Isoniazid preventive therapy-related adverse events among Malawian adults on antiretroviral therapy: A cohort study

Adverse events may be a cause of observed poor completion of isoniazid preventive therapy (IPT) among people living with HIV in high tuberculosis burden areas. Data on IPT-related adverse events (AE) from sub-Saharan Africa are scarce. We report IPT-related AEs, associated clinical characteristics, and IPT discontinuations in adults who were stable on antiretroviral therapy (ART) when they initiated IPT. Cohort study nested within a randomized, controlled, clinical trial of cotrimoxazole and chloroquine prophylaxis in Malawians aged ≥ 18 years and virologically suppressed on ART. Eight hundred sixty-nine patients were followed for a median of 6 months after IPT initiation. IPT relatedness of AEs was determined retrospectively with the World Health Organization case-causality tool. Frailty survival regression modeling identified factors associated with time to first probably IPT-related AE. The overall IPT-related AE incidence rate was 1.1/person year of observation. IPT relatedness was mostly uncertain and few AEs were severe. Most common were liver and hematological toxicities. Higher age increased risk of a probably IPT-related AE (aHR = 1.02; 95% CI 1.00–1.06; P = .06) and higher weight reduced this risk (aHR = 0.98; 95% CI 0.96–1.00; P = .03). Of 869 patients, 114 (13%) discontinued IPT and 94/114 (82%) discontinuations occurred at the time of a possibly or probably IPT-related AE. We observed a high incidence of mostly mild IPT-related AEs among individuals who were stable on ART. More than 1 in 8 persons discontinued IPT. These findings inform strategies to improve implementation of IPT in adults on ART, including close monitoring of groups at higher risk of IPT-related AEs.     

Long COVID-19 and Health-Related Quality of Life of Mild Cases in Korea: 3-Months Follow-up of a Single Community Treatment Center

BackgroundSevere acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) survivors mount as the pandemic continues. To date, studies on persistent symptoms and their effects on health-related quality of life (HRQoL) in mild COVID-19 cases have been limited.MethodsA prospective online survey was conducted in COVID-19 patients who were admitted to Seongnam Community Treatment Center, an isolation center in South Korea, from November 23rd 2021 to January 2nd 2022. Patients above the age of 19 with no or mild symptoms were included in the study. Total of 147 patients returned to the follow-up survey 3 months after discharge. Baseline demographics, clinical characteristics, symptoms, and EuroQol-5 dimensions-5 levels (EQ-5D-5L) measures were investigated.ResultsThe median (interquartile range [IQR]) interval period between the initial and follow-up survey was 96.0 (93.0–98.0) days. The median (IQR) age of participants was 51.0 (43.0–61.0). During isolation, 131 (89.1%) patients manifested symptoms. On follow-up, 82 (55.8%) participants remained symptomatic. Common symptoms were constitutional (fatigue, myalgia), neurological (memory impairment, hyposmia, hypogeusia, dizziness), and neuropsychiatric (anxiety) symptoms. Participants with remaining neuropsychiatric symptoms reported the lowest EQ-5D-5L index values. Factors associated with persistent symptoms and diminished HRQoL were identified as female sex, metabolic disease, and anxiety during acute COVID-19 phase.ConclusionsCardiopulmonary symptoms improved over time but constitutional, neurological, neuropsychiatric symptoms remained. Patients with neuropsychiatric symptoms (anxiety and insomnia) reported the worst HRQoL. Female sex, metabolic disease, and anxiety during the acute COVID-19 phase were associated with long COVID. Observations of long-term symptoms of COVID-19 with decline in HRQoL and integrated research in COVID-19 survivors are warranted.     

妊娠期糖尿病产妇开展生活节奏规范化管理的临床效果分析

目的:分析妊娠期糖尿病产妇实施生活节奏规范化管理的临床效果。方法:选取南京医科大学附属常州市妇幼保健院2017年1月至2018年10月收治的妊娠期糖尿病产妇86例,以数字表作为分组依据,将纳入对象划分为研究组和对照组,各43例。其中,对照组实施传统干预,研究组在对照组传统干预的基础上引入生活节奏规范化管理措施。比较两组...     

不同剂量左西孟旦治疗老年重症心力衰竭的临床研究

目的 分析不同剂量左西孟旦对老年重症心力衰竭患者心功能及预后的影响.方法 选取2016年5月—2019年6月金华市中心医院收治的老年重症心力衰竭患者150例.按照随机数字表法分为A、B、C组,每组50例.患者均给予常规治疗,伴有高血压、糖尿病等基础病患者给予降压、降糖药控制血压血糖,二尖瓣狭窄者需要进行球囊扩张、外科换...     

华法林钠片在健康受试者生物等效性试验中的安全性分析

目的 探讨健康受试者参加华法林钠片生物等效性试验的安全性。方法 收集2017—2020在首都医科大学宣武医院开展的4项随机、开放、四周期、交叉对照设计的华法林钠片生物等效性（BE）试验中188例受试者,比较空腹与餐后给药所发生不良事件（TEAEs）的差异及TEAEs与性别和年龄的相关性。结果 4个试验中共报告了116例次TEAEs,与试验药物相关的TEAEs 29例次,均属于轻度,主要为凝血功能指标异常（14例次）和肝功能指标异常（10例次）。餐后给药试验中肝功能指标异常的发生例次多于空腹给药试验（8∶2）,与试验药物具有相关性的TEAEs发生率出现随年龄增加而增高的趋势。结论 健康受试者参加BE试验单次口服华法林钠片的安全性良好,与试验药物相关的不良事件多与华法林的药理机制有关,年龄是不良事件发生类型和发生率的潜在影响因素。     

