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1.
BMJ Case Rep ; 15(1)2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34992061

RESUMO

A 59-year-old woman underwent an open pancreaticoduodenectomy. Thoracic patient controlled-epidural anaesthesia provided excellent incisional pain relief; however, the patient experienced intractable left shoulder pain (10/10 on the Numerical Rating Scale). To our knowledge, there is no effective established treatment for patients experiencing shoulder pain after an open pancreaticoduodenectomy. The patient's shoulder pain did not respond to medical management with acetaminophen, ketorolac, lidocaine transdermal patch, oxycodone and hydromorphone. Then, on postoperative day 2, the acute pain service was consulted. Considering that the sphenopalatine ganglion block has been previously reported to be helpful in a number of painful conditions, including shoulder tip pain after thoracic surgery, we offered this treatment to the patient. After just one topical sphenopalatine ganglion block, using a cotton-tipped applicator, the patient's shoulder pain entirely resolved and did not return. This is the first report of a successful treatment of intractable ipsilateral shoulder pain following an open pancreaticoduodenectomy with transnasal sphenopalatine ganglion block.


Assuntos
Bloqueio do Gânglio Esfenopalatino , Acetaminofen/uso terapêutico , Feminino , Humanos , Lidocaína , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Pancreaticoduodenectomia , Dor de Ombro/tratamento farmacológico , Dor de Ombro/etiologia
2.
J Environ Sci (China) ; 112: 331-342, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34955216

RESUMO

Nanosized Ba1-xBixFe1-xCuxO3 (12-50 nm) with x values of 0, 0.01, 0.05, and 0.1 system was prepared using the Pechini method. Structural, morphological, surface and optical characterizations were performed for the prepared samples. Cubic phase was the predominant phase for the undoped BaFeO3 and Bi and Cu co-doped BaFeO3 samples. Minor phases of monoclinic Ba2Fe2O5, orthorhombic BaFe2O4 and orthorhombic BaCO3 were identified for all the prepared samples. Ba0.95Bi0.05Fe0.95Cu0.05O3 sample has the lowest band gap (2.43 eV). 98.1% paracetamol removal was achieved with 0.75 g/L of Ba0.95Bi0.05Fe0.95Cu0.05O3 at pH 9 after 120 min. The paracetamol degradation follows the pseudo first-order kinetics. HO• is the main oxidative species responsible for the paracetamol degradation. Gas chromatography-mass spectrometry (GC-MS) analysis was performed at the end of the photocatalytic degradation experiment under optimum operating condition using Ba0.95Bi0.05Fe0.95Cu0.05O3 to explain the reaction mechanism and identify the intermediate by-products which is confirmed by ultraviolet/visible (UV/Vis) spectroscopy study at different reaction times.


Assuntos
Acetaminofen , Bismuto , Bário , Catálise , Cobre , Ferro , Luz
3.
Talanta ; 237: 122975, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34736697

RESUMO

The contamination of water sources by anthropogenic activities is a topic of growing interest in the scientific community. Therefore, robust analytical techniques for the determination and quantification of multiple substances are needed, which often require complex and time-consuming procedures. In this context, we describe a univariate calibration method to determine emerging multi-class contaminants in different water sources. The instrumental setup is composed of a lab-made glass electrochemical cell with three electrodes: Pt counter, Ag/AgCl reference, and BDD working electrodes. With this system, we were able to simultaneously quantify tert-butylhydroquinone, acetaminophen, estrone, sulfamethoxazole, enrofloxacin, caffeine, and ibuprofen by differential pulse voltammetry. Only two calibration solutions are required for the Single-shot Dilution Differential Pulse Voltammetric Calibration (SSD-DP-VC) method described here, which can significantly improve sample throughput. Two robust univariate calibration strategies were also applied and compared with SSD-DP-VC. The new method is simple, fast, and comparable with traditional calibration methods, showing similar precision and accuracy for all determinations evaluated.


