拉莫三嗪与丙戊酸钠先后致皮疹、红细胞巨幼化及高敏综合征

1 例64 岁男性患者,因癫痫反复发作口服丙戊酸钠（500 mg,bid）及拉莫三嗪（25 mg,qd）进行治疗,30 d 后因发热、皮疹、抽搐、行走障碍入院.骨穿刺结果提示红细胞形态呈巨幼化,予氯雷他定（10 mg,qd,po）及复方甘草酸苷（60 mg,qd,ivgtt）,停用拉莫三嗪,改用口服丙戊酸钠（早上750 mg,下午500 mg）抗癫痫,12 d后患者病情好转出院,继续服用丙戊酸钠抗癫痫.2 d 后患者皮疹及发热再次加重入院,予甲泼尼龙（40 mg,bid,ivgtt）、氯雷他定（10 mg,qd,po）及复方甘草酸苷（60 mg,qd,ivgtt）,停用丙戊酸钠改用苯巴比妥钠（100 mg,bid,im）抗癫痫治疗,20 d 后改为苯巴比妥钠（30 mg,bid,po）,期间患者发热及皮疹消退、肝功能恢复,于第22 天出院.     

Reported toxicity in 1486 liquid detergent capsule exposures to the UK National Poisons Information Service 2009–2012, including their ophthalmic and CNS effects

Context. Data on the ophthalmic and central nervous system (CNS) adverse effects of liquid detergent capsules (liquid laundry pods) are limited. Objective. To ascertain the reported toxicity of liquid detergent capsules, particularly their ophthalmic and CNS adverse effects, in a large case series. Methods. Between 1 May 2009 and 30 July 2012 the UK National Poisons Information Service collected prospectively 1509 telephone enquiries (involving 1486 exposures) relating to liquid detergent capsules. Results. The majority of patients (95.6%) were children aged less than 5. Exposure to these products occurred mainly as a result of ingestion alone (n = 1215; 81.8%), with eye contact alone (n = 110; 7.4%), and skin contact alone (n = 20; 1.3%) being less common; multiple routes of exposure were involved in 141 (9.5%) cases. Following ocular exposure (n = 212), features suggesting conjunctivitis (n = 145; 68.4%) and corneal ulceration (n = 6; 2.8%) developed. The most common features reported following ingestion alone were nausea and vomiting (n = 721; 59.3%), followed by coughing (n = 53; 4.4%), drowsiness/CNS depression (n = 49; 42 of these were children were aged 2 years or less) and foaming at the mouth (n = 47; 3.9%). A rash occurred in 22 patients where ingestion was considered to be the route of exposure. Twenty patients were exposed via the dermal route alone and developed erythema (n = 9), rash (n = 6) and burn (n = 3). Conclusions. Ocular exposure to liquid detergent capsules may lead to conjunctivitis and corneal ulceration; detergent ingestion may result in central nervous system (CNS)depression. Greater consumer awareness is required to reduce injury from liquid detergent capsules, particularly that involving the eye.     

Transfer of peanut allergy from donor to recipient after liver transplant

31 years old female with a history of contact dermatitis, eczema, allergic rhinitis, pernicious anemia, alopecia areata and latent tuberculosis was treated concurrently with methotrexate along with isoniazid and pyridoxine. Five months into the therapy she developed acute onset jaundice progressing into fulminant liver failure with altered mentation and worsening liver function tests. Extensive workup including serological and histopathological evaluation revealed drug-induced liver injury as the etiology of her liver failure and she underwent a successful orthotropic liver transplant. On post-transplant follow-up at four months, she was noted to have an allergic reaction consisting of a perioral rash and swelling (without anaphylaxis) after receiving a kiss from her significant other who had just eaten a peanut butter chocolate. She denied any history of allergic reaction to peanuts prior to the transplant. Percutaneous skin testing revealed immediate hypersensitivity to peanut, hazelnut, and pecan believed to be acquired newly post-transplant. Further investigation revealed that the organ donor had a documented history of systemic anaphylaxis from the peanut allergy and a positive peanut-specific IgE level. Also, another parallel solid organ recipient (lung transplant) from the same organ donor experienced a serious anaphylactic reaction after peanut exposure. This is a case of food (peanut) allergy transfer from the donor to the recipient after the liver transplant. This case highlights the importance of incorporating known donor allergies as a part of pre-transplant screening, given the potentially serious consequences from the transfer of allergies to a previously anergic recipient.     

