中西医结合治疗慢性盆腔炎的临床效果

〔摘 要〕 目的：探究中西医结合治疗慢性盆腔炎的临床效果。方法：选取 2018 年 11 月至 2019 年 11 月佛冈县人民医 院收治的慢性盆腔炎患者 120 例为研究对象，基于随机数字表法分为对照与观察组，各 60 例。对照组给予常规西医治疗， 观察组则实施中西医结合治疗。比较两组患者临床有效率、各项症状消失时间及复发率情况。结果：观察组患者临床治疗 总有效率为 90.00 %，高于对照组的 78.33 %，差异具有统计学意义（P ＜ 0.05）。观察组患者白带异常增多、呕吐恶心、 腰部疼痛症状消失时间均短于对照组，差异具有统计学意义（P ＜ 0.05）。观察组患者的复发率为 3.33 %，明显低于对照 组的 15.00 %，差异具有统计学意义（P ＜ 0.05）。结论：采用中西医结合治疗慢性盆腔炎效果显著，能有效提高治疗有效率， 改善患者症状，降低复发率。     

5-Nitroimidazole refractory giardiasis is common in Matanzas,Cuba and effectively treated by secnidazole plus high-dose mebendazole or quinacrine: a prospective observational cohort study

ObjectiveTo evaluate the effectiveness and tolerability of secnidazole combined with high-dose mebendazole for treatment of 5-nitroimidazole-resistant giardiasis.MethodAdults with microscopically verified Giardia intestinalis monoinfection attending a secondary level hospital in Matanzas City, Cuba were prospectively included in a cohort. A recently introduced treatment ladder consisting of metronidazole as first-line treatment, followed by secnidazole, tinidazole, secnidazole plus mebendazole and quinacrine as second-to fifth-line treatments, respectively, was used. Adverse events and treatment success were determined by questioning and microscopy on concentrated stool samples, respectively on days 3, 5 and 7 after the end of treatment. If G. intestinalis was detected on day 3, 5 or 7, then the infection was classified as refractory and no further microscopy was performed.ResultsA total of 456 individuals were included. Metronidazole, 500 mg three times daily for 5 days, cured 248/456 (54%) patients. A single 2-g secnidazole dose as second-line treatment cured 50/208 (24%) patients. A single 2-g tinidazole dose as third-line treatment cured 43/158 (27%) patients. Three rounds of 5-nitroimidazole therapy therefore cured 341/456 (75%) patients. Secnidazole plus mebendazole (200 mg every 8 hours for 3 days) cured 100/115 (87%) of nitroimidazole refractory infections. Quinacrine cured the remaining 15 patients. All treatments were well tolerated.Conclusions5-Nitroimidazole refractory giardiasis was common, indicating that an alternative first-line treatment may be needed. Retreatment of metronidazole refractory giardiasis with an alternative 5-nitroimidazole was suboptimal, indicating cross-resistance. Mebendazole plus secnidazole were well tolerated and effective for the treatment of 5-nitroimidazole refractory G. intestinalis infection in this setting.     

V Conferencia Española de Consenso sobre el tratamiento de la infección por Helicobacter pylori

Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.     

中西结合治疗84例盆腔炎疗效分析

盆腔炎主要是由于阴道内菌群内源性病原体以及来自外界外源性病原体引发。该病是中老年女性的常见病、多发病。该病反复缠绵，单一治疗久治难愈。发作期疼痛难隐，病情险恶。近年来我院采用中西结合用药，取得满意的临床效果。抗生素的恰当使用有利于尽快杀死致病菌。中药内服外用有利于健脾益气，清热解毒。诸药合力，起到＂消炎止痛、清热除湿，解毒祛邪＂显著效果。     

Evidence of self-protonation on the electrodic reduction mechanism of an anti-Helicobacter pylori metronidazole isotere

The electrochemical reduction mechanism of 1-(2-ammoniumethyl)-2-methyl-5-nitroimidazole bromide (2) in DMSO + 0.1 mol l^?1 TBAP has been investigated by cyclic voltammetry and macroscale electrolysis, on a glassy carbon electrode, in comparison with metronidazole (1). The cyclic voltammogram of 2 is represented by three reduction waves, one of them at less negative potential, when compared to the first wave of metronidazole which indicates that it undergoes easier reduction. There is evidence for a self-protonation mechanism in the electroreduction of 2, represented by the absence of the first wave in the successive cyclic voltammogram, by the disappearance of the first reduction wave upon addition of base and increase of the same wave in the presence of exogenous proton donors. The stoichiometry of the reaction, at the first reduction wave, involves 0.8 mol electron mol^?1 and yields 0.2 mol of 4e^?/4H⁺ reduced derivative (probably an unstable hydroxylamine) and 0.8 mol of the amine derivative, the conjugated base of 2. The second and third waves are typical for nitroaromatic reduction and are related to the reduction of the nitro group in this aminoderivative.     

