Lower gastrointestinal adverse effects of NSAIDS: an extreme example of a common problem

Causal relationships of mental diseases and thyroid diseases based on a Mendelian randomization study

Evidence from observational researches have suggested that mental diseases are able to affect thyroid diseases. However, the causal relationship between mental diseases and the risk of thyroid diseases still remains unclear. Herein, we conducted a two-sample Mendelian randomization (MR) statistical analysis method to assess the causality between mental diseases and thyroid diseases. Initially, publicly available genome-wide association studies summary data were leveraged to obtain single-nucleotide polymorphisms based on set parameters. Subsequently, a two-sample MR was utilized to analyze causal relationships between mental diseases (Alzheimer disease, bipolar disorder, major depressive disorder, Parkinson disease, schizophrenia) and thyroid diseases (hyperthyroidism/thyrotoxicosis, hypothyroidism) with removing outliers based on MR-PRESSO method. Finally, 8 regression MR methods (inverse variance weighted [IVW], IVW fixed effects, c, MR Egger, weighted median, penalized weighted median, simple mode, weighted mode) were performed to evaluate bias and effectiveness, of which IVW was considered as the primary method. Our results demonstrated that most of mental diseases have no causal relationships with thyroid diseases except bipolar disorder and hyperthyroidism/thyrotoxicosis based on IVW method [odds ratio: 0.999, 95% confidence interval: 0.998-1.000, P = .028], and bipolar disorder and hypothyroidism based on IVW method [odds ratio: 0.997, 95% confidence interval: 0.995-0.999, P = .002]. Then we subsequently conducted a consistent robustness analysis to assess heterogeneity and horizontal pleiotropy. Our method reports causal relationships exist mental diseases and the risk of thyroid diseases. Subsequent researches are still warranted to determine how mental diseases influence the development of thyroid diseases.

The Therapeutic Effect of Nigella sativa Seed on Indomethacin-induced Gastric Ulcer in Rats

Background:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve pain and reduce inflammation. However, gastric complications remain a major problem limiting their clinical usage. This study was carried out to evaluate the therapeutic effect of Nigella sativa seed (N. sativa seed) hydroalcoholic extract on indomethacin-induced gastric ulcer in rats and its possible mechanism.

Methods:

This study was carried out on forty-eight male Wistar rats. Gastric ulcer was induced by indomethacin (35 mg/kg). N. sativa seed extract (100, 200, and 400 mg/kg) and ranitidine (50 mg/kg) was administered orally for five days after ulcer induction. Ulcer index, gastric acid secretion, gastric mucus content, total thiol, malondialdehyde (MDA), and total hexose, and protein content in gastric juice were determined.

Results:

The ulcer index in groups of N. sativa seed was significantly lower as compared to indomethacin group. N. sativa seed significantly decreased MDA and protein content, but increased total thiol, total hexose, and mucus content as compared to indomethacin group. N. sativa seed did not affect gastric acid secretion.

Conclusion:

These findings showed that the gastroprotective effect of N. sativa seed against indomethacin- induced ulcer was mainly exerted by antioxidant activity, stimulation of gastric mucus secretion and also increased total hexose in the gastric mucosa.

Serum tau levels are increased in patients with hyperthyroidism

Hyperthyroidism may cause cognitive decline and increases the risk of Alzheimer's disease (AD), the major form of dementia; however, the underlying mechanism of this relationship is unclear. AD is associated with increased serum levels of tau. In this study, we investigated the relationship between serum thyroid hormones (THs) and tau. Fifty participants diagnosed with hyperthyroidism and fifty euthyroid counterparts were included and received clinical examinations. Serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and tau protein were assessed. The total tau protein level was significantly higher in hyperthyroidism participants than in their euthyroid counterparts. The level of circulating total tau had a significant positive association with the serum concentrations of FT3 and FT4. Total tau level was increased in the low TSH group and the serum THs decreased with the increase of age. These findings reveal that peripheral THs are associated with the serum concentration of tau, which may be involved in the pathogenesis of AD, suggesting a potential therapeutic target of AD via hyperthyroidism therapy.

