An Approach to Drug-Induced Liver Injury from the Geriatric Perspective

Lee, Brian T.; Odin, Joseph A.; Grewal, Priya

doi:10.1007/s11894-021-00804-7

Cited by 9 publications

(3 citation statements)

References 60 publications

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“…It was also observed that pain control was sub-optimal with acetaminophen alone. The literature reports similar systemic events including hypotension after taking acetaminophen [42][43][44][45][46][47][48].…”

Section: Discussionmentioning

confidence: 88%

Optimal and Safe Pain Management Approach in Ankle and Hindfoot Fractures: Improving Practitioner Decision

Ahmad,

Muhammad,

Mohib

et al. 2023

Preprint

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BackgroundOver or sub-optimal analgesic treatment leads to undesired consequences and patient dissatisfaction. The study aims to assess the sub-optimal or optimal pain relief and safety of routinely prescribed oral analgesic(s) at discharge and 1-week post-discharge in ankle and foot fracture surgeries.MethodsThe ongoing prospective cohort study data on 54 ankle and hindfoot trauma fracture adult patients enrolled between June 2022 to July 2023 was analyzed. Post-surgery oral analgesics prescribed at hospital discharge and 1-week follow-up were stratified for assessing adverse events and pain (Visual Analogue Scale) at 1- and 2 weeks post-discharge. The relationship of age, gender, and comorbidity was analyzed by multiple logistic regression for adverse events and multiple linear regression for pain score.ResultsMedian pain scores at 1- and 2-week follow-ups were 3.2 (IQR=3.0) and 2 (IQR=2.0) respectively. Combinations of tramadol, acetaminophen with naproxen or diclofenac or orphenadrine; and naproxen, pregabalin, with acetaminophen seemed toxic with sub-optimal pain control. Similar results were for celecoxib combined with pregabalin and etoricoxib combined with diclofenac or tramadol. Acetaminophen alone was safe but occasionally showed intolerance. Etoricoxib or diclofenac alone or with acetaminophen was safe and showed better pain control in this cohort. A regression model was non-significant for a relationship between covariates and pain scores or adverse events.ConclusionCurrent data suggests that certain oral analgesics or their combinations are harmful with sub-optimal pain control while some are safe and effective. Choosing suitable analgesics or their combinations in specific fractures might reduce patient harm with optimal pain management.

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Section: Discussionmentioning

confidence: 88%

Optimal and Safe Pain Management Approach in Ankle and Hindfoot Fractures: Improving Practitioner Decision

Ahmad,

Muhammad,

Mohib

et al. 2023

Preprint

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“…The primary treatment for DILI is the discontinuation of suspected drugs, and corticosteroids can improve the condition of DILI with autoimmune features ( Chalasani et al, 2021 ; Björnsson et al, 2022 ). Nevertheless, clinicians must weigh the risks of infection, osteoporosis, cognitive decline, etc., against the progression of DILI when treating older adults with corticosteroids ( Lee et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Autoimmunity associates with severity of illness in elderly patients with drug-induced liver injury

Xiong

Wang²,

Niu³

et al. 2023

Front. Pharmacol.

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Background: Drug-induced liver injury (DILI) is a potentially serious adverse drug reaction. Due to the lack of definite etiology, specific clinical manifestations, and diagnostic methods, its prediction and diagnosis are challenging. Elderly individuals are deemed to be at high risk for DILI due to abnormal pharmacokinetics, aging tissue repair function, comorbidities, and taking multiple drugs. This study aimed to identify the clinical characteristics and explore the risk factors associated with the severity of illness in elderly patients with DILI.Methods: In the present study, the clinical characteristics at the time of liver biopsy of consecutive patients with biopsy-proven DILI who presented at our hospital from June 2005 to September 2022 were evaluated. Hepatic inflammation and fibrosis were assessed according to the Scheuer scoring system. The presence of autoimmunity was considered if IgG level >1.1 × ULN (1826 mg/dL), or high titer (>1:80) of ANA, or SMA.Results: In total, 441 patients were enrolled, and the median age was 63.3 years (IQR, 61.0–66.0); 122 (27.7%), 195 (44.2%), or 124 (28.1%) were classified as having minor, moderate, or severe hepatic inflammation, respectively; and 188 (42.6%), 210 (47.6%) or 43 (9.8%) patients presented minor, significant fibrosis or cirrhosis, respectively. Female sex (73.5%) and the cholestatic pattern (47.6%) were dominant in elderly DILI patients. Autoimmunity existed in 201 patients (45.6%). Comorbidities were not directly associated with the severity of DILI. PLT (OR: 0.994, 95% CI: 0.991–0.997; p < 0.001), AST (OR: 1.001, 95% CI: 1.000–1.003, p = 0.012), TBIL (OR: 1.006, 95% CI: 1.003–1.010, p < 0.001), and autoimmunity (OR: 1.831, 95% CI: 1.258–2.672, p = 0.002) were associated with the degree of hepatic inflammation. Meanwhile, PLT (OR: 0.990, 95% CI: 0.986–0.993, p < 0.001), TBIL (OR: 1.004, 95% CI: 1.000–1.007, p = 0.028), age (OR: 1.123, 95% CI: 1.067–1.183, p < 0.001), and autoimmunity (OR: 1.760, 95% CI: 1.191–2.608, p = 0.005) were associated with the stage of hepatic fibrosis.Conclusion: This study revealed that the presence of autoimmunity represents a more serious illness state of DILI, deserving more intensive monitoring and progressive treatment.

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“…Often, times this will eliminate the symptoms, but there are times where the damage is too extensive or an antidote to a particular drug may be administered. Treatment is then varied on an individual basis 7 .…”

Section: Sign and Symptoms Of Drug Inducedmentioning

confidence: 99%

Untitled

2023

IJPSR

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Since ancient times, natural products, especially plants have been utilized to treat variety of disorders, and an astounding number of contemporary medications have been created from them. All across the world, liver problems are prevalent. These conditions are only mildly handled traditionally; however, allopathic treatment always makes the situation worse when used to address more severe conditions. The current review offers summaries of plants (44 species from various families) with hepatoprotective qualities that may be discovered in literature sources from various databases and are properly categorized based on the parts utilized. Through the use of experimental animal models, all the plants were examined scientifically for their ability to protect the liver by testing certain parameters, such as liver indicators (AST, ALT, ALP, total protein content, albumin, and bilirubin), as well as through histological analysis, the hepatoprotective action was scientifically demonstrated. From the review, phytoconstituents such flavonoids, glycosides, terpenoids, and alkaloids are primarily responsible for medicinal plants' hepatoprotective properties. It will be useful for the researchers to discover a field of traditional systems of medicine. Professionals will find it useful to learn about the world of conventional medical practice. More research on these plants is necessary to evaluate their effectiveness, safety for use around sensitive organs, and precise mechanisms of action in the treatment of liver disorders. INTRODUCTION:The liver is a major organ that plays an important role in the metabolism and elimination of xenobiotics from the human body. The liver is responsible for numerous vital tasks in our survival, including blood purification, detoxification, cholesterol control, digestion, and storage.

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An Approach to Drug-Induced Liver Injury from the Geriatric Perspective

Cited by 9 publications

References 60 publications

Optimal and Safe Pain Management Approach in Ankle and Hindfoot Fractures: Improving Practitioner Decision

Optimal and Safe Pain Management Approach in Ankle and Hindfoot Fractures: Improving Practitioner Decision

Autoimmunity associates with severity of illness in elderly patients with drug-induced liver injury

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