Nonsteroidal Anti-inflammatory Drugs Group Research Articles

Associations between the use of common nonsteroidal anti-inflammatory drugs, genetic susceptibility and dementia in participants with chronic pain: A prospective study based on 194,758 participants from the UK Biobank

ObjectiveTo investigate the potential relationship between common nonsteroidal anti-inflammatory drugs (NSAIDs), genetic susceptibility and all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VD) among individuals experiencing chronic pain. MethodsThis study was based on 194,758 chronic pain participants form UK biobank with a median follow-up of 13.7 years. Participants were categorized into different NSAIDs painkiller regimen groups: No NSAIDs group, Aspirin group, Ibuprofen group, Paracetamol group, and 2–3 NSAIDs group. Cox proportional risk models were used to examine the correlation between regular NSAIDs usage and the risk of ACD, AD, and VD. In addition, we further performed subgroup analyses and sensitivity analyses. Results1) Compared to the No NSAIDs group, the aspirin group (HR = 1.12, 95% CI:1.01–1.24, P < 0.05), the paracetamol group (HR = 1.15, 95% CI:1.05–1.27, P < 0.01), and the 2–3 NSAIDs group (HR = 1.2, 95% CI:1.08–1.33, P < 0.05) showed a higher risk of ACD. Furthermore, the 2–3 NSAIDs group was also associated with a higher risk of VD (HR = 1.39, 95% CI: 1.08–1.33, P < 0.05). 2) At high dementia GRS participants with chronic pain, the paracetamol group (HR = 1.2, 95% CI: 1.03–1.43, P < 0.05) and the NSAIDs group (HR = 1.3, 95% CI: 1.07–1.59, P < 0.05) were associated with a higher risk of ACD compared to the no painkiller group. 3) There was no significant association between ibuprofen use and higher risk of dementia. ConclusionIn individuals with chronic pain, the use of aspirin and paracetamol was associated with a higher risk of ACD, whereas the use of ibuprofen was not significantly associated with a higher risk of ACD.

Drug-drug salts of Naftopidil with non-steroidal anti-inflammatory drugs for potential multi-drug therapy

Drug-drug cocrystals (DDCs) are a subclass of pharmaceutical cocrystals in which both the components of a cocrystal are active drugs. DDCs are the recent advancement based on the crystal engineering approach to overcome the problems associated with conventional combination therapy. They also allow the modulation of the physicochemical properties of parent drugs. Four new drug-drug salts of Naftopidil (NFPD), a BCS class IV anti-cancer drug, were prepared by liquid-assisted grinding and solvent evaporation technique, with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Aspirin (ASP), Tolfenamic acid (TFA), Mefenamic acid (MFA) and Niflumic acid (NIFA) as coformers. The solids obtained were characterized by Single Crystal X-Ray diffraction (SCXRD), Powder X-ray Diffraction (PXRD), Thermo Gravimetric Analysis (TGA) and Differential Scanning Calorimetry (DSC). Furthermore, the solubility of NFPD in the solids was determined by the shake flask method. SCXRD analysis showed that O–H···N hydrogen bond interactions found in the pure NFPD crystal structure are replaced by the N+–H···O- and O–H···O hydrogen bond interactions in the drug-drug solids. Additionally, the transfer of a proton from the carboxylic group of NSAIDs to piperazine nitrogen of NFPD is observed in all the drug-drug crystal structures, which suggests the nature of the solids as salts. NFPD-ASP salt exhibited improved solubility (33.2 µg/ml), which is eight-fold higher than the pure NFPD solubility (4.3 µg/ml). NFPD-MFA (0.6 µg/ml), NFPD-TFA (0.17 µg/ml), and NFPD-NIFA (1.35 µg/ml) showed reduced solubility than the pure NFPD. We anticipate that the current research will provide an alternate strategy to overcome the solubility issue of NFPD and provide potential candidates for designing combination therapy to treat complications in Benign Prostatic Hypertrophy (BPH), which involves pain and inflammation.

