About 39.2% were males, and 60.8% were females. Careers. There is a continual increase of the concerns about paracetamol safety. Thats why, the suggestion of drug legalization to be prescription only or at least a pharmacy-only sale should be considered [45], [56], [57].

Liver failure has been reported even with doses just more than the maximum therapeutic dose [11], [16], [17], [18]. 8600 Rockville Pike Exploring consumers perceptions and knowledge of acetaminophen (paracetamol): a cross-sectional study from Penang, Malaysia. Stomach pain, diarrhea and vomiting were considered the warning signs of paracetamol overdose as identified by the study participants (10.8%, 2.8%, 10.8%). Majority of the participants were of moderate level of socioeconomic status, while 13.6% were high and only 0.6% of low level.

Challenges encountered during COVID-19 pandemic shouldn't be exacerbated by inappropriate usage of drugs, which in turn leads to increased risk of drug-induced toxicities and shortage of drugs [37]. Knowledge regarding Paracetamol instructions of administration and total Knowledge % Score among the studied participants (n=176).

These results agree with Boudjemai et al. The most prevalent exposures in both were paracetamol and cholinesterase inhibitors [46], during the one-year period (1 January to 31 December 2017), a retrospective analysis of poisoning calls received by the Ministry of Health Saudi Poisons Control Centers was conducted to determine the most prevalent toxins among Saudi Arabians. Manipulation of genes could inhibit SARS-CoV-2 infection that causes COVID-19 pandemics. Our result could be explained by that such risky practices are based on deep-seated firm beliefs that paracetamol is a harmless drug. Enas M. A. Mostafa, Khadiga M. Abd-Elrahman: Methodology, Investigation. Accordingly, people's attention may be diverted towards over the counter (OTC) medicines that mitigate fever and aches as non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol (acetaminophen) [10]. Hegazy M., Elfiky A.

Hepatotoxicity can be caused by its repeated supratherapeutic overuse, unintentional misuse, or purposeful intake. [44] study in which they concluded that 57.6% of their research participants were not aware of the signs of paracetamol overdosage [44]. It also warns against exceeding the maximum recommended daily dose as this may lead to hepatic injury and may also lead to death [22], [23].

The Banerjee A., Mukherjee S., Maji B.K.

S. Agrawal, B. Khazaeni, Acetaminophen Toxicity, StatPearls Publishing [Internet], 2018. Enners S., Gradl G., Kieble M., Bhm M., Laufs U., Schulz M. Utilization of drugs with reports on potential efficacy or harm on COVID 19 before, during, and after the first pandemic wave. and transmitted securely. Paracetamol: Mechanism of action, applications and safety concern. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/204767s000lbl.pdf (accessed January 2, 2021).

Data were coded, entered, and manipulated using Microsoft Excel (2016 version).

Ain Shams J. Forensic Med. Dart R.C., Erdman A.R., Olson K.R., Christianson G., Manoguerra A.S., Chyka P.A., Martin Caravati E., Wax P.M., Keyes D.C., Woolf A.D., Scharman E.J., Booze L.L., Troutman W.G.

On the other hand, cytochrome P450 isoforms (CYP2E1, CYP2A6) in liver microsomes convert a small fraction of paracetamol (510%) into a reactive metabolite, N-acetyl-para-benzo-quinone imine (NAPQI), which is linked to paracetamol hepatotoxicity.

We concluded that the unsupervised use of paracetamol is an alarming sign that should be addressed as this could lead to a high rate of accidental paracetamol toxicity. Regardless of various therapeutic benefits for paracetamol, paracetamol toxicity is considered one of the most prevalent forms of poisoning in the globe. A total score was calculated by adding-up the correct choices for knowledge questions and then converted into a percent-score (by division with the maximum score and multiplied by 100). The overall percent-score revealed that only 24.4% of participants had good knowledge about paracetamol and its related potential toxicities.

about navigating our updated article layout. Eliminating such risky behaviors isn't that easy.

Ibrahim T., Agnihotri S., Agnihotri A.K. will also be available for a limited time. Comparison of practice of paracetamol administration before and during COVID-19 pandemic among the studied participants (n=176). Paracetamol toxicity: a review.

We concluded that the unsupervised use of paracetamol is an alarming sign that should be addressed as this could lead to a high rate of accidental paracetamol toxicity. A Chi-square test was used for testing the statistical significance of categorical data.

