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1.
Acta Chir Orthop Traumatol Cech ; 88(2): 117-123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33960924

RESUMO

PURPOSE OF THE STUDY The objective of the present study is to compare the efficacy of two different concentrations of diclofenac sodium phonophoresis (DSPH) (1.16% vs 2.32%) in patients with knee osteoarthritis (OA). MATERIAL AND METHODS A randomized, double-blind, controlled design was applied. Ninety patients (mean age± SD, 59.98 ± 8.89 years) who had Kellgren-Lawrence (K-L) grades II to III knee OA were randomly allocated into three groups; 1.16% DSPH, 2.32% DSPH, TUS (30 in each group). Each patient was treated five sessions per week for two weeks. A 100-mm visual analogue scale (VAS) for usual pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated before and after treatment in all groups. RESULTS The VAS pain and WOMAC scores were significantly improved after treatment in all groups (p < 0.05). The 2.32% DSPH showed more significant effects than the 1.16% DSPH, both in improving WOMAC- pain and physical function scores (p = 0.020, p = 0.008) and reducing the VAS pain measure, although it did not reach the level of significance (p = 0.077). The 2.32% DSPH was superior to the TUS, both in reducing the VAS pain measure (p < 0.001) and in improving WOMAC-pain, stiffness, physical function and total scores (p = 0.022, p = 0.016, p < 0.001, p < 0.001 respectively). 1.16% DSPH significantly reduced stiffness and physical function scores compared with TUS (p = 0.042, p = 0.047). CONCLUSIONS DSPH and TUS are effective treatments for knee OA. Our results indicated that 2.32% DSPH produces additional benefits to functional improvement and pain reduction compared with 1.16% DSPH in K-L grades II to III knee OA. Key words: diclofenac sodium, knee osteoarthritis, phonophoresis, therapeutic ultrasound, topical formulation.


Assuntos
Osteoartrite do Joelho , Fonoforese , Diclofenaco/uso terapêutico , Método Duplo-Cego , Humanos , Osteoartrite do Joelho/terapia , Medição da Dor , Resultado do Tratamento
2.
Molecules ; 26(1)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33374575

RESUMO

Topical anti-inflammatory and analgesic effect for the treatment of rheumatoid arthritis is of major interest because of their fewer side effects compared to oral therapy. The purpose of this study was to prepare different types of topical formulations (ointments and gels) containing synthetic and natural anti-inflammatory agents with different excipients (e.g.,: surfactants, gel-forming) for the treatment of rheumatoid arthritis. The combination of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), diclofenac sodium, a topical analgesic agent methyl salicylate, and a lyophilized extract of Calendula officinalis with antioxidant effect were used in our formulations. The aim was to select the appropriate excipients and dosage form for the formulation in order to enhance the diffusion of active substances and to certify the antioxidant, analgesic, and anti-inflammatory effects of these formulations. To characterize the physicochemical properties of the formulations, rheological studies, and texture profile analysis were carried out. Membrane diffusion and permeability studies were performed with Franz-diffusion method. The therapeutic properties of the formulations have been proven by an antioxidant assay and a randomized prospective study that was carried out on 115 patients with rheumatoid arthritis. The results showed that the treatment with the gel containing diclofenac sodium, methyl salicylate, and lyophilized Calendula officinalis as active ingredients, 2-propenoic acid homopolymer (Synthalen K) as gel-forming excipient, distilled water, triethanolamine, and glycerol had a beneficial analgesic and local anti-inflammatory effect.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Diclofenaco/uso terapêutico , Excipientes/química , Géis/química , Extratos Vegetais/farmacologia , Administração Tópica , Calendula/química , Feminino , Flores/química , Humanos , Masculino , Pessoa de Meia-Idade , Pomadas , Estudos Prospectivos
3.
Front Immunol ; 11: 2167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33013911

