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Showande SJ, Akinbode TE. Nonsteroidal anti-inflammatory drug use by patients: Impact of modular educational training on pharmacists' questioning, counselling and risk assessments. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 15:100494. [PMID: 39257532 PMCID: PMC11385433 DOI: 10.1016/j.rcsop.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 09/12/2024] Open
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs)-related morbidity and mortality can be reduced through medication counselling and risk reduction. Objectives This study evaluated the impact of short online modular NSAID training on the type and quality of questions asked, risk factors assessed, and counselling offered by community pharmacists to NSAID users. Methods A cross-sectional questionnaire-guided survey conducted in Ibadan, Nigeria, among 87 pharmacists evaluated the frequency of counselling, NSAID risk factor assessment and barriers to risk assessment. Additionally, a before-and-after RCT was used to evaluate the impact of short online modular NSAID training for the intervention group (IG) on the type and quality of the questions asked, counselling provided, and risk assessed by the pharmacists. Eight standardised patients, aged 25-43 years, four at pre- and postintervention, presented four standardised scenarios at community pharmacies [IG, n = 22, control group (CG, n = 30)] to assess these outcomes. The quality of each outcome (questions asked, counselling offered and risk assessed) was classified as poor (0-≤20%), fair (>20-≤40%), moderate (>40 - ≤60%), or optimal (>60-100%). The data are presented with descriptive statistics. Results The community pharmacists reported counselling patients on NSAID precautions (80-86%) and dosages (51-69%). Gastrointestinal bleeding risk was assessed by 61-89% of the pharmacists, and time constraints (39-42%) and patient impatience (47-75%) were some barriers to risk assessment. Online modular educational intervention significantly improved the types and quality of questions asked by pharmacists (CG: poor to fair, 16%-21%; IG: poor to moderate, 14%-45%), NSAID risk factors assessed (CG: poor to poor, 10%-9%; IG: poor to fair, 11%-27%) and counselling offered (CG: poor to poor, 6%-7%; IG: poor to fair, 6%-22%). Conclusions Short online modular educational training on NSAIDs improved the types and quality of the questions asked, NSAID risk factors assessed, and counselling provided by community pharmacists to patients during consultations.
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Affiliation(s)
- Segun Johnson Showande
- University of Ibadan, Department of Clinical Pharmacy and Pharmacy Administration, Ibadan, Nigeria
| | - Tolulope Eunice Akinbode
- University of Ibadan, Department of Clinical Pharmacy and Pharmacy Administration, Ibadan, Nigeria
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Jiko PA, Mohammad M, Richi FT, Islam MA, Alam S, Taher MA, Shao C, Wang S, Geng P, Mamun AA. Anti-Inflammatory, Analgesic and Anti-Oxidant Effects of Shirakiopsis Indica (Willd). Fruit Extract: A Mangrove Species in the Field of Inflammation Research. J Inflamm Res 2024; 17:5821-5854. [PMID: 39228677 PMCID: PMC11370890 DOI: 10.2147/jir.s470835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/07/2024] [Indexed: 09/05/2024] Open
Abstract
Background Shirakiopsis indica (Willd)., commonly known as Sa-Mor-Ta-Lay in Thailand, is a mangrove plant belonging to the Euphorbiaceae family. As mangrove plants' medicinal potentials are less explored, this study sought to qualitatively and quantitatively verify the bioactive components of Shirakiopsis indica fruits methanolic extract (SIF-ME) at the side of its analgesic, anti-inflammatory and anti-oxidant effects followed by in-silico studies. Methods The in-vivo assessments of analgesic activity involved the hot plate test, acetic acid-induced writhing test, and formalin-induced licking test. The anti-inflammatory efficacy was assessed through the human RBC membrane stabilization assay (HRBC), protein denaturation assay, and xylene-induced ear edema methods. Antioxidant potential was implemented by the DPPH scavenging method. Results The SIF-ME consistently displayed significant anti-nociceptive activity in a dose-dependent pattern (p < 0.05). The maximum analgesic activity was found in the highest dose (200 mg/kg; p < 0.001) in a hot plate, acetic acid-induced writhing test 43.47%, and in formalin-induced licking test in both early phase (43.3%; p < 0.01) and late phase (61.84%; p < 0.001%). The extract provided optimal protection against hemolysis (83.41% decrease) at 1000 µg/mL and significantly inhibited protein denaturation (67.34-26.05%) at doses of 1000-62.5 µg/mL. At 200 mg/kg, the extract showed dose-dependent and substantial inhibition (54.07%; p < 0.01) of xylene-induced ear edema. The in-vitro DPPH (IC50 = 469.5 µg/mL) results showed remarkable scavenging activity and concentration-dependent reducing power. The extract demonstrates no acute oral toxicity, as indicated by an LD50 value exceeding 1000 mg/kg body weight. Gas Chromatography-Mass Spectrometry/Mass Spectrometry (GC-MS/MS) analysis was performed which yielded sixty bioactive compounds. In-silico and molecular docking studies revealed favorable pharmacological properties, including good binding affinities and ADME/T profiles. Conclusion These results support the medicinal use of the plant, which makes it a potential source of analgesic, anti-inflammatory, and antioxidant candidates.
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Affiliation(s)
- Pair Ahmed Jiko
- Department of Chemistry, Chittagong University of Engineering & Technology, Chittagong, 4349, Bangladesh
| | - Mahathir Mohammad
- Department of Chemistry, Chittagong University of Engineering & Technology, Chittagong, 4349, Bangladesh
| | - Fahmida Tasnim Richi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md. Anisul Islam
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4202, Bangladesh
| | - Safaet Alam
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka, 1000, Bangladesh
- Chemical Research Division, BCSIR Dhaka Laboratories, Bangladesh Council of Scientific and Industrial Research (BCSIR), Dhaka, 1205, Bangladesh
| | - Mohammad Abdullah Taher
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka, 1000, Bangladesh
- Bangladesh Reference Institute for Chemical Measurements (BRiCM), Laboratory Road, Dhaka, 1205, Bangladesh
| | - Chuxiao Shao
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Shuanghu Wang
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Peiwu Geng
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
| | - Abdullah Al Mamun
- Central Laboratory of The Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People’s Hospital, Lishui, Zhejiang, 323000, People’s Republic of China
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Amedi D, Gazerani P. Deprescribing NSAIDs: The Potential Role of Community Pharmacists. PHARMACY 2024; 12:116. [PMID: 39195845 PMCID: PMC11358956 DOI: 10.3390/pharmacy12040116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are largely used for controlling various pain conditions and are widely available in community pharmacies, with and without prescription. Despite their effectiveness, NSAIDs can pose significant risks due to potential side effects and drug interactions, particularly in polypharmacy and comorbidity contexts and for vulnerable users. This study investigated whether and how NSAIDs deprescribing can be conducted at the community pharmacy level by assessing pharmacists' confidence, attitudes, and potential barriers and facilitators. Additionally, we aimed to identify any deprescribing guidelines that pharmacists could use. A literature search and a cross-sectional digital questionnaire targeting community pharmacists in Norway were conducted. Results showed that study participants (N = 73) feel confident in identifying needs for deprescribing NSAIDs but barriers such as time constraints, lack of financial compensation, and communication challenges were noted. Participants reported positive attitudes toward deprescribing but highlighted a need for better guidelines and training. This study highlights a gap in specific guidelines for deprescribing NSAIDs and a potential for enhancing pharmacists' roles in the deprescribing process, for example, through training and improved financial incentives. Further research is encouraged to develop concrete strategies for an effective implementation where community pharmacists can be involved in the deprescribing of NSAIDs.
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Affiliation(s)
- Delsher Amedi
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9260 Gistrup, Denmark
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Kathirvel B, AlSalhi MS, Ha HA, Nguyen-Thi TH. Anti-inflammatory, anti-diabetic, and biocompatibility properties of aqueous extract of Tamarindus indica L. fruit coat analyses by in-vitro and in-vivo approaches. ENVIRONMENTAL RESEARCH 2024; 251:118702. [PMID: 38503381 DOI: 10.1016/j.envres.2024.118702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
The anti-inflammatory, anti-diabetic, and biocompatibility nature of Tamarindus indica L. fruit coat aqueous extract were investigated in this research through in-vitro and in-vivo studies. The anti-inflammatory property was determined through albumin denaturation inhibition and antiprotease activities as up to 39.5% and 41.2% respectively at 30 mg mL-1 concentration. Furthermore, the antidiabetic activity was determined through α-amylase and α-glucosidase inhibition as up to 62.15% and 67.35% respectively at 30 mg mL-1 dosage. The albino mice based acute toxicity study was performed by different treatment groups (group I-V) with different dosages of aqueous extract to detect the biocompatibility of sample. Surprisingly, findings revealed that the T. indica L. fruit coat aqueous extract had no harmful impacts on any of the groups. Urine, as well as serum parameter analysis, confirmed this. Moreover, the findings of SOD (Superoxide Dismutase), GST (Glutathione-S-transferase), & CAT (Catalase) as well as glutathione peroxidase as well as reduced glutathione antioxidant enzymes studies stated that the aqueous extract possess high antioxidant ability via a dose-dependent way. These findings indicate that T. indica fruit coat aqueous extract contains medicinally important phytochemicals with anti-inflammatory and anti-diabetic properties, as well as being biocompatible in nature.
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Affiliation(s)
- Brindhadevi Kathirvel
- University Centre for Research & Development, Department of Chemistry, Chandigarh University, Mohali, 140103, India
| | - Mohamad S AlSalhi
- Department of Physics and Astronomy, College of Science, King Saud University, P.O. Box: 2455, Riyadh, 11451, Saudi Arabia
| | - Hai-Anh Ha
- Faculty of Pharmacy, Duy Tan University, Da Nang, 550000, Vietnam
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Kim AY, Al Jerdi S, MacDonald R, Triggle CR. Alzheimer's disease and its treatment-yesterday, today, and tomorrow. Front Pharmacol 2024; 15:1399121. [PMID: 38868666 PMCID: PMC11167451 DOI: 10.3389/fphar.2024.1399121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/25/2024] [Indexed: 06/14/2024] Open
Abstract
Alois Alzheimer described the first patient with Alzheimer's disease (AD) in 1907 and today AD is the most frequently diagnosed of dementias. AD is a multi-factorial neurodegenerative disorder with familial, life style and comorbidity influences impacting a global population of more than 47 million with a projected escalation by 2050 to exceed 130 million. In the USA the AD demographic encompasses approximately six million individuals, expected to increase to surpass 13 million by 2050, and the antecedent phase of AD, recognized as mild cognitive impairment (MCI), involves nearly 12 million individuals. The economic outlay for the management of AD and AD-related cognitive decline is estimated at approximately 355 billion USD. In addition, the intensifying prevalence of AD cases in countries with modest to intermediate income countries further enhances the urgency for more therapeutically and cost-effective treatments and for improving the quality of life for patients and their families. This narrative review evaluates the pathophysiological basis of AD with an initial focus on the therapeutic efficacy and limitations of the existing drugs that provide symptomatic relief: acetylcholinesterase inhibitors (AChEI) donepezil, galantamine, rivastigmine, and the N-methyl-D-aspartate receptor (NMDA) receptor allosteric modulator, memantine. The hypothesis that amyloid-β (Aβ) and tau are appropriate targets for drugs and have the potential to halt the progress of AD is critically analyzed with a particular focus on clinical trial data with anti-Aβ monoclonal antibodies (MABs), namely, aducanumab, lecanemab and donanemab. This review challenges the dogma that targeting Aβ will benefit the majority of subjects with AD that the anti-Aβ MABs are unlikely to be the "magic bullet". A comparison of the benefits and disadvantages of the different classes of drugs forms the basis for determining new directions for research and alternative drug targets that are undergoing pre-clinical and clinical assessments. In addition, we discuss and stress the importance of the treatment of the co-morbidities, including hypertension, diabetes, obesity and depression that are known to increase the risk of developing AD.
