Retrospective Study Open Access
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2023; 11(23): 5440-5446
Published online Aug 16, 2023. doi: 10.12998/wjcc.v11.i23.5440
Application effect of phloroglucinol injection in elderly patients with spastic abdominal pain in emergency department
Yu-Fei Liu, Jian Chen, Emergency Medicine Department, Hefei BOE Hospital, Hefei 230000, Anhui Province, China
ORCID number: Yu-Fei Liu (0000-0002-2364-8462); Jian Chen (0000-0002-8053-6328).
Author contributions: Liu YF and Chen J contributed equally to this work; Liu YF designed the study; Chen J contributed to the analysis of the manuscript; Liu YF and Chen J involved in the data and writing of this article; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Hefei BOE Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Chen, Doctor, Associate Chief Physician, Master’s Student, Emergency Medicine Department, Hefei BOE Hospital, Northwest of the Intersection of Dongfang Avenue and Wenzhong Road, Yaohai District, Hefei 230000, Anhui Province, China. 2670260592@qq.com
Received: June 14, 2023
Peer-review started: June 14, 2023
First decision: June 21, 2023
Revised: June 29, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: August 16, 2023
Processing time: 62 Days and 22 Hours

Abstract
BACKGROUND

Although norepinephrine injection is commonly used in emergency situations, it is associated with risks for elderly patients with spasmodic liver pain. This study explores the safety and effectiveness of mebendazole injection, an alternative treatment option, for the emergency management of spasmodic abdominal pain, while minimizing adverse reactions, in elderly patients.

AIM

To explore the development of norepinephrine injection and the adverse reactions of this drug in emergency elderly patients with spasmodic liver pain.

METHODS

The control group consisted of 56 elderly patients visiting our hospital from January 2021 to December 2021. After hospital admission, the control group was intravenously administered tolopin. The experimental group consisted of 56 emergency patients with spasmodic abdominal pain who visited our hospital until June 2022. After hospital admission, the experimental group was intravenously administered toloxazole. The two groups were treated for 3 d. The disappearance of clinical symptoms was observed before and after the treatment, and the difference in adverse reactions between the two groups was compared.

RESULTS

The pain of the wife, fire, diarrhea, drowning, and surrounding time disappeared in the experimental group. No statistical difference was observed between the experimental and control groups in visual pain analog scale (VAS) scores before and after the treatment (P > 0.05). The VAS scores of abdominal pain severity after 0.5 h, 1.0 h, and after 6.0 h of treatment were significantly lower for the experimental group than for the control group. After the treatment, the therapeutic effect in the experimental group was higher and statistically significant than that in the control group (P < 0.05). The probability of adverse reactions before the treatment was lower in the experimental group than in the control group.

CONCLUSION

During emergency, mebendazole injection exhibited a good therapeutic value when used for the clinical treatment of elderly patients with spasmodic stomach pain. It accelerated the disappearance of clinical symptoms such as stomach pain, reduced the stomach weight, and improved clinical activity. Reducing and promoting the frequency of high treatment safety with mebendazole injection is worthwhile.

Key Words: M-triophenol injection; Emergency; Spasmodic abdominal pain in the elderly; Abdominal pain disappearance time; Adverse reactions; Therapeutic effect

Core Tip: Mebendazole injection is a safe and effective treatment option for elderly patients with spasmodic abdominal pain in emergency situations. It can accelerate clinical symptom disappearance, reduce the stomach weight, and improve clinical activity. Mebendazole injection can potentially be applied as a valuable treatment option that is safe for use in this vulnerable population.



