The British journal of clinical practice
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A patient with a greatly prolonged international normalised ratio (INR) during the combined use of warfarin and indomethacin is described. In patients on warfarin, non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided as far as possible. If NSAIDs are absolutely necessary, patients should be closely monitored for prolongation of INR and bleeding.
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Focal lymphoid hyperplasia of the terminal ileum is a rare cause of terminal ileitis. We describe the case of a 13-year-old boy with a stricture of the terminal ileum that was diagnosed as Crohn's disease on barium meal and follow through. This failed to resolve on steroid therapy and the boy eventually required resection of his terminal ileum. Pathology of the terminal ileum showed focal lymphoid hyperplasia and not Crohn's disease.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparative efficacy and tolerability of two diclofenac formulations in the treatment of painful osteoarthritis.
The efficacy and tolerability of a new resinate formulation of diclofenac 75mg taken once or twice daily were compared with that of conventional enteric-coated diclofenac sodium 50mg tablets given two or three times daily in a double-blind, randomised, between-patient, 12-week trial in 216 adult patients suffering from painful osteoarthritis of the hip and/or knee. Similar and clinically significant reductions in the mean intensity scores of pain at rest or on activity were observed after treatment with either formulation. ⋯ A significant analgesic effect was obtained within two weeks of treatment with 150mg diclofenac daily; this improvement was maintained on reduction of the dosage to 75-100mg over the next ten weeks. One or more drug-related adverse events, predominantly gastrointestinal adverse events, were reported by 40% and 38% of patients in the diclofenac resinate and diclofenac sodium groups, respectively.
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Chronic non-malignant pain is often treated inadequately because of opiophobia. There is no scientific justification for this fear. ⋯ There is no scientific evidence that patients with chronic non-malignant pain are more prone to addiction or tolerance. It is also pertinent to consider that the endpoint of chronic pain treatment is not just freedom from pain but global wellbeing.