抗结核药物性肝损害94例临床分析

目的 分析抗结核药物所造成的药物性肝损害.方法 分析94例服用抗结核药物的肺结核患者出现药物性肝损害发生时间、损害程度和治疗方法.结果 抗结核药物性肝损害消化道症状和肝功能改变多发于用药后4周内,占56％.停用抗结核药组为中、重度肝损害;未停药组为轻度肝损害.治愈率93.6％(82/94).结论 应重视抗结核药物对肝脏的损害,及早行保肝治疗.     

药物性肺损害12例临床分析

目的:对药物性肺损害的临床诊治进行探讨。方法:对12例药物性肺损害的临床资料进行回顾性分析。结果:药物性肺损害占同期住院患者的0.15%;中西药均可发生药物性肺损害;临床表现呈呼吸系统疾病表现;治疗后全部恢复正常。结论:药物性肺损害是由药物引起的肺部疾患,各科均有发生的可能。药物性肺损害可单独出现,也可同时合并药物性肝、肾损害及其他器官的损害。提高对药物性肺损害的认识,及时作出正确的诊断和治疗,是每位临床医生值得探讨的一个课题。     

老年人群药物性肝损害的防治措施及相关因素分析

目的：探讨老年人群药物性肝损害的防治措施及易患因素。方法总结分析2009年3月至2013年3月郑州市第六人民医院收治的40例老年药物性肝损害患者的临床资料。结果对40例老年药物性肝损害患者进行基本资料分析发现,有慢性病史23例,占57.5%;药物过敏史11例,占27.5%;合并用药21例,占52.5%;吸烟25例,占62.5%;酗酒7例,占17.5%;HbsAg阳性12例,占30.0%。引起药物性肝损害的主要药物有抗生素类及中药类,所占比例达65.0%。抗生素引起的肝损害以急性损害为主,主要表现为肝内淤胆型肝损害;中药及抗结核药物引起的肝损害以慢性损害为主,主要表现为肝内淤胆型及混合型肝损害。经保肝、降酶、利胆、退黄及支持综合治疗后治愈7例,占17.5%,好转31例,占77.5%,病情无变化2例,占5.0%。说明经对症治疗后大部分患者病情都能得到有效控制。结论应提高临床医师对药物性肝损害的认识水平,药物使用过程中要常规检查肝功能,发现肝损害后应及时停药治疗。     

药物性肝损害150例临床分析

目的总结药物性肝损害的临床特点。方法对150例药物性肝损害患者的临床资料进行回顾性分析。结果药物性肝损害分为肝细胞损害型、肝内胆汁瘀积型,停药或减量,并给予保肝药物,肝损害大多可恢复。结论临床许多药物都可致药物性肝损害。在临床用药中要熟知药物的毒副作用,及时、严密观察其不良反应,以减少药物性肝损害的发生。     

药物性肝损害68例临床分析

目的总结药物性肝损害的临床特点。方法对68例药物性肝损害患者的临床资料进行回顾性分析。结果药物性肝损害发生时间在服药后的1—9个月，临床症状以乏力、纳差为主，临床类型以急性肝炎多见；经停药或减量，并给予保肝药物，肝损害大多可恢复。结论临床许多药物都可致药物性肝损害。在临床用药中要熟知药物的毒副作用，严密观察其不良反应，以减少药物性肝损害的发生。     

血浆置换治疗药物性肝损害临床疗效评价

药物性肝损害是临床常见且后果严重的药物副反应之一[1],常规临床治疗方法疗效较差,血浆置换可以有效清除患者体内由于肝脏损害而产生的有害物质,改善肝脏功能,已经成为治疗药物性肝损害的重要辅助手段.本中心应用血浆置换治疗药物性肝损害45例,取得了显著的疗效.     

重度药物性肝损害(附19例临床分析)

我院 1989年 1月～ 2 0 0 1年 12月收治药物性肝损害患者 2 39例 ,其中重度药物性肝损害 19例 (7.95 % )。现对该 19例进行分析探讨 ,以期提高对药物性肝损害严重性的认识 ,做到早发现、早诊断 ,降低重度药物性肝损害发生率和病死率。1　临床资料1.1　一般资料　男 7例 ,女 12例 ;年龄 15～ 6 4岁。1.2　病例选择标准　有明确的用药史 ;用药后出现严重肝损害的表现 :总胆红素 (TB) >171μmol/ L,凝血酶原活动度(PTA)≤ 4 0 % ,出现腹水或肝性脑病或肝肾综合征 ;排除甲、丙、戊、庚、TTV病毒性肝炎、酒精性肝炎、脂肪肝及阻塞性黄疸等 ;…     

药物性肝病108例临床分析

【目的】分析诱发药物性肝病的临床特点,提高对该病认识,减少药源性疾病的发生。【方法】回顾分析我院2001年～2009年108例药物性肝病的住院病例临床特点治疗及预后。【结果】药物性肝病患病平均年龄（39±15）岁,多在用药后2～4周出现临床症状,用药前HBsAg阳性、有饮酒史者更易出现肝损害,65例肝损由抗结核药和抗生素引起,占60．19％,其次为抗肿瘤药、中药和抑酸药物。治疗10～30d,103例症状改善,肝功能恢复,占病例的95．37％。【结论】药物性肝病病因多样,起病隐匿,中药引起药物性肝病近年有增多趋势,肝功能检查是早期诊断的主要方法,经治疗大部分患者愈后良好。     

抗结核药物致肝损害68例临床分析

目的 探讨抗结核药物致肝损害的诊断与治疗.方法 2008年1月至2010年1月我们收治肺结核患者478例,给予抗结核治疗后出现肝损害68例,对其临床资料进行分析.结果 抗结核药物所致肝损害多集中在抗结核治疗后的前2个月,以恶心、食欲不振、厌油、乏力、上腹不适等消化道症状为主者占61.8%(42/68).乙型肝炎病毒标志物阳性者肝损害的发生率为16.7%(11/68).无因药物性肝损害而死亡的病例,药物性肝损害患者停用抗结核药物并行保肝等治疗后肝功能均恢复正常.结论 抗结核药物致肝损害早期诊断和及时合理的治疗可以使患者的肝功能恢复正常.     

药物性肝损害56例临床分析

目的探讨药物性肝损害的临床特点，提高医务工作者对该病的认识。方法回顾性分析我院自2001—2007年6年间56例药物性肝损害患者相关特点。结果抗生素、非甾体抗炎药及中草药是最常见的引起药物性肝损害的三类药物；急性肝损害50例，慢性表现6例；肝细胞型表现29例，胆汁淤积型15例，混合型12例。结论多种药物均可引起药物性肝损害，以急性肝损害常见，肝损害临床表现各异，与药物有关。早期发现及停药是治疗药物性肝损害的关键。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.