NSAID Users Research Articles

Anti-inflammatory medication use associated with reduced delirium risk and all-cause mortality: A retrospective cohort study

ObjectiveTo investigate the relationship between history of anti-inflammatory medication use and delirium risk, as well as long-term mortality. MethodsIn this retrospective cohort study, subjects recruited between January 2016 and March 2020 were analyzed. Information about anti-inflammatory medication use history including aspirin, NSAIDs, glucosamine, and other anti-inflammatory drugs, was collected. Logistic regression analysis investigated the relationship between anti-inflammatory medications and delirium. Log-rank analysis and cox proportional hazards model investigated the relationship between anti-inflammatory medications and one-year mortality. ResultsThe data from 1274 subjects were analyzed. The prevalence of delirium was significantly lower in subjects with NSAIDs usage (23.0%) than in those without NSAIDs usage (35.0%) (p < 0.001). Logistic regression analysis controlling for age, sex, dementia status, and hospitalization department showed that the risk of delirium tended to be reduced by a history of NSAIDs use (OR, 0.76 [95% CI, 0.55 to 1.03]). The one-year mortality in the subjects with NSAIDs (survival rate, 0.879 [95% CI, 0.845 to 0.906]) was significantly lower than in the subjects without NSAIDs (survival rate, 0.776 [95% CI, 0.746 to 0.803]) (p < 0.001). A history of NSAIDs use associated with the decreased risk of one-year mortality even after adjustment for age, sex, Charlson Comorbidity Index, delirium status, and hospitalization department (HR, 0.70 [95% CI, 0.51 to 0.96]). ConclusionThis study suggested that NSAIDs usage was associated with decreased delirium prevalence and lower one-year mortality. The potential benefit of NSAIDs on delirium risk and mortality were shown.

A176 ASSOCIATIONS OF ANTIBIOTICS, HORMONAL THERAPIES, ORAL CONTRACEPTIVES, AND LONG-TERM NSAIDS WITH INFLAMMATORY BOWEL DISEASE: RESULTS FROM THE PROSPECTIVE URBAN RURAL EPIDEMIOLOGY (PURE) STUDY

A176 ASSOCIATIONS OF ANTIBIOTICS, HORMONAL THERAPIES, ORAL CONTRACEPTIVES, AND LONG-TERM NSAIDS WITH INFLAMMATORY BOWEL DISEASE: RESULTS FROM THE PROSPECTIVE URBAN RURAL EPIDEMIOLOGY (PURE) STUDY

Peptic ulcer in nephrotic syndrome patients due to steroid therapy

Peptic ulcers comprise gastric and duodenal ulcers. Complications of peptic ulcers include bleeding, perforation, and obstruction. Bleeding is a major problem of peptic ulcers, as it is at times fatal. Peptic ulcer bleeding is diagnosed and treated by upper gastrointestinal (GI) endoscopy. Oral glucocorticosteroids (referred to hereafter as corticosteroids) are commonly prescribed for symptom control in patients receiving palliative care. A recent study has shown that one-third of patients admitted to an inpatient hospice unit were receiving corticosteroids. This frequency in prescribing exposes a large number of patients to the potential side effects known to be associated with corticosteroids, including weight gain, impaired glucose tolerance, and proximal myopathy.H. pylori infection is a risk factor for PUD in aspirin and NSAID users.

Prescription pattern of non-steroidal anti-inflammatory drugs among patients admitted with fever in a tertiary hospital

Background: WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately. Nonsteroidal anti-inflammatory drugs are a group of drugs that are commonly prescribed for the treatment of fever associated with pain and inflammation. The objective was to assess the prescribing pattern of NSAIDs in fever patients. Along with this, we looked at the clinical indications for prescribing and the pattern of prescribing with respect to use of generic or trade names. Methods: This observational study was conducted in a tertiary care teaching hospital in Malappuram district of Kerala, India by extracting data of inpatients retrospectively from medical records for a six-month period. The reported prevalence of NSAID use in previous study was 20%, with a relative precision of 18% the sample size required was 500. The data was analyzed and expressed as absolute numbers and/or percentages. Results: Out of these 500 patients, Dengue fever was the most common diagnosis (86.6%) followed by Typhoid (2.8%) and Leptospirosis (2.4%). Among these, 392 (78.4%) received any of the NSAIDs. The most commonly prescribed drug was Paracetamol (77.04%). Among to the prescriptions, 91.7% were prescribed with generic names. As concomitant medications, antibiotics were prescribed at 21.2% cases, gastro protective agents were prescribed to 24.23% and vitamins were prescribed in 72.6% cases. Conclusions: This study has shown that the prescribing, usage and preferences of NSAIDs practiced rationally. No over use, under use or misuse of drugs was noticed.

