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Eddie Garcia Abdul H. Zaid Diane P. Calello Lisa McHugh Grant Arzumanov Najaf Asrar Ari Sapin Kristin G. Fless 《The Journal of emergency medicine》2018,54(4):e61-e64
Background
Botulism is a paralytic disease caused by the neurotoxin produced by Clostridium botulinum. The majority of cases are due to ingestion or injection drug use. Wound botulism from traumatic injury is exceedingly rare, with only one to two cases reported each year in the United States.Case Report
A 27-year-old man presented to the Emergency Department with diplopia, dysphagia, and progressive weakness 10 days after sustaining a gunshot wound to his right lower leg. He had been evaluated for the same complaints at a different facility the day prior and was discharged. His wound appeared well-healing, but a high suspicion for wound botulism led to rapid consultation with the state Poison Control Center and the Centers for Disease Control and Prevention. The patient developed worsening respiratory insufficiency and required mechanical ventilation. Expeditious treatment with equine heptavalent botulinum antitoxin resulted in significant recovery of strength in 4 days. Serum toxin bioassay tested positive for botulinum neurotoxin type A.Why Should an Emergency Physician be Aware of This?
Wound botulism now accounts for the majority of adult botulism in the United States. It should be considered in any patient with signs of neuromuscular disease and a recent injury, even if the wound appears uninfected. 相似文献93.
Norlisa Harruddin Syed M. Saufi Che Ku M. Faizal Abdul Wahab Mohammad 《RSC advances》2018,8(45):25396
In this study, the removal of acetic acid by supported liquid membrane (SLM) using hybrid polyethersulfone (PES)–graphene membrane prepared by vapor induced phase separation (VIPS) was investigated. The effects of graphene loading, coagulation bath temperature, air exposure time, and air humidity on the morphology, mechanical strength, porosity, and contact angle of the membrane were analyzed. The performance and stability of the hybrid membrane as a SLM support for acetic acid removal were studied. The best PES–graphene membrane support was produced at a coagulation bath temperature of 50 °C, an air exposure time of 30 s and air humidity of 80%. The fabricated membrane has a symmetrical micropore cellular structure, high porosity and high contact angle. Under specific SLM conditions, almost 95% of acetic acid was successfully removed from 10 g L−1 aqueous acetic acid solution. The hybrid membrane remains stable for more than 116 h without suffering any membrane breakage during the continuous SLM process.In this study, the removal of acetic acid by supported liquid membrane (SLM) using hybrid polyethersulfone (PES)–graphene membrane prepared by vapor induced phase separation (VIPS) was investigated. 相似文献
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Azrin N Abd Rahman Susan E Tett Halim A Abdul Gafor Brett C McWhinney Christine E Staatz 《British journal of clinical pharmacology》2015,80(5):1064-1075
Aims
The aim was to examine relationships between total and unbound mycophenolic acid (MPA) and prednisolone exposure and clinical outcomes in patients with lupus nephritis.Methods
Six blood samples were drawn pre- and at 1, 2, 4, 6 and 8 h post-dose and total and unbound MPA and prednisolone pre-dose (C0), maximum concentration (Cmax) and area under the concentration–time curve (AUC) were determined using non-compartmental analysis in 25 patients. The analyses evaluated drug exposures in relation to treatment response since starting MPA and drug-related adverse events.Results
Dose-normalized AUC varied 10-, 8-, 7- and 19-fold for total MPA, unbound MPA, total prednisolone and unbound prednisolone, respectively. Median values (95% CI) of total MPA AUC(0,8 h) (21.5 [15.0, 42.0] vs. 11.2 [4.8, 30.0] mg l–1 h, P= 0.048) and Cmax (11.9 [6.7, 26.3] vs. 6.1 [1.6, 9.2] mg l–1, P = 0.016) were significantly higher in responders than non-responders. Anaemia was significantly associated with higher total (37.8 [14.1, 77.5] vs. 18.5 [11.7, 32.7] mg l–1 h, P = 0.038) and unbound MPA AUC(0,12 h) (751 [214, 830] vs. 227 [151, 389] mg l–1 h, P = 0.004). Unbound prednisolone AUC(0,24 h) was significantly higher in patients with Cushingoid appearance (unbound: 1372 [1242, 1774] vs. 846 [528, 1049] nmol l–1 h, P = 0.019) than in those without. Poorer treatment response was observed in patients with lowest tertile exposure to both total MPA and prednisolone as compared with patients with middle and higher tertile exposure (17% vs. 74%, P = 0.023).Conclusions
This study suggests a potential role for therapeutic drug monitoring in individualizing immunosuppressant therapy in patients with lupus nephritis. 相似文献97.
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Design,Synthesis, and Biological Evaluation of Thiazolidine‐2,4‐dione Conjugates as PPAR‐γ Agonists
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