Interstitial glucose profile associated with symptoms attributed to hypoglycemia by otherwise healthy women

BACKGROUND: Reports of postprandial symptoms attributed to hypoglycemia by otherwise healthy individuals appear to be relatively common in UK women. Whether these symptoms are related to blood glucose is a contentious issue, which periodic ambulatory blood glucose measurement has failed to resolve. OBJECTIVE: The authors investigated, using continuous glucose monitoring technology, whether postprandial symptoms are associated with interstitial glucose concentrations (IG) in the hypoglycemic range or with a previous fall in IG. DESIGN: Thirty healthy nonobese women (age 20-48 y) who reported symptoms attributable to hypoglycemia and 20 nonsymptomatic controls wore a subcutaneous probe in abdominal fat for 4-7 d (median: 5 d) and kept a diet and activity diary during this time. RESULTS: Twenty women reported postprandial symptoms; 41 episodes were recorded. When symptomatic, IG was < or =3.3 mmol/L in 5% of cases. A significant fall in IG over the preceding 60 min was observed before autonomic symptoms (P < 0.005). The proportion of total energy intake derived from dietary fat in the symptomatic group was higher than that in the controls (P < 0.05). The proportion of total sugars was similar between groups; however, the meal preceding symptoms had a higher percentage of energy derived from total sugars when compared with the individuals' diet over the study period (P < 0.05). CONCLUSIONS: Most symptoms attributable to hypoglycemia were not associated with an IG concentration in the hypoglycemic range. A previous fall in IG may be implicated in the etiology of autonomic symptoms, with the consumption of meals high in sugars potentially playing a role in symptom initiation.     

Interstitial nephritis in human kala-azar

Little is known about renal alterations in kala-azar. The renal histopathology of 21 patients admitted to hospital in São Paulo, Brazil, during the period 1960 through 1981 who either died or had a renal biopsy (two cases) is presented.All the specimens showed oedema and diffuse interstitial inflammatory infiltrate of lymphocytes and plasma cells with more compact foci of cells in some areas. In general, glomeruli did not show any important alterations. These aspects were interpreted as acute interstitial nephritis aetiologically related to later phase kala-azar. This interstitial alteration does not usually seem to determine any clinical manifestations. However, it seems that moderate and severe cortical intersitial damage contribute to the onset of renal insufficiency when severe clinical complications occur. The precise mechanisms of this lesion need further investigation since the aetiological agents have not been seen causing the damage locally.     

哌拉西林/他唑巴坦治疗支气管扩张合并铜绿假单胞菌感染的疗效与安全性评价

目的 评价哌拉西林/他唑巴坦静脉注射对支气管扩张合并铜绿假单胞菌感染患者的临床疗效和安全性.方法 确诊为支气管扩张合并铜绿假单胞菌感染患者106例,随机分为哌拉西林/他唑巴坦(治疗组)56例和哌拉西林/舒巴坦(对照组)50例;治疗组给予哌拉西林/他唑巴坦以2.5g,2次/d静脉滴注,对照组给予哌拉西林/舒巴坦3.0g,2次/d静脉滴注;疗程均为10～14 d,所有入选病例均完成治疗,未因药物不良反应而中止治疗.结果 哌拉西林/他唑巴坦治疗组痊愈21例,显效30例,总有效率为91.07％;对照组痊愈15例,显效25例,总有效率为80.00％;治疗组治疗有效率高于对照组,差异有统计学意义(P＜0.05),哌拉西林/他唑巴坦治疗组临床疗效更好,两组不良反应无明显差异.结论 哌拉西林/他唑巴坦静脉注射安全、有效地治疗支气管扩张合并铜绿假单胞菌感染患者,且具有低附加损害的特点,无1例患者出现伪膜性肠炎及二重真菌感染,值得临床推广.     