According to the United States Food and Drug Administration (FDA) guidelines, it is safe to consume up to a maximum daily dose of 4000mg of acetaminophen [19], [20], [21]. The new PMC design is here! Chong C.P., Tan S.F., Chooi W.-T. Patients received supratherapeutic doses to get the maximum therapeutic benefit of the drug [49]. Tuccori M., Convertino I., Ferraro S., Cappello E., Valdiserra G., Focosi D., Blandizzi C. The Impact of the COVID-19 Infodemic on Drug-Utilization Behaviors: Implications for Pharmacovigilance. Paracetamol toxicity- an overview. Majority of the study participants (67%) didnt know about possibility of death with paracetamol overdose. Shi Y., Wang G., Cai X., Deng J., Zheng L., Zhu H., Zheng M., Yang B., Chen Z.

Majority of it is transformed to glucuronidated and sulfated conjugates, which are pharmacologically inactive. The relation between participants demographic characteristics and their knowledge (N=176). Less than half of the participants in our study were knowledgeable about the maximum number of tablets per dose, the maximum number of tablets per day, and the right time space between doses. On the other hand, Hornsby et al. Veale D.J.H., Wium C.A., Mller G.J. A total of 176 participated in this study. Alpha Cronbach test used to assess the internal consistency reliability of the survey revealed good reliability.

6.3% were 50 years of age.

[19] retrospective observational study of paracetamol-intoxicated patients presenting to Bern University Hospital Emergency Department, as 87% reported that they believed that increasing the doses of paracetamol could relieve the unrelieved pain.

Excess NAPQI leads to increased oxidative stress, and mitochondrial dysfunction. Al-Mousa F.A., Al-khayyal R.A., Gado A.M., Tammam H.G., Ragab A.R. Practice of paracetamol administration more than the allowed number of tablets/dose and more than the minimum allowed time space between doses was less evident during the pandemic when compared to before the pandemic (P-value <0.05). General Knowledge regarding paracetamol among the studied participants (n=176). On the other hand, about 86% of the studied consumers in Chong et al. Accordingly, cautious administration of paracetamol by vulnerable groups should be considered[19]. government site. P-value of (< 0.05) was considered statistically significant.

Thus, our result is considered an alarming sign as unaware patients of the alternative names of acetaminophen and the different over-the-counter and prescription medications containing paracetamol/acetaminophen are potentially at risk of developing paracetamol-induced toxicities [12], [15], [39], [40]. Boudjemai Y., Mbida P., Potinet-Pagliaroli V., Gffard F., Leboucher G., Brazier J.-L., Allenet B., Charpiat B. Patients knowledge about paracetamol (acetaminophen): A study in a French hospital emergency department.

Ejeikwu T.M., Folashade W. Risk Perception of Paracetamol Use among Undergraduate Students of University of Jos.

Toxicol. Seven distinct coronaviruses have been recognized until recently. Dorji T., Gyeltshen K., Pongpirul K. Rational use of paracetamol among out-patients in a Bhutanese district hospital bordering India: a cross-sectional study. Moreover, lay people may be uninterested in reading the drug's leaflet which declares the risk of liver damage in cases of overdosage[15], [41].

Our results showed that many of the participants were not knowledgeable about Acetaminophen as a synonym of paracetamol. [42] survey conducted in a French hospital on emergency patients where 38% thought that a paracetamol overdose couldn't cause death [42]. The epidemiology, diagnosis and treatment of COVID-19. sharing sensitive information, make sure youre on a federal Origin and evolution of pathogenic coronaviruses. National Library of Medicine In our study, participants' overall knowledge was not significantly associated with their age, gender, education, residence, and the socioeconomic status.

The present study shows some limitations. Another recent article raised the question of whether paracetamol is the preferable alternative, based on new evidence and hypotheses about the likely significance of limited glutathione (GSH) levels in the worsening of COVID-19. However, less percentage of the participants were knowledgeable about the maximum number of tablets (500mg tablet) per day (16.5%), and only 17% were knowledgeable about the minimum time space between doses.

In this setting, it is critical to not only combat the virus, but also to protect the organ integrity by suitable and focused therapy. Vidhya Malar H.L., Mary Mettilda Bai S. Beware of paracetamol toxicity. Bari K., Fontana R.J. Acetaminophen overdose: What practitioners need to know: Acetaminophen Overdose. The .gov means its official.

