Topical NSAIDs for chronic musculoskeletal pain: systematic review and meta-analysis

A previous systematic review reported that topical NSAIDs were effective in relieving pain in chronic conditions like osteoarthritis and tendinitis. More trials, a better understanding of trial quality and bias, and a reclassification of certain drugs necessitate a new review. Studies were identified by searching electronic databases, and writing to manufacturers. We identified randomised, double blind trials comparing topical NSAID with either placebo or another active treatment, in adults with chronic pain. The primary outcome was a reduction in pain of approximately 50% at two weeks, and secondary outcomes were local and systemic adverse events and adverse event-related withdrawals. Relative benefit and number-needed-to-treat (NNT), and relative harm and number-needed-to-harm (NNH) were calculated, and the effects of trial quality, validity and size, outcome reported, and condition treated, were examined by sensitivity analyses. Twelve new trials were added to 13 trials from a previous review. Fourteen double blind placebo-controlled trials had information from almost 1,500 patients. Topical NSAID was significantly better than placebo with relative benefit 1.9 (95% confidence interval 1.7 to 2.2), NNT 4.6 (95% confidence interval 3.8 to 5.9). Results were not affected by trial quality, validity or size, outcome reported, or condition treated. Three trials with 764 patients comparing a topical with an oral NSAID found no difference in efficacy. Local adverse events (6%), systemic adverse events (3%), or the numbers withdrawing due to an adverse event were the same for topical NSAID and placebo. Topical NSAIDs were effective and safe in treating chronic musculoskeletal conditions for two weeks. Larger and longer trials are necessary to fully elucidate the place of topical NSAIDs in clinical practice

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis

Background: Oesophageal cancer, in particular adenocarcinoma, has a strong male predominance. However, the impact of patient sex on operative and oncologic outcomes and recovery of health-related quality of life is poorly documented, and was the focus of this large multicentre cohort study. Methods: All consecutive patients who underwent oncological oesophagectomy from 2009 to 2015 in the 20 European iNvestigation of SUrveillance after Resection for Esophageal cancer study group centres were assessed. Clinicopathologic variables, therapeutic approach, postoperative complications, survival and health-related quality of life data were compared between male and female patients. Multivariable analyses adjusted for age, sex, tumour histology, treatment protocol and major complications. Specific subgroup analyses comparing adenocarcinoma versus squamous cell cancer for all key outcomes were performed. Results: Overall, 3974 patients were analysed, 3083 (77.6%) male and 891 (22.4%) female; adenocarcinoma was predominant in both groups, while squamous cell cancer was observed more commonly in female patients (39.8% versus 15.1%, P < 0.001). Multivariable analysis demonstrated improved outcomes in female patients for overall survival (HRmales 1.24, 95% c.i. 1.07 to 1.44) and disease-free survival (HRmales 1.22, 95% c.i. 1.05 to 1.43), which was caused by the adenocarcinoma subgroup, whereas this difference was not confirmed in squamous cell cancer. Male patients presented higher health-related quality of life functional scores but also a higher risk of financial problems, while female patients had lower overall summary scores and more persistent gastrointestinal symptoms. Conclusion: This study reveals uniquely that female sex is associated with more favourable long-term survival after curative treatment for oesophageal cancer, especially adenocarcinoma, although long-term overall and gastrointestinal health-related quality of life are poorer in women

Evaluation of the efficacy and tolerability of a new locally acting preparation of flurbiprofen in scapulohumeral periarthritis

This randomised, double-blind, placebo-controlled, parallel-group trial was carried out to assess the efficacy and tolerability of a new, locally acting, transcutaneous flurbiprofen preparation (flurbiprofen LATTM, Boots Company PLC) in the treatment of scapulohumeral periarthritis. The new preparation consists of a nonwoven polyester patch supporting a mentholated formulation containing flurbiprofen 40 mg. Eighty patients suffering from the acute, painful phase of scapulohumeral periarthritis entered the trial, three of which failed to provide follow-up data. Each patient applied one patch every 12 hours for the 14 day trial period. Efficacy was assessed in terms of reduction of pain, improvement in shoulder movement and overall clinical assessment of the severity of the condition after treatment. Statistically significant improvements from baseline were observed in both treatment groups, with a constant overall trend in favour of flurbiprofen. The differences between the two treatment groups, however, did not reach statistical significance

