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Vajro P, Mandato C, Fischler B. Acute hepatitis of unknown origin in children: Should we move the discussion from a purely infectious origin also to other plausible causes? Virulence 2024; 15:2318582. [PMID: 38388366 PMCID: PMC10896148 DOI: 10.1080/21505594.2024.2318582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- Pietro Vajro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Pediatrics, Baronissi, Salerno, Italy
| | - Claudia Mandato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Pediatrics, Baronissi, Salerno, Italy
| | - Björn Fischler
- Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Ray S, Stampf JL, Kudlacek O, Yang JW, Schicker KW, Graf Y, Losgott T, Boehm S, Salzer I. A triple cysteine motif as major determinant of the modulation of neuronal K V7 channels by the paracetamol metabolite N-acetyl-p-benzo quinone imine. Br J Pharmacol 2024. [PMID: 38657956 DOI: 10.1111/bph.16380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/10/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND PURPOSE The analgesic action of paracetamol involves KV7 channels, and its metabolite N-acetyl-p-benzo quinone imine (NAPQI), a cysteine modifying reagent, was shown to increase currents through such channels in nociceptors. Modification of cysteine residues by N-ethylmaleimide, H2O2, or nitric oxide has been found to modulate currents through KV7 channels. The study aims to identify whether, and if so which, cysteine residues in neuronal KV7 channels might be responsible for the effects of NAPQI. EXPERIMENTAL APPROACH To address this question, we used a combination of perforated patch-clamp recordings, site-directed mutagenesis, and mass spectrometry applied to recombinant KV7.1 to KV7.5 channels. KEY RESULTS Currents through the cardiac subtype KV7.1 were reduced by NAPQI. Currents through all other subtypes were increased, either by an isolated shift of the channel voltage dependence to more negative values (KV7.3) or by such a shift combined with increased maximal current levels (KV7.2, KV7.4, KV7.5). A stretch of three cysteine residues in the S2-S3 linker region of KV7.2 was necessary and sufficient to mediate these effects. CONCLUSION AND IMPLICATION The paracetamol metabolite N-acetyl-p-benzo quinone imine (NAPQI) modifies cysteine residues of KV7 subunits and reinforces channel gating in homomeric and heteromeric KV7.2 to KV7.5, but not in KV7.1 channels. In KV7.2, a triple cysteine motif located within the S2-S3 linker region mediates this reinforcement that can be expected to reduce the excitability of nociceptors and to mediate antinociceptive actions of paracetamol.
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Affiliation(s)
- Sutirtha Ray
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jan-Luca Stampf
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oliver Kudlacek
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jae-Won Yang
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Klaus W Schicker
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Yvonne Graf
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Thomas Losgott
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Stefan Boehm
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Isabella Salzer
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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Roberts BM, Geddis AV, Ciuciu A, Reynoso M, Mehta N, Varanoske AN, Kelley AM, Walker RJ, Munoz R, Kolb AL, Staab JS, Naimo MA, Tomlinson RE. Acetaminophen influences musculoskeletal signaling but not adaptations to endurance exercise training. FASEB J 2024; 38:e23586. [PMID: 38568858 DOI: 10.1096/fj.202302642r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
Acetaminophen (ACE) is a widely used analgesic and antipyretic drug with various applications, from pain relief to fever reduction. Recent studies have reported equivocal effects of habitual ACE intake on exercise performance, muscle growth, and risks to bone health. Thus, this study aimed to assess the impact of a 6-week, low-dose ACE regimen on muscle and bone adaptations in exercising and non-exercising rats. Nine-week-old Wistar rats (n = 40) were randomized to an exercise or control (no exercise) condition with ACE or without (placebo). For the exercise condition, rats ran 5 days per week for 6 weeks at a 5% incline for 2 min at 15 cm/s, 2 min at 20 cm/s, and 26 min at 25 cm/s. A human equivalent dose of ACE was administered (379 mg/kg body weight) in drinking water and adjusted each week based on body weight. Food, water intake, and body weight were measured daily. At the beginning of week 6, animals in the exercise group completed a maximal treadmill test. At the end of week 6, rats were euthanized, and muscle cross-sectional area (CSA), fiber type, and signaling pathways were measured. Additionally, three-point bending and microcomputer tomography were measured in the femur. Follow-up experiments in human primary muscle cells were used to explore supra-physiological effects of ACE. Data were analyzed using a two-way ANOVA for treatment (ACE or placebo) and condition (exercise or non-exercise) for all animal outcomes. Data for cell culture experiments were analyzed via ANOVA. If omnibus significance was found in either ANOVA, a post hoc analysis was completed, and a Tukey's adjustment was used. ACE did not alter body weight, water intake, food intake, or treadmill performance (p > .05). There was a treatment-by-condition effect for Young's Modulus where placebo exercise was significantly lower than placebo control (p < .05). There was no treatment by condition effects for microCT measures, muscle CSA, fiber type, or mRNA expression. Phosphorylated-AMPK was significantly increased with exercise (p < .05) and this was attenuated with ACE treatment. Furthermore, phospho-4EBP1 was depressed in the exercise group compared to the control (p < .05) and increased in the ACE control and ACE exercise group compared to placebo exercise (p < .05). A low dose of ACE did not influence chronic musculoskeletal adaptations in exercising rodents but acutely attenuated AMPK phosphorylation and 4EBP1 dephosphorylation post-exercise.
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Affiliation(s)
- Brandon M Roberts
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Alyssa V Geddis
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Alexandra Ciuciu
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marinaliz Reynoso
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Nikhil Mehta
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alyssa N Varanoske
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- Oak Ridge Institute for Science and Education, Belcamp, Maryland, USA
| | - Alyssa M Kelley
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Raymond J Walker
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Rigoberto Munoz
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Alexander L Kolb
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Jeffery S Staab
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Marshall A Naimo
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Ryan E Tomlinson
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Bachvarova-Nedelcheva A, Iordanova R, Kaneva N. The Solvent Role for the Decomposition of Paracetamol in Distilled and Drinking Water by Pure and Ag-Modified TiO 2 Sol-Gel Powders. Materials (Basel) 2024; 17:1791. [PMID: 38673148 DOI: 10.3390/ma17081791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
In this study, pure TiO2 gels were synthesized by applying the sol-gel method, using Ti(IV) butoxide with the addition of two different solvents, namely ethylene glycol (EG) and isopropanol (isop), with only air moisture present. It was established using XRD that the gel prepared with the addition of EG was amorphous even at 400 °C, while the other gel was amorphous up to 300 °C. It was found that TiO2 (anatase) had a dominant crystalline phase during heating to 600 °C, while at 700 °C, TiO2 (rutile) appeared. The as-obtained powdered materials were annealed at 500 °C and subsequently underwent photocatalytic tests with paracetamol. Additionally, the TiO2 samples were modified with Ag+ co-catalysts (10-2 M), using photofixation by UV illumination. The photocatalytic activity of the Ag-modified powders was also tested in the photodegradation of a commonly used paracetamol in aqueous solution under UV light illumination. The obtained data exhibited that the annealed samples had better photocatalytic efficiency and decomposed paracetamol faster in comparison to the non-annealed sol-gel powders. The highest degradation efficiency was observed for the TBT/isop/Ag material, with degradation efficiencies average values of 65.59% and 75.61% paracetamol achieved after the third cycle of photocatalytic treatment. The co-catalytically modified powders had higher photocatalytic efficiency in comparison to the pure nanosized powders. Moreover, the sol-gel powders of TBT/EG, TBT/EG/Ag (10-2 M), TBT/isop, and TBT/isop/Ag (10-2 M) demonstrated the ability to retain their photocatalytic activity even after three cycles of use, suggesting that they could find practical use in the treatment of pharmaceutical wastewater. The observed photocatalytic efficiency and positive impact of silver make the prepared powders a desirable choice for pharmaceutical drug degradation, helping to promote environmentally friendly and effective wastewater treatment technology.
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Affiliation(s)
- Albena Bachvarova-Nedelcheva
- Institute of General and Inorganic Chemistry, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., bld. 11, 1113 Sofia, Bulgaria
| | - Reni Iordanova
- Institute of General and Inorganic Chemistry, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., bld. 11, 1113 Sofia, Bulgaria
| | - Nina Kaneva
- Laboratory of Nanoparticle Science and Technology, Department of General and Inorganic Chemistry, Faculty of Chemistry and Pharmacy, University of Sofia, 1 James Bourchier Blvd., 1164 Sofia, Bulgaria
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Okiljević B, Martić N, Govedarica S, Andrejić Višnjić B, Bosanac M, Baljak J, Pavlić B, Milanović I, Rašković A. Cardioprotective and Hepatoprotective Potential of Silymarin in Paracetamol-Induced Oxidative Stress. Pharmaceutics 2024; 16:520. [PMID: 38675181 DOI: 10.3390/pharmaceutics16040520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Silymarin, derived from Silybum marianum, has been used in traditional medicine for various ailments. In this study, the cardioprotective and hepatoprotective effects of silymarin against paracetamol-induced oxidative stress were examined in 28 male Swiss Webster mice, divided into four groups and treated for 7 days (via the oral route) with (a) saline 1 mL/kg (control group), (b) saline 1 mL/kg + single dose of paracetamol 110 mg/kg on the 7th day; (c) silymarin 50 mg/kg; and (d) silymarin 50 mg/kg + single dose of paracetamol 110 mg/kg on the 7th day. In vitro and in vivo antioxidant activity together with liver enzyme activity were evaluated. Histopathological and immunohistochemical assessment was performed. Silymarin mitigated paracetamol-induced liver injury by reducing oxidative stress markers such as lipid peroxidation and restoring antioxidant enzyme activity. Silymarin treatment resulted in a significant decrease in liver enzyme levels. Reduced necrosis and inflammatory infiltrate in liver tissues of silymarin-treated groups were detected as well. Immunohistochemical analysis demonstrated reduced expression of inflammatory markers (COX2, iNOS) and oxidative stress marker (SOD2) in the liver tissues of the silymarin-treated groups. Similar trends were observed in cardiac tissue. These results suggest that silymarin exerts potent hepatoprotective and cardioprotective effects against paracetamol-induced oxidative stress, making it a promising therapeutic agent for liver and heart diseases associated with oxidative damage.
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Affiliation(s)
- Bogdan Okiljević
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, 11000 Belgrade, Serbia
| | - Nikola Martić
- Department of Pharmacology, Toxicology, and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Srđan Govedarica
- Clinic of Urology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Bojana Andrejić Višnjić
- Department of Histology and Embryology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Milana Bosanac
- Department of Histology and Embryology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Jovan Baljak
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Branimir Pavlić
- Faculty of Technology, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Isidora Milanović
- Department of Pharmacology, Biochemistry, Pharmacy and Ecology, Academy for Applied Studies Belgrade, College of Health Sciences, 11080 Belgrade, Serbia
| | - Aleksandar Rašković
- Department of Pharmacology, Toxicology, and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
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Sabbatini B, Perinelli DR, Palmieri GF, Cespi M, Bonacucina G. Exploring Immersion Coating as a Cost-Effective Method for Small-Scale Production of Enteric-Coated Gelatin Capsules. Pharmaceuticals (Basel) 2024; 17:433. [PMID: 38675394 DOI: 10.3390/ph17040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The coating process for solid dosage forms is widely used in the pharmaceutical industry but presents challenges for small-scale production, needed in personalized medicine and clinical or galenic settings. This study aimed to evaluate immersion coating, a cost-effective small-scale method, for enteric-coated gelatin capsules using standard equipment. Two enteric coating polymers and different polymer concentrations were tested, along with API solubility. Results were compared with commercially available enteric capsule shells. Successful preparation of enteric coating capsules via immersion necessitates a comprehensive grasp of API and enteric polymer behavior. However, utilizing commercially available enteric capsule shells does not guarantee ease or robustness, as their efficacy hinges on the attributes of the active ingredient and excipients. Notably, coating with Eudragit S100 stands out for its superior process robustness, requiring minimal or no development time, thus representing the best option for small-scale enteric capsule production.