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Affiliation(s)
- A. Y. Kim
- Medical Education, Weill Cornell Medicine—Qatar, Doha, Qatar
| | | | - R. MacDonald
- Health Sciences Library, Weill Cornell Medicine—Qatar, Doha, Qatar
| | - C. R. Triggle
- Department of Pharmacology and Medical Education, Weill Cornell Medicine—Qatar, Doha, Qatar
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Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process. BMC Health Serv Res 2024; 24:511. [PMID: 38658997 PMCID: PMC11040918 DOI: 10.1186/s12913-024-10992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. METHODS We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. RESULTS The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? CONCLUSION All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- The hospital pharmacy research unit, Hospital Sønderjylland, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Alruwad MI, Salah El Dine R, Gendy AM, Sabry MM, El Hefnawy HM. Exploring the Biological and Phytochemical Potential of Jordan's Flora: A Review and Update of Eight Selected Genera from Mediterranean Region. Molecules 2024; 29:1160. [PMID: 38474670 DOI: 10.3390/molecules29051160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Jordan's flora is known for its rich diversity, with a grand sum of 2978 plant species that span 142 families and 868 genera across four different zones. Eight genera belonging to four different plant families have been recognized for their potential natural medicinal properties within the Mediterranean region. These genera include Chrysanthemum L., Onopordum Vaill. Ex. L., Phagnalon Cass., and Senecio L. from the Asteraceae family, in addition to Clematis L. and Ranunculus L. from the Ranunculaceae family, Anchusa L. from the Boraginaceae family, and Eryngium L. from the Apiaceae family. The selected genera show a wide variety of secondary metabolites with encouraging pharmacological characteristics including antioxidant, antibacterial, cytotoxic, anti-inflammatory, antidiabetic, anti-ulcer, and neuroprotective actions. Further research on these genera and their extracts will potentially result in the formulation of novel and potent natural pharmaceuticals. Overall, Jordan's rich flora provides a valuable resource for exploring and discovering new plant-based medicines.
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Affiliation(s)
- Manal I Alruwad
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo 11562, Egypt
| | - Riham Salah El Dine
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo 11562, Egypt
| | - Abdallah M Gendy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, October 6 University, Giza 12585, Egypt
| | - Manal M Sabry
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo 11562, Egypt
| | - Hala M El Hefnawy
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo 11562, Egypt
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Ju Y, Wang CM, Yu JJ, Li X, Qi MX, Ren J, Wang Y, Liu P, Zhou Y, Ma YX, Yu G. Higenamine inhibits acute and chronic inflammatory pain through modulation of TRPV4 channels. Eur J Pharmacol 2024; 964:176295. [PMID: 38154768 DOI: 10.1016/j.ejphar.2023.176295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
Pain is the cardinal symptom of many debilitating diseases and results in heavy health and economic burdens worldwide. Asarum (Asarum sieboldii Miq.) is a commonly used analgesic in Chinese medicine. However, the analgesic components and mechanisms of asarum in acute and chronic pain mice model remain unknown. In this study, we first generated asarum water extract and confirmed strong analgesic properties in mice in both the acute thermal and mechanical pain models, as well as in the complete Freund's adjuvant (CFA) induced chronic inflammatory pain model. Second, we identified higenamine as a major component of asarum and found that higenamine significantly inhibited thermal and mechanical induced acute pain and CFA induced chronic inflammatory pain. Then, using Trpv4-/- mice, we found that TRPV4 is necessary for CFA induced thermal and mechanical allodynia, and demonstrated that higenamine analgesia in the CFA model is partly through TRPV4 channel inhibition. Finally, we found that GSK1016790A, a TRPV4 agonist, induced calcium response was significantly inhibited by higenamine in both cultured DRG neurons and TRPV4 transfected HEK293 cells. Consistent with calcium imaging results, higenamine pretreatment also dose-dependently inhibited GSK1016790A induced acute pain. Taken together, our behavior and calcium imaging results demonstrate that the asarum component higenamine inhibits acute and chronic inflammatory pain by modulation of TRPV4 channels.
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Affiliation(s)
- Ying Ju
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing, 210023, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Chang-Ming Wang
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Juan-Juan Yu
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Xue Li
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Ming-Xin Qi
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jiahui Ren
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Ying Wang
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Pei Liu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yuan Zhou
- Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yu-Xiang Ma
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, 210009, China.
| | - Guang Yu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing, 210023, China; Key Laboratory for Chinese Medicine of Prevention and Treatment in Neurological Diseases, School of Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
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Wang T, Kang HC, Chen CC, Lai TS, Huang CF, Wu CC. The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease. Patient Prefer Adherence 2024; 18:267-274. [PMID: 38327729 PMCID: PMC10848922 DOI: 10.2147/ppa.s436952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Purpose Patients with chronic kidney disease (CKD) are particularly vulnerable to the risks of polypharmacy, largely owing to various comorbid conditions. This vulnerability is further compounded by an escalated risk of renal function deterioration when exposed to nephrotoxic medications. As part of the national health insurance program in Taiwan, the pre-end-stage kidney disease patient care and education plan has included pharmaceutical care since October 2021. This study aims to explore the effect of pharmacist involvement in a multidisciplinary care team for patients with kidney disease in outpatient settings. Patients and Methods This retrospective observational study was conducted at a single center. It analyzed data from May 2022 to May 2023, focusing on patients who received medication therapy management in the kidney disease pharmacist-managed clinic. The study assessed changes in patient medication adherence, non-steroidal anti-inflammatory drugs (NSAIDs) usage, CKD stage, and urine protein-to-creatinine ratio (UPCR) after pharmacist intervention. It also documented pharmacists' medication recommendations and the rate of acceptance by physicians. Results A total of 202 patients who had at least two clinic visits were included in the study. After pharmacist intervention, the proportion of poor medication adherence reduced significantly from 67.8% to 43.1% (p<0.001). The proportion of NSAID users also decreased significantly from 19.8% to 8.4% (p=0.001). CKD stage showed a significant reduction (p=0.007), and the average UPCR improved from 2828.4 to 2111.0 mg/g (p<0.001). The pharmacists provided a total of 56 medication recommendations, with an acceptance rate of 86%. Conclusion The involvement of pharmacists in the multidisciplinary care team can effectively provide medication-related recommendations, ensuring the effectiveness and safety of patients' medication use, and lead to better kidney function and lower proteinuria.
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Affiliation(s)
- Ting Wang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Cheng Kang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Chi Chen
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Shuan Lai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fen Huang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Chih Wu
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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10
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Maloy GC, Halperin SJ, Ratnasamy PP, Grauer JN. Characterizing Gabapentinoid Use Among Patients With Isolated Low Back Pain. Global Spine J 2024:21925682231224390. [PMID: 38270402 DOI: 10.1177/21925682231224390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Gabapentinoids have been increasingly studied as a non-narcotic option for neuropathic and postoperative pain. However, there is evidence suggesting that off-label use of these medications for the treatment of isolated LBP is not effective. The purpose of the current study was to evaluate prescription patterns for gabapentinoids among patients with isolated low back pain. METHODS Adult patients with LBP were abstracted from the 2019 M91Ortho PearlDiver dataset using International Classification of Diseases (ICD-10) code M54.5. Patients were excluded if they had a diagnosis of neurologic symptoms, history of spinal surgery, spinal fracture, or conditions for which gabapentinoids are FDA approved. Gabapentinoid and narcotic prescriptions within one year of LBP diagnosis were identified. Patient characteristics and prescriber specialty were extracted from the dataset and predictors of gabapentinoid prescriptions were determined using univariate and multivariate analyses. RESULTS Among the 1,158,875 isolated LBP patients, gabapentinoids were prescribed for 11%, narcotics for 8%, and both for 3%. The most common prescriber specialties included: primary care physicians (45%), nurse practitioners (15%), and pain management physicians (5%). Independent predictors of gabapentinoid prescriptions included: female sex, region of the country, and insurance type (P-values <.001). CONCLUSIONS Of nearly 1.2 million patients with isolated LBP, 14.2% were prescribed gabapentinoids within one year of their LBP diagnosis. Patient characteristics predictive of receiving gabapentinoids were predominantly non-clinical factors.
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Affiliation(s)
- Gwyneth C Maloy
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Scott J Halperin
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Philip P Ratnasamy
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Allen S, Rashid A, Adjani A, Akram M, Khan FS, Sherwani R, Khalil MT. Efficacy and safety of thermobalancing therapy with Dr Allen's Device for chronic low back pain: A randomised controlled trial. World J Orthop 2023; 14:878-888. [PMID: 38173805 PMCID: PMC10758594 DOI: 10.5312/wjo.v14.i12.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/12/2023] [Accepted: 11/08/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients' health-related quality of life (HRQoL). Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen's Device can relieve chronic low back pain, there have been no randomised controlled trials for these indications. AIM To evaluate the efficacy of Dr Allen's Device in lumbar disc herniation (LDH) and non-specific low back pain (NSLBP). METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH (n = 28) or NSLBP (n = 27), out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group. The intervention was treatment with Dr Allen's Device for 3 mo. Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire. RESULTS Thermobalancing therapy with Dr Allen's Device showed a significant reduction in pain in the treatment group (P < 0.001), with no recorded adverse effects. Both pain assessment scales showed a significant improvement in patients' perception of pain indicating improvement in HRQoL. CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen's Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects, improves the level of activity and HRQoL among patients with LDH and NSLBP. This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.
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Affiliation(s)
- Simon Allen
- Director and Head of Medical Research, Fine Treatment, Oxford OX2 7SL, United Kingdom
| | - Abid Rashid
- Director of Faculty of Medical Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Ariana Adjani
- Senior Researcher, Fine Treatment, Oxford OX2 7SL, United Kingdom
| | - Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Fahad Said Khan
- Faculty of Medical and Health Sciences, University of Poonch Rawalakot, Rawalakot 12350, Pakistan
| | - Rehan Sherwani
- College of Statistical and Actuarial Science, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Talha Khalil
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad 38000, Pakistan
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12
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Mauschitz MM, Verzijden T, Schuster AK, Elbaz H, Pfeiffer N, Khawaja A, Luben RN, Foster PJ, Rauscher FG, Wirkner K, Kirsten T, Jonas JB, Bikbov MM, Hogg R, Peto T, Cougnard-Grégoire A, Bertelsen G, Erke MG, Topouzis F, Giannoulis DA, Brandl C, Heid IM, Creuzot-Garcher CP, Gabrielle PH, Hense HW, Pauleikhoff D, Barreto P, Coimbra R, Piermarocchi S, Daien V, Holz FG, Delcourt C, Finger RP. Association of lipid-lowering drugs and antidiabetic drugs with age-related macular degeneration: a meta-analysis in Europeans. Br J Ophthalmol 2023; 107:1880-1886. [PMID: 36344262 DOI: 10.1136/bjo-2022-321985] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/AIMS To investigate the association of commonly used systemic medications with prevalent age-related macular degeneration (AMD) in the general population. METHODS We included 38 694 adults from 14 population-based and hospital-based studies from the European Eye Epidemiology consortium. We examined associations between the use of systemic medications and any prevalent AMD as well as any late AMD using multivariable logistic regression modelling per study and pooled results using random effects meta-analysis. RESULTS Between studies, mean age ranged from 61.5±7.1 to 82.6±3.8 years and prevalence ranged from 12.1% to 64.5% and from 0.5% to 35.5% for any and late AMD, respectively. In the meta-analysis of fully adjusted multivariable models, lipid-lowering drugs (LLD) and antidiabetic drugs were associated with lower prevalent any AMD (OR 0.85, 95% CI=0.79 to 0.91 and OR 0.78, 95% CI=0.66 to 0.91). We found no association with late AMD or with any other medication. CONCLUSION Our study indicates a potential beneficial effect of LLD and antidiabetic drug use on prevalence of AMD across multiple European cohorts. Our findings support the importance of metabolic processes in the multifactorial aetiology of AMD.