RESUMO

The inflammatory response to and the subsequent development of Adult Respiratory Distress Syndrome (ARDS) is considered to underpin COVID-19 pathogenesis. With a developing world catastrophe, we need to examine our known therapeutic stocks, to assess suitability for prevention and/or treatment of this pro-inflammatory virus. Analyzing commonly available and inexpensive immunomodulatory and anti-inflammatory medications to assess their possible effectiveness in improving the host response to COVID-19, this paper recommends the following: (1) optimize current health-cease (reduce) smoking, ensure adequate hypertension and diabetes control, continue exercising; (2) start on an HMG CoA reductase inhibitor "statin" for its immunomodulatory and anti-inflammatory properties, which may reduce the mortality associated with ARDS; and (3) consider using Diclofenac (or other COX-2 inhibition medications) for its anti-inflammatory and virus toxicity properties. For purposes of effectiveness, this needs to be in the early course of the disease (post infection and/or symptom presentation) and given in a high dose. The downsides to these recommended interventions are considered manageable at this stage of the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , /tratamento farmacológico , Corticosteroides/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Diclofenaco/efeitos adversos , Diclofenaco/uso terapêutico , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , /virologia , Internalização do Vírus/efeitos dos fármacos
4.
PLoS One ; 15(9): e0238024, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991606

RESUMO

INTRODUCTION: At present, information about clinical efficacy and adverse events of controlled release (CR) form of pelubiprofen, a prodrug of 2-arylopropionic acid with relatively selective effects on cyclooxygenase-2 activity, remains scarce. In this study, we sought to determine non-inferiority of pelubiprofen CR 90 mg/day compared to aceclofenac 200 mg/day regarding clinical efficacy and adverse events after a 4-week course of medication in the patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS: A total of 191 patients were randomly assigned to take either pelubiprofen CR 90 mg (n = 95) or aceclofenac 200 mg (n = 96). The primary outcome variable was non-inferiority of pain reduction between baseline and week 4 when assessed using a 100 mm pain visual analogue scale (VAS). Pelubiprofen was considered non-inferior to aceclofenac if the upper limit of the one-sided 97.5% confidence interval for the difference in terms of pain VAS was above 15 mm (the average change of pain VAS in the pelubiprofen group-pain VAS reduction in the aceclofenac group). Secondary outcome variables were the changes in 100 mm pain VAS at week 2 versus baseline, K-Western Ontario, and McMaster University Arthritis Index (K-WOMAC) changes at weeks 2 and 4 as compared to baseline, patient global assessment at weeks 2 and 4. The frequency and amount of rescue medicine usage at weeks 2 and 4 were also evaluated as the secondary outcome variable. For safety analysis, adverse events, clinical laboratory tests, vital signs, and physical examinations were assessed and conducted at each follow-up visit. RESULTS: At week 4, the pain VAS values were significantly reduced in both groups receiving either pelubiprofen CR 90 mg or aceclofenac 200 mg as compared to the baseline. However, the pelubiprofen group and the aceclofenac group respectively showed the pain VAS changes of -22 and -21.9 in the pre-protocol set and -20.8 and -21.7 in the full analysis set, confirming non-inferiority. The pelubiprofen CR 90 mg showed a reduced incidence of adverse events compared to the aceclofenac 200 mg (p = 0.005). CONCLUSIONS: Pelubiprofen CR 90 mg is as effective as aceclofenac 200 mg with reduced adverse events for the treatment of symptomatic knee osteoarthritis.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/análogos & derivados , Osteoartrite do Joelho/tratamento farmacológico , Fenilpropionatos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Diclofenaco/uso terapêutico , Método Duplo-Cego , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Medição da Dor , Segurança do Paciente , Resultado do Tratamento
5.
Oral Maxillofac Surg ; 24(4): 461-468, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32638173

RESUMO

OBJECTIVE: The aim of this study was to determine if the timing of administration of systemic enzyme therapy [SET] has any effect on its efficacy in controlling postoperative sequelae of third molar surgery. STUDY DESIGN: A double blinded prospective randomized control trial was planned. The sample included patients requiring impacted mandibular third molar surgical extraction. Patients were randomly allocated to four groups (50 patients per group). Group A included administration of SET 48 h prior to surgery; Group B, started on the day of surgery; Group C started immediately after surgery and control group D included NSAIDS started 3 h after surgery. The predictor variable was timing of administration of SET. The primary outcome variables were pain and swelling measured on 1st day, 5th day, and 7th day after surgery. FINDINGS: Groups A and D reported lower mean and median VAS scores and lesser swelling than groups C and D on postop day 1. On days 5 and 7, all four groups were comparable. On overall analysis, no statistically significant difference (p > 0.05) was evident. INTERPRETATION: The results of the study showed that the differences in swelling and pain with starting the SET 2 days before, on the day of surgery, or immediately after when compared with diclofenac was not statistically significant. TRIAL REGISTRATION: CTRI Registration Number CTRI/2018/03/012502.


