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

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

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

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

 The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly used NSAIDs for post-caesarean pain management.

 One hundred and eighty-eight participants slated for caesarean delivery under spinal anesthesia were randomized into two groups of 94 participants each. One group received 2ml intravenous 8mg dexamethasone while the second group received 2ml of intravenous sterile water as placebo. Both groups received similar doses of intramuscular acetaminophen and diclofenac. Intramuscular pentazocine at a dose of 0.5mg/kg body weight was used as rescue analgesia. Primary outcome was the mean summed pain intensity difference (MDPID) in the two groups while the secondary outcomes include the needs and frequency of rescue analgesia, and the levels of maternal satisfaction. P-value set as ≤0.05.

 The mean summed pain intensity difference (MSPID) at 24hours post-caesarean was higher in the dexamethasone group, (29.27±18.10 versus 24.24±13.14, p=0.036). The percentage of the participants that required rescue analgesia in the dexamethasone group was less (60.6% versus 76.1%, p=0.024). The Overall levels of maternal satisfaction were comparable in both groups.

Intraoperative dexamethasone given intravenously as adjuvant to intramuscular diclofenac and acetaminophen minimizes opioid administration within the first 24hours after caesarean section.

Stenotrophomonas maltophilia is an opportunistic pathogen causing nosocomial infections. Diclofenac is an anti-inflammatory drug that is considered a non-antibiotic drug. This study assessed the antibacterial and antibiofilm effects of diclofenac and levofloxacin/diclofenac combination against levofloxacin resistant isolates.

Minimum inhibitory concentration was determined using broth microdilution method for levofloxacin, diclofenac, and levofloxacin/diclofenac combination. Biofilm forming capacity and biofilm inhibition assay were determined. Relative gene expression was measured for efflux pump genes; smeB, and smeF genes and biofilm related genes rmlA, spgM, and rpfF without and with diclofenac and the combination.

Diclofenac demonstrated MIC of 1 mg/ml. The combination-with ½ MIC diclofenac- showed synergism where levofloxacin MIC undergone 16-32 fold decrease. All the isolates that overexpressed smeB and smeF showed a significant decrease in gene expression in presence of diclofenac or the combination. The mean percentage inhibition of biofilm formation with diclofenac and the combination was 40.59% and 46.49%, respectively. This agreed with biofilm related genes expression investigations.

Diclofenac showed an antibacterial effect against Stenotrophomonas maltophilia. The combination showed in-vitro synergism, significant reduction in biofilm formation and in the relative level of gene expression. Furthermore, it can potentiate the levofloxacin activity or revert its resistance.

Fenugreek has a long history as both a culinary and medicinal herb in the ancient world. In the current study, the authors aimed to determine the effect of this plant on diclofenac-induced hepatic, renal and duodenal damages.

Thirty five albino rats were randomly divided into five groups consisting of seven rats each. The extract of fenugreek seeds or Trigonella foenum-graecum (TFG) was administered to the rats in groups III and IV via the orogastric route. Diclofenac at 50mg/kg was also administered by the oral route to the rats in groups II, III, IV and V to induce hepatotoxicity and nephrotoxicity. 500mg/kg Levofloxacin was administered as treatment to rats in group V. Twenty four hours after the last treatment, all animals were sacrificed and the organs of interest removed and dissected for histopathological examinations.

The extract of TFG increased the weight of kidney and liver tissues relative to total body weight, maintained the histology of the kidneys at a concentration of 500 and 1000mg/kg, and ameliorated the damages observed in the intestinal mucosa following administration of diclofenac. The extract also mitigated hepatocytic damages, interhepatocytic hemorrhages, vascular congestions and restored the hepatocytes’ arrangements.

The findings of the current study demonstrate that the TFG extract produced promising therapeutic effects by significantly preventing toxicity in the duodenum, liver and kidneys of the rats by healing the diclofenac-induced damages.

