NSAID Users Research Articles

Diagnosis of cystoid macular edema by comparison of pre-operation and post-operation macular thickness calculated by optical coherence tomography (OCT) after cataract extraction surgery with and without pre-operative use of NSAIDS.

ABSTRACT… Objective: To compare mean macular thickness after cataract extraction surgery with and without pre-operative NSAIDs. Study Design: Randomized Controlled Trial. Setting: Department of Ophthalmology, Madinah Teaching Hospital, Faisalabad. Period: 21-10-2022 to 20-04-2023. Methods: Total 640 patients (320 in each group) were involved in the study. In group-A patients received one drop of NSAID three times a day for one day prior surgery. In group-B, patients not received NSAID. Results: Results showed that there was a total 395 males and 245 females. Mean age of the patients was 48.24±5.54 in group A and 47.05±5.20 in group B. Comparison of macular thickness showed that thickness was 215.69±14.20 in group A and 227.99±06.09 in group B. There was a significant difference in macular thickness of two groups (P <0.001). Conclusion: In conclusion, preoperative usage of NSAIDs revealed statistically significant (p0.001) and clinically relevant benefits in avoiding macular edoema and preserving visual acuity in patients undergoing cataract surgery as compared to the non-NSAIDs group.

The clinical significance of the Neutrophil-to-Lymphocyte Ratio as a novel inflammatory biomarker for assessing the severity of intervertebral disc degeneration.

Inflammation is integral to the pathogenesis of intervertebral disc degeneration, yet the role of systemic inflammatory markers in this process remains underexplored. This study aims to explore the association between the Neutrophil-to-Lymphocyte Ratio (NLR) and the severity of disc degeneration. A retrospective analysis was conducted on 375 patients diagnosed with lumbar disc degeneration between April 2018 and May 2021. All patients underwent a complete blood cell count examination. We applied the Pfirrmann grading system for cumulative disc grading, stratifying patients into two groups: a high-score group (cumulative grade > 17) and a low-score group (cumulative grade ≤ 17), based on the median cumulative grade. The association between the NLR and and the severity of disc degeneration was further analyzed using correlation analysis and logistic regression models. Furthermore, the predictive capacity of the NLR for lumbar disc degeneration was assessed using the Receiver Operating Characteristic (ROC) curve. We found a significant positive correlation between high NLR levels and severe disc degeneration. The high-score group exhibited a significantly higher NLR compared to the low-score group [2.63 (1.91-4.18) vs. 2.04 (1.38-2.74), respectively, p < 0.001]. Significant correlations were found between NLR and patient characteristics (including age, BMI, VAS, NSAIDs usage, hemoglobin) and the cumulative grading. Logistic regression analysis identified age and NLR as independent predictors of the severity of disc degeneration. The ROC curve analysis demonstrated a good predictive capability of NLR for lumbar disc degeneration. NLR could serve as a promising biomarker for assessing the severity of lumbar disc degeneration and offer potential benefits in both early diagnosis and treatment strategies.

Real-world impact of acupuncture on analgesics and healthcare resource utilization in breast cancer survivors with pain

BackgroundThis study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.MethodsFrom a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics), we selected 18–63 years old malignant breast cancer survivors experiencing pain and ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.ResultsAmong 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.ConclusionsAlthough adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.

The Neuroprotective Role of Indole-3-Propionic Acid in Migraine Pathophysiology.

