哌拉西林钠他唑巴坦钠致血细胞减少误诊为消化道出血

1例79岁男性患者因头部外伤合并大肠埃希菌肺炎给予哌拉西林钠他唑巴坦钠4.5 g静脉滴注、1次/8 h治疗。治疗前白细胞计数（WBC）10.20×10 9/L,红细胞计数（RBC）3.58×10 12/L,血红蛋白（Hb）101 g/L,血小板计数（PLT）202×10 9/L。用药第2天...     

哌拉西林钠他唑巴坦钠致继发性血小板增多1例

目的 探讨继发性血小板增多的原因,提高对哌拉西林钠他唑巴坦钠不良反应的认识,为临床安全用药提供参考.方法 临床药师参与1例哌拉西林钠他唑巴坦钠致血小板增多的治疗,分析不良反应发生的原因、机制及处理方法.结果 患者因肺炎入院使用哌拉西林钠他唑巴坦钠(4.5 g,q8h)治疗,用药前血小板计数(PLT)为285×109·L...     

临床药师参与处理1例哌拉西林钠他唑巴坦钠引起的血小板减少症患者的分析

1例63岁的脑外伤患者在接受硬膜外血肿治疗13 d后发生了导管相关性泌尿系统感染,医师先后给予左氧氟沙星和哌拉西林钠他唑巴坦钠治疗,但在加用哌拉西林钠他唑巴坦钠治疗3 d后,患者的血小板计数从127×109/L降至44×109/L.临床药师早期识别了患者血小板减少发生的原因,及时建议改用阿米卡星治疗并为医师采纳.10 d后患者的泌尿系统感染痊愈,且其间未再出现药物不良反应.     

哌拉西林他唑巴坦致血小板减少1例并个案文献分析

目的 为临床安全使用哌拉西林他唑巴坦提供参考。方法 分析某院收治的1例哌拉西林他唑巴坦致血小板减少患者的治疗过程。检索中国知网、维普、万方数据库，检索时限为各数据库自建库起至2021年7月1日，收集已发表的哌拉西林他唑巴坦致血小板减少的个案报道，并分析其发生特点。结果 该例患者因慢性阻塞性肺疾病急性加重、肺部感染入院，入院后予哌拉西林他唑巴坦(2.25 g,8 h 1次)抗感染，次日出现血小板计数(PLT)降低(最低时4×10⁹/L)，考虑为感染引起，补充血小板治疗，PLT一度回升至47×10⁹/L，但2 d后其他症状改善，PLT再次降至4×10⁹/L，遂改用莫西沙星抗感染，继续补充血小板治疗；换药次日PLT升至99×10⁹/L，停止输注血小板，1 d后PLT恢复正常且至患者出院前未再降低。共纳入文献16篇，涉及患者19例，年龄26～84岁，平均年龄(65.84±16.24)岁；用药原因多为肺部感染(12例)；用法用量以4.5 g、每日3次为主(7例)；联合用药10例；PLT降低发生于用药后1～20...     

1例哌拉西林钠他唑巴坦钠致肾移植术后患者血小板减少的病例分析

通过分析1例肾移植术后男性患者,在胃溃疡穿孔修补术后使用哌拉西林钠他唑巴坦钠抗感染治疗过程中,出现血小板计数(platelet count,PLT)持续下降的问题,检索相关中英文文献,探讨患者PLT减少的可能原因及哌拉西林钠他唑巴坦钠造成患者PLT下降可能的作用机制。结果提示,导致肾移植术后患者血小板减少的因素较多,应及时辨别,出现药源性血小板减少症时,应及时发现,避免潜在的不良反应,有利于提高患者用药的安全性及有效性,促进临床合理用药。     

哌拉西林钠他唑巴坦钠致重症肝病患者贫血加重及血小板减少3例

3例重症肝病合并感染患者（均为男性,年龄分别为40、68、50岁）接受碳青霉烯类、利奈唑胺及氟康唑联合治疗,期间未出现明显血象变化。因疗效不佳换用哌拉西林钠他唑巴坦钠4.5 g,8 h/次静脉滴注。其中例1于换用哌拉西林钠他唑巴坦钠11 d后出现贫血及血小板计数下降;例2、例3分别于换用哌拉西林钠他唑巴坦钠4、7 d后出现贫血加重及血小板计数下降。3例患者分别在停用哌拉西林钠他唑巴坦钠后31、21、7 d,血红蛋白及血小板计数明显恢复。     

哌拉西林钠他唑巴坦钠致白细胞减少

1例46岁女性患者,因术后颅内感染静脉滴注哌拉西林钠他唑巴坦钠4.5 g,1次/8 h。用药第13、15天外周血白细胞计数从用药前的10.61×109/L分别降至1.79×109/L和1.00×109/L。立即换用其他抗菌药物,同时给予重组人粒细胞巨噬细胞集落刺激因子(rhGM-CSF)150μg皮下注射,1次/d。改变治疗后4 d,血白细胞计数升至6.95×109/L。改变治疗后6 d脑脊液白细胞数由首次用药后15 d的8×106/L升至56×106/L,再次给予哌拉西林钠他唑巴坦钠4.5 g静脉滴注,1次/8 h,rhGM-CSF剂量未变。用药6 d颅内感染治愈,遂停用抗菌药物。治疗第2、5天白细胞计数分别为2.67×109/L和1.65×109/L。第8天停用rhGM-CSF后为5.75×109/L,第15天为4.56×109/L。     

哌拉西林钠/他唑巴坦钠治疗下呼吸道感染

哌拉西林钠/他唑巴坦钠为哌拉西林钠和他唑巴坦钠按8:1组成的混合物.两者合用,可耐酶并产生强大的杀菌作用.2006年5月至2006年12月,我们应用哌拉西林钠/他唑巴坦钠疗治疗68例下呼吸道感染患者,取得较好疗效,现报告如下:     

丙戊酸钠致严重血小板减少

1例87岁女性患者因抽搐和心动过缓给予注射用丙戊酸钠1200mg静脉持续泵入,20ml／h,1次／d。用药前患者血小板计数为214×10^9／L。用药8d后血小板计数降至63×10^9／L,停用注射用丙戊酸钠,改为口服丙戊酸钠缓释片500mg,1次／d。5d后患者血小板计数降至25×10^9／L。停用丙戊酸钠缓释片,输注血小板1U,口服氨肽素1000mg,3次／d。对症治疗8d后血小板计数升至160×10^9／L。     

一例哌拉西林钠/他唑巴坦钠致药物热和白细胞减少的案例分析

目的 了解哌拉西林钠/他唑巴坦钠致患者药物热和白细胞减少的发生时间、严重程度及处理方法,并分析不良反应产生的可能机制,为临床合理用药提供参考。方法 对临床诊疗过程中发现的1例哌拉西林钠/他唑巴坦钠致药物热和白细胞减少的案例进行分析。结果 该例患者发生药物热和白细胞减少在使用哌拉西林钠/他唑巴坦钠20 d后,给予停药处理,患者停药第2日体温正常。结论 对于长期大剂量使用哌拉西林钠/他唑巴坦钠的患者,应密切监测患者体温及血常规变化情况,及时识别药品不良反应,给予对应处理,避免药害事件发生。     

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.