Steroidal Anti-inflammatory Drugs Research Articles

Potential Nano Gel Extract of Avocute Fruit (Persea Americana Mill) as Alternative in Prevention of Inflammation in White Rats White Rats Post-Extraction Wounds

Complications after tooth extraction include inflammation, bleeding, edema, discomfort, and dry socket. Both nonsteroidal anti-inflammatory drugs (NSAIDs) and steroidal anti-inflammatory drugs are used to treat inflammation. Using chemo drugs is not without side effects. Avocado seed is an herbal substance that is needed as an alternative therapy to reduce wound inflammation caused by tooth extraction. To prove the potential of nano gel (avocado seed extract) and can be applied as an alternative to prevent inflammation in wounds after tooth extraction of white rats. True experiment with randomized posttest with control group design. Consisting of intervention group nano gel avocado seed extract 10%, positive control group povidone iodine 10% and aquadest. Observations were made for 7 days. The variables studied were inflammation of the wound after tooth extraction of rats and histopathological examination (Lymphocytes, Neocapillary and Fibroblasts). According to the unpaired test results, there was no significant difference between the avocado and povidone groups (p=0.143), a significant difference between the avocado and aquadest groups (p=0.001), and a significant difference between the povidone and aquadest groups (p=0.001). p = 0.015). Application of avocado seed extract nanogels at concentrations of 10% and 10% povidone-iodine showed the same ability during wound regeneration and new blood vessel enlargement, and also reduced the number of lymphocyte inflammatory cells, as shown by histology Check confirmed. The administration of nano gel of avocado seed extract is effective and can be applied as an alternative to prevent inflammation in wounds after tooth extraction in white rats.

Efficacy of transtympanic infusion of dexamethasone into the tympanic cavity in mice with acute sensorineural hearing loss associated with cytomegalovirus infection

Background There is no report on acute sensorineural hearing loss with congenital cytomegalovirus (cCMV) infection in basic experiments. Aims/Objectives The aim of this study was to evaluate the effect of dexamethasone, an anti-inflammatory steroid, on acute sensorineural hearing loss in the mouse cytomegalovirus (MCMV) infection model mice. Material and Methods Sensorineural hearing loss model mice were divided into two groups, one with and one without intratympanic dexamethasone. Dexamethasone was injected into the tympanic cavity of only the right ear, and hearing ability was assessed at the ages of three, six, and eight weeks by auditory brainstem response measurement. Results Among the 23 mice intratympanically injected with dexamethasone (15 μg/mouse) at the age of three weeks, five (21.7%) had a hearing improvement of at least 10 dB and 18 (78.3%) had no improvement at the age of six weeks. Among the 19 mice that did not receive a dexamethasone injection, one (5.3%) showed improvement and 18 (94.7%) showed no improvement (p = 0.129). Conclusions and Significance In this study, transtympanic infusion of dexamethasone into the tympanic cavity was effective in some mice with sensorineural hearing loss, suggesting that, in addition to angiogenesis, anti-inflammatory activity might be a mechanism of treatment for hearing loss.

Clinical presentation and outcomes of hospitalized children with COVID-19 in Mexico City.

We describe the demographic, clinical, radiological, and laboratory findings relating them also to the severity and clinical outcome of 129 children (0–18 years) who were admitted to a tertiary care pediatric hospital in Mexico City due to severe acute respiratory syndrome coronavirus 2 infection between April 1, 2020 and March 31, 2021. The infection was confirmed using reverse transcription‐polymerase chain reaction Fever (82.2%), tachypnea (72.1%), and cough (71.3%) were the most reported signs at the moment of hospitalization. The most frequent radiological pattern that stood out was the interstitial pattern (66.7%). History of oncologic pathology (25.6%) was the most frequent past medical history. Non‐steroidal anti‐inflammatory drugs (93%), antibiotics (57.4%), and steroids (40.3%) were the most common medication given. The average hospitalization stay was 14.2 days, and 21.7% of the total patients required transfer to the intensive care unit. At discharge, 20.2% required oxygen on an outpatient basis, and unfortunately, 7.0% of the patients who were admitted to the institute for COVID‐19 died. Our findings confirm that COVID‐19 in children has a mild presentation except for patients with hematologic/oncologic comorbidities who had severe presentations.

