Utilisation de la N-acétylcystéine pour le traitement de l’hépatotoxicité induite par un traitement antituberculeux
Bibliographic record
Abstract
Resume Objectif : Presenter un cas d’hepatotoxicite induite par un traitement antituberculeux et traite avec de l’acetylcysteine. Resume du cas : Il s’agit d’un homme de 66 ans d’origine vietnamienne transfere a l’urgence a la suite de sa visite medicale mensuelle en raison de la presence d’un bilan hepatique anormal, de nausees, d’une diminution de l’appetit, de fatigue et d’un ictere, qui sont apparus environ une semaine auparavant. Un mois plus tot, le patient avait debute un traitement pour une tuberculose active, comprenant de l’isoniazide, de la rifampine, de l’ethambutol, de la pyrazinamide et de la pyridoxine depuis un peu plus d’un mois. Son bilan hepatique montrait une augmentation des transaminases, de la phosphatase alcaline, de la bilirubine totale et directe et du ratio normalise international. A la suite de l’arret du traitement antituberculeux et des le debut de la perfusion continue d’acetylcysteine, on a pu constater des ameliorations du bilan hepatique et du ratio normalise international. Discussion : Les etudes a repartition aleatoire et controlees actuellement disponibles concluent a une amelioration de la survie avec l’utilisation de la N-acetylcysteine pour le traitement de l’hepatotoxicite non induite par une intoxication a l’acetaminophene. Toutefois, les donnees liees a son utilisation pour le traitement de l’hepatotoxicite induite par les antituberculeux demeurent limitees. Conclusion : L’arret du traitement demeure la pierre angulaire du traitement lors d’hepatotoxicite induite par les antituberculeux. Les donnees appuyant l’utilisation de la N-acetylcysteine dans les cas d’hepatotoxicites demeurent limitees. Neanmoins, ce traitement pourrait etre pris en consideration pour les patients ayant des valeurs d’enzymes hepatiques elevees malgre l’arret de l’agent causal et n’etant pas des candidats a la transplantation hepatique. Abstract Objectives: To present a case of antitubercular therapy induced hepatotoxicity treated with acetylcysteine. Case summary: A 66-year-old man of Vietnamese origin who admitted to the emergency room after his monthly medical check-up because of an abnormal liver profile, nausea, decreased appetite, fatigue and jaundice, which had appeared about a week earlier. A month earlier, the patient had started treatment for active tuberculosis, which included isoniazid, rifampin, ethambutol, pyrazinamide and pyridoxine. His liver profile showed an increase in the transaminase and alkaline phosphatase levels, the total and direct bilirubin, and the international normalized ratio. After the antitubercular treatment was stopped and as soon as a continuous infusion of acetylcysteine was started, the liver profile and international normalized ratio improved. Discussion: Currently available randomized controlled studies on the use of N-acetylcysteine to treat hepatotoxicity not related to acetaminophen intoxication mention that survival is improved. However, data concerning its use to treat antitubercular-induced hepatotoxicity are limited. Conclusion: Discontinuing the therapy is the cornerstone of treatment for antitubercular-induced hepatotoxicity. The data supporting the use of N-acetylcysteine in cases of hepatotoxicity are limited. Nevertheless, this treatment might be considered for patients with elevated liver enzyme values despite withdrawal of the causal agent and who are not candidates for a liver transplant.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".