جستجوی مقالات مرتبط با کلیدواژه « NSAIDs » در نشریات گروه « پزشکی »

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs widely prescribed and used worldwide. Patients taking NSAIDs, including diclofenac, should be aware of its potential nephrotoxic effects. However, the rapid onset of acute kidney injury (AKI) after a single dose of diclofenac is considered a very rare side effect.

We present a 66-year-old woman with habitual self-induced anuria with the chief complaint of shoulder pain due to falling down. The patient presented with various co-morbid conditions, including hypertension, type 2 diabetes, tricuspid valve repair, and aortic valve replacement. She rapidly developed anuria after receiving a single dose of diclofenac over the previous two days of admission. Creatinine and BUN exhibited a significant rise in laboratory tests. During hospitalization, the consumption of NSAIDs was prohibited and losartan and furosemide were discontinued. Moreover, phenacetin was used to relieve pain instead. Luckily, after two days of hospitalization, urine output returned to normal levels. Additionally, creatinine and BUN levels gradually decreased to baseline values.

To the best of our knowledge, we described a rare case of diclofenac-induced AKI presenting with anuria, a complete cessation of urine flow, in a patient with no previous kidney complications. This case can be explained by the phenomenon known as “quadruple Whammy,” which involves the concurrent use of NSAIDs, ARBs, and diuretics in the setting of hypovolemia.

 To systematically review the recent alternative medical interventions on renal colic pain and compare their efficiency with conventional treatments.

 This was a systematic review and network meta-analysis (NMA) study, based on the PRISMA guidelines on online databases of PubMed, Scopus, and web of science. We quarried these databases with relevant keywords for clinical trial studies that aimed at reducing renal colic pain in patients refereeing to the ED from after January 2011 to February 2022. Randomized clinical trials that used the Visual Analogue Scale (VAS) for assessment of renal colic pain before and after medical interventions in adult patients were included in this study. NMA was conducted based on the continuous values of the mean difference of the pain after 30 and 60 minutes of the medication administration.

 Twenty-four studies that were meeting the inclusion criteria were included in our review with 2724 adult participants who were mostly male. Study arms included conventional medications (NSAID, Opioid, paracetamol), ketamine, MgSo4, desmopressin, and lidocaine. Based on the qualitative synthesis, ten studies (41.7%) did not find significant differences between conventional and alternative treatments. Also, there is no agreement on some more recent medications like using ketamine or desmopressin while MgSO4 and lidocaine use are supported by most studies. NMA revealed that desmopressin is significantly having worse pain reduction properties. NMA did not show any difference between ketamine, lidocaine, and MgSo4, versus the conventional treatment.

 To conclude, lidocaine and MgSo4 might be good alternative treatments for renal colic when conventional treatments are contraindicated or pain is not responding to those. Ketamine might be indicated in patient-based circumstances. Desmopressin may be agreeably avoided in further research or clinics.

Acute pancreatitis is one of the most common complications following endoscopic retrograde cholangiopancreatography (ERCP), which can be life-threatening if the treatment is postponed. This study aimed to evaluate the effect of non-steroidal anti-inflammatory drugs (suppository diclofenac) on preventing post-ERCP pancreatitis (PEP).

In this double-blind, randomized clinical trial, 219 patients referred to our ERCP unit who passed inclusion and exclusion criteria were randomly assigned to two groups: group A (103 patients) received a diclofenac suppository 30 minutes before and immediately after ERCP. In Group B (116 patients), a diclofenac suppository was prescribed only before the procedure. Patients were evaluated regarding clinical signs and symptoms of pancreatitis for 24 hours. Also, serum amylase level was checked at baseline, 6, and 24 hours after the procedure. The study protocol was approved by the Ethics Committee of the Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.190). Also, the study protocol was registered in the Iranian Registry for Clinical Trials (IRCT20191231045969N2).

The PEP was seen in three patients in group A and seven patients in group B, which was not significantly different (P=0.341). The severity of pancreatitis was mild in all patients except one in group B, who developed moderate PEP. Moreover, in 97.71 % of cases, ERCP was successful for the first time, and in 94.18 % of group A and 89.66% of group B, no complications of bleeding or perforation were detected.

Administration of rectal diclofenac before and after ERCP had no significant effect on the prevention of pancreatitis compared with pre-ERCP administration.

