Nonsteroidal Anti-inflammatory Medications Research Articles

Anti-inflammatory peptide therapeutics and the role of sulphur containing amino acids (cysteine and methionine) in inflammation suppression: A review.

Inflammation serves as our body's immune response to combat infections, pathogens, viruses, and external stimuli. Inflammation can be classified into two types: acute inflammation and chronic inflammation. Non-steroidal anti-inflammatory medications (NSAIDs) are used to treat both acute and chronic inflammatory disorders. However, these treatments have various side effects such as reduced healing efficiency, peptic ulcers, gastrointestinal toxicities, etc. METHOD: This review assesses the potential of anti-inflammatory peptides (AIPs) derived from various natural sources, such as algae, fungi, plants, animals, and marine organisms. Focusing on peptides rich in cysteines and methionine, sulphur-containing amino acids known for their role in suppression of inflammation. Due to their varied biological activity, ability to penetrate cells, and low cytotoxicity, bioactive peptides have garnered interest as possible therapeutic agents. The utilisation of AIPs has shown great potential in the treatment of disorders associated with inflammation. AIPs can be obtained from diverse natural sources such as algae, fungi, plants, and animals. Cysteine and methionine are sulphur-containing amino acids that aid in the elimination of free radicals, hence assisting in the treatment of inflammatory diseases. This review specifically examines several sources of AIPs including peptides that contain numerous cysteines and methionine. In addition, the biological characteristics of these amino acids and advancements in peptide delivery are also discussed.

The Multifaceted Effects of Non-Steroidal and Non-Opioid Anti-Inflammatory and Analgesic Drugs on Platelets: Current Knowledge, Limitations, and Future Perspectives.

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely utilized pharmaceuticals worldwide. Besides their recognized anti-inflammatory effects, these drugs exhibit various other pleiotropic effects in several cells, including platelets. Within this article, the multifaceted properties of NSAIDs on platelet functions, activation and viability, as well as their interaction(s) with established antiplatelet medications, by hindering several platelet agonists' pathways and receptors, are thoroughly reviewed. The efficacy and safety of NSAIDs as adjunctive therapies for conditions involving inflammation and platelet activation are also discussed. Emphasis is given to the antiplatelet potential of commonly administered NSAIDs medications, such as ibuprofen, diclofenac, naproxen and ketoprofen, alongside non-opioid analgesic and antipyretic medications like paracetamol. This article delves into their mechanisms of action against different pathways of platelet activation, aggregation and overall platelet functions, highlighting additional health-promoting properties of these anti-inflammatory and analgesic agents, without neglecting the induced by these drugs' side-effects on platelets' functionality and thrombocytopenia. Environmental issues emerging from the ever-increased subscription of these drugs are also discussed, along with the need for novel water treatment methodologies for their appropriate elimination from water and wastewater samples. Despite being efficiently eliminated during wastewater treatment processes on occasion, NSAIDs remain prevalent and are found at significant concentrations in water bodies that receive effluents from wastewater treatment plants (WWTPs), since there is no one-size-fits-all solution for removing all contaminants from wastewater, depending on the specific characteristics of the wastewater. Several novel methods have been studied, with adsorption being proposed as a cost-effective and environmentally friendly method for wastewater purification from such drugs. This article also presents limitations and future prospects regarding the observed antiplatelet effects of NSAIDs, as well as the potential of novel derivatives of these compounds, with benefits in other important platelet functions.