Assuntos
Diclofenaco , Dente Impactado , Diclofenaco/uso terapêutico , Método Duplo-Cego , Edema/tratamento farmacológico , Terapia Enzimática , Humanos , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Peptídeo Hidrolases/uso terapêutico , Estudos Prospectivos , Extração Dentária , Dente Impactado/cirurgia
7.
Ter Arkh ; 92(5): 61-68, 2020 Jun 05.
Artigo em Russo | MEDLINE | ID: mdl-32598777

RESUMO

AIM: To evaluate the effectiveness and tolerability of the drug in patients with undifferentiated peripheral inflammatory arthritis (UPIA). MATERIALS AND METHODS: We observed 60 patients (39 women and 21 men) met G. Hazlewood et al., UPIA criteria, 2011. Patients were divided into 3 groups: with monoarthritis, oligoarthritis and polyarthritis. They took aceclofenac 100 mg twice day for 3 weeks. RESULTS: We noted significant decreasing in pain level according to visual analogue scale: in patients with monoarthritis by 69.3 mm (p0.001); in oligoarthritis group by 47.5 mm (p0.001), in patients with polyarthritis by 30 mm (p0.001). The life quality by the EQ-5D-5L index was improved too in all groups from 0.616 to 0.829 (p0.001). The satisfaction with the therapy was: in monoarthritis patients (80% of patients and 93% of doctors noted good results), in oligoarthritis group (53% and 39% accordingly) and polyarthritis (74% and 64% respectively). We suppose the difference was due to the fact that mono- and oligoarthritis patients suffered from initial forms of seronegative spondylarthropathy, in which the effectiveness of NSAIDs is traditionally higher; polyarthritis patients probably had debut of rheumatoid arthritis. Adverse events of therapy were mild. We noted gastrointestinal tract symptoms (dyspepsia) and increased ALT in 10 patients and increased blood pressure in 1 patient. The symptoms did not require discontinuation of therapy. Сonclusion. Post-registration observational study of first Russian generic aceclofenac (Alental, Vertex, Russia) was conducted. In UPIA patients aceclofenac therapy was most effective in mono- and oligoarthritis patients. The first Russian generic aceclofenac (Alental, Vertex, Russia) has good efficacy, tolerability and safety and can be recommended for arthritis treatment.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Diclofenaco/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/análogos & derivados , Feminino , Humanos , Masculino , Federação Russa
8.
J Shoulder Elbow Surg ; 29(7): 1310-1315, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32553436

RESUMO

BACKGROUND: We investigated the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR). METHODS: We evaluated 128 shoulders undergoing ARCR and used block randomization to divide patients into 2 groups in this double-blind trial: The cocktail group received 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 mg of epinephrine, 2 mg of betamethasone, and saline solution to a total of 42 mL, whereas the control group received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL. Postoperatively, one of the drug mixtures was injected into the glenohumeral joint, subacromial bursa, suprascapular nerve, and anterior, middle, and posterior parts of the deltoid muscle according to the treatment group. We recorded patients' visual analog scale scores preoperatively and at 4, 8, 16, 24, and 48 hours postoperatively; the number of patients using postoperative diclofenac suppositories and buprenorphine hydrochloride; the number of patients experiencing nausea; the number of patients with infection and delayed wound healing as adverse effects; the surgery time; the retear rate; and passive shoulder range of motion. RESULTS: The cocktail group constituted 64 shoulders (50.0%), with 39 men (60.9%) and 25 women (39.1%); the mean age was 64.2 ± 10.2 years. The control group constituted 64 shoulders (50.0%), with 41 men (64.1%) and 23 women (35.9%); the mean age was 65.2 ± 7.5 years. We found no significant difference in age or sex between the 2 groups. There was also no significant difference in rotator cuff tear size or surgery time between the 2 groups. The visual analog scale scores at 8, 16, and 24 hours postoperatively were significantly lower in the cocktail group. The number of patients using suppositories was also significantly lower in the cocktail group. The number of patients receiving buprenorphine injections tended to be lower in the cocktail group, but the difference was not significant. Nausea occurred in 6.3% of patients in the cocktail group and 15.6% in the control group, but the difference was not significant. No infection or delayed wound healing occurred in either group. There was no significant difference in the retear rate between the 2 groups. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group than in the control group. CONCLUSION: We compared cocktail therapy and ropivacaine after ARCR and found no difference in results except for VAS score at 8, 16, and 24 hours postoperatively and frequency of postoperative suppository use without an apparent risk of infection or a detrimental effect on tendon healing.


