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1.
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
2.
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
3.
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
4.
Dermatol Clin ; 37(4): 435-441, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466584

RESUMO

Although surgical intervention remains the standard of care for nonmelanoma skin cancer, other treatment modalities have been studied and used. Nonsurgical treatment methods include cryotherapy, topical medications, photodynamic therapy, radiation therapy, Hedgehog pathway inhibitors, programmed cell death protein 1 inhibitors, and active nonintervention. Despite the favorable efficacy of surgical treatment methods, many factors, including but not limited to patient age, preference, and severity of disease, must be taken into consideration when choosing the most appropriate, patient-centered treatment approach.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Fotoquimioterapia , Radioterapia , Neoplasias Cutâneas/terapia , Administração Cutânea , Anilidas/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Criocirurgia , Inibidores de Ciclo-Oxigenase/uso terapêutico , Diclofenaco/uso terapêutico , Diterpenos/uso terapêutico , Fluoruracila/uso terapêutico , Humanos , Imiquimode/uso terapêutico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Piridinas/uso terapêutico , Conduta Expectante
5.
Chemosphere ; 236: 124256, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31319305

RESUMO

Use of reclaimed water for irrigation is a main way for pharmaceutical compounds such as diclofenac getting into the soil environment. However, the role of minerals, especially iron oxides, in the diclofenac adsorption to soils with low soil organic matter (SOM) is still in the lack of evaluation. In this study, adsorption of diclofenac onto six minerals (five nature minerals-hematite, goethite, magnetite, kaolinite and aluminium oxide and one engineered mineral-activated aluminia) and five reference soils was investigated by column chromatography. Adsorption of diclofenac onto minerals and soils was totally reversible and interactions such as H-bonding were the primary mechanisms. Adsorption affinity of iron oxides was much higher than that of nature silicon and aluminum oxides. Diclofenac tended to be adsorbed by mineral surface -OH groups with high thermodynamic stability, which were dehydroxylated at high temperature. Compared with the SOM-dominated sorption of naphthalene, adsorption of diclofenac onto soils was controlled by bonding with surface -OH groups of iron oxides. Adsorption coefficients of diclofenac onto soils can be well predicted by contents of extracted Fe by diethylenetriamine pentaacetic acid (DTPA) instead of total iron oxides contents, suggesting that the bonding was adsorption site-dependent. These findings highlighted the importance of iron oxides in the adsorption of diclofenac (an anionic pharmaceutical compound) in soils with relatively low SOM (e.g., 1.03-3.45%). It also indicated that contents of effective surface -OH groups and DTPA-Fe were the promising parameters to develop the predictive models for diclofenac adsorption onto minerals and soils, respectively.


Assuntos
Adsorção/fisiologia , Diclofenaco/uso terapêutico , Poluentes do Solo/química , Solo/química , Água/química , Diclofenaco/farmacologia
6.
Emerg Med J ; 36(7): 401-406, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31217178

RESUMO

OBJECTIVE: The current study aimed to ascertain differences in early postmedication pain reduction in participants presenting with acute musculoskeletal injuries (MSI) to the ED receiving intramuscular (IM) versus per oral (PO) diclofenac. METHODS: This was a prospective, double-blinded, randomised controlled trial conducted between January and June 2018 at the ED of Hamad General Hospital in Doha, Qatar. Adults (18-65 years of age) presenting to the ED within 24 hours of an acute MSI, who had a triage pain score measured using numerical rating scale of at least five or above were enrolled in this trial. Participants randomised to either IM (75 mg) with oral placebo, or oral (100 mg) diclofenac group with IM placebo using a computer-generated randomised concealed list in blocks of six and eight. The primary objective was to compare the proportion of IM versus PO participants attaining a 50% reduction in pain score at 30 min from t0. RESULTS: 300 participants were enrolled (150 in the IM diclofenac group and 150 in the PO diclofenac group) in the trial. The primary outcome was achieved in 99.3 (95% CI 96.3 to 100) in the IM group and 86.7 (95% CI 80.2 to 91.7) in PO group. There was an absolute risk difference of 12.7%. This corresponds to a number needed to treat of 8 cases (95% CI 6 to 14) receiving IM rather than the PO diclofenac in order to achieve one additional case of 50% pain reduction within 30 min of drug administration. There were no adverse events experienced in any treatment groups. CONCLUSION: IM diclofenac injection provides rapid analgesia over PO administration of diclofenac. However, given the preparation needed for an IM injection, oral administration may be preferable when and if clinical circumstances allow a choice in non-steroidal anti-inflammatory drug administration route.