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Affiliation(s)
| | | | | | - Marco Cespi
- School of Pharmacy, University of Camerino, 62032 Camerino, Italy
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7
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Sridharan K, Doss C GP, Cathryn R H, Kumar D T, Al Jufairi M. Comparative Analysis of Machine Learning Algorithms Evaluating the Single Nucleotide Polymorphisms of Metabolizing Enzymes with Clinical Outcomes Following Intravenous Paracetamol in Preterm Neonates with Patent Ductus Arteriosus. Curr Drug Metab 2024; 25:CDM-EPUB-138958. [PMID: 38445694 DOI: 10.2174/0113892002289238240222072027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 03/07/2024]
Abstract
AIMS Pharmacogenomics has been identified to play a crucial role in determining drug response. The present study aimed to identify significant genetic predictor variables influencing the therapeutic effect of paracetamol for new indications in preterm neonates. BACKGROUND Paracetamol has recently been preferred as a first-line drug for managing Patent Ductus Arteriosus (PDA) in preterm neonates. Single Nucleotide Polymorphisms (SNPs) in CYP1A2, CYP2A6, CYP2D6, CYP2E1, and CYP3A4 have been observed to influence the therapeutic concentrations of paracetamol. OBJECTIVES The purpose of this study was to evaluate various Machine Learning Algorithms (MLAs) and bioinformatics tools for identifying the key genotype predictor of therapeutic outcomes following paracetamol administration in neonates with PDA. METHODS Preterm neonates with hemodynamically significant PDA were recruited in this prospective, observational study. The following SNPs were evaluated: CYP2E1*5B, CYP2E1*2, CYP3A4*1B, CYP3A4*2, CYP3A4*3, CYP3A5*3, CYP3A5*7, CYP3A5*11, CYP1A2*1C, CYP1A2*1K, CYP1A2*3, CYP1A2*4, CYP1A2*6, and CYP2D6*10. Amongst the MLAs, Artificial Neural Network (ANN), C5.0 algorithm, Classification and Regression Tree analysis (CART), discriminant analysis, and logistic regression were evaluated for successful closure of PDA. Generalized linear regression, ANN, CART, and linear regression were used to evaluate maximum serum acetaminophen concentrations. A two-step cluster analysis was carried out for both outcomes. Area Under the Curve (AUC) and Relative Error (RE) were used as the accuracy estimates. Stability analysis was carried out using in silico tools, and Molecular Docking Studies (MDS) were carried out for the above-mentioned enzymes. RESULTS Two-step cluster analyses have revealed CYP2D6*10 and CYP1A2*1C to be the key predictors of the successful closure of PDA and the maximum serum paracetamol concentrations in neonates. The ANN was observed with the maximum accuracy (AUC = 0.53) for predicting the successful closure of PDA with CYP2D6*10 as the most important predictor. Similarly, ANN was observed with the least RE (1.08) in predicting maximum serum paracetamol concentrations, with CYP2D6*10 as the most important predictor. Further MDS confirmed the conformational changes for P34A and P34S compared to the wildtype structure of CYP2D6 protein for stability, flexibility, compactness, hydrogen bond analysis, and the binding affinity when interacting with paracetamol, respectively. The alterations in enzyme activity of the mutant CYP2D6 were computed from the molecular simulation results. CONCLUSION We have identified CYP2D6*10 and CYP1A2*1C polymorphisms to significantly predict the therapeutic outcomes following the administration of paracetamol in preterm neonates with PDA. Prospective studies are required for confirmation of the findings in the vulnerable population.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - George Priya Doss C
- Laboratory of Integrative Genomics, School of BioSciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Hephzibah Cathryn R
- Laboratory of Integrative Genomics, School of BioSciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - Thirumal Kumar D
- Faculty of Allied Health Sciences, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Muna Al Jufairi
- Department of Pediatrics, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
- Department of Pediatrics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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Huang Y, Qiu F, Dziegielewska KM, Koehn LM, Habgood MD, Saunders NR. Effects of paracetamol/acetaminophen on the expression of solute carriers (SLCs) in late-gestation fetal rat brain, choroid plexus and the placenta. Exp Physiol 2024; 109:427-444. [PMID: 38059686 PMCID: PMC10988763 DOI: 10.1113/ep091442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
Solute carriers (SLCs) regulate transfer of a wide range of molecules across cell membranes using facilitative or secondary active transport. In pregnancy, these transporters, expressed at the placental barrier, are important for delivery of nutrients to the fetus, whilst also limiting entry of potentially harmful substances, such as drugs. In the present study, RNA-sequencing analysis was used to investigate expression of SLCs in the fetal (embryonic day 19) rat brain, choroid plexus and placenta in untreated control animals and following maternal paracetamol treatment. In the treated group, paracetamol (15 mg/kg) was administered to dams twice daily for 5 days (from embryonic day 15 to 19). In untreated animals, overall expression of SLCs was highest in the placenta. In the paracetamol treatment group, expression of several SLCs was significantly different compared with control animals, with ion, amino acid, neurotransmitter and sugar transporters most affected. The number of SLC transcripts that changed significantly following treatment was the highest in the choroid plexus and lowest in the brain. All SLC transcripts that changed in the placenta following paracetamol treatment were downregulated. These results suggest that administration of paracetamol during pregnancy could potentially disrupt fetal nutrient homeostasis and affect brain development, resulting in major consequences for the neonate and extending into childhood.
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Affiliation(s)
- Yifan Huang
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | - Fiona Qiu
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
| | | | - Liam M. Koehn
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical SciencesMonash UniversityParkvilleVictoriaAustralia
| | - Mark D. Habgood
- Department of NeuroscienceMonash UniversityMelbourneVictoriaAustralia
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Czarnomska M, Lewkowicz A, Pierpaoli M, Gruszczyńska E, Kasprzak M, Gryczyński Z, Bojarski P, Steinborn S, Woźniewski K. Analysis of friction ridge evidence for trace amounts of paracetamol in various pharmaceutical industries by Raman spectroscopy. J Forensic Sci 2024; 69:437-447. [PMID: 38095210 DOI: 10.1111/1556-4029.15451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 03/07/2024]
Abstract
The detection of potentially harmful substances presents a multifaceted challenge. On one hand, it can directly save lives, on the other, it can significantly aid and enhance police work, thereby increasing the effectiveness of investigations. The research conducted in this study primarily aims to identify paracetamol in fingerprints, considering situations involving direct contact of a person with paracetamol either chronically or in a single dose. The identification procedure presented, utilizing Raman spectroscopy, aims to rapidly detect the xenobiotic following ingestion by an individual, which involves touching the tablet with their fingers-this can be termed as touch evidence in forensic science investigations. Additionally, the authors focus on assessing the impact of additives present in drugs containing paracetamol as the main active ingredient. The screening results obtained will enable us to analyze the composition of drugs in terms of potentially toxic substances, and their influence on the physicochemical activity of the active substance. We successfully identified the paracetamol molecule using a noninvasive forensic trace detection method. Samples in the form of common drugs containing 500 mg of paracetamol were studied. Throughout the study, comprehensive validation of the method was ensured through the utilization of a statistical model, which excluded sensitivity to the presence of other substances, whether additives or from the external environment. The proposed approach to trace the content of substances in fingerprint using Raman scattering analysis provides a useful starting point to enhance current analytical methods not only in forensic science but also in toxicology.
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Affiliation(s)
- Martyna Czarnomska
- Faculty of Mathematics, Physics, and Informatics, University of Gdansk, Gdańsk, Poland
| | - Aneta Lewkowicz
- Faculty of Mathematics, Physics, and Informatics, University of Gdansk, Gdańsk, Poland
| | - Mattia Pierpaoli
- Department of Metrology and Optoelectronics, Faculty of Electronics, Telecommunication, and Informatics, Gdańsk University of Technology, Gdańsk, Poland
| | | | | | - Zygmunt Gryczyński
- Department of Physics and Astronomy, Texas Christian University, Fort Worth, Texas, USA
| | - Piotr Bojarski
- Faculty of Mathematics, Physics, and Informatics, University of Gdansk, Gdańsk, Poland
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Sacco N, Iguini A, Gamba I, Marchesini FA, García G. Pd:In-Doped TiO 2 as a Bifunctional Catalyst for the Photoelectrochemical Oxidation of Paracetamol and Simultaneous Green Hydrogen Production. Molecules 2024; 29:1073. [PMID: 38474584 DOI: 10.3390/molecules29051073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The integration of clean energy generation with wastewater treatment holds promise for addressing both environmental and energy concerns. Focusing on photocatalytic hydrogen production and wastewater treatment, this study introduces PdIn/TiO2 catalysts for the simultaneous removal of the pharmaceutical contaminant paracetamol (PTM) and hydrogen production. Physicochemical characterization showed a high distribution of Pd and In on the support as well as a high interaction with it. The Pd and In deposition enhance the light absorption capability and significantly improve the hydrogen evolution reaction (HER) in the absence and presence of paracetamol compared to TiO2. On the other hand, the photoelectroxidation of PTM at TiO2 and PdIn/TiO2 follows the full mineralization path and, accordingly, is limited by the adsorption of intermediate species on the electrode surface. Thus, PdIn-doped TiO2 stands out as a promising photoelectrocatalyst, showcasing enhanced physicochemical properties and superior photoelectrocatalytic performance. This underscores its potential for both environmental remediation and sustainable hydrogen production.
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Affiliation(s)
- Nicolás Sacco
- Instituto de Investigaciones en Catálisis y Petroquímica, INCAPE (UNL-CONICET), Facultad de Ingeniería Química, Santiago del Estero 2829, Santa Fe 3000, Argentina
| | - Alexander Iguini
- Departamento de Química, Instituto Universitario de Materiales y Nanotecnología, Universidad de La Laguna (ULL), P.O. Box 456, 38200 La Laguna, Spain
| | - Ilaria Gamba
- Departamento de Química, Instituto Universitario de Materiales y Nanotecnología, Universidad de La Laguna (ULL), P.O. Box 456, 38200 La Laguna, Spain
| | - Fernanda Albana Marchesini
- Instituto de Investigaciones en Catálisis y Petroquímica, INCAPE (UNL-CONICET), Facultad de Ingeniería Química, Santiago del Estero 2829, Santa Fe 3000, Argentina
| | - Gonzalo García
- Departamento de Química, Instituto Universitario de Materiales y Nanotecnología, Universidad de La Laguna (ULL), P.O. Box 456, 38200 La Laguna, Spain
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Thacher JD, Högfeldt H, Vilhelmsson A, Lindh C, Rylander L. Exposure to Paracetamol in Early Pregnancy and the Risk of Developing Cerebral Palsy: A Case-Control Study Using Serum Samples. J Pediatr 2024; 269:113959. [PMID: 38369234 DOI: 10.1016/j.jpeds.2024.113959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To investigate whether maternal paracetamol use in early pregnancy is associated with cerebral palsy (CP) in offspring. STUDY DESIGN We conducted a registry and biobank-based case-control study with mother-child pairs. We identified CP cases (n = 322) born between 1995 and 2014 from a nationwide CP-registry. Randomly selected controls (n = 343) and extra preterm controls (n = 258) were obtained from a birth registry. For each mother, a single serum sample from early pregnancy (gestation weeks 10-14) was retrieved from a biobank and analyzed for serum concentrations of paracetamol, categorized into unexposed (<1 ng/ml), mildly exposed (1-100 ng/ml), and highly exposed (>100 ng/ml), and in quartiles. Analyses were performed using logistic regression and adjusted for potential confounders. Separate analyses were conducted including only those children born preterm and only those born term. RESULTS Of the 923 participants, 36.8% were unexposed, 53.2% mildly exposed, and 10% highly exposed to paracetamol. Overall, prenatal exposure to paracetamol was not associated with CP. Sensitivity and subgroup analyses showed no clear associations between paracetamol and CP across strata of term/preterm birth as well as subtypes of CP. CONCLUSIONS The present study does not support an association between intrauterine exposure to paracetamol in early pregnancy and the risk of CP. However, it is important to stress that the exposure estimate is based on a single serum sample.
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Affiliation(s)
- Jesse D Thacher
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Hannah Högfeldt
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Andreas Vilhelmsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
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12
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Suárez J, de Ceglia M, Rodríguez-Pozo M, Vargas A, Santos I, Melgar-Locatelli S, Castro-Zavala A, Castilla-Ortega E, Rodríguez de Fonseca F, Decara J, Rivera P. Inhibition of Adult Neurogenesis in Male Mice after Repeated Exposure to Paracetamol Overdose. Int J Mol Sci 2024; 25:1964. [PMID: 38396643 PMCID: PMC10888347 DOI: 10.3390/ijms25041964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Paracetamol, or acetaminophen (N-acetyl-para-aminophenol, APAP), is an analgesic and antipyretic drug that is commonly used worldwide, implicated in numerous intoxications due to overdose, and causes serious liver damage. APAP can cross the blood-brain barrier and affects brain function in numerous ways, including pain signals, temperature regulation, neuroimmune response, and emotional behavior; however, its effect on adult neurogenesis has not been thoroughly investigated. We analyze, in a mouse model of hepatotoxicity, the effect of APAP overdose (750 mg/kg/day) for 3 and 4 consecutive days and after the cessation of APAP administration for 6 and 15 days on cell proliferation and survival in two relevant neurogenic zones: the subgranular zone of the dentate gyrus and the hypothalamus. The involvement of liver damage (plasma transaminases), neuronal activity (c-Fos), and astroglia (glial fibrillar acidic protein, GFAP) were also evaluated. Our results indicated that repeated APAP overdoses are associated with the inhibition of adult neurogenesis in the context of elevated liver transaminase levels, neuronal hyperactivity, and astrogliosis. These effects were partially reversed after the cessation of APAP administration for 6 and 15 days. In conclusion, these results suggest that APAP overdose impairs adult neurogenesis in the hippocampus and hypothalamus, a fact that may contribute to the effects of APAP on brain function.
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Affiliation(s)
- Juan Suárez
- Departamento de Anatomía Humana, Medicina Legal e Historia de la Ciencia, Facultad de Medicina, Universidad de Málaga, 29071 Málaga, Spain; (J.S.); (M.R.-P.); (I.S.)
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
| | - Marialuisa de Ceglia
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
| | - Miguel Rodríguez-Pozo
- Departamento de Anatomía Humana, Medicina Legal e Historia de la Ciencia, Facultad de Medicina, Universidad de Málaga, 29071 Málaga, Spain; (J.S.); (M.R.-P.); (I.S.)
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
| | - Antonio Vargas
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
| | - Ignacio Santos
- Departamento de Anatomía Humana, Medicina Legal e Historia de la Ciencia, Facultad de Medicina, Universidad de Málaga, 29071 Málaga, Spain; (J.S.); (M.R.-P.); (I.S.)
| | - Sonia Melgar-Locatelli
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, 29010 Málaga, Spain
| | - Adriana Castro-Zavala
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, 29010 Málaga, Spain
| | - Estela Castilla-Ortega
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad de Málaga, 29010 Málaga, Spain
| | - Fernando Rodríguez de Fonseca
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
- Unidad Clínica de Neurología, Hospital Regional Universitario de Málaga, Instituto IBMA-Plataforma BIONAND, 29010 Málaga, Spain
| | - Juan Decara
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
| | - Patricia Rivera
- Grupo de Neuropsicofarmacología, Instituto IBIMA-Plataforma BIONAND, Unidad de Gestión Clínica de Salud Mental, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 29010 Málaga, Spain; (M.d.C.); (A.V.); (S.M.-L.); (A.C.-Z.); (E.C.-O.); (F.R.d.F.)
