Liver involvement in the drug reaction,eosinophilia,and systemic symptoms syndrome

First described in 1996,the drug reaction,eosinophilia,and systemic symptoms syndrome(DReSS) is considered,along with Stevens-Johnson syndrome and toxic epidermal necrolysis,a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption,fever,lymphadenopathy,influenza-like symptoms,eosinophilia,and visceral involvement such as hepatitis,pneumonitis,myocarditis,pericarditis,nephritis,and colitis. The prognosis of patients with DReSS is related to the severity of visceral involvement. The mortality ranges from approximately 5% to 10%,and death is mainly due to liver failure,which is also the organ most commonly involved in this syndrome. Although it was previously hypothesized in 1994,DReSS syndrome can lead to reactivation of one or more human herpesvirus family members. Now being included as diagnostic criteria in a proposed diagnostic score system,this reactivation can be detected up to 2-3 wk after DReSS syndrome onset. Other causes of mortality in DReSS syndrome include myocardial or pulmonary lesions and hemophagocytosis. We reviewed the literature of previously reported case-series of DReSS and liver involvement,highlighting the pattern of liver damage,the treatment used,and the outcome.

High doses of dextromethorphan induced shock and convulsions in a 19-year-old female:A case report

BACKGROUND Dextromethorphan is a prevalent antitussive agent that can be easily obtained as an over-the-counter medication.There has been a growing number of reported cases of toxicity in recent years.Generally,there are numerous instances of mild symptoms,with only a limited number of reports of severe cases necessitating intensive care.We presented the case of a female who ingested 111 tablets of dextromethorphan,leading to shock and convulsions and requiring intensive care that ultimately saved her life.CASE SUMMARY A 19-year-old female was admitted to our hospital via ambulance,having overdosed on 111 tablets of dextromethorphan(15 mg)obtained through an online importer in a suicide attempt.The patient had a history of drug abuse and multiple self-inflicted injuries.At the time of admission,she exhibited symptoms of shock and altered consciousness.However,upon arrival at the hospital,the patient experienced recurrent generalized clonic convulsions and status epilepticus,necessitating tracheal intubation.The convulsions were determined to have been caused by decreased cerebral perfusion pressure secondary to shock,and noradrenaline was administered as a vasopressor.Gastric lavage and activated charcoal were also administered after intubation.Through systemic management in the intensive care unit,the patient’s condition stabilized,and the need for vasopressors ceased.The patient regained consciousness and was extubated.The patient was subsequently transferred to a psychiatric facility,as suicidal ideation persisted.CONCLUSION We report the first case of shock caused by an overdose of dextromethorphan.

Analysis on the law of differentiating and treating insomnia by physicians based on cluster analysis of drug syndrome

Objective:To explore the general differentiation and treatment of insomnia by Professor Gao Ying through drug clustering and group correspondence analysis,and provide reference for clinical diagnosis and treatment.Methods:Collect retrospective case data from outpatient system,use SPSS20.0 software to perform frequency and cluster analysis on high-frequency symptoms and drug data,and perform corresponding analysis on the clustered drug syndrome groups.Results:A total of 349 consultations in 204 patients were included.Cluster analysis of 35 symptoms and 40 flavors with a frequency of more than 10%resulted in a corresponding relationship between 7 symptom groups,6 drug groups and 5 drug syndrome groups.The medicine symptom group has a high degree of matching;the doctors distinguish and tre at insomnia with calming,clearing heat,nourishing yin,liver,spleen,qi and phlegm as the core treatment,with consistent decoction,two to pill,lily ground Huang Tang,Lily Zhimu Decoction,Wendan Decoction,Sini San,Xiao Chai Hu Tang,Xiaoyao San,etc.are commonly used prescriptions;the physician's experience is to add or subtract Danshen and Zao Ren drink,which has a wide range of applicability to various insomnia syndrome.Conclusion:Based on the cluster analysis of drug symptoms and group correspondence analysis,it can reveal the pathogenesis,treatment and class information hidden in the data of drug symptoms,which can reflect the general law of physicians'syndrome differentiation and treatment of insomnia.This method has a reference for the exploration of TCM clinical experience significance;The results of this study can provide feedback to guide the clinical diagnosis and treatment of insomnia.