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Affiliation(s)
| | - Timo Verzijden
- Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Hisham Elbaz
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Anthony Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Robert N Luben
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Franziska G Rauscher
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, 04107 Leipzig, Germany
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, 04103 Leipzig, Germany
| | - Kerstin Wirkner
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, 04107 Leipzig, Germany
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, 04103 Leipzig, Germany
| | - Toralf Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, 04107 Leipzig, Germany
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, 04103 Leipzig, Germany
- Leipzig University Medical Center, Medical Informatics Center - Dept. of Medical Data Science, 04107 Leipzig, Germany
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | | | - Ruth Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Audrey Cougnard-Grégoire
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Team LEHA, F-33000 Bordeaux, France
| | - Geir Bertelsen
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - Maja Gran Erke
- Directorate of eHealth, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Fotis Topouzis
- Department of Ophthalmology, Aristotle University of Thessaloniki, School of Medicine, AHEPA Hospital, Thessaloniki, Greece
| | - Dimitrios A Giannoulis
- Department of Ophthalmology, Aristotle University of Thessaloniki, School of Medicine, AHEPA Hospital, Thessaloniki, Greece
| | - Caroline Brandl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | | | | | - Hans-Werner Hense
- University of Münster, Faculty of Medicine, Institute of Epidemiology, Münster, Germany
| | | | - Patricia Barreto
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal
- Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal
| | - Rita Coimbra
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Stefano Piermarocchi
- Padova-Camposampiero Hospital, Padova, Italy
- University of Padova, Department of Neuroscience, Padova, Italy
| | - Vincent Daien
- Department of Ophthalmology, Gui de Chauliac Hospital, F-34000 Montpellier, France
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091 Montpellier, France
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Cecile Delcourt
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Team LEHA, F-33000 Bordeaux, France
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Hossain MR, Alam R, Chung HJ, Eva TA, Kabir MF, Mamurat H, Hong ST, Hafiz MA, Hossen SMM. In Vivo, In Vitro and In Silico Study of Cucurbita moschata Flower Extract: A Promising Source of Natural Analgesic, Anti-Inflammatory, and Antibacterial Agents. Molecules 2023; 28:6573. [PMID: 37764349 PMCID: PMC10536299 DOI: 10.3390/molecules28186573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/02/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
For thousands of years, medicinal plants have played a pivotal role in maintaining human health and improving the quality of human life. This study was designed to analyze the analgesic, anti-inflammatory, and antibacterial potentials of a hydro-methanolic extract of Cucurbita moschata flowers, along with qualitative and quantitative phytochemical screening. The anti-inflammatory effect was tested using the in vitro membrane stabilizing method for human red blood cells (HRBC), the analgesic effect was tested using the in vivo acetic acid-induced writing method, and the antibacterial effect was tested using the disc diffusion method. In silico ADME/T and molecular docking studies were performed to assess the potential of the stated phytochemicals against Cyclooxygenase-II enzyme. Phytochemical screening confirmed the presence of flavonoids, alkaloids, glycosides, tannins, and carbohydrates. The flower extract demonstrated the maximum protection of human red blood cells at 1000 µg/mL, with a 65.73% reduction in hemolysis in a hypotonic solution. The extract also showed significant (p < 0.05) and dose-dependent analgesic effects at oral doses of 200 and 400 mg/kg on the tested animals. Furthermore, the flower extract exhibited potent antibacterial activity due to the disc diffusion method, which was compared with standard ciprofloxacin. In silico testing revealed that 42 phytochemicals exhibited notable pharmacokinetic properties and passed drug likeness screening tests. Among the six best-selected compounds, 3,4-dihydro-2H-pyran-2-yl)methanamine showed the highest binding affinity (-10.1) with significant non-bonding interactions with the target enzyme. In conclusion, the hydro-methanolic extract of Cucurbita moschata was found to be rich in various phytochemicals that may be associated with therapeutic potential, and this study supports the traditional use of Cucurbita moschata flowers in the management of inflammation and painful conditions.
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Affiliation(s)
- Md. Rabiul Hossain
- Department of Pharmacy, University of Science and Technology, Foy’s Lake, Chittagong 4202, Bangladesh; (M.R.H.); (H.M.)
| | - Rashedul Alam
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Hea-Jong Chung
- Gwanju Center, Korea Basic Science Institute, Gwanju 61715, Republic of Korea
| | - Taslima Akter Eva
- Department of Pharmacy, University of Chittagong, Chittagong 4331, Bangladesh;
| | | | - Husnum Mamurat
- Department of Pharmacy, University of Science and Technology, Foy’s Lake, Chittagong 4202, Bangladesh; (M.R.H.); (H.M.)
| | - Seong-Tshool Hong
- Department of Biomedical Sciences, Institute for Medical Science, Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea;
| | - Md. Al Hafiz
- Department of Pharmacy, East West University, Dhaka 1212, Bangladesh;
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14
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Mikkelsen TH, Søndergaard J, Kjaer NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Handling polypharmacy -a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatr 2023; 23:477. [PMID: 37553585 PMCID: PMC10410867 DOI: 10.1186/s12877-023-04131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the challenges experienced by the patients, relatives, and healthcare professionals pertinent to the concomitant use of many drugs. METHODS We conducted a qualitative study using focus group interviews to collect information from patients, relatives, and healthcare professionals regarding older patients' management of prescribed medicine. We interviewed seven patients using five or more medications daily, three relatives, three general practitioners, nine nurses from different healthcare sectors, one home care assistant, two hospital physicians, and four pharmacists. RESULTS The following themes were identified: (1) Unintentional non-adherence, (2) Intentional non-adherence, (3) Generic substitution, (4) Medication lists, (5) Timing and medication schedule, (6) Medication reviews and (7) Dose dispensing/pill organizers. CONCLUSION Medication is the subject of concern among patients and relatives. They become confused and insecure about information from different actors and the package leaflets. Therefore, patients often request a thorough medication review to provide an overview, knowledge of possible side effects and interactions, and a clarification of the medication's timing. In addition, patients, relatives and nurses all request an indication of when medicine should be taken, including allowable deviations from this timing. Therefore, prescribing physicians should prioritize communicating information regarding these matters when prescribing.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjaer
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, 6 The, Odense, Denmark
| | - Lene Juel Kjeldsen
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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15
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Zară-Dănceanu CM, Stavilă C, Minuti AE, Lăbușcă L, Nastasa V, Herea DD, Malancus RN, Ghercă D, Pasca SA, Chiriac H, Mares M, Lupu N. Magnetic Nanoemulsions for the Intra-Articular Delivery of Ascorbic Acid and Dexamethasone. Int J Mol Sci 2023; 24:11916. [PMID: 37569290 PMCID: PMC10419142 DOI: 10.3390/ijms241511916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Osteoarthritis (OA) is a progressive joint degenerative disease that currently has no cure. Limitations in the development of innovative disease modifying therapies are related to the complexity of the underlying pathogenic mechanisms. In addition, there is the unmet need for efficient drug delivery methods. Magnetic nanoparticles (MNPs) have been proposed as an efficient modality for the delivery of bioactive molecules within OA joints, limiting the side effects associated with systemic delivery. We previously demonstrated MNP's role in increasing cell proliferation and chondrogenesis. In the design of intra-articular therapies for OA, the combined NE-MNP delivery system could provide increased stability and biological effect. (2) Proprietary Fe3O4 MNPs formulated as oil-in-water (O/W) magneto nanoemulsions (MNEs) containing ascorbic acid and dexamethasone were tested for size, stability, magnetic properties, and in vitro biocompatibility with human primary adipose mesenchymal cells (ADSC), cell mobility, and chondrogenesis. In vivo biocompatibility was tested after systemic administration in mice. (3) We report high MNE colloidal stability, magnetic properties, and excellent in vitro and in vivo biocompatibility. By increasing ADSC migration potential and chondrogenesis, MNE carrying dexamethasone and ascorbic acid could reduce OA symptoms while protecting the cartilage layer.
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Affiliation(s)
- Camelia Mihaela Zară-Dănceanu
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
| | - Cristina Stavilă
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
- Faculty of Physics, Alexandru Ioan Cuza University, 700506 Iaşi, Romania
| | - Anca Emanuela Minuti
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
- Faculty of Physics, Alexandru Ioan Cuza University, 700506 Iaşi, Romania
| | - Luminiţa Lăbușcă
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
- County Emergency Hospital Saint Spiridon, Orthopedics and Traumatology Clinic, 700111 Iaşi, Romania
| | - Valentin Nastasa
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania (S.-A.P.); (M.M.)
| | - Dumitru-Daniel Herea
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
| | - Răzvan-Nicolae Malancus
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania (S.-A.P.); (M.M.)
| | - Daniel Ghercă
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
| | - Sorin-Aurelian Pasca
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania (S.-A.P.); (M.M.)
| | - Horia Chiriac
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
| | - Mihai Mares
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania (S.-A.P.); (M.M.)
| | - Nicoleta Lupu
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania; (C.M.Z.-D.); (C.S.); (H.C.)
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16
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Zară-Dănceanu CM, Stavilă C, Minuti AE, Lăbușcă L, Nastasa V, Herea DD, Malancus RN, Ghercă D, Pasca SA, Chiriac H, Mares M, Lupu N. Magnetic Nanoemulsions for the Intra-Articular Delivery of Ascorbic Acid and Dexamethasone. Int J Mol Sci 2023; 24:11916. [DOI: doi.org/10.3390/ijms241511916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
(1) Osteoarthritis (OA) is a progressive joint degenerative disease that currently has no cure. Limitations in the development of innovative disease modifying therapies are related to the complexity of the underlying pathogenic mechanisms. In addition, there is the unmet need for efficient drug delivery methods. Magnetic nanoparticles (MNPs) have been proposed as an efficient modality for the delivery of bioactive molecules within OA joints, limiting the side effects associated with systemic delivery. We previously demonstrated MNP’s role in increasing cell proliferation and chondrogenesis. In the design of intra-articular therapies for OA, the combined NE-MNP delivery system could provide increased stability and biological effect. (2) Proprietary Fe3O4 MNPs formulated as oil-in-water (O/W) magneto nanoemulsions (MNEs) containing ascorbic acid and dexamethasone were tested for size, stability, magnetic properties, and in vitro biocompatibility with human primary adipose mesenchymal cells (ADSC), cell mobility, and chondrogenesis. In vivo biocompatibility was tested after systemic administration in mice. (3) We report high MNE colloidal stability, magnetic properties, and excellent in vitro and in vivo biocompatibility. By increasing ADSC migration potential and chondrogenesis, MNE carrying dexamethasone and ascorbic acid could reduce OA symptoms while protecting the cartilage layer.
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Affiliation(s)
- Camelia Mihaela Zară-Dănceanu
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
| | - Cristina Stavilă
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
- Faculty of Physics, Alexandru Ioan Cuza University, 700506 Iaşi, Romania
| | - Anca Emanuela Minuti
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
- Faculty of Physics, Alexandru Ioan Cuza University, 700506 Iaşi, Romania
| | - Luminiţa Lăbușcă
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
- County Emergency Hospital Saint Spiridon, Orthopedics and Traumatology Clinic, 700111 Iaşi, Romania
| | - Valentin Nastasa
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania
| | - Dumitru-Daniel Herea
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
| | - Răzvan-Nicolae Malancus
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania
| | - Daniel Ghercă
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
| | - Sorin-Aurelian Pasca
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania
| | - Horia Chiriac
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
| | - Mihai Mares
- Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” University of Life Sciences (IULS), 8 Mihail Sadoveanu Alley, 700489 Iaşi, Romania
| | - Nicoleta Lupu
- Department of Magnetic Materials and Devices, National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
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17
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Shaban NS, Radi AM, Abdelgawad MA, Ghoneim MM, Al-Serwi RH, Hassan RM, Mohammed ET, Radi RA, Halfaya FM. Targeting Some Key Metalloproteinases by Nano-Naringenin and Amphora coffeaeformis as a Novel Strategy for Treatment of Osteoarthritis in Rats. Pharmaceuticals (Basel) 2023; 16:260. [PMID: 37259405 PMCID: PMC9959020 DOI: 10.3390/ph16020260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2024] Open
Abstract
Osteoarthritis (OA) represents the highest degenerative disorder. Because cartilage erosion is a common pathological alteration in OA, targeting some key metalloproteinases such as MMP-3, ADAMTS-5 besides their inhibitor TIMP-3 by natural products, could be an effective strategy to protect against osteoarthritis. Forty female Wister rats were categorized into five equal groups. Control, osteoarthritic (OA) (monosodium iodoacetate (MIA) 2 mg/50 µL saline, single intra-articular injection), OA+ indomethacin (2 mg/kg/daily/orally), OA+ nano-naringenin (25 mg/kg/daily/orally), and OA+ Amphora coffeaeformis (772 mg/kg/daily/orally). Treatments were initiated on the 8th day after osteoarthritis induction and continued for 28 days thereafter. Finally, blood and knee joint samples were collected from all rats for biochemical and histopathological evaluations. The current study showed that MIA induced oxidative stress, which resulted in changes in the inflammatory joint markers associated with increased right knee diameter and higher clinical scores for lameness. Amphora coffeaeformis followed by nano-naringenin exhibited a potential anti-arthritic activity by reducing the concentrations of serum MMP-3, ADAMTS-5, and joint MDA and increasing the levels of serum TIMP-3 and joint GSH, similar to indomethacin. The histopathological results confirmed these outcomes. In conclusion, Amphora coffeaeformis and nano-naringenin can be considered as natural therapeutic agents for osteoarthritis owing to their antioxidant and anti-inflammatory activities.