INTRODUCTION

Spasmodic abdominal pain is mainly caused by intestinal spasms, which involves strong contraction of intestinal smooth muscles. It is a common condition in the emergency department and is often characterized by colic pain, which is paroxysmal and persistently worsens[1,2]. These emergency patients may also experience various degrees of gastrointestinal symptoms, such as diarrhea, nausea, and vomiting. These symptoms severely affect their physical and mental health. The elderly people are a special group highly prone to spasms of gastrointestinal smooth muscles because of the deterioration of their body’s functions, a decline in their immune system, and the effects of mental stimulation and poor dietary habits[3-10]. In elderly patients with spasmodic abdominal pain, due to their advanced age, additional care is required while selecting drugs for treatment[11-17]. In the present study, 112 elderly patients with spasmodic abdominal pain admitted to our hospital from July 2021 to June 2022 were selected for further investigating the effect of mebendazole injection on the time required for the disappearance of abdominal pain and the adverse effects associated with this drug.

MATERIALS AND METHODS
General information

This study was approved by the moral principal commission of our hospital. In total, 56 emergency geriatric patients with spasmodic abdominal pain admitted between July 2021 and December 2021 were assigned to the control group, while 56 emergency geriatric patients with spasmodic abdominal pain admitted between January 2022 and June 2022 were included in the experimental group. The control group had 26 male and 30 female patients, respectively. The maximum patient age was not more than 88 years, and the minimum patient age was not less than 64 years. The average patient age was (75.44 ± 4.78) years. The maximum and minimum durations of the patients’ illness were not more than 31 h and not less than 5 h, respectively, with an average duration of (18.17 ± 4.48) h. The experimental group had 27 male and 29 female patients, respectively. The maximum patient age did not exceed 89 years, and the minimum age was not less than 62 years, with an average patient age was (75.51 ± 4.85) years. The maximum and minimum durations of the patients’ illness were not more than 30 h and not less than 7 h, respectively, with an average duration of (18.28 ± 4.45) h. The general data of the two elderly patient groups with spasmodic abdominal pain exhibited no statistically significant differences (P > 0.05). The patient inclusion criteria were as follows: (1) Those aged ≥ 60 years; (2) those who met the diagnostic criteria for spasmodic abdominal pain[18]; (3) those who had not used relevant antispasmodic and analgesic drugs before study participation; (4) those who signed the informed consent form; (5) those who had good compliance with the treatment; and (6) those who could communicate normally. The patient exclusion criteria were as follows: (1) Combination of malignant neoplasms; (2) allergy to scopolamine and methotrexate injection; (3) abnormal liver and kidney functions; (4) combination of other types of acute abdominal diseases; (5) cognitive impairment; (6) combination of serious systemic infectious diseases; and (7) combination of serious cardiovascular and cerebrovascular diseases.

Methodology

After the patients were admitted to the hospital, the control group was intravenously injected with scopolamine once a day for 3 d. Scopolamine injection was manufactured by Sinopharm Group Rongsheng Pharmaceutical Co. The drip rate was controlled within the range of 70-80 drops/min. After hospital admission, the experimental group was intravenously injected with mebendazole once a day for 3 d. Mebendazole injection was manufactured by Wuhan Renfu Pharmaceutical Co Ltd. Approval No.: Guopharm Quanzhi H20057106. The drip rate was controlled within the range of 70-80 drops/min.

Observation indicators

We observed the disappearance of clinical symptoms in the control and experimental groups after treatment, including the clinical symptoms of abdominal pain, fever, diarrhea, nausea, and vomiting. To observe the changes in abdominal pain severity in the control and experimental groups, the visual pain analog scale (VAS)[19,20] was used to assess pain severity before treatment, and after 0.5 h, 1.0 h, and 6.0 h of treatment. A maximum VAS score of 10 indicated that the patient had very severe pain symptoms, and a minimum VAS score of 0 indicated that the patient had no pain symptoms. Abdominal pain severity increased with an increase in the VAS score. The treatment efficacy in the control and experimental groups was evaluated according to the following criteria[21-30]: If the patients did not have clinical symptoms or had mild clinical symptoms such as vague pain, distension, and stabbing pain below the stomach and above the pubic hairline after treatment, the treatment was considered effective. If patients had clinical symptoms such as vague pain, distension, and tingling in the area below the stomach and above the pubic bone, the treatment was considered ineffective. Total effective rate = (number of patients with a significant effect + number of effective patients)/total number of cases × 100%. We also monitored the occurrence of adverse reactions in the control and experimental groups after treatment, including the number of cases of blurred vision, dry mouth, and palpitations. The overall incidence rate of adverse reactions = total number of adverse reactions/total number of cases × 100%.

