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Post-operative pain is one of the main causes of chronic pain, and it is the most representative form of acute pain that can be debilitating, reduce the standard of living, and generate economic implications. When patients undergo a craniotomy, they could face severe consequences such as increased blood pressure, tachycardia, intracranial hypertension, agitation, and chronic cephalgia, which can lead to an increase in mortality. Post-craniotomy pain falls into the moderate to critical category; thus, the anesthesiologist requires the knowledge and skill to achieve adequate pain control during the intraoperative and immediate postoperative periods without interfering with the patient's neurological status. This literature mini-review informs us about the different options available to prevent post-craniotomy pain, such as medications like acetaminophen, nonsteroidal analgesics, gabapentinoids, and dexmedetomidine, among others, or even invasive procedures such as scalp block, which aim to provide analgesia during and after the surgery procedure. [ABSTRACT FROM AUTHOR]

This work shows a comparative dissolution test study carried out on different commercial acetaminophen tablets 650 mg from Spanish market. The conditions of the dissolution test applied are described in the monography USP 44/ NF39. Agilent Technologies model 708-DS (CQ59) continuous dissolution test is used with its corresponding Agilent Technologies model 708-DS (CQ59) spectrophotometer. Six tablets per batch were processed in each dissolution experiment. Mean dissolution profi les are defi ned by results obtained continuously every minute between the start of the test and 15 minutes; from this time there are results of times 20, 25 and 30 minutes. Among all the brands studied, it should be noted that the reference Gelocatil® 650 mg shows a faster release of the API compared with the other references, obtaining a dissolution rate of 100% at 2 minutes. All the brands studied meet the requirements of the dissolution test of USP 44/FN39, since the dissolved amount of API is not less than 85% in 30 minutes. [ABSTRACT FROM AUTHOR]

Objective: this work seeks to characterize the behavior related to suicide in the population admitted to the Hospital San Vicente Fundación, Rionegro, with an overdose of acetaminophen between January 2019 and December 2020, and to identify factors associated with the toxic dose. Methodology: descriptive analysis with information obtained from medical records. Results: 63 individuals presented acute ingestion of a toxic dose of acetaminophen as behavior related to suicide. Forty-three were women, 60% had a history of psychiatric illness, 35% reported at least one previous suicide attempt, and 22% consumed 25g or more. Acute liver injury was associated with a toxic dose. Conclusions: we evidenced a high prevalence of a history of psychiatric illness and behavior related to suicide; almost a third of the patients ingested doses greater than the risk threshold for liver failure. In addition, impulsiveness and eating at home suggests that restrictive public policies may not have an impact on reducing these events in the population. [ABSTRACT FROM AUTHOR]

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Copyright of Revista de Toxicología is the property of Asociacion Espanola de Toxicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Stevens-Johnson syndrome is a rare and life-threatening mucocutaneous disease. Its main etiology is hypersensitivity secondary to drug intake, where carbamazepine, allopurinol and sulfonamides stand out. Paracetamol as a causal agent has been described in only a few reports and case series, predominantly in Asian population. CLINICAL CASE: A 3-years-old male patient with a history of penicillin allergy. He presented erythematous-violaceous macules on the trunk secondary to the administration of paracetamol to relieve abdominal and testicular pain. He went to the emergency room where he received antihistamines and the dose of paracetamol was increased. After this, he began to exhibit blisters and areas of detached skin with systemic affection. Due to this, he was hospitalized in the pediatric intensive care unit where the diagnosis of Stevens-Johnson syndrome was established. His main treatment was focused on immunoglobulin and steroids, with which he presented progressive clinical improvement. CONCLUSIONS: Although most of drug hypersensitivity reactions are limited to mild skin conditions, it is important to recognize that even seemingly innocuous medications, such as paracetamol, can cause severe side reactions like Stevens-Johnson syndrome. [ABSTRACT FROM AUTHOR]

acetaminophen is an analgesic and antipyretic medication considered safe and effective. Because of this, in Colombia it is freely available and widely used in both children and adults. Due to its easy access, acetaminophen intoxication is a frequent event, so primary care physicians must be knowledgeable about its diagnosis and management. In addition to the risk factors for the development of liver failure and the indications for referring patients to specialized services. The purpose of this article is to guide primary health care personnel about the pathophysiology, diagnosis and treatment of this intoxication. [ABSTRACT FROM AUTHOR]

