Diclofenac sodium 75mg gastro-resistant / Misoprostol 200microgram tablets

Abstract Objectives To assess the value of misoprostol intake before hysteroscopy in nulliparous women. Search strategy Databases screening was done from inception to July 2023 using “Misoprostol” AND “Hysteroscopy” AND “Nullipara” and their MeSH terms as keywords. Selection criteria Thirteen studies were included in our analysis. Seven studies compared misoprostol to placebo, 3 studies compared it to dinoglandin, 1 study compared it to diclofenac and 4 studies compared different misoprostol doses and routes. These studies were conducted on 1528 participants,958 of them received misoprostol, 221 received dinoglandin, 51 received diclofenac and 308 received placebo. Data collection and analysis Extracted data included study place, participants number, inclusion and exclusion criteria, intervention details as dose, route, timing and comparotor, and hysteroscopy details. Main Results Ease of cervical dilatation was reported in 3 studies (309 participants) and revealed an effect estimate mean difference (MD) of -0.57 [-1.72, 0.58] and a P value of 0.33. The time needed for cervical dilatation was reported in 6 studies (512 participants) and revealed a MD of -22.96 [-43.29, -2.62] and a P value of 0.03. The preoperative cervical width was reported in 4 studies (263 participants) and revealed MD of 1.69 [-0.09, 3.46] and a P value of 0.06. The number of women with failure of cervical dilatation or who needed further dilatation was reported in 4 studies (372 participants) and revealed a MD of 0.40 with [0.13, 1.17] 95% CI and a P value of 0.09. The preoperative pain was reported in 3 studies (351 participants) and revealed a MD of -0.56 [-2.30, 1.18] and a P value of 0.53. Total number of cases who experienced side effects and procedure complications were reported in 2 and 3 studies (249 and 252 participants) respectively and revealed an effect estimate Odd Ratio of 1.99 and 0.42 with [0.27, 14.67] and [0.14,1.32] 95% CI and a P value of 0.50 and 0.14 respectively. In the 3 studies comparing misoprostol to dinoglandin, The ease of cervical dilatation, time needed for cervical dilatation and preoperative cervical width were evaluated in 1,3 and 2 studies with 60, 436 and 376 participants respectively. The estimated MD were not estimated, 0.17 and 0.01; 95% CI were not estimated, [-4.70, 5.05], and [-0.78, 0.79]; P values of 0.94, 0.98 and 0.99 and I 2 of 96%,95% and 74% respectively. Conclusion Misoprostol improved the time needed for cervical dilatation without affecting the rate of complications or drug side effects when compared to placebo but has similar outcomes to dinoglandin with higher side effects. Registration number CRD42023438432.

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Conflicting evidence exists regarding the effectiveness of pharmacological interventions in reducing pain during intrauterine device (IUD) insertion. This study aimed to evaluate the safety and efficacy of various analgesics and to rank their effectiveness. A total of 71 randomized controlled trials (RCTs) involving 10,870 women were included. Data were sourced from PubMed, Cochrane Library, Scopus, and other databases up to September 2023. Analyses were performed using the Netmeta package in R, with results reported as standardized mean differences (SMDs) and risk ratios (RRs), each with corresponding 95% confidence intervals (CIs). Lidocaine 4% gel (5 mL) emerged as the most effective option for pain relief during IUD insertion (SMD = -4.5; 95% CI: -5.9- -3.0; low-quality evidence), followed by lidocaine 1% solution (10 mL; SMD = -3.20). Lidocaine 4% gel also ranked highest for reducing pain during tenaculum placement, while misoprostol 400 mcg improved the ease of IUD insertion. Despite the low quality of evidence, lidocaine 4% gel appears to be the most effective pharmacological intervention for pain reduction during IUD insertion.

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OBJECTIVE: The management of postoperative endodontic pain (PEP) is essential to contemporary endodontic practice. Diclofenac and ibuprofen (IBU) are two of the most widely-used non-steroidal anti-inflammatory analgesics. However, their comparative data are neither sufficient nor conclusive. This prospective randomised clinical trial aimed to compare the analgesic efficacy of diclofenac potassium (DFK) with IBU on PEP in maxillary and mandibular first molars diagnosed with irreversible pulpitis after single-visit non-surgical root canal treatment. METHODS: Sixty-four patients were randomised into two groups of DFK (n=32) and IBU (n=32), using the stratified permuted randomisation method, and 61 participants completed the trial. After root canal treatment, patients randomly received IBU 400 mg every 6 hours (n=31) or DFK 50 mg every 8 hours (n=30) for 24 hours. Patients recorded their pain level on 0-100 mm visual analogue scales (VAS) at 2, 4, 6, 12, and 24 hours after the treatment. Recorded VAS scores and the number of pain-free patients (VAS<5) were compared between the two groups. A generalised linear estimation equation model, Chi-Square test, and Mann-Whitney U test were used to analyse the data. RESULTS: The mean overall PEP score was statistically significantly lower in the DFK group than the IBU group with a p value of 0.030. Pain scores at 2 (p=0.034), 4 (p=0.021), and 24 hours (p=0.042) after the treatment were also significantly lower for DFK than IBU. The number of pain-free patients was also significantly higher in the DFK group at 2-hour (p=0.015) and 4-hour (p=0.048) time points and overall (p=0.013) compared to the IBU group. There was no adverse effect observed in either group. CONCLUSION: Based on the results, taking multi-dose DFK 50 mg by the clock had better analgesic outcomes than multi-dose IBU 400 mg for PEP management. (EEJ-2022-01-07).

