Intake Of Non-steroidal Anti-inflammatory Drugs Research Articles

Elderly-onset rheumatoid arthritis — clinical findings and treatment features (systematic literature review)

Background. Elderly-onset rheumatoid arthritis ­(EORA) is characterized by the disease onset after 60 years. Gi­ven the importance of the global increase in the proportion of older people in the population and the potential consequences, the problem of diagnosis and treatment of EORA is quite relevant. Purpose: to analyze the current literature data on the peculiarities of the clinical picture, differential diagnosis, and treatment of patients with EORA, taking into account comorbidity. Materials and methods. An analytical review of literature data was conducted using information analysis of the databases PubMed, Web of Science, Scopus, and Google Scholar for the period 2013–2023, but it did not exclude key works that were published earlier, using the keywords “elderly-onset rheumatoid arthritis”, “rheumatoid arthritis”, “diagnosis”, “treatment”, “prognosis”. Results. A review of the lite­rature demonstrated that while previous studies have mainly argued that EORA is a milder form of the disease with a favorable prognosis, recent studies have shown greater disease activity and severity, as well as worse clinical, functional, and radiological outcomes. Despite recent advances in the understanding of RA pathogenesis and new treatment strategies, there is still controversy regarding the management of EORA patients. Clinical practice shows that most patients with EORA are prescribed purely nonsteroidal anti-inflammatory drugs (NSAID) and glucocorticoids (GC) without the addition of disease-modifying antirheumatic drugs (DMARD). Real-world data have demonstrated that the treatment of elderly patients with RA is often unsatisfactory due to concerns about the possible side effects of DMARD, the presence of comorbidities, polypharmacy, and cognitive dysfunction in elderly patients. Conclusions. EORA presents a unique clinical profile, such patients require individualized treatment strategies, mandatory addition or switch to DMARD based on disease activity, comorbidities, and safety considerations to optimize treatment outcomes and minimize GC and NSAIDs intake, thereby improving the quality of treatment of elderly patients.

Outcomes of combined treatment of patients with acute lumbodynia

Introduction. Acute dorsalgia is a common reason to seek outpatient medical care in Russia. The clinical picture usually includes muscular-tonic and pain syndromes. The most common form of dorsalgia by localization is acute lumbar pain (lumbodynia).Aim. To evaluate the effectiveness of Spascuprel®, Traumeel S in the complex treatment of patients with acute lumbar pain in real-world clinical practice.Materials and methods. We conducted a non-interventional, prospective, observational study of 110 outpatients aged 26 to 65 years. Patients received a standard on-demand therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, Group 1 received Spascuprel® and Traumeel® C, and Group 2 received centrally acting muscle relaxants. The effectiveness of treatment was assessed using the visual analogue scale (VAS) of pain intensity and the limitations of various activities in daily living were measured using the Roland – Morris questionnaire. Consideration was given to the exacerbation duration, the need for additional intake of NSAIDs, and the number of cases of pain exacerbation within 60 days from the start of participation in the observational study.Results. Under treatment, pain intensity showed statistically significant decreases in VAS scores (from 61.0 to 35.5 scores out of 100 according to VAS by Day 7 and to 19.5 scores by Day 14 of treatment in Group 1, from 61.2 to 41.1 and to 25.8 scores in Group 2, respectively (p < 0.05)). A more rapid decrease was observed in VAS pain intensity score from baseline in Group 1. Over 2-month observation period, group 1 had less exacerbations (p < 0.05) and fewer cases of need for additional intake of NSAIDs (p < 0.05). The frequency and severity of adverse events did not differ between two groups.Conclusion. A more rapid decrease in VAS pain intensity scores and reduction in the need for NSAIDs were noted in the group of patients with acute dorsalgia who used Traumeel® C and Spascuprel® in addition to standard NSAID therapy.

Effect of nonsteroidal anti-inflammatory drugs (aspirin and naproxen) on inflammation-associated proteomic profiles in mouse plasma and prostate during TMPRSS2-ERG (fusion)-driven prostate carcinogenesis.