Although generalizability of our findings cannot be assured, major concerns on risk perception regarding paracetamol potential toxicities among Egyptians were revealed.

According to the participants' responses, physicians were less concerned to give instructions about possibility of overdosage. However, paracetamol is preferred due to the concerns raised on NSAIDs[35], [37]. Our study showed that participants practice of paracetamol administration without physician prescription was more during COVID-19 pandemic.

Participants practice of paracetamol administration without physician prescription was more during the pandemic (P-value <0.05). [51] study among 441 outpatients in a Bhutanese district hospital bordering India showed poor knowledge about safe use of paracetamol [51]. The questionnaire was then made available for assessing the internal consistency reliability using Alpha Cronbach test which showed good reliability (Cronbach's Alpha was 0.74). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Confidentiality was ensured by keeping the questionnaire anonymous and avoiding mentioning any identifying features of the participants. Prior to the COVID-19 outbreak, the twenty-first century had outbreaks produced by two additional extremely pathogenic zoonotic coronaviruses, the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV). This agrees with the results of a cross sectional survey among 1037 residents of Al Ahsa city- Saudi Arabia which showed that age, gender, and education do not show any association (>0.05) with questions concerned with paracetamol [55].

The site is secure. Another study on 400 consumers at Malaysia showed that 69.1% consider paracetamol a safe drug [44]. About two-thirds of the participants considered paracetamol safer than other medications of the same indications (62.5%). Yoon E., Babar A., Choudhary M., Kutner M., Pyrsopoulos N. Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update. 62.5% of participants considered paracetamol safer than other medications of the same indications. Content validity of the questionnaire was assessed by four experts in, public health and toxicology medicine. Therapeutic misadventures with acetaminophen: Hepatoxicity after multiple doses in children. Li W., Moore M.J., Vasilieva N., Sui J., Wong S.K., Berne M.A., Somasundaran M., Sullivan J.L., Luzuriaga K., Greenough T.C., Choe H., Farzan M. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Potential health concerns must be informed to the general public, and policymakers at all levels. A lesson learnt from COVID-19 pandemic is the need to implement behavior change measures to mitigate the risk of accidental paracetamol toxicity. Almost third of our participants (34.7%) knew that liver is the most affected organ with paracetamol overdose.

Association between participants practices of paracetamol administration before and after COVID-19 Pandemic and their knowledge (N=176). Knowledge, attitude, and practices on over the counter oral analgesics among female students of Jazan University. Our results also revealed that participants administration of paracetamol without physician prescription was more during COVID-19. The Poison Control Center at Ain Shams University Hospitals (PCC-ASUH) is Egypt's primary poison control center.

25.6% and 31.8% considered the importance of cautious administration of paracetamol when used with other drugs containing paracetamol in their ingredients and with other non-paracetamol drugs respectively. Only 9.7% knew that acetaminophen is a synonym of paracetamol. The authors declare that they have no competing interests. The lack of such knowledge about paracetamol is an alarming sign as this may place patients at risk of toxicity by taking supratherapeutic doses [42]. Ethics approval and consent to participate. (2013) survey among emergency department patients in a French hospital where 30% knew the maximum daily dose to be 4g and 48% considered the minimum time between two doses to be 4h [42]. Accordingly, careful monitoring of paracetamol use during pregnancy is mandatory [20]. Tawfik H., Khalifa E. Evaluation of Poisoning and Drug Overdose among Cases Presented to Poison Control Centre, Ain Shams University Hospital during the Year 2015. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Tittarelli R., Pellegrini M., Scarpellini M.G., Marinelli E., Bruti V., Luca N.M.D., Busard F.P., Zaami S. Hepatotoxicity of paracetamol and related fatalities.

There were 662 TAH hospitalizations and 2459 hospital-based TPIC consults. These considerations about paracetamol -as a safe medication and the decreased possibility of causing toxicity- disagree with existence of paracetamol toxicity cases in different settings; according to PPC-ASUH in Egypt, paracetamol is one of the top ten most frequently involved exposure substances received in PCC-ASUH during 2019 [25], [26], Over a year (1 August 200831 July 2009), a survey was conducted based on acute poisoning admissions to investigate patterns in admissions and the initial management of hospital admissions for acute poisoning at Tygerberg Academic Hospital (TAH) and hospital-based poisoning consultations with the Tygerberg Poison Information Centre (TPIC) in Parow, Cape Town, South Africa. Therefore, we aim at assessing the knowledge, and attitude of a sample of Egyptian population regarding paracetamol safe usage and its related potential toxicities as well as their practices regarding the use of paracetamol before and during COVID-19 pandemic. Zhai P., Ding Y., Wu X., Long J., Zhong Y., Li Y.