Diclofenac (DIC) is an NSAID that can cause toxic effects in animals and humans and carvacrol (CAR) is a monoterpene compound that displays effective pharmacological and biological actions. The purpose of this work was to assess the influences of CAR on DIC‑induced liver injury and oxidative stress in male rats.

The male Wistar rats were segregated into four groups. Group 1, the control group; Group 2 received DIC‑only (10 mg/kg BW, p.o); Group 3, received CAR‑only (10 mg/kg BW, p.o), and group 4 received DIC plus CAR. The serum levels as well as the activity of several liver‑associated markers, and oxidative and anti‑oxidant compounds were tested. The expression of pro‑inflammatory mediators was also studied using the qRT‑PCR analysis.

Our results showed that DIC treatment was associated with the elevation in the serum levels of liver‑related markers together with the increase in the serum and the hepatic levels of malondialdehyde (MDA) and protein carbonyl (PC). Moreover, DIC reduced the activity of the antioxidant system in the rats and increased lymphocyte infiltration into the hepatocytes. CAR; however, protected the hepatocytes from the toxic effects of DIC by enhancing the activity of antioxidant enzymes such as catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and Glutathione (GSH). By diminishing the expression of tumor necrosis factor (TNF)‑α, CAR was also capable of preventing the inflammatory effects of DIC on liver cells.

The findings of this study indicated that the administration of CAR could alleviate the noxious effects of DIC on the antioxidant defense system and liver tissue.

Nicolau syndrome (NS) is a rare aseptic cutaneous adverse reaction and necrosis caused by intra-muscular, subcutaneous,intravenous, or intra-articular injection of various drugs. We report a case of this syndrome. A 20-year-old male who developedintense pressure pain, the local sensation of heat, and reddish discoloration of the skin after receiving an intramuscular injection ofdiclofenac for renal colic. The complaints started two days after the injection. The patient was managed at peripheral health care center as a case of post-injection site abscess. However, the patient developed gluteal necrosis and was referred to our tertiary care center for further management. The patient was treated with antibiotics, and aggressive multiple debridements, and healed with secondary intention with an ugly scar. The observed syndrome was due to the injection of the drug into subcutaneous tissue instead of proper muscular planes. Medical and paramedical personnel must be properly educated and sensitized to such a complication that can occur during drug administration. They should follow the standard and appropriate injection techniques and take all necessary precautions to avoid this severe complication, which increases the patient's morbidity. Proper teachings of injection techniques to junior medical and paramedical staff should be exercised at the apex and peripheral centers for the prevention of this syndrome.

Postoperative pain following laparoscopic cholecystectomy is common in abdominal surgeries. Opioids and non-steroidal anti-inflammatory drugs are used in the management of postoperative pain. The current clinical study was undertaken to evaluate the efficacy of a preemptive diclofenac suppository for the alleviation of post-surgery pain and opioid consumption in laparoscopic cholecystectomy patients.

A total of eighty patients aged 18 to 65 who underwent laparoscopic cholecystectomy in Sina Hospital of Maragheh University of Medical Sciences were included in this prospective, matched case-control study and were randomly allocated to two groups of 40 each. Subjects received 100 mg diclofenac suppository or placebo within 2 h before surgery. The pain score and analgesic consumption data were recorded up to 24 h postoperatively. An Independent t-test was utilized for the analysis of results.

Visual Analogue Scale (VAS) scores in the diclofenac group were statistically lower at 2, 4, 8, and 12 hours compared to the placebo-controlled group. Opioid consumption was statistically significantly reduced in the treatment group compared to the control group (20.0 ± 3.48 vs 54.7 ± 3.63 ml, respectively. Rescue analgesia usage was significantly higher in the control group. Half of the patients in the diclofenac group did not need any opioid drug. Besides, postoperative side effects and hospital staying duration were decreased in the diclofenac group in comparison to the control group.

Current study demonstrates that preemptive diclofenac 100 mg administration could be taken into consideration to alleviate postoperative pain and is a valuable addition to the standard treatment following cholecystectomy pain management.

