Colorectal neoplasia (CRN) continues to be a leading cause of morbidity and mortality in the developed world and with westernisation, similar trends are now emerging in the developing world. Although secondary prevention through screening programmes has reduced mortality, uptake remains poor due to the invasive nature of colonoscopy, which also exerts increased costs to the health care system. Primary prevention remains the ultimate aim to reduce the morbidity and mortality associated with CRN. In this regard, chemoprevention strategies through regular use of aspirin and other NSAIDS have showed great promise but the associated significant side-effects of these drugs has prevented their routine clinical application for this purpose. Hence there is an urgent need for the identification of safer alternatives for primary prevention of CRN. In parallel to this search, better understanding of the molecular pathogenesis of CRN to identify biomarkers that aid in stratification of at risk individuals would also help. In this regard, the role of chronic inflammation and the influence of host genetics in the pathogenesis of CRN has been the focus of extensive research in recent years. However there is a lack of studies which have investigated these associations in an exclusively screened population, which confers some advantages for this type of investigation. Firstly, most of the screened subjects are relatively healthy, asymptomatic and with no significant co-morbidities, the factors which could otherwise influence the levels of inflammatory markers. Secondly, the screened population is in the 50 to74 year age group which represents the group with a high prevalence of CRN and hence increasing the possibility of finding associations which would be more relevant and generalisable. Thirdly, the selected controls match the cases in all important respects, apart from having CRN, thus increasing the validity of the findings in this population. The Grampian region was one of the first in the UK to participate in the National Colorectal Cancer Screening Programme and this resource gave the ideal opportunity to conduct research involving an exclusively screened population. Utilising this cohort, the current thesis addressed three important aspects of the association between inflammation and CRN. Firstly the investigation of the association of inflammatory genotype, inflammatory phenotype and CRN risk. Secondly the impact of environmental factors, specifically dietary antiinflammatory salicylic acid intakes on CRN risk. And finally assessing if inflammation, and hence in the long term risk of CRN, could be attenuated through a comprehensive anti-inflammatory dietary supplementation in the form of a randomised dietary intervention clinical trial. The study of the association of polymorphisms in key inflammatory genes (IL1B- 31, IL8-251, IL6-174, TNFα-308, IL10-1082, IL10-592, PTGS2-765, and IL1RN VNTR) and CRN risk showed some significant findings. A novel finding was that the homozygous IL1B-31C*C genotype was associated with statistically significant increased risk of CRN, OR 1.63 (95% CI 1.06-2.50) whilst the IL8-251 A*A genotype increased the propensity of having high risk lesions by two-fold (OR 2.04; 95% CI 1.02-4.07). The study of circulating inflammatory marker levels in subjects in whom the CRN was in-situ showed that increased CRP levels were associated with increased risk of CRN, OR 1.55 (95% CI 1.00-2.39). Increased levels of IL8 were associated with increased risk of having a high risk lesion, OR 2.57 (95% CI 1.03-6.44). In a sub group of subjects, it was observed that levels IL8 and CRP decreased following polypectomy (mean IL8 20.3 pg/ml to 14.9 pg/ml, p=0.05 and mean CRP 5.99 mg/l to 3.82 mg/l, p=0.07) raising an important question regarding the sequence of the inflammation-neoplasia cascade, “Is inflammation the cause or the effect of neoplasia?” The study of the association of dietary salicylic acid (SA) and CRN using the newly constructed SA database showed that high levels of total SA (aspirin and dietary SA) intakes were associated with a 75% and moderate levels with a 67% decreased risk of CRN. But dietary SA on its own showed no significant effect on CRN risk probably because of low intake levels in the current cohort. Applying the SA database to populations with higher dietary SA intake would help to further explore its association with CRN risk. The randomised clinical trial examining the effect of a combined antiinflammatory dietary supplement (curcumin, omega-3 PUFA and polyphenols rich fruit smoothie) on markers of inflammation in subjects who had adenomatous colorectal polyps removed showed that the inflammatory marker levels in the control group who just continued their habitual diet remained stable without any statistically significant changes at 6 weeks compared to the baseline. Whereas following 6 weeks of dietary intervention, there was marginally significant increase in IL8 and IL1B levels. One of the possible mechanisms for increase in pro-inflammatory marker levels in the intervention group was the weight gain seen in the intervention group. In the intervention group, the post-intervention mean weight (86.80kgs) was significantly higher than the pre-intervention mean weight (85.38 kgs). In summary, the findings from these investigations suggest that a proinflammatory genotype (IL1B-31C*C and IL8-251 A*A) and elevated circulating inflammatory marker levels (CRP and IL8) are associated with increased risk of CRN. And along with the findings that regular NSAID use and total dietary SA are associated with decreased risk of CRN, our data point to inflammation as an underlying pathogenetic mechanism in CRN. The pilot clinical trial has demonstrated that a clinical trial with combined dietary supplementation is feasible, but challenging. The anti-inflammatory dietary intervention strategy employed to reduce the inflammatory markers did not achieve the desired effect and hence more research is required to establish the ideal delivery strategy of the anti-inflammatory dietary agents. Once this is established, dietary chemoprevention of CRN as a safe alternative should be a realistic achievable goal in the future.