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Affiliation(s)
- Nema S Shaban
- Department of Pharmacology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Abeer M Radi
- Department of Pharmacology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Mohamed A Abdelgawad
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Aljouf 72341, Saudi Arabia
| | - Mohammed M Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah 13713, Saudi Arabia
- Pharmacognosy and Medicinal Plants Department, Faculty of Pharmacy, Al-Azhar University, Cairo 11884, Egypt
| | - Rasha Hamed Al-Serwi
- Department of Basic Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Randa M Hassan
- Department of Cytology and Histology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Eman T Mohammed
- Department of Biochemistry and Chemistry of Nutrition, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Rania A Radi
- Department of Biochemistry and Chemistry of Nutrition, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Fatma M Halfaya
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
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Dawson KG, Mok V, Wong JG, Bhalla A. Deprescribing initiative of NSAIDs (DIN): Pharmacist-led interventions for pain management in a federal correctional setting. Can Pharm J (Ott) 2023; 156:85-93. [PMID: 36969304 PMCID: PMC10034525 DOI: 10.1177/17151635221149712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for management of pain and inflammation. However, these medications are associated with adverse outcomes such as dyspepsia and acute myocardial infarction, especially with long-term uses. Objective: We sought to determine the effect of a pharmacist-led deprescribing intervention on oral NSAID use among patients in federal custody. Methods: Clinical pharmacists from Correctional Services Canada (CSC) conducted a prospective case series of adult patients with chronic noncancer pain who were on long-term NSAIDs (defined as >90 days supply in the past 120 days) in 3 CSC institutions in British Columbia, Canada. CSC clinical pharmacists met with patients to perform medication reviews and identify drug-related problems, with a focus on analgesic therapy. Pharmacist-led interventions were implemented in consultation with the primary care team to address these drug-related problems. Patient progress was monitored weekly for 3 months. Function, quality of life and pain severity scores (modified SPAASMS, Patient-Specific Functional Scale [PSFS] and visual analog scale [VAS] scores) were compared at baseline, 6 weeks and 3 months postintervention. Patient satisfaction survey results were also collected at 3 months. Results: A total of 53 patients received clinical pharmacist interventions. Modified SPAASMS, PSFS and VAS scores were collected at baseline, 6 weeks and 3 months from 38 patients (some were lost to follow-up when released back into the community). All 38 patients demonstrated clinically significant improvements to all 3 pain scales at 3 months (mean SPAASMS scores decreased by 7 points, mean PSFS scores increased by 2 points, mean VAS scores decreased by 2 points). Twenty-four of 31 patients who completed the patient satisfaction survey agreed that their overall health and well-being improved because of the visit they received from the pharmacist. Conclusion: Clinical pharmacist-led interventions in CSC have shown to reduce oral NSAID use as well as contribute positively to patient pain scores.
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Affiliation(s)
| | - Vanessa Mok
- Pacific Regional Hospital Pharmacy, Abbotsford, British Columbia
| | - Jason G.M. Wong
- Pacific Regional Hospital Pharmacy, Abbotsford, British Columbia
| | - Alka Bhalla
- Correctional Service Canada, National Headquarters, Ottawa, Ontario
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19
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Halpin SJ, Casson AJ, Tang NKY, Jones AKP, O'Connor RJ, Sivan M. A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance. FRONTIERS IN PAIN RESEARCH 2023; 4:1096084. [PMID: 36910250 PMCID: PMC9996154 DOI: 10.3389/fpain.2023.1096084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance. Materials and methods In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 min pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861. Results 28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 min (p = 0.0033), reduction in sleep onset latency of 13 min (p = 0.0043), and increase in sleep efficiency of 4.7% (p = 0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p = 0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11). Discussion Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies.
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Affiliation(s)
- Stephen J Halpin
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Alexander J Casson
- Department of Electrical and Electronic Engineering, University of Manchester, Manchester, United Kingdom
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Warwick, United Kingdom
| | - Anthony K P Jones
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
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20
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Renal Papillary Necrosis Associated with Multiple Risk Factors: A Case Report. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-127074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: 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. Case Presentation: 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. Conclusions: 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.
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Development and Challenges of Diclofenac-Based Novel Therapeutics: Targeting Cancer and Complex Diseases. Cancers (Basel) 2022; 14:cancers14184385. [PMID: 36139546 PMCID: PMC9496891 DOI: 10.3390/cancers14184385] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Diclofenac is a widely used drug for its anti-inflammatory and pain alleviating properties. This review summarizes the current understanding about the drug diclofenac. The potential applications of diclofenac beyond its well-known anti-inflammatory properties for other diseases such as cancer are discussed, along with existing limitations. Abstract Diclofenac is a highly prescribed non-steroidal anti-inflammatory drug (NSAID) that relieves inflammation, pain, fever, and aches, used at different doses depending on clinical conditions. This drug inhibits cyclooxygenase-1 and cyclooxygenase-2 enzymes, which are responsible for the generation of prostaglandin synthesis. To improve current diclofenac-based therapies, we require new molecular systematic therapeutic approaches to reduce complex multifactorial effects. However, the critical challenge that appears with diclofenac and other drugs of the same class is their side effects, such as signs of stomach injuries, kidney problems, cardiovascular issues, hepatic issues, and diarrhea. In this article, we discuss why defining diclofenac-based mechanisms, pharmacological features, and its medicinal properties are needed to direct future drug development against neurodegeneration and imperfect ageing and to improve cancer therapy. In addition, we describe various advance molecular mechanisms and fundamental aspects linked with diclofenac which can strengthen and enable the better designing of new derivatives of diclofenac to overcome critical challenges and improve their applications.
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22
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Curative Effect of Heat-sensitive Moxibustion on Primary Dysmenorrhea: A Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1281336. [PMID: 35942380 PMCID: PMC9356805 DOI: 10.1155/2022/1281336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Abstract
Background Primary dysmenorrhea (PD) refers to functional dysmenorrhea, typically characterized by cyclical, pronounced lower abdominal pain and seriously affects a woman's work and quality of life. Some studies have reported that heat-sensitive moxibustion (HSM) is expected to alleviate the clinical symptoms. This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of HSM on PD. Methods 7 databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data Knowledge Service Platform (Wan Fang Data), and China Science and Technology Journal Database (VIP) were searched for clinical randomized controlled trials. Meanwhile, Revman 5.3 software was used to evaluate the methodological quality of the included literature. The confidence interval (CI) of either relative risk or mean difference was set to 95%. Besides, the heterogeneity of the research results is tested by I2. Results 19 studies were ultimately included in this meta-analysis. All of them were declared as random controlled trials. 18 studies reported the total effective rate of the test group and the control group, which was significantly higher (RR: 0.92; 95% CI: 0.85,0.99; P=0.031 < 0.05) than the control group. It is demonstrated that the VAS score of the test group, totally 9 studies included, was significantly lower (SMD: −0.98; 95% CI: −1.15, −0.81; P < 0.001). The meta-analysis of 6 studies showed the symptom score of the test group was significantly lower (SMD: −0.67; 95% CI: −0.87, −0.47; P < 0.001). There were the CMSS results of 3 studies which were significantly lower (SMD: −0.88; 95% CI: −1.13, −0.62; P < 0.001). Combined with the results of subgroup analysis, compared with the control group, the test group had advantages in the VAS score, symptom score, and CMSS score. Conclusions The result has revealed the effectiveness and feasibility of HSM in treating PD, especially in improving the total effective rate and reducing the VAS score, symptom score, and CMSS score.
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Burtscher J, Vanderriele PE, Legrand M, Predel HG, Niebauer J, O’Keefe JH, Millet GP, Burtscher M. Could Repeated Cardio-Renal Injury Trigger Late Cardiovascular Sequelae in Extreme Endurance Athletes? Sports Med 2022; 52:2821-2836. [DOI: 10.1007/s40279-022-01734-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 12/17/2022]
Abstract
AbstractRegular exercise confers multifaceted and well-established health benefits. Yet, transient and asymptomatic increases in markers of cardio-renal injury are commonly observed in ultra-endurance athletes during and after competition. This has raised concerns that chronic recurring insults could cause long-term cardiac and/or renal damage. Indeed, extreme endurance exercise (EEE) over decades has sometimes been linked with untoward cardiac effects, but a causal relation with acute injury markers has not yet been established. Here, we summarize the current knowledge on markers of cardiac and/or renal injury in EEE athletes, outline the possible interplay between cardiac and kidney damage, and explore the roles of various factors in the development of potential exercise-related cardiac damage, including underlying diseases, medication, sex, training, competition, regeneration, mitochondrial dysfunction, oxidative stress, and inflammation. In conclusion, despite the undisputed health benefits of regular exercise, we speculate, based on the intimate link between heart and kidney diseases, that in rare cases excessive endurance sport may induce adverse cardio-renal interactions that under specific, hitherto undefined conditions could result in persistent cardiac damage. We highlight future research priorities and provide decision support for athletes and clinical consultants who are seeking safe strategies for participation in EEE training and competition.
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Namiranian P, Karimi M, Razavi SZE, Garoos AF, Ayati MH. Comparison of an Iranian Traditional Massage (Fateh Method) with Physiotherapy and Acupuncture for Patients with Chronic Low Back Pain: a Randomized Controlled Trial. J Acupunct Meridian Stud 2022; 15:163-173. [PMID: 35770546 DOI: 10.51507/j.jams.2022.15.3.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/04/2022] [Accepted: 03/08/2022] [Indexed: 11/03/2022] Open
Abstract
Background Low back pain (LBP) is currently a major reason for disability worldwide. Therapeutic massage is one of the most popular non-pharmacological methods for managing chronic LBP (CLBP), and the Fateh method is a massage technique based on Iranian Traditional Medicine. Objectives The current study aimed to compare the effects of Fateh massage with those of acupuncture and physiotherapy on relieving pain and disability in CLBP. Methods Eighty-four patients with CLBP were categorized into groups that received Fateh massage, acupuncture, or physiotherapy. Each group included 28 randomly assigned patients who completed 10 sessions of therapy. Visual analogue scale (VAS) scores and Roland-Morris disability scores were evaluated at baseline, after intervention, and four weeks later. The findings were analyzed with SPSS software. Results The baseline VAS and Roland-Morris scores of the three study groups did not indicate significant differences (p > 0.05). All three groups showed significant pre-post improvements in both scores (p < 0.05). At the end of the treatment sessions, the three groups showed no significant difference in the reductions in pain intensity and disability score (p > 0.05). Improvements in disability and pain between the first and third time points were significant in all three groups (p < 0.05 for each group). In addition, the results of massage, physiotherapy, and acupuncture groups were not significantly different (p > 0.05). No adverse events occurred in the patients. Conclusion The effects of Fateh massage were comparable to those of acupuncture and physiotherapy in reducing pain and disability in patients with CLBP.
