抗生素的合理使用

随着医药工业的发展,新药层出不穷。以抗生素为例,20世纪50年代临床用的抗生素只有青、链、红、氯四大素,现在常用临床的抗生素以有100多种,临床医生长期来忙与医疗任务,如何掌握新药信息,做到合理选药,合理用药,使药物的药理作用转化为治疗效应,已成为临床医生日益关心的问题。1抗生素在临床应用中存在问题1.1常规固定方案长期以来根据以往的经验或资料,正式或非正式采用抗生素治疗方案。如:氨苄西林+庆大霉素、青霉素+庆大霉素、红霉素+氯霉素。由于对致病菌针对性不强,以致延误治疗。1.2抗生素在选择中存在问题随着医药工业的发展,抗生素…     

Rapidly progressive parkinsonism in a self-reported user of ecstasy and other drugs.

A 38-year-old man developed parkinsonism that progressed to Hoehn and Yahr stage 5 within 4 years of onset. Response to ropinirole deteriorated, levodopa was not tolerated, and subthalamic nucleus stimulation has provided only partial relief of symptoms. He reported heavy use of Ecstasy through most of his twenties and thirties. His neurological problems may be unrelated to his drug use, but it is also possible they represent an idiosyncratic reaction.     

Alcohol and drug use following traumatic brain injury: A prospective study

Primary objectives: To establish pre-morbid alcohol and drug use in persons with TBI, relative to controls, investigate how patterns of substance use change over time following TBI and identify factors associated with heavy post-injury substance use.

Methods and procedures: The Alcohol Use Disorders Identification test (AUDIT) and Drug Abuse Screening Test (DAST) was completed by 121 hospital inpatients with TBI, documenting pre-injury alcohol and drug use, and 133 demographically similar controls. Participants with TBI completed these measures and the Hospital Anxiety and Depression Scale (HADS) again 1 and 2 years post-injury and 76 also completed them at 3 years.

Results: Participants with TBI showed similar levels of drug and alcohol use to controls pre-injury, with 31.4% of the TBI group and 29.3% of controls drinking at hazardous levels. Alcohol and drug use declined in the first year post-injury, but increased by 2 years post-injury, with only 21.4% of participants with TBI reporting abstinence from alcohol and 25.4% drinking at hazardous levels. Only 9% showed a drug problem, but 24% had returned to some drug use. Those showing heavy alcohol use post-injury were young, male and heavy drinkers pre-injury. Drug and alcohol use was similar at 3 years post-injury.

Conclusions: More active intervention is needed to reduce alcohol and drug use following TBI.     

Clinical and antimicrobial effects of a single episode of subgingival irrigation with tetracycline HCI or chlorhexidine in deep periodontal pockets

Abstract. 15 adults, each providing 4 non-adjacent untreated periodontal pockets with a probing depth (PD) exceeding 6 mm. volunteered for a randomized, split-mouth, double-blind, clinical study evaluating subgingival irrigation with chlorhexidine (CHX) or tetracycline HCl (TTC). The study protocol included oral hygiene instructions followed by scaling and root planing. Experimental and immediately adjacent teeth did not receive instrumentation. The 4 deep periodontal pockets in each patient were assigned to be irrigated with 150 ml CHX (0.12%). TTC (10 or 50 mg/ml; TTC10, TTC50), or sterile saline (control) in a single episode. Post-irrigation mechanical plaque control was supported by 2× daily CHX rinses throughout the 12-week observation interval. Recordings of oral hygiene (PlI), gingival health (GI). bleeding on probing (BoP). probing depth (PD), clinical attachment level (CAL), and microbial morphotypes from subgingival paper point samples were performed pre-irrigation. and at 1, 2, 4, 6, 8, 10, and 12 weeks post-irrigation. Mean post-irrigation PlI was low, fluctuating between 0.0 and 0.4, without significant differences between experimental groups. Mean pre-irrigation GI approximated 1.4 and reached 0.8 at the exit of study without significant differences between experimental groups. All experimental sites exhibited BoP pre-irrigation. BoP was significantly reduced in TTC50 compared to TTC10, CHX and control sites from week 8 post-irrigation. PDs were reduced for the experimental groups with TTC50 exhibiting the strongest reduction. CALs remained unaltered from pre-irrigation for TTC10. CHX and control sites over the 12-week observation interval, whereas TTC50 sites consistently improved to significantly differ from all other groups at week 10 and 12 post-irrigation. The distribution of bacterial morphotypes was significantly altered towards one of periodontal health for all experimental groups with a profound effect for TTC50 sites. Our results suggest that subgingival irrigation with TTC solutions at high concentrations may have a rôle in the management of adult periodontitis.     

