on these data, it can be concluded that there is an increase in the anti-inflammatory effect of celecoxib emulgel with increasing surfactant concentration in the formula with Lecithin and in the formula with Tween 80. Keywords: Anti-inflammatory; celecoxib; emulgel; surfactant

Non-Invasive Therapeutic Approaches for Mechanical Low Back Pain: An Integrative Systematic Review

Background: Mechanical low back pain (LBP) is one of the most prevalent musculoskeletal conditions, affecting a significant portion of the global population at some point in their lives. It is characterized by pain in the lumbar region without an obvious inflammatory or infectious origin, typically exacerbated by movement, posture, or mechanical load. LBP, whether acute, subacute, or chronic, is a leading cause of temporary and permanent disability, with significant economic repercussions due to lost workdays and healthcare costs. Recent clinical guidelines, such as those from the American College of Physicians (ACP) and the National Institute for Health and Care Excellence (NICE), emphasize the importance of non-invasive interventions for managing mechanical LBP, particularly in acute and chronic cases. In this context, this systematic review aims to consolidate current evidence on available therapeutic interventions, focusing on non-invasive treatments. Objective: To evaluate the available evidence on non-invasive therapeutic interventions for the treatment of mechanical low back pain. The review aims to synthesize international clinical guideline recommendations and identify the most effective practices for reducing pain and improving functional outcomes. Methods: This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials, systematic reviews, and clinical guidelines published up to 2023 addressing the management of mechanical low back pain in adults were included. Databases such as PubMed, Cochrane Library, and grey literature sources, including guidelines from medical societies, were searched. The study selection process followed strict eligibility criteria, including publications in English and Portuguese focused on non-invasive treatments for LBP. The methodological quality of the studies was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool. A total of 15 studies met the inclusion criteria, covering a range of non-invasive interventions such as physical therapy, exercise, acupuncture, manual therapy, and pharmacological approaches. Results: Evidence suggests that exercise-based interventions, particularly programs focused on muscle strengthening and stretching, are effective in reducing pain and improving functional outcomes in patients with mechanical LBP. Manual therapies and acupuncture also demonstrated benefits, albeit with less robust evidence. Reviewed guidelines recommend caution in the use of pharmacological interventions, such as nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in chronic cases. Conclusion: This review highlights that non-invasive therapies, especially supervised exercise programs, represent the most effective and safe treatment for mechanical low back pain. The revised international guidelines reinforce the importance of avoiding early invasive interventions, except in cases of persistent or refractory pain. Appropriate management of mechanical LBP should be individualized, integrating evidence-based interventions to promote functional rehabilitation and minimize the impact of pain on patients' quality of life.

Unusual Presentation of Osteoid Osteoma with Exacerbating Pain during Menses

Osteoid osteomas (OO) are benign neoplasms commonly present during the second and third decade of life, showing a male predominance with classical nocturnal bone pain dramatically responding to nonsteroidal anti-inflammatory drugs. We report a rare OO in a young female who presented with right leg bone pain that was exacerbated during menstruation, a presentation that had never been reported before. The pain intensity increased and interfered with her daily activity, which urged for a careful evaluation by a computerized tomography scan showing OO signs. Surgical excision and histopathology confirmed OO. The patient’s pain drops down to zero on the visual analog scale. Two years after the surgery, she is well with no recurrence signs. A novel OO presentation may increase physician awareness of atypical presentation. A careful evaluation of a challenging presentation added to an imaging study may reveal the underlying cause and rule out other diagnostic dilemmas.

Overview of Uterine Fibroid Treatment Procedures; Review Article

Myomas are benign uterine tumours found in 40-70% of women of reproductive age. About 30% of them cause various ailments (bleeding, pain, infertility) that reduce the quality of women’s life. Uterine fibromas are the cause of 40-60% of hysterectomies. Different treatment methods are used depending on the size, number, location of myomas and the patient's preferences. Conservative treatment includes nonsteroidal anti-inflammatory drugs, hormonal therapies as contraceptives, GnRH agonists or antagonists, selective progesterone receptor modulators and levonorgestrel. Radiologic intervention types include are UAE (uterine artery embolization), high-intensity focused ultrasound (HIFU), magnetic resonance (MRgFUS), and radiofrequency ablation (RFA). There are also more radical methods, namely surgical treatments, such as myomectomy (hysteroscopic, laparoscopic, robotic or abdominal) and hysterectomy. The oldest of methods is abdominal hysterectomy, while in some women, vaginal hysterectomy can be applied. Recently, laparoscopic or robotic hysterectomy (using the da Vinci robot) has been used. The latter procedures are associated with a better quality of life following treatment.

Comparison of the efficacy of aescin and diclofenac sodium in the management of postoperative sequelae and their effect on salivary Prostaglandin E2 and serum C-reactive protein levels after surgical removal of impacted mandibular third molar: a randomized, double-blind, controlled clinical trial.

Surgical removal of an impacted third molar is one of the most common oral surgical procedures performed in dental offices. The postoperative phase is often associated with severe inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to manage postoperative discomfort. NSAIDs have been associated with gastrointestinal bleeding, renal function disturbances, and platelet count reductions. Thus, the present study demonstrates the utility of aescin in managing postoperative discomfort after the surgical removal of impacted mandibular third molars.This study aimed to correlate and compare the impact of aescin and diclofenac on salivary PGE2 levels and serum C-reactive protein levels after surgical extraction of the mandibular third molar. The study will also evaluate and compare the effectiveness of individual drug therapy in managing postoperative pain, swelling and mouth opening. The planned study is a single-center, double-blind, randomized, parallel, prospective clinical trial. Each patient will be prescribed either diclofenac sodium 150 mg/day or aescin (escin) 120 mg/day to be taken orally in divided doses for five days after surgically removing the impacted mandibular third molar.Pain will be assessed using a visual analog scale. Facial swelling and mouth opening will be recorded using a metric scale with standardized reference points. ELISA (enzyme-linked immunosorbent assay (ELISA) will be employed to measure salivary Prostaglandin E2 and serum C-reactive protein levels. All parameters will be recorded preoperatively (T0) on the second postoperative day (T1) and fifth postoperative day (T2). The proposed study is expected to show a clinically acceptable response to the administration of aescin for the management of postoperative discomfort compared to diclofenac sodium after third molar surgery.The proposed study is expected to positively manipulate the levels of salivary Prostaglandin E2 and serum C-reactive protein, which are reliable inflammatory markers.The outcome of this study may provide an efficacious and safe alternative to conventional nonsteroidal anti-inflammatory drugs for managing postoperative discomfort following third molar surgery.