早发型重度子痫前期的发病及母婴结局预测分析

目的探讨早发型重度子痫前期的发病特点,为早期诊断、预测预后、选择适宜孕周终止妊娠提供临床依据。方法回顾性分析2009年1月至2011年6月重度子痫前期243例(早发型74例,晚发型169例)的一般情况、临床实验室指标、妊娠并发症及母婴结局,对早发型组不良妊娠结局的病例进行危险因素的Logistic多因素回归分析。结果两组孕妇平均年龄、孕次、产次、系统产检方面,差异无显著统计学意义(P>0.05),但两组入院孕周、分娩孕周、孕前身高体重指数差异有统计学意义;早发型组的白细胞计数、红细胞计数、血细胞比容、转氨酶水平、尿素氮、肌酐及舒张压均明显高于晚发型组,而血小板、血浆总蛋白均低于晚发型组,两组收缩压无明显差异;早发型组孕妇发生神经系统症状、消化系统症状、眼底改变、肝功能损害、低蛋白血症、胎盘早剥、心力衰竭及溶血、肝酶升高、血小板减少综合征的发生率均高于晚发型组;早发型组胎儿生长受限、胎儿窘迫、早产、新生儿死亡及死胎等发病率明显高于晚发型组;早发型重度子痫前期红细胞计数越高、血小板计数越低、转氨酶水平越高,越有可能出现母儿异常结局。结论掌握早发型重度子痫前期临床特点,积极预防预测不良妊娠结局的危险因素,找到母婴双方利益的平衡点,及时终止妊娠对改善母儿预后有重大意义。     

低蛋白血症对重度子痫前期妊娠结局的影响

目的探讨低蛋白血症对重度子痫前期妊娠结局的影响及其相关的处理和治疗。方法回顾性分析2009年1月～2012年6月笔者所在医院收治的247例重度子痫前期患者的临床资料,将所有患者分为两组,A组:低蛋白血症组134例,B组:非低蛋白血症组113例,比较两组患者的妊娠结局。结果 A组患者血压、蛋白尿均显著高于B组,且发病孕周早,严重并发症发生率高(P0.05)。与B组相比,A组的新生儿体重较低,新生儿窒息、围生儿死亡率高(P0.05)。结论重度子痫前期患者常合并低蛋白血症,易导致母亲及围生儿预后不良。血浆蛋白的变化具有非常重要的临床意义,应作为重度子痫前期常规监测指标。     

重度子痫前期患者妊娠结局的预测

目的探讨各项生化指标在预测重度子痫前期患者妊娠结局中的意义。方法回顾性分析2010年6月至2010年12月在郑州大学第三附属医院住院的115例重度子痫前期患者和117例正常妊娠者的临床资料及各项生化指标,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总蛋白、白蛋白、胆汁酸、尿素、肌酐、尿酸、β2-微球蛋白(β2-MG),比较两组资料的差异,同时,观察重度子痫前期患者的乳酸脱氢酶(LDH)水平,分析其与妊娠结局的关系。结果重度子痫前期组ALT[(22.36±24.44)比(10.44±7.51)U/L]、AST[(31.08±27.23)比(18.37±6.99)U/L]、GGT[(28.47±39.81)比(10.79±7.50)U/L]、胆汁酸[(5.64±4.40)比(3.34±1.84)μmol/L]、尿素[(5.73±2.21)比(3.49±0.95)mmol/L]、肌酐[(78.42±32.23)比(62.30±10.36)μmol/L]、尿酸[(390.10±97.84)比(274.48±59.98)μmol/L]及β2-MG[(3.42±1.21)比(2.19±0.44)mg/L]均高于正常妊娠组,差异有统计学意义(P<0.05);总蛋白[(57.83±6.64)比(66.50±6.01)g/L]和白蛋白[(28.33±3.87)比(33.40±2.82)g/L]均低于正常妊娠组,差异有统计学意义(P<0.05);重度子痫前期患者ALT、GGT和LDH异常者其妊娠结局较ALT、GGT和LDH正常者差。结论多项生化指标的变化可提示重度子痫前期的发生,ALT、GGT及LDH异常时提示重度子痫前期病情严重,可能出现不良围产儿结局。临床医生应重视这些指标的异常变化,并采取有效的干预措施,预防妊高征的发生与发展,改善围产儿结局。     

