N-acetylcysteine In Patients Research Articles

Antioxidative effects of N-acetylcysteine in patients with β-thalassemia: A quick review on clinical trials.

Several studies have highlighted the potent antioxidant properties of N-acetyl cysteine (NAC). This review aimed to assess the impact of NAC on oxidative stress biomarkers in patients with β-thalassemia. The review included articles published before 2024 that investigated the effects of NAC on oxidative stress in individuals with β-thalassemia. A comprehensive search was conducted across various databases, including Scopus, PubMed, Web of Science, Trip, and CENTRAL. Only English-language clinical trials were considered for inclusion in this review. Besides, the number needed to treat (NNT) was calculated based on the included studies. Ninety-nine articles were retrieved from electronic databases, and after a thorough review, eight articles were selected for comprehensive text analysis. The highest dose of NAC administered was 10 mg/kg/day (equivalent to 600 mg/day) over a period of 3-6 months. All the studies assessing the impact of NAC on oxidative stress indicators in β-thalassemia patients demonstrated positive effects during the 3-month follow-up period. Most estimated NNTs fell into 1-5, suggesting significant clinical therapeutic value in this context. The current potency of NAC alone appears to be effective in ameliorating oxidative stress in patients with β-thalassemia major. While a 3-month duration seems adequate to demonstrate the antioxidant properties of NAC in this population, larger and well-designed clinical trials are warranted. Current clinical evidence possesses a high risk of bias.

Evaluating the mucolytic effectiveness of Ambroxol and N-Acetylcysteine in patients with Acute exacerbation of chronic obstructive pulmonary disease

IntroductionChronic obstructive pulmonary disease (COPD) is the third most fatal disease globally. Acute deterioration of the patient's respiratory symptoms is known as an acute exacerbation of COPD (AECOPD), that goes beyond usual variations and result in change in medications. Ambroxol (ABX) and N-acetylcysteine (NAC), are mainly used as mucolytics in the treatment of AECOPD. MethodologyThis prospective observational study examines effectiveness of ABX and NAC in COPD patients by assessing the quality of cough relief, peak expiratory flow rate (PEFR), length of hospital stay, quality of life (QOL) and reduction in symptoms of COPD. Leicester Cough Questionnaire (LCQ); Breathlessness, Cough and Sputum scale (BCSS)and St. George Respiratory Questionnaire (SGRQ) scales are used to evaluate patient condition before and after the treatment. ResultsThe mean duration of hospital stay for NAC and ABX were found to be 8 ± 3.6 and 9.9 ± 3.9 days, respectively. Lung function in both groups improved with a change in percentage mean score of PEFR. Reduction in symptoms of COPD was evident in both groups by decrease in mean BCSS score from admission to discharge. Our study also demonstrated better QOL in both groups using SGRQ. LCQ showed a mean increase in all domains: physical, psychological and social. ConclusionIt was concluded that both ABX and NAC leads to betterment in lung function, cough relief and control AECOPD. Hence, this study gives a signal to clinicians about these treatment options along with standard therapy of COPD for a better therapeutic outcome.

The potential use of N-acetylcysteine in respiratory conditions

Currently, despite the accumulated experience with the use of N-acetylcysteine (NAC) in scientific and real clinical practice, there are a number of questions about its potential and the future prospects for its use.The aim of this work was to summarize new data on the use of NAC in patients with various conditions, based on publications in domestic and foreign medical journals.Results. The article presents an overview of publications in domestic and foreign medical journals devoted to the use of N-acetylcysteine (NAC) in pulmonology practice. The experience with the use of NAC in chronic bronchitis (CB), chronic obstructive pulmonary disease (COPD), bronchial asthma, community-acquired pneumonia, idiopathic pulmonary fibrosis, postinfectious bronchiectasis, and acute respiratory distress syndrome associated with COVID-19 (COronaVIrus Disease 2019) is summarized. The aspects of dose-dependent clinical effects and long-term administration of NAC in CB and COPD are analyzed. In addition, there are controversial and contradictory data on the possibility of prescribing NAC for idiopathic pulmonary fibrosis.Conclusion. NAC is a drug with a broad spectrum of action. Due to its antioxidant and anti-inflammatory properties, minor side effects compared to other anti-inflammatory drugs even at high doses, and low price, NAC can be prescribed for many respiratory diseases. Although it has been used for more than half a century, interest in both its practical application and clinical research has not waned to this day.