 Renal papillary necrosis (RPN) is a multifactorial complication that occurs under the following conditions: Pyelonephritis, obstruction of the urogenital tract, non-steroidal anti-inflammatory drugs (NSAIDs) abuse, diabetes mellitus (DM2), and coronavirus disease 2019 (COVID-19). The present report presented a case of right ureteral obstruction due to RPN.

 The patient was a 68-year-old woman referred to the hospital due to flank pain, fever, vomiting/nausea, frequency, and nocturia. She also had a history of DM2, hypertension, dialysis, COVID-19, and the use of NSAIDs and antihypertensive. The results of computed tomography (CT) scan suspected a clot, bladder fungus or RPN, and COVID-19. After performing the ultrasound, mild hydroureteronephrosis and two echogenic foci were seen in the right kidney, suggesting a possible RPN. The patient was transferred to the urology service. After cystoscopy and urethroscopy, a severe stenosis was seen in the distal right ureter. As soon as inserting double J, lots of pus came out. The definitive diagnosis was RPN, ureteral obstruction, and pyelonephritis.

 It is important to pay enough attention to the disorders related to the urinary system, especially in the elderly with a history of NSAIDs abuse, DM2, hypertension, COVID-19, and renal diseases. Additionally, the underlying diseases, blood glucose, infection, dehydration, and use of NSAIDs must be well-controlled to protect nephro-ureteral structures.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a family of drugs that are among the most commonly prescribed drugs worldwide. Due to the ease of access and widespread use of these drugs, many cases of intentional and accidental poisoning of these compounds have been reported.The aim of this study was to determine the prevalence of the clinical signs of drug toxicity with aspirin and NSAIDs in patients referred to Razi Hospital in Ahwaz. In this study, patients suffering from aspirin and NSAIDs poisoning referred to Razi Hospital during 2013-2015 were included in the study. Information reviewed from their stored records includes clinical presentation, demographic information, reference data, and treatment options. In this study, 79.5% were female respondents and 20.5% were male, and Faye and Kramer coefficients confirmed the existence of a strongly separate relationship between the gender variable and the first clinical signs of poisoning. The results showed that Diclofenac with 27% had the highest toxicity and nausea was the most common symptom in all drug toxicity with aspirin and NSAIDs. Nausea is a common symptom of poisoning with these drugs. There was a significant relationship between laboratory changes with the type of drug and the need for ICU admission, and this relationship was not strong due to the index values. According to the results, most of the patients were aged between 14-24 years old. Nausea was the most common symptom in all drug toxicity with aspirin and NSAIDs.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used as analgesics and antipyretics in viral infections, as supportive therapy is the mainstay of treatment. However, their role in the course of the illness is still ambiguous. Several experimental evidences carried out on various viral infections about the role of NSAIDs in the course of illness are contradictory; some reported possible antiviral effects and some negate it. NSAIDs inhibit PGs and also have their own actions on immune system and viruses. NSAIDs have stimulatory effects on T lymphocytes, Nitric Oxide (NO) and interferons, but inhibitory effects on neutrophils, macrophages and antibodies formation. NSAIDs are used as adjunctive treatment in infectious diseases in which cytokines storm plays a role in the pathogenicity. However, in other studies their effects on immune system were associated with unresolved symptoms and complications. The worth saying in this entity is the evidence-based studies of antimicrobial activity of NSAIDs. NSAIDs are proven to inhibit the entry of virus to the cells like in ZIKV, as well as they inhibit the replication of many viruses like the inhibitory effect of naproxen on SARS-CoV-2 replication. However, they fail to show any direct antiviral activity in adenovirus infections, and Ibuprofen increases the shedding of RSV in a bovine model. Indeed, there are many contradictory published studies between various viruses, patients’ cases, and whether it’s a study on animals or humans. More randomized clinical trials are mandatory to exactly elucidate if use of NSAIDs, during viral infections especially COVID-19, modify and abort the course of viral infection by exerting beneficial therapeutic effects or the use of them is accompanied by delirious hazards and negatively impact the health of the patient.

The idiopathic peptic ulcers (IPU) or non-Helicobacter pylori, non-steroidal anti-inflammatory drug non-NSAIDs associated peptic ulcers are a serious therapeutic challenge. The prevalence of IPU is increasing in some parts of the world.

This study aimed to determine the prevalence of IPU in southeastern Iran.