Recent preclinical studies have shown that the intake of nonsteroidal anti-inflammatory drugs (NSAIDs) aspirin and naproxen could be an effective intervention strategy against TMPRSS2-ERG fusion-driven prostate tumorigenesis. Herein, as a follow-up mechanistic study, employing TMPRSS2-ERG (fusion) positive tumors and plasma from TMPRSS2-ERG. Ptenflox/flox mice, we profiled the stage specific proteomic changes (focused on inflammatory circulating and prostate tissue/tumor-specific cytokines, chemokines, and growth factors/growth signaling-associated molecules) that contribute to prostate cancer (PCa) growth and progression in the TMPRSS2-ERG fusion-driven mouse model of tumorigenesis. In addition, the association of the protective effects of NSAIDs (aspirin 1400 ppm and naproxen 400 ppm) with the modulation of these specific molecular pathways was determined. A sandwich Elisa based membrane array-proteome profiler identifying 111 distinct signaling molecules was employed. Overall, the plasma and prostate tissue sample analyses identified 54 significant and differentially expressed cytokines, chemokines, and growth factors/growth signaling-associated molecules between PCa afflicted mice (TMPRSS2-ERG. Ptenflox/flox, age-matched noncancerous controls, NSAIDs-supplemented and no-drug controls). Bioinformatic analysis of the array outcomes indicated that the protective effect of NSAIDs was associated with reduced expression of (a) tumor promoting inflammatory molecules (M-CSF, IL-33, CCL22, CCL12, CX3CL1, CHI3L1, and CD93),(b) growth factors- growth signaling-associated molecules (Chemerin, FGF acidic, Flt-3 ligand, IGFBP-5, and PEDF), and (c) tumor microenvironment/stromal remodeling proteins MMP2 and MMP9. Overall, our findings corroborate the pathological findings that protective effects of NSAIDs in TMPSS2-ERG fusion-driven prostate tumorigenesis are associated with antiproliferative and anti-inflammatory effects and possible modulation of the immune cell enriched microenvironment.

NSAID-induced gastropathy in a comorbid patient in a multidisciplinary hospital

The purpose of this case report is to demonstrate the importance of outpatient management of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients, especially those at risk (elderly patients, alcohol abusers, patients with a history of peptic ulcer disease, patients taking glucocorticoids or anticoagulants) to avoid life-threatening complications. The following clinical case shows the association between gastric and duodenal mucosal barrier disruption and the use of nonsteroidal anti-inflammatory drugs. Methods: a complete blood count, blood biochemistry test, ultrasound, and abdominal radiography. Results. The clinical case describes a patient with coronary heart disease, ischemic cardiomyopathy, hypertension, permanent atrial fibrillation, impaired glucose tolerance, obesity, and a long history of smoking who had been taking 1–2 tablets of Nimesulide per day for a long time without doctor’s prescription; the intake of NSAIDs was not controlled on an outpatient basis. The reason for hospitalization was sharp pain in the epigastrium; the plain abdominal radiography in the emergency room revealed free gas below both domes of the diaphragm, and ultrasound examination of the abdominal cavity showed a level of inhomogeneous free fluid detected in all sloping areas and pneumatosis intestinalis. In this regard, the patient was urgently hospitalized to the department of surgery, where surgical intervention was performed, including upper-middle laparotomy, abdominoscopy, suture repair of the perforated gastric ulcer, and sanitation and drainage of the abdominal cavity. Conclusion. This clinical case draws attention to the problem of NSAID gastropathy in clinical practice. The task of a clinician is to prevent the development of NSAID-induced gastropathy, identify patients with risk factors for NSAID gastropathy at the earliest possible time, and carry out preventive and therapeutic measures. Patient management at the outpatient stage according to the clinical recommendations could have prevented the development of gastrointestinal bleeding associated with NSAID gastropathy.

Progress in application of aspirin desensitization and maintenance therapy in aspirin-exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome characterized by chronic rhinosinusitis with nasal polyps, asthma and the development of significant airway symptoms following the ingestion of aspirin and other nonsteroid anti-inflammatory drugs (NSAIDs). At present, aspirin challenge is the gold standard for diagnosis. Aspirin desensitization and aspirin therapy after desensitization (ATAD) is one of the classical therapies. This paper described the application of aspirin desensitization and ATAD in AERD and provided the reference for the comprehensive treatment of AERD.