Statistical analysis

The study data were analyzed using SPSS 22.0. The measurement data analyzed using t-test were expressed as (mean ± SD), and the count data analyzed using the χ2 test were expressed as n (%). P < 0.05 indicated a statistically significant difference.

RESULTS
Comparison of time to disappearance of all relevant clinical symptoms after treatment between the groups

As shown in Table 1, abdominal pain, fever, diarrhea, and nausea and vomiting disappeared in a significantly shorter time in the experimental group than in the reference group.

Table 1 Comparison of the time to disappearance of all relevant clinical symptoms after treatment between the study groups (mean ± SD, h).
Grouping
Number of examples
Time for abdominal pain to disappear
Time for fever to disappear
Time for diarrhea to disappear
Time for nausea and vomiting to disappear
Reference group5622.17 ± 1.457.48 ± 0.779.90 ± 0.936.69 ± 1.17
Experimental group5620.04 ± 1.336.82 ± 0.658.11 ± 0.875.55 ± 1.20
t value-8.1014.90110.5185.909
P value-0.0000.0000.0000.000
Comparison of changes in VAS scores for abdominal pain severity before and after treatment between the groups

As shown in Table 2, the VAS scores of abdominal pain severity before treatment for the experimental group exhibited no statistical significance compared with those for the control group (P > 0.05). The VAS scores of abdominal pain severity after 0.5 h, 1.0 h, and 6.0 h of treatment for the experimental group were significantly lower than those for the control group, and statistically significant differences in VAS scores were observed between the groups (P < 0.05).

Table 2 Comparison of the changes in visual pain analog scale scores for severity of abdominal pain before and after treatment between the study groups (mean ± SD, points).
Grouping
Number of examples
Before treatment
After 0.5 h of treatment
1 h after treatment
6 h after treatment
Reference group567.52 ± 1.135.08 ± 1.044.17 ± 0.963.76 ± 0.82
Experimental group567.44 ± 1.254.22 ± 0.803.79 ± 0.622.77 ± 0.69
t value-0.3554.9052.4886.913
P value-0.7230.0000.0140.000
Comparison of differences in efficacy between the groups after treatment

The efficacy after treatment was significantly higher in the experimental group than in the reference group, and the difference was statistically significant (P < 0.05; Table 3).

Table 3 Comparison of the differences in efficacy between the study groups after treatment, n (%).
Grouping
Number of examples
Visible effect
Effective
Invalid
Total efficiency
Reference group5629 (51.79)16 (28.57)11 (19.64)45 (80.36)
Experimental group5633 (58.93)20 (35.71)3 (5.36)53 (94.64)
χ2----5.224
P value----0.022
Comparison of differences in the occurrence of adverse reactions between the groups after treatment

The incidence of adverse reactions after treatment was significantly lower in the experimental group than in the control group, and the difference was statistically significant (P < 0.05; Table 4).

Table 4 Comparison of the differences in the occurrence of adverse reactions after treatment between the study groups, n (%).
Grouping
Number of examples
Blurred vision
Dry mouth
Heart palpitations
Total incidence
Reference group562 (3.57)6 (10.71)4 (7.14)12 (21.43)
Experimental group560 (0.00)3 (5.36)1 (1.79)4 (7.14)
χ2----4.667
P value----0.031
DISCUSSION

Spasmodic abdominal pain is a common occurrence in the emergency department. It may occur due to diet, mental stimulation and cold, as well as acute gastroenteritis, or urinary stones. The primary characteristics of spasmodic abdominal pain are its rapid onset and progression. The severity of this pain has a serious impact on the patient’s normal life[31]. In elderly patients who are weaker than young and middle-aged people and have a declining immunity, the onset of spasmodic abdominal pain can be more severe, with the duration of pain being longer. The former, as an anticholinergic drug, is widely used in the treatment of abdominal cramps caused by gastrointestinal and pancreatic duct diseases, etc. Although it can effectively relieve these cramps and help release smooth muscle spasm, it is associated with a high incidence of post-treatment adverse reactions. Thus, it does not meet the drug safety needs of elderly patients with spastic abdominal pain[32-34].