Postoperative NSAIDs use and the risk of anastomotic leakage after restorative resection for colorectal cancer.

Although non-steroidal anti-inflammatory drugs (NSAIDs) are useful options for multimodal opioid-sparing analgesia, their effect on anastomotic leakage (AL) after colorectal surgery remains unclear. We aimed to investigate the association between early postoperative NSAID use and AL occurrence in patients who underwent colorectal cancer surgery at a high-volume tertiary care center. This retrospective observational study included all adult patients who underwent elective colorectal cancer resection surgery during 2011-2021at a tertiary teaching hospital. Based on NSAID use within five postoperative days, patients were classified into either NSAID or no NSAID groups. We performed multivariable logistic regression analysis for the primary outcome, AL, within the first 30 postoperative days, before and after propensity score analysis using stabilized inverse probability of treatment weighting (sIPTW). Among the 7928 patients analyzed, 0.6% experienced AL after surgery. The occurrence rates of AL were 1.7% (12/714) and 0.5% (37/7214) in the NSAID and no NSAID groups, respectively. Multivariable logistic regression analysis revealed that early postoperative NSAID use was significantly associated with AL [odds ratio (OR), 3.41; 95% confidence interval (CI), 1.76-6.60; P<0.001]. Significance was maintained after sIPTW (OR, 3.65; 95% CI, 1.86-6.72; P<0.001). Early postoperative NSAID use was significantly associated with AL in patients undergoing colorectal cancer surgery at a high-volume tertiary care center. Further prospective studies are required to investigate NSAIDs' clinically meaningful unfavorable effects following colorectal cancer surgery.

Under what conditions is the intra-articular steroid injection superior to nonsteroidal anti-inflammatory drugs for treating sacroiliac joint pain?

The purpose of this prospective study was to determine the conditions under which intra-articular injection therapy may be superior to nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with sacroiliac joint pain in the outpatient setting at our hospital. Patients with sacroiliac pain were divided into two groups: NSAID and the sacroiliac injection group. The NSAID group received 25 mg of indometacin orally once a day and 750 mg of naproxen orally once a day. In the sacroiliac injection group, 5 mg of betamethasone were injected into the sacroiliac joint. The patients' history of lumbar surgery, whether they had sacroiliitis, and the duration of pain were recorded. The patients' VAS (Visual analogue scale) scores at week 1 and month 1 were evaluated. VAS scores were decreased after the first week and first month in the sacroiliac injection group compared to the NSAID group (p<0.001). Sacroiliac steroid injection was found to be superior to NSAIDs in reducing VAS scores in patients with sacroiliitis, a history of lumbar surgery, and pain lasting more than 30 days (p<0.001). In patients without sacroiliitis, without a history of lumbar surgery, and with less than 30 days of pain, no difference was observed between the groups in reducing VAS scores at the end of the first month. In patients with sacroiliac joint pain, sacroiliac joint injection is superior to NSAIDs in pain relief in patients with pain for more than 30 days, those with MRI-diagnosed sacroiliitis, and those who have undergone lumbar surgery.

Synthesis and pharmacological characterization of new curcumin ester pro-drugs with enhanced anti-inflammatory, anti-ulcerogenic and improved tissue distribution

In this work, curcumin- Non steroidal anti-inflammatory drugs (NSAIDs) conjugates were synthesized by esterification of the phenolic group of curcumin with the acid group of NSAIDs using the Steglich esterification method to enhance the anti-inflammatory activity of curcumin and to reduce the gastrointestinal side effects of NSAIDs. A set of bis C-NSAIDs conjugates was prepared by direct coupling of curcumin with Aceclofenac and Diflunisal respectively in good yield and characterized by Fourier-transform infrared spectra (FTIR) and Proton Nuclear Magnetic Resonance Spectra (1HNMR). In vivo, studies were performed to evaluate the toxicity, anti-inflammatory activity, bio-distribution, and anti-ulcerogenic studies of selected conjugates using different animal models. In Vivo, studies reveal enhanced biological activity with better tissue distribution of conjugates than that of parent curcumin and it could be a curcumin-based therapeutic molecule that might be explored further for its efficacy in managing inflammatory diseases.