Exercise as an anti-inflammatory Therapy in Axial Spondyloarthritis Therapeutic Intervention (EXTASI study): a randomised control trial

Abstract Objectives Axial Spondyloarthritis (AxSpA) is a chronic inflammatory disease, yet despite known anti-inflammatory effects of exercise, the effect of exercise on inflammatory immune cell populations and associated inflammatory profiles in AxSpA is unknown. This randomised-control trial investigated the effect of 12-weeks of walking on symptom severity, cardiometabolic health, inflammatory biomarkers, and immune cell populations. Methods Twenty people (60% male) living with AxSpA who were on stable dose non-steroidal anti-inflammatory (NSAIDs) medication participated. Participants were randomly assigned to control or exercise (30 min of walking five x per week). Participants were invited back every four-weeks for assessment. Results There was a 0% drop out and no adverse events in the exercise group showing walking exercise was well tolerated. Home-based walking for 12-weeks lowered the proportion of pro-inflammatory monocytes, whereas they increased in the control group. Changes were associated with lower interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations, lower spinal pain, and lower systolic blood pressure in the exercise group, whereas these markers increased in the control group. Reductions in IL-6 and pro-inflammatory monocytes with exercise were independent of lower body fat percentage. Conclusion Supplementing NSAID therapy with walking exercise can improve inflammatory immune profiles in people with AxSpA coinciding with reductions in spinal pain. Importantly, the exercise was well tolerated, suggesting walking exercise can be used as an adjuvant anti-inflammatory therapy for NSAID treatments. This should now be explored in people living with AxSpA who have had high enough disease activity to necessitate the prescription of biologic or synthetic DMARD treatments. Clinical trials registration ClinicalTrials.Gov, NCT04368494

The antidepressant efficacy of flurbiprofen in mice: Behavioural assessment

Flurbiprofen is a nonsteroidal anti-inflammatory medication (NSAID). The psychological effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is a source of contention based on clinical and experimental evidence. As a result, the goal of our study was to assess the antidepressant effects of various flurbiprofen doses in mice. We evaluated the effect of oral administration of flurbiprofen at 10, 20, and 40 mg/kg in the tail suspension and forced swimming tests after 1 h of treatment. Fluoxetine (10 mg/kg, i.p.) was used as a positive control. Flurbiprofen at 40 mg/kg showed a significant antidepressant effect, which was revealed by a significant decrease in immobility time compared with the control group, with the group administered flurbiprofen at 10 mg/kg, and with the group given flurbiprofen at 20 mg/kg in the tail suspension test. Flurbiprofen at 40 mg/kg showed an antidepressant effect, which was revealed by a significant decrease in immobility time compared with the control group and with the group given flurbiprofen at 10 mg/kg. Flurbiprofen at 20 mg/kg had a minimal antidepressant effect in the swimming forced test, which was reflected by a non-significant decrease in immobility time compared with the control group. In conclusion, our results showed that relatively high therapeutic doses of flurbiprofen might have an antidepressant effect in a mouse model, and we recommended conducting other in vivo studies to clarify the variation in dose response.

P075 What has parenteral iron got to do with rheumatology?