Anti-colonial injections are used as antispasmodic drugs. Once administered, they move directly to treat the small gastrointestinal muscle spasm. It is also used to treat physical problems due to entry problems and warning systems. The Martin et al[35] trial indicated that membranes could be used to improve the health of patients with diabetes as well as cardiac problems with a health center and can be used as the first card for elderly people to make sickness finances. This study period shows that abdominal pain ended for a short period, a very short restaurant, a very short period, a short period of diabetes, a short period and a short period of time of disease and dust, learning the reference group. The difference was not statistically significant (P > 0.05). The VAS scores decreased by 0.5 h, 1.0 h, and 6.0 h in the experimental group than in the control group. The intermediate group of VAS was statistically significant (P < 0.05), which helped you to seek health, such as pregnancy and health care less than abdominal disease. Husain et al[36] also wrote about 56 years of illness, that the duration of pain to membership is too short for the duration of illness and that VAS patients with disease are less than the rest of the gospel (P < 0.05). These study findings confirm that mebendazole injections have the therapeutic value against the development of abdominal diseases. This includes the results of these studies, which confirm the possibility of a triophenol Good News to increase the signs of pregnant adult diseases in emergency abdominal diseases. As shown in Tables 3-4, the impact of the drug on the examination group was considerably higher than that on the control group, and the difference was statistically significant (P < 0.05). The mebendazole injection is effective in treating elderly patients with abdominal diseases in the emergency room. The risks of adverse events with mebendazole injection in the patients was lower. Some study[37-39] indicated that urgent physical treatment of sports disease is associated with 84.44% adverse events. However, 17.78% mebendazole’s active body was 97.78% of the adverse events were 2.22%. The impact of care and safety associated with mebendazole injection is higher than that of scopolamine. This may be possible to open the gospel for membership, such as proper medicines other than the use of health and non-infectious drugs, directly or directly open the equivalent instrument of music, which is not only about anti-colonial products, But there are also no common problems related to the same muscle or not sexual orientation or prevention of the patient’s safety, so it is safe for the patient and can improve the end of the mother and economy doctor[40].

However, this study has certain limitations. This study only relies on certain regional research data. For this study, information was only collected from a certain hospital, which may be accidental and biased. In the future, data from different countries, regions, and age groups should be further supplemented to eliminate contingency and limitations. In addition, follow-up studies with larger sample sizes and research breadths are required. The findings obtained might be shared as part of oral education and dental research.

CONCLUSION

In conclusion, mebendazole injection has a good clinical therapeutic value for elderly patients with spasmodic abdominal pain. It can accelerate the disappearance of clinical symptoms such as abdominal pain, reduce pain severity, optimize the clinical treatment effect, reduce adverse reactions, and offer a high therapeutic safety, and is therefore worth promoting.

ARTICLE HIGHLIGHTS
Research background

Drugs for elderly patients with spasmodic abdominal pain must be selected carefully to avoid adverse reactions. Alternative treatments are required for safe and effective management of spasmodic abdominal pain.

Research motivation

To address the requirement for safe and effective alternative treatments for elderly patients with spasmodic abdominal pain, because drug selection is critical for avoiding adverse reactions in this vulnerable population.

Research objectives

To determine the safety and effectiveness of mebendazole injection as an alternative treatment for the emergency management of spasmodic abdominal pain, while minimizing adverse reactions, in elderly patients. The study establishes a valuable treatment option that accelerates symptom disappearance and improves clinical activity in this vulnerable population.