Transplacental non-steroidal anti-inflammatory drugs versus expectant management in fetal Ebstein anomaly with circular shunt: Systematic review and meta-analysis.

Ebstein anomaly (EA) is a rare congenital cardiac malformation associated with high perinatal mortality. In this systematic review and meta-analysis, we aimed to investigate the outcomes of pregnancies affected by EA or tricuspid valve dysplasia (TVD) with circular shunt, focusing on two prenatal management approaches: (1) expectant management (EM) and (2) transplacental non-steroidal anti-inflammatory drugs (NSAID) therapy. We searched PubMed, Scopus, and Web of Science systematically from its inception until June 2023. The random-effect model was used to pool the data. Heterogeneity was assessed using the I2 value. Twenty-one studies with a total of 610 fetuses with EA/TVD with circular shunt were included in the synthesis, of which 17 studies (583 fetuses) were on EM and 4 studies (27 fetuses) used transplacental NSAID therapy. The NSAID group had higher rates of moderate to severe tricuspid regurgitation, hydrops, and pericardial effusion on prenatal ultrasound compared with the EM group. However, ductal constriction was achieved in 81% of NSAID cases, mitigating the disease pathophysiology, although 65% of them experienced oligohydramnios. Notably, the NSAID group showed significantly higher rates of live birth (86%) and survival to hospital discharge (89%) compared with the EM group (67% and 43%, respectively). Despite these promising results, it's important to acknowledge that the number of cases treated with NSAIDs was small, with limited safety data. Therefore, caution is advised in interpreting these findings, and patients considering NSAID therapy should be informed about these limitations. Future multicenter studies are necessary to further explore the safety and effectiveness of NSAID therapy in this particular population.

Evaluation of the efficacy and safety of various non-steroidal anti-inflammatory drugs in postmenopausal women with an inflammatory phenotype of osteoarthritis

Introduction. Non-steroidal anti-inflammatory drugs (NSAIDs) are currently the mainstay of the management for relieving pain syndrome in osteoarthritis (OA). NSAIDs are characterized by an individual reaction to medication, as well as a quite high frequency of gastrointestinal side effects. The issue of the disadvantages and advantages of a particular group of NSAIDs is still open.Aim. To evaluate the safety and efficacy of Meloxicam at a dose of 15 mg/day as compared with Nimesulide and placebo in postmenopausal women with an inflammatory phenotype of OA.Results and discussion. The frequency of all adverse events was comparable among the group of patients receiving meloxicam (40.0%), and lower than in the nimesulide group (48.0%), but higher than in the placebo group. A decrease in pain syndrome was observed as early as at 2 weeks of treatment in the group of patients receiving meloxicam. A significant decrease in WOMAC scores (overall result, pain syndrome, stiffness, function) was observed in the group of patients receiving meloxicam, and in the group of patients receiving nimesulide, after 3 weeks of treatment. meloxicam and nimesulide demonstrated high efficacy at 3 weeks compared with the initial VAS scores. The placebo group showed no efficacy.Conclusion. The frequency of all adverse events was lower while taking meloxicam as compared to nimesulide. Our results substantiate the concept to prescribe meloxicam at a dose 15 mg once daily for the treatment of pain and stiffness in post-menopausal women with OA.