Assuntos
Administração Oral , Diclofenaco/administração & dosagem , Injeções Intramusculares/métodos , Doenças Musculoesqueléticas/tratamento farmacológico , Dor Aguda/tratamento farmacológico , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/farmacologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/farmacologia , Diclofenaco/uso terapêutico , Método Duplo-Cego , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Estudos Prospectivos , Catar/epidemiologia
7.
Drugs Aging ; 36(Suppl 1): 15-24, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31073921

RESUMO

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recommended and prescribed to treat pain in osteoarthritis. While measured to have a moderate effect on pain in osteoarthritis, NSAIDs have been associated with wide-ranging adverse events affecting the gastrointestinal, cardiovascular, and renal systems. Gastrointestinal toxicity is found with all NSAIDs, which may be of particular concern when treating older patients with osteoarthritis, and gastric adverse events may be reduced by taking a concomitant gastroprotective agent, although intestinal adverse events are not ameliorated. Cardiovascular toxicity is associated with all NSAIDs to some extent and the degree of risk appears to be pharmacotherapy specific. An increased risk of acute myocardial infarction and heart failure is observed with all NSAIDs, while an elevated risk of hemorrhagic stroke appears to be restricted to the use of diclofenac and meloxicam. All NSAIDs have the potential to induce acute kidney injury, and patients with osteoarthritis with co-morbid conditions including hypertension, heart failure, and diabetes mellitus are at increased risk. Osteoarthritis is associated with excess mortality, which may be explained by reduced levels of physical activity owing to lower limb pain, presence of comorbid conditions, and the adverse effects of anti-osteoarthritis medications especially NSAIDs. This narrative review of recent literature identifies data on the safety of non-selective NSAIDs to better understand the risk:benefit of using NSAIDs to manage pain in osteoarthritis.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Artralgia/tratamento farmacológico , Diclofenaco/efeitos adversos , Meloxicam/efeitos adversos , Osteoartrite/tratamento farmacológico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/administração & dosagem , Diclofenaco/uso terapêutico , Gastroenteropatias/induzido quimicamente , Humanos , Meloxicam/administração & dosagem , Meloxicam/uso terapêutico , Infarto do Miocárdio/induzido quimicamente , Risco
8.
Drugs Aging ; 36(Suppl 1): 45-64, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31073923

RESUMO

OBJECTIVE: We aimed to assess the safety of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the management of osteoarthritis (OA) in a systematic review and meta-analysis of randomized, placebo-controlled trials. METHODS: A comprehensive literature search was undertaken in the MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus electronic databases. Randomized, double-blind, placebo-controlled, parallel-group trials that assessed adverse events (AEs) with topical NSAIDs in patients with OA were eligible for inclusion. Authors and/or study sponsors were contacted to obtain the full report of AEs. The primary outcomes were overall severe and serious AEs, as well as the following MedDRA System Organ Class (SOC)-related AEs: gastrointestinal, vascular, cardiac, nervous system, skin and subcutaneous tissue, musculoskeletal and connective tissue. RESULTS: The search strategy identified 1209 records, from which 25 papers were included in the qualitative synthesis and 19 were included in the meta-analysis, after exclusions. Overall, more total AEs (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.04-1.29; I2 = 0.0%) and more withdrawals due to AEs (OR 1.49, 95% CI 1.15-1.92; I2 = 0.0%) were observed with topical NSAIDs compared with placebo. The same results were achieved with topical diclofenac, largely driven by an increase in skin and subcutaneous tissue disorders (OR 1.73, 95% CI 0.96-3.10), although the difference was not statistically significant compared with placebo. No significant difference in the odds for gastrointestinal disorders was observed between topical NSAIDs and placebo (OR 0.96, 95% CI 0.73-1.27). CONCLUSIONS: Topical NSAIDs may be considered safe in the management of OA, especially with regard to low gastrointestinal toxicity. The use of topical NSAIDs in OA should be considered, taking into account their risk: benefit profile in comparison with other anti-OA treatments.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Diclofenaco/administração & dosagem , Diclofenaco/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Osteoartrite/tratamento farmacológico , Administração Cutânea , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
Molecules ; 24(9)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31075867

RESUMO

In this work, hybrid compounds 1-4 obtained by conjugation of the non-steroidal anti-inflammatory drug diclofenac, with natural molecules endowed with antioxidant and antiproliferative activity were prepared. The antiproliferative activity of these hybrids was evaluated on immortalized human keratinocyte (HaCaT) cells stimulated with epidermal growth factor (EGF), an actinic keratosis (AK) model, and on human squamous cell carcinoma (SCC) cells (A431). Hybrid 1 presented the best activity in both cell models. Self-assembling surfactant nanomicelles have been chosen as the carrier to drive the hybrid 1 into the skin; the in vitro permeation through and penetration into pig ear skin have been evaluated. Among the nanostructured formulations tested, Nano3Hybrid20 showed a higher tendency of the hybrid 1 to be retained in the skin rather than permeating it, with a desirable topical and non-systemic action. On these bases, hybrid 1 may represent an attractive lead scaffold for the development of new treatments for AK and SCC.


Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Diclofenaco/uso terapêutico , Ceratose Actínica/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Animais , Carcinoma de Células Escamosas/patologia , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Diclofenaco/síntese química , Diclofenaco/química , Diclofenaco/farmacologia , Humanos , Concentração Inibidora 50 , Ceratose Actínica/patologia , Micelas , Nanopartículas/química , Tamanho da Partícula , Neoplasias Cutâneas/patologia , Suínos
11.
BMC Musculoskelet Disord ; 20(1): 201, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077160

RESUMO

BACKGROUND: We have reported that a single intra-articular injection of diclofenac etalhyaluronate (SI-613) exerted a potent and long-lasting analgesic effect in experimental arthritis models. In the present study, we investigated the effect of SI-613 on the production of high molecular weight hyaluronic acid (HMW-HA) in synoviocytes from osteoarthritis (OA) patients and compared its efficacy with that of hyaluronic acid (HA). METHODS: We compared the effect of SI-613, HA, and diclofenac sodium (DF-Na) on high molecular weight HA production by human synoviocytes. RESULTS: SI-613 and exogenous HA induced the production of high molecular weight HA in synoviocytes from OA patients, whereas DF-Na had no effect. The molecular weight of newly produced HA was about 1000 kDa in the HA-treated synoviocytes and much higher than 2400 kDa in the SI-613-treated cells. The effect of the mixture of HA and DF-Na was similar to that of HA alone in that the molecular weight of newly produced HA was around 1000 kDa. SI-613 significantly suppressed hyaluronidase 2 (HYAL2) mRNA expression and significantly enhanced hyaluronan synthase 2 (HAS2) mRNA expression. HA had no effect on the expression levels of HYAL and HAS. CONCLUSION: The present results clearly demonstrate that SI-613 induces the production of high molecular weight HA in synoviocytes from OA patients, suggesting the long-lasting analgesic and disease modifying effect of SI-613 for OA. Taken together with the anti-inflammatory and analgesic effects we recently reported for the intra-articular administration of SI-613 to experimental animal models, SI-613 holds great promise for the treatment of knee osteoarthritis.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Diclofenaco/análogos & derivados , Diclofenaco/farmacologia , Ácido Hialurônico/análogos & derivados , Ácido Hialurônico/metabolismo , Sinoviócitos/efeitos dos fármacos , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/patologia , Moléculas de Adesão Celular/antagonistas & inibidores , Moléculas de Adesão Celular/metabolismo , Células Cultivadas , Diclofenaco/uso terapêutico , Avaliação Pré-Clínica de Medicamentos , Proteínas Ligadas por GPI/antagonistas & inibidores , Proteínas Ligadas por GPI/metabolismo , Humanos , Hialuronan Sintases/metabolismo , Ácido Hialurônico/química , Ácido Hialurônico/farmacologia , Hialuronoglucosaminidase/antagonistas & inibidores , Hialuronoglucosaminidase/metabolismo , Injeções Intra-Articulares , Peso Molecular , Osteoartrite/tratamento farmacológico , Osteoartrite/patologia , Cultura Primária de Células , Sinoviócitos/metabolismo
12.
Ann Dermatol Venereol ; 146 Suppl 2: IIS22-IIS30, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31133226

RESUMO

Dermatologists have many therapeutic options for the management of actinic keratoses (AK), in order to treat individual lesions or wider areas. Field cancerization is an area of sun-damaged skin, where visible and subclinical lesions co-exist, and is prone to the development of further AK lesions and sun-related skin cancers (SC). Treatments available are instrumental or medical. Resistance to treatment or atypical symptoms must lead to a biopsy for histological exam. Cryotherapy is the most frequently used method to destroy small or isolated AK, whereas photodynamic therapy (PDT), 5-fluoro-uracil (5-FU), imiquimod, ingenol mebutate and diclofenac are required for large, multiple lesions, and for the treatment of field cancerization. Side-effects of these therapies are essentially local, including pain, irritation, erythema, edema and scars. There is no randomized comparative study reviewing all these treatments, therefore physicians must also consider clinical characteristics, patient's compliance, side-effects and cost when treating AK. Medicoeconomic data of these treatments have been analyzed in several countries, and annual costs are estimated between 250 € and 2 000 €, with an uncertain cost-effective relation. Finally, beyond treatment of AK lesions, patients with AK are at high risk of developing SC, and must therefore have regular full-body examination, in order to be detected and treated precociously. © 2019 Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Kératoses actiniques : comprendre et traiter réalisé avec le soutien institutionnel de Galderma International.