Assuntos
Boro , Diamante , Acetaminofen , Calibragem , Eletrodos
4.
Med Clin North Am ; 106(1): 169-185, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34823729

RESUMO

Buprenorphine formulations (including buprenorphine/naloxone) are effective treatments of pain and opioid use disorder (OUD). Historically, perioperative management of patients prescribed buprenorphine involved abstinence from buprenorphine sufficient to allow for unrestricted mu-opioid receptor availability to full agonist opioid (FAO) treatment. Evidence is mounting that a multimodal analgesic strategy, including simultaneous administration of buprenorphine and FAO, nonopioid adjuncts such as acetaminophen and nonsteroidal anti-inflammatory drugs, and regional anesthesia, is a safe and effective perioperative strategy for the patient prescribed long-term buprenorphine treatment of OUD. This strategy will likely simplify management and more seamlessly provide continuous buprenorphine treatment of OUD after hospital discharge.


Assuntos
Analgésicos Opioides/farmacologia , Buprenorfina/farmacologia , Tratamento de Substituição de Opiáceos/métodos , Dor Pós-Operatória/prevenção & controle , Assistência Perioperatória/métodos , Acetaminofen/administração & dosagem , Acetaminofen/uso terapêutico , Idoso , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Buprenorfina/administração & dosagem , Buprenorfina/uso terapêutico , Terapia Combinada/métodos , Composição de Medicamentos/métodos , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Dor/tratamento farmacológico , Manejo da Dor/métodos , Receptores Opioides mu/efeitos dos fármacos
5.
Chemosphere ; 286(Pt 3): 131875, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34411933

RESUMO

Herein, an efficient photocatalyst composed of graphitic carbon nitrate and iron-based metal-organic framework (g-C3N4/NH2-MIL-101(Fe)) composite was fabricated by a solvothermal method for the degradation of acetaminophen (AAP) and reduction of Cr(VI) under sunlight illumination. The composite was confirmed by X-ray diffraction. UV-visible spectra showed that the bare g-C3N4, pure Fe-MOF, and composite harvest solar light effectively. The photocatalytic experiment indicated that the composite exhibited superior reduction efficiency of Cr(VI) (66%) compared to the bare g-C3N4 (35%) and pure Fe-MOF (51%) at pH 7. As the pH decreases from 9 to 2, the reduction efficiency increased. The highest Cr(VI) reduction (91%) was observed at pH 2. On the other hand, the catalyst degraded 94% of AAP at pH 7 compared to the bare g-C3N4 (42%) and pure Fe-MOF (60%) in the presence of hydrogen peroxide. A radical scavenger experiment endorsed that the generation of superoxide radicals was the main reason for the AAP degradation. The cyclic stability test indicated that there was no substantial decrease in the degradation efficiency of AAP after ten repeated cycles. The kinetic studies showed that the photodegradation of AAP and reduction Cr(VI) was well-fitted to the first-order kinetics. Gas chromatography-mass spectrometry analysis showed that hydroquinone, aliphatic carboxylic acids, monohydroxy, and dihydroxy paracetamol were the main products formed as a result of such degradation process. Therefore, the iron-based MOF and their composites can be used as effective photocatalysts for pollutants degradation.


Assuntos
Recuperação e Remediação Ambiental , Estruturas Metalorgânicas , Acetaminofen , Catálise , Cromo , Grafite , Cinética , Compostos de Nitrogênio
6.
Chemosphere ; 287(Pt 1): 132070, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34478967

RESUMO

This paper presents the use of B and N co-doped reduced graphene oxide (BN-GN) as an electrode for paracetamol electrochemical degradation. The reaction mechanism, focused on active sites in the atom level and dominant radical species generated through the reaction, was analyzed by characterization, density functional theory (DFT) calculation, quenching experiments, and electron paramagnetic resonance analysis. The characterization results indicated that the introduction of N and B functionalities into GN improved catalytic activity due to the generation of new surface defects, active sites, and improvement of conductivity. Results of experiments and DFT showed that co-doping of B and N greatly improved the catalytic activity, and the B atoms in C-N-B groups were identified as main active sites. The main active substances of BN-GN generated in the electrocatalytic oxidation of paracetamol in the solution were O2•- and active chlorine. The influence of O2•- and active chlorine on the efficiency/path of catalytic oxidation and the proposed mechanism were also determined for paracetamol degradation. This study provides an in-depth understanding of the mechanism of BN-GN catalysis and suggests possibilities for practical applications.