Elimination profile of low-dose chlortalidone and its detection in hair for doping analysis-Implication for unintentional non-therapeutic exposure.

Chlortalidone (CLT) is a thiazide-type diuretic with high affinity for the erythrocyte carbonic anhydrase. Therapeutically, it is mostly used to treat edema and hypertension due to liver cirrhosis, heart insufficiency, or renal dysfunction. Although diuretics and masking agents are prohibited by the World Anti-Doping Agency (WADA) at all times in sports, substances belonging to this category are constantly detected in athlete samples, according to WADA's annual testing figures. Within this group of structurally diverse compounds, a threshold of 20 ng/mL has been introduced for six substances solely due to their presence as contaminants in other permitted drugs because of pharmaceutical production processes. In a recent presumptive doping case with a low urinary CLT concentration, the question of unintentional doping, for example, by contaminated non-steroidal anti-inflammatory drug intake, arose. To examine this potential scenario, a co-elimination of low-dose CLT and hydrochlorothiazide (HCTA; 20 × 50 μg, 0.2 mg/day each) was conducted on five consecutive days in two volunteers. Urine samples were subjected to liquid chromatography-tandem mass spectrometry (LC-MS/MS). Moreover, we examined the incorporation of CLT in scalp hair. HCTA is rapidly excreted renally in comparatively high concentrations. In contrast, the elimination of CLT is considerably slower (terminal elimination half-life extended by a factor of 12) and, consequently, much less concentrated in corresponding urine samples (45 and 53 ng/mL, respectively). Conversely, a higher hair incorporation of chlorthalidone was observed with simultaneous dosing of both. The results suggest that an unintentional intake of sub-therapeutic CLT doses due to contamination might result in an adverse analytical finding.

The Role of TAP/RS Block in Minor Gynecologic Laparoscopic Surgery: A Randomized Clinical Trial

Objectives: The aim of the study was to compare, in patients undergoing minor gynecological laparoscopic procedures, the effects of ultrasound (US)-guided transversus abdominis plane (TAP) + rectus sheath (RS) block versus no TAP/RS block in terms of post-surgical pain control using the numeric pain rating scale (NRS) and the degree of patient satisfaction, according to the main goals of Early Recovery After Surgery (ERAS) programs. The primary outcome is to value the postoperative abdominal pain using NRS in both groups. Secondary outcomes are to evaluate blood values, presence of postoperative nausea and vomiting (PONV), postoperative ileus, level of patient expected satisfaction, time of discharge, length of stay (LOS), and the amounts of additional analgesics required. Design: In this prospective randomized controlled trial, patients were randomly assigned to loco-regional anesthesia (LRA) group, who received TAP and RS block under US guidance, or no loco-regional anesthesia (N-LRA) group. Enrolled patients were randomized 1:1 to either receive bilateral TAP/RS block with ropivacaine or sham treatment (patches were applied on the abdominal wall of the patients under general anesthesia). Participants: All patients aged between 18 and 75 years, with ASA (American Society of Anesthesiologists) physical status 1-2, undergoing laparoscopic minor gynecological surgery, were enrolled. Setting: The study was conducted to the University of Campus Bio-Medico Hospital of Rome. Methods: Half an hour before surgery, all patients received gabapentin 300 mg per os. Once the patient underwent general anesthesia, US-guided bilateral TAP/RS block was performed by the anesthesiology team, while the uterine manipulator was positioned by a gynecology resident (not involved in the study). In the operative room, all patients received the same standardized anesthetic regimen. Postoperative abdominal pain was assessed at rest, after palpation, during movement, and after a cough by evaluating the patient at 6, 12, 18, 24, 36, 48, and 72 h after surgery, using the NRS from 0 to 10 in both groups. The amount of drug used for analgesia in the first 48 h after surgery was recorded. Moreover, hemoglobin, white blood cells, and c-reactive protein levels were recorded at 24, 48, and 72 h. The presence of PONV and the postoperative ileus was recorded throughout convalescence. The expected level of patient satisfaction at discharge and finally the LOS were assessed. Limitations: The major weakness of this study is that 60 mL of 0.5% ropivacaine was administered to each patient, without considering weight differences, yet contemporary literature rarely suggests volume/dose titration in fascial blocks. Results: A total of 104 women, undergoing gynecological minor laparoscopic surgery, were enrolled and assigned to LRA group (53 pts) and N-LRA group (51 pts). Postoperative pain was significantly reduced in patients who received TAP/RS block. A reduction in the intake of non-steroidal anti-inflammatory drugs after surgery was registered in LRA group (p p p Conclusions: US-guided TAP and RS block significantly reduces postoperative pain after minor gynecologic laparoscopic surgery and improves patients’ post-operative recovery.