Assuntos
Ceratose Actínica/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Antineoplásicos/uso terapêutico , Análise Custo-Benefício , Crioterapia/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/uso terapêutico , Diclofenaco/uso terapêutico , Diterpenos/uso terapêutico , Eletrocoagulação , Fluoruracila/uso terapêutico , Humanos , Imiquimode/uso terapêutico , Terapia a Laser , Fotoquimioterapia/efeitos adversos
13.
Trials ; 20(1): 214, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975196

RESUMO

BACKGROUND: The purpose of this study was to compare the efficacy and safety of curcumin with those of diclofenac in the treatment of knee osteoarthritis (OA). METHODS: In this randomized, open-label, parallel, active controlled clinical study, 139 patients with knee OA were randomly assigned to receive either a curcumin 500-mg (BCM-95®) capsule three times daily or a diclofenac 50-mg tablet two times daily for 28 days. Patients underwent assessment at baseline and days 7, 14, and 28. The main outcome measure was severity of pain using visual analogue scale score at days 14 and 28. Knee Injury and Osteoarthritis Outcome Score (KOOS) (at days 14 and 28), anti-flatulent effect (at day 7), anti-ulcer effect, weight-lowering effect, and patient's and physician's global assessment of therapy at day 28 were included as secondary outcome measures. Safety after treatment was evaluated by recording adverse events and laboratory investigation. RESULTS: At days 14 and 28, patients receiving curcumin showed similar improvement in severity of pain and KOOS scale when compared with diclofenac, and the difference was not statistically significant. At day 7, the patients who received curcumin experienced a significantly greater reduction in the number of episodes of flatulence compared with diclofenac (P <0.01). At day 28, a weight-lowering effect (P <0.01) and anti-ulcer effect (P <0.01) of curcumin were observed. None of the patients required H2 blockers in the curcumin group, and 19 patients required H2 blockers in the diclofenac group (0% versus 28%, respectively; P <0.01). Adverse effects were significantly less in the curcumin group (13% versus 38% in the diclofenac group; P <0.01). Patient's and physician's global assessment of therapy was similar in the two treatment groups. CONCLUSION: Curcumin has similar efficacy to diclofenac but demonstrated better tolerance among patients with knee OA. Curcumin can be an alternative treatment option in the patients with knee OA who are intolerant to the side effects of non-steroidal anti-inflammatory drugs. TRIAL REGISTRATION: ISRCTN, ISRCTN10074826 . Registered 21 November 2017 - Retrospectively registered.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Curcumina/uso terapêutico , Diclofenaco/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Adulto , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Curcumina/efeitos adversos , Diclofenaco/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa
14.
Acta Med Port ; 32(2): 119-125, 2019 Feb 28.
Artigo em Português | MEDLINE | ID: mdl-30896392

RESUMO

INTRODUCTION: Portugal presents the highest incidence of stage 5 chronic kidney disease in Europe. It is speculated that a high consumption of non-steroidal anti-inflammatory drugs (NSAIDS) may contribute to this high incidence. Our aim was to characterize the prescription of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus in Portugal. MATERIAL AND METHODS: We analyzed the national prescription database in triennium 2015 - 2017. In patients with diabetes mellitus, we evaluated the prescription of non-steroidal anti-inflammatory drugs according to age, gender and region of the patient and specialty of the prescribing physician. We evaluated the prescription of non-steroidal anti-inflammatory drugs in all patients with diabetes mellitus, in patients with presumed renal impairment, and in those with concomitant prescription of angiotensin converting enzyme inhibitors or angiotensin receptor antagonists. RESULTS: We analyzed 23 320 620 prescriptions, corresponding to 610 157 adults, including 104 306 patients with diabetes mellitus. The most prescribed non-steroidal anti-inflammatory drugs were ibuprofen (20.1%), metamizole (14.7%), and diclofenac (11.4%). The prescription of non-steroidal anti-inflammatory drugs was higher in females, in patients aged 51 - 70 years and in the Alentejo region. Non-steroidal anti-inflammatory drugs were prescribed to 70.6% of patients with diabetes mellitus, from which 10.6% were prescribed ≥ 10 packages during the three years. Among patients with diabetes mellitus on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and with presumed reduction in kidney function, 69.3% were prescribed non-steroidal anti-inflammatory drugs and 11.5% were prescribed ≥ 10 packages during the three years. DISCUSSION: The level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus is high. The concern of reducing non-steroidal anti-inflammatory drugs prescription to patients already on angiotensin converting enzyme inhibitors/angiotensin receptor antagonists and/or decreased renal function does not seem to exist. CONCLUSION: In Portugal, the level of prescribing of non-steroidal anti-inflammatory drugs to patients with diabetes mellitus should be reduced, particularly in the subgroups identified with higher prescription and with higher risk of progression to stage 5 chronic kidney disease.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Diabetes Mellitus , Insuficiência Renal Crônica , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Diclofenaco/uso terapêutico , Dipirona/uso terapêutico , Feminino , Humanos , Ibuprofeno/uso terapêutico , Masculino , Pessoa de Meia-Idade , Portugal , Estudos Retrospectivos , Especialização/estatística & dados numéricos , Adulto Jovem
15.
PLoS One ; 14(3): e0214329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30897156

