Aspirin

Injection-induced necrosis is a rare but dreaded consequence of soft tissue augmentation with filler agents. It usually occurs as a result of injection of filler directly into an artery, but can also result from compression or injury. We provide recommendations on the use of hyaluronidase when vascular compromise is suspected. Consensus recommendations were developed by thorough discussion and debate amongst the authors at a roundtable meeting on Wednesday June 18, 2014 in Las Vegas, NV as well as significant ongoing written and verbal communications amongst the authors in the months prior to journal submission. All authors are experienced tertiary care providers. A prompt diagnosis and immediate treatment with high doses of hyaluronidase (at least 200 U) are critically important. It is not felt necessary to do a skin test in cases of impending necrosis. Some experts recommend dilution with saline to increase dispersion or lidocaine to aid vasodilation. Additional hyaluronidase shou...

ABSTRAK
Sekolah Tinggi Ilmu Kesehatan Mandala Waluya Kendari
Program Studi Farmasi
Skripsi Penelitian,  September 2020
BORIS YASIN (F201601082)
“UJI EFEKTIVITAS GASTROPROTEKTIF EKSTRAK DAUN LABU KUNING (Cucurbita moschata) PADA TIKUS (Rattus norvegicus) YANG DIINDUKSI ASPIRIN”
Pembimbing I : apt. Jastria Pusmarani, S.Farm. M.Sc.
Pembimbing II : apt. Citra Dewi, S.Farm. M.Farm.
(xii + 86 Halaman + 5 Gambar + 6 Tabel + 9 Lampiran)

Di Indonesia Angka kejadian gastritis menurut World Health Organization (WHO) tahun 2017 cukup tinggi yaitu 274.396 kasus dari 283.452.952 jiwa penduduk. Efek samping dari penggunaan obat antiinflamasi non steroid (OAINS) menjadi 20% penyebab dari ulkus peptikum dan akan meningkat seiring bertambahnya usia. Pengobatan ulkus peptikum hingga saat ini menggunakan obat sintetik yang memiliki beberapa efek samping sehingga diperlukan pengobatan alternatif seperti pengobatan herbal. Daun labu kuning (Cucurbita moschata) mengandung senyawa flavonoid, saponin, tanin, alkaloid yang mampu melindungi mukosa lambung. Tujuan dilakukan penelitian ini adalah untuk mengetahui efektifitas gastroprotektif ekstrak daun labu kuning (Cucurbita moschata) pada tikus (Rattus norvegicus) yang  diinduksi aspirin.
Penelitian ini merupakan penelitian analitik laboratorium. Sampel diekstraksi menggunakan metode maserasi. Pengujian efek gastroprotektif menggunakan 18 ekor tikus yang dibagi menjadi 6 kelompok yaitu kelompok kontrol normal (Na.CMC 0,5%), kelompok kontrol positif (Omeprazole 20 mg/kgBB), kelompok kontrol induksi (Aspirin 300 mg/kgBB), kelompok (Dosis ekstrak 100 mg/kgBB), kelompok (Dosis ekstrak 200 mg/kgBB), dan kelompok (Dosis ekstrak 300 mg/kgBB). Analisis data menggunakan uji Kruskall Wallis dan Mann Whitney untuk mengetahui perbedaan tiap kelompok.
Hasil penelitian menunjukan adanya efek gastroprotektif ekstrak daun labu kuning (Cucurbita moschata) pada Dosis ekstrak 300 mg/kgBB dengan nilai P signifikan 0,037  <  0,05 yang sebanding dengan kelompok kontrol positif.

Kata Kunci : Gastroprotektif, Aspirin, Daun labu kuning (Cucurbita moschata).
Daftar Pustaka : 33 (2001-2018)

Salicylic acid is a major hydrolytic degradation product of aspirin, responsible especially for gastric irritation during oral aspirin administration. This impurity was investigated in 12 different brands of aspirin formulation readily available in our locality. A simple, rapid and sensitive high performance liquid chromatographic method was adopted for this investigation. The mobile phase was methanol/water (20/80, v/v) adjusted to pH 2.5 with phosphoric acid and was run on a 50 mm reversed-phase column monitored at 240 nm. The limit of detection for salicylic acid was 5 ng. Only three of these formulations showed the presence of salicylic acid impurity and all these contained salicylic acid in excess of the USP 1980 limit of 0.3% salicylic acid per tablet.