Assuntos
Anestésicos Locais/uso terapêutico , Artroscopia/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/uso terapêutico , Lesões do Manguito Rotador/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Betametasona/uso terapêutico , Buprenorfina/uso terapêutico , Diclofenaco/uso terapêutico , Método Duplo-Cego , Quimioterapia Combinada , Epinefrina/uso terapêutico , Feminino , Humanos , Injeções Intra-Articulares , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Náusea/etiologia , Bloqueio Nervoso , Duração da Cirurgia , Amplitude de Movimento Articular , Recidiva , Ropivacaina/administração & dosagem , Articulação do Ombro , Infecção da Ferida Cirúrgica/etiologia , Vasoconstritores/uso terapêutico , Cicatrização
9.
Ann Afr Med ; 19(2): 131-136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499470

RESUMO

Background: Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients (≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients' case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients (259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Acetaminofen/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Codeína , Estudos Transversais , Diclofenaco/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Retrospectivos , Tramadol/uso terapêutico
10.
Medicine (Baltimore) ; 99(19): e19881, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384431

RESUMO

BACKGROUND: Primary dysmenorrhea is common and troublesome. The comparative efficacy of over-the-counter analgesics (OTCAs) for dysmenorrhea is unclear. This study was aimed at conducting a network meta-analysis to assess the efficacy and safety of 5 OTCAs - naproxen, ibuprofen,diclofenac, aspirin, and ketoprofen - in patients with primary dysmenorrhea. METHODS: The study was registered with PROSPERO (number: CRD42019133556). The search strategy involved a review of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL for relative randomized controlled trials of the 5 analgesics from the date of database establishment to July 2019. The outputs are presented as odds ratios (ORs), their corresponding 95% confidence intervals (CIs), and the surface under the cumulative ranking area (SUCRA) probabilities. RESULTS: Thirty-five trials with 4383 participants were included in our study. As for efficacy outcomes, all the included analgesics except aspirin were more effective than placebo in treating dysmenorrhea [naproxen (OR 3.99, 95% CI 2.18-7.30), ibuprofen (OR 10.08, 95% CI 3.29-30.85), diclofenac (OR 11.82, 95% CI 2.66-52.48), and ketoprofen (OR 5.12, 95% CI 1.57-16.69). The OTCAs were superior to the placebo in terms of pain relief in primary dysmenorrhea. Aspirin was less effective than ibuprofen (OR 0.17, 95% CI 0.04-0.73) and diclofenac (OR 1.17, 95% CI 0.02-0.85). The SUCRA curves showed that diclofenac and ibuprofen were the most and second most effective (85.1% and 83.8%, respectively), followed by ketoprofen, naproxen, and aspirin. Regarding safety, there was no significant difference between the 5 OTCAs included and the placebo. Diclofenac versus ibuprofen (OR 4.31, 95% CI 1.18-15.67), ketoprofen versus diclofenac (OR 0.18, 95% CI 0.04-0.78), and ketoprofen versus aspirin (OR 0.41, 95% CI 0.18-0.97) presented statistically significant differences. Ketoprofen and ibuprofen were ranked the best (SUCRA 90.6% and 79.6%), followed by naproxen, aspirin, and diclofenac. CONCLUSION: Considering the efficacy and safety, ibuprofen is recommended as the optimal OTCA for primary dysmenorrhea. Further well-designed studies that directly compare these analgesics are needed to support our conclusion.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dismenorreia/tratamento farmacológico , Medicamentos sem Prescrição/uso terapêutico , Adolescente , Adulto , Aspirina/uso terapêutico , Diclofenaco/uso terapêutico , Feminino , Humanos , Ibuprofeno/uso terapêutico , Cetoprofeno/uso terapêutico , Pessoa de Meia-Idade , Naproxeno/uso terapêutico , Metanálise em Rede , Resultado do Tratamento , Adulto Jovem
12.
Medicine (Baltimore) ; 99(15): e19680, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282721