重度子痫前期患者血清GAS6与其他炎症因子的相关性研究

目的 探讨重度子痫前期患者血清生长停滞特异性基因产物6（GAS6）的水平与其他炎症因子的相关性。方法 回顾性选取2018年1月—10月期间我院分娩的产妇133例,其中重度子痫前期产妇77例为病例组,正常妊娠产妇56例为对照组。酶联免疫吸附试验检测血清GAS6、白细胞介素6（IL-6）、白细胞介素10（IL-10）、白细胞介素18（IL-18）水平,生化分析仪检测C反应蛋白（CRP）,分析2组各指标差异及有差异的指标与GAS6的相关性。结果病例组收缩压、舒张压高于对照组,孕周少于对照组,血清GAS6以及IL-10水平降低,而IL-6、IL-18水平高于对照组（P＜0.05）。血清GAS6水平变化与IL-6水平呈负相关。结论 重度子痫前期患者血清GAS6参与炎症反应,发挥抗炎因子的作用,其血清浓度与炎症反应严重程度存在相关性。     

早发型重度子痫前期母婴结局38例分析

目的 探讨早发型重度子痫前期对母婴结局的影响. 方法 分析早发型重度子痫38例（早发组）与同期晚发型重度子痫112例（晚发组）的围产期情况和分娩172例婴儿的结局. 结果 两组孕产妇并发症比较：早发组发生率36.8%,晚发组16.1%,差异有统计学意义（P＜0.01）;围生儿比较：早发组围生儿体质量明显低于晚发组（P＜0.01）,早发组发生新生儿窒息、围生儿病死率、FGR明显高于晚发组（均P＜0.05）. 结论 早发型重度子痫孕妇并发症发生率高,围生儿病情严重、预后不良.早发型重度子痫孕妇应严格选择病例行短期的期待疗法.     

孕前肥胖的早发型子痫前期患者临床特点与围产结局分析

摘要： 目的 探讨孕前肥胖的早发型子痫前期患者临床特点及对围产儿多系统的影响。方法 回顾分析我院产科住院的早发型子痫前期产妇 111 例, 按孕前体质指数（BMI）分为正常组（BMI＜28 kg/m2） 56 例和肥胖组（BMI≥ 28 kg/m2） 55 例, 比较 2 组产妇基础体质量、 基础 BMI、 孕期增重、 高危因素、 临床特征、 血脂指标及新生儿临床特点,并分析产妇血糖、 血脂指标与新生儿各指标的相关性。结果 肥胖组产妇更易发生血液浓缩和血脂代谢紊乱, 血脂水平、 糖化血红蛋白 （HbA1c）、 血细胞比容、 血小板及纤维蛋白原均显著高于正常组; 引发新生儿酸中毒及心脏等脏器损害, 肥胖组新生儿出生 Apgar 评分、 pH、 血糖显著低于正常组, 而剩余碱 （BE）、 乳酸 （LAC）、 肌酸激酶 （CK）、 肌酸激酶同工酶 （CKMB） 高于孕前正常组 （均 P＜0.05）; 相关分析示产妇低密度脂蛋白胆固醇 （LDL-C）、 总胆固醇 （TC）、三酰甘油（TG）及 HbA1c 与新生儿 Apgar 评分、 pH 呈负相关, 与新生儿 LAC、 CKMB 呈正相关（P＜0.05 或 P＜ 0.01）。结论 孕前肥胖的早发型子痫前期产妇所发生的脂代谢紊乱与母婴围产结局密切相关。     

Psychopharmacoteratophobia: Excessive fear of malformation associated with prescribing psychotropic drugs during pregnancy: An Indian perspective

“Psychopharmacoteratophobia is the fear or avoidance of prescribing psychotropic medicine to a pregnant woman on a given indication in anticipation of fetal malformation.” It is rooted in the tragedy associated with thalidomide use and is increasing due to the inability to predict accurately, strict legal provision of consumer protection, ethical and legal issues involved, and pitfalls in the available evidence of teratogenicity. In the Indian setting, the physicians face more challenges as the majority of the patients may ask them to decide, what is the best for their health. Most guidelines emphasize more on what not to do than what to do, and the locus of decision is left to the doctor and the patient. In this review, we have focused on relevant issues related to psychopharmacoteraophobia that may be helpful to understand this phenomenon and help to address the deprivation of a mentally ill woman from the required treatment.KEY WORDS: Causality, drugs, fetal malformation, mental illness, pregnancy, psychotropic drugs, teratogenicity     

