Steroidal Anti-inflammatory Drugs Research Articles

Efficacy of Diclofenac Transdermal Patch versus Diclofenac Rectal Suppository for Management of Postoperative Pain Following Open Cholecystectomy: A Randomised Clinical Trial

Introduction: Postoperative pain can have detrimental effects if proper analgesia is not provided. The most widely used medicines for the management of postoperative pain is Non Steroidal Anti-Inflammatory Drugs (NSAIDs), among the NSAIDs the most commonly used drug for postoperative pain is diclofenac sodium. Repeated intramuscular/intravenous (i.m/i.v.) injections of diclofenac are associated with pain and discomfort while oral use of diclofenac before and after surgery is limited and is also associated with increased risk of gastrointestinal complications like dyspepsia, peptic ulcer, etc. Diclofenac Transdermal Patch (TD) and Rectal Suppository (RS) are good methods of drug delivery as they avoid first pass metabolism, gastrointestinal complications and pain associated with i.m/i.v. route. Aim: To evaluate the efficacy of the transdermal diclofenac patch versus the diclofenac RS for management of postoperative pain. Materials and Methods: This hospital-based, randomised, prospective, interventional, open label comparative clinical trial was conducted in Department of General Surgery and Department of Pharmacology at FH Medical College and Hospital, Agra, Uttar Pradesh, India, from April 2021 to September 2021. A total of 64 patients were included in the trial and they were randomly divided into two groups using simple randomisation technique. Group A received 100mg diclofenac TD (n=32) and group B received 100 mg diclofenac RS (n=32) just before induction of anaesthesia and repeated 12 hourly for 48 hours. Pain was assessed postoperatively at 6, 12, 24 hours, respectively using the Visual Analogue Scale (VAS) and adverse effects like gastrointestinal complications were also noted in the both groups. The student's t-test was applied to compare the mean values of quantitative variables while qualitative variables were analysed using Chi-square test. p-value <0.05 was considered statistically significant. Results: Both the groups were comparable with respect to age (p-value=0.1048) and gender distribution (p-value=0.3760). VAS score at 12 hours and 24 hours postsurgery in patients of both groups showed significant decrease (p-value <0.001), when compared with VAS score values at 6 hours postsurgery of the same group. On comparison of VAS score between the two groups at 6 hour, 12 hour and 24 hour significant decrease (p-value <0.05) in VAS score was observed with a higher decrement in group B patients i.e., those who received diclofenac rectal suppositories. In group A, seven patients needed rescue analgesia while in group B only three patients required rescue analgesia. Conclusion: Rectal diclofenac suppository had higher efficacy in comparison to transdermal diclofenac patch in management of postoperative pain.

Efficacy of Low Level Laser Therapy in Reducing Pain, Swelling and Trismus Following Impacted Third Molar Extraction Surgery: A Split-mouth Randomised Controlled Trial

Introduction: The use of local or systemic corticosteroids and non steroidal anti-inflammatory drugs are often recommended after surgical extraction of impacted lower third molars to abolish postoperative pain, but some of them may manifest adverse effects such as gastrointestinal irritation, systemic bleeding tendency, and allergic reactions. Aim: To evaluate the efficacy of low level laser therapy in reducing pain, swelling, and trismus following impacted third molar extraction surgery. Materials and Methods: The present split-mouth randomized controlled clinical trial was carried out in the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Mangalore, Karnataka, India. The study sample consisted of nine clinically and radiologically confirmed cases of bilateral symmetrical impacted mandibular third molars indicated for extraction. After extraction surgery, low level laser therapy was administered intraorally and extraorally (Low Level Laser Group). On the contralateral side (Non laser Group), extraction was carried out 15 days prior in the same manner except that patient was not subjected to laser therapy. Trismus, pain, swelling and healing were evaluated on 2nd, 3rd, 4th and 7th day; and were subjected to statistical analysis using Independent-t-Test and Mann-Whitney Test. Results: The study consisted of nine patients, among which six were males and three were females with mean age of 25.89±6.79 years. Pain intensity was lower in the laser group than in the non laser group at all-time points assessed and was non significant (p-value >0.05). Swelling when assessed was less for laser group than non laser group at all-time points and were statistically significant (p-value <0.05) except on the 7th day. The extent of mouth opening was greater in the laser group than in the non laser group at all-time points which was statistically significant only on 2nd day (p-value=0.048). Both laser and non laser group had no statistically significant difference in healing (p-value >0.05). Conclusion: The use of therapeutic laser in the postoperative management of patients undergoing surgical removal of impacted third molars decreases postoperative pain, swelling, and trismus.