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Affiliation(s)
- Parva Namiranian
- Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Emami Razavi
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Fateh Garoos
- Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ayati
- Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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25
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Fu JL, Perloff MD. Pharmacotherapy for Spine-Related Pain in Older Adults. Drugs Aging 2022; 39:523-550. [PMID: 35754070 DOI: 10.1007/s40266-022-00946-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
As the population ages, spine-related pain is increasingly common in older adults. While medications play an important role in pain management, their use has limitations in geriatric patients due to reduced liver and renal function, comorbid medical problems, and polypharmacy. This review will assess the evidence basis for medications used for spine-related pain in older adults, with a focus on drug metabolism and adverse drug reactions. A PubMed/OVID search crossing common spine, neck, and back pain terms with key words for older adults and geriatrics was combined with common drug classes and common drug names and limited to clinical trials and age over 65 years. The results were then reviewed with identification of commonly used drugs and drug categories: nonsteroidal anti-inflammatories (NSAIDs), acetaminophen, corticosteroids, gabapentin and pregabalin, antispastic and antispasmodic muscle relaxants, tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tramadol, and opioids. Collectively, 138 double-blind, placebo-controlled trials were the focus of the review. The review found a variable contribution of high-quality studies examining the efficacy of medications for spine pain primarily in the geriatric population. There was strong evidence for NSAID use with adjustments for gastrointestinal and renal risk factors. Gabapentin and pregabalin had mixed evidence for neuropathic pain. SNRIs had good evidence for neuropathic pain and a more favorable safety profile than TCAs. Tramadol had some evidence in older patients, but more so in persons aged < 65 years. Rational therapeutic choices based on geriatric spine pain diagnosis are helpful, such as NSAIDs and acetaminophen for arthritic and myofascial-based pain, gabapentinoids or duloxetine for neuropathic and radicular pain, antispastic agents for myofascial-based pain, and combination therapy for mixed etiologies. Tramadol can be well tolerated in older patients, but has risks of cognitive and classic opioid side effects. Otherwise, opioids are typically avoided in the treatment of spine-related pain in older adults due to their morbidity and mortality risk and are reserved for refractory severe pain. Whenever possible, beneficial geriatric spine pain pharmacotherapy should employ the lowest therapeutic doses with consideration of polypharmacy, potentially decreased renal and hepatic metabolism, and co-morbid medical disorders.
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Affiliation(s)
- Jonathan L Fu
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, 85 E. Concord St, 1122, Boston, MA, 02118, USA
| | - Michael D Perloff
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, 85 E. Concord St, 1122, Boston, MA, 02118, USA.
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Galai E, Scotti L, Gilardetti M, Ucciero A, Ferrante D, Poluzzi E, Genazzani AA, Barone-Adesi F. Time-Trends of Drug-Drug Interactions among Elderly Outpatients in the Piedmont Region (Italy): A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127353. [PMID: 35742605 PMCID: PMC9224286 DOI: 10.3390/ijerph19127353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023]
Abstract
Adverse drug reactions (ADRs) are a major health problem in the primary care setting, particularly among the elderly population. While the high frequency of ADRs in the elderly has several causes, a major and common determinant is polypharmacy, which can in turn increase the risk of drug-drug interactions (DDIs). In this paper, we analyzed the drugs prescriptions dispensed to elderly outpatients, to assess changes in the prevalence of selected DDIs in the period 2013−2019. Overall, about 15% of the patients aged >65 years were poly-treated. Among them, a decreasing trend in prevalence was observed for the majority of DDIs during the study period. This trend was particularly noticeable for DDIs involving fluoroquinolones and vitamin K antagonists, where a sharp reduction of over 40% was observed. On the opposite, a small increase in prevalence was observed for the association of antidiabetics and beta-blocking agents and for that of clopidogrel and PPIs. While the occurrence of most of the considered DDIs among poly-treated elderly decreased over time, the prevalence of some of them is still worrying. The complexity of the national drug formularies, as well as the increased number of prescribing actors that are involved, further urges the update of DDI lists to be used to monitor drug appropriateness and reduce avoidable ADRs.
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Affiliation(s)
- Elisabetta Galai
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, 28100 Novara, Italy; (E.G.); (A.A.G.)
- Azienda Ospedaliero-Universitaria “Maggiore della Carità”, 28100 Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
- Correspondence:
| | - Marco Gilardetti
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l’Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, 10100 Torino, Italy;
| | - Andrealuna Ucciero
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
| | - Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40100 Bologna, Italy;
| | - Armando A. Genazzani
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, 28100 Novara, Italy; (E.G.); (A.A.G.)
| | - Francesco Barone-Adesi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
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Hou Y, Dong B, Peng Y, Peng C, Wang M, Li X. Pharmacodynamics assessment of β-carboline from the roots of Psammosilene tunicoides as analgesic compound. JOURNAL OF ETHNOPHARMACOLOGY 2022; 291:115163. [PMID: 35247473 DOI: 10.1016/j.jep.2022.115163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The root of Psammosilene tunicoides (W. C. Wu et C. Y. Wu) is a well-known medicinal herb for the treatment of pain, hemostasia and rheumatoid arthritis among Chinese people. AIM OF THE STUDY The present study aimed to investigate the antinociceptive activity and mechanism of β-carboline alkaloids 1-4 which were extracted from the roots of P. tunicoides. MATERIALS AND METHODS The analgesic effects were evaluated using peripheral and central pain mouse models of nociception, including the formalin test and the tail flick test. The levels of glutamic acid (Glu) and nitric oxide (NO) in cerebellar cortexes and spinal cords (L4-6) were determined. The anti-inflammatory of all compounds were then assessed on RAW264.7 cells. RESULTS Our results showed that compounds 1-4 had significant analgesic effects on both phases of formalin test of mice. Furthermore, all compounds showed suppressive effects on Glu in the brain and NO levels in the brain cortex and the spinal cord. Except for compound 1, the others could extend the pain threshold of hot water tail-flick in mice. In addition, compounds 2 and 3 (60 μmol/kg) could decrease GABAAα1 protein levels in spinal cord. All compounds exhibited anti-inflammatory effects by inhibiting lipopolysaccharide (LPS)-induced NO production in RAW264.7 cells with half-maximal inhibitory concentration (IC50) 1.1-34.9 μM. CONCLUSION β-carboline alkaloids from the roots of P. tunicoides had significant analgesic activity by both central and peripheral mechanisms. Our findings suggested that regulating the release of NO or Glu or GABAα1 are some of the mechanisms of analgesic activity of β-carboline alkaloids.
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Affiliation(s)
- Yinhuan Hou
- School of Pharmacy, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, 200240, China
| | - Bangjian Dong
- School of Pharmacy, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, 200240, China
| | - Ying Peng
- School of Pharmacy, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, 200240, China
| | - Chongsheng Peng
- School of Pharmacy, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, 200240, China
| | - Mengyue Wang
- School of Pharmacy, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, 200240, China
| | - Xiaobo Li
- School of Pharmacy, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, 200240, China.
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Systemic, Intrathecal, and Intracerebroventricular Antihyperalgesic Effects of the Calcium Channel Blocker CTK 01512–2 Toxin in Persistent Pain Models. Mol Neurobiol 2022; 59:4436-4452. [DOI: 10.1007/s12035-022-02864-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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Abd El-Hay SS, El Sheikh R, Gouda AA, Ali M, El-Sayed HM. Simultaneous estimation of pantoprazole and piroxicam by HPLC: Response surface methodology approach. Microchem J 2022. [DOI: 10.1016/j.microc.2022.107247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Does osteoarthritis modify the association between NSAID use and risk of comorbidities and adverse events? OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100253. [DOI: 10.1016/j.ocarto.2022.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
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Paul AK, Jahan R, Paul A, Mahboob T, Bondhon TA, Jannat K, Hasan A, Nissapatorn V, Wilairatana P, de Lourdes Pereira M, Wiart C, Rahmatullah M. The Role of Medicinal and Aromatic Plants against Obesity and Arthritis: A Review. Nutrients 2022; 14:nu14050985. [PMID: 35267958 PMCID: PMC8912584 DOI: 10.3390/nu14050985] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity is a significant health concern, as it causes a massive cascade of chronic inflammations and multiple morbidities. Rheumatoid arthritis and osteoarthritis are chronic inflammatory conditions and often manifest as comorbidities of obesity. Adipose tissues serve as a reservoir of energy as well as releasing several inflammatory cytokines (including IL-6, IFN-γ, and TNF-α) that stimulate low-grade chronic inflammatory conditions such as rheumatoid arthritis, osteoarthritis, diabetes, hypertension, cardiovascular disorders, fatty liver disease, oxidative stress, and chronic kidney diseases. Dietary intake, low physical activity, unhealthy lifestyle, smoking, alcohol consumption, and genetic and environmental factors can influence obesity and arthritis. Current arthritis management using modern medicines produces various adverse reactions. Medicinal plants have been a significant part of traditional medicine, and various plants and phytochemicals have shown effectiveness against arthritis and obesity; however, scientifically, this traditional plant-based treatment option needs validation through proper clinical trials and toxicity tests. In addition, essential oils obtained from aromatic plants are being widely used as for complementary therapy (e.g., aromatherapy, smelling, spicing, and consumption with food) against arthritis and obesity; scientific evidence is necessary to support their effectiveness. This review is an attempt to understand the pathophysiological connections between obesity and arthritis, and describes treatment options derived from medicinal, spice, and aromatic plants.
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Affiliation(s)
- Alok K. Paul
- School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, TAS 7001, Australia
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka 1207, Bangladesh; (R.J.); (T.A.B.); (K.J.); (A.H.)
- Correspondence: (A.K.P.); (P.W.); (M.R.)
| | - Rownak Jahan
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka 1207, Bangladesh; (R.J.); (T.A.B.); (K.J.); (A.H.)
| | - Anita Paul
- Department of Pharmacy, University of Development Alternative, Dhanmondi, Dhaka 1207, Bangladesh;
| | - Tooba Mahboob
- School of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD) and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand; (T.M.); (V.N.)
| | - Tohmina A. Bondhon
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka 1207, Bangladesh; (R.J.); (T.A.B.); (K.J.); (A.H.)
| | - Khoshnur Jannat
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka 1207, Bangladesh; (R.J.); (T.A.B.); (K.J.); (A.H.)
| | - Anamul Hasan
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka 1207, Bangladesh; (R.J.); (T.A.B.); (K.J.); (A.H.)
| | - Veeranoot Nissapatorn
- School of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD) and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand; (T.M.); (V.N.)
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Correspondence: (A.K.P.); (P.W.); (M.R.)
| | - Maria de Lourdes Pereira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Christophe Wiart
- The Institute for Tropical Biology and Conservation, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia;
| | - Mohammed Rahmatullah
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka 1207, Bangladesh; (R.J.); (T.A.B.); (K.J.); (A.H.)
- Correspondence: (A.K.P.); (P.W.); (M.R.)
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Spittler AP, Afzali MF, Martinez RB, Culver LA, Leavell SE, Timkovich AE, Sanford JL, Story MR, Santangelo KS. Evaluation of electroacupuncture for symptom modification in a rodent model of spontaneous osteoarthritis. Acupunct Med 2021; 39:700-707. [PMID: 34105396 PMCID: PMC11110889 DOI: 10.1177/09645284211020755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Faced with the frustration of chronic discomfort and restricted mobility due to osteoarthritis (OA), many individuals have turned to acupuncture for relief. However, the efficacy of acupuncture for OA is uncertain, as much of the evidence is inconclusive. The purpose of this study was to evaluate electroacupuncture (EA) in a rodent model of OA such that conclusions regarding its effectiveness for symptom or disease modification could be drawn. METHODS Ten 12-month-old male Hartley guinea pigs-which characteristically have moderate to advanced OA at this age-were randomly assigned to receive EA for knee OA (n = 5) or anesthesia only (control group, n = 5). Treatments were performed three times weekly for 3 weeks, followed by euthanasia 2 weeks later. Gait analysis and enclosure monitoring were performed weekly to evaluate changes in movement. Serum was collected for inflammatory biomarker testing. Knee joints were collected for histology and gene expression. RESULTS Animals receiving EA had significantly greater changes in movement parameters compared to those receiving anesthesia only. There was a tendency toward decreased serum protein concentrations of complement component 3 (C3) in the EA group compared to the control group. Structural and antioxidant gene transcripts in articular cartilage were increased by EA. There was no significant difference in total joint histology scores between groups. CONCLUSION This study provides evidence that EA has a positive effect on symptom, but not disease, modification in a rodent model of OA. Further investigations into mechanistic pathways that may explain the efficacy of EA in this animal model are needed.