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13
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Az A, Sogut O, Akdemir T, Dogan Y. Intradermal Sterile Water Injection: Safe and Effective Alternative for Relief of Acute Renal Colic in the Emergency Department. J Emerg Med 2024; 66:83-90. [PMID: 38267297 DOI: 10.1016/j.jemermed.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The optimal pain relief method for acute renal colic in the emergency department remains controversial. OBJECTIVE We compared the safety and efficacy of intradermal sterile water injection (ISWI) to treatment with intramuscular (IM) diclofenac, intravenous (IV) opioids, and IV paracetamol in patients with acute renal colic. METHODS This randomized, single-blind study included 320 patients with renal colic to one of four treatment groups. The first group received ISWI at four different points around the most painful flank area. Patients in the DI, PARA, and TRAM groups received 75 mg IM diclofenac, 1 g IV paracetamol, and 100 mg IV tramadol, respectively. Pain intensity was measured using a visual analog scale (VAS) before treatment and 15, 30, and 60 min after treatment. RESULTS VAS scores 15 and 30 min after treatment were significantly lower in group ISWI than in groups DI, PARA, and TRAM. However, there were no significant differences in the decrease in the pain score at baseline and at 60 min after treatment. In addition, fewer patients required rescue analgesia in group ISWI than in group TRAM. However, no significant differences were observed between group ISWI and group DI or PARA in terms of the need for rescue analgesia. Finally, there were significantly fewer adverse events in group ISWI than in groups DI and TRAM. CONCLUSIONS ISWI had similar efficacy, faster pain relief, and lower need for rescue analgesia compared with diclofenac, paracetamol, and tramadol for the management of acute renal colic. In addition, ISWI was well-tolerated and had no adverse effects.
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Affiliation(s)
- Adem Az
- Department of Emergency Medicine, Istanbul Beylikduzu State Hospital, Istanbul, Turkey
| | - Ozgur Sogut
- Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Tarik Akdemir
- Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Yunus Dogan
- Department of Emergency Medicine, Mus State Hospital, Mus, Turkey
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14
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Edwina AE, Dreesen E, Hias J, Koch BCP, Van den Eede N, Pauwels S, Allegaert K, Van der Linden L, Spriet I, Tournoy J. Agreement Between a Colorimetric Assay and Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry for Quantifying Paracetamol Plasma Concentrations. AAPS J 2024; 26:23. [PMID: 38302833 DOI: 10.1208/s12248-024-00890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024] Open
Abstract
Special populations, like geriatric patients, experience altered paracetamol pharmacokinetics (PK), complicating pain management. More PK research is essential to optimize paracetamol (acetaminophen) dosing. Yet, the reference method ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) is not readily available. Therefore, we aimed to evaluate the agreement between UPLC-MS/MS and the more accessible colorimetric Roche acetaminophen (ACETA) assay in quantifying paracetamol plasma concentrations, to facilitate PK studies and therapeutic drug monitoring for pain management. Patient data and plasma samples were obtained from a prospective study including geriatric patients admitted to the geriatric wards. ACETA and UPLC-MS/MS assays were performed in two separate laboratories. Bland-Altman plot and Passing-Bablok regression were used to assess agreement. Accuracy was evaluated using the McNemar test for a threshold value of 10 mg/L. Population PK modeling was employed to bridge PK data obtained from both methods (NONMEM 7.5). A total of 242 plasma sample pairs were available from 40 geriatric patients (age range, 80-95 years). Paracetamol plasma concentrations from ACETA (median 9.8 [interquartile range 6.1-14.4] mg/L) and UPLC-MS/MS (9.5 [6.2-14.8] mg/L) did not differ significantly (P > 0.05). No significant proportional nor additive bias was observed between both assay methods. The classification accuracy (at threshold 10 mg/L) was 85% (P = 0.414). The conversion factor between ACETA and UPLC-MS/MS was estimated at 1.06 (relative standard error 5%), yet with a 13.4% (relative standard error 23%) interindividual variability. ACETA assay showed no systematic bias in comparison with the UPLC-MS/MS assay in determining paracetamol exposure in geriatric blood samples despite the imprecision.
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Affiliation(s)
- Angela Elma Edwina
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven - University of Leuven, UZ Herestraat 49, Box 7003, 3000, Leuven, Belgium
| | - Erwin Dreesen
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Julie Hias
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Karel Allegaert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven - University of Leuven, UZ Herestraat 49, Box 7003, 3000, Leuven, Belgium.
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
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15
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Milella MS, Petraccia L, Pirelli F, Foti G, Sapio M, Berardi R, Caprioli D, Pugliese F, Vivino G. Self-harm by single- and multi-agent medication poisoning in a retrospective analysis of a Poison Control Center database from January 2018 to December 2022. Pharmacoepidemiol Drug Saf 2024; 33:e5767. [PMID: 38357800 DOI: 10.1002/pds.5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. METHODS Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. RESULTS A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. CONCLUSION Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.
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Affiliation(s)
- Michele Stanislaw Milella
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Luisa Petraccia
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Francesca Pirelli
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Foti
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Maria Sapio
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
| | - Rosaria Berardi
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Daniele Caprioli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
| | - Gabriella Vivino
- Poison Control Center Unit, Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital - Sapienza, University of Rome, Rome, Italy
- Department of Emergency, Anesthesia and Critical Care Medicine, Policlinico Umberto I Hospital-Sapienza, University of Rome, Rome, Italy
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16
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Davies JF, McAlister S, Eckelman MJ, McGain F, Seglenieks R, Gutman EN, Groome J, Palipane N, Latoff K, Nielsen D, Sherman JD. Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle analysis. Br J Anaesth 2024:S0007-0912(23)00725-0. [PMID: 38296752 DOI: 10.1016/j.bja.2023.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.v. and oral formulations of paracetamol used in the perioperative period. METHODS Life-cycle assessment of GHG emissions (expressed as carbon dioxide equivalents CO2e) of i.v. and oral paracetamol preparations was performed. Perioperative paracetamol prescribing practices and costs for 26 hospitals in USA, UK, and Australia were retrospectively audited. For those surgical patients for whom oral formulations were indicated, CO2e and costs of actual prescribing practices for i.v. or oral doses were compared with optimal oral prescribing. RESULTS The carbon footprint for a 1 g dose was 38 g CO2e (oral tablet), 151 g CO2e (oral liquid), and 310-628 g CO2e (i.v. dependent on type of packaging and administration supplies). Of the eligible USA patients, 37% received paracetamol (67% was i.v.). Of the eligible UK patients, 85% received paracetamol (80% was i.v.). Of the eligible Australian patients, 66% received paracetamol (70% was i.v.). If the emissions mitigation opportunity from substituting oral tablets for i.v. paracetamol is extrapolated to USA, UK, and Australia elective surgical encounters in 2019, ∼5.7 kt CO2e could have been avoided and would save 98.3% of financial costs. CONCLUSIONS Intravenous paracetamol has 12-fold greater life-cycle carbon emissions than the oral tablet form. Glass vials have higher greenhouse gas emissions than plastic vials. Intravenous administration should be reserved for cases in which oral formulations are not feasible.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Scott McAlister
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J Eckelman
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Forbes McGain
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sydney School of Public Health, University of Sydney, Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia
| | - Richard Seglenieks
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia; Department of Anaesthesia, Grampians Health, Ballarat, VIC, Australia
| | - Elena N Gutman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Groome
- Barts Health NHS Trust, London, UK; Nuffield Health, London, UK
| | - Natasha Palipane
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Katherine Latoff
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Dominic Nielsen
- Greener Anaesthesia & Sustainability Project (GASP), London, UK
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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17
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Grădinariu L, Dediu L, Crețu M, Grecu IR, Docan A, Istrati DI, Dima FM, Stroe MD, Vizireanu C. The Antioxidant and Hepatoprotective Potential of Berberine and Silymarin on Acetaminophen Induced Toxicity in Cyprinus carpio L. Animals (Basel) 2024; 14:373. [PMID: 38338016 PMCID: PMC10854737 DOI: 10.3390/ani14030373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Berberine (BBR) and silymarin (SM) are natural compounds extracted from plants known for their antioxidant and chemoprotective effects on the liver. The present study aimed to investigate the beneficial properties of BBR and SM and the association of BBR with SM on liver function using fish as "in vivo" models. Moreover, the study investigated their hepatoprotective role after acetaminophen (APAP) exposure. For this purpose, the fish (N = 360; 118.4 ± 11.09 g) were fed with control or experimental diets for 9 weeks. In the experimental diets, the feed was supplemented with either SM (1 g/kg feed), BBR (100 and 200 mg/kg feed), or a combination of BBR with SM (SM 1 g/kg feed + BBR 100 mg/kg feed and, respectively, SM 1 g/kg feed + BBR 200 mg/kg feed). After the feeding trial, seven fish from each tank were randomly selected and exposed to a single APAP dose. The selected serum biochemical markers, oxidative stress markers, and lysozyme activity were used to evaluate the efficiency of the supplements on carp's health profile, particularly regarding the hepatopancreas function. Our results showed that the inclusion of SM and BBR (either as a single or in combination) reduced the serum contents of total cholesterol, triglyceride, and alanine transaminase. An increase in the high-density cholesterol was observed after the administration of BBR or BBR in association with SM. Both supplements showed hepatoprotective activity against APAP-induced hepatotoxicity, especially BBR. The ameliorative effects of SM (1 g) in association with BBR (100 mg) were highlighted by the modulation of the nonspecific immune system and oxidative stress alleviation after APAP exposure.
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Affiliation(s)
- Lăcrămioara Grădinariu
- Faculty of Food Science and Engineering, “Dunărea de Jos” University of Galați, 47 Domnească Street, 800008 Galați, Romania (M.C.); (I.R.G.); (A.D.); (D.I.I.); (C.V.)
| | - Lorena Dediu
- Faculty of Food Science and Engineering, “Dunărea de Jos” University of Galați, 47 Domnească Street, 800008 Galați, Romania (M.C.); (I.R.G.); (A.D.); (D.I.I.); (C.V.)
| | - Mirela Crețu
- Faculty of Food Science and Engineering, “Dunărea de Jos” University of Galați, 47 Domnească Street, 800008 Galați, Romania (M.C.); (I.R.G.); (A.D.); (D.I.I.); (C.V.)
- Institute of Research and Development for Aquatic Ecology, Fishing and Aquaculture, 54 Portului Street, 800211 Galați, Romania; (F.M.D.); (M.D.S.)
| | - Iulia Rodica Grecu
- Faculty of Food Science and Engineering, “Dunărea de Jos” University of Galați, 47 Domnească Street, 800008 Galați, Romania (M.C.); (I.R.G.); (A.D.); (D.I.I.); (C.V.)
| | - Angelica Docan
- Faculty of Food Science and Engineering, “Dunărea de Jos” University of Galați, 47 Domnească Street, 800008 Galați, Romania (M.C.); (I.R.G.); (A.D.); (D.I.I.); (C.V.)
| | - Daniela Ionela Istrati
- Faculty of Food Science and Engineering, “Dunărea de Jos” University of Galați, 47 Domnească Street, 800008 Galați, Romania (M.C.); (I.R.G.); (A.D.); (D.I.I.); (C.V.)
| | - Floricel Maricel Dima
- Institute of Research and Development for Aquatic Ecology, Fishing and Aquaculture, 54 Portului Street, 800211 Galați, Romania; (F.M.D.); (M.D.S.)
- Faculty of Engineering and Agronomy, 29 Calea Calărașilor Street, 810017 Brăila, Romania
| | - Maria Desimira Stroe
- Institute of Research and Development for Aquatic Ecology, Fishing and Aquaculture, 54 Portului Street, 800211 Galați, Romania; (F.M.D.); (M.D.S.)
| | - Camelia Vizireanu
- Faculty of Food Science and Engineering, “Dunărea de Jos” University of Galați, 47 Domnească Street, 800008 Galați, Romania (M.C.); (I.R.G.); (A.D.); (D.I.I.); (C.V.)
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Stasiowski MJ, Lyssek-Boroń A, Zmarzły N, Marczak K, Grabarek BO. The Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries with Preemptive Paracetamol/Metamizole. Pharmaceuticals (Basel) 2024; 17:129. [PMID: 38256962 PMCID: PMC10819548 DOI: 10.3390/ph17010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the possibility of postoperative pain occurrence, in some patients, vitreoretinal surgeries (VRSs) require performance of general anesthesia (GA). The administration of intraoperative intravenous rescue opioid analgesics (IROA) during GA constitutes a risk of perioperative adverse events. The Adequacy of Anesthesia (AoA) concept consists of an entropy electroencephalogram to guide the depth of GA and surgical pleth index (SPI) to optimize the titration of IROA. Preemptive analgesia (PA) using cyclooxygenase-3 (COX-3) inhibitors is added to GA to minimize the demand for IROA and reduce postoperative pain. The current analysis evaluated the advantage of PA using COX-3 inhibitors added to GA with AoA-guided administration of IROA on the rate of postoperative pain and hemodynamic stability in patients undergoing VRS. A total of 165 patients undergoing VRS were randomly allocated to receive either GA with AoA-guided IROA administration with intravenous paracetamol/metamizole or with preemptive paracetamol or metamizole. Preemptive paracetamol resulted in a reduction in the IROA requirement; both preemptive metamizole/paracetamol resulted in a reduced rate of postoperative pain as compared to metamizole alone. We recommend using intraoperative AOA-guided IROA administration during VRS to ensure hemodynamic stability alongside PA using both paracetamol/metamizole to reduce postoperative pain.