Research methods

The study investigated 112 elderly patients with spasmodic abdominal pain admitted to the hospital from July 2021 to June 2022. A control group (n = 56 patients) received intravenous tolopin from January 2021 to December 2021, while the experimental group (n = 56 patients) received mebendazole injection from June 2022 to June 2022. Both groups were treated for 3 days. Clinical symptoms and adverse reactions were observed before and after the treatment to compare the differences in symptom disappearance time and adverse reactions between the two groups.

Research results

Mebendazole injection had a higher therapeutic effect and led to faster symptom disappearance in elderly patients with spasmodic abdominal pain than traditional treatments.

Research conclusions

Mebendazole injection is a safe and effective treatment option for elderly patients with spasmodic abdominal pain in emergency situations. It can accelerate clinical symptom disappearance, reduce the stomach weight, and improve clinical activity. Mebendazole injection can potentially be applied as a valuable treatment option that is safe for use in this vulnerable population.

Research perspectives

Future studies should focus on the long-term safety and effectiveness of mebendazole injection in elderly patients with spasmodic abdominal pain.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Gastroenterology and hepatology

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): 0

Grade C (Good): C, C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Holdsworth-Carson SJ, Australia; Solomon SD, United States S-Editor: Chen YL L-Editor: A P-Editor: Chen YL

