Aspirin and Reye's syndrome: discovery of aspirin and paracetamol

Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease

INTRODUCTION

Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur.

AREAS COVERED

This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide.

EXPERT OPINION

Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.

Microwave-Aided Reactions of Aniline Derivatives with Formic Acid: Inquiry-Based Learning Experiments

The synthesis of amides belongs to traditional experimental tasks not only in organic chemistry exercises at universities but also at chemically focused secondary schools or in special practices at general high schools. An example of such a synthesis may be the preparation of acetanilide via reaction of aniline with acetic acid or acetic anhydride. However, both of these reactions are associated with a rather long reaction time and certain hazards that limit their straightforward use in pedagogical practice. Conveniently, the reaction of aniline with acetic acid may be significantly optimised if it is performed under solvent-free conditions in the presence of microwaves, which reduces considerably the reaction time and provides very good yield, compared to traditional heating by a heating nest. In this study, the main pedagogical aim of the experimental design is elucidation of the influence of the structure of the amines on the course of the reaction with formic acid through inquiry-based learning. Specifically, the proposed experiments consist in investigation of the chemical yield achieved in microwave assisted reactions of aniline and its derivatives with formic acid in such a way that is adequate for constructive learning of undergraduate chemistry students. The selected series of amines involves aniline, 4-methoxyaniline, 4-chloroaniline, and 4-nitroaniline. In accordance with the chemical reactivity principles, students gradually realise that the influence of the substituent is reflected in the reaction yield, which grows in the following order: N-(4-nitrophenyl)formamide ˂ N-(4-chlorophenyl)formamide ˂ N-phenylformamide ˂ N-(4-methoxyphenyl)formamide. Therefore, the results of the experiments enable students to discover that stronger basicity of the amine increases the yield of the amide. In order to deepen the students’ chemical knowledge and skills, the concept of the experiments was transformed to support inquiry-based student learning. The proposed experiments are intended for experimental learning in universities educating future chemistry teachers, but they may be also utilised in the form of workshops for students at secondary schools of a general educational nature.

Chorismate synthase mediates cerebral malaria pathogenesis by eliciting salicylic acid-dependent autophagy response in parasite

Cerebral malaria caused by Plasmodium falciparum is the severest form of the disease resulting in the morbidity of a huge number of people worldwide. Development of effective curatives is essential in order to overcome the fatality of cerebral malaria. Earlier studies have shown the presence of salicylic acid (SA) in malaria parasite P. falciparum, which plays a critical role in the manifestation of cerebral malaria. Further, the application of SA for the treatment of acute symptoms in cerebral malaria increases the activity of iNOS leading to severe inflammation-mediated death, also called as Reye's syndrome. Therefore, modulation of the level of SA might be a novel approach to neutralize the symptoms of cerebral malaria. The probable source of parasite SA is the shikimate pathway, which produces chorismate, a precursor to aromatic amino acids and other secondary metabolites like SA in the parasite. In this work, we performed the immunological, pathological and biochemical studies in mice infected with chorismate synthase knocked-out Plasmodium berghei ANKA, which does not produce SA. Fewer cerebral outcomes were observed as compared to the mice infected with wild-type parasite. The possible mechanism behind this protective effect might be the hindrance of SA-mediated induction of autophagy in the parasite, which helps in its survival in the stressed condition of brain microvasculature during cerebral malaria. The absence of SA leading to reduced parasite load along with the reduced pathological symptoms contributes to less fatality outcome by cerebral malaria.

Effects of prostaglandins and COX-inhibiting drugs on skeletal muscle adaptations to exercise

It has been ∼40 yr since the discovery that PGs are produced by exercising skeletal muscle and since the discovery that inhibition of PG synthesis is the mechanism of action of what are now known as cyclooxygenase (COX)-inhibiting drugs. Since that time, it has been established that PGs are made during and after aerobic and resistance exercise and have a potent paracrine and autocrine effect on muscle metabolism. Consequently, it has also been determined that orally consumed doses of COX inhibitors can profoundly influence muscle PG synthesis, muscle protein metabolism, and numerous other cellular processes that regulate muscle adaptations to exercise loading. Although data from acute human exercise studies, as well as animal and cell-culture data, would predict that regular consumption of a COX inhibitor during exercise training would dampen the typical muscle adaptations, the chronic data do not support this conjecture. From the studies in young and older individuals, lasting from 1.5 to 4 mo, no interfering effects of COX inhibitors on muscle adaptations to resistance-exercise training have been noted. In fact, in older individuals, a substantial enhancement of muscle mass and strength has been observed. The collective findings of the PG/COX-pathway regulation of skeletal muscle responses and adaptations to exercise are compelling. Considering the discoveries in other areas of COX regulation of health and disease, there is certainly an interesting future of investigation in this re-emerging area, especially as it pertains to older individuals and the condition of sarcopenia, as well as exercise training and performance of individuals of all ages.