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Affiliation(s)
- Michał Jan Stasiowski
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
| | - Anita Lyssek-Boroń
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
- Department of Ophthalmology, Faculty of Medicine, Academy of Silesia, 40-055 Katowice, Poland
| | - Nikola Zmarzły
- Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland; (N.Z.); (B.O.G.)
| | - Kaja Marczak
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
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Ren Y, Xu Z, Qiao Z, Wang X, Yang C. Flaxseed Lignan Alleviates the Paracetamol-Induced Hepatotoxicity Associated with Regulation of Gut Microbiota and Serum Metabolome. Nutrients 2024; 16:295. [PMID: 38257189 PMCID: PMC10821007 DOI: 10.3390/nu16020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
This study examined the protective effect of flaxseed lignans on liver damage caused by an overdose of paracetamol (PAM). The findings demonstrated that administering 800 mg/kg/d flaxseed lignan prior to PAM significantly decreased the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBi) levels, while it increased liver superoxide dismutase (SOD) and glutathione (GSH) levels in mice. Flaxseed lignan renovated the gut microbiota dysbiosis induced by PAM by promoting the proliferation of sulfonolipid (SL) producing bacteria such as Alistipes and lignan-deglycosolating bacteria such as Ruminococcus while inhibiting the growth of opportunistic pathogen bacteria such as Acinetobacter and Clostridium. Furthermore, flaxseed lignan modulated the serum metabolomic profile after PAM administration, specifically in the taurine and hypotaurine metabolism, phenylalanine metabolism, and pyrimidine metabolism. The study identified eight potential biomarkers, including enterolactone, cervonyl carnitine, acutilobin, and PC (20:3(5Z, 8Z, 11Z)/20:0). Overall, the results suggest that flaxseed lignan can alleviate PAM-induced hepatotoxicity and may be beneficial in preventing drug-induced microbiome and metabolomic disorders.
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Affiliation(s)
- Yongyan Ren
- Key Laboratory of Oilseeds Processing of Ministry of Agriculture and Rural Affairs, Hubei Key Laboratory of Lipid Chemistry and Nutrition, Oil Crops Research Institute of the Chinese Academy of Agricultural Sciences, No. 2 Xudong 2nd Road, Wuhan 430062, China
| | - Zhenxia Xu
- Key Laboratory of Oilseeds Processing of Ministry of Agriculture and Rural Affairs, Hubei Key Laboratory of Lipid Chemistry and Nutrition, Oil Crops Research Institute of the Chinese Academy of Agricultural Sciences, No. 2 Xudong 2nd Road, Wuhan 430062, China
| | - Zhixian Qiao
- Institute of Hydrobiology, Chinese Academy of Sciences, No. 7 Donghu South Road, Wuhan 430060, China
| | - Xu Wang
- College of Animal Science and Technology, Huazhong Agricultural University, No. 1 Shizishan Street, Wuhan 430070, China
| | - Chen Yang
- Key Laboratory of Oilseeds Processing of Ministry of Agriculture and Rural Affairs, Hubei Key Laboratory of Lipid Chemistry and Nutrition, Oil Crops Research Institute of the Chinese Academy of Agricultural Sciences, No. 2 Xudong 2nd Road, Wuhan 430062, China
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20
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Skwarczynska-Wojsa A, Puszkarewicz A. Removal of Acetaminophen from Aqueous Solutions in an Adsorption Process. Materials (Basel) 2024; 17:431. [PMID: 38255599 PMCID: PMC10820461 DOI: 10.3390/ma17020431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
Acetaminophen (C8H9NO2, also called paracetamol) is an active metabolite of phenacetin with antipyretic and analgesic effects and has been extensively used as a painkiller. Currently, the problem of pharmaceuticals in water and sewage is common, especially in highly urbanized countries. Laboratory-scale experiments were carried out using an adsorbent-granulated activated carbon (WD-extra)-to remove acetaminophen (ACT) from water. The initial concentration of acetaminophen was 20 mg ACT/dm3. The adsorption kinetics, influence of the pH on adsorption and dose of the used adsorbent were determined under batch conditions. The adsorption of ACT on activated carbon was more efficient when the water solution was acidic (at pH 2, it was the most effective). The highest percentage of removal (99%) was obtained for the WD-extra dose of 10.0 g/dm3. The time taken to establish the dynamic equilibrium of the system was 60 min. The effectiveness of adsorption was determined based on the Freundlich and Langmuir adsorption isotherms. It was found that WD-extra activated carbon effectively removed ACT from water solutions.
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Affiliation(s)
- Agata Skwarczynska-Wojsa
- Department of Water Purification and Protection, Rzeszow University of Technology, Al. Powstancow Warszawy 12, 35-959 Rzeszow, Poland;
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21
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Bedir Z, Ozkaloglu Erdem KT, Doymus O, Suleyman H, Yavuzer B, Cicek B, Altuner D, Mammadov R, Yilmaz M, Coban TA, Suleyman B, Bulut S. Effects of benidipine, paracetamol, and their combination on postoperative and normal tissue pain thresholds. Front Pharmacol 2024; 14:1326128. [PMID: 38249347 PMCID: PMC10796563 DOI: 10.3389/fphar.2023.1326128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: In clinical practice, inadequate pain inhibition leads to increased morbidity and mortality. Increased intracellular calcium, oxidants, and proinflammatory cytokines are known to play a role in the pathogenesis of postoperative pain. Therefore, we investigated the analgesic effects of benidipine, paracetamol, and benidipine-paracetamol combination (BPC) on postoperative and normal pain thresholds in rats. Material and methods: Sixty-four male albino Wistar rats weighing 285-295 g were used. The without-incision rats were divided into 4 subgroups: healthy control, benidipine alone, paracetamol alone, and BPC. The scalpel-incision rats were divided into 4 subgroups: scalpel incision, scalpel incision + benidipine, scalpel incision + paracetamol, and scalpel incision + BPC. Paw pain thresholds of rats were measured using a Basile algesimeter. Biochemical analyses were performed on the paw tissues of 6 rats randomly taken from the experimental groups, each containing 8 rats. Rats were sacrificed immediately after the measurements. After the pain threshold tests were finished, the paw tissues were removed and malondialdehyde (MDA), total glutathione (tGSH), cyclooxygenase (COX), and interleukin-6 (IL-6) levels were measured. Results: There was no significant difference between the groups in paw pain threshold and measured biochemical parameters in rats without incision. The decrease in the pain threshold of the incised paw was also best prevented by BPC, followed by benidipine and then paracetamol. Furthermore, increases in scalpel-incised paw tissue MDA, COX-2, and IL-6 levels and the decrease in tGSH were significantly suppressed by benidipine and BPC, while paracetamol could only significantly inhibit the increase in IL-6 production. Conclusion: The combination of the L-type Ca2+ channel blocker benidipine and paracetamol (BPC) may provide potent analgesia. Our experimental results support that BPC may be useful in the treatment of severe pain that cannot be adequately inhibited by paracetamol.
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Affiliation(s)
- Zehra Bedir
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Erzurum State Hospital, Erzurum, Türkiye
| | - Kezban Tuna Ozkaloglu Erdem
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Omer Doymus
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Erzurum State Hospital, Erzurum, Türkiye
| | - Halis Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Türkiye
| | - Bulent Yavuzer
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Türkiye
| | - Betul Cicek
- Department of Physiology, Faculty of Medicine, Erzincan Binali Yildirim University, Türkiye
| | - Durdu Altuner
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Türkiye
| | - Renad Mammadov
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Türkiye
| | - Mehmet Yilmaz
- Department of Orthopaedics and Traumatology, Private Deva Hospital, Gaziantep, Türkiye
| | - Taha Abdulkadir Coban
- Department of Biochemistry, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Türkiye
| | - Bahadir Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Türkiye
| | - Seval Bulut
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Türkiye
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Prescott LF. Paracetamol (acetaminophen) poisoning: The early years. Br J Clin Pharmacol 2024; 90:127-134. [PMID: 37683599 DOI: 10.1111/bcp.15903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023] Open
Abstract
Paracetamol (acetaminophen) was marketed in the 1950s as a nonprescription analgesic/antipyretic without any preclinical toxicity studies. It became used increasingly for self-poisoning, particularly in the UK and was belatedly found to cause acute liver damage, which could be fatal. Management of poisoned patients was difficult as maximum abnormalities of liver function were delayed for 3 days or more after an overdose. There was no treatment and the mechanism of hepatotoxicity was not known. The paracetamol half-life was prolonged with liver damage occurring when it exceeded 4 h and the Rumack-Matthew nomogram was an important advance that allowed stratification of patients into separate zones of risk. It is used to guide prognosis and treatment and its predictive value could be increased by combining it with the paracetamol half-life. The problems of a sheep farmer in Australia in the early 1970s led to the discovery of the mechanism of paracetamol hepatotoxicity, and the first effective treatment of overdosage with intravenous (IV) cysteamine. This had unpleasant side effects and administration was difficult. N-acetylcysteine soon became the treatment of choice for paracetamol overdose and given early it was very effective when administered either IV or orally. N-acetylcysteine could cause anaphylactoid reactions, particularly early during IV administration when the concentrations were highest. Simpler and shorter regimes with slower initial rates of infusion have now been introduced with a reduced incidence of these adverse effects. In addition, there has been a move to use larger doses of N-acetylcysteine given over longer periods for patients who are more severely poisoned and those with risk factors. There has been much interest recently in the search for novel biomarkers such as microRNAs, procalcitonin and cyclophilin that promise to have greater specificity and sensitivity than transaminases. Paracetamol-protein adducts predict hepatotoxicity and are specific biomarkers of toxic paracetamol metabolite exposure. Another approach would be measurement of the plasma levels of cysteine and inorganic sulfate. It is 50 years since the first effective treatment for paracetamol poisoning and, apart from liver transplantation, there is still no effective treatment for patients who present late.
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Affiliation(s)
- Laurie F Prescott
- Emeritus Professor of Clinical Pharmacology, University of Edinburgh, Edinburgh, UK
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Alam MM, Alsenani NI, Abdelhamid AA, Ahmad A, Baothman OA, Hosawi SA, Altayeb H, Nadeem MS, Ahmad V, Nazreen S, Elhenawy AA. New paracetamol hybrids as anticancer and COX-2 inhibitors: Synthesis, biological evaluation and docking studies. Arch Pharm (Weinheim) 2024; 357:e2300340. [PMID: 37880869 DOI: 10.1002/ardp.202300340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
Drug repurposing is an emerging field in drug development that has provided many successful drugs. In the current study, paracetamol, a known antipyretic and analgesic agent, was chemically modified to generate paracetamol derivatives as anticancer and anticyclooxygenase-2 (COX-2) agents. Compound 11 bearing a fluoro group was the best cytotoxic candidate with half-maximal inhibitory concentration (IC50 ) values ranging from 1.51 to 6.31 μM and anti-COX-2 activity with IC50 = 0.29 μM, compared to the standard drugs, doxorubicin and celecoxib. The cell cycle and apoptosis studies revealed that compound 11 possesses the ability to induce cell cycle arrest in the S phase and apoptosis in colon Huh-7 cells. These results were strongly supported by docking studies, which showed strong interactions with the amino acids of the COX-2 protein, and in silico pharmacokinetic predictions were found to be favorable for these newly synthesized paracetamol derivatives. It can be concluded that compound 11 could block cell growth and proliferation by inhibiting the COX-2 enzyme in cancer therapy.
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Affiliation(s)
- Mohammad Mahboob Alam
- Department of Chemistry, Faculty of Science, Al-Baha University, Al-Baha, Kingdom of Saudi Arabia
| | - Nawaf I Alsenani
- Department of Chemistry, Faculty of Science, Al-Baha University, Al-Baha, Kingdom of Saudi Arabia
| | - Antar A Abdelhamid
- Department of Chemistry, Faculty of Science, Al-Baha University, Al-Baha, Kingdom of Saudi Arabia
- Department of Chemistry, Faculty of Science, Sohag University, Sohag, Egypt
| | - Abrar Ahmad
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Othman A Baothman
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Salman A Hosawi
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Hisham Altayeb
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohammad Shahid Nadeem
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Varish Ahmad
- Department of Health Information Technology, Faculty of Applied Studies, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Syed Nazreen
- Department of Chemistry, Faculty of Science, Al-Baha University, Al-Baha, Kingdom of Saudi Arabia
| | - Ahmed A Elhenawy
- Department of Chemistry, Faculty of Science, Al-Baha University, Al-Baha, Kingdom of Saudi Arabia
- Chemistry Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt
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24
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Mercer MA, Davis JL, McKenzie HC, Byron CR, Kelleher ME, Trager L, Cecere TE, Wilson KE, Council-Troche RM, Werre SR. Pharmacokinetics, clinical efficacy and safety of acetaminophen ( paracetamol) in adult horses with naturally occurring chronic lameness. Equine Vet J 2024; 56:202-214. [PMID: 37287331 DOI: 10.1111/evj.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/05/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Acetaminophen is used clinically in horses with musculoskeletal pain; however, no studies have been performed in horses with chronic lameness. OBJECTIVES To determine the pharmacokinetics, safety and efficacy of chronic dosing of acetaminophen in horses with naturally occurring chronic lameness. STUDY DESIGN Longitudinal. METHODS Twelve adult horses with chronic lameness were treated with acetaminophen (30 mg/kg PO) every 12 h for 21 days. Plasma concentrations of acetaminophen were analysed on days 7 and 21 via LC-MS/MS and noncompartmental pharmacokinetic analysis. Lameness was evaluated by body-mounted inertial sensor (BMIS) and 10-point subjective lameness score on day 21 and compared to untreated baseline evaluation on day 35. Clinicopathological analysis (n = 12), hepatic biopsy (n = 6) and gastroscopy (n = 6) were evaluated on days -1 and 22. RESULTS Maximum plasma acetaminophen concentration (Cmax ) was 20.83 ± 10.25 μg/mL at time (Tmax ) 0.40 ± 0.22 h on day 7. The Cmax on day 21 was 17.33 ± 6.91 μg/mL with a Tmax of 0.67 ± 0.26 h. Subjective lameness scores significantly improved at 2 and 4 h post-treatment; Significant percent improvement was detected in PDmax for horses with hindlimb lameness at 1, 2 and 8 h post-treatment. There were no significant differences in gastroscopy or hepatic biopsy scores between days -1 and 22. MAIN LIMITATIONS Small sample size, multi-limb lameness of varying severity and aetiology, lack of intermediary lameness evaluation. CONCLUSIONS In horses with naturally occurring chronic lameness, acetaminophen at 30 mg/kg produced a transient improvement in subjective lameness and BMIS evaluation. Acetaminophen may not be effective as a monotherapy. Acetaminophen was safe following 21 days of 30 mg/kg PO every 12 h, with no evidence of clinically significant changes in clinicopathological analysis, hepatic biopsy or gastric ulceration scores.