RESUMO

PURPOSE: To estimate the prevalence of use of analgesics in Brazil; and to characterize this use, according to sociodemographic and health-related characteristics. METHODS: A cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines, PNAUM) was conducted between September 2013 and February 2014. A total of 41,433 people of all ages in Brazilian urban households were interviewed. Occasional use (within the last 15 days) and continuous use of non-opioid analgesics, opioid analgesics and non-steroidal anti-inflammatory drugs were investigated, regardless of whether this use occurred through prescription or self-medication. The main outcome was the use of at least one analgesic. RESULTS: The majority of the individuals were female (52.8%), aged between 20 and 59 years (57.2%), with 1 to 8 years of schooling (45.6%). The overall prevalence of analgesic use was 22.8% [95% CI: 21.4-24.2]. The use of analgesics was significantly higher among women, adults and elderly (20 years or more), highly educated individuals and respondents who referred: diagnosis of one or more chronic diseases, using three or more medications, possession of health insurance and with one or more emergency care admittances or hospitalizations within the last year. Non-opioid analgesics were the agents most used (18.5% of the sample), followed by non-steroidal anti-inflammatory drugs (6.9%) and opioid analgesics (0.5%). The most commonly used drugs were metamizole (37.8% of all analgesics), paracetamol (25.3%) and diclofenac (10.7%). These drugs were used mainly to manage occasional health conditions, particularly pain. CONCLUSION: One in five Brazilians used some analgesic, especially non-opioid analgesics, to manage acute health problems such as painful conditions.


Assuntos
Analgésicos/classificação , Analgésicos/uso terapêutico , Acetaminofen/uso terapêutico , Adulto , Fatores Etários , Brasil , Estudos Transversais , Diclofenaco/uso terapêutico , Dipirona/uso terapêutico , Uso de Medicamentos , Feminino , Promoção da Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-30734687

RESUMO

INTRODUCTION: Nowadays, the group of NSAIDs is used the most widely in order to treat the inflammatory process. But its long-term administration increases the risk of complications of pharmacotherapy. Therefore, today it is urgent to search for new molecules that can selectively block biological targets that directly perceive inflammatory mediators. One of such targets is TRPA1. ZC02-0012, a compound from the group of substituted pyrazinopyrimidinones, which is a selective inhibitor of TRPA1 ion channel. OBJECTIVE: The aim of our study was to study the anti-inflammatory activity of an innovative molecule under the laboratory code ZC02-0012 from the group of selective inhibitors of TRPA1 ion channel. MATERIALS AND METHODS: Anti-inflammatory activity of ZC02-0012 was studied on the model of acute exudative inflammation of the paw in response to subplantar injection in the right hind paw of mice with 0.02 ml of 2% formaldehyde solution. The mass of the paw was measured after 4 hours (peak edema) after phlogistic injection. The test substance and the reference drug was administered intragastrically or intramuscularly 45 minutes before the injection of formaldehyde solution. The presence and intensity of antiinflammatory activity was judged by the inhibitory effect, represented in percent. RESULTS AND DISCUSSION: Selective inhibitor of the TRPA1 ion channel ZC02-0012 revealed the anti-inflammatory activity at doses of 3 and 9 mg/kg, its intensity is comparable to diclofenac sodium. CONCLUSION: The selective inhibitor of the ion channel TRPA1, a substance under code ZC02-0012, has an anti-inflammatory activity comparable with diclofenac sodium.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Edema/tratamento farmacológico , Inflamação/tratamento farmacológico , Canal de Cátion TRPA1/antagonistas & inibidores , Analgésicos não Entorpecentes/síntese química , Analgésicos não Entorpecentes/farmacologia , Animais , Animais não Endogâmicos , Anti-Inflamatórios/síntese química , Anti-Inflamatórios/farmacologia , Diclofenaco/uso terapêutico , Modelos Animais de Doenças , Descoberta de Drogas , Edema/induzido quimicamente , Formaldeído , Humanos , Masculino , Camundongos
17.
Gastroenterology ; 156(6): 1753-1760.e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30772342