Postoperative Analgesic Efficacy of Transverse Abdominis Plane Block versus Port Site Local Infiltration in Laproscopic Gynaecological SurgeriesA Randomised Clinical Trial

Introduction: Pain relief postoperatively has advantages related to better patient satisfaction in terms of early ambulation and discharge and also better cardiovascular stability, decreased infections, neurological complications, prevention of thromboembolic phenomenon, and chronic pain syndrome. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids are the most commonly used drugs in pain management. Transverse Abdominis Plane (TAP) block is a regional analgesic technique, which provides analgesia of the anterolateral abdominal wall and hence can be used to provide analgesia for cesarean section, hernia repairs, hysterectomies, cholecystectomy. Aim: To compare the effectiveness of bilateral TAP block versus port sites local anaesthetic infiltration to relieve postoperative pain in laparoscopic gynaecological surgeries. Materials and Methods: This single-blinded randomised controlled study conducted at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The clinical trial was conducted on 80 patients belonging to American Society of Anesthesiologists (ASA) I and II posted for elective laparoscopic gynaecological surgeries. Patients were randomly allocated into two groups with 40 patients in each group. Group T (TAP block) received 0.6 mL/ kg of 0.25% bupivacaine for bilateral ultrasound guided TAP block and group O (port sites local infiltration) received 0.6 mL/ kg of 0.25% bupivacaine for port sites infiltration. At the end of surgery, patients received either TAP block or port site infiltration as per the group allocated and then extubated. Postoperative pain intensity using Visual Analogue Scale (VAS) score were recorded at the time of shifting as 0 hr and then every 2 hrs, 4 hrs, 6 hrs, 8 hrs, 12 hrs, 24 hrs. The mean time for first rescue analgesia and total number of rescue analgesic given in first 24 hrs were noted. Haemodynamic parameters and side-effects with study drug were noted. For inferential statistics, numerical data was analysed by Chi-square test and for categorical data student’s t-test was used. A p-value <0.05 was considered as statistically significant. Results: Demographic parameters in both groups were comparable. There was no significant difference in VAS score up to 4 hours in between two groups. But mean VAS score was significantly low in group T when compared to group O at 6 hours (2.2±0.4 vs 2.7±0.5), 8 hours (2.7±0.4 vs 3.2±0.7) and 12 hours (3.3±0.5 vs 3.6±0.5). The time to receive rescue analgesic was longer in TAP block group (13.7±1.5 vs 10.6±1.64 hrs) when compared to port sites local infiltration group. And total number of rescue analgesia received was low in TAP block group (70% recieved single dose) when compared to port sites local infiltration group (80%received two doses). Conclusion: The TAP block and port sites infiltration in patients undergoing laparoscopic gynaecological surgeries are used for effective postoperative analgesia as part of multimodal analgesia, which reduces the use of other analgesics like NSAIDS and opioids. However, TAP block provides superior and prolonged pain relief when compared to port sites local infiltration.

The Effect of Alcoholic Essence Satureja Sahandica Bornm L. on the Expression of Metalloproteinases 1, 2, 9 and 13 in a Model Similar to Osteoarthritis

