Usage of antimicrobial agents in a private primary healthcare setting in South Africa

Objective The aim of this study was to investigate the prescribing of antimicrobials in a private primary healthcare setting in South Africa. Setting A group of private primary healthcare clinics in South Africa. Method A retrospective, drug utilisation study was conducted on nine clinics that were randomly selected from 33 clinics situated in different geographical areas of South Africa, and whose data were electronically available. Data were obtained from the central database of the private primary healthcare provider and extracted for the period January 1, to December 31, 2001. Key findings The study population consisted of the total patient population (n = 83 655) who visited the clinics during this one‐year period. The total number of medicine items prescribed was 515 976 at a total cost of R1 716 319 ($17 163). Of these, antimicrobials represented 18.69% (n = 96 421) of all medicine items prescribed at a cost of R1 045 108 ($10 451) (60.89%). Antimicrobials were prescribed during 72.72% of consultations at the nine clinics during the one‐year period. The antimicrobials most frequently prescribed were penicillins (38.17%) followed by sulphonamides (22.49%), antiprotozoals (9.88%) and tetracyclines (9.34%). The most common diagnoses for which antimicrobials were prescribed were viral influenza, upper respiratory tract infections, hypertension, acute bronchitis, and common cold. Conclusions The high percentage of antimicrobial prescribing obtained in this study could indicate excessive use of antimicrobials in the private primary healthcare setting. The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these agents. This could have an effect on the health of the patients needing care, and the general budget for healthcare services. It is recommended that further investigations on the prescribing protocols of antimicrobial usage be done.     

胰岛干细胞来源及诱导分化与分子标记物

目的:胰岛干细胞移植是治疗糖尿病的一条新途径,可避免胰腺供体匮乏及长期使用免疫抑制剂的问题。本文对有关胰岛干细胞的来源、诱导分化及其分子标记物等研究进展做一综述。资料来源:应用计算机检索PUBMED 1997-06/2006-06期间的相关文章,检索词为“pancreatic,stem cell,differentiate,marker”,并限定文章语言种类为English。同时计算机检索万方数据库1997-06/2006-06期间的相关文章,检索词为"胰岛干细胞,诱导分化,分子标记物",并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与胰岛干细胞的来源、诱导分化及其分子标记物研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到82篇相关文献,31篇文献符合纳入标准,排除的51篇文献为内容陈旧或重复。符合纳入标准的31篇文献中,6篇涉及主要概念,15篇涉及胰岛素分泌细胞的来源及其诱导分化,9篇涉及胰岛干细胞的分子标志,2篇涉及目前存在的问题。资料综合:干细胞是具有自我更新能力的多潜能细胞,分为胚胎干细胞和成体干细胞两大类。胰腺干细胞属于成体干细胞,能在体内分化成导管细胞、胰岛素分泌细胞、外分泌腺胞等特定胰腺组织细胞型,并具有无限分裂和永久自我更新能力。胰岛干细胞的来源、诱导分化及其分子标记物等研究对糖尿病治疗有非常重要的意义。近年研究表明:胰岛素分泌细胞主要来源于胚胎干细胞和成体干细胞,如胰腺导管上皮细胞、巢蛋白阳性胰岛前体细胞、骨髓间充质干细胞、肝脏干细胞等的诱导分化,也可利用基因工程获得。胰岛干细胞的分子标志对基础和临床研究均有重要意义,目前所使用的主要分子标志主要有PDX-1、巢蛋白、角蛋白19、角蛋白20、神经原素3、9.5蛋白基因产物等,可用于胰岛干细胞鉴定、分离及纯化。结论:胰岛细胞及干细胞移植的研究发展迅速,胰岛干细胞的来源及鉴定取得了突破性进展,但还有很多问题急需解决。随着干细胞研究的深入发展和技术的不断完善,必将能够在体外培育出数量充足的胰岛细胞供移植之用。