Introduction: Preventive analgesia is the administration of a drug or performance of an intervention capable of inhibiting or blocking the painful response in order to prevent the pain associated with a surgical procedure. Objective: To identify whether there are differences in postoperative pain control using preventive analgesia versus postoperative analgesia, managed with paracetamol + ketorolac in patients undergoing elective laparoscopic cholecystectomy. Material and methods: Controlled clinical trial, randomized, longitudinal, unicentric, prolective, homodemic, double blind; 70 patients divided into two groups. group 1 received preventive analgesia using paracetamol + ketorolac and group 2 same scheme in an immediate postsurgical manner. Bloodpressure, heartrate, numerical verbal scale of pain and presence of side effects of drugs at different times were measured. Student's t-test with statistical significance of p < 0.05. Results: At 60 minutes the diastolic blood pressure in group 1 had difference of means -4.20 with p = 0.027 and numerical verbal scale presented difference of means of -0.71 and p = 0.002. At four hours diastolic bloodpressure showed difference of means of -3.5 and p = 0.033. Nausea was reported in 2.9% for group 1 and 8.6% for group 2. Conclusions: There is a better response to pain in those patients who receive a preventive analgesia scheme compared to those who are administered an immediate post-surgical analgesia scheme. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Toxicología is the property of Asociacion Espanola de Toxicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute liver failure is a rare disease but life-threatening, and occurs more frequently in patients without preexisting liver disease. Paracetamol (acetaminophen) is one of the analgesic-antipyretic drugs most frequently prescribed by physicians and selfmedicated by people, whose adverse effects are mild discomfort and even lethal side effects that do not necessarily require the toxic dose to cause such serious effects. Not surprisingly, acetaminophen remains a major cause of overdose: from intentional poisoning (suicide) and unintentional (chronic use), whose major effects are ranging from fulminant hepatic failure related to overdose to death; half of these episodes are attributable to paracetamol, and these cases seem to be increasing more and more, because of its easy access and free sale. The aim of this paper is to present a case report and a literature review. [ABSTRACT FROM AUTHOR]

Objective: To determine the scientific evidences of accidental overdose with acetaminophen that caused acute liver failure in patients and the causes of the overdose. Method: Bibliographic search of original research studies, published from January of 2010 to November of 2018. Results: Of the patients that developed acute liver failure due to accidental overdose with acetaminophen, the great majority were polymedicated with opiates; patients that seeked to calm the pain, thus a poor supervision of the treatment by the prescribing doctors and the pharmacists, gave place to self-medication, duplicity, and overdose. In children, younger than 18 years of age, the principal cause was produced by mistakes of the caregivers: confusion in the alternating pattern with ibuprofen, due to confusion of the dose and correct guideline of age and weight. Conclusion: Cases of hepatotoxicity and acute liver failure exist due to accidental overdose with acetaminophen, being the main causes those produced by the health system: poor management and supervision of treatment by medical centers and pharmacies. Patient medication knowledge: on the part of the patients, the perception of "innocuous" is alarming, regardless of the dose, understood as the absence of toxicity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prophylactic analgesic effect of paracetamol and ibuprofen administered before the extraction of deciduous teeth in children. Materials and methods: Sixty children of 6 to 8 years of age were evaluated and attended the Dental Center of the Faculty of Dentistry of the University of San Martín de Porres, which were distributed in three groups, each of 20 children: group paracetamol, ibuprofen group and the control group. In the first two, the corresponding drug was administered orally 30 minutes before surgery (paracetamol 15 mg / kg or Ibuprofen 10 mg / kg). The following variables were evaluated: presence of pain, time of presence of pain, intensity of pain, and time elapsed for rescue analgesia. Results: Significant differences were found in the presence of pain variable and in the time of presence of pain among the 3 groups. There was no significance between the variables studied between the two groups with drugs. Conclusions: Analgesic prophylaxis is an effective alternative to conventional post-surgical pharmacological treatment. Ibuprofen and Paracetamol are drugs with similar efficacy for this purpose, despite presenting different pharmacological action. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El presente artículo muestra un estudio de estructura electrónica de la interacción del paracetamol con un modelo de grafeno. La superficie de energía potencial muestra tres estructuras de mínima energía las cuales fueron reoptimizadas sin restricción en sus ángulos. Un modelo de fisisorción fue utilizado para este estudio, utilizando al coroneno como una parte pequeña y representativa del grafeno. Se tomaron en cuenta efectos de largo alcance en el modelo propuesto, encontrándose que es importante tomar en cuenta estas fuerzas para poder representar de una manera más real la fisisorción de este tipo de compuestos. De acuerdo a los resultados obtenidos, la interacción es mediada principalmente por efectos de dispersión asociados a la interacción tipo π - π entre los anillos aromáticos del coroneno y el anillo fenólico del paracetamol. [ABSTRACT FROM AUTHOR]