Dissertation submitted to the Faculty of Health in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this study was to test the Effectiveness of Proprioceptive Neuromuscular Facilitative Stretching combined with administration of Diclofenac compared to Proprioceptive Neuromuscular Facilitative Stretching and placebo medication for the treatment of Cervical Facet Syndrome in a clinical experimental setting. Neck pain is a common disorder, which can often be attributed to mechanical dysfunction of the cervical spine. The patient with facet syndrome may complain of sudden onset of unilateral neck pain, often with referred pain. Muscle spasm is usually present causing restricted movement. Pain increases with movement and is relieved by rest. The pain is aggravated by hyperextension and relieved by flexion and often follows a sclerotomal rather than a dermatomal pattern. Forty subjects with mechanical neck pain were screened for facet syndrome and randomly divided into two groups of twenty. Each patient received Proprioceptive Neuromuscular Facilitative (PNF) stretching of the Posterior Cervical and Trapezius musculature. In conjunction with this, half the patients received Cataflam D while the other half received placebo medication. The patients were treated five times over a period of two weeks. Both groups were evaluated in terms of subjective and objective clinical findings by making use of questionnaires (Numerical Pain Rating Scale 101, Short Form McGill Pain Questionnaire and the CMCC) and algometer and goniometer measurements respectively. The data was collected at the initial, middle and final treatments for each patient. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / There are many non-surgical treatments that are available to patients with low back pain but few have been proven effective in controlled clinical trials. Arguably, the treatments with the greatest evidence for efficacy are nonsteroidal anti-inflammatory drugs (NSAIDs), some muscle relaxants and spinal manipulation (Deyo et al.(1983) and Shekelle et al.(1992). Non-steroidal antiinflammatory drugs are the most widely used agents for musculoskeletal pain and inflammation. The widespread use of NSAIDs augments the impact not only of their benefits but also the risk of their adverse effects. The effectiveness of chiropractic management is now firmly established for most patients with acute and chronic low-back pain (Koes et aI.1996). The purpose of this study was to determine the relative efficacy of combined diclofenac sodium therapy and spinal manipulation compared to combined placebo therapy and spinal manipulation in the treatment of mechanical low back pain. Sixty subjects were selected and randomly divided into two groups of thirty subjects. Subjects were treated four times over a two-week period, including a diclofenac or placebo medication course, taken three times daily for five days, starting from the first consultation. The results of the Numerical Pain Rating Scale-101, Revised Oswestry Low Back Pain Disability Questionnaire, Orthopaedic Rating Scale and Algometer readings were taken before the first, third and fourth consultations. The statistical tests used were the parametric two-sample unpaired t-tests and the paired t-tests, and the nonparametric intra-group Friedman test, multiple comparison procedure, Wilcoxon Signed Ranks test and the inter-group Mann Whitney U-test at the 95% level of significance using the SPSS statistical package. There was a statistically significant improvement in both treatment groups for both subjective and objective clinical findings, suggesting that spinal manipulation combined with either an NSAID or placebo medication will ultimately give relief to a patient suffering from lower back pain. The conclusions / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 2001. / For neck pain, the first-line treatment of allopathic physicians is usually the prescription on non-steroidal ant-inflammatory drugs (NSAIDs), whereas the firstline treatment of chiropractic physicians is usually cervical manipulation. The literature shows that both chiropractic manipulation alone and NSAIDs alone are effective for the treatment of cervical facet syndrome, with chiropractic manipulation being much safer than the use of NSAIDs. Furthermore, patients