The preventive effect of Nigella sativa seed on gastric ulcer induced by indomethacin in rat

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered as one of the most administrated groups of medications worldwide. Due to the role of NSAIDs in inducing gastric ulceration, their clinical applications are still challenging. Nigella sativa seed is widely used as an herbal medication against gastrointestinal complications. The present experiment was carried out to investigate the impact of N. sativa seed hydro-alcoholic extract on gastric ulcer induced by indomethacin (IND) and to evaluate its possible mechanisms in rat. Methods: This study was performed on 48 male Wistar rats. Acute gastric ulceration was induced by IND (35 mg/kg). N. sativa seed extract (100, 200, 400 mg/kg) and ranitidine (50 mg/kg) were administered orally for five days before the induction ulcer. Ulcer index, gastric acid secretion, gastric mucus content, glutathione (GSH), malondialdehyde (MDA), total hexose, gastric juice protein content were determined on the fifth day. Results: The ulcer index in all groups of N. sativa seed was significantly lower than that of the IND group. N sativa seed considerably decreased MDA and protein content, but increased total thiol, total hexose, and mucus content compared to the IND group. N. sativa seed did not affect gastric acid secretion. Conclusion: These findings were indicative of the gastroprotective effect of N. sativa seed against the IND-induced ulcer, suggesting that it can mainly be exerted through the anti-oxidant activity of the extract as well as its role in stimulating gastric mucus secretion and increasing total hexose in the gastric mucosa.

The effects of thyroid hormones on memory impairment and Alzheimer's disease

Thyroid hormones (THs) have a wide and important range of effects within the central nervous system beginning from fetal life and continuing throughout the adult life. Thyroid disorders are one of the major causes of cognitive impairment including Alzheimer's disease (AD). Several studies in recent years have indicated an association between hypothyroidism or hyperthyroidism and AD. Despite available evidence for this association, it remains unclear whether thyroid dysfunction results from or contributes to the progression of AD. This review discusses the role of THs in learning and memory and summarizes the studies that have linked thyroid function and AD. Eventually, we elaborate how THs may be effective in treating AD by putting forward potential mechanisms.

Strategies for optimising musculoskeletal health in the 21st century

We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled "Musculoskeletal Health in the 21st Century" and held at the University of Surrey from 30th June-1st July 2015.The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.

Low-level laser treatment applied at auriculotherapy points to reduce postoperative pain in third molar surgery: A randomized, controlled, single-blinded study

OBJECTIVE

Evaluate the effectiveness of LLL (Low level laser therapy) in auriculotherapy points for pain reduction following lower third molar extractions.

STUDY DESIGN

Randomized, controlled, single-blinded study.

METHODS

Eighty-four bilateral, symmetrical third molar surgeries were performed in 42 healthy patients using a split-mouth design. In the immediate postoperative period, each side was randomly treated in a single-blind method with an LLL at the auriculotherapy points or simulation of its use (contralateral side) over a 21-day interval. This protocol was repeated 24 and 48 hours after surgery. All patients used the same analgesic (paracetamol) but only in case of pain. The primary variable was postoperative pain according to the visual analogue scale, and the secondary variables were mouth opening, edema, local temperature, dysphagia, and the presence of infection (systemic temperature, lymphadenopathy). These variables were evaluated at baseline and at 24 hours, 48 hours and seven days after surgery. Adverse effects were recorded and reported.

RESULTS

There was no difference between the groups in relation to any of the evaluated parameters (p>0.05).

CONCLUSION

For this experimental model, application of a low-intensity laser at auriculotherapy points did not prevent postoperative pain following lower third molar surgery.

TRIAL REGISTRATION

This trial is registered at ClinicalTrials.gov; the registration number is NCT02657174 and the Unique Protocol ID number is 1.100.869. (https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U0002BEY&ts=11&sid=S0006026&cx=6g4wff).