Efficacy and Safety of Vamorolone vs Placebo and Prednisone Among Boys With Duchenne Muscular Dystrophy

Corticosteroidal anti-inflammatory drugs are widely prescribed but long-term use shows adverse effects that detract from patient quality of life. To determine if vamorolone, a structurally unique dissociative steroidal anti-inflammatory drug, is able to retain efficacy while reducing safety concerns with use in Duchenne muscular dystrophy (DMD). Randomized, double-blind, placebo- and prednisone-controlled 24-week clinical trial, conducted from June 29, 2018, to February 24, 2021, with 24 weeks of follow-up. This was a multicenter study (33 referral centers in 11 countries) and included boys 4 to younger than 7 years of age with genetically confirmed DMD not previously treated with corticosteroids. The study included 4 groups: placebo; prednisone, 0.75 mg/kg per day; vamorolone, 2 mg/kg per day; and vamorolone, 6 mg/kg per day. Study outcomes monitored (1) efficacy, which included motor outcomes (primary: time to stand from supine velocity in the vamorolone, 6 mg/kg per day, group vs placebo; secondary: time to stand from supine velocity [vamorolone, 2 mg/kg per day], 6-minute walk distance, time to run/walk 10 m [vamorolone, 2 and 6 mg/kg per day]; exploratory: NorthStar Ambulatory Assessment, time to climb 4 stairs) and (2) safety, which included growth, bone biomarkers, and a corticotropin (ACTH)-challenge test. Among the 133 boys with DMD enrolled in the study (mean [SD] age, 5.4 [0.9] years), 121 were randomly assigned to treatment groups, and 114 completed the 24-week treatment period. The trial met the primary end point for change from baseline to week 24 time to stand velocity for vamorolone, 6 mg/kg per day (least-squares mean [SE] velocity, 0.05 [0.01] m/s vs placebo -0.01 [0.01] m/s; 95% CI, 0.02-0.10; P = .002) and the first 4 sequential secondary end points: time to stand velocity, vamorolone, 2 mg/kg per day, vs placebo; 6-minute walk test, vamorolone, 6 mg/kg per day, vs placebo; 6-minute walk test, vamorolone, 2 mg/kg per day, vs placebo; and time to run/walk 10 m velocity, vamorolone, 6 mg/kg per day, vs placebo. Height percentile declined in prednisone-treated (not vamorolone-treated) participants (change from baseline [SD]: prednisone, -1.88 [8.81] percentile vs vamorolone, 6 mg/kg per day, +3.86 [6.16] percentile; P = .02). Bone turnover markers declined with prednisone but not with vamorolone. Boys with DMD at baseline showed low ACTH-stimulated cortisol and high incidence of adrenal insufficiency. All 3 treatment groups led to increased adrenal insufficiency. In this pivotal randomized clinical trial, vamorolone was shown to be effective and safe in the treatment of boys with DMD over a 24-week treatment period. Vamorolone may be a safer alternative than prednisone in this disease, in which long-term corticosteroid use is the standard of care. ClinicalTrials.gov Identifier: NCT03439670.

Potential Nano Gel Avocodo Seed Extract as an Alternative Relief in Wounds After Removal of White Rats Tooth

Inflammation, bleeding, swelling, pain, dry socket are common complications of tooth extraction. The inflammatory response is divided into two, including the administration of non-steroidal anti-inflammatory drugs (NSAIDs) and steroid anti-inflammatory drugs. Every use of chemical drugs has side effects. Herbal ingredients are needed, namely avocado seeds as an alternative treatment in preventing inflammation in wounds after tooth extraction. Avocado seeds contain polyphenols that play a role in inflammation in wounds, including flavonoids, alkaloids, tannins, and saponins. Experiment with randomized posttest design with control group design. Consisting of intervention group nano gel avocado seed extract 10%, positive control group povidone iodine 10% and aquadest. Observations were made for 7 days. The variables studied were inflammation of the wound after tooth extraction of rats and histopathological examination (Lymphocytes, Neocapillary and Fibroblasts). Based on the results of the unpaired test, the avocado and povidone groups were not significantly different (p=0.143), the avocado and aquadest groups had a significant difference (p=0.001) and the povidone and aquadest groups had a significant difference (p =0.015). The administration of nano gel of avocado seed extract with a concentration of 10% and 10% povidone iodine has the same ability in the process of wound regeneration and increases new blood vessels and can also reduce the number of lymphocyte inflammatory cells as evidenced by histological examination . The administration of nano gel of avocado seed extract is effective and can be applied as an alternative to prevent inflammation in wounds after tooth extraction in white rats.