Background and Objectives: Migraine is a leading cause of disability worldwide, with complex pathophysiological mechanisms involving oxidative and nitrosative stress. Recent research suggests that Indole-3-Propionic Acid (IPA) may have a neuroprotective role in reducing nitrosative stress. This study aims to elucidate the roles of IPA and nitrosative stress biomarkers in migraine patients, focusing on their potential as therapeutic targets. Materials and Methods: This cross-sectional, case-control study included 57 migraine patients and 30 healthy controls. Patients were categorized into episodic migraine (EM) and chronic migraine (CM) groups. Socio-demographic and clinical characteristics were documented through structured interviews. Validated scales such as the Visual Analog Score (VAS), Headache Impact Test 6 (HIT-6), Migraine Disability Assessment Test (MIDAS), Migraine 24 h Quality of Life Scale (24 h QoL), Mini-Mental State Examination (MMSE), and Migraine Attacks-Subjective Cognitive Impairments Scale (Mig-SCog) were administered. Venous blood samples were collected, and serum levels of IPA, Nitric Oxide (NO), Nitric Oxide Synthase (NOS), and Peroxynitrite (ONOO-) were measured using ELISA and spectrophotometric methods. Results: Significant differences in serum IPA and NO levels were observed between migraine patients and controls. Specifically, higher serum IPA levels were found in the EM group, while higher serum NO levels were observed in the CM group. Elevated NO levels correlated with increased migraine attack frequency. Conversely, serum IPA levels showed a negative correlation with attack frequency, suggesting a protective role. Specifically, NO levels were positively correlated with the number of painful days, NSAID usage, VAS scores, HIT-6 scores, and MIDAS scores, while negatively correlated with 24 h QoL scores. Conclusions: The study highlights the significant involvement of IPA and nitrosative stress in migraine pathophysiology. Elevated IPA levels, particularly in EM patients, suggest its potential neuroprotective role. These findings underscore the importance of targeting oxidative and nitrosative stress pathways in developing effective migraine therapies.

Nonsteroidal anti-inflammatory drug use by patients: Impact of modular educational training on pharmacists' questioning, counselling and risk assessments

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs)-related morbidity and mortality can be reduced through medication counselling and risk reduction. ObjectivesThis study evaluated the impact of short online modular NSAID training on the type and quality of questions asked, risk factors assessed, and counselling offered by community pharmacists to NSAID users. MethodsA cross-sectional questionnaire-guided survey conducted in Ibadan, Nigeria, among 87 pharmacists evaluated the frequency of counselling, NSAID risk factor assessment and barriers to risk assessment. Additionally, a before-and-after RCT was used to evaluate the impact of short online modular NSAID training for the intervention group (IG) on the type and quality of the questions asked, counselling provided, and risk assessed by the pharmacists. Eight standardised patients, aged 25–43 years, four at pre- and postintervention, presented four standardised scenarios at community pharmacies [IG, n = 22, control group (CG, n = 30)] to assess these outcomes. The quality of each outcome (questions asked, counselling offered and risk assessed) was classified as poor (0–≤20%), fair (>20–≤40%), moderate (>40 – ≤60%), or optimal (>60–100%). The data are presented with descriptive statistics. ResultsThe community pharmacists reported counselling patients on NSAID precautions (80–86%) and dosages (51–69%). Gastrointestinal bleeding risk was assessed by 61–89% of the pharmacists, and time constraints (39–42%) and patient impatience (47–75%) were some barriers to risk assessment. Online modular educational intervention significantly improved the types and quality of questions asked by pharmacists (CG: poor to fair, 16%–21%; IG: poor to moderate, 14%–45%), NSAID risk factors assessed (CG: poor to poor, 10%–9%; IG: poor to fair, 11%–27%) and counselling offered (CG: poor to poor, 6%–7%; IG: poor to fair, 6%–22%). ConclusionsShort online modular educational training on NSAIDs improved the types and quality of the questions asked, NSAID risk factors assessed, and counselling provided by community pharmacists to patients during consultations.

Diagnosis and Management of Upper Gastrointestinal Bleeding in Long-Term NSAID Users : Case Report