Cyclic voltammetric determination of free radical species from nitroimidazopyran: a new antituberculosis agent

PA-824 (2-nitro-6-(4-trifluoromethoxy-benzyloxy)-6,7-dihydro-5H-imidazo[2,1-b][1,3]oxazine) is being tested as antituberculosis drug. Little is known on the action mechanism of PA-824; however the reduction of the nitro group seems to be a key step in the metabolic activation, as is observed for the well-known bactericidal metronidazole. Consequently, this paper is focused on the cyclic voltammetric behavior of PA-824 with the aim of revealing the formation and stability of the corresponding nitro radical anion and its comparison with the metronidazole behavior.Both compounds PA-824 and metronidazole reveal, in aprotic medium (DMSO + 0.1 tetrabutylammonium hexafluorophosphate), a similar reduction pattern showing a well-resolved couple due to nitro reduction to form the corresponding nitro radical anion. The electrode reaction obeys an EC₂ mechanism with a dimerization reaction as the chemical step in aprotic medium. Using cyclic voltammetry theory for a dimerization reaction we have calculated the second-order decay constants, k_2,dim, and the half-life time, t_1/2, for the nitro radical anions formed from PA-824 and metronidazole. We have obtained k_2,dim values of 2.22 × 10² and 2.58 × 10⁴ M^?1s^?1 for metronidazole and PA-824, respectively. Our voltammetric results show that the PA-824 nitro radical anion requires more energy for formation (about 200 mV) and it is approximately 100 times less stable than the metronidazole radical anion.     

牙周基础治疗对胃内幽门螺杆菌根除率的影响

目的 :分析牙周炎与胃内幽门螺杆菌 (Helicobacterpylori ,Hp)的关系以及牙周基础治疗对胃内幽门螺杆菌根除率的影响。方法 :选择有慢性牙周炎且胃镜活检尿素酶阳性、病理诊断为慢性胃炎、胃或十二指肠溃疡患者91人进行三联药物治疗 ,其中 3 3人还同时进行了牙周基础治疗。三联药物治疗后分析胃内幽门螺杆菌根除率与患者牙周临床指数的关系 ,以及牙周基础治疗对胃内Hp根除率的影响。 结果 :4个位点平均牙周袋深 <4mm组的患者三联药物治疗 4周后及 1年后的Hp根除率明显高于平均袋深≥ 4mm组的患者 (80 %vs5 2 .2 % ,62 .9%vs 3 4.5 % ,P <0 .0 5 )。经过牙周基础治疗的患者 1年后的Hp根除率显著高于未做牙周基础治疗的患者 (63 .6%vs 3 4.5 % ,P <0 .0 5 )。结论 :药物治疗Hp的根除率与患者的牙周状况和口腔卫生状况有关。口腔Hp可能是胃Hp再感染的病原因素 ,因此对胃内Hp感染同时伴有牙周炎的患者在进行三联药物治疗的同时应配合牙周基础治疗。     

Combinatorial effects of amoxicillin and metronidazole on selected periodontal bacteria and whole plaque samples

Objective

The aim of the present study was to analyze in vitro the combinatorial effects of the antibiotic combination of amoxicillin plus metronidazole on subgingival bacterial isolates.

Design

Aggregatibacter (Actinobacillus) actinomycetemcomitans, Prevotella intermedia/nigrescens, Fusobacterium nucleatum and Eikenella corrodens from our strain collection and subgingival bacteria isolated from patients with periodontitis were tested for their susceptibility to amoxicillin and metronidazole using the Etest. The fractional inhibitory concentration index (FICI), which is commonly used to describe drug interactions, was calculated.

Results

Synergy, i.e. FICI values ≤ 0.5, between amoxicillin and metronidazole was shown for two A. actinomycetemcomitans (FICI: 0.3), two F. nucleatum (FICI: 0.3 and 0.5, respectively) and one E. corrodens (FICI: 0.4) isolates. Indifference, i.e. FIC indices of >0.5 but ≤4, occurred for other isolates and the 14 P. intermedia/nigrescens strains tested. Microorganisms resistant to either amoxicillin or metronidazole were detected in all samples by Etest.

Conclusion

Combinatorial effects occur between amoxicillin and metronidazole on some strains of A. actinomycetemcomitans, F. nucleatum and E. corrodens. Synergy was shown for a few strains only.     

雷尼替丁三联疗法对幽门螺杆菌阳性十二指肠溃疡的近期及远期疗效

对82例幽门螺杆菌(HP)阳性的十二指肠溃疡用雷尼替丁、羟氨苄青霉素和甲硝唑三联疗法2周,追踪1年,并与145例铋剂三联疗法病例对照。结果治疗组溃疡愈合率87.8%,HP根除率89.0%;对照组两参数为92.4%和85.7%(P均＞0.05)。治疗组副反应显著少。追踪1年,治疗组HP感染再燃9例(12.3%),重感染2例(2.7%),溃疡复发率HP阴转组1/61(1.6%),HP阳性组7/11(63.6%)(P＜0.01)。因再燃率高且在停药后4~8周发生,建议修定HP根除的标准时间,应从4周末延到8周末。     

Pelvic radiation disease: Updates on treatment options

Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.