早发型重度子痫前期期待治疗对母婴结局影响的探讨

目的探讨早发型重度子痫前期期待治疗对母婴结局的影响。方法回顾性分析我院2009年1月至2011年6月收治的140例早发型重度子痫前期患者的临床资料,按照孕周的不同分为A组(<28周)、B组(28～31+6周)和C组(32～34周),比较三组患者的母婴结局。结果随着孕龄的延长,并发症的发生率逐渐降低,三组比较差异无统计学意义(P>0.05);B组的治疗时间明显长于A、C组(P<0.05);随着孕龄的延长,胎死宫内、新生儿窒息、死亡率逐渐降低,A组与B、C组比较,差异有统计学意义(P<0.05)。结论早发型子痫前期患者的孕周越小,母婴预后越差,而短期保守治疗可有效延长孕周,同时,在适当的时候采取合适的方式终止妊娠,可改善母婴结局。     

PEG10在重度子痫前期患者胎盘组织中的表达及临床价值

目的：探讨印记基因 PEG10在重度子痫前期（SPE）患者胎盘组织中的表达及临床价值。方法选取2013年4月至2015年3月分娩以及因故中止妊娠的145位孕母作为研究对象,按照孕周和孕期发作 SPE 情况将研究对象分为4组：早发 SPE 组33例,早期健康组35例,晚发 SPE 组37例,晚期健康组40例。采集孕母胎盘组织制成切片,免疫组化法进行附染并检视 PEG10蛋白表达情况,CMIAS 病理图像分析软件测定吸光度 A 并比较。结果PEG10蛋白在4组滋养层细胞膜和胞浆均有表达。早发 SPE 组 PEG10蛋白表达强度明显高出早期健康组,晚发 SPE组 PEG10蛋白表达强度远远超出晚期健康组（ P ＜0.01）;晚发 SPE 组表达值较早发 SPE 组小幅偏低,但差异无统计学意义（P ＞0.05）。结论胎盘组织中 PEG10的高水平表达可能与 SPE 的发病有关。     

Assessment of sotalol prescribing in a community hospital: opportunities for clinical pharmacist involvement

Objective Due to risk of serious adverse drug events (ADEs) sotalol use is limited in renal insufficiency and heart failure. To reduce potential life‐threatening ADEs, medication safety initiatives that ensure appropriate dosing of sotalol are necessary. Pharmacist‐managed renal dosing assessment programmes ensure appropriate dosing of renally eliminated medications. A prospective medication safety evaluation was conducted to assess the need to include sotalol in an existing renal dosing assessment programme as well as the impact of clinical pharmacist assessment on sotalol prescribing. Methods Patients in a 736‐bed community hospital, receiving sotalol during a 6‐week period, were prospectively evaluated. Information was collected on indication, dosing, concomitant disease states and medications, renal function, QTc length, symptoms of toxicity and readmissions. Pharmacist recommendations were made when necessary and were followed to determine acceptance rate and patient outcomes. Key findings Thirty‐six patients were prescribed sotalol for atrial tachyarrhythmias. Thirty‐two (89%) were dosed inappropriately with respect to renal function. Twenty (56%) had left‐ventricular dysfunction as defined by an ejection fraction of ≤40%. At time of initial assessment, 15 (42%) were exhibiting signs of potential sotalol toxicity. Pharmacists provided recommendations regarding discontinuation or dosage adjustment on 32 patients with a 38% full and a 12% partial acceptance rate. All‐cause readmission rates for patients receiving appropriate therapy, including those after pharmacist recommendations were accepted (Group A; n = 16), were compared to those remaining on inappropriate therapy (Group B; n = 20). Readmission rates within 6 months differed between groups (31% for Group A, 55% for Group B; P = 0.095, odds ratio 3.7). Conclusion This medication safety evaluation suggests the need for pharmacist assessment in patients receiving sotalol. Dosage adjustment or avoidance in patients with renal insufficiency, heart failure and other relative contraindications is often necessary to avoid toxicity. Sotalol was inappropriately prescribed in the majority of patients secondary to renal insufficiency. Based on this evaluation, it was recommended to add sotalol to the institution's pharmacist‐managed renal dosing adjustment programme. Ensuring clinical pharmacist assessment when sotalol is prescribed can help reduce potential life‐threatening ADEs and hospital readmissions.     