Assuntos
Acetaminofen , Grafite , Catálise , Oxirredução
7.
Spectrochim Acta A Mol Biomol Spectrosc ; 265: 120308, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34509889

RESUMO

Spectrophotometric data analysis using multivariate approaches has many useful applications. One of these applications is the analysis of active ingredients in presence of impurities. Four chemometric-assisted spectrophotometric methods, namely, principal component regression (PCR), partial least-squares (PLS), artificial neural networks (ANN) and multivariate curve resolution-alternating least squares (MCR-ALS) were proposed and validated. The developed chemometric methods were compared to resolve the severely overlapped spectrum of Paracetamol (PAR) and Phenylephrine HCl (PHE) along with PAR impurities namely, P-Aminophenol (PAP), P-Nitrophenol (PNP), Acetanilide (ACT) and P-Chloroacetanilide (CAC). The four multivariate calibration methods succeeded in simultaneous determination of PAR and PHE with further quantification of PAR impurities. So, the proposed methods could be used with no need of any separation step and successfully applied for pharmaceutical formulation analysis. Furthermore, statistical comparison between the results obtained by the proposed chemometric methods and the official ones showed no significant differences.


Assuntos
Acetaminofen , Redes Neurais de Computação , Análise dos Mínimos Quadrados , Fenilefrina , Espectrofotometria
8.
Chemosphere ; 286(Pt 1): 131570, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34293559

RESUMO

The increase in pollution increased the threat level of living organisms in the environment. Municipal Solid Waste is one of the most important wastes which contribute to polluted sites affecting livelihood. They pollute the water stream, marine environment ecology, soil fertility, and agriculture production. This, in turn, reduces the microflora of the marine environment, agricultural soil, and fertility. This could be analyzed by setting up a Winogradsky column using dumpsite soil samples. The current work was designed to study the municipal solid wastes from different dumpsite soil. Soil characterization revealed that the pH of Kodungaiyur and Otteri was 7.3 and 6.4. The bulk density was 0.067 g/cm3 and 0.069 g/cm3. The Porosity resulted to be 0.511 particle/volume and 0.513 particle/volume for Kodungaiyur and Otteri. The Kodungaiyur soil containing contaminants supplied with natural sources showed a 100% germination index, and Otteri soil containing contaminants supplied with natural sources showed a maximum vigour index. The presence of medicinal strips in the collected soil samples led to the study on Acetaminophen degradation. HB1 showed to be 79 ± 0.005% at optimum pH 5 containing 100 mg/L of Acetaminophen at day four among the isolated bacterial strains. Further, the intermediate formation was determined using FTIR and GC-MS. The isolated HB1 bacterial strain was identified as Staphylococcus hominis, which is heterotroph.


Assuntos
Poluentes do Solo , Solo , Acetaminofen/toxicidade , Agricultura , Poluentes do Solo/análise , Poluentes do Solo/toxicidade , Resíduos Sólidos/análise
9.
Sci Total Environ ; 806(Pt 2): 150541, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34601175