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Background: Postoperative pain after cesarean section remains a frequent clinical concern and may delay mobilization and recovery. Nonsteroidal anti-inflammatory drugs such as diclofenac sodium are commonly used, but the optimal route of administration for effective analgesia and reduced need for rescue medication remains debated. Aim: To compare the effectiveness of per-rectal diclofenac sodium versus intramuscular diclofenac sodium for postoperative analgesia after cesarean section. Materials and Methods: A randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, National Hospital Lahore, from November 2024 to April 2025. A total of 274 primigravida women (137 per group), aged 18 to 35 years, with singleton pregnancies and ASA physical status I or II undergoing cesarean section under spinal anesthesia were enrolled through non-probability consecutive sampling. Group A received intramuscular diclofenac sodium 75 mg twice daily for 24 hours, while Group B received per-rectal diclofenac suppository 100 mg twice daily. Primary outcome was the requirement of rescue analgesia within 24 hours. Secondary outcomes included Visual Analogue Score at 24 hours and time to rescue analgesia. Data were analyzed using chi-square and independent sample t-tests. Results: Mean maternal age was 26.42 ± 4.18 years in Group A and 25.87 ± 4.32 years in Group B (p = 0.31). Mean gestational age was 38.16 ± 1.52 versus 38.34 ± 1.48 weeks (p = 0.34), and mean body mass index was 27.63 ± 3.41 versus 27.28 ± 3.56 kg/m² (p = 0.43). Rescue analgesia was required in 79 participants (57.66%) in Group A and 58 participants (42.34%) in Group B (p = 0.011). Mean 24-hour VAS score was 4.53 ± 1.82 in Group A and 3.76 ± 1.96 in Group B (p = 0.001). Time to rescue analgesia was 3.87 ± 2.46 hours versus 4.52 ± 2.71 hours (p = 0.14). Conclusion: Per-rectal diclofenac sodium achieved better postoperative pain control and reduced reliance on rescue analgesia compared to intramuscular diclofenac sodium after cesarean section.

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Intrauterine devices (IUDs) are considered a reliable contraceptive option for women, but they can come with side effects. There is a disconnect in standard guidelines for IUD insertion within and without the U.S. The objective of this review was to address a gap in the literature regarding official procedures for pain management during IUD implantation. This scoping review was initiated using keywords to extract relevant articles from multiple databases: U.S. National Library of Medicine National Institutes of Health (PubMed), MEDLINE (Ovid), and Excerpta Medica dataBASE (EMBASE, Ovid). Initially, 457 articles were identified and after a rigorous screening and selection process, 37 articles were chosen to be further assessed to ascertain if they met the study's inclusion criteria. Those 37 articles were further evaluated fully to check for relevancy. From that process, 19 articles were chosen for the review, and all passed quality assessment evaluations using the JB Appraisal Tools. To best address the research question, the data from the 19 articles were divided into three categories: 1) circumstantial factors, 2) non-pharmacological methods, and 3) pharmacological methods. Circumstantially, women with previous vaginal deliveries experienced the lowest pain during the procedure, and nulligravid (never pregnant) women experienced the most pain. Lower pain scores were reported by lactating women compared to non-lactating. Black women experienced the most anticipated pain compared to other races. Regarding non-pharmacological methods, different insertion techniques, tools, and the use of a cold compress were found to not affect the level of pain during IUD insertion. Lastly, it was shown that pharmacological methods such as lidocaine gel, lidocaine paracervical block, and lidocaine combined with either diclofenac or prilocaine decreased pain scores at different time stamps of the procedure. Also, oral ketorolac and a vaginal combination of misoprostol and dinoprostone helped reduce pain. Findings from this scoping review revealed a lack of uniformity across practices when performing IUD insertions, possibly due to differences in procedures across circumstantial factors, non-pharmacological methods, and pharmacological methods. More research is needed to investigate the intricacies of pain with IUD insertion. Moving forward, especially following a potential increase in the use of IUDs after the reversal of Roe v. Wade, establishing this gap may lead to a more refined standardized protocol to mitigate pain with IUD insertions.

