Introduction: Toxic epidermal necrolysis (TEN) is among the most severe forms of dermatological reactions, which often occurs in response to NON-STEROIDAL ANTI-INFLAMMATORY DRUGs (NSAIDs) and leads to death in 20-50% of the cases. Case Presentation: A 41-year-old male patient was referred with a history of NSAID use, presenting with maculopapular rashes, at Kowsar Hospital in Sanandaj, Iran. The patient was hospitalized and received various therapies. He was discharged after 14 days in a good overall condition. Conclusion: Determining the basic etiology and disruption of pharmaceutical factors are essential to the treatment of TEN. The therapeutic interventions are similar to those used for burn patients.

Background: Duodenal ulcer perforations (DUP) are missed in the differential diagnosis of acute abdomen because they are less commonin children than in adults. Delay in diagnosismaycause morbidity or even mortality. It was aimed to raise awareness about DUP in adolescent by comparing the data of adolescent cases treated in our clinic with the adult cases’,data in the literature. Objectives: We reviewed the clinical characteristics of nine male patients with DUP, ages between 14 and 17 years, admitted to our clinic between January 2007 and June 2020 retrospectively. Literature data on DUP in adults were reviewed. Methods: The obtained data were compared with the data of adult patients in the literature. Results: Patients were reported to have symptoms such as abdominal pain and vomiting that lasted for 1-30 days on average in 8 patients, and nonsteroidal anti-inflamatory DRUGs were used all patients except 2 patients. There was diffuse tenderness at the abdomen in all of the remaining patients and in 7 patients intraabdominal free air was observed. Perforation was repaired with omentoplasty in all patients. Unlike the adult population, DUP adolescents are more related to NSAID use rather than Helicobacter pylori infection and complicated surgical techniques were not required because the cases were generally not complicated. Conclusions: Although it is rarely seen in adolescents and shows certain differences compared to adult patients, the anamnesis and physical examination of the patients should direct the physicians to the DUP. Differences from adult population should be considered in diagnosis and treatment.

Background: Diverse studies suggest that NON-STEROIDAL ANTI-INFLAMMATORY DRUGs (NSAIDs) induce antinociception through the inhibition of cyclooxygenases. Objectives: This study evaluated the effect of NSAIDs in inducing antinociception either alone or in combination in mice formalin orofacial pain. Methods: Male mice were injected intraperitoneally with dexibuprofen, dexketoprofen, diclofenac meloxicam, metamizole and piroxicam. Then from a dose-response curve the ED50 (dose that produce 50% of maximum effect) was obtained from each DRUG. Results: The administration of NSAIDs produced a dose-dependent antinociception in both phases of the assay with different potency. Then, combinations of the cited NSAIDs were tested and analyzed by isobolographic analysis. The results demonstrate that the nocifensive response induced when dexketoprofen (DEX), the dextrorotatory enantiomer of the S (+) configuration of ketoprofen, was combined with piroxicam, diclofenac, dexibuprofen, metamizole, and meloxicam, was synergistic, either in Phase I or Phase II of the formalin orofacial mice assay. Conclusion: The data demonstrated that the NSAIDs administered alone or in combination produce antinociception. These effects need to be explained by other mechanisms of action of NSAIDs other than the simple inhibition of COXs. The findings may be relevant for the relief of acute or chronic pain such as migraine, post‐ herpetic neuralgia and tooth pain.

Background: Conventional route, the most common route of administration, has drawbacks such as hepatic first-pass metabolism, poor bioavailability, and ability to alter DRUG concentrations in the blood. These problems can be overcome by a controlled-release DRUG delivery system, which can be accomplished with the development of transdermal DRUG delivery system. Objective: The objective of this study was to design and develop a lornoxicam-loaded matrix-type transdermal films with different permeation enhancers and determine their physicochemical characteristics. Materials and Methods: Lornoxicam-loaded transdermal films were prepared by the solvent evaporation technique. The Fourier transform infrared spectroscopic studies were performed to determine the DRUG– excipient interactions. Six formulations were prepared with different permeation enhancers such as propylene glycol, dimethylformamide, dimethyl sulfoxide (DMSO), sodium lauryl sulfate, Span 20, and TWEEN 80 by using 500 mg of sodium alginate as the polymer and 60% w/w glycerin as the plasticizer. The prepared formulations were evaluated for thickness, uniformity of weight, moisture loss, moisture uptake, DRUG content, and tensile strength. The effect of different permeation enhancers on diffusion was determined through a shed snakeskin by using Franz diffusion cells. Results: The preformulation studies conducted were fulfilled to design a matrix-type transdermal film. In vitro diffusion 24 h indicated that the steady state flux were in the order of F3  > F2  > F1  > F6  > F5  > F4. It was observed that the film prepared with DMSO showed higher diffusion than the formulations with other permeation enhancers. Conclusion: It was concluded that permeation enhancer to prepare lornoxicam-loaded matrix-type transdermal film to improve patient compliance.

Introduction: The use of nonsteroidal ANTI-INFLAMMATORY DRUGs (NSAIDs) are one of the most commonly therapeutic classes and are responsible for ten percent of medications dispensed annually. Twelve percent of individuals currently report taking a NSAID daily. Renal injury caused by these agents can present in various forms, resulting from either acute or chronic use. Historically approximately five percent of patients initiated on NSAIDs experience a kidney-related adverse event. DRUG-induced renal injury accounts for twenty percent of episodes of acute kidney injury (AKI). Patients requiring renal replacement therapy (RRT) have experienced an increased length of stay with associated healthcare costs per incident. The adverse effects of NSAIDs contribute to a significant economic burden, both to the patient and to the healthcare system. Methods: A medical literature review was composed. Results: Numerous risk factors contribute to the development of DRUG-induced renal injury and disease. Patient specific factors include volume depletion and comorbid conditions. External risk factors such as use of high-risk medications and diagnostic contrast dyes contribute to the increased risk. Implementation of risk mitigation and educational strategies targeting healthcare professionals has the potential to decrease negative clinical and economic outcomes. Conclusion: Healthcare providers’ understanding of the pathophysiology, diagnostic criteria, and risk factors associated with AKI is vital to improve patient outcomes. Proactively screening high risk patients and utilizing appropriate mitigation strategies contributes to limiting the incidence and severity of injury. When the use of NSAIDs cannot be avoided, utilization of lower doses may be a suitable alternative.