Loss of the extracellular matrix of cartilage is one of the most important and prominent features of osteoarthritis (OA). The ECM has two important components, including the proteoglycan aggrecan and type II collagen, which are the main targets of MMPs and ADAM TSs enzymes. In this paper, the effect of ASSB Compared with dexamethasone and ibuprofen as representatives of steroidal and nonsteroidal anti-inflammatory drugs. One way to prevent irreversible joint damage in OA is to inhibit MMPs. ASSB can improve the condition of patients with osteoarthritis by reducing the expression of the MMPs 9 and 13 gene. <i>Background</i>: OA is a progressive joint disease characterized by cartilage degeneration, cartilage bone regeneration, and synovial membrane inflammation and is exacerbated with age. Given the side effects of conventional OA treatments, including nonsteroidal anti-inflammatory drugs and corticosteroids, it is important to consider new treatments for this disorder. Recently, the effect of matrix metalloproteinases on the pathogenesis of OA has been attracted attention. <i>Objective</i>: The aim of this paper was to evaluate the impact of Alcoholic Satureja Sahandica Bornem L. (ASSB) essence on inhibiting the expression of metalloproteinase gene 1, 2, 9 and 13 in bovine fibroblast-like synoviocytes stimulated by lipopolysaccharide as a model of osteoarthritis. <i>Methods</i>: Synovial cells were isolated from the articular cartilage of the radiocarpal joint of an 8-month-old Holstein cow. After determining the degree of toxicity by MTT Assay, the cells were exposed to stimulation of LPS without or in the presence of dexamethasone, ibuprofen and alcoholic Satureja Sahandica Bornem essence (ASSB). Metalloproteinase gene expression 1, 2, 9 and 13 were measured by RT-PCR and ELISA. The effect of ASSB on migration and cell invasion was investigated by Transwell chambers. <i>Results</i>: The results showed that Satureja Sahandica Bornm (SSB) essential oil significantly reduced the expression of metalloproteinases 9 and 12 in bovine fibroblast-like synovocytes stimulated by lipopolysaccharide. It also suppressed migration and invasion of these cells. However, Satureja Sahandica Bornm L. had no significant impact on the expression of MMPs 1 and 2. <i>Conclusion</i>: Based on our results, ASSB can significantly reduce the activity and inflammatory effect of MMPs 9 and 12 in OA, its potential role as a complement to NSAIDs and common corticosteroids was confirmed. However, cellular modeling does not confirm the beneficial effect of OA in patients.

Nutraceutical Treatment in Knee Osteoarthritis&amp;lt;br/&amp;gt;—Arthritis-Presentation of a Dietary Plan by Means of Additional Nutraceuticals in Lieu of the Detrimental Side Effects of Current Conventional Medicine

Arthritis (AR) is a disease that affects the joints and of which there are, remarkably, over 100 different types. Osteoarthritis (OA) is the most common type and knee osteoarthritis (KOA) is the most common subgroup of OA. KOA is a pathological degeneration of joints, connective tissue and the sub-chondral bone of the knee. The origin of the disease is not fully understood but the etiology includes risk factors such as age, gender, physiological trauma and BMI. It is a complex pathological state of cause, effect, and manifestation where the exact mechanisms responsible are not visible. Inflammatory mediators are involved in the progression of KOA and this cascade of reactions to the inflicted area is unfortunately chronic. Pain is a key feature, and it ranges from mild to severe. Patients are likely to use analgesics that are more potent than “over the counter” (OCT) drugs at some stage. As the condition develops over time the need increases and prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and steroids are used. NSAIDs can help reduce the pain as well as enhance the joints range of movements again. However not in an optimal way, nor do they have the ability to alter any of the mechanisms behind the disease. Inevitably, the side effects from the medicine will have a negative impact on the patient; even more so the longer they are used. Currently, alternative medicine and nutraceuticals can be controversial. Several countries and organizations consistently deny any beneficial outcome from these in the context of KOA-treatment. Official statements are made about the lack of evidence and consequently official non-recommendations are commonplace. This review will show viable complementary alternative medicine (CAM) that has been studied over decades with unequivocal positive results on KOA. These options exhibit minimal side effects and a high safety-margin. Included are up-to date clinical studies with current evidence of beneficial effects. This review presents key strategies for the arthritis patients. A dietary plan not to deviate from and the use of specific nutrients and herbs. The analysis of nutrachemicals include glucosamine, chondroitin sulfate, collagen type 1, undenatured collagen type II and hyaluronic acid. Therapeutic dosages of nutraceuticals as well as a specified diet designed to curb and to some extent reverse KOA. Traditional Chinese medicine consisting of T. wilfordii, A. bidentate, bromelain, Boswellia and Curcuma longa. To a certain extent these nutraceuticals have an ability that is absent in current pharmacological treatments. The ability to reverse and sometimes rebuild tissues and cells affected by KOA. All nutraceuticals in the review is evaluated with the standard methods WOMAC and VAS in order to measure degrees of pain, stiffness and functionalities of the knee.

