Effectiveness and Tolerability of Carbamazepine vs. Oxcarbazepine as Mood Stabilizers

Abstract

Background.?Patients with bipolar illness or maniac-type schizoaffective disorder often present a variety of symptoms and mixed responses to treatment. Several anticonvulsants have been found effective in the treatment of mood disorders. In the early 70's, the clinical efficacy of carbamazepine in the treatment of acute mania was reported. Oxcarbazepine has been available in the United States since 2000. Both drugs display a different spectrum of properties and side effect profiles. Objective.?To compare the effectiveness and tolerability of carbamazepine and oxcarbazepine in a naturalistic setting. Methods.?A retrospective and concurrent chart review of all patients treated with carbamazepine or oxcarbazepine (n = 33) as mood stabilizers between 01 and 12 2002. The effectiveness was evaluated using the Positive And Negative Syndrome Scale (PANSS). Tolerability was assessed according to side effects recorded on charts. Patients with charts that were not complete were excluded from this study. Results.?There were no significant differences in efficacy between groups on positive (F = 3.575, P = 0.075), negative (F = 2.641, P = 0.121), or the general subscales (F = 1.111, P = 0.306) of the PANSS. Patients in both groups developed gastrointestinal upset and headache, but no significant differences in tolerability between the two therapies were found (χ² = 0.466, df = 1, P = 0.659) and (χ² = 0.195, df = 1, P = 0.367 respectively). Conclusion.?In summary, the patient charts reviewed demonstrated that carbamazepine, as well as, oxcarbazepine are equally effective and tolerable as mood stabilizers.     

Cognitive Behavioural Therapy for anorexia nervosa: A systematic review

Evidence for the effectiveness of psychological therapies for anorexia nervosa (AN) is inconsistent. There have been no systematic reviews solely on the effectiveness for Cognitive Behavioural Therapy (CBT) for AN. This review aimed to synthesise and appraise the recent evidence for CBT as a treatment for AN. Using specific search criteria, 16 relevant articles were identified which evaluated CBT alone or as part of a broader randomised/non-randomised trial. Various formats of CBT were utilised in the reviewed papers. Studies were evaluated using established quality criteria.     

健康教育干预对预防儿童维生素A缺乏的效果评价

目的:探讨在幼儿园开展儿童维生素A缺乏健康教育的效果。方法:随机抽取育才幼儿园181名儿童及其家长为研究对象对其实施健康教育,对比健康教育前后家长及儿童对相关知识的掌握程度。结果:通过对家长及儿童的健康教育,实施181名儿童及其家长对儿童维生素A营养缺乏及防治知识掌握程度比较干预前后差异有统计学意义(P<0.01)。结论:实施儿童维生素A缺乏的健康教育对家长及儿童对于维生素A摄入的知识、态度、行为有重要影响,健康教育是控制儿童维生素A缺乏的重要措施,健康教育技术适宜在社区及幼儿园推广应用并持续推进。     

Effectiveness of Single-dose Rasburicase in Patients With Lymphoid Malignancies at a High Risk for Tumor Lysis Syndrome

BackgroundTumor lysis syndrome (TLS) is a life-threatening disorder that occurs mainly in patients with high-tumor burden hemato-oncologic malignancies. It results in metabolic derangements, including hyperuricemia and acute renal failure. The powerful management for TLS is a daily dose of rasburicase for up to 5 days before chemotherapy; however, the optimal dose and duration of rasburicase for TLS prophylaxis have not been standardized for patients at high risk for TLS. Therefore, we evaluated the efficacy of single-dose rasburicase for prophylactic purposes in patients with malignant lymphoma at high risk for TLS.Patients and MaterialsWe retrospectively evaluated patients with malignant lymphoma at high risk for TLS treated with a prophylactic single-dose of rasburicase (0.1-0.2 mg/kg) from March 2012 to March 2016.ResultsA total of 67 patients treated with a single-dose of rasburicase for prophylaxis were analyzed. A relatively large number of patients (n = 23; 34.3%) had the highly proliferative lymphoblastic lymphoma subtype (n = 14) or Burkitt lymphoma (n = 9) and were at the highest risks of tumor lysis. Two patients were newly diagnosed with TLS; the incidence of TLS after single-dose prophylaxis was 3.0%. Multivariate analysis revealed no predictable risk factors for response to prophylactic rasburicase, though increased level of serum creatinine approached statistical significance in reducing the efficacy of single-dose rasburicase to prevent TLS (odds ratio, 3.61; P = .054).ConclusionOur data indicated that single-dose rasburicase effectively prevented progression of TLS, and, regardless of any risk factors, including increased creatinine, single-dose rasburicase for TLS prophylaxis was useful in patients with lymphoma at a high risk for TLS.     