P856 Associations of antibiotics, hormonal therapies, oral contraceptives, and long-term NSAIDs with Inflammatory Bowel Disease: results from the Prospective Urban Rural Epidemiology (PURE) study

Abstract Background Several medications have been considered to contribute to the aetiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort. Methods This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including Crohn’s disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) was evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results During the median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], we recorded 571 incident cases of IBD (143 CD and 428 UC). Higher risk of incident IBD was associated with baseline antibiotic use [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p=5.02E-10]. NSAID users were also observed to have increased risk of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term users [aOR: 5.58 (95% CI: 2.26-13.80), p&amp;lt;0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity. Conclusion Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.

Associations of prenatal exposure to non-steroidal anti-inflammatory drugs with preterm birth and small for gestational age infants among women with autoimmune disorders.

Estimate associations between prenatal non-steroidal anti-inflammatory (NSAID) exposure and preterm birth and small for gestational age among women with autoimmune conditions. Participants were enrolled in the MotherToBaby cohort and had an autoimmune disorder and singleton live birth >20 weeks gestation (n= 2007). We characterized self-reported NSAID exposure over gestation for timing, duration, and average daily dose. Outcomes were preterm birth (i.e., <37 weeks' gestation) and small for gestational age infants (SGA; <10th percentile birthweight). We used Poisson regression to estimate associations between NSAID exposure and study outcomes adjusting for demographics, co-use of other medications (Model 1), and disease severity at baseline (Model 2). Secondarily, we considered the role of acetaminophen use by individually matching NSAID users to controls on cumulative dose of acetaminophen exposure. Overall, 15% of women reported NSAID use in pregnancy, with most use in the first trimester. No NSAID use exposure variables were associated with risk of preterm birth. Any NSAID use was associated with 1.7 (95% CI 1.2, 2.5) times greater risk of SGA and this estimate was attenuated to 1.5 (95% CI 1.0, 2.3) after adjustment for baseline disease severity. NSAID exposure in the first trimester was most strongly associated with SGA. After matching on acetaminophen exposure, associations between any NSAID use and preterm birth and SGA were 0.9 (95% CI 0.6, 1.4) and 1.8 (95% CI 1.1, 2.9). NSAID use in pregnancy is associated with SGA but not preterm birth. Future research should explore mechanisms that may explain these findings. Future research must also consider alternative explanations for these associations.

Non-Steroidal Anti-Inflammatory Drugs and Associated Toxicities in Horses.

Effective pain management in horses can be a challenge despite the understanding that appropriate analgesia improves animal welfare and increases treatment success. The administration of NSAID drugs, particularly phenylbutazone and flunixin, are common practice in equine veterinary patients. Known for their analgesic and anti-inflammatory properties, NSAIDs are used for the treatment of a variety of conditions in horses, from gastrointestinal to orthopedic pain. Despite extensive usage, NSAIDs have a narrow margin of safety and the body of literature documenting the efficacy and side effects of different NSAIDs is broad. The three main side effects associated with excessive or prolonged NSAID usage in horses include gastroduodenal ulceration, right dorsal colitis (RDC) and renal papillary necrosis. The use of cyclooxygenase-2 selective NSAIDS, such as firocoxib, are theoretically safer. The aim of this paper is to review the current literature on the use and efficacy of different NSAIDs, summarise the associated side effects of NSAID usage and evaluate the current state of knowledge for the diagnosis and treatment of such toxicities.