Add-on Sodium Benzoate and N-Acetylcysteine in Patients With Early Schizophrenia Spectrum Disorder: A Multicenter, Double-Blind, Randomized Placebo-Controlled Feasibility Trial.

Oxidative stress pathways may play a role in schizophrenia through direct neuropathic actions, microglial activation, inflammation, and by interfering with NMDA neurotransmission. N-acetylcysteine (NAC) has been shown to improve negative symptoms of schizophrenia, however, results from trials of other compounds targeting NMDA neurotransmission have been mixed. This may reflect poor target engagement but also that risk mechanisms act in parallel. Sodium Benzoate (NaB) could have an additive with NAC to act on several pathophysiological mechanisms implicated in schizophrenia. A multicenter, 12 weeks, 2 × 2 factorial design, randomized double-blind placebo-controlled feasibility trial of NaB and NAC added to standard treatment in 68 adults with early schizophrenia. Primary feasibility outcomes included recruitment, retention, and completion of assessments as well as acceptability of the study interventions. Psychosis symptoms, functioning, and cognitive assessments were also assessed. We recruited our desired sample (n = 68) and retained 78% (n = 53) at 12 weeks, supporting the feasibility of recruitment and retention. There were no difficulties in completing clinical outcome schedules. Medications were well tolerated with no dropouts due to side effects. This study was not powered to detect clinical effect and as expected no main effects were found on the majority of clinical outcomes. We demonstrated feasibility of conducting a clinical trial of NaB and NAC. Given the preliminary nature of this study, we cannot draw firm conclusions about the clinical efficacy of either agent, and a large-scale trial is needed to examine if significant differences between treatment groups emerge. ClinicalTrials.gov: NCT03510741.

An Optimal Dose Finding Study of N-Acetylcysteine in Patients with Myeloproliferative Neoplasms