携带SPK1基因的重组腺病毒对犬酒精性胃溃疡愈合的影响

目的探讨基因药物Ad-SPK1对酒精性胃溃疡的治疗作用。方法建立酒精诱导的实验犬胃溃疡模型,制备携带绿色荧光蛋白（GFP）基因的腺病毒作为对照,观察GFP在犬胃壁中的分布,分别于给药后7、14、21、28d电子胃镜下观察溃疡的愈合情况,取胃溃疡组织进行Western blot检测SPK1蛋白的表达和γ-P32掺入法检测SPK酶活性和免疫组化检测CD34表达和MVD计数。结果腺病毒能有效介导GFP和SPK1基因在胃溃疡黏膜层细胞表达。电子内镜下可见腺病毒介导的SPK1基因转移能促进胃溃疡愈合。微血管密度计数结果显示,Ad-SPK1组的微血管密度计数值明显高于对照组Ad-GFP组（P〈0.05）。结论 Ad-SPK1可促进实验犬胃溃疡黏膜上皮修复和溃疡面血管增生,加快溃疡愈合。     

Rash in psychiatric and nonpsychiatric adolescent patients receiving lamotrigine in Korea: a retrospective cohort study

Objective

Lamotrigine is a widely used medication for psychiatric disorders and epilepsy, but the adverse effects of this drug in adolescent Korean patients have not yet been investigated. In the present study, we sought to compare the incidence and impact of lamotrigine-induced skin rashes and different pattern of adverse events in psychiatric and nonpsychiatric adolescent patients.

Methods

Using a retrospective cohort design, all of the charts were reviewed for adolescents (13 to 20 years old), treated with lamotrigine during the previous 2 years in the Child and Adolescent Psychiatric Clinic and Pediatric Neurologic Clinic of the Ulsan University Hospital in South Korea.

Results

Of the 102 subjects, 23 patients developed a skin rash. All of these rashes were observed within 7 weeks of the initiation of the lamotrigine therapy. Only one subject developed a serious rash, which was diagnosed as Stevens-Johnson syndrome. Although the psychiatric subjects were administered statistically lower doses of lamotrigine during weeks 1 through 5 and at week 12, the likelihood of developing a rash was not significantly different between the psychiatric and nonpsychiatric patients.

Conclusion

Careful dose escalation and close observation of side effects for the first 7 weeks of treatment is important. The present study reveals the tolerability of lamotrigine in an adolescent population, although a double-blind, controlled trial is needed to confirm these findings.     

Phenotypic and molecular characterization of Arcanobacterium haemolyticum isolated from clinical samples

The aim of this study was to assess the phenotypic and genotypic diversity of 56 Arcanobacterium haemolyticum isolates isolated from 51 patients attending primary health care centres and emergency units in the health area of Santander (Cantabria, northern Spain). Phenotypic characterization was based on morphological, biochemical, and antigenic tests. Species identification was confirmed by amplification and sequencing of the 16S rDNA gene. Antimicrobial susceptibility testing was determined by microdilution following the Clinical and Laboratory Standards Institute recommendations for coryneform bacteria. Genetic diversity was evaluated using BOX-PCR and pulsed-field gel electrophoresis. Eighty percent of the isolates had an identical BOX-PCR pattern, suggesting the spread of a single clone. The present report provides extensive information on the phenotypic and genotypic characterization of A. haemolyticum.     

退疹清热汤治疗小儿手足口病的疗效观察

目的:观察自拟退疹清热汤治疗小儿手足口病的疗效.方法:将110例手足口病患儿随机分为治疗组56例和对照组54例,2组患儿均给予西药常规治疗,治疗组在此基础上口服中药自拟退疹清热汤治疗,分别观察其治疗效果并进行比较.结果:治疗组总有效率为96.4%,对照组总有效率为87.0%,经统计学处理,差异具有统计意义(P<0.05),治疗组疗效明显优于对照组.结论:退疹清热汤配合西药治疗小儿手足口病疗效显著.     

重组人干扰素α1b治疗小儿手足口病的临床疗效观察

目的 观察重组人干扰素α1b治疗小儿手足口病的临床疗效。方法 选择我院2018年6月~8月儿科门诊收治的手足口病患儿60例,随机分为治疗组和对照组,各30例。对照组患儿给予一般抗病毒对症治疗,治疗组在此基础上加用重组人干扰素α1b注射液治疗。观察两组患儿治疗后热退时间、咽部充血程度改善时间、口腔溃疡愈合时间及皮疹消退时间,比较两组患儿的临床疗效。结果 治疗组总有效率为93.33%,高于对照组的70.00%,差异有统计学意义（P＜0.05）;治疗组的热退时间、咽峡部充血程度改善时间、口腔溃疡愈合时间及皮疹消退时间均短于对照组,差异有统计学意义（P＜0.05）。结论 重组人干扰素α1b注射液治疗小儿手足口病疗效确切,可有效加快患者临床症状改善,缩短患儿病程。