Coadministration of Stigmasterol and Dexamethasone (STIG+DEX) Modulates Steroid-Resistant Asthma

Airway inflammation in asthma is managed with anti-inflammatory steroids such as dexamethasone (DEX). However, about 20% of asthmatics do not respond to this therapy and are classified as steroid-resistant. Currently, no effective therapy is available for steroid-resistant asthma. This work therefore evaluated the effect of a plant sterol, stigmasterol (STIG), and stigmasterol-dexamethasone combination (STIG+DEX) in LPS-ovalbumin-induced steroid-resistant asthma in Guinea pigs. To do this, the effect of drugs on inflammatory features such as airway hyperreactivity and histopathology of lung tissue was evaluated. Additionally, the possible pathway of drug action was assessed by measuring events such neutrophil levels, oxidative and nitrative stress, and histone deacetylase 2 (HDAC2) and interleukin 17 (IL-17) levels. STIG alone did not affect inflammatory features, although it caused some changes in the molecular events associated with steroid-resistant asthma. However, STIG+DEX caused significant modulation of inflammatory features by protecting against destruction of lung tissue. The modulation of inflammatory features was associated with significant inhibition of neutrophilia and oxidative and nitrative stress, decrease in HDAC2, and increase in IL-17 levels that are usually associated with steroid-resistant asthma. Our findings show that although STIG and DEX individually do not protect against steroid-resistant asthma, their coadministration results in significant modulation of inflammatory features and the associated molecular events that lead to steroid-resistant asthma.

HERPETIC GINGIVOSTOMATITIS IN ADULT—CASE REPORT

Herpetic gingivostomatitis (HGE) is a pathology caused herpes simplex virus. Although occurring more often in children, it can affect adults and is often more extensive and aggressive. Diagnosis is defined by clinical features, and hematological tests are important to treat cases in adults, where there is the possibility of some type of immunosuppression. The patient is a 46-year-old male patient who sought treatment for ulcerative and papular lesions on the gums, tongue, and oral mucosa the caused pain, discomfort, and dysphagia. The patient reported no recent illnesses of any kind. Platelet changes were observed on hematological exam. Clinical diagnosis was HGE. Propaedeutic was steroidal anti-inflammatory drugs and hygiene instructions. In 10 days, all lesions had regressed and the patient could eat again without difficulty. Herpetic gingivostomatitis (HGE) is a pathology caused herpes simplex virus. Although occurring more often in children, it can affect adults and is often more extensive and aggressive. Diagnosis is defined by clinical features, and hematological tests are important to treat cases in adults, where there is the possibility of some type of immunosuppression. The patient is a 46-year-old male patient who sought treatment for ulcerative and papular lesions on the gums, tongue, and oral mucosa the caused pain, discomfort, and dysphagia. The patient reported no recent illnesses of any kind. Platelet changes were observed on hematological exam. Clinical diagnosis was HGE. Propaedeutic was steroidal anti-inflammatory drugs and hygiene instructions. In 10 days, all lesions had regressed and the patient could eat again without difficulty.

Comparative study between ketamine versus betamethasone gargles in attenuating post-operative sore throat after endotracheal intubation

: Postoperative sore throat (POST) is a commonly encountered side effect which causes patient discomfort after airway instrumentation during general anesthesia (GA). This study was conducted to investigate the efficacy of preop­erative gargling with Ketamine, a NMDA receptor an­tagonist and Betamethasone gargles, a steroidal anti inflammatory drug in reducing POST in patients being intubated for surgery under GA. This was a randomized, single blinded, prospective study conducted after obtaining the Institutional Ethics Committee approval. 90 patients undergoing surgery under GA with endotracheal intubation were enrolled in the study after obtaining written informed consent from all. They were further divided into 3 groups; group B, group K and group C who received Betamethasone gargles, Ketamine gargles and Dextrose Saline gargles respectively, 5 minutes before GA. Results obtained were compared statistically by using Kruskal-Wallis test, which showed significant difference between median POST grading. The Mann-Whitney U test was used for the statistical intergroup analysis. There was no statistical difference among groups as far as age, height, weight by using ANOVA test; p value > 0.05. Age of patients varied between 16-60 years in three groups. The severity of sore throat were noticeably reduced after Ketamine, Betamethasone gargles in group K and group B (p < 0.05) as compared to group C when statistically analysed by Mann-Whitney U test. But Betamethasone gargles in group B patients more efficiently reduced the incidence, severity of sore throat compared to Ketamine gargles (p<0.05) during postoperative period. The incidence & severity of POST decreased with use of pre-operative Ketamine gargles or Betamethasone gargles during post-operative period in patients with tracheal intubation. The Betamethasone gargles were more effective than Ketamine gargles in reducing the incidence, severity of POST.