The aim of the present study was to investigate the prevalence of left ventricular (LV) thrombus formation and important determinants in patients with acute ST elevation myocardial infarction localized to the anterior wall treated with percutaneous coronary intervention (PCI) and dual-antiplatelet therapy. One hundred selected patients with ST elevation myocardial infarctions revascularized with PCI in the left anterior descending coronary artery were included. The patients participated in the Autologous Stem Cell Transplantation in Acute Myocardial Infarction (ASTAMI) trial. All were treated with aspirin 75 mg/day and clopidogrel 75 mg/day and underwent serial echocardiography and magnetic resonance imaging during the first 3 months after PCI. After 4 to 5 days, the ejection fraction and infarct size in percentage of the left anterior descending coronary artery area were assessed using single photon-emission computed tomography in addition to the ejection fraction by echocardiography. LV thrombi were detected in 15 patients during the first 3 months, 2/3 of them within the first week. No differences in baseline characteristics between the groups with and without LV thrombi were shown. However, in the thrombus group, significantly higher peak creatine kinase levels (6,128 vs 2,197 U/L, p <0.01), larger infarct sizes (82.5% vs 63.8%, p <0.01), and lower ejection fractions on single photon-emission computed tomography (35.5% vs 40.0%, p ‫؍‬ 0.03) and on echocardiography (43.0% vs 46.0%, p ‫؍‬ 0.03) were found compared to patients without LV thrombi. In conclusion, LV thrombus formation is a frequent finding in patients with anterior wall ST elevation myocardial infarction treated acutely with PCI and dualantiplatelet therapy and should be assessed by echocardiography within the first week.

Background: The net benefit of aspirin in prevention of CVD and nonvascular events remains unclear. Our objective was to assess the impact (and safety) of aspirin on vascular and nonvascular outcomes in primary prevention. Data Sources: MEDLINE, Cochrane Library of Clinical Trials (up to June 2011) and unpublished trial data from investigators. Study Selection: Nine randomized placebocontrolled trials with at least 1000 participants each, reporting on cardiovascular disease (CVD), nonvascular outcomes, or death were included. Data Extraction: Three authors abstracted data. Studyspecific odds ratios (ORs) were combined using randomeffectsmeta-analysis.Risksvsbenefitswereevaluatedbycomparing CVD risk reductions with increases in bleeding. Results: During a mean (SD) follow-up of 6.0 (2.1) years involving over 100 000 participants, aspirin treatment reduced total CVD events by 10% (OR, 0.90; 95% CI, 0.85-0.96; number needed to treat, 120), driven primarily by reduction in nonfatal MI (OR, 0.80; 95% CI, 0.67-0.96; number needed to treat, 162). There was no significant reduction in CVD death (OR, 0.99; 95% CI, 0.85-1.15) or cancer mortality (OR, 0.93; 95% CI, 0.84-1.03), and there was increased risk of nontrivial bleeding events (OR, 1.31; 95% CI, 1.14-1.50; number needed to harm, 73). Significant heterogeneity was observed for coronary heart disease and bleeding outcomes, which could not be accounted for by major demographic or participant characteristics. Conclusions: Despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.

To establish the anti-platelet or aspirin like effects of flavonoid rich food (chocolate). Methods: This was a non-randomized quasi experimental study in which, 65 healthy adult volunteers, 27 males and 38 females, participated. The subjects included were healthy, non-smoking adults. Health of subjects was evaluated by a questionnaire for which a written informed consent was taken prior to admission in the study. Research protocol was approved by the college's, "Research and Ethical committee". Division of subjects into two groups, a control group which consumed 100mgs of oral aspirin and an interventional group consuming 100mgs oral aspirin and 18.75gms of dark chocolate (flavonoid rich), was carried out. The Bleeding time estimation for both the groups was done by "Duke Method" of bleeding time estimation. Results: Data was analyzed by SPSS 15.0. First, a bivariate analysis was done by comparing both the pre-test groups i.e. before consumption of aspirin and also before consumption of chocolate and aspirin together through independent t-test Later, regression analysis was also done. Bivariate analysis compared both the control and interventional groups. After comparing pre-test groups a p-value of 0.798 was obtained and after comparing post test groups a p-value of 0.006 was determined. Regression analysis yeilded an R-square of 0.25. Conclusion: Chocolate has a significant role in augmenting the anti-platelet effects of aspirin.