早、晚发型重度子痫前期产妇临床指标特征及与围产儿结局的影响

目的探讨早、晚发型重度子痫前期产妇的临床特征,并分析其对围产儿结局的影响。方法收集我院2015年2月～2018年2月180例重度子痫前期产妇作为研究对象,依据不同的病发类型分组,各90例,即早发型组与晚发型组,对比两组孕妇的临床特征和围产儿结局等情况。结果早发型组发病时间、终止妊娠时间均早于晚发型组,而收缩压、舒张压和剖宫产率均高于晚发型组,差异有统计学意义(P 0.05);产妇指标中,早发型组中胎盘早剥、心力衰竭、HELLP综合征、低蛋白血症和视网膜病变的发生率均明显的高于晚发型组,差异有统计学意义(P 0.05);围产儿指标中,早发型组中新生儿呼吸窘迫综合征、围产儿死亡、低体重儿、早产、新生儿感染的发生率均明显的高于晚发型组,差异有统计学意义(P 0.05)。结论早发型重度子痫前期产妇较晚发型重度子痫前期产妇的病情严重,是临床高危人群,更容易引起围产儿不良结局的情况,应加强对重度子痫前期的病情监测,尤其着重关注早发型发病重度子痫前期产妇,及时采取诊疗措施,从而改善母婴不良结局。     

期待治疗在早发型重度子痫前期中的应用及妊娠结局分析

目的探讨期待治疗在早发型重度子痫前期中的应用效果及其对妊娠结局的影响。方法选取2005年至2011年我院收治的126例早发型重度子痫前期患者,按孕周不同分为A组（〈28周）40例、B组（28～31周）45例和C组（32～34周）41例,分别给予期待治疗,比较三组患者治疗情况、并发症及围生儿并发症发生率。结果A组期待治疗天数及终止妊娠时间均短于B、c组,围生儿并发症率高于B、c组,差异有显著性（P〈0．05）;A组孕产妇并发症率高于B、C组,但三组差异无显著性（P〉0．05）。结论早发型重度子痫前期能对母婴造成严重危害,患者孕周越短母婴预后越差,而综合各种因素后给予一定时间的期待治疗延长孕周并在合适时间终止妊娠,可改善母婴预后。     

Early clinical outcomes with tocilizumab for severe COVID-19: a two-centre retrospective study

Severe COVID-19 (coronavirus disease 2019) is associated with elevated inflammatory markers, consistent with cytokine release syndrome (CRS). Tocilizumab is an interleukin-6 (IL-6) inhibitor effective in treating CRS secondary to chimeric antigen receptor T-cell (CAR T-cell) therapy. The efficacy of tocilizumab in treating COVID-19 is unknown. This was a retrospective cohort study conducted at two hospitals in northern New Jersey (USA). All patients treated with tocilizumab for confirmed or suspected COVID-19 between 10 March 2020 and 9 April 2020 at the study sites were included. The primary endpoint was clinical improvement on Day 7 after treatment as assessed by respiratory status. Univariate analysis compared data between those who improved and those who did not. A total of 45 severe and critically ill patients treated with tocilizumab for COVID-19 were evaluated. Of the 45 patients, 11 (24.4%), 22 (48.9%) and 12 (26.7%) patients improved, had no change or worsened by Day 7 after treatment, respectively. Lower white blood cell count and lactate dehydrogenase at the time of drug administration as well as shorter time from supplemental oxygen initiation to dosing were significantly associated with clinical improvement in the univariate analysis. In conclusion, tocilizumab administration was associated with a low rate of clinical improvement within 7 days in this cohort of severe and critically ill patients with COVID-19.     

单胎重度子痫前期并发HELLP综合征终止妊娠时机对母婴结局的影响

目的 探讨终止妊娠时机对重度子痫前期并发HELLP综合征患者母婴结局的影响.方法 回顾性分析我院收治的44例重度子痫前期并发HELLP综合征的单胎妊娠患者的临床资料,根据确诊至终止妊娠时间的不同分为三组,A组确诊24h内终止妊娠14例,B组确诊24～48h终止妊娠14例,C组确诊48 h后终止妊娠16例,比较分析三组产妇和新生儿并发症发生率及临床死亡率的差异.结果 A组产妇胎盘早剥、心力衰竭、急性肾衰竭的发生率和新生儿呼吸窘迫、窒息的发生率均明显低于B、C组,B组则明显低于C组,差异有统计学意义(P＜0.05);三组产妇的临床死亡率分别为7.14％、14.28％、18.75％,新生儿死亡率分别为14.28％、21.42％、37.5％,差异有统计学意义(P＜0.05).结论 重度子痫前期合并HELLP综合征易导致胎儿发育受限和产妇并发症发生率升高,严重威胁母婴的生命安全,较早终止妊娠对于争取良好的母婴结局具有重要的临床价值.     

