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.

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.

A Perplexing Case of a Germ Cell Tumor: A Case Report.

Germ cell tumors (GCTs) are associated with pure gonadal dysgenesis or Swyer syndrome. Swyer syndrome usually presents with primary amenorrhea, streak ovaries, and mixed GCT. However, our patient presented with secondary amenorrhea, normal female external genitalia, and a mixed GCT. Constitutional karyotype was suggestive of 46,XY. Management comprised chemotherapy, followed by surgery. Histopathology was suggestive of dysgerminoma complicating a gonadoblastoma. The purpose of reporting this case is its rarity and the importance of diagnosing an XY karyotype, as the incidence of GCTs is higher in these patients.