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OBJECTIVE To explore the effects of intensive pharmaceutical intervention led by clinical pharmacists on hypertension patients with medium and high risk of ischemic stroke. METHODS The hypertension outpatients with medium and high risk of ischemic stroke， who were assessed by the modified Framingham stroke scale in Zhengzhou People’s Hospital from Oct. 2019 to Apr. 2020， were randomly divided into control group and intervention group， with 200 cases in each group. Patients in the control group received conventional treatment without pharmaceutical intervention； on the basis of conventional treatment， patients in the intervention group received 12-month intensive pharmaceutical intervention （grading management of compliance+ regular follow-up， involving medication education and guidance， blood glucose， blood pressure， blood lipid management and healthy life guidance） provided by clinical pharmacists. The blood glucose indexes， blood lipid indexes， blood pressure compliance rate， medication compliance， 10-year stroke risk and stroke incidence were compared between two groups at baseline and 12 months after enrollment. RESULTS After 12 months of enrollment， the level of low-density lipoprotein cholesterol （LDL-C） in intervention group was significantly lower than that in the same group at baseline， and the levels of fasting blood glucose， glycosylated hemoglobin， total cholesterol and LDL-C in intervention group were significantly lower than those in control group at the same time points （P＜0.05 or P＜0.01）. The compliance rate of blood pressure and medication compliance in intervention group were significantly higher or better than those in control group （P＜0.01）. There were 12 and 15 patients in control group and intervention group turned into low-risk ones respectively， and the proportion of high-risk patients in intervention group was significantly lower than that in control group（P＜0.01）， while the proportion of medium-risk patients was significantly higher than that in control group（P＜0.05）； the incidence of stroke in intervention group was significantly lower than that in control group （1.0% vs. 4.5%， P＜0.05）. CONCLUSIONS The pharmaceutical intensive intervention led by clinical pharmacists can reduce blood glucose and blood lipid levels of hypertensive outpatients， improve their blood pressure compliance rate and medication compliance， and help reduce the risk of stroke.
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Objective To investigate evaluation role of IP-10 level in urine of kidney transplant recipients when using rabbit anti-human T-lymphocyte immunoglobulin to treat acute cellular rejection.Methods A total of 40 patients who underwent renal transplantation and had been diagnosed as acute cellular rejection according to the results of histopathological examination were randomly divided them into IP-10 group (n =20) and serum creatinine group (Scr group,n =20).Urinary IP-10 and Scr levels were measured in time and patients then were treated with ATG,of which the doses and duration were adjusted according to IP-10 or Scr levels.We compared the total and daily ATG dosages,ATG administration period,side effects of ATG such as incidence of severe platelet and neutropenia,acute rejection during first 3 months and infection rates during first 1 year.Result The number of ATG duration is 5.35 ± 1.93 for IP-10 group versus 6.70 ± 1.75 for Scr group.We used a daily dose of 2.50 ± 0.57 mg/(kg·d) for IP-10 group and 2.77 ± 0.74 mg/(kg· d) for Scr group,a total dose of 13.40 ± 6.59 mg/kg for IP-10 group and 18.25 ± 7.35 mg/kg for Scr group.There was significance between the two group in above three outcomes (P ＜ 0.05).There was no significance in incidences of severe thrombocytopenia and neutropenia,incidences of acute rejection during first 3 months,incidences of infection during first 1 year between the two group (P ＞ 0.05).Conclusion Urine IP-10 test is effective and reliable indicators which can guide ATG usage in patients with acute rejection and reduce the ATG cost.
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Objective:To provide some thoughts for pharmaceutical treatment and care for the patients with pulmonary infection af-ter renal transplantation. Methods:Clinical pharmacists participated the whole treatment process of one case of pulmonary infection af-ter renal transplantation. According to the literatures combined with medical history, clinical symptoms and lab results, the drug treat-ment process of the patient was analyzed, and the key points of the optimized pharmaceutical care were summarized. Results: The pharmaceutical care included the dose adjustment of immunosuppressants at the early phase of the disease and after the improvement of clinical symptoms, attention paid to the interactions between multiple anti-infective drugs and immunosuppressive agents, dosage ad-justment based on the renal function of the patient, monitoring adverse drug reactions and drawing up personalized regimen. Conclu-sion:Through comprehensive medication monitoring, clinical pharmacists can help physicians develop timely and effective treatment programs and provide professional and effective pharmaceutical care for patients.
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Objective To study the implact of tacrolimus blood concentration (Tac) after renal transplantation on blood lipid and fasting glucose (FBG) in recipients.Method The recipients who regularly given Tac + mycophenolate mofetil + prednisone after renal transplantation were chosen and those had normal preoperative levels of blood lipid and fasting glucose as subjects.The recipients were classied into high concentration group,normal concentration group and low concentration group by comparing Tac blood concentration of different postoperative periods with corresponding normal concentration range.The changes of biochemical indexes such as steady Tac valley blood concentration,blood lipid and FBG were monitored,and the differences in blood lipid and FBG levels at different periods among three concentration groups were compared.Result TG level was significantly higher (P＜0.05),and HDL-C level was significantly lower in high concentration group than in normal and low concentration groups one month after operation (P＜0.05).Three months after operation,TG and FBG levels were significantly higher in high concentration group than in normal and low concentration groups (P＜0.05 and 0.01,respectively).Six months after operation,TC,TG and FBG levels were significantly higher in high concentration group than in normal and low concentration groups (P＜0.05,0.01 and 0.05,respectively).There was no significant difference between normal and low concentration groups in various biochemical indexes at any time point (P＞0.05).Conclusion The higher blood concentration of Tac and the longer used after renal transplantation,the easier it might cause drug-induced hyperlipidemia and diabetes.