Occupational exposure to different levels of mixed organic solvents and colour vision impairment

Mixed organic solvents have a broad range of applications in industry. Occupational exposure to organic solvents has been shown to be associated with colour vision impairment. The study was designed to determine the impact of chronic occupational exposure to organic solvent mixtures on colour vision of car industry painters. 408 workers of assembly location and 2 different paint locations of a car manufacturing company were included in the study. The workers were studied in three groups. The first group consisted of those working in the assembly location with no exposure to organic solvents. The second and third groups included those working in the new and old paint locations, exposed to organic solvents at lower and higher levels than the permissible level, respectively. The Lanthony D-15 desaturated (LD-15) test was used for screening acquired colour vision impairment. The frequency of acquired colour vision impairment was 44.28% for workers of the old paint location, 29.31% for workers of the new paint location, and 3.90% for workers of the assembly location, indicating a significant difference (p < 0.001). The results of logistic regression indicated there was a significant relationship between colour confusion index (CCI) and exposure to organic solvents (p < 0.001) for the old and new paint locations. We suggest that chronic occupational exposure to organic solvents at higher and even lower levels than the permitted levels may lead to acquired colour vision impairment. It is recommended that LD-15 test would be implicated in the early diagnosis of nervous system disorders in workers exposed chronically to organic solvents.     

Driving impairment in depressed patients receiving long-term antidepressant treatment

Background Depression is a common mental disorder with cognitive deficits, but little information is available on the effects of antidepressant treatment on driving performance in depressed patients.Aims Assessing actual driving performance and cognition of depressed patients receiving long-term antidepressant treatment.Materials and methods Performance was assessed in depressed patients receiving selective serotonin reuptake inhibitor (SSRI) or serotonin and noradrenalin reuptake inhibitor (SNRI) treatment for 6–52 weeks and in matched healthy controls by means of two standardised on-the-road driving tests and laboratory tests of cognition.Results Data showed poorer driving performance as indicated by a higher standard deviation of lateral position or ‘weaving motion’ in medicated patients relative to controls. Time to speed adaptation and critical flicker fusion threshold were also impaired in medicated patients. The Hamilton Depression Rating Scale scores in medicated patients were significantly higher as compared to that of controls. No other significant results between the two groups were demonstrated on the variables of the driving tests and laboratory tests of cognition.Conclusions The depressed patients receiving long-term treatment with SSRI- and SNRI-type antidepressants show impaired driving performance. This impairment in driving performance can probably be attributed to residual depressive symptoms instead of the antidepressant treatment.     

丁苯酞用于血管性认知功能障碍患者有效性与安全性Meta分析

目的：系统评价丁苯酞用于血管性认知功能障碍（VCI）患者的有效性和安全性。方法：检索PubMed、Embase、Cochrane library、CNKI、万方电子数据库,同时进行手工检索,收集国内外2000-2017年7月公开发表的关于丁苯酞用于治疗VCI的随机对照研究。依据纳入和排除标准筛选文献,对纳入文献进行方法学质量评估。采用RevMan 5.3软件统计学分析。结果：共纳入30个研究（共2 875例）。Meta分析结果表明,丁苯酞组与对照组相比,能够显著改善患者MMSE评分（SMD=1.16,95% CI：0.89~1.2,P<0.000 01）,ADL评分（SMD=2.25,95% CI：1.65~2.85,P<0.000 01）和CDR评分（SMD=-1.50,95% CI：-2.13~-0.87,P<0.000 01）。有9个研究测定血浆SOD含量,丁苯酞相比对照组可改善血浆SOD含量（SMD=1.94,95% CI：1.76~2.11,P<0.000 01）,4个研究测定血浆MDA水平,丁苯酞相比对照组可改善血浆MDA含理（MD=-2.65,95% CI：-3.53~-1.77,P<0.000 01）。剔除低评分的研究,敏感性分析结果不变。19个研究报道了药品不良事件,主要为胃肠道等轻微不良反应,一般可耐受。结论：丁苯酞用于VCI治疗有一定疗效且安全性较好,但纳入的文献质量不高,需更多高质随机双盲对照试验进一步证实。     

Drug-specific antibodies in patients receiving captopril.