Characterization of &#8220;in vivo&#8221; sampled VOCs of Bixa orellana and its seeds extracts properties

The purpose of this study was to identify the volatile organic compounds (VOCs) profile of different organs of Bixa orellana plants sampled \u201cin vivo\u201d in the North of Par\ue1 State, Brazil. Sampling was done during an expedition on February 2011 within the Itaputyr project, an Italian-Brazilian experience of bottom-up cooperation for development. (1,2). Moreover, antioxidant capacity, phenolic content and insect repellent activity of powdered seeds extracts (aqueous and ethanolic) were tested. Branches, leaves, fruits and seeds were sampled "in vivo" using Divinylbenzene/Carboxen/Polydimethylsiloxane (DVB/CAR/PDMS) fibers with the HS-SPME technique. Each plant\u2019s part was enclosed in a customised teflon cage (manufactured by SNK, Inc, Fullerton, CA: 11 x 21 cm) into which a manual SPME holder was inserted to extract the headspace. HS-SPME analyses were performed using a Trace GC Ultra Gas Chromatograph coupled to a quadrupole Mass Spectrometer Trace DSQ (Thermo-Fisher Scientific; Waltham, MA, USA). Volatile compounds detected in Bixa orellana seed headspace consisted mainly of sesquiterpenes, monoterpenes, and arenes. Most monoterpenes and sesquiterpenes have been previously detected in other spices and plants (3). \u3b1-humulene is the major volatile present in Bixa orellana seed extracts followed by D-germacrene, \u3b1-and \u3b2-pinene and \u3b3-elemene. Some of the monoterpenes and sesquiterpenes found in plant extracts have been previously described as having antimicrobial and repellent properties (4). Phenolic content and antioxidat capacity, evaluated with Folin-Ciocalteur and DPPH tests respectively, were not so high, while preliminary data on repellency against Aedes aegypti of three different dried seeds extracts (ethanol, hexane, ethanol /water) indicated a significant activit

Ethnobotanical study of medicinal plants traditionally used in the North of Par&#225; State, Brazil

Traditional knowledge about the use of natural resources is becoming increasingly important in defining the basis of sustainable strategies and actions for conservation, valorization and development of rural and marginal areas. In this study is presented an ethnobotanical survey on medicinal plants used by an Indio tribe leaving in the Amazon rainforest, in the North of Brazil inside the Indigenous Reserve Alto Rio Guam\ue0, Par\ue0 state. First step has been conducted by collecting information directly from the Indio Temb\ue8 population, during an expedition on February 2011, done within the Itaputyr project, an Italian-Brazilian experience of bottom-up cooperation for development (1,2). The methods of participant observation, semi-structured interviews and informal discussions with indigenous people and plant specialists were used. 10 different medicinal plant species commonly used by natives resulted to be interesting for further investigations. Andira anthelmintica, Bauhinia forficata, Bauhinia splendens, Bixa orellana, Copaifera langsdorfii, Parahancornia fasciculata, Pilocarpus jaborandi, Ptychopetalum olacoides, Stryphnodendron adstringens, Symphonia globulifera were analysed to verify antioxidant capacity and phenol content using DPPH. and Folin-Ciocalteau assay respectively. Characterization of volatile compounds of Andira anthelmintica, Ptychopetalum olacoides and Bauhinia splendens by SPME-GC/MS was also conducted. Almost all investigated plant species resulted to be good sources of phenolic compounds with high antioxidant capacity as compare to other plant species (3). Sustainable harvesting method and domestication of the highly used or traded species could be proposed in the study area to preserve biodiversity and also to create a sustainable development opportunity for Indio population based on traditional knowledge

A Multicentre Comparison of Flurbiprofen and Naproxen in Rheumatoid Arthritis: A Four-Week Study in 118 Patients

One-hundred and eighteen patients with rheumatoid arthritis were treated for 4 weeks with flurbiprofen 300 mg/day (sixty patients) or naproxen 750 mg/day (fifty-eight patients) in a six-centre randomized trial. Flurbiprofen proved to be more effective than naproxen in reducing morning stiffness (p &lt; 0·01), Ritchie articular index (p &lt; 0·01) and number of swollen joints (p &lt; 0·05) and in relieving night pain (p &lt; 0·01).The incidence and severity of side-effects, mainly gastric, were both low and similar with flurbiprofen (17%) and naproxen (19%).</jats:p