American journal of therapeutics
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Pharmacologic treatment of chronic pain is challenging. Oral therapy may require multiple medications; each has side effects, dose limitations, and limited efficacy. Compounded topical formulations have evolved as potential treatment options. ⋯ After treatment, the pain intensity score decreased by 3.11 ± 1.65 (37%) with Cream I (from 8.44 ± 1.19 to 5.33 ± 2.0, P < 0.001), by 2.93 ± 1.58 (35%) with Cream II (from 8.42 ± 1.27 to 5.50 ± 1.96, P < 0.001), and by 1.49 ± 0.73 (19%) with Voltaren gel (from 7.93 ± 0.81 to 6.44 ± 1.14, P < 0.001). Cream I and Cream II did not differ significantly in efficacy, and both were significantly more effective than Voltaren gel (P < 0.001). It is concluded that Voltaren gel had less efficacy than the compounded creams, which were effective and provided pain relief in the majority of the patients studied.
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Observational Study
Role of Anemia in Home Oxygen Therapy in Chronic Obstructive Pulmonary Disease Patients.
Anemia is a known comorbidity found in chronic obstructive pulmonary disease (COPD) patients. Hypoxemia is common and basically due to ventilation/perfusion (V/Q) mismatch in COPD. Anemia, by decreasing arterial oxygen content, may be a contributing factor for decreased delivery of oxygen to tissues. ⋯ Multivariate logistic regression showed that anemia remained a strong predictor for long-term oxygen therapy use in COPD patients after adjusting for other significant parameters. Anemic COPD patients are more hypoxic especially during exercise than those who are not anemic. We conclude that anemia is a contributing factor in qualifying COPD patients for home oxygen therapy.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of pain associated with a variety of indications, including arthritic conditions, but their usefulness is often limited by dose-dependent adverse events (AEs), such as gastrointestinal disturbances, cardiovascular events, and renal toxicity. The risk of such effects could be reduced by the use of topical formulations, which offer the potential to deliver analgesic concentrations locally, at the site of inflammation, while minimizing systemic concentrations. The topical preparations currently approved in the United States are diclofenac sodium 1.5% topical solution (containing dimethyl sulfoxide as a penetration enhancer), diclofenac sodium gel 1%, and a diclofenac hydroxyethylpyrrolidine 1.3% patch. ⋯ Meta-analyses have confirmed the efficacy and safety of these preparations. However, it is important to recognize that pharmacokinetic absorption from topical formulations can vary markedly, even between different formulations of the same drug, depending on the agent, the underlying disorder, and the site of application. It is therefore essential to consider the patient, the drug, and the drug delivery mechanism when selecting a topical NSAID preparation.
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It is widely accepted that randomized controlled trials (RCTs) are the gold standard for demonstrating the efficacy of a given therapy (results under ideal conditions). Observational studies, on the other hand, can complement this by demonstrating effectiveness (results under real-world conditions). ⋯ Observational studies of statin use in 'real-world' populations have served to augment the evidence base generated from statin RCTs in preselected populations of patients who are often at high CV risk and have led to similar safety and efficacy findings. They have also raised questions about factors affecting medication adherence, under-treatment, switching between statins, and failure to reach low-density lipoprotein cholesterol target levels, questions for which the answers could lead to improved patient care.
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Although depression has been reported to be associated with various cardiovascular risk factors, whether an association exists between depression and prevalence of cardiovascular events is not well known. In particular, the effect of symptom frequency and cardiovascular events has not been described. Data were collected for patients older than 45 years from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) data to study whether an association exists between depression and prevalence of coronary artery disease (CAD), myocardial infarction (MI), congestive heart failure (CHF), and stroke. ⋯ Significant associations were noted between depressive symptoms and prevalence of CAD, MI, CHF, and stroke. Those who reported being depressed more than half of the days of the week had 1.95 times greater odds of CAD [95% confidence interval (CI), 1.2473-3.0523], 2.54 times greater odds of CHF (95% CI, 1.6114-4.0126), 2.65 times greater odds of MI (95% CI, 1.7789-3.9521), and 1.91 greater odds of stroke (95% CI, 1.2002-3.0356) when compared with those who reported being depressed less than half of the days of the week. The results of this study suggest that the prevalence of CAD, MI, CHF, and stroke are significantly increased in individuals who report feeling down/depressed/hopeless for more than half the days of the week.