Background and Significance: The major clinical issues that impact myeloproliferative neoplasm (MPN) patients are thromboses, debilitating symptoms such as itching and fatigue, and progression to acute leukemia. There are no available therapies that address all three of these issues. We have found that N-acetylcysteine (N-AC), an anti-oxidant with an established safety profile, protects animal MPN models from thrombosis and extends survival. Moreover, N-AC is known to reduce inflammation and protect cells from DNA damage, properties which are likely to be beneficial for reduction in symptoms and prevention of leukemia, respectively. We are performing a Phase I/II optimal biological dose (OBD) finding study. Our goals with this initial dose finding study are 1) to identify a dose which has a signal of efficacy (based on reduction in MPN symptom burden) without excessive toxicity and 2) to explore biological correlates of oxidative stress, inflammation, and thrombosis. Study Design and Methods: We have obtained an IND, IRB approval and opened for recruitment in January 2022 (NCT05123365). Nine patients have been enrolled. This is a single center study performed at University of California, Irvine. We are recruiting patients with all types of classic Ph-neg myeloproliferative neoplasms (ET, PV, MF). Patients must be symptomatic with an MPN symptom score (MPN-TSS) of ≥ 10. Patients on interferon-alpha or JAK inhibitors are excluded, however all other MPN directed therapies are allowed. We are using a Simple Toxicity and Efficacy Interval (STEIN) design for phase I/II trials which identifies the OBD based on both safety and efficacy. In contrast, the conventional 3+3, continuous reassessment method (model based Bayesian method) or Bayesian optimal interval designs for phase I dose finding study determine the maximum tolerable dose (MTD) solely on toxicity. The STEIN design is simple, robust and does not have strict assumptions. We will accrue patients in up to 9 cohorts of size 3 for a total of up to 27 patients. Three dose levels will be evaluated (600mg BID, 1200mg BID, 1800mg BID). Patients receive N-AC for a total of 8 weeks. For efficacy, the MPN symptom score (MPN-TSS) is assessed daily from the time of enrollment for 7 days before starting treatment to quantify the mean baseline symptom score and daily for 7 days during the last week of treatment (days 50-56) to assess the mean final symptom score. The desired target efficacy outcome is achievement of more than 30% reduction of MPN-TSS from baseline. Patients are monitored for toxicity with adverse event queries and labs including complete blood counts (CBC) and comprehensive metabolic panel (CMP) at weeks 1, 3, 6, 8, and 12 (week 12 is 30 day post-treatment follow-up). Dose-limiting toxicity (DLT) is defined as hematologic and non-hematologic toxicity, grade 3 or more according to The Common Terminology Criteria for Adverse Events (CTCAE Version 5), reported from the day of starting N-AC through the follow up period. N-AC possesses anti-oxidant, anti-inflammatory, and anti-thrombotic properties. Quantifying biologic measures of these features of N-AC at each dose level will help identify the specific mechanism(s) by which N-AC may be inducing benefit in MPN patients. At week 1 (immediately before initiating treatment) and Week 8 (last week of treatment) biological samples will be used for biological correlates. Plasma will be frozen within 2 hours of draw for metabolomics, multiplex cytokine array, and assessment of neutrophil extracellular trap (NET) formation by citrullinated histone H3 (H3Cit). We will also collect a stool sample at week 1 and week 8 to explore any changes in the gut microbiome.

Use of N-acetylcysteine in patients with hepatitis by antitubercular agents: systematic review

El objetivo de esta revisión sistemática fue estimar la efectividad de la N-acetilcisteína en el tratamiento de hepatotoxicidad por antituberculosos; se incluyeron ensayos clínicos controlados aleatorizados, sin restricciones de idioma ni estado de publicación; se tuvieron en cuenta estudios publicados hasta diciembre de 2022. Búsqueda en bases de datos bibliográficas: CENTRAL, CINAHL, LILACS, MEDLINE, Pubmed, Scielo, Scopus y Web of Science; de 33 artículos encontrados, uno cumplió los criterios de inclusión con bajo riesgo de sesgos. El tiempo a mejoría bioquímica del grupo intervención fue 7,5 días (RIQ 5,5-11) y en el grupo placebo 8 (RIQ 5-13). El tiempo de estancia hospitalaria en el grupo intervención fue 9 días (RIQ 6-15) y en el grupo placebo 18 (RIQ 10-25). La mortalidad no difirió entre grupos y fue 14 %. No es posible concluir sobre el efecto terapéutico de la N-acetilcisteína en pacientes con DILI por antituberculosos, lo cual justifica realizar ensayos clínicos.

N-acetylcysteine efficacy in patients hospitalized with COVID-19 pneumonia: a systematic review and meta-analysis.