Risk factors associated with age at onset of Parkinson’s disease in the UK Biobank

Substantial evidence shown that the age at onset (AAO) of Parkinson’s disease (PD) is a major determinant of clinical heterogeneity. However, the mechanisms underlying heterogeneity in the AAO remain unclear. To investigate the risk factors with the AAO of PD, a total of 3156 patients with PD from the UK Biobank were included in this study. We evaluated the effects of polygenic risk scores (PRS), nongenetic risk factors, and their interaction on the AAO using Mann–Whitney U tests and regression analyses. We further identified the genes interacting with nongenetic risk factors for the AAO using genome-wide environment interaction studies. We newly found physical activity (P < 0.0001) was positively associated with AAO and excessive daytime sleepiness (P < 0.0001) was negatively associated with AAO, and reproduced the positive associations of smoking and non-steroidal anti-inflammatory drug intake and the negative association of family history with AAO. In the dose-dependent analyses, smoking duration (P = 1.95 × 10−6), coffee consumption (P = 0.0150), and tea consumption (P = 0.0008) were positively associated with AAO. Individuals with higher PRS had younger AAO (P = 3.91 × 10−5). In addition, we observed a significant interaction between the PRS and smoking for AAO (P = 0.0316). Specifically, several genes, including ANGPT1 (P = 7.17 × 10−7) and PLEKHA6 (P = 4.87 × 10−6), may influence the positive relationship between smoking and AAO. Our data suggests that genetic and nongenetic risk factors are associated with the AAO of PD and that there is an interaction between the two.

The effectiveness of interventions in reducing pain related to orthodontic separation: a systematic review and meta-analysis.

Pain is an unpleasant experience and annoying sensation. To control this pain during orthodontic separation, different pharmacological and non-pharmacological methods have been used. This systematic review and meta-analysis aimed to critically assess the evidence of the effectiveness of pharmacological and non-pharmacological methods in reducing pain induced by orthodontic separation. An electronic search was conducted using the following databases: PubMed® (Medline), Scopus®, EMBASE®, Web of ScienceTM, Google ScholarTM, ProQuest, and Cochrane Central Register of controlled trials (CENTRAL) searching for the studies published between January 2012 and April 2023. Only randomized controlled trials (RCTs) were included, each experimental group included patients who received elastomeric separators and one kind of pharmacological or non-pharmacological interventions for pain reduction during the separation stage. Cochrane's risk of bias tool (RoB2 tool) was applied. The Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach was used to evaluate the strength of the evidence. Thirty-one studies (RCTs) were included in this systematic review. Nineteen of them were appropriate for quantitative synthesis and used VAS for pain assessment. Meta-analysis showed that low-level laser therapy (LLLT) was an effective approach for pain relief after separators placement with standard mean difference of 13.79 mm (95% confidence interval (CI): -15.64, -11.94) at 6 h and 23.34 mm at 24 h (95% CI: -25.91, -20.77). LLLT was also effective when applied in split-mouth and the standard mean difference was 8.9 mm at 6 h (95% CI: -12.86, -3.33) and 17.15 mm at 24 h (95% CI: -30.12, -4.17). Ibuprofen had a pain control effect at 6 h and at 24 h compared with the placebo group. The standard mean difference was 14.37 mm (95% CI: -20.54, -8.19) and 20.46 mm (95% CI: -27.79, -13.13), respectively. There was no difference in pain control between ibuprofen and acetaminophen. Naproxen had lower visual analog scale scores in pain perception at 6 h and the standard mean difference was 7.03 mm (95% CI: -12.67, -1.40). The application of LLLT decreased the pain induced by the separation during the first day of teeth separation; the pain reduction showed an increase from 6 h to the end of the 24 h. However, the evidence is weak to moderate. The analgesics reduced the pain compared to placebo; this pain reduction had shown an increase from 6 h to the end of the 24 h. The strength of the evidence is moderate. Naproxen gel effectively reduced the pain compared to placebo; the evidence in this regard is moderate. Naproxen gel effectively reduced the pain compared to placebo, but it was less effective than the oral intake of non-steroidal anti-inflammatory drugs. However, the evidence in this regard is moderate. This systematic review was registered with PROSPERO (CRD42022335553) during the first stages of its conduction.