Intracoronary nitroglycerin (NTG) increases coronary blood flow and NTG inhibits thromboxane (Tx) A~, production and release. However, whether an alteration in TxA~, is the mechanism by which NTG increases coronary blood flow is not known. Coronary sinus (CS) blood flow (BF) (by thermodiluUon) and the concentration of TxB2 (the stable metabolite of TxA2) in CS blood were measured in 23 patients (16 men and 7 women, aged 26 to 65 years) with coronary artery disease before, during and after injection of normal saline solution (n = 5, control subjects) or NTG, 100/zg (n = 18), into the left coronary artery. In the 5 control subjects, saline solution caused no change in CSBF or the concentration of TxB~, in CS blood. Ten of the 18 patients to whom NTG was given had received no cyclooxygenase inhibitors for 10 days. In these patients, NTG caused a marked increase in CSBF (from 112 -I-64

Low doses of aspirin can injure the gastric mucosa. It is not clear whether other drugs such as the antiplatelet agent clopidogrel also cause gastric mucosal injury or exacerbate aspirin-induced injury, or whether proton pump inhibitors prevent damage. METHODS: Twenty Japanese subjects with different CYP2C19 genotypes were randomly assigned to groups that were given a low dose of aspirin (100 mg; A), clopidogrel (75 mg; C), low dose of aspirin and clopidogrel (AC), or low dose of aspirin in combination with clopidogrel and rabeprazole (10 mg; ACR) once daily for 7 days. Subjects underwent gastroduodenoscopy and platelet tests on days 3 and 7; gastric mucosal damage was assessed by using the modified Lanza score (MLS). We performed 24-hour intragastric pH monitoring on day 7 of each regimen. We also analyzed the effects of the AC regimen on 30 patients with different CYP2C19 genotypes. RESULTS: Subjects in groups A, C, and AC had significantly higher levels of gastric mucosal damage on days 3 and 7, compared with baseline. The median MLS for the AC group was similar to that of the A group. Helicobacter pylori-negative subjects in the ACR group with different CYP2C19 genotypes had significant differences in MLS, intragastric pH, and platelet function. Gastric mucosal injury was inhibited equally among H pylori-positive subjects in the ACR group. Rabeprazole did not appear to affect platelet function or intragastric pH in subjects given clopidogrel. CONCLU-SIONS: Clopidogrel and low doses of aspirin cause a similar degree of gastric mucosal damage. Rabeprazole prevented this damage without reducing the antiplatelet function of clopidogrel. However, its prophylactic effect varies with CYP2C19 genotype in H pylori-negative subjects.

Phospholipase A2 is potentially an important target for structure-based rational drug design. In order to determine the involvement of phospholipase A2 in the action of non-steroidal anti-inflammatory drugs (NSAIDs), the crystal structure of the complex formed between ...

Aspirin (acetylsalicylic acid) and clopidogrel are two major antithrombogenic agents that are widely used for the treatment and prevention of cerebro-and cardiovascular conditions such as stroke. Combined use produces enhanced therapeutic effect. Aspirin and clopidogrel both are esters, and hydrolysis leads to decreased or inactivated therapeutic activity. The aim of the study was to determine whether aspirin and clopidogrel are hydrolyzed by the same enzyme(s), thus reciprocally prolonging the antithrombogenic activity. To test this possibility, microsomes from the liver and intestine were assayed for the hydrolysis of aspirin and clopidogrel. In contrary to the hypothesis, aspirin and clopidogrel were hydrolyzed in a tissue-differential manner. Liver microsomes hydrolyzed both drugs, whereas intestinal microsomes hydrolyzed aspirin only. Consistent with the tissue distribution of two carboxylesterases

Evidence from a wide range of sources suggests that individuals taking aspirin and related non-steroidal anti-inflammatory drugs have reduced risk of large bowel cancer. Work in animals supports cancer reduction with aspirin, but no long-term randomised clinical trials exist in human beings, and randomisation would be ethically unacceptable because vascular protection would have to be denied to a proportion of the participants. However, opportunistic trials of aspirin, designed to test vascular protection, provide some evidence of a reduction in cancer, but only after at least 10 years. We summarise evidence for the potential benefit of aspirin and natural salicylates in cancer prevention. Possible mechanisms of action and directions for further work are discussed, and implications for clinical practice are considered.