N-acetylcysteine (NAC) is a mucolytic agents with anti-inflammatory properties that has been suggested as an adjunctive therapy in patients with COVID-19 pneumonia. We conducted a systematic review and meta-analysis to evaluate available evidence on the possible beneficial effects of NAC on SARS-CoV-2 infection. In September 2022, we conducted a comprehensive search on Pubmed/Medline and Embase on randomized controlled trials (RCTs) and observational studies on NAC in patients with COVID-19 pneumonia. Study selection, data extraction and risk of bias assessment was performed by two independent authors. RCTs and observational studies were analyzed separately. We included 3 RCTs and 5 non-randomized studies on the efficacy of NAC in patients with COVID-19, enrolling 315 and 20826 patients respectively. Regarding in-hospital mortality, the summary effect of all RCTs was OR: 0.85 (95% CI: 0.43 to 1.67, I2=0%) and for non-randomized studies OR: 1.02 (95% CI: 0.47 to 2.23, I2=91%). Need for ICU admission was only reported by 1 RCT (OR: 0.86, 95% CI:0.44-1.69, p=0.66), while all included RCTs reported need for invasive ventilation (OR:0.91, 95% CI:0.54 to 1.53, I2=0). Risk of bias was low for all included RCTs, but certainty of evidence was very low for all outcomes due to serious imprecision and indirectness. The certainty of evidence in the included studies was very low, thus recommendations for clinical practice cannot be yet made. For all hard clinical outcomes point estimates in RCTs are close to the line of no effect, while observational studies have a high degree of heterogeneity with some of them suggesting favorable results in patients receiving NAC. More research is warranted to insure that NAC is both effective and safe in patients with COVID-19 pneumonia.

N-acetylcysteine (NAC) and in psychodermatological conditions. Is it useful?

IntroductionPathologic grooming disorders can lead to clinically significant distress and functional impairment. Various psychopharmacological and nonpharmacological treatments have been used to ameliorate the symptoms of these disorders. N-Acetylcysteine (NAC) is a newer modality in the treatment of these disorders and has shown promise in treatment of obsessive-compulsive and related disorders.ObjectivesTo determine whether NAC is useful in the treatment of body-focused repetitive behavior disorders.MethodsA literature review was carried out in PubMed using the descriptors: “body-focused repetitive behaviour disorders” “grooming disorders” AND “N-Acetylcysteine”.Six results were obtained when using the time limit of 5 years. We selected two of them for their relevance to the PICO question. Subsequently, the search was repeated using the same descriptors and the time limit in the Cochrane Library, Epistemokinos and Tripdatabase, in which no additional results were found.ResultsOverall, thirty-three articles were included in these systematic reviews that we studied, which consisted of 23 case reports, one case series, and seven randomized controlled trials. Dosing of oral NAC ranged from 450 to 3,000 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child. Two randomized controlled trials showed a significant improvement in trichotillomania and excoriation disorder in adults. The other two were performed in pediatric population, showing no statistical difference. Two randomized controlled trials and six case reports studying the effects of NAC in patients suffering from trichotillomania (one performed in adults and the other one in infants) were included. Only the one performed in adults showed improvement when adding NAC to the treatment using the Massachusetts General Hospital, Hairpulling Scale (MGH-HPS). Four case reports and two randomized controlled trials included patients with excoriation disorder showed statistical differences in all of them. Three case reports and one randomized controlled trial in patients with onicotylomania showed a difference that wasn’t consistent after two months of treatment.ConclusionsThere are multiple case reports an several clinical trials supporting both the safety and efficacy of NAC in the treatment of body-focused repetitive behavior disorders. Based on these positive preliminary results and the absence of serious adverse effects, carrying out a therapeutical trial with NAC is a plausible option in the management of this pathology, especially in those in which other therapeutic options have not been effective. Further studies are needed to develop a treatment algorithm and elucidate the difference in the efficacy of NAC between children and adults with this disorder.Disclosure of InterestNone Declared

Global Perspectives in Acute Kidney Injury: Spain.

Global Perspectives in Acute Kidney Injury: Spain.

N-acetylcysteine reduces severity and mortality in COVID-19 patients: A systematic review and meta-analysis.

