帕拉米韦注射液治疗儿童流感的临床疗效分析

目的探讨儿童流感应用帕拉米韦注射液治疗的临床疗效以及用药安全性。方法随机选定在2016年1月-2019年1月期间佛山市高明区人民医院儿科住院治疗并确诊流感A或B型患儿200例,通过随机数字法将其分为治疗组和对照组。治疗组100例用帕拉米韦注射液治疗,对照组100例用国产磷酸奥司他韦颗粒治疗,评价两组患儿治疗前后症状评分、治疗效果、治疗指标以及不良反应发生情况。结果两组患儿治疗前流感样症状评分无统计学意义(P>0.05),两组患儿治疗后较治疗前流感样症状评分均下降,差异有统计学意义(P<0.05);治疗组治疗后流感样症状评分略小于对照组,但是无统计学意义(P>0.05);治疗组治疗总有效率高于对照组,治疗组患儿发热症状缓解、全部症状缓解以及住院时间均小于对照组,存在统计学意义(P<0.05)。治疗组与对照组不良反应发生率较低,且无统计学意义(P>0.05)。结论帕拉米韦注射液可用于儿童流感治疗,不仅能够保证临床疗效,而且可加快症状缓解,同时存在较高用药安全性。     

Oseltamivir (Tamiflu)-induced bilateral acute angle closure glaucoma and transient myopia

A 27-year-old woman developed bilateral acute angle closure glaucoma (AACG) and transient myopia after taking oseltamivir for four days. On the fourth day, she received systemic and topical intraocular pressure (IOP)-lowering agents, and IOP decreased in both eyes. However, her visual acuity was unchanged. A myopic shift of -5.25 D OD and -5.0 D OS was estimated to have occurred in the acute phase. A-scan ultrasonography and Pentacam showed markedly shallow anterior chambers and increased lens thickness. Ultrasound biomicroscopy revealed an annular ciliochoroidal effusion with forward displacement of the lens-iris diaphragm. Ciliochoroidal effusion and transient myopia were resolved after discontinuation of oseltamivir.     

3种方案治疗儿童流感样症状的成本效果分析

目的:评价磷酸奥司他韦颗粒以及联合百蕊颗粒和三臣散治疗儿童流感样症状的经济性。方法:采用前瞻性实际临床试验法将2017年12月-2018年2月门急诊收治的流感样症状患儿270例随机分成奥司他韦颗粒(A组)、磷酸奥司他韦颗粒联合百蕊颗粒(B组)和磷酸奥司他韦颗粒联合三臣散(C组)3组,收集效果和成本数据。从患儿家长角度出发,采用成本-效果法进行分析。结果:实际纳入奥司他韦颗粒82例、磷酸奥司他韦颗粒联合百蕊颗粒82例和磷酸奥司他韦颗粒联合三臣散80例。3组的总有效率分别是80.49%,96.34%,88.75%。差异有显著性(P=0.005<0.05),不良反应发生率分别是6.1%,7.32%,7.5%,差异无显著性(P=0.93>0.05)。3组平均医疗总成本分别是547.63,604.40,590.82元,发热缓解时间分别是2.93,1.99,2.24d,总成本和发热缓解时间均有显著性(P=0.000<0.05)。以总有效率为效果指标,C/E分别是680.37,327.36,665.71,增量成本效果比(ICER)以成本最小的A组为对照,B组358.17,C组522.88。结论:以总有效率为效果指标,磷酸奥司他韦颗粒联合百蕊颗粒在3组中疗效较好,C/E值和并发症较低,是较经济的方案。     

奥司他韦治疗小儿流行性感冒75例疗效及对血清细胞因子的影响

目的探讨奥司他韦治疗小儿流行性感冒的疗效及对血清细胞因子等指标的影响。方法选择医院2012年7月到2013年5月收治的流行性感冒患儿150例,随机分为对照组和治疗组,各75例。对照组患儿给予利巴韦林片口服,治疗组患儿给予奥司他韦片口服,疗程均为3-5 d。比较两组患儿的临床疗效,观察症状及体征改善状况,检测治疗前后C反应蛋白（CRP）、γ干扰素（IFN-γ）等血清细胞因子的水平。结果治疗组总有效率为90.67%,明显高于对照组的80.00%（P〈0.05）;治疗组患儿的退热时间、咳嗽、鼻塞、咽部充血症状及体征改善时间、平均病程均短于对照组（P〈0.05）。两组患儿治疗后血CRP及IFN-γ水平均较治疗前显著下降（P〈0.05）,其中观察组患儿IFN-γ下降更显著（P〈0.05）。两组患儿不良反应发生率差异无显著性（P〉0.05）。结论奥司他韦治疗儿童流感的疗效确切,不影响宿主细胞,不良反应较小,值得推广。     

Thapsigargin Is a Broad-Spectrum Inhibitor of Major Human Respiratory Viruses: Coronavirus,Respiratory Syncytial Virus and Influenza A Virus