Evaluation of low-level laser at auriculotherapy points to reduce postoperative pain in inferior third molar surgery: study protocol for a randomized controlled trial

Background

A comfortable postoperative return to daily activities has increased the need to control inflammation after third molar surgery. Anti-inflammatory drugs and analgesics are not exempt from adverse effects such as allergies and chronic gastritis, and they are not without cost. The association between low-level laser and auricular acupuncture can be an alternative when conventional drugs are contraindicated. Among its advantages, we can mention the low risk of side effects, low cost and simplicity of application. The objective of this study is to evaluate the efficiency of low-level laser at auriculotherapy points in reducing postoperative pain in lower third molar surgery.

Methods/design

Ninety bilateral, symmetrical lower third molar surgeries will be performed in 45 healthy patients. Each patient will be their own control, through a split-mouth crossover study. One side of the mouth will be randomly chosen and, immediately after surgery, will be treated with low-level laser. After 21 days, the contralateral side will be operated on with low-level laser simulation used postoperatively. This regimen (laser application or not) will be repeated at 24 and 48 h after surgery. All patients will be requested to take analgesics (acetaminophen) if they have pain, i.e. in case of pain. Neither the surgeon nor the patients will know the assigned treatment. The primary variable will be postoperative pain assessed using a Visual Analog Scale, and the secondary variables will be trismus, edema, local temperature, dysphagia, presence of infection and painkiller ingestion. These variables will be assessed at baseline, 24 h, 48 h and 7 days after surgery. Blood samples for systemic inflammatory cytokine (TNF-α, IL-1, IL-6 and IL-8) analysis will be assessed at baseline and 24 h after surgery.

Discussion

Some authors believe that using a wavelength of 633 to 670 nm is a good option for laser therapy in the field of acupuncture. This wavelength can penetrate biological tissue to a depth of about 3 mm. However, for auriculotherapy points, the stimulus (mustard seeds, needles 1 to 2.5 mm) does not penetrate so deeply. For this reason, we chose a laser wavelength of 660 nm (red wavelength).

Trial registration

ClinicalTrials.gov Identifier: NCT02657174, registered on 11 January 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1540-9) contains supplementary material, which is available to authorized users.

Nonsteroidal anti-inflammatory drugs, proton pump inhibitors, and gastrointestinal injury: contrasting interactions in the stomach and small intestine

Nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) are among the most frequently prescribed groups of drugs worldwide. The use of NSAIDs is associated with a high number of significant adverse effects. Recently, the safety of PPIs has also been challenged. Capsule endoscopy studies reveal that even low-dose NSAIDs are responsible for gut mucosal injury and numerous clinical adverse effects, for example, bleeding and anemia, that might be difficult to diagnose. The frequent use of PPIs can exacerbate NSAID-induced small intestinal injury by altering intestinal microbiota. Thus, the use of PPI is considered to be an independent risk factor associated with NSAID-associated enteropathy. In this review, we discuss this important clinical problem and review relevant aspects of epidemiology, pathophysiology, and management. We also present the hypothesis that even minor and subclinical injury to the intestinal mucosa can result in significant, though delayed, metabolic consequences, which may seriously affect the health of an individual. PubMed was searched using the following key words (each key word alone and in combination): gut microbiota, microbiome, non-steroidal anti inflammatory drugs, proton pump inhibitors, enteropathy, probiotic, antibiotic, mucosal injury, enteroscopy, and capsule endoscopy. Google engine search was also carried out to identify additional relevant articles. Both original and review articles published in English were reviewed.

Stercoral perforation in a child: a rare complication of NSAID use

The adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the gastrointestinal (GI) tract are well known. However, NSAID use rarely leads to a stercoral perforation, an extremely rare but life-threatening cause of acute abdomen. We present a case of stercoral sigmoid colon perforation in a 2-year-old girl, secondary to unintentional NSAID overdose, developing as a result of miscommunication between the general practitioner (GP) and the mother. To the best of our knowledge, stercoral perforation has never before been reported in a child.