Carbamazepine-induced immune thrombocytopenia confirmed by modified MASPAT test

A 76-year-old man suffering post-herpetic neuralgia developed severe thrombocytopenia 15 days after the administration of carbamazepine. Carbamazepine-dependent platelet antibodies were proved to be present in the patient’s serum by a modified Monoclonal Antibody Solid-phase Platelet Antibody Test (MASPAT), and the diagnosis of carbamazepine-induced immune thrombocytopenia was confirmed. For the patient, carbamazepine should be advised to be avoided permanently. The present report advocated the application of a modified MASPAT test for the detection of carbamazepine-dependent platelet antibodies.     

温补脾肾化痰法治疗多囊卵巢综合征疗效观察

目的观察温补脾肾化痰法联合达英-35治疗多囊卵巢综合征(PCOS)的疗效。方法将痰湿型PCOS患者60例,随机分为对照组和观察组,均给予达英-35口服,观察组在此基础上加用中药口服,治疗3个月经周期后观察疗效。比较治疗前后抗苗勒管激素(AMH)及性激素水平。结果两组患者治疗后AMH及性激素水平均有所改善(P<0.05),观察组降低睾酮(T)、AMH优于对照组(P<0.05)。结论温补脾肾化痰法联合达英-35治疗多囊卵巢综合征效果显著,可有效改善AMH及性激素水平。     

复发性流产伴胰岛素抵抗患者的中医体质分析

目的探讨复发性流产伴胰岛素抵抗患者的中医体质分布特征,了解此类患者血清SHBG、PAI-1水平,并探讨其与中医体质的关联性。方法采用横断面问卷调查形式,选择复发性流产伴胰岛素抵抗患者92例(观察组)和复发性流产不伴胰岛素抵抗患者92例(对照组),比较两组中医体质及血清SHBG及PAI-1水平进行统计分析。结果观察组中医体质类型以阳虚质(27.01%)、气郁质(13.79%)、痰湿质(12.07%)为主,对照组以阳虚质(34.67%)、气郁质(13.33%)、阴虚质(11.33%)为主,两组痰湿质差异有统计学意义(P<0.05)。观察组中血清SHBG的表达水平为(9.692.78)nmol/ml,对照组中血清SHBG的表达水平为(11.09±2.56)nmol/ml,观察组中血清SHBG表达水平低于对照组,差异具有统计学意义(P<0.05)。观察组中血清PAI-1的表达水平为(11,056.1±1631.8)pg/ml,对照组中血清PAI-1的表达水平为(10,302.7±1688.8)pg/ml,观察组中血清PAI-1的表达高于对照组,差异有统计学意义(P<0.05)。复发性流产伴胰岛素抵抗患者不同的中医体质类型中阳虚质的SHBG表达水平为(9.51±3.14)nmol/ml,气郁质SHBG表达水平为(9.96±2.94)nmol/ml,痰湿质SHBG表达水平为(9.94±2.50)nmol/ml,各组间比较差异无统计学意义(P>0.05)。阳虚质的PAI-1表达水平为(11,241.6±1701.7)pg/ml,气郁质PAI-1表达水平为(10,739.3±1334.6)pg/ml,痰湿质PAI-1表达水平为(11,046.7±1372.1)pg/ml,各组间比较差异无统计学意义(P>0.05)。结论复发性流产伴胰岛素抵抗患者中医体质以阳虚质、气郁质、痰湿质为主。血清SHBG水平在复发,性流产伴胰岛素抵抗患者表达偏低,血清PAI-1水平在复发性流产伴胰岛素抵抗患者表达升高。     

托吡酯与卡马西平治疗对脑梗死后继发癫痫患者神经功能缺损、日常活动能力及认知功能的影响

目的分析托吡酯与卡马西平治疗对脑梗死后继发癫痫患者神经功能缺损、日常活动能力和认知功能的影响,为临床治疗提供思路。方法选取2017年3月至2019年8月我院收入的脑梗死后继发癫痫138例患者。按随机数字表法分为A组(治疗上加以卡马西平)和B组(治疗上加以托吡酯)各69例。治疗6个月后比较两组临床效果,治疗前后神经功能缺损、日常活动能力和认知功能的评分及不良反应发生情况。结果治疗后B组疗效高于A组(P<0.05);B组神经功能缺损较治疗前明显下降,且低于A组,不同时间评估分神经功能缺损情况差异有统计学意义(P<0.001);两组日常活动能力和认知功能评分均较治疗前升高,且B组评分高于A组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论托吡酯的临床疗效优于卡马西平,对脑梗死后继发癫痫患者的预后恢复疗效更好,且不良反应程度轻微,值得临床推广。     