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Affiliation(s)
- Melissa A Mercer
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - Jennifer L Davis
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - Harold C McKenzie
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - Christopher R Byron
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - Maureen E Kelleher
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Leesburg, Virginia, USA
| | - Lauren Trager
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - Thomas E Cecere
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - Katie E Wilson
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - R M Council-Troche
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia, USA
| | - Stephen R Werre
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
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Hamed Ali Bakr E, Hamdan Almuraee AA. Protective Effect of Black Seed and Lettuce Oils Against Paracetamol-Induced Hepatotoxicity in Rats. Pak J Biol Sci 2024; 27:59-68. [PMID: 38516747 DOI: 10.3923/pjbs.2024.59.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
<b>Background and Objective:</b> The liver is one of the organs that play an essential role in the human body, including supporting metabolism, immune functions, digestive system, detoxification, storage of vitamins and other functions. This investigation aimed to study the protective effects of black seed and lettuce oil against hepatotoxicity as induced by paracetamol in experimental rats. <b>Materials and Methods:</b> Twenty male Sprague-Dawley albino rats weighing 150±5 g were divided randomly into four groups (5 rats each) and distributed as follows; 1st group was controlled negative (C -ve group), 2nd group controlled positive (orally administered with 500 mg/kg b.wt., paracetamol), 3rd and 4th groups were orally administered with black seed oil and lettuce oil at a dose of 1 mL/kg b.wt., each) as a preventive dose. All rats were sacrificed and blood was collected for biochemical analysis and then statistically analyzed. <b>Results:</b> The rat administered with black seed and lettuce oils enhanced body weight gain, food intake and feed efficiency ratio. Moreover, exhibited a significant reduction in the liver enzymes AST, ALT, ALP and TBIL. Meanwhile, black seed and lettuce oils significantly improved kidney functions, lipid profiles and some immune biomarkers including creatine kinase (CK), Creatine Kinase-MB (CK-MB) and Lactate Dehydrogenase (LDH). <b>Conclusion:</b> This study revealed that the oils of black seed (<i>Nigella sativa</i>) and lettuce (<i>Lactuca sativa</i>) have a protective role in improving body weight gain, food intake, feed efficiency ratio, liver enzymes, kidney functions, lipid profiles and some immune biomarkers against paracetamol-induced hepatotoxicity in experimental rats.
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26
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Tanaka C, Tagami T, Nagano M, Nakayama F, Kaneko J, Kuno M. Risk factors for the need for advanced care among prescription and over-the-counter drug overdose patients. Acute Med Surg 2024; 11:e942. [PMID: 38500638 PMCID: PMC10946162 DOI: 10.1002/ams2.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Aim Prescription drug and over-the-counter (OTC) drug overdose is a major problem in emergency departments in Japan, and some need advanced care which is more than observation. We aimed to identify the prehospital risk factors for the need of advanced care among overdose patients. Methods This was a single-center retrospective cohort study. We included overdoses patients of prescription drugs or OTC drugs, who admitted to our hospital between 2016 and 2021. We grouped them into advanced care and non-advanced care. The main outcome was the need for advanced care. We performed a multiple logistic regression analysis, calculated the PAV score (Paracetamol use, Alcohol use, abnormal Vital signs on scene) and performed a receiver operating characteristic (ROC) analysis. Results There were 229 subjects. The logistic regression analysis revealed that alcohol, paracetamol, and the abnormal vital signs on scene were associated with advanced care (alcohol-odds ratio [OR]: 2.95; 95% confidence interval [CI]: 1.29-6.75; paracetamol-OR: 5.47; 95% CI: 2.18-13.71; abnormal vital signs-OR: 4.61, 95% CI: 2.07-10.27). The rate of advanced care in the high PAV score (2 and 3) group was statistically higher than that in the low PAV score (0-1) group (p = 0.04). Area under the ROC curve of the PAV score was 0.72 (95% CI, 0.65-0.80). Conclusion Alcohol, paracetamol use and abnormal vital signs on scene might be risk factors for advanced care among prescription drugs or OTC drugs overdose patients, and the PAV score may predict the need for advanced care.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Takashi Tagami
- Department of Emergency and Critical Care MedicineNippon Medical School Musashikosugi HospitalKawasakiJapan
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoBunkyoJapan
| | | | - Fumihiko Nakayama
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Junya Kaneko
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Masamune Kuno
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
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27
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Aparcana-Choque WD, Pisconti-Palacios YM, Cordova-Tello I, Ausejo-Galarza J, Gomez-Gonzales W, Kochubei-Hurtado A, Arteaga-Livias K. Steven-Jonhson Syndrome in a Patient With Dengue Infection in Peru: A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096241242574. [PMID: 38546109 PMCID: PMC10981262 DOI: 10.1177/23247096241242574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/08/2024] [Accepted: 01/20/2024] [Indexed: 04/01/2024] Open
Abstract
Stevens-Johnson syndrome is an infrequent condition affecting the skin and mucous membranes, it involves cutaneous detachment with high mortality without adequate treatment. We present the case of a 40-year-old male with a history of epilepsy treated with valproic acid and lamotrigine, previously diagnosed with dengue. Evaluation showed erythematous blisters on skin and mucosa with bleeding and desquamation, covering 10% of the body surface. The patient progressed favorably with the medical care received. Stevens-Johnson syndrome should be studied in association with arboviral diseases.
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Affiliation(s)
| | | | - Ivan Cordova-Tello
- Universidad Privada San Juan Bautista, Lima, Perú
- Hospital Regional de Ica, Perú
| | - Jhon Ausejo-Galarza
- Universidad Privada San Juan Bautista, Lima, Perú
- Hospital Regional de Ica, Perú
| | | | | | - Kovy Arteaga-Livias
- Universidad Privada San Juan Bautista, Lima, Perú
- Universidad Nacional Hermilio Valdizán, Huánuco, Perú
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Claves J, Chennell P, Le Basle Y, Krautwurst N, Sautou V. Comparative Study of Sorption Phenomena Between Three Medications and Syringes Made of Cyclic Olefin Copolymer or Polypropylene. Pharm Res 2024; 41:51-62. [PMID: 37989952 DOI: 10.1007/s11095-023-03633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Medical syringes are widely used in hospitals to store and administer drugs, and the contact time between the drugs and these syringes can vary from a few minutes to several weeks like for pharmaceutical preparations. The aim of this comparative study was to evaluate the potential sorption phenomena occurring between three drugs (paracetamol, diazepam and insulin aspart) and polypropylene syringes (PP) or syringes made of Cyclic Olefin Copolymer (COC). MATERIALS AND METHODS 50 mL 3-part syringes made of either COC with crosslinked silicone on the barrel inner surface (COC-CLS) and a bromobutyl plunger seal, or PP lubricated with silicone oil (PP-SOL) with a polyisoprene plunger seal were used. RESULTS COC-CLS syringes induced less sorption of diazepam and insulin than PP-SOL syringes and the plunger seal material seemed to be the main cause of these interactions. An alkalinization of the medications in contact with the PP-SOL syringes was observed. It could be caused by leachable compounds and should be investigated further. CONCLUSION This work shows once again that it is essential to consider content-container interactions to help improve the safe use of parenteral drugs.
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Affiliation(s)
- Joëlle Claves
- Université Clermont Auvergne, CHU Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, 63000, Clermont-Ferrand, France
| | - Philip Chennell
- Université Clermont Auvergne, CHU Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, 63000, Clermont-Ferrand, France.
| | - Yoann Le Basle
- Université Clermont Auvergne, CHU Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, 63000, Clermont-Ferrand, France
| | - Nina Krautwurst
- SCHOTT Pharma Schweiz AG, St. Josefen-Strasse 20, 9001, St Gallen, Switzerland
| | - Valérie Sautou
- Université Clermont Auvergne, CHU Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, 63000, Clermont-Ferrand, France
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Samar A, Sahana GN, Deepak P, Nagaral JV, Saranyaa M. Drug-induced Stevens-Johnson syndrome in Post traumatic facial injury. Indian J Pharmacol 2024; 56:58-60. [PMID: 38454591 PMCID: PMC11001176 DOI: 10.4103/ijp.ijp_485_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/22/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
Stevens-Johnson syndrome is a severe adverse drug reaction affecting the skin and mucous membrane. The causes include Sulfonamides, Anticonvulsants, etc. A patient developed ulcerations in the lips and oral cavity with difficulty in swallowing and rashes over the back, abdomen, and genitalia following administration of injection ceftriaxone 1 g intravenous (IV) b.i.d, injection pantoprazole 40 mg IV b.i.d, tablet aceclofenac + paracetamol 325 mg b.i.d, tablet cetirizine 10 mg b.i.d, chlorhexidine mouth wash, and injection metronidazole 500 mg IV t.i.d for the treatment of traumatic facial injury after 4 days of treatment. Injection ceftriaxone and tablet aceclofenac + paracetamol were suspected as the cause of this reaction. The two drugs were stopped. The patient was treated with corticosteroids, other antimicrobials, and oral topical anesthetics. Health-care providers should be careful about the possible adverse drug reactions even to commonly used drugs.
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Affiliation(s)
- Asfiya Samar
- Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
| | - GN Sahana
- Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
| | - P Deepak
- Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
| | - Jayashree V Nagaral
- Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
| | - M Saranyaa
- Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
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Parker W, Anderson LG, Jones JP, Anderson R, Williamson L, Bono-Lunn D, Konsoula Z. The Dangers of Acetaminophen for Neurodevelopment Outweigh Scant Evidence for Long-Term Benefits. Children (Basel) 2023; 11:44. [PMID: 38255358 PMCID: PMC10814214 DOI: 10.3390/children11010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Based on available data that include approximately 20 lines of evidence from studies in laboratory animal models, observations in humans, correlations in time, and pharmacological/toxicological considerations, it has been concluded without reasonable doubt and with no evidence to the contrary that exposure of susceptible babies and children to acetaminophen (paracetamol) induces many, if not most, cases of autism spectrum disorder (ASD). However, the relative number of cases of ASD that might be induced by acetaminophen has not yet been estimated. Here, we examine a variety of evidence, including the acetaminophen-induced reduction of social awareness in adults, the prevalence of ASD through time, and crude estimates of the relative number of ASD cases induced by acetaminophen during various periods of neurodevelopment. We conclude that the very early postpartum period poses the greatest risk for acetaminophen-induced ASD, and that nearly ubiquitous use of acetaminophen during early development could conceivably be responsible for the induction in the vast majority, perhaps 90% or more, of all cases of ASD. Despite over a decade of accumulating evidence that acetaminophen is harmful for neurodevelopment, numerous studies demonstrate that acetaminophen is frequently administered to children in excess of currently approved amounts and under conditions in which it provides no benefit. Further, studies have failed to demonstrate long-term benefits of acetaminophen for the pediatric population, leaving no valid rationale for continued use of the drug in that population given its risks to neurodevelopment.
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Affiliation(s)
- William Parker
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA
- WPLab, Inc., Durham, NC 27707, USA
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | - Lauren Williamson
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, KY 41099, USA;
| | - Dillan Bono-Lunn
- Department of Public Policy, University of North Carolina, Chapel Hill, NC 27599, USA;
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Gasthuys E, Sandra L, Statelova M, Vertzoni M, Vermeulen A. The Use of Population Pharmacokinetics to Extrapolate Food Effects from Human Adults and Beagle Dogs to the Pediatric Population Illustrated with Paracetamol as a Test Case. Pharmaceuticals (Basel) 2023; 17:53. [PMID: 38256887 PMCID: PMC10818831 DOI: 10.3390/ph17010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
To date, food-drug interactions in the pediatric population remain understudied. The current food effect studies are mostly performed in adults and do not mimic the real-life situation in the pediatric population. Since the potential benefits of food effect studies performed in pediatrics should be counterbalanced with the burden that these studies pose to the patients, alternative research strategies should be evaluated. The present study aimed to evaluate whether population pharmacokinetics (popPK) using data in beagle dogs and human adults could reliably assess food effects relevant for the pediatric population. PopPK was utilized to understand the performance of paracetamol under different dosing conditions (when the participants were fasted, with a reference meal, and with infant formula) in human adults (n = 8) and beagle dogs (n = 6) by constructing models to derive the pharmacokinetic parameters and to evaluate the food effects in both species. A two-compartment model with a single input function for the absorption phase best described the profiles of paracetamol in the beagle dogs. In the human adults, a one-compartment model with a dual input function for the absorption phase best described the data. The simulated profiles for the different dosing conditions demonstrated that both the human adults' and beagle dogs' simulations were able to acceptably describe the plasma concentration-time profiles of paracetamol observed in a representative pediatric population, which opens up perspectives on pediatric-relevant food effect predictions. However, the obtained results should be carefully interpreted, since an accurate validation of these findings was not possible due to the scarcity of the literature on observed pediatric data.
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Affiliation(s)
- Elke Gasthuys
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; (L.S.); (A.V.)
| | - Louis Sandra
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; (L.S.); (A.V.)
| | - Marina Statelova
- Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 157 84 Athens, Greece; (M.S.); (M.V.)
