Changes in serum inflammatory factors in acute gouty arthritis patients treated using ultrashort wave combined with loxoprofen sodium

Objectives: To study the effect of ultrashort wave combined with loxoprofen sodium on serum inflammatory factors in patients with acute gouty arthritis. Methods: Records of patients with acute gouty arthritis who were treated in The Fourth Hospital of Changsha from May 2018 to September 2020, were reviewed. Of them, 77 cases were selected and divided into two groups based on the received treatment. The control group (n=39) was treated with loxoprofen sodium, and the treatment group (n=38) was treated with an ultrashort wave combined with loxoprofen sodium, for 10 continuous days. The clinical efficacy of the treatment in two groups was analyzed. Results: After treatment, the quality of life of patients in both groups was improved (P < 0.05), but there was no significant difference in the degree of improvement between the two groups (P > 0.05). After treatment, the VAS score of the treatment group was lower than that of the control group (P < 0.05), the improvement of symptoms and signs of the treatment group was better than that of the control group (P < 0.05). Serum CRP and ESR levels in the treatment group were lower than those in the control group (P < 0.05), and the serum IL-1 β, IL-8, TNF-a and MMP-3 levels of the treatment group were lower than those of the control group (P < 0.05). The total effective rate of the treatment group (94.87%) was slightly higher than that of the control group (89.47%), but the difference was not statistically significant (P>0.05). No adverse reactions occurred in all patients during the treatment. Conclusion: An ultrashort wave combined with loxoprofen sodium in the treatment of acute gouty arthritis can reduce the inflammatory reaction, improve the degree of joint pain and swelling, improve the curative effect, and do not increase the adverse reactions. The results may be related to the regulation of IL-1 β, IL-8, TNF-a and MMP-3. doi: https://doi.org/10.12669/pjms.37.7.4765 How to cite this:Wu Y, Wang Y, Yuan W, Xiao X, Cheng G. Changes in serum inflammatory factors in acute gouty arthritis patients treated using ultrashort wave combined with loxoprofen sodium. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4765 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study

Objectives Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. Methods This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). Results The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. Conclusions and clinical relevance Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

Acute Generalized Exanthematous Pustulosis Due to Cephalexin: A Case Report and Literature Review

Introduction: Acute Generalized Exanthematous Pustulosis (AGEP) is a cutaneous reaction that may appear after using certain medications, such as cephalexin. This disease is characterized by non-follicular sterile pustules, erythematous, urticaria, fever over , and leukocytosis. Cephalexin belongs to the family of β-lactam antibiotics, which are widely used to treat infections. However, cephalexin skin sensitivities have been reported rarely. Herein, in this case, we aimed to report a patient presented with AGEP due to cephalexin usage. Case Presentation: A 12-year-old boy presented with warm skin lesions that gradually appeared on the limbs, trunk, face, and neck after using cephalexin powder on his left leg injury. Because of his symptoms, acetaminophen, fexofenadine hydrochloride, loxoprofen sodium, and ointment, including difluprednate and hydrocortisone, were prescribed. Over time, the patient’s fever subsided, and 8 days later, the symptoms of AGEP, including urticaria, erythematous, and pustules in the neck and trunk, disappeared. Conclusions: Cephalexin is one of the antibiotics that doctors and patients consider when there is a possibility of infection. AGEP is a rare but severe reaction that can manifest as skin rashes in any age and sex following the use of cephalexin, so the patient should be careful when using this antibiotic.