Efficacy and safety of Gutong Patch compared with NSAIDs for knee osteoarthritis: A real-world multicenter, prospective cohort study in China

The Gutong Patch (GTP) is common in clinical practice for bone diseases. This study compared the efficacy and safety of GTP and nonsteroidal anti-inflammatory drugs (NSAIDs) for KOA patients from 35 medical centers assigned to GTP, selective COX-2 inhibitor (SCI), GTP + SCI, non-selective COX-2 inhibitor (NSCI), and GTP + NSCI groups. The visual analog scale (VAS) pain score, EuroQol-VAS, EuroQol 5D-3 L, time to articular pain relief / disappearance, and joint motion recovery were the efficacy assessments. Safety assessments included contact dermatitis, gastrointestinal disorders, etc. The p-value < 0.05 was considered statistically significant. After statistical analysis, the SCI and GTP + SCI groups showed better improvement of VAS than the GTP group; the time to articular pain relief in the NSCI group was shorter than that in GTP and SCI group; the time to joint motion recovery in the GTP + NSCI group was longer than that in the SCI group. Additionally, the improvement of the quality of life in all groups was significant after treatments. While the incidence of gastrointestinal adverse events in the NSAIDs group was higher than that in the GTP and GTP + NSAIDs groups. GTP and NSAIDs are effective for KOA patients, and GTP is more suitable for KOA patients with cardiovascular and gastrointestinal comorbidities. This study was approved by the Ethics Committee at Peking Union Medical College Hospital (HS-1766) and registered in the Chinese Clinical Trial Registry (ChiCTR2100046391).

THE CONCEPTS AND PROSPECTS OF NIMESULIDE INDUCED HEPATOTOXICITY

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely prescribed class of drug. The current study wascarried out to reveal the facts and prospects of Nimesulide, an over-the-counter NSAID drug. Around 57 cases ofhepatotoxicity collected from the DILI registry in Spain and Latin America were reviewed. Various causality cases wereassessed using the RUCAM scale, which revealed the mean age of 59 years of patients among the entire case series ofhepatotoxicity, out of which 86% were women, and the mean onset time of action was 40 days, while 46 patients, i.e.,81%, were also suffering from jaundice. Nimesulide-induced liver injury was found to be hepatocellular in 38 cases(67%), mixed type in 12 cases (21%), and cholestasis in 7 cases (12%). The reported incidence of NSAID-induced liverdisease in clinical trials was found to be fairly constant, ranging from 0.29 per 100,000 [95% confidence interval (CI):0.17-051] to 9 per 100,000 (95% CI: 6-15). Therefore, a higher risk of liver-related hospitalisation (32.3 per 100,000patients) was reported. The studies indicated that Nimesulide and other NSAIDs cause extensive liver damage, rangingfrom asymptomatic transient hyperaminotransducers to fulminant liver failure. However, various shortcomings inepidemiologic studies jeopardise the opportunity to determine the actual risk of hepatotoxicity. The drugs, such asBenoxaprofen and Bromfenac, have been withdrawn from the market due to their hepatotoxic behaviour. The presentreview was carried out to critically analyse the results currently available in the literature on NSAID-inducedhepatotoxicity and to create an overview of the most commonly used compounds of the NSAID groups.

Association Between Aspirin-Exacerbated Respiratory Disease and Atherosclerotic Cardiovascular Disease: A Retrospective Review of US Claims Data

Aspirin-exacerbated respiratory disease (AERD) consists of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Asthma is associated with increased risk of atherosclerotic cardiovascular diseases (ASCVD). However, there is lack of data on association between AERD and ASCVD. To investigate the relationship between AERD and subsequent risk of ASCVD. An algorithm to find patients with AERD was generated and validated through chart review at our home institution. This algorithm was applied to a national insurance claims database to obtain data for a retrospective cohort study. Demographic and comorbidity data were obtained for propensity matching. Several methods of analysis were performed on the data. A total of 571 patients met criteria for AERD; 3909 met criteria for asthma, CRSwNP, and no allergy to aspirin or NSAIDs (group 1); and 75,050 met criteria for asthma, CRS without nasal polyps, and no allergy to aspirin or NSAIDs (group 2). After covariate adjustment, AERD was significantly associated with ASCVD, including severe ASCVD, over groups 1 and 2 regardless of asthma severity. Patients with AERD are at higher risk of ASCVD than patients with asthma and CRSwNP or CRS without nasal polyps, underscoring the need for early ASCVD screening and a consideration for aspirin desensitization or use of a nonaspirin antiplatelet agent in the setting of AERD and comorbid ASCVD.