CTH1/TH2 repolarization in induction of immune tolerance to non-steroidal anti-inflammatory drugs during the management of sickle cell disease vaso-occlusive crisis

Respiratory manifestations related to the intake of non-steroidal anti-inflammatory drugs (NSAIDs) during the treatment of the painful vaso-occlusive crisis of sickle cell disease are either a type I hypersensitivity mechanism of the Gell and Coombs classification, or a pharmacological mechanism of NSAIDs. The use of NSAIDs is essential in the Abidjan school because of the absence of therapeutic alternatives in the management of the inflammatory crisis of this disease. The induction of tolerance to NSAIDs initiated by the authors has had clear clinical success. The basic biological reasons for this tolerance were evaluated in this study. A group of 11 sickle cell patients aged 12 to 39 years in whom post-NSAID respiratory manifestations disappeared for at least 6 months following a short tolerance induction protocol with ibuprofen, was assayed by ELISA for TNFα, INFg (Th1 cytokines), IL-4 (Th2 cytokine), IL-10, TGF-β (immunosuppressive cytokines) and total IgE, before induction or pre-induction (D-1) and at day one (D1), D2- 3, one month (M1), and M6 after induction. A repolarization of the Th1/Th2 balance was noted during the post induction period. The high concentration of IL-4 observed at D-1 gradually decreased in favor of the cytokines TNFα, INFg. The decrease in cytokine IL-4 with the level of total IgE was accompanied by the increase of IL-10 and TGF-β demonstrating the regulatory role of these cytokines in the control of allergic diseases. In conclusion, the induction of immuno-tolerance to NSAIDs through a short protocol is well supported by immune regulation. The medium-term effects are real, unlike the results of allergen desensitization or specific immunotherapy. However, this protocol could be used in certain circumstances such as in the case of intolerance to trimethoprim-sulfamethoxazole, used as the treatment of choice for the prevention of opportunistic diseases in people living with human immunodeficiency virus.

Cis-vaccinic acid, Dibutyl-Cyanamide and 9, 12-Octadecadienoic acid from pistachio (Pistachia vera) seed coat (PSCE) induced nuclear damage and cytotoxicity in human colon cancer HT-115 cells

Current strategy for colorectal cancer (CRC) therapy like regular intake of non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of developing CRC but they induce the regression of adenomas. Even the CRC management technique include colectomy, have not yet been proven to reduce mortality. The present study aimed to reduce the susceptibility of CRC via controlling cellular oxidative stress, inflammation and caspase depended apoptosis in HT-115 human colorectal cancer cells using pistachio seed coat extract as nutritional therapy. Increasing concentrations of pistachio seed coat ethyl acetate extract (PSCE) were applied to HT-115 cells, which were incubated for 24 h and 48 h. The IC50 values were 14 mg/dl after 24 h, and and 7.5 mg/dl after 48 h. Acridine orange/ ethidium bromide staining confirmed the presence of 32% early apoptotic, 27% pre-apoptotic, 12% apoptotic, and 6% necrotic cells after 48 h. PSCE at 14 mg/dl significantly increased the antioxidant capacity via the expression of CYP1A and GSK3β, and decreased inflammatory agents via decreasing NF-κb, TNF-α, COX-2 and PGE-2 expression three-fold after 48 h. The expression of the tumor suppression related genes p53 and mdm2, and the apoptosis related genes Bax, Bcl-2, Caspase 3, p21, and PCNA levels increased one-fold, and levels of mdm2, Bcl-2 and PCNA decreased after PME treatment of 48 h. PSCE effectively controlled colon cancer cell proliferation via the caspase-dependent mitochondrial mediated apoptotic pathway.&#x0D; Keywords: Pistachia vera, cytotoxicity, human colon cancer, Cis-Vaccininc acid, apoptosis