- Analytical Research and Development, Global Drug Development, Novartis Pharma AG, Fabrikstrasse 2, 4056 Basel, Switzerland
| | - Maria Vertzoni
- Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou, 157 84 Athens, Greece; (M.S.); (M.V.)
| | - An Vermeulen
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; (L.S.); (A.V.)
- Clinical Pharmacology and Pharmacometrics, Janssen R&D, A Division of Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340 Beerse, Belgium
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Nguyen TT, Nguyen DTN, Pham TTT, Oei JL. Prophylaxis of Patent Ductus Arteriosus with Paracetamol in Extremely Low Gestational Age Newborns (ELGANs): A Single-Institution Observational Study in Vietnam. Children (Basel) 2023; 10:1934. [PMID: 38136136 PMCID: PMC10741618 DOI: 10.3390/children10121934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Prophylactic paracetamol for extremely low gestation age neonates (ELGAN, <27 weeks' gestation) with symptomatic patent ductus arteriosus (sPDA) in high-income countries (HIC) reduces medical and surgical interventions. Its effectiveness in low-to-middle-income countries (LMIC) remains uncertain. This study assesses prophylactic paracetamol's impact on sPDA interventions in ELGANs in an LMIC. METHODS This is a retrospective cohort study that compared a historical cohort of ELGANs that were treated with oral ibuprofen or intravenous paracetamol after diagnosis of sPDA (n = 104) with infants (n = 76) treated with prophylactic paracetamol (20 mg/kg loading, 7.5 mg/kg qid for 4 days), in a tertiary neonatal intensive care unit (NICU) in Vietnam. Oral ibuprofen or intravenous therapeutic paracetamol were administered if prophylactic paracetamol failed to close sPDA. Surgical ligation was conducted if targeted medical intervention failed, or the infant deteriorated from conditions attributable to sPDA. RESULTS In the historical cohort, 57 (55%) infants died within 7 days of life compared to 18 (24%) from the prophylactic cohort (p < 0.01). Of the survivors, 21 (45%) of the historical and 23 (39.7%) of the prophylactic cohort required surgical ligation (p = 0.6). Duration of hospitalization for survivors was lower in the prophylactic cohort (mean 74 vs. 97 days, p = 0.01). In the prophylactic cohort, 24 (41%) infants did not need further treatment while 34 (59%) required further treatment including ibuprofen and/or paracetamol 28 (48%) and surgical ligation 22 (38%). CONCLUSIONS Prophylactic paracetamol for ELGAN in LMIC does not reduce the need for surgical ligation, sPDA rates, and other PDA-related morbidities in infants who survive beyond 7 days of age. It may reduce the risk of death and the duration of hospitalization but further study into the reasons behind this need to be determined with larger studies.
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Affiliation(s)
- Tinh Thu Nguyen
- Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam;
- Neonatal Intensive Care Unit, Children’s Hospital 2, Ho Chi Minh City 700000, Vietnam
| | - Dung Thi Ngoc Nguyen
- Pediatric and Neonatology Department, Franco-Vietnamese Hospital, Ho Chi Minh City 700000, Vietnam;
| | - Tam Thi Thanh Pham
- Neonatal Intensive Care Unit, Children’s Hospital 1, Ho Chi Minh City 700000, Vietnam;
| | - Ju-Lee Oei
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
- Department of Newborn Care, The Royal Hospital for Women, Randwick, Sydney, NSW 2031, Australia
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Golding J, Tunstall H, Gregory S, lies-Gaven Y. Maternal prenatal paracetamol ingestion and scholastic attainments of the offspring. Front Pharmacol 2023; 14:1116683. [PMID: 38149049 PMCID: PMC10749925 DOI: 10.3389/fphar.2023.1116683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Background: Fetal exposure to paracetamol (acetaminophen) has been shown to be associated with asthma and other atopic disorders, as well as behavioural problems including hyperactivity, in childhood. However, there is little information on scholastic abilities among children exposed to paracetamol in pregnancy. Objectives: To determine whether there are any differences in scholastic abilities among the offspring of women who ingested paracetamol during pregnancy compared with non-exposed children. Methods: Mothers enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) had recorded the frequency with which they had taken the medication over two time periods during pregnancy: i) the first 18 weeks and ii) 18-32 weeks. The offspring have been followed up ever since. For this study we use as outcomes: a) 14 tests of ability at reading and 2 of spelling using the study's tests and the national education system test results; b) 6 of mathematical abilities including tests of arithmetic and mathematical reasoning, and c) 1 of scientific understanding. Multiple regression was used, adjusting for 15 different exposures including reasons for taking the medication as well as demographic features. Results: Almost all unadjusted and adjusted mean differences were negative (i.e., those exposed to maternal intake of paracetamol did less well), but negative associations for exposures between 18 and 32 weeks of gestation were much more evident than for exposures earlier in pregnancy. Of the later exposures, after adjustment, 12 of the 23 scholastic tests were associated with prenatal exposure to paracetamol at p < 0.05. These negative effects were found in the girls (12 tests at p < 0.05) but not boys (0 tests at p < 0.05). Conclusion: Evidence from this longitudinal study suggests that maternal exposure to paracetamol is associated with disadvantages to the offspring in scholastic abilities such as mathematics and reading at secondary school ages. This raises the question as to whether there are longer-lasting effects on educational attainment from age 15 years onwards, including at university level. Clearly these results should be tested in other settings, but meanwhile they add to a growing accumulation of known adverse effects of exposure to paracetamol in pregnancy.
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Affiliation(s)
- Jean Golding
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Ratnasari A. Modified polymer membranes for the removal of pharmaceutical active compounds in wastewater and its mechanism-A review. Bioengineered 2023; 14:2252234. [PMID: 37712708 PMCID: PMC10506444 DOI: 10.1080/21655979.2023.2252234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 09/16/2023] Open
Abstract
Membrane technology can play a suitable role in removing pharmaceutical active compounds since it requires low energy and simple operation. Even though membrane technology has progressed for wastewater applications nowadays, modifying membranes to achieve the strong desired membrane performance is still needed. Thus, this study overviews a comprehensive insight into the application of modified polymer membranes to remove pharmaceutical active compounds from wastewater. Biotoxicity of pharmaceutical active compounds is first prescribed to gain deep insight into how membranes can remove pharmaceutical active compounds from wastewater. Then, the behavior of the diffusion mechanism can be concisely determined using mass transfer factor model that represented by β and B with value up to 2.004 g h mg-1 and 1.833 mg g-1 for organic compounds including pharmaceutical active compounds. The model refers to the adsorption of solute to attach onto acceptor sites of the membrane surface, external mass transport of solute materials from the bulk liquid to the membrane surface, and internal mass transfer to diffuse a solute toward acceptor sites of the membrane surface with evidenced up to 0.999. Different pharmaceutical compounds have different solubility and relates to the membrane hydrophilicity properties and mechanisms. Ultimately, challenges and future recommendations have been presented to view the future need to enhance membrane performance regarding fouling mitigation and recovering compounds. Afterwards, the discussion of this study is projected to play a critical role in advance of better-quality membrane technologies for removing pharmaceutical active compounds from wastewater in an eco-friendly strategy and without damaging the ecosystem.
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Affiliation(s)
- Anisa Ratnasari
- Department of Environmental Engineering, Faculty of Civil Planning and Geo Engineering, Institut Teknologi Sepuluh Nopember, Surabaya, East Java, Indonesia
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35
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Billet S, Vanbiervliet P, Remery M, Dekoninck J, Janssens W. The concomitant use of paracetamol and flucloxacillin. A rare cause of high anion gap metabolic acidosis in the frail oldest old. Acta Clin Belg 2023; 78:509-515. [PMID: 37573520 DOI: 10.1080/17843286.2023.2246226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES This article describes the occurrence of a high anion gap metabolic acidosis (HAGMA) in two older, female patients with a methicillin sensitive staphylococcus aureus (MSSA) infection. Both patients received flucloxacillin and paracetamol. Both of them initially improved but declined rapidly after two to three weeks of treatment. They developed a severe HAGMA resulting in their death. The objective of this article is to determine whether old age is a major risk factor for developing HAGMA when combining paracetamol with flucloxacillin. METHODS A literature study was conducted using the MEDLINE database, PubMed. The used MeSH terms were 'flucloxacillin, acetaminophen, glutathione synthetase deficiency and acidosis'. Furthermore, we used two cases to illustrate our findings. RESULTS The origin of the high anion gap metabolic acidosis is the accumulation of 5-oxoproline which is known to occur when combining flucloxacillin with paracetamol due to their interaction with different enzymes of the gamma glutamyl cycle. This leads to the depletion of glutathione and the formation of 5-oxoproline. This phenomenon has a higher risk of occurring in frail older adults as most of them have several predisposing risk factors which result in lower baseline glutathione reserve. These risk factors include old age, malnutrition, assigned female at birth, pre-existing kidney and/or liver dysfunction, uncontrolled diabetes and sepsis. CONCLUSION The purpose of this article is to raise awareness of this phenomenon and its higher occurrence in frail older adults, which hopefully will lead to an earlier diagnosis with a better outcome for the patient.
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Affiliation(s)
- Sarah Billet
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Mark Remery
- Department of Internal Medicine, AZ Oudenaarde, Oudenaarde, Belgium
| | - Julien Dekoninck
- Department of Geriatric Medicine, Tielt Sint-Andries Hospital, Tielt, Belgium
| | - Wim Janssens
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Mahdi ZA, Ibrahim JA. Dentists' attitudes and prescription practices for analgesics and antibiotics in Kirkuk Governorate, Iraq. J Med Life 2023; 16:1818-1824. [PMID: 38585523 PMCID: PMC10994614 DOI: 10.25122/jml-2023-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/14/2023] [Indexed: 04/09/2024] Open
Abstract
The inappropriate use of analgesics and antibiotics is a widespread issue among dentists globally, leading to the risk of over-prescription that could negatively affect patient health and quality of life. This study aimed to assess the prescribing patterns of analgesics and antibiotics by dentists in Kirkuk City, Iraq, focusing on their attitudes, knowledge levels, and practices regarding these medications. A cross-sectional survey was conducted among 280 dentists in Kirkuk City. The dentists were contacted via their work email addresses, and they responded to a survey. Descriptive statistics, including frequency analysis, were employed to evaluate the appropriateness of analgesic and antibiotic prescriptions for different dental conditions. The first-choice analgesic for 44.6% of dentists was mefenamic acid, followed by paracetamol (31.1%). Regarding antibiotic use, 56.8% of dentists in Kirkuk City reported using antibiotics for empirical and direct therapy. Other dentists (43.2%) revealed that they did not have enough information regarding antibiotic group preference in empirical therapy. 106 of the participants (37.85%) recommended the use of broad-spectrum antibiotics in the treatment of bacterial infections. However, most (45%) were unfamiliar with the group preferences in empirical therapy. Dentists in Kirkuk City showed variations in knowledge and awareness regarding using analgesics and antibiotics. This requires further education and training on proper analgesics and antibiotic stewardship guidelines.
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Affiliation(s)
- Zainab Azal Mahdi
- Department of Basic Sciences, College of Dentistry, University of Kirkuk, Kirkuk, Iraq
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Koshak MF, El-Readi MZ, Elzubier ME, Refaat B, Almaimani RA, Idris S, Althubiti M, Al-Amodi HS, Eid SY. Antioxidative and Anti-Inflammatory Protective Effects of Fucoxanthin against Paracetamol-Induced Hepatotoxicity in Rats. Mar Drugs 2023; 21:592. [PMID: 37999416 PMCID: PMC10672227 DOI: 10.3390/md21110592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Paracetamol or acetaminophen (PAC) is a commonly used analgesic and antipyretic drug. It has been shown that overdoses beyond the therapeutic range can cause hepatotoxicity and acute liver injury. The most common cause of drug-induced liver injury (DILI) in Saudi Arabia and worldwide is paracetamol overdose. Fucoxanthin (FUC) is an allenic carotenoid that is found in edible brown seaweeds, and it has antioxidant and anti-inflammatory effects. Several studies have shown the potential therapeutic effects of FUC in diabetes, cancers, and inflammatory disorders. This study aims to investigate the protective effect of FUC against PAC-induced acute liver injury in rats. FUC was administered (100, 200, and 500 mg/kg, p.o.) for 7 days, and then the liver injury was induced by the administration of PAC (2000 mg/kg, oral). Blood and liver tissue samples were collected from PAC-positive untreated, treated, and negative control rats. Biochemical and inflammatory parameters in the blood were measured. In addition, RT-PCR, Western blotting, and immunohistochemistry were performed for liver tissue. The serum levels of liver biomarkers (ALT, AST, and ALP) increased after PAC-induced liver toxicity; FUC-treated rats showed lower levels compared to the positive control. There was an increase in the expression of TNF-α, IL-1, IL-6, NF-kB, INF-γ, and iNOS and a decrease in IL-10, IL-22, and IL-10R expression after the FUC treatment of injured liver rats. For the hepatic inflammation and PAC-toxicity-induced oxidative stress genes and proteins, FUC-treated rats (100, 200, and 500 mg/kg) showed a reduction in the expression of oxidative stress genes. These results showed that FUC protected the liver against PAC-induced injury through antioxidant and anti-inflammatory actions. However, further clinical studies are required to confirm the findings.