RESUMO

Even though the toxic effects of paracetamol (PCM) and ciprofloxacin (CPX) have been deeply studied in the last decades, the impact of the PCM-CPX mixture may induce in aquatic organisms is poorly known. Thus, the objective of this work was to investigate the teratogenic effects and oxidative stress that PCM, CPX, and their mixture induce in Danio rerio embryos. Moreover, we aimed to determine whether the PCM-CPX mixture induces more severe effects on the embryos than the individual drugs. For this purpose, zebrafish embryos (4 hpf) were exposed to environmentally relevant concentrations of PCM, CPX, and their mixture until 96 hpf. In addition, at 72 hpf and 96 hpf, we also evaluated the oxidative stress biomarkers (superoxide dismutase, catalase, glutathione peroxidase, lipid peroxidation, and hydroperoxides and carbonyl content) in the embryos. Our results demonstrated that PCM, CPX, and their mixture reduced the survival rate of embryos by up to 75%. In addition, both drugs, induced morphological alterations in the embryos, causing their death. The most observed malformations were: scoliosis, craniofacial malformations, hypopigmentation, growth retardation, pericardial edema. Concerning oxidative stress, our integrated biomarkers response (IBR) analysis demonstrated that PCM, CPX, and their mixture induce oxidative damage on the embryos. In conclusion, PCM, CPX, and their mixture can alter zebrafish embryonic development via an oxidative stress response.


Assuntos
Poluentes Químicos da Água , Peixe-Zebra , Acetaminofen/metabolismo , Acetaminofen/toxicidade , Animais , Ciprofloxacina/metabolismo , Ciprofloxacina/toxicidade , Embrião não Mamífero/metabolismo , Estresse Oxidativo , Poluentes Químicos da Água/metabolismo , Poluentes Químicos da Água/toxicidade
10.
Spectrochim Acta A Mol Biomol Spectrosc ; 266: 120422, 2022 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-34619510

RESUMO

The development of analytical chemistry is omnipresent in all fields, this leads to considerable consumption of organic solvents and hazardous reagents with an increase in the production of waste to be treated. In this work, we developed simple, fast, cost-effective and above all environmentally friendly methods for the analysis of Acetaminophen (ACT) and Ascorbic acid (ASC) in synthetic mixtures and pharmaceutical formulation, using UV spectroscopy. Four chemometric methods were studied, including PLS-1 with full-spectrum (Full-PLS) and PLS-1 using three variable selection methods, namely subset selection through a genetic algorithm (GA), uninformative variable elimination using iterative predictor weighting (IPW), and variable selection by sub-window permutation analysis (SwPA). The accuracy of the developed methods was evaluated through the root mean square error of prediction (RMSEP), the mean absolute percentage error (MAPE) and the recovery values. All methods showed more accurate prediction results in comparison with full-PLS calibration. Furthermore, the results indicate that the GA-PLS models showed the highest prediction accuracy among all other models with RMSEP and MAPE values of (0.0494 and 0.610) and (0.0163 and 0.321) for the estimation of ACT and ASC, respectively. The proposed methods were successfully applied to the determination of ACT and ASC in their combined dosage form. In addition, the results obtained were statistically compared to those of the conventionally used HPLC method and were found to be in good agreement. The main advantages of the developed methods over HPLC during routine analysis are that they are faster, inexpensive, simple to perform, without the need for major pretreatment of samples. Besides, no organic solvents are used, and thus toxicity and pollution are avoided.


Assuntos
Acetaminofen , Ácido Ascórbico , Composição de Medicamentos , Análise dos Mínimos Quadrados , Espectrofotometria
11.
J Agric Food Chem ; 70(1): 238-246, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-34965133

RESUMO

2-Acetamidophenol (AAP) is an aromatic product with promising activities in agricultural applications and medical research. At present, AAP is synthesized by chemical methods from nonrenewable fossil fuel resources, which cause environmental pollution and the reaction conditions are harsh. In this study, we constructed the artificial biosynthetic pathway of AAP with five different expressed proteins in Escherichia coli for the first time. By introducing the hydrogen peroxide degrading enzyme catalase and improving cell tolerance to toxic intermediates or products, the yield of AAP reached 33.54 mg/L using shaking-flask culture. The best-engineered strain could produce 568.57 mg/L AAP by fed-batch fermentation from glucose and precursor (2-aminophenol, 2-AP) addition. Furthermore, a one-pot whole-cell cascade biocatalytic pathway to AAP and analogues was developed and optimized. This method can efficiently produce 1.8 g/L AAP using the methyl anthranilate hydrolysis product as the substrate. This study provides not only the de novo artificial biosynthetic pathway of AAP in E. coli but also a promising sustainable and efficient strategy to enable the synthesis of AAP on a gram scale.