头孢哌酮/舒巴坦与亚胺培南/西司他丁和哌拉西林/他唑巴坦治疗革兰阴性菌感染的药物经济学评价

目的评价头孢哌酮/舒巴坦、亚胺培南/西司他丁及哌拉西林/他唑巴坦治疗革兰阴性菌感染的有效性和经济性。方法采用非随机观察性研究,选取2012年1月1日-2016年5月11日期间,使用头孢哌酮/舒巴坦、亚胺培南/西司他丁或哌拉西林/他唑巴坦进行治疗的革兰阴性菌感染住院患者322例的抗菌药物治疗数据,采用成本效果分析进行经济学评价。结果本研究数据来源于一项大样本、非随机主动监测研究课题,原始数据组间协变量存在不均衡现象,采用倾向性评分匹配后,组间协变量不均衡现象得到显著改善。匹配后以目标抗菌药物成本进行经济学分析,头孢哌酮/舒巴坦VS亚胺培南/西司他丁时,头孢哌酮/舒巴坦每获得1%临床疗效、微生物疗效、综合疗效、30d生存率仅需39.15元、51.02元、52.61元、40.09元,而亚胺培南/西司他丁则需要75.54元、81.28元、83.39元、72.15元;头孢哌酮/舒巴坦VS哌拉西林/他唑巴坦时,头孢哌酮/舒巴坦每获得1%临床疗效、微生物疗效、综合疗效、30d生存率仅需36.94元、46.80元、48.40元、33.42元,而哌拉西林/他唑巴坦则需要99.99元、117.64元、121.21元、95.23元。四种成本效果分析均显示头孢哌酮/舒巴坦具有明显的经济学优势。在同等疗效下,头孢哌酮/舒巴坦成本约是哌拉西林/他唑巴坦和亚胺培南/西司他丁的1/3-1/2。采用疗效的95%可信限进行敏感性分析,结论仍然成立。结论头孢哌酮/舒巴坦在治疗革兰阴性菌(包括多重耐药菌)感染时更具有成本效果优势。     

False positive galactomannan Platelia due to piperacillin-tazobactam

Introduction

Invasive aspergillosis is a serious disease, the lethality of which is important among hematology patients. Early diagnosis is crucial for treatment options and the prognosis. Detection of the antigen galactomannan is the most frequently used microbiological tools. But galactomannan detection may be falsely positive, and this false positivity has been associated with piperacillin-tazobactam treatment, the main antibiotic combination used in clinical hematology.

Objective

The purpose of our study, carried out from January 2009 to December 2010 at the Versailles hospital on in-patients with hematological disorders, was to evaluate the association between false galactomannan positivity and administration of piperacillin-tazobactam, and to study a possible variability of products issued by three manufacturers.

Patients and method

We noted that 207 patients were included (n = 207), accounting for 69 false positive and 138 true negative results. The intrinsic galactomannan values in the study were sensitivity 100%, specificity 68%, positive and negative predictive values respectively 16%, 100%, and a likelihood positive and negative test at respectively 3.12, and 0.

Results

The statistical analysis did not determine any association between false positivity in galactomannan and piperacillin-tazobactam issued by two manufacturers (P = 0.87 and P = 0.94). But, there was a significant association between false galactomannan positivity and piperacillin-tazobactam issued by the third manufacturer (P = 0.02). Four of the 25 batches issued by this manufacturer were tested and negative “in vitro” for galactomannan.

Discussion

This study results suggest that the association between false galactomannan positivity and piperacillin-tazobactam is not longer systematic, but can still prevail depending on the manufacturers. It also confirmed the positive contribution of testing piperacillin-tazobactam batches “in vitro” before using the antibiotic.     

浅析门诊慢性病管理

慢性病全称是慢性非传染性疾病,是指起病隐匿,病程长,病情迁延不愈,且难以治愈的一类疾病的总称。主要包括脑血管疾病、糖尿病、恶性肿瘤、免疫系统疾病和精神疾病等。随着人口老龄化和人群疫病谱的变化,慢性病越来越成为影响人口健康和疾病负担的重要因素,而门诊慢性病作为基本医疗保险政策的一项重要内容,对方便门诊慢性病人就医诊疗,像障其医疗需求发挥了重要作用,随着门诊慢性病统筹基金支出越来越多,了解门诊慢性病的管理现状、存在问题及改善措施尤为重要。     

Interstitial cystitis: diagnosis and treatment options

Interstitial cystitis (IC) is a disease complex characterized by urinary frequency, urgency, and bladder pain without an identifiable cause. Essentially, IC is a diagnosis of exclusion. The lack of knowledge of pathophysiology remains the biggest hurdle in diagnosis and treatment of this puzzling and troublesome disorder. Nevertheless, several recent advances, coupled with increased public awareness of this disease, make it easier for physicians and patients to effectively deal with IC.     