Abstract Background/Aims A 39 year-old female had been experiencing a six-month history of insidious onset migratory joint and bone pain, stiffness, malaise and over the last four months proximal muscle weakness. There had been partial relief with the use of non-steroidal anti-inflammatory medication. Past medical history included severe menorrhagia secondary to fibroids with a haemoglobin of 50g/dl on a handful of occasions, requiring x3 iron infusions (Ferric Carboxymaltose (FCM)1000mg) over a two year period. The last two infusions were provided three months apart. After each infusion, profound fatigue ensued. A blood test demonstrated an elevated ALP 301 (RR 30-130 U/L), reduced phosphate 0.48 (RR 0.8-1.5mmol/L) and mildly reduced 25OH vitamin D 44 (RR 50-140nmol/L). Corrected calcium was low-normal 2.29 (RR 2.2-2.6mmol/L) as was PTH 4.62 (RR 1.6-6.9pmol/L). A CTCAP excluded malignancy. Methods The patient had been treated with Cholecalciferol 1000iu and Dipyridamole 100mg daily with weekly blood test monitoring for six weeks prior to review in the metabolic bone clinic. Dipyridamole aided biochemical and symptomatic improvement. Further tests returned with an elevated FGF23 252 (RR 0-100 RU/ml), a normal Urine phosphate/Creatinine 1.6 and TmP/GFR ratio (suggesting the FGF23 effect on the kidney was not severe or its effects inhibited by Dipyridamole). ALP had reduced slightly to 269, PTH was elevated at 10.81 (RR 1.95-8.49micromol/L) and 1,25 Dihydroxy Vit D 182 (RR43-144 pmol/L). Results The patient was diagnosed with Parenteral iron triggered hypophosphatemia osteomalacia (6H-syndrome). A delayed diagnosis and referral resulted from unfamiliarity of side-effects of parenteral iron, especially Ferric Carboxymaltose, which has an alert on the GOV.UK website. The patient discontinued IV iron and was placed on oral Ferrous Gluconate 300mg daily. In retrospect, bone and joint pain was likely the result of enthesial pain and pseudofractures. In patients with diagnostic uncertainty, an isotope bone scan would be beneficial in assessing the extent of such pseudofractures. Hypophosphatemia is common following FCM (≥1/100 to < 1/10), and often self-limiting and asymptomatic. However, sustained hypophosphatemia (from recurrent infusions) can result in osteomalacia. Both anaemia and certain iron preparations can cause an elevation in FGF23 leading to increased urinary phosphate excretion. Dipyridamole has anti-phosphaturic effects by inhibiting FGF23. Conclusion It is advised in such patients to monitor serum phosphate levels at two- and five-weeks post infusion and to re-evaluate therapy with FCM in patients with persistent hypophosphatemia. It is common for symptoms, imaging, and biochemistry (FGF23 and ALP) to remain elevated/positive several months after diagnosis. This case highlights the need to ask about iron infusions in the drug history in patients presenting with hypophosphatemia and to be aware that musculoskeletal pain following iron infusions can be a sign of osteomalacia which will need investigating. Rarely, proximal muscle weakness can occur following the above iron preparation. Disclosure K.M. Achilleos: None. V. Rajagopal: None. C. Adams: None. G. Clunie: None.

Identifying Vulnerabilities to NSAID Adverse Events in the U.S. Population: An Analysis of Preexisting Conditions and Sex.

Purpose: In 2005, the Food and Drug Administration (FDA) issued a decision memorandum regarding nonsteroidal anti-inflammatory drugs (NSAIDs). The memorandum recommended the withdrawal of certain NSAIDs due to potential cardiovascular adverse effects. It highlighted the issue of cardiovascular risk associated with NSAIDs as a class. The NSAID medication guide includes a wide range of adverse drug reactions (ADRs), such as increased blood pressure, liver failure, allergic reactions, heart attack, and intestinal bleeding. Although both sexes have an increased risk of ADRs with NSAID use, females have a greater risk than males due to differences in pharmacodynamics and higher medication concentrations (mg/kg). In particular, females with high blood pressure, coronary heart, kidney, and liver disease are at an additional risk of harm from NSAID ADRs. This study quantifies sex-specific differences and other factors associated with prescription NSAID use. Method: The data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES), a complex survey conducted by the Centers for Disease Control and Prevention (CDC) in two-year cycles. A survey-weighted logistic regression model was utilized to investigate potential sex differences with prescription NSAIDs in the context of other factors, including kidney disease, hypertension, liver disease, insurance status, coronary heart disease, and age, within the 2011-2018 NHANES survey data. Results: Females reported a slightly higher percentage of high blood pressure and kidney disease than males, while males reported a slightly higher percentage of coronary heart and liver disease than females. Last, the model indicated that females were 58% more likely to have used a prescription NSAID than males. Conclusion: The results confirm that women and people with medical conditions, who would potentially suffer greater harm from NSAID ADRs, are more likely to use a prescription NSAID than individuals without these conditions.