Time trends in use of non-steroidal anti-inflammatory drugs and opioids one year after total hip arthroplasty due to osteoarthritis during 1996–2018: a population-based cohort study of 103,209 patients

To examine time trends in the use of NSAIDs and opioids for patients with osteoarthritis undergoing total hip arthroplasty (THA) during 1996-2018. Using Danish population-based medical databases, we identified 103,209 THA patients. Prevalence rates of NSAID and opioid use among preoperative users and non-users were calculated in four quarters (Q1-Q4) after THA by calendar periods (1996-2000, 2001-2006, 2007-2012 and 2013-2018). Prevalence rate ratios (PRR) were adjusted for age and gender. Among preoperative NSAID users and non-users, NSAID use in Q1 increased from 32.6% in 1996-2000 to 48.0% in 2013-2018 (PRR=1.49, 95% CI: 1.42-1.55) and from 12.9% to 32.0% (PRR=2.49 (2.32-2.67)), respectively. Among preoperative opioid users and non-users, opioid use in Q1 increased from 42.7% in 1996-2000 to 76.9% in 2013-2018 (PRR=1.81 (1.73-1.89)) and from 15.2% to 58.2% (PRR=3.85 (3.65-4.05)), respectively. NSAID use in Q4 decreased from 24.5% in 1996-2000 to 21.4% in 2013-2018 (PRR=0.88 (0.83-0.93)) and from 6.9% to 5.6% (PRR=0.81 (0.73-0.91)) in preoperative NSAIDs users and non-users, respectively. Opioid use in Q4 increased from 26.6% in 1996-2000 to 28.6% (PRR=1.08 (1.02-1.15)) in 2013-2018 and from 4.1% to 5.0% (PRR=1.25 (1.11-1.40)) in preoperative opioid users and non-users, respectively. We observed up to a 4-fold increase in NSAID and opioid use in Q1 during 1996-2018, while usage in Q4 did not change substantially. However, 5-6% of the preoperative non-users of NSAIDs and opioids were users in Q4, which might relate to inaccurate indication for or timing of THA and the post-surgical phasing out of analgesics use.

Perbandingan Identifikasi Obat yang Berpotensi Tidak Tepat Menggunakan Kriteria Beers dan Kriteria STOPP pada Pasien Geriatri Rawat Inap di Jakarta

Adverse Drug Events (ADE) are closely related to Potentially Inappropriate Medications (PIMs) among the elderly, and can cause an increase in morbidity, mortality, and medical cost. The tools often used to assess PIMs include Beers and Screening Tool of Older Persons’ Prescriptions (STOPP) Criteria. Therefore, this study aimed to compare the PIMs identification using Beers 2019 and STOPP version 2 2016 Criteria. A descriptive-analytical method was used, and data were collected retrospectively from the medical records of 340 patients at Pondok Kopi Islamic Hospital period in 2018. The results showed that among 324 patients who met the inclusion criteria with Beers 2019, PIMs were present in 136 (41.85%), with 181 cases. Most of them were on criteria 3, namely 46 (25.41%) and 33 (18.23%) cases of furosemide and spironolactone, respectively. Meanwhile, out of 308 patients who met the inclusion criteria with STOPP, PIMs were found in 14 (4.55%) with a total of 18 cases. The use of aspirin or clopidogrel was observed in 7 people (38.89%) with uncontrolled severe hypertension, while NSAID usage was found in 3 uncontrolled severe hypertension patients (16.67%). Furthermore, there were 3 cases of aldosterone antagonist or ARB usage, which was combined with other drugs that can increase potassium without proper monitoring of the serum level (16.67%). In Pondok Kopi Islamic Hospital, Beers 2019 criteria can describe PIMs data better than the STOPP version 2 2016 due to data availability. Clinician and pharmacist collaboration is also needed in formulating the critical supporting data.

Does Pain Medication Use Influence the Outcome of 8 Weeks of Education and Exercise Therapy in Patients with Knee or Hip Osteoarthritis? An Observational Study.

ObjectivePatients with osteoarthritis are mainly managed in primary care settings and many patients use pain medication as symptomatic treatment. We investigated in OA-patients receiving an education and exercise program, the use and type of pain medication and its impact on outcomes at 3 months follow-up.Design, Setting and SubjectsThe design was a retrospective cohort study using prospectively collected data from the GLA: D® registry. The study included 15,918 primary care patients.ResultsAmong the included patients, 62% were pain medication users and 38% were non-users. Among the pain medications users, 35% were classified as paracetamol users, 54% as NSAID users, and 11% as opioid users. Medication users and non-users differed regarding a higher pain intensity, poorer physical and mental health. Pain medication use before and during the education and exercise program was associated with the pain intensity at 3 months follow-up. However, patients either using or not using pain medications improved over time, and the magnitude of the difference between patient groups was small (less than 10 mm on a 0–100 scale).ConclusionsPain medication use is weakly associated with outcome at 3 months follow up in OA-patients receiving an education and exercise program. Between-group differences, however, are small and probably not clinically important.