哌拉西林/他唑巴坦治疗住院患者泌尿系统感染的疗效分析

目的 观察哌拉西林/他唑巴坦治疗住院患者泌尿系统感染临床疗效,分析其有效性和安全性.方法 将94例患者随机分为试验组和对照组,试验组用哌拉西林/他唑巴坦,对照组用替卡西林/克拉维酸治疗,比较两组在疗效和细菌清除效果的变化.结果 试验组与对照组可进行疗效评价各47例,可进行安全性评价各47例;试验组痊愈28例,显效19例,总有效率100.00％,对照组痊愈22例,显效17例,进步8例,总有效率82.98％,两组比较差异有统计学意义(P＜0.05);细菌清除率试验组为100.00％,对照组为82.98％,两组比较差异有统计学意义(P＜0.05);试验组无不良反应发生,对照组有2例患者出现不良反应,不良反应发生为4.25％,两组差异有统计学意义(P＜0.05).结论 哌拉西林/他唑巴坦治疗泌尿系统感染的临床疗效明显,细菌清除率高,安全可靠,值得临床推广应用.     

Adverse work outcomes and events attributed to asthma

BACKGROUND: Asthma is a chronic condition that has been linked to lower employment rates, job effectiveness, productivity and increased absenteeism. The objectives of this study were to assess the impact of asthma on work function, workplace events, and career. METHODS: One hundred ninety-six patients in an urban practice completed standardized major and minor life events scales and rated whether adverse work events were caused by asthma. RESULTS: Thirty-eight percent of the patients had either changed jobs, work hours, or work duties, and 65% had taken days off because of asthma. In multivariate analyses, less education, not wanting to work, more comorbidity, prior use of oral corticosteroids, and current use of oral beta agonists and methylxanthines (P < or = 0.05 for all comparisons) were associated with these outcomes. Also, currently working patients were more likely to be using inhaled corticosteroids (P = 0.018). Thirty-nine percent believed asthma had adversely affected their career by causing them to: not pursue a desired career; not get promoted due to absenteeism; change to a worse job; and be perceived as incapable of more responsible assignments. Seven percent had a negative work event in the preceding year that they attributed to asthma, including job loss and unfavorable interactions with co-workers. CONCLUSIONS: Patients attribute daily and long-term adverse work outcomes to asthma. Asthma severity and demographic and occupational characteristics were associated with adverse occurrences.     

Short-course treatment of typhoid fever with ciprofloxacin in south India.

This study assessed the performance of short-course ciprofloxacin for the treatment of 34 adult patients with culture-positive typhoid fever. Patients received ciprofloxacin, 750 mg orally twice daily for 7 d. Measurement of response was based upon time from initial treatment to fever lysis, to afebrile state, and to symptom resolution. Ciprofloxacin-treated patients defervesced in a mean of 3.21 d (+/- 0.56), with stabilization of temperature in 4.0 +/- 0.73 d. After 90 d follow-up, no relapse or carrier was identified. Side effects during therapy were minimal.     

依替米星联合哌拉西林/他唑巴坦治疗急性心肌梗死PCI后肺部感染的临床疗效

目的探究依替米星联合哌拉西林/他唑巴坦治疗急性心肌梗死患者经皮冠状动脉介入治疗(PCI)后肺部感染的临床疗效。方法选取2012年1月-2016年12月医院收治的400例PCI急性心肌梗死合并肺部感染患者作为研究对象,按照随机数字表法分为对照组和研究组,每组200例。对照组患者采用静脉注射硫酸依替米星治疗,研究组患者在对照组治疗的基础上加用哌拉西林/他唑巴坦治疗。分析两组患者病原菌感染情况;比较两组患者临床治疗效果、临床症状好转时间及住院时间;测定两组患者治疗前后血清中谷草转氨酶(AST)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CKMB)、D-二聚体及炎症因子肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及白介素-8(IL-8)的含量。结果对照组患者共检出病原菌217株,研究组检出病原菌221株,两组比较差异无统计学意义(χ2=0.692,P=0.405);研究组患者疗效率高于对照组,(Z=4.188,P<0.001);研究组患者体温恢复时间、咳嗽消失时间、肺部啰音消失时间、白细胞恢复时间及住院时间均比对照组缩短(P<0.05);治疗后两组患者血清心肌酶、炎症因子指标及D-二聚体含量均降低,且研究组患者降低幅度较大(P<0.05)。结论依替米星联合哌拉西林/他唑巴坦治疗急性心肌梗死患者经皮冠状动脉介入治疗后肺部感染具有较好的临床效果,能够改善临床症状并降低血浆D-二聚体、心肌酶指标及血清炎症因子水平。     

