盐酸左氧氟沙星注射液致过敏、高热1例

患女,41岁,因双侧颈部淋巴结肿大,收治住院,入院诊断疑为颈部淋巴结炎或颈部淋巴结核。住院当日下午给予9g.L-1氯化钠注射液100mL加盐酸左氧氟沙星注射液0.2g,静脉滴注,2次/d;50g.L-1葡萄糖氯化钠注射液500mL加维生素C注射液2g、氯化钾注射液1g静脉滴注,1次/d。d2继续静脉滴注上述药物,当滴注完9g.L-1氯化钠注射液100mL加盐酸左氧氟沙星注射液0.2g时,患者畏寒、发热,体温最高达40.3℃。给予地塞米松注射液5mg静脉注射,非那根注射液25mg肌肉注射,复方氨基比林注射液2mL肌肉注射,冰敷,至d3上午体温正常。再次静脉滴注9g.L-1氯化钠注射液10…     

左氧氟沙星相关精神障碍

1例90岁男性患者因肺炎合并头部带状疱疹,给予左氧氟沙星0.3 g,2次/d静脉滴注;三磷酸腺苷20 mg、辅酶A 100 U及10%氯化钾注射液7 ml溶入5%葡萄糖注射液250 ml,1次/d静脉滴注.第2天患者出现失眠、幻听、幻视及思维散漫.神经系统查体未见阳性体征.停用左氧氟沙星,改用阿奇霉素,1 d后患者精神症状消失.     

左氧氟沙星注射液致严重呃逆、呕吐1例

41岁男性, 2022年10月6日于上海市松江区中心医院因"泌尿道感染、附睾炎"给予盐酸左氧氟沙星氯化钠注射液静脉滴注, 使用3 d后患者出现呃逆, 当时未予重视, 继续使用盐酸左氧氟沙星氯化钠注射液3 d后患者出现不间断呃逆伴呕吐, 考虑药物引起, 10月12日给予收住入院。入院后停用盐酸左氧氟沙星氯化钠注射液, 并给予奥美拉唑抑制胃酸, 甲氧氯普胺止吐, 补钾营养支持等对症治疗, 4 d后患者症状好转出院。     

醒脑静注射液致神经精神症状1例

患者,女,82岁. 因慢性胆囊炎急性发作、胆囊多发性结石,于2011年3月11日11:00入院. 患者有老年性震颤麻痹病史9 a. 无药物及其他变态反应史. 入院后给予头孢哌酮2.0 g加入0.9%氯化钠注射液100 mL,静脉滴注,bid;左氧氟沙星0.3 g加入5%葡萄糖注射液250 mL,静脉滴注,qd. 黄体酮注射剂20 mg,im,bid. 患者于入院第2天11:00在滴注左氧氟沙星组液的过程中出现意识模糊,答非所问. 体检:体温36.8 ℃,脉搏85次.min^-1,呼吸率20次.min^-1,血压120/70 mmHg(1 mmHg＝0.133 kPa). 心肺正常,腹平坦,右上腹压痛明显,无肌紧张及反跳痛,肠鸣音正常. 四肢肌力肌张力正常. 诊断为左氧氟沙星不良反应. 停用左氧氟沙星(其他药物不变),给予醒脑静注射液20 mL,加入5%葡萄糖注射液250 mL,静脉滴注. 患者10 h后意识清楚,能正确回答问题,同时发现震颤麻痹症状明显减轻,为观察醒脑静注射液治疗震颤麻痹的疗效,继续给予醒脑静注射液20 mL,加入5%葡萄糖注射液250 mL,静脉滴注,qd. 使用醒脑静3 d后(总量达60 mL)患者出现谵妄,表现为躁动不安,定向力丧失,整夜不眠,循衣摸床,产生幻觉. 经科内会诊,为醒脑静注射液所致不良反应. 停用醒脑静注射液,并给予地西泮等对症治疗,其他药物不变. 1 d后患者神志清楚. 共住院10 d,腹痛缓解而出院. 随访2个月神志清楚,精神正常.     