References
1.  Ismaili-Jaha V, Toro H, Spahiu L, Azemi M, Hoxha-Kamberi T, Avdiu M, Spahiu-Konjusha S, Jaha L. Gallbladder ascariasis in Kosovo - focus on ultrasound and conservative therapy: a case series. J Med Case Rep. 2018;12:8.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 9]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
2.  Chai JY, Jung BK, Hong SJ. Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update. Korean J Parasitol. 2021;59:189-225.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 56]  [Cited by in F6Publishing: 69]  [Article Influence: 23.0]  [Reference Citation Analysis (1)]
3.  Amato A, Liotta R, Mulè F. Effects of menthol on circular smooth muscle of human colon: analysis of the mechanism of action. Eur J Pharmacol. 2014;740:295-301.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 60]  [Article Influence: 6.0]  [Reference Citation Analysis (0)]
4.  Mansoori S, Fryknäs M, Alvfors C, Loskog A, Larsson R, Nygren P. A phase 2a clinical study on the safety and efficacy of individualized dosed mebendazole in patients with advanced gastrointestinal cancer. Sci Rep. 2021;11:8981.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 16]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
5.  Carroquino-Garcia P, Jiménez-Rejano JJ, Medrano-Sanchez E, de la Casa-Almeida M, Diaz-Mohedo E, Suarez-Serrano C. Therapeutic Exercise in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Phys Ther. 2019;99:1371-1380.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 36]  [Article Influence: 7.2]  [Reference Citation Analysis (0)]
6.  Kern P. Echinococcus granulosus infection: clinical presentation, medical treatment and outcome. Langenbecks Arch Surg. 2003;388:413-420.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 67]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
7.  Velasco-Tirado V, Alonso-Sardón M, Lopez-Bernus A, Romero-Alegría Á, Burguillo FJ, Muro A, Carpio-Pérez A, Muñoz Bellido JL, Pardo-Lledias J, Cordero M, Belhassen-García M. Medical treatment of cystic echinococcosis: systematic review and meta-analysis. BMC Infect Dis. 2018;18:306.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 55]  [Cited by in F6Publishing: 75]  [Article Influence: 12.5]  [Reference Citation Analysis (0)]
8.  Escobedo AA, Almirall P, González-Fraile E, Ballesteros J. Efficacy of mebendazole in paediatric patients with giardiasis: A systematic review and meta-analysis. Acta Trop. 2018;188:50-57.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 6]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
9.  Schuh S, Sweeney J, Rumantir M, Coates AL, Willan AR, Stephens D, Atenafu EG, Finkelstein Y, Thompson G, Zemek R, Plint AC, Gravel J, Ducharme FM, Johnson DW, Black K, Curtis S, Beer D, Klassen TP, Nicksy D, Freedman SB; Pediatric Emergency Research Canada (PERC) Network. Effect of Nebulized Magnesium vs Placebo Added to Albuterol on Hospitalization Among Children With Refractory Acute Asthma Treated in the Emergency Department: A Randomized Clinical Trial. JAMA. 2020;324:2038-2047.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 21]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
10.  Nazligul Y, Kucukazman M, Akbulut S. Role of chemotherapeutic agents in the management of cystic echinococcosis. Int Surg. 2015;100:112-114.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 33]  [Cited by in F6Publishing: 32]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
11.  Ren LW, Li W, Zheng XJ, Liu JY, Yang YH, Li S, Zhang S, Fu WQ, Xiao B, Wang JH, Du GH. Benzimidazoles induce concurrent apoptosis and pyroptosis of human glioblastoma cells via arresting cell cycle. Acta Pharmacol Sin. 2022;43:194-208.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 28]  [Article Influence: 14.0]  [Reference Citation Analysis (0)]
12.  Reuter S, Jensen B, Buttenschoen K, Kratzer W, Kern P. Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature. J Antimicrob Chemother. 2000;46:451-456.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 122]  [Cited by in F6Publishing: 107]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
13.  Falagas ME, Bliziotis IA. Albendazole for the treatment of human echinococcosis: a review of comparative clinical trials. Am J Med Sci. 2007;334:171-179.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 35]  [Cited by in F6Publishing: 36]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
14.  Kale OO. Mebendazole in the treatment of dracontiasis. Am J Trop Med Hyg. 1975;24:600-605.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 12]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
15.  Yuan S, Gao F, Xin Z, Guo H, Shi S, Shi L, Yang X, Guan J. Comparison of the efficacy and safety of phloroglucinol and magnesium sulfate in the treatment of threatened abortion: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019;98:e16026.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 7]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
16.  Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database Syst Rev. 2015;CD006027.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 34]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
17.  Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med. 2019;131:438-444.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 80]  [Cited by in F6Publishing: 67]  [Article Influence: 13.4]  [Reference Citation Analysis (0)]
18.  Loonen AJ, Ivanova SA. Neurobiological mechanisms associated with antipsychotic drug-induced dystonia. J Psychopharmacol. 2021;35:3-14.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 28]  [Cited by in F6Publishing: 18]  [Article Influence: 6.0]  [Reference Citation Analysis (0)]