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Affiliation(s)
- Alexa P Spittler
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Maryam F Afzali
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Richard B Martinez
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Lauren A Culver
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sarah E Leavell
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Ariel E Timkovich
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joseph L Sanford
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Melinda R Story
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kelly S Santangelo
- Department of Microbiology, Immunology, & Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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do Nascimento L, Nicoletti NF, Peletti-Figueiró M, Marinowic D, Falavigna A. Hyaluronic Acid In Vitro Response: Viability and Proliferation Profile of Human Chondrocytes in 3D-Based Culture. Cartilage 2021; 13:1077S-1087S. [PMID: 34775798 PMCID: PMC8804839 DOI: 10.1177/19476035211057244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the efficacy of hyaluronic acid in the viability and proliferation profile of human femoral-tibial joint cartilage affected by osteoarthritis using in vitro models of chondrocytes in a 2-dimensional (2D)- and 3-dimensional (3D)-based culture model by spheroids. DESIGN In vitro study of knee cartilage affected by osteoarthritis that required surgical treatment. Samples were cultured and exposed to hyaluronic acid (100 and 500 μM; intervention group) or vehicle solution. In monolayer or 2D culture, proliferation and cell viability were measured, and nuclear morphometry was analyzed by 4',6'-diamino-2-fenil-indol (DAPI) staining. The 3D-based culture established from the culture of articular cartilage of patients submitted to total knee arthroplasty evaluated the diameter, viability, and fusion ability of the chondrospheres created. RESULTS Samples from 3 patients resulted in viable cultures, with chondrocyte cells exhibiting a potential for cell proliferation and viability to establish a culture. Hyaluronic acid (100 and 500 μM) improved chondrocyte viability and proliferation up to 72 hours in contact when compared with the control group, and no nuclear irregularities in morphology cell characteristics were observed by DAPI. In the 3D evaluation, hyaluronic acid (500 μM) improved the cellular feedback mechanisms, increasing the survival and maintenance of the chondrospheres after 7 days of analysis, showing the intrinsic capacity of chondrospheres grouped in the attempt to rearrange and reestablish new articular tissue. CONCLUSIONS The 2D- and 3D-based culture models with hyaluronic acid improved chondrocyte viability and proliferation and demonstrated the ability of freshly formed chondrospheres to undergo fusion when placed together in the presence of hyaluronic acid.
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Affiliation(s)
| | | | | | - Daniel Marinowic
- Brain Institute of Rio Grande do Sul,
Graduate Program in Medicine and Health Sciences and School of Medicine, Pontifical
Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Asdrubal Falavigna
- Health Sciences Graduate Program,
Universidade de Caxias do Sul, Caxias do Sul, Brazil,Cell Therapy Laboratory, Universidade
de Caxias do Sul, Caxias do Sul, Brazil,Laboratory of Basic Studies on Spinal
Cord Pathologies, Department of Neurosurgery, University of Caxias of Sul,
Brazil,Asdrubal Falavigna, Laboratory of Basic
Studies on Spinal Cord Pathologies, Department of Neurosurgery, University of
Caxias of Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil.
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An increased intake of nutrients, fruits, and green vegetables was negatively related to the risk of arthritis and osteoarthritis development in the aging population. Nutr Res 2021; 99:51-65. [DOI: 10.1016/j.nutres.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/14/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
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35
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Iacovides S, Kamerman P, Baker FC, Mitchell D. Why It Is Important to Consider the Effects of Analgesics on Sleep: A Critical Review. Compr Physiol 2021; 11:2589-2619. [PMID: 34558668 DOI: 10.1002/cphy.c210006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We review the known physiological mechanisms underpinning all of pain processing, sleep regulation, and pharmacology of analgesics prescribed for chronic pain. In particular, we describe how commonly prescribed analgesics act in sleep-wake neural pathways, with potential unintended impact on sleep and/or wake function. Sleep disruption, whether pain- or drug-induced, negatively impacts quality of life, mental and physical health. In the context of chronic pain, poor sleep quality heightens pain sensitivity and may affect analgesic function, potentially resulting in further analgesic need. Clinicians already have to consider factors including efficacy, abuse potential, and likely side effects when making analgesic prescribing choices. We propose that analgesic-related sleep disruption should also be considered. The neurochemical mechanisms underlying the reciprocal relationship between pain and sleep are poorly understood, and studies investigating sleep in those with specific chronic pain conditions (including those with comorbidities) are lacking. We emphasize the importance of further work to clarify the effects (intended and unintended) of each analgesic class to inform personalized treatment decisions in patients with chronic pain. © 2021 American Physiological Society. Compr Physiol 11:1-31, 2021.
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Affiliation(s)
- Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona C Baker
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Human Sleep Research Program, SRI International, Menlo Park, California, USA
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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36
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Novel CBG Derivatives Can Reduce Inflammation, Pain and Obesity. Molecules 2021; 26:molecules26185601. [PMID: 34577072 PMCID: PMC8467477 DOI: 10.3390/molecules26185601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
Interest in CBG (cannabigerol) has been growing in the past few years, due to its anti-inflammatory properties and other therapeutic benefits. Here we report the synthesis of three new CBG derivatives (HUM-223, HUM-233 and HUM-234) and show them to possess anti-inflammatory and analgesic properties. In addition, unlike CBG, HUM-234 also prevents obesity in mice fed a high-fat diet (HFD). The metabolic state of the treated mice on HFD is significantly better than that of vehicle-treated mice, and their liver slices show significantly less steatosis than untreated HFD or CBG-treated ones from HFD mice. We believe that HUM-223, HUM-233 and HUM-234 have the potential for development as novel drug candidates for the treatment of inflammatory conditions, and in the case of HUM-234, potentially for obesity where there is a huge unmet need.
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37
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Wibowo I, Marlinda N, Nasution FR, Putra RE, Utami N, Indriani AD, Zain RS. Down-regulation of complement genes in lipopolysaccharide-challenged zebrafish (Danio rerio) larvae exposed to Indonesian propolis. BRAZ J BIOL 2021; 83:e245202. [PMID: 34378662 DOI: 10.1590/1519-6984.245202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/25/2021] [Indexed: 11/21/2022] Open
Abstract
Although propolis has been reported for having anti-inflammatory activities, its effects on complement system has not been much studied. This research was conducted to find out the effects of Indonesian propolis on the expression levels of C3, C1r/s, Bf, MBL, and C6 in zebrafish larvae which were induced by lipopolysaccharide (LPS). Counting of macrophages migrating to yolk sac and liver histology were carried out. Larvae were divided into four groups: CON (cultured in E3 medium only), LPS (cultured in a medium containing 0.5 μg/L LPS), LPSIBU (cultured in a medium containing LPS, and then treated with 100 μg/L ibuprofen for 24 hours), and LPSPRO (cultured in a medium containing LPS, and then immersed in 14,000 μg/L propolis for 24 hours) groups. The results showed that complement gene expression in larvae from the LPSIBU and LPSPRO groups were generally lower than in larvae from the LPS group. The number of macrophage migrations to the yolk in the LPSPRO group was also lower than in the LPS group. Histological structure of liver in all groups were considered normal. This study shows that Indonesian propolis has the potential to be used as an alternative to the substitution of NSAIDs.
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Affiliation(s)
- I Wibowo
- Institut Teknologi Bandung, School of Life Sciences and Technology, Bandung, Indonesia
| | - N Marlinda
- Institut Teknologi Bandung, School of Life Sciences and Technology, Bandung, Indonesia
| | - F R Nasution
- Institut Teknologi Bandung, School of Life Sciences and Technology, Bandung, Indonesia
| | - R E Putra
- Institut Teknologi Bandung, School of Life Sciences and Technology, Bandung, Indonesia
| | - N Utami
- Indonesian Institute of Sciences, Research Center for Biotechnology, Cibinong Science Center, Bogor, Indonesia
| | - A D Indriani
- Institut Teknologi Bandung, School of Life Sciences and Technology, Bandung, Indonesia
| | - R S Zain
- Institut Teknologi Bandung, School of Life Sciences and Technology, Bandung, Indonesia
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38
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Mohammadi MR, Rodriguez SM, Luong JC, Li S, Cao R, Alshetaiwi H, Lau H, Davtyan H, Jones MB, Jafari M, Kessenbrock K, Villalta SA, de Vos P, Zhao W, Lakey JRT. Exosome loaded immunomodulatory biomaterials alleviate local immune response in immunocompetent diabetic mice post islet xenotransplantation. Commun Biol 2021; 4:685. [PMID: 34083739 PMCID: PMC8175379 DOI: 10.1038/s42003-021-02229-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/07/2021] [Indexed: 12/16/2022] Open
Abstract
Foreign body response (FBR) to biomaterials compromises the function of implants and leads to medical complications. Here, we report a hybrid alginate microcapsule (AlgXO) that attenuated the immune response after implantation, through releasing exosomes derived from human Umbilical Cord Mesenchymal Stem Cells (XOs). Upon release, XOs suppress the local immune microenvironment, where xenotransplantation of rat islets encapsulated in AlgXO led to >170 days euglycemia in immunocompetent mouse model of Type 1 Diabetes. In vitro analyses revealed that XOs suppressed the proliferation of CD3/CD28 activated splenocytes and CD3+ T cells. Comparing suppressive potency of XOs in purified CD3+ T cells versus splenocytes, we found XOs more profoundly suppressed T cells in the splenocytes co-culture, where a heterogenous cell population is present. XOs also suppressed CD3/CD28 activated human peripheral blood mononuclear cells (PBMCs) and reduced their cytokine secretion including IL-2, IL-6, IL-12p70, IL-22, and TNFα. We further demonstrate that XOs mechanism of action is likely mediated via myeloid cells and XOs suppress both murine and human macrophages partly by interfering with NFκB pathway. We propose that through controlled release of XOs, AlgXO provide a promising new platform that could alleviate the local immune response to implantable biomaterials.
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Affiliation(s)
- M Rezaa Mohammadi
- Department of Materials Science and Engineering, University of California Irvine, Irvine, CA, USA
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
- Department of Surgery, University of California Irvine, Irvine, CA, USA
| | | | - Jennifer Cam Luong
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
- Department of Surgery, University of California Irvine, Irvine, CA, USA
| | - Shiri Li
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
- Department of Surgery, University of California Irvine, Irvine, CA, USA
| | - Rui Cao
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
- Department of Surgery, University of California Irvine, Irvine, CA, USA
| | - Hamad Alshetaiwi
- Department of Biological Chemistry, University of California Irvine, Irvine, CA, USA
| | - Hien Lau
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA
| | - Hayk Davtyan
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, CA, USA
| | - Mathew Blurton Jones
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, USA
- Institute for Immunology, University of California Irvine, Irvine, CA, USA
| | - Mahtab Jafari
- Department of Pharmaceutical Sciences, University of California Irvine, Irvine, CA, USA
| | - Kai Kessenbrock
- Department of Biological Chemistry, University of California Irvine, Irvine, CA, USA
| | - S Armando Villalta
- Institute for Immunology, University of California Irvine, Irvine, CA, USA
| | - Paul de Vos
- Department of Pathology and Medical Biology, Section Immunoendocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Weian Zhao
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA
- Department of Pharmaceutical Sciences, University of California Irvine, Irvine, CA, USA
- Chao Family Comprehensive Cancer Center; Edwards Life Sciences Center for Advanced Cardiovascular Technology; Department of Biomedical Engineering, Department of Biological Chemistry, University of California Irvine, Irvine, CA, USA
| | - Jonathan R T Lakey
- Sue and Bill Stem Cell Center, University of California Irvine, Irvine, CA, USA.
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
- Department of Surgery, University of California Irvine, Irvine, CA, USA.
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Rodríguez-Sánchez I, Ortolá R, Graciani A, Martínez-Gómez D, Banegas JR, Rodríguez-Artalejo F, García-Esquinas E. Pain Characteristics, Cardiovascular Risk Factors, and Cardiovascular Disease. J Gerontol A Biol Sci Med Sci 2021; 77:204-213. [PMID: 33725724 DOI: 10.1093/gerona/glab079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is unclear evidence that chronic pain may increase the risk of cardiovascular disease (CVD) incidence and mortality. This work evaluated the association between chronic pain, incidence of CVD and changes in CVD risk factors. METHODS Cohort of 1091 community-dwelling individuals ≥60years, free from CVD at baseline, followed up for 6 years. Data on psychosocial factors and CVD risk factors was obtained through validated questionnaires and laboratory measurements. A pain scale ranging from 0 (no pain) to 6 (worst pain) was created according to pain frequency, location and intensity. RESULTS The cumulative incidence of CVD was 4.2% at 3 years, and 7.7% at 5-years of follow-up. Compared to individuals without pain in the first 3 years (2012-2015), those with maintained scores ≥2 showed a mean reduction of 3.57 (-5.77,-1.37) METs-h/week in recreational physical activity; a 0.38-point (0.04,0.73) increase in psychological distress; and a 1.79 (1.03,3.11) higher odds of poor sleep. These associations held in the second follow-up period, when individuals with maintained pain also worsened their diet quality. A 1-point increase in the pain scale in 2012 was associated with a 1.21 (1.03,1.42) and 1.18 (0.97,1.44) increased CVD incidence in 2015 and 2017, respectively; none of the studied factors mediated this relationship. CONCLUSIONS Older adults with chronic pain show important reductions in recreational physical activity and deterioration in mental health, sleep and diet quality, which may well aggravate pain. Future studies should evaluate whether these factors mediate the increased risk of CVD observed in older adults with chronic pain.