Corticoids identification in a lipolytic product promoted by two influencers

Two influencers have consulted for abscesses requiring surgery on the faces and thighs which began, respectively, one month and ten days following injections by a Russian cosmetologist, of the so-called “Light Fit”, a lipolytic product. The “Light Fit” is made in South Korea and is available on the internet market. It claims that the composition includes different mineral salts and natural extracts of chestnut and walnut with exception of any other products. This product is frequently used in Russia for its indirect lipolytic action based on the promotion of “rapid breakdown of excessive fat”. Following the surgery of the two patients, the microbiological examination of the specimens allowed the identification of an atypical mycobacterium. We reported here the investigation of the chemical composition of this lipolytic product, which have led to side effects for two internet influencers promoting it, using both high-resolution targeted and untargeted approach. A saddled sample of the “Light Fit” product was furnished by the two influencers. Plasma and urine samples of the two patients were collected during the medical consultation, several weeks following the last injection of the lipolytic product. A sample preparation based on liquid-liquid extraction using acetonitrile and methyl tert-butyl ether was performed for each sample. Subsequently, extracts were analyzed by targeted and untargeted screening using liquid chromatography hyphenated to high-resolution tandem mass spectrometry with electrospray as ion source operating in polarity switching mode and a Q-Exactive Focus® Orbitrap mass spectrometer. The qualitative analysis of the lipolytic injection product allowed identifying glucocorticoids including triamcinolone acetonide and dexamethasone. The other detected chemicals were theophylline, lidocaine and tramadol using both targeted and untargeted approach. The “Light Fit” product was determined to be a normo-osmolar solution. Regarding the biological samples, triamcinolone acetonide was detected as trace amounts in the plasma of the two influencers. Furthermore, paracetamol was detected in urine samples as it was administered to the patients during medical consultation. The qualitative analysis of the lipolytic injection product invalidated the claim of a strictly natural composition. It is nevertheless known that theophylline and lidocaine are widely used as lipolytic agents. A conclusion of the natural or synthetic origin of theophylline, an alkaloid found in tealeaves, cannot be drawn. The synthetic glucocorticoid triamcinolone acetonide detected in the product is known to be a local anti-inflammatory steroid. The detection of trace amounts of triamcinolone acetonide in the plasma of the two patients may be related to the half-life of the compounds, which is higher than 20 days (Shen et al. Ophtalmology 2010;117:2375–2371; Schweitzer et al. Neth J Med 2000;56:12–16). Furthermore, the skin lesions observed at the injection site may be related to the infection by the atypical mycobacterium, highly favored by the local injection of triamcinolone acetonide, which, like other glucocorticoids, decreases immune response to pathogens. This study confirmed the usefulness of high-resolution screening to qualitatively characterize these types of products, a needed step prior to quantification. These two cases highlight the health risk of buying products on the internet with a falsified claim, even for people who promote these products like these two influencers.

Study of clinical and laboratory profile of patients with reactive arthritis in a tertiary healthcare center

Background: Reactive arthritis (ReA) is a spondyloarthropathic disorder characterized by joint pain and swelling triggered by an infection in another part of the body – most often the intestines, genitals, or urinary tract. This condition usually targets the knees, ankles, and feet. The present study was conducted to study the clinical, microbiological, and laboratory profile of patients with ReA and to determine the outcomes over a duration of 3 months. Aims and Objectives: This study aimed to assess the clinical and laboratory profile of patients with ReA in a tertiary healthcare center. Materials and Methods: This was a prospective analytical study undertaken in the Rheumatology Out Patient Department of a tertiary care center. The study involved 73 participants and was completed over a duration of 18 months. Results: Majority of the subjects belonged to the age group of 18–25 years (54.79%), followed by 26–35 years (23.29%) and 36–45 years (10.96%). The mean age of the study subjects was 28.71 ± 10.72 years (median age –25 years). Most of the patients were male (82.19%). While majority of the subjects showed improvement with Non Steroidal Anti-inflammatory Drugs (NSAIDs) (80.82%), steroids were used among 12.33% subjects, sulfasalazine was used among 15.07%, and methotrexate among 1.37% of the study subjects. Conclusion: Statistically significant association was found between HLA B27 positivity and DAREA score, presence of sacroiliitis and extra-articular manifestation. NSAIDs remain the first line agents for patients with ReA. However, high baseline DAREA and ESR of more than 30 is associated with poor response to NSAIDs.