In this cross-sectional study, a total of 367 patients with active peptic ulcer were diagnosed by endoscopy between Jan 2018 and Feb 2019. The patients were assessed for history of medication use (including NSAIDs) in the past month, smoking, alcohol, as well as a complete history of health problems related to underlying disease such as cardiopulmonary, hepatic, renal problems, and chronic pancreatitis. Biopsy samples from antrum were performed for rapid urease test (RUT), and if RUT was negative, then biopsies were sent for histopathology. If both RUT and pathologic findings were negative for H. pylori, in patients who had treatment for H. pylori eradication, anti-H. pylori IgG antibody of blood samples was assessed. Patients were considered infected with H. pylori if any of the diagnostic tests had a positive result.

According to the results, 336 (91.3%) cases had at least one of the two main etiologic factors (H. pylori and NSAIDs) for peptic ulcer. While 323 (87.7%) patients were H. pylori-positive, 45 (12.3%) patients were H. pylori-negative. However, out of 45 H. pylori-negative cases, 13 patients had a positive history of using NSAIDs, and 32 (8.69%) patients were IPU.

Our study showed that both H. pylori infection and NSAIDs use remain the main cause of peptic ulcers, and the prevalence of IPU is relatively high in Zahedan.

We synthesized twelve hybrids, S-allyl Cysteine methyl, ethyl and propyl ester-based non-steroidal anti-inflammatory drugs and their structures were elucidated by spectroscopic analysis. The chemopreventive potential of all compounds was evaluated against SW480 human colon adenocarcinoma cells and the non-malignant CHO-K1 cell line. Among the tested compounds, hybrids 10b-c, 11b and 12b displayed the best anticancer activity with IC50 values between 0.131-0.183 mM and selectivity indices higher than 1 after 48 h of treatment. Selectivity indices were comparable to those reported for the reference drug, 5-fluorouracil (SI > 1). The SAR analysis showed that compounds with two carbon atom alkylic chains displayed the best activity (10b, 11b and 12b). Modeling studies including drug-likeness, bioactivity score and ADME/tox studies using online tools like molinspiration and Osiris suggested that these designed hybrids have a good pharmacological profile and can be considered as promising scaffolds for further studies in the search for new therapeutic alternatives to treat colorectal cancer.

Adjuvant drugs for peripheral nerve blocks are a promising solution to acute postoperative pain and the transition to chronic pain treatment. Peripheral nerve blocks (PNB) are used in the brachial plexus, lumbar plexus, femoral nerve, sciatic nerve, and many other anatomic locations for site-specific pain relief. However, the duration of action of a PNB is limited without an adjuvant drug. The use of non-opioid adjuvant drugs for single-shot peripheral nerve blocks (sPNB), such as alpha-2 agonists, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs, can extend the duration of local anesthetics and reduce the dose-dependent adverse effects of local anesthetics. Tramadol is a weak opioid that acts as a central analgesic. It can block voltage-dependent sodium and potassium channels, cause serotonin release, and inhibit norepinephrine reuptake and can also be used as an adjuvant in PNBs. However, tramadol’s effectiveness and safety as an adjuvant to local anesthetic for PNB are inconsistent. The effects of the adjuvants on neurotoxicity must be further evaluated with further studies to delineate the safety in their use in PNB. Further research needs to be done. However, the use of adjuvants in PNB can be a way to help control postoperative pain.

Pancreatitis is considered as the most prevalent serious disorders of endoscopic retrograde cholangiopancreatography (ERCP). Different approaches have been suggested to prevent or reduce this complication. Therefore we aim to investigate them in the current study. This systematic review was performed in 2019 using Pubmed, Embase, google scholar and Cochrane library. Two reviewers selected eligible studies and outcomes of interest were extracted. Meta-analysis was done by using the random or fixed-effect models. I-square statistic test was used for heterogeneity analysis.

Totally, 2758 articles were searched. Thereafter duplicated and irrelevant articles were excluded, and six articles were entered to the present study. Six RCTs were considered eligible with a total participants of 1685.

The relative risk of PEP was not significantly different in NSAID and hydration groups (Pooled RR=1.19, 95%CI: 0.40 to 3.50, P-value=0.74). The random effect model indicated no significant differences between NSAID and NSAID+hydration groups regarding the incidence of PEP (Pooled RR=2.19, 95%CI: 0.70 to 6.88, P-value=0.17).