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people. The purpose of this meta-analysis was to compare celecoxib and diclofenac sodium in patients with knee osteoarthritis (KOA). METHODS: Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing the use of celecoxib and diclofenac sodium in KOA patients were retrieved from each database from the date of database inception to September 2019. The outcome measurements were the treatment effect, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and complication rate. The pooled data were evaluated with Review Manager 5.3.5. RESULTS: The literature will provide a high-quality analysis of the current evidence supporting celecoxib for KOA based on various comprehensive assessments including the treatment effect, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and complication rate. CONCLUSION: This proposed systematic review will provide up-to-date evidence to assess the effect of celecoxib in the treatment for patients with KOA. RESEARCH REGISTRY REGISTRATION NUMBER:: reviewregistry827.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Celecoxib/uso terapêutico , Diclofenaco/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Sedimentação Sanguínea/efeitos dos fármacos , Proteína C-Reativa/efeitos dos fármacos , Feminino , Humanos , Masculino , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Escala Visual Analógica
13.
J Glaucoma ; 29(4): 280-286, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32053556

RESUMO

PRéCIS:: Adjuvant diclofenac and apraclonidine eye drop given in conjunction with selective laser trabeculoplasty (SLT) do not significantly impact medium-term intraocular pressure (IOP) reduction compared with placebo, but apraclonidine can be used to blunt immediate postlaser pressure spikes. PURPOSE: There is limited high-grade evidence guiding the choice of eye drops given before and after SLT. The authors chose to measure IOP during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. MATERIALS AND METHODS: In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016 and 2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. RESULTS: Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1 hour and 2 hours post-SLT in the placebo and diclofenac study arms (mean=+4.05±0.58 mm Hg and +4.47±0.73, respectively, P<0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean=-2.41±0.88 mm Hg, P<0.0001 vs. other study arms post-SLT). There were no significant differences between the 3 arms of the study on the long-term IOP reduction achieved by SLT (6 wk: P=0.51, 6 mo: P=0.42). CONCLUSIONS: Neither the use of apraclonidine before SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.


Assuntos
Clonidina/análogos & derivados , Diclofenaco/uso terapêutico , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/cirurgia , Trabeculectomia , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Clonidina/uso terapêutico , Método Duplo-Cego , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Soluções Oftálmicas/uso terapêutico , Tonometria Ocular
14.
Eur J Histochem ; 64(1)2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31941266