Bullous fixed drug eruptions consequent to NSAID usage − a case series

Fixed drug eruption (FDE) is a distinct, delayed type-IV hypersensitivity manifesting as recurring cutaneous reaction (on skin or mucosa) in the same locations on re-exposure to the offending drug. This is most commonly due to oral medications, antimicrobials and NSAIDs being the most common culprits. Herein, we discuss six cases of bullous FDE due to diverse NSAIDs. The first case was Naproxen-induced bullous fixed drug eruption (BFDE), the second case was due to Etoricoxib, the third patient had Mefenamic acid-induced BFDE, the fourth was Ibuprofen-induced FDE, the fifth one was Diclofenac-induced BFDE, the sixth was Aceclofenac-induced BFDE, and the seventh was a case of paracetamol-induced BFDE. All these patients noticed skin reactions that were clinically diagnosed by the dermatologist as NSAID-induced BFDE. The mainstay of treatment adopted was to avoid the culprit drug. All the seven patients were treated with oral steroids, followed by antihistaminics for reducing FDE-associated pruritus, ointment soframycin, and topical steroids for hyperpigmented lesions. Prompt diagnosis of BFDE and drug withdrawal at the clinician side may help in rapid resolution of the reaction within days to delayed recovery within few weeks, thus preventing rise in morbidity and mortality.

Prevalence of Helicobacter Pylori Infection in Patients with Chronic Dyspeptic Symptoms at Rawal General and Dental Hospital, Islamabad

Background: Helicobacter Pylori infection is the most common cause of chronic dyspeptic symptoms all over the world and covers more than 60% of the out-patient department’s (OPD) registry. That is why we aimed to conduct this study to determine the prevalence of helicobacter pylori infection in patients with chronic dyspeptic symptoms visiting at our out-patient department (OPD) of Rawal General and Dental Hospital.&#x0D; Methods: This was a descriptive cross-sectional hospital based study conducted in the Department of Gastroenterology, Rawal General and Dental Hospital, Islamabad between the periods of two years June 2018 – June 2020 with in patients who presented with a chief complain of dyspepsia through a consecutive sampling technique. Baseline and clinical variables were collected and correlated with the presence and absence of H. pylori infection among 355 finally recruited participants.&#x0D; Results: The overall prevalence of H. pylori infection was 59.71% (n = 212). Among them, married males were more common. Positive H. pylori patients were younger than negative H. pylori patients, 40.24±6.62 vs. 44.9±8.05 (p 0.04). Participants who had a history of NSAIDS intake for past 7 days were significantly associated with positive H. pylori infection, 54.24% (n = 115), p 0.02. While on the other hands, patients who were receiving proton pump inhibitor for the past 4 weeks were significantly associated with absence of H. pylori infection when they presented with chronic dyspeptic symptoms, 65.03% (n = 93), p 0.01.&#x0D; Conclusions: Our study has found that almost two third of the population suffering from chronic dyspeptic symptoms had positive H. pylori infection and these patients are younger than H. pylori negatives. Chronic NSAID users have direct relation in increased prevalence of H. pylori detection while use of PPI plays safety role in prevention and reducing of H. pylori infection.

Preventive Activity of Muntingia calabura Fruits Extract in Aspirin-induced Gastric Ulcer Rat

Gastric ulcer can be affected people at any age. One cause of this disease is NSAID usage. The aim of this study is to determine Muntingia calabura L. fruit activity for prevent ulcer using aspirin-induced gastric ulcer in rat model. Thirty male Wistar rats were divided become six groups: normal (CMC 0.5%), negative control (CMC 0.5%), positive control (omeprazole 20 mg/kg), treatment group (ethanol M . calabura L. fruit extract): I (100 mg/kg), II (200 mg/kg), and III (300 mg/kg) and given orally once a day for 9 days. On the 10th day, aspirin at a dose of 500 mg/kg was given to all groups except the normal group. Four hours after induction, all animals were sacrificed. Preventive effect against stomach ulcer were determined by calculating the index of ulcer and histopathological examination. Index ulcer of M. calabura fruit extract at all dose were different than negative group, although not significant (p&lt;0.05). Histopathological examination of M. calabura extract at a dose of 300 mg/kg showed few inflammatory cells and congestion compared with the other treatment group. Therefore, ethanol M . calabura L. fruit extract at a dose 300mg/kg gave best activity in preventive of gastric ulcer. Keywords: aspirin, gastric ulcer, Muntingia calabura fruit

Intra-Individual Variability in Self-Reported Use of Non-Steroidal Anti-Inflammatory and Analgesic Medicines Depending on Mode of Data Collection - Observations from the Population Study of Women in Gothenburg, Sweden.

