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Vantomor Medical Knowledge

Scientific AffairsDecember 2016

VANTOMORDICLOFENAC SODIUM 50 MG/

DISPERSIBLE TABLETS

Diclofenac Sodium belongs to NSAIDS

“ Analgesic & Anti inflammatory “

1- What does Inflammation mean ? (1)*

• Complex protective reaction

• Caused by various endo- and exogenous stimuli(examples)

• Injurious agents are destroyed, diluted or walled-off

• Without inflammation and mechanism of healing , living organism could not survive

(1)* http://www.slideshare.net/lheannetesoro/general-pathology-lecture-5-inflammation-repair?from_action=save

Acute InflammationAcute inflammation:

can be defined as the early response

to local injury in a vascularized tissue .

The purpose:

is to deliver plasma and blood cells to the injured tissue .

Can be divided into:

vascular events – chemical events.

http://vet.uga.edu/ivcvm/courses/VPAT5200/03_inflammation/02_acute/inflamm02.htm

Vascular Events of Acute InflammationIn the early stages of inflammation, the affected tissue becomes reddened and swollen, due to increased blood flow and to edema fluid. The vascular events of the acute inflammatory response involve three main processes.

changes in vessel caliber and, consequently, flowincreased vascular permeability andformation of the fluid exudate

Vessel walls also change, to allow inflammatory cells to adhere and get out into the tissue where they are needed.

http://vet.uga.edu/ivcvm/courses/VPAT5200/03_inflammation/02_acute/inflamm02.htm

Permeability ChangesMostly from inflammatory chemicalsOccurs in capillaries & small venulesJunctions between epithelial cells loosen Fluid leaks

) transudate exudate(Leads to hemoconcentrationMakes margination easier

(1)* http://www.slideshare.net/lheannetesoro/general-pathology-lecture-5-inflammation-repair?from_action=save

Vascular Events of Acute Inflammation

Events in Acute Inflammation

The order of the events in acute inflammation are

1 .vascular dilatation 2 .increased vascular permeability

3 .local hemoconcentration and slowing of blood

4 .margination of white blood cells 5 .emigration of leukocytes

(1)* http://www.slideshare.net/lheannetesoro/general-pathology-lecture-5-inflammation-repair?from_action=save

Acute Inflammation – Chemical events

Over 180 different chemicals involved in acute inflammationSources => damaged cells, inflammatory cells, platelets, plasma, etc.Histamine –> ( 1st chemical released ) strong vasodilator & increases permeabilityBradykinins –> increases permeability & pain (especially with prostaglandins)Prostaglandins –> made from released phospholipids (arachadonic acid cascade)

Target of NSAIDS & steroidal anti-inflammatories

(1)* http://www.slideshare.net/lheannetesoro/general-pathology-lecture-5-inflammation-repair?from_action=save

SIGNS OF INFLAMMATION• REDNESS : Due to increased blood

blow and vasodilation

• HEAT : Due to increase blood flow to the periphery

• SWELLING : From inflammatory edema

• PAIN : From swelling and presence of inflammatory mediators (Prostaglandin)

• LOSS OF FUNCTION : Due to main and structural necrosis

(1)* http://www.slideshare.net/lheannetesoro/general-pathology-lecture-5-inflammation-repair?from_action=save

https://en.wikipedia.org/wiki/Pain

Pain is a distressing feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger or putting alcohol on a cut.

Pain categories :

1. Somato-genic pain: is pain with cause (usually known) localised in the body tissue a/ nociceptive pain b/ neuropatic pain

2. Psychogenic pain : is pain for which there is no known physical cause but processing of sensitive information in CNS is disturbed

www.brown.edu/Courses/BI_278/Other/.../national/...Pain/Pain.ppt

http://www.slideshare.net/scribeofegypt/chronic-pain-as-a-disease-state

Nociceptive pain

Nociceptors: Endings of small neurons

Stimulators: Chemical, mechanical and thermal noxaeMild stimulation positive, pleasurable sensation

(e.g. tickling)Strong stimulation painThese differences are a result of the frequency

and amplitude of the afferent signal transmitted from the nerve endings to the CNS

Location: In muscles, tendons, epidermis, subcutanous tissue, visceral organs

- they are not evenly distributed in the body (in skin more then in internal structures)

www.brown.edu/Courses/BI_278/Other/.../national/...Pain/Pain.ppt

http://www.slideshare.net/TomokoYamada2/pain-and-depression

Mechanism of Pain

Prostaglandin Physiological Effect

Inflammation

• PGs are natural mediators of inflammation

• PGE2 & PGE1 induce signs of inflammation- redness, heat ( vasodilation), swelling, edema, etc

Pain & Fever

• Stimulation of PG synthesis & release of PGE2 in the Hypothalamus region of brain where temp is regulated.

• PGE2 can enhance the intensity & duration of pain caused by bradykinin & histamine.

http://www.slideshare.net/TomokoYamada2/pain-and-depression

(*)Acute Pharyngitis:

What Is Pharyngitis?

Pharyngitis is inflammation of the pharynx, which is in the back of the throat. It’s most often referred to simply as “sore throat.”

Pharyngitis can also cause scratchiness in the throat and difficulty swallowing.