Combined Central Retinal Artery and Vein Occlusion with Ischemic Optic Neuropathy After COVID-19 Vaccination

PurposeTo report a case of combined central retinal vein and artery occlusion that evolved into ischemic optic neuropathy following the Pfizer COVID-19 vaccination.MethodsPatient was followed with optical coherence tomography (OCT), fluorescein angiography, and Humphrey visual field.ResultsPatient was able to recover vision from count fingers to 20/30 on a combination of aflibercept, steroidal and non-steroidal anti-inflammatories, a diuretic (acetazolamide), antiplatelet agents (aspirin and pentoxifylline), and an anticoagulant (apixaban).ConclusionCOVID-19 vaccination may be associated with a myriad of sight-threatening ocular thrombotic conditions, which may respond to a combination of anti-inflammatory and anticoagulant therapies.

L’ulcère de Mooren: une cause rare parfois grave d’ulcération cornéenne périphérique!

Mooren´s ulcer is a rare form of peripheral corneal ulceration. The ulcer originates from an inflammatory infiltrate involving the limbal cornea. The disease spreads circumferentially, resulting in ulceration that progresses around the limbo and then centrally. Treatment is based on local steroidal anti-inflammatory drugs and conjunctival resection, amniotic membrane transplant and, in patients with severe perforation, on lamellar corneo-scleral transplant and appropriate immunosuppressive therapy. We here report the case of a male patient aged 55 years with nasal corneal ulceration involving the limbus. Ulceration extended circumferentially and centrally and was complicated by a perforation measuring 2.5 mm in vertical diameter with iris hernia. Possible causes of vasculitis were eliminated. The diagnosis Mooren´s ulcer was made. The patient received bolus application of corticosteroids and was referred for lamellar corneo-scleral transplant.

Glucocorticoid Use and Misuse in a Rural Community of Kerala, India.

Background:Glucocorticoids (GCs) are anti-inflammatory steroid medications prescribed globally by doctors for various illnesses and they are known to produce quick symptom relief. In India, they are among the cheapest and easily accessible over-the-counter medications. Thus, it can be misused, leading to many life-threatening illnesses such as diabetes mellitus, hypertension, overwhelming infections, Cushing’s syndrome, and hypo-adrenal crisis.Objective:This study reports the misuse of GCs in a rural community in the state of Kerala, India, and compares it with the only other community GC misuse study in India, from the state of Bihar.Methods:A community-based cross-sectional survey of 452 households comprising 1,734 people was conducted in rural Konni, Kerala, during June and July of 2019. In each house, people who had been taking medications over the previous 6 months were interviewed.Results:Almost 2% (n = 31) had consumed one or more GCs in the last 6 months (95% CI: 1.3–2.5%). Of these, 26% (n = 8) were taking oral GCs and 36% (n = 11) of them were inappropriately using them based on current clinical guidelines. 29% (n = 9) had used GCs for more than 1 month.Conclusions:GC misuse exists in Kerala but not to the extent seen in Bihar. In Kerala, inhaled GCs are more common than oral GCs, and the prescription is obtained predominantly from qualified medical practitioners. The prevalence of prolonged GC use could be implicated as an underlying factor for diabetes, hypertension, osteoporosis, and cataracts. It is possible that approximately 220,000 people in Kerala may have a suppressed hypothalamus-pituitary-adrenal axis which can predispose them to a fatal hypo-adrenal crisis.

Kikuchi disease: An unusual cause of cervical lymphadenopathy in a young female

Kikuchi-Fujimoto disease (KD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of unilateral cervical lymphadenopathy usually described in adolescents and young adults with female preponderance. Clinically patients present with palpable lymphadenopathy, fever, and loss of weight. Hence, it should be differentiated from other causes of lymphadenopathy such as tuberculosis, lymphoma, or malignancy. Although the majority resolve spontaneously without treatment some may require non-steroidal anti-inflammatory drug or steroids. It may also be associated with systemic lupus erythematosus. Hence early detection, prompt diagnosis, and follow-up of the patient are essential in all cases of unilateral cervical lymphadenopathy in young adults. Here, we describe a 22-year old female who presented with unilateral neck swelling and was clinically diagnosed initially as a case of tuberculous lymphadenitis which on biopsy turned out to be KD.