The major clinical outcomes of diabetic foot infections: One center experience

Diabetes mellitus with its limb and life-threatening complications such as diabetic foot infection and amputation are increasing at epidemic rates all over the world. The objective of this study was to determine the rate of lower extremity amputation, the risk factors and the bacteriologic profile for diabetic foot lesions. The records of all 84 patients with diabetic foot infections of a large general hospital over a 4-year period were retrospectively included. The most commonly isolated pathogens were Staphylococcus aureus (39%), Pseudomonas aeruginosa (14%), Proteus mirabilis (14%), Escherichia coli (14%), Group B streptococci (12%), and Klebsiella pneumonia (8%). The variables, independently associated with higher foot infections, were inadequate diabetic regulation (93%), peripheral neuropathy (88.1%), peripheral vascular disease (73.8%), smoking (56%), past history of ulcer (28.5%), penetrating injury (20.3%), inadequate foot wear (15%) and Charcot osteoartropathy (10.7%). The general amputation rate was 38.1%. Diabetic foot ulcers and its complication rates including infection, gangrene and lower extremity amputation in Turkey are still high. Preventive care of the foot in patients with diabetes mellitus is extremly important. Therefore early diagnosing of risk factors for diabetic foot infections in the primary care setting and their adequate therapy under multidisciplinary approach should not be neglected.     

The impact of pharmacy computerised clinical decision support on prescribing,clinical and patient outcomes: a systematic review of the literature

Objectives Computerised clinical decision support systems (CDSSs) are being used increasingly to support evidence‐based decision‐making by health care professionals. This systematic review evaluated the impact of CDSSs targeting pharmacists on physician prescribing, clinical and patient outcomes. We compared the impact of CDSSs addressing safety concerns (drug interactions, contraindications, dose monitoring and adjustment) and those focusing on medicines use in line with guideline recommendations (hereafter referred to as Quality Use of Medicines, or QUM). We also examined the influence of clinical setting (institutional versus ambulatory care), system‐ or user‐initiation of CDSS, prescribing versus clinical outcomes reported and use of multi‐faceted versus single interventions on system effectiveness. Methods We searched Medline, Embase, CINAHL and PsycINFO (1990–2009) for methodologically adequate studies (experiments and strong quasi‐experiments) comparing a CDSS with usual pharmacy care. Individual study results are reported as positive trends or statistically significant results in the direction of the intentions of the CDSS being tested. Studies are aggregated and compared as the proportions of studies showing the effectiveness of the CDSS on the majority (≥ 50%) of outcomes reported in the individual study. Key findings Of 21 eligible studies, 11 addressed safety and 10 QUM issues. CDSSs addressing safety issues were more effective than CDSSs focusing on QUM (10/11 versus 4/10 studies reporting statistically significant improvements in favour of CDSSs on ≥ 50% of all outcomes reported; P= 0.01). A number of QUM studies noted the limited contact between pharmacists and physicians relating to QUM treatment recommendations. More studies demonstrated CDSS benefits on prescribing outcomes than clinical outcomes (10/10 versus 0/3 studies; P= 0.002). There were too few studies to assess the impact of system‐ versus user‐initiated CDSS, the influence of setting or multi‐faceted interventions on CDSS effectiveness. Conclusions Our study demonstrated greater effectiveness of safety‐focused compared with QUM‐focused CDSSs. Medicine safety issues are traditional areas of pharmacy activity. Without good communication between pharmacists and physicians, the full benefits of QUM‐focused CDSSs may not be realised. Developments in pharmacy‐based CDSSs need to consider these inter‐professional relationships as well as computer‐system enhancements.     

Analysis of inpatient and high-risk medicine pharmacist interventions associated with insulin prescribing for hospital inpatients with diabetes

Background Insulin is a high-risk medicine, associated with hospital medication errors. Pharmacists play an important role in the monitoring of patients on insulin.

Objective To analyse interventions made by hospital pharmacists that were associated with insulin prescribing for inpatients with diabetes.

Method Retrospective audit of pharmacist interventions for adult inpatients for an 8-month period, 1 June 2019–31 January 2020. Pharmacist interventions recorded in the electronic medication management system by inpatient unit and dedicated high-risk medicine pharmacists were extracted, screened, and analysed.

Results Of 3975 pharmacist interventions 3356 (84.43%) were recorded by high-risk medicine pharmacists and 619 (15.57%) by inpatient unit pharmacists. July and August 2019 had the highest numbers of interventions with 628 and 643 (15.80 and 16.18%) respectively. Most of the interventions, namely 3410 (85.79%) were classified as medicine optimisation interventions and 565 (14.21%) as prescribing errors. In the medicine optimisation intervention category, 2985 (75.09%) were due to insulin not charted for ongoing administration.

Conclusion This study provides insights into pharmacist interventions for inpatients on insulin, showing that high-risk medicine pharmacists recorded most interventions. The classification of the insulin interventions into medicine optimisation and prescribing errors provides useful information for the training of prescribers in insulin management.