The aim of this review was to identify anti-inflammatory and antioxidant therapeutic agents and their effects on patients with chagasic myocarditis. A systematic review of the MEDLINE, EMBASE, WEB OF SCIENCE, SCOPUS, LILACS and CENTRAL databases (Cochrane Library) was carried out without language restrictions. The descriptors used were: ‘Chagas cardiomyopathy’, ‘treatment’, ‘Chagas disease’, ‘anti-inflammatory agents’, ‘Trypanosoma cruzi’ and ‘antioxidants’. A total of 4,138 articles was identified, six of which were selected for data extraction. Of these, four were related to antioxidant therapy with vitamins C and E supplementation, and two using anti-inflammatory therapy. The studies were carried out in Brazil and were published between 2002 and 2017. Antioxidant therapy with vitamin C and E supplementation increases the activity of antioxidant enzymes and reduces the oxidative markers. There is no conclusive data to support the use of vitamin supplementation and anti-inflammatory therapy in the treatment of chagasic cardiomyopathy. However, the studies indicate the possibility of vitamin supplementation as a new approach to the treatment of Chagas disease. Antioxidant therapy was proven to be a viable alternative for attenuating the oxidative damage caused by chronic chagasic cardiopathy, leading to a better prognosis for patients.

Non-steroidal anti-inflammatory drugs (NSAIDs) may inhibit antibody production by peripheral blood mononuclear cells; one consequence of this could be decreased effectiveness of vaccines in NSAID users. Because many older adults use low-dose aspirin for primary or secondary prevention of coronary events, any inhibitory effect of aspirin on vaccine immune response could reduce the benefits of vaccination programmes in older adults. We tested whether immune response to vaccination differed between users vs. non-users of low-dose aspirin, using data from four randomized trials of monovalent 2009 pandemic influenza A(H1N1) vaccine. Geometric mean haemagglutination inhibition antibody titres were not significantly lower in low-dose aspirin users compared to non-users. Our results provide reassurance that influenza vaccination effectiveness is probably not reduced in older adults taking chronic low-dose aspirin.

Introduction. Les réactions d’oxydation constatées régulièrement dans les aliments peuvent causer des dommages importants, entraînant parfois des cancers et maladies chroniques. Les extraits d’huiles essentielles étant connus pour posséder d’importantes propriétés thérapeutiques, notre étude a cherché à comparer les activités antiradicalaires et anti-inflammatoires des essences de C. reticulata var. Madagascar et C. sinensis var. Casagrande. Matériel et méthodes. Les huiles essentielles des feuilles d’agrumes ont été extraites par hydrodistillation et leur composition chimique a été analysée par chromatographie en phase gazeuse et par chromatographie en phase gazeuse couplée à la spectrométrie de masse. La détermination des propriétés antiradicalaires a été faite par la méthode du piégeage des radicaux libres à l’aide du diphenyl picryl hydrazyl (DPPH). En revanche, la méthode enzymatique par la lipoxygénase a permis d’évaluer l’activité anti-inflammatoire des extraits d’huiles essentielles obtenues par hydrodistillation. Résultats. Les propriétés antiradicalaires de nos échantillons ont été évaluées avec une SC50 égale à (4,10 ± 0,05) g·L–1 et (7,40 ± 0,55) g·L–1, respectivement, pour C. reticulata var. Madagascar et C. sinensis var. Casagrande, alors que le composé antiradicalaire de référence (butylhydroxytoluène ou BHT) donnait une SC50 de (7,02 ± 0,5) mg·L–1. Par ailleurs, les deux échantillons ont montré une activité anti-inflammatoire exploitable (IC50 de 53,5 mg·L–1 et 20,3 mg·L–1, respectivement) même si le NDGA (acide nordihydroguaiarétique) a eu une IC50 de 0,7 mg·L–1. Conclusion. C. reticulata var. Madagascar se révèle avoir une activité antiradicalaire plus importante que C. sinensis var. Casagrande, alors que cette dernière espèce a présenté l’activité anti-inflammatoire la plus marquée. Ces huiles essentielles pourraient être utilisées comme additifs alimentaires.