Assuntos
Escherichia coli , Engenharia Metabólica , Acetaminofen , Técnicas de Cultura Celular por Lotes , Vias Biossintéticas , Escherichia coli/genética , Fermentação
12.
Bioorg Chem ; 118: 105476, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34788696

RESUMO

Schisandrae Chinensis Fructus (SCF) was a Traditional Chinese Medicine for protecting liver. However, underlying therapeutic mechanisms of these bioactive lignans from SCF similar hepatoprotective effects against drug-induced liver injury (DILI) by acetaminophen (APAP) are still unclear. This study aims to discover the potential regulation mechanisms of Schisandrol A in the treatment of DILI by APAP. The integrated UPLC-Q-TOF/MS, pharmacodynamic study, histopathological combination with network pharmacology and molecular docking technology were used to explore the potential mechanisms. The results showed that Schisandrol A reduced the level of AST, ALT, MDA, PNP, TNF-α and IL-1ß, increased the levels of the GSH against acute liver failure. Additionally, Schisandrol A could improve the morphological characteristics of DILI by APAP in mice with liver tissue. Molecular docking results had showed that Schisandrol A with high scores when docking with COX-2, ALOX5, CYP2E1, CYP2C9, CYP2C19, EGFR SRC, Nrf2, MAPK14 and MAPK8. The study demonstrated that Schisandrol A could play critical roles in DILI by APAP via regulating TNF signaling pathway, inhibiting oxidative stress, inflammation and inhibiting the activities of cytochrome P450 enzymes, which contributed to searching for leading compounds and the development of new drugs for DILI by APAP.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Ciclo-Octanos/uso terapêutico , Lignanas/uso terapêutico , Simulação de Acoplamento Molecular , Acetaminofen , Animais , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Relação Dose-Resposta a Droga , Masculino , Camundongos , Camundongos Endogâmicos ICR , Estrutura Molecular , Relação Estrutura-Atividade
13.
Clin Chim Acta ; 525: 12-14, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34906557

RESUMO

Acute liver injury (ALI) is seen in conjunction with elevated iron concentrations in the setting of acute iron toxicity. However, occult or delayed presentations of iron toxicity can be difficult to identify clinically and there is limited data describing iron concentrations in ALI without a confirmed history of iron overdose. This was a single center observational before-and-after study of adult patients who developed acute liver injury during hospitalization. Patients with a serum ALT > 500 U/L were identified by a daily hospital laboratory report and met inclusion if the ALT< 80 U/L at the time of admission, no history of overdose (iron, acetaminophen, or other ingestion), and no underlying liver disease. Serum AST, iron, and ferritin concentrations were obtained from blood samples at the time of admission and at peak serum ALT. Ten patients met inclusion criteria. The median age was 69 years old and 60% were male. There was a significant difference in serum AST (p = 0.005), serum ALT (p = 0.005), and ferritin (p = 0.005) before and after development of ALI. Serum iron concentrations were not clinically or significantly different (median: 23 mcg/dL vs 27 mcg/dL, p = 0.8). In this cohort of patients with non-iron induced acute liver injury, serum iron concentrations did not significantly change with the observed rise in aminotransferases. These data help to further characterize patterns of serum iron concentrations in patients with ALI.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Overdose de Drogas , Acetaminofen , Adulto , Idoso , Alanina Transaminase , Overdose de Drogas/tratamento farmacológico , Humanos , Ferro , Fígado , Masculino
15.
BMC Complement Med Ther ; 21(1): 299, 2021 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922514