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Affiliation(s)
- Maimonah Fuad Koshak
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Al Abdeyah, Makkah 24381, Saudi Arabia
- Laboratory of Clinical Chemistry, King Salman Armed Forces Hospital, Tabuk 47512, Saudi Arabia
| | - Mahmoud Zaki El-Readi
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Al Abdeyah, Makkah 24381, Saudi Arabia
| | - Mohamed Elzubier Elzubier
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Al Abdeyah, Makkah 24381, Saudi Arabia
| | - Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, P.O. Box 7607, Makkah 24381, Saudi Arabia
| | - Riyad Adnan Almaimani
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Al Abdeyah, Makkah 24381, Saudi Arabia
| | - Shakir Idris
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, P.O. Box 7607, Makkah 24381, Saudi Arabia
| | - Mohammad Althubiti
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Al Abdeyah, Makkah 24381, Saudi Arabia
| | - Hiba Saeed Al-Amodi
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Al Abdeyah, Makkah 24381, Saudi Arabia
| | - Safaa Yehia Eid
- Department of Biochemistry, Faculty of Medicine, Umm Al-Qura University, Al Abdeyah, Makkah 24381, Saudi Arabia
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Tibbetts JD, Hutchby M, Cunningham WB, Chapman RSL, Kociok-Köhn G, Davidson MG, Bull SD. Sustainable Syntheses of Paracetamol and Ibuprofen from Biorenewable β-pinene. ChemSusChem 2023; 16:e202300670. [PMID: 37332029 DOI: 10.1002/cssc.202300670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/20/2023]
Abstract
Scalable processes have been developed to convert β-pinene into 4-isopropenylcyclohexanone, which is then used as a feedstock for the divergent synthesis of sustainable versions of the common painkillers, paracetamol and ibuprofen. Both synthetic routes use Pd0 catalysed reactions to aromatize the cyclohexenyl rings of key intermediates to produce the benzenoid ring systems of both drugs. The potential of using bioderived 4-hydroxyacetophenone as a drop-in feedstock replacement to produce sustainable aromatic products is also discussed within a terpene biorefinery context.
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Affiliation(s)
- Joshua D Tibbetts
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Marc Hutchby
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - William B Cunningham
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Robert S L Chapman
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Gabriele Kociok-Köhn
- Materials and Chemical Characterisation Facility (MC2), University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Matthew G Davidson
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Steven D Bull
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
- School of Chemistry, University of Leicester, University Rd, Leicester, LE1 7RH, United Kingdom
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Jain A, Meshram RJ. Toxic Epidermal Necrolysis Following the Ingestion of Paracetamol in a Pediatric Patient: A Case Report. Cureus 2023; 15:e48216. [PMID: 38050528 PMCID: PMC10693832 DOI: 10.7759/cureus.48216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Paracetamol is considered to be a relatively safe drug, even in the pediatric age group, at the recommended doses. Here we present a case of a six-year-old male presenting with symptoms and signs of Steven Johnson syndrome/toxic epidermal necrosis (SJS/TEN) following the ingestion of paracetamol. Steven Johnson syndrome/toxic epidermal necrosis is a potentially life-threatening dermatological emergency requiring intensive treatment. The patient was initially misdiagnosed as a case of chickenpox and was administered paracetamol. However, upon attending a tertiary care facility, he was diagnosed with TEN and treated with immunosuppressants. He recovered fully without any complications and was discharged within a week.
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Affiliation(s)
- Aditya Jain
- Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences School of Epidemiology and Public Health, Wardha, IND
| | - Revat J Meshram
- Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences School of Epidemiology and Public Health, Wardha, IND
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Mohan S, Bloom J, Kerester S, Hoffman RS, Su MK. An international survey of the treatment of massive paracetamol overdose in 2023. Clin Toxicol (Phila) 2023; 61:968-973. [PMID: 38112311 DOI: 10.1080/15563650.2023.2286922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Changes in the commercialization of nonprescription drugs have made large quantities of paracetamol available to individuals, resulting in larger overdoses than previously observed. Although most patients with paracetamol overdose can be managed with acetylcysteine, patients with a massive overdose may become critically ill earlier and fail standard antidotal therapy. Several strategies are proposed for the management of these patients, including using increased doses of acetylcysteine, extracorporeal removal, and fomepizole. However, the benefits of these strategies remain largely theoretical, with sparse evidence for efficacy in humans. METHODS This cross-sectional study surveys international practice patterns of medical toxicology providers regarding the management of a hypothetical patient with a massive paracetamol overdose. RESULTS A total of 342 responses from 31 different nations were obtained during the study period. Sixty-one percent of providers would have increased their acetylcysteine dosing when treating the hypothetical massive overdose. Thirty percent of respondents recommended an indefinite infusion of acetylcysteine at 12.5 mg/kg/hour after the bolus dose, whereas 20 percent recommended following the "Hendrickson" protocol, which advocates for a stepwise increase in acetylcysteine dosing to match high paracetamol concentrations at the 300 mg/L, 400 mg/L, and 600 mg/L lines on the Rumack-Matthew nomogram. Ten percent of respondents stated they would have given "double dose acetylcysteine" but did not specify what that entailed. Forty-seven percent of respondents indicated that they would have given fomepizole, and 28 percent of respondents recommended extracorporeal removal. DISCUSSION Our survey study assessed the approach to a hypothetical patient with a massive paracetamol overdose and demonstrated that, at minimum, most respondents would increase the dose of acetylcysteine. Additionally, almost half would also include fomepizole, and nearly one-third would include extracorporeal removal. CONCLUSIONS There is considerable international variation for the treatment of both non-massive and massive paracetamol overdoses. Future research is needed to identify and standardize the most effective treatment for both non-massive and massive paracetamol overdoses.
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Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Department of Emergency Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, NY, USA
| | - Joshua Bloom
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Samantha Kerester
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
- New York City Poison Control Center, New York, NY, USA
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41
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Haslund-Krog S, Barry JM, Birnbaum AK, Dalhoff K, Brink Henriksen T, Sherwin CMT, Avachat C, Poulsen S, Christensen U, Remmel RP, Wilkins D, van den Anker JN, Holst H. Pharmacokinetics and safety of prolonged paracetamol treatment in neonates: An interventional cohort study. Br J Clin Pharmacol 2023; 89:3421-3431. [PMID: 37353311 DOI: 10.1111/bcp.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
AIMS To investigate the pharmacokinetics and safety of prolonged paracetamol use (>72 h) for neonatal pain. METHODS Neonates were included if they received paracetamol orally or intravenously for pain treatment. A total of 126 samples were collected. Alanine aminotransferase and bilirubin were measured as surrogate liver safety markers. Paracetamol and metabolites were measured in plasma. Pharmacokinetic parameters for the parent compound were estimated with a nonlinear mixed-effects model. RESULTS Forty-eight neonates were enrolled (38 received paracetamol for >72 h). Median gestational age was 38 weeks (range 25-42), and bodyweight at inclusion was 2954 g (range 713-4750). Neonates received 16 doses (range 4-55) over 4.1 days (range 1-13.8). The median (range) dose was 10.1 mg/kg (2.9-20.3). The median oxidative metabolite concentration was 14.6 μmol/L (range 0.12-113.5) and measurable >30 h after dose. There was no significant difference (P > .05) between alanine aminotransferase and bilirubin measures at <72 h or >72 h of paracetamol treatment or the start and end of the study. Volume of distribution and paracetamol clearance for a 2.81-kg neonate were 2.99 L (% residual standard error = 8, 95% confidence interval 2.44-3.55) and 0.497 L/h (% residual standard error = 7, 95% confidence interval 0.425-0.570), respectively. Median steady-state concentration from the parent model was 50.3 μmol/L (range 30.6-92.5), and the half-life was 3.55 h (range 2.41-5.65). CONCLUSION Our study did not provide evidence of paracetamol-induced liver injury nor changes in metabolism in prolonged paracetamol administration in neonates.
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Affiliation(s)
- Sissel Haslund-Krog
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen NV, Denmark
| | - Jessica M Barry
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Angela K Birnbaum
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen NV, Denmark
| | - Tine Brink Henriksen
- Neonatal Intensive Care Unit, Department of Paediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Catherine M T Sherwin
- Pediatric Clinical Pharmacology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Pediatrics, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Charul Avachat
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susanne Poulsen
- Neonatal Intensive Care Unit, Rigshospitalet, Copenhagen Ø, Denmark
| | - Ulla Christensen
- Neonatal Intensive Care Unit, Department of Paediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Rory P Remmel
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Diana Wilkins
- Division of Medical Laboratory Sciences, Department of Pathology, University of Utah, School of Medicine, Salt Lake City, Utah, USA
| | - John N van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, District of Columbia, USA
- Division of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Helle Holst
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen NV, Denmark
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42
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Loh GOK, Wong EYL, Goh CZ, Tan YTF, Lee YL, Pang LH, Shahridzo SH, Damenthi N, Hermansyah A, Long CM, Peh KK. Simultaneous determination of tramadol and paracetamol in human plasma using LC-MS/MS and application in bioequivalence study of -fixed-dose combination. Ann Med 2023; 55:2270502. [PMID: 37857359 PMCID: PMC10588528 DOI: 10.1080/07853890.2023.2270502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
The study aimed to develop a sensitive and high-throughput liquid chromatography coupled with tandem mass spectrometry method to quantify concentrations of tramadol and paracetamol simultaneously in human plasma. Sample preparation involved single-step protein precipitation using methanol and two deuterated internal standards, tramadol D6 and paracetamol D4. Agilent Poroshell 120 EC-C18 (100 × 2.1 mm, 2.1 µm) analytical column was employed to achieve chromatographic separation. Detection was in positive ion multiple reaction monitoring mode. A tailing factor (Tf) of <1.2, separation factor (K prime) of >1.5 from the column dead time and signal-to-noise (S/N) ratio >10, were obtained for analytes and internal standards. The standard curve was linear over the concentration range of 2.5-500.00 ng/mL for tramadol and 0.025-20.00 μg/mL for paracetamol. A small injection volume of 1 µL, low flow rate of 440 µL/min and short analysis time of 3.5 min reduced the solvent consumption, analysis cost and system contamination. The results of method validation parameters fulfilled the acceptance criteria of bioanalytical guidelines. The method was successfully applied to a bioequivalence study of fixed-dose combination products of tramadol and paracetamol in Malaysian healthy subjects.
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Affiliation(s)
- Gabriel Onn Kit Loh
- Bioxis Sdn. Bhd., Taman Perindustrian Bukit Minyak, Simpang Ampat, Penang, Malaysia
| | - Emily Yii Ling Wong
- Bioxis Sdn. Bhd., Taman Perindustrian Bukit Minyak, Simpang Ampat, Penang, Malaysia
| | - Chen Zhu Goh
- Bioxis Sdn. Bhd., Taman Perindustrian Bukit Minyak, Simpang Ampat, Penang, Malaysia
| | - Yvonne Tze Fung Tan
- Bioxis Sdn. Bhd., Taman Perindustrian Bukit Minyak, Simpang Ampat, Penang, Malaysia
| | - Yi Lin Lee
- Centre for Clinical Trial, Institute for Clinical Research, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Ampang, Selangor, Malaysia
| | - Lai Hui Pang
- Centre for Clinical Trial, Institute for Clinical Research, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Ampang, Selangor, Malaysia
| | - Siti Halimah Shahridzo
- Centre for Clinical Trial, Institute for Clinical Research, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Ampang, Selangor, Malaysia
| | - Nair Damenthi
- Centre for Clinical Trial, Institute for Clinical Research, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Ampang, Selangor, Malaysia
| | - Andi Hermansyah
- Department of Pharmacy Practice, Universitas Airlangga, Surabaya, Indonesia
| | - Chiau Ming Long
- Department of Pharmacy Practice, Universitas Airlangga, Surabaya, Indonesia
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
| | - Kok Khiang Peh
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
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Nouioura G, Kettani T, Tourabi M, Elousrouti LT, Al kamaly O, Alshawwa SZ, Shahat AA, Alhalmi A, Lyoussi B, Derwich E. The Protective Potential of Petroselinum crispum (Mill.) Fuss. on Paracetamol-Induced Hepatio-Renal Toxicity and Antiproteinuric Effect: A Biochemical, Hematological, and Histopathological Study. Medicina (Kaunas) 2023; 59:1814. [PMID: 37893532 PMCID: PMC10608762 DOI: 10.3390/medicina59101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Paracetamol overdose is a significant global issue due to its widespread use, which can lead to a lack of awareness regarding its potential side effects. Paracetamol can harm the liver, possibly resulting in liver failure. Conversely, this study employed extracts from Petroselinum crispum (PC), known for its rich content of bioactive compounds, with demonstrated antioxidant properties shown in previous research as well as protective effects against various diseases. The primary objective of this study was to investigate the potential protective effects of Petroselinum crispum on altered hematological and biochemical parameters in the blood of rats exposed to paracetamol. Materials and Methods: The study involved twenty Wistar rats divided into four groups. Different groups of male rats were administered PC extract at 200 mg/kg body weight daily for 15 days, along with a standard reference dose of paracetamol at 200 mg/kg. The study assessed hepatoprotection capacity by analyzing liver enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, albumin, and lipid profiles. Renal safety was evaluated through creatinine, urea, uric acid, lactate dehydrogenase (LDH), and total protein. Additionally, histopathological examinations of the liver and kidneys were conducted. Results: Following Paracetamol overdose, there were reductions in hemoglobin levels, serum total protein, albumin, and uric acid. Paracetamol overdose also elevated levels of several blood biomarkers, including creatinine, urea, nitrogen, ALT, AST, triglycerides, LDH activity, white blood cell count, and platelet count compared to the control group. However, using an ethanolic extract of Petroselinum crispum significantly mitigated the severity of these alterations and the extent of the effect correlated with the dose administered. Parsley extract helped prevent proteinuria and low hemoglobin, which are common side effects of Paracetamol. Conclusions: Therefore, parsley may hold promise in managing liver and kidney conditions-particularly in addressing proteinuria. Ultimately, these results may have implications for human health by potentially mitigating paracetamol-induced renal, hepatic, and hematological toxicity.