Upper gastrointestinal bleeding is one of the most frequently encountered emergency cases. For most general practitioners, diagnosing and providing initial management is a challenge in itself. Upper gastrointestinal bleeding is divided into variceal and non-variceal bleeding. Clinical symptoms that can be found include hematemesis or melena. Patients with melena tend to have lower hemoglobin (Hb) levels than hematemesis because clinical manifestations appear more slowly. Drug Induced NSAIDs are also one of the etiologies that can cause upper gastrointestinal bleeding. Endoscopy is the gold standard for diagnosis, but not all health facilities are able to perform it. This case reported a 66-years-old male patient came to the emergency room with complaints of blackish stools with a soft, sticky consistency for 6 days, accompanied by weakness, dizziness, nausea in the stomach and disruption of daily activities. The patient has a history of taking over-the-counter NSAIDs long term to relieve his knee pain. On physical examination, hepatomegaly and splenomegaly were not found and the patient’s hemodynamics is stable. On laboratory examination, Hb was found to be 3.4 g/dl. It was suspected that there was upper gastrointestinal bleeding, then received therapy in the form of PPI injections, antiemetic injections and planned PRC transfusion.

#2206 Predictors of post-operative acute kidney injury after colorectal cancer surgery

Abstract Background and Aims Post-operative acute kidney injury (PO-AKI) is a common complication of colorectal cancer (CRC) surgery associated with increased morbidity and mortality, and higher hospital costs. Specific treatment of AKI is still limited, supporting the importance of preventing AKI. Identification of patients at high risk may allow early interventions, including closer monitoring and perioperative optimization. This study aimed to identify predictors of PO-AKI by assessing the association between preoperative factors and the occurrence of PO-AKI. Method We conducted a nationwide cohort study including adult CRC surgery patients in 2010–2021 using Danish health registries. We defined PO-AKI as AKI within 7 days after the CRC surgery according to the 2012 KDIGO criteria using creatinine measurements. A list of patient characteristics associated with AKI was identified using existing literature. We obtained information on variables using population-based health registries containing data on diagnosis codes, redeemed prescriptions, and laboratory data. We investigated the individual predictive factors by estimating PO-AKI risks and the odds ratios (ORs) with 95% confidence intervals (CIs) adjusting for sex and age. Results We identified 35,650 CRC surgery patients, of whom 24,555 had creatinine measurements during the study period, making them eligible for further analysis. Among these patients, we identified 2,694 cases of PO-AKI, corresponding to a 11% risk of PO-AKI. The risk of PO-AKI was higher for males (13.5% vs. 8.4%, aOR=1.76 [1.62-1.91]), and patients with diabetes (15.4% vs. 10.2%, aOR=1.46 [1.32-1.61]), cardiovascular disease (15.4% vs. 9.9%, aOR=1.38 [1.26-1.52]), CKD (18.9% vs. 9.2%, aOR=1.99 [1.80-2.19]), COPD (16.6% vs. 10.3%, aOR=1.59 [1.42-1.78]), and hypertension (13.6% vs. 7.5%, aOR=1.68 [1.53-1.84]). When examining potentially nephrotoxic medicine, the risk was higher in ACE-I/ARB users (14.5% vs. 9.6%, aOR=1.44 [1.32-1.56]) and similar in NSAID users and nonusers (10.3% vs. 11.0%, aOR=1.00 [0.84-1.19]). Conclusion We found that male gender, diabetes, cardiovascular disease, CKD, COPD, hypertension, and the use of ACE-I/ARB medications were associated with a higher risk of PO-AKI. Interestingly, users and nonusers of NSAIDs had similar risks of AKI. The identification of high-risk groups, such as those with pre-existing comorbidities or users of specific medications, may aid clinicians in identifying patients with a particularly high risk of PO-AKI.

The Effects of Corticosteroid and Nonsteroid Anti-Inflammatory Therapies on Permanent Hypothyroidism Occurring After the Subacute Thyroiditis