Nano crystalline cellulose based drug delivery system for some non-steroidal anti-inflammatory drugs: Synthesis, characterization and in-vitro simulation studies

Nano crystalline cellulose (NCC) created a breakthrough in biomedical field because of its important characteristics like large surface area, good mechanical strength, biocompatibility, renewability and feasibility of incorporation to both hydrophilic and hydrophobic substances. In the present study NCC based drug delivery systems (DDSs) of some non-steroidal anti-inflammatory drugs (NSAIDs) were obtained by covalent bonding between hydroxyl groups of NCC with carboxyl group of NSAIDs. Developed DDSs were characterized by means of FT-IR, XRD, SEM and thermal analysis. In-vitro release study and fluorescence study showed that these systems are stable up to 18 h in upper gastrointestinal (GI) tract at pH 1.2 and released NSAIDs in sustained manner over the period of 3 h in intestine at pH 6.8–7.4. Present study performed with the aim to reuse bio-waste even in the form of DDSs is of greater therapeutic efficacy with reduced dosing frequency that overcome physiological adversities involved with NSAIDs.

Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis

ObjectiveParacetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opiates/opioids, administered parenterally via intravenous or intramuscular route, are widely used to provide analgesia for patients with moderate to severe pain. This systematic review...

Hypersensitivity to Non-Steroidal Anti-Inflammatory Drugs on a pediatric Portuguese cohort.

Background. Non-steroidal anti-inflammatory drugs (NSAID)/analgesics (paracetamol) are among the most common causes of drug hypersensitivity reactions in children, with a reported prevalence of around 0.3% in the pediatric population. Paracetamol and ibuprofen are the most commonly reported culprits in the pediatric population. Our objective was to describe the allergy workup to NSAID/paracetamol of a pediatric population monitored in an allergy outpatient clinic. Methods. Retrospective observational study by consulting the medical records of patients evaluated in a pediatric outpatient clinic with history of NSAID/paracetamol, between January 2016 to August 2022. Results. A total of 43 patients have been evaluated for NSAID/paracetamol suspected allergy: 53.5% females, mean age of 9.8 ± 5.1 years, 47.7% atopic. The drugs reported as culprits were: ibuprofen (75.6%), paracetamol (17.8%), metamizole (4.4%) and naproxen (2.2%) and clinical manifestations were mainly urticaria/angioedema and maculopapular exanthema. Skin tests were performed in 7 patients: paracetamol (n = 5) and metamizole (n = 2), which were all negative. Fourty-six drug provocation tests were performed: 28 with the culprit drug and 18 with an alternative one; only 2 were positive (ibuprofen - culprit NSAID group): one immediate periorbital angioedema and one delayed lip edema with oropharyngeal tightness. Conclusions. The investigation of allergy to NSAID/paracetamol in children remains a challenge. In our population, ibuprofen was the most common NSAID reported. There were only 2 (4.3%) mild reactions on DPT. We could allow the use of the culprit NSAID/analgesic in 11 patients and an alternative one in 9 patients. This study highlights the importance of DPT in children for a correct diagnosis of NSAID hypersensitivity and selection of an alternative drug.