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

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

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

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

This study was designed to investigate the effect of berberine (BBR) on diclofenac sodium-induced testicular impairment in mice.  Eighteen male mice were divided randomly and equally into three groups for three weeks. One group was kept as control, the second group was injected intraperitoneally with diclofenac sodium (DS) at a dose of 10 mg/kg BW daily during the second and third weeks. The third group received daily oral administration of BBR at a dose of 50 mg/kg BW throughout the whole period of the experiment in parallel with the injection of the above-mentioned dose of DS during the second and third weeks. Plasma testosterone as well as testicular lipid peroxides (LPO), nitric oxide (NO), glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were evaluated. In paraffin-embedded testicular tissues, histological examination, immuno-expression of glutathione reductase (GR), and TUNEL assay were carried out.  Testosterone levels were within the normal range in all groups. BBR decreased testicular LPO and induced SOD and GSH without marked changes in CAT and NO. The histology of testis was improved and, regularity and integrity of seminiferous tubules basement membranes, and distribution and amount of peritubular collagen fibers were normalized. BBR treated group showed few positive GR immuno-expression in spermatogenic cells and negative GR immuno-expression in interstitial cells of Leydig along with a few apoptotic spermatogenic cells.  BBR is effective in protecting against DS-induced testicular dysfunction by improving oxidant/anti-oxidant balance and blocking the apoptotic cascade.

Diclofenac is one of the drug compounds that is known as an emerging contaminant in aqueous solutions. Studies have shown that biological treatment is not sufficient to treat these compounds and new methods such as adsorption should be used to prevent contamination of aquatic environments. One of the native absorbers in this regard is the pumice. This study aimed to investigate the removal of diclofenac from aqueous solutions using magnesium chloride modified pumice.

In this experimental study, with a practical approach, the required adsorbent was prepared from pumice. Magnesium chloride was used for pumice modification. The experiments were performed in a closed system at laboratory temperature. In this study, the effect of variables, adsorbent dose, contact time, and pH on diclofenac removal was investigated. Diclofenac was analyzed by KNAUER model HPLC at a wavelength of 254 nm.

Modified pumice by magnesium chloride was able to remove 95.83% of diclofenac (20 mg/l) at a concentration=1 g/l for 15 minutes at pH=5. Comparison of modified and natural pumice performance in 5, 10, 15, 30, 40 minutes with an average of 89.52% of modified pumice removal, compared to 48.15% of natural pumice removal, which was 1.86 times more efficient.

Pumice can be used as a cheap, available, and highly effective adsorbent for the removal of diclofenac from aqueous solutions.

 Pain is the most common side effect of induced medical abortion. However, the optimal analgesia method remains as a clinical challenge. This study aimed to compare the efficacy of two methods of administration of diclofenac as a prophylactic or a therapeutic in pain management in induced second-trimester medical abortion. 

This randomized clinical trial study was conducted upon pregnant women who were candidates for induced medical abortion and referred to a tertiary educational hospital between October 2019 and December 2020. Participants were divided into two groups based on the mode of diclofenac administration, which was either simultaneously with the first dose of misoprostol or after beginning of the pain. Pain severity, induction-to-abortion time interval, total misoprostol dosage, Hemoglobin concentration, length of hospitalization, and size of retained pregnancy products by ultrasound, and the cumulative dose of opioid usage were compared between the groups.

The severity of pain which was measured by a visual analog scale (VAS), residual of conceived products, hospitalization days, and the total misoprostol dosage were significantly lower (P<0.05) in the prophylaxis compared to the treatment group.

Simultaneous administration of diclofenac with misoprostol as prophylactic method of pain management may be an optimal method in induced medical abortion in the second trimester.

In recent years, there has been a great deal of concern related to drug pollutants in water resources. The aim of this study was to evaluate the efficacy of the biochar obtained from the pine bark in removing of diclofenac from aqueous solutions.

In this batch study, the effect of various variables such as pH (2-12), adsorbent dose (0.1- 2 gr), initial concentration of diclofenac (50- 500 mg/L), contact time (10-120 min) and temperature (10- 50°C), as well :as char:acterization of the biochar were investigated with BET, FTIR and FESEM techniques. The isotherm, kinetics and thermodynamics of the adsorption process were evaluated.

