Gastrointestinal Bleeding Associated With Warfarin and Rivaroxaban Therapy in Atrial Fibrillation Cases with Concomitant Coagulopathy

Background:: There is inadequate information on the risk of gastrointestinal (GI) bleeding in patients who are un-der rivaroxaban and warfarin therapy in Iran. Determining the risk of GI bleeding in patients receiving these two drugs can help to select a more appropriate anti-coagulation prophylaxis in high-risk patients. Objective:: The aim of this study was to compare the incidence of GI bleeding in patients with atrial fibrillation (AF) and concomitant bleeding risk factors receiving either warfarin or rivaroxaban. Methods:: In this observational study, 200 patients with AF and bleeding risk factors who referred to Imam Hossein Hospital (Tehran, Iran) were included. The patients were under treatment with either warfarin or rivaroxaban. The incidence of GI bleeding was compared between the two groups monthly for one year. Results:: GI bleedings were observed in 61% and 34% of patients treated with warfarin and rivaroxaban, respectively (P = 0.001). Melena was the most common type of GI bleeding in both groups. History of hypertension, history of stroke, con-sumption of anti-platelet drugs, NSAID consumption, and history of alcohol consumption were associated with more fre-quent GI bleeding only in warfarin group. Conclusion:: The incidence of GI bleeding was lower in AF patients who received rivaroxaban compared to those treated with warfarin. Also, GI bleeding risk does not change according to the consumption of other anti-coagulant drugs and un-derlying history of hypertension or stroke in patients received rivaroxaban. Therefore, rivaroxaban is suggested as the choice of prophylaxis in patients with AF and concomitant coagulopathy.

Controlled study of the efficacy ozone therapy in Fibromyalgia, a randomised controlled trial [abstract]

INTRODUCTION: Fibromyalgia meaning muscle and connective tissue pain it a disorder classified by the presence of chronic widespread pain and a heightened and painful response to gentle touch (tender points). Other core features of the disorder include debilitating fatigue, sleep disturbance, and joint stiffness. PURPOSE: The aim of the study is to see the efficacy of ozone in relation to other local anaesthetic and placebo for relief of pain. MATERIAL AND METHODS: The Study involved 300 patients with classical Fibromyalgia (ACR criteria) age between 45 and 70. The first group treated only with ozone 2 - 3 x per week for over 4 necks (15 mcgr/mL) The second group with local anaesthetic /Lidocain 2 % 10- 20 mL) The third group, placebo. Several clinical parameters were monitored during a demonstration in 4-6 weeks. The clinical examination included vital signs, pain using visual analog Scale, Duration of morning stiffness, night pain, NSAID consumption RESULTS AND CONCLUSION: 1.- Ozone has significant effect in Fibromyalgia in relation to the other two groups. 2.- Function index improved in both groups ozone and anaesthetic. 3.- Ozone treatment is a safe therapy compared to the local anaesthetic.

Analgesic Herbal Medicines in the Treatment of Knee Osteoarthritis: A Systematic Review

Background: Osteoarthritis (OA) is a type of progressive rheumatoid disease, which leads to the degeneration of the articular cartilage, synovium, subchondral bone, tendons, and the surrounding ligaments.There are various treatments for knee OA, including pharmaceutical, nonpharmaceutical, and surgical treatments. Considering the chronic nature of the disease as well as the necessity for the long-term use of chemical medications, various side effects could occur that include gastrointestinal bleeding, hypertension, congestive heart failure, hyperkalemia, and kidney failure. Therefore, suitable treatments with fewer side effects should be recommended. Recent investigations suggest increased tendency in people to use Complementary and Alternative Medicine (CAM) for knee OA treatment. Objective: This systematic review aimed to assess the effectiveness and safety of herbal preparations for the treatment of OA. Methods: The searched databases were Cochrane, Scopus, and PubMed. All the selected papers pertained to randomized controlled trials until August 8, 2017 in English in which one or several specific herbs had been used in knee OA treatment. Results: We included 24 randomized trials (involving 2399 women and men). There were several different herbal medicines used within the included trials. Conclusion: The results show that the methods used in these trials may reduce symptoms and the extent of NSAID consumption and enhance the quality of life. Additional trials are suggested to investigate the safety and efficacy of herbs for the treatment of patients with OA.

Use of Non-Steroidal Anti-Inflammatory Drugs and Associated Gastroprotection in a Cohort of Workers

Background: This study describes the prevalence of non-steroidal anti-inflammatory drug (NSAID) use, and analyses prescribing patterns of NSAIDs and associated gastroprotection. Methods: The study population consisted of 5650 workers at the General Motors automobile assembly plant in Zaragoza, Spain. NSAID prescription data for 2014 were obtained from the prescription database of Aragon (Spain). NSAID consumption was determined based on the number of defined daily doses purchased per year. Heavy NSAIDs users were identified using Lorenz curves. Results: NSAID use in the cohort was high (40.7% of workers, 95% CI 39.4–41.9). The prescription of proton pump inhibitors increased with age. Gastrointestinal protection was lacking in some participants who were being treated with drugs associated with a high risk of gastrointestinal bleeding. Heavy NSAID users (defined as those above the 95th percentile of consumption), accounted for 26% of total DDDs, and consumed a greater proportion of coxibs than non-heavy users. Conclusions: The rate of NSAID consumption in the cohort was high. To reduce the risk of gastrointestinal complications, monitoring and adequate gastroprotection are essential in patients who are prescribed NSAIDs for long periods of time or who are treated concomitantly with drugs that increase the risk of gastrointestinal bleeding.