POMPP Score and Boey Score: To Predict Mortality in Peptic Ulcer Perforation

Introduction: Peptic ulcer is an insult to the mucosa of the upper digestive tract. Helicobacter pylori infection, long term use of non-steroidal anti-inflammatory drugs or steroids, excessive alcohol ingestion and smoking are common etiological factors. A number of scoring systems for prediction of outcomes in perforated peptic ulcer patients have been developed such as Predictive score of mortality in perforated peptic ulcer score and Boey score.
 Aims: To evaluate Predictive score of mortality in perforated peptic ulcer score and Boey Score in predicting accuracy of mortality in patients with peptic ulcer perforation.
 Methods: A hospital based study was conducted from June 2021 to May 2022 in the department of Surgery, Nepalgunj Medical College, Kohalpur. The Predictive score of mortality in perforated peptic ulcer and Boey score were recorded after history taking, physical examination, basic pre-operative investigations and radiological imaging. The patients were classified into high risk and low risk categories based on scores and followed up to predict the mortality within 30 days post operatively.
 Results: 80 patients were included in the study. 53 were male and 27 female. Peptic ulcer perforation was seen more in age groups of 45 to 60 years. In Boey score 8 patients out of 27 high risk patients died whereas in Predictive score of mortality in perforated peptic ulcer score 8 patients died out of 12 high risk patients. When compared, predictive score of mortality in perforated peptic ulcer was found to be more accurate than Boey score (p-<0.05) score.
 Conclusion: Predictive score of mortality in perforated peptic ulcer is easy to use and more accurate in predicting mortality in peptic ulcer perforation than Boey score.

Method optimisation and application based on solid phase extraction of non steroidal anti-inflammatory drugs, antiretroviral drugs, and a lipid regulator from coastal areas of Durban, South Africa

This study presents an optimized method that is applicable in monitoring the occurrence of pharmaceuticals in a wide range of aquatic environments. The optimised Solid Phase Extraction method is based on Bond Elut Plexa cartridges for the identification and quantification of three non-steroidal anti-inflammatory drugs, three antiretroviral drugs and a lipid regulator in the coastal area of Durban city, South Africa covering four seasons. The extracted compounds are qualitatively and quantitatively detected by a high-performance liquid phase chromatographic instrument coupled to a photodiode array detector. The recoveries range from 62 to 110% with a Relative Standard Deviation of 0.56−4.68%, respectively, for the determination of emtricitabine, tenofovir, naproxen, diclofenac, ibuprofen, efavirenz, and gemfibrozil. The analytical method is validated by spiking estuarine water samples with 5 µg L− 1 of a mixture containing the target pharmaceuticals and the matrix detection limit is established to be 0.62–1.78 µg L− 1 for the target compounds. The optimized method is applied to seasonal monitoring of pharmaceuticals at chosen study sites from winter and spring of 2019 and summer and autumn of 2020. The results indicate the concentration of the pharmaceuticals studied varies with the type of aquatic environment and season.

Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients in Malaysia

Aim of the workThis study aimed to compare the clinical features, associated comorbidities and treatment patterns of ankylosing spondylitis (AS) patient to those with non-radiographic axial spondyloarthritis (nr-axSpA) in Malaysia. Patients and methodsThis study was conducted in multiple rheumatology centre in Malaysia. Patients with axial spondyloarthritis (axSpA) were included. The AS and nr-axSpA group were compared. ResultsA total of 302 AS patients and 43 nr-axSpA patients were included. The age was comparable (41.7 ± 12.4 vs 38.5 ± 14.3 years; p = 0.13) however the male:female in those with AS was 4.8:1 vs 1.2:1 (p < 0.0001). The diagnostic delay was longer in AS patients (6.04 ± 6.6 vs 3.4 ± 7.3; p = 0.03), more were frequently smoking (50.3 % vs 25.6 %; p = 0.003), were Chinese (56.6 % vs 37.2 %; p = 0.02), had a higher frequency of HLA-B27 (p < 0.0001) and family history of axSpA (p = 0.04).More AS patients experienced inflammatory back pain (p < 0.0001), had higher Bath AS Metrology Index (BASMI) (p < 0.0001) and Bath AS functional index (BASFI) (p = 0.04). Nr-axSpA patients more likely to experience dactylitis (16.3 % vs 5.6 %; p = 0.014) but no significant differences in frequency of enthesitis. The frequency of comorbidities was similar in both groups. The use of non steroidal anti inflammatory drugs was more frequent in AS (p = 0.038) while nr-axSpA patients more likely to receive conventional disease modifying antirheumatic drug (p = 0.002). ConclusionAS and nr-axSpA shared some characteristics but also had some significant difference especially on gender, inflammatory back pain and HLA-B27. This study offers a better understanding of both the subtypes of axSpA in Malaysia.