Additionally, the results of one study showed that rectal indomethacin alone appeared to be more effective for preventing PEP than no prophylaxis, PSP alone, and the combination of indomethacin and PSP. Using NSAIDs alone or the combination of NSAIDs and hydration can reduce the risk of post-ERCP pancreatitis. Lack of studies comparing different approaches of prophylaxis in post-ERCP patient or the reporting of different parameters among the existing studies seriously limited the possibility and quality of meta-analysis. Further well-designed studies with accurate reporting of data is necessary to provide more reliable conclusion.

Gastrointestinal bleeding (GIB) and especially upper GIB in children under 18 years, is underestimated compared to the adult population. Although mortality rate in this group of patients is reported to be about 2 percent, the role of early endoscopy in diagnosis and treatment of underlying causes and prevention of recurrence is essential. We aimed to evaluate endoscopic findings in children with hematemesis and assess the relationships between these findings and demographic/clinical variables.
In this cross-sectional study, we have studied the medical records of 102 patients from November 2017 to November 2018, under 18 years who referred to Children’s Medical Center with hematemesis and had undergone the endoscopic procedure. The demographic information, past medical history, history of using NSAIDs (Non-Steroidal Anti-inflammatory Drugs), accompanying symptoms, laboratory records, and endoscopic findings were investigated.
Participants are mostly between 6-11 years old (52.9%, n=54). The most common accompanying symptom is non-bleeding vomiting (52%, n=51). Patients with a history of using NSAIDs had a significantly higher rate of gastric ulcers (P-value

No specific study has investigated the effect of non-steroidal anti inflammatory drugs (NSAIDs) and especially the effects of Ibuprofen on COVID-19, so far.

The purpose of this study was to investigate the effect of Ibuprofen on the severity of COVID-19 and mortality caused by the disease.

This study was conducted on 158 patients with COVID-19 who had consumed Ibuprofen, Gelofen, and Novafen for at least one week in the last three months. Patients were divided into three groups (mild, moderate and sever). The relationship among the severity of the disease and the history of ibuprofen consumption, diabetes, history of cardiovascular problems, hypertension, and GFR was investigated. Also, the association between the history of ibuprofen consumption, GFR ≤ 60 mL/min, hypertension, LDH ≥ 500 U/L, lymphocyte count ≤ 1500, and mortality was examined.

Our findings showed a significant relationship between the history of Ibuprofen before COVID-19 and the severity of COVID19, as well as the mortality rate (P value < 0.001, adjusted odd ratio: 2, respectively). This study also showed a significant relationship among the severity of the disease and the history of smoking, diabetes, hypertension, history of cardiovascular diseases, and GFR. In addition, a significant relationship was found among GFR ≤ 60 mL/min mortality, diabetes, LDH ≥ 500 U/L, and lymphocyte count ≤ 1500.

Our study showed a significant relationship between the history of the consumption of ibuprofen and its compounds before COVID-19 and the severity of COVID-19, as well as themortality rate of the patients with this disease, and accordingly, this result can suggest health policies during the epidemic of COVID-19.

Regarding Lemon verbena gastroprotective effects, we investigated the protective effects of Lemon verbena extracts on reducing gastric ulcer induced by indomethacin.

Rats received aqueous and ethanolic extracts of Lemon verbena (50, 100, and 200 mg/kg), zileuton (100 mg/kg), montelukast (10 mg/kg), or 1% Tween 80 in presence or absence of indomethacin (100 mg/kg).

Indomethacin produced stomach ulcer and increased neutrophils percentage and MDA level compared with the control group (p <0.001). Co-administration of indomethacin and zileuton, montelukast and ethanolic (200 mg/kg) (p <0.001), aqueous extract (200 mg/kg) (p <0.05) reduced ulcer compared with the indomethacin group (p <0.001). Ethanolic extracts (100 and 200 mg/kg) and aqueous extract (200 mg/kg) reduced the MDA level (p <0.001). Ethanolic (50, 100, and 200 mg/kg) and aqueous extracts (200 mg/kg) significantly decreased neutrophils percentage compared with the indomethacin group (p <0.001).

Aqueous and particularly ethanolic extracts of Lemon verbena have protective effects on indomethacin-induced gastric ulcers.