RESUMO

The tissue inflammatory response can influence the outcome of anastomotic healing. Anastomotic leakage represents a dreadful complication after gastrointestinal surgery, in particular sepsis and intra-abdominal infections impair the restorative process of colic anastomoses. It has been debated whether the administration of non-steroidal anti-inflammatory drugs (NSAIDs) is a risk factor for dehiscence, since many patients receive NSAIDs in the early postoperative period. Our aim was, for the first time, to analyze the morpho-functional effects of postoperative administration of two commonly used NSAIDs, Diclofenac and Ketorolac, on the healing process of colo-colic anastomoses constructed under condition of fecal peritonitis in a rat model. Sixty adult male rats underwent two surgical procedures: peritonitis induction and colo-colic anastomosis, and were divided into three groups: 20 rats received saline; 20 rats 4 mg/kg Diclofenac and 20 rats 5 mg/kg Ketorolac. We assessed anastomosis strength, morphological features of tissue wound healing, immunohistochemical metalloproteinase 9 (MMP9) expression and collagen deposition and content by Sirius red staining and hydroxyproline level. We found no significant difference in bursting pressure, collagen content and organization and morphological features between the groups, except a significantly reduced presence of inflammatory cells and MMP9 expression in the groups treated with NSAIDs. Our findings showed that Diclofenac and Ketorolac administration did not affect post-surgical healing and did not increase the leakage risk of colo-colic anastomoses during peritonitis.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Ceco/cirurgia , Diclofenaco/farmacologia , Cetorolaco/farmacologia , Peritonite/cirurgia , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Fístula Anastomótica/etiologia , Fístula Anastomótica/patologia , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Ceco/metabolismo , Ceco/patologia , Diclofenaco/uso terapêutico , Inflamação/tratamento farmacológico , Inflamação/patologia , Cetorolaco/uso terapêutico , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Peritonite/metabolismo , Peritonite/patologia , Ratos Wistar , Fatores de Risco , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/patologia
15.
Eur J Pain ; 24(3): 639-648, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31782864

RESUMO

BACKGROUND: Opioids and non steroidal anti inflammatory drugs (NSAIDs) are commonly used for pain relief in acute pancreatitis (AP). Opioids carry risk of sphincter of oddi constriction. Although diclofenac prevents post endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis, few reports of diclofenac associated AP are also present. Although, both tramadol and diclofenac are commonly used for pain relief in AP, no study has evaluated their comparative efficacy and safety. MATERIALS AND METHODS: Forty-six eligible participants were randomized to either diclofenac or tramadol. Primary objectives of our study were improvement in pain intensity on visual analogue scale (VAS pain score after 1 hr of drug administration) and number of patients requiring supplementary analgesia. The secondary objectives were total number of times of supplementary analgesia requirement, time to significant decrease (33%) in VAS pain score from baseline, number of painful days (VAS pain score >5), VAS pain score on 7th day, side effects, all cause death and complications of pancreatitis between the two groups. RESULTS: Although 46 patients were randomized, the final analysis included 41 participants. Five patients were withdrawn from the study (intubation = 3, altered sensorium = 2). No significant difference was seen in terms of VAS score after 1 hr of drug administration, number of patients requiring supplementary analgesic and number of painful days. However, time taken to significant reduction of pain was lower in the diclofenac group (p = .028). Both the agents were comparable in terms of safety. Although complications were less in the diclofenac group, the difference was not statistically significant. CONCLUSION: Both diclofenac and tramadol are equally effective in controlling pain in AP with similar safety profile. SIGNIFICANCE: There are no studies that have compared the safety and efficacy of two commonly used analgesics for pain relief in patients with AP. We found that both diclofenac and tramadol are equally effective in decreasing the pain associated with AP. There is also no significant difference in the incidence of side effects between both the groups. Hence both diclofenac and tramadol can be used safely and effectively for pain control in AP. TRIAL REGISTRATION: The trial was registered with clinical trials registry India (Number- CTRI/2018/05/014309).


Assuntos
Pancreatite , Tramadol , Doença Aguda , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Método Duplo-Cego , Humanos , Dor/tratamento farmacológico , Dor/etiologia , Dor Pós-Operatória/tratamento farmacológico , Pancreatite/complicações , Pancreatite/tratamento farmacológico , Tramadol/efeitos adversos
17.
J Med Case Rep ; 13(1): 373, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31847889

RESUMO

INTRODUCTION: Elevation in body temperature within the first 24 hours of ischemic stroke is fairly common and known to be associated with worse outcomes. Only after thoroughly ruling out infection and the noninfectious etiologies and in the appropriate clinical setting should the diagnosis of central fever be made. Acetaminophen and nonsteroidal anti-inflammatory drugs are typical therapeutic options. External cooling is frequently used when pharmacologic interventions are inadequate. However, reports have suggested that neurogenic fevers are somewhat resistant to traditional pharmacologic therapies. CASE PRESENTATION: We describe a case of a Caucasian patient with central fever after ischemic stroke not responsive to acetaminophen administration and external cooling. After an initial bolus of diclofenac sodium (0.2 mg/kg in 100 ml of saline solution for 30 minutes), a continuous infusion (75 mg in 50 ml of saline solution) was started. After 5 days of treatment, the patient's body temperature was below 37.5 °C, and the diclofenac sodium infusion was stopped. CONCLUSIONS: We observed that a low-dose diclofenac sodium infusion was effective in treating fever without systemic side effects. This treatment may be suggested as an alternative to conventional antipyretic drugs, but additional clinical trials are required.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Isquemia Encefálica/tratamento farmacológico , Diclofenaco/uso terapêutico , Febre/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Feminino , Febre/etiologia , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
18.
Complement Ther Med ; 47: 102183, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31780006