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Affiliation(s)
- Ghizlane Nouioura
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El-Mehraz, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (M.T.); (B.L.); (E.D.)
| | - Tayeb Kettani
- Saâda Laboratory of Medical Analysis, Fez 30000, Morocco;
| | - Meryem Tourabi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El-Mehraz, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (M.T.); (B.L.); (E.D.)
| | | | - Omkulthom Al kamaly
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (O.A.k.); (S.Z.A.)
| | - Samar Zuhair Alshawwa
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (O.A.k.); (S.Z.A.)
| | - Abdelaaty A. Shahat
- Department of Pharmacognosy, College of Pharmacy King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia;
| | - Abdulsalam Alhalmi
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Badiaa Lyoussi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El-Mehraz, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (M.T.); (B.L.); (E.D.)
| | - Elhoussine Derwich
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El-Mehraz, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (M.T.); (B.L.); (E.D.)
- Unity of GC/MS and GC, City of Innovation, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco
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Charde V, Sanklecha M, Rajan P, Sangoi RV, A P, Palande A, Dighe P, Kothari R, Mittal G. Comparing the Efficacy of Paracetamol, Ibuprofen, and a Combination of the Two Drugs in Relieving Pain and Fever in the Pediatric Age Group: A Prospective Observational Study. Cureus 2023; 15:e46907. [PMID: 37954757 PMCID: PMC10636696 DOI: 10.7759/cureus.46907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Fever and pain are common afflictions in the pediatric population, prompting the use of paracetamol and ibuprofen as primary treatment options. However, a comprehensive understanding of their comparative efficacy, safety profiles, and potential combined use remains crucial for informed clinical decision-making. In this prospective observational study, we aimed to delve into these aspects, shedding light on the optimal management strategies for fever and pain in pediatric patients. Methodology A total of 108 children were enrolled and categorized into three groups, namely, paracetamol monotherapy, ibuprofen monotherapy, and a combination of both drugs. Axillary temperature monitoring and assessment of pain on the Face, Legs, Activity, Cry, and Controllability (FLACC) scale/Visual Analog Scale (VAS) were employed as critical indicators. Concurrently, associated symptoms encompassing discomfort, activity levels, and appetite were meticulously recorded. To ensure safety, laboratory parameters including serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), serum creatinine, platelet count, and stool for occult blood were closely monitored before and after drug administration. The study duration spanned 48 hours post-initiation of the initial drug dose. Results A total of 108 pediatric cases were included in the study, spanning ages from six months to 18 years. Among them, the majority fell within the age group of six months to five years (n = 77). Participants were categorized based on the duration of fever, with 81 cases having a fever lasting more than 24 hours and 27 cases having a fever lasting less than 24 hours. The majority of cases presented with temperatures ranging from 38°C to 39°C. Comparison of drug efficacy in defervescence within the first four hours revealed that paracetamol alone took significantly longer than ibuprofen monotherapy or the paracetamol and ibuprofen combination (p = 0.026). In terms of the onset of effect, the paracetamol and ibuprofen combination showed comparable efficacy to ibuprofen alone. Regarding the total time without fever in 48 hours, significant differences were observed among the three drug regimens (p = 0.001 by the one-way analysis of variance (ANOVA) test). Paracetamol and ibuprofen were superior to paracetamol alone (p < 0.001) and ibuprofen alone (p = 0.014), while paracetamol alone and ibuprofen alone exhibited similar efficacy (p = 0.197). Based on the laboratory results as well as the clinical profile observed over 48 hours, we confirm safety based on this study. The combination of paracetamol and ibuprofen showed enhanced effectiveness in fever and pain relief. Conclusion This study demonstrates the favourable efficacy of paracetamol, ibuprofen, and their combination in the pediatric population. The combination of paracetamol and ibuprofen showed enhanced effectiveness in fever and pain relief, with minimal adverse effects and no significant derangements in biochemical parameters. This study thus contributes valuable insights to optimize the therapeutic approach to fever and pain in pediatric patients.
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Affiliation(s)
- Vivek Charde
- Pediatrics and Child Health, Bhanukrupa Hospital, Nagpur, IND
- Pediatrics and Child Health, Bombay Hospital, Mumbai, IND
| | | | - Priyank Rajan
- Pediatrics and Child Health, SRCC (Society for Rehabilitation of Crippled Children) Children's Hospital, Mumbai, IND
| | - Ravi V Sangoi
- Pharmacology and Therapeutics, Punyashlok Ahilyadevi Holkar Government Medical College, Baramati, IND
| | - Prashanth A
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | | | - Pranav Dighe
- Pharmacology and Therapeutics, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Ruchi Kothari
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Gaurav Mittal
- Research and Development, Rotaract Club of Indian Medicos, Mumbai, IND
- Research, Student Network Organization, Mumbai, IND
- Internal Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
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45
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Zacharia GS, Jacob A. Acetaminophen: A Liver Killer or Thriller. Cureus 2023; 15:e47071. [PMID: 38022064 PMCID: PMC10645398 DOI: 10.7759/cureus.47071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Acetaminophen, or paracetamol, ranks among the most extensively utilized analgesic and antipyretic medications globally. The administration of acetaminophen to individuals with underlying liver disease has long sparked concerns regarding the potential risk of hepatotoxicity. However, the available literature and recommendations consider it a safe option in all forms of liver diseases and is deemed safe when used at recommended doses. This article aims to offer a concise review of the pharmacokinetics, toxicity profile, and the intricate considerations surrounding the safety of acetaminophen in patients with liver disease. By delving into the liver-acetaminophen interactions, we seek to provide a nuanced perspective on the use of acetaminophen in this critical patient population.
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Affiliation(s)
- George S Zacharia
- Gastroenterology and Hepatology, Al Ahalia Hospital Mussafah, Abu Dhabi, ARE
| | - Anu Jacob
- Anesthesiology and Perioperative Medicine, Al Ahalia Hospital Mussafah, Abu Dhabi, ARE
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46
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Wright CJ, McCulley DJ, Mitra S, Jensen EA. Acetaminophen for the patent ductus arteriosus: has safety been adequately demonstrated? J Perinatol 2023; 43:1230-1237. [PMID: 37169914 PMCID: PMC10626600 DOI: 10.1038/s41372-023-01697-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
Patent ductus arteriosus (PDA) is the most common cardiovascular condition diagnosed in premature infants. Acetaminophen was first proposed as a potential treatment for PDA in 2011. Since that time acetaminophen use among extremely preterm neonates has increased substantially. The limited available data demonstrate that acetaminophen reduces PDA without evident hepatotoxicity. These findings have led some to suggest that acetaminophen is a safe and effective therapy for PDA closure. However, the lack of apparent hepatoxicity is predictable. Acetaminophen induced cellular injury is due to CYP2E1 derived metabolites; and hepatocyte CYP2E1 expression is low in the fetal and neonatal period. Here, we review preclinical and clinical data that support the hypothesis that the lung, which expresses high levels of CYP2E1 during fetal and early postnatal development, may be particularly susceptible to acetaminophen induced toxicity. Despite these emerging data, the true potential pulmonary risks and benefits of acetaminophen for PDA closure are largely unknown. The available clinical studies in are marked by significant weakness including low sample sizes and minimal evaluation of extremely preterm infants who are typically at highest risk of pulmonary morbidity. We propose that studies interrogating mechanisms linking developmentally regulated, cell-specific CYP2E1 expression and acetaminophen-induced toxicity as well as robust assessment of pulmonary outcomes in large trials that evaluate the safety and efficacy of acetaminophen in extremely preterm infants are needed.
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Affiliation(s)
- Clyde J Wright
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA.
| | - David J McCulley
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, CA, USA
| | - Souvik Mitra
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Erik A Jensen
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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47
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Verd S, Rodríguez-Trabal C, Mambié M. Lack of evidence for a beneficial effect of antipyretic drugs. Acta Paediatr 2023; 112:2250-2251. [PMID: 37471514 DOI: 10.1111/apa.16913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Sergio Verd
- Paediatric Unit, Department of Primary Care, La Vileta Surgery, Palma de Mallorca, Spain
- Balearic Institute of Medical Research (IdISBa), Palma de Mallorca, Spain
| | | | - Marianna Mambié
- Paediatric Unit, Department of Primary Care, La Vileta Surgery, Palma de Mallorca, Spain
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48
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Sajid Ali M, Singh E, Muthukumaran J, Al-Lohedan HA. Non-Steroidal Anti-Inflammatory Drug Effect on the Binding of Plasma Protein with Antibiotic Drug Ceftazidime: Spectroscopic and In Silico Investigation. Int J Mol Sci 2023; 24:14811. [PMID: 37834259 PMCID: PMC10573175 DOI: 10.3390/ijms241914811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
The coexistence of ceftazidime, which is a popular third-generation of cephalosporin antibiotic, with ubiquitous paracetamol or acetaminophen, is very likely because the latter is given to the patients to reduce fever due to bacterial infection along with an antibiotic such as the former. Therefore, in this study, we investigated the detailed binding of ceftazidime with plasma protein, human serum albumin (HSA), in the absence and presence of paracetamol using spectroscopic techniques such as fluorescence, UV-visible, and circular dichroism, along with in silico methods such as molecular docking, molecular dynamics simulations, and MM/PBSA-based binding free energy analysis. The basic idea of the interaction was attained by using UV-visible spectroscopy. Further, fluorescence spectroscopy revealed that there was a fair interaction between ceftazidime and HSA, and the mechanism of the quenching was a dynamic one, i.e., the quenching constant increased with increasing temperature. The interaction was, primarily, reinforced by hydrophobic forces, which resulted in the partial unfolding of the protein. Low concentrations of paracetamol were ineffective in affecting the binding of ceftazidime with has; although, a decrease in the quenching and binding constants was observed in the presence of high concentrations of the former. Competitive binding site experiments using warfarin and ibuprofen as site markers revealed that ceftazidime neither binds at drug site 1 or at drug site 2, articulating another binding site, which was confirmed by molecular docking simulations.
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Affiliation(s)
- Mohd Sajid Ali
- Surfactant Research Chair, Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
| | - Ekampreet Singh
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida 201310, India; (E.S.); (J.M.)
| | - Jayaraman Muthukumaran
- Department of Biotechnology, Sharda School of Engineering and Technology, Sharda University, Greater Noida 201310, India; (E.S.); (J.M.)
| | - Hamad A. Al-Lohedan
- Surfactant Research Chair, Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
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49
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Zanza C, Saglietti F, Giamello JD, Savioli G, Biancone DM, Balzanelli MG, Giordano B, Trompeo AC, Longhitano Y. Effectiveness of Intranasal Analgesia in the Emergency Department. Medicina (Kaunas) 2023; 59:1746. [PMID: 37893464 PMCID: PMC10608673 DOI: 10.3390/medicina59101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992-2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management.
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Affiliation(s)
- Christian Zanza
- Italian Society of Prehospital Emergency Medicine-SIS 118-Taranto, 74121 Taranto, Italy
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Francesco Saglietti
- Department of Anesthesia and Critical Care, Santa Croce and Carle Hospital, 12100 Cuneo, Italy
| | | | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | | | | | - Benedetta Giordano
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Roma, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia and Critical Care, AOU Città della Scienza e della Salute, 10126 Torino, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
- Department of Emergency Medicine, Humanitas University, 20089 Milan, Italy
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50
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Abushanab D, Gasim M, Devi D, Elbdairy M, Elqasass H, Ahmed N, Vincent M, Abdul Rouf PV, Mohammed HR, Hail MA, Thomas B, Elkassem W, Hanssens Y, Elgassim M, Elmoheen A, Azad A, Mohammed S, Salem W. Patterns and outcomes of paracetamol poisoning management in Hamad Medical Corporation, Qatar: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34872. [PMID: 37746996 PMCID: PMC10519564 DOI: 10.1097/md.0000000000034872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 09/26/2023] Open
Abstract
We aimed to investigate the characteristics and clinical outcomes of paracetamol poisoning and paracetamol overdose in Qatar. This retrospective cohort study included patients admitted to the emergency department (ED). We included patients who presented with excessive paracetamol ingestion, between December 2018 and September 2019. The primary outcomes were describing the characteristics and outcomes of paracetamol overdose (from a suicidal overdose or accidental overdose, dose ≤ 150 mg/kg, when serum levels of <60 mmol/L) or dose ingested (≤75 mg/kg) with staggered ingestion poisoning due to suicidal attempt or accidental attempt, defined as the dose ingested (>150 mg/kg), acute ingestion, nomogram level more than the treatment line, or dose ingested (>75 mg/kg) with staggered ingestion, and assessing the management of excessive paracetamol ingestion. Secondary outcomes included evaluation of the time difference between ingestion and time of administration, hospitalization, and adverse drug events. Significant differences were detected between patients who presented with paracetamol overdose and those who presented with paracetamol toxicity. A total of 69 patients were analyzed, of whom 43 received paracetamol overdose (mean age 27.5 ± 11.1 years) and 26 had paracetamol poisoning (mean age 25 ± 6.22 years). Paracetamol poisoning was identified in 26% of the patients with a 24.3% history of psychiatric illness, compared to 18.6% with paracetamol overdose. More patients presented with paracetamol toxicity in the time between ingestion and obtaining serum levels compared to the overdose group. A significantly longer length of hospitalization was observed in the toxicity group. A significantly higher number of patients in the toxicity group received N-acetylcysteine (NAC). More hypotension and rashes were observed among those who received NAC in the toxicity group. Patients presenting to the ED due to paracetamol toxicity are not uncommon, and most cases occur in young adults, and few in patients with a history of psychiatric illness, suggesting that preventive approaches are highly required.
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Affiliation(s)
- Dina Abushanab
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Mahmoud Gasim
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Dyomgy Devi
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Noon Ahmed
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Manna Vincent
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Moza Al Hail
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Binny Thomas
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Wessam Elkassem
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammed Elgassim
- Department of Accident and Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Amr Elmoheen
- Department of Accident and Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Azad
- Department of Accident and Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Shaban Mohammed
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Waleed Salem
- Department of Accident and Emergency, Hamad Medical Corporation, Doha, Qatar
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