BackgroundSelf-report by questionnaire is one of the main methods to collect data on drug utilization. There are several modes of data collection by questionnaire, differing in the way of delivering the questionnaire to respondents and in the administration of the questions, both influencing the recall and participation rates. The aim of this study was to compare different modes of data collection for self-reported use of non-steroidal anti-inflammatory (NSAIDs) and analgesic medicines.MethodsData on 573 women (38 or 50 years) were retrieved from the Population Study of Women in Gothenburg. Data on medicine use were collected using two different modes: (1) a self-administered questionnaire with closed-ended medicine-specific questions; and (2) an interviewer-administered questionnaire with open-ended questions. Cohen’s kappa statistics were applied to assess the agreement of the two modes.ResultsThe proportion of participants that reported use of NSAIDs and analgesics was higher with the self-administered questionnaire compared with the interviewer-administered questionnaire (69.3% vs 58.5%, p <0.001). The overall agreement between the two modes of data collection was fair (Ⱪ=0.27), ranging from none for antimigraine preparations to fair (Ⱪ=0.36) for NSAIDs. A higher proportion of the participants aged 38 years reported use of NSAIDs and analgesics compared with the 50-year olds. In the regression model using data from the self-administered questionnaire, all four categories of bodily pain were significant predictors for use of NSAIDs and analgesics. The most severe reported bodily pain was the only significant predictor in the model using data from the interviewer-administered questionnaire.ConclusionThis study showed that use of a self-administered questionnaire with closed-ended medicine-specific questions identified more users of NSAIDs and analgesic medicines compared with an interviewer-administered questionnaire with open-ended questions. Reported use according to the self-administered questionnaire was also more strongly associated with experienced pain.

Does NSAID Consumption Reduce the Risk of Acute Myeloid Leukemia? a National Population-Based Case-Control Study

BackgroundAutoimmune diseases and infections have been reported to increase the risk of acute myeloid leukemia (AML). However, most studies lacked information on prior hematological diseases and cytotoxic therapy and thus, such factors and not inflammation may explain prior findings. To test the hypothesis that inflammation has no or little impact on leukemogenesis, we investigated whether the risk of AML was decreased in individuals using anti-inflammatory drugs.MethodsWe conducted a nationwide case-control study, using the Danish National Acute Leukemia Registry to all AML patients diagnosed from 2000 to 2013, and selected 10 population controls per case matched on sex and age. To avoid recall bias, we used the Danish National Health Service Prescription Database to identify all prescriptions redeemed from 1995 to 2013 and before the AML diagnosis/index date. We used conditional logistic regression analysis to compute odds ratios (ORs) associating NSAID. To avoid reverse causation we ignored prescription 3 years before diagnosis/index date. Results were given for overall use, by NSAID subtype, by number of prescriptions both overall and for de novo AML and AML related to previous hematological disease (secondary AML) or therapy-related AML (previous cytotoxic therapy). Results were further stratified by sex and age (<60 years, ≥60 years).Results were given with 95% confidence intervals (CIs).ResultsThe final study population included 3165 AML cases and 31,650 sex- and age-matched population controls. The median age was 66.8 years (range 15-99). In total, 68% of cases and 66% of controls redeemed NSAID prescriptions before the AML diagnosis or the index date.The associations between NSAID use and risk of AML overall and by AML type are shown in Table 1. Overall, any-use of NSAID was associated with an increased risk of AML (OR 1.1 (CI=1.0-1.2)). Similar effect was seen across NSAID subtypes, though results were less precise.Long-term use did not reduce the risk of AML, when comparing the risk of AML between patients with different numbers of prescriptions (1-2 prescriptions OR 1.0 (CI=0.9-1.1) vs. >10 prescriptions 1.1 (CI=0.9-1.2)).Repeating analysis for de novo AML and sAML/tAML patients, separately, the increased risk of AML in NSAID users across NSAID subtype and numbers of prescriptions could be contributed entirely to sAML/tAML patients (OR 1.3 (CI=1.1-1.5)), whereas no association was found between NSAID consumption and risk of de novo AML (OR 1.0 (CI=1.0-1.1)).Stratification by acute promyelocytic leukemia (APL)/non-APL, sex or age did not change the interpretation of results (results not shown).ConclusionIn this large population-based study we did not find NSAID to reduce the risk of AML. In contrast, a higher risk of sAML/tAML was seen in NSAID users, likely reflecting higher use of NSAIDs in in patients with an a priori increased risk of AML. Neither age, sex, type of NSAID, nor number of prescriptions influenced the results. These findings support the hypothesis that inflammation is an unlikely causal factor for AML. [Display omitted] DisclosuresØstgård:The Danish Cancer Society: Research Funding; Pfizer: Other: Travel expences. Nørgaard:Program for Clinical Research Infrastructure (PROCRIN): Research Funding. Pedersen:Program for Clinical Research Infrastructure (PROCRIN): Research Funding. Østgård:AbbVie: Consultancy; Pfizer: Consultancy; Bristol-Myers Squibb: Consultancy; Lilly: Consultancy. Severinsen:Novartis: Research Funding; Celgene: Research Funding; ARIAD: Research Funding. Schöllkopf:Karyopharm Therapeutics: Research Funding; Teva: Other: Travel expences; Pfizer: Other: Travel expences. Jensen:The Dagmar Marshall Foundation: Research Funding; The Danish Acute Leukemia Group: Research Funding.