Since the marketing of intravenous acetaminophen, cases of overdose secondary to errors in administration have been reported. We present the case of a term newborn, in whom who incidentally was given 250 mg of intravenous paracetamol in a hospital setting, as part of the management of post-surgical pain. With plasma paracetamol levels over the Rumack-Matthew normogram treatment line, early treatment with N-acetylcysteine was initiated. During hospitalization he did not develop symptoms of liver toxicity. It is assumed that safety and tolerance to paracetamol in neonates is due to the greater sulfation capacity than glucuronidation as well as lower expression of cytochrome P-450 in the immature liver of the newborn. [ABSTRACT FROM AUTHOR]

Fever is the result of a systemic inflammatory response that can be triggered by numerous stimuli, which can be a double-edged sword, because it can have beneficial effects, such as improved immune response and suppress bacterial growth, but also harmful effects, such as up to six times higher metabolic rate, causing hyperdynamia that in cardiac patients is poorly tolerated and even increases lung damage mediated by cytokines. Therefore several questions arise about how and when to control fever in septic patient; however, current evidence is limited, but it can be concluded that the thermal control must be performed with temperatures above 38.5°C with physical means and if not, give antipyretics is suggested. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sepsis mortality in intensive and intermediate care units is high. To speak of fever is to speak of a factor that has been considered independent of mortality, since there are studies in which they evaluate the rate of elevation above of 38.3°C directly related to a worse prognosis for the patient1, it is currently unknown what is the most efficient way of treating it, whether with the use of antipyretic drugs or with the use of physical means2, and if these treatment modalities impact on mortality, All this remains controversial. MATERIALS AND METHODS: Randomized controlled trial in which treatment with acetaminophen IV against physical therapy was compared in patients who developed sepsis fever at the high speciality naval hospital in the area of hospitalization and intermediate care unit, follow-up was 28 days and the primary outcome was mortality. RESULTS: It was found that both treatment modalities are effective for the control of fever (p = 0.04), however regarding the primary objective that was the analysis of mortality did not report significant statistical difference (p = 0.11) We found a slight trend toward higher mortality in the acetaminophen group, so we conclude that a larger population sample is needed to make recommendations regarding mortality, now in relation to effectiveness and cost-benefit we conclude is better Treatment with physical means. [ABSTRACT FROM AUTHOR]

The treatment of mild to moderate intensity oral-dental pain and of nociceptive and inflammatory origin generally requires the prescription of non-opioid analgesics. The actions of these medications and their main indications are exposed in the clinical and odontological practice, in order to contribute to increase the knowledge level on this topic, the quality of the prescription and the comprehensive care to the patient by the Odontology professional in the health primary level. [ABSTRACT FROM AUTHOR]