Automated Identification of Aspirin-Exacerbated Respiratory Disease Using Natural Language Processing and Machine Learning: Algorithm Development and Evaluation Study

Background Aspirin-exacerbated respiratory disease (AERD) is an acquired inflammatory condition characterized by the presence of asthma, chronic rhinosinusitis with nasal polyposis, and respiratory hypersensitivity reactions on ingestion of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Despite AERD having a classic constellation of symptoms, the diagnosis is often overlooked, with an average of greater than 10 years between the onset of symptoms and diagnosis of AERD. Without a diagnosis, individuals will lack opportunities to receive effective treatments, such as aspirin desensitization or biologic medications. Objective Our aim was to develop a combined algorithm that integrates both natural language processing (NLP) and machine learning (ML) techniques to identify patients with AERD from an electronic health record (EHR). Methods A rule-based decision tree algorithm incorporating NLP-based features was developed using clinical documents from the EHR at Mayo Clinic. From clinical notes, using NLP techniques, 7 features were extracted that included the following: AERD, asthma, NSAID allergy, nasal polyps, chronic sinusitis, elevated urine leukotriene E4 level, and documented no-NSAID allergy. MedTagger was used to extract these 7 features from the unstructured clinical text given a set of keywords and patterns based on the chart review of 2 allergy and immunology experts for AERD. The status of each extracted feature was quantified by assigning the frequency of its occurrence in clinical documents per subject. We optimized the decision tree classifier’s hyperparameters cutoff threshold on the training set to determine the representative feature combination to discriminate AERD. We then evaluated the resulting model on the test set. Results The AERD algorithm, which combines NLP and ML techniques, achieved an area under the receiver operating characteristic curve score, sensitivity, and specificity of 0.86 (95% CI 0.78-0.94), 80.00 (95% CI 70.82-87.33), and 88.00 (95% CI 79.98-93.64) for the test set, respectively. Conclusions We developed a promising AERD algorithm that needs further refinement to improve AERD diagnosis. Continued development of NLP and ML technologies has the potential to reduce diagnostic delays for AERD and improve the health of our patients.

Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India.

The incidence of Clostridioides difficile infection (CDI) is high in ulcerative colitis and is associated with disease flares and adverse outcomes. However, the data on the dynamics of CDI in patients with acute severe ulcerative colitis (ASUC) is rather scarce. We evaluated the prevalence of CDI in patients with ASUC. This retrospective analysis of a prospectively maintained cohort admitted to the All India Institute of Medical Sciences, India, from May 2016 to December 2021, included patients with ASUC (as per Truelove and Witts criteria) who were tested for CDI. CDI testing was performed using enzyme-linked immunoassay for toxins A and B. Risk factors for developing CDI were analyzed along with short-term outcomes of ASUC. Steroid failure was defined as the need for medical rescue therapy or colectomy. Total 153 patients with ASUC were included (mean age 34.92 ± 12.24years; males 56.2%; disease duration 36 (IQR: 16-55.5) months, pancolitis 67.3%). Ninety-eight (63.4%), 72 (47%) and 10 (6.5%) patients, respectively, had received steroids, azathioprine and biologics in the past. Forty patients (26.14%) had a prior history of ASUC. Among risk factors for CDI, 14% of the patients had prior admission within 30days, 22.2% had a recent history of antibiotics and 3.9% had long-term non-steroidal anti-inflammatory drug intake. Only one sample was positive for Clostridioides difficile toxin assay. Tissue Cytomegalovirus DNA-PCR positivity was noted in 57 patients (37.3%). Fifty-seven patients (37.3%) had steroid failure, 35 required medical rescue therapy and 30 (19.6%) required colectomy (eight after medical rescue therapy failure). Despite antecedent risk factors for CDI, the overall prevalence of CDI in ASUC was low and theoutcomes were determined by underlying disease severity.