Comparative study between H. Pylori induced and NSAIDs induced peptic ulcer

The use of Non-steroidal anti-inflammatory drugs as well as the infecting agent H Pylori has been attributed as the prominent common etiological factor for peptic ulcers in patients. Distinguishing proof of Helicobacter pylori as the essential etiologic factor in the improvement of peptic ulcer illness and the perception that the frequency of H. pylori increments with age have brought up the issue of a potential synergistic connection between the presence of H. pylori contamination and NSAID use in the improvement of treatment in gastroenterology. Both H.Pylori and NSAIDs have, nevertheless, been appeared to affect the creation rate and the nature of gastric cyclic AMP, the bodily fluid layer, mucosal prostaglandins, blood stream, and platelet-activating factor. Therefore, it is necessary to determine the risk factors such as age and history of peptic ulcers of the patient prior to prescribing. A co-prescription may be important to reduce the risk of peptic ulcers in patients of high risk. Since H.Pylori infection remains the world's most common chronic bacterial infection, it has been suggested that the establishment of a synergistic or additive effect of H.Pylori infection and NSAID use in the development of peptic ulcer is of great clinical importance as eradication of the bacterium is likely to reduce the risk of upper gastrointestinal complications in infected NSAID users. The prevention and overcoming of NSAIDS induced peptic ulcer and H Pylori induced peptic ulcer is embedded in the thorough understanding and assessment of pathophysiology and other underlying causes in each individual patient. There are wide range of studies that emphasize on the various methods of overcoming these conditions as well as understanding the co factors for the risk of ulcer. The main aim of the treatment is to protect the gastric mucosal layer from further eroding away and heal the mucosal ulcer as soon as possible to avoid further complications.

Systemic inflammation is associated with inferior disease control and survival in stage III non-small cell lung cancer