Recent clinical studies suggest that oxidative stress is one of the key players in the pathogenesis of coronavirus disease 2019 (COVID-19), and N-acetylcysteine (NAC), a potent antioxidant, has been shown to improve clinical outcomes in COVID-19 patients. We conducted a systematic review and meta-analysis of the literature published on the therapeutic intervention of NAC on COVID-19 infection. We searched PubMed, Google Scholar, and Science Direct. We identified and screened eight studies with 20,503 participants, including 2,852 in the NAC-treated group and 17,651 in the placebo group, which reported the effect of NAC on COVID-19 infection. A meta-analysis was performed using forest plots under fixed effect estimates based on the standardized mean difference (SMD) and risk ratio (RR). Pooled analysis showed that NAC was associated with lower mortality in patients with COVID-19 compared with the placebo group [RR, 0.65; (95% CI: 0.56 to 0.75); p < 0.0001]. Similarly, C-reactive protein (CRP) [SMD, -0.32; (95% CI: -56 to -0.09); p = 0.0070] and D-dimer [SMD, -0.35, (95% CI: -0.59 to -0.10; p = 0.0062] levels were significantly decreased, and the oxygenation marker, PaO2/FiO2 ratio, was increased in the NAC-treated group compared with the placebo group [SMD, 0.76; (95% CI: 0.48 to 1.03); p < 0.0001]. Although the number of included studies was minimal, this meta-analysis suggests that NAC may have a positive effect on COVID-19 outcomes, specifically, a significant decrease in CRP and D-dimer levels and a significant increase in oxygen saturation, which decreased mortality. We have also presented a comprehensive review of the role and mechanisms of NAC in patients with COVID-19.

Renoprotective effect of highdose N-Acetylcysteine in patients who underwent cardiac surgery: an observational study

Renoprotective effect of highdose N-Acetylcysteine in patients who underwent cardiac surgery: an observational study

The effect of N-acetylcysteine in patients with non-cystic fibrosis bronchiectasis (NINCFB): study protocol for a multicentre, double-blind, randomised, placebo-controlled trial

BackgroundN-acetylcysteine (NAC), which is specifically involved in airway mucus clearance and antioxidation, is recommended by the treatment guideline for non-cystic fibrosis bronchiectasis (NCFB). However, there is little clinical evidence of its long-term efficacy concerning quality of life (QoL) and exacerbation in patients with NCFB. In addition, the influences of NAC on airway bacterial colonization, chronic inflammation and oxidative stress in NCFB are also unclear.MethodsNINCFB is a prospective, multicentre, double-blind, randomised, placebo-controlled trial that will recruit 119 patients with NCFB and randomly divide them into an NAC group (n = 79) and a control group (n = 40). Participants in the NAC group will receive 600 mg oral NAC twice daily for 52 weeks, while patients in the control group will receive 600 mg placebo twice daily for 52 weeks. The information at baseline will be collected once participants are enrolled. The primary endpoints are the changes in St George’s Respiratory Questionnaire scores and the number of exacerbations in 52 weeks. The secondary endpoints are the 16S rRNA of sputum and the levels of inflammatory factors and oxidative stressors in sputum and serum. Other data related to radiography, lung function tests, number of oral and/or intravenous antibiotic therapies and adverse events (AEs) will also be analysed. Further subgroup analysis distinguished by the severity of disease, severity of lung function, airway bacterial colonization and exacerbation frequency will be performed.DiscussionThe objective of this study is to determine the long-term efficacy of NAC on QoL and exacerbation of NCFB and to explore the effectiveness of NAC for antibiosis, anti-inflammation and antioxidation in NCFB. The study results will provide high-quality clinical proof for the revision and optimization of treatment guidelines and for expert consensus on NCFB treatment.Trial registrationThe trial was registered on the Chinese Clinical Trial Register at April 11, 2020 (chictr.org.cn, ChiCTR2000031817).

