Articles: acetaminophen.
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Acetaminophen (APAP) is the leading cause of acute liver injury in the developed world. Timely administration of N-acetylcysteine (N-Ac) prevents the progression of serious liver injury and disease, whereas failure to administer N-Ac within a critical time frame allows disease progression and in the most severe cases may result in liver failure or death. In this situation, liver transplantation may be the only life-saving measure. Thus, the outcome of an APAP overdose depends on the size of the overdose and the time to first administration of N-Ac. We developed a system of differential equations to describe acute liver injury due to APAP overdose. The Model for Acetaminophen-induced Liver Damage (MALD) uses a patient's aspartate aminotransferase (AST), alanine aminotransferase (ALT), and international normalized ratio (INR) measurements on admission to estimate overdose amount, time elapsed since overdose, and outcome. The mathematical model was then tested on 53 patients from the University of Utah. With the addition of serum creatinine, eventual death was predicted with 100% sensitivity, 91% specificity, 67% positive predictive value (PPV), and 100% negative predictive value (NPV) in this retrospective study. Using only initial AST, ALT, and INR measurements, the model accurately predicted subsequent laboratory values for the majority of individual patients. This is the first dynamical rather than statistical approach to determine poor prognosis in patients with life-threatening liver disease due to APAP overdose. ⋯ MALD provides a method to estimate overdose amount, time elapsed since overdose, and outcome from patient laboratory values commonly available on admission in cases of acute liver failure due to APAP overdose and should be validated in multicenter prospective evaluation.
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Jornal de pediatria · Jul 2012
ReviewAlternating antipyretics in the treatment of fever in children: a systematic review of randomized clinical trials.
To summarize the existing evidence on the efficacy of therapy with alternating antipyretics compared to monotherapy in the management of fever in children. ⋯ Although there was a tendency towards the reduction of mean temperatures with alternating antipyretics compared to the use of one antipyretic alone, there is not enough evidence to say that alternating antipyretic therapy is more effective than monotherapy.
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Acta Anaesthesiol Scand · Jul 2012
Randomized Controlled Trial Comparative StudyDiclofenac-tramadol vs. diclofenac-acetaminophen combinations for pain relief after caesarean section.
We compared the analgesic efficacy of diclofenac-acetaminophen combination with diclofenac-tramadol combination to optimize multimodal post-operative analgesia in women undergoing caesarean section. ⋯ Both diclofenac-tramadol and diclofenac-acetaminophen combinations can achieve satisfactory post-operative pain control in women undergoing caesarean section. The diclofenac-tramadol combination was overall more efficacious but associated with higher incidence of post-operative nausea.
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Int J Gynaecol Obstet · Jul 2012
Randomized Controlled Trial Comparative StudyIntravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor.
To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of pethidine hydrochloride for intrapartum analgesia. ⋯ The effectiveness of intravenous paracetamol was comparable to that of intravenous pethidine, but paracetamol had fewer maternal adverse effects.
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Randomized Controlled Trial Comparative Study
Comparison of post operative pain relief between paracetamol and wound infiltration with levobupivacaine in inguinal hernia repair.
The present study has been designed to compare the intensity of postoperative pain in children by wound infiltration with levobupivacaine with that provided by paracetamol administration per rectaly. This intervention study was carried out at the department of paediatric surgery, Mymensingh Medical College Hospital, Mymensingh and Dhaka Medical College Hospital, Dhaka, during the period of January 2009 to September 2010. ⋯ Both groups were followed up post operatively for 23 hours. The intensity of post operative pain relief following inguinal hernia repair in children by wound infiltration with levobupivacaine is significantly higher than rectal administration of paracetamol.