The long-term control strategy of SARS-CoV-2 and other major respiratory viruses needs to include antivirals to treat acute infections, in addition to the judicious use of effective vaccines. Whilst COVID-19 vaccines are being rolled out for mass vaccination, the modest number of antivirals in use or development for any disease bears testament to the challenges of antiviral development. We recently showed that non-cytotoxic levels of thapsigargin (TG), an inhibitor of the sarcoplasmic/endoplasmic reticulum (ER) Ca²⁺ ATPase pump, induces a potent host innate immune antiviral response that blocks influenza A virus replication. Here we show that TG is also highly effective in blocking the replication of respiratory syncytial virus (RSV), common cold coronavirus OC43, SARS-CoV-2 and influenza A virus in immortalized or primary human cells. TG’s antiviral performance was significantly better than remdesivir and ribavirin in their respective inhibition of OC43 and RSV. Notably, TG was just as inhibitory to coronaviruses (OC43 and SARS-CoV-2) and influenza viruses (USSR H1N1 and pdm 2009 H1N1) in separate infections as in co-infections. Post-infection oral gavage of acid-stable TG protected mice against a lethal influenza virus challenge. Together with its ability to inhibit the different viruses before or during active infection, and with an antiviral duration of at least 48 h post-TG exposure, we propose that TG (or its derivatives) is a promising broad-spectrum inhibitor against SARS-CoV-2, OC43, RSV and influenza virus.     

Evaluating the effects of oseltamivir phosphate on platelet counts: a retrospective review

Abstract

Desialylation of platelets results in platelet clearance by the Ashwell-Morrell Receptors (AMR) found on hepatocytes. Studies suggest that oseltamivir phosphate inhibits human sialidases, enzymes responsible for desialylation, extending the lifespan of circulating platelets. We thus evaluated, the effects of oseltamivir on platelet count (PC) following treatment. Of the 385 patients evaluated for influenza, 283 (73.5%) were influenza-infected. Of the 283 infected patients, 241 (85.2%) received oseltamivir (I + O+) while 42 patients did not (I + O-). One hundred two non-infected patients received oseltamivir (I-O+). The two groups receiving oseltamivir (I + O+, I-O+), demonstrated a statistically greater increase in the PC (57.53 ± 93.81, p = .013 and 50.79 ± 70.59, p = .023, respectively) relative to the group that did not (18.45 ± 89.33 × 10⁹/L). The observed increase in PC was statistically similar (p = .61) in both groups receiving oseltamivir (I + O+, I-O+), suggesting that this effect is independent of influenza. Comparing clinical characteristics between responders and non-responders to oseltamivir treatment showed that only duration of oseltamivir treatment (AOR = 1.30, 95% CI 1.05–1.61, p = .015) was associated with a positive PC response. Our findings suggest a correlation between oseltamivir treatment and an increase in PCs. Future studies assessing the possible uses of oseltamivir in medical conditions characterized by diminished or defective thrombopoiesis are warranted.     

奥司他韦致结膜炎1例及文献复习

奥司他韦(oseltamivir)是一种神经氨酸酶抑制剂,通过抑制病毒从被感染细胞中释放,从而减少甲型或乙型流感病毒的播散,用于治疗成人和1岁以上儿童的甲型和乙型流感,以及用于预防成人和13岁及以上青少年的甲型和乙型流感[1].奥司他韦常见的不良反应主要有胃肠系统损害(呕吐、恶心、腹泻、腹痛)、神经系统紊乱(睡眠障碍、...     

Treatment of cryptosporidiosis

Evaluation of: Bloom JD, Gong LI, Baltimore D. Permissive secondary mutations enable the evolution of influenza oseltamivir resistance. Science 328(5983), 1272–1275 (2010).

Influenza A viruses (IAVs) encode two critical glycoproteins, hemagglutinin and neuraminidase (NA). Hemagglutinin promotes viral docking onto cells via interactions with IAV’s receptor, sialic acid and NA facilitates release of newly synthesized virions by cleaving cellular and viral sialic acid. NA inhibitors, such as oseltamivir, are widely used drugs that work by binding to the active site of NA. Although oseltamivir-resistant viruses were easily generated years ago in laboratory experiments, it was widely believed that these viruses would not be able to circulate in the human population as they did not replicate efficiently. However, oseltamivir-resistant H1N1 viruses rapidly spread during the 2007–2008 IAV season and these viruses contained precisely the same exact drug-resistance mutation identified years prior, a histidine to tyrosine substitution at NA residue 274 (H274Y). Unlike the experimentally derived NA inhibitor-resistant viruses, 2007–2008 H1N1 viruses containing H274Y replicated efficiently. Bloom et al. have solved this riddle by identifying permissive NA mutations that allow viruses to tolerate H274Y. Here, we discuss these important findings and speculate how these studies may facilitate early detection of drug-resistant strains in the future.