Possible Potentiation by Certain Antioxidants of the Anti-Inflammatory Effects of Diclofenac in Rats

In the present study, we investigated the potential beneficial impact of the addition of antioxidant supplements to diclofenac regimen in a model of carrageenan-induced paw. Rats were treated daily with antioxidants, that is, a-lipoic acid (50 mg/kg), selenium (2.5 mg/kg), vitamin C (1 g/kg), vitamin E (300 mg/kg), or zinc (25 mg/kg) on seven successive days and then received a single treatment with diclofenac or saline before carrageenan was injected to induce paw inflammation. The results indicated that these combinations did not significantly affect the percentage inhibition of paw edema caused by diclofenac alone; however, some combination treatments ameliorated signs of concomitant oxidative stress (such as alterations in plasma malondialdehyde (MDA) levels, hemolysate reduced glutathione levels, and erythrocytic superoxide dismutase enzyme activities) imparted by diclofenac alone. In some cases, few tested antioxidants in combination with diclofenac resulted in increased plasma levels of interleukin- (IL-) 6 and C-reactive protein (CRP). In conclusion, the results of these studies suggested to us that the added presence of natural antioxidants could be beneficial as standard anti-inflammatory therapeutics for a patient under diclofenac treatment, albeit that these effects do not appear to significantly build upon those that could be obtained from this common anti-inflammatory agent per se

Is spinopelvic sagittal alignment correlated with pain level, functional disability and frontal plane projection angle in women with patellofemoral pain syndrome? A cross-sectional study

There is a growing interest concerning the understanding of measurements of spinal and leg alignment in patients with patellofemoral pain syndrome (PFPS). However, evaluating spinopelvic alignment in the sagittal plane with pain level, functional disability and frontal plane projection angle (FPPA) in PFPS has not been adequately addressed. The aim of the study was to identify the correlation of spinopelvic parameters with pain level, functional disability and frontal plane projection angle in women with PFPS. This was a cross–sectional study involving sixty female patients diagnosed with PEPS, with a mean age of 32±6.47. The measurements used in the study included: radiographic parameters (X-Ray), the numeric pain rating scale (NPRS), the Arabic anterior knee pain scale (AAKP/Kujala) and the 2D-FPPA. Spearman correlation analysis was conducted to evaluate the relationship between these parameters. The results of our study demonstrated a strong positive correlation of lumbar lordosis (LL) with pain level and FPPA (r=0.825, r=0.812, p=0.0001). Also, a strong positive correlation of sacral slope (SS) with pain level (r = 0.0.820) and FPPA (r= 0.783). Pelvic tilt (PT) showed a moderate correlation with pain level (r = 0.0.614) and FPPA (r= 0.605), while a weak negative correlation was found between LL, SS and PT and functional disability score (r=-0.397, r=-0.385 and, r=-0.215 p=0.002). It was concluded that LL, SS and PT were significantly related to the pain level, functional disability and frontal plane projection angle in women with PFPS. These spinal alignments should be considered in clinical evaluation of knee-related disorders associated with PFPS

Immunomodulatory effect of Premna odorata volatile oils in Mycobacterium tuberculosis by inhibiting TLR4/NF-κB pathway

Introduction: The development of multi drug resistant (MDR) tuberculosis (TB) and extensively drug resistant (XDR) TB, increased the interest in the usage of medicinal plants that are complementary to antibiotics to improve anti-TB efficacy. The present study aimed to confirm the anti-TB efficacy of volatile oils (VOs) isolated from different parts of Premna odorata in vivo, and moreover, to test the possible involvement of TLR4/NF-κB signaling pathway in its anti-TB efficacy. Methods: Thirty mice were divided into six equal groups. Group 1: healthy mice (negative control). Groups 2-6 were injected intravenously with a positive TB solution of purified MeDiPro Mycobacterium tuberculosis (MTB) antigen for 7 days to induce tuberculosis. Group 3-6: TB-injected mice treated respectively with leaves VO (300 μL/d), young stems VO (300 μL/d), flowers VO and a combination of the three essential VOs (1:1:1). Various immunologic factors and antioxidant activity were evaluated and compared in the groups. Results: TB-infected mice showed a significant increase in the serum levels of tumor necrosis factor-α (TNF-α), interferon-gamma (IFN-γ), interleukin (IL) 1-β and the mRNA expression levels of toll-like receptor 4 (TLR-4) & nuclear factor-κB (NF-κB) and a decrease in IL-10 & total antioxidant capacity (TAC). While pretreatment with VOs extracted from leaves, flowers, young stems and a combination of the three oils reversed these effects. Conclusion: The immunomodulatory effects of VOs extracted from different parts of P. odorata against TB infection involve the TLR-4/NFκB signaling pathway as well as, antioxidant effects, recommending that the use of this plant may help TB infected patients