Comparison of First Analgesic Demand in Post-Operative Period Among Diclofenac Group Versus Paracetamol Group

Background: Pain after major surgery causes delays in patients' postoperative recovery, extended hospitalization periods, excessive use of analgesics, and is extremely stressful for both surgery and anesthesia. Preemptive analgesia is a treatment that begins before surgery to prevent the development of central sensitization caused by incisional and inflammatory damage that occur during surgery and in the early postoperative period. Opioids and nonsteroidal anti-inflammatory medications (NSAIDs) are commonly used for this purpose. Diclofenac sodium is a typical, inexpensive NSAIDS. Preemptive analgesia can reduce the severity and duration of pain while also delaying it. Objectives: The aim of the study was to evaluate the Comparison of first analgesic demand in post-operative period among Diclofenac group versus Paracetamol group. Methods: This randomized controlled trial study was carried out in the Department of Anaesthesiology & ICU Bangladesh Medical College Hospital Dhaka, Bangladesh during 18th January 2020 to 17th July 2020. A total of 50 patients were participated in the study. Sample was selected by random sampling in two groups distributed as- group A (Oral diclofenac sodium), group B (Oral paracetamol). Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The majority of patients (63.0%) were between 40 and 59 years old, with a mean age of 48.3 ± 11.2 years. In groups A (58%) and B (56%), nearly two-thirds of the patients had an ASA grade of one. There was no statistically significant difference between the two groups (p>0.05). At baseline, no significant change in heart rate, SBP, or DBP was seen across groups. The postoperative heart rate and other haemodynamic state were assessed at two, six-, and twelve-hours following surgery. Conclusion: Preemptive oral Diclofenac sodium had significant effect on reducing postoperative pain and postoperative .......

Effect of NSAIDs in the Tooth Movement in Orthodontic Treatment

Background: Patients undergoing tooth movement in orthodontics often utilize non-steroidal anti-inflammatory medications (NSAIDs) to alleviate inflammation and discomfort. On the other hand, the orthodontic profession is still debating whether or not NSAIDs slow down or hinder tooth mobility. Materials and Methods: About 60 mouths that needed their teeth moved participated in a randomized controlled experiment. There were two groups of patients: Group A received NSAIDs (ibuprofen, 400 mg), while group B received a placebo. Tooth movement was measured using digital calipers at baseline and then at intervals of 4 weeks over a period of 12 weeks. Results: The mean rate of tooth movement in group A was 1.5 ± 0.3 mm per month, whereas in group B it was 1.8 ± 0.4 mm per month. Analysis of variance (ANOVA) showed a statistically significant difference (p < 0.05) in the rate of tooth movement between the two groups, with group B demonstrating faster tooth movement compared to group A. Conclusion: The administration of NSAIDs during orthodontic treatment appears to have a modest but statistically significant inhibitory effect on the rate of tooth movement. Clinicians should consider the potential impact of NSAIDs on treatment outcomes when managing pain and inflammation in orthodontic patients.

Potential of Cytokines in the Management of Intervertebral Disc Degeneration

The illness known as intervertebral disc degeneration (IDD) is characterized by discomfort in the intervertebral discs. The IDD is made up of the annulus fibrosus (AF) and nucleus pulposus (NP), which function as a joint and cushion for the spine. IDD can develop with ageing, which can cause the NP to herniate and cause pain. IDD patients experience detrimental effects on their quality of life and mental health in addition to their physical health. It also poses a critical economic burden on society as a whole. Imaging techniques used for the diagnosis are disc herniation, X-ray plain film, CT, and MRI are discussed as imaging modalities, with MRI being particularly useful for diagnosing disc herniation. Treatment approaches range from conservative methods to surgical intervention, related to the type of IDD. Nonsteroidal anti-inflammatory medications, rest, traction therapy, and physical therapy are examples of non-surgical therapies. Options for surgery include conventional open surgery, microsurgical lumbar discectomy, minimally invasive IVD removal surgery, and artificial IVD replacement surgery. Many studies are focused on the role of cytokines to explain the cause of IDD. And these cytokines can be classified as cell cycle inhibitor, proinflammatory factor and growth factor. The article highlights cell cycle inhibitors (p16INK4a and p53), proinflammatory factors (IL-1β and TNF-α), and growth factor (TGF-β) involvement in IDD. However, currently, there are no cytokine-based treatments available for IDD in clinical practice. Future research could focus on developing new treatment or prevention targets for IL-1β or TNF-α.