Resumen Introducción La metahemoglobinemia adquirida inducida por medicamentos es un trastorno raro en el recién nacido que, de no diagnosticarse y tratarse oportuna y adecuadamente, puede ser particularmente grave y determinar daño cerebral permanente o la muerte del paciente. Caso clínico Se reporta un caso metahemoglobinemia clínica severa que desarrolló un recién nacido después de la aplicación de una cantidad mínima de crema con benzocaína en una herida quirúrgica anal cuando al mismo tiempo recibía paracetamol. Además de considerar la benzocaína como agente causal primario de la metahemoglobinemia, se analiza y sustenta la posibilidad de que el paracetamol haya aumentado la susceptibilidad del paciente a las caínas debido a la inmadurez enzimática de los sistemas involucrados en la depuración de los agentes oxidantes, en particular de caínas y de paracetamol. Conclusiones Se alerta sobre la posibilidad de metahemoglobinemia en el recién nacido al emplear caínas solas o junto con otros medicamentos oxidantes en esta época del desarrollo humano, cuando es más susceptible a los efectos oxidantes de químicos incluyendo medicamentos. Se revisa el tratamiento y se propone etiquetar debidamente los productos farmacológicos que contienen caínas, prohibiendo su empleo en recién nacidos para evitar la metahemoglobinemia iatrogénica. Background Drug-induced acquired methemoglobinemia in the newborn is a rare event; however, when it develops, early diagnosis and proper treatment become paramount because it can evolve rapidly into a particularly serious disease causing permanent brain damage or death. Case report We report a unique case of severe methemoglobinemia that developed in a newborn associated with a minimal application of a benzocaine healing cream to an anal surgical wound while on acetaminophen. In addition to benzocaine as the primary cause in this case, we raise the possibility that acetaminophen—a mild oxidant—increased the susceptibility of the patient to benzocaine, leading to severe clinical methemoglobinemia based on the known immaturity of the enzymatic systems involved in caines and acetaminophen clearance in the newborn. Treatment of methemoglobinemia is reviewed. Conclusions Methemoglobinemia is a serious condition that can be easily induced by the use of oxidant medications in the newborn like local anesthetics. The possibility of unexpected drug to drug interactions, particularly between commonly used medications such as acetaminophen with other methemoglobin-causing agents, must always be kept in mind. Because of the possible deleterious consequences, mandatory labelling of caine-containing local anesthetic creams, gels and sprays with a warning for the likelihood of causing severe methemoglobinemia in children is recommended. Also, prohibiting their use in the newborn becomes mandatory. [ABSTRACT FROM AUTHOR]

Background: Ciclooxigenase inhibitors such as indometacin and ibuprofen, currently used for closure of the ductus arteriousus (DA) are associated with significant adverse effects on the newborn, so it is important to explore new alternatives of effective and safe treatment. One of these could be intravenous paracetamol. Objective: Evaluate the efficacy and safety of intravenous paracetamol for the closure of DA in preterm newborns. Material and Methods: We performed a prospective, experimental study, in preterm newborns with echocardiographic diagnosis of hemodynamically persistent ductus arteriousus (PDA), who were administered intravenous paracetamol 15mg/kg/day every six hours for three to seven days. In the follow up of these patients we looked for DA closure and side effects of paracetamol. Results: We included nine preterm newborn with gestacional age and weight mean of 33.2 weeks and 1509 grams respectively. Five patient (55%) had Yeh index ≥ 3 and by echocardiography the mean internal diameter of the DA was 2.81 ± 1.05 mm., with a ratio of left atrium/ aortic root (LA/Ao): 1.5 ± 0.32. Closure of DA was detected in eight (89%) patients; closure average time was 3.4 ± 1.7 days. No adverse reactions were detected. Conclusions: Intravenous paracetamol can be an effective and safe alternative treatment for closure of hemodinamically significant DA; however further studies are needed to validate these initial observations. [ABSTRACT FROM AUTHOR]

