Othoniel H. Aragon-Martinez

Analgesic efficacy and safety of single-dose tramadol and non-steroidal anti-inflammatory drugs in operations on the third molars: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate published randomised, double-blind, clinical trials to compare the analgesic efficacy and safety of tramadol with that of non-steroidal anti-inflammatory drugs (NSAID) in operations on the third molars. We identified eligible reports from searches of PubMed, MedLine, the Cochrane Library, Oxford Pain Relief database, Imbiomed, and Google Scholar. The full text of studies that met our minimum requirements were evaluated using inclusion and exclusion criteria with the Oxford Quality Scale. Those with a Score ≥ 3 in this scale were included and their data were extracted and analysed. Absolute increase in risk, the number needed to harm, odds ratio and 95% CI were calculated using Risk Reduction Calculator software. Each meta-analysis was made with the help of the Mantel-Haenszel random effects model, estimates of risk (odds ratio (OR)) and 95% CI were calculated using the Review Manager 5.2. from the Cochrane Library. A significant risk was assumed when the lower limit of the 95%CI was greater than 1. Probabilities of less than 0.05 were accepted as significant. The results showed that tramadol had less analgesic efficacy and an increased risk of adverse effects compared with NSAID. In conclusion, a single dose of tramadol was not as effective or as safe as NSAID for the relief of pain after operations on the third molars.

Risk of wound infection and safety profile of amoxicillin in healthy patients which required third molar surgery: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to assess the risk of surgical wound infection and the adverse effects of amoxicillin in healthy patients who required excision of third molars. We identified eligible reports from searches of PubMed, Medline®, the Cochrane Library, Imbiomed, LILACS, and Google Scholar. Studies that met our minimum requirements were evaluated using inclusion and exclusion criteria and the Oxford Quality Scale. Those with a score of 3 or more on this Scale were included and their data were extracted and analysed. For evaluation of the risk of infection the absolute risk reduction, number needed to treat, and 95% CI were calculated. For evaluation of the risk of an adverse effect the absolute risk increase, number needed to harm, and 95% CI were calculated using the Risk Reduction Calculator. Each meta-analysis was made with the help of the Mantel-Haenszel random effects model, and estimates of risk (OR) and 95% CI were calculated using the Review Manager 5.3, from the Cochrane Library. A significant risk was assumed when the lower limit of the 95% CI was greater than 1. Probabilities of less than 0.05 were accepted as significant. The results showed that there was no reduction in the risk of infection when amoxicillin was given before or after operation compared with an untreated group or placebo. In conclusion, this study suggests that amoxicillin given prophylactically or postoperatively does not reduce the risk of infection in healthy patients having their third molars extracted.

Measurement of levofloxacin in human plasma samples for a reliable and accessible drug monitoring.

OBJECTIVES Levofloxacin monitoring is recommended to obtain clinical cure and low incidence of antimicrobial resistance. During the monitoring procedure, levofloxacin should be measured in plasma samples and several assays are reported for this purpose. However, those methods do not have all of the characteristics for an accessible and reliable drug monitoring. For this reason, we develop a method that has all of the essential characteristics for levofloxacin monitoring. DESIGN AND METHODS The procedure of validation was done in terms of Food and Drug Administration guidelines. Subsequently, our assay was applied in plasma samples obtained from healthy volunteers with a single oral administration of levofloxacin as well as patients with respiratory diseases under levofloxacin therapy. RESULTS Levofloxacin was extracted from samples using only two precipitation steps. Our assay had a rapid run time (5min), adequate sensitivity (0.05μg/ml of lower limit of quantification), and acceptable parameters of validation. Moreover, compound identities were supported using three dimensional spectra and purities were confirmed employing similarity factors (values>900). Variable concentrations of levofloxacin in samples were observed during the application. CONCLUSIONS Levofloxacin is successfully quantified using our method that shows reliable results, appropriate range, rapid analyses, and cost-effective measurements under a simple and easy technique while all prior methods did not have it all together. Consequently, our method is a valuable tool for routine drug monitoring. Moreover, a complete evaluation of specificity was done for levofloxacin in plasma samples for the first time. Meanwhile, the application data supported the necessity of levofloxacin monitoring.

