In addition to the conversion of ibuprofen to the S-enantiomer, the body can metabolize ibuprofen to several other compounds, including numerous hydroxyl, carboxyl and glucuronyl metabolites. Virtually all of these have no pharmacological effects.Unlike most other NSAIDs, ibuprofen also acts as an inhibitor of Rho kinase and may be useful in recovery from spinal-cord injury. Pharmacokinetics
After oral administration, peak serum concentration is reached after 1–2 hours, and up to 99% of the drug is bound to plasma proteins. The majority of ibuprofen is metabolized and eliminated within 24 hours in the urine; however, 1% of the unchanged drug is removed through biliary excretion. Chemistry
Ibuprofen is practically insoluble in water, but very soluble in most organic solvents like ethanol (66.18 g/100 mL at 40 °C for 90% EtOH), methanol, acetone and dichloromethane.The original synthesis of ibuprofen by the Boots Group started with the compound 2-methylpropylbenzene. The synthesis took six steps. A modern, greener technique for the synthesis involves only three steps. Stereochemistry
Ibuprofen, like other 2-arylpropionate derivatives such as ketoprofen, flurbiprofen and naproxen, contains a stereocenter in the α-position of the propionate moiety. The product sold in pharmacies is a racemic mixture of the S and R-isomers. The S (dextrorotatory) isomer is the more biologically active; this isomer has been isolated and used medically (see dexibuprofen for details).The isomerase enzyme, alpha-methylacyl-CoA racemase, converts (R)-ibuprofen into the (S)-enantiomer.The (S)- ibuprofen, the eutomer, harbors the desired therapeutic activity. Interestingly, the inactive (R)-enantiomer, the distomer, undergoes a unidirectional chiral inversion to offer the active (S)-enantiomer.
Oslers nodes are painful, red, raised lesions found on the hands and feet. They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition. Their presence is one definition of Oslers sign. Causes
Oslers nodes result from the deposition of immune complexes. The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions. The nodes are commonly indicative of subacute bacterial endocarditis. 10–25% of endocarditis patients will have Oslers nodes. Other signs of endocarditis include Roths spots and Janeway lesions. The latter, which also occur on the palms and soles, can be differentiated from Oslers nodes because they are non-tender.Oslers nodes can also be seen in

Systemic lupus erythematosus
Marantic endocarditis
Disseminated gonococcal infection
Distal to infected arterial catheter

Etymology
Oslers nodes are named after Sir William Osler who described them in the early twentieth century. He described them as "ephemeral spots of a painful nodular erythema, chiefly in the skin of the hands and feet." == References ==