Role of antipsychotics for treating behavioral and psychological symptoms of dementia

Over the past three decades, concerns about the high prevalence of antipsychotic use in the nursing homes(NHs) for the management of behavioral and psychological symptoms of dementia continue to be emphasized and intervened by many. However, despite the numerous side effects and the recent blackbox warning by the United States Food and Drug Administration about the increased risks for stroke and sudden death associated with the use of antipsychotics in dementia, the prevalence of antipsychotic use in NHs remains high. While the use of antipsychotics appeared to have modest efficacy in reducing symptoms of aggression and psychosis in dementia, there is insufficient evidence to routinely recommend the use of alternative psychopharmacological treatments for these symptoms. Hence, clinicians have to balance the safety warnings against the need to treat these symptoms in order to prevent harm to the resident that may result from his/her dangerous behaviors. Although the use of antipsychotics may be warranted in some cases, organizational, resource and training support should be provided to encourage and equip NH staff to participate in interventions so as to minimize inappropriate use of these medicines in NHs. This review will discuss the place in therapy, the trend and appropriateness of antipsychotic use in NHs, as well as the effectiveness of current and future strategies for reducing antipsychotic use in the NHs.

Pulmonary sarcoidosis:A novel sequelae of drug reaction with eosinophilia and systemic symptoms:A case report

BACKGROUND Drug reaction with eosinophilia and systemic symptoms(DRESS)syndrome is an uncommon yet serious adverse drug hypersensitivity reaction with the presentations including rash,fever,lymphadenopathy,and internal organ involvement.Sarcoidosis is a systematic granulomatous disease with unknown etiology.We herein report a case of pulmonary sarcoidosis secondary to allopurinol-induced DRESS.CASE SUMMARY A 37-year-old man with a history of hyperuricemia was treated with allopurinol for three weeks at a total dose of 7000 milligrams before developing symptoms including anorexia,fever,erythematous rash,and elevated transaminase.The patient was diagnosed with DRESS and was treated with prednisone for 6 mo until all the symptoms completely resolved.Three months later,the patient presented again because of a progressively worsening dry cough.His chest computed tomography images showed bilateral lung parenchyma involvement with lymph node enlargement,which was confirmed to be nonnecrotizing granuloma by pathological examination.Based on radiologic and pathological findings,he was diagnosed with sarcoidosis and was restarted on treatment with prednisone,which was continued for another 6 mo.Reexamination of chest imaging revealed complete resolution of parenchymal lung lesions and a significant reduction in the size of the mediastinal and hilar lymph nodes.Following a 6-month follow-up of completion of treatment,the patient's clinical condition remained stable with no clinical evidence of relapse.CONCLUSION This is the first case in which pulmonary sarcoidosis developed as a late complication of allopurinol-induced DRESS.The case indicated that the autoimmune reaction of DRESS may play an important role in the pathogenesis of sarcoidosis.

Clinical and endoscopic characteristics of drug-induced esophagitis

AIM: To investigate clinical, endoscopic and pathological characteristics of drug-induced esophagitis.METHODS: Data for patients diagnosed with drug-induced esophagitis from April 2002 to May 2013 was reviewed. Patients diagnosed with malignancy, viral or fungal esophagitis were excluded. Clinical, endoscopic and pathological characteristics of patients diagnosed with drug-induced esophagitis were analyzed.RESULTS: Seventy-eight patients were diagnosed with drug-induced esophagitis. Their mean age was 43.9 ± 18.9 years and 35.9% were male. Common symptoms were chest pain(71.8%), odynophagia(38.5%) and dysphagia(29.5%). The endoscopic location was in the middle third of esophagus in 78.2%. Endoscopic findings were ulcer(82.1%), erosion(17.9%), ulcer with bleeding(24.4%), coating with drug material(5.1%), impacted pill fragments(3.8%) and stricture(2.6%). Kissing ulcers were observed in 43.6%. The main causative agents were antibiotics and non-steroidal antiinflammatory drugs. All the patients were treated with proton pump inhibitors(PPIs) or sucralfate, and the causative drugs were discontinued. Nineteen patients with drug-induced esophagitis were followed up with endoscopy and revealed normal findings, scars or healing ulcers.CONCLUSION: Drug-induced esophagitis mainly presents as chest pain, odynophagia and dysphagia, and may be successfully treated with PPIs and discontinuation of the causative drug. Kissing ulcers were observed in 43.6%.

Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

Pioneering drugs for overactive bladder and detrusor overactivity: Ongoing research and future directions

The ongoing research on pioneering drug candidates for the overactive bladder(OAB) aimed to overcome the limitations of currently licensed pharmacotherapies, such as antimuscarinics, β3-adrenergic agents, and botulinum neurotoxin, has been reviewed performing a systematic literature review and web search. The review covers the exploratory agents alternative to available medications for OAB and that may ultimately prove to be therapeutically useful in the future management of OAB patients based on preclinical and early clinical data. It emerges that many alternative pharmacological strategies have been discovered or are under investigation in disease-oriented studies. Several potential therapeutics are known for years but still find obstacles to pass the clinical stages of development, while other completely novel compounds, targeting new pharmacological targets, have been recently discovered and show potential to translate into clinical therapeutic agents for idiopathic and neurogenic OAB syndrome. The global scenario of investigational drugs for OAB gives promise for the development of innovative therapeutics that may ultimately prove effective as first, combined or second-line treatments within a realistic timescale of ten years.

Is the Current Diagnosis of Schizophrenia Useful or Harmful?

In recent decades, evidence has appeared in various scientific fields—genetic, psychopharmacological, neuro-psychological, etc.—which makes it difficult to maintain the positive and negative syndrome of schizophrenia under one and the same diagnosis. On the other hand, there are social and legal reasons recommending the conception of these two syndromes as different entities. In this paper, we conduct appropriate bibliographical researches to reveal these evidences. We discuss these findings and conclude proposing the split of positive and negative syndromes of schizophrenia in two different disorders.

Clinical Response to Treatment of Central Nervous System Tuberculosis in Non-Human Immunodeficiency Virus-Infected Adolescents and Adults

Introduction: More than half of patients with central nervous system tuberculosis (CNS TB) die or are left with severe neurological deficits despite receiving anti-TB treatment. Aims of the study: This study examined risk factors associated with poor response to initial treatment with four anti-TB drug regimens or three drug regimens with steroids as adjuvant therapy. Methods: This study analyzed medical records from two tertiary hospitals in Busan, Korea, between January 2009 and March 2012. The subjects were non-human immunodeficiency virus (HIV)-infected patients aged ≥16 years with clinical CNS TB. The subjects were divided into two groups according to response to treatment. Results: In totally, 52 patients with CNS TB were included. Of these, 14 (26%) and 38 (73%) showed poor and good responses, respectively. Of the patients with poor response, nine had stage III disease (64.3%) according to the British Medical Research Council (BMRC) staging system. A significantly higher proportion was seen in the good response group (p < 0.05). Patients with positive cerebrospinal fluid (CSF) acid-fast bacillus (AFB) culture, positive sputum AFB culture, positive CSF TB polymerase chain reaction (PCR) results, and brain tuberculoma had poorer responses (p < 0.05). Multivariate analysis to determine risk factors associated with poor response to anti-TB therapy revealed that a poor response was associated with stage III clinical signs upon diagnosis (odds ratio [OR] 32.122;95% confidence interval [CI] 2.221 - 464.605), positive sputum AFB culture (OR 13.624;95% CI 1.066 - 174.149), and tuberculoma on brain images (OR 45.714;95% CI 1.893 - 1104.018). Conclusions: The results demonstrate the importance of identifying the severity of CNS TB and promptly administering anti-TB drugs. It is necessary to perform drug susceptibility testing for anti-TB drugs. Further studies are needed to confirm the correlations between risk factors associated with poor response and anti-TB drug resistance and the other risk factors.

Study on the feasibility of five tones combined with electric acupuncture therapy for drug rehabilitation

Objective:To explore the feasibility of five tones combined with electro-acupuncture for drug rehabilitation.Methods:Search and screen the literature related to drug rehabilitation with musical electrico-acupuncture in PubMed,CNKI,CQVIP and Wanfang data to May 2019,and summarize and analyze the literature.Results:Either music therapy or acupuncture therapy has therapeutic responses respectively,and the combined use of both is more effective than the single-use.Conclusion:The combination of five tones and acupuncture is highly feasible for drug rehabilitation.