Efficacy of salmeterol and magnesium isoglycyrrhizinate combination treatment in rats with chronic obstructive pulmonary disease

The most classic treatment recommended in the current chronic obstructive pulmonary disease (COPD) guidelines is glucocorticoid and β2 receptor agonist combination, such as salmeterol xinafoate and fluticasone propionate (Sal/Flu), causing many adverse reactions due to hormones. Magnesium isoglycyrrhizinate (MgIG) is an anti-inflammatory glycyrrhizic acid preparation for treating chronic inflammation, contributing to its structure is similar to steroidal anti-inflammatory drugs. In this study, we successfully established COPD rat model by endotracheal-atomized lipopolysaccharide exposure and cigarette smoke induction, as characterized by lung function decline. We discovered that salmeterol xinafoate/MgIG combination could alleviated lung inflammation infiltration, airway wall thickness (AWT) and the secretion of bronchial mucin MUC5AC of COPD rats more than salmeterol xinafoate, MgIG, or salmeterol xinafoate and fluticasone propionate treatment did, as well as reduced inflammatory cells (white blood cells, neutrophils and lymphocytes) accumulation in bronchoalveolar lavage fluid and decreased TNF-α, IL-6 and IL-1β production in the serum of COPD rats. Finally, we found that Moreover, the mechanism involved might be related to the suppression of JAK/STAT signaling pathway. Overall, our studies suggested that MgIG might be a potential alternative adjuvant drug for fluticasone propionate for the clinical treatment of patients with COPD.

When All Is Not as It Seems: Recurrent Fever and New-onset Joint Pain in a 17-Month-old Girl.

When All Is Not as It Seems: Recurrent Fever and New-onset Joint Pain in a 17-Month-old Girl.

Paper 92: Outcomes of Percutaneous Barbotage for Calcific Tendonitis of the Shoulder

Objectives:Calcific tendonitis is a painful shoulder condition that occurs secondary to deposition and resorption of calcium deposits within the tendinous insertions of the rotator cuff musculature. Its prevalence within the population ranges from 2.7 to 20% and it can be a cause of acute and debilitating pain. The treatment for calcific tendinitis is classically self-limited, as the natural history of the disease is for it to resolve with time. Anti-inflammatory medications and steroid use therefore are a common first line treatment option. In certain instances secondary measures such as extracorporeal shock wave therapy and percutaneous barbotage have been utilized when initial therapies have failed, but prior to pursuing surgical interventionSurgical intervention with removal of the calcium deposit and possible rotator cuff repair as needed is utilized only once all prior treatment options have been exhausted. Percutaneous needle barbotage of calcium deposits has been demonstrated to provide pain relief and improved symptoms in patients suffering from calcific tendonitis, but continued research is necessary to determine which patients might benefit most from this procedure as opposed to continued conservative approach. The purpose of our study is to assess the demographics and outcomes of those patients with a diagnosis of shoulder calcific tendonitis who underwent needle barbotage procedure. We evaluated those that had success with the procedure, including if any required surgery for their calcific tendonitis.Methods:This study was performed at a single institution. All patients were first seen and evaluated by an orthopedic surgeon fellowship trained in either sports medicine or shoulder and elbow surgery. Once calcific tendonitis was confirmed as the diagnosis and etiology of their symptoms they were referred to a single, family medicine physician with fellowship training in sports medicine. With this physician they underwent needle barbotage procedure of their calcific tendonitis with injection of local anesthetic, aspiration of the calcium deposit, and injection of corticosteroid all under ultrasound guidance. These patients were then retrospectively reviewed for demographic information and procedure details then prospectively contacted to evaluate the current status of their shoulder, as well as, if they ever had to undergo any further or operative treatment of their shoulder for calcific tendonitis.Results:Since 2018, twenty-two patients who had undergone needle barbotage for calcific tendonitis were able to be prospectively reached while 19 opted in to the study after informed consent. Of these patients, 14 were female (73%) vs. 5 male (27%), 13 of the 19 (68%) had at least one significant medical comorbidity, an average BMI of 26.3 (range 20-42), and average age was 56.8 years (range 31-76). The follow-up from time to procedure until they were prospectively contacted by phone was avg. 12.6 mo (range 2-30mo). The average Sane score for the affected extremity was 81.05 (range 25-100) vs. the unaffected extremity avg 91.6 (range 60-100) (P=0.054). Of these 19 patients zero went on the have surgical treatment of their calcific tendonitis at the time of follow up, only one patient had a subsequent corticosteroid injection into the affected shoulder.Conclusions:Calcific tendonitis remains a severe and idiopathic cause of acute shoulder pain. Though the disease is self-limiting this may take up to 6 months to resolve on its own. Previously, operative management for severe disease after corticosteroid injection failure was a mainstay. In our study cohort all patients were able to avoid surgical intervention by undergoing needle barbotage of the lesion after an average of 1 year follow up. Needle barbotage appears to be an effective way to treat symptomatic calcific tendonitis while allowing patients to avoid surgical debridement.