IgG anti-captopril (CP) antibody activity was detected by enzyme-linked immunosorbent assay (ELISA) in serum from two out of 45 patients receiving the drug (25-75 mg day-1). Five of the 45 patients, including one whose serum was antibody-positive, suffered skin rashes which were thought to be drug-induced. The specificity of the antibody for the disulphide-conjugated form of captopril was established as follows: serum IgG bound to disulphide-linked captopril-human albumin (CP-S-S-HSA) conjugate but not to HSA; binding of IgG to CP-S-S-HSA was inhibited by disulphide-linked captopril-ovalbumin (CP-S-S-OVA) conjugate and captopril disulphide (CP-S-S-CP). The structurally related drug D-penicillamine (PA) in disulphide-linked form (PA-S-S-OVA and PA-S-S-PA) was without inhibitory activity. The inhibitory preparations of CP-S-S-OVA and CP-S-S-CP were shown to be inactive in an ELISA for human IgG directed against the unrelated benzylpenicilloyl antigen. Since disulphide-linked CP-plasma protein conjugates are formed extensively in vivo, and since the antibodies we describe are directed against CP in disulphide-linked form, it appears that CP may be immunogenic in some patients receiving the drug.     

Hypophosphataemic osteomalacia in patients receiving haemodialysis.

Four patients had symptomless osteomalacia at the time of starting regular haemodialysis. After 21-40 months they became hypophosphataemic and developed disabling skeletal symptoms. In each case an exacerbation of histological osteomalacia was shown. Symptoms improved after measures designed to raise serum inorganic phosphate concentrations or vitamin D administration, or both. Patients undergoing maintenance haemodialysis should have their serum phosphate and alkaline phosphatase levels monitored every month. Predialysis phosphate levels below 1 mmol/1 (3 mg/100 ml) and rising serum alkaline phosphatase concentrations are danger signals. If the diagnosis is confirmed early aggressive treatment should be started.     

Antinuclear antibodies in patients receiving non-practolol beta-blockers.

Antinuclear antibodies (ANA) were found in 54 (7.0%) out of 767 treated hypertensive patients compared with 59 (2.4%) out of 2470 healthy controls. Inclusion of a non-practolol beta-blocker in the treatment regimen did not significantly affect the incidence of ANA. ANA was found in significantly more patients being treated with methyldopa (13.0%) than patients receiving other hypotensive agents (3.8%). Non-practolol beta-blockers in combination with methyldopa did not increase the incidence of ANA further.     

Determinants of anticoagulant control in patients receiving warfarin.

1 A hospital-based drug information system has been used to assess the time for which patients treated with warfarin were outside the range of Thrombotest values 5-10% and 5-15% and to examine possible contributory factors in situations where anticoagulation fell outside these ranges. 2 Anticoagulant control varied with the age of the patient and with concomitant drug therapy but not with patient sex or indication of anticoagulation. 3 Most patients were 'under-anticoagulated' at some stage but patients over 70 years spent significantly longer in the 5-10% range than those in the age range 30-59 years and Thrombotest values of less than 5% were found predominantly in the older group. 4 Patients given drugs known to interact with warfarin spent least time in the defined Thrombotest ranges. Those on drugs known to potentiate warfarin effect had significantly lower Thrombotest values than the other patients studied.     

Ranitidine disposition in patients with renal impairment.

Ranitidine disposition has been studied in 12 patients with renal impairment following 50 mg given intravenously and 150 mg given by mouth on separate occasions. The clearance of ranitidine from plasma (y) was correlated with creatinine clearance (x): y = 10.47 + 0.289x,r2 = 0.751, but there was no significant correlation of creatinine clearance with distribution volume or bioavailability. The mean (s.e. mean) distribution volume was 1.62 (0.08) 1/kg and the mean bioavailability 0.81 (0.05). These data suggest that in order to obtain similar ranitidine plasma concentrations in anephric patients and patients with normal renal function, the maintenance dose in the anephric patients should be 25-30% of that for patients with normal renal function.     

Potential warfarin-ciprofloxacin interaction in patients receiving long-term anticoagulation.

This study prospectively evaluated the potential interaction between the oral anticoagulant warfarin and the quinolone antimicrobial agent ciprofloxacin. After a 10-day placebo lead-in phase, 16 patients stabilized with long-term warfarin therapy were randomized to receive ciprofloxacin 500 mg or a matching placebo twice/day for 10 days. International normalized ratios (INRs) measured by both standard laboratory analysis and by Coumatrak (finger-stick) methods were evaluated at 3- to 5-day intervals. No patient experienced a significant increase in INR. No patient experienced a bleeding event. These data support the fact that a warfarin-ciprofloxacin interaction does not routinely occur at this dosage and duration of ciprofloxacin therapy.