The highest removal of diclofenac (80.4%) was at pH 6.2. In this study, the adsorption efficiency of diclofenac increased with increasing the adsorbent dose and decreased with increasing the initial concentration of diclofenac. The adsorption isotherm of diclofenac fitted to Langmuir model with maximum adsorption capacity was 54.64 mg/g. The kinetics of the adsorption process followed by the pseudo-second-order kinetic model and thermodynamic parameters showed the diclofenac adsorption onto the biochar was exothermic and spontaneous.

Based on the results, the adsorption efficiency of diclofenac by the biochar of the pine bark is suitable and it can be efficient for removal of diclofenac from hospital and other pharmaceutical compounds producers’ wastewaters.

Patients with nasal polyposis frequently have associated bronchial asthma and hypersensitivity to NSAIDs. When the three conditions co-exist, it is referred to as the Samter’s triad. Patients with Samter’s triad are an important subset of those with aspirin-exacerbated respiratory disease (AERD). We present a case of a young female patient undergoing endoscopic sinus surgery for nasal polyps, who although did not show any other features of AERD, went on to develop florid anaphylaxis to diclofenac administration intra-operatively. After adequate resuscitation and intensive care stay, the patient made a complete recovery. NSAIDs must be avoided in patients with nasal polyps, despite showing no other features of this syndrome. Other analgesic agents that can be used include IV paracetamol and opioids like tramadol.

Various methods of analgesia can be used to reduce or prevent procedural pain in emergencydepartment (ED). This study aimed to evaluate the effectiveness of topical lidocaine-diclofenac combinationcompared to lidocaine-prilocaine combination (Xyla-P) in reduction of the pain during central venous catheter(CVC) insertion.

In this randomized clinical trial, 100 adult patients requiring CVC insertion in the EDwere enrolled. These patients were randomly divided into two groups. The site of CVC insertion was coveredwith 2 g of topical Xyla-P cream in the first group, and 2 g of topical lidocaine-diclofenac cream in the secondgroup. The primary outcome was the pain during CVC implantation. The secondary outcomes were physiciansatisfaction and the incidence of side effects.

On the visual analog scale (VAS), the pain score duringCVC insertion was significantly lower in the second group (p = 0.027). However, there was no difference in painscores during lidocaine injection between the two groups (p = 0.386). Also, there was no significant differencein the rate of side effects between the two groups (p = 1.0). The physician’s satisfaction with the first groupwas significantly lower than the second group (p = 0.042).

Although the CVC insertion pain wassignificantly lower in patients who received the topical combination of Lidocaine plus Diclofenac, there wasno clinically important difference between the two groups and both topical anesthetics were effective and safein reducing pain intensity. Also, lidocaine-diclofenac combination cream was more cost-effective than Xyla-Pcream.

Fever is the most common complaint among the children admitted to health care centers. The aim of this study was to compare the anti-pyretic effect of diclofenac and high dose acetaminophen suppository in 1 to 6 years old children.

This double-blind clinical trial study was performed on 1-6-year-old children hospitalized in 17th Shahrivar Teaching Hospital, Rasht, Iran. Children were divided into two groups of 45 using a block randomization design. The first group received a high dose of acetaminophen suppository at a dose of 30 mg/kg and the second group received a diclofenac suppository at a dose of 1 mg/kg. The rectal temperature of the patients was measured using a digital thermometer at the time of drug administration, and one and three hours after that.

90 children were studied in two groups of 45 each. Temperature changes in the diclofenac group were significantly greater than the acetaminophen group, so from zero to 3 hours after administering diclofenac, the temperature decreased to 1.76±0.95°C. This reduction was lower in acetaminophen group (1.26±0.49°C, P=0.019).

Both acetaminophen and diclofenac suppositories significantly reduced the rectal temperature. However, the effect of rectal diclofenac on reducing temperature is more than rectal acetaminophen.