RESUMO

BACKGROUND & AIMS: Acute pancreatitis is a major adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Rectal administration of nonsteroidal anti-inflammatory drugs (NSAIDs) decreases the incidence of post-ERCP pancreatitis (PEP). Little is known about the combined effects of sublingual nitrate and NSAIDs. We performed a randomized trial to assess whether the combination of NSAIDs and sublingual nitrate is more effective than NSAIDs alone in preventing PEP. METHODS: In a prospective superiority trial, eligible patients underwent ERCP at 12 endoscopic units in Japan, from March 2015 through May 2018. Patients were randomly assigned to groups given diclofenac suppositories (50 mg) within 15 minutes after the endoscopic procedure alone (diclofenac-alone group, n = 442) or in combination with sublingual isosorbide dinitrate (5 mg) 5 minutes before the endoscopic procedure (combination group, n = 444). The primary endpoint was the occurrence of PEP. RESULTS: PEP developed in 25 patients in the combination group (5.6%), and in 42 patients in the diclofenac-alone group (9.5%) (relative risk 0.59; 95% confidence interval 0.37-0.95; P = .03). Moderate to severe pancreatitis developed in 4 patients (0.9%) in the combination group, and 10 patients (2.3%) in the diclofenac-alone group (relative risk 0.12; 95% confidence interval 0.13-1.26; P = .12). There was no serious adverse event related to the additional administration of sublingual nitrate. CONCLUSIONS: In a randomized controlled trial, we found that prophylaxis with rectal diclofenac and sublingual nitrate significantly reduces the overall incidence of PEP compared with diclofenac suppository alone. ClinicalTrials.gov, no: UMIN 000016274.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Diclofenaco/uso terapêutico , Dinitrato de Isossorbida/uso terapêutico , Doadores de Óxido Nítrico/uso terapêutico , Pancreatite/prevenção & controle , Administração Sublingual , Idoso , Quimioterapia Combinada , Feminino , Humanos , Dinitrato de Isossorbida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Doadores de Óxido Nítrico/administração & dosagem , Pancreatite/etiologia , Estudos Prospectivos
18.
Cochrane Database Syst Rev ; 1: CD011101, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30699235

