1例哌拉西林钠他唑巴坦钠致皮试阴性患者迟发型过敏反应的病例分析

目的 分析哌拉西林钠他唑巴坦钠致皮试阴性患者迟发型过敏反应发生的原因与特点,为临床合理安全使用哌拉西林钠他唑巴坦钠提供参考.方法 对1例哌拉西林钠他唑巴坦钠致皮试阴性患者发生迟发型过敏反应的病例进行报道,分析青霉素类抗生素皮试阴性但用药后出现过敏反应的原因以及处置办法.结果 哌拉西林钠他唑巴坦钠皮试阴性患者在用药第2天...     

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。     

注射用哌拉西林钠他唑巴坦钠与清开灵注射液合用致过敏反应1例

观察注射用哌拉西林钠他唑巴坦钠与清开灵注射液合用致过敏反应。分析1例患者联合应用注射用哌拉西林钠他唑巴坦钠与清开灵注射液引发过敏反应发生情况,其引发过敏反应产生的机制与药物联合应用有关。针对注射用哌拉西林钠他唑巴坦钠与清开灵注射液联合应用产生的过敏反应,必须引起医护人员的重视,确保临床用药安全。     

哌拉西林钠/他唑巴坦钠治疗老年严重肺部感染的临床疗效

目的对哌拉西林钠／他唑巴坦钠治疗老年严重肺部感染的疗效及其抗菌活性进行分析,评价其目前的临床应用价值。方法50例患者应用哌拉西林钠／他唑巴坦钠2．25g／div,每8h一次。疗程7～14d;对痰培养出的24株细菌作药敏试验,并检测哌拉西林钠／他唑巴坦钠等5种药物对同期72株I盛床分离菌的抗菌活性。结果哌拉西林钠／他喳巴坦钠治疗的有效率为86％,细菌清除率为83％,不良反应发生率4％。结论哌拉西林钠／他唑巴坦钠是广谱、有效、低毒、安全的抗生素,尤其对老年人严重肺部感染。     

注射用哌拉西林钠他唑巴坦钠致凝血障碍一例

血液透析是晚期肾功能衰竭患者赖以生存的治疗基础,维持性血液透析并发感染患者以革兰阳性球菌为主,肺部感染是最常见的感染,敏感抗菌药物治疗是控制感染最快捷有效的方法[1]。注射用哌拉西林钠他唑巴坦钠为复方制剂,由半合成的广谱青霉素哌拉西林钠和β-内酰胺酶抑制剂他唑巴坦钠组成,具有抗菌谱广、抗菌活性强、对     

基于加权TOPSIS法的注射用哌拉西林钠他唑巴坦钠药物利用评价

目的:为临床合理使用注射用哌拉西林钠他唑巴坦钠提供参考.方法:以注射用哌拉西林钠他唑巴坦钠说明书为基础,依据《抗菌药物临床应用指导原则》(2015年版),参照相关文献及规范,建立基于加权优劣解距离法(TOPSIS)的哌拉西林钠他唑巴坦钠药物利用评价细则,以此为依据,对某院2018年11-12月共140例患者哌拉西林钠他...     

注射用哌拉西林钠他唑巴坦钠致药物热的临床分析

目的:为临床及时、准确地判断注射用哌拉西林钠他唑巴坦钠引起的药物热和合理用药提供参考。方法:对2013年9月-2014年9月临床药师收集的30例由注射用哌拉西林钠他唑巴坦钠致药物热住院患者的用药情况、临床表现、实验室检查结果、医师处理方式等进行回顾性统计分析。结果:注射用哌拉西林钠他唑巴坦钠致药物热多发生在连续用药7~14 d,单位累积用量多在1.3~2.7 g/kg之间;30例患者中,73.3%在滴注期间开始发热,体温以≥38.5℃高热为主;嗜酸性粒细胞计数升高、血清C反应蛋白(CRP)和血细胞沉降速率(ESR)轻度升高可作为药物热的判断指标,但白细胞计数降低并不适合作为判断指标;停用该药或改用其他抗菌药物后,患者体温均在24~48 h内降至正常。结论:注射用哌拉西林钠他唑巴坦钠致药物热与患者性别、年龄没有关联,也没有特异性的诊断标准,但与用药时间、累积天数、单位累积用量存在一定的相关性,结合一些血液学检查指标可作为判断药物热的依据。临床医师应提高对药物热的认识和重视程度,及时停用可疑药物。     

静脉滴注哌拉西林钠-他唑巴坦钠致白细胞、血小板减少1例

哌拉西林钠为半合成的氨脲苄类抗假单胞菌青霉素，他唑巴坦钠为β-内酰胺酶抑制剂。哌拉西林钠-他唑巴坦钠对哌拉西林敏感的细菌和产β-内酰胺酶耐哌拉西林的细菌有抗菌作用。哌拉西林钠临床应用有致白细胞减少、过敏反应、过敏性休克、支气管哮喘、双腿疼痛等不良反应的报道.本文报道的病例在静滴哌拉西林钠-他唑巴坦钠后出现白细胞、血小板计数明显减少，值得引起重视。     

某院2020年临床哌拉西林-他唑巴坦钠医嘱用药点评分析与对策

目的:分析医院哌拉西林-他唑巴坦钠临床用药的合理性.方法:抽取住院药房2020年1月—12月含有哌拉西林-他唑巴坦钠的用药医嘱,根据2020年度医院抗菌药物使用强度等相关指标,点评其用药的合理性.结果:2020年1月—6月医院住院患者医嘱中使用注射用哌拉西林-他唑巴坦钠7 630支,其DDDs值为44 072;经处方点评、临床宣教等举措后,2020年7月—12月注射用哌拉西林-他唑巴坦钠使用量减至7 057支,降幅达7.51％,而DDDs值为37 870,降幅均达14.07％;虽受疫情影响,2020年7月—12月出院患者数量增长31.91％.结论:下半年在患者数量增长的情况下,临床哌拉西林-他唑巴坦钠的使用强度(DDDs)并未增加,趋势平稳,说明管理后的成效凸显,哌拉西林-他唑巴坦钠用药的合理性显著提高.     

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...     

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.