The barks of Drimys winteri are used in folk medicine as a remedy to treat several diseases, including dolorous processes. Previous pre-clinical experiments carried out in our laboratories revealed that the hydroalcoholic extract of this plant showed anti-allergenic, anti-inflammatory and antinociceptive properties. Such promising results led us to determine the analgesic compounds present in D. winteri. Through conventional chromatographic procedures with fractions of CH 2 Cl 2 and EtOAc obtained from methanolic extract, it was found that polygodial (1), 1-i-(p-methoxycynnamyl) polygodial (2), taxifolin (3) and astilbin (4), are the main components of these fractions. Compounds 1 and 2 exhibited marked antinociceptive action by intraperitoneal and oral routes against acetic acid-induced abdominal constrictions in mice, suggesting that they are responsible, at least partially, for the antinociceptive effects of this plant. In addition, both compounds were notably more potent than aspirin and acetaminophen, two well-known drugs used here as comparison.

This is the first evaluation of dabigatran, an oral direct thrombin inhibitor, in patients with atrial fibrillation (AF). Patients (n ‫؍‬ 502) were randomized to receive blinded doses of 50-, 150-, or 300-mg dabigatran twice daily alone or combined with 81-or 325-mg aspirin or open-label warfarin administered to achieve an international normalized ratio of 2 to 3 for 12 weeks. Dabigatran plasma concentrations, activated partial thromboplastin time, D-dimer, urinary 11-dehydrothromboxane B 2 (DTB2), and liver function were measured at baseline and at 1, 2, 4, 8, and 12 weeks. Clinical end points were assessed according to the treatment received at the time of the event. Overall, 92% of patients completed the study. Major hemorrhages were limited to the group treated with 300-mg dabigatran plus aspirin (4 of 64), and the incidence was significant versus 300-mg dabigatran alone (0 of 105, p <0.02). Total bleeding events were more frequent in the 300-mg (39 of 169, 23%) and 150-mg (30 of 169, 18%) dabigatran groups compared with the 50-mg groups (7 of 107, 7%; p ‫؍‬ 0.0002 and p ‫؍‬ 0.01, respectively). Thromboembolic events were limited to the 50-mg dabigatran dose groups (2 of 107, 2%). The mean trough D-dimer measurements were suppressed for the 2 highest doses of dabigatran and warfarin (international normalized ratio of 2 to 3). Aminotransferase levels >3 times the upper limit of normal were observed in 0.9% of the dabigatran recipients and in none of the warfarin recipients. Two dabigatran recipients had aminotransferase levels >5 times the upper limit of normal as a result of gallstones, which resolved. Trough activated partial thromboplastin time values were 1.2, 1.5, and 1.8 times the baseline level for the 50-, 150-, and 300-mg dabigatran groups, respectively. DTB2 concentrations after 12 weeks of 50-, 150-, and 300-mg dabigatran treatment were increased by 31%, 17%, and 23%, respectively, versus baseline (p ‫؍‬ 0.02, p ‫؍‬ 0.03, and p ‫؍‬ 0.0004). In conclusion, major bleeding events were limited to patients treated with dabigatran 300 mg plus aspirin and thromboembolic episodes were limited to the 50-mg dabigatran groups. The 2 highest doses of dabigatran suppress D-dimer concentrations. Serious liver toxicity was not seen. The significance of the increase of DTB2 concentrations in dabigatran-treated patients needs resolution.