RESUMO

BACKGROUND: Laparoscopy is a common procedure used to diagnose and treat various gynaecological conditions. Shoulder-tip pain (STP) as a result of the laparoscopy occurs in up to 80% of women, with potential for significant morbidity, delayed discharge and readmission. Interventions at the time of gynaecological laparoscopy have been developed in an attempt to reduce the incidence and severity of STP. OBJECTIVES: To determine the effectiveness and safety of methods for reducing the incidence and severity of shoulder-tip pain (STP) following gynaecological laparoscopy. SEARCH METHODS: We searched the following databases: Cochrane Gynaecology and Fertility (CGF) Specialised Register, the Cochrane Central Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO and CINAHL from inception to 8 August 2018. We also searched the reference lists of relevant articles and registers of ongoing trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) of interventions used during or immediately after gynaecological laparoscopy to reduce the incidence or severity of STP. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Primary outcomes: incidence or severity of STP and adverse events of the interventions; secondary outcomes: analgesia usage, delay in discharge, readmission rates, quality-of-life scores and healthcare costs. MAIN RESULTS: We included 32 studies (3284 women). Laparoscopic procedures in these studies varied from diagnostic procedures to complex operations. The quality of the evidence ranged from very low to moderate. The main limitations were risk of bias, imprecision and inconsistency.Specific technique versus "standard" technique for releasing the pneumoperitoneumUse of a specific technique of releasing the pneumoperitoneum (pulmonary recruitment manoeuvre, extended assisted ventilation or actively aspirating intra-abdominal gas) reduced the severity of STP at 24 hours (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -0.82 to -0.50; 5 RCTs; 670 participants; I2 = 0%, low-quality evidence) and reduced analgesia usage (SMD -0.53, 95% CI -0.70 to -0.35; 4 RCTs; 570 participants; I2 = 91%, low-quality evidence). There appeared to be little or no difference in the incidence of STP at 24 hours (odds ratio (OR) 0.87, 95% CI 0.41 to 1.82; 1 RCT; 118 participants; low-quality evidence).No adverse events occurred in the only study assessing this outcome.Fluid instillation versus no fluid instillationFluid instillation is probably associated with a reduction in STP incidence (OR 0.38, 95% CI 0.22 to 0.66; 2 RCTs; 220 participants; I2 = 0%, moderate-quality evidence) and severity (mean difference (MD) (0 to 10 visual analogue scale (VAS) scale) -2.27, 95% CI -3.06 to -1.48; 2 RCTs; 220 participants; I2 = 29%, moderate-quality evidence) at 24 hours, and may reduce analgesia usage (MD -12.02, 95% CI -23.97 to -0.06; 2 RCTs; 205 participants, low-quality evidence).No study measured adverse events.Intraperitoneal drain versus no intraperitoneal drainUsing an intraperitoneal drain may reduce the incidence of STP at 24 hours (OR 0.30, 95% CI 0.20 to 0.46; 3 RCTs; 417 participants; I2 = 90%, low-quality evidence) and may reduce analgesia use within 48 hours post-operatively (SMD -1.84, 95% CI -2.14 to -1.54; 2 RCTs; 253 participants; I2 = 90%). We are uncertain whether it reduces the severity of STP at 24 hours, as the evidence was very low quality (MD (0 to 10 VAS scale) -1.85, 95% CI -2.15 to -1.55; 3 RCTs; 320 participants; I2 = 70%).No study measured adverse events.Subdiaphragmatic intraperitoneal local anaesthetic versus control (no fluid instillation, normal saline or Ringer's lactate)There is probably little or no difference between the groups in incidence of STP (OR 0.72, 95% CI 0.42 to 1.23; 4 RCTs; 336 participants; I2 = 0%; moderate-quality evidence) and there may be no difference in STP severity (MD -1.13, 95% CI -2.52 to 0.26; 1 RCT; 50 participants; low-quality evidence), both measured at 24 hours. However, the intervention may reduce post-operative analgesia use (SMD-0.57, 95% CI -0.94 to -0.21; 2 RCTs; 129 participants; I2 = 51%, low-quality evidence).No adverse events occurred in any study.Local anaesthetic into peritoneal cavity (not subdiaphragmatic) versus normal salineLocal anaesthetic into the peritoneal cavity may reduce the incidence of STP at 4 to 8 hours post-operatively (OR 0.23, 95% CI 0.06 to 0.93; 2 RCTs; 157 participants; I2 = 56%; low-quality evidence). Our other outcomes of interest were not assessed.Warmed, or warmed and humidified CO2 versus unwarmed and unhumidified CO2There may be no difference between these interventions in incidence of STP at 24 to 48 hours (OR 0.81 95% CI 0.45 to 1.49; 2 RCTs; 194 participants; I2 = 12%; low-quality evidence) or in analgesia usage within 48 hours (MD -4.97 mg morphine, 95% CI -11.25 to 1.31; 1 RCT; 95 participants; low-quality evidence); there is probably little or no difference in STP severity at 24 hours (MD (0 to 10 VAS scale) 0.11, 95% CI -0.75 to 0.97; 2 RCTs; 157 participants; I2 = 50%; moderate-quality evidence).No study measured adverse events.Gasless laparoscopy versus CO2 insufflationGasless laparoscopy may be associated with increased severity of STP within 72 hours post-operatively when compared with standard treatment (MD 3.8 (0 to 30 VAS scale), 95% CI 0.76 to 6.84; 1 RCT; 54 participants, low-quality evidence), and there may be no difference in the risk of adverse events (OR 2.56, 95% CI 0.25 to 26.28; 1 RCT; 54 participants; low-quality evidence).No study measured the incidence of STP. AUTHORS' CONCLUSIONS: There is low to moderate-quality evidence that the following interventions are associated with a reduction in the incidence or severity, or both, of STP, or a reduction in analgesia requirements for women undergoing gynaecological laparoscopy: a specific technique for releasing the pneumoperitoneum; intraperitoneal fluid instillation; an intraperitoneal drain; and local anaesthetic applied to the peritoneal cavity (not subdiaphragmatic).There is low to moderate-quality evidence that subdiaphragmatic intraperitoneal local anaesthetic and warmed and humidified insufflating gas may not make a difference to the incidence or severity of STP.There is low-quality evidence that gasless laparoscopy may increase the severity of STP, compared with standard treatment.Few studies reported data on adverse events. Some potentially useful interventions have not been studied by RCTs of gynaecological laparoscopy.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Exame Ginecológico/efeitos adversos , Laparoscopia/efeitos adversos , Dor Processual/prevenção & controle , Dor de Ombro/prevenção & controle , Acetaminofen/uso terapêutico , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dióxido de Carbono/administração & dosagem , Diclofenaco/uso terapêutico , Drenagem/efeitos adversos , Feminino , Exame Ginecológico/métodos , Humanos , Incidência , Insuflação/métodos , Laparoscopia/métodos , Meperidina/uso terapêutico , Medição da Dor , Dor Processual/epidemiologia , Dor Processual/etiologia , Pirinitramida/uso terapêutico , Pneumoperitônio/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Dor de Ombro/epidemiologia , Dor de Ombro/etiologia
19.
Eur J Clin Pharmacol ; 75(4): 577-586, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30596208