Pathogenetic features of cardiovascular pathology in patients with osteoarthritis

Cardiovascular pathology occupies a leading place among all causes of death and permanent disability of the population. In recent years, there has been an increase in the number of cardiovascular comorbidity cases, which leads to a significant deterioration in the quality of life, difficulties in the selection of therapy and a worse prognosis. Cardiorheumatology is an actual and actively discussed direction in this area. One of the most common rheumatic pathologies is osteoarthritis. Researchers identify a number of factors aggravating the course of cardiovascular pathology in the presence of osteoarthritis: regular intake of non-steroidal antiinflammatory drugs, chronic pain syndrome, decreased mobility. The review provides current data on the problem under discussion, in particular, the current understanding of pathogenetic relationships. The issues of safety of non-steroidal anti-inflammatory drugs in cardiovascular patients are highlighted. The potential of using modern immunological cytokines in this group of patients are described using the example of galectin-3 as a marker of prognosis.

The relationship between long-term use of nonsteroidal anti-inflammatory drugs and kidney function in patients with ankylosing spondylitis.

Although nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for ankylosing spondylitis (AS), their effect on kidney function remains unclear. This longitudinal study investigated the correlation between long-term NSAID use and kidney function in patients with AS using electronic medical records. The electronic medical records of 1,280 patients with AS collected from a single center between January 2001 and December 2018 were reviewed. The Assessment of Spondyloarthritis International Society (ASAS) NSAID Intake Score was used to determine the cumulative dose of all NSAIDs prescribed for a different time intervals. Each ASAS NSAID Intake Score was obtained for intervals of 6 months, 1 year, 2 years, 3 years, 5 years, and 10 years. The correlation between the ASAS NSAID Intake Score and final estimated glomerular filtration rate (eGFR) for each interval was investigated. The mean ASAS Intake Scores for 6-month, 1-year, 2-year, 3-year, 5-year, and 10-year intervals were 55.30, 49.28, 44.84, 44.14, 44.61, and 41.17, respectively. At each interval, the pearson correlation coefficients were -0.018 (95% CI -0.031 to -0.006, p=0.004), -0.021 (95% CI -0.039 to -0.004, p=0.018), -0.045 (95% CI -0.071 to -0.019, p=0.001), -0.069 (95% CI -0.102 to -0.037, p<0.001), -0.070 (95% CI -0.114 to -0.026, p=0.002), -0.019 (95% CI -0.099 to 0.062, p=0.645), respectively. There was a very weak negative relationship between ASAS Intake Score and eGFR at each interval. Long-term NSAID use did not correlate with kidney function based on real-world data in patients with AS.

Eosinophilic Pneumonitis Complicated by ARDS Following DRESS Syndrome: Case Report

Introduction: Drug reaction syndrome with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal hypersensitivity reaction, The reaction usually manifests as a febrile skin rash accompanied by lymphadenopathy and malaise between two and eight weeks after drug exposure. The pulmonary manifestations of DRESS are variable and may include interstitial pneumonia, pleural effusion, pneumonia, pulmonary nodules and (in the most severe cases) acute respiratory distress syndrome (ARDS). We report the observation of an acute eosinophilic pneumonitis which is unique in that it is part of a DRESS syndrome following the use of non-steroidal anti-inflammatory drugs and Ciprofloxacin. Observation: This was a 63-year-old patient admitted to the outpatient department of the Mohamed VI University Hospital in Marrakech for acute respiratory distress. Her history included a chronic depressive syndrome for 7 years under Taraxet and Deroxat; a megaloblastic anemia under Tardyferon; a non-dialyzed renal failure; a Gout having been under Zyloric for 7 months; a DRESS syndrome following the intake of non-steroidal anti-inflammatory drugs and Ciprofloxacin (Cystitis) having been hospitalized in the dermatology department 15 days before. The diagnosis of community-acquired pneumonia had been evoked and treated with Amoxicillin-clavulanic acid + Azithromycin (Suspicion of covid infection and appearance of Crazy Paving on thoracic Angioscanner), The evolution had been marked the following day by severe respiratory distress with hypoxia at 68% with MHC at 15, the respiratory frequency was at 51 cycles per minute with generalized cyanosis, signs of respiratory struggle. The blood gases on admission:Ph 7. 43 PaCo2 40.3 pAo2 45 HCo3- 25.8, PaO2/FiO2 at 98; The picture of hypoxaemia on a severe and very hypoxaemic pneumopathy required orotracheal intubation. Refractory hypoxemia (PaO2/FIO2 = 69 in the control gasometry despite a PEEP = 14 cmH2O, deep sedation completed with .....