儿童药物超敏反应30例分析

目的:评估儿童药物超敏反应综合征(DRESS)在药物暴露后发生的时间特点以及可疑致敏药物种类。方法:对近十年来在我院诊断为DRESS的患儿病例进行回顾性分析。结果:30例患儿中17例为快速发作组(<15 d),13例为延迟发作组(≥15 d)。DRESS平均发生时间为(11.13±8.69)d,小于15 d。停药后,DRESS平均持续时间为(22.80±19.65)d,两组间没有差异。致敏药物中抗菌药物占43.3%,其中多数抗菌药物为快速发生组;抗癫痫药物占比32.3%,其中6例为延迟发生组。结论:药物超敏反应综合征多数发生在可疑药物暴露后15天以内,也可发生在可疑药物暴露后15天以上。研究还发现儿童药物超敏反应主要致敏药物为抗菌药物与抗癫痫药物。

复方聚乙二醇电解质散致患儿过敏样反应2例分析

目的探讨复方聚乙二醇电解质散引起过敏样症状的不良反应,为研究复方聚乙二醇电解质散引起过敏的机制提供参考。方法对复方聚乙二醇电解质散同时导致同父同母姐弟2例患儿过敏样反应病例进行分析,检索同类文献病例,提出用药建议。结果2例患儿服用复方聚乙二醇电解质散后同时出现过敏样症状,停用该药,给予抗过敏治疗后症状逐渐消失,分析其因果关系,同时查阅国内外相关文献和病例报告,提示2例患儿出现该不良反应与复方聚乙二醇电解质散很可能相关。结论这2例复方聚乙二醇电解质散剂过敏反应呈家族聚集性,可能与特定基因位点相关,需进一步研究其与基因分子生物学的关联。提示肠镜操作前服用复方聚乙二醇散剂进行肠道清洁时有引起过敏反应风险,需告知患者尽量避免自行服用,如出现任何不适,应立即停药及时就医。

《五十二病方》方剂与病类及病症相对应的思维特征解析

《五十二病方》基于“病类或病种-症状群或症状-复方或单药方”临床模式,具备了理法方药体系的基本框架,其方剂与病类及病症相对应的思维特征,表现为三个方面:集体表象、互渗律和原逻辑为特征的原逻辑思维应用;直观思维和表象思维为特征的初级逻辑思维应用;原始认知和实证使用的经验型逻辑思维应用。由此构建了初始的临床医学体系,医巫分道扬镳。这种方症对应的思维特征,直接引发创新性的逻辑思维,为辨病辨证论治的临床思维之缘起。

儿童支原体肺炎重症化影响因素的研究进展

肺炎支原体(Mycoplasma pneumoniae,MP)感染是一种异质性疾病。在临床中,诊断为支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)的患儿中,重症支原体肺炎(severe Mycoplasma pneumoniae pneumonia,SMPP)、难治性支原体肺炎(refractory Mycoplasma pneumoniae pneumonia,RMPP)和危重症MPP除带来治疗困难、预后差等严重影响儿童生命安全的情况外,还常遗留不同程度的后遗症。分析MPP重症化的影响因素,寻找早期识别MPP重症化的相关预警指标,对于进行早期干预,降低SMPP和RMPP的致残率和减少后遗症的发生,以及降低SMPP和RMPP的病亡率具有重要意义。在临床中,感染MPP的患儿对支原体耐药性、临床表现、实验室指标、影像学表现等,以及支气管肺泡灌洗术(bronchoalveolar lavage,BAL)的应用与MPP重症化发生相关,笔者对上述相关影响因素的研究进展予以综述。

丁螺环酮用药对焦虑症患者疗效及睡眠状况的影响

目的研究分析丁螺环酮用药对焦虑症患者疗效及睡眠状况的影响。方法随机选取2020年8月—2023年8月泉州市第三医院收治的60例焦虑症患者为研究对象,通过随机数表法分为对照组和观察组,每组30例。对照组予以帕罗西汀治疗,观察组在对照组的基础上加用丁螺环酮,比较两组的用药疗效、焦虑症状程度、睡眠状况以及用药安全状况。结果观察组的总有效率(96.67%)高于对照组(73.33%),差异有统计学意义(χ^(2)=4.705,P=0.030)。用药4、8周后,观察组汉密尔顿焦虑量表得分均低于对照组,差异有统计学意义(P均<0.05)。用药后,观察组匹兹堡睡眠质量指数得分低于对照组,差异有统计学意义(P<0.05)。两组药物不良反应发生率比较,差异无统计学意义,差异有统计学意义(P>0.05)。结论丁螺环酮用于焦虑症患者的治疗效果显著,可有效减轻患者的焦虑症状,改善睡眠状况,并且药物不良反应较少,可保障用药安全。