Background and objective: To determine whether prior exposure of non-steroidal anti-inflammatory drugs increases perioperative blood loss associated with major orthopaedic surgery.

Methods: Fifty patients scheduled for total hip replacement were allocated to two groups (double blind, randomized manner). All patients were pretreated for 2 weeks before surgery: Group 1 with placebo drug, Group 2 with ibuprofen. All patients were injected intrathecally with bupivacaine 20 mg plus morphine 0.1 mg, in a total volume of 4 mL, to provide surgical anaesthesia.

Results: The presence of severe adverse effects caused eight patients in the ibuprofen group and six in the placebo group to terminate their participation in the trial. The perioperative blood loss increased by 45% in the ibuprofen group compared with placebo. The total (±SD) blood loss in the ibuprofen group was 1161 (±472) mL versus 796 (±337) mL in the placebo group.

Conclusions: Pretreatment with ibuprofen before elective total hip surgery increases the perioperative blood loss significantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

Pain following tonsillectomy in children is a significant problem that tends to be underestimated. We audited post-operative pain in 33 children and found significant proportions of children in moderately severe to severe pain, particularly at, or soon after returning to the ward. These findings led to changes in practice that included the administration of pre-operative paracetamol and diclofenac as well as the uniform post-operative prescription of them, with printed instructions to reduce the scope for mistakes by medical staff. Other changes included a uniform policy, with which the nursing staff could become familiar, and the regular formal recording of pain to assist in the recognition of pain and analgesic requirements. On re-auditing two years later, in a group of 100 children, post-operative pain was significantly improved. The proportion experiencing moderately severe to severe pain on returning to the ward, as their maximum pain score and pain score at discharge fell from 70 per cent to 48 per cent, 85 per cent to 56 per cent, and six per cent to two per cent respectively.

We present a case of hypoxic brain damage that occurred after intramuscular injection of diclofenac due to a severe anaphylactic reaction. A 38-year-old nurse treated herself for acute lower back pain with 100 mg diclofenac intramuscularly. Five minutes later, she collapsed and developed coma and respiratory arrest. After cardiopulmonary resuscitation she was transferred to hospital. On admission she was comatose and received controlled ventilation of the lungs. Magnetic resonance imaging and computerized tomography showed signs of hypoxic brain injury and the patient died from central cardiopulmonary failure 7 days later. Intramuscular treatment with non-steroidal anti-inflammatory drugs such as diclofenac has rare but potentially severe side-effects. Therefore, intramuscular injections are inappropriate and should be replaced with oral or rectal treatment, which has similar absorption profiles.

The pain experienced at home and the burden this places on primary care resources is considerable following tonsillectomy in children. This was audited by postal questionnaire in 52 patients (36 responders). We found a significant proportion of patients experiencing moderately severe to severe pain and a high rate of consultation with general practitioners (50 per cent) for pain-related issues. These findings lead to changes in practice which included the provision of five days discharge medication (paracetamol/ibuprofen in non-asthmatics; paracetamol/dihydrocodeine in asthmatics) and improved written discharge advice. On re-auditing a year later in 100 patients (56 responders), we found reduced rates of consultation with general practitioners (27 per cent). However, the proportion of children experiencing moderately severe to severe pain was not reduced probably because most children were given the recommended analgesia during the first audit. We also found that paracetamol and ibuprofen was superior to paracetamol and dihydrocodeine for analgesia (p <0.05). Suggestions for further improvements are discussed.

The effect of a single pre-operative oral dose of controlled release diclofenac sodium on post-operative pain after minor gynaecological surgery was investigated. Fifty-two women took part in a double-blind controlled study. Pain was assessed by visual analogue scale (VAS), a four-point verbal rating score, and the requirement for post-operative analgesia. Those patients who received diclofenac had significantly less post-operative pain than the placebo group up to 2 h after surgery.