Lee H. Goldstein

Effectiveness of oral vs rectal acetaminophen: a meta-analysis.

OBJECTIVE To determine, on the basis of published studies, the efficacy of rectal vs oral acetaminophen as treatment of fever and pain. DATA SOURCES MEDLINE, PubMed, and the Cochrane database as well as major pharmacologic textbooks and the references of all included studies were searched for studies comparing oral and rectal administration of acetaminophen. STUDY SELECTION Randomized and quasi-randomized controlled studies comparing rectal and oral administration of acetaminophen were included. Reviews, letters, and studies that compared combined treatments or additional drugs were excluded. Main Exposure Oral vs rectal acetaminophen. MAIN OUTCOME MEASURES Standardized measures of temperature and pain reduction. RESULTS For temperature reduction, 4 studies met the inclusion criteria. The decline in temperature 1 hour after administration of acetaminophen was no different between rectal and oral administration (weighted mean difference [WMD], -0.14 degrees C; 95% confidence interval [CI], -0.36 degrees C to 0.08 degrees C; P for heterogeneity = .49). There was no difference in the decline of temperature 3 hours after administration (WMD, -0.10 degrees C; 95% CI, -0.41 degrees C to 0.21 degrees C; P = .84), the maximum decline in temperature (WMD, -0.10 degrees C; 95% CI, -0.24 degrees C to 0.04 degrees C; P > .99), or the average time to temperature reduction of 1 degrees C (WMD, -0.06 degrees C; 95% CI, -1.34 degrees C to 1.23 degrees C; P < .001). We did not perform a meta-analysis comparing rectal and oral acetaminophen for pain reduction because only 1 study fulfilled the inclusion criteria. CONCLUSIONS Rectal and oral acetaminophen are comparable with respect to temperature reduction. The American Academy of Pediatrics recommendation to refrain from rectal acetaminophen in children should possibly be revised.

Oral N-acetylcysteine has a deleterious effect in acute iron intoxication in rats.

Acute iron intoxication is associated with depletion of reduced glutathione in hepatocytes and changes in the glutathione system enzymes. We hypothesized that treatment with N-acetylcysteine (NAC), a glutathione reducing agent and an antioxidant, would reduce mortality in acute iron intoxication. We used a rat model to test this hypothesis. Male rats were assigned to 4 groups. Group 1 received 400 mg/kg elemental iron by oral gavage, group 2 received the same dose of iron followed by NAC, group 3 received NAC only, whereas group 4 received distilled water. Iron and liver transaminases in the blood, and glutathione system enzymes in the liver and erythrocytes were measured. Mortality in group 2 was significantly higher after 2, 6, and 24 hours compared with group 1 (P < .001). No deaths were observed in groups 3 and 4. Serum iron levels were significantly higher in group 2 rats compared to group 1 rats (P < .001). Hepatic and erythrocyte glutathione system enzymes were significantly lower among rats in group 2 compared to rats in group 1. The administration of NAC probably increased the absorption of iron through the gastrointestinal tract, causing higher serum iron levels with significant hepatic damage. These results indicate that in a rat model of acute iron intoxication, orally administered NAC may increase mortality.

Hepcidin in acute iron toxicity

BACKGROUND Hepcidin regulates extracellular iron concentration by inhibiting iron release from macrophages and preventing iron absorption in the intestine. Our objective was to evaluate the expression of hepcidin in the liver in acute iron poisoning in a rat model. METHODS Male Wistar rats were assigned to group 1, who received 750 mg/kg elemental iron (LD(50)) by gavage, and group 2 (control), who received distilled water. Iron concentrations and liver transaminases were measured in the serum. Hepcidin messenger RNA levels were measured in the liver. RESULTS Mean serum iron levels, aspartate aminotransferase, alanine aminotransferase, and uric acid were significantly higher in group 1 compared to group 2 (P < .0001, P = .01, P < .0001, and P = 0.0001, respectively). Hepcidin messenger RNA levels in the liver were significantly higher in the study group (P = .005). CONCLUSIONS In acute iron intoxication, hepcidin expression in the liver significantly increased. Further studies are needed to determine whether hepcidin levels correlate with the severity of the intoxication.

