Poisoning by acetaminophen is a serious public health concern because of its accessibility and the ease with which overdoses can occur accidentally or on purpose. The liver metabolizes acetaminophen, and when taken in excess, it is transformed into a poisonous metabolite that seriously damages the liver and may result in hepatic failure and death. The cornerstone of treatment is the early administration of N-acetylcysteine, which is most effective within 8 hours of ingestion. Co-ingestants, therapy timing, and pre-existing liver diseases are some of the factors that affect toxicity. Both unintentional overdoses and deliberate poisonings have legal and forensic ramifications, especially where minors or self-harm are involved. In fatal cases, a toxicological investigation is essential to identify the cause of death and differentiate acetaminophen poisoning from other possible causes. Regulations such as age restrictions, pack-size constraints, and improved labeling have demonstrated the potential to reduce the prevalence of acetaminophen toxicity. Intentional and accidental overdoses can be avoided in part by raising public awareness and educating healthcare professionals. To lessen the impact of acetaminophen poisoning on public health systems, more research is required to enhance early identification, improve treatment techniques, and guide policy decisions. This review aims to familiarize clinicians and forensic professionals with the pharmacology, clinical presentation, management, and medicolegal aspects of acetaminophen toxicity..

The improper disposal of pharmaceuticals such as paracetamol and propranolol represent a significant environmental concern due to their high persistence in the environment and low removal efficiency by conventional wastewater treatment processes. In this context, this work aimed to develop and evaluate five adsorbents derived from peanut shells precursor for removal of paracetamol and propranolol in a binary mixture (228 and 279 nm), an application that has not yet been explored for this bioresidue. Among the produced adsorbents, phosphoric-acid-modified activated carbon (CAH3PO4) presented the best performance, achieving removal efficiencies of 99.40% and 99.47% at wavelengths of 228 and 279 nm, respectively. This result can be attributed to its high specific surface area (547 m[2] g [-1]) and the presence of oxygenated and phosphorylated functional groups on the CAH3PO4 surface, formed through thermochemical treatment. The kinetic data were best fitted to pseudo-second order model, indicating the predominance of chemical interactions between adsorbate and adsorbent. In the equilibrium study, the data best fitted the Sips model, suggesting a surface with both homogeneous and heterogeneous adsorption sites. Thermodynamic analysis revealed that the adsorption process is exothermic, indicating spontaneous and energetically favorable interactions. These results highlight the high adsorption potential of CAH3PO4 as an effective and viable alternative for the treatment of pharmaceutical-contaminated effluents.

Objective: To describe the timing, frequency, and accessibility of Instagram posts from pediatric health institutions during the 2025 acetaminophen-autism controversy.Methods: Cross-sectional audit of public Instagram accounts of 62 pediatric health institutions from September 22 to November 15, 2025. The a priori sampling frame comprised the top 50 US children's hospitals for pediatric behavioral health, the top 10 Honor Roll children's hospitals (US News and World Report), 5 national medical societies, and health departments of the 10 states with the largest pediatric populations. Posts were extracted with a web-scraping tool and manually verified. Two reviewers independently coded relevant posts for prespecified content and accessibility features. Readability was assessed with two validated measures.Results: Twelve of 62 institutions (19%) posted relevant content. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists posted on day 0, while hospital time to first post ranged from 3 to 51 days. No state health department posted. Nonresponding institutions remained active: 1 hospital published 108 unrelated posts. The 26 relevant posts had a mean Flesch-Kincaid Grade Level of 11.4 and SMOG Index of 10.2. Among coded features, 88% included resource links, 73% directed audiences to a health care provider, 46% featured a named clinician, 42% discussed risks and benefits, and none were multilingual.Conclusions: Most sampled institutions published no relevant content during an active health controversy despite remaining active. Readability of relevant posts exceeded recommended targets, and none were multilingual. These gaps in institutional communication infrastructure could be addressed.

Recent studies indicate that injury-induced dedifferentiation generates transient regenerative progenitors (TRPs), which support tissue repair across multiple organs, including the liver. In vivo partial reprogramming using Yamanaka factors (Oct4, Sox2, Klf4, and c-Myc; OSKM) produces intestinal TRPs closely resembling those arising from injury-induced dedifferentiation, but transgenic or viral approaches raise safety concerns because of prolonged expression. Here, we show that transient OSKM induction generates two distinct liver progenitor-like cell (LPLC) populations without injury and with limited activation of injury-associated immune responses. Single-nucleus RNA sequencing shows that one population resembles injury-induced LPLCs observed in acetaminophen-injured mouse and human livers. To develop a temporally controlled regenerative strategy, we establish a liver-targeted lipid nanoparticle system for OSKM mRNA delivery. OSKM mRNA-LNP treatment induces hepatocyte dedifferentiation and Sox9[+] LPLC-like cell formation and is associated with enhanced regeneration after acetaminophen-induced injury. Together, these findings identify transient hepatic reprogramming as a strategy for inducing regenerative plasticity and support liver-targeted OSKM mRNA delivery as a potential approach for acute liver injury.