PHARMACY CONSULTING: NEW DRUG FORMS AND NEW OPPORTUNITIES

Pain syndrome of various origins and varying intensity is the most common and leading reason for seeking medical care in the world. The main drugs for the relief of both acute and chronic pain syndrome from the 20th century to the present are non- steroidal anti-inflammatory drugs (NSAIDs). More than 30 million people worldwide receive them every day. Along with pain, other common indications for NSAIDs are fever and inflammation. All NSAIDs differ in the degree of effectiveness, form of release, speed of onset of clinical effect and dosage. That is why one of the fundamental tasks of the pharmacist, in the framework of pharmacy counseling, is to provide the patient with quality medicines and teach them how to use them rationally. With the rapid development of medical and information technologies in the modern world, the fulfillment of this task becomes more and more important, complex and responsible action. The appearance, on the pharmaceutical market innovative NSAIDs in accelerated-release dosage’s forms (for example, Ketorol® Express), makes it possible to expand the pharmacy list.

Evaluation of Recovery Rate in COVID-19 Patients Treated with Steroidal Drugs

Introduction: Coronavirus belongs to the family coronaviridae that majorly affects the respiratory system this group of virus outbreak previously as SARS and MERS in various countries and recently as COVID-19. COVID-19 has symptoms like fever, dry cough, breathing problems, loss of smell and taste, body aches. COVID-19 has spread to 210 countries and infected 272.51 million people worldwide, reached over 5.34 million deaths. Treatment includes antivirals, antibiotics, Non Steroidal Anti-Inflammatory Drugs, corticosteroids.&#x0D; Methodology: It is a hospital-based retro-prospective study was conducted for 6 months in the Inpatient department. 100 patients were taken who met the inclusion criteria. Data collected and evaluated, analyzed by open label study.&#x0D; Results and Discussion: severe COVID-19 can develop systemic inflammatory responses that can lead to lung injury and multisystem organ dysfunction. It has been proposed that the potent anti-inflammatory effects of corticosteroids might prevent or mitigate these deleterious effects. Both beneficial and deleterious clinical outcomes have been reported with the use of corticosteroids in patients with other pulmonary infections&#x0D; From study, The Recovery% using steroids in the time period of 0-10 and 11-20 days was found to be 34 and 27% respectively. The Recovery percentage using steroids in the time period of 0-10 and 11-20 days was found to be 18 and 8% respectively. Dexamethasone was most commonly used in males and females, 77.08 and 84% respectively.&#x0D; Conclusion: Considering beneficial effects of corticosteroids in COVID -19, prescribing steroids is safe by dose tapering continued up to 10days or hospital discharge

Tempe Kedelai (Rhizopus oligosporus) sebagai Alternatif Anti Inflamasi

Background: Inflammation is a protective mechanism of the immune system due to tissue damage caused by infectious and non infectious agents. The most widely used synthetic drugs in treating the inflammation is NSAIDs (Non Steroidal Anti Inflammatory Drugs) but long-term use of NSAIDs can cause undesirable side effects. Tempeh (R. oligosporus) is one of the processed soy products that is made through the fermentation process by Rhizopus sp. Tempeh has many benefits for health, one of which is anti-inflammatory. According to some research results, tempeh is recognized as having an anti-inflammatory role. The mechanism of tempeh as an anti-inflammatory, namely by maintain a balance between reactive oxygen species (ROS) and antioxidants in the body, increasing the production of anti-inflammatory cytokines (IL-10), suppressing the activation of NF-kB. This process can suppress the expression of iNOS and COX-2 and inhibit several inflammatory mediators, such as TNF-α, IL-1β and NO. Objective: The purpose of this study was to investigate anti-inflammatory activity of soybean tempeh (R.oligosporus) and find out the potential of active compounds in soybean tempeh that play role as anti-inflammatory. Method: The study was conducted by collecting and examining of various literatures on potential of soybean tempeh (R.oligosporus) in suppressing inflammatory response. Conclusion: The active compounds found in soybean tempeh (R. oligosporus) is able to suppress the inflammatory response.