Assessing Blood-Brain Barrier Function in the Context of Pain Management.

One essential component of the neurovascular system is known as the blood-brain barrier (BBB). This highly effective biological barrier plays a pivotal role in regulating the brain's internal microenvironment and carefully controlling the passage of various chemicals into and out of the brain. Notably, it serves as a safeguard for the brain, particularly when it comes to the selective transportation of drugs like opioids and non-steroidal anti-inflammatory medications (NSAIDs), which are commonly used in the management of chronic pain. It's important to note that during the development of chronic pain, the activation of microglia and astrocytes can potentially disrupt or damage the integrity of the BBB. In this comprehensive review, we aim to delve into the intricate interplay between the blood-brain barrier and the transportation of pain-relieving drugs, shedding light on the challenges and mechanisms involved in this process.

Abstract A108: Aspirin and non-steroidal anti-inflammatory medication and survival following an ovarian cancer diagnosis: A Norwegian nationwide registry-based cohort study

Abstract A108: Aspirin and non-steroidal anti-inflammatory medication and survival following an ovarian cancer diagnosis: A Norwegian nationwide registry-based cohort study

A Patent Review on Cardiotoxicity of Anticancerous Drugs.

Chemotherapy-induced cardiotoxicity is an increasing concern and it is critical to avoid heart dysfunction induced by medications used in various cancers. Dysregulated cardiomyocyte homeostasis is a critical phenomenon of drug-induced cardiotoxicity, which hinders the cardiac tissue's natural physiological function. Drug-induced cardiotoxicity is responsible for various heart disorders such as myocardial infarction, myocardial hypertrophy, and arrhythmia, among others. Chronic cardiac stress due to drug toxicity restricts the usage of cancer medications. Anticancer medications can cause a variety of adverse effects, especially cardiovascular toxicity. This review is focused on anticancerous drugs anthracyclines, trastuzumab, nonsteroidal anti-inflammatory medications (NSAIDs), and immune checkpoint inhibitors (ICI) and associated pathways attributed to the drug-induced cardiotoxicity. Several factors responsible for enhanced cardiotoxicity are age, gender specificity, diseased conditions, and therapy are also discussed. The review also highlighted the patents assigned for different methodologies involved in the assessment and reducing cardiotoxicity. Recent advancements where the usage of trastuzumab and bevacizumab have caused cardiac dysfunction and their effects alone or in combination on cardiac cells are explained. Extensive research on patents associated with protection against cardiotoxicity has shown that chemicals like bis(dioxopiperazine)s and manganese compounds were cardioprotective when combined with other selected anticancerous drugs. Numerous patents are associated with drug-induced toxicity, prevention, and diagnosis, that may aid in understanding the current issues and developing novel therapies with safer cardiovascular outcomes. Also, the advancements in technology and research going on are yet to be explored to overcome the present issue of cardiotoxicity with the development of new drug formulations.

Coccydynia: Do Corticosteroid Injections Hit the Mark Over NSAIDs?

Objective: Coccydynia is a medical ailment that causes discomfort at the coccyx, or tailbone, which can make it difficult for a person to go about their regular business. Nonsteroidal anti-inflammatory medications taken orally, and corticosteroid injections are two potential treatments for Coccydynia. However, the most effective and appropriate course of treatment for this condition must be identified. The study aimed to compare the effectiveness of Corticosteroid Injection vs. NSAID for pain relief in Coccydynia patients. Materials & Methods: A total of 47 patients with idiopathic coccydynia were allocated to receive either oral NSAIDs plus a tailbone cushion (n=24) or fluoroscopic corticosteroid injection (n=23). Pain levels were measured by a visual analog scale at baseline and 2-, 3-, and 4-months post-treatment. Chi-square and t-tests were used to compare treatment efficacy. Results: The two treatment groups showed no significant differences. Both groups demonstrated reduced pain over time, with no significant difference between injections and NSAIDs (p=0.209). While injections provided more relief for mild pain, NSAIDs showed better results for no-pain patients. Overall mean pain scores were similar between groups. The treatments differed in effectiveness for certain pain levels but exhibited comparable efficacy in reducing overall coccyx pain. The hypothesis of differing treatment efficacy was not supported. Conclusion: As a result, it can be considered a viable alternative therapy for patients who have difficulty adhering to oral medication regimens due to its one-time administration and affordable cost. To achieve optimal therapeutic outcomes, it is critical to choose the appropriate patients.