A 42-year-old man born in Pakistan was referred for a painless, gradual decline in visual acuity over 4 months in both eyes. He had no history of diabetes, hypertension, or other systemic diseases. His best-corrected visual acuity was 20/25 right eye and 20/200 left eye. He had no relative afferent pupillary defect (RAPD), but his pupils reacted sluggishly to light, the left eye more than the right. Adnexae and ocular motility were normal. Slit lamp examination revealed bilateral neovascularization of the iris with peripheral anterior synechiae on gonioscopy ( and B). The intraocular pressure was 10 mm Hg in the right eye and 6 mm Hg in the left eye. Fundus examination showed numerous microaneurysms in the mid-peripheral retina and posterior pole, arteriovenous shunts between the superior and inferotemporal vessels of the arcade, arteriolar narrowing, and venous dilation without beading in both eyes. In the left eye, neovascularization of the optic disc and preretinal and vitreous hemorrhage were also present ( .

The mechanism by which nonsteroidal antlinflammatory drugs interfere with the action of loop diuretics is not clear. We studied the renal response to an acute challenge of piretanide superimposed on pretreatment with either placebo, probenecid, indomethacin, or piroxicam in seven maximally hydrated subjects. No change was seen in glomerular filtration rate, as measured by creatinine clearance, throughout the experiments. When compared with responses to piretanide challenge after placebo pretreatment, probenecid reduced by 65% the peak fractional excretion of sodium (FENa), with a corresponding reduction in diuretic excretion. Pretreatment with indomethacin reduced peak FENa by 35%, but urinary delivery of piretanide was not altered. In contrast, piroxicam did not influence FENa but significantly reduced the delivery of both sodium and piretanide into urine. We conclude that the activity of nonsteroidal antiinflammatory drugs within the renal tubule varies among individual drugs and cannot be explained solely by their common mechanism of antiinflammatory action.

Resolvins (Rvs) are oxygenated products derived from x-3 polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid that carry potent protective bioactions present in resolving inflammatory exudates. Resolvin E1 (RvE1) is biosynthesized in vivo from EPA via transcellular biosynthetic routes during cell-cell interactions, and thus RvE1 is formed in vivo during multicellular responses such as inflammation and microbial infections. RvE1 protects tissues from leukocyte-mediated injury and counterregulates proinflammatory gene expression. These newly identified Rvs may underlie the beneficial actions of x-3 PUFAs especially in chronic disorders where unresolved inflammation is a key mechanism of pathogenesis. Here, we present an overview of the biosynthesis of RvE1, with a focus on the aspirin-triggered and microbial P450-initiated pathways. The generation of RvE1 and its actions appear to dampen acute leukocyte responses and facilitate the resolution of inflammation.

The demonstration that leukotrienes, mainly cysteinyl leukotrienes, have biological properties relevant to the pathogenesis of asthma has stimulated the development of many therapeutic compounds to block these deleterious effects. Two main classes of leukotriene modulators have been developed: CysLT receptor antagonists and leukotriene synthesis 1 inhibitors. This article reviews the pharmacodynamics, the effects on baseline airway function, the protective effects in airway challenges as well as the results in chronic asthma of the different leukotriene modulators. In addition, the complementary anti-inflammatory effect of leukotriene modulators to that of corticosteroids and H -histamine receptor 1 antagonists is reviewed. Finally, a concise overview of the clinical responsiveness to this new class of drug, the safety and the drug interactions as well as the place in the strategies of treatment for asthmatic patients of the leukotriene modulators is also provided.

Synthesis and biological evaluation of thieno[2,3-d]pyrimidine derivatives for anti-inflammatory, analgesic and ulcerogenic activity 5-Methyl-6-phenyl-2-thioxothieno[2,3-d]pyrimidone derivative (2) reacted with hydrazonoyl chloride derivatives to afford triazolothienopyrimidones 4a-f. Also, acetone-1-(2-amino-5-isopropyl-thiophene-3-carbonitrile) (3) reacted with functional and bifunctional groups to yield the corresponding compounds 5-11. The new products showed anti-inflammatory, analgesic, and ulcerogenic activities comparable to that of indomethacin and acetylsalicylic acid, respectively.