BackgroundThe systemic immune-inflammation index (SII) correlates with patient survival in various types of solid malignancies, including non-small cell lung cancer (NSCLC). However, limited information is available on the prognostic implication and disease-specific survival of SII in patients undergoing definitive chemoradiation therapy (CRT) for stage III NSCLC.MethodsWe retrospectively reviewed 125 patients who underwent curative intent CRT for stage III NSCLC with sufficient laboratory assessment from 2010–2019. SII was calculated at the time of diagnosis as platelet count × neutrophil count/lymphocyte count. Chi-squared analysis was used to compare categorical variables. A Kaplan-Meier analysis was performed to estimate progression-free survival (PFS), disease specific survival (DSS), and overall survival (OS) rates, with Cox regression used to determine absolute hazards.ResultsAt a median follow-up of 19.7 months, 5-year OS, DSS, and PFS rates were 22.6%, 30.9%, and 13.4%, respectively. A low SII (<1,266) at diagnosis was independently associated with an improved OS (HR: 0.399, 95%, CI: 0.247–0.644, P<0.001), DSS (HR: 0.383, 95%, CI: 0.228–0.645, P<0.001), and PFS (HR: 0.616, 95%, CI: 0.407–0.932, P=0.022). We did not detect an association between SII and freedom from recurrence (FFR), freedom from locoregional recurrence (FFLRR), or freedom from distant recurrence (FFDR). NSAID (1,483.4 vs. 2,302.9, P=0.038) and statin usage (1,443.9 vs. 2,201.7, P=0.046) were associated with a lower SII while COPD exacerbations (2,699.7 vs. 1,573.7, P=0.032) and antibiotic prescriptions (2,384.6 vs. 1,347.9, P=0.009) were associated with an elevated SII. These factors were not independently associated with improved survival outcomes.ConclusionsLow SII scores were independently associated with improved OS, DSS, and PFS rates in patients with stage III NSCLC undergoing definitive CRT. NSAIDs and statin usage may be associated with lower SII at diagnosis of NSCLC. This study suggests that SII may be an effective prognostic indicator of patient mortality. Further investigation of the therapeutic potential of these agents in patients with an elevated SII in this setting may be warranted.

Association between current medication use and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative.

ObjectiveUse of specific medications may accelerate the progression of radiographic knee OA (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA.MethodsWe used longitudinal data from the Osteoarthritis Initiative (OAI), an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (Kellgren–Lawrence grade ≥2) and excluded those with a history of knee-related injury/surgery and other musculoskeletal disorders. Current medication use (use/non-use in the previous 30 days) and radiographic medial minimum joint space width (mJSW) data were available at baseline and annually up to 96 months follow-up. We used random effects, panel regression to assess the association between current medication use (non-users as reference group) and change in mJSW.ResultsOf 2054 eligible participants, 2003 participants with baseline mJSW data were included [55.7% female, mean age 63.3 (s.d. 8.98) years]. Of seven medication classes, at baseline NSAIDs were the most frequently used analgesia (14.7%), anti-histamine (10.4%) use was frequent and the following comorbidity medications were used most frequently: statins (27.4%), anti-hypertensives (up to 15.0%), anti-depressant/anxiolytics/psychotropics (14.0%), osteoporosis-related medication (10.9%) and diabetes-related medication (6.9%). Compared with current non-users, current use of NSAIDs was associated with a loss of mJSW (b = −0.042, 95% CI −0.08, −0.0004). No other associations were observed.ConclusionsIn current users of NSAIDs, mJSW loss was increased compared with current non-users in participants with RKOA. Clinical trials are required to assess the potential disease-modifying effects of these medications.

Do postpartum nonsteroidal antiinflammatory drugs (NSAIDs) affect neonatal hyperbilirubinaemia?

ObjectiveThere has been no previous study on the interaction between neonatal hyperbilirubinemia and NSAID use in breastfeeding mothers. This study aimed to investigate whether postpartum analgesics (with NSAIDs) can affect neonatal hyperbilirubinaemia. Materials and methodsMothers who gave birth between January 2017 and December 2017 were included. Those who were not exclusively breastfeeding, gave premature birth, who underwent caesarean section, or whose infants had abnormalities such as an imperforated anus, diaphragmatic hernia, or ovarian tumour were excluded. Mothers were divided into 2 groups based on the analgesics received postpartum: acetaminophen and NSAID (non-steroidal anti-inflammatory drug; flurbiprofen) users. Multivariable logistic regression was adopted to estimate the risk of hyperbilirubinaemia with the use of different kinds of painkillers. ResultsIn total, 1153 mothers were reviewed. After applying the exclusion criteria, 480 mothers were finally included in the analyses. Among them, 348 (72.67%) and 132 (27.33%) mothers received acetaminophen and flurbiprofen, respectively. Seven (2.01%) and 1 (0.76%) newborn had hyperbilirubinaemia among the acetaminophen and flurbiprofen users, respectively. Hyperbilirubinaemia risk of infants whose mothers were flurbiprofen users was not significantly different from that of infants whose mothers were acetaminophen users (adjusted odd ratio = 0.50, 95% confidence interval = 0.06–4.50, p-value = 0.4552). ConclusionsBreastfeeding mothers receiving flurbiprofen do not have increased risk of neonatal hyperbilirubinaemia.

Controversias en cirugía: Erradicación del Helicobacter pylori ¿Terapia a todos o según indicaciones usuales?

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