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Affiliation(s)
- Isabel Rodríguez-Sánchez
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,Geriatrics Department. Hospital Clínico San Carlos, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - David Martínez-Gómez
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autónoma de Madrid/ IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
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Mworia JK, Kibiti CM, Ngeranwa JJN, Ngugi MP. Anti-inflammatory potential of dichloromethane leaf extracts of Eucalyptus globulus (Labill) and Senna didymobotrya (Fresenius) in mice. Afr Health Sci 2021; 21:397-409. [PMID: 34394322 PMCID: PMC8356592 DOI: 10.4314/ahs.v21i1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Inflammation is an immune response characterized by swelling, redness, pain and heat. Inflammation is mainly managed using conventional medicines that are associated with many side effects. Plant-based remedies are considerably better alternative therapies for they have fewer side effects. Objective This study aimed at determining the anti-inflammatory potential of dichloromethane (DCM) leaf extracts of Eucalyptus globulus and Senna didymobotrya in mice. Methods Fresh leaves of these plants were harvested from Embu County, Kenya. Quantitative phytochemical analysis was done using Gas Chromatography-Mass Spectrometry (GC-MS). Anti-inflammatory test comprised nine groups of five animals each: normal, negative, positive controls and 6 experimental groups. Inflammation was induced with Carrageenan. One hour post-treatment, the different groups were intraperitoneally administered with the reference drug, diclofenac, 3% DMSO and six DCM leaf extracts at doses of 25, 50, 100, 150, 200 and 250mg/kgbw. Results GC-MS results revealed α-phellandrene, camphene, terpinolene, and limonene among others. Anti-inflammatory effects showed that extract doses of 100,150,200 and 250mg/kg bw significantly reduced the inflamed paw. Doses of 200 and 250mg/kgbw in both plants were more potent and compared with diclofenac. E. globulus extract dose of 250mg kg bw reduced inflamed paw in the 1st, 2nd, 3rd and 4th hours, by 2.27,6.52,9.09 and 10.90% respectively while S.didymobotrya at similar dose ranges, inflamed paw reduced by 2.41, 5.43, 8.31 and 9.05% respectively. Conclusion E. globulus and S. didymobotrya have potent anti-inflammatory activities, attributed to their constituent phytochemicals. This study confirms the traditional use of these plants in treating inflammation.
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Affiliation(s)
- Joseph Kiambi Mworia
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, P.O Box 43844-00100, Nairobi, Kenya
| | - Cromwell Mwiti Kibiti
- Department of Pure and Applied Sciences, Technical University of Mombasa, P.O Box 90420-80100, Mombasa, Kenya
| | - Joseph JN Ngeranwa
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, P.O Box 43844-00100, Nairobi, Kenya
| | - Mathew Piero Ngugi
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, P.O Box 43844-00100, Nairobi, Kenya
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41
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Marttinen MK, Kautiainen H, Haanpää M, Pohjankoski H, Hintikka J, Kauppi MJ. Analgesic purchases among older adults - a population-based study. BMC Public Health 2021; 21:256. [PMID: 33517898 PMCID: PMC7849135 DOI: 10.1186/s12889-021-10272-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults’ prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods One thousand four hundred twenty community-dwelling citizens aged 62–86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults’ pain management.
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Affiliation(s)
- Maiju K Marttinen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland. .,Department of Anesthesiology, Intensive Care and Pain Medication, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, 00290, Helsinki, Finland.
| | - Hannu Kautiainen
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Puijonlaaksontie 2, 70200, Kuopio, Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company, Porkkalankatu 1, 00180, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00270, Helsinki, Finland
| | - Heini Pohjankoski
- Department of Paediatrics, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Jukka Hintikka
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Markku J Kauppi
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Department of Rheumatology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
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42
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Effectiveness of ibuprofen plus paracetamol combination on persistence of acute musculoskeletal disorders in primary care patients. Int J Clin Pharm 2021; 43:1045-1054. [PMID: 33411104 DOI: 10.1007/s11096-020-01215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Background General practitioners often deal with patients suffering acute musculoskeletal disorders. Paracetamol, non-steroidal anti-inflammatory drugs, and opioids are the most prescribed medications, according to pain intensity and patient's features. Combinations of different analgesics can be adopted to enhance pain relief, but only one fixed-dose combination has been recently launched to treat acute musculoskeletal pain. Objective This study aimed to investigate the effectiveness of ibuprofen plus paracetamol (fixed-dose) combination compared to other analgesics in preventing musculoskeletal pain persistence. Setting Italian outpatients' data extracted from a national general practice database. Method A retrospective cohort study was conducted on the Health Search Database. Patients prescribed with analgesics for acute musculoskeletal painful conditions were considered (i.e., non-chronic painful conditions, identified using a query validated by two expert General Practitioners (GPs)). For each patient, the first prescription of an analgesic was defined as index date. A new GP's visit related to musculoskeletal disorders in the first 3 months following the index date was defined as "pain persistence". Main outcome measure Risk of pain persistence among users of the ibuprofen plus paracetamol combination compared to other systemic analgesics. Results Overall, 102,216 patients were treated with systemic analgesics for acute musculoskeletal disorders. Most patients were middle-aged or elderly women. 939 (0.92%) patients were prescribed with the fixed-dose ibuprofen plus paracetamol combination for a mean duration of 7.23 ± 2.68 days, mainly for low back pain and cervicalgia. Musculoskeletal pain persistence was found in 22,125 (21.65%) patients. Compared to other systemic analgesics, the ibuprofen plus paracetamol combination resulted significantly more effective in preventing pain persistence (adjusted hazard ratio 0.72, 95% confidence interval 0.61-0.85). Conclusion These findings suggest that the fixed-dose ibuprofen plus paracetamol combination might be effective in controlling musculoskeletal pain persistence.
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Wang Y, Tang B, Long L, Luo P, Xiang W, Li X, Wang H, Jiang Q, Tan X, Luo S, Li H, Wang Z, Chen Z, Leng Y, Jiang Z, Wang Y, Ma L, Wang R, Zeng C, Liu Z, Wang Y, Miao H, Shi C. Improvement of obesity-associated disorders by a small-molecule drug targeting mitochondria of adipose tissue macrophages. Nat Commun 2021; 12:102. [PMID: 33397994 PMCID: PMC7782823 DOI: 10.1038/s41467-020-20315-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/25/2020] [Indexed: 12/20/2022] Open
Abstract
Pro-inflammatory activation of adipose tissue macrophages (ATMs) is causally linked to obesity and obesity-associated disorders. A number of studies have demonstrated the crucial role of mitochondrial metabolism in macrophage activation. However, there is a lack of pharmaceutical agents to target the mitochondrial metabolism of ATMs for the treatment of obesity-related diseases. Here, we characterize a near-infrared fluorophore (IR-61) that preferentially accumulates in the mitochondria of ATMs and has a therapeutic effect on diet-induced obesity as well as obesity-associated insulin resistance and fatty liver. IR-61 inhibits the classical activation of ATMs by increasing mitochondrial complex levels and oxidative phosphorylation via the ROS/Akt/Acly pathway. Taken together, our findings indicate that specific enhancement of ATMs oxidative phosphorylation improves chronic inflammation and obesity-related disorders. IR-61 might be an anti-inflammatory agent useful for the treatment of obesity-related diseases by targeting the mitochondria of ATMs. Adipose tissue macrophages are central to controlling inflammation in the context of obesity. Here the authors present a new infrared dye (IR-61) that accumulates in the mitochondria of these cells resulting in anti-inflammatory effects that counter obesity-associated pathology in mice.
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Affiliation(s)
- Yawei Wang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Binlin Tang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China.,Oncology Department, The General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Lei Long
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Peng Luo
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Wei Xiang
- Department of Biochemistry and Molecular Biology, Third Military Medical University, Chongqing, 400038, China
| | - Xueru Li
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Huilan Wang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China.,Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Qingzhi Jiang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China.,Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Xu Tan
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Shenglin Luo
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Huijuan Li
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Ziwen Wang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Zelin Chen
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Yu Leng
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Zhongyong Jiang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Yang Wang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Le Ma
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Rui Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Zujuan Liu
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China
| | - Yu Wang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China.
| | - Hongming Miao
- Department of Biochemistry and Molecular Biology, Third Military Medical University, Chongqing, 400038, China.
| | - Chunmeng Shi
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing, 400038, China.
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Han YM, Park JM, Her S, Kim MS, Park YJ, Hahm KB. Revaprazan prevented indomethacin-induced intestinal damages by enhancing tight junction related mechanisms. Biochem Pharmacol 2020; 182:114290. [PMID: 33075311 DOI: 10.1016/j.bcp.2020.114290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed medications for alleviating pain and inflammation but may cause gastrointestinal tract damage. Proton pump inhibitors (PPI) prevent NSAID-induced gastric damage but may aggravate intestinal damage via dysbiosis and intestinal permeability alteration. Currently, there is growing interest regarding the influence of potassium competitive acid blockers (PCAB) on NSAID-induced enteropathy. Here, we investigated the relative changes in indomethacin-induced enteropathy by combining indomethacin with pantoprazole (as PPI) or revaprazan (as PCAB). We examined intestinal permeability-related molecular changes in in vitro Caco-2 cell models and in an in vivo indomethacin-induced enteropathy rat model. Indomethacin alone or in combination with pantoprazole significantly increased relative lucifer yellow dye flux and decreased relative trans-epithelial electrical resistance and tight junction protein (TJP) expression compare to normal cells. In contrast, indomethacin combined with revaprazan significantly preserved TJPs compare to indomethacin-treated cells. MLC phosphorylation, Rho activation, and ERK activation responsible for TJP were significantly increased by indomethacin alone or a combination of indomethacin and pantoprazole but not by a combination of indomethacin and revaprazan. Intestinal damage scores significantly increased with indomethacin and pantoprazole combination but not with indomethacin and revaprazan combination. Indomethacin and pantoprazole combination significantly activated Rho-GTPase, p-MLC, and p-ERK but significantly decreased TJP expression. However, indomethacin and revaprazan combination significantly preserved TJPs and inactivated Rho-GTPase, MLC, and ERK. Hence, revaprazan rather than PPIs should be co-administered with NSAIDs to mitigate NSAID-induced intestinal damage.
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Affiliation(s)
- Young-Min Han
- Seoul Center, Korea Basic Science Institute, Seoul, Republic of Korea
| | - Jong-Min Park
- College of Oriental Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Song Her
- Seoul Center, Korea Basic Science Institute, Seoul, Republic of Korea
| | - Min Sun Kim
- Seoul Center, Korea Basic Science Institute, Seoul, Republic of Korea
| | | | - Ki Baik Hahm
- Medpacto Research Institute, Medpacto, Seoul, Republic of Korea; CHA Cancer Preventive Research Center, CHA Bio Complex, Pangyo, Republic of Korea.
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45
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Chung R, Tyebally S, Chen D, Kapil V, Walker JM, Addison D, Ismail-Khan R, Guha A, Ghosh AK. Hypertensive Cardiotoxicity in Cancer Treatment-Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies-Epidemiology, Incidence, and Pathophysiology. J Clin Med 2020; 9:jcm9103346. [PMID: 33081013 PMCID: PMC7603211 DOI: 10.3390/jcm9103346] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/05/2020] [Accepted: 10/10/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiotoxicity is the umbrella term for cardiovascular side effects of cancer therapies. The most widely recognized phenotype is left ventricular dysfunction, but cardiotoxicity can manifest as arrhythmogenic, vascular, myocarditic and hypertensive toxicities. Hypertension has long been regarded as one of the most prevalent and modifiable cardiovascular risk factors in the general population, but its relevance during the cancer treatment journey may be underestimated. Hypertensive cardiotoxicity occurs de novo in a substantial proportion of treated cancer patients. The pathology is incompletely characterized—natriuresis and renin angiotensin system interactions play a role particularly in conventional treatments, but in novel therapies endothelial dysfunction and the interaction between the cancer and cardiac kinome are implicated. There exists a treatment paradox in that a significant hypertensive response not only mandates anti-hypertensive treatment, but in fact, in certain cancer treatment scenarios, hypertension is a predictor of cancer treatment efficacy and response. In this comprehensive review of over 80,000 patients, we explored the epidemiology, incidence, and mechanistic pathophysiology of hypertensive cardiotoxicity in adjunct, conventional chemotherapy, and novel cancer treatments. Conventional chemotherapy, adjunct treatments, and novel targeted therapies collectively caused new onset hypertension in 33–68% of treated patients. The incidence of hypertensive cardiotoxicity across twenty common novel therapies for any grade hypertension ranged from 4% (imatinib) to 68% (lenvatinib), and high grade 3 or 4 hypertension in <1% (imatinib) to 42% (lenvatinib). The weighted average effect was all-grade hypertension in 24% and grade 3 or 4 hypertension in 8%.