ANTI-INFLAMMATORIES FOR DELAYED ONSET MUSCLE SORENESS: SYSTEMATIC REVIEW AND META-ANALYSIS

ABSTRACT Objective: To investigate the effectiveness of pharmacological interventions in the treatment of delayed onset muscle soreness (DOMS). Design: A systematic review and meta-analysis of randomized controlled clinical trials (RCTs). Data sources: The PubMed/MEDLINE, EMBASE, SPORTDiscus, Scielo and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for RCTs published prior to August 3, 2020. Eligibility criteria for selecting studies: Studies that 1) used an RCT design; 2) evaluated the effectiveness of steroidal or nonsteroidal anti-inflammatory drugs (NSAIDs) in treating DOMS; and 3) therapeutically used drugs after exercise were included. Results: In total, 26 studies (patients = 934) were eligible for inclusion in the qualitative analysis on the treatment of DOMS. The results of the meta-analysis showed no superiority between the use and non-use of NSAIDs in the improvement of late muscle pain, as no statistically significant differences were verified (21 studies, n= 955; standard mean difference (SMD)= 0.02; 95% confidence interval (CI) −0.58, 0.63; p=0.94; I2=93%). The quality of the synthesized evidence was very low according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and there was significant heterogeneity among the included studies. Conclusion: The results demonstrate that NSAIDs are not superior to controls/placebos in treating DOMS. The inclusion of both studies with dose-response protocols and those with exercise protocols may have influenced the results. In addition, the high risk of bias identified reveals that limitations need to be considered when interpreting the results. Level of evidence I; ystematic review of RCT (Randomized and Controlled Clinical Trials).

Mechanochemical synthesis and characterization of a novel AAs–Flucytosine drug–drug cocrystal: A versatile model system for green approaches

Mechanochemistry approach is addressed herein for the green formation of a novel 1:1 drug–drug cocrystal (DDC) involving the antifungal prodrug Flucytosine (5FC) and the non-steroidal anti-inflammatory acetylsalicylic acid (AAS). This DDC was designed considering the huge market demand for new antifungal agents and the antifungal activity reported for some non–steroidal anti–inflammatory drugs, including AAS. The structure-properties characterization of the 5FC-AAS cocrystal was determined by X–ray diffraction (single crystal and powder), differential scanning calorimetry, thermogravimetric analysis, spectroscopic techniques (Raman and Fourier transform infrared), and hot–stage microscopy. The strong O–H…O and N–H…O hydrogen bonds formed between the hydroxyl group of AAS and the carbonyl and amine groups of two symmetry–related 5FC molecules maintain the crystalline packing, together with the same classical R22(8)homodimers observed in other 5FC cocrystals. The direct exposure under accelerated conditions (75% relative humidity/40 °C for 7 days) and at 12–months at room condition were also evaluated. Although the hygroscopicity addressed to 5FC was observed in the cocrystal during the stability studies, nevertheless this property discrepancy can easily be handled with the use of appropriate excipients and packing. DDC production was interestingly achieved by solvent evaporation, neat, and solvent-drop grinding (manually and in a ball-milling), resulting in a very fast production with suitable yield. In this sense, it is believed that this new model DDC will serve as a potential binary base cocrystal system for further developments of related higher dimensional cocrystals in this field, alongside other important drug molecules or in relation to the feasibility of using it therapeutically.

COVID INDUCED THYROIDITIS: A CASE REPORT

INTRODUCTION: Thyroiditis is one of the manifestations of novel Covid-19 virus. Thyroid function test (TFTs) shows typical features of hyperthyroidism. Inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and serum ferritin] and thyroid scan give clue to the diagnosis. Up till now very few cases of subacute thyroiditis (SAT) due to Covid-19 have been reported CASE DESCRIPTION: We present a case of 39-year-old female with no personal or family history of thyroid disorder presented with features suggestive of thyrotoxicosis along with pain in the neck, odynophagia and intermittent fever after recovering from covid-19 recently i.e. 2 weeks before the onset of symptoms. TFTs revealed high triiodothyronine-T3 (1.8 ηg/ml) and thyroxine-T4 (2.66 ηg/dl) and low TSH (&lt;0.04 uIU/ml). Thyroid scan revealed decrease uptake, ESR was 115 mm/hour, CRP was 48 mg/L and serum ferritin was 740ηg/ml. She was started on non-steroidal anti-inflammatory drugs, steroids and beta blocker. Four weeks later she reverted back with the resolution of symptoms and normal TFTs. CONCLUSION: Early recognition and timely management of SAT with anti-inflammatory therapy can help in successful management of the disease.