Causes:- Pharyngitis may be caused by bacterial or viral infections

(*)http://www.healthline.com/health/pharyngitis

(*)Otitis externa :

What Is it?

-Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both.-This condition can be found in all age groups

causing :Hearing lossErythema, edema, and narrowing of the EACFever (occasionally)Itching (especially in fungal OE or chronic OE)Severe deep pain

http://emedicine.medscape.com/article/994550-overview

Pulpitis:

• Pulpitis is a general term for inflammation of the tooth "pulp“

• Pulpitis can be caused by any adverse event experienced by the tooth, including decay, traumatic injury

• Pulpitis divided into two types: Irreversible pulpitis and reversible pulpitis.

http://www.toothiq.com/dental-diagnosis/irreversible-pulpitis/

Irrevesible Pulpitis Reversible Pulpitis

• characterized by prolonged sensitivity to cold and/or heat, and sometimes to sweets.

• accompanied by a continuous low grade ache, which is aggravated by these stimuli.

• Swelling may be present.

characterized by sharp sensitivity to cold, sometimes to sweets and sometimes to biting.

no low-grade ache, and the painful response to stimuli is not as prolonged .

Swelling is generally not present. Normally.

(*)Endodontic :

• Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.”

• Endodontic treatment treats the inside of the tooth. Root canal treatment is one type of endodontic treatment

. • To understand endodontic treatment, it helps to know

something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development

.• The pulp extends from the crown of the tooth to the tip

of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.* http://www.aae.org/patients/treatments-and-procedures/root-canals/root-canals-explained.aspx

Why would I need an endodontic procedure?

• Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected.

The inflammation or infection can have a variety of causes:a) deep decayb) repeated dental procedures on the toothc) a crack or chip in the tooth.

• In addition, an injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks.

• If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess

* http://www.aae.org/patients/treatments-and-procedures/root-canals/root-canals-explained.aspx

(*)Abscess :

• An abscess is a tender mass generally surrounded by a colored area from pink to deep red. Abscesses are often easy to feel by touching. The middle of an abscess is full of pus and debris.

• Painful and warm to touch, abscesses can show up any place on your body

http://www.webmd.com/a-to-z-guides/abscess?page=2

(*)Hernia :

What Is a Hernia?

• A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place.

• For example, the intestines may break

through a weakened area in the abdominal wall.

• Hernias are most common in the abdomen, but they can also appear in the upper thigh, belly button, and groin areas. Most hernias are not immediately life threatening, but they don’t go away on their own and can require surgery to prevent potentially dangerous complications

http://www.healthline.com/health/hernia#Prevention9

Anti Microbial Susceptibility tests

When a microorganism is isolated from a patient, the microbiology lab will often perform susceptibility testing. There is often confusion about what these results mean and how it can be used by the clinician to guide the treatment of the patient.

To find out what these test are and what they mean......http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amt.html

What is the goal of testing?

The goal of antimicrobial susceptibility testing is to predict the in vivo success or failure of antibiotic therapy. Tests are performed in vitro, and measure the growth response of an isolated organism to a particular drug or drugs. The tests are performed under standardized conditions so that the results are reproducible. The test results should be used to guide antibiotic choice. The results of antimicrobial susceptibility testing should be combined with clinical information and experience when selecting the most appropriate antibiotic for your patient.

What is the output from antimicrobial susceptibility testing?

The raw data are either in the form of a zone size or MIC. CLSI has published interpretation criteria for these tests, which has come from extensive testing and clinical correlation.

Zone SizeBauer-Kirby Disk Diffusion

This is one of the more commonly used methods of antimicrobial susceptibility testing. In this test, small filter paper disks (6 mm) impregnated with a standard amount of antibiotic are placed onto an agar plate to which bacteria have been swabbed. The plates are incubated overnight, and the zone of inhibition of bacterial growth is used as a measure of susceptibility (see below). Large zones of inhibition indicate that the organism is susceptible, while small or no zone of inhibition indicate resistance. An interpretation of intermediate is given for zones which fall between the accepted cutoffs for the other interpretations.

Measurement of MIC The minimum inhibitory concentration or MIC is defined as

the minimum concentration of antibiotic which will inhibit the growth of the isolated microorganism . There are many ways to measure the MIC, including:

Broth dilution Agar dilution E-test

An example of the broth dilution test is shown below.

This figure shows a schematic of the broth dilution test. Bacteria are inoculated into tubes containing culture broth and varying concentrations of the antibiotic to be tested. The tubes are incubated to allow bacterial growth. The MIC is read as the lowest concentration of antibiotic which inhibited bacterial growth. In the above example, the MIC would be 8 micrograms/ml.

Measurement of CFUIn microbiology, a colony-forming unit (CFU, cfu,

Cfu) is a unit used to estimate the number of viable bacteria or fungal cells in a sample. Viable is defined as the ability to multiply via binary fission under the controlled conditions. Counting with colony-forming units requires culturing the microbes and counts only viable cells, in contrast with microscopic examination which counts all cells, living or dead. The visual appearance of a colony in a cell culture requires significant growth, and when counting colonies it is uncertain if the colony arose from one cell or a group of cells. Expressing results as colony-forming units reflects this uncertainty.