A22 A HIDDEN CAUSE OF DRUG-INDUCED LIVER FAILURE
Notice bibliographique
Résumé
Nimesulide is a non-steroidal anti-inflammatory drug with relative selectivity for cyclooxygenase-2 enzyme marketed in 1985. Nimesulide was never approved for use in Canada, United States, United Kingdom, Australia, or New Zealand due to safety concerns. Multiple reports in the literature have linked nimesulide to severe liver injuries ranging from marked aminotransferase elevation to acute liver failure (ALF), need for liver transplantation, and death. Such reports have led to nimesulide’s withdrawal from the market in Finland and Spain in 2002, and in Ireland in 2007; however, it remains widely available in more than 50 countries worldwide. The mechanism for its hepatotoxicity remains unknown. We report a fatal case of ALF sustained by consumption of a “herbal” product purchased in Canada. Chart review. A 52-year-old female developed jaundice and malaise with rapid progression to ALF. Her past medical history was significant for type 2 diabetes, hypothyroidism, sickle cell trait, and breast adenocarcinoma in remission. Her medications included metformin, levothyroxine, tamoxifen, and “herbal” medications (Arjun heart tonic, R. Pyine and Hari tablets). She had no risks factors for chronic liver disease and family history was non-contributory. After initial presentation to a community hospital, she was transferred to a liver transplant center where she developed encephalopathy associated with worsening liver function. Serologies were negative for viral, auto-immune, and metabolic etiologies. Acetaminophen and ethanol levels were undetectable. Imaging showed patent hepatic vasculature, normal biliary ducts and hepatic parenchyma. Her clinical status deteriorated further and she underwent an orthotropic liver transplant three weeks after presentation. The liver explant appeared pale and shrunken. Histopathologic examination showed subacute massive paracinar and periportal necrosis compatible with drug-induced liver injury. Since the patient’s labeled “herbal” medications did not include hepatotoxic drugs, the “herbal” products were analyzed by our medicinal chemistry lab and revealed presence of high concentrations of nimesulide and chlordiazepoxide within two of the three herbal products. Four days postoperatively, she passed away due to sepsis and multiorgan failure. In Canada, 73% of the population regularly consumes herbal products. The majority (59%) of herbal medicines sold in North America contain ingredients that are not listed on the label. Here, we report a fatal case of ALF sustained by consumption of a commercially available herbal product that contained a known pharmaceutical product that is neither approved nor marketed in Canada. This case highlights the urgent need for governmental regulation and consumer safety policies regarding the manufacture, importation and dispensing of herbal/natural products to prevent serious adverse events. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».