Isobolographic Analysis of the Interaction Between Tapentadol and Ketorolac in a Mouse Model of Visceral Pain

Preclinical Research

Bacterial resistance and failure of clinical cure could be produced by oxidative stress in patients with diabetes or cardiovascular diseases during fluoroquinolone therapy

Fluoroquinolone agents are used widely for the treatment of infectious diseases which are a common cause of deaths around the world. The level of oxidative stress in patients taking fluoroquinolone antibiotics has not been considered a factor to reduce the clinical efficacy of this kind of drugs. Patients with diabetes and/or cardiovascular diseases present abnormal levels of oxidative stress in the blood stream. In this regards, our hypothesis supposes that patients with diabetes and/or cardiovascular disease suffering a bacterial disease could experience a therapeutic failure and bacterial resistance when treated with fluoroquinolones. The crucial mechanism could be an inefficient blood distribution of the drug via red blood cell dysfunction induced by oxidative stress that might reduce the pharmacokinetic-pharmacodinamic ratios. In this way, we review the scientific information to support our hypothesis alongside possible implications. Additionally, this work exhibits the urgent need of studies considering these conditions for quinolone agents.

Synergism Between Tramadol and Parecoxib in the Orofacial Formalin Test

Preclinical Research

Infection, Alveolar Osteitis, and Adverse Effects Using Metronidazole in Healthy Patients Undergoing Third Molar Surgery: A Meta-analysis

Purpose The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery.Materials and Methods The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study. The evaluation of risk was done using the Risk Reduction Calculator and Review Manager 5.3., from the Cochrane Library. A significant risk reduction was assumed when the upper limit of the 95% confidence intervals was <1 and the lower limit did not cross zero (negative number) alongside a p value of <0.05 for the overall test. Data of 667 patients from five clinical trials were used for the assessment of risk.Results Our analysis showed no reduction of the risk of infection or dry socket in patients receiving metronidazole compared to whom took placebo. Meanwhile, the adverse effects did not exhibit a difference between the studied groups.ConclusionThe routine use of systemic metronidazole to prevent surgical site infection and/or dry socket in healthy patients undergoing third molar surgery is not recommended.

Validated and rapid measurement of the ferric reducing antioxidant power in plasma samples

The ferric reducing antioxidant power assay was developed using rat plasma samples and validated according to the Food and Drug Administration guidelines as well as strategies for the lack of endogenous compounds-free samples of matrix. For validation procedures, the phosphate buffered saline solution was used as the artificial matrix because this led to a direct interpolation in calibration curves. The absorbance responses and antioxidant activities in curves showed a second order polynomial relationship (R2 value = 0.9982). The precision, accuracy, and stability of the method ranged from 1.7 to 7.2%, 89.8 to 100.0%, and 82.7 to 111.6%, respectively. This assay had a short time of analysis (96 samples per min) and absence of interferences during the spectrophotometric monitoring. For the application of the method, the plasma antioxidant capacity, blood distribution of levofloxacin, and biometry hematic were evaluated in samples obtained from rats under different experimental conditions. The in vitro condition applied to blood samples increased the plasma antioxidant capacity and volume of erythrocytes, whereas diminished the levofloxacin concentration in these cells. The high antioxidant activity was produced by a high amount of inosine, which in turn was caused by high oxidative stress leading to an impaired blood distribution of levofloxacin and erythrocyte swelling. This assay is a validated and rapid biomarker for the evaluation of the total antioxidant capacity in plasma samples.Graphical abstract

Synergism between Naproxen and Rutin in a Mouse Model of Visceral Pain

Preclinical Research

Nutritional and biochemical effects of aspartame intake in rats under an experimental diet

The present study evaluates the effect of aspartame intake in rats under a diet mimicking the trends of fat consumption in the society. The composition of the experimental diet was within the recommended human limits except the saturated fat amount supplying from coconut fat. Rats under the experimental diet showed an increase in the body weight, transitory increase in the blood pressure and in plasma values of glucose and triglycerides alongside a transitory reduction in plasma urea versus the standard group. Rats under the experimental diet plus aspartame intake (54.8 ± 7.3 mg/kg bw/day) did not show any increase of body weight and in plasma values of glucose and triglycerides while showed an improvement in the plasma value of urea with respect the group under only the experimental diet. However, the aspartame group showed a more maintained increase of blood pressure. In conclusion, experimental diet produces negative effects on cardiovascular risk factors of the rats while the aspartame intake under the experimental feeding had mixed effects on the cardiometabolic factors of the animals.