Intermittent Topical Bevacizumab for Treatment of Pediatric Corneal Neovascularization after Keratitis

Introduction : Corneal neovascularization imposes pediatric patients to risk of amblyopia. Current treatment of corneal neovascularization consists of topical steroids, nonsteroidal anti-inflammatory medications, immunomodulatory agents, anti-Vascular Endothelial Growth Factor (anti-VEGF) and few surgical procedures. Anti-VEGF shows promising results in treating corneal neovascularization but is difficultto obtain in developing countries such as Indonesia. We report intermittent topical use of Bevacizumab as antiVEGF in a child experiencing corneal neovascularization in the settings of limited antiVEGF availability.
 Case Illustration : A 5-year-old girl presented with corneal neovascularization after keratitis. Topical fluorometholone 4 times a day for 3 weeks was given with no clinical improvement. An intermittent topical Bevacizumab was started, each episode of treatment lasted 4 days. Corneal neovascularization regressed after 1 episode of treatment and thus continued until a total of 2 treatment episodes. She improved clinically on treatment, with some residual corneal scarring. Visual acuity improved from logMar 0.5 to logMar 0.2 following treatment.
 Discussion : Bevacizumab regresses corneal neovascularization by inhibiting proangiogenic factor VEGF which is upregulated in neovascularization. Topical Bevacizumab ability to penetrate cornea was contributed by defective corneal epithelial overlying neovascularization. Long-term use of antiVEGF may hinder VEGF beneficial role on wound recovery and trigger unwanted side effects.
 Conclusion : Intermittent short-term use of topical bevacizumab may be effective to treat corneal neovascularization during acute period in pediatric patient and is safely tolera

A STUDY OF DRUG UTILIZATION PATTERN OF ANALGESICS IN POST-OPERATIVE PATIENTS IN A TERTIARY CARE HOSPITAL

Objectives: The objective of the study was to evaluate the utilization pattern of analgesic use in post-operative wards of different surgical specialties. Methods: The study was observational and retrospective conducted, for 4 months from November 2022 to February 2023 in Tezpur Medical College, Assam and data were collected from 80 patients’ case sheets regarding analgesics prescribed during post-operative days, their route of administration, mono/combined therapy. Results: Non-steroidal anti-inflammatory medications (NSAIDs) as diclofenac (55.5%) and paracetamol (32.5%) were commonly prescribed for relief, both in monotherapy and combination therapy. Tramadol, an opioid was also used for severe pain relief and then shifted to NSAIDs. All patients were prescribed injectable analgesics on the day of surgery and the 1st post-operative day. Combination of aceclofenac + paracetamol (7.70%) was the most prescribed oral analgesic followed by tramadol + paracetamol (3.50%), mostly prescribed as brand names. Conclusion: Diclofenac was the most used NSAID in post-operative pain both in mono and combined therapy and the prescribing pattern was not rational related to more use of brand names.