ABSTRACT Objective Subacute thyroiditis(SAT) is an acute inflammatory, self-limited, and destructive disease of the thyroid gland. Although it is a temporary disease, it has permanent consequences. We aim to investigate the influences of the treatment choice on permanent hypothyroidism occurring after SAT and whether there are predictive factors for the development of permanent hypothyroidism. Methods We retrospectively investigated 57 SAT patients admitted to our tertiary hospital between 2017 and 2019. After excluding 6 patients, demographic, clinical, laboratory, and imaging findings of 36 patients treated with NSAIDs and 15 patients treated with corticosteroids were compared. The median duration of follow-up was 4 (3.5-5.5) years. Results Permanent hypothyroidism occurred in 16 patients (31.4%) of 51 patients. It developed at a significantly higher rate in NSAID users (p=0.019). There was no significant difference in the occurrence of transient hypothyroidism and recurrence (p=0.472, p=0.082). The early maximum TSH values were strongly associated with permanent hypothyroidism. The Odds Ratio (OR) value was 2.59 (95% CI = 1.26 – 5.33, p=0.009), Nagelkerke R2 = 0.821. The early maximum TSH level had a predictive value, with an AUC of 0.966 for post-SAT permanent hypothyroidism (p<0.001). The cutoff values for the early maximum TSH were 9.07uIU/ml (81.3% sensitivity, 100% specificity), and 7.05 uIU/ml (87.5% sensitivity, 94.3% specificity). Conclusion Corticosteroid therapy is significantly effective in preventing permanent hypothyroidism from developing after SAT. The early maximum TSH values are an indicator for the prediction of the development of permanent hypothyroidism.

Addressing limitations of single GON blockade treatment and repetitive intervention with GON block or onabotulinum toxin A in chronic migraine- part 2 of three men in a boat study

This study investigated the effectiveness of three treatment interventions for managing migraine symptoms over a three-month assessment period: single greater occipital nerve block (GON), repetitive GON block, and single GON block combined with onabotulinium toxin A (BoNT-A) treatment. Significant improvements were observed across all treatment groups in various migraine-related parameters, including medication usage, frequency and severity of attacks, and subjective measures such as Headache Impact Test-6 scores and Pittsburgh Sleep Quality Index scores. Notably, all groups showed reductions in NSAID and triptan usage, total number of attacks with VAS>4, and number of headache days. However, slight differences in the magnitude of improvements were observed between the groups, with GON block combined with BoNT-A treatment demonstrating slightly greater reductions compared to single GON block treatment. Additionally, the integration of BoNT-A therapy alongside GON blockade appeared to confer supplementary benefits in migraine prophylaxis. These findings highlight the importance of implementing comprehensive treatment approaches to address various aspects of migraine management and improve patient outcomes.

Prevalence and risk factors of gastroesophageal reflux disease in Iran: A cross-sectional analysis from the PERSIAN cohort.

This study assessed the prevalence of gastroesophageal reflux disease (GERD) in a general adult population in Iran. The association between GERD and various factors was also evaluated. We performed a cross-sectional study on 163,018 individuals aged over 35 who were enrolled in the PERSIAN cohort. GERD was defined as the occurrence of heartburn and/or regurgitation symptoms at least several days a month. Survey design analysis for pooled data was performed and multiple regression analysis was conducted to determine the independent risk factors for GERD. The prevalence of GERD in our study was estimated at 21.86% (95% confidence interval:17.4%-36.4%). The mean age of the participants was 49.84 years±9.25 (35-70) and 44.75% of the participants were male. Symptoms of heartburn and regurgitation were reported in 18.65% (n: 29,170) and 6.06% (n: 9,717) of participants, respectively. In the multivariate analysis, several factors were found to be associated with a higher prevalence of GERD: female sex, age >50, current smoking, opium use, weekly consumption of fried foods, frequent consumption of hot tea, less than 6 hours of sleep per night, psychiatric disorders, usage of NSAIDs, and poor oral hygiene, were associated with a higher prevalence of GERD. Conversely, higher education levels and average physical activity were found to be less commonly associated with GERD. We found a relatively high prevalence of GERD (21.86%) in this population-based study in Iran. By identifying modifiable risk factors, this research offers opportunities for targeted interventions and lifestyle modifications to reduce the burden of GERD.