Fatal adverse events of rivaroxaban combined with aspirin: an analysis using data from VigiBase

PurposeThe aim of this study was to analyze the clinical characteristics of fatal adverse events (AEs) of rivaroxaban combined with aspirin and to underline the importance of the rational use of drugs.MethodsThe WHO global database of reported potential side effects of medicinal products (VigiBase) was searched for fatal AEs in the combined use of rivaroxaban and aspirin, and the clinical characteristics of those cases with sufficient information (vigiGrade completeness score ≥ 0.80) were analyzed.ResultsBy January 19, 2020, 2309 fatal adverse event reports of rivaroxaban combined with aspirin from 21 countries were entered in VigiBase. One hundred and twenty cases contained further information, of which 42 were female (35%) and 78 were male (65%). The median age was 75 (range 34 to 93) years, and 109 cases (91%) were elderly patients (≥ 65 years). The AEs listed in the fatal case reports included bleeding in 114 cases (mainly intracranial hemorrhage and gastrointestinal hemorrhage, 59 and 46 respectively, accounting for 88%) and ischemic events in six cases (ischemic stroke in three, acute myocardial infarction in two, myocardial infarction combined with acute liver failure in one). Among the patients with bleeding events, 108 (95%) had existing risk factors for bleeding or for interacting with aspirin or rivaroxaban. These may be divided into the following: diseases (hypertension, renal impairment, history of stroke, peptic ulcer, or previous bleeding), drugs (high dose aspirin, antiplatelet drugs, anticoagulants, P-gp inhibitors/CYP3A4 inhibitors, non-steroidal anti-inflammatory drugs, steroids, and selective serotonin reuptake inhibitors), or other factors (e.g., elderly, low body weight, or excessive intake of ginger, fish oil, or alcohol). There were 45 cases with two or more of these risk factors in addition to rivaroxaban and aspirin. Patients with ischemic events are often in very high-risk groups of atherosclerotic cardiovascular disease (ASCVD) or self-discontinuation of treated drugs. Medication errors occurred in 24 patients (20%): excessive treatment in 17 cases, contraindication in three, frequency error in two, excessive treatment combined with contraindication in one, and self-discontinuation in one.ConclusionsFatal AEs related to rivaroxaban combined with aspirin, including bleeding and ischemic events, have been reported mostly in the elderly, and sometimes involved medication errors. The fatal AEs mainly manifested as serious bleeding, and most of them occurred in patients with concurrent multiple risk factors. Monitoring coagulation during rivaroxaban treatment is recommended in very high-risk ASCVD populations, and attention should be paid to prevention of medication errors.

Idiopathic granulomatous mastitis: experience at a New York hospital.

Idiopathic granulomatous mastitis (IGM) often mimics breast cancer. Presentation includes pain, palpable mass, suppuration or suspicious imaging. Widely reported in Asia and the Middle East, IGM is diagnosed after excluding specific granulomatous mastitis (SGM). Aetiology remains unknown. Lactation, prolactinaemia, ethnicity, autoimmune disease and Corynebacteria are associated. Treatment is controversial and the prevalence rising. Surgery and non-operative treatments including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate and observation have advocates. A retrospective chart review of 63 patients with IGM from 2008 to 2018 was undertaken focusing on birthplace, age, clinical presentation, wound cultures, imaging, treatments and outcomes. Sixty-one of 63 patients were Hispanic; 53 were Mexican-born women aged 23-46. Clinical presentation included pain, painful mass, painless mass, suppuration and abnormal imaging. Some 31/61 ultrasound examinations and 17/33 mammograms were deemed Breast Imaging Reporting and Data System (BI-RADS) score 4 or 5. Management included antibiotics (43), incision and drainage (24), NSAIDs (29), steroids (8), lumpectomy (18) and observation (12). Some 12/20 patients with painless masses resolved with observation, 3 received NSAIDs, 2 received steroids and 3 underwent lumpectomies. Antibiotics resolved 8/43 cases, 5 needed incision and drainage, 26 received NSAIDs, 6 received steroids and 5 underwent lumpectomies. Nineteen patients had indolent disease or recurrence. Excluding malignancy is critical, treatment challenging and recurrence common in IGM. A preponderance of patients were Mexican-born, similar to other reports from the USA. Over 50% of IGM cases had suspicious BI-RADS scores. Best management remains a challenge and ranges from observation to lumpectomy.