Real-world evidence on systemic diclofenac patch use in cancer pain is limited. We described prescribing patterns in oncology practice. In this single-center retrospective descriptive study, we reviewed consecutive patients with cancer who received a systemic diclofenac patch (75 mg per patch) for cancer-related pain at a Japanese university hospital (n = 48). The usual regimen was two 75-mg patches once daily (150 mg/day); one patient started one 75-mg patch/day. Among 48 patients, 35 (73%) retained oral medication intake and 32 (67%) were receiving ongoing anticancer therapy at patch initiation. Gastroprotective agents were co-prescribed in 31 patients (65%), any acetaminophen in 29 (60%; scheduled acetaminophen in 28 [58%]), and opioids in 28 (58%). Transdermal fentanyl-containing regimens were observed in 9 patients (19%), whereas strict all-transdermal scheduled baseline analgesia was identified in 3 (6%). No recipient had documented clinically apparent gastrointestinal bleeding or symptomatic peptic ulcer during available follow-up. The systemic diclofenac patch was prescribed to selected patients with cancer-related pain in routine Japanese practice and was commonly incorporated into multimodal analgesic regimens. These findings describe prescribing patterns and chart-documented observations only; prospective studies with standardized outcomes are needed to clarify effectiveness, safety, and patient-centered impact.

N-acetylcysteine (NAC) is used in small-animal medicine as an antidote, mucolytic, thiol donor, and cytoprotective adjunct, yet its evidentiary basis varies markedly among indications and between dogs and cats. We systematically evaluated species-specific pharmacokinetic, clinical, experimental, and in vitro evidence to distinguish established uses from extrapolated practice.

A woman in her 80s was diagnosed with colon cancer, and she underwent chemotherapy after surgery. Oxycodone extended-release tablets were initiated for abdominal pain, but oral administration was difficult, leading to a change to fentanyl patches. Owing to severe numbness from the buttocks to the toes, tramadol/acetaminophen (T/A) tablets were initiated at a dose of 2 tablets per day. The fentanyl patch dose was increased to 2 mg/d, and pain was relieved on combination with 2 T/A tablets. The patient subsequently reported behavioral disturbances, including agitation, anxiety, and sudden diarrhea. She had been taking 1 T/A tablet 2 to 3 times per day at her discretion when the pain worsened. Suspecting an additive effect from the combination of the fentanyl patch and T/A tablets, the T/A tablets were immediately discontinued, and the symptoms resolved. Loxoprofen tablets were initiated at 180 mg/d, and the fentanyl patch dose was increased to 4 mg/d, without side effects such as agitation, anxiety, or behavioral disorders. The combined use of tramadol and fentanyl likely induced excessive serotonergic activity; careful observation is required in adult patients and those receiving multiple medications.

Study DesignRetrospective Cohort Study.ObjectivesTo determine whether cytochrome P450 2D6 (CYP2D6) metabolizer phenotype is associated with new persistent opioid use after cervical, thoracic, or lumbar spine surgery among opioid-naive adults.MethodsAdults with whole-genome sequencing data who underwent cervical, thoracic, or lumbar fusion or decompression between May 2018 and January 1, 2025, were identified in the All of Us Research Program. Participants had 365 days of baseline observation, 180 days of postoperative follow-up, and no opioid fills from 365 to 30 days before surgery. CYP2D6 phenotype was categorized as poor, intermediate, normal, or ultrarapid metabolizer. New persistent opioid use required a perioperative opioid fill and another fill 90 to 180 days postoperatively. Associations were estimated using Firth-penalized logistic regression adjusted for ancestry principal components and clinical covariates.ResultsAmong 3,820 participants, 460 (12.0%) developed new persistent opioid use. The overall association across CYP2D6 phenotypes was significant (χ[2] = 15.30; P = .002). Compared with normal metabolizers, adjusted odds ratios were 1.48 (95% CI, 1.00-2.18) for poor, 1.05 (95% CI, 0.85-1.30) for intermediate, and 1.50 (95% CI, 0.89-2.54) for ultrarapid metabolizers. Poor metabolizers receiving hydrocodone had higher odds of persistent use (OR, 2.15; 95% CI, 1.07-4.32).ConclusionsCYP2D6 phenotype was associated with new persistent opioid use after spine surgery, with higher risk estimates at the metabolic extremes. Extreme-phenotype estimates were reportable only in European-ancestry participants, so risk in other ancestry groups remains unknown. Medication-specific replication in larger, ancestry-diverse cohorts is needed before clinical implementation.