Exploring Drug Utilization Patterns and Adverse Drug Reactions in the Management of Osteoarthritis: A Prospective Study

Aim/Background Osteoarthritis (OA) is a degenerative joint disease characterized by pain and functional impairment, leading to significant healthcare challenges. Pharmacological management, including NSAIDs, analgesics, disease-modifying osteoarthritis drugs (DMOADs), and corticosteroids, is commonly used. However, limited data exist on drug utilization patterns and adverse drug reactions (ADRs) in OA treatment. This study aimed to evaluate these patterns and identify potential ADRs in patients with OA. Methods This prospective study included OA patients from diverse backgrounds. Baseline demographic data, disease severity, and treatment history were recorded. Drug utilization was monitored, focusing on NSAIDs, analgesics, DMOADs, corticosteroids, and alternative therapies. ADRs were identified through patient self-reports, clinician observations, and medical record reviews. Statistical analysis examined drug prescription trends, ADR frequency, severity, and associated risk factors. Results NSAIDs were the most frequently prescribed drugs (44.45%), followed by analgesics and DMOADs. Gastrointestinal discomfort was the most commonly reported ADR, particularly among NSAID users. Corticosteroids were linked to systemic side effects in a minority of patients. Advanced age, longer treatment duration, and existing gastrointestinal conditions were significant risk factors for ADRs. Conclusion The study underscores the widespread use of NSAIDs in OA treatment and highlights the need for careful monitoring due to potential ADRs, especially gastrointestinal issues. Identifying risk factors helps clinicians make informed prescribing decisions, improving patient outcomes and minimizing ADRs. Future research should focus on optimizing drug therapies to ensure better safety and efficacy in OA management.

Antibody responses after BNT162b2 vaccination in Japanese geriatric intermediate care facilities

BackgroundTo evaluate antibody responses against the primary series of vaccination of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2] vaccines in the staff and residents of Japanese geriatric intermediate care facilities. MethodsAll subjects (159 staff and 96 residents) received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Baseline data of subject were collected using a structured form. Serum samples were collected three times: before vaccination, 3 weeks after the first dose, and 4 weeks after the second dose, and anti-receptor binding domain of the spike protein of SARS-CoV-2 [anti-RBD] IgG was measured using two immunoassays. ResultsAfter the second dose, geometric mean titers [GMT] of anti-RBD with both the Abbott and Roche assay were significantly lower in residents than staff (2282 AU/mL vs. 8505 AU/mL, and 258 U/mL vs. 948 U/mL, respectively). Multivariate analysis of characteristics affecting antibody responses (≥1280 AU/mL for Abbott and > 210 U/mL for Roche) showed lower odds ratios [ORs] for older age (adjusted OR per 10 year increase [aOR] = 0.62, 95 % confidence interval [95 %CI]; 0.38–1.02), steroid usage (aOR = 0.09, 95 %CI; 0.01–0.60) and regular nonsteroidal anti-inflammatory drugs [NSAIDs] usage (aOR = 0.16, 95 %CI; 0.03–0.88). ConclusionsElderly people and steroid and NSAID users had lower antibody responses following the second vaccine dose.

A comparison between therapeutic effects of Salvia Officinalis. Extract, meloxicam and dexamethasone following acute sciatic nerve injury due to analgesic drug injection in rats

BackgroundAn intramuscular (IM) injection into gluteal muscle can lead to iatrogenic trauma to sciatic nerve. The drugs can be injected directly into sciatic or into the tissue adjacent to the nerve. Besides the direct damage to nerve due to needle and drug entrance to nerve tissue, the chemical nature of each drug activates immune system near healthy peripheral nerves in order to remove damaged tissues and start healing process. This immune system response has a great role in creating pathological pain and it makes functional recovery as a major challenge. Material methodIn this study, 25 adults male Fischer- Wistar rats were used. An analgesic drug (diclofenac) was injected in the muscles near sciatic nerve (4 groups) and also in sciatic nerve (1 group, nerve control group). For clinical assessment of sciatic nerves integrity, sciatic functional index test (SFI test) was done before, 1 day and 7 days after surgery. Treatments with meloxicam, dexamethasone and extract of Salvia Officinalis were started for 3 muscle groups and 1 group remained as a control muscle group. After 1 week, all the animals were euthanized under deep anesthesia and the sciatic nerves with surrounding muscles were removed and sent to histopathological examination. Resultsall three treatment groups showed decreased inflammatory process and increased repair regeneration in compare to control group. Although, the amount recovery in the dexamethasone group was significantly higher in compared to the control and other treatment groups. ConclusionThis study showed That IM injection of analgesic drug (Diclofenac), without direct damage to sciatic nerve, causes activation of the immune system and iatrogenic sciatic neuropathy. This study also showed therapeutic effects of two common drugs (NSAID and corticosteroids) and an extract of Salvia Officinalis. Treatment with all three drugs, decreased inflammatory response at injury site and increased recovery but Long-term usage of corticosteroids and NSAIDs can be challenging. The Salvia extract also have showed acceptable improvement effects with minimal side effects.