带锁髓内针治疗股骨骨折74例

目的 探讨股骨带锁髓内针治疗股骨干骨折的临床应用价值。方法 回顾我院74例带锁钉治疗股骨干骨折的临床资料。结果 74例股骨干骨折术后能早期负重,早期功能锻炼,均骨性愈合,关节功能良好。结论 股骨带锁钉治疗股骨骨折特别是复杂的股骨干骨折疗效满意,且并发症发生率较低,带锁钉的临床应用扩大了普通髓内针的适应证。     

Perception of contraceptive counseling and contraceptive use among systemic lupus erythematosus patients

Objectives(1) To evaluate the perception of contraceptive counseling and knowledge regarding the impact of unintended pregnancy and (2) examine the prevalence of, and predictors for contraceptive use among systemic lupus erythematosus (SLE) patients.Study designA cross-sectional survey was conducted at the Rheumatology Clinic of a university hospital. SLE patients who attended the clinic from April 2018 to January 2019 and at risk for unintended pregnancy and were invited to be interviewed. The structured interview guide consisted of three parts: personal and obstetric information, perception of contraceptive counseling and knowledge about the impact of unintended pregnancy, and contraceptive use.ResultsThe mean age of the 137 patients who gave informed consents was 34 ± 8 years, with 47 patients (34%) stating that they had received contraceptive counseling. Seventy-five patients (52%) reported practicing contraception. The intention to not become pregnant (Odds Ratio; 95% CI = 7.28; 1.75–30.27), perception of adequate contraceptive counseling (2.77; 1.06–7.20) and discussion with partners and physicians about contraception (3.95; 1.64–9.50) were predictors for contraceptive use (p < 0.05).ConclusionMost patients reported no contraceptive counseling with approximately half of the patients using contraceptive methods within the past three months. Desire to avoid pregnancy, perception of adequate contraceptive counseling, and the influence of partners and physicians were significant predictors for contraceptive use.ImplicationsContraceptive counseling should be routinely included in discussions about disease processes and treatment plans, including access issues. Best practices for contraceptive counseling and integrated, multi-disciplinary team services should be developed and provided in clinical settings.     

Beyond Zinberg's 'social setting': a processural view of illicit drug use

This article seeks to go beyond existing understandings of 'social setting', or social context, in the addictions field. Using drug-career data, collected during recent ethnographic research, the fluidity and dynamism of recreational drug-using social scenes are described before introducing a number of anthropological and sociological concepts. These concepts are processural, that is, they seek to describe and analyze social and cultural change. Finally, the theoretical and practical implications of recognizing the diversity and ever-changing nature of recreational drug-using social networks are discussed.     

Children with Autism Experience Problems with Both Objects and People

Kanner (1943), in his classic account, described autism as a specific impairment in interpersonal relations which leaves the child's uses of objects relatively unaffected. This combination of the difficulties in relating to people and the supposedly excellent relations to objects figures centrally within many of the current theories of autism, which have had relatively little to say on the question of object use. This paper draws attention to evidence of widespread impairments in relating to objects, not only in interpersonal aspects of object use but also in early sensorimotor exploration and the functional and conventional uses of objects. In stressing these problems with objects, our purpose is not to downplay the social dimension of autism, but rather to highlight the reciprocal nature of the interactions between the child, other people, and objects. Given the evidence that other people play an important role in introducing objects to children, we propose that an impairment in interpersonal relations should itself lead us to expect corresponding disruption in the autistic child's use of objects. Conversely, an unusual use of objects is likely to manifest itself in disturbances in relating to other people, given the importance of a shared understanding and use of objects in facilitating interaction.