19.  Wang Q, Qian Y, Wang Q, Yang YF, Ji S, Song W, Qiao X, Guo DA, Liang H, Ye M. Metabolites identification of bioactive licorice compounds in rats. J Pharm Biomed Anal. 2015;115:515-522.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 32]  [Cited by in F6Publishing: 26]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
20.  Coelho Neto MA, Ludwin A, Petraglia F, Martins WP. Definition, prevalence, clinical relevance and treatment of T-shaped uterus: systematic review. Ultrasound Obstet Gynecol. 2021;57:366-377.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 10]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
21.  von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495-1499.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3667]  [Cited by in F6Publishing: 6115]  [Article Influence: 611.5]  [Reference Citation Analysis (0)]
22.  Mousa AM, El-Sammad NM, Hassan SK, Madboli AENA, Hashim AN, Moustafa ES, Bakry SM, Elsayed EA. Antiulcerogenic effect of Cuphea ignea extract against ethanol-induced gastric ulcer in rats. BMC Complement Altern Med. 2019;19:345.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 58]  [Cited by in F6Publishing: 50]  [Article Influence: 10.0]  [Reference Citation Analysis (0)]
23.  Yu W, Ye F, Yuan X, Ma Y, Mao C, Li X, Li J, Dai C, Qian F, Fan X, Zhou Y, Wang D, Guo Z, An H, Zhang M, Chen D, Xia S. A phase I/II clinical trial on the efficacy and safety of NKT cells combined with gefitinib for advanced EGFR-mutated non-small-cell lung cancer. BMC Cancer. 2021;21:877.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 7]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
24.  Alexander JL, Wilson ID, Teare J, Marchesi JR, Nicholson JK, Kinross JM. Gut microbiota modulation of chemotherapy efficacy and toxicity. Nat Rev Gastroenterol Hepatol. 2017;14:356-365.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 451]  [Cited by in F6Publishing: 582]  [Article Influence: 83.1]  [Reference Citation Analysis (0)]
25.  Kalt W, Cassidy A, Howard LR, Krikorian R, Stull AJ, Tremblay F, Zamora-Ros R. Recent Research on the Health Benefits of Blueberries and Their Anthocyanins. Adv Nutr. 2020;11:224-236.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 286]  [Cited by in F6Publishing: 174]  [Article Influence: 43.5]  [Reference Citation Analysis (0)]
26.  Balkrishna A, Goswami S, Singh H, Gohel V, Dev R, Haldar S, Varshney A. Herbo-mineral formulation, Divya-Swasari-Vati averts SARS-CoV-2 pseudovirus entry into human alveolar epithelial cells by interfering with spike protein-ACE 2 interaction and IL-6/TNF-α /NF-κB signaling. Front Pharmacol. 2022;13:1024830.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
27.  Rohwer AC, Khondowe O, Young T. Antispasmodics for labour. Cochrane Database Syst Rev. 2013;2013:CD009243.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 11]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
28.  Kim HP, Son KH, Chang HW, Kang SS. Anti-inflammatory plant flavonoids and cellular action mechanisms. J Pharmacol Sci. 2004;96:229-245.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 591]  [Cited by in F6Publishing: 570]  [Article Influence: 28.5]  [Reference Citation Analysis (0)]
29.  Tone JN, Jensen DR. Radioiron utilization and gossypol acetic acid in male rats. Drug Chem Toxicol. 1985;8:69-82.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
30.  Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin North Am. 2006;24:371-388, vii.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 51]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
31.  Stone R. Acute abdominal pain. Lippincotts Prim Care Pract. 1998;2:341-357.  [PubMed]  [DOI]  [Cited in This Article: ]
32.  Willard MD. Gastrointestinal drugs. Vet Clin North Am Small Anim Pract. 1998;28:377-394.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
33.  Whitehead L, Ghosh M, Walker DK, Bloxsome D, Vafeas C, Wilkinson A. The relationship between specialty nurse certification and patient, nurse and organizational outcomes: A systematic review. Int J Nurs Stud. 2019;93:1-11.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 36]  [Article Influence: 7.2]  [Reference Citation Analysis (0)]
34.  Guo H, Wang T, Niu X, Wang H, Yang W, Qiu J, Yang L. The risk factors related to bruxism in children: A systematic review and meta-analysis. Arch Oral Biol. 2018;86:18-34.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 42]  [Article Influence: 7.0]  [Reference Citation Analysis (0)]
35.  Martin F. Why we do what we do: implementation of practice guidelines by family nurse practitioner students. J Am Acad Nurse Pract. 2008;20:515-521.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
36.  Husain M, Sachan PK, Khan S, Lama L, Khan RN. Role of diagnostic laparoscopy in chronic and recurrent abdominal pain. Trop Gastroenterol. 2013;34:170-173.  [PubMed]  [DOI]  [Cited in This Article: ]
37.   Technology Assessment: Early Sense for Monitoring Vital Signs in Hospitalized Patients [Internet]. Washington (DC): Department of Veterans Affairs (US); 2016 May- .  [PubMed]  [DOI]  [Cited in This Article: ]
38.  Bonnot O, Tordjman S. [Schizophrenia and pain reactivity]. Presse Med. 2008;37:1561-1568.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 9]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
39.  Gosmanov AR, Gosmanova EO, Kitabchi AE.   Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. 2021 May 9. In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–.  [PubMed]  [DOI]  [Cited in This Article: ]
40.  Morison R. ABDOMINAL EMERGENCIES: The Substance of Two Lectures of the Post-Graduate Course, Newcastle-on-Tyne. Br Med J. 1920;1:425-428.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]