Experimental evaluation of analgesic activity of Naga Parpam: An Siddha formulation

Background : Prolonged usage of NSAIDs and corticosteroids was associated with serious side effects. Siddha is an ancient system of medicine, promotes the utilization of herbal anad elemental formulations. Interestingly, certain elements considered toxic in modern medicine, such as Arsenic (As), Cadmium (Cd), Mercury (Hg), Iron (Fe), Silver (Ag), Gold (Au), etc., have been employed in Siddha herbo mineral formulation for the treatment of illness, a practice that dates back to ancient times. Introduction Pain is a widely recognized indicator of poor health, the analgesic medications are employed to alleviate it. In Siddha classics, pain is considered a separate disease called Soolai. Naga Parpam is one of the herbo metal preparations with analgesic potential but no scientific evaluation there. Aim: To evaluate the analgesic activity of Naga parpam in experimental rats using Tail immersion method. Materials and methods : After obtaining permission from the IAEC, the animals were separated into 5 groups of 6 animals Each Group 1 (control) received ghee orally, and Group 2 (standard) received Pentazocine in dose 10 mg/kg intraperitoneally. The test drug Naga parpam was mixed with the adjuvant Ghee and administrated per oral route to three groups (Group 3,4,5), Group 3 (test) received Naga Parpam in low dose 6 mg/kg, Group 4 (test) received mid dose 12 mg/kg, Group 5 (test) received high dose – 24 mg/kg ). Statistical analysis : One-way ANOVA followed by the Dunnett test P &lt; 0.05 was considered to be significant. Results : The test drug Naga parpam has significant analgesic activity in the tail flick method (P &lt;0.01) by increasing the reaction time of the rats. Conclusion : The present study indicates that the test drug Naga parpam possesses significant central analgesic activity in the tail flick method.

Total knee arthroplasty: do newer CR implants yield better results? A single center prospective study.

The aim of this study was to compare whether the newest TKA prosthesis (Persona) gives improved clinical outcomes due its more anatomical design in comparison to older prostheses (balanSys). This study included a total of 89 patients planned for TKA from June 2018 to September 2019. Outcomes such as Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), numeric pain rating scale (NRS), analgesics and alignment were recorded next to patient characteristics and complications. Our results showed a significant improvement in NRS, ROM and functional scores postoperatively compared to preoperatively for both the Persona and the balanSys implants. Although the flexion ROM for the Persona group was higher at 6 and 12 months postoperative compared to the balanSys, this was mainly a regaining of the preoperative ROM. Throughout all timepoints, there were no statistically significant differences observed in NSAID and opioid usage between the balanSys and Persona groups. Both implants are safe and efficient to use in the treatment of knee osteoarthritis. Although Persona had an improved postoperative flexion, this did not have an impact on any of the patient-reported outcomes.