that receive chiropractic care have been shown to generally be much more satisfied than those that receive conventional medical care. The aim of this study was to determine the short-term effectiveness of cervical spine manipulation as compared to Piroxicam administration in the treatment of chronic cervical facet syndrome. The study design that was chosen was that of a comparative clinical trial. Forty consecutive patients diagnosed with chronic facet syndrome of the cervical spine were randomly assigned to either the manipulation group or the NSAID group (twenty patients in each group). Each patient in group A received manipulative therapy of the cervical spine on three consecutive days. Each patient in group B received 40 mg of Adco Piroxicam on the first two days of treatment, and 20 mg daily for the remainder of the seven day treatment period. The patients were assessed by means of objective and subjective data obtained before each consultation on days 1, 3 and 7. The objective data was gathered from algometric pressure-pain threshold readings over the involved facet joint. The subjective information was obtained from the Short-Form McGill Pain Questionnaire, the Numerical Pain Rating Scale - 101 and the CMCC Neck Disability Index, as well as the patients perceived improvement which was recorded as a percentage on days 3 and 7. / M

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg for the Degree of Master of Science / The antiinflammatory effects of lnterleukin-4 (IL-4) and the synthetic glucocorticoid dexamethasone were studied in adhered monocytes and the leukaemic cells HL-60 and THP-1, with respect to the expression of interleukin-lB (IL-lLB), the (signalling) IL-1 receptor type I (IL..1RtI), and the (inhibitory) IL-1 receptor type I (IL-lRtI). (Abbreviation abstract) / AC2018

Os anti-inflamatórios não esteroidais (AINEs) são medicamentos utilizados no alívio da dor após a ativação dos aparelhos ortodônticos, mas estas substâncias podem influenciar a formação óssea ou remodelação. Diante da possibilidade de interferência dos medicamentos durante o tratamento ortodôntico, foi avaliado o efeito á curto prazo de AINEs e anti-inflamatório seletivo COX-2, em doses terapêuticas, sobre osteoblastos durante a movimentação dentária induzida. Os fármacos foram determinados através de questionários aplicados a ortodontistas, os quais mais selecionaram os mais prescritos para alívio da dor durante o tratamento ortodôntico. Os medicamentos selecionados e a nimesulida (seletivo COX-2) foram administrados em uma amostra de 80 ratos albinos da linhagem Wistar, nos quais foi realizada a instalação de dispositivos constituídos por uma mola de secção fechada ancorada aos incisivos centrais superiores, movimentando mesialmente o primeiro molar superior esquerdo. Os animais foram distribuídos em quatro grupos de 20 de acordo com a administração medicamentosa diária: paracetamol, ibuprofeno, nimesulida e um grupo controle (animais não medicados). E divididos em subgrupos de 5 de acordo com o tempo de tratamento da movimentação dentária induzida: 3, 5 e 7 dias. Posteriormente, os animais receberam doses letais da mistura de relaxante muscular e anestésico por via intramuscular para coleta do material, o qual foi devidamente processado, corado com hematoxilina-eosina e submetido à análise microscópica óptica para avaliar a quantidade de osteoblastos, na área de tensão, do osso adjacente de cada raiz distovestibular dos primeiros molares superiores esquerdo. Os resultados mostraram que o uso de paracetamol até 5 dias pode gerar interferências na formação óssea, pois diminuiu o número de osteoblastos e que o ibuprofeno foi a droga que melhor agiu por apresentar menor ação de inibição sobre os osteoblastos num período de uso de até 7 dias. Sugere-se que o ideal para aliviar dor e/ou desconforto causado pela movimentação ortodôntica sem prejuízo ao reparo ósseo seria o uso da medicação associada, no primeiro dia utilizar o paracetamol seguido pela administração de ibuprofeno. Caso ocorra distúrbios sistêmicos devido aos medicamentos indicados, o medicamento de eleição é a nimesulida. / The nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs used to relieve pain after activation of orthodontic appliances, but these substances can influence bone