Anti-Oxidant Treatment in Obstructive Sleep Apnoea Syndrome

To investigate whether oral intake of N-acetylcysteine (NAC) is a treatment option in patients with obstructive sleep apnoea syndrome (OSAS). Twenty patients with OSAS were enrolled in the study. After polysomnography (PSG), they were randomly assigned to receive a placebo (n = 10) and NAC (n = 10). A repeat PSG was done after the treatment period of 30 days. Fasting venous samples were collected for various biochemical analysis. In the patients of NAC group, compared to their baseline values, slow wave sleep as sleep percent time (27.9 +/- 2.7 vs 42.3 +/- 4.2; p < 0.01) and sleep efficiency (90.8 +/- 1.3 vs 94.4 +/- 1.5; p < 0.05) improved considerably. The apnoea-hypopnoea index (61.2 +/- 8.5 vs 43.1 +/- 8.6; p < 0.05), apnoea related arousals (22.2 +/- 7.6 vs 11.6 +/- 4.7; p < 0.05), longest apnoeic episode duration (seconds) (54.9 +/- 7.1 vs 37.8 +/- 5.6; p < 0.01), oxygen desaturation events per hour (51.8 +/- 7.7 vs 37 +/- 7.8; p < 0.01) and epworth sleepiness score (16.6 +/- 0.8 vs 9.2 +/- 0.9; p < 0.001) decreased significantly. The relative snore time (%) (10.2 +/- 2.9 vs 4.9 +/- 1.9; p < 0.01), number of snore episodes (63.8 +/-23.9 vs 28.2 +/- 9.9; p < 0.05) and duration of longest snore episode (min) (2.5 +/- 0.7 vs 0.6 +/- 0.1; p < 0.05) also decreased significantly. Such responses were not evident in the placebo group. N-acetylcysteine produced significant decrease in lipid peroxidation and increase in total reduced glutathione. Oral NAC administration appears to have a therapeutic potential in the treatment of OSAS. It is proposed that long-term treatment with NAC in patients with OSAS may reduce their dependency on continuous positive airway pressure therapy.

P521. Preliminary Results From a Multi-Centre, Double-Blind, Randomised Placebo Controlled Feasibility Trial of Add-on Sodium Benzoate and/or N-acetylcysteine in Patients With Early Schizophrenia

Oxidative stress pathways may play a role in schizophrenia through direct neuropathic actions, microglial activation and inflammation, and by interfering with NMDA receptor (NMDAR) neurotransmission. N-acetylcysteine (NAC) has been shown to improve negative symptoms of schizophrenia, however, results from trials of other compounds targeting NMDAR neurotransmission have been mixed. This may reflect poor target engagement but may also suggest that risk mechanisms act in parallel.

Efficacy of N-acetylcysteine on idiopathic or postinfective non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis protocol

IntroductionNon-cystic fibrosis (non-CF) bronchiectasis is a chronic pulmonary disorder that causes destruction and permanent dilatation of the airways, resulting in excessive sputum production, repeated infection and inflammation. A need for...

The Effectiveness of High-dose N-acetylcysteine in Severe COVID-19 Patients

The study's objective was to describe the effect of using high doses of N-acetylcysteine on severe COVID-19 patients. It was evaluated from the length of stay and by monitoring the drug use data, laboratory data, and clinical data at Bhayangkara H.S Samsoeri Mertojoso Hospital Surabaya. The data was collected retrospectively from patients' Health Medical Records who got high dose N-acetylcysteine in October 2020 – February 2021, with standard therapy: antivirus (Remdesivir), antibiotics, vitamins, symptomatic and comorbid therapy, anticoagulant, and corticosteroids (Dexamethasone) as inclusion criteria, then described descriptively. The observation result confirmed that the use of a high dose of N-acetylcysteine (NAC) [1 x 1200 – 5000 mg] po/iv had effective results as seen from the patients' length of stay, which was 12 days for patients without comorbid and 14 days for patients with comorbid like diabetes and/or hypertension. The use of high dose NAC showed improvement in the patients' clinical condition that is evaluated from improved oxygen saturation by 37%. In addition, the laboratory results are shown an improvement in thorax X-ray by 69% and inflammatory markers like CRP and d-dimer by 100%. Further research that uses a prospective method is needed to get a better result on the use of high-dose NAC in patients with severe COVID-19.