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Affiliation(s)
- Robin Chung
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
| | - Sara Tyebally
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
| | - Daniel Chen
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
- Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
| | - Vikas Kapil
- Barts Blood Pressure Centre of Excellence, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK;
- Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - J. Malcolm Walker
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
- Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (D.A.); (A.G.)
| | - Roohi Ismail-Khan
- Cardio-oncology Program, H. Lee Moffitt Cancer Center, Tampa, FL 33559, USA;
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH 43210, USA; (D.A.); (A.G.)
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (R.C.); (S.T.); (D.C.)
- Cardio-Oncology Service, University College London Hospital, London WC1E 6HX, UK;
- Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
- Correspondence: ; Tel.: +44-20-7377-7000
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46
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Al-Qurain AA, Gebremichael LG, Khan MS, Williams DB, Mackenzie L, Phillips C, Russell P, Roberts MS, Wiese MD. Prevalence and Factors Associated with Analgesic Prescribing in Poly-Medicated Elderly Patients. Drugs Aging 2020; 37:291-300. [PMID: 32016823 DOI: 10.1007/s40266-019-00742-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pain is common in older patients and management guidelines rarely consider the effect of multiple comorbidities and concurrent medications on analgesic selection. OBJECTIVES The objectives of this study were to identify the prevalence and pattern of analgesic prescribing and associated factors in older patients with polypharmacy. METHODS Older patients (aged ≥ 75 years) admitted to the Royal Adelaide Hospital between September 2015 and August 2016 and with polypharmacy were included and their comorbidities and medications prescribed at discharge were recorded. Drug Burden Index and Charlson Comorbidity Index were calculated. The number of medications that increased the risk of orthostatic hypotension were recorded. Logistic regression was used to compute the association between analgesic use and participant characteristics, and results were presented as odds ratios and 95% confidence intervals, adjusted for age, sex, Charlson Comorbidity Index, Drug Burden Index and orthostatic hypotension. RESULTS Over 15,000 admissions were identified, of which 1192 patients were included, 824 (69%) of whom were prescribed an analgesic medication. Paracetamol (used by 89% of analgesic users), opioids (34%) and adjuvants (17%) were used more frequently than non-steroidal anti-inflammatory drugs (8%). Analgesic users had a higher Drug Burden Index, were prescribed more medications and were less likely to be male compared with non-users. Charlson Comorbidity Index across the cohort was high (7.3 ± 1.9) but there was no difference between analgesic users and non-users, but analgesic users were more likely to have a documented diagnosis of osteoarthritis, osteoporosis and falls. Opioid use was associated with the Drug Burden Index, while adjuvant use was associated with orthostatic hypotension. Opioid use was associated with having a diagnosis of osteoporosis and falls. CONCLUSIONS In our cohort of poly-medicated elderly patients, prescription of analgesic medications was common, and these patients are likely to have an increased rate of adverse drug reactions and falls compared with those who were not prescribed analgesic medications.
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Affiliation(s)
- Aymen Ali Al-Qurain
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia.,Saudi Arabian Cultural Mission, Ministry of Education, Riyadh, Saudi Arabia
| | - Lemlem G Gebremichael
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia
| | - Muhammad Suleman Khan
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia
| | - Desmond B Williams
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Lorraine Mackenzie
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia
| | - Craig Phillips
- School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
| | | | - Michael S Roberts
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Basil Hetzel Institute for Translational Research, The Queen Elizabeth Hospital, Woodville, Australia.,Therapeutics Research Centre, Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia
| | - Michael D Wiese
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
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47
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Jafari Z, Hadjmohammadi MR. A banana peel/silicon glue coated stir bar for extraction of aspirin, diclofenac, ibuprofen and mefenamic acid followed by high performance liquid chromatography-UV detection. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:4429-4437. [PMID: 32853301 DOI: 10.1039/d0ay01332c] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the current study, a green, cost-effective, and bio-degradable additive was used for the preparation of a highly efficient sorbent based on silicon glue. Here, a banana peel was pretreated and mixed with silicon glue. It was proved that the prepared banana peel-silicon glue bar is a reliable sorbent for stir bar sorptive extraction of nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, diclofenac, ibuprofen and mefenamic acid in human urine and plasma. Compared to the lab-made sorbents, the prepared sorbent showed high extraction performance, high stability, and satisfactory reproducibility and involved easy preparation. In order to optimize the effective factors, different parameters such as (stirring rate, pH, extraction time, desorption time and elution solvent volume) were optimized using response surface methodology (RSM) through applying Central-Composite Design (CCD). Under the optimum conditions, the linear dynamic ranges of the target analytes were investigated in the range of 0.2-200 μg L-1 with r2 higher than 0.9929. Limits of detection (LODs) and limits of quantification (LOQs) of analytes were in the ranges of 0.04-0.5 and 0.15-1.65, respectively. The reproducibility of the method was also investigated by calculating the relative standard deviation. The RSD was measured to be lower than 4.9%. Bar-to-bar reproducibility at a 100 μg L-1 concentration level was also evaluated to be lower than 5.3% (n = 3). Also, each prepared film can be used up to 64 times without any reduction in extraction performance. Finally, the method was successfully applied for the determination of selected drugs in different biological fluids including urine and plasma samples. The calculated relative recovery in real sample analysis was higher than 90%.
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Affiliation(s)
- Zahra Jafari
- Department of Analytical Chemistry, Faculty of Chemistry, University of Mazandaran, NirooHavayiiboulevard, 47416-95447 Babolsar, Iran.
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Petzke F, Bock F, Hüppe M, Nothacker M, Norda H, Radbruch L, Schiltenwolf M, Schuler M, Tölle T, Viniol A, Häuser W. Long-term opioid therapy for chronic noncancer pain: second update of the German guidelines. Pain Rep 2020; 5:e840. [PMID: 32904018 PMCID: PMC7447355 DOI: 10.1097/pr9.0000000000000840] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022] Open
Abstract
The opioid epidemic in North America challenges national guidelines worldwide to define the importance of opioids for the management of chronic noncancer pain (CNCP). METHODS The second update of the German guidelines on long-term opioid therapy for CNCP was developed by 26 scientific associations and 2 patient self-help organizations. A systematic literature search in CENTRAL, Medline, and Scopus (to May 2019) was performed. Meta-analyses of randomized controlled trials and open-label extension studies with opioids for CNCP were conducted. Levels of evidence were assigned according to the Oxford Centre for Evidence-Based Medicine classification system. The formulation and strength of recommendations were established by multistep formalized procedures to reach a consensus according to German Association of the Medical Scientific Societies regulations. The guidelines underwent external review by 4 experts and public commentary. RESULTS Opioids are one drug-based treatment option for short- (4-12 weeks), intermediate- (13-26 weeks), and long-term (>26 weeks) therapy of chronic pain in osteoarthritis, diabetic polyneuropathy, postherpetic neuralgia, and low back pain. Contraindications are primary headaches, functional somatic syndromes, and mental disorders with the (cardinal) symptom of pain. For specified other clinical pain conditions, short- and long-term therapy with opioids should be evaluated on an individual basis. Long-term therapy with opioids is associated with relevant risks. CONCLUSION Responsible application of opioids requires consideration of possible indications and contraindications, as well as regular assessment of clinical response and adverse effects. Neither uncritical opioid prescription nor general rejection of opioids is justified in patients with CNCP.
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Affiliation(s)
- Frank Petzke
- Pain Medicine, Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Frietjof Bock
- Orthopaedics at the Green Tower, Ravensburg, Germany
| | - Michael Hüppe
- Department Anesthesiology and Intensive Care Medicine, Universität zu Lübeck, Lübeck, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management (AWMF-IMWi), Berlin, Germany
| | | | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Marcus Schiltenwolf
- Department of Orthopedics and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Schuler
- Clinic for Geriatric Medicine, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Thomas Tölle
- Department of Neurology, Technische Universität München, München, Germany
| | - Anika Viniol
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Marburg, Germany
| | - Winfried Häuser
- Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
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49
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Ho KY, Cardosa MS, Chaiamnuay S, Hidayat R, Ho HQT, Kamil O, Mokhtar SA, Nakata K, Navarra SV, Nguyen VH, Pinzon R, Tsuruoka S, Yim HB, Choy E. Practice Advisory on the Appropriate Use of NSAIDs in Primary Care. J Pain Res 2020; 13:1925-1939. [PMID: 32821151 PMCID: PMC7422842 DOI: 10.2147/jpr.s247781] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflammation. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.
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Affiliation(s)
- Kok Yuen Ho
- The Pain Clinic, Mt Alvernia Hospital, Singapore
| | | | - Sumapa Chaiamnuay
- Rheumatic Disease Unit, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Rudy Hidayat
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusomo Hospital, Jakarta, Indonesia
| | | | - Ozlan Kamil
- Gleneagles Hospital, Kuala Lumpur, Malaysia.,Prince Court Medical Center, Kuala Lumpur, Malaysia
| | - Sabarul A Mokhtar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sandra V Navarra
- Section of Rheumatology, Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Van Hung Nguyen
- Department of Rheumatology, Bach Mai Hospital, Hanoi, Vietnam
| | - Rizaldy Pinzon
- Department of Neurology, Faculty of Medicine, Kristen Duta Wacana University, Bethesda Hospital, Yogyakarta, Indonesia
| | | | - Heng Boon Yim
- Mount Elizabeth Novena Hospital, Singapore.,Faculty of Medicine, National University of Singapore, Singapore
| | - Ernest Choy
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
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50
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Nguyen TNM, Laetsch DC, Chen LJ, Haefeli WE, Meid AD, Brenner H, Schöttker B. Pain severity and analgesics use in the community-dwelling older population: a drug utilization study from Germany. Eur J Clin Pharmacol 2020; 76:1695-1707. [PMID: 32648116 PMCID: PMC7661425 DOI: 10.1007/s00228-020-02954-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/03/2020] [Indexed: 01/23/2023]
Abstract
Purpose Chronic pain is common in the older population and a significant public health concern. However, comprehensive studies on analgesics use in this age group from Germany are scarce. This study aims to give a comprehensive overview on the use of the most common therapeutic groups of analgesics in community-dwelling older adults from Germany. Methods A cross-sectional study was carried out using data from a German cohort of 2038 community-dwelling adults aged 63–89 years. Descriptive statistics and logistic regression models were applied to assess the utilization of analgesics by age, sex, pain severity, pain duration, and locations. Results One out of four study participants was suffering from high-intensity or disabling pain. Approximately half of those taking analgesics still reported to suffer from high-intensity or disabling pain. Among analgesics users, occasional non-steroidal anti-inflammatory drugs (NSAIDs) use was the most frequent pain therapy (in 43.6% of users), followed by metamizole (dipyrone) use (16.1%), regular NSAIDs use (12.9%), strong opioids use (12.7%), and weak opioids use (12.0%). In multivariate logistic regression models, higher age, higher pain severity, longer pain duration, abdominal pain, and back pain were statistically significantly associated with opioids use. Metamizole use was also statistically significantly associated with higher pain severity but inversely associated with pain duration. Conclusions A significant number of older German adults are affected by high-intensity and disabling chronic pain despite receiving analgesics. Long-term studies are needed to compare the effectiveness and safety of different treatments for chronic pain in older adults. Electronic supplementary material The online version of this article (10.1007/s00228-020-02954-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thi Ngoc Mai Nguyen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Dana Clarissa Laetsch
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.
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