Among the more than 253,000 patients that underwent coronary artery bypass surgery (CABS); over half were over the age of 65. 1 Older individuals often present for surgery with multiple chronic diseases and multiple prescription and nonprescription medications. These factors, in addition to age related physiological changes, make this population at risk for medication related problems. 2 In addition, these problems may be compounded by symptoms experienced during the post-operative period. Common postoperative symptoms include chest incision symptoms (pain, discomfort), shortness of breath, loss of appetite, 3 fatigue, 3,4 and difficulty sleeping. 3,5,6 Psychological symptoms such as depression/sadness and anxiety/uneasiness have also been identified post-CABS. 7-9 Many of these symptoms are reported for weeks and months after surgery. 10-12 A patient's ability to discern between postoperative symptoms and new medication side effects may result in reluctance to adhere to the medication regimens. Medication adherence is critical for optimal recovery from surgery and secondary prevention of coronary artery disease. While much research has been done on medication regimens and symptoms in the postoperative CABS period, little data has been reported regarding the relationship between post-operative medications and post-operative symptoms following CABS. As more people age 65 and older choose to undergo revascularization procedures, examining this relationship has become more important. Therefore the purpose of this secondary analysis was to describe the frequently used postoperative medications and examine the relationship between postoperative symptoms and medication side effects in CABS patients. The specific aims of this study are: Aim 1: Describe frequently occurring medications used by CABS patients in the preoperative period and at three and six weeks and three months postoperatively. Aim 2: Describe medication use and selected symptoms/problems at three and

Stable gastric pentadecapeptide BPC 157 is an anti-ulcer peptidergic agent, proven in clinical trials to be both safe in inflammatory bowel disease (PL-10, PLD-116, PL 14736) and wound healing, stable in human gastric juice, with no toxicity being reported. Recently, we claim that BPC 157 may be used as an antidote against NSAIDs. We focused on BPC 157 beneficial effects on stomach, duodenum, intestine, liver and brain injuries, adjuvant arthritis, pain, hyper/hypothermia, obstructive thrombus formation and thrombolysis, blood vessel function, counteraction of prolonged bleeding and thrombocytopenia after application of various anticoagulants and antiplatelet agents and wound healing improvement. The arguments for BPC 157 antidote activity (i.e., the role of BPC 157 in cytoprotection, being a novel mediator of Robert's cytoprotection and BPC 157 beneficial effects on NSAID mediated lesions in the gastrointestinal tract, liver and brain and finally, counteraction of aspirin-induced prolonged bleeding and thrombocytopenia) obviously have a counteracting effect on several established side-effects of NSAID use. The mentioned variety of the beneficial effects portrayed by BPC 157 may well be a foundation for establishing BPC 157 as a NSAID antidote since no other single agent has portrayed a similar array of effects. Unlike NSAIDs, a very high safety (no reported toxicity (LD1 could be not achieved)) profile is reported for BPC 157. Also, unlike the different dosage levels of aspirin, as a NSAID prototype, which differ by a factor of about ten, all these beneficial and counteracting effects of BPC 157 were obtained using the equipotent dosage ( g, ng/kg) in parenteral or peroral regimens.

The nonsteroidal anti-inflammatory drugs are one of the most commonly prescribed classes of drugs used in medical practice. This review discusses the diverse cutaneous reactions associated with nonsteroidal anti-inflammatory drugs. Adverse cutaneous reactions occur most frequently with benoxaprofen, piroxicam, sulindac, meclofenamate sodium, zomepirac sodium, and phenylbutazone. The most serious adverse cutaneous reactions, Stevens-Johnson syndrome and toxic epidermal necrolysis, appear to be most often associated with sulindac and phenylbutazone. Tolmetin and zomepirac sodium, two structurally similar pyrrole derivatives, have been associated with a disproportionate number of cases of anaphylactoid reactions. Among the currently marketed nonsteroidal anti-inflammatory drugs, piroxicam appears to have the highest rate of phototoxic reactions. This phototoxic eruption is most often vesiculobullous. (J AM ACAD DERMATOL 12: 866-876, 1985.)

Reacţii de hipersensibilitate la antiinflamatorii nesteroidiene: scurtă actualizare Reacțiile de hipersensibilitate induse de aspirină și alte AINS reprezintă o provocare pentru clinician, din cauza severității potențiale. La indivizi susceptibili, AINS pot genera un spectru larg de reacții, având interval de debut variabil și manifestări clinice diverse. Mecanisme imunologice și non-imunologice pot fi implicate. Diagnosticul hipersensibilității la AINS se bazează pe recunoașterea simptomelor caracteristice precipitate de aspirină sau de alte AINS. Testul de provocare orală este standardul de aur în diagnostic; el poate fi efectuat pentru confirmarea hipersensibilității la medicamentul incriminat, dar și pentru a confirma sau exclude toleranța la un alt drog alternativ. Diagnosticul implică înțelegerea mecanismelor subiacente și este indispensabil pentru prevenția reacțiilor viitoare.