This could be explained by considering symptomatic treatment at the start of treatment COVID-19 patients who suffer from fever or pain, including paracetamol and NSAIDs [53]. Saccomano S.J. World Health Organization in collaboration with the United Nations Environment Programme and the International Labour Organization, Guidelines On the Prevention of Toxic Exposures: Education and public awareness activities/ International Programme on Chemical Safety., (2004).

Worldwide flavor enhancer monosodium glutamate combined with high lipid diet provokes metabolic alterations and systemic anomalies: An overview. Accordingly, hazardous levels of NAPQI will accumulate. First, the use of a self-report questionnaire might have resulted in social desirability and recall bias.

This result disagrees with Salih et al. On a percent scale, the mean overall knowledge score was 3615. (2010) study concluded that one-half of their research participants recognized liver damage as the primary toxicity [38]. Practice of paracetamol administration more than the allowed number of tablets/day was significantly more evident during the pandemic.

Such practice could be a major contribution to the increased rate of paracetamol-induced toxicities[19], [38].

Informed consent to participate in this study was obtained from all study participants. Third, we used a convenience sampling approach, which resulted in a non-probability sample, limiting the generalizability of our findings. Accordingly, the practice of self-medication has also increased. Pattern of Acute Poisoning Cases Admitted to Menoufia Poisoning and Addiction Control Center: A Prospective Study. It exists both in the form of a single component or multi-component preparations, also as OTC and prescription formulations [11], [12]. Overall percent-score revealed that only 24.4% of participants had good knowledge about paracetamol and its related potential toxicities.

The results of CFA showed a statistically significant correlation between the questionnaire items. Our results could be explained by the misbelief that paracetamol is harmless. Drugs poisoning represented 25.4%, and Paracetamol was 6.7% [27].

Our results also agree with Ejeikwu and Folashade (2019) study who declared that 53.6% of the studied undergraduate students at the University of Jos, Plateau state, Nigeria do not consider paracetamol self-administration harmful [41]. Sestili P., Fimognari C. Paracetamol-Induced Glutathione Consumption: Is There a Link With Severe COVID-19 Illness? Completion of the online survey denoted participants consent to participate in the study. Accessibility 42.6% could advise others to use paracetamol without prescription (Table 3).

aForensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt, bPublic Health and Community Medicine Department, Faculty of Medicine, Port-Said University, Port-Said, Egypt. Fourth, there were deficient similar studies in developing countries to compare with. Such results agree with Ejeikwu and Folashade (2019) study on undergraduate students at University of Jos, Plateau state, Nigeria about the risk perception of paracetamol use where only 39.5% considered intake of paracetamol with Procold harmful [41]. Lauder S.N., Taylor P.R., Clark S.R., Evans R.L., Hindley J.P., Smart K., Leach H., Kidd E.J., Broadley K.J., Jones S.A., Wise M.P., Godkin A.J., ODonnell V., Gallimore A.M. Paracetamol reduces influenza-induced immunopathology in a mouse model of infection without compromising virus clearance or the generation of protective immunity. Ali S.I., Khawaja R., Khan A., Almulhim A.M. Accordingly, they become more subjected to accidental poisoning [42]. Fever, fatigue, dry cough, and pulmonary manifestations are COVID-19 common clinical manifestations.

However, practice of paracetamol administration more than the allowed number of tablets/day was more evident during the pandemic than before the pandemic (P-value <0.05) (Table 4). ACE2 Receptor Expression and Severe Acute Respiratory Syndrome Coronavirus Infection Depend on Differentiation of Human Airway Epithelia. Paracetamol is one of the most effective and most widely used analgesics and antipyretics worldwide. Participants' attitude was assessed with three-point Likert scale (agree, neutral, disagree), while participants' practice was assessed by yes/no questions. For pregnant, our results disagree with those of Chong et al. Many of the participants were not knowledgeable about the possibility of toxicity with paracetamol administration.