remodeling and formation. Faced with the possibility of interference of drugs in treatments, the effects will be short-term NSAIDs and COX-2 selective antiinflammatory in therapeutic doses on osteoblasts during induced tooth movement. The drugs were determined through questionnaires given to orthodontists, selecting then, the most commonly prescribed for pain relief during orthodontic treatment. The selected drugs and nimesulide (selective COX-2) were administered in a sample of 80 albino Wistar rats, in which the installation of devices consisted of an enclosed section spring anchored to the upper central incisors, moving out mesially the first upper left molar. The animals were divided into four groups of 20 according to the daily drug administration: acetaminophen, ibuprofen, nimesulide and a control group (animals not treated). Then, divided into subgroups of 5 according to the treatment time of the induced tooth movement, 3, 5 and 7 days. Subsequently, the animals received lethal doses of the mixture of anesthetic and muscle relaxant intramuscularly for the collection of the material, which has been properly processed, stained with hematoxylin-eosin and subjected to microscopic analysis to assess the amount of osteoblasts in the stressed area of the adjacent bone of each distobuccal root of the first left molars. The results showed that the use of acetaminophen up to 5 days will cause interference in bone formation decreasing the number of osteoblasts and ibuprofen was the drug that best acted by having less inhibiting action on osteoblasts in a usage period of up to 7 days. It is suggested that the ideal to relieve pain and/or discomfort caused by orthodontic movement without prejudice to the bone repair would be the use of the associated medication. On the first day, use acetaminophen followed by the administration of ibuprofen. If systemic disorders occur due to the indicated drugs, the drug of choice is nimesulide.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / O acidente vascular cerebral (AVE) à uma das principais causa de mortalidade no Brasil, acometendo cerca de 200.000 indivÃduos anualmente. A fisiopatologia do AVE isquÃmico envolve uma complexa cascata de eventos como a inflamaÃÃo e o estresse oxidativo que podem à morte neuronal e dÃficits cognitivos. O α-bisabolol à um Ãlcool sesquiterpeno, monocÃclico, que ocorre na natureza e à encontrado como constituinte majoritÃrio do Ãleo essencial sintÃtico da Matricaria chamomilla, que possui atividade antiinflamatÃria, antioxidante e anti-apoptÃtica jà descritas. Para avaliar o efeito neuroprotetor deste composto em camundongos submetidos à oclusÃo permanente da artÃria cerebral media (pMCAO), os animais foram prà e pÃs tratados com α-bisabolol nas doses de 50, 100 e 200 mg/kg, v.o, durante 24, 48, 72, 96 ou 120 horas apÃs a isquemia. Os animais foram avaliados 24h apÃs a isquÃmia para verificar a Ãrea de lesÃo isquÃmica, avaliaÃÃo neurolÃgica e atividade da mieloperoxidase. 72 horas apÃs a pMCAO, os testes de atividade locomotora, memÃria de trabalho e memÃria aversiva recente foram realizados. 96 horas apÃs a pMCAO foi realizado o teste do reconhecimento de objecto, e os animais foram eutanasiados para a realizaÃÃo da Imunohistoquimica para TNF-α, iNOS e GFAP e anÃlise histologica para Cresil violeta e Fluoro Jade C. Finalmente, 120h apÃs a isquemia, avaliou-se a memÃria espacial. O α-bisabolol reduziu significativamente a lesÃo isquemica e o dÃficit neurolÃgico e normalizou a atividade locomotora. O α-bisabolol mostrou proteÃÃo contra os dÃficits nas memÃrias de trabalho, espacial, reconhecimento de objeto e aversiva. O α-bisabolol (200 mg/kg) preveniu significativamente o aumento da MPO e TNF-α no cÃrtex temporal e o aumento do iNOS tanto no cÃrtex temporal como no estriado. Tambem preveniu o aumento da astrogliose nessas Ãreas. O α-bisabolol (200 mg/kg) mostrou protecÃÃo contra a morte neuronal. Os resultados do presente estudo mostraram que o α-bisabolol possui atividade neuroprotetora provavelmente devido a sua aÃÃo antiinflamatÃria, mas outros mecanismos nÃo podem ser descartados. / Stroke is the leading cause of mortality in Brazil, affecting about 200,000 individuals annually. The pathophysiology of ischemic stroke involves a complex cascade of events such as inflammation