Inflammation and Fibrosis Induced by Joint Remobilization, and Relevance to Progression of Arthrogenic Joint Contracture: A Narrative Review

Joint immobilization is frequently administered after fractures and ligament injuries and can cause joint contracture as a side effect. The structures responsible for immobilization-induced joint contracture can be roughly divided into muscular and articular. During remobilization, although myogenic contracture recovers spontaneously, arthrogenic contracture is irreversible or deteriorates further. Immediately after remobilization, an inflammatory response is observed, characterized by joint swelling, deposit formation in the joint space, edema, inflammatory cell infiltration, and the upregulation of genes encoding proinflammatory cytokines in the joint capsule. Subsequently, fibrosis in the joint capsule develops, in parallel with progressing arthrogenic contracture. The triggers of remobilization-induced joint inflammation are not fully understood, but two potential mechanisms are proposed: 1) micro-damage induced by mechanical stress in the joint capsule, and 2) nitric oxide (NO) production via NO synthase 2. Some interventions can modulate remobilization-induced inflammatory and subsequent fibrotic reactions. Anti-inflammatory treatments, such as steroidal anti-inflammatory drugs and low-level laser therapy, can attenuate joint capsule fibrosis and the progression of arthrogenic contracture in remobilized joints. Antiproliferative treatment using the cell-proliferation inhibitor mitomycin C can also attenuate joint capsule fibrosis by inhibiting fibroblast proliferation without suppressing inflammation. Conversely, aggressive exercise during the early remobilization phases is counterproductive, because it facilitates inflammatory and then fibrotic reactions in the joint. However, the adverse effects of aggressive exercise on remobilization-induced inflammation and fibrosis are offset by anti-inflammatory treatment. To prevent the progression of arthrogenic contracture during remobilization, therefore, care should be taken to control inflammatory and fibrotic reactions in the joints.

Aspirin inhibits the growth of hypertrophic scar in rabbit ears via regulating Wnt/β-catenin signal pathway.

Steroidal anti-inflammatory drugs have certain side effects in the treatment of hypertrophic scar, and the scar recurrence is easy after withdrawal of steroid anti-inflammatory drugs. Finding reliable alternative drugs is an effective means to improve this defect. Aspirin, a traditional non-steroidal anti-inflammatory drug, is safe for topical use and has anti-inflammatory effects similar to those of steroidal anti-inflammatory drugs, which may have similar effects on the treatment of hypertrophic scar. This study aims to investigate the inhibitory effect of aspirin on the proliferation of hypertrophic scar in rabbit ears and the underlying mechanism. The rabbit ear hypertrophic scar models were prepared. The rabbits were randomly divided into a normal skin group (group A), a blank control group (group B), a 0.9% NaCl group (group C), a 0.2% aspirin group (group D), a 0.5% aspirin group (group E), a 2% aspirin group (group F), and a triamcinolone acetonide group (group G). Macroscopic observation of hyperplasia was performed 8 weeks after local injection of the scar, followed by collecting the scar tissue samples for HE staining, Masson staining, and immunohistochemistry, respectively to assess the proliferation of fibroblasts and collagen fibers, and calculate the hypertrophic index, microvessel density, and immunohistochemical score. All rabbit ear hypertrophic scar models were successfully constructed. In groups B and C, the hypertrophic scar edge was irregular, with reddish protruding epidermis, significant contracture and hard touch. In group D, E, and F, with the increase of aspirin administration concentration, the scar became thinner and gradually flat, the proliferation of fibrocytes and collagen fibers was weakened, and the hypertrophic index was gradually decreased (P<0.05). Immunohistochemistry showed that the expression of β-catenin was decreased in the group D, E and F in turn, and the immunohistochemical score was gradually decreased (P<0.05). There was no significant difference in hypertrophic index, microvessel density, and immunohistochemical score (all P>0.05). Local injection of aspirin can reduce the generation of hypertrophic scar in a dose-dependent manner within a certain concentration range; aspirin inhibits the growth of hypertrophic scar in rabbit ears by inhibiting Wnt/β-catenin signal pathway; 2% aspirin and 40 mg/mL triamcinolone acetonide have similar curative efficacy on hypertrophic scar.