Comparison of the Effectiveness between Oral NSAIDs and Dextrose Prolotherapy in Knee Osteoarthritis

Non-steroidal anti-inflammatory drugs (NSAIDs) are the first treatment choice for pain relief in osteoarthritis (OA). However, known to have an 85% risk of side effects on the gastrointestinal and a 40% chance of cardiovascular complications. In addition, in certain classes of NSAIDs, the risk of chronic kidney disease increases due to long-term consumption. On the other hand, dextrose prolotherapy is a regenerative therapy. This study aimed to compare the effectiveness of oral NSAIDs with dextrose prolotherapy in knee OA based on clinical features. This study used an observational method (cross-sectional) conducted in three locations; Jember Clinic Hospital, Balung Hospital, and Harapan Mulya Kertonegoro Jenggawah Clinic from September 2021 to March 2022. Of the 75 population, 23 patients with mild to moderate knee OA were divided into two groups; 15 samples of dextrose prolotherapy and eight samples of oral NSAIDs. Data in the study showed the mean WOMAC score in the dextrose prolotherapy group was 12.4±11.7, while the oral NSAID group was 34.75±17.6. A total of 14 samples experienced a decrease in scores after switching from oral NSAIDs to dextrose prolotherapy. Bivariate analyses were performed using Mann-Whitney and Wilcoxon tests. Both statistical tests show a p=0.001 (p&lt;0.05). Thus, this study concluded that dextrose prolotherapy was more effective than oral NSAIDs in knee OA.

Comparative effectiveness of early initiation of oral nonsteroidal anti-inflammatory drug and oral acetaminophen therapies on the time to knee replacement in patients with knee osteoarthritis in Japan

BackgroundAlthough disease-modifying properties of nonsteroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis (OA) have been reported, the effects of NSAIDs on OA progression remain controversial. The purpose of this study was to investigate the effect of early initiation of oral NSAID therapy on the progression of knee OA.MethodsIn this retrospective cohort study, we extracted data of patients newly diagnosed with knee OA between November 2007 and October 2018 from a Japanese claims database. The primary outcome was the time to knee replacement (KR), and the secondary outcome was the time to composite event including joint lavage and debridement, osteotomy, or arthrodesis in addition to KR. Weighted Cox regression analysis with standardized mortality/morbidity ratio (SMR) weight was performed to compare the outcomes between patients prescribed oral NSAID (NSAID group) and those prescribed oral acetaminophen (APAP) (APAP group) early after a diagnosis of knee OA. Propensity scores were calculated using logistic regression conditioned on potential confounding factors, and SMR weights were calculated using the propensity scores.ResultsThe study population comprised 14,261 patients, who were divided into two groups as follows: 13,994 in the NSAID group and 267 in the APAP group. The mean ages of patients in the NSAID and APAP groups were 56.9 and 56.1 years, respectively. Furthermore, 62.01% and 68.16% patients in the NSAID and APAP groups, respectively, were female. The NSAID group had a reduced risk of KR compared with the APAP group in the analysis using SMR weighting (SMR-weighted hazard ratio, 0.19; 95% confidence interval, 0.05–0.78). While no statistically significant difference was found for the risk of composite event between the two groups (SMR-weighted hazard ratio, 0.56; 95% confidence interval, 0.16–1.91).ConclusionsThe risk of KR in the NSAID group was significantly lower than that in the APAP group after accounting for residual confounding using SMR weighting. This finding suggests that oral NSAID therapy early after the initial diagnosis is associated with a reduced risk of KR in patients with symptomatic knee OA.

Identification of some novel amide conjugates as potent and gastric sparing anti-inflammatory agents: In vitro, in vivo, in silico studies and drug safety evaluation