乳酸左氧氟沙星氯化钠注射液致严重低血糖

1例78岁女性2型糖尿病患者因恶心、呕吐、反酸、腹泻3d,先后静脉滴注注射用奥美拉唑钠20mg和乳酸左氧氟沙星氯化钠注射液0．3g。静脉滴注乳酸左氧氟沙星氯化钠注射液约10min后患者出现大汗、心慌、面色苍白、意识淡漠,即测血糖3．0mmol／L。暂停静脉滴注乳酸左氧氟沙星氯化钠注射液,给予葡萄糖氯化钠注射液500ml静脉滴注,并进食糖块、面包,约5min后症状缓解。恢复静脉滴注乳酸左氧氟沙星氯化钠注射液,约5min后前述症状复现,即刻血糖为1．9mmol／L。立即停用乳酸左氧氟沙星氯化钠注射液,静脉推注50％葡萄糖注射液20m1后继续静脉滴注5％葡萄糖注射液500ml,约10min后患者低血糖症状消失,输液结束后血糖升至9．6mmol／L。     

左氧氟沙星致低血糖

1例57岁女性患者因直肠黑色素瘤切除术后感染,给予左氧氟沙星注射液0.2 g/100 ml静脉滴注,2次/d,用药约20 min时患者出现乏力、盗汗、心悸等症状,急查血糖,为2.7 mmol/L.立即停用左氧氟沙星,静脉滴注10％葡萄糖500 ml,同时进食糖果,上述症状缓解.次日,再次静脉滴注左氧氟沙星约10 min后上述症状复现,即时血糖2.8 mmol/L.再次停用左氧氟沙星并给予对症治疗,症状缓解.改用其他抗生素治疗,患者感染得到控制,未再出现低血糖反应.     

盐酸左氧氟沙星注射液与乳酸左氧氟沙星注射液治疗下呼吸道感染的比较

目的比较盐酸左氧氟沙星注射液与乳酸左氧氟沙星注射液治疗下呼吸道感染的疗效、不良反应。方法采用回顾性调查分析的方法,将符合入选条件的下呼吸道感染患者分成两组:盐酸左氧氟沙星注射液治疗组60例,0.3 g2次/d,静脉滴注,乳酸左氧氟沙星注射液治疗组58例,0.5 g 1次/d,静脉滴注,疗程均为7～14 d。结果盐酸左氧氟沙星注射液与乳酸左氧氟沙星注射液治疗下呼吸道感染的有效率分别为83.33%和87.93%,痊愈率分别为71.67%和77.59%,不良反应发生率均为6.3%,两组相比较均无显著性差异(P>0.05)。结论左氧氟沙星是一种治疗下呼吸道感染的理想药物,盐酸左氧氟沙星注射液与乳酸左氧氟沙星注射液同样安全有效,临床疗效和不良反应相仿。     

阿奇霉素静脉滴注治疗急性咽喉炎致失眠

1例35岁女性患者,因患急性咽喉炎给予阿奇霉素0.5 g加入5%葡萄糖注射液250 ml静脉滴注,1次/ d.当晚出现入睡困难.次日静脉滴注后又出现入睡困难,给予安神片5片及地西泮10 mg口服,失眠症状仍未改善.停用阿奇霉素,改用左氧氟沙星100 ml静脉滴注,1次/d,1 d后睡眠恢复正常.追问病史,患者1年前使用阿奇霉素治疗,曾出现过失眠.     

静脉注射左氧氟沙星致抽搐1例分析

对静脉注射左氧氟沙星致抽搐1例分析如下。1病历摘要男,30岁。因急性阑尾炎于2009-10-06T06：30收住院。应用5%葡萄糖液500ml＋左氧氟沙星0.3静脉滴注1次/d,0.9%氯化钠注射液250ml＋青霉素400万U静脉注射2次/d,替硝唑100ml静脉滴注1次/d治疗。入院第2天14：00时患者突然出现四肢抽搐,憋气症状,神志清楚,BP100/80mm Hg,P120-150次/min,即刻给氧气吸入,地西泮10mg静脉推注,患者病情随即稳定,P80-100次/min。查血常规及血生化,均大致正常,再次询问病史,否认癫痫等脑部疾病史。     

左氧氟沙星联合头孢曲松钠治疗社区获得性肺炎30例临床观察

目的评价左氧氟沙星联合头孢曲松钠治疗社区获得性肺炎（CAP）的疗效。方法选择CAP患者60例,随机分为左氧氟沙星联合头孢曲松钠（治疗组）和单用头孢曲松钠（对照组）各30例,其中治疗组用头孢曲松钠4g／d,分两次静脉滴注,加用左氧氟沙星注射液300mg静脉滴注,1次／d;对照组仅用头孢曲松钠4g／d,分两次静脉滴注治疗,10d为一疗程。结果治疗组有效率93．33％,明显高于对照组的73．33％（P〈0．05）。结论头孢曲松钠联合左氧氟沙星治疗,可明显提高CAP的有效率,改善预后,安全性能良好。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.