糖皮质激素治疗3例重/危重型COVID-19患者有效性及安全性分析

目的：初步评估糖皮质激素治疗重/危重型COVID-19患者的有效性及安全性。方法：通过回顾性分析3例重/危重型COVID-19患者激素使用指征、使用时机、用法用量及疗程和不良反应，对比患者使用激素前后症状、体征，炎症因子、血氧饱和度、氧合指数及影像学等变化，分析激素使用的有效性和安全性。结果：有效性方面：3例患者有激素使用指征且使用后症状体征有一定好转，影像学有吸收；患者C病情反复并进行了气管插管。安全性方面：3例患者均出现了血糖升高；患者B的乙肝病毒被激活并继发了糠秕孢子菌毛囊炎；患者C细菌感染加重并出现了异常躁动。3例患者的排毒时间均大于35天，其中患者B排毒时间最长，为44.67天；3例患者住院时间均超过1个月，B患者长达47.46天。结论：激素应用是把双刃剑，应严格掌握使用指征和疗程，权衡利弊，重视激素使用后的不良反应。     

Roadmap for the international collaborative epidemiologic monitoring of safety and effectiveness of new high priority vaccines

With the advent of new vaccines targeted to highly endemic diseases in low- and middle-income countries (LMIC) and with the expansion of vaccine manufacturing globally, there is an urgent need to establish an infrastructure to evaluate the benefit-risk profiles of vaccines in LMIC. Fortunately the usual decade(s)-long time gap between introduction of new vaccines in high and low income countries is being significantly reduced or eliminated due to initiatives such as the Global Alliance for Vaccines and Immunizations (GAVI) and the Decade of Vaccines for the implementation of the Global Vaccine Action Plan. While hoping for more rapid disease control, this time shift may potentially add risk, unless appropriate capacity for reliable and timely evaluation of vaccine benefit-risk profiles in some LMIC's are developed with external assistance from regional or global level. An ideal vaccine safety and effectiveness monitoring system should be flexible and sustainable, able to quickly detect possible vaccine-associated events, distinguish them from programmatic errors, reliably and quickly evaluate the suspected event and its association with vaccination and, if associated, determine the benefit-risk of vaccines to inform appropriate action. Based upon the demonstrated feasibility of active surveillance in LMIC as shown by the Burkina Faso assessment of meningococcal A conjugate vaccine or that of rotavirus vaccine in Mexico and Brazil, and upon the proof of concept international GBS study, we suggest a sustainable, flexible, affordable and timely international collaborative vaccine safety monitoring approach for vaccines being newly introduced. While this paper discusses only the vaccine component, the same system could also be eventually used for monitoring drug effectiveness (including the use of substandard drugs) and drug safety.     

不同起始剂量的帕立骨化醇治疗血液透析伴继发性甲状旁腺亢进患者的有效性

目的 探讨不同起始剂量的帕立骨化醇(PCT)治疗血液透析伴继发性甲状旁腺功能亢进(SHPT)患者12周的有效性。方法 选取我院2017年6月至2020年6月收入的30例维持性血液透析伴SHPT患者,采用随机排列表法分为A组与B组,每组各15例。A组患者采用PCT起始剂量0.06μg/kg,3次/周,透析后给药;B组采用iPTH(pg/mL)/80μg公式计算PCT的起始剂量,3次/周,透析后给药。比较两组患者治疗12周后iPTH值、iPTH达标率、不良反应发生率及血钙、磷水平。结果 治疗12周后,A组iPTH数值低于B组,iPTH达标率高于B组,差异均有统计学意义(P0.05);A组血钙、血磷浓度显著低于B组,差异有统计学意义(P0.05);A组不良反应发生率显著低于B组,差异有统计学意义(P0.05)。结论 采用起始剂量0.06μg/kg的PCT,较之全段iPTH(pg/mL)/80μg起始剂量给药方案治疗血液透析伴SHPT患者,可显著改善SHPT,血钙、血磷波动较小,且不良反应发生率较低,值得应用与推广。