Chaturbeeja Arka in Primary Dysmenorrhoea- A Case Series

Dysmenorrhoea is the most common problem in adolescent gynaecology. It is related to significant absenteeism from school and poor academic performance. Primary dysmenorrhoea is widely prevalent in more than 50% of teenagers. Among Yonirogas udavartha yonivyapath, presents with painful menstruation and its main feature is relief of pain following discharge of blood, which is characteristic of primary dysmenorrhoea. The objective of treating primary dysmenorrhoea is to reduce pain, so that the patient is not restricted from attending her daily routine activities. Pharmacological strategies for Primary Dysmenorrhoea generally involve non- steroidal anti-inflammatory drugs or hormonal contraceptives which may have adverse effects. So, developing Ayurveda medicines with minimal adverse effects have significant relevance.&#x0D; Chaturbeeja arka mentioned in Chaturtha sathakam of Arka prakasha consists of Methika, Chandrashura, Kalaajaji and Yavani. It has Soolahara, Adhmanahara and Sameerajith properties. Compared to Kashaya kalpana, Arka kalpana is required in lesser dosage, has higher patient compliance, has longer shelf life and does not require addition of preservatives. A pilot study was conducted in 5 diagnosed cases of Primary dysmenorrhoea. It was found to be effective in lower abdominal pain and associated low back ache. The current article is an attempt to explore the effect of Chaturbeeja arka in primary dysmenorrhoea.

Abstract 12136: Detection of Sub-Clinical Left Ventricular Dysfunction in COVID-19 Patients

Introduction: Abnormalities of left ventricular (LV) strain have been shown to occur prior to impairment of global left ventricular function, measured by global LV ejection fraction (EF). Although first described in patients receiving cardiotoxic chemotherapy, impairment of LV strain prior to a decrease in EF has also been shown in many other disease states which affect LV function. This study was designed to assess impairment of LV strain in post COVID-19 patients with normal EF using cardiac MRI MyoStrain Fast-SENC (strain encoded) pulse sequences. Methods: An institutional cardiac imaging database was queried for all patients with documented COVID-19 test positivity and a normal LVEF &gt;= 55% who underwent measurement of global longitudinal strain (GLS), global circumferential strain (GCS), and regional longitudinal and circumferential strain using cardiac MRI Fast-SENC pulse sequences. Global and regional strain measurements were compared to a cohort of healthy volunteers who also underwent CMR Fast-SENC imaging. Abnormal myocardial strain was defined as a value &gt;-17%. Results: Of 50 COVID-19 patients in the cardiac imaging database who underwent CMR Fast-SENC imaging, 40 had a normal LVEF, constituting the study cohort. Mean GLS and GCS for the study cohort were -16.40% and -15.45% and for healthy volunteers were -19.71% and -20.93% respectively; both comparisons were statistically significant with an unpaired t-test (p&lt;0.01). Furthermore, the prevalence of abnormal LV strain in COVID-19 patients with normal LVEF was 77.78%. Conclusions: These data suggest that impairment of LV strain (longitudinal and circumferential) occurs in COVID-19 patients who have a normal LVEF. Whether a decrease in GLS and/or GCS precede a decrease in LVEF, is beyond the scope of this study. However, the ability to evaluate progression of LV strain abnormalities with CMR may help identify changes in LV function before the onset of a reduction in LVEF and development of heart failure. The ability to identify and quantify abnormal left ventricular GLS and GCS with cardiac MRI also opens the door to assess any benefit of therapy, including anti-inflammatory agents, anti-viral drugs and steroids.