RESUMO

BACKGROUND: Recently, extracellular vesicles have come to the fore following their emerging role in cell communication, thanks to their ability to reach cells into the human body without dissipating their cargo, transferring biological active molecules, such as proteins, nucleic acids, lipids, etc. They appear as a promising tool in medicine, because of their capability to modulate cellular response in recipient cells. Moreover, a considerable number of publications suggests that exosome uptake is selective but not specific, and it can cross species and cell-type boundaries. This study aims to explore the potential role of porcine liver derived extracellular vesicles, exosomes in particular, to protect human cells from acute damage induced by acetaminophen. METHODS: Extracellular vesicles were isolated from porcine lyophilized liver using polymer-based precipitation and a further enrichment was performed using affinity beads. The effects of obtained fractions, total extracellular vesicles and enriched extracellular vesicles, were assessed on human liver derived HepG2 cells. Cell growth and survival were tested, with MTT and area coverage analysis designed by us, as well as protein expression, with immunofluorescence and Western blot. Oxidative stress in live cells was also measured with fluorogenic probes. RESULTS: After proving that porcine extracellular vesicles did not have a toxic effect on HepG2, quite the contrary total extracellular vesicle fraction improved cell growth, we investigated their protective capability with a preconditioning strategy in APAP-induced damage. EVs displayed not only the ability to strongly modulate cell survival responses, but they also were able to boost cell cycle progression. CONCLUSIONS: Extracellular vesicles derived from farm animal food derivatives are able to modulate human hepatic cell metabolism, also improving cell survival in a damaged context.


Assuntos
Acetaminofen/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Exossomos , Animais , Feminino , Liofilização , Células Hep G2 , Humanos , Fígado/efeitos dos fármacos , Masculino , Suínos
16.
Ann Biol Clin (Paris) ; 79(6): 567-578, 2021 Dec 01.
Artigo em Francês | MEDLINE | ID: mdl-34961739

RESUMO

An increase of pyroglutamic acid, or 5-oxoproline plasmatic concentration was reported in metabolic acidosis observed after chronic intake of some drugs, as acetaminophen. We developed a simple, fast and reproducible method by capillary zone electrophoresis using a commercial Anion Analysis Kit® to quantify pyroglutamic acid, in plasma after acetonitrile precipitation, and after simple dilution in urines. Fumaric acid was used as internal standard in both. In less than 7 min, the method separates pyroglutamic acid from other organic and inorganic anions. The method is linear between 0.25 and 10 mmol/L in plasma, and 0.15 and 10 mmol/L in urines. The quantification limits are 0.25 mmol/L and 0.15 mmol/L for plasma and urines, respectively. For repeatability and intermediate precision, the variation coefficients are less than 15% and the bias values are between ± 10%. For the 2 matrices, the recoveries are between 88% and 101%. The method does not interfere with physiological organic and inorganic anions. Pyroglutamic acid concentrations measured in 9 children were between 0.45 and 3.96 mmol/L in the plasma and between 0.15 and 3.2 mmol/L in the urine. No correlation between pyroglutamic acid and acetaminophen concentrations were found, regardless of the biological media. In conclusion, our method measures pathophysiological concentrations of pyroglutamic acid and highlights the increase in other organic acids that may explain metabolic acidosis due to chronic acetaminophen intake.


Assuntos
Acidose , Preparações Farmacêuticas , Acetaminofen , Acidose/induzido quimicamente , Acidose/diagnóstico , Criança , Eletroforese Capilar , Humanos , Ácido Pirrolidonocarboxílico
17.
CMAJ Open ; 9(4): E1181-E1186, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34906994