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Copyright of Revista ADM is the property of Asociacion Dental Mexicana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Settings: Surgical procedures in Mexico are frequent. It is possible that during the next five years the number procedures will increase a 20%. It has been reported that 80% of surgical patients will present pain and 80% of those in pain will report a moderate to severe intensity. National and International evidence-based guidelines for the management of perioperative pain had been published and are accessible however the recommended approach for pain management in surgical patients is neuraxial epidural continuous analgesia with a combination of local anesthetics and opioids. In some patients this approach is not possible due multiple causes. Objective: To fundament in the available evidence the use of paracetamol in the management of perioperative pain as an integrative structured analgesic approach. Materials and methods: Review of available evidence. Results: Despite the controversies related to the mechanism of action of paracetamol it has been proposed that this drug have a predominant effect in systems that are independent (but somehow related) to COX activity. Its analgesic effect when compared to placebo is statistically significant and its «spare opioid effect» decreases opioid consumption in 50%. The combination of paracetamol and NASAID decreases significantly the opioid consumption and promote a better analgesia. Conclusion: We propose that the analgesic approach for a surgical patient must consider opioids in combination with paracetamol and NASAID. This scheme must consider the specific conditions of each individual. It is necessary to generate new lines of investigation in order to generate more evidence. [ABSTRACT FROM AUTHOR]

Ecotoxicological assessment of pharmaceutical products in freshwater environments is an emergent research globally. The aim of this research was to evaluate acute ecotoxicological effects of seven pharmaceutical products widely used in Peru: four antimicrobians (Amoxicillin, Ciprofloxacin and Trimethoprim + Sulfamethoxazole), two analgesics (Ibuprofen and Paracetamol), and a sedative (Diazepan) on freshwater flea Daphnia magna Strauss, 1820 (Crustacea: Daphniidae). Relationships with the main physicochemical characteristics and molecule compounds were also assessed in order to evaluate environmental aquatic risks. Acute toxicity test were evaluated with five concentrations plus a control, with four repetitions, using a 6 x 4 CRB design . The following decreasing ecotoxicity sequence in terms of LC50 (mg⋅L-1) at 96 h of exposure on D. magna was observed: Diazepan (17.1) > Paracetamol (62.3) > Ibuprofen (175) > Ciprofloxacin (230.6) > Trimethoprim (296) > Sulfamethoxazole (1480) > Amoxicillin (6950). Relationships between LogLC50 and excreted product proportion, logKow and solubility of pharmaceutical products were not found. Potential ecotoxicity indicated that Diazepan caused the highest aquatic risk. However, using the quotient risk only Paracetamol produced aquatic risk. [ABSTRACT FROM AUTHOR]

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Introducción: En el estudio de estabilidad de un medicamento se obtiene información para poder definir su caducidad, determinando cómo varía la calidad del medicamento bajo la influencia de una serie de factores ambientales a lo largo del tiempo. En algunos casos es importante poder predecir esta caducidad sin haber terminado el estudio a tiempo real. Objetivos: Establecer mediante extrapolación de los datos del estudio, la fecha de vencimiento del ParacetamolDEF500mg E/20 cápsulas fabricado en las nuevas instalaciones del Centro Militar de Farmacia de la Defensa (Colmenar Viejo) en condiciones ambientales normales teniendo en cuenta las nuevas condiciones de fabricación. Material y Métodos: Se utilizan tres lotes de paracetamol cápsulas. Se observaron y estudiaron como variables clave: la concentración de principio activo mediante valoración por HPLC y el porcentaje de fármaco disuelto en 45 minutos mediante el Test de Disolución. El estudio de estabilidad a largo plazo se realizó durante un periodo de 6 meses a temperatura ambiente (25°C/60%HR), realizando Paralelamente y durante el mismo periodo el estudio de estabilidad acelerada, sometiendo el producto a la influencia de la temperatura y la humedad (40°C/75%HR). Se realiza un análisis de regresión de la degradación del principio activo y una predicción a 36 meses con el programa estadístico SPSS para el límite Inferior para un intervalo de confianza de 95%. Resultados: La formulación cumplió con las especificaciones de calidad escritas en La Farmacopea Española 5.ª ed. En los estudios acelerados y a largo plazo se comprueba, con un análisis de varianza de la regresión, que no existe degradación significativa (p>0,05) del producto. Con el estudio de predicción a 36meses, los límites inferiores de las medias de la valoración y disolución, para un intervalo de confianza del 95% son de 95,25% y 88,3% respectivamente, estando dentro de los límites de las especificaciones de la Farmacopea. Conclusiones: Se propone un período de validez de 36 meses para el Paracetamol DEF 500.mg E/20cápsulas. [ABSTRACT FROM AUTHOR]