1072 Diaphragm Disease: NSAID-Induced Small Bowel Strictures. the Challenges of Surgical management

Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are used commonly, yet there is little literature surrounding NSAID-induced small bowel strictures, particularly those requiring surgery. We present the case of a 42-year-old female treated surgically over six years. This patient had used NSAIDs for several years; she was referred due to weight loss, anaemia and abdominal pain. Computerised topography (CT) scan showed small bowel obstruction. Initial treatment was laparotomy with small bowel resection. Histology revealed six strictures in the jejunum with incomplete obstruction – attributed to NSAIDs. Despite counselling her NSAID usage persisted and over the next two years she was treated for jejunitis and had a perforated duodenal ulcer repaired. At this point the patient ceased NSAID use, however the next twelve months saw three presentations with small bowel obstruction, all managed conservatively. This case is concordant with literature suggesting strictures can continue to develop despite NSAID cessation. She was placed on the surgical waiting list but symptoms worsened – anaemia requiring transfusions; hypokalaemia requiring IV replacement and 38-kilogram weight loss. She received total parenteral nutrition before surgery. She underwent another bowel resection with anastomosis. Initially she regained weight and biochemistry stabilised, however further obstruction developed the next year at the anastomosis site. This case highlights the difficulties managing this disease – nutrition, haematology and strictures developing years after NSAID cessation. It raises questions over surgery, choice of anastomosis and how to manage this ongoing dilated small bowel segment.

Genome-wide association study on pharmacological outcomes of musculoskeletal pain in UK Biobank.

The pharmacological management of musculoskeletal pain starts with NSAIDs, followed by weak or strong opioids until the pain is under control. However, the treatment outcome is usually unsatisfying due to inter-individual differences. To investigate the genetic component of treatment outcome differences, we performed a genome-wide association study (GWAS) in ~23,000 participants with musculoskeletal pain from the UK Biobank. NSAID vs. opioid users were compared as a reflection of the treatment outcome of NSAIDs. We identified one genome-wide significant hit in chromosome 4 (rs549224715, P = 3.88 × 10-8). Suggestive significant (P < 1 × 10-6) loci were functionally annotated to 18 target genes, including four genes linked to neuropathic pain processes or musculoskeletal development. Pathway and network analyses identified immunity-related processes and a (putative) central role of EGFR. However, this study should be viewed as a first step to elucidate the genetic background of musculoskeletal pain treatment.

Synthetic transformation of 6-Fluoroimidazo[1,2-a]Pyridine-3-carbaldehyde into 6-Fluoroimidazo[1,2-a]Pyridine-Oxazole Derivatives: In vitro urease inhibition and in silico study

PurposeUlcer is a serious disease that is caused due to different bacteria and over usage of various NSAIDs which caused to reduce the defensive system of stomach. Therefore, some novel series are needed to overcome these issues. MethodsOxazole-based imidazopyridine scaffolds (4a-p) were designed and synthesized by two step reaction protocol and then subjected to urease inhibition profile (in vitro). All the newly afforded analogs (4a-p) were found potent and demonstrated moderate to significant inhibition profile. ResultsParticularly, the analogs 4i (IC50 = 5.68 ± 1.66 μM), 4o (IC50 = 7.11 ± 1.24 μM), 4 g (IC50 = 9.41 ± 1.19 μM) and 4 h (IC50 = 10.45 ± 2.57 μM) were identified to be more potent than standard thiourea drug (IC50 = 21.37 ± 1.76 μM). Additionally, the variety of spectroscopic tools such as 1H NMR, 13C NMR and HREI-MS analysis were employed to confirm the precise structures of all the newly afforded analogs. DiscussionThe structure–activity relationship (SAR) studies showed that analogs possess the substitution either capable of furnishing strong HB like –OH or had strong EW nature such as -CF3 & –NO2 groups displayed superior inhibitory potentials than the standard thiourea drug. A good PLI (protein–ligand interaction) profile was shown by most active analogs when subjected to molecular study against corresponding target with key significant interactions such as pi-pi stacking, pi-pi T shaped and hydrogen bonding.