RESUMO

PURPOSE: The objective of this study was to examine the impact of an academic detailing programme in primary care in Norway on the prescribing rate of diclofenac, naproxen and non-steroidal anti-inflammatory drugs (NSAIDs) in total. METHODS: An academic detailing programme was delivered to general practitioners (GPs) in two Norwegian cities. The key message was to avoid diclofenac and COX-2 inhibitors and to use naproxen as the NSAID of choice. We analysed prescription data for 12 months before and after the programme to estimate its impact, using interrupted time series to control for underlying trends, and using the rest of Norway as a comparator. The primary outcome was change in the proportion of the population filling a prescription for diclofenac; secondary outcomes were change in naproxen prescribing and change in total NSAID prescribing. RESULTS: Controlling for baseline trends, and relative to changes in the rest of Norway, there was a statistically significant reduction in the prescribing rate of diclofenac in both cities (- 18% and - 16%, respectively) immediately after the intervention. The impact of the programme on prescribing of diclofenac was maintained by the end of the 12 month follow-up period. An increase in the prescribing of naproxen was observed in both cities. The programme had no impact on the overall rate of prescribing of NSAIDs. CONCLUSION: Academic detailing was effective in changing the choice of prescribed NSAID amongst Norwegian GPs. Academic detailing is potentially an important method for providing GPs with independent, evidence-based updates on pharmacotherapy to improve prescribing.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Educação Médica Continuada/métodos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Diclofenaco/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Humanos , Naproxeno/uso terapêutico , Noruega , Medicamentos sob Prescrição/uso terapêutico , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos
20.
Med Sci Monit ; 25: 157-164, 2019 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-30612134

RESUMO

BACKGROUND NSAIDs are the most common agents used in dysmenorrhea treatment. They reduce menstrual pain by reducing uterine pressure and PGF2alpha levels in the menstrual fluid. The aim of this study was to compare the effects of piroxicam and diclofenac sodium as treatments for primary dysmenorrhea. MATERIAL AND METHODS The study was conducted using a randomized and double-blind method. Patients with Visual Analogue Scale (VAS) scores greater than 5 were accepted into the study. The patients who were suitable for inclusion were randomized into 2 groups and received either intramuscular piroxicam or diclofenac sodium. The patients' pain levels were measured at baseline and at 15, 30, 45, and 60 min. A VAS of 10 cm, a numeric scale, a verbal scale, and additional symptoms, as well as pain relapse after 24 hours and required analgesics, were recorded. RESULTS The study included 400 patients. Overall, 200 patients (50%) were in the proxicam group, and 200 patients were in the diclofenac sodium group. The average decrease on the VAS after piroxicam or diclofenac administration was measured as 7.9±1.8 cm and 7.9±1.7 cm (median ± standard deviation), respectively. The pain-reducing efficiency of all the treatments was compared using the Mann-Whitney U test (p=0.929). Rescue medication was needed for 25 patients in the proxicam group (p=0.014). Overall, 30 patients in the proxicam group and 41 patients in the proxicam group needed analgesics again in the 24-hour period after treatment (p=0.150). CONCLUSIONS At the end of our study, it was observed that there was no difference in the results of primary dysmenorrhea treatment with 20 mg piroxicam or 75 mg diclofenac sodium.


Assuntos
Diclofenaco/uso terapêutico , Dismenorreia/tratamento farmacológico , Piroxicam/uso terapêutico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Método Duplo-Cego , Serviços Médicos de Emergência , Feminino , Humanos , Medição da Dor , Adulto Jovem
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