Ecchordosis physaliphora is a rare congenital, benign, hamartomatous, retroclival mass derived from notochordal tissue that is typically located intradurally in the prepontine cistern. Ecchordosis physaliphora is usually asymptomatic. In rare cases, ecchordosis physaliphora can be symptomatic due to tumor expansion and compression of the surrounding structures and extratumoral hemorrhage. To our knowledge, ecchordosis physaliphora associated with intratumoral hemorrhage and vasogenic edema has not been previously described. We present a case of 22-year-old man who presented with headache and confusion. MR imaging and CT revealed intracranial ecchordosis physaliphora associated with intratumoral hemorrhage and vasogenic edema. The neurological findings resolved completely after medical therapy.

Topically applied acetylsalicylic acid (ASA), salicylic acid (SA) and indomethacin were tested in an experimental pain model that provides direct nociceptor excitation through cutaneous tissue acidosis. In 30 volunteers, sustained burning pain was produced in the palmar forearm through a continuous intradermal pressure infusion of a phosphate-buffered isotonic solution (pH 5.2). In 5 different, double-blind, randomized cross-over studies with 6 volunteers each, the flow rate of the syringe pump was individually adjusted to result in constant pain ratings of around 20% (50% in study 4) on a visual analog scale (VAS). The painful skin area was then covered with either placebo or the drugs which had been dissolved in diethylether. In the first study on 6 volunteers, ASA (60 mg/ml) or lactose (placebo) in diethylether (10 ml) was applied, using both arms at 3-day intervals. Both treatments resulted in sudden and profound pain relief due to the cooling effect of the evaporating ether. With lactose, however, the mean pain rating was restored close to the baseline within 6-8 min while, with ASA, it remained significantly depressed for the rest of the observation period (another 20 min). This deep analgesia was not accompanied by a loss of tactile sensation. The further studies served to show that indomethacin (4.5 mg/ml) and SA (60 mg/ml) were equally effective as ASA (each 92-96% pain reduction) and that the antinociceptive effects were due to local but not systemic actions, since ASA and SA did not reach measurable plasma levels up to 3 h after topical applications. With a higher flow rate of acid buffer producing more intense pain (VAS 50%), ASA and SA were still able to significantly reduce the ratings by 90% or 84%, respectively. On the other hand, by increasing the flow rate by a factor of 2 on average, during the period of fully developed drug effect it was possible to overcome the pain suppression, which suggests a competitive mechanism of (acetyl-) salicylic antinociception.

Purpose The objective of the present study was to evaluate fetal biometry, Doppler values, and perinatal outcomes in pregnant women with antiphospholipid syndrome treated with acetylsalicylic acid and heparin. Study design Twenty-five pregnant women with antiphospholipid syndrome using 100 mg/day acetylsalicylic acid and 5,000 IU heparin every 12 h were evaluated in this prospective observational study. Ultrasonography was performed between 24 and 38 weeks of gestational age to assess estimated fetal weight, placental thickness, amniotic fluid index, fetal biophysical profile and Doppler evaluation of maternal uterine arteries, and fetal middle cerebral and umbilical arteries. Data regarding Apgar score, gender, delivery mode, and birth weight and length were recorded after birth. Results The observed values for ultrasonographic assessment and perinatal outcomes were not very different from the expected values for normal pregnancies. The birth weight was 2863.3 ± 737.7 g (mean ± SD) and length was 46.8 ± 4.2 cm. Only one newborn (4%) had the 1-min Apgar score\7 and all had the 5-min Apgar score[7. Conclusion Gestational and perinatal evaluation of pregnant women with antiphospholipid syndrome using both acetylsalicylic acid and heparin was reassuring.