and oxidative stress which will lead to neuronal death and cognitive deficits. The α-bisabolol is a sesquiterpene alcohol, natural, monocyclic, found as main constituents of the essential oil of Matricaria chamomilla, which has anti-inflammatory, antioxidant and anti-apoptotic already described. To evaluate the neuroprotective effects of this compound in mice underwent permanent occlusion of the middle cerebral artery (pMCAO), the animals were pre and post treated with α-bisabolol at doses of 50, 100 and 200 mg / kg, orally for 24, 48, 72, 96 or 120 hours after pMCAO. The animals were evaluated 24 hours after ischemia to verify the area of ischemic damage, and neurological evaluation and myeloperoxidase activity. Seventy-two hours after pMCAO, the locomotor activity tests, working memory and aversive recent memory were performed. Ninety six hours after the pMCAO was performed the object recognition test, and the animals were euthanized for carrying out the immunohistochemistry for TNF-α, iNOS and GFAP and for histology analyes Cresil violet and Fluoro Jade C. Finally, 120 h after pMCAO, the spatial memory was evaluated. The α-bisabolol reduced significantly ischemic damage and neurological deficit and normalized the locomotor activity. The α-bisabolol showed protection against the deficits in working, spatial, object recognition and aversive memories. The α-bisabolol (200 mg / kg) significantly prevented the increase of MPO and TNF-α in the temporal cortex and the increased of iNOS both in the temporal cortex and in striatum. Also prevented the increase in astrogliosis in there area. The α-bisabolol (200 mg / kg) showed protection against neuronal death. The results of this study showed that α-bisabolol has neuroprotective activity probably due to its anti-inflammatory action, but other mechanisms can not be discarded.

Os anti-inflamatórios não esteroidais (AINEs) são medicamentos utilizados no alívio da dor após a ativação dos aparelhos ortodônticos, mas estas substâncias podem influenciar a formação óssea ou remodelação. Diante da possibilidade de interferência dos medicamentos durante o tratamento ortodôntico, foi avaliado o efeito á curto prazo de AINEs e anti-inflamatório seletivo COX-2, em doses terapêuticas, sobre osteoblastos durante a movimentação dentária induzida. Os fármacos foram determinados através de questionários aplicados a ortodontistas, os quais mais selecionaram os mais prescritos para alívio da dor durante o tratamento ortodôntico. Os medicamentos selecionados e a nimesulida (seletivo COX-2) foram administrados em uma amostra de 80 ratos albinos da linhagem Wistar, nos quais foi realizada a instalação de dispositivos constituídos por uma mola de secção fechada ancorada aos incisivos centrais superiores, movimentando mesialmente o primeiro molar superior esquerdo. Os animais foram distribuídos em quatro grupos de 20 de acordo com a administração medicamentosa diária: paracetamol, ibuprofeno, nimesulida e um grupo controle (animais não medicados). E divididos em subgrupos de 5 de acordo com o tempo de tratamento da movimentação dentária induzida: 3, 5 e 7 dias. Posteriormente, os animais receberam doses letais da mistura de relaxante muscular e anestésico por via intramuscular para coleta do material, o qual foi devidamente processado, corado com hematoxilina-eosina e submetido à análise microscópica óptica para avaliar a quantidade de osteoblastos, na área de tensão, do osso adjacente de cada raiz distovestibular dos primeiros molares superiores esquerdo. Os resultados mostraram que o uso de paracetamol até 5 dias pode gerar interferências na formação óssea, pois diminuiu o número de osteoblastos e que o ibuprofeno foi a droga que melhor agiu por apresentar menor ação de inibição sobre os osteoblastos num período de uso de até 7 dias. Sugere-se que o ideal para aliviar dor e/ou desconforto causado pela movimentação ortodôntica sem prejuízo ao reparo ósseo seria o uso da medicação associada, no primeiro dia utilizar o paracetamol seguido pela administração de ibuprofeno. Caso ocorra distúrbios sistêmicos devido aos medicamentos indicados, o medicamento de eleição é a nimesulida. / The nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs used to relieve pain after activation of orthodontic appliances, but these