风险管理方法及其在医院管理工作中的应用研究

目的 分析医院风险管理方法,观察风险管理在医院管理工作中的应用效果。方法 本院于2020年1月起在管理工作中应用风险管理方法,随机抽取开展前（2019年2—10月）、开展后（2020年2—10月）的就诊患者各500例,观察管理效果。结果 开展风险管理后,风险事件发生率低于开展前,医疗服务质量评分、患者满意度评分、医护人员知信行评分高于开展前,差异有统计学意义（P <0.05）。结论 医院管理中引入风险管理方法后,可有效减少医疗服务提供过程中的风险事件,提高医疗服务质量,让患者更加满意。     

中西医结合治疗216例哮喘儿童的临床效果与生活质量评价

目的对中西医结合治疗支气管哮喘（简称哮喘）患儿临床疗效与生活质量进行评价,并以单纯西医治疗为对照,探讨哮喘中西医结合治疗的优势。方法在GINA方案的基础上将444例哮喘患儿随机分为观察组和对照组,观察组加用中药汤剂及穴位贴敷,总疗程2年,观察两组治疗前后临床疗效指标及生活质量变化。结果在改善肺功能、减少呼吸道感染次数方面,两组比较差异有统计学意义（P〈0．01）,观察组优于对照组。观察组在住院率、急诊率、缺课率（节）、心理障碍率、运动受限率等方面优于对照组,P〈0．01,提高哮喘患儿生活质量方面优于对照组。结论中西医结合治疗小儿哮喘能显著改善哮喘患儿临床症状及肺功能,具有较好的远期疗效,并能显著提高哮喘患儿的生活质量。     

醒脑开窍针法对脑外伤患者认知功能和日常生活能力的影响

目的：观察醒脑开窍针法对脑外伤（TB）I患者认知功能和日常生活能力影响。方法：将60例TBI认知功能障碍患者随机分为观察组（规范化醒脑开窍针法）、对照组（非规范化的醒脑开窍针法）。治疗前后分别采用神经行为认知状态检查表（NCSE）和改良的Barthel指数评定法（MB）I来评定2组患者的认知功能和日常生活能力。结果：观察组治疗前后比较,在定向能力、专注能力、复述能力、记忆能力、命名能力、计算能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）;对照组治疗前后比较,在定向能力、复述能力方面上,差异均有显著性意义（P〈0.05）;治疗后2组间比较,在专注能力、定向能力、复述能力、记忆能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）。2组MBI治疗前后比较,差异均有非常显著性意义（P〈0.01）;治疗后2组间MBI比较,差异有显著性意义（P〈0.05）。结论：规范化的醒脑开窍针法能更有效地改善脑外伤后认知功能和日常生活能力。     

ADE触发工具在药品不良事件监测中的应用

目的：探索ADE触发工具在医院药品不良事件（ADE）监测中的应用。方法：根据医疗保健研究所（IHI）推出的ADE触发工具及医院具体用药情况,选择19项触发器。自医院电子病历系统随机抽取2015年第三季度出院病历共967份（肿瘤患者和18岁以下患者除外）,回顾性研究患者的用药情况、检验检查指标及病程记录,对触发器显示阳性的患者进行ADE判定和分析,并进行数据统计和分析,评估各触发器信号与ADE发生的相关性。结果：967位患者中触发器阳性者达到417例次,涉及319位患者,确定33位患者发生ADE,ADE检出率为10.34%（33/319）。33例ADE中E级ADE为31例,F级为2例。同时间段医院ADE自愿上报率为0.67%（147/21897）,与经触发器检出的ADE发生率相比,有统计学差异;且在医院ADE自愿上报系统中未检查到此33例ADE患者信息。结论：ADE触发工具对发现ADE具有较强的敏感性,与自愿上报系统相比,可发现更多的ADE,但触发器需要进一步修正。     

Paediatric issues relating to the pharmacotherapy of allergic rhinitis

The prevalence of allergic rhinitis in children has risen significantly over the last two decades. Important comorbidities like asthma have grown in parallel due to a complex mix of environmental and genetic factors. These conditions have similar allergic inflammatory mechanisms, which raises the possibility of treating both conditions by targeting shared inflammatory mediators pharmacologically. The first line treatment for paediatric allergic rhinitis is a topical nasal corticosteroid or a non-sedating antihistamine. Available intranasal corticosteroids show superior symptom control to second-generation antihistamines. However, most topical steroids and non-sedating antihistamines have equivalent clinical efficacy within their respective classes, so the choice of agent depends on safety and tolerability. Ideally, topical nasal steroids should exhibit high local receptor binding affinity and low systemic bioavailability, allied with a lack of long-term growth suppression in children and adolescents. Regular use of topical steroids is advisable, but intermittent and prophylactic use is also effective. Second-generation antihistamines are effective and some have no adverse cardiac or sedative effects. Non-sedating antihistamine treatment can ameliorate rhinitis-induced decrements in learning. α-Adrenergic nasal decongestants provide short-term benefit, but topical agents can cause rebound symptoms. Prophylactic treatment with chromones is safe and effective, but multiple daily dosing is needed. Ipratroprium bromide nasal spray is useful as an intermittent therapy for mild disease or as add-on treatment, but its effect is limited to the control of rhinorrhoea. Children with allergic rhinitis should receive pharmacotherapy if allergen avoidance measures are ineffective, ideally with a topical intranasal steroid or a second-generation antihistamine.