Carbamazepine-induced hypersensitivity syndrome in chronic schizophrenia

Drug-induced hypersensitivity syndrome is a clinically important issue. We report a case of carbamazepine-induced hypersensitivity syndrome in a 35-year-old schizophrenia patient. This patient had no previous food or medication allergy history and presented a negative test result of HLA-B*1502 genotype. After 19 days exposure of carbamazepine, high fever up to 39.4°C, leucopenia (1670/mm³), proteinuria and bilateral lung field infiltration were developed. These clinically significant physical conditions resolved after discontinuing carbamazepine. The importance of genetic susceptibility other than HLA-B*1502 should not be overlooked in drug-induced hypersensitivity syndrome.     

托吡酯与卡马西平治疗脑梗死后继发癫（癎）患者的疗效比较

目的 比较托吡酯与卡马西平治疗脑梗死后继发癫（癎）的临床疗效.方法 选取2011-05-2013-05我院收治的72例脑梗死后继发癫（癎）患者,采用随机对照方法分为观察组和对照组各36例.对照组在常规治疗基础上应用卡马西平,观察组在常规治疗基础上应用托吡酯,比较2组临床疗效、癫（癎）发作次数及不良反应.结果 观察组总有效率91.7%,对照组为80.6%,观察组总有效率显著高于对照组,差异有统计学意义（P〈0.05）;观察组3个月和6个月内癫（癎）发作次数均显著少于对照组,差异有统计学意义（P〈0.05）.结论 托吡酯治疗脑梗死后继发癫（癎）的临床疗效明显优于卡马西平,可有效降低癫（癎）的发作次数,且不良反应少,值得临床应用和推广.     

Effects of lacosamide and carbamazepine on human motor cortex excitability: A double-blind,placebo-controlled transcranial magnetic stimulation study

PurposeLacosamide (LCM) and carbamazepine (CBZ) are antiepileptic drugs both acting on neuronal voltage-gated sodium channels. Patch-clamp studies demonstrated significant differences in how LCM and CBZ affect neuronal membrane excitability. Despite valuable information patch-clamp studies provide, they also comprise some constraints. For example, little is known about effects of LCM on intracortical synaptic excitability. In contrast, transcranial magnetic stimulation (TMS) can describe drug-induced changes at the system level of the human cerebral cortex.MethodsThe present study was designed to explore dose-depended effects of LCM and effects of CBZ on motor cortex excitability with TMS in a randomized, double-blind, placebo-controlled crossover trial in healthy human subjects. Subjects received 600 mg CBZ, 200 mg LCM, 400 mg LCM or placebo preceding TMS measurements.ResultsCompared to placebo, TMS motor thresholds were significantly increased after carbamazepine and lacosamide, with a trend for a dose dependent effect of lacosamide. Both, carbamazepine and lacosamide did not affect TMS parameters of intracortical synaptic excitability.ConclusionsTMS measurements suggest that lacosamide and carbamazepine predominantly act on neuronal membrane excitability.     

Exploring the feasibility of the use of biopolymers as a carrier in the formulation of amorphous solid dispersions – Part I: Gelatin

Biopolymers have rarely been used so far as carriers in the formulation of amorphous solid dispersions (ASD) to overcome poor solubility of active pharmaceutical ingredients (APIs). In an attempt to enlarge our knowledge on this topic, gelatin, type 50PS was selected. A screening study was initiated in which twelve structurally different poorly soluble biopharmaceutical classification system (BCS) Class II drugs (carbamazepine, cinnarizine, diazepam, itraconazole, nifedipine, indomethacin, darunavir (ethanolate), ritonavir, fenofibrate, griseofulvin, ketoconazole and naproxen) were selected for evaluation. Solid dispersions of five different drug loadings of these twelve compounds were prepared by lyophilization and evaluated for their solid state properties by mDSC and XR(P)D, and in vitro dissolution performance. Even without any process optimization it was possible to form either fully amorphous or partially amorphous systems, depending on the API and API to carrier ratio. Hence in this respect, gelatin 50PS behaves as any other carrier. Dissolution of the API from the solid dispersions significantly exceeded that of their crystalline counterparts. This study shows the potential of gelatin as a carrier to formulate amorphous solid dispersions.