(217) Revitalizing Penile Health: Advanced Surgical Approach for Treating Penile Mass Formation Resulting from Neglected Fractures, Enhanced with Pericardial Graft Reinforcement

Abstract Introduction Penile fractures are rare but serious emergencies caused by the rupture of the tunica albuginea during sexual activity. Prompt medical attention is crucial to prevent complications like erectile dysfunction, penile curvature, and hematoma. Delayed reporting due to embarrassment or fear can lead to further complications. Diagnosing penile fractures primarily relies on clinical examination, and treatment options depend on the timing of presentation. Seeking immediate medical help is vital to prevent long-term complications and ensure proper management. Objective To emphasize the importance of early medical attention and surgical intervention in the context of penile fractures, with the aim of preventing or reducing the occurrence of long-term complications. Methods This case report involves a 55-year-old male who experienced a penile fracture during intercourse. Initially, he had no hematoma, bruising, pain, or loss of erection. Two weeks later, he sought medical advice due to a penile bump and slightly painful erections. He was managed conservatively with ice, nonsteroidal anti-inflammatory medications, and abstinence from intercourse. Two months later, he presented to our clinic with complaints of a penile mass and curvature, affecting his erections and penetration. A penile Doppler ultrasound revealed a fibrotic hematoma with a complex cystic lesion measuring 23.1 mm × 18.1 mm × 28.3 mm on the right lateral mid-penile shaft. The patient underwent complex penile mass excision, tunica albuginea plication, and pericardium graft reinforcement. During the surgery, scar tissue and underlying fibrotic hematoma were removed (Figure 1). A complex cystic lesion on the right lateral mid-penile shaft was also excised (Figure 2). A tunica albuginea plication corrected the 30° left dorsal curvature. A pericardium graft (Tutoplast®, IOP Ophthalmics, Costa Mesa, CA, USA) reinforced the weakened tunica albuginea and covered the defect (Figure 3). Histopathology of the mass reported “a penile fibrotic mass, measuring 2 cm × 1.8 cm × 2.6 cm with an irregular dark brown firm cystic structure filled with yellow-tan necrotic tissue.” Microscopic description showed “a fibrous capsule with central hemorrhage and fibrin.” Results The patient had a successful procedure and smooth recovery. At 6- and 9-month follow-up, he expressed satisfaction with no complications or long-term side effects. Erectile function was restored, and penile curvature resolved, enabling satisfactory penetrative intercourse. Surgical treatment is recommended for achieving satisfactory results and restoring sexual function in penile fractures. Various graft materials can be used to reinforce penile defects. Tutoplast® (processed allograft tissue from cadaveric pericardium) has shown excellent results in Peyronie's curvature repair, but the efficacy of bovine pericardium remains uncertain. In this case, Tutoplast® was chosen for its accessibility and the surgeons' expertise in Peyronie's repair and penile prosthesis implantation, ensuring the best possible outcome. Conclusions This case report highlights fibrotic hematoma due to delayed penile fracture presentation, managed through mass excision and curvature correction. Currently, there is no literature available that discusses fibrotic hematoma formation from delayed penile fractures. Prompt medical attention crucial to avoid long-term complications. Early surgical management prevents erection loss, curvature, hematoma, or mass formation, improving quality of life for patients with penile fractures. Disclosure No.

Effect of Nonsteroidal Anti-inflammatory Drug (NSAID) in Disease Relapse, Progression, and Development of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis investigated the association between nonsteroidal anti-inflammatory drugs (NSAIDs) and inflammatory bowel disease (IBD). Pooled analysis showed no significant association in disease relapse (OR 0.97; 95% CI 0.70–1.35; p = 0.86) and disease worsening (OR 2.06; 95% CI 0.92–4.57; p = 0.08) of existing IBD in patients receiving NSAID. In patients without prior IBD diagnosis, NSAID medication was significantly associated with risk of new-onset IBD (OR 1.51; 95% CI 1.19–1.92; p = 0.0008). Given the varied effects of NSAIDs on IBD, careful management and consideration of dosage and frequency are essential in IBD patients. Despite these insights, the heterogeneity of study designs and small sample sizes in some cases call for further large-scale research to validate these findings.

Reviving Intervertebral Discs: Treating Degeneration Using Advanced Delivery Systems.