Acute paralysis following recreational MDMA (Ecstasy) use

Methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy, is a hallucinogenic compound structurally related to amphetamine. Ecstasys severe neurological toxicity includes seizures, subarachnoidal hemorrhage, cerebral infarction, intracranial bleeding and cerebral venous thrombosis. We describe the first case of spinal cord damage presenting as acute quadriplegia and respiratory insufficiency in a healthy adolescent following Ecstasy recreational usage.

Antiasthmatic and cough medication

Abstract Bronchial asthma affects pregnant women worldwide. During pregnancy asthma should be adequately treated for the benefit of the mother and the fetus, as severe, poorly treated asthma is associated with adverse perinatal outcomes. This chapter addresses the various medications used for asthma such as short- and long-acting beta agonists, inhaled and systemic corticosteroids, leukotriene modifiers, theophylline, mast cell stabilizers, anticholinergics and anti-IgE treatment. This chapter also addresses the use of mucolytics, expectorants and antitussive pharmacotherapy during pregnancy.

Intraperitoneal N-acetylcysteine for acute iron intoxication in rats

Free radical formation and release of oxidant agents have been suggested as possible mechanisms for tissue damage in acute iron intoxication. N-acetylcysteine (NAC), a glutathione substitute and an antioxidant, is widely used as an antidote for various intoxications. Our aim was to determine whether intraperitoneal (i.p.) NAC would reduce the mortality of rats after acute, toxic oral doses of iron. Male Wistar rats were studied in three phases. In the first phase, animals were assigned to groups 1 (distilled water by gavage) and 2 (i.p. NAC) and observed for survival. In the second phase, rats were assigned to groups 3 (400 mg/kg elemental iron orally) and 4 (400 mg/kg elemental iron, followed by 150 mg/kg i.p. NAC). Survival was observed. Because most rats in Group 3 died within 90 minutes after iron administration, a third phase was conducted in order to allow for comparison of iron and transaminase serum levels after the administration of iron and NAC (group 5: n = 10). Mortality was significantly lower in rats treated with iron and NAC, compared to those treated with iron (P = 0.016). Median serum iron level was significantly lower among rats treated with iron and NAC, compared with rats treated with iron alone (P = 0.002). In a rat model of acute iron intoxication, i.p. administration of NAC may decrease serum iron levels and mortality.

Effect of a 24+ hour fast on breast milk composition.

In this preliminary prospective study, breast milk is sampled surrounding 4 religious fast days to determine the effect of a more than 24-hour fast on breast milk composition. The participants are 48 healthy women nursing healthy babies between 1 and 6 months of age. Samples are collected within 2 days before the fast (baseline), immediately after the fast, and 24 hours after fast completion. Samples are tested for sodium, calcium, phosphorus, triglycerides, total protein, and lactose. From baseline to immediately after fast, mean sodium, calcium, and protein levels increase (P = .013, P < .0001, and P < .0001, respectively) and mean phosphorus and lactose levels decrease (P < .0001 and P = .003, respectively). Mean triglycerides are unchanged. Twenty-four hours after fast, parameters are no longer significantly different from baseline except for elevated mean protein levels (P = .022) and lactose that is still reduced (P = .017). A fast of this nature is statistically associated with certain biochemical changes in breast milk. J Hum Lact. 25(2):194-198

Nausea and vomiting in pregnancy

Fifty to 80% of pregnant women suffer from nausea and vomiting during pregnancy (NVP), also known as morning sickness; ranging from mild discomfort to hyperemesis gravidarum (HG). The treatment options for NVP range from conservative measures, such as reassurance and diet manipulation in the mildly symptomatic women, to drug therapy and if necessary, in severe and intractable cases, total parenteral nutrition or even therapeutic pregnancy termination. Drug free treatments, including acupuncture, acupressure, ginger and hypnosis are also presented. Medicinal therapy addressed in this chapter includes vitamins such as pyridoxine, dopamine antagonists, serotonin antagonists, antihistamines and corticosteroids.

Allergy and hyposensitization therapy

Allergic reactions are common during pregnancy, as throughout life. There is a large choice of antiallergic medications, but often, for pregnant women it is preferable to be more conservative and choose the older medications, that have safety evidence. This chapter includes information on antiallergic and desensitization pharmacotherapy during pregnancy.