基于症状-药物网络与网络药理学探讨中医药治疗慢性心力衰竭的症药对应关系及机制

目的:探讨当代医家治疗慢性心力衰竭(CHF)临床验案中的驱动型药物及症状-药物的对应关系,并借助网络药理学揭示相关机制。方法:检索中国知网、万方数据知识服务平台与维普数据库中当代医家以中药方剂治疗CHF的有效临床验案。验案中包含的中医四诊信息及中药处方利用FangNet平台进行驱动型药物的筛选及“症状-药物”网络的构建。进一步借助网络药理学构建“药物-成分-症状-疾病-靶点”网络,揭示药物干预疾病症状的相关机制。结果:共获得226例临床验案,涉及268味药物,其中23味为驱动型药物。“症状-药物”网络包含下肢肿胀、水肿、胸闷、气喘、气短、尿少等38个CHF常见症状;与茯苓、黄芪、白术、附子、丹参、桂枝等10味驱动型中药的对应关系。通过网络药理学构建了“症状-药物”网络中胸闷对应的丹参、葶苈子“药物-成分-症状-疾病-靶点”网络,其中槲皮素、木犀草素、山柰酚、丹参酮ⅡA为筛选出的关键成分,G1/S期特异性细胞周期蛋白-D1(CCND1)、低氧诱导因子1α(HIF1A)、转录因子Jun(JUN)、蛋白激酶B1(AKT1)、转录激活因子3(STAT3)、半胱氨酸天冬氨酸蛋白酶-3(CASP3)、Myc原癌蛋白(MYC)、血管内皮生长因子A(VEGFA)为筛选的关键靶点。富集分析显示,丹参、葶苈子改善CHF病人胸闷症状的机制可能涉及凋亡信号通路的负调控、细胞周期蛋白依赖性蛋白激酶复合物、磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(AKT)信号通路、肿瘤抑制基因p53信号通路、表皮生长因子受体(ErbB)信号通路等生物学过程。结论:基于FangNet平台构建了当代医家治疗CHF验案集合的“症状-药物”网络,发掘了CHF常用药物与疾病症状之间的对应关系,其中丹参、葶苈子改善胸闷的机制可能涉及抑制心肌细胞凋亡、炎症反应及促进新生血管生成。

胃食管反流样症状患者质子泵抑制剂使用的规范性与合理性分析

目的分析消化内科门诊胃食管反流样症状患者口服质子泵抑制剂(PPIs)的规范性与合理性,为临床提供参考。方法选取2017年7月1日~2022年12月31日消化内科门诊以胃食管反流样症状为主诉且完善内镜检查及食管24 h pH值监测的患者200例,统计患者PPIs的使用情况,分析PPIs用药的合理性和规范性。结果200例患者中,使用PPIs患者有182例,其中102例(56.04%)患者长期服用PPIs时间超过3个月,服用的PPIs中以雷贝拉唑钠肠溶胶囊占比较重,其次为奥美拉唑肠溶胶囊、艾司奥美拉唑肠溶胶囊、泮托拉唑钠肠溶胶囊、兰索拉唑肠溶片;182例患者中有111例不合理用药者(占比60.99%),包括71例预防用药不合理者(占比39.01%)和40例治疗用药不合理者(占比21.98%);111例不合理用药的症状分布中以反流、烧心为主要症状的有63例,占比较重,为56.76%,其次为胸骨后不适、嗳气、腹痛、咳嗽等相关症状;182例使用过PPIs患者中,幽门螺杆菌感染者有74例(40.66%),仅12例(6.59%)在服用PPIs前进行了^(13)C呼气试验的检测,明确了有无幽门螺杆菌感染。结论某院普遍存在PPIs药物不合理应用现象,因此,应加强PPIs的科普与规范化使用。

人类肠道病毒的研究进展

自1908年脊髓灰质炎病毒被鉴定以来,已发现超百种肠道病毒致病血清型,可引起手足口病、新生儿败血症样疾病、无菌性脑炎、急性弛缓性脊髓炎、呼吸系统疾病、急性出血性结膜炎等多种疾病。近年来,诸如EV-A71和EVD68等肠道病毒趋于全球化周期性流行,已成为公共卫生领域不可忽视的重要挑战之一。然而,当前针对肠道病毒的防控手段仍然非常有限,迫切需要深入探究肠道病毒致病的分子机制,为开发高效、安全、广谱的抗肠道病毒药物提供新靶点与新思路。本文通过对肠道病毒的分类、流行病学、结构、生命周期、病毒蛋白与宿主因子相互作用、并发症致病机制与临床治疗以及动物感染模型的确立与应用等方面进行系统的综述,旨在为肠道病毒防治提供理论参考依据,为肠道病毒的药物研发与疫苗储备库建设提供新的思路。