Intervertebral disc degeneration (IVDD) is commonly associated with many spinal problems, such as low back pain, and significantly impacts a patient's quality of life. However, current treatments for IVDD, which include conservative and surgical methods, are limited in their ability to fully address degeneration. To combat IVDD, delivery-system-based therapy has received extensive attention from researchers. These delivery systems can effectively deliver therapeutic agents for IVDD, overcoming the limitations of these agents, reducing leakage and increasing local concentration to inhibit IVDD or promote intervertebral disc (IVD) regeneration. This review first briefly introduces the structure and function of the IVD, and the related pathophysiology of IVDD. Subsequently, the roles of drug-based and bioactive-substance-based delivery systems in IVDD are highlighted. The former includes natural source drugs, nonsteroidal anti-inflammatory drugs, steroid medications, and other small molecular drugs. The latter includes chemokines, growth factors, interleukin, and platelet-rich plasma. Additionally, gene-based and cell-based delivery systems are briefly involved. Finally, the limitations and future development of the combination of therapeutic agents and delivery systems in the treatment of IVDD are discussed, providing insights for future research.

Polypharmacy, Potentially Inappropriate Medications, and Dysphagia in Older Inpatients: A Multi-Center Cohort Study.

Although the relationship between medication status, symptomatology, and outcomes has been evaluated, data on the prevalence of polypharmacy and potentially inappropriate medications (PIMs) and the association of polypharmacy and PIMs with swallowing function during follow-up are limited among hospitalized patients aged ≥65 years with dysphagia. In this 19-center cohort study, we registered 467 inpatients aged ≥65 years and evaluated those with the Food Intake LEVEL Scale (FILS) scores ≤8 between November 2019 and March 2021. Polypharmacy was defined as prescribing ≥5 medications and PIMs were identified based on the 2023 Updated Beers Criteria. We applied a generalized linear regression model to examine the association of polypharmacy and PIMs with FILS score at discharge. We analyzed 399 participants (median age, 83.0 years; males, 49.8%). The median follow-up was 51.0 days (interquartile range, 22.0-84.0 days). Polypharmacy and PIMs were present in 67.7% of and 56.1% of patients, respectively. After adjusting for covariates, neither polypharmacy (β = 0.05; 95% confidence interval [CI], -0.04-0.13, p=0.30) nor non-steroidal anti-inflammatory medications (β = 0.09; 95% CI, -0.02-0.19; p=0.10) were significantly associated with FILS score at discharge. The results of this study indicated a high proportion of polypharmacy and PIMs among inpatients aged ≥65 years with dysphagia. Although these prescribed conditions were not significantly associated with swallowing function at discharge, our findings suggest the importance of regularly reviewing medications to ensure the appropriateness of prescriptions when managing older inpatients.

Long-Acting Reversible Etonogestrel Subdermal Implant in Adolescents.

Several effective contraceptive options are available for use by adolescents, including the long-acting reversible subdermal implant and intrauterine devices, which provide a high level of convenience, privacy, and effectiveness for an adolescent. Knowledge of all the effective birth control methods is essential for the pediatrician to be able to provide effective contraceptive counseling for an adolescent. An approach to counseling using a reproductive justice framework, which allows the provider and adolescent patient to engage in shared decision-making, is described. This article focuses on the long-acting reversible etonogestrel (ENG) subdermal implant for adolescents. The ENG implant is labeled for preventing pregnancy by suppressing ovulation. The ENG implant may also have a role in ameliorating dysmenorrhea and heavy menstrual bleeding. Postlabeling studies indicate that the ENG implant is effective for up to 5 years, although the device's labeling states effectivenessup to 3 years. The main contraindication to using the ENG implant is pregnancy itself. Safe initiation of the ENG implant is described, including an approach to determine whether an adolescent is pregnant. The main adverse effect of the ENG implant is an unpredictable bleeding pattern that is most often ameliorated by use of nonsteroidal anti-inflammatory medications, as well as estrogen, if not contraindicated for the patient. Details of the insertion and removal procedures, including potential complications, are described to enable the pediatrician to provide effective anticipatory guidance for the adolescent.