P032 Methotrexate and hepatic tolerance in Juvenile Idiopathic Arthritis

Abstract Background Methotrexate (MTX) is considered as the main treatment for some juvenile idiopathic arthritis (JIA) subtypes. The hepatic toxicity of MTX has been reported in numerous studies in rheumatoid arthritis which have shown that prolonged treatment can induce hepatic fibrosis and a disturbance of the liver biologic tests. In patients with JIA, the potential hepatic toxicity of MTX needs to be confirmed. Methods A retrospective study of patients followed for JIA and treated with MTX was conducted. The results of the hepatic assessment looking for cytolysis or cholestasis performed during the pre-treatment assessment and then during regular checks were noted. Results Thirty-nine JIA patients were included. The mean age of disease onset was 8 years [1.5–17 years]. The JIA subtype was systemic in 11 cases, enthesitis related arthritis in 5 cases, rheumatoid factor seronegative polyarthritis in 15 cases and rheumatoid factor seropositive polyarthritis in 2 cases, and oligoarthritis in 2 cases. Patients were treated with low doses of corticosteroids (0.2–0.4 mg/kg) in majority of cases (82%). Non steroid anti-inflammatory drugs were used in 51% of cases. MTX was prescribed as monotherapy in 20 cases, in combination with Sulfasalazine in 6 cases and Anti TNF alpha in 12 cases. MTX has been used on average for 11 years [2 months-26 years]. This drug was stopped for ineffectiveness in 7 cases, for digestive intolerance in 2 cases and in one case for severe hepatic cytolysis after 2 years of treatment with a progressive normalization of hepatic laboratory tests after 6 months. During regular monitoring, no further disturbances of liver function were observed. Conclusion MTX hepatotoxicity appears to be very mild and rare in JIA. These results are reassuring given that MTX is a highly effective treatment in JIA.

Combining short-term bioassays using fish and crustacean model organisms with ToxCast in vitro data and broad-spectrum chemical analysis for environmental risk assessment of the river water (Sava, Croatia)

This study focused on the short-term whole organism bioassays (WOBs) on fish (Danio rerio) and crustaceans (Gammarus fossarum and Daphnia magna) to assess the negative biological effects of water from the major European River Sava and the comparison of the obtained results with in vitro toxicity data (ToxCast database) and Risk Quotient (RQ) methodology. Pollution profiles of five sampling sites along the River Sava were assessed by simultaneous chemical analysis of 562 organic contaminants (OCs) of which 476 were detected. At each sampling site, pharmaceuticals/illicit drugs category was mostly represented by their cumulative concentration, followed by categories industrial chemicals, pesticides and hormones. An exposure-activity ratio (EAR) approach based on ToxCast data highlighted steroidal anti-inflammatory drugs, antibiotics, antiepileptics/neuroleptics, industrial chemicals and hormones as compounds with the highest biological potential. Summed EAR-based prediction of toxicity showed a good correlation with the estimated toxicity of assessed sampling sites using WOBs. WOBs did not exhibit increased mortality but caused various sub-lethal biological responses that were dependant relative to the sampling site pollution intensity as well as species sensitivity. Exposure of G. fossarum and D. magna to river water-induced lower feeding rates increased GST activity and TBARS levels. Zebrafish D. rerio embryo exhibited a significant decrease in heartbeat rate, failure in pigmentation formation, as well as inhibition of ABC transporters. Nuclear receptor activation was indicated as the biological target of greatest concern based on the EAR approach. A combined approach of short-term WOBs, with a special emphasis on sub-lethal endpoints, and chemical characterization of water samples compared against in vitro toxicity data from the ToxCast database and RQs can provide a comprehensive insight into the negative effect of pollutants on aquatic organisms.

La sindrome “Cefalea e deficit neurologici transitori con linfocitosi liquorale”: un’altra encefalopatia autoimmune?

Headache and neurologic deficits with cerebrospinal fluid lymphocytosis syndrome (HaNDL) is a rare nosographic entity, which mainly affects adults but can also occur in the paediatric age. In the literature, 31 cases in this age group are described. Symptomatology typically lasts about three months with episodes that tend to relapse. An autoimmune pathogenesis has been hypothesized. The paper describes the case of an adolescent who presented with three acute and transient episodes of migraine headache in three days associated with impaired consciousness, focal neurological deficits and CSF lymphocytosis. After treatment with steroidal and non-steroidal anti-inflammatory drugs, the patient did not relapse in the following four months. The treatment indicated in the literature is only supportive (analgesics, antiemetics), however in this case the anti-inflammatory therapy reduced the duration of the episode and the recurrence of further episodes.