Correlation of Total Cholesterol and Glucose in Serum of Iraqi Patients with Atherosclerosis and Diabetes Mellitus Type 2

Cholesterol is a fatty substance (lipid) classified as a waxy steroid of fat. It is absorbed by the intestine into blood stream and is packaged inside a protein coat a chylomicron. Blood glucose is a simple monosaccharide absorbed directly into the blood stream during digestion. The level of blood glucose normally represents a balance between the inflow of glucose into blood and it is uptake by the tissue. Atherosclerosis is a general term for a number of different medical conditions that affect the heart, this is occurs when the blood supply to a part of heart is interrupted, must commonly due to plaque, is build up in the coronary arteries consist of lipid cholesterol and calcium. It causes a damage of potential disease of heart muscle due to thickening and hardening of arteries. Diabetes mellitus is a disorder in which the level of blood glucose is persistently elevated above the normal range due to decrease secretion of insulin. The main objective of this study is to determine the concentrations of total cholesterol and glucose into blood serum of Iraq patients with atherosclerosis and diabetes mellitus type 2. This study included 60 specimens of patients with atherosclerosis and 60 patients with type 2 diabetes mellitus; their age range was 45-65 years. These patients were then matched by age and sex to 30 healthy individuals. Results revealed that there was highly significantly increased in the mean value of total cholesterol and glucose concentrations in patients of atherosclerosis (p<0.001) and diabetes mellitus (p<0.001) as compared with healthy individuals

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Stability indicating HPLC and spectrophotometric methods for the determination of bupropion hydrochloride in the presence of its alkaline degradates and related impurity

Four sensitive and selective stability-indicating methods for the determination of bupropion hydrochloride in the presence of its alkaline degradates, related impurity, 3-chlorobenzoic acid, and in its pharmaceutical formulation were developed. Method A is an isocratic reversed phase HPLC, good separation between bupropion hydrochloride, its alkaline degradates and related impurity was achieved using a mobile phase of 1.2% w/v ammonium dihydrogen phosphate pH 4.5 and acetonitrile (80:20, v/v) and detection at 210 nm. Method B is based on the first derivative (D1) measurement of the drug at 259 nm, zero contribution point of its alkaline degradates and related impurity. Method C is based on the resolution of the drug, its alkaline degradates and related impurity by first derivative ratio spectra (DD1). Method D is based on the determination of bupropion hydrochloride and its impurity by the Q value method at 248 nm, 227 nm and at isoabsorptive point 237 nm. These methods are successfully applied for the determination of bupropion hydrochloride in bulk powder, pharmaceutical formulation and in the presence of its alkaline degradates and related impurity. The results obtained are statistically analyzed and there are no significant differences between the four methods and the official one with respect to accuracy and precision

Spectrum subtraction as a complementary method for six resolution techniques resolving overlapping spectra; application to multicomponent veterinary formulation with greenness and whiteness assessment

Abstract Mathematical filtration is an efficient tool to resolve the overlapping spectra of binary mixtures in zero or first order form. Herein, a comparative study was conducted between six economic, accurate and precise spectrophotometric methods for determination of Triclabendazole (TCB) and Levamisole HCl (LVM). Each component was resolved with minimum mathematical steps in its zero-order absorption spectrum by ratio subtraction, constant multiplication, and the recent factorized response method; coupled with spectrum subtraction. In addition, the mixture was resolved in its first derivative form by derivative subtraction, D1 constant multiplication, and the recent D1 factorized response method; coupled with spectrum subtraction. Results obtained were also compared to those obtained from constant value, concentration value, and derivative ratio methods. The linearity range was found to be either 1.0–10.0 µg/mL or 2.0–20.0 µg/mL for TCB, and 2.0–14.0 µg/mL for LVM with LOD of 0.08 µg/mL and 0.19 µg/mL, respectively. Validation of the proposed methods was performed according to VICH guidelines. Results obtained from the statistical data showed no significant difference regarding accuracy and precision compared to the reported methods. The developed spectrophotometric methods followed the principles of green analytical chemistry, in which the green assessment was done through four tools, called, National Environmental Methods Index (NEMI), Analytical Eco-Scale (AES), Green Analytical Procedure Index (GAPI) and Analytical greenness metric (AGREE). Also, a white assessment was performed using RGB model. The proposed methods could offer an economic alternative for the routine analysis of bulk materials and combined veterinary dosage form. Graphical Abstrac