Today, usage of NSAIDs (nonsteroidal anti-inflammatory drugs) is very common. However, it has been proven by many studies that NSAIDs with free carboxylic acid group damage the GI (gastrointestinal) system. Our aim was to mask the acidic groups of NSAIDs to prevent or reduce their side effects while preserving their pharmacological effects. In this study, new amide derivatives of known NSAIDs, compounds 11–20, were synthesized to investigate their analgesic and anti-inflammatory effects using in vivo models. While compound 11 showed the most remarkable anti-inflammatory activity by 60.9% inhibition value at 200 mg/kg dose, compounds 11, 12, 15 and 18 had almost the same analgesic activity to that of acetylsalicylic acid (100 mg/kg) and flurbiprofen (100 mg/kg). In addition, all test compounds used at high dose (200 mg/kg, p.o) did not show any acute toxicity. COX-1 and COX-2 inhibition properties of all compounds were measured by biochemical methods and the interaction of the most active compounds with COX enzymes is elucidated by computer-assisted virtual screening methods. It was determined by in vitro enzyme inhibition studies that compound 11 and 13, synthesized from selective COX-1 inhibitors dexketoprofen and flurbiprofen, are selective COX-2 inhibitors. Moreover, compounds 11–13 were found to be non-mutagenic according to the mutagenicity assay using Salmonella TA98 and TA100 strains with and without metabolic activation. Finally, the prediction of ADMET profile and drug-likeness properties of compounds 11–20 were examined and the obtained results were evaluated.

Serious Clinical Outcomes of COVID-19 Related to Acetaminophen or NSAIDs from a Nationwide Population-Based Cohort Study

Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) have been widely prescribed to infected patients; however, the safety of them has not been investigated in patients with serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Our objective was to evaluate the association between the previous use of acetaminophen or NSAIDs and the clinical outcomes of SARS-CoV-2 infection. A nationwide population-based cohort study was conducted using the Korean Health Insurance Review and Assessment Database through propensity score matching (PSM). A total of 25,739 patients aged 20 years and older who tested for SARS-CoV-2 were included from 1 January 2015 to 15 May 2020. The primary endpoint was a positive result for a SARS-CoV-2 test, and the secondary endpoint was serious clinical outcomes of SARS-CoV-2 infection, such as conventional oxygen therapy, admission to the intensive care unit, need for invasive ventilation care, or death. Of 1058 patients, after propensity score matching, 176 acetaminophen users and 162 NSAIDs users were diagnosed with coronavirus disease 2019. After PSM, 162 paired data sets were generated, and the clinical outcomes of the acetaminophen group were not significantly different from those of the NSAIDs group. This suggests that acetaminophen and NSAIDs can be used safely to control symptoms in patients suspected of having SARS-CoV-2.

A Comparative Study between NSAID with McKenzie Exercise versus NSAID Treatment in Ankylosing Spondylitis

Background: McKenzie method of mechanical diagnosis and therapy (MDT)) is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) a system encompassing assessment, diagnosis and treatment for the spine and extremities. On the other hand, Ankylosing spondylitis (AS) is a type of arthritis that causes lower back pain, hip pain and a stiff back which causes due to overtime work, vertebrae in the spinal column. In relieving pain and inflammation in AS patients, non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the world. Aim of the Study: The aim of this study was to compare between NSAID with McKenzie exercise versus NSAID treatment in Ankylosing spondylitis. Methods: This was a comparative experimental study which was conducted in the department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, Bangladesh from October 2019 to September 2020. The study was approved by Institutional Review Board (IRB) of BSMMU. A total of 112 patients with ankylosing spondylitis were selected who were divided into two groups. 56 patients were allotted in group A (NSAID group) and another 56 were allotted in group B (NSAID with McKenzie exercise). All comparative data were analyzed and disseminated by using MS Excel and SPSS version 23.0. Results: The mean age was 28.02±5.86 years in group A whereas 28.8±5.94 years in group B and the difference was statistically not significant (p&gt;0.05). The mean VAS score at baseline was 34.44±2.78 in group A and 34.03±2.23 in group B, at 4 weeks 28.89±3.67 in group A and 21.23±3.57 in group B, at 8 weeks 30.59±3.69 in group A and 16.95±3.62 in group B and at 12 weeks 28.08±3.34 in group A and 15.04±3.77 in group B. The mean BASFI at baseline was 3.19±0.15 in group A and 3.51±0.18 in group B, at 4 weeks 2.99±0.15 in group A and 2.15±0.05 in .....