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Introduction: Esophageal Cancer (EC) ranks among the most common malignancies worldwide. Most EC patients acquire drug resistance to chemotherapy either intrinsically or acquired after T-DM1 treatment, which shows that increasing or decreasing the expression of particular genes might influence chemotherapeutic sensitivity or resistance. Therefore, gaining a deeper understanding of the altered expression of genes involved in EC drug resistance and developing new therapeutic methods are essential targets for continued advancement in EC therapy. Methods: The present study aimed to find critical regulatory genes/pathways in the progression of T-DM1 resistance in OE-19 EC cells. Expression datasets were extracted from GEO omnibus. Gene interactions were analyzed, and the protein-protein interaction network was drawn. Then, enrichment analysis of the hub genes and network cluster analysis of the hub genes was performed. Finally, the genes were screened in the DrugBank database as therapeutic targets and molecular docking analysis was done on the selected targets. Results: In the current study, nine hub genes were identified in TDM-1-resistant EC cells (CTGF, CDH17, THBS1, CXCL8, NRP1, ITGB5, EDN1, FAT1, and PTGS2). The KEGG analysis highlighted the IL-17 signaling pathway and ECM-receptor interaction pathway as the most critical pathways; cluster analysis also showed the significance of these pathways. Therefore, the genes involved in these two pathways, including CXCL8, FSCN1, PTGS2, SERPINE2, LEF1, THBS1, CCN2, TAGLN, CDH11, and ITGA6, were searched in DrugBank as therapeutic targets. The DrugBank analysis suggests a potential role for Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in reducing T-DM1 drug resistance in EC. The docking results revealed that NSAIDs, including Diclofenac, Mefenamic acid, Celecoxib, Naproxen, and Etoricoxib, significantly suppress resistant cancer cells. Conclusion: This comprehensive bioinformatics analysis deeply explains the molecular mechanisms governing TDM-1 resistance in EC. The identified hub genes and their associated pathways offer potential targets for therapeutic interventions. Moreover, the possible role of NSAIDs in mitigating T-DM1 resistance presents an intriguing avenue for further investigation. This research contributes significantly to the field and establishes a basis for further research to enhance treatment efficacy for EC patients.

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BACKGROUND: Pterospermum rubiginosum has been traditionally used by the tribal inhabitants of Southern India for treating bone fractures and as a local anti-inflammatory agent; however, experimental evidence to support this traditional usage is lacking. The present study aimed to investigate the phytochemical characterization, in silico and in vitro anti-inflammatory evaluation, followed by in vivo toxicological screening of P. rubiginosum methanolic bark extract (PRME). RESULTS: The LCMS evaluation revealed the presence of 80 significant peaks; nearly 50 molecules were identified using the LCMS database. In silico analysis showed notable interactions with inducible nitric oxide synthase (iNOS) and interleukin-6 (IL-6). In vitro gene expression study supported the docking results with significant down-regulation of iNOS, IL-6, and IL-10. PRME was administered orally to the SD rats and was found to be non-toxic up to 1000 mg/kg body weight for 14 days. The antioxidant enzymes catalase and sodium dismutase exhibited an increased value in PRME-administered groups, possibly due to the diverse phytochemical combinations in bark extract. CONCLUSIONS: PRME administration significantly downregulated the gene expression of inflammatory markers, such as iNOS, IL-6, and IL-10. The molecular docking analysis of iNOS and IL-6 supports the in vitro study. In vivo toxicological study of PRME in SD rats was found to be non-toxic up to a concentration of 1000 mg/kg body weight for 14 days.

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Prostaglandins have stimulative influence on the human uterus and therefore were introduced to medical treatment in reproductive healthcare as labor inductors or abortifacients. The UHPLC-ESI-QqQ-MS/MS method was developed for six prostaglandins: carboprost, cloprostenol, dinoprost (PGF2α), dinoprostone (PGE2), misoprostol and sulprostone (substances for pregnancy termination) in pharmaceutical samples and was applied for the toxicological examination of pills containing misoprostol (collected during gynecological examination). There were used two internal standards: misoprostol-d5 and PGF2α-d4. The quantification of analytes was performed in the MRM mode. The linearity of method was in the range from 0.1 to 10 µg/mL, with a coefficient of determination above 0.997 (R2) for each compound. The precision and accuracy values did not exceed ±5.0%. Analysis of the pills revealed the presence of two substances: misoprostol and diclofenac. Misoprostol and diclofenac dose per sample were as follows: 608.8 ng (sample 1), 708.4 ng (sample 2), 618.8 ng (sample 3) and 67.7 mg (sample 1), 65.3 mg (sample 2) 67.3 mg (sample 3), respectively. A simple, precise and reliable method can be applied for routine examinations in terms of clinical and forensic toxicology examinations as well as in quality control of drugs for pharmaceutical purposes (original drugs and counterfeit medications).

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