RESUMO

BACKGROUND: Low-dose codeine products can be purchased without a prescription in most of Canada. We explored trends in the purchasing of these products across the Canadian provinces from 2014 to 2019, evaluating the impact of Health Canada's 2016 announcement of a proposed regulatory change and the 2017 opening of a 60-day public comment period, as well as the impact of Manitoba's 2016 policy change requiring a prescription for the purchase of all codeine products in that province. METHODS: We evaluated population-adjusted monthly purchasing of codeine products from January 2014 to October 2019 using the IQVIA Canadian Drug Store and Hospital Purchases Audit database, stratified by province and over-the-counter (OTC) status. The primary outcomes were change in the monthly volume of low-dose codeine purchased after the 2016 federal regulatory proposal and the 2017 period of public comment across the provinces. Our secondary analysis was the impact of Manitoba's policy change in February 2016 requiring a prescription for low-dose codeine. We conducted a time-series analysis using interventional autoregressive integrated moving average models. RESULTS: Over the study period, 24 120 kg of codeine (3.025 billion units) and 937 867 kg of acetaminophen were sold as OTC, low-dose codeine products across the Canadian provinces. Health Canada's 2016 announcement did not significantly affect OTC codeine purchasing (p = 0.57). The initiation of a 60-day public comment period was associated with a roughly 44% decrease in OTC codeine purchasing (p = 0.03). In Manitoba, purchasing of the same codeine formulations decreased after rescheduling in February 2016 (p < 0.001). We observed no significant change in the rate of purchasing of higher dose codeine formulations in response to scheduling changes in Manitoba (p = 0.22). INTERPRETATION: Although Health Canada's 2016 announcement of a proposed regulatory change did not appear to have an effect on OTC codeine purchasing nationally, the 60-day comment period was associated with a decrease in purchasing. Further, Manitoba's 2016 policy change was associated with a significant and sustained decrease in the overall volume of codeine purchased. Given the potential risks of codeine dependence and acetaminophen toxicity with these products, a national rescheduling strategy should be considered.


Assuntos
Analgésicos Opioides , Codeína , Controle de Medicamentos e Entorpecentes/métodos , Hospitais , Medicamentos sem Prescrição , Farmácias , Medicamentos sob Prescrição , Acetaminofen , Analgésicos não Narcóticos , Composição de Medicamentos , Humanos , Manitoba
18.
PLoS One ; 16(12): e0260638, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932553

RESUMO

INTRODUCTION: The study aimed at exploring the adverse events following immunization (AEFI) and their incidences among health workers in three different districts of central and western Nepal following the first dose of Covishield vaccine,. It also aimed at studying the association of AEFI with demographic and clinical characteristics of vaccinees, pre-vaccination anxiety level and prior history of COVID-19 infection (RT- PCR confirmed) status. MATERIALS AND METHODS: This was a cross-sectional study carried out via face-to-face or telephonic interview among 1006 health workers one week after receiving their first dose of the Covishield vaccine. Incidence of adverse events was calculated in percentage while Chi-square Test was used to check the association of AEFI with independent variables. Logistic regression was used to find out the adjusted odd's ratio at 95% CI. RESULTS: Incidence of AEFI was 79.8% with local and systemic AEFI being 68.0% and 59.7% respectively. Injection site tenderness was the commonest manifestation. Local and systemic symptoms resolved in less than one week among 96.8% and 98.7% vaccinees respectively. Females were more likely to develop AEFI than males (AOR = 1.7, 95% CI = 1.2-2.4). Vaccinees aged 45-59 years were 50% less likely to develop AEFI as compared to those aged less than 30 years (AOR 0.5, 95% CI = 0.3-0.8). Most of the vaccinees had not undergone RT-PCR testing for COVID-19 (59.8%). Those who were not tested for COVID-19 prior were 1.5 odds more likely to develop AEFI compared to those who were negative (AOR = 1.5, 95% CI = 1.1-2.1). CONCLUSION: More than two-third of the vaccinees developed one or more forms of adverse events, but most events were self-limiting. Females and young adults were more prone to develop AEFI.