Comparison of Efficacy and Safety of Duloxetine and Nonsteroidal Anti-inflammatory Drugs in Subacromial Impingement Syndrome

Background: Subacromialimpingement syndrome (SIS) is characterized by shoulder pain and restriction in range of motion (ROM), which lead to debility and decrease quality of life (QoL). Duloxetine could provide persistent long-term pain relief in chronic musculoskeletal pain. Therefore, we aimed to investigate the efficacy of duloxetine in stage I or II SIS patients through comparing the nonsteroidal anti-inflammatory drugs (NSAIDs) treatment.Methods: The patients diagnosed with stage I or II SISwere randomly assigned into the duloxetine group (N= 37) and NSAIDs group (N= 37). Duloxetine group patients started on oral duloxetine 40 mg per day for one week and then titrated up to 60 mg per day for one week. NSAIDs group patients received oral loxoprofen sodium tablets 60mg3 times a day for two weeks. The standard measures for investigating the efficacy include pain intensity (VAS), ROM, shoulder functional status, and the QoL at baseline, end of treatment, and at 1 and 3 months follow-up.Results: 74 eligible patients completed the treatment and evaluation. Both treatment groups improved significantly from baseline over time. And all parameters of pain intensity, shoulder functionalstatus and QoL in the duloxetine group were significantly better than those in the NSAIDs group.And no one manifested SIS recurrence and side effects during the entire follow-up period.Conclusions: Both duloxetine and NSAIDs can be beneficial in the rehabilitation of stage I or II SIS patients. Moreover, duloxetine resulted in improvements in outcomes greater than NSAIDs for the treatment of SIS. The current results indicated that duloxetine treatment might be used as a new safe and effective alternative for SIS. Given the encouraging results of this study, it would be worthwhile to confirm our findings in randomized placebo-controlled multicentre clinical trials.

Fabrication of an Organogel-Based Transdermal Delivery System of Loxoprofen Sodium

Joint pain with high prevalence and yet without any specific treatment option is posing a challenge to healthcare professionals day by day. Amongst several treatment options currently utilized for arthritic joint pain are merely giving symptomatic relief rather than curative treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely accessed treatment option amongst all of the options. However, their adverse effects profile is a major hurdle for their use, especially in elderly patients. The present study was focused on developing a transdermal patch of a novel NSAID Loxoprofen sodium with enhanced penetration and improved patient compliance. Pluronic lecithin organogel (PLO) was selected as transdermal drug delivery platform to enhance its penetration through skin. Moreover, the transdermal route bypasses first-pass metabolism, gastrointestinal (GI) side effects, and the necessity to administer drug orally. All of these credentials ultimately improved patient compliance. Several experimental batches (PL1 to PL8) were formulated to prepare the PLO of loxoprofen sodium. All the batches were evaluated for physical appearance, pH, viscosity, spreadability, drug content, and in vitro drug diffusion profiles. An optimized batch was selected on the basis of the obtained results. It showed sustained drug release up to 12 h. The study evidenced that similar transdermal formulations of other NSAIDs can significantly enhance current treatment scenario for joint pain. Moreover, conversion of such formulations in transdermal patches or other forms ensure sustained and reproducible transdermal flux, which can be further fabricated as bioequivalent to the oral formulations. Further studies can be designed to evaluate the clinical applicability of the formulation.

Evaluation of the Percutaneous Absorption of Drug Molecules in Zebrafish

In recent decades, zebrafish (Danio rerio) has become a widely used vertebrate animal model for studying development and human diseases. However, studies on skin medication using zebrafish are rare. Here, we developed a novel protocol for percutaneous absorption of molecules via the zebrafish tail skin, by applying a liquid solution directly, or using a filter paper imbibed with a chemical solution (coating). Human skin is capable of absorbing felbinac and loxoprofen sodium hydrate (LSH), but not glycyrrhetinic acid (GA) and terbinafine hydrochloride (TH). To evaluate the possibility and the quality of transdermal absorption in zebrafish, we transdermally administered these four drugs to zebrafish. Pharmacokinetics showed that felbinac was present in the blood of zebrafish subjected to all administration methods. Felbinac blood concentrations peaked at 2 h and disappeared 7 h after administration. GA was not detected following transdermal administrations, but was following exposure. LSH was not found in the circulatory system after transdermal administration, but TH was. A dose-response correlation was observed for felbinac blood concentration. These findings suggest that zebrafish are capable of absorbing drug molecules through their skin. However, the present data cannot demonstrate that zebrafish is a practical model to predict human skin absorption. Further systemic studies are needed to observe the correlations in percutaneous absorption between humans and zebrafish.