Effectiveness of pseudoephedrine plus acetaminophen for treatment of symptoms attributed to the paranasal sinuses associated with the common cold

BACKGROUND: Little data exist on the cause and treatment of subfacial pain and pressure and other discomfort attributed to the paranasal sinuses that develop early during the course of the common cold. The purpose of this study was to determine the efficacy of the combination of pseudoephedrine hydrochloride with acetaminophen for the treatment of early symptoms during colds, which are attributed by the patient to the sinuses. METHODS: Four hundred thirty subjects (216, pseudoephedrine and acetaminophen recipients; 214, placebo recipients) with cold symptoms of 48 hours or less who reported overall "sinus" symptoms of at least moderate severity were enrolled in this randomized double-blind placebo-controlled 2-dose study. Self-reported symptoms were scored (0 to 4, absent to severe) before and at 2 hours after the first and second doses. The 2 primary were measured 2 hours after the second dose were the overall sinus symptom assessment and a weighted composite assessment of sinus pressure, pain, and congestion (sinus symptoms). RESULTS: Compared with baseline, 2 hours after the second dose, the mean +/- SEM overall sinus symptom assessment score had decreased by 1.30 +/- 0. 06 in the pseudoephedrine and acetaminophen-treated subjects compared with 0.93 +/- 0.06 in the placebo-treated subjects (P< or = .029). The mean +/- SEM weighted average of sinus symptoms 2 hours after the second dose of study medication had decreased by 1.14 +/- 0.06 in the pseudoephedrine and acetaminophen-treated subjects compared with 0.84 +/- 0.06 in the placebo-treated subjects (P< or = .029). Reductions in similar magnitude were also observed for each of the individual sinus symptoms, and headache and rhinorrhea. Nervousness occurred in 4% of the pseudoephedrine and acetaminophen recipients compared with 0% of placebo recipients (P =.007). CONCLUSION: Our results suggest that pseudoephedrine plus acetaminophen is effective for relief of symptoms attributable to the paranasal sinuses that may develop early in the course of a cold. Arch Fam Med. 2000;9:979-985     

Interdisciplinary clinical assessment of patients with illness attributed to environmental factors

Patients with health problems attributed to environmental factors such as chemical pollutants and electromagnetic fields often do not present evidence of an environmental aetiology of their symptoms. It has been postulated, that their problems are due to disorders diagnosed by other medical disciplines, especially allergology and psychiatry. Our study was designed to subject these patients to a comprehensive diagnostic program involving several medical disciplines in order to achieve diagnoses appropriate to explain the patients' symptoms.Fifty patients consecutively referred to the department of environmental medicine in the university hospital of Aachen, Germany, were submitted to the following examinations: (i) environmental medicine (history, clinical examination, biological and/or ambient monitoring for environmental agents); (ii) allergological examination (history, clinical examination, skin tests); (iii) psychiatric examination (psychopathological examination, psychometric and neuropsychological testing). In addition, the patients were examined in other hospital departments according to the symptoms presented. The findings were discussed in case conferences attended by the physicians involved in order to achieve individual diagnoses.The numbers of patients to whom diagnoses were given by different medical disciplines are as follows: psychiatry (32 patients), dermatology (4), allergology (2), neurology (2), rheumatology (2), gynaecology (1), haematology (1). The most frequent mental disorders diagnosed by the psychiatrists were somatoform disorders (19), followed by schizophreniform and delusion disorders (7).In spite of extensive diagnostic efforts, patients with health problems attributed to the environment usually do not present sufficient evidence of an environmental aetiology of their symptoms. On the other hand the symptoms often meet the diagnostic criteria of other diseases, especially of mental disorders.