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It should also be noted that ROS generates a metabolic syndrome due to changes in energy metabolism, activation of RNS, xanthine oxidase, increased expression of inflammatory mediators, and low levels of GPx and other antioxidant enzymes

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This mismatch between ideal diagnostic conditions and real-world practice contributes to false-negative assessments (Goncalves et al., 2010)

This has been reported to have resulted in a 7% absolute increase in the number of patients admitted to hospital for paracetamol poisoning [2]