RESUMO

OBJECTIVE: Sesame oil is an herbal product that has been used to treat the joints pain in several traditional medicines. In this study, we evaluated the efficacy of topical sesame oil versus diclofenac gel in patients with knee osteoarthritis (OA). METHODS: One hundred and four patients were randomly enrolled in two arms of the trial. Patients were treated by topical sesame oil or diclofenac (three times a day) for 4 weeks. Outcome measures were knee pain via visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, knee joint's flexion angle, 8-meter walk test and number of used analgesics. Patients were evaluated at baseline, 2 and then 4 weeks after the intervention. RESULTS: At the follow-up visits, sesame oil was not inferior to diclofenac regarding scores of WOMAC pain, 8-meter walk test, and knee flexion angle. Although, its non-inferiority was not proved regarding scores of VAS, WOMAC stiffness, and WOMAC total at the 4th week. Moreover, sesame oil was not inferior to diclofenac regarding consumed analgesics. CONCLUSION: It seems that the topical sesame oil was non-inferior to diclofenac gel on the reduction of the knee OA pain and improvement of some indicators of its function.


Assuntos
Osteoartrite do Joelho/tratamento farmacológico , Manejo da Dor/métodos , Óleo de Gergelim/uso terapêutico , Administração Tópica , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Inquéritos e Questionários
19.
Kathmandu Univ Med J (KUMJ) ; 17(65): 35-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734676

RESUMO

Background Acute renal colic is the most frequent clinical presentations of renal stone and a common cause of patient visits to emergency departments worldwide. The prevalence of the renal stone disease has increased steadily over the past decades. Objective To describe the prevalence, epidemiological features and clinical management of renal colic patients at emergency department in Kathmandu University Hospital, Kavre, Nepal. Method Two hundred and thirty-six patients with acute renal colic presented in emergency department during a six-months period were included in the study. Using a standard predesigned proforma, demographic characteristics, presenting symptoms, practice of pain management and outcome were investigated. Renal colic attacks in patients were defined according to International Classification of Diseases, Tenth Revision, and Clinical Modification-10. Result Prevalence of renal colic was 2.61%. Mean age of the patients was 33.9±13.7 years. More than half of participants were male (54%). Majority of the patients (47.9%) were from Kavrepalanchowk district. The most common presenting symptom of the patients was flank pain on affected side (79.2%). In almost 43% of patients, diclofenac sodium was administered as a first line analgesic. There was no significant difference between diclofenac and ketolorac with respect to the need of second line analgesic (Chi-square value: 0.19, p value = 0.664). Conclusion Prevalence of renal colic was 2.61% at Dhulikhel hospital. More male pateints were affected and the most common presenting symptom was flank pain on the affected. Diclofenac and ketorolac are equally effective for the pain management of renal colic patients.


Assuntos
Diclofenaco/uso terapêutico , Cetorolaco/uso terapêutico , Manejo da Dor/métodos , Cólica Renal/patologia , Adulto , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Adulto Jovem
20.
Emerg Med J ; 36(10): 638, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31551306

RESUMO

A shortcut review was carried out to establish whether diclofenac is better than a triptan in treating migraine. 32 papers were found of which only 1 addressed this question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. It is concluded that there is insufficient evidence that either treatment is superior to the other for migraine therapy.


Assuntos
Diclofenaco/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Triptaminas/uso terapêutico , Adulto , Medicina de Emergência Baseada em Evidências/métodos , Feminino , Humanos , Resultado do Tratamento
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