The emergence of a novel coronavirus and coronavirus disease 2019 (COVID-19) represents a challenge to global healthcare. In the past 20 years, this is the third coronavirus that jumped the species barrier and infected humans. It is highly contagious but associated with low pathogenicity. First identified in Wuhan, China, a city of over 11 million, the disease has since spread to every continent except Antarctica. About 15% to 20% of all cases may be called severe, and it is believed many cases are asymptomatic. The average age of a person with COVID has been reported as 49 years. Worse outcomes are associated with geriatric populations and those with underlying diseases such as cardiovascular, respiratory disorders, and/or diabetes. The coronavirus, like other coronaviruses, is highly contagious and has a latency period of about 14 days. Most patients present with fever and a dry cough, but fever may be absent. Differential diagnosis can be challenging since influenza may present with similar symptoms. Chest radiography or computed tomography may be used to find evidence of secondary pneumonia. Nosocomial infection is of concern, and it has been reported that 3.8% of all cases with COVID-19 in that country involve healthcare workers in China. Most patients have mild disease, and supportive care suffices. A variety of repurposed and investigational drugs are being evaluated. There are currently no antiviral therapies or vaccines, even if many therapies are proposed. Hand hygiene, social distancing, and scientifically sound information are the best strategies at the moment to combat this epidemic.

Shoulder pain is very frequent, especially in middle-aged male adults. Its treatment may be very problematic, mainly in patients who cannot rest and stop their work. At present, it is treated with analgesics, physiotherapy, infiltration of corticosteroids, and/or radiofrequency neuromodulation of the suprascapular nerve. This may be effective but not easy to do. Its efficacy is limited in time, especially because the approach to the nerve trunk may be problematic for its anatomical nature. Ultrasonography has helped, but it is not always completely helpful, due to the small dimension and the complexity of the anatomical structure. In this case report, we describe a more helpful approach to the nerve trunk using an endoscopic technique. The results are very promising. However, larger studies would be necessary to make clear its usefulness.

Considering the recent controversies regarding the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in Coronavirus disease 2019 (COVID-19) patients, and due to the limited published data in this field, we reviewed currently available evidence for the use of NSAIDs in viral respiratory tract infections to help make decisions in this area. Currently, there is insufficient evidence to judge the safety and efficacy of NSAIDs in patients with COVID-19. According to the current evidence, acetaminophen is the choice treatment for symptomatic relief. If the patients’ symptoms are not controlled by acetaminophen, naproxen may be used as an alternative therapy.

Emergence and development of antifungal drug resistance in Candida species constitute a serious concern. Candida auris as an emerging multidrug-resistant fungus is the most important public health threat with high levels of mortality and morbidity. Almost all C. auris isolates are resistant to fluconazole, and there have been reports of elevated minimum inhibitory concentrations (MICs) to amphotericin B and echinocandins. To overcome the growing challenge of antifungal resistance, a valuable alternative option would be the use of drug combination.

The present study evaluated the in vitro combination of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and aspirin with fluconazole against fluconazole-resistant C. auris in comparison to other fluconazole-resistant Candida species, including C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei originating from patients with candidiasis.

The MIC ranges of fluconazole-ibuprofen and fluconazole-diclofenac decreased from 32-256 to 32-128 and 16-256 μg/ml, respectively and remained the same for fluconazole-aspirin against C. auris. However, the combination of fluconazole with ibuprofen resulted in a synergistic effect for 5 strains, including C. albicans (n=2), C. tropicalis (n=1), C. glabrata (n=1), and C. krusei (n=1), by decreasing the MIC of fluconazole by 2-3 log2 dilutions.

Although the interaction of NSAIDs with fluconazole was not synergistic against fluconazole-resistant C. auris isolates, no antagonism was observed for any combinations. Therefore, combination with newer azole agents needs to be conducted.

This study investigated whether naproxen has an ergogenic effect on neuromuscular performance. A randomized, double-blind, placebo-controlled, crossover trial was conducted on 11 resistance-trained men who performed one strength-training session after taking 500 mg of naproxen and another session after taking a placebo. Participants performed three sets of the horizontal bench press with a load of 90% of repetition maximum (RM) to concentric failure. Outcome variables included number of repetitions, workload, fatigue index (FI), and delayed onset muscle soreness (DOMS). Results showed a statistically insignificant reduction in the number of repetitions for placebo when compared to naproxen, amounting to a relative difference of 44.89%. DOMS was lower in the naproxen group, but differences between conditions were not statistically significant. A statistically significant treatment effect was found for workload, favoring naproxen treatment. A statistically significant difference was found for FI between the second and third sets compared to the first set, with results favoring naproxen. We concluded that naproxen helps enhance neuromuscular outcomes in an acute high-intensity strength training bout.