Characterisation of gut microbiota composition in patients with axial spondyloarthritis and its modulation by TNF inhibitor treatment

ObjectiveTo assess whether gut microbiota composition is associated with patient characteristics and may have predictive value on the response to TNF inhibitor (TNFi) treatment in axial spondyloarthritis (AxSpA).MethodsThe study involved...

Food anaphylaxis in the elderly: Analysis of allergy vigilance network data from 2002 to 2021.

Few studies have focused on food allergies in the elderly, even though it may persist or appear de novo. We reviewed data for all cases of food-induced anaphylaxis in people age ≥ 60 reported to the French "Allergy Vigilance Network" (RAV) between 2002 and 2021. RAV collates data reported by French-speaking allergists regarding cases of anaphylaxis graded II to IV according to the Ring and Messmer classification. In total, 191 cases were reported, with an even sex distribution and mean age was 67.4 years (range 60 to 93). The most frequent allergens were mammalian meat and offal (31 cases, 16.2%), often associated with IgE to α-Gal. Legumes were reported in 26 cases (13.6%), fruits and vegetables in 25 cases (13.1%), shellfish 25 cases (13.1%), nuts 20 cases (10.5%), cereals 18 cases (9.4%), seeds 10 cases (5.2%), fish 8 cases (4.2%) and anisakis 8 cases (4.2%). Severity was grade II in 86 cases (45%), grade III in 98 cases (52%) and grade IV in 6 cases (3%) with one death. Most episodes occurred at home or in a restaurant and in most cases adrenaline was not used to treat the acute episode. Potentially relevant cofactors such as beta-blocker, alcohol or non-steroidal anti-inflammatory drug intake were present in 61% of cases. Chronic cardiomyopathy, present in 11.5% of the population, was associated with greater, grade III or IV reaction severity (OR 3.4; 1.24-10.95). Anaphylaxis in the elderly has different causes to younger people and requires detailed diagnostic testing and individualized care plans.

Gastrointestinal bleeding in children with familial dysautonomia: a case-control study.

Familial dysautonomia (FD) is a rare inherited autosomal recessive disorder with abnormal somatosensory, enteric, and afferent autonomic neurons. We aimed to define the incidence of gastrointestinal bleeding and its associated risk factors in patients with FD. In this retrospective case-control study, we identified all episodes of gastrointestinal bleeding in patients with FD, occurring over four decades (January 1980-December 2017), using the New York University FD registry. We identified 104 episodes of gastrointestinal bleeding occurring in 60 patients with FD. The estimated incidence rate of gastrointestinal bleeds in the FD population rate was 4.20 episodes per 1000 person-years. We compared the 60 cases with 94 age-matched controls. Bleeding in the upper gastrointestinal tract from gastric and duodenal ulcers occurred most frequently (64 bleeds, 75.6%). Patients were more likely to have a gastrostomy (G)-tube and a Nissen fundoplication [odds ratio (OR) 3.73, 95% confidence interval (CI) 1.303-13.565] than controls. The mean time from G-tube placement to first gastrointestinal bleed was 7.01years. The mean time from Nissen fundoplication to bleed was 7.01years. Cases and controls had similar frequency of intake of nonsteroidal antiinflammatory drugs (NSAID) and selective serotonin reuptake inhibitors (SSRI). The incidence of gastrointestinal bleeding in the pediatric FD population was estimated to be 4.20 per 1000 person-years, 21 times higher than in the general pediatric population (0.2 per 1000 person-years). Patients with FD with a G-tube and a Nissen fundoplication had a higher risk of a subsequent gastrointestinal bleeding.

Eine (un)gewöhnliche OSG-Distorsion

Non-steroidal anti-inflammatory drugs (NSAID) belong to the most prescribed and used drugs in sports medicine. Not as prevalent as the well-known gastrointestinal side effects and bleeding complications is a nephrogenic complication. This case report is supposed to sharpen the differential diagnostic view on a patient with flank pain and acute renal dysfunction. It should also emphasize the etiology, course, pathophysiology and therapy of a rare but possible consequence of NSAID intake.