patients with a transient ischaemic attack or minor ischaemic stroke were randomly allocated to receive long term "blind" treatment with aspirin 600 mg twice daily (n = 815), aspirin 300 mg once daily (n = 806) or placebo (n = 814). No patient was lost to follow up. The "intention to treat" comparison included all the serious vascular events and deaths which occurred before the end of the follow up period on 30 September 1986. There was no difference in efficacy between the 300 mg and 1200 mg daily doses of aspirin, but the lower dose was undoubtedly less gastrotoxic. Also, there was no definite difference in the response of males and females to aspirin. The odds of suffering a major stroke, myocardial infarction or vascular death were 15% less in the combined aspirin groups compared with the placebo group (95% confidence interval 29% reduction to 3% increase in odds) which is compatible with the continuing overview of all the similar trials of antiplatelet drugs where the relative reduction in odds was 25%. There was no statistically significant reduction in the likelihood of either disabling major stroke and vascular death or vascular death occurring.

Objective: Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass grafting. Methods: Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD) were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety endpoint was severe bleeding Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries [GUSTO] classification). Results: In the overall population, the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151 of 426 patients in the placebo (plus ASA) group (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.78-1.23). In a prespecified subgroup analysis, the primary endpoint was significantly reduced by clopidogrel in prosthetic graft patients (HR, 0.65; 95% CI, 0.45-0.95; P ‫؍‬ .025) but not in venous graft patients (HR, 1.25; 95% CI, 0.94-1.67, not significant [NS]). A significant statistical interaction between treatment effect and graft type was observed (P interaction ‫؍‬ .008). Although total bleeds were more frequent with clopidogrel, there was no significant difference between the rates of severe bleeding in the clopidogrel and placebo (plus ASA) groups (2.1% vs 1.2%). Conclusion: The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk. ( J Vasc Surg 2010;52:825-33.)

The aim of the study was to evaluate the antiulcer activity of Linum usitatissimum fixed oil against aspirin-, indomethacin-, ethanol-, reserpine-, serotonin- and stress-induced gastric ulceration in rats and histamine-induced gastric ulceration in guinea pigs. Attempts were also made to evaluate the in vitro anticholinergic and antihistaminic activity and in vivo antisecretary and antiulcer activity of oil following pylorus ligation in rats. L. usitatissimum fixed oil exhibited significant antiulcer activity against different ulcerogens in experimental animal models. The fixed oil significantly inhibited acetylcholine- and histamine-induced contraction of guinea pig and rat ileums, respectively, suggesting its anticholinergic and antihistaminic activity. The oil also exhibited significant inhibitory effect on gastric secretion/total acidity and aspirin-induced gastric ulceration in pylorus-ligated rats. The lipoxygenase inhibitory, histamine antagonistic and antisecretory (anticholinergic) effects of the oil could probably have contributed towards antiulcer activity. L. usitatissimum fixed oil may be considered to be a drug of natural origin which possesses significant antiulcer activity. The present observation is the first experimental data showing antiulcer activity of L. usitatissimum fixed oil.

In this experiment, Aspirin is made by using a process called esterification. Esterification occurs when a carboxylic acid and an ALCOHOL combine in a reaction to produce an ester. In the synthesis, salicylic acid behaves as an alcohol and reacts with acetic anhydride (with a small amount of sulfuric acid acting as a catalyst). During the reaction process, a molecule of water splits off and the remaining carboxylic acid and alcohol fragments become attached producing an ester (alcohol + carboxylic acid).

This investigation aimed to evaluate the effect of sodium bicarbonate on the urinary excretion rate of aspirin, testing the hypothesis that sodium bicarbonate increases aspirin excretion. Aspirin overdose is a common medical emergency as deacylated aspirin, salicylate, is a metabolic poison that causes lactic acidosis. Sodium bicarbonate administration is currently the standard treatment because it increases urinary salicylate excretion. To elucidate this process, two experiments were carried out: the first investigating the effect of pH on drug absorption, and the second the effect of sodium bicarbonate on the excretion of aspirin in the form of salicylate. It was determined that pH and drug absorption are related and that an increasing urinary pH results in reduced aspirin absorption. Through the measurement of salicylate concentrations in the urine of participants, the effect of sodium bicarbonate on the excretion rate of aspirin was evaluated. The results showed a clear rise in urinary pH and salicylate excretion upon the administration of sodium bicarbonate. Therefore, the investigation proved that sodium bicarbonate effectively increases aspirin elimination in the form of salicylate and is an appropriate measure to combat aspirin-induced poisoning.