Ketamine Induced RCVS (P3-12.008)

<h3>Objective:</h3> To present a case of RCVS induced by ketamine infusions compounded with triptan and NSAID usage. <h3>Background:</h3> A 47 yo female with a history of depression and migraines presented with a persistent headache for 3 days. On the day of presentation, the patient reported the “worst headache of her life”. The headache was “sharp and squeezing”, frontal and retro-orbital in location, radiating to the back of her head, and exasperated by laying flat. The patient reported taking multiple high-dose NSAIDs along with sumatriptan. She had completed a 3-week course of ketamine infusions (75 mg twice weekly for depression) with last infusion 2 days prior to presentation. She was also on a chronic SSRI for depression. Patient denied any alcohol or current recreational drug use, but did report a history of opioid dependency. Initial CT head demonstrated a moderate-sized right frontal lobe subarachnoid and a small subarachnoid in the right posterior parietal lobe. CTA of head and neck demonstrated vasospasm of the left supraclinoid ICA, left M1 segment, and basilar artery. The location, radiographic appearance, and temporal course was consistent with RCVS. CT Angiogram was negative for any luminal irregularity, focal stenosis, or narrowing. MRI brain with contrast redemonstrated the subarachnoid hemorrhage without evidence of a vasculitic process. Lab work-up was negative for ANA, C4, C3, Sjogren’s Antibodies, RF, Anti-DNAs Ab. CRP and ESR were mildly elevated suggesting mild inflammation. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> The etiology of the headache and subarachnoid hemorrhage was suspected to be medication induced RCVS in the setting of concomitant use of sumatriptan, SSRI, and high doses of ketamine. <h3>Conclusions:</h3> Although a rare phenomena, RCVS is a concerning cause of thunderclap headache that should be recognized. RCVS is not a common occurrence with ketamine usage but clinicians should be aware is this possible adverse effect. <b>Disclosure:</b> Dr. Mufti has nothing to disclose. Dr. Canlas has nothing to disclose. Dr. Ritenuti has nothing to disclose.

Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study

Study design: Prospective randomized clinical study. Purpose: To compare the effectiveness and safety of intra-articular platelet-rich plasma (PCP) and steroid along with radiofrequency ablation (RFA) in the treatment of chronic low back pain (LBP) due to facet joint arthropathy. Overview of literature: Facet joint pathology is an important cause of LBP—15–30% of all LBP cases. Lumbar intra-articular PRP is a relatively new method in the treatment of LBP. PRP stimulates the cells involved in regeneration. Hence, it seems a suitable option for the treatment of lumbar facet joint syndrome. Methods: We evaluated the efficacy and safety of facet joint injections in LBP secondary to facet joint arthropathy. Chronic LBP for ≥3 months (visual analogue scale (VAS) &gt; 4), failed conservative treatment, no neurological deficit, unilateral facet joint pain, focal tenderness with hyperextension pain, and relief by diagnostic medial branch block were included. Patients were randomly allocated to Group S: Steroid (Triamcinolone) + RFA or Group P: PRP + RFA or Group R: 0.9% saline + RFA as control. Demographic, clinico-radiological, and outcome parameters were recorded till 6 months. Data were analyzed using SPSS and p &lt; 0.05 was considered significant. Results: We studied 45 patients (n = 15 in each group) in the final analysis. Mean age was 45.7 ± 13.6 years and 60% were females in all groups. VAS decreased to 1.6 ± 0.8 (Group S) and 3.2 ± 0.8 (Group P) on day 1 ( p &lt; 0.05). At 3 and 6 months, VAS reduced more in Group P (0.47 ± 0.5; 0.07 ± 0.2) versus Group S (2.53 ± 0.5; 3.07 ± 0.2) ( p &lt; 0.001). Mean Oswestry Disability Index (ODI) score at baseline was 72.8 ± 7.6 (all groups). At 1 month, Group S (17.2 ± 3.2) showed better improvement than Group P (23.2 ± 3.1) ( p &lt; 0.05). At 6 months, Group P (8.9 ± 1.2) had more decrease in ODI than Group S (29.0 ± 2.1) ( p &lt; 0.001). NSAIDs usage and Patient Satisfaction Score (PSS) were significantly better at 6 months in Group P than Group S ( p &lt; 0.01; p &lt; 0.05, respectively). Conclusion: Both PRP and corticosteroid injections were determined to be effective and safe for the treatment of lumbar facet joint syndrome after 6 months of follow-up. However, autologous PRP may be a superior treatment option for longer efficacy.