Assuntos
/efeitos adversos , Pessoal de Saúde/estatística & dados numéricos , Acetaminofen/farmacologia , Adulto , Idoso , COVID-19/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Fatores de Tempo , Vacinação/efeitos adversos , Vacinação/psicologia
19.
Pol Merkur Lekarski ; 49(293): 346-351, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34800021

RESUMO

It is known that the violation of one or more functions of the liver, where the basic biochemical processes take place, is reflected in the functional state of many organs and systems, causing severe consequences. For the effective treatment of the hepatobiliary system diseases the drugs from fungi and plant materials are promising, the ingredients of which are close to natural metabolites, have different mechanisms of hepatoprotective action and, in general, can have a positive effect on liver function. AIM: The aim of the research was to investigate the hepatoprotective properties of the Maitake mushrooms thick extract in the experiment on rats with paracetamol (acetaminophen)-induced hepatitis. MATERIALS AND METHODS: The study was performed on 60 white male rats weighing 180-210 g and aged 6-6,5 months. Rats were divided into 10 groups, each of which included 6 animals. Acute hepatitis was simulated by acetaminophen intragastrically administering at a dose of 1250 mg/ kg of body weight 1 time per day as a suspension in 2% starch gel solution for 2 days. Correction of the toxic lesions was performed with a thick extract of Maitake mushrooms, which was administered intragastrically 2 hours before the introduction of acetaminophen and daily after the lesion at a dose of 150 mg/kg of body weight. "Silibor" (active basis - silymarin) was chosen as a comparison drug, which was administered according to the same scheme as Maitake extract at a dose of 20 mg/kg of animal body weight. On the 3rd, 7th and 10th days from the onset of the lesion, rats were euthanized using sodium barbamyl. Liver homogenate and blood serum were tested. Blood was taken from the hearts of animals. Endogenous intoxication of animals after the introduction of corrective factors was assessed by the activity of ALT, AST, GGTP, LF and the size of the thymol sample. All changes were confirmed by parametric and nonparametric methods of statistical analysis of the results of the study. RESULTS: The expressed cytolysis of hepatocytes, after administration to rats of toxicant, on the basis of research of the activity of aminotransferases, gamma-glutamyltranspeptidase, alkaline phosphatase and thymol sample size is proved. The results of the experiment were confirmed histologically. The introduction of a thick extract of Maitake mushrooms contributed to the normalization of the studied indicators. CONCLUSIONS: The application of the Maitake mushrooms thick extract as a corrective factor in the simulated acetaminophen hepatitis indicates its hepato-, cytoprotective and antioxidative properties.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Grifola , Hepatite , Doenças Metabólicas , Acetaminofen/toxicidade , Animais , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Fígado , Masculino , Extratos Vegetais/uso terapêutico , Ratos
20.
Am J Case Rep ; 22: e934190, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34807902

RESUMO

BACKGROUND Kounis syndrome is a hypersensitive coronary disorder triggered by drugs, food, and environmental factors. A 38-year-old male patient with acetaminophen-induced type 1 Kounis syndrome is described. The purpose of this paper is to show that Kounis syndrome is a serious condition that may be linked to a common medication and that it should be recognized earlier in clinical practice. CASE REPORT We report a case of a 38-year-old male patient with chest discomfort, dyspnea, and hypotension following a paracetamol continuous infusion, as well as ST elevation on numerous leads during the episode. The diagnosis of drug-induced Kounis syndrome was made when the patient no longer had angina and the EKG returned to normal after the infusion was discontinued; the coronary angiography also showed no remarkable stenosis. CONCLUSIONS Kounis syndrome is a hypersensitive coronary disease that involves eosinophil and/or mast cell infiltrated coronary stent thrombosis, vasospastic angina, and allergic myocardial infarction. Although acetaminophen is widely used, acetaminophen-induced Kounis syndrome is uncommon and seldom documented. The necessity of detecting the distinct appearance earlier to give more suitable therapy is highlighted in this report.


Assuntos
Vasoespasmo Coronário , Síndrome de Kounis , Acetaminofen/efeitos adversos , Adulto , Vasoespasmo Coronário/induzido quimicamente , Vasoespasmo Coronário/diagnóstico , Vasos Coronários , Humanos , Síndrome de Kounis/diagnóstico , Masculino , Espasmo
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