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Viral Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Management: In immunocompetent children, routine antiviral therapy is not recommended, and varicella can be treated symptomatically with antipyretics, antihistamines, and topical anti-pruritic lotions. Aspirin should be avoided in children because it increases the risk of Reye syndrome. Antiviral agents are FDA-approved treatments for children >2 years and adults. Antivirals initiated within 24–72 hours of lesion onset would have maximum benefit with the decrease in the severity of symptoms and time to healing. Acyclovir at 20 mg/kg (800 mg maximum) four times a day for 5–7 days or valacyclovir 20 mg/kg TID (1000 mg maximum) for 5 days are the recommended dosages. The varicella vaccine, which is a live attenuated vaccine given at 12–15 months and 4–6 years, has been crucial in decreasing rates of varicella and preventing severe disease.
Breast Feeding
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Induction with thiopental and propofol is safe. All volatile agents and muscle relaxants are thought to be safe. Analgesia is best achieved with combination therapy, thus limiting the use of opioids. Non-steroidal anti-inflammatory drugs (anti-prostenoids) are not contraindicated with the exception of aspirin. There is a theoretical risk of Reye’s syndrome with the latter.
3-Hydroxy-3-methylglutarylCoA lyase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Hyperammonemia has been observed in about 50 percent of patients [4]. In three patients, concentrations ranged from 388 μM/L to 1370 μmol/L [4] and in one patient the plasma concentration of ammonia was greater than 2000 μmol/L [3]. Abnormal liver function tests included alanine and aspartate aminotransferase [1, 6]; bilirubin, gamma-glutamyl transpeptidase (gGT) [11], and prolonged prothrombin time [6, 7], all of which lead to confusion with the diagnosis of Reye syndrome. In fact, the provisional diagnosis was Reye syndrome in the first four patients reported. With successful treatment, the abnormalities in liver function disappear. The prognosis is guarded. Death has been observed in at least five patients [8, 11, 17, 18, 22], as has sudden death in a 13-month old.
Chikungunya fever: a threat to global public health
Published in Pathogens and Global Health, 2018
Raíza Nara Cunha Moizéis, Thales Allyrio Araújo de Medeiros Fernandes, Paulo Marcos da Matta Guedes, Hannaly Wana Bezerra Pereira, Daniel Carlos Ferreira Lanza, Judson Welber Veríssimo de Azevedo, Josélio Maria de Araújo Galvão, José Veríssimo Fernandes
Therefore, the treatment that is being performed is only in support of individuals who suffer from intense pain in the joints. The use of non-steroidal anti-inflammatory drugs (NSAIDs), antipyretics and analgesics for the relief of symptoms is recommended. Other drugs such as codeine and tramadol may be used to treat refractory or severe allergic symptoms. The use of these resources associated with rest has shown variable efficiency, but does not solve the problem of artralgias. The use of aspirin should be avoided in the first weeks of the disease because of the difficulty in establishing the differential diagnosis in the acute phase between chikungunya fever and dengue fever, and aspirin would increase the risk of bleeding if the patient has dengue. In addition, salicylate should also be avoided because the use of this drug in acute viral infections in children may lead to Reye syndrome. In the chronic phase, an oral corticosteroid may be recommended for treating musculoskeletal and neuropathic complaints, using low doses (5 to 20 mg/day) of prednisone or prednisolone. The usage time may vary from six to eight weeks and then must be withdrawn. One study showed that the risk of reoccurring joint symptoms after treatment withdrawal was slow and gradual [111].
The development and hepatotoxicity of acetaminophen: reviewing over a century of progress
Published in Drug Metabolism Reviews, 2020
Mitchell R. McGill, Jack A. Hinson
Only in the past 50 years has APAP become the analgesic drug of choice. This occurred for a few major reasons. First, Greenberg and Lester demonstrated that APAP is a metabolite of acetanilide, and that the methemoglobinemia observed by von Mering was probably not due to APAP itself (Greenberg and Lester 1947). Shortly thereafter, Brodie and Axelrod found that APAP is also the major metabolite of phenacetin (Brodie and Axelrod 1949), and indeed that it is the pharmacologically active product (Flinn and Brodie 1948). Second, phenacetin was acutely and chronically nephrotoxic. Long-term abuse of phenacetin was associated with kidney damage, renal carcinoma, and tumors of the bladder. It was also carcinogenic in long-term feeding studies in both mice and rats and induced tumors of the kidney and lower urinary tract. Thus, the US FDA removed it from the market in 1983. Although phenacetin is metabolized to APAP, nephrotoxicity was not associated with APAP early on. Seeing an opportunity, McNeil Laboratories introduced APAP to the market in a barbiturate combination called Algoson, then later as a stand-alone product under the brand name Tylenol. Although the NSAID aspirin was also available as an analgesic by this time, APAP became more popular than aspirin due to the absence of GI toxicity. Aspirin causes GI bleeding. It has also been associated with Reye’s syndrome (Schror 2007), a rare condition that may occur in children that causes swelling of the liver and brain. Furthermore, in contrast to aspirin, APAP does not prevent blood from clotting, so it can be used in patients who have concerns with blood coagulation such as during and following surgery.
Acute necrotizing encephalopathy
Published in Baylor University Medical Center Proceedings, 2022
Roberto Hernandez, Richi Ota, Yasier Medina, Yaimara Hernandez, Parunyou Julayanont, Henrik Wilms
Neurological complications of viral infections ranging from febrile seizures to ANE are rare, and they are reported more often in children than in adults. Approximately 21% to 45% of patients with neurological complications from influenza experience moderate to severe neurological disability.6 The incidence of influenza-associated encephalitis is about 0.21 per million.7 The differential diagnosis includes Reye syndrome, acute disseminated encephalomyelitis, Wernicke’s encephalopathy, as well as ANE secondary to other viruses like COVID-19.8