Is the use of nonsteroidal anti-inflammatories after bowel anastomosis in trauma safe?

With an increasing interest in multimodal and opioid-reducing pain strategies, nonsteroidal anti-inflammatory drugs (NSAIDs) have become common place in the care of injured patients. Long-standing concerns of increased anastomotic leak (AL) rate with the use of NSAIDs, however, have persisted. We hypothesized that there would be no significant risk associated with NSAID use after bowel anastomosis in trauma patients. All patients presenting to a level 1 trauma center who required intestinal resection and anastomosis from 2011 to 2017 were reviewed. Patients receiving NSAIDs were compared with those managed without NSAIDs. Primary outcome of interest was anastomosis-related complications (AL, intra-abdominal abscess, anastomotic bleed, fascial dehiscence, fascial dehiscence, and enterocutaneous fistula). Multivariable logistic regression analyses were performed with propensity adjustment for inverse probability of NSAID treatment weights. A total of 295 patients met the inclusion criteria with 192 receiving NSAIDs. Patients receiving NSAIDs had lower abdominal Abbreviated Injury Scale and Injury Severity Score ( p < 0.046). Arrival systolic blood pressure, diastolic blood pressure, and Glasgow Coma Scale were higher in the NSAID group ( p < 0.013). After propensity weighting, NSAID use was not a major predictor of anastomotic complication ( p = 0.39). There was an increased risk of AL with perioperative vasopressor exposure (odds ratio [OR], 3.33; 95% confidence interval [CI], 1.17-9.05; p < 0.001). Increasing red blood cell transfusions in the first 24 hours were associated with intra-abdominal complications (OR, 1.02; 95% CI, 1.00-1.04; p = 0.05). Nonsteroidal anti-inflammatory drug exposure demonstrated a weak association with AL (OR, 1.92; 95% CI, 0.97-3.90; p = 0.06). Consistent with previous studies, perioperative vasopressor exposure and increased number of red blood cell transfusions are risk factors for ALs and intra-abdominal complications, respectively. Nonsteroidal anti-inflammatory drug use in trauma patients with multiple risk factors may be associated with an increased risk of AL and should be used with caution in the setting of other established risk factors. Therapeutic/Care Management; Level III.

Comparative analysis of neurological recovery and adverse effects in chondrodystrophic dogs with thoracolumbar intervertebral disc herniation treated with methylprednisolone versus non-steroidal anti-inflammatory drugs

Thoracolumbar intervertebral disc herniation is a common neurological disease presented to the small-animal practitioner. The use of methylprednisolone sodium succinate (MPSS) as an adjunct to surgical decompression in cases of acute spinal cord injury following intervertebral disc extrusion is controversial. A prospective study was undertaken to compare the perioperative use of MPSS and non-steroidal anti-inflammatory drugs (NSAIDs) in 40 chondrodystrophic dogs presenting with similar signs and undergoing spinal decompressive surgery. Twenty dogs received MPSS and 20 had NSAIDs administered preoperatively. Dogs were administered with either MPSS intravenously 20 min before surgery (30 mg/kg) or NSAID (meloxicam 0.2 mg/kg or carprofen 4 mg/kg) subcutaneously 20 min before surgery. Dogs were evaluated by neurological examination of gait 24 h postoperatively, at time of discharge, and then at 8 weeks. The neurological recovery was similar in both groups, but the frequency of side effects such as vomiting (MPSS group: 90% vs NSAIDs group: 55%), and anorexia within the first three days (present in all 20 dogs pretreated with MPSS) was significantly different, with complications being more prevalent in the MPSS group. This study showed that side effects were significantly more evident with the MPSS treatment group than with the NSAID group, with a neurological recovery similar in both groups.