A systematic review of N-acetylcysteine for treatment of acne vulgaris and acne-related associations and consequences: Focus on clinical studies.

Acne vulgaris is one of the most common dermatologic disorders affects people of all races and ethnicities and has many adverse effects on the quality of life. The increased bacterial resistance to antibiotics has reduced the effectiveness of treatment with these agents. There is an increasing focus on the involvement of oxidative stress in the pathophysiology of acne. This study investigates the effect of N-acetylcysteine (NAC) as an antioxidant in the treatment of acne vulgaris. This systematic review was conducted through a search in databases such as Science Direct, PubMed, Scielo, and Medline using keywords including acne vulgaris, anti and NAC, and all the keywords associated with each of the subtitles. The factors affecting the occurrence and expansion of acne include increased sebum synthesis, hyperkeratinization of pilosebaceous units, colonization with Propionibacterium acnes, and increased release of inflammatory mediators and ROS. Studies have shown that glutathione stimulation following the administration of NAC increases glutathione levels for the detoxification of oxygen-free radicals. Moreover, NAC prevents the synthesis and release of inflammatory cytokines such as TNF-α, IL-8, IL-6, MP9, and IL-1β and has shown antibacterial activities against important bacteria including E. coli, S. epidermidis, Pseudomonas, and Klebsiella. This medication has anti-proliferative effects and is also used for excoriation and PCOD. The results of the present study showed the beneficial effects of using NAC in patients with acne vulgaris in terms of the disease complications and comorbidities. Given its diverse functional mechanisms, this medication can be used to treat acne and its consequences.

N-Acetyl-Cysteine Treatment after Lower Extremity Amputation Improves Areas of Perfusion Defect and Wound Healing Outcomes

Patients with critical limb-threatening ischemia (CLTI) and diabetes are at increased risk of poor major amputation site healing. Preclinical studies have demonstrated that the antioxidant N-acetyl-cysteine (NAC) can augment tissue perfusion and angiogenesis in mice. We hypothesize that perioperative administration of NAC in patients with CLTI improves amputation stump perfusion and healing. In a randomized prospective, double-blinded, placebo-controlled, pilot clinical trial, patients with CTLI were recruited at the time of major lower extremity amputation. Patients were randomized to a 5-day perioperative course of intravenous NAC or placebo treatment. Amputation stump perfusion was evaluated on postoperative days (POD) 0, 3, and 5 using noninvasive Laser-Assisted Fluorescent Angiography (LAFA; SPY Elite system). Rate of arterial inflow and peak perfusion were determined using dynamic intensity versus time analysis. Perfusion defects were determined at the time of peak perfusion as a percentage stump surface area (Fig). Amputation stump healing was also evaluated on POD 3, 5, and 30 using modified Bates-Jensen score. Continuous variables were analyzed using the Student t-test. Categorical variables were analyzed using Fisher’s exact test. A total of 33 patients were enrolled in the study. One patient withdrew consent and eight were excluded for missing or incomplete files. Four patients (three NAC, one placebo) had no perfusion defects. In the remaining 20 patients (7 NAC, 13 placebo) with baseline perfusion defects, NAC-treated patients had a more favorable recovery slope compared to control. From POD 3 to 5, NAC-treated patients had a greater relative reduction in defect size (–53% decrease vs +71%; P < .05), whereas perfusion defects increased in the placebo group. Patients that received NAC also had superior healing outcomes at POD30 (100% healing for NAC vs 46% for placebo; P < .01; Table). No differences in the LAFA-derived rate of arterial inflow or time to peak perfusion were observed between the study groups. In patients with CLTI and amputation stump perfusion defects at baseline, perioperative NAC administration may improve short-term perfusion and long-term tissue healing. Intraoperative LAFA may help identify patients with decreased stump perfusion who can benefit from early therapeutic intervention.