substances can influence bone remodeling and formation. Faced with the possibility of interference of drugs in treatments, the effects will be short-term NSAIDs and COX-2 selective antiinflammatory in therapeutic doses on osteoblasts during induced tooth movement. The drugs were determined through questionnaires given to orthodontists, selecting then, the most commonly prescribed for pain relief during orthodontic treatment. The selected drugs and nimesulide (selective COX-2) were administered in a sample of 80 albino Wistar rats, in which the installation of devices consisted of an enclosed section spring anchored to the upper central incisors, moving out mesially the first upper left molar. The animals were divided into four groups of 20 according to the daily drug administration: acetaminophen, ibuprofen, nimesulide and a control group (animals not treated). Then, divided into subgroups of 5 according to the treatment time of the induced tooth movement, 3, 5 and 7 days. Subsequently, the animals received lethal doses of the mixture of anesthetic and muscle relaxant intramuscularly for the collection of the material, which has been properly processed, stained with hematoxylin-eosin and subjected to microscopic analysis to assess the amount of osteoblasts in the stressed area of the adjacent bone of each distobuccal root of the first left molars. The results showed that the use of acetaminophen up to 5 days will cause interference in bone formation decreasing the number of osteoblasts and ibuprofen was the drug that best acted by having less inhibiting action on osteoblasts in a usage period of up to 7 days. It is suggested that the ideal to relieve pain and/or discomfort caused by orthodontic movement without prejudice to the bone repair would be the use of the associated medication. On the first day, use acetaminophen followed by the administration of ibuprofen. If systemic disorders occur due to the indicated drugs, the drug of choice is nimesulide.

Abstract not available

Microbial contamination of contact lenses is a significant risk factor leading to adverse responses. Adhesion of microorganisms to a contact lens is the first step in a series of events that leads to contact lens-related infections or inflammation. Recently, some of the non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to have the ability to interfere with microbial biofilm formation. In this project, antibacterial properties of commonly used NSAIDs (salicylic acid, sodium diclofenac and ketorolac) were assessed and characterised using biological assays and molecular biological techniques. Salicylic acid, ketorolac and diclofenac reduced adhesion of a range of bacterial species isolated from corneal infection and inflammatory events to contact lenses in a dose-dependent manner. Salicylic acid also decreased the adhesion of Pseudomonas aeruginosa and Staphylococcus epidermidis to human corneal epithelial cells in a dose-dependent manner. Results further demonstrated that NSAIDs had a significant impact on the production of virulence factors such as Type IV pili mediated (twitching) motility, flagella mediated swimming, elastase, protease IV and alkaline protease and affected the production of acylated homoserine lactones of P. aeruginosa. Salicylic acid and ketorolac affect the expression of P. aeruginosa outer membrane proteins. In the presence of the salicylic acid and ketorolac more than 85% of all detectable outer membrane proteins changed and most were down-regulated. Moreover, in the presence of salicylic acid at least five gene products, including Na+ - translocating NADH (Nrq1), choline dehydrogenase (CHDH), a hypothetical protein of unknown function, a gene product with no similarity to any known sequence in the database and a sequence similar to 23S rRNA of P. aeruginosa, were down-regulated. The results of this study clearly demonstrated that NSAIDs have a significant impact on virulence factors and the expression of acylated homoserine lactones by P. aeruginosa. This thesis has illustrated the potential of NSAIDs for preventing bacterial contamination of contact lenses by ocular pathogens and highlights the potential for NSAIDs as antibacterial agents. Therefore, this class of compound should be investigated further for their therapeutic efficacy in vivo.