Factors of Determining N-acetylcysteine Administration in Patients with Acute Acetaminophen Poisoning

Purpose: In acute acetaminophen poisoning, the administration of N-acetylcysteine (NAC) can effectively treat the main complications, such as kidney injury and liver failure. In the current situation, measurements of the acetaminophen concentration are not checked in the usual medical facilities. Therefore, this study examined the factors of determining the administration of NAC in addition to the stated amount of intake. Methods: The medical records of patients who visited Ajou University Hospital emergency center with acetaminophen poisoning from January 2015 to December 2019 were reviewed retrospectively. One hundred and seventy-nine patients were initially included. Among these patients, 82 patients were finally selected according to the inclusion criteria in the study. The inclusion criteria were as follows: patients who were 15 years of age or older; those whose ingested dose, ingested time, and body weight were clearly identified; and patients whose acetaminophen sampling time was within 24 hours. Patients were divided into two groups: NAC administered vs. non-NAC administered. The following variables were compared in these two groups: ingested dose, ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, psychiatric disease history, classification of toxic/non-toxic groups, duration of hospitalization, and laboratory results. Results: Univariate analysis revealed the ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, and psychiatric disease history to be the determining factors in administering NAC. Logistic regression analysis confirmed that the ingested dose per body weight was the only significant factor leading to an NAC treatment decision. (Odds ratio=1.039, 95% Confidential interval=1.009-1.070, p=0.009) Conclusion: The ingested dose per body weight was the only determining factor for administering NAC in patients with acute acetaminophen poisoning. On the other hand, additional criteria or indicators for the NAC administration decision will be necessary considering the inaccuracy of the ingested dose per body weight and the efficiency of NAC administration.

Evidence for a Beneficial Effect of Oral N-acetylcysteine on Functional Outcomes and Inflammatory Biomarkers in Patients with Acute Ischemic Stroke.

PurposeNumerous preclinical studies have demonstrated the potential neuroprotective effects of N-acetylcysteine (NAC) in the treatment of brain ischemia. Accordingly, the present study aimed to assess the potential therapeutic effects of oral NAC in patients with acute ischemic stroke.Patients and MethodsIn a randomized, double-blind, placebo-controlled trial study, 68 patients with acute ischemic stroke with the onset of symptoms less than 24 hours were randomly assigned to either the NAC-treated group or placebo-treated group. NAC and matched placebo were administrated by a 72-hour oral protocol (initially 4 grams loading dose and after on, 4 g in 4 equal divided doses for more 2 days). The primary outcomes were quantification of any neurologic deficit by the use of the National Institute of Health Stroke Scale (NIHSS) score and functional disability by the use of the modified Rankin scale (mRS) at 90 days after stroke. Additionally, serum levels of markers of oxidative stress and inflammation as a main mechanism of its action were assessed at baseline and the end of 3-day treatment protocol.ResultsNAC-treated patients in comparison with placebo-treated patients showed a significantly lower mean NIHSS scores at day 90 after stroke. A favorable functional outcome which was defined as an mRS score of 0 or 1, also in favor of NAC compared to placebo was noted on day 90 after stroke (57.6% in the NAC-treated group compared with 28.6% in the placebo-treated group). Further, compared to the placebo, NAC treatment significantly decreased serum levels of proinflammatory biomarkers such as interleukin 6 (IL-6), soluble intercellular cell adhesion molecule-1 (sICAM-1), nitric oxide (NO), malondialdehyde (MDA), and neuron-specific enolase (NSE) and significantly increased serum levels of anti-oxidant biomarkers such as superoxide dismutase (SOD), glutathione peroxidase (GPx), and total thiol groups (TTG).ConclusionThe pattern of results suggests that oral NAC administration early after an acute ischemic stroke is associated with a better outcome profile in terms of acute neurological deficit and disability grade compared